RICKY'S CFRN STUDY GUIDE EXAM 140 Questions with Verified Answers,100% CORRECT

RICKY'S CFRN STUDY GUIDE EXAM 140 Questions with Verified Answers MI PATTERNS - CORRECT ANSWER LISA P. LATERAL: I,aVL, v5,v6 (LCA/RCA-high lateral wall L Vent) INFERIOR: II, III, aVF (RCA-inferior & posterior wall ...

RICKY'S CFRN STUDY GUIDE EXAM 140 Questions with Verified Answers MI PATTERNS - CORRECT ANSWER LISA P. LATERAL: I,aVL, v5,v6 (LCA/RCA-high lateral wall L Vent) INFERIOR: II, III, aVF (RCA-inferior & posterior wall L Vent) SEPTAL: V1, V2 (LCA/bundle branches) ANTERIOR: V3, V4 (LCA-anterior wall L Vent) POSTERIOR: V1,V2,V3,V4:ST Depression (RCA/LCA-L Vent posterior wall) Charles's Law - CORRECT ANSWER Gas pressure increases as Temp increases Gas expands in a heated tank Henry 's Law - CORRECT ANSWER Decompression Dalton's Law - CORRECT ANSWER Molecules shrink under pressure. It takes more molecules to fill the same space. More altitude=more O2 needed. Graham's Law - CORRECT ANSWER Diffusion rate of gas thru a liquid is related to solubility of the gas. Higher to Lower Concentrations. (mucous in the lungs with O2 Boyle's Law - CORRECT ANSWER Trapped gas expands with altitude. (Air splints, Chest tubes, ET Tubes, Bowels) Gay-Lussac's Law - CORRECT ANSWER Pressure in the tanks go down as temperature goes down Murphy Sign - CORRECT ANSWER Gallbladder, unable to take deep breath upon palpation under the right ribs. Cullen Sign - CORRECT ANSWER Retroperitoneal bleed, pancreatitis, Trauma, Bruising of the umbilicus. Grey-Turner Sign - CORRECT ANSWER Retroperitoneal bleed, pancreatitis, Trauma, Bruising of the flanks. Asterixis - CORRECT ANSWER Liver, Hepatitis, Hands held out and shaking Cushing's Reflex - CORRECT ANSWER Increased ICP, widening pulse pressure, bradycardia, resp changes (cheyne stokes). RBC, HGB, HCT - CORRECT ANSWER 5, 15, 45 WBC - CORRECT ANSWER 4000-10,000 PLT - CORRECT ANSWER 150,000-400,000 K+ (Potassium) - CORRECT ANSWER 3.5-5.0 Creat - CORRECT ANSWER 0.8-1.4 Glucose - CORRECT ANSWER 65-110 Cl (Cloride) - CORRECT ANSWER 95-105 Sodium - CORRECT ANSWER 135-145 BUN - CORRECT ANSWER 7-20 Phos - CORRECT ANSWER 2.4-4.1 AMY - CORRECT ANSWER 60-160 LIP - CORRECT ANSWER <160 Urine pH - CORRECT ANSWER 4.8-7.5 Anion Gap - CORRECT ANSWER 8-16, greater than 16=metabolic acidosis Lactate - CORRECT ANSWER >2=abnormal >3=lactic acidosis >4=significant hypoperfusion Fibrin Degregation - CORRECT ANSWER DIC >40 ug/ml=Critical PT - CORRECT ANSWER 11-13 seconds (Coumadin) PTT - CORRECT ANSWER 25-35 seconds (Heparin) PT/INR - CORRECT ANSWER 0.9-1.2 (Coumadin) Cranial Nerves 1-6 of 12 - CORRECT ANSWER 1: olfactory-smell 2: optic-vision 3: occulomotor-eye opening/pupil constriction 4: troclear-up/down eye movement 5: trigeminal-chewing/ facial sensation 6: abducens-right/left eye movement Cranial Nerves 7-12 of 12 - CORRECT ANSWER 7: facial-taste/ mouth movement/ tears/ saliva 8: acoustic-hearing/ equilibrium 9: glossophargeal-talking/ gag reflex/ taste/ carotic reflex 10: vegus-talking/ swollowing 11: spinal accessory-shoulder shrug 12: hypoglossal-tongue movement APGAR - CORRECT ANSWER Appearance Pulse Rate Grimmace Activity Resp Effort Hypoxia 4 Types - CORRECT ANSWER Hypoxic-not enough O2 to go around=Altitude Hypemic-not enough RBC's to carry O2=Anemia Histonic-incapable of using O2=CO2 poisoning Stagnant-block by body parts=pedal edema, touniquets, heart fail, trapped air in ABD What Altitude is Night Vision cut in 1/2 - CORRECT ANSWER 5,000-10,000 ft Heat Loss 4 Ways - CORRECT ANSWER Radiation: heat rises off skin Conduction: lose heat in contact with cold Convection: heat loss by moving air over skin Evaporation: fluids are absorbed to surrounding object or air CVP (central venous pressure) measures? - CORRECT ANSWER Right side of the heart PRELOAD (norm: 2-6) (to decrease PRELOAD: Lasix, Nitro, Morphine) PCWP (pulm cap wedge pressure) measures? - CORRECT ANSWER Left side of the heart PRELOAD (norm: 6-12) (to decrease PRELOAD: Lasix, Nitro, Morphine) PVR (pulm vasc resistance) measures? - CORRECT ANSWER Right side of the heart AFTERLOAD (norm: 50-250) SVR (systemic vasc resistance) measures? - CORRECT ANSWER Left side of the heart AFTERLOAD (norm: 700-1500) Meds to decrease afterload - CORRECT ANSWER Nipride, Nicardipine, Dilt, Labetolol,Esmolol Meds to increase afterload - CORRECT ANSWER NorEpi (Levophed),Vasopressin,Dopamine, Phenylephrine CO=SV x HR - CORRECT ANSWER SV (norm 60-130 ml/beat) HR (norm 60-100 beats/min) IABP Timing Errors 4 Types - CORRECT ANSWER Early Inflation-inflates while still in systole (harmful) Late Inflation-inflates while in diastole (sub optimal) Early Deflation-deflates while in diastole (not pushing blood) Late Deflation-deflates while still in systole (very harmful) IABP Benefits - CORRECT ANSWER Diastolic augmentation Reduction of the afterload Gives the heart a chance to rest Reduces O2 demand Increases CO IABP Indications - CORRECT ANSWER Left vent failure Unstable angina Angina after AMI Cardiogenic shock Post CABG Ventricular septal rupture IABP Contraindication - CORRECT ANSWER Aortic Aneurysm Aortic Valve insufficiency Severe Aortic Disease Anything that says Aortic______ Parkland Formula for Burns - CORRECT ANSWER 4ml x KG x TBSA (1/2 vol in first 8 hours, last 1/2 over next 16 hours) Emergency Radio Frequencies ELT: - CORRECT ANSWER 121.5 and 406 Hyperthyroid-Graves S/S-Tx - CORRECT ANSWER Enlarged thyroid Wt loss Cold Tachy Exophthalmos (eyeballs protruding) TX=betablockers Hyperthyroid-Storm S/S-Tx - CORRECT ANSWER LIFE THREATENING Very Tachy (140's +) Hypotension (low refilling time) Hyperprexia (104-106 degrees) TX=O2, cooling measures, IV fluids, betablockers, large dosing of Synthroid, Hydrocortisone Hypothyroid S/S-Tx - CORRECT ANSWER All slows down FatigueThinning hair constipation Wt. gain Cold TX=Synthroid Hypothyroid-Myxedema S/S-Tx - CORRECT ANSWER Extreme hypothyroid pale cold doughy skin profoundly hypothermic 75F, stupourous state TX=protect airway warmed fluids Slow rewarming Synthroid ETT Sizing for Peds - CORRECT ANSWER (age in years + 16) / 4 Beck's Triad - CORRECT ANSWER CARDIAC TAMPONADE JVD Muffled heart tones hypOtension Coopernail's sign - CORRECT ANSWER PELVIC FX ecchymosis on the perineum and scrotum or labia Cullen's Sign - CORRECT ANSWER INTRAPERITONEAL HEMMORHAGE, ECTOPIC RUPTURE, PANCREATITIS bluish discoloration around the umbilicus Cushing's Triad - CORRECT ANSWER INCREASED ICP, PENDING BRAIN STEM HERNIATION Bradycardia Hypertension Change in Resp pattern Grey-Turner's Sign - CORRECT ANSWER PANCREATITIS Discoloration of the flank Kehr's Sign - CORRECT ANSWER RUPTURED SPLEEN (blood irritating diaphragm) Left Shoulder Pain Kernig's Sign - CORRECT ANSWER MENINGITIS pain to knee extention when hip is flexed 90degrees Brudzinski's Sign - CORRECT ANSWER MENINGITIS Flex the neck, the hip flexes Kerr's Sign - CORRECT ANSWER SPINAL LESION alteration of skin tone below the damage Murphy's Sign - CORRECT ANSWER GALL BLADDER unable to take deep breath with deep palp under right costal arch Psoa's Sign - CORRECT ANSWER APPENDICITIS abd pain when layingon left side, right leg is passively extended RSI Mnemonic: LOAD - CORRECT ANSWER Lidocaine (1.5mg /kg) Opiates (fentanyl 1.5-3mcg/ kg) Atropine (for peds 0.02mg/ kg) Defasiculating MB (1.0mg/ kg up to150mg) Succinylcholine Containdications - CORRECT ANSWER HyperKalemia Crush injury Burns greater than 24 hours old Penetrating Eye Injury Hx of malignant hypErthermia Glaucoma Confirmation of Tube placement - CORRECT ANSWER "Placement with proof" Visualization Breath/ belly sounds ETCO2 devices XR Vecuronium (NORCURON)-PARALYTIC - CORRECT ANSWER 0.1 MG/ KG DOSE 2-3 MIN ONSET 30-40 MIN DURATION Rocuronium (ZEMURON)-PARALYTIC - CORRECT ANSWER 0.5-1.0 MG/KG DOSE 1-2 MIN ONSET 30-40 MIN DURATION Pancuronium (PAVULON)-PARALYTIC - CORRECT ANSWER 0.01-0.04MG/KG DOSE 3-5 MIN ONSET 90-180 DURATION Etomidate (ETOMIDATE)-INDUCTION AGENT - CORRECT ANSWER 0.3MG/KG DOSE 30 SEC ONSET 3-5 MIN DURATION Propofol (DIPROVAN)-INDUCTION AGENT - CORRECT ANSWER 2.0-2.5 MG/KG DOSE 40 SEC ONSET 3-5 MIN DURATION INFUSION 50-100 mcg/kg/min Ketamine (KETALAR)-INDUCTION AGENT - CORRECT ANSWER 1-2MG/KG 1 MIN ONSET 15 MIN DURATION Thiopental-INDUCTION AGENT - CORRECT ANSWER 5MG/KG 30 SEC ONSET 5-10 MIN DURATION Midazolam (VERSED)-INDUCTION AGENT - CORRECT ANSWER 0.2-0.3 MG/KG DOSE 1-2 MIN ONSET 1-2 HOURS DURATION Fentanyl (SUBLIMAZE)-INDUCTION AGENT - CORRECT ANSWER PAIN MANAGEMENT ALWAYS USED IN COMBO WITH VERSED 1.5-3.0 mcg /kg DOSE 1 MIN ONSET 20 MIN DURATION Sympathetic Toxidrome (CNS excitation)-THIRDS - CORRECT ANSWER Tachy HypErthermia Increased motor action Restlessness Dialated Pupils Sweating Crack, Meth, sudafed, caffeine TX=valium and supportive care Cholinergic Toxidrome (wet-slows you down) SLUDGE - CORRECT ANSWER Salivation Lacrimation Urination Diarrhea Gastric upset Emesis Insecticides, organophosphates, Diazinon, Raid TX=Atropine and supportive care Anticholinergic (dry-speeds you up) - CORRECT ANSWER "Red as a beet Dry as a bone Blind as a bat Mad as a hatter Hot as a hare" Atropine, Benadryl, Phenergan, Compazine,Haldol Depressant Toxidrome - CORRECT ANSWER LOC, down HR/BP/Temp/Resp Narcotics, Tranquilizers TX=Narcan, Romazicon and supportive care Salicylates Toxidrome - CORRECT ANSWER metabolic acidosis, ringing in ears, kussmaul respiration, hypOglycemia, bleeding time TX=bicarb D50 >500mg/kg fatal dose Acetaminophen OD - CORRECT ANSWER ABC's EKG TX=Mucomyst NSAID - CORRECT ANSWER GI upset, sz, coma, renal failure, nystagmus TX=supportive Tricycyclic (TCA) OD - CORRECT ANSWER Widening QRS, deadly, V-Tach, sz, coma TX=Bicarb, Levophed for HypOtension Cyanide - CORRECT ANSWER inhaled, fruit seeds, Nitroprusside TX=decontamination first, O2, amyl nitrite, B12 Alcohols - CORRECT ANSWER Methanol:paints varnishes (4ml can blind) N/V/D abd pain TX=30-60ml 80 proof ethanol-prevents conversion of methanol to formaldehyde Ethlene Glycol-antifreeze,sz, abd pain, stupor, coma, cyanosis, uremia Isopropyl-rubbing alcohol resp arrest, ketoacidosis, coma TX=supportive therapy CO poisoning - CORRECT ANSWER Cars, N/V/D weakness, decreased LOC, headache TX=high flow O2, hyperbarics Beta/ Calcium Channel Blockers OD - CORRECT ANSWER OD TX=Glucogon, Calcium Coumadin OD - CORRECT ANSWER OD TX=Vit K, FFP Heparin OD - CORRECT ANSWER OD TX=Protamine GCS-Eye Opening (1 of 3) - CORRECT ANSWER 4-spontaneous 3-to command 2-to pain 1-no response GCS-Verbal Response (2 of 3) - CORRECT ANSWER 5=oriented 4-confused 3-inappropriate 2-incomprehensible 1-no response GCS-Motor Response (3 of 3) - CORRECT ANSWER 6-obeys commands 5-localizes pain 4-withdraws 3-flexion 2-extension 1-no response Flight Temp: every 1000ft up- - CORRECT ANSWER temp down 2 degrees Celcius Flight Altitudes (4) - CORRECT ANSWER 0000-10,000 Physiological 10,001-50,000 Physiological Deficit 50,001-250,000 Space Equivelent 250,001-UP Space BNP - CORRECT ANSWER < 100=Normal > 100-200=Heart Failure > 500=Severe Heart Failure No Calcium Channel Blockers or Beta Blockers for CHF/Pulm Edema PEDS SBP= - CORRECT ANSWER 90+ (age X 2) MAP= - CORRECT ANSWER 2 X DBP + SBP ------------------- NORM 80-100 3 FiO2= - CORRECT ANSWER % of O2 ( 21%=room air) I:E Ratio= - CORRECT ANSWER Inspiration to Expiration Ratio 1:2, or 1:3, (COPD can be up to 1:4 or 1:5) PEEP= - CORRECT ANSWER End tidal pressure to keep aveoli open (3-5 is good) PaO2= - CORRECT ANSWER Partial pressure of O2 in the blood Plateau Pressure= - CORRECT ANSWER Pressure throughout the lungs measured on Inspiratory Pause < 30cm H2O Vent Modes (1 of 2) - CORRECT ANSWER Control: complete control of vent Assisted: pt can trigger breath then vent delivers preset vol or pressure Spontaneous: breath controlled by pt CMV: pt can't do anything, preset vol at preset pressure SIMV: vent senses pt's start of breath and assists with effort, allows for varied support, pt can hypervent Vent Modes (2 of 2) - CORRECT ANSWER High Frequency: high tidal vol < dead space vol (fast and hard) Volume Targeted: sends preset vol regardless of the pressure Pressure Targeted: sends gas when triggered until a preset pressure is achieved O2 Calculation of time remaining in tanks= - CORRECT ANSWER PSI X Factor*/ Liter flow= Amt of O2 left in tank in hours and minutes Factors* D Tank-0.16 G Tank-2.40 E Tank-0.30 H Tank-3.00 F Tank-0.90 K Tank-3.40 N Tank-0.79 (Bell 260 has N Tank) S-1 (normal) - CORRECT ANSWER closure of the A-V Valves (bicuspid and tricuspid) at the beginning of Systole S-2 (normal) - CORRECT ANSWER Closure of the Semilunar (aortic & pulmonic) at the beginning of of diastole S-3 (abnormal) - CORRECT ANSWER ventricular gallup (lub dub dub) = heart failure fluid overload S-4 (abnormal) - CORRECT ANSWER atrial gallup= ventricular hypertrophy (stiff ventricals) Murmurs - CORRECT ANSWER swooshing sound-stenosis or regurgitation Parkland Formula - CORRECT ANSWER 4ml x kg x BSA Burned 1/2 of amt over the first 8 hours Malignant hypErthermia from Succinycholine - CORRECT ANSWER Dantrolene 1mg/kg up to 3mg/kg No Charcoal for: PHAILS - CORRECT ANSWER Pesticides, Hydrocarbons, Alcohols, Iron, Lithium, Solvents Iron Toxicity Tx - CORRECT ANSWER Desferal No Succinycholine for: - CORRECT ANSWER Renal, Burn, Crush pts MAP (mean arterial pressure) formula - CORRECT ANSWER 2 x Diastolic + Systolic / 3 (MAP should be 80-100) ICP Range - CORRECT ANSWER 0-10 CO (cardiac output) formula - CORRECT ANSWER SV (stroke vol) x HR (heart rate) should be 4-8 liters SV (stroke vol) - CORRECT ANSWER 60-130 ml / heart beat Blood vol = - CORRECT ANSWER 70 ml/ kg BNP tells? - CORRECT ANSWER the kidneys to pee Coreg (carvidilol) and Natracor (neseritide)-Drugs of choice for Heart Failure X-Ray Sign-Steeple Sign - CORRECT ANSWER Croup (A/P chest vew) X-Ray Sign-Thumbprint Sign - CORRECT ANSWER Epiglotittis (lateral neck view) Drugs for AAA - CORRECT ANSWER Nipride and Beta Blockers ABG values - CORRECT ANSWER pH 7.35-7.45 pCO2 35-45 HCO3 22-26 (bicarb) Vent Adjustments-Ventilation Problem - CORRECT ANSWER Tidal Vol first then Resp Rate Vent Adjustments-Oxygenation Problem - CORRECT ANSWER FiO2 and then Peep "Bottle to Throttle" Time - CORRECT ANSWER At least 8 hours per FAA part 135 ART Line Catheter Distance and what they measure - CORRECT ANSWER Catheter Distance markers 20-25 cm RA /CVP 30-35 cm RV 40-45 cm PA 50+ cm Wedge Urinary Output-Normal - CORRECT ANSWER 30-50 ml/ hr Adults (minimum) 1-2 ml/ kg/ hr Peds (minimum) Urinary Output-Electrical Injuries - CORRECT ANSWER 100 ml/ hr Adults 2-4 ml/ kg/ hr Peds Sterile Cockpit - CORRECT ANSWER Taxiing, Takeoff and Landing Rotor Wing Shutdown Sequence - CORRECT ANSWER Throttle Fuel Battery Survival Meeting Location - CORRECT ANSWER 12 O'clock position if safe Survival Sequence - CORRECT ANSWER Shelter Fire Water Food No Thrombolytics for... (4) - CORRECT ANSWER Hx of hemorrhagic stroke CVA in last 12 months SBP over 180 Pregnancy up to 1 month post partum 3 Killers of Vent patients during flight - CORRECT ANSWER Pericardial tamponade Tension pneumothorax Hypovolemia