CFRN Back to Basics Book Flashcards
Clinical Signs: Kehr’s, Kernig’s, Brudzinski’s, Hamman’s
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
Xrays: Steeple, Thumbprint
Steeple: Croup. Thumbprint: Epiglottitis
Drugs given for AAA
Nipride, beta blockers
What do you adjust first on vent settings?
Tidal volume first
Most common dislocation
Hip
Most common spontaneous reoccurrence
Anterior shoulder
Values for BNP
Below 100 is normal, 500-700+ = <3 failure
Rotor wing pilot required hours
2000 hours. 1000 PIC, 100 night hours
Bottle to throttle?
8 hours
What does CVP measure
Preload, aka R atrial pressrue
Normal CVP
2-6 mmhg
Which port do you use on CVP catheter
Proximal port
CVP Catheter placement outside line marker, RA/CVP
25-30 cm
CVP Catheter placement outside line marker, RV
35-45 cm
CVP Catheter placement outside line marker, PA
50-55
Anterior cord syndrome
Complete motor, pain, and temp loss below the lesion
Brown-sequard syndrome
ipsilateral loss of motor, position, and vibration sense; contralateral loss of pain and temp perception
Central cord syndrome
Greater motor weakness in UE than LE with varying degrees of sensory loss
Autonomic dysreflexia
urinary retention, massive increase in sympathetic tone which causes HTN. Tx - foley
Normal urinary output (adult & ped)
30-50mL/hr
1-2 mL/kg/hr
Normal blood volume (adult & ped)
70 mL/kg
80 mL/kg
Normal temps, mild, moderate, severe hypothermia sx
37.6
Mild: 32-36
Moderate 29-32 (Loss of shivering, ALOC)
Severe: 20-28 (coma, vf)
Major causes of heat loss and when thermoregulation ceases
Radiation & evaporation. Ceases at 28 degrees
Rules of flight
Sterile cockpit during phase of flight, 15 min. max between comm center during flight, 45 min max while on ground
Rotor wing shut off sequence
Throttle, fuel, battery (TFB), survival bag, meet at 12 o’clock
Survival sequence
Shelter, fire, water, food
Abdomen inspection order
Inspect, auscultate, palate, percuss
Contraindications for thrombolytics
Hx hemorrhagic CVA, CVA < 12 months, SBP > 180, pregnancy or 1 month post partum
FARs
Part 91: No passengers. Part 135: Passengers (14 hours max for pilots)
Local flying area determined by
Certificate holder
Cell phones are prohibited when
while airborne
What is PaO2
Plasma measured as pressure
What is SaO2
Hemoglobin measured as percentage
Bariobariatrauma
Nitrogen release in obese patients, administer high flow O2 within 15 minutes to lift for nitrogen wash out
When does pediatric BP drop?
Last to go
Normal pediatric SBP/DBP
90 + (2 x age) | DBP 2/3 SBP
3 killers of vent patients during flight
Pericardial tamponade, tension pneumo, hypovolemia
Death from crush injuries is due to
renal failure
Complications of crush injuries
DIC, compartment syndrome, renal failure, hyperkalemia
CAMTS: Medical director not required to
live in same state
CAMTS: Intubation requirements
Quarterly
CAMTS: Live intubation required during training
5
CAMTS: Specialty team response time
45 min
CAMTS: Pilot area orientation day/night
5 day hours, 2 night hours
CAMTS: Helipad required to have
2 paths, security
CAMTS: Fixed wing twin engine time
500 hours
CAMTS: Ambulance fuel requirement
175 miles
CAMTS: ELT set off at
4 g’s
CAMTS: Uniform fit
1/4 in space between body/uniform
Henry’s law
The bends, decompression, soda can, CO2 in blood
Dalton’s law
Tissue swelling, hypoxic hypoxia, O2 available @ altitude
Graham’s law
Cellular gas exchange, diffusion
Gay-Lussac’s law
Oxygen tank pressure in heat/cold
Boyle’s law on IABP
purges with ascent and descent
High velocity
above 2000 fps
medium velocity
1000-2000 fps
low velocity
below 1000 fps
tumbling & yaw
tumbling is rotation 360 degree axis. yaw is deviation up to 90 degrees from straight path
Normal CVP
2-6
Normal cardiac output
SV x HR (4-8 L/min)
Normal cardiac index
2.5-4.2
Normal pulmonary artery systolic/diastolic
15-25/8-15
Normal PAWP/wedge
8-12
Normal SVR
800-1200 dynes/sec/cm
When do you assess CVP or PA on vent pt
Pressure @ end of exhalation
Chest tube location
4th intercostal space anterior axillary line
Normal needle thoracostomy
Second intercostal space mid clavicular (anterior, 5th ICS)
Scaphoid abdomen indication
aortic disruption/diaphragmatic rupture
Abruptio placenta
Dark red & painful
Placenta previa
Bright red, painless
Terbutaline dose/route
0.25 SQ
PP hemorrhage
500 mL >
Uterine rupture
Can palpate fetal parts over abdomen
When do effects of altitude worsen
Cold upper latitudes
Components of Gay Lussac’s law
Temperature/pressure increases. Temperature/pressure decreases
Example of gay lussac’s law
O2 take pressure 2200 in afternoon, drops to 1800 in evening due to temperature/pressure decline
Universal law
Combines Boyle’s and Charles’ laws
Graham’s law definition
Gas moves from high to low concentration
Graham’s law effects
Gas through liquid, cellular gas exchange
Henry’s law definition
Gas in liquid proportional to gas above liquid
Henry’s law example
The bends, CO2 in blood, decompression
Golume of gas in GI expands thrice at what altitude?
25,000 feet
What law affects the GI the most
Boyle’s law
2 components of boyle’s law
Increased volume = decreased pressure
Examples of boyle’s law
Cuffs, MAST, GI, ETT, IABP
Charles’ law components
Temperature and volume are proportional
Effects of Charles’ law
Up to 100 meters = down 1 degree C
Passive rewarming
Mild hypothermia only! Blankets, heater
Active rewarming
Apply heat to body
Warm and dead?
32 celcius
Heat stroke
> 42 celcius
Grey turner’s sign
Flank bruising (retroparitonal bleeding)
Coopernail’s sign
Scrotum/labia (abdominal/pelvic bleeding)
Halstead’s sign
Marbled abdomen (Bleeding)
Cullen’s sign
Umbilical discoloration (pancreatitis)
Murphy’s sign
RUQ pain with inspiration (gallbladder)
Levine’s sign
Fist to chest (cardiac)
Hypoxic hypoxia
Altitude hypoxia, decreased alveolar oxygen, tension pneumo (altitude! )
Hypemic hypoxia
Decreased O2 carrying capacity in blood
Hisotoxic hypoxia
Poisoning (nitrates)
Stagnant hypoxia
Decreased cardiac output (g-forces, CHF)
Cardiogenic shock: CVP, cardiac output, cardiac index, PAS/PAD, PAWP, SVR, HR
high, low, low, high, high, high, HR fast then slows
Normal fetal heart rate
120-160
Factors in fetal well being
FHR, movement, variability
Most important factor
Variability
Treatment for fetal distress
LOCK: Left lateral recumbent, oxygen, correct factors, keep reassessing
CHF considerations:
Most are hypovolemic, be cautious of diuretics or meds that < preload
Meds for CHF
No beta blockers except for carvidolol or coreg. Neseritide is the synthetic version of BNP
1 cause of death for vent dependent pts
Vent acquiried pneumonia
Digoxin class
Cardiac glycoside
Digoxin causes what electrolyte imbalance
Hypokalemia
Dig causes what EKG changes
ST depression (dig dip)
Treatment for ARDS
PEEP
Effects of PEEP & normal range
Increased pulmonary vascular resistance. Normal range 3-5 cm h2o
Normal physiologic of PEEP
Cause cause hypotension over 15 cm h2o
When do you treat HTN
Systolic over 220 or map over 130
Dehydration raises what electrolyte
Sodium. Normal is 135-145
Objective data is
ABCs, neuro assessment, AEIOUTIPS
Bowel sounds in chest cavity mean
diaphragmatic rupture, most common in L chest
Crunching sound heard over chest with auscultation may be synced with heart beat
Tracheobronchial injury, hamman’s sign
Preferred method for moving injured pts
Scoop stretcher over log roll
Differential diagnosis: pulmonary contusion
Low sats despite O2, rales
Differential diagnosis: ruptured diaphragm
Chest pain/abd pain to L shoulder
Differential diagnosis: Tracheobronchial injury
Hemoptysis, sub-q air, air leak with chest tube
ET tube with tracheobronchial injury
Advance tube below level of injury into right mainstem
Differential diagnosis: Esophageal perforation
Fever, hematemesis
Differential diagnosis: Fat embolus
Fever, rash after fracture
Blood loss in humerus fracture
750 mL
Blood loss in femur fracture
1500 mL
What does PAWP/PCWP mean
Pulmonary artery wedge pressure/pulmonary capillary wedge pressure
Function of PAWP/PCWP
Looks at L side of heart, if high can indicate pulmonary congestion, CHF, and cardiogenic shock
Normal PAWP/PCWP
8-12 mm Hg
Do not keep wedged for more than 15 seconds, make sure that balloon is deflated and have pt cough forcefully
.
ETT depth in adults
3 x ETT size or average is 19-23 cm
ETT depth in kids
10 + age in years
ETT depth in neonates
6 + weight in kg
How to adjust CO2 in vent
Adjust rate, TV
How to change oxygenation in vent
Adjust PEEP, PAP
Parkland formula
4 mL x kg x BSA
How to administer fluids using parkland formula
1/2 over first 8 hours, rest over 16 hours
Concensus formula
2-4 mL x kg x TBSA
How to administer fluids using concensus formula
1/2 over 1st 8 hours, rest over next 16 hours
ELT frequency
121.5
How to confirm ELT working
Tune in, listen
Twin engine requirements off shore
Raft, vest
Induction agent of choice with bronchospastic patients
ketamine
Indications for Ativan, dose, max
seizures. 1-2 mg with a max of 4 mg
Mannitol dose
1-2 g/kg
Drug choice of tricyclic antidepressant overdose
Sodium bicarb
Drug choice for beat blocker OD
glucagon
Dose of fentanyl
3 mcg/kg
Treatment for malignant hyperthermia
Dantrium (dantrolene)
Drug used for GI bleeds
sandostatin (octerotide)
Neurogenic shock: CVP, CO, CI, PAWP/PCWP, SVR, HR
down, down, down, down, down
What kind of shock is neurogenic shock
distributive
Sites for art lines
radial & femoral
Purpose of art lines
Monitor pressure, blood draws, abgs
Pressure bag for art line needs to be maintained at
300 mgHg
Underdampening
Caused by air in system, loose connection, low pressure bag, altitude changes
Overdampening
Kinking, increased bag pressure, tip against the wall
Most common reprofusion dysrhythmia
AVIR
Most common hypothermia dysrhythmia
VF with an Osborn wave
Hypokalemia presents on EKG with
Peaked P’s, flat T’s
Hyperkalemia presents on EKG with
flat P’s, peaked T’s
Treatment for hyperkalemia
calcium
MAP goal with CHI
80-100
CPP goal with increased ICP
70-90
Normal ICP
0-10
Normal CPP (head)
70-90
Normal MAP
80-100
Normal for the other CPP (heart)
50-60 (head higher than heart)
CPP (head) formula
MAP-ICP
MAP formula
2 x diastolic + systolic / 3
CPP (heart) formula
DBP - wedge
Rotor wing minimums ceiling/visibility: Day/local
500 foot ceiling 1 mile visibility
Rotor wing minimums ceiling/visibility: Day/cross country
1000 foot ceiling 1 mile visibility
Rotor wing minimums ceiling/visibility: Night/local
500 foot ceiling 2 mile visibility
Rotor wing minimums ceiling/visibility: Night/cross-country
1000 foot ceiling 3 mile visibility
Number one cause of air med crashes
controlled flight into terrain, pushing the weather
Normal potassium
3.5-5.5
Normal sodium
135-145
Normal choloride
95-105
Normal calcium
8.5-10.5
What does metabolic acidosis elevate
Potassium
Time of useful consciousness with sudden decompression at 30,000 feet
90 seconds
Time of useful consciousness with sudden decompression at 41,000 feet
Under 15 seconds (least amount of time is exam answer!)
Cardic ischemia
ST depression
Cardiac injury
ST elevation
Cardiac infarct
Q wave > 25% of the R wave
Peds ETT cuffed vs uncuffed
Uncuffed under 10
Needle cricothyrotomy in peds
Only under 11
Nasal intubation in peds
Not under 12
Primary cause of PTL
Infection
Terbutaline contraindications
IDDM, maternal HR > 120, vag bleeding
PIH triad signs
HTN, edema, proteinuria
O2 adjustment calculation to maintain sats at altitude
% O2 patient is already on times pressure at departure pressure at ????????????????????????????????????????????????????????????????
Vent modes: CMV
present volume or PIP at set rate, can’t initiate breath
Vent modes: AC
Preset volume or PIP with every breath, can trigger breath, can’t control tidal volume
Vent modes: IMV/SIMV
Preset breaths, TV, PIP, patient breaths allowed
SIMV allows variation of support
IABP: Action
Increases cardiac output, coronary profusion
IABP: Deflates
During ventricular systole
IABP: Dicrotic notch
Aortic valve closing, sync with a line or EKG (most common trigger)
IABP: S/s of balloon leak
Blood specs in tubing, alarm
IABP: Clot prevention
Cycle manually q 30 min
IABP increases CO by
10-20%
IABP: Balloon rupture
Rusty flakes in line, turn machine off
IABP: migration/dislodged
Assess left radial and urine output
Lethal IABP timing cycles
Late deflation/early inflation
Oxyhemoglobin disassociate curve left shift
Alkalosis, low hgb holding oxygen. L STANDS FOR ALKALOSIS. Low CO2, low temp, low DPG, myxedema coma
Oxyhemoglobin disassociation curve right shift
R stands for raised. Acidosis. Raise = right = releases oxygen. Raised CO2, raised temp, raised DPG, thyroid storm
Where is the phlebostatic axis and what is it
Where pressure measurements made with invasive line. Fourth intercostal space, level of atria
Boyle’s law on ascent
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
Boyle’s law on descent
Barotitis media can affect pts
Mild hypertension
140-159/90-99
Moderate htn
160-179/100-109
Severe htn
180+/110+
Volume for RBC administration
10 mL/kg
Volume for WBC’s
20 mL/kg
ABG rules: CO2 and pH
CO2 up 10 = pH down 0.08
ABG rules: Bicarb and pH
HCO3 up 10 = pH up 15 (proportional)
Bicarb replacement
kg/4 x base deficit = meq of bicarb to give
PaO2 at altitude drops
drops 5 for every 1000 feet elevation
Hypoxia: elevation & s/s: Indifferent
10,000 feet MSL: increased HR and RR, decreased night vision
Hypoxia: elevation & s/s: Compensatory
10,000-15,000 feet MSL: HTN, task impairment
Hypoxia: elevation & s/s: Disturbance
15,000-20,000 feet MSL: Dizzy, sleepy, cyanotic
Hypoxia: elevation & s/s: Critical
20,000-30,000 feet MSL: ALOC, incapacitated
Night vision is lost at
5,000 MSL
PA Catheter: Named
Swan-ganz
PA Catheter: Proximal port use
CVP, meds
PA Catheter: S/s for bad placement
VT, ventricular ectopy
PA Catheter: What do you do for bad placement
Float forward to PA or pull back to RA
PA Catheter: Measure?
R heart directly, L heart indirectly
PA Catheter: Which port is used
Distal
PA Catheter: Pressure bag set to
300 mmHg
Normal cardiac index
2.5-4.3
Stressors of flight (9)
third spacing, fatigue, g-forces, noise, vibration, hypoxia, dehydration, temp changes, barometric pressure changes
Dalton’s law definition
Sum total of partial pressures equal to total atmospheric pressures
Examples of Dalton’s Law
Tissue swelling, altitude hypoxia, hypoxic hypoxia
What law shows why we need O2 at altitude
Dalton’s law
Cardiac thrombolytics must be administered within
3 hours of chest pain onset
Hypovolemic shock: CVP, CO, CI, Wedge, SVR, HR
Down, down, down, down, high, fast
Values for acute respiratory failure
pO2 below 60, pCO2 above 50
Newton’s first law
An object in motion tends to stay in motion
Newton’s second law
Force = mass x acceleration
Newton’s third law
Ever action has an equal and opposite reaction
Tetralogy of fallot
PROV: Pulmonary stenosis, right ventricular hypertrophy, overriding aorta, ventral septal defect VSD
Tet spell
Right ventricular outflow of blood is decreased, causing right to left shunt out of VSD out of aorta, bypassing lungs
Atrial waveforms: CVP
R atrial pressure
Atrial waveforms: PAWP/PCWP
Left atrial pressure
