Final Flashcards
An abdominal assessment on a patient with abdominal pain and without abdominal pain?
With pain
■ Start where there is the least pain and go to the most
■ Inspect
● Ausutate
● Percuss
● Palpate
○ Without pain
■ Inspect
● Note quality and frequency of sounds
● Auscultation before percussion and palpation
what is the important consideration as a critical care provider
holding c-spine
P1 x V1= P2 x V2 or P1/P2=V1/V2
■ At constant temp the volume of gas is inversely proportional to its pressure
■ Higher altitude there is less pressure creating a larger volume of gas to expand
Boyle’s law
P= P1 + P2 + P3….
■ The total pressure of a mixture of gasses is equal to the sum of the partial pressures of each gas in the mix
■ P1= F1 x P
Dalton’s law
V1/V2= T1/T2 or V1/T1= V2/T2
■ When pressure is constant the volume of a Gas is very nearly proportional to its absolute temp
■ If temp increases or decrease volume will do the same
■ Colder temps will have more dense air making it easier for aircraft to fly
■ temp= volume
Charles’s law
Solubility if Gas in liquids
■ At constant temp the amount of a given gas that dissolves in a given type and volume of liquid is directly proportional to the partial pressure of that gas in equilibrium with that liquid
Henry’s law
P1/T1=P2/T2
■ The pressure of a gas when volume is constant is directly proportional to the absolute temp for a constant amount of gas
■ Higher altitude the colder the temp
■ Volume remains constant
■ Altitude increase= temp decrease
Gay-Loussac’s law
What organs are in the retroperitoneal space?
○ Duodenum
○ Kidneys
○ Adrenal gland
○ Pancreas
○ Nerve roots
○ Lymph nodes
○ Abd aorta
○ IVC
What are the accepted criteria for intubating a patient?
■ Protection of airway
■ Positive pressure
■ Partial pressure of o2
■ Pulmonary toilet
■ Pt progression
______________shock =
■ Vasomotor dysfunction results in either high/ normal arterial resistance with expanded venous capacitance or low arterial resistance
■ Relative hypovolemia as blood is sequestered in either the arterial or venous beds
■ No change in blood volume but increase size in vascular space decreasing perfusion
Distributive
____________ shock =
● Shock caused by infection
● Usually bacterial, fungal, viral
● Recognition
○ AMS
○ SBP less than or equal to 100 with MAP greater than or equal to 65
○ Rr greater than 22
○ Serum lactate greater than 2
Septic
________________ shock =
● Occurs with SCI results in loss of SNS control of vascular tone, which produces venous
and arterial vasodilation
● Relaxed vagal below the injury
● Possible spinal cord injury with hypotension and variable HR
● Injury above T6
● Best perfusion with a MAP up to 85 for the first 7 days following the injury
Neurogenic
____________ shock =
● Acute systemic allergic reaction that results from the release of chemical mediators after
an antigen antibody reaction
● Acute systemic allergic reaction resulting from the release of chemical mediators after an
antigen antibody reaction
● IgE (Mast and basophils)
Anaphylactic
_____________ shock =
■ Hypotension caused by cardiac failures that causes a failure of perfusion of the vital organs
■ MI with LV failure is most common cause
■ Hypoperfusion from cardiac failure
■ Treatment is resolution of the problem
■ Norepinephrine is preferred to increase the hypotension
■ Will see the IABP
Cardiogenic
___________ shock =
Obstruction to cardiovascular flow resulting in impaired diastolic filling or significantly increased in afterload
Obstructive
What are the indications for performing a chest decompression?
Tension pneumothorax
What are the common causes of hypotension in a medical patient?
Sepsis
Dehydration
Vagal stimulation
Parasympathetic stimulation Cardiogenic shock
When should you fly low and consider taking the patient to a hyperbaric chamber?
Decompression sickness
txt- Recompression to ground level as rapidly as possible
What are the indications for performing pericardiocentesis?
Cardiac tamponade
Non refractory to aggressive fluid resuscitation
Beck’s triad signs and symptoms
Who is responsible for all aspects of safe aircraft operation IAW FAA regulations?
○ The pilot in command
what is the definition of sterile cockpit?
Being quiet over coms during critical phases of flight
■Taxi
■ Takeoff
■ Landing
What are the acceptable crash positions In the forward facing seat equipped with shoulder straps
■ Hold arms across the chest forming an x with the forearms and grasping the shoulder harness
Standard crash position?
■ Sit upright with their knees together
and feet 6 inches apart
■ Do not tuck feet under seat
What are the acceptable crash positions In forward facing seat without shoulder straps?
They should bend forward at the waist and encircle knees with arms
What are the acceptable crash positions In rear facing seats?
■ Sit upright with the head held against the seat head rest and arms in an X across the chest
Where should you plan to form up after exiting the helicopter after a crash landing or emergency landing?
○ Rotor wing
■ 12 o’clock of the nose
○ Fixed wing
■ 6 o’clock of the tail
What should you accomplish when the pilot announces an aircraft emergency?
Sterile cockpit
Assist the pilot as needed or request to prepare self for an emergency landing
Position properly, secure/ tighten seatbelts
Prepare the cabin for an emergency landing
Secure equipment, shut off O2 and inverter
Look for suitable emergency landing sites
Initiate emergency communications as directed by pilot
Lay pt flat
What are the required times to wear a seatbelt during transport
All times except for pt care with pilot approval
What are your primary roles and responsibilities as a medical team member in a disaster?
Minimize risk for the task force
■ Provide minor/major medical treatments
■ Provide intervention for incident stress
■ Provide limited treatment of hazardous materials/ biologic exposures for task force members
■ Provide treatment to the search team canine triage, treatment, stanging, transport
What does “first on, last off” for every mission mean?
Helmet and comms or least critical patient
What is the proper procedure to follow when approaching a helicopter?
○ In full view of the pilot and should not proceed under the rotor disk without pilot’s permission
○ Safest approach is from the sides at the 3 o’clock or 9 o’clock position
What are the steps to accomplishing a good scene assessment?
○ Eval of the area that you will
be working/ where aircraft
will be staged
○ Communication center
obtaining information
○Relay contact info for onscene providers
○situational awareness
○Scene safely
○Be aware of secondary incidents
○Equipment
What is the purpose of a preflight walk around?
Ensure the aircraft is ready to respond and check onboard safety equipment
Make sure everything is safe and missionary ready
What are the indications of an aircraft pressurization failure?
○Slow aircraft leak
■ Insidious and gradual onset
■ Can occur without detection
■ signs/ symptoms
● Hypoxia
○Rapid decompression
■ Onset is immediate 1-3 sec accompanied by noise, flying debris and fog
What is the partial pressure of oxygen at sea level?
760 mmHg
21%
760 X .21= 159.6 (160)
Define stagnant hypoxia
○Reduced blood flow/ CO
pooling of the blood within
certain regions of the body
○HF, shock, continuous PPV,
accelerations forces, PE,
extreme environmental
changes, prolonged sitting or
bed rest, tourniquet
Define Histotoxic hypoxia.
○Metabolic disorders or
poisonings of cytochrome
oxidase enzyme systems
results in a cells inability to use
O2
■ Tissue poisoning
■CO
■ Alcohol
Define Hypoxic hypoxia.
○Lack of O2
MI flying is one
Altitude hypoxia from lack of O2
○MI flying is one
○Altitude hypoxia because
higher the altitude the
decrease in PaO2
What is Barosinusitis?
○Sinus block
○Acute or chronic inflammation of one or more of the paranasal sinuses produced by the development of a pressure difference, usually negative between the air in the sinus cavity and that of the surrounding atmosphere
○caused by cold or URI
What is Barodontalgia?
○Toothache that is caused by exposure to changing barometric pressures during actual or simulated flights ○commonly occurs during ascent with descent bringing relief
○Any crew member with tooth work should wait 48-72 hours for pulp to stabalize
types of decompression sickness?
■ Pain in the joints caused by nitrogen bubbles in the joint space
■ Becomes deep and penetrating
■ Pain increases with motion
Limb pain (the bends)
types of decompression sickness?
■ Deep sharp pain under the sternum
■ Dry cough
■ Attempted deep breath causes coughing
Respiratory disturbances (the chokes)
types of decompression sickness?
■ Paresthesia (numbness and tingling feeling)
■ Mottled or diffuse rash of short duration
■ Itching
■ Cold or warm sensations
Skin irritations (the creeps)
What are the effects of positive gravitational forces?
mass
speed
velocity
acceleration
weight
What sensory system is responsible for perception of movement and orientation?
Visual (most important), vestibular, and proprioceptive
What are the common symptoms of high-altitude hypoxia? (indifferent stage)
■ Sea level to 10,000 ft
■ Decrease night vision
■ Increase rr, hr, tv
■ Neuro fine no compromise
What are the common symptoms of high-altitude hypoxia? (compensatory stage)
■ 10-15000 ft
■ Increased BP, HR, depth/rate
■ Decreased efficiency and performance in tasks that require mental alertness
What are the common symptoms of high-altitude hypoxia? (Disturbance stage)
■ 15000- 20,000 ft
■ Dizziness, sleepiness, tunnel vision, cyanosis
■ Performance decrease
What are the common symptoms of high-altitude hypoxia? (Critical stage)
■ 20,000- 30,999 ft
■ Marked mental confusion and incapacitation
■ CNS and CVS severely compromised
■ Leads to unconsciousness and death
what are the indications for use, mechanism of action, contraindications, and class for Succinylcholine?
■Depolarizing NMDA
■ Binds to the nicotinic receptors at the neuromuscular junction resulting in depolarization and inhibition of neuromuscular transmission
■ DO NOT USE ON CRUSH INJURY CAN RISK PT GOING INTO HYPERKALEMIA
what are the indications for use, mechanism of action, contraindications, and class for Rocuronium?
Non depolarizing NMBA
Adult: .5-1 mg/kg
Onset: 1-2 min
Duration: 20-40 min
what are the indications for use, mechanism of action, contraindications, and class for Vecuronium?
Non depolarizing NMBA
Adult: .1 mg/kg
Onset: 2-3 min
Duration: 20-40 min
Allows for short time of completion of procedure
what is the proper procedure for placing an oropharyngeal airway in a pediatric patient?
Use tongue depressor
OPA normal curve down position as opposed to upside down
Do not turn like adults
Follow the curve of the mouth
what are the indications for intubating an asthma patent?
○Decreased LOC
○Progressive exhaustion
○Absent breath sounds
○pH < 7.2
○pCO2> 55
○pO2< 60 despite O2
○Vital capacity decreased to
level of tidal volume
what is the narrowest part of the adult airway?
Adult
■ Glottic opening
Children
■ Level of the cricoid
what is the proper ETT size for a 4yom IAW the SMOG
(4/4)+4= 5
what are the signs and symptoms of a Basaliar skull fracture?
○Battle sign
○Raccoon eyes
○Can occur when the mandibular condyles perforate into the base of the skull but they most often result from extension of fractures of the calvaria
what are the common early signs and symptoms of neurologic deterioration in a patient?
○AMS
○Numbness
○Loss of touch
○Speech problems
○Mostly LOC
what are the commonly expected outcomes for patients experiencing Cerebral vascular Accidents?
Long term neurological deficit
When transporting a patient with meningitis, when should you don respiratory PPE?
Prior to pt contact and during cleaning
what would you expect a patient with Brudzinski sign to display upon examination?
Neck stiffness causes hips and knees to flex when neck is flexed
Indication of meningitis
what are the typical signs and symptoms expected for a patient with an epidural hematoma?
Acute
■ Symptoms within a few hours
■ Usually arterial bleed
■ Follow outer layer of the dura
subacute
■ May take longer to present symptoms
■ Usually venous bleed
Transient LOC
Recovery with lucid interval during which neurological status returns to normal and the secondary onset of headache and a decreasing level of consciousness
what are the typical signs and symptoms expected for a patient with a subdural hematoma?
○Acute
■ Within 24 hours
■ High morbidity and mortality rate
○Subacute
■ 2-10 days
○Chronic
■ After 2 weeks
If in children under 2 they commonly have bulging fontanel and a large head as well as retinal hemorrhages
Elderly patients may have larger subdural with slower symptoms because of cerebral atrophy
what are the typical signs and symptoms expected for a patient with central cord syndrome?
■ Motor impairment with sensory impairment
■ Usually worse in upper extremities than lower
■ Most common type of incomplete cord syndrome
what are the typical signs and symptoms expected for a patient with anterior cord syndrome
■ Paraplegia below the level of injury with loss of pain and temp sensation
what are the typical signs and symptoms expected for a patient with Brown sequard syndrome
■ Loss of motor function on ipsilateral side of injury
■ Sensory impairment to contralateral side
what are the typical signs and symptoms expected for a patient with Complete cord transection
■ Complete loss of sensory and motor function below the level of the injury
■ High level can be associated with spinal shock
what steps would you accomplish to treat a patient with ventricular fibrillation while in flight?
Use ACLS protocol
Let PIC know when you are about to defib them
what should you continuously assess when transporting a patient with an Intra-Aortic balloon Pump?
Depth
bleeding from site
unilateral BP
LOC
what are the indications of a failed Intra-Aortic Balloon Pump?
placed to high or low
baloon rupture = rusty flakes
what is the only absolute contraindication for an Intra-Aortic Balloon Pump?
○Severe aortic insufficiency
○Aortic aneurysm
○Aortic dissection
○Limb ischemia
○Thromboembolism
what are the associated signs and symptoms for diagnosing an acute aortic dissection?
back pain radiating to the abdomen
what is the accepted initial management of a patient with suspected cardiac tamponade?
○Aggressive IV fluid management is sued to keep SBP at 90-100
○Ensures volume in the ventricles does not overcome the fluid accumulating in the sac
○Emergent pericardiocentesis
what are the accepted treatment goals for treating a diaphragmatic rupture?
Surgical repair
Clinical support with intubation
Mechanical ventilation
Gastric decompression
what is the most sensitive enzyme evaluated to determine myocardial damage?
troponin and creatine
what are the common signs and symptoms for a patient with Congestive Heart Failure?
■ Results in the accumulation of fluid behind the left or right ventricle or both
■ SOB starting with exercise progressing into at rest as well
○RVF (Right=rest)
● JVD
● Elevated CVP
● Hepatomegaly
● Peripheral pitting edema
○LVF (Left=lungs)
● Dyspnea
● Orthopnea
● Cough
● Fatigue
● Weakness
● S3 gallop
_______ respirations =
■ Gradually increasing rate and depth of reparations followed by a gradual decrease of respirations with intermittent periods of apnea
■ Brainstem insult
■ Crescendo decrescendo breathing pattern
Cheyne- stokes
_________ respirations =
■ Deep rapid respirations
■ DKA
■ Cardiac tamponade
Kussmaul
________ respirations =
■ Irregular pattern, rate, depth of breathing with intermittent periods of apnea
■ Increased ICP
Biot
_________ respiratons =
■ Prolonged gasping inhalation followed by extremely short ineffective exhalation
■ Brainstem insult
apneustic
____________ =
■ Pt is dead
■ Slow shallow irregular or occasional gasp
■ Cerebral anoxia
■ May be seen when the heart has stopped but the brain continues to send signals to the muscles of
respiration
agonal gasps
what are the signs and symptoms indicating your patient is experiencing a fat embolism?
■ Respiratory failure
■ Shock
■ Elevation in serum lipase levels
■ Thrombocytopenia
Platelet count <150,000
what are the signs and symptoms of a pt experiencing a spontaneous pneumothorax?
■ Hallmark complaint is an acute onset of severe stabbing chest pain, dyspnea
■ Occurs primarily on inspiration
■ Breath sounds are decreased or absent on the affected side and can be difficult to auscultate in
the presence of obstructive lung disease
■ Acute
● Tachypnea, tachycardia, anxiety, acute alveolar hyperventilation with hypoxia
what is the ROME mnemonic and what is it used for
○ Acid base balance
○ Respiratory is opposite
○ Metabolic is equal
what are the indications for the use of pulse oximetry?
○ Seeing the amount of O2 that is bound to the hemoglobin
○ May be affected by temp, hypotension, vasopressor therapy, red nail polish
○ All patients should have pulse ox on
what is measured with oxygen saturation
O2 dissociation curve
right shift
left shift
measuring hemoglobin affinity
O2 dissociation curve left shift =
■ Low pCO2
■ High pH
■ Low temp
■ Low 2,3-= DPG
O2 dissociation curve right shift =
■ High pCO2
■ Low pH
■ High temp
■ High 2,3- DPG
what is functional residual capacity?
The volume of air remaining in the lungs after a normal passive exhalation
Under what conditions would the use of succinylcholine be unadvised?
○Can induce hyperkalemia, malignant hyperthermia
○Should not be used on quad and paraplegics with persistent paralysis
○Do not use in crush injury patients or anyone at risk of developing hyperkalemia
Open globe injury
what medications are commonly used to pre-medicate patients for (RSI) endotracheal intubation?
■Opioids
provide anesthesia and analgesia and decrease sympathetic tone
■Esmolol
beta blocker for pt with a parti ular need for sympatholysis during intubation
■Atropine
used to counterbalance the cholinergic effects of succ especially in children
what is the only absolute contraindication for standard nasotracheal intubation?
apnea
Bitter almonds, from toxic gas from fire involving plastic, rubber =
Cyanide
Freshly mowed grass =
phosgene
Fruity or sweet =
Isopropyl alcohol/ acetone
Garlic=
Arsenic
organophosphates ( insecticides, pesticides, and nerve agents)
Wintergreen=
Methyl salicylate
what are the signs and symptoms of salicylate poisoning?
■ Can lead to severe anion
gap metabolic acidosis
■ Acetylsalicylic acid greater
than 150 mg/kg is toxic
■ These drugs stimulate the
respiratory center so the
first acid- base
abnormality is a
respiratory alkalosis
what is activated charcoal, how is it administered, and when is it commonly used?
absorption agent
ng/og tube
within the first few hours or less
tylenol antidote
N-acetylcysteine
benzos antidote
flumazenil (Romazicon)
b-blockers and CCB antidote
glucagon
Calcium
High dose insulin therapy
IV lipid emulsion therapy
calcium antidote
lipid emulsion therapy
CO antidote
O2
cyanide antidote
cyanokit
digoxin antidote
digifab (digibond)
heparin antidote
protamine
iron antidote
deferoxamine
serotoin syndrome antidote
■ Cyproheptadine
■ Benzo
toxic alcohol antidote
■ Fomepizole
■ Ethanol
TCA or aspirin antidote
bicarb
warfarin antidote
vitamin K
what tests are used to determine the level of acetaminophen poisoning?
Serum levels should be measured 4 hrs post ingestion
24-72 hrs
test for RUQ pain
72-96 hrs
Peak liver function abnormalities
4-14 days
Enzymes return to baseline
what are the indications a patient may have an intraovarian cyst?
Frequent urination
unilateral pelvic pain
IUD placement or use
bloating, spotting dysmenorrhea
what is anaphylactic syndrome of pregnancy?
■Amniotic fluid embolism
■During labor, delivery or right after results in obstruction of the pulmonary vasculature
■Includes amniotic fluid, meconium lanugo hairs, fetal squamous cells, bile, fat, and mucin
Factors that are associated with anaphylactic syndrome of pregnancy include
■ Uterine rupture
■ C section
■ Use of uterine stimulation to induce labor
■ Large fetus
■ Placenta previa
■ Plecenta abruptio
■ Intrauterine fetal death
■ Knees to chest position
■ Multiple pregenancy delivery
symptoms of anaphylactic syndrome of pregnancy include
■ Acute dyspnea with cyanosis and shock
■CP
■ Restless
■ Anxiety
■ Coughing
■ Vomiting
■ Pulmonary edema
■ Pink sputum
■ Seizure with coma
what is the most common cause of preterm labor?
■ Infection- primary cause
■ Spontaneous or premature rupture of membrane
what are the classic signs of pregnancy induced hypertension?
Gestational HTN
preeclampsia
uteroplacental changes
renal changes
hematologic changes
hepatic changes
cerebral changes
retinal changes
pulmonary changes
what are the SUBTLE signs and symptoms commonly associated with seizures in newborns?
Repetitice mouth or tongue movement, bicyclic movement, eye deviation, repetitive, blinking, staring or apnea
what are the CLONIC signs and symptoms commonly associated with seizures in newborns?
■Multifocual or focal
■Characterized by slow repetitive, rhythmic, contractions of the limbs, face or trunk
what are the TONIC signs and symptoms commonly associated with seizures in newborns?
■Generalized or focal
■Activity that resembles posturing seen in older infants and children, may be accompanied by
disturbed respiratory patterns
what are the MYOCLONIC signs and symptoms commonly associated with seizures in newborns?
Multiple jerking motions of upper or lower extremities
what are the signs and symptoms commonly associated with a newborn in stress?
HR less than 60
Cyanosis
Respiratory distress
what s the best IV solution to provide a maintenance infusion for a 6-year-old patient?
125 mEq/L with 3% hypertonic or 1 mL/kg/hr or D10W
pediatric blood loss class 1
very mild (15%)
normal vitals
slightly anxious
skin is warm and pink
normal UOP
pediatric blood loss class 2
mild (15-30%)
tachy
tachypnic
irritable, confused, combative
cool extremities
oliguria
pediatric blood loss class 3
moderate (30-40%)
significant tachy
moderate tachypnea
irratble, lethargic
cool extremities
oliguria
pediatric blood loss class 4
severe >40%
severe tachy
severe tachypnea
lethargic, comatose
cold extremities, cyanosis
anuria
What are the typical signs and symptoms indicating a child may have cyanotic heart disease?
Tetralogy of Fallot
Tetralogy of Fallot
just ask herrera
Tetralogy of Fallot
○ Ventricular septal defect
○ Pulmonary stenosis
○ Displaced aorta
○ RVH
Why can we use uncuffed ET tubes on children?
Children narrowest point is through the cricoid cartilage
what are the signs and symptoms of a saddle injury?
■Hits the vulva or perineum on an object and the force generated by the weight of her body causes an
■s&s
Bleeding
Bruising
Swelling
what is bronchiolitis?
Most common lower respiratory tract infection
■ Occurs at 0-24 months with peak incidence at 3-6 months
■ Viral infection with the most common being RSV
what are the signs and symptoms indicating your patient may have bronchiolitis?
■ 1-3 days history with signs and symptoms or URI
■ After third day of wheezing signs of respiratory distress with increased WOB ■ Can have expiratory wheeze
■ Prolonged expiratory phase with coarse or fine crackles
■ O2 less than 93
what are the signs and symptoms indicating your patient may have epiglottitis?
■ thumb print sign on x-ray
■ Toxic appearance
■ History of rapid onset of symptoms of high fever
■ Noisy breathing
■ Sore throat
■ Inability to tolerate secretions
■ Drooling
■ Suprasternal and subcostal retractions
■ Signs of airway obstruction and circulatory collapse
what is epiglottitis?
Bacterial infection
Affects children 2-6 years before introduction of conjugated heamophilus influenza type B
what are the signs and symptoms indicating your patient may have osteogenesis imperfecta?
■Genetic bone disorder that
is present at birth
■Brittle bone disease
■Soft bones that break easily
■Easy broken bones, bowing
legs
■ Discoloration of whites of
eyes may be blue or grey
and teeth
■ Barrel chest
■ Curved spine
■ Triangle face
■ Loose joints
■ Muscle weak
■ Hearing loss
osteogenesis imperfecta type 1
Mildest and most common
Few fx and deformities
osteogenesis imperfecta type 2
●Most severe type
●Baby with very short arms
and legs, a small chest, and
soft skull
●May be born with fx
●LBW and lungs
underdeveloped
●Usually dies within weeks of
birth
osteogenesis imperfecta type 3
●Most severe in babies who
dont die as newborns
●Sightly shorter arms and
legs than normal and arm,
leg, and rib fx
●Larger than normal head,
triangle face, deformed chest
and spine shallow breathing
osteogenesis imperfecta type 4
●Mild and severe
●May not fx until crawling
●Bones in arms and legs may not be straight
●May not grow normal
osteogenesis imperfecta type 5
Enlarged thickened areas
○ Hypertrophic calluses
osteogenesis imperfecta type 6
Rare
Medium symptoms
osteogenesis imperfecta type 7
Shorter than normal heigh Shorter upper arm and femur
osteogenesis imperfecta type 8
Very soft bones severe growth problems
what concerns should you have when treating infants less than 6 months old and thermoregulation?
○Neonates at high risk for
hypothermia due to large
surface area to body mass
ratio and poor thermal
insulation
○Uncontrolled can increase
metabolism and cause
peripheral vasoconstriction
○Metabolic acidosis is then
caused by this decreased
peripheral perfusion
what are the signs and symptoms indicating your patient may have croup to include radiographic indications?
■Chest x-ray will show steeple
signs
■ URI with low grade fever
and coryza
■ Inspiratory striodor
■ Barking cough
■ Nasal flaring
■ Retractions
what is croup?
■ Viral infection
■ Caused by PIC type 1 and
type 3
■ Ages 6 months to 3 years of
age
■ Common in the fall and
winter
When managing a burn patient, how would you monitor and adjust fluid administration?
○ Urinary output
○ Thermal
■ adults= .5-1 mL/kg/hr
■ peds= 1-1.5 mL/kg/hr
○ Electrical
■ adult = 100 mL/hr
■ peds= 1.5-2 mL/kg/hr
What are the common causes of renal failure in THERMAL burn patients
■ Insensible fluid loss from the burn wound increases the basal metabolic rate and along with fluid shift, leads to hypovolemia, hypotension, and inadequate end organ perfusion
■ Hemoglobin is filtered through the kidneys
■ Increased peripheral vascular resistance will lead to renal failure
What are the common causes of renal failure in ELECTRICAL burn patients
■ Complication from direct damage to the kidney by the electrical current or blunt trauma to the kidney or from myoglobinuria
■ Myoglobin is released as a result of extensive muscle necrosis and myoglobinuria is proportionate to the amount of muscle damage incurred
What are the signs and symptoms you would expect a patient to have with Hepatitis A
■ Recoverable with lifelong immunity
■ Does not cause chronic liver disease
■ Fever, malaise, loss of appetite
■ N/V/D
■ Abd discomfort
■ Jaundice
What are the signs and symptoms you would expect a patient to have with Hepatitis B
■ Nonspecific fatigue, malaise, and low grde fever
■ ABD pain, N/V, jaundice
■ Hepatic enzyme elevation
■ Most patients recover uneventfully from acute cases
What are the signs and symptoms you would expect a patient to have with Hepatitis C
■ Nonspecific or progress to chronic
■ 85% convert to chronic
■ 30% with chronic infection develop cirrhotic liver
■ Mainly from sharps related injuries
How is Hepatitis A transmitted?
■ Someone unknowingly ingests the virus
■ Through close personal contact with infected person through eating contaminated food or drink
How is Hepatitis B transmitted?
■ When blood, semen, or another body fluid from a person infected enters the body of someone who is not
● Sexual contact
● Needle sticks
● Mother to baby at birth
How is Hepatitis C transmitted?
■ When someone comes in contact with blood from infected person
● Needles
How is Hepatitis A treated?
■ No treatment your body will clear it on its own
■ The liver heals within 6 months
How is Hepatitis B treated?
■ Antiviral medications
■ Hep B immunoglobulin
■ Liver transplant
How is Hepatitis C treated?
■ Direct acting antiviral tabs
What are the signs and symptoms you would expect a patient to have with HIV/AIDS?
■ May seem like a URI
■ May develop fever, malaise,
HA, sore throat
■ Immune system begins to weaken
How is HIV transmitted?
○ Depends on viral load and host immunity
○ Needle stick
○ Mucus membranes
How is HIV treated?
○ Antiretroviral therapy (ART)
○ Combination of HIV meds
○ Cannot cure HIV but helps people live longer and decrease symptoms
What should you always consider monitoring when transporting a general medical patient?
○ ETCo2
○ BGL
○ O2
○ Temp
○ Vitals
What are the common causes of hypoglycemia?
■ Iatrogenic insulin effects in pt with type 1 diabetes
■ Adrenal insufficiencies
■ Sepsis
■ Pancreatic timors
■ Congenital metabolic disorders
■ Too much med
■ Not eating enough
■ Unexpected physical activity
■ Alcohol consumption
What are the appropriate treatments for hypoglycemia?
Establishing and maintaining fluid and electrolyte balance by initiating IV fluids with rapidly available
glucose
What are the typical signs and symptoms for a patient experiencing DKA?
■ Polyuria
■ Weakness
■ Fatigue
■ Weight loss
■ N/D/V
■ Abd cramping
■ Kussmaul respirations
What is the appropriate treatment for a patient experiencing DKA?
○ Corrections of fluid loss with IV fluids
○ Insulin (Held until
potassium levels are
greater than 3.5)
○ Correction of electrolyte disturbances
○ Correction of acid- base balances
○ Fluid replacement will drop BGL 20-50 mg/ Dl/ HR
What are the typical signs and symptoms for a patient experiencing HHNS?
● Mild abd pain
● Decreased appetite
● Polydipsia
● Polyuria
● HA
● Blurred vision
● Confusion
● Hypotension, tachycardia, dysrhythmias
What is the appropriate treatment for a patient experiencing HHNS?
○ Establish and maintain fluid and electrolyte balance by initiating IV fluids with NS
○ Monitor I:O
○ After initial bolus pt should receive insulin infusion
■ Discontinued when BGL falls to 250- 300 or declines by more than 100 per hour
What are the common causes of increased sodium levels in the body?
■ Gastric fluid loss
■ Osmotic diuresis
■ Hjypothalamic
disorders
■ Seizures
■ Intake or admin of hypertonic saline
What are the indications for the administration of blood in a patient?
○ Hypovolemic
○ Anemic
○ Hemoglobin less than 7
○ SBP less than 90
What are the signs and symptoms of hypocalcemia?
■Less than 8.5 mEq/L
■ Chvostek sign
■ Trousseau sign
● Carpal spasms induced by the inflammation of a blood pressure cuff of the upper arm
■ Numbness and tingling of the finers toes nose lips or earlobes
■ Facial grimmace
■ Muscle twitching hyperactive DTR
■ Laryngospasms
■ Seizure
■ Bronchospasm
What are the signs and symptoms of hypokalemia?
○ Less than 3.5
○ Excessive diarrhea and vomiting
○ Excessive diuresis
○ Intestinal obstruction
○ GI suctioning
○ Renal insufficiency
■ Cardiac conduction
abnormalities
■ Ventricular ectopy
■ Flattened T waves on
ECG
What are the signs and symptoms of hyponatremia?
○ Less than 135
○ Less than 120 is critical
What lab value is important to monitor when treating a patient with hypoparathyroidism?
○ Calcium
○ Phosphorus
○ Renal function
○ Urine calcium excretion
What patient would you expect to experience Myxedema coma?
○ Hypothyroidism pt
○ Can occur as a result of autoimmune thyroiditis (Hashimotos disease), iodine deficiency, tumor activity, ablation or drug therpy
What ECG ectopy associated with hypocalcemia
Prolonged QT intervals
How would you properly treat and care for a patient with frostbite?
■ Protect he affected area from trauma and partial thawing
■ Superficial treat by removing wet clothing and putting them in warm area
■ DO NOT MASSAGE
■ Pain management and fluids
What complication is often associated with submersion emergencies?
○ Nitrogen narcosis
○ Barotrauma
○ Rupture TM
○ Decompression sickness
What are the environmental stressors affecting thermoregulation?
○ Hypothalamus controls thermoregulation
How would you properly treat a hypothermic patient?
Active/passive rewarming
What is the Mammalian diving reflex?
Physiological response to emersion that overrides basic homeostatic responses and preserves O2 stores
in time of emergent
Types of toxic/poison exposure
Absorption
Inhalation
Ingestion
Injection
What is the Intra-Aortic Balloon Pump doing for the patient?
Increase coronary perfusion and CO by 10-15% and decrease the cardiac workload
What are your monitoring/intervention priorities when transporting a patient with sickle cell disease?
02
Fluids
Pain control (fentanyl, morphine, benzos) do not use ketamine
