Aeromedical Flashcards
1
Q
What are the 5 main layers of the atmosphere listed in order starting from the ground?
A
- Troposphere
- Stratosphere
- Mesosphere
- Thermosphere
- Exosphere
Note There are other zones contained within these main layers that are not listed.
2
Q
What factors lead to the vertical profile of the atmosphere?
A
Solar thermal radiation results in expansion of gas molecules, and expansion of the space filled by the atmosphere. The gravitational pull of the earth opposes this expansion of molecules, pulling them toward the earths surface.
3
Q
When ascending through the troposphere, how quickly does the temperature drop?
A
The temperature drops with ascent approx -2c per every 1000 feet of elevation.
4
Q
Where is the ozone layer
A
The ozone layer is in the stratosphere.
5
Q
Briefly describe the stratosphere.
A
This is the layer directly above the troposphere and extends up about 50km. The temperature of the upper stratosphere remains constant at about -55c. There is no water vapor. Apparently swans, cranes, and vultures can fly this high.
6
Q
Briefly describe the troposphere
A
The first layer of the atmosphere that is in contact with the earth. It extends to 50-60k feet at the equator and 25-30k feet at the poles. Water vapour reduces with ascent. Weather and turbulence are present. Transition to stratosphere is called the tropopause (jet streams). Temp drops about -2c per 1000 feet ascent.
7
Q
Where do unpressurized aircraft fly?
A
Unpressurized aircraft fly in the troposphere, and generally within the first 10,000 feet of this layer.
8
Q
What is an isobaric system?
A
It is what is used in most military and civilian aircraft to maintain
aircraft pressurization. It maintains a constant cabin pressure, while the atmospheric pressure falls. It is limited by the structural integrity of the aircraft to withstand a given differential pressure between ambient external pressure and that of the cabin.
9
Q
Generally speaking, where in the atmosphere would a piston propeller aircraft, turbo prop aircraft, and jet fixed wing aircraft fly?
A
Most piston propeller aircraft will remain in the lower regions of the
troposphere. Turbo props will fly in the upper reaches of the troposphere, and occasionally may extend into the stratosphere. Jet fixed wing aircraft will fly in the upper reaches of the troposphere and commonly extend into the stratosphere.
10
Q
What are the 4 basic variables of the gas laws?
A
- Temperature
- Pressure
- Volume
- Relative mass of gas or number of molecules
11
Q
Boyle’s Law
A
The volume of a gas is inversely proportional to its pressure, temperature remaining constant.
12
Q
Dalton’s Law
A
The total pressure of a gaseous mixture is equal to the sum of the partial pressures of the individual gases in the mixture. PO2 = 20.95 (21%) x 760 mmHg = 159.6
13
Q
Charles’ Law
A
The volume of gas is proportional to its absolute temperature, when pressure and mass is constant.
14
Q
Gay-Lussac’s Law
A
The pressure of gases is directly proportional to absolute temperature, for a constant amount of gas, when the volume remains constant.
15
Q
Henry’s Law
A
The amount of gas that is dissolved in a solution and remains in solution is directly related to the pressure of the gas over the solution.
16
Q
Graham’s Law
A
The rate of diffusion of a gas through a liquid medium is directly related to the solubility of the gas and is inversely proportional to the square root of its density.
17
Q
What happens with a sudden loss of cabin pressure?
A
- Rapid temp drop
- Fogging due to rapid cooling of air
- Explosion or swish of air occurs d/t collision of two air masses
- Debris, dust, and unsecured items will often fly about
- Gases expend in body cavities
18
Q
The pressure environment that surrounds the earth can be divided into four zones. What are they?
A
Physiologic zone – Sea level up to 10,000’
Physiologically deficient zone - 10,000 to 50,000’
Space equivalent zone: 50,000 to 250,000’
Space - Beyond 250,000’
19
Q
Time of Useful Consciousness (TUC)
A
18,000’ or below: 30 minutes
25,000’: 3 - 5min normal, or 1.5 - 2.5min with rapid decompression
30,000’: 90sec normal, or 30 - 45sec with rapid decompression
35,000’: 30 - 60sec normal, or 15 - 30sec with rapid decompression
40,000 or above: 15sec normal, or 7 - 10sec with rapid decompression
20
Q
There is a rapid decompression on your aircraft… what are you going to do?
A
All AMC need to apply O2 to their face and ensure the pilots have their masks on. Then ensure the patient has oxygen on. A rapid descent will bring the aircraft to a flight alt that is physiologically safe. Other equipment that will require attention during a rapid decompression would include any equipment with gas filled chambers.. ie ETT cuffs, Pressure bags, MAST, certain ventilators, NG tubes etc
21
Q
Hypoxia
A
A general term that describes the state of oxygen deficiency in the tissues. It refers to a decrease in tissue oxygen or an oxygen supply inadequate to meet tissue needs. Hypoxia disrupts the intracellular oxidative process and impairs cellular function.
22
Q
Hypoxemia
A
Refers to a decrease in arterial blood oxygen tension (PaO2). A normal
PaO2 doesn’t guarantee adequate tissue oxygenation conversely a low PaO2 may not indicate tissue hypoxia and may be clinically acceptable.
23
Q
Hypercapnia
A
Refers to an increased amount of carbon dioxide in the blood.
24
Q
Four Stages of Hypoxia (based on altitude)
A
- Indifferent stage
- Compensatory stage
- Disturbance stage
- Critical stage
25
Briefly describe the Indifferent stage of hypoxia
The physiologic zone for this stage starts at sea level and extends to 10 000’. In this stage the body reacts to the lessened availability of oxygen in the air with a slight increase in heart rate and ventilation. Night vision deterioration occurs at 5000’
26
Briefly describe the compensatory stage of hypoxia
The second stage of hypoxia which occurs from 10,000 to 15,000'.
In this stage the body attempts to protect itself against hypoxia by increasing BP, HR and depth/rate of respirations. Efficiency and performance of tasks that require mental alertness become impaired.
27
Briefly describe the disturbance stage of hypoxia.
This is the third stage of hypoxia which occurs between 15,000 and 20,000'. It is characterized by dizziness, sleepiness, tunnel vision and cyanosis. Thinking becomes slowed and muscle coordination decreases.
28
Briefly describe the critical stage of hypoxia.
This is the fourth stage of hypoxia and occurs between 20,000 and 30,000'. It features marked mental confusion and incapacitation followed by unconsciousness usually within a few minutes.
29
List the 4 main types of hypoxia
- Hypoxic hypoxia
- Hypemic hypoxia
- Stagnant hypoxia
- Histotoxic hypoxia
30
Briefly describe Hypoxic hypoxia
Deficiency in alveolar oxygen exchange. Causes include breathing air at reduced barometric pressure, resp arrest, severe asthma, malfunctioning oxygen delivery equipment. It is also referred to as altitude hypoxia because in this case its primary cause is exposure to low barometric pressure (so low PaO2). The blood oxygen sat which is 98% at sea level is reduced to 87% at 10 000’ and 60% at 22000’.
31
Briefly describe hypemic hypoxia
Decrease in oxygen carrying capacity of the blood. Even with normal ventilation and diffusion, cellular hypoxia can occur if the rate of delivery of oxygen doesn’t satisfy metabolic requirements. Think anemia, hemorrhage, hgb abnormalities, or intake of chemicals. Remember that CO binds to hgb 200 times more readily than O2 and its present in aircraft fumes.
32
Briefly describe stagnant hypoxia
Occurs when conditions result in reduced total cardiac output, pooling of blood with certain regions of the body, decreased blood flow to tissues or restriction of blood flow. Causes include heart failure, shock, continuous positive pressure ventilation, or PE. A reduction in regional or local blood flow may be caused by extremes of enviro temps, postural changes like prolonged sitting, bed rest, tourniquets, hyperventilation, embolism or CVAs.
33
Briefly describe histotoxic hypoxia
Occurs when metabolic disorders or poisoning of the cytochrome oxidase
enzyme results in a cells inability to use molecular oxygen. Causes include respiratory enzyme poisoning and intake of carbon monoxide, cyanide, or alcohol.
34
The primary treatment of hypoxia for any patient transported by air is?
PREVENTION - The transport team must remember that the patient’s condition is already compromised and that the stresses related to transport increase the risk of patient hypoxia unless the transport team continuously monitors the patient and accurately anticipates the oxygen needs of the patient during transport.
35
Stressors of Flight
**Ghostban**
- Gravitational Forces
- Humidity/hyperventilation
- Oxygen
- Shakes/Vibration
- Temperature
- Barometric Pressure
- Atmosphere
- Noise
36
Why is vibration a significant stressor of flight?
It increases metabolic rate, increases vasoconstriction, and overrides the body’s ability to cool itself, delaying cooling in hyperthermia, decreased ability to sweat, joint stiffness, headache nausea. The response to whole body vibration is an increase in muscle activity to maintain posture and to reduce the resonant amplification of the body structures. This response is reflected in an increase in metabolic rate and a redistribution of blood flow with peripheral vasoconstriction. The increase in metabolic rate during vibrations is comparable with that seen in gentle exercise. Respirations are increased to achieve the necessary elimination of carbon dioxide.
37
Dehydration during flight is influenced by?
- Relative humidity of aircraft cabin
- Cardiovascular status
- Hydration status of crew or patient pre flight which is affected by age, diet, and general health status
38
How many G's can turbulence produce?
Turbulence can produce 1.5 to 2Gs of vertical acceleration and at high speeds up to 3 Gs.
39
How many Gs can people tolerate?
People have tolerated acceleration forces of 40G without injury, but protection is generally provided to a max of 25G’s.
40
Other than altittude, what else can affect barometic pressure?
Temperature and Humidity
41
How does moisture effect barometric pressure?
Water vapor is only 63% as heavy as ambient air. As the water vapor content of air increases barometric pressure falls.
42
How does temperature effect barometric pressure during flight?
The temp experienced by AMC normally changes from -45 to +45 C, representing a 31% change in gas volume.
43
Impact of noise include? (think stressors of flight)
- Distracting
- Contributes to fatigue and irritation
- Reduced ability to concentrate
- Interference with communications
- Interference with patient assessment
- Ear damage
44
Safe zones for noise intensity?
0-90 decibels
45
Frequency is the speed that soundwaves travel. What is it expressed in?
Hertz
46
Briefly describe Barotitis media. Why is there a difference between ascent and descent?
During ascent, air in the middle ear cavity expands but normally vents into the throat through the eustachian tub. However, during descent, the gas in the middle ear shrinks in size as external pressure increases. The eustachian tube does not allow for gas to readily enter the middle ear in order to equalize the pressure and so it can become quite painful.
47
What are some things that can be done to reduce pressure in the middle ear?
Valsalva maneuver, yawning, swallowing, moving the lower jaw, topical admin of vasoconstrictors, or use of the bag valve mask. Infants can bottle feed but watch for gastric distention and gas.
48
Barosinusitis
Inflammation of the soft tissues in the sinuses due to the positive and negative pressure changes that occur as the result of changes in barometric pressure. S/S include: Dull to sharp pain below one or both eyes or check bones, lacrimation, and epistaxis.
49
How can you manage barosinusitis?
- Decongestants
- Topical vasoconstrictors
- Utilize Valsalva on descent
- Avoid flying with an URTI
- Cabin altitude restriction and slow descent
50
Barodontalgia
Cavities in teeth or recent fillings may be sensitive to gas expansion during ascent. Tooth pain can result.
51
How can you manage barodontalgia?
- Preventative measures (dental care)
- Slow ascent
- Restrict flying for at least 24hrs following dental work
52
When was the first air medivac?
During the Prussian siege of Paris in 1870. The wounded were evacuated by hot air balloon.
53
Who was Marie Marvingt?
The first recorded flight nurse and probably the true founder of flight nursing. She was the most decorated woman in the history of France. She
was a surgical nurse and a pioneering aviator. In 1910 she designed the first air ambulance capable of carrying a stretcher. Between the two world wars, she worked as a medical officer with French forces in North Africa. While in Morocco, she invented metal skis and suggested their use on airplanes that landed in the sand
54
During the Korean war the corpsman evolved into what?
The field medic, whose rapid care and interventions included packaging the patient for helicopter evacuation.
55
What was used for medivac in the Vietnam war?
The medics worked out of helicopters to provide rapid transport and immediate care.
56
Which organization sets and enforces all airport safety and security standards, certifies and regulates all airports, and ensures that Canada’s civil aircraft conform to nation and international standards?
Transport Canada
57
Who is responsible for aircraft incident investigation in Canada?
Transportation safety board of Canada
58
What are the two main types of helicopters used for medivac in Canada?
Single engine and twin engine.
59
In a twin engine helicopter, what happens if you lose power to one engine?
When one engine goes out, the aircraft loses 80% of it’s power and so the pilot would have to make an emergency landing.
60
Fuselage
The fuselage is one of the major aircraft components with its long hollow tube that’s also known as the body of the airplane, which holds the passengers along with cargo. This area includes the cockpit, so the pilots are in the front of the fuselage. Despite there being different types of fuselages, they all connect the major parts of an airplane together.
61
Wings
Not surprisingly, the wings, also commonly known as foils, are aircraft parts that are imperative for flight. The airflow over the wings is what generates most of the lifting force necessary for flight. Along with the large wings that stem from the middle of the fuselage, the wings also include two smaller ones at the back of most aircraft, at the tail.
62
Empennage
The empennage is the tail end of the aircraft. It helps with the stability of the plane and has two main components called the rudder and the elevator. The rudder helps the aircraft steer from right to left, and the elevator helps with the up and down movement.
63
Power Plant
The power plant of an airplane structure includes the engine and the propeller. The engine itself is a complicated system comprised of many smaller parts like cylinders, fans, and pistons. Together, these aircraft engine parts work to generate the power or thrust of an aircraft.
64
Landing Gear
You cannot have a safe plane without having the landing gear. Not only are these parts imperative in order to land, but the landing gear is also used to help an aircraft take-off and taxi. The landing gear includes shock absorbers for a smooth landing and takeoff as well as the wheels on the plane.
65
What is meant by the gross weight of an aircraft?
The maximum total weight allowable for a safe flight.
66
What is meant by the operational weight of an aircraft?
The weight of the aircraft loaded with fuel, pilots and passengers.
67
Visual Flight Rules
Simply means that the aircraft is intended to operate in visual meteorological conditions (VMC, i.e. nice and clear weather). Clouds, heavy precipitation, low visibility, and otherwise adverse weather conditions should be avoided under VFR. Most general aviation flying and flight training occurs in visual meteorological conditions
68
Instrument Flight Rules
Implies that the flight may operate in instrument meteorological conditions (IMC, meaning cloudy or otherwise adverse weather conditions). However, many aircraft may operate under IFR while completing the entirety of the flight in VMC due to the efficiency provided by IFR flying as well as the safety of continuing to avoid bad weather. Just because you can fly in the clouds or less than acceptable weather under IFR doesn’t mean you should.
69
EMERGENCY LOCATOR TRANSMITTER (ELT)
Equipment that broadcasts distinctive signals on designated frequencies and may be automatically activated by impact or be manually activated.
70
FIXED VS ROTARY WING
Fixed wing is less susceptible to weather constraints with a decreased response time to patients with distances greater than 160km. Fixed Wing can travel greater distances faster.
71
What is the purpose of flaps. Where are they located.
Their purpose is to increase the wing surface area, providing additional lift
for takeoff and landing. Additional lift becomes necessary as the speed of the aircraft falls below normal cruising speeds. Flaps are located on the trailing portion of each wing, inboard of the ailerons.
72
What is the difference in movement between ailerons and flaps?
Flaps move in unison, where as ailerons move in opposition to one another.
73
What is the purpose of ailerons? Where are they located?
They are located distal to the flaps and are used to control the roll rate by moving in opposition to one another.
74
Flight deck
Cockpit
75
Which side is port? What colour is the port side light?
Port is the left side of the plane as viewed from the captains seat. The light on the port side is red.
76
Which side is starboard? What colour is the light on the starboard side?
Starboard is the right side of the aircraft as viewed from the captain's seat. The light on the starboard side is green.
77
Where is the exterior white light located on an aircraft?
At the tail.
78
What are the forces of flight?
* Lift
* Thrust
* Drag
* Gravity
Lift opposes gravity and thrust opposes drag.
79
All disciplines should have ____ hours of uninterrupted rest before the beginning of a shift.
10 hours
80
PRE MISSION PLANNING
* Shift prep
* Vehicle inspection
* Flight briefings
* Team rest
* Weather check
* Risk analysis matrix
* Flight authorization
* Decline missions
* Vehicle walk around
81
Should you fly immediately after the removal of a chest tube?
Most places recommend waiting at least 72hrs prior to flying after a chest tube has been removed, unless you can guarantee maintaining a sea level/ground level cabin pressure.
82
What is the proper way to assess cuff pressure of an endotracheal tube?
Utilizing a cuff monometer. It should be checked regularly and whenever air is taken out or put into the cuff. The Recommended cuff pressure is between 20 and 30 cmH2O and will show as a green zone on the monometer.
83
What should your PiP be?
Less than 35
84
Decompensation of patients with acute cardiovascular disease during transports at high altitudes is generally caused by?
Hypoxic hypoxia
85
Volutrauma
Volume related overdistention injury of the alveoli inflicted by mechanical ventilation. More recently attention has been placed on ventilator induced injury caused by high volumes and alveolar overdistention, also referred to as hyperinflation. The stretch of alveoli causes micro vascular injury, high permeability pulmonary edema, accumulation of fluid in the interstitial and alveolar space, disruption of surfactant function and alveolar collapse
86
Barotrauma
Damage to lung tissue from high airway pressures. Alveolar rupture
may lead to pneumothorax, pulmonary interstitial edema and pneumomediastinum.
87
Flow triggering
An assisted breath can be triggered by flow triggering which means it detects a change in the flow of gas with spontaneous effort. A base flow continually moves past the patient. When the patient makes an inspiratory effort, the vent detects a deviation in the flow and is triggered to deliver a supported breath. A base flow of 10L/min is often used with a trigger sensitivity threshold of
2L/min.
88
Pressure triggering
An assisted breath in a mechanical ventilator that is triggered by sensing a negative airway pressure generated by the patient during spontaneous respiratory effort. The demand valve sensitivity is set at a level that allows the patient to easily take a breath, but not so sensitive that it interprets artifact, such as patient movement, air leak, or water in the vent circuit. This could cause unintended hyperventilation, resp alkalosis and auto PEEP. If the sensitivity is set too high the ventilator does not trigger a breath when the patient makes a spontaneous effort and increases the patient’s work of breathing. The usual range is set at -1 to -3 cmH2O
89
Apnea (ventilator alarms)
Insufficient spontaneous breathing by patient in CPAP or Pressure support mode.
90
High Airway Pressure (ventilator alarms)
ETT obstruction: sputum, kinking, biting. Decreased compliance or increased resistance. Circumferential burns, bronchospasm, lung collapse, pneumothorax, worsening lung pathology. Anxiety/fear/pain/vent
asynchrony.
91
Low airway pressure (ventilator alarms)
Ventilator disconnection, leak in system, cuff leak, inadvertent
extubation. Ensure all connections are intact and tight, trouble shoot ETT cuff, BVM if ETT is dislodged.
92
Oxygen pressure low (ventilator alarms)
O2 cylinder is empty, cylinder valve is closed, unit not connected to wall terminal, oxygen flow in off position.
93
Aviation factors affecting respiratory conditions:
* Reduced partial pressure of oxygen (hypoxemia)
* Reduced atmospheric pressure (gas expansion)
* Decreased presence of water vapor (dehydration)
* Gravitation forces
94
Effects of flight on the respiratory system
* Increased hypoxemia
* Dehydration
* Vomiting with potential for aspiration
* Gas expansion possibly resulting in spontaneous pneumothorax (depending on reason for transport)
95
Patient care considerations for transport (respiratory system)
* Restrict cabin alt to 2000’
* Administer supplemental O2 to maintain SPO2 96%
* Monitor for evidence of pneumo
* Humidify O2 if possible
* Antiemetics to help prevent vomiting
* Load patient with head to nose of the aircraft
* Monitor cuff pressures if intubated
96
Briefly describe the mechanism for decompensation of patients with acute cardiovascular disease at high altitudes.
It starts with onset hypoxic hypoxia due to decreased PaO2 since higher altitudes have lower barometric pressure. Eg.) 98% spo2 at sea level, will be 93% at 8000' (the lvl which commercial airlines often pressurize cabins). Compensatory mechanisms include Increased RR, HR and CO which increases cardiac workload, myocardial oxygen consumption, and so increased blood flow requirements to heart muscle. CAD patients may not be able to compensate for this and develop chest pain, CHF, pulmonary edema, or arrhythmias resulting in cardiac arrest.
97
Your patient recently had a VAD installed. What are some considerations preflight?
There is a potential for blood loss during surgical insertion. Hgb should be evaluated and pts transfused if necessary before departure from the referring facility. Anemia can be made worse in a lower PaO2 environment because reduced hemoglobin counts coupled with reduced O2 carrying capacity can lead to tissue hypoxia.
98
What should all patients with cardiovascular disease receive in flight?
Supplemental oxygen. The potential effects of altitude can be minimized if the aircraft is pressurized at or below 4000’ and supplemental oxygen is delivered. In fixed wing transport, limiting cabin alt to a max of 6000’ has been shown to eliminate problems for patients with cardiovascular disease.
99
What aviation factors can affect the cardiovascular system?
- Reduced partial pressure of oxygen (hypoxemia)
- Reduced atmospheric pressure (gas expansion)
- Decreased presence of water vapor (dehydration)
- Gravitational forces
100
What effects of flight could you expect on the cardiovascular system?
- Redistribution of blood flow
- Increased hypoxemia
Remember that hypoxia may aggravate existing ischemia. G forces may cause hypotension and tachycardia. An increase in altitude decreases the ambient pressure and temperature and can contribute to third spacing
101
Patient care considerations for transport (cardivascular system)
- Altitude restriction
- O2 supplementation
- Pt positioning in aircraft
- Stabilize BP with volume and/or meds
102
Gas trapped in the brain is very dangerous for what two reasons?
1. ) Brain tissue has the consistency of pudding which renders it very sensitive to damage.
2. ) The rigid skull makes the brain unable to adapt to the volume expansion
103
What is pneumoencephalopathy?
When air is introduced into the brain/cranial vault, often due to skull fractures, particularly basal skull fractures where sinuses are involved. Tumors and cysts might also have gas occupying spaces, which may produce symptoms of varying degrees at increased altitude.
104
Your patient has suffered a basal skull fracture. What might you consider during flight? (think pneumoencephalopathy)
Cabin altitude restriction of sea level or ground level is indicated.
105
Anxiety, hypoxia, hyperventilation and flicker vertigo (brought on by flickering/strobe lights, propellers or rotors) may result in what?
Seizure activity, which may be enhanced in patients with a head injury or a history of seizures.
106
How to manage head injuries in flight?
Consider maintaining an SPO2 of >97%. Airway management to maintain ETCO2 at 35-40. Spinal immobilization. Keep the head of bed elevated and position the head in midline to promote venous drainage. Position head to nose of aircraft. Maintain a quiet cabin (blinds closed). Manage increased ICP. Cabin altitude restriction.
107
Your patient has their jaw wired and requires flight. What is necessary to manage this?
Jaw wiring necessitates a means of quick release in the event of air sickness. A ripcord is ideal and wire cutters mandatory if no ripcord in place. The patient should be positioned on his/her side in order to protect the airway.
108
Always remember that mid face fractures may be associated with?
Pneumoencephalopathy.
109
Management of facial trauma in flight includes?
- Establish airway pre flight
- Have suction readily available
- Rip cord or wire cutters if jaw wired
- Keep head elevated
- Cabin altitude restriction
110
Factors which will affect patients with neuro disorders during air transport include?
Hypoxia, gas expansion, dehydration, thermal changes, G forces, vibration and noise.
111
Motion sickness related to decreased motility, gas expansion in the GI tract, and aircraft motion is very common. How is this managed? When?
Administration of an antiemetic PRIOR to lift off can help to avoid the problem of managing vomiting in a patient with an unprotected airway during transport.
112
How should a patient be positioned to help prevent transient increases in ICP during take off?
Positioning the head injured patient with head forward in a fixed wing aircraft.
113
Limiting external stimuli with hearing protection and vision protection (dim lighting and covered eyes) may help to prevent what?
Nausea, vomiting, flicker vertigo, and seizures.
114
What aviation factors affect the CNS?
- Reduced PaO2
- Reduced atmospheric pressure (gas expansion)
- G forces
- Motion sickness
115
What are some effects of flight on the CNS to prepare for?
- Increased hypoxemia
- Gas expansion and swelling leading to increased ICP
- Vomiting and potential airway compromise
116
Some ways to manage CNS issues in flight?
- O2 supplementation
- Airway control and protection as needed
- Hyperventilation
- Cabin alt restriction of 2000’ AGL or sea level if pneumoencephalopathy
- C Spine control as required
- Elevate head of bed 30 degrees
- Anticonvulsants as necessary
- Admin meds to reduce ICP
117
What should be inserted in all intubated patients prior to flight?
A nasogastric or oral gastric tube
118
All pneumothoraces should be ____________ prior to flight
Decompressed
119
What factors should be considered for interfacility transfer out of the country?
- Length of transport
- Land transport facilities
- Patient condition relative to length of transport
- Patient condition relative to equipment and supplies
- Qualifications of air medical personnel
- Refueling stops
- Customs arrangements
- Family members accompanying patient
- Immunizations/documentation of the AMC and pilots
120
During approach to the scene, the pilot and AMC are looking for?
- Smoke
- Trees
- Mechanism of injury
- Traffic in the area
- Other Hazards
121
Scene response must be preceded by?
a careful scene assessment
122
Preparation for interfacility transport must include?
Patient stabilization, anticipation of potential problems, and preparation of equipment and supplies.
123
When selecting the type of air craft, one must consider the need for?
Pressurization
124
Is vascular access considered part of the primary assessment and stabilization of a trauma patient?
YES
125
Dalton's law mainly applies to?
Partial pressure
126
The gas that composes the largest percentage of the dry atmosphere is?
Nitrogen
127
To calculate the partial pressure of a gas at a certain altitude, what must be known?
Gas concentration and barometric pressure
128
According to Dalton's law, hypoxia results at high altitudes because?
While oxygen concentration remains unchanged, decreased partial pressure makes it less available.
129
Time of useful consciousness (TUC) is what at higher altitudes?
Shorter
130
The average time of useful consciousness (TUC) for rapid depressurization at 25,000 feet is?
1.5 to 2.5 minutes
131
Length of time at altitude and general health status/level of fitness are factors to consider for what?
Factors that can contribute to hypoxia of the AMC.
132
By 18,000 feet ASL, what volume would you expect a 10ml air filled cuff on an ETT tube to expand to?
20mL
133
Gas remains in solution relative to the pressure of gas around the solution. Decompression sickness is also attributed to this law. Which one is it?
Henry's law.
| good ol' henry doing the back stroke
134
The amount of gas expansion associated with reduced barometric pressure is mediated by a drop in what?
Temperature
135
What formula is used when figuring out how much you need to increase the FiO2 at a higher altitudes?
FiO2 x AP1 / AP2 = Required FiO2
Example: 0.40 x 732.9 mmHg / 656.4 mmHg = 0.45 (45% FiO2 required)
136
You have a pregnant patient with PV bleeding following an MVC. She has a pneumothorax and abdominal trauma, with hypovolemia. What types of hypoxia do you suspect in this patient?
Hypemic, Hypoxic, and Stagnant
137
Your patient has smoke inhalation and thermal respiratory burns. What types of hypoxia do you expect?
Hypoxic, Hypemic, and Histotoxic
138
Your patient is intoxicated with massive chest trauma, hypovolemic shock, and a fractured femur. What types of hypoxia do you suspect?
Hypemic, Hypoxic, Histotoxic, and Stagnant
139
What is an appropriate intervention for a patient with pneumoencephaly?
Fly with a cabin altitude as near to sea level as possible.
140
How may an obstetrical patient be affected by flight?
- Labour may be enhanced by the stressors of flight
- Maternal hypoxia may lead to fetal hypoxia
- Acceleration forces may cause the fetal head to become engaged, enhancing labour
141
Neonates are _________ to excessive nose.
very sensitive
142
Vasoconstriction may be _________ due to stressors of flight
enhanced
143
Fatigue in flight may be attributed to noise and __________.
vibration
144
Decompression sickness may include?
- Shock
- Chokes
- Joint pain
- Visual field defects
- Skin rashes
145
During descent, pain and fullness in the ear may be relieved by?
swallowing, yawning, or decongestants
146
Drowning, airway obstruction, and pulmonary edema may be associated with which type of hypoxia?
Hypoxic hypoxia
147
Nasal prongs at 5 Lpm provide approximately what percentage of oxygen?
40%
148
If a patient requires 40% oxygen at 1000', and the destination altitude is 4000', what FiO2 should the patient receive enroute? You check your handy dandy altitude chart and see that the barometric pressure at 1000' is 732.9 mmHg, and at 4000' it's 656.4 mmHg.
FiO2 x AP1 / AP2 = required FiO2
| 0.40 x 732.9 / 656.4 = 0.45 (or 45% FiO2)
149
Your patient requires 45% FiO2 and isn't intubated. What oxygen delivery devices are available?
- Nasal prongs a 6 Lpm (may not be reliable)
| - Simple face mask at 6-7 Lpm
150
How much fuel and oil must be on board an IFR flight prior to departure?
Sufficient to reach destination, perform a missed approach, fly to alternate, and 45 minutes thereafter.
151
What age of child requires a seatbelt in flight?
Any child over the age of two
152
If an ELT is required to be carried on board an aircraft, does its location and operation have to be made available to all passengers?
YES
153
Aircraft defects must be entered into which log and rectified or deferred appropriately prior to subsequent flights?
Journey log
154
Information detailing the type of flights an air carrier is authorized to conduct is found in what document?
Operations manual
155
Does a preflight briefing have to be provided to all passengers prior to a flight?
YES
156
Briefly describe the roll movement of an aircraft
Movement about the longitudinal axis produced and controlled by the ailerons.
157
When must IFR flight rules be closed?
Immediately upon landing
158
What should the air medical policy and procedure manual cover?
- Personnel policies should clearly define the role of the air medical personnel
- Policies on cleaning and maintenance of equipment and air craft
- Should include medical protocols or directives on advanced skills
- Manual should be revised regularly
159
____________ is one of the most influential types of power in EMS / air medical operations.
Expert power
160
A total quality management program is designed to?
- Involve all levels of staff
- Improve the quality of service provided
- Assess the appropriateness of the utilization of the service
- Incorporate aviation aspects of the service in to the quality improvement program
161
The __________ must have policies and procedures in place to address safety systems as well as an educational system.
SMS system (safety management system)
162
The process outlined in the ___________ provides a step by step procedure to follow during the stressful event of an accident or incident.
Preparedness / Readiness Procedure Manual
163
_________ is meant to support air medical providers who have been exposed to critical events, in order to assist them dealing with the stress.
CISM (critical incident stress management)
164
What should an air medical organization's mission statement reflect?
The mission statement should reflect the current mission and goals of the air medical service.
165
The most important reason aircraft wings must be free of contaminants prior to takeoff is?
Wing contaminants disrupt smooth airflow over the aircraft wings destroying lift.
166
Unless special permission has been received from the minister, no aircraft may commence a takeoff unless the prevailing visibility is at least?
A 1/2 statute mile
167
An aircraft stalls because?
The wing exceeds the critical angle of attack, disrupting the smooth airflow and destroying lift.
168
Who is responsible for inspecting the aircraft prior to takeoff if snow or ice is suspected to be adhering to the critical surfaces?
The pilot in command is responsible.
169
What are important considerations when de-icing an aircraft in a hangar?
- If the aircraft is not allowed to dry completely, any standing water in or on the aircraft will freeze when it is moved outside.
- If it is snowing outside, the snow may melt on the warm aircraft skin and later freezes, forming ice.
170
List three ramp dangers
Noise, propellers, and jet blast.
171
List four inflight emergencies
Engine out, fire, decompression, emergency landing
172
Identify safety considerations when approaching a rotor wing aircraft.
- Remain in protected area away from rotor wash
- Ensure loose objects are secure
- Don't smoke
- Wait until rotors are shut down and the pilot has come out to assist you
- Approach helicopter from the side where pilot can see you
- If rotors are turning, approach in a crouch position and ensure that any equipment is not extending above the level of your head
- Keep in view of pilot.
173
When a helicopter is landed in a ravine, and the land is raised on all sides of it, should hot loading be avoided?
YES
174
Can a standard communication headset be used outside the aircraft to protect your ears?
YES
175
When preparing for an emergency landing what should be done?
Turn off oxygen and electrical equipment to limit the risk of fire.
176
A safety briefing must include?
- No smoking within 100' of aircraft
- Wear seatbelts
- Seat backs kept upright for takeoff and landing
- Location and means of opening doors and exits
- Location of survival gear
- Procedures for utilizing floatation devices if flying extensively over water
- Use of emergency oxygen
- Location and operation of fire extinguishers
177
What should the air medical personnel consider prior to interfacility transport?
- All patients require assessment pre-flight
- A nasogastric or oral gastric tube should be placed in all intubated patients
- All pneumothoraces must be decompressed prior to flight
- Seriously ill patients should have multiple IVs
- The patient should be stabilized prior to flight
178
Who's responsibility is it to allow or deny permission to take specific medical equipment or supplies on the aircraft?
The pilot.
179
What should chest tubes be attached to for flight?
A proper pleuravac system with appropriate suction.
180
Dispatch information for scene response should include?
- Location of scene
- Landing zone arrangements
- Radio communications channel
- Pertinent patient information directly to AMC (not pilots)
181
What are two priorities immediately after a remote emergency landing?
- Assess people on board, and provide care as needed
| - Light a fire to provide warmth and light
182
What information do S.A.R. personnel require?
- Amount of fuel on aircraft
- Number of people on board
- The last time of radio contact with aircraft
- Type of survival equipment carried
- The point of origin and final destination
183
How should signal fires be built?
In a triangular pattern approximately 60 to 90' apart.
184
What is a good way to build a shelter?
Utilizing aircraft components
185
Should the ELT ever been turned off after an emergency landing in a remote area?
NO!
186
To conserve rations in the event of an emergency remote landing, what should the AMC do?
Avoid eating any of the rations for the first 24hrs.
187
The weight of passengers, equipment and supplies on an aircraft should be reported accurately because?
The maximum weight limit as set by the manufacturer must not be exceeded because flight safety cannot be ensured if flying outside of the aircraft restriction.
188
Should medical history of air medical personnel, if required, include social history?
YES
189
Can smoking result in hypemic hypoxia?
YES. Smoking can cause a significant reduction of vitamin C in the body which is essential to absorb iron.
190
What acronym is used to remind staff about personal safety?
I'M SAFE (illness, medication, stress, alcohol, fatigue, exercise/emotion)
191
List components of standard infection control precautions.
- Proper hand hygiene
- PPE
- Proper handling of equipment, soiled linens, and contaminated items
- Prevention of needle stick injuries
- Proper cleaning of patient care environment including spill management
- Appropriate waste management
192
What immunization series are recommended for air medical personnel?
- Tetanus, pertussis, diphtheria (x10 years)
- TB testing
- Measles, mumps, rubella
- Influenza
- Hep B series
- Others as dictated by service (i.e. yellow fever for international carriers)
193
What processes should be implemented to prevent infections spread by droplet, airborne, or contact?
The book has a huge list and they're all basically the same. Wear all the PPE things, use the air exchanger, position patient nearest the air exchanger exhaust outlet, for long flights try to isolate patient from any none AMC personnel, and clean like a mo fo. Airing out the plane afterwards is generally a good idea, but using fans to blow TB around isn't advisable.
194
The international alphabet is used because?
All people flying aircraft must use a consistent means of communication.
195
List communication equipment used on an air medical aircraft?
- VHF radios
- Satellite phone
- Intercom system
196
When should the AMC avoid communications with the pilots?
- During takeoff
- During landing
- Under IFR approach
- In dense air traffic
- During an aviation emergency
197
The aircraft is making an emergency landing in a remote area. Which emergency communication is involved?
This mandates a distress call, starting with May Day, May Day, May Day.
198
You over hear the pilot start a communication using the words; Pan Pan, Pan Pan, Pan Pan. What does this mean?
It's an international standard urgency signal used to declare an urgent situation, but for the time being it doesn't pose immediate danger to life or aircraft.
199
What factors should be considered when setting up the central communication / coordination centre?
- Population including distribution and density
- Call volume including frequency of simultaneous requests
- Number and location of land and air ambulance resources
- Location and types of medical facilities and resources available
- Airport and runway resources in the service area
200
What personnel should be available in the central communications / coordination centre in order to ensure appropriate resource allocation for all transport requests?
- Air medical communication specialist
- Physician familiar with EMS and the service area
- Critical care flight nurse knowledgeable of area and resources
**Remember, Critical care paramedics don't count, the book was written by a nurse.**
201
Which communication steps are important preflight?
- With patient and significant others such as family members
- With pilots in regards to patient needs and potential problems
- With receiving facility to advise regarding patient condition and ETA
- With medical control or the most responsible physician to discuss management
202
What are appropriate responses to an in flight medical emergency?
- Inform the pilots
- Request diversion to the closest airport that has a medical facility capable of providing appropriate health care services to the patient
- If time allows, call medical control to discuss management
- Ensure that the central communication and control centre is aware
