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CFRN Back to Basics Book > CFRN Back to Basics Book > Flashcards

CFRN Back to Basics Book Flashcards

1
Q

Clinical Signs: Kehr’s, Kernig’s, Brudzinski’s, Hamman’s

A

Kerr’s: L shoulder pain - Splenic injury/ectopic. Kernig’s: back, leg, pain on knee extension - meningitis. Brudzinski’s: Back, leg pain on flexion - Meningitis, SA Hemorrhage. Hamman’s: Crunching on anterior chest - tracheobronchial injury

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2
Q

Xrays: Steeple, Thumbprint

A

Steeple: Croup. Thumbprint: Epiglottitis

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3
Q

Drugs given for AAA

A

Nipride, beta blockers

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4
Q

What do you adjust first on vent settings?

A

Tidal volume first

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5
Q

Most common dislocation

A

Hip

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6
Q

Most common spontaneous reoccurrence

A

Anterior shoulder

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7
Q

Values for BNP

A

Below 100 is normal, 500-700+ = <3 failure

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8
Q

Rotor wing pilot required hours

A

2000 hours. 1000 PIC, 100 night hours

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9
Q

Bottle to throttle?

A

8 hours

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10
Q

What does CVP measure

A

Preload, aka R atrial pressrue

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11
Q

Normal CVP

A

2-6 mmhg

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12
Q

Which port do you use on CVP catheter

A

Proximal port

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13
Q

CVP Catheter placement outside line marker, RA/CVP

A

25-30 cm

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14
Q

CVP Catheter placement outside line marker, RV

A

35-45 cm

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15
Q

CVP Catheter placement outside line marker, PA

A

50-55

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16
Q

Anterior cord syndrome

A

Complete motor, pain, and temp loss below the lesion

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17
Q

Brown-sequard syndrome

A

ipsilateral loss of motor, position, and vibration sense; contralateral loss of pain and temp perception

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18
Q

Central cord syndrome

A

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

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19
Q

Autonomic dysreflexia

A

urinary retention, massive increase in sympathetic tone which causes HTN. Tx - foley

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20
Q

Normal urinary output (adult & ped)

A

30-50mL/hr

1-2 mL/kg/hr

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21
Q

Normal blood volume (adult & ped)

A

70 mL/kg

80 mL/kg

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22
Q

Normal temps, mild, moderate, severe hypothermia sx

A

37.6
Mild: 32-36
Moderate 29-32 (Loss of shivering, ALOC)
Severe: 20-28 (coma, vf)

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23
Q

Major causes of heat loss and when thermoregulation ceases

A

Radiation & evaporation. Ceases at 28 degrees

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24
Q

Rules of flight

A

Sterile cockpit during phase of flight, 15 min. max between comm center during flight, 45 min max while on ground

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25
Q

Rotor wing shut off sequence

A

Throttle, fuel, battery (TFB), survival bag, meet at 12 o’clock

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26
Q

Survival sequence

A

Shelter, fire, water, food

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27
Q

Abdomen inspection order

A

Inspect, auscultate, palate, percuss

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28
Q

Contraindications for thrombolytics

A

Hx hemorrhagic CVA, CVA < 12 months, SBP > 180, pregnancy or 1 month post partum

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29
Q

FARs

A

Part 91: No passengers. Part 135: Passengers (14 hours max for pilots)

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30
Q

Local flying area determined by

A

Certificate holder

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31
Q

Cell phones are prohibited when

A

while airborne

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32
Q

What is PaO2

A

Plasma measured as pressure

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33
Q

What is SaO2

A

Hemoglobin measured as percentage

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34
Q

Bariobariatrauma

A

Nitrogen release in obese patients, administer high flow O2 within 15 minutes to lift for nitrogen wash out

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35
Q

When does pediatric BP drop?

A

Last to go

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36
Q

Normal pediatric SBP/DBP

A

90 + (2 x age) | DBP 2/3 SBP

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37
Q

3 killers of vent patients during flight

A

Pericardial tamponade, tension pneumo, hypovolemia

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38
Q

Death from crush injuries is due to

A

renal failure

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39
Q

Complications of crush injuries

A

DIC, compartment syndrome, renal failure, hyperkalemia

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40
Q

CAMTS: Medical director not required to

A

live in same state

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41
Q

CAMTS: Intubation requirements

A

Quarterly

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42
Q

CAMTS: Live intubation required during training

A

5

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43
Q

CAMTS: Specialty team response time

A

45 min

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44
Q

CAMTS: Pilot area orientation day/night

A

5 day hours, 2 night hours

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45
Q

CAMTS: Helipad required to have

A

2 paths, security

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46
Q

CAMTS: Fixed wing twin engine time

A

500 hours

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47
Q

CAMTS: Ambulance fuel requirement

A

175 miles

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48
Q

CAMTS: ELT set off at

A

4 g’s

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49
Q

CAMTS: Uniform fit

A

1/4 in space between body/uniform

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50
Q

Henry’s law

A

The bends, decompression, soda can, CO2 in blood

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51
Q

Dalton’s law

A

Tissue swelling, hypoxic hypoxia, O2 available @ altitude

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52
Q

Graham’s law

A

Cellular gas exchange, diffusion

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53
Q

Gay-Lussac’s law

A

Oxygen tank pressure in heat/cold

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54
Q

Boyle’s law on IABP

A

purges with ascent and descent

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55
Q

High velocity

A

above 2000 fps

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56
Q

medium velocity

A

1000-2000 fps

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57
Q

low velocity

A

below 1000 fps

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58
Q

tumbling & yaw

A

tumbling is rotation 360 degree axis. yaw is deviation up to 90 degrees from straight path

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59
Q

Normal CVP

A

2-6

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60
Q

Normal cardiac output

A

SV x HR (4-8 L/min)

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61
Q

Normal cardiac index

A

2.5-4.2

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62
Q

Normal pulmonary artery systolic/diastolic

A

15-25/8-15

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63
Q

Normal PAWP/wedge

A

8-12

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64
Q

Normal SVR

A

800-1200 dynes/sec/cm

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65
Q

When do you assess CVP or PA on vent pt

A

Pressure @ end of exhalation

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66
Q

Chest tube location

A

4th intercostal space anterior axillary line

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67
Q

Normal needle thoracostomy

A

Second intercostal space mid clavicular (anterior, 5th ICS)

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68
Q

Scaphoid abdomen indication

A

aortic disruption/diaphragmatic rupture

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69
Q

Abruptio placenta

A

Dark red & painful

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70
Q

Placenta previa

A

Bright red, painless

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71
Q

Terbutaline dose/route

A

0.25 SQ

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72
Q

PP hemorrhage

A

500 mL >

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73
Q

Uterine rupture

A

Can palpate fetal parts over abdomen

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74
Q

When do effects of altitude worsen

A

Cold upper latitudes

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75
Q

Components of Gay Lussac’s law

A

Temperature/pressure increases. Temperature/pressure decreases

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76
Q

Example of gay lussac’s law

A

O2 take pressure 2200 in afternoon, drops to 1800 in evening due to temperature/pressure decline

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77
Q

Universal law

A

Combines Boyle’s and Charles’ laws

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78
Q

Graham’s law definition

A

Gas moves from high to low concentration

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79
Q

Graham’s law effects

A

Gas through liquid, cellular gas exchange

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80
Q

Henry’s law definition

A

Gas in liquid proportional to gas above liquid

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81
Q

Henry’s law example

A

The bends, CO2 in blood, decompression

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82
Q

Golume of gas in GI expands thrice at what altitude?

A

25,000 feet

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83
Q

What law affects the GI the most

A

Boyle’s law

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84
Q

2 components of boyle’s law

A

Increased volume = decreased pressure

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85
Q

Examples of boyle’s law

A

Cuffs, MAST, GI, ETT, IABP

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86
Q

Charles’ law components

A

Temperature and volume are proportional

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87
Q

Effects of Charles’ law

A

Up to 100 meters = down 1 degree C

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88
Q

Passive rewarming

A

Mild hypothermia only! Blankets, heater

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89
Q

Active rewarming

A

Apply heat to body

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90
Q

Warm and dead?

A

32 celcius

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91
Q

Heat stroke

A

> 42 celcius

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92
Q

Grey turner’s sign

A

Flank bruising (retroparitonal bleeding)

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93
Q

Coopernail’s sign

A

Scrotum/labia (abdominal/pelvic bleeding)

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94
Q

Halstead’s sign

A

Marbled abdomen (Bleeding)

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95
Q

Cullen’s sign

A

Umbilical discoloration (pancreatitis)

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96
Q

Murphy’s sign

A

RUQ pain with inspiration (gallbladder)

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97
Q

Levine’s sign

A

Fist to chest (cardiac)

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98
Q

Hypoxic hypoxia

A

Altitude hypoxia, decreased alveolar oxygen, tension pneumo (altitude! )

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99
Q

Hypemic hypoxia

A

Decreased O2 carrying capacity in blood

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100
Q

Hisotoxic hypoxia

A

Poisoning (nitrates)

101
Q

Stagnant hypoxia

A

Decreased cardiac output (g-forces, CHF)

102
Q

Cardiogenic shock: CVP, cardiac output, cardiac index, PAS/PAD, PAWP, SVR, HR

A

high, low, low, high, high, high, HR fast then slows

103
Q

Normal fetal heart rate

A

120-160

104
Q

Factors in fetal well being

A

FHR, movement, variability

105
Q

Most important factor

A

Variability

106
Q

Treatment for fetal distress

A

LOCK: Left lateral recumbent, oxygen, correct factors, keep reassessing

107
Q

CHF considerations:

A

Most are hypovolemic, be cautious of diuretics or meds that < preload

108
Q

Meds for CHF

A

No beta blockers except for carvidolol or coreg. Neseritide is the synthetic version of BNP

109
Q

1 cause of death for vent dependent pts

A

Vent acquiried pneumonia

110
Q

Digoxin class

A

Cardiac glycoside

111
Q

Digoxin causes what electrolyte imbalance

A

Hypokalemia

112
Q

Dig causes what EKG changes

A

ST depression (dig dip)

113
Q

Treatment for ARDS

A

PEEP

114
Q

Effects of PEEP & normal range

A

Increased pulmonary vascular resistance. Normal range 3-5 cm h2o

115
Q

Normal physiologic of PEEP

A

Cause cause hypotension over 15 cm h2o

116
Q

When do you treat HTN

A

Systolic over 220 or map over 130

117
Q

Dehydration raises what electrolyte

A

Sodium. Normal is 135-145

118
Q

Objective data is

A

ABCs, neuro assessment, AEIOUTIPS

119
Q

Bowel sounds in chest cavity mean

A

diaphragmatic rupture, most common in L chest

120
Q

Crunching sound heard over chest with auscultation may be synced with heart beat

A

Tracheobronchial injury, hamman’s sign

121
Q

Preferred method for moving injured pts

A

Scoop stretcher over log roll

122
Q

Differential diagnosis: pulmonary contusion

A

Low sats despite O2, rales

123
Q

Differential diagnosis: ruptured diaphragm

A

Chest pain/abd pain to L shoulder

124
Q

Differential diagnosis: Tracheobronchial injury

A

Hemoptysis, sub-q air, air leak with chest tube

125
Q

ET tube with tracheobronchial injury

A

Advance tube below level of injury into right mainstem

126
Q

Differential diagnosis: Esophageal perforation

A

Fever, hematemesis

127
Q

Differential diagnosis: Fat embolus

A

Fever, rash after fracture

128
Q

Blood loss in humerus fracture

A

750 mL

129
Q

Blood loss in femur fracture

A

1500 mL

130
Q

What does PAWP/PCWP mean

A

Pulmonary artery wedge pressure/pulmonary capillary wedge pressure

131
Q

Function of PAWP/PCWP

A

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

132
Q

Normal PAWP/PCWP

A

8-12 mm Hg

133
Q

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

A

.

134
Q

ETT depth in adults

A

3 x ETT size or average is 19-23 cm

135
Q

ETT depth in kids

A

10 + age in years

136
Q

ETT depth in neonates

A

6 + weight in kg

137
Q

How to adjust CO2 in vent

A

Adjust rate, TV

138
Q

How to change oxygenation in vent

A

Adjust PEEP, PAP

139
Q

Parkland formula

A

4 mL x kg x BSA

140
Q

How to administer fluids using parkland formula

A

1/2 over first 8 hours, rest over 16 hours

141
Q

Concensus formula

A

2-4 mL x kg x TBSA

142
Q

How to administer fluids using concensus formula

A

1/2 over 1st 8 hours, rest over next 16 hours

143
Q

ELT frequency

A

121.5

144
Q

How to confirm ELT working

A

Tune in, listen

145
Q

Twin engine requirements off shore

A

Raft, vest

146
Q

Induction agent of choice with bronchospastic patients

A

ketamine

147
Q

Indications for Ativan, dose, max

A

seizures. 1-2 mg with a max of 4 mg

148
Q

Mannitol dose

A

1-2 g/kg

149
Q

Drug choice of tricyclic antidepressant overdose

A

Sodium bicarb

150
Q

Drug choice for beat blocker OD

A

glucagon

151
Q

Dose of fentanyl

A

3 mcg/kg

152
Q

Treatment for malignant hyperthermia

A

Dantrium (dantrolene)

153
Q

Drug used for GI bleeds

A

sandostatin (octerotide)

154
Q

Neurogenic shock: CVP, CO, CI, PAWP/PCWP, SVR, HR

A

down, down, down, down, down

155
Q

What kind of shock is neurogenic shock

A

distributive

156
Q

Sites for art lines

A

radial & femoral

157
Q

Purpose of art lines

A

Monitor pressure, blood draws, abgs

158
Q

Pressure bag for art line needs to be maintained at

A

300 mgHg

159
Q

Underdampening

A

Caused by air in system, loose connection, low pressure bag, altitude changes

160
Q

Overdampening

A

Kinking, increased bag pressure, tip against the wall

161
Q

Most common reprofusion dysrhythmia

A

AVIR

162
Q

Most common hypothermia dysrhythmia

A

VF with an Osborn wave

163
Q

Hypokalemia presents on EKG with

A

Peaked P’s, flat T’s

164
Q

Hyperkalemia presents on EKG with

A

flat P’s, peaked T’s

165
Q

Treatment for hyperkalemia

A

calcium

166
Q

MAP goal with CHI

A

80-100

167
Q

CPP goal with increased ICP

A

70-90

168
Q

Normal ICP

A

0-10

169
Q

Normal CPP (head)

A

70-90

170
Q

Normal MAP

A

80-100

171
Q

Normal for the other CPP (heart)

A

50-60 (head higher than heart)

172
Q

CPP (head) formula

A

MAP-ICP

173
Q

MAP formula

A

2 x diastolic + systolic / 3

174
Q

CPP (heart) formula

A

DBP - wedge

175
Q

Rotor wing minimums ceiling/visibility: Day/local

A

500 foot ceiling 1 mile visibility

176
Q

Rotor wing minimums ceiling/visibility: Day/cross country

A

1000 foot ceiling 1 mile visibility

177
Q

Rotor wing minimums ceiling/visibility: Night/local

A

500 foot ceiling 2 mile visibility

178
Q

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

A

1000 foot ceiling 3 mile visibility

179
Q

Number one cause of air med crashes

A

controlled flight into terrain, pushing the weather

180
Q

Normal potassium

A

3.5-5.5

181
Q

Normal sodium

A

135-145

182
Q

Normal choloride

A

95-105

183
Q

Normal calcium

A

8.5-10.5

184
Q

What does metabolic acidosis elevate

A

Potassium

185
Q

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

A

90 seconds

186
Q

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

A

Under 15 seconds (least amount of time is exam answer!)

187
Q

Cardic ischemia

A

ST depression

188
Q

Cardiac injury

A

ST elevation

189
Q

Cardiac infarct

A

Q wave > 25% of the R wave

190
Q

Peds ETT cuffed vs uncuffed

A

Uncuffed under 10

191
Q

Needle cricothyrotomy in peds

A

Only under 11

192
Q

Nasal intubation in peds

A

Not under 12

193
Q

Primary cause of PTL

A

Infection

194
Q

Terbutaline contraindications

A

IDDM, maternal HR > 120, vag bleeding

195
Q

PIH triad signs

A

HTN, edema, proteinuria

196
Q

O2 adjustment calculation to maintain sats at altitude

A

% O2 patient is already on times pressure at departure pressure at ????????????????????????????????????????????????????????????????

197
Q

Vent modes: CMV

A

present volume or PIP at set rate, can’t initiate breath

198
Q

Vent modes: AC

A

Preset volume or PIP with every breath, can trigger breath, can’t control tidal volume

199
Q

Vent modes: IMV/SIMV

A

Preset breaths, TV, PIP, patient breaths allowed

SIMV allows variation of support

200
Q

IABP: Action

A

Increases cardiac output, coronary profusion

201
Q

IABP: Deflates

A

During ventricular systole

202
Q

IABP: Dicrotic notch

A

Aortic valve closing, sync with a line or EKG (most common trigger)

203
Q

IABP: S/s of balloon leak

A

Blood specs in tubing, alarm

204
Q

IABP: Clot prevention

A

Cycle manually q 30 min

205
Q

IABP increases CO by

A

10-20%

206
Q

IABP: Balloon rupture

A

Rusty flakes in line, turn machine off

207
Q

IABP: migration/dislodged

A

Assess left radial and urine output

208
Q

Lethal IABP timing cycles

A

Late deflation/early inflation

209
Q

Oxyhemoglobin disassociate curve left shift

A

Alkalosis, low hgb holding oxygen. L STANDS FOR ALKALOSIS. Low CO2, low temp, low DPG, myxedema coma

210
Q

Oxyhemoglobin disassociation curve right shift

A

R stands for raised. Acidosis. Raise = right = releases oxygen. Raised CO2, raised temp, raised DPG, thyroid storm

211
Q

Where is the phlebostatic axis and what is it

A

Where pressure measurements made with invasive line. Fourth intercostal space, level of atria

212
Q

Boyle’s law on ascent

A

Barondontalgia (tooth ache), Barosinusitis can occur. Bariobariatrauma = nitrogen in fat cells can expand causing the bends, give high flow o2 15 minutes prior to lift off to remove nitrogen to prevent this

213
Q

Boyle’s law on descent

A

Barotitis media can affect pts

214
Q

Mild hypertension

A

140-159/90-99

215
Q

Moderate htn

A

160-179/100-109

216
Q

Severe htn

A

180+/110+

217
Q

Volume for RBC administration

A

10 mL/kg

218
Q

Volume for WBC’s

A

20 mL/kg

219
Q

ABG rules: CO2 and pH

A

CO2 up 10 = pH down 0.08

220
Q

ABG rules: Bicarb and pH

A

HCO3 up 10 = pH up 15 (proportional)

221
Q

Bicarb replacement

A

kg/4 x base deficit = meq of bicarb to give

222
Q

PaO2 at altitude drops

A

drops 5 for every 1000 feet elevation

223
Q

Hypoxia: elevation & s/s: Indifferent

A

10,000 feet MSL: increased HR and RR, decreased night vision

224
Q

Hypoxia: elevation & s/s: Compensatory

A

10,000-15,000 feet MSL: HTN, task impairment

225
Q

Hypoxia: elevation & s/s: Disturbance

A

15,000-20,000 feet MSL: Dizzy, sleepy, cyanotic

226
Q

Hypoxia: elevation & s/s: Critical

A

20,000-30,000 feet MSL: ALOC, incapacitated

227
Q

Night vision is lost at

A

5,000 MSL

228
Q

PA Catheter: Named

A

Swan-ganz

229
Q

PA Catheter: Proximal port use

A

CVP, meds

230
Q

PA Catheter: S/s for bad placement

A

VT, ventricular ectopy

231
Q

PA Catheter: What do you do for bad placement

A

Float forward to PA or pull back to RA

232
Q

PA Catheter: Measure?

A

R heart directly, L heart indirectly

233
Q

PA Catheter: Which port is used

A

Distal

234
Q

PA Catheter: Pressure bag set to

A

300 mmHg

235
Q

Normal cardiac index

A

2.5-4.3

236
Q

Stressors of flight (9)

A

third spacing, fatigue, g-forces, noise, vibration, hypoxia, dehydration, temp changes, barometric pressure changes

237
Q

Dalton’s law definition

A

Sum total of partial pressures equal to total atmospheric pressures

238
Q

Examples of Dalton’s Law

A

Tissue swelling, altitude hypoxia, hypoxic hypoxia

239
Q

What law shows why we need O2 at altitude

A

Dalton’s law

240
Q

Cardiac thrombolytics must be administered within

A

3 hours of chest pain onset

241
Q

Hypovolemic shock: CVP, CO, CI, Wedge, SVR, HR

A

Down, down, down, down, high, fast

242
Q

Values for acute respiratory failure

A

pO2 below 60, pCO2 above 50

243
Q

Newton’s first law

A

An object in motion tends to stay in motion

244
Q

Newton’s second law

A

Force = mass x acceleration

245
Q

Newton’s third law

A

Ever action has an equal and opposite reaction

246
Q

Tetralogy of fallot

A

PROV: Pulmonary stenosis, right ventricular hypertrophy, overriding aorta, ventral septal defect VSD

247
Q

Tet spell

A

Right ventricular outflow of blood is decreased, causing right to left shunt out of VSD out of aorta, bypassing lungs

248
Q

Atrial waveforms: CVP

A

R atrial pressure

249
Q

Atrial waveforms: PAWP/PCWP

A

Left atrial pressure

CFRN Back to Basics Book (1 decks)

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