CFRN Flashcards
3 things that high CO2 indicates
acid buildup
low pH
apnea/hypoventilation
what is CO2 regulation a function of
minute ventilation (Ve) = Vt x F
base deficit >-4
need a blood transfusion
how can you use base deficit to predict need for blood transfusion
> -4 needs a blood transfusion
replacement formula for bicarbonate
0.1 x base excess x wt in kg = # bicarbonate needed
left shift affinity
increased
mneumonic for left shift
LEFT = LOW
acidosis, temp, 2,3-DPG, pCO2
mneumonic for right shift
RIGHT = RAISE
alkalosis, temp, 2,3-DPG, pCO2
how to tell if ABG is compensated
the compensation mnechanism is the opposite of the primary problem
- R. acidosis is compensated by bicarbonate
- m. alkalosis is compensated by CO2
partially compensated
pH, resp, & metabolic are all out of range
pH, CO2 & bicarbonate are all out of range
partially compensated
fully compensated
pH is normal
CO2 & bicarbonate are out of range
pH is normal
CO2 & bicarbonate are out of range
fully compensated
critical pH for intubation
under 7.2
critical CO2 to intubate
pCO2 over 55
critical pO2 to intubate
under 60
considered lactic acidosis
over 4
acid base in hyperthermia
m. acidosis
acid base in rhabdo
m. acidosis
acid base at high altitudes
r. alkalosis
increased minute ventilation
increased to blow off CO2 (Vt x F)
every __ in pH, expect the bicarbonate to change by ___ in the ___ direction
0.15 pH
10 bicarbonate
same direction
every __ in pH, expect change in K by __ in the ___ direction
0.1 pH
K shifts 0.6
opposite direction
- as pH lowers, K shifts outside the cell giving a falsely elevated K.
- when correct imbalance by raising pH, K shifts intracellularly so life threatbning low K
every change in ___ ETCO2, expect pH to change by ___ in the ___ direction
10 mm hg
0.08
opposite direction
every change in ___ CO2 K shifts ___ in the ___ direction
10 CO2
0.5K
same direction
ABG to intubate
7.2 pH
CO2 over 55
PaO2 under60
ETT size pediatrics
16 + age in years
divided by 4
3-3-2 rule
difficult airway predictor
3 in mouth
3 between jaw & hyoid
2 betweenhyoid and thyroid
Mallampati II
tonsilar pillars are hidden by tongue
Mallampati III
only the base of hte uvula is seen
HEAVEN
difficult airway predictor hypoxemia under 93% extremes of size (under 8/obese) anatomic vomit/blood/fluid exsanguination/anemia neck mobility
failed airway algorithm
3 failed attemps,
cric
post intubation management
fent
ketamine
versed
SALAD technique
suction assisted laryngoscopic airway decontaminatin
*clean airway w/suction, place suction in esophagus, as the intubation tube is passed
RSI dose of paralytic if shock
double paralytic b/c low CO slows the onset
RSI pathology consideration when planning the paralytic dose
double paralytic if low CO/shock b/c low CO slows the onset
RSI dose of induction agent if in shock
1/2 induction dose
less is needed due to depletion of catacholamine stores
RSI dose if low CO/shock
- 1/2 induction dose. less is needed b/c depletion of catecholamine stores
- double the paralytic bc low CO slows onset
onset/duration of ROc
onset under 2 min
duration 30-60 min
reverses Roc
Sugammadex
Sugammadex
reverses Rocuronium
ABG in Malignant Hyperthermia
mixed acidosis
high RR
increased COw
DO NOT give in Malignant Hyperthermia
CaCHB b/c problem w/calcium removal from the muscle
contraindications for succ - 7
burns over 24hrs rhabdo high K crush eye injuries hx of malignant hyperthermia any nervous system injury like GB or MG
burn contraindication for succ
contraindicated if burns over 24hrs
SE of Succ
high K
malignant hypertheria
K in succ
high K
4 RSI induction
fentanyl
etomidate
ketamine
propofol
RSI & their complications
Fentanyl - chest wall rigidity, low bp
etomidate - adrenal suppression
propofol - decrease CPP/MAP so not for head injury/hemodynamically unsatable
Ketamine - preserves larungeal function os airway protection
problem of ETomidate
adrenal suppression
RSI w/adrenal suppression
Etomidate
RSI that decreasnes CPP/MAP
propofol
who should not get ETomidate
anyone w/adrenal suppressio
who should not get propofol
decreases CPP/MAP so not for head injury/hemodynamically unstable
RSI that decreases CPP/MAP
propofol
don’t give to head injury/hemodynamicaly unstable
RSI that shoudl not be given to head injuries
NO propofol! b/c decreases CPP/MAP
RSI that should NOT be given to hemodynamically unstable
NO propofol! decreases CPP/MAP
important things to remember w/Propofol
milk of amnesia
NO analgesiaproperties
decreases CPP/MAP so don’t give to head injury or hemodyanmically unstable
good RSI if in shock
ketamine
SE of FLumazenil
low bp
position for ramping
ear to sternal notch
MacIntosh versus Miller blades
Mac = lifts epiglottis via the vallecula Miller = direct displacement of the epiglottis
preferred intubation blade for a pediatric
Miller = direct displacement of hte epiglottis
bougie size for adults versus kids
adults = 15Fr kids = 10F
confirm ETT placement -3
distal tip 2-3cm above carina
level T3-T4
visualizeing Murphy’s eye where teh clavicle meets
intubation pretreatment
LOAD
airway manipulation may cause relfexive sympathetatic response so elevate vials
best RSI for asthmatics
Ketamine b/c bronchoD
onset & duration of Ketamine
onset = 40 - 60 seconds duration = 10-20 minutes
3 properties of KEtamine
hypnotic
analgesic
amnesic
common SE w/Etomiate
common to vomit when awaken
contraindications to Etomidate
don’t use if adrenal suppresision, COPD, shock, Addisons or if hemodynamically unstable
onset & duration of ETomidate
15-45 second onset
lasts 3- 12 minutes
dosing of defasciculating rx as RSI pretreatmetn
1/10 dose of Roc/Vec prior to SUcc
atropine as RSI pretreatment
prevents reflexive bradycarida in under 1yo
lidocaine as RSI pretratment
blunts the cough reflex to prevent ICP increase
when do you hear apneurisitic respirations
decerebrate posturing
irregular breathing w/pauses & apnea
ataxic
BIot’s
quick shallow inspiration w/apnea
stroke & pressure on medulla during herniation
respirations in stroke
Biot’s
progressively deeper/faster then apnea
Cheyne-SToke
respirations in herniation
Cheyne-STokes *Cushings Triad
Biots medulla pressure
respirations in posturing
Cheyne-STokes - decorticate
apneurisitic - decerebrate
respiratory failure in ARDS
hypoxic respiratory failure
respiratory failure in pneumonia
hypoxic respiratiory failure
respiratory failure in CHF
hypoxic respiratory failure
diagnose hypoxic respiratory failure
pO2 under 60
treat hypoxic respiratory failure
increase oxygen concentration (FiO2 & PEEP)
*treatment assumes you have adequate tidal volume & rate
dx hypercarbic respiratory failure
ETCO2 over 45
ETCO2 over 45
hypercarbic respiratory failure
treatment of hypercarbic respiratory failure
increase tidal volume (pPLAT)
then rate increase
(double the minute volume (Ve - normal is 4-8L/min)
how to change Vt settings
over 8ml/kg can cause barotrauma
*slowly increae and reassess every 15min
Vt setting
4-8ml/kg of ideal body weight
pressure versus volume delivery
volume = preset volume is consistent. once Vt is reached, exhalation begins
pressure = preset inspiratory pressure. once the pressure is reached, exhalation begins
pPLAT
measures the pressure applied during PPV to smal airways/alveoli
*represents the end of inspiratory recoil
when is pPLAT mesured
during an inspiratory pause while on m. ventilation
ventilator setting where all aspects of the respiratory cycle are controlled & pt cannot override
controlled mandatory ventilationh
best ventilator setting for paralyzed or apneic
CMV
peferred ventilation setting for respiratory distress
Assist Control
who benefits from Assist Control
preferred ventilation setting for respiratory distress
trigger for breaths in Assist Control
pt or elapsed time
how does Assist Control work
full Vt each time regardless of if it is initiated by pt or the machine. will be supported each time
*irrespective of respiratory effort/drive
anxiety while on Assist Control
breath stacking/auto-PEEP
what ventilator setting can cause auto-peep
assist control
preferred ventilator setting for ARDS
assist control
ventilator supports every breath regardless of it is initiated by pt or the machine
Assist COntrol
problem of auto-peep
predisposes to barotrauma/hemodynamic compromise
increases WOB/effort to trigger the vnetilato
diminishes the forces generated by the respiratory muscles
how does SIMV work
if pt fails to take a breath, the ventilator will do it
*spontaneous breathing in-between breaths set to pre-set intervals
ventilator that allows pt to breathe in-between preset breaths
SIMV
ventilator lets pt breathe in-between preset intervals OR ventilator supports every breath but the pt can initiate
breathe in-between = SIMV
support each time but pt can initiate= AC
no pt control, all ventilatior = CMV
who benefits from SIMV
intact respiratory drive. can take their own breathes between pre-set intervals
best ventilator setting for intact respiratory drive
SIMV
how to use pressure support ventilation
makes it easier to overcome resistance of hte ET tube. often used during weaning b/c decreases WOB
good ventilator setting to help pt wean
pressure support ventilation (PSV)
good ventilator setting to help decrease WOB
Pressure Support Ventilation (PSV)
what does the pt determine in PSV
pressure support ventilation
*Vt & F
what does PSV do
pressure support ventilation
provides pressure during inspiration to decrease pt overall WOB
what does pt need to be able to do in order to use PSV
consistent vnetilation effort
pt determiens Vt, F (minute volume)(
pressure alarm if pneumo
high
pressure alarm if pt is hypovolemic
low
pressure alarm if ARDS
high
pt is bucking the ventilator
pt-ventilator dysynchrony
problem of pt bucking the ventilator
increased oxygen demand, WOB, vitals up. ICP up
how do you know if the pt-ventilator dyssynchrony is occurring
curare cleft
curare cleft
pt-ventilator dyssynchrony
6 ways to intervene w/pt-ventilator dyssynchrony
manage auto-peep adjust rate to pt demand adjust sensitivity/Ve suction analgesia/sedation
what settings should you look at if you have sudden acute respiratory deterioration while on m. ventilation
PIP (decrease/increase/no change)
pPLAT (no change or increased)
Ventilator Troubleshoot for acute resp deterioration
*PIP is decreased
3: air leak, hypo/hypervent
Ventilator Troubleshoot for acute resp deterioration
*no PIP change
consider PE
Ventilator Troubleshoot for acute resp deterioration
*PIP increased
next you must consider if the pPlat is increased or no change
Ventilator Troubleshoot for acute resp deterioration
- PIP increased
- pPLAT increased
abd distension atelectasis pneumo p. edema atelectasis pleural efflusion
Ventilator Troubleshoot for acute respiratory deterioration
- PIP increased
- pPLAT no change
airway obstruction
bronchospasm
ET cuff herniation
RASS scale
richmond agitation-sedation scale
+4 = combative
0= alert/calm
-4: deeply sedated
V/Q decreased
ventilation not keeping up w/perfusion
resp fail/pneumonia/ARDS/paO2, high pCO2
formula for V/Q
alveolar ventilation/CO
~0.8
low V/Q
normal V/Q
high V/Q
SAD
low: shunted. alveoli are ventilated but not perfused
A= ventilated and perfused
D= deadspace. alveoli are ventilated but not perfused
example of low V/Q
under 0.8
shunt
alveoli are perfused but not vented
ET in mainstem bronchus
V/Q if ET is in the mainstem bronchuis
low V/Q
shunted
perfusion w/o ventilation
acid-base in asthma
breathing out problem
r. acidosis b/c hypercarbic respiratory failure
CXR in asthma
flatted diaphragm
chest cavity is overexpanded due to air trapping
appearence of asthma on ETCO2
shark fin
shark fin ETCO2
asthma
ventilator intervention for asthma
increase I:E ratio to 1:4
b/c this is an exhalation problem
zero peep if possible
I:E setting on ventilator in an asthma attack
1:4 b/c this is an exhalation problem
PEEP if asthma attack
zero if possible
CXR of COPD
flattened diaphragm
chest cavity is expanded form air trapping
problem of COPD
breathing out
r. acidosis b/c hypercarbic rspiratory failure
benefit of increased I:E
more expiratory time increases CO2 clearence but it does carry a risk of atelectasis
*
CXR of pneumonia
patchy infiltrates
lobular consolidation
pathology of ARDS
diffuse alveolar injury
increased permeability of the alveolar-capillary barrier
influx of fluid into the alveolar space
CXR of ARDS
ground glass appearence
patchy infiltrates
bilateral diffuse infiltrates
CXR shows ground glass appearence
ARDS
Swan-Ganz findings in ARDS
high PAWP (18-20) b/c the right heart is pumping against the increased resistance in the lung vasculature)
consider if PAWP is high (18-20 range)
ARDS/ b/c the right heart is pumping against the increased resistance in the lung vasculature)
ARDS treatment -5
focus on oxygenation increase PEEP increase FiO2 lower Vt increase rate
PEEP setting in ARDS
increase
minimum 5
FiO2 setting in ARDS
increase
Vt setting in ARDS
decrese
F setting in ARDS
increase
IBW males
50 + 2.3(hight in inches - 60)
IBW females
45.5 + 2.3(height in inches -60)
3 criteria for ARDS
- PaO2/FiO2 under 300
- bilateral infiltrates consistent w/p. edema
- no clinical evidence of left arterial HTN
what lab indicates ARDS
PaO2/FiO2 under 300
pPLAT goal in ARDS
under 30
how often should you check pPLAT if on a ventilator for ARDS
q4 hrs
after each change in PEEP/Vt
intervention for ARDS if pPLAT is over 30
decrease Vt by 1ml/steps
intervention for ARDS if pPLAT is under 25 and Vt under 6ml;kg
increase Vt by 1ml/kg until pPlat is over 25 or Vt 6ml/kg
intervention for ARDS if pPLAT is under 30 & breath stacking is occurring
increase Vt in 1mk/kg increments to 7 or 8
abnormal labs in Tylenol overdose
LFT elevated
low glucose
phosphate abnormal
acid base in ASA overdose
r. alkalosis
can progress to m. acidosis
complications of ASA overdose
liver & brain damage
hepatic encephalopathy so high ICP
s/s of BB overdose
low bp/hr conduction delays low glucose p. edema bronchospasms
s/s of CaChB overdose
low bp/hr/conduction delays
high glucose
m. acidosis
treat CaChB overdsoe
activated charcoal
atropine/pacing
gluconate
IV F
EKG of digoxin overdose
slurred upstroke on QRS
risk of high K
overdose that has a slurred upstroke on the QRS
digoxin
K in digoxin overdose
high
avoid if digoxin overdose
avoid electricity like pacing/cardioversion
s/s of DIlantin overdose
SVT coma confusion tremors DI-like
4 s/s of cocaine overdose
CP
HTN
seizures
rhabdo
treat PCP
sedatives
no ketamine b/c delirum worsens
treat anticholinergic
physostigimine
physostigimine
anticholinergic overdose
amyl nitrite
sodium nitrite
sodum thiosulfate
cyanide
treat hydrocarbon overdose
intubation
overdose that is treated w/vitamin B6
INH
treat INH overdose
vitamin B6 (pyridoxine)
treatment is 2-PAM
organosphosphates
organophosphate treatment
atropine
2-PAM
what does tricyclic antidepressant overdose look like
anticholinergic
EKG of tricyclic antidepressant overdose
widened QRS
prolonged QT
treatment of tricyclic antidepressnat overdose
bicarb to get pH 7.5 - 7.55
vasopressors if low bp
ABG of toxic alcohols
lethal anion-gap of over 16
aka antifreeze
ethylene glycol
aka windshield wiper fluid
methanol
complications of hydrocarbon overdsoe
chemical pheumoitis
decreased viscosity causes aspiraiton
NO induce vomiting
toxidrome of pesticides
cholinergic
toxidrome is SLUDGE/DUMBELS
cholinergic
organophosphates
nerve gases like Vx/Sarin
toxidrome of VX/Sarin
SLUDGE?DUMBELS
cholinergic
examples of cholinergic toxidrome
organophosphates
nerve gases like VX, Sarin
s/s of nerve agents
cholinergic toxidrome
SLUDGE
DUMBBELS
nicotinic stimulation = tachycardia, HTN, fascuculations, paralyskis of respiratory muscles
DUMBBELS
diarrhea urinatino miosis bronchorrhea, bronchospasm emesis lacrimination sweating
death from organophosphates
respriatory muscle paralysis
treatment of organophosphate oversoe
atropine - decrease airway secreations
pralidoxime
2-PAM to crowbar organophsphate off of ACh
benzos for seizures
what type of overdose is atropine
anticholinergic
what type of overdose is benadryl
anticholinergic
what type of overdose is antidepressants
anticholinergic
mad as a hatter….
anticholinergic
anticholinergic oversoe s/s
mad as a hatter... blind as a bat -mydriasis red as a beet hot as a hare dry as a bone
mad as a hatter…
anticholinergic
atropine, benadry, antidepressants
level a-line
phlebostatic axis
4th ICS midaxillary
dicrotic notch
represents aortic valve closure
represents aortic valve closure
dicrotic notch
how to determine proper a-line pressure
no more/less than 3 ossilations before returning to normal
pressure = determine dampening
many ossillations = too little dampening so the ossilations won’t die and continue to reverbrate
to much prssure = overdampening
too little pressure - underdampening. system is too dynamic
air in a-line
too much pressure so overdampened
air in a-line if the tubing is noncompliant
underdampened = too little pressure
what does Swan-Ganz measure?
pulmonary artery catheter
R heart preload/afterload
L heart preload
insertion site of Swan-Ganz
central line into subclavian vein
PA catheter tips
distal tip = pressure
PA port = monitoring/lab samples
proximal = infusions/fluids
take wedge pressure
distal tip
1.5ml
end of exhalation
not for longer than 15 sec or 3 breaths
how to transport a PA catheter
deflate balloon to prevent inadvertent wedge with advance
balloon increases at altitude b/c BOyle’s law
dicrotic notch on left side of PA catheter waveform
RV waveform = tricuspid valve closing
dicrotic notch on the right side of the PA catheter waveform
PA waveform = pulmonic valve clsoing
measure R heart preload
CVP 2-6
Right ventricular pressure
15-25
0-5
Pulmonary Artery pressure
15-25
8-15
PAWP
8-12
right heat afterload
left heart preload
measure left heart preload
PAWP
measure right heart afterload
PAWP
normal coronary perfusion pressure
50-60
DBP - PAWP
normal CO
4-8 L/min
catheter whip
exaggereated waveforms w/elevated systolic pressure and additional peaks = excessive movement of the catheter within the artery
PA catheter has excessive movement within the artery
catheter wip
exaggerated waveforms & elevated systolic pressure
consider if PA catheter shows elevated systolic pressures
catheter whip
excessive movement within the artery
how to handle catheter whip
excessive movement of the catheter in teh artery elevated systolic pressure 1. inflate cuff w/1.5ml of air 2. cough 3. lay o right side
2 causes of inadvertent PA catheter wedge
balloon migration
Boyle’s law inflation
treat inadvertent wedge
you’ll see a PAWP waveform
- deflate the balloon
- cough
- reposition pt
- withdraw until you see a PA waveform
proper waveform to see if using PA catheter
PA waveform
SVR in hypovolemia
increaed
indirect estimate of left arterial pressure
PCWP = pulmonary capillary wedge pressure
CVP in cardiogenic shock
decreased
PAWP in hypovolemic shock
decreased
PACP in cardogenic shock
increased
normal SVR & PVR
SVR is 800 -1200
CVP in late septic shock
decreased
SVR in late septic shock
increased
CO in anaphylaxis
increaed
`CVP in anaphylaxis
decreased
PAWP in late anaphylaxis
decreased
PAWP that indicates IABP
PAWP over 18
2 effects of IABP
increase coronary perfusion
decrease heart workload
IABP during systole & diastole
deflated
inflated
insertion of IABP
into femoral vein towards teh heart into descending aorta. above renal arteries/below left subclavian
IABP in power failure
manually pump every 3-5 minutes to prevent clots
early IABP inflation
inflation before the aortic valve closes
forces blood back into the LV
IABP timing error when blood is forced back into the left ventricle
early inflation
effects of early IABP inflation
harmful
aortic regurgitation
decreased CO
increased SVR
shape of early inflantion of IABP
U
when does late inflation of IABP occur
inflation after the aortic valve closes
inflation of IABP after the aortic valve closes
late inflation
shape of late inflation of IABP
W
problem of late inflation
suboptimal augmentation
decreased coronary pressure
4 shapes of IABP timing errors
early inflate - U
late inflate W
early deflate- deflate
late deflate- widened
problems of early deflation
decreased negative pressure
deflation of bloon before systole
increaed afterload
when does the IABP deflate in early deflation
deflate before systole
worst IABP timing error
late deflation
what happens in late deflation of IABP
inflation of hte balloon during systole
thus increases afterload & workload
Impella
continuous flow pump
pulls blood from left ventricle and propels it back into the aorta
uses for ECMO
external oxygenation w/o PPV messing w/hemodynamics
ARDS, hypoxemia refraxtory to m. ventilation
pacing spikes are present but not followed by QRS
failure to capture
failure to capture
pacing spikes are present but not followed by QRS
3 causes of failure to capture
lead dislodged
low output
lead/pacer failure
pacemaker problem if low output
failure to capture
decreased or absent pacemaker function
failure to pace
failure to pace
decreased or absent pacemaker function
pacemaker problem if interference
failure to pace
pacemaker problem if wire fracture
failure to pace
causes of failure to pace
oversensing
wire frature
interference
lead displacement
undersensing
pacemaker fails to sense native cardiac activity
pacemaker fails to sense native cardiac activity
undersensing
pacemaker if new LBBB
undersensing
pacemaker if increased stimulus threshold at the electorde site
failure to sense/undersensign
pacemaker failure if poor lead contact
undersensing/failure to sense
causes of failure to sense
poor lead contact
new LBBB
increased stimulation threshold at electrode site
PVR
right heart afterload
SVR
left heart afterload
measures PVR/SVR
afterload of right versus left heart
measure afterload
PVR/SVR
3 causes of decreased afterload
alkalosis
hypocapnia
vasoD
pH & PVR
increased PVR = acid
decreasded PVR = alkalosis
CO2 & PVR
increased PVR in high CO2
PVR in ARDS
increased over 250
PVR in atelectasis
increased over 250
heart sound heard in hypertrophic cardiomyopathy
S4 b/c blood forced back into noncompliant
heart if high K
decreased conduction
inferior MI
blocked RCA
II, III, AvL
widowmaker
LCA block
basically the entire left sid eof hte heart is blocked
LAD block
anterior
septal
anteriorseptal
blocked in anterior MI
LAD
blocked in septal MI
LAD
LCX block
lateral
posterior
troponin times
onset 4
peak 14-2
duation 3-5
CK-MB times
onset 3-6
peak 12-24
duration 2-3
V2, V3, V4
anterior
LAD
anterior MI
V2, V3, V4
LAD
V1, V2, V3, V4
anteriorseptal
anteriorseptal MI
V1-V4
anterior versus anterioseptal
anterior V2-V4
anteriorseptal V1-V4
I, aVL, V5, V6
lateral MI
LCX
lateral MI
I, aVL, V5, V6
LCX
posterior MI
V1-V3
dominant R wave in V2
V1-V3
dominant R wave in V2
posterior MI
5 types of MI
posterior. V1-V4. LCX
anterior. V2-V4. LAD
inferior. II, III, aVL. RCA
lateral. I, aVL, V5, V6. LCX
septal. V1, V2. LAD
BBB
STEMI mimic
widened QRS in V1
Sgarbossa’s criteria
to determine if EKG changes are a variant of LBBB or a STEMI
when do you give fibrinoilytics s/p STEMI
within 12 hours of MI
contraindication fo fibrinolytics s/p STEMI
cannot be in cardiogenic shock
second line rx for bradycardia
dopamine
classes antiarrhythmics
Na Channel BLockers
BB
K Channel BLockers
CaChB
examples of K Channel BLockers
Amidarone
Sotalol
CaChB
vasoDI
negative I/D/C
HR & cholinergic
decreae HR
dobutamine
positive inotroph
pressors for hypovolemic shock
NE
dpoamine
pressors for cardiogenic shock
dobutamine
milrinone
indication for NE
hypovolemic shock
indication for dopamine
hypovolemic shock
indication for dobutamine
cardiogenic shock
indication for milrinone
cardiogenic shock
action of nitroprusside on preload/afterload
dilates so decreases
SVR and dopamine
increae SVR
SVR and nicardipine
decrease
s/s of endocarditis
osler nodes = painful red fingertips
janeway lesions - red lesions on palm/soles
EKG of Dressler Syndrome
global ST elevation
CXR of HF
butterfly/Kerly B lines
bilateraldiffuse infiltrates
dx mild HTN
BNP over 300
CXR of aortic dissection
widened mediastinum
loss of aortic knob
pleural efflusion
Graham’s Law
gaseous exchange at the cellular level
- rate of diffusion directly related to solubility
- inversely proprotional to square root of density
when does TUC change
1/2 if rapid decompression
gas law that explains soft tissue swelling at altitude
Daltons
Fick’s Law
diffusion of gas
- partial pressure, area of membrane
- inversely proprotional to the membrane thickness
Graham’s versus Fick’s Law
Graham: gas exchange at cellular level
(diffusion rate, solubility, density)
Fick’s
*partial pressure, area, membrane thickness)
Henry’s Law
solubility of gas r/t pressure above it
increased pressure = increased gas solubility
Gay-Lussac’s Lw
temp & pressure
increased diffusion = decreased molecular weight
Graham’s law
lower molecular weight diffuses easier
oxygen adjustment calculation for flight
FiO2 x P1
divided by P2
tooth pain when flying
pain on ascent as air trapped in fillings expands
ear pain when flyign
barotitis
face pain when flying
ascent & descent
mottled skin that looks like a sunburn: skin bends
cutis mamorata
skin bends s/s
cutis mamorata = sunburn
ants on skin
transport a diving injury
ground
pressurize to 1K
obese prior to flight
breathe 10L/min nonrebreather for 15min to nitrogen washout
anemic hypoxia
aka hypemic
hypoxic would be low oxygen
anemia in cardiogenic shock
stagnant
anemia in hemorrhage
hypemic
4 stages of hypoxia
indifferent
compensatory
disturbance
critical
stage of hypoxia where you act drunk
stage 3- disturbance
vitals in g force
low bp
2 types of peopel who are the most severely affected by high F forces
dehydrated
BP meds like BB
COBRA
protects uninsured pt from being denied hospital care or transfer inappropriately for inability to pay
distance from a hospital when you must treat on campus
250 yd rule
pilot rules
- training
- Area orientation
2K total hours
1K as pilot in charge
100 at night
5hr area orientation/2 night
general operating flight rules
Part 91
weather minimums under Part 91
none
flying passengers rules
Part 135
14hr day
8hr fly
squak code 1200
VIsual Flight RUles
squak code for gliders
1202
squak code 1202
gliders
squak code for hijack
7500
squak code for communication failure
7600
squak code 7600
communication failure
transponder code for emergency
7700
squak code 7700
emergency
air movement in autorotation
air moves up from below as the helicopter descends
pre/post crash sequence
pt flat
turn off oxygen
crash position
TFB
transmitter frquency of emergency locator
121.5 MHz
406
who does search and rescue
CONUS - civil air patrol
uswaters - coast guard
radio frequency blocked by hills/mt
VHF
limitation of VHF
radio frequency blocked by hills/mt
distance of VHF
long range line of sight 100km
air traffic control frequency
118-137 VHF
range of ultra high frequency
300MHz to 1GH
limits of ultra high frequency
blocked by hills/large bilidings
limited to visual horizon of 30-40 miles
can penetrate foliage/buildings for indoor
public safety radio system frequency
800 MHz
lights on aircraft wings
red is port
green is starboard
white is tail
ambient temperature of an ambulance
68-78 degrees
fuel range capacity of an ambulance
178 miles
ground clearnance of an ambulance
6 inches
range of audible siren & strobe light
> 500ft
how often shoudl you check fluid of an ambulance
twicea week
how often should you check tire pressures of an ambulance
twice a week
first law of motion
body in motion stays…
second law of motion
mass x accelertion
thrid law of motion
every action has an equal/opposite reaction
red & yellow catagory of STAT
immediate
delayed
blood loss inj class III shock
1500 - 2L
blood loss %
1 - under 15%
2- 15-30%
3- 30-40%
4. over 40%
what 2 values in blood hemorrhage chart are similar
RR & % blood loss
specific spinal cord fractures
C1- JEfferson
C2 = hangman
T12 - chance
burst fraxcture = severely compressed
ballance sign
dullness in LUQ tha tshifts
2 signs in spleen injuries
balance - dullness in LUQ that shifts
right flank dull
Kehr’s
dullness ot percussion in LUQ
Ballance sign
REBOA
resuscitative endovascualr balloon occlusion of hte aorta
*internal tourniquet to occlude blodo flow from the aorta until go to OR
blood in labia/scrotum
COopernail’s sign
suspect pelvic fracture
when do you suspect tension pneumo if on m. ventilation
sudden PIP/pPLAT increase
scaphoid abdomen on xcary
diaphragmic hernia
dxray of diaphragmic hernia
scaphoid hernia
Kussmaul’s sign
rise in venous pressure on inspiration
cardiac tamponade
when do you see paradoxial pusle
cardia tamonade
5 s/s in cardiac tamponade
pulsus paradous tachyardia Beck's Triad Kussmaul's sign electrical alternans
Beck’s Triad
in cardiac tamponade
JVD
narrow p[ulse pressure
muffled heart sounds
electrical alternans
EKG of cardiac tamponade
heat gets closer to and further away as it moves around inside the sac of fluid
pulmonary edema in blood transfusions
TRALI
treatment of TRALI
reaction to leukocyte antibodies
up to 6hr post transfusion
causes acute pulmonary edema
treat TACO
circulatory ocverload so give Lasix
uses of cryoprecipitate
hemophilia
DIC in trauma
von willebrand
treat von willebrand
cryo
treat hemophilia
cryo
what is cryo
created from FFP
conains factors
created from FFP
cryo
most common rd for trauma related DIC
cryo
acceptance of FFP
requires ABO compatibility but not Rh matching
needs ABO compatibility but not Rh matchin
FFP
reverses warfarin
FFP
uses for FFP
coagulation
reverse warfarin
make cryo
what is FFP
PRBC with RBC suspended
T&C for plt
not needed
T&C for FFP
ABO compatible but not Rh match
blood in anteior chamber of eye
hyphema
s/s of tracheobrachial disruption
occurs within 1.5 of carina
SC emphysema
Hamman’s Crunch
EKG of Rhabdo
peaked T
prolonged QT
landmarks for femoral line insertion
lateral to medial = NAVEL
nerve, artery, vein, lymph nose
rules for pilots wearing oxygen
10-12K if unpressureized over 30 minutes
always over 12K
rules for passengers weraing oxygen
12-14K minimum crew wars if over 30min
all over 15
rate at which temperature and altitude change
lapse rate
3.5F per 1K ft
pain in GI w/altitude
ascend = pain worse descend = pain better
4 stages of hypoxia
indifferent = up to 10K
compensatory = 10-15
disturbance= 15-20K
critical - over 20K
TUC 18K ft
20/30min
10-15 if rapid decompression
TUC i25K ft
3-5min
TUC 30K ft
1-2 minutes
TUC ar 35Kft
30-60sec
decibels of a single engine cockpit
70-90 db
F if on a ventilator for ARDS
18-22
PEEP if on a ventilator for ARDFS
over 10
Vt if ARDS
low
4ml/kg
ventilator settings for ARDS
peep over 10
high FIO2
low Vt like 4ml/kg
increase F to 18-22
Swan-Ganz of ARDS
high PAWP (18-20) pressure is higher than normal b/c right heart is pumping against increased resistance in teh lung vasculature
CXR of ARDS
ground glass
patchy infiltates
bilaterlal diffuse infiltrates
rule of 9’s legs
9%
rule of 9’s chest/abdomen
each are 9%
rule of 9’s head
4.5%
rule of 9;s arms
4.5%
burn transfer center critieria for parital thickness
transfer if partial thickness is over 10% TBSA
gas law that explains hypoxic hypoxia
Graham’s
R on T phemenon
A PVC close to or at the same time as T so R & T at the same time. Ventricular repolarization (T) at the same time as the PVC so the cells assume thr ventricular rhythm as the dominant one which can lead to Hemodynamic instability
R on T phemenon
A PVC close to or at the same time as T so R & T at the same time. Ventricular repolarization (T) at the same time as the PVC so the cells assume thr ventricular rhythm as the dominant one which can lead to Hemodynamic instability
3 causes of PVC
Low K, heart disease, hypoxia
