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Paramedic Study > Air Methods PCG's > Flashcards

Air Methods PCG's Flashcards

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1
Q

RSI: Indications

A
  1. Unable to maintain airway
  2. Unable to oxygenate or ventilate
  3. Expected clinical course
  4. Unable to facilitate safe patient transport
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2
Q

RSI: Contraindications

A
  1. Unable to ventilate with a BVM
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3
Q

RSI: Etomidate

A

Dose: 0.3mg/kg IV (Max of 40 mg)
Caution: in pt’s with adrenal insufficiency or sepsis
Preferred: In pt’s with Severe HTN (SBP >160)

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4
Q

RSI: Ketamine

A

Dose: 1 - 2 mg/kg IV or IM
Preferred: In pt’s with bronchospasm, shock/hypotension, sepsis, & pediatrics
Caution: pt’s with severe HTN (SBP > 160)

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5
Q

RSI: Rocuronium

A

Dose: 0.6 - 1.2 mg/kg IV (usual dose 1 mg/kg)
Caution: In pt’s with difficult airway (long-term paralysis)

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6
Q

RSI: Succinylcholine

A

Dose: 1.5 - 2 mg/kg IV
Contraindications: Hyperkalemia, Severe injury > 2 days, Spinal injury > 2 days, Burn > 24 hours, Renal failure, pseudocholinesterase deficiencies, Hx of malignant hyperthermia, neuromuscular disorders, penetrating eye injuries

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7
Q

RSI: Push Dose Pressors

A

Resuscitate with NS/LR fluid, if SBP < 90
PDP may be used 15 min before or 15 min after intubation

Medical:
Phenylephrine 200mcg IV and MR q 2 mins

Trauma:
Vasopressin 2 units IV MR q 2 mins

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8
Q

Needle Thoracotomy: Sites

A
  1. 4th-5th ICS anterior axillary line

2. 2nd-3rd ICS midclavicular line

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9
Q

Needle Thoracotomy: Indications

A

S/S of tension pneumothorax

  • Tachycardia
  • increased RR or work of breathing
  • decreased SPO2
  • Increased PIP and MAP in intubated pt’s
  • decreased lung sounds
  • decreased chest rise
  • JVD
  • Subcutaneous emphysema
  • hypotension
  • tracheal deviation
  • hyper-resonance upon percussion
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10
Q

Needle Thoracotomy: Needle sizes

A

Adult: 10-14 g 3 inch catheter
Pediatric: 18 g 1 inch catheter

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11
Q

NPPV Settings

A 
Initial Settings: 
IPAP = 10 cmH2O
EPAP= 5 cm H2O
FiO2= Low pressure source (LPS @ 15 lpm)
Breath Rate= 0
Rise profile = 1-2
Flow termination= 40 %
Time Termination= 0.7 s
Turn off low pressure and Ve alarms
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12
Q

EZ- IO: Approved Sites

A
  • Proximal Tibia (Adult/child/infant)
  • Distal Tibia (Adult/child/infant)
  • Proximal Humerus (Adult/child/infant)
  • Distal Femur (Child/infant)
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13
Q

EZ-IO: Analgesia

A

Adult: Lidocaine 2% 40mg IO over 120 seconds & let sit in IO space for 60 seconds and then flush w/NS

Infant/Child: Lidocaine 2 % 0.5mg/kg to max of 40mg (follow same method as adult)

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14
Q

Needle Cricothyrotomy

A

Indications: Inability to oxygenate or ventilate the pt by any other means. Pediatric pt less than 8y/o (Surgical airway contraindicated)

Contraindications: Damage to the larynx, cricoid cartilage, or trachea -or- ability to ventilate by another means.

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15
Q

Manometer: ETT Cuff pressures

A

Adult: 20-30 cmH2O
Pediatric: 20-25 cmH2O

Should take Initial, Altitude, & Landing

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16
Q

Ways to verify Tracheal tube placement

A
  • Direct Visualization
  • Quantitative ETCO2 waveform (Gold Standard)
  • Re-visualization
  • Chest rise and fall with Lung sounds and negative epigastric sounds
  • Chest x-ray
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17
Q

RSI: Pre-medications

A

Oxygen
Push-Dose Pressors
Atropine 0.02 mg/kg IV for peds < 1 y/o to max of 1mg

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18
Q

HEAVEN Criteria

A
  • Hypoxemia
  • Extremes of size
  • Anatomic disruption/obstruction
  • Vomit/blood/fluid in airway
  • Exsanguination
  • Neck Mobility
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19
Q

IBW: Calculations

A

[(2.3)(# inches over 5 ft) + 50 (males) or 45.5 (females)

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20
Q

Tidal Volume Calculation

A

6mL/kg of IBW

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21
Q

Minute Ventilation (Ve)

A

100mL/kg/min of IBW

22
Q

Ventilation management for Acidosis

A

Target minute ventilation to achieve pt’s pre-intubation ETCO2

Minute Ventilation Goals:

  • Adults = 9 L/min
  • Pediatrics = 4-5 L/min
  • Infants = 1.5-3 L/min
23
Q

Ventilator Setting Confirmation

A

Vte: make sure Vt matches Vte

f (frequency): make sure frequency closely matches the set RR

PIP: confirm the PIP < 35 cmH2O

Pplat: Confirm Pplat is <30 cmH2O

AutoPEEP: Confirm air trapping is not occurring (AutoPEEP < 0)

24
Q

IBW Calculations: Infant & Pediatric

A

Infants: (months of age + 9)/2

Pediatrics: (years of age x 2) + 8

25
Q

Resuscitative Ventilation

A
  • Maintain same Ve
  • Vt is increased to 8-10mL/kg
  • RR is decreased to around 8-10/min
  • Consider decreasing PEEP to 0*
26
Q

How to fix increased AutoPEEP

A
  • Reduce RR
  • Increase the expiratory time, by lowering the inspiratory time
  • Consider Bronchodilators
27
Q

Initial Settings for Pressure Control (PC) ventilation

A

Pressure Control= 15 cmH2O
PEEP = 5 cmH2O

PIP = PC + PEEP

28
Q

Pressure Control should be used for what patients?

A
  • Any pt < 10 kg

- Pt with injured, damaged, or non-compliant lungs (Pplat > 30)

29
Q

ETT size for pediatrics

A

16 + age / 4

30
Q

OG/NG tube size

A
  • 2 x ETT size

- Measure from nose around the ear and to the stomach

31
Q

Tranexamic Acid (TXA)

A

MOA: Prevents clot breakdown

Dose: 1g in 100mL given over 10 minutes

Inclusion: Age > 15 years, injury < 3 hours, S/S of SBP < 90mmHg or HR > 110 after 10mL/kg fluid bolus.

32
Q

Cerebral Perfusion Pressure

A

MAP - ICP = CPP

Normal 70-90mmHg

33
Q

MAP

A

MAP= [SBP + (2 x DBP)] /3

Hypotension: maintain MAP of 65mmHg

34
Q

PACO tool

A

Conversion factor x psi/ flow rate = duration

Conversion factors

  • Portable tank (D) = 0.16
  • Aircraft tank (M) = 1.56
  • Small hospital tank (E) = 0.28
35
Q

Pain Management: Adult

A

Fentanyl 0.5 - 1 mcg/kg IV/IN MR q 3-5 min; max single dose of 100 mcg

Ketamine 0.1 - 0.25 mg/kg IV if opioids are not managing pain MR q 10 minutes

36
Q

Pain Management: Pediatric

A

Fentanyl 0.5 - 1 mcg/kg IV/IN MR q 3-5 min; max single dose of 100 mcg

Ketamine 0.1 - 0.25 mg/kg IV if opioids are not managing pain MR q 10 minutes

37
Q

ETCO2 goal for TBI

A

30-35 cm H2O

38
Q

Hypertension parameters per disease

A

AAA = SBP < 110
Subarachnoid= SBP < 140
Hemorrhagic = SBP < 160
Ischemic = SBP < 180 w/ tpa & < 220 w/o tpa
Aortic Dissection = HR < 60 & SBP < 120
PIH = BP < 160/110

39
Q

qSOFA score

A

RR > 22
Change in mental status
SBP < 100

40
Q

SIRS criteria

A 
Temp < 36 or > 38
RR > 20
ETCO2 < 29
HR > 90
WBC > 12, 000/mm3
41
Q

Seizures: Treatment

A
  • Check BGL
  • RSI prn (short-term paralytic preferred)
  • For active seizing or hx of multiple seizures give Versed.
  • Midazolam 5 mg IV/IN or 10 mg IM repeat prn q 2-5 min
42
Q

Lab Values: Sodium

A

135-145 mEq/L

43
Q

Lab Values: Potassium

A

3.5- 5 mEq/L

44
Q

Lab Values: Chloride

A

95- 105 mEq/L

45
Q

Lab Values: Calcium

A

8.5 - 10.5 mg/dL

46
Q

Blood Urea Nitrogen (BUN)

A

6- 23 mg/dL

47
Q

Creatinine

A

0.6- 1.4 mg/dL

48
Q

Serum Osmolality

A

275- 295 mOSm/kg H2O

49
Q

H & H= Hgb & Hct

A

Hgb- 12-18 g/dL
Hct- 36-52%

Hematocrit is typically 3 x higher than your hemoglobin

50
Q

Anxiety: Treatment Adult

A

Midazolam 2.5- 5mg IV/IM/IN MR in 3-5 minutes

or

Lorazepam 1 -2 mg IV MR in 15 minutes

51
Q

Excited Delirium: Treatment Adult

A

Ketamine 0.5 - 1 mg/kg IV MR x 1 or 4 mg/kg IM x 1

or

Etomidate 10 mg IV x 1

52
Q

King Airway Sizes

A 
Size 0 = for a 0-1 y/o
Size 1 = for a 1-2 y/o
Size 2= for a 2 y/o
Size 2.5 =  for 25 kg
Size 3= bigger than broselow or > 4 ft
Size 4= for most adults 5-6 ft
Size 5 = over 6 ft

Paramedic Study (3 decks)

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