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thenursingandparamedicacademy

3 days ago

NREMTP Review-Chancellor R. 🚑🚒 Acid/Base/Cardiac

pH scale-0-14

ABG Values (Arterial Blood Gases)

pH blood-7.35-7.45

PCO2/CO2/PaCO2/ETCO2-35-45 Carbon Dioxide=Carbonic ACID!!

PaO2 (Partial pressure of oxygen)-75-100
How much arterial oxygenated blood is in the alveoli/lungs
Less than 60=Severe Hypoxia

HCO3 (Bicarbonate)-22-26 (BASE)

Electrolyte
Produced in the kidneys
It fights acid & neutralizes It and increases the pH level

BIG MISTAKE PEOPLE MAKE!!!!!

The patient is breathing fast so that means they are having a respiratory problem!!!!!
Absolutely NOT
ALWAYS Determine the underlying cause!!!!!!

2 Systems that regulate Acid/Base balance

Lungs-Work the fastest, but they are the weakest (Deal w/ CO2)

Kidneys-Work the slowest (hours-days) but, they are the strongest (Deal w/ HCO3)

Each system will help each other out=Compensation

In order for a pt. to be fully compensated, remember, the pH has to be back WNL (7.35-7.45)

Metabolic-problem w/ the body/kidneys

Respiratory-problem w/ the lungs

ALWAYS DETERMINE THE UNDERLYING CAUSE

If the Ph is WNL that means 1 of 2 things

Normal ABG
Fully Compensated

Examples of ACIDS in the body

CO2=Carbonic ACID
Shock=Lactate=Lactic ACID
Ketones=ACIDS
Hydrogen Ions=ACIDS
Potassium=ACID

Acid/base imbalances

Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis

Metabolic Acidosis

Shock

Rapid degeneration of the body's vital functions due to an INSUFFICIENT amount of oxygenated blood to the tissues and organs
Hypoperfusion to the organs/tissues
Biproduct of hypoperfusion=Lactic ACID

"ASS for ASS-Severe Diarrhea-losing bicarbonate in stool

Insulin (Hormone)

Released from the BETA Cells of the Pancreas
Lowers BGL
Lock & Key-Opens up the cells and allows them to use glucose for energy!!

Type 1=Born w/ it

Does NOT produce any Insulin!!!

DKA (Type 1 Diabetes)

Glucose levels rise-250-550 mg/dl (non-compliant w/ insulin)
The cells now begin to starve!!!!! (No insulin)
The cells now start using FATS for energy
The biproduct of FAT breakdown=KETONES!!!
Ketones are ACIDS!!!
Metabolic Acidosis

Potassium

It is an ACID when it elevates
Lives inside the cells
Intracellular

Hyperkalemia=Metabolic Acidosis

EKG Changes

Peaked T-waves
Absent or flattened P-waves
Prolonged or widened QRS

Renal Failure

The kidneys have failed, unable to produce urine
Potassium levels go up!!
Dialysis

Crush Syndrome

All the cells are damaged, and the potassium is now leaking out of the cells, and into the blood stream

TCA Overdose

Tricyclic antidepressants
Nortriptyline & Amitriptyline
TCAs directly attack the heart
They decrease the cardiac output & cause EKG changes
Causes Hypoperfusion to the organs and tissues
Lactic Acid=Metabolic Acidosis

In Summary (Metabolic Acidosis)

Shock (lactate=Lactic Acid)
Severe Diarrhea
DKA (ketones=Acids
Hyperkalemia (Acid)
Renal Failure/Dialysis
TCA OD
Crush Syndrome

____________________________________________________________

Metabolic Alkalosis

Severe Vomiting=Losing stomach acid (Most common cause!!!!)

OD on antacids

Hypokalemia-Metabolic Alkalosis

Milk Alkali Syndrome

OD on Milk
Milk is a Base (Alkaline)

***Our teeth store Calcium & Vitamin D

Tachypnea=Fast breathing

Respiratory distress=Tachypnea

Hyperventilation=DEEP & FAST!!!!!!

Cap=CO2=Carbon Dioxide=Carbonic Acid

100 dollars

Chancellor=spends 20 at 7-11 and 30 at the market

Respiratory Acidosis (Hypercapnia)-Holding onto CO2=ACID=>45

Asthma
COPD
Chronic Bronchitis
Emphysema
Respiratory failure
Opioid OD
Respiratory Arrest

Respiratory Alkalosis (Hypocapnia)-Getting rid of CO2-less than 35

Hyperventilation syndrome=getting rid of CO2-less than 35
PAIN
Panic attacks
Fear
Infections/Fever

Capnography=CO2=Carbon Dioxide=Carbonic Acid

EKG Changes

Hyperkalemia

Peaked T-waves
Absent or flattened P-waves
Widened QRS

Hypokalemia

Flattened T-waves
Prolonged QT interval
Prominent U-waves

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Stable vs Unstable

CASH 💸=Unstable

Ischemic CP
AMS or ALOC
Syncope/SOB w/ severe Hypoxia
Hypotension (Less than 100 mmHg)

Symptomatic Bradycardia

HR less than 50/min

Paramedic Treatment

ABCs & O2 as needed
12 Lead EKG
IV
Atropine 1 mg (Cannot give for a 2nd degree type II or 3rd degree)
TCP
OR
Dopamine (5 mcg/kg/min-20 mcg/kg/min)
OR
Epi infusion at 2-10 mcg/min

Pediatrics

Paramedic Treatment

ABCs & O2 as needed
12 Lead EKG
IV
Epinephrine 0.01 mg/kg
Atropine 0.02 mg/kg

Peds

Birth-11 years old

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SVT (Narrow Complex tachycardia)

Stable

Paramedic Treatment

ABCs & O2 as needed
12 Lead EKG
IV

Vagal Maneuvers

Valsalva=Bearing Down
"Mammalian Diving Reflex-Place their face in a bowl of ice or cold water
CSM-Carotid sinus massage

Adenosine 6 mg RIVP
MR Adenosine at 12 mg RIVP
May consider calcium Channel Blockers (Cardizem or Verapamil)

Unstable

Paramedic Treatment

ABCs & O2 as needed
12 Lead EKG
IV
Immediate Cardioversion at 100 J

_______________________________________________

V-tach (Wide Complex tachycardia)

Monomorphic
With pulses

Stable

Paramedic Treatment

ABCs & O2 as needed
12 Lead EKG
IV
Amiodarone 150 mg in 50 mL bag over 10 minutes
OR
Lidocaine 1 mg/kg
MR Amiodarone at 150 mg or Lidocaine 1 mg/kg
Procainamide 17 mg/kg (If unresponsive to Amio or Lido or you have maxed out those drugs)

Unstable

Paramedic Treatment

ABCs & O2 as needed
12 Lead EKG
IV
Synchronized cardioversion

Torsades de pointes

Immediate Unsynchronized Cardioversion=Defibrillation
Mag Sulfate 1-2 gm

Pediatric SVT

Adenosine 0.1 mg/kg
MR at 0.2 mg/kg

If the pt. has a pulse=ABCs

If the pt. does NOT have a pulse=CAB

ROSC

Obtain Vital Signs
Airway-Secure the airway and Intubate
Breathing-PPV at 10/min. Attach waveform capnography-35-45. Maintain Spo2 between 90-98%
Circulation-Maintain MAP >65 (Crystalloids and/or vasopressors)
Obtain 12 Lead EKG
If they are unresponsive-TTM-purposely making the pt. hypothermic at 32-37.5 C
Maintain BGL between 70-180 mg/dl