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