Critical Care Needs Assessment 3

The temperature at sea level is 14 degrees Celsius. In the rotor-wing aircraft, you ascend to an altitude of 4,000 feet, with a temperature of 6 degrees Celsius. Which gas law explains the on-board oxygen tank pressure decreasing?

While responding to a motor vehicle rollover, dispatch informs you that the vehicle was a nonemergency medical transport van taking wheelchair-bound children to a rehabilitation facility. While considering the possible need for RSI, which RSI medication would be potentially harmful?

While treating an asthmatic patient that is being mechanically ventilated. The primary therapy should be focused on?

You are transporting a 65kg IBW patient who is five days post-intubation from COVID-19. Current bedside ABG is pH 7.16, PaCO2 30, PaO2 52, and HCO3 15.

Ventilator settings: SIMV 16, Vt 600, PEEP 5, FiO2 0.6, I:E ratio 1:2

What is the next best treatment choice?

Your patient is an adult male that is 5’10”. Look at the ABG and ventilator settings below and make the necessary ventilator changes.

The ABG is: PH 7.41, PaCO2 40, HCO3 24, PaO2 76. The Hamilton T1 ventilator settings are: sCMV 16, Vt 740, FiO2 0.5, I:E 1:2, PEEP 5. PIP is 42 cmH2O. What would be the first ventilator change?

A burn patient with 60% TBSA full-thickness burn has tea-colored urine. The next most appropriate action is to administer?

A construction worker fell 30 feet to dirt and gravel. Your assessment reveals hypotension, priapism, and loss of movement from the nipple line down. The vital signs are BP 85/50, HR 50, RR 8, SpO2 91% on 2 L/NC, nasal ETCO2 – 70 mmHg. The next most appropriate action is to?

A diver is being transported from an incident in Lake Superior. The patient was pulled from the depth of 66 feet with confusion and now has joint pain with a headache. How many atmospheres was the patient was subjected to?

A drug known to decrease afterload is?

A late sign of increased intracranial pressure is?

A newly diagnosed 15kg patient with RSV has the following vital signs: BP 92/45, HR 137, oxygen saturation 94%, EtCO2 28 mmHg. Ventilator settings: pSIMV 20, Pressure Control (PC) and Pressure support (PS) 10 cm H2O, FiO2 0.3, PEEP 5 cm H2O, I:E 1:2. Vte is 154 mL, . What would the most appropriate ventilator change be?

A patient has a cardiac index of 1.9. The flight crew recognizes the most appropriate drug to improve the cardiac index is?

A patient’s hemodynamic profile of CI 4.5, CVP 4, SVR 600 represents what clinical condition?

A patient diagnosed with an aortic dissection at the aortic root in the emergency department is awaiting transport. The clinician should anticipate the administration of which medication?

A patient with a partial airway obstruction has oxygen saturation of 80%. What type of hypoxia is present?

A positive sliding sign during an ultrasound of the thorax exam is indicative of?

A prisoner on a hunger strike for the last week is in the ED. The lab values show a very low albumin. The clinician recognizes albumin is a?

A sign of herniation in an acute traumatic brain injury patient would include?

A skateboarder has just arrived in the emergency department and is under your care. EMS states he was alert, with an episode of unconsciousness at the scene after hitting his head on the concrete. He currently complains of severe headache, nausea, and vomiting. During your examination, the patient starts having a decreased level of consciousness. The clinician knows that this is likely a(n):

A state of temporary confusion resulting from misleading information being sent to the brain by various sensory organs is defined as?

A trauma patient is on the hospital ventilator with the following settings: AC 16, Vt 400 mL, FiO2 1.0, PEEP 5 cmH2O, I:E 1:2, with initial EtCO2 22 mmHg. Vital signs are: BP 86/36, HR 120, and oxygen saturation 93%. The next most appropriate action is to?

A young adult fell down the steps and is unconscious. During your assessment in the back of the ambulance, the patient begins to seize. After an anticonvulsive drug, the seizures have stopped but the patient requires intubation. The most appropriate combination of medications for this RSI is?

A young male has fallen 15 ft. On the scene, he is unresponsive to verbal stimuli. His right pupil is 6 mm and nonreactive and his left pupil is 2 mm and brisk. There is no response to a sternal rub. The VS are BP 80/60, HR 40, Oxygen Saturation of 94%, and RR 6. The next most appropriate action after providing adequate BVM assistance should be?

After you have performed a surgical cricothyroidotomy you note there are absent breath sounds and no chest rise. The most likely explanation for this is?

An 80 kg IBW patient is intubated and being mechanically ventilated secondary to an asthma exacerbation. The current EtCO2 is 67 mmHg. Current Hamilton T-1 ventilator settings are: PCV 18, Pcontrol 30 cmH2O, FiO2 1.0, Peep 5 cmH2O, I:E 1:4. PIP is 35 cmH2O and Vte 280 mL.  The first setting to change would be:

An acute GI bleed has a hematocrit of 17% and is transfused one unit of whole blood during transport. Provided all bleeding has stopped, the clinician expects the hematocrit upon arrival at the accepting facility to be?

An adult patient has rib fractures and suspected internal injuries following an ejection from an auto rollover at high speed. The patient has a GCS 2-2-4 (8) with VS: BP 70/30, HR-130, RR-8  with labored, diminished, unequal breath sounds, and SpO2 84%. Ground providers are assisting ventilations with a BVM and one IV has been established. The next most appropriate action is to?

An ETCO2 of less than 10 mmHg is indicative of?

An EtCO2 reading on an intubated, mechanically ventilated patient is 54 mmHg. One way to improve minute ventilation in this patient is to:

A medication best suited to improve cardiac output and decrease systemic vascular resistance is?

An officer sustained a gunshot wound to his jaw and chest. VS are: BP 64/36, HR 150, RR 30, SpO2 88% on an NRB 15 L/min. You decide to RSI and intubate. The police and fire are rushing you to the helicopter. The most appropriate location to intubate the patient is?

Cardiogenic shock is identified by which clinical parameters:

Cerebral perfusion pressure (CPP) is calculated by?

Commonly used sedatives include?

During an abdominal ultrasound, the most likely location for a large amount of free blood or fluid is?

During intubation with a CMAC device with the D blade, you keep hitting the bottom of the cords when you attempt to pass your ETT through the vocal cords. The next most appropriate action is to?

In the administration of Metoprolol, one possible contraindication would be?

In the emergency department awaits a 17-year-old with a stab wound to the abdomen. The referring physician states the patient has a ruptured small bowel. Which gas law would have the most effect on this patient during a rotor wing transport?

Which patient condition is a contraindication to succinylcholine?

Neurogenic shock often presents with which of the following symptoms?

Pressure control ventilation is best described by

Right-sided heart failure caused by pulmonary hypertension is called?

The area immediately below the hyoid bone is known as the?

The calculation of minute ventilation is done by?

One of the clinical differences between hemorrhagic shock and septic shock is?

What differentiates neurogenic shock from spinal shock?

Epidural hematoma is:

The flight crew is assessing a patient with chest pain that radiates into his back. A 12-lead is performed and shows ST elevation in leads II, III, and aVF. The patient states he has a past medical history of HTN. What is the next best action?

The goal of ventilation for a patient who has severe metabolic acidosis is?

The peak inspiratory pressure in a lung-protective ventilatory strategy should be less than?

The gold standard for confirmation and monitoring of an ETT placement in the transport environment is?

The Hemoglobin (Hgb) of a pelvic fracture patient you are packaging for transport is 8 g/dL. The referring facility is initiating a transfusion of two units of packed red blood cells. Provided there is no more bleeding and minimal isotonic fluid given, on arrival at the destination the hemoglobin should be?

The location for finger thoracostomy is the:

The patient has a right radial arterial line and a pulmonary artery catheter. Select the most important waveforms to monitor if you are limited to two pressure line ports on your monitor?

The purpose of placing the EtCO2 on the BVM is to?

The purpose of using the blade and handle during insertion of a supraglottic device is to?

The rate at which the ventilator achieves a target pressure is the:

Which of the following drugs will likely increase the blood glucose of a patient?

The treatment for malignant hyperthermia is?

The treatment of a symptomatic pericardial tamponade is?

The components of oxygen delivery are?

Tidal volume, respiratory rate, and I:E ratio directly affect?

Tidaling in a chest tube drainage device indicates?

Upon a rapid cabin decompression in a fixed-wing aircraft at an altitude of 25,000 feet, what is the time of useful consciousness?

Upon increasing your patient’s PEEP setting on the mechanical ventilator to 16 cmH2O, the flight crew anticipates which of the following will occur?

Appropriate fluid resuscitation volume for an infant up to 28 days is?

What is the antidote for Dopamine infiltration into tissue?

What is the normal auto-peep for the mechanically ventilated patient?

What is the time limit on intubation attempts if you are unable to get the oxygen saturations greater than 92%?

During an air transport of a patient with shortness of breath after a deep dive, which gas law would explain a sudden onset of a dry, uncontrollable cough and a feeling of suffocation?

When attempting to get a proper mask seal when utilizing BVM ventilation, what is the most appropriate method to hold the mask?

When intubating a patient with a Macintosh curved blade, the tip should be placed in which location during tracheal intubation?

When zeroing a transducer for an invasive hemodynamic monitoring system, the transducer should be placed at the patient’s phlebostatic axis which is located?

Which assessment group is part of the pre-hospital Cincinnati stroke scale?

Which drug is known to decrease preload?

Which drug increases systemic vascular resistance?

Which medication is used to treat Torsades de Points?

Which of the following directly improves oxygenation?

Which of the following drugs has a secondary effect of decreasing systemic vascular resistance?

Which two conditions reduce the survival of a traumatic brain injury patient?

You are requested to transport an adult female diagnosed with DKA. She is 5’6” weighing 86 kg. While in the ED, she has been breathing at a rate of 34 and you notice upon the assessment that the patient appears fatigued. She is currently on an NRB at 15 LPM. You make the decision to intubate the patient and request current ABGs. They are as follows: pH 7.01, PaCO2 23, PaO2 390, HCO3 17. Which of the following plans would best suit this patient initially after RSI?

You decide to intubate a patient with Ketamine and Rocuronium. Immediately after administering the medication, you notice the patient has a decrease in respiratory drive, and secondary laryngospasm. The primary cause for this is?

You have a patient in a rural hospital ICU who has developed a small bowel obstruction and is being transferred for possible surgery at a tertiary facility. The patient has been hypotensive requiring fluid resuscitation. The clinician recognizes the patient most likely has a deficit of:

Which medication may exacerbate bronchoconstriction if administered?

In the ICU, a patient is on the following ventilator settings: pSIMV 10, Pressure Control 14 cmH2O, PEEP 15 cmH2O, FiO2 1.0. The referring RN advises it has taken 7 hours to get the patient’s oxygen saturation from an initial 78% to the current 88%. The best method to prevent desaturation during transfer to the transport ventilator is to.

Your patient is receiving noninvasive ventilation (NIV) for acute asthma exacerbation and ventilatory failure. Current hospital ventilator settings are IPAP 10 cmH2O, EPAP 5 cmH2O, oxygen saturations 92%, and EtCO2 60 mmHg. The transport clinician anticipates the next ventilator action is to.

To improve intubation success of a patient in full c-spine immobilization, the flight crew member(s) should:

The fishbone lab diagram in the attached picture represents the standard for lab value documentation for physicians. The highlighted red areas represent what lab values?

The Hemoglobin (Hgb) of a young adult male patient with acute hemorrhage due to trauma is 8g/dL. Which of the following is the most likely explanation for this?

A patient is mechanically ventilated with the following settings: SIMV 14, PC 10, Vt 650, FIO2 1.0, PEEP 20. Vital signs are BP 100/80, HR 118, RR 14, Sp02 98%, ETCO2 37, CVP 10, PAS/PAD 26/12. The flight crew recognizes the next most appropriate intervention is to initiate?

A patient diagnosed with an acute posterior myocardial infarction has a central venous pressure (CVP) of 14. Which infusion is most appropriate for this patient?

During the transport of a patient with a pulmonary artery catheter, the flight crew notices the waveform below on the monitor. The next most appropriate action is to?

During the transport of a patient with a pulmonary artery catheter, the flight crew notices the waveform below on the monitor. The next most appropriate action is to?

In the cardiac catheterization lab awaits a 74-year-old with the following vital signs and hemodynamics. BP 88/50, HR 75, RR 16, oxygen saturations 95%, CO/CI 3.8/1.9, CVP15, PAS/PAD 28/19, SVR 1900. The next most appropriate infusions for the scenario would be?

Peak Inspiratory Pressure (PIP) reflects?

Metoprolol, labetalol, esmolol are examples of what type of drug?

An adult motorcyclist struck a tree at 30 mph. The patient currently has GCS 5, BP 145/80, HR 90, RR agonal 8, oxygen saturation 85%. The patient’s estimated weight is 190 lbs. What would be the correct dose of Etomidate for this patient?

An adult with severe SOB sitting in a high Fowler position is awaiting transfer in the ED. The patient was newly diagnosed with renal failure. The transport crew decides that the patient requires intubation. Which drug should be avoided in this procedure?

An elderly patient arrives at the ED with confusion, weakness, SOB, cough, and temperature of 102F. Vital signs are BP 100/50, HR 90, RR 38 and labored, oxygen saturations 86% with the chest x-ray results pending. You and your partner decide the patient requires intubation. Which drug would be the best choice as an RSI induction agent for this patient?

Endotracheal tube depth for an 8.0 ETT should be?

Malignant hyperthermia an absolute contraindication for the administration of?

Priapism in acute spinal cord injury is a result of?

The correct dose range of Rocuronium for the adult patient is?

The oxygen saturation reading on an intubated, mechanically ventilated patient is 88%. To improve the oxygenation in this patient:

Impact of hyperoxygenation in the premature neonate may cause?

Which statement best corresponds to a blood glucose level of 207 mg/dL in an acute multiple systems trauma patient?

A complication of surfactant therapy is?

A driver who was involved in a lateral impact collision is complaining of  upper abdominal pain, left chest pain, cough, and slight shortness of breath. Assessment of breath sounds reveals bowel sounds on the left and normal sounds on the right. BP is  110/70, HR 98, oxygen saturations 96%, and RR 28/minute. The patient is on a NRB at 15 liters per minute and 2 IVs have been established. There is no ultrasound available. The next MOST appropriate step is to?

A patient eight days post coronary artery bypass X 4 is in a rural ED for shortness of breath. On examination, the patient is tachypneic, diaphoretic, and tachycardic. VS: BP 180/110, HR 128, RR 32 with oxygen saturation 94%. Physical exam finds JVD and distant heart sounds. The patient most likely has?

A patient in your care has been diagnosed with the bends from a diving trip. The patient is being transported by rotor-wing aircraft. What is the most appropriate treatment?

A patient with an ejection fraction of 35% has an INR 3.3, Fibrinogen level 180 mg/dL, with GI bleeding. Crackles were auscultated bilaterally in the posterior bases. The patient has received Aquamephyton (vitamin K). The most appropriate next action is to administer?

An 80 kg IBW patient is intubated and being mechanically ventilated secondary to an asthma exacerbation, current EtCO2 is 76 mmHg. Hospital Ventilator parameters: PCV 10, Pcontrol 30 cmH2O, FiO2 1.0, Peep 5 cmH2O, I:E 1:4. Vte is 300 mL. The next best action is:

An asthmatic patient has the following Hamilton T1 ventilator parameters: PSIMV 10, Pinsp 20 cmH2O, FiO2 1.0, Peep 5 cm H2O, I:E 1:3. What is the current inspiratory and expiratory time?

During the assessment of a multiple systems trauma patient, the admission white blood count (WBC) is 10. Two hours later at the time of transport, the WBC count is 15. The clinician recognizes that:

More than a ten-point difference between upper and lower extremity blood pressures in the newborn may signify?

Prostaglandin (PGE1) should be initiated on transport in a newborn with suspicions for?

The atmosphere is divided into three distinct zones that directly correlate with a human’s response to hypoxia. These zones are the?

The flight crew arrives to find a patient with a single gunshot wound to the abdomen. The assessment finds a GCS 15, NC at 2 L/min, IV x 2 on pressure bags. VS: BP 80/55 (65), HR 108, oxygen saturations 95%.The next most appropriate action is to?

In order to be  most effective, the initial bolus dose of Tranexamic acid (TXA) should be given within?

The sum of the individual pressures of all gases is explained by which gas law?