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Critical Care Flight Paramedic > Back to Basics - Critical Care Transport Review - Flash Cards > Flashcards

Back to Basics - Critical Care Transport Review - Flash Cards

1
Q

Clinical Signs of

Kehr’s Sign

A

Referred left shoulder pain

Possible splenic injury or ectopic pregnacy

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2
Q

Clinical Signs of

Kernig’s Sign

A

Back, leg pain on knee extension from 90 degrees

Possible bacterial meningitis.

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3
Q

Clinical Signs of

Brudzinski’s Sign

A

Flexion of knees on neck flexion

Possible bacterial meningitis (or subarachnoid bleed)

“Chin to chest will cause knees to flex.”

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4
Q

Hamman’s Sign

A

Crunching sound heard with auscultation over the anterior chest synchronized with heartbeat -

TRACHEOBRONCHIAL INJURY

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5
Q

X-Ray Findings

Steeple Sign

A

Possible Croup (laryngotracheobronchitis)

A/P neck view

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6
Q

X-Ray Findings

Thumbprint Sign

A

Possible epiglottitis

lateral neck view

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7
Q

when pCO2 is high, pH is

A

low (acidosis)

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8
Q

When pCO2 islow, pH is

A

high (alkalosis)

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9
Q

When pH is low, HCO3 is

A

low (acidosis)

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10
Q

When pH is high, HCO3 is

A

high (alkalosis)

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11
Q

Normal range:

pCO2

A

35-45 (respiratory)

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12
Q

Normal Range:

pH

A

7.35-7.45 (metabolic)

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13
Q

Normal Range:

HCO3

A

22-26 (metabolic)

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14
Q

Rx for AAA

A

Nipride and beta-blockers

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15
Q

First adjustment on ventilator

A

VT first, not rate

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16
Q

Most common joint dislocation

A

Hip

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17
Q

Most common spontaneous dislocation recurrance

A

Anterior Shoulder

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18
Q

Significance

Brain natriuretic peptide

A

Heart failure marker. BNP released by an overdistension of the heart

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19
Q

Normal Range

Brain natriuretic peptide

A

Below 100 = Normal

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20
Q

Brain natriuretic peptide

Critical Range

A

Above 500-700 = Heart failure

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21
Q

Rotor-wing pilot required hours

A

2000 hours

1000 PIC

100 hours at night

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22
Q

“Bottle-to-throttle” Time

A

At least 8 hours

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23
Q

CVP

Measures:

A

preload (right atrial pressure)

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24
Q

CVP

Normal parameter:

A

2-6 mmHg

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25
Q

CVP

Which port to use:

A

Catheter placement outside line markers:

RA/CVP = 25-30 cm

RV = 35-45 cm

PA = 50-55 cm

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26
Q

Spinal Cord Injury S/Sx

Anterior cord:

A

complete motor, pain and temperature loss below the lesion

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27
Q

Spinal Cord Injury S/Sx

Brown-Séquard

A

ipsilateral loss of motor, position and vibration sence; contralateral loss of pain and temperature perception

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28
Q

Spinal Cord Injury S/Sx

Central cord syndrome

A

greater motor weakness in UE than in LE with varying degrees of sensory loss

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29
Q

Spinal Cord Injury S/Sx

Autonomic dysreflexia

A

urinary retention, massive increase in sympathetic tone which can cause HTN, treated by insertion of foley

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30
Q

Normal urinary output:

A

Adult: 30-50 mL/hr

Pedi: 1-2 mL/kg/hr

*If suspected myoglobinuria: (lightning strike, electrical injury, rabdo) 100 mL/hr

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31
Q

Normal Blood Volume:

A

Adult: 70 mL/kg

Pedi: 80 mL/kg

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32
Q

Normal temperature:

A
  1. 0°C
  2. 6°F
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33
Q

Mild hypothermia:

A

32-36°C (~90-95F, decreasing HR)

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34
Q

Moderate hypothermia:

A

29-32° (~84-89F, loss of shivering, Altered LoC)

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35
Q

Severe hypothermia:

A

20-28°C (<83F, coma, VF common)

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36
Q

Two major causes of heat loss?

A

Radiation/Evaporation

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37
Q

Thermoregulation ceases @ what temperature?

A

28°C (83F)

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38
Q

Rules of flight following

A

Sterile cockpit during critical phase of flight

15 minutes maximum between communication center, during flight

45 minutes maximum while on the ground

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39
Q

Rotor-wing shut-off sequence

A

Remember TFB

Throttle

Fuel

Battery

Take survival bag and meet at 12 o’clock position

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40
Q

Survival sequence

A

Shelter

Fire

Water

Food

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41
Q

Order of how to assess the abdomen

A

Inspection

Auscultation

Palpation

Percussion

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42
Q

Contraindications for thrombolytics

A
  • History of hemorrhagic stroke
  • CVA in last 12 months
  • SBP over 180
  • Pregnancy
  • 1 month post partum
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43
Q

FARs (Federal Aviation Regulations):

**Local flying area determined by: **

Cell phones prohibited:

A

Part 91: no passengers

Part 135: passengers (14 hours max for pilots)

Certificate holder

While Airborne

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44
Q

Definition:

PaO2, SaO2

A

PaO2: partial presure of oxygen (plasma)

SaO2: saturation of arterial oxygen (hemoglobin)

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45
Q

Bariobariatrauma

A

Nitrogen release in obese patients at altitude (administer high flow oxygen >15 minutes before to lift off to wash out nitrogen)

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46
Q

Normal Pedi SBP, DBP?

When does it drop?

A

SBP: 90 + (2x age)

DBP: 2/3 the SBP

BP last to go…

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47
Q

Three killers of ventillator patients during flight?

A

Pericardial tamponade

Tension pneumothorax

Hypovolemia

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48
Q

Death from crush injury due to?

A

Renal failure

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49
Q

Complications of crush injury?

A

DIC

compartment syndrome

renal failure

hyperkalemia

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50
Q

CAMTS

Medical director not required to:

A

Live in the same state

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51
Q

CAMTS

Intubation requirement:

A

Quarterly

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52
Q

CAMTS

Live intubation required during training:

A

Five

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53
Q

CAMTS

Specialty team response time:

A

45 minutes

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54
Q

​CAMTS

Pilot area orientation day/night:

A

5 hours day / 2 hours night

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55
Q

​CAMTS

Helipad required to have:

A

2 paths, security

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56
Q

​CAMTS

Fixed wing twin engine time:

A

500 hours

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57
Q

​CAMTS

(Air) Ambulance fuel requirments:

A

175 miles

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58
Q

​CAMTS

ELT set off at:

A

4 g’s

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59
Q

​CAMTS

Uniform fit:

A

1/4 in space between body and uniform

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60
Q

Applied gas laws:

The bends, decompression soda can, CO2 in blood

A

Henry’s Law

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61
Q

Applied Gas Laws

Tissue swelling

Hypoxic

Hypoxia

O2 available at altitude

A

Dalton’s Law

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62
Q

Applied gas laws:

Celular gas exchange

Diffusion

A

Graham’s law

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63
Q

Applied gas laws

Oxygen tank pressure in heat or cold

A

Guy- Lussac’s law

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64
Q

Applied gas laws

BP cuff, ETT cuff, MAST

A

Boyle’s Law

IABP purges with ascent or descent

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65
Q

Trauma & Kinematics

High Velocity:

A

>2000 FPS

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66
Q

Trauma & Kinematics

Medium Velocity

A

1000-2000 FPS

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67
Q

Trauma & Kinematics

Low Velocity

A

<1000 FPS

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68
Q

Tumbling

A

Rotation on 360 degree axis

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69
Q

Yaw

A

deviation up to 90 degrees from straight path

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70
Q

Normal Values:

CVP/RAP

A

CVP: 2-6

*When assessing CVP or PA, pressures on a mechanically ventillated patient, assess pressures at the end of exhalation

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71
Q

Normal Values:

Cardiac Output

A

4-8 L/min

(CO: SV x HR)

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72
Q

Normal Values:

Cardiac Index

A

2.5-4.2

(CI = CO / BSA)

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73
Q

Normal Values:

Pulmonary Artery Systolic/Diasolic

A

PAS = 15-25

PVD = 8-15

*When assessing CVP or PA, pressures on a mechanically ventillated patient, assess pressures at the end of exhalation

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74
Q

Normal Values:

Wedge (PAWP/PCWP)

A

PAWP/wedge: 8-12

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75
Q

Normal Values:

SVR

A

800-1200

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76
Q

Chest/ABD trauma

Chest tube location?

A

Chest tube: Fourth IC space, anterior-axillary

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77
Q

Chest/ABD trauma

Needle thoracostomy?

A

Second ICS midclavicular or the fifth ICS mid-axillary line

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78
Q

Chest/ABD trauma

Suspect with fracture of first 3 ribs?

A

Aortic disruption

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79
Q

Chest/ABD trauma

Scaphoid abdomen indicates

A

Diaphragmatic rupture

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80
Q

High-risk OB - S/Sx

Abruptio placenta

Placenta previa

A

Abruptio: dark red, painful

Previa: bright red, painless

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81
Q

High-risk OB

Terbutaline dose:

A

0.25mg SQ

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82
Q

High-risk OB

Postpartum hemorrhage (abnormal volume of blood loss)

A

>500 mL

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83
Q

High-risk OB

Uterine rupture

A

Uterine Rupture: Fetal parts can be palpated over abdomen

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84
Q

Effects of altitude worsen with

A

Cold upper latitudes

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85
Q

Gay-Lussac’s law

(two components)

Example

A

Temperature increases & pressure increases

Temperature decreases & pressure decreases

Example:

Oxygen tank pressure at 2200 in the afternoon, pressure drops to 1800 in evening (temp declined in eveining, pressure decreased)

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86
Q

Universal Law

A

Combines **Boyle’s & Charles’ **laws

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87
Q

Graham’s Law

Definition

Effects/Examples

A

Rate gas moves from high to low concentration based on size and solubility

gas through liquid, cellular gas exchange

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88
Q

Henry’s Law

A

Gas in liquid proportional to gas above liquid

Example:

“The Bends,” CO2 in blood, decompression

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89
Q

Volume of gas in GI expands thrice at what altitude?

A

25,000 feet

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90
Q

What law affects GI the most?

A

Boyle’s law

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91
Q

Cardiogenic shock

CVP Cardiac output Cardiac index PAS/PAD PAWP SVR HR

A

CVP: High

Cardiac output: Low

Cardiac index: Low

PAS/PAD: High

PAWP: High

SVR: High

HR: initially fast, then slows down

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92
Q

Boyle’s law

Two components

Effects

A

Increased Volume = decreased pressure

Examples

Cuffs, MAST, GI, ETT, IABP

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93
Q

Charles’ Law

Two Components

Effects

A

Temperature and Volume Proportional

(Increased temperature = increased volume)

Up 100 meters = down 1 degree C

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94
Q

Environmental

1. Passive rewarming?

2. Active rewarming?

3. Warm & Dead?

4. Heat Stroke?

A
  1. mild hypothermia only. Up 1˚C/hr with blankets, heater
  2. apply heat to body
  3. 32˚C
  4. over 42˚C
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95
Q

Clinical Signs

Grey Turner’s sign

A

​Flank brusing (retroperitoneal bleeding)

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96
Q

Clinical Signs

Coopernail’s sign

A

Scrotem/labia (abdominal/pelvic bleeding)

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97
Q

Clinical Signs

Halstead’s sign

A

​Marbled abdomen (bleeding)

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98
Q

Clinical Sign’s

Cullen’s sign

A

Umbilical discoloration (pancreatitis)

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99
Q

Clinical Sign’s

Murphy’s sign

A

RUQ pain with inspiration (Gall bladder)

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100
Q

Clinical Sign’s

​Levine’s sign

A

Fist to chest “Clutching” (Cardiac)

101
Q

Types of hypoxia

Hypoxic hypoxia

A

deficency in alveolar oxygen exchange

altitude hypoxia

decreased alveolar oxygen

tension pneumo

102
Q

Types of hypoxia

Hypemic hypoxia

A

reduction in the oxygen carrying capacity of the blood

carboxyhemoglobin (CO poisoning)

methemoblobin (excessive use of benzocaine, nitrates)

103
Q

Types of hypoxia

Histotoxic hypoxia

A

cellular inability to use molecular oxygen

cyanide poisoning

104
Q

Types of hypoxia

​Stagnant hypoxia

A

​occurs when conditions exist that result in the reduced total cardiac output

Decreased cardiac output

Poor circulation

(e.g. g-forces, CHF)

105
Q

High-risk OB

Normal Fetal HR

A

​120-160

106
Q

High-risk OB

Factors in fetal well-being?

Most important factor?

A

​FHR

Fetal movement

Variability

​

107
Q

High-risk OB

TX for fetal distress

A

LOCK:

** L**eft lateral recumbent​

                **O<sub>2</sub>**

Correct contributing factors

                **K**eep reassessing

​

108
Q

CHF considerations

Preload

A

Many CHF patients are relatively hypovolemic.

Careful with diuretics and medications that can decrease preload.

109
Q

CHF considerations

Lab Test

A

Lab Tests

BNP = lab test nonspecific > 500

110
Q

CHF considerations

Medications

A

No beta-blockers, except for carvidolol (coreg)

Natracor (neseritide) = synthetic version of BNP

111
Q

Primary cause of death with ventilator dependent patients

A

Ventilator acquired pneumonia

112
Q

Digoxin

Class

Causes what electrolyte imbalance

ECG changes

A

Cardiac glycoside

Hypokalemia

ECG - “dig dip” ST depression

113
Q

ARDS

CXR

A

CXR reveals widespread pulmonary infiltrates;

glass-like apperance

114
Q

ARDS

TX

A

PEEP

115
Q

PEEP

Effects of PEEP

A

Effects of PEEP:

Increased pulmonary vascular resistance can cause hypotension over 15 cm H2O

116
Q

PEEP

Normal physiologic PEEP

A

**Normal PEEP: **3-5 cm H2O

117
Q

Treat HTN when SBP?

MAP?

A

SBP > 220

MAP > 130

118
Q

Dehydration raises serum?

A

Sodium

Normal sodium: 135-145

119
Q

Objective data?

A

things you can observe

ABC’s

Neurological assessment

Differential Diagnosis for altered mental status: AEIOUTIPS

120
Q

Bowel sounds in chest cavity?

A

Diaphragmatic rupture

Most common in the left chest

121
Q

Crunching sounds heard over chest with auscultation, may be syncronized with heartbeat?

A

Associated with tracheobronchial injury aka Hamman’s sign

122
Q

Preferred method for moving spinal injured patients?

A

Scoop stretcher is prefered to log rolling paitent

123
Q

Differential diagnosis

Pulmonary contusion

A

Low sats despite O2

Rales

124
Q

Differential diagnosis

Ruptured diaphram

A

Chest/abdomen pain radiated to left shoulder

125
Q

Differential diagnosis

Trachobronchial injury

A

Hemoptysis

Sub-q air

Air leak with chest tube

Advance ETT below level of injury into right mainstem

126
Q

Differential diagnosis

Esophageal perforation

A

Fever

Hemaremesis

127
Q

Differential diagnosis

​Fat embolus

A

Fever

Rash after fracture

128
Q

Blood loss

Humerus

A

Humerus: 750 mL

129
Q

Blood loss

Femur

A

Femur: 1500 mL

130
Q

PAWP/PCWP

Function?

Normal Range

A

Pulmonary artery wedge pressure/

Pulmonary capillary wedge pressure

Function: Looks @ L side of heart, if high can indicate pulmonary congestion, CHF, and cardiogenic shock

PAWP/PCWP: 8-12 mmHg

Do not keep wedged for more than 15 seconds, make sure that baloon is deflated and have patient cough forcefully

131
Q

ADULT ETT Depth

A

Adult

3 x ETT size or average is 19-23

132
Q

Pedi ETT Depth

A

**Pedi: **10 + age in years

133
Q

Neonatal ETT Depth

A

**Neonatal: **6 + age weight in kg

134
Q

Ventillator miscellaneous

To change CO2…

A

Adjust rate (*f *), then VT

135
Q

Ventillator miscellaneous

To change oxygenation

A

Adjust PEEP, PAP

136
Q

Burns - Rule of 9’s for Pedi

Head

Torso

Arms

Legs

Perineum

A

Pedi

Head - 18%

Torso - 18% Front/Back

Arms - 9%

Legs - 13.5%

Perineum - 1%

137
Q

Burns - Rule of 9’s for Adult

Head

Torso

Arms

Legs

Perineum

A

Adult

Head - 9%

Torso - 18% Front/Back

Arms - 9%

Legs - 18%

Perineum - 1%

138
Q

Burns

Parkland Formula

A

Parkland:

4 mL x kg x TBSA

1/2 of first 8 hr’s, rest over next 16 hours

139
Q

Burns

​Consensus formula

A

Consensus:

2-4 mL x kg x TBSA

1/2 of first 8 hr’s, rest over next 16 hours

140
Q

Saftey

  1. ELT Frequency
  2. Confirm ELT working
  3. Twin engine required offshore
A
  1. ELT Frequency - 121.5
  2. Tune it in and listen
  3. Raft, vest
141
Q

Drugs

Induction agent of choice with bronchospastic patients

A

Ketamine (ketalar)

142
Q

Drugs

Ativan aka:

Indication:

Dose:

Max.

A

Lorazapam

**Indication: **Seizures

**Dose: **1-2 mg

**Max: **4 mg

143
Q

Drugs

Mannitol Dose

A

1-2 g/kg

144
Q

Drugs

Drug of choice for cyclic antidepressant OD

A

Sodium bicarbonate

145
Q

Drugs

Drug of choice for beta-blocker OD

A

Glucagon

146
Q

Drugs

Fentanyl aka:

Dose:

A

Sublimaze

3µg/kg

147
Q

Drugs

Treatment for malignant hyperthermia

A

Dantrium (dantrolene)

148
Q

Drugs

Drugs for GI bleeds

A

Sandostatin (octreotide)

149
Q

Neurogenic Shock

CVP:

CO:

CI:

PCWP:

SVR:

HR:

A

Neurogenic Shock

**CVP: **down

**CO: **down

**CI: **down

**PCWP: **down

**SVR: **down (distributive shock)

**HR: **Can be present as normal or slow

150
Q

Arterial Line

Sites:

A

**Sites: **

Radial

Femoral

151
Q

Arterial Line

Purpose

A

**Purpose: **

Monitor pressure

Draw blood

ABG’s

Maintain pressure bag @ 300 mmHg

152
Q

Arterial Line

Underdampening:

A

Underdampening:

Caused by having air in the system,

Loose connection

Low pressure bag

Altitude changes

153
Q

Arterial Line

Overdampening

A

Overdampening:

Caused by kinking

Increased bag pressure

Tip against the wall

154
Q

ECG

Most common reperfusion dysrhythmia

A

AVIR

155
Q

ECG

Most common hypothermia dysrhythmia

A

VF

(osborn wave)

156
Q

Hypokalemia on ECG

A

Hypokalemic - Peaked P’s, flat T’

157
Q

Hyperkalemia on ECG

A

Hyperkalemic

Peaked T’s (treat with calcium)

158
Q

**MAP goal with CHI **

A

MAP: 80-100

159
Q

CPP goal with increased ICP

A

CPP: 70-90

160
Q

Normal ICP

Normal CPP (head)

Normal MAP

Normal for the other CPP (heart)(Cornary Perfusion Pressure)

A

**ICP: **0-10

**CPP (head): **70-90

**MAP: **80-100

Heart CPP: 50-60

Remember your head is higher than your heart

161
Q

GCS
Mild
Moderate
Severe

A

GCS or Scale

Mild: 14-15

Moderate: 9-13

Severe: 3-8

162
Q

CPP (head) formula

A

CPP: MAP-ICP

163
Q

MAP formula

A

SBP + 2 DBP

3

164
Q

CPP (heart) formula

A

Heart CPP: DBP - wedge

165
Q

Rotor-wing minimums ceiling/visibility
Day/local
Day/cross-country

A

Day/local: 500 foot (ceiling) and 1 mile (visibility)

Day/cross-country: 1000 feet and 1 mile

166
Q

Rotor-wing minimums ceiling/visibility
Night/local
Night/cross-country

A

Night/local: 500 feet and 2 miles

Night/cross-country: 1000 feet and 3 miles

167
Q

Number one cause of air medical crashes

A

Controlled flight into terrain,

Pushing the weather

168
Q

Lab Values:

Normal Potassium

A

K: 3.5-5.5

169
Q

Lab Values:

Normal Sodium

A

Na: 135-145

170
Q

Lab Values:

Normal Chloride

A

Cl- : 95-105

171
Q

Lab Values:

Normal Calcium

A

Ca: 8.5-10.5

172
Q

Metabolic acidosis elevates which electrolyte?

A

Potassium

173
Q

Time of useful consciousness with sudden decompression at:
30,000 feet
41, 000 feet

A

30,000: 90 seconds

41,000: under 15 seconds

*Least amount of time is your answer on the exam

174
Q

Which Leads?

12-lead ECG:
Inferior

A

Inferior – II, III, aVF

175
Q

Which Leads?

12-lead ECG:
Septal

A

Septal – V1, V2

176
Q

Which Leads?

12-lead ECG:

Anterior

A

Anterior – V3, V4

177
Q

Which Leads?

12-lead ECG:

Lateral

A

Lateral – I, aVL, V5, V6

178
Q

Which Leads?

12-lead ECG:

Posterior

A

Posterior – ST segment depression or reciprocal changes noted in V1-V4, ST elevation V6

179
Q

Cardiac Ischemia

A

Ischemia: ST depression (1 mm in 2 leads)

180
Q

Cardiac Infarct

A

Infarct: Q wave > 25% the height of R wave

181
Q

Cardiac Injury

A

Injury: ST elevation (1mm in 2 leads)

182
Q

Pediatric age guidelines

  • ETT cuffed vs. uncuffed
  • Needle Cricothyrotomy
  • Nasal intubation
A

“10, 11, 12” Rules

  • Uncuffed tube under 10
  • Needle cricothyrotomy only under 11
  • No nasal intubation under 12
183
Q

High-risk OB:

PIH triad signs

A

HTN

Edema

Proteinuria

184
Q

High-risk OB

Terbutaline contraindications

A

IDDM

Maternal HR over 120

Vaginal bleeding

185
Q

High-risk OB

Primary cause of PTL

A

Infection

186
Q

O2 adjustment calculation to maintain saturation at altitude

A

**FiO2 * **Pressure at departure (mmHg)

** Pressure at altitude**

Example: Patient on FiO2 of 0.40

Depart: 681 mmHg

Altitude: 565 mmHg

0.40 * (681/565) = 0.48

187
Q

Ventilator modes: IMV & SIMV

A

IMV: preset breaths, TV, PIP.

Patient breaths allowed.

SIMV: allows variation of support.

188
Q

Ventilator modes: AC

A

AC: preset volume or PIP with every breath.

Can trigger breath, can’t control TV.

189
Q

Ventilator modes: CMV

A

CMV: preset volume or PIP at set rate.

Patient can’t initiate breath

190
Q

IABP: Action

A

Increase cardiac output coronary perfusion

191
Q

IABP: Deflates

A

During ventricular systole

192
Q

IABP: Dicrotic Notch

A

Aortic valve closing, synchronized with a-line or ECG

(most common trigger)

193
Q

IABP: Signs/Symptoms of balloon leak

A

Blood specs in tubing

Alarm

194
Q

**IABP: Clot prevention **

A

Cycle manually every 30 minutes

195
Q

IABP increases CO by

A

Increases CO by 10-20%

196
Q

IABP: Balloon rupture

A

Rusty flakes in line or turn machine off

197
Q

IABP: Migration/dislodged

A

Assess left radial and urine output

198
Q

Lethal IABP timing cycles

A

Late deflation and early inflation

199
Q

Oxyhemoglobin disassociation curve
Left Shift

A

“L” stands for Alkalosis

Left shift = low Hemoglobin holding oxygen Alkalosis

Low CO2

Low temperature

Low DPG

Mxydema Coma

200
Q

Oxyhemoglobin disassociation curve
Right Shift

A

“R” stands for raised

Right = raise/releases oxygen, Acidosis, Raised CO2

Raised temperatures

Raised DPG

Thyroid Storm

201
Q

Phlebostatic axis
Where?
What?

A

Where pressure measurements are made with invasive line

Fourth ICS, level of atria

202
Q

Boyle’s Law
Ascent

A

Ascent

Barondontalgia (toothache)

Barosinusitis can occur on ascent

Bariobariatrauma (obese) = Nitrogen in the fat cells can expand causing the “bends” administer high flow oxygen for 15 minutes prior to lift-off to remove nitrogen

203
Q

Boyle’s Law
Descent

A

Descent

Barotitis media (middle ear) can affect the patient during descent

204
Q

Hypertension:
Mild
Moderate
Severe

A

Mild: 140-159/90/99

Moderate: 160-179/100-109

Severe: over 180/110

205
Q

Volume for RBC
administration
Volume for WBC

A

RBC 10 mL/kg

WBC 20 mL/kg

206
Q

ABG rules: CO2 and pH

A

CO2 up 10mmHg = pH down .08 (inverse)

207
Q

ABG rules: Bicarb and pH

A

HCO3 up 10 = pH up 0.15 (proportional)

208
Q

ABG rules: Bicarb replacement

A

Kg/4 x base deficit = mEq of bicarb needed

209
Q

ABG rules: PaO2 at altitude

A

PaO2 drops 5 for every 1000 feet elevation

210
Q

Stages of Hypoxia elevations
Signs and Symptoms:

Indifferent

A

Indifferent: (10,000 feet MSL)

Increased HR and RR, decreased night vision

211
Q

Stages of Hypoxia elevations
Signs and Symptoms:

Compensatory

A

Compensatory: (10,000-15,000 feet MSL)

HTN, task impairment

212
Q

Stages of Hypoxia elevations
Signs and Symptoms:

Disturbance

A

Disturbance: (15,000-20,000 feet MSL)

dizzy, sleepy, cyanosis

213
Q

Stages of Hypoxia elevations
Signs and Symptoms:

Critical

A

Critical: (20,000-30,000 feet MSL)

ALOC, incapacitated

214
Q

Night vision lost at:

A

5,000’ MSL

215
Q

PA Catheter: Named?

A

Swan-Ganz

216
Q

PA Catheter: Proximal port is for?

A

CVP

Medications

217
Q

PA Catheter: S/S of bad placement?

A

VT

Ventricular ectopy

218
Q

PA Catheter: Proceedure for bad placement?

A

Float forward to PA or pull back to RA

219
Q

PA Catheter: Measures?

A

Right heart directly

Left heart indirectly

220
Q

PA Catheter: Which prt Used?

A

Distal port

221
Q

PA Catheter: Pressure bag set to?

A

300 mmHg

222
Q

Normal cardiac index

A

CI: 2.5-4.3

223
Q

Stressors of flight

A
  1. Third spacing
  2. Fatigue
  3. G-forces
  4. Noise
  5. Vibration
  6. Hypoxia
  7. Dehydration
  8. Temp changes
  9. Barometric pressure changes
224
Q

Personal factors affecting stressors of flight?

A

DEATH

Drugs

Exhaustion

Alcohol

Tobacco

Hypoglycemia

225
Q

Dalton’s law

A

Sum total of partial pressures equal to total atmospheric pressures (Dalton’s gang)

Examples:

Tissue swelling, altitude hypoxia, hypoxic hypoxia

This is why O2 is needed at altitude

226
Q

Cardiac Thrombolytics

must be administered within

A

Three hours of onset of chest pain

227
Q

Diving injuries
ATM

A

ATM for every 33 feet descent

&

Add 1 if asking for total ATM versus water pressure

228
Q

Hypovolemic shock
CVP
CO
Cardiac Index
Wedge
SVR
Heart Rate

A

CVP: down
CO: down
Cardiac Index: down
Wedge: down
SVR: high
Heart Rate: fast

229
Q

pO2 & pCO2

Acute Respiratory failure

A

pO2 below 60

pCO2 above 50

230
Q

Newton’s laws

A

First law: an object in motion tends to stay in motion

Second law: force = mass x acceleration

Third law: every action has = and opposite reaction

231
Q

Tetralogy of Fallot (TOF)

A

Remember PROV

P = pulmonary stenosis

R = right ventricular hypertrophy

O = overriding aorta

V = ventricular septal defect

232
Q

What is a tet spell?

A

During a “tet” spell, blood flow across the right ventricular outflow tract is significantly decreased, resulting in shunting right to left through the VSD out of the aorta, thus bypassing the lungs.

Causes include: spasms, sudden decrease in systemic vascular resistance secondary to hypovolemia, dehydration, hot weather, or defecation.

Tet spells are usually seen in the neonatal period,

& peak in incidence between two and four months of life.

233
Q

Atrial waveforms

A

“Filling pressures”

Right atrial pressure (CVP)

Left atrial presure (PAWP/PCWP)

234
Q

Ventricular waveforms

A

Right ventricular pressure obtained upon insertion of PA catheter or if the catheter has been dislodged backward into the right ventricle resulting in a right ventricular waveform.

Looks like “VT,” no dicrotic notch seen on the downslope of the right side of the waveform

Left ventricular pressure measured during cardiac catheterization

235
Q

Arterial waveforms

A

Arterial lines

Pulmonary artery pressure (PAP)

Dicrotic notch seen on the downslope of the right side of the waveform

236
Q

Waves:** A wave**

A

A wave = rise in atrial pressure as a result o atrial contraction

237
Q

Waves: C wave

A

C wave = not always visible on the tracing, rise in the atrial pressure which closure of the AV valves (tricuspid and mitral) bulge upward into the atrium following valve closure

238
Q

Waves: ​V wave

A

V wave = rise in atrial pressure as it refills during ventricular contraction

239
Q

A Wave correlation to ECG

A

A wave generally coincides with PR interval on the WCG in a right atrial pressure waveform

It will be slightly delayed in a left atrial pressure waveform

240
Q

C Wave correlation to ECG

A

C wave generally coincides with mid to late QRS on the ECG in a right atrial pressure waveform

It will be slightly delayed in a left atrial pressure waveform

241
Q

V Wave correlation to ECG

A

V wave is generally seen immediately after the peak of the T wave on the ECG in a right atrial pressure waveform.

It will be slightly delayed in a left atrial pressure waveform

242
Q

Wave descents

A

Decline in right atrial pressure during atrial relaxation (remember “x” in relaXation)

Decline in right atrial pressure resulting from atrial emptying (Remember the “Y” in emptYing)

243
Q

Breathing and waveforms

A

Record pressure measurements at the end of exhalation

In a spontaneously breathing patient, inspiration is the fall in pressure, expiration is the rise in pressure. End-expiration occurs just prior to the respiratory drop in pressure

Positive pressure mechanical ventilated patients will cause cardiac pressure to rise upon inspiration

244
Q

Measuring waveforms

A

The end-diastolic pressure can be estimated by identifying the “Z” point

A line is drawn from the end of the QRS to the hemodynamic tracing. The point where the line intersects with the waveform is the “Z” point. The “Z” point on the PAWP tracing will be delayed by 0.08-0.12 sec from the QRS

245
Q

Cardiac output formula

A

HR x SV = CO

246
Q

Diacrotic notch

A

Closure of the aortic valve

247
Q

Neonatal

A

Maintains the PSA open = prostaglandin (PGE1)

Closed the PSA = indomethacin and long-term use of high oxygen delivery

32 weeks or less in gestation = surfactant

Common cause of seizures = hypoglycemia < 40 mg/dL and hypoxia

Scaphoid abdomen = diaphragmatic hernia managed with orogastric tube and PPV

248
Q

CPK > 20,000

A

CPK (muscle enzymes) levels greater than 20K is ominous and is an indication of later DIC, acute renal failure and is potentially dangerous hyperkalemia in the heatstroke patient

249
Q

Anion gap

A

Na – (Cl + Bicarb/CO2) = AG Normal 12 (+/-) 4 >16 indicates an underlying metabolic acidosis

Remember: “MUDPILES” Methanol Uremia DKA Paraldehyde Isoniazide/Iron Lactate Ethylene glycol Salicylate

Critical Care Flight Paramedic (4 decks)

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