Critical Care Paramedic Exam
Normal pH
7.35-7.45
Normal CO2
35-45
Normal HCO3
22-26 (good dating age)
Normal PaO2
80-100
Normal SaO2
> 95%
Base (deficit/excess)
(-2) - (+2)
Buffer systems: Bicarb reaction time
seconds
Buffer systems: Lungs reaction time
minutes
Buffer systems: Kidneys reaction time
hours to days
Minute volume calculation
Tidal volume x respiratory rate
pCO2 >45
acidotic
pCO2 <35
alkalotic
HCO3 <22
acidotic
HCO3 >26
alkalotic
,base deficit of < -4
indicator for the potential need for blood transfusion
base deficit of < -19
indicates poor outcome (death likely)
base deficit replacement formula
0.1 x (-BE) x patient weight in kg = bicarb needed
PO2 of 60 is roughly equivalent to a SaO2 of
90%
critical pH for intubation
< 7.2
critical pCO2 for intubation
> 55
critical pO2 for intubation
< 60
number one cause of metabolic acidosis
lactic acidosis (lactate > 4)
CO2 is a byproduct of
metabolism
for every __ change in ETCO2, you should expect the pH to change __ in the ___________ direction.
10, 0.08, opposite
for every __ change in pH, you should expect the HCO3 to change __ in the ___________ direction.
0.15, 10, same
for every __ change in pH, you should expect the potassium to change __ in the ___________
direction.
0.10, 0.6, opposite
LEMON
difficult intubation
look, evaluate (3-3-2), mallampati, obstructions, neck mobility
HEAVEN
difficult intubation
, Hypoxia, extremes of size, anatomic challenges, vomit/blood/fluid, exsanguination, neck mobility
issues
ramping
ear to sternal notch
without ramping during intubation or transport causes a potential for
decrease in functional reserve capacity, tidal volume, and preload
Sellick's maneuver and BURP
no longer recommended
External laryngeal manipulation (ELM)
current standard of practice
bougie adult size
15 Fr
bougie pediatric size
10 Fr
bougie neonatal size
6 Fr
supraglottic devices
provide little protection against aspiration
ETT cuff pressure
20-30 mmHg (25 is standard)
gold standard of confirming ET placement
chest X-Ray
distal tip of ET
2-3 cm (1 inch) above carina, at T3 or T4
7 p's for RSI success
preparation, preoxygenation, pretreatment, paralysis with induction, protect/position, placement
(with proof), post intubation management
LOAD
pretreatment for RSI
lidocaine, opiates, atropine (infants), defasiculating dose
Normal pH
7.35-7.45
Normal CO2
35-45
Normal HCO3
22-26 (good dating age)
Normal PaO2
80-100
Normal SaO2
> 95%
Base (deficit/excess)
(-2) - (+2)
Buffer systems: Bicarb reaction time
seconds
Buffer systems: Lungs reaction time
minutes
Buffer systems: Kidneys reaction time
hours to days
Minute volume calculation
Tidal volume x respiratory rate
pCO2 >45
acidotic
pCO2 <35
alkalotic
HCO3 <22
acidotic
HCO3 >26
alkalotic
,base deficit of < -4
indicator for the potential need for blood transfusion
base deficit of < -19
indicates poor outcome (death likely)
base deficit replacement formula
0.1 x (-BE) x patient weight in kg = bicarb needed
PO2 of 60 is roughly equivalent to a SaO2 of
90%
critical pH for intubation
< 7.2
critical pCO2 for intubation
> 55
critical pO2 for intubation
< 60
number one cause of metabolic acidosis
lactic acidosis (lactate > 4)
CO2 is a byproduct of
metabolism
for every __ change in ETCO2, you should expect the pH to change __ in the ___________ direction.
10, 0.08, opposite
for every __ change in pH, you should expect the HCO3 to change __ in the ___________ direction.
0.15, 10, same
for every __ change in pH, you should expect the potassium to change __ in the ___________
direction.
0.10, 0.6, opposite
LEMON
difficult intubation
look, evaluate (3-3-2), mallampati, obstructions, neck mobility
HEAVEN
difficult intubation
, Hypoxia, extremes of size, anatomic challenges, vomit/blood/fluid, exsanguination, neck mobility
issues
ramping
ear to sternal notch
without ramping during intubation or transport causes a potential for
decrease in functional reserve capacity, tidal volume, and preload
Sellick's maneuver and BURP
no longer recommended
External laryngeal manipulation (ELM)
current standard of practice
bougie adult size
15 Fr
bougie pediatric size
10 Fr
bougie neonatal size
6 Fr
supraglottic devices
provide little protection against aspiration
ETT cuff pressure
20-30 mmHg (25 is standard)
gold standard of confirming ET placement
chest X-Ray
distal tip of ET
2-3 cm (1 inch) above carina, at T3 or T4
7 p's for RSI success
preparation, preoxygenation, pretreatment, paralysis with induction, protect/position, placement
(with proof), post intubation management
LOAD
pretreatment for RSI
lidocaine, opiates, atropine (infants), defasiculating dose
