Flight Medic Class Flashcards
Succinylcholine
Adult Dose
- 5 mg/kg IV
- 5-4 mg/kg IM
150 mg MAX
Succinylcholine
(Pedi)
1 - 1.5 mg/kg IV
2.5 mg/kg IM
50 mg MAX
Succinylcholine
(Contraindications)
Hypersensitivity
Penetrating injuries to the eye
History of glaucoma/Ocular pressure
Malignant hypothermia
Rocuronium
Adult Dose
1 mg/kg IV
Rocuronium
Pedi Dose
1mg/kg IV
Rocuronium
Contraindications
NONE
Vecuronium
(Adult Dose)
0.1 mg/kg IV
Vecuronium
(Pedi Dose)
0.1 mg/kg IV
Vecuronium
Contraindications
NONE
Hypoxic Hypoxia
“”Ain’t enough Air getting to the lungs””
Airway obstruction
ARDS
Decrease partial pressure of oxygen at high altitude
Tension Pneumothorax
{Patient will turn Blue}
Hypemic Hypoxia
“Not enough Blood” 🩸
Lack of blood volume (Hypovolemic Shock)
Anemia or hemorrhage
TXA is used during Hypemic Hypoxia
Stagnant hypoxia
“Blood Ain’t Moving”
Cardiogenic shock Distributive shock Septic shock Anaphylactic shock Neurogenic shock Obstructive shock
{Patient will turn Blue}
Hysto-toxic Hypoxia
Cyanide Poison
Carbon monoxide
Alcohol poisoning
Which side of the O2 disassociation curve is Acidosis?
The right side
Which side of the O2 disassociation curve is alkalosis?
The left side
What is bad about the right side of the O2 disassociation curve?
It can’t carry O2
What are symptoms for the right side of the O2 disassociation curve?
High Heart rate High metabolic state High fever Low respiratory High 23DGP
What are symptoms of a left-sided disassociation curve?
(Left side = Alkalosis)
Low temperatures
High respiratory
Low 23DPG
How do you reverse a high 23DGP?
Calcium gluconate
Calcium chloride
Explain base excess?
The more negative you are, the more acid you have
It’s a great way to trend any shock status
Explain the Gap?
Greater than 12 is acidosis
Less than 12 your normal
Sodium bicarb is the poor man’s what?
Dialysis machine (helps urinate/expel acid)
If it’s potassium related, get calcium first
What’s the formula to reach a desired ETCO2?
(Respiratory Rate X ETCO2)
—————————————
Desired ETCO2
= New Respiratory Rate
If you have a respiratory alkalosis, what should you ALWAYS rule out?
Metabolic acidosis (possible underlying cause)
What are the Golden Rules of ABG’s?
- Every 10mm/Hg change in CO2, the pH will change 0.08 in the opposite direction
- For every change in Bicarb of 10 mEq, the pH will change 0.15 in the same direction
- Formula for calculating Bicarb replacement Kg/4 X base deficit = Bicarb needed
Name the Gas Laws?
Boyle's Law Charles' Law Dalton's Law Henry's Law Gay-Lussac's Law
Describe Boyle’s Law?
o Effects equipment and anything that contains air
o Higher the altitude the more gases expand
Describe Charles’ Law?
o Air expands when hot. Aircrafts love cold and dry air
Describe Dalton’s Law?
o As altitude increases, partial pressure decreases, Supplemental O2 is needed (Hypoxic Hypoxia)
Describe Gay-Lussac’s Law?
o If Temperatures increase, O2 tank pressure increases
Describe Henry’s Law?
Diving adds pressure, when surfacing nitrogen comes out
Adenosine dose for Heart Transplants / Central Lines?
1st Dose: 3mg
2nd Dose: 3mg
How many MM of pressure can the brain take before it herniates?
15mm
How to calculate the B/P?
CO x SVR = B/P
How to calculate Cardiac Output?
HR x SV = CO
High SVR equals?
Vasoconstriction
Low SVR equals?
Vasodilation
What happens during narrowing pulse pressure?
Vasoconstricting
What happens during widening pulse pressure?
Vasodilation
What are the STRESSORS of Flight?
SELF IMPOSED o Dehydration o Exhaustion o Alcohol o Tobacco o Hypoglycemia INHERENT o Thermal Changes o Humidity o Gravitational Forces o Fatigue o Partial Pressure of O2 o Barometric Pressure Change o Noise o Vibration
When ascending to altitude, if your FIO2 IS 40%. What should your PEEP be?
PEEP of 5
What is a Steril Cockpit?
Only essential communication during all phases of flight except straight and level flight
What are Critical phases of flight?
o Takeoff
o Landing
o Refueling
o Taxi
What is the FIO2 calculation for take off?
(FIO2 x P1) / P2 = FIO2 required for ascent
P1=Sea level
P2=Desired Altitude
What should you do if a Diver has the Bens?
o Grab the diving laptop
o Call Divers Alert Network
o The amount of O2 that is running and the time they were placed on it
If a 12 lead is presenting with right side Deviation, what should you do?
Move V4 over to the right side of the rib cage
An inferior wall MI involves which coronary artery?
Right Coronary Artery
A Septal and Anterior wall MI involves which coronary artery?
Left Anterior Descending
A Lateral and Posterior MI involves which coronary artery?
Left Circumflex
A Posterior wall MI involves which coronary artery?
Posterior Descending Artery
Describe Lead I and Lead III during Left Axis Deviation?
Lead I is positive (thumbs up)
Lead III is negative (thumbs down)
Describe Lead I and Lead III during Right Axis Deviation?
Lead I is negative (thumbs down)
Lead III is positive (thumbs up)
How many ml/Hr does a pressure infuser run at 300 mm?
3mL/Hr
What is the purpose of a 12 lead?
To find a STEMI
Which Lead confirms your Lead placement?
aVR
How do you identify Pericarditis in a 12 Lead?
o WIDESPREAD concave ST elevation and PR depression
o Reciprocal ST depression and PR elevation in aVR
o Flat or inverted T waves
What is early Repolarization?
Elevation of J-point with a late QRS sluring or notching
What is Left Ventricular Hypertrophy?
Deviation of the ST segment in the opposite direction of the QRS complex
Greater than 11mm (positive) indicates L.V.H.
What is a Left Bundle Branch Block?
o When the QRS is 120 milliseconds or more
o Absent Q wave in Leads I, V5, and V6
What are the 3 I’s of ACS?
o Ischemia
• Demand is greater than the supply of O2
• Elevated T waves (Not Peaked) / Inverted T waves
• ST-Depression
o Injury
• ST Elevation
o Infarct
• Pathological (Wide or Deep) Q waves
What locations can a Myocardial Infarct occur?
- Inferior (Special assessment and Treatment)
- Inferolateral
- Posterior
- Anterior
- Anteroseptal
- Lateral
- Right ventricular
What is the main cause of Right sided Heart Failure?
Left Sided Heart Failure
What is the range for Pulmonary Artery Wedge Pressure, and what is it responsible for?
8-12mmHg
Measure Right Heart AFTERload and Left Heart PREload
What are the symptoms for Pericarditis?
Febrile & Tachycardic
After zeroing an Arterial line what do you do next?
Flush it
Every pediatric pt that has a central line, how should you check it?
Transduce it
What is another name for a Pulmonary Artery Catheter?
A Swanz Ganz Catheter
You should not see, what type of pressure during transport?
A Wedge Pressure
How long is a pseudo Wedge pressure allowed for?
1 Breath Cycle
If its persistent, Deflate the tube or pull the tube back till you see CVP
Critical Care Lyfepak’s should be able to monitor how many invasive lines.
2
How do you calculate a Coronary Perfusion Pressure?
Diastolic - Pulmonary Wedge Pressure = CPP
What is the normal range for Coronary Perfusion Pressure?
50-60 mmHg
What is the normal range for Central Venous Pressure, and what is it responsible for?
2 - 6 mmHg
Measures Right Heart PRELOAD
What is the Systolic and Diastolic range for a Right Ventricular Pressure?
Systolic 15-25mmHg
Diastolic 0-5mmHg
What is the normal range for Systolic and Diastolic Pulmonary Artery Pressure?
Systolic 15-25mmHg
Diastolic 8-15mmHg
What is the normal range for Cardiac Output?
4 - 8 L/min
What is the normal range for Cardiac Index?
2.5 - 5.0 L/m
How do you calculate MAP?
Systolic + 2(Diastolic) / 3
How do you calculate Cerebral Perfusion Pressure?
MAP - ICP = CPP
How do you calculate a Shock Index?
Systolic Blood Pressure
What is the normal range for Shock Index?
- 5 - 0.7
* Anything greater than 1 the patient is in shock*
If you raise your PEEP, what else should you raise?
FIO2
How do you calculate Minute Volume (Ve)?
Volume(Vt) x Rate (F) = Ve
What is a normal I:E ratio?
1:2
What is the maximum for your Peak Inspiratory Pressure?
40
Does PIP cause Barotrauma?
No
Can a Plateau Pressure cause Barotrauma?
Yes
What are the steps for setting up the vent?
Strategy • Protective or Obstructive Type of Ventilation • Volume or Pressure Mode of Ventilation • A/C, SIMV, PRVC Settings • Vt, RR, FIO2, PEEP
How do you calculate Male IBW?
MALE
50 + 2.3 for every inch over 5 feet = IBW (kg)
How do you calculate Female IBW?
FEMALE
45(kg) + 2.3 for every inch above 5 feet
At what Tidal Volume can most adult patients start at?
Vt 400 - 600
What is the altitude for the Physiologic zone?
Sea level to 10,000 ft
What is the altitude for the Physiologically Deficient zone?
10,000 to 50,000 ft
What is the altitude for the Space Equivalent zone?
50,000 to 250,000 ft
What is the altitude for Space?
Greater than 250,000 ft
How do you calculate the ET Tube?
16 + Age / 4 = ET Tube size
Every 33 feet equals how many ATM?
33 feet= 1 ATM (Atmosphere)
How many torr is sea level?
760 torr
How many torr is Sea level, 10k, 18k, 63k?
Sea level = 760 torr
10,000 ft = 523 torr
18,000 ft = 380 torr
63,000 ft = 0 torr
What is Barondontalgia?
It occurs during ascent, it is when air gets trapped in the fillings in your teeth
What is Barotitis?
It occurs during descent, it’s when the air gets trapped in the middle ear and blocks the Eustachian tube.
What is Barosinusitis?
Occurred during decent and Ascent, it is when air is trapped in your sinuses
For every 1000 feet of elevation how much does your temperature change?
2°C
When is the emergency action plan activated?
15 minutes after failure to report in
How many hours of flight time with a pilot qualify for rotor wing?
2,000 hours
How many hours does a pilot need to fly a helicopter to qualify?
1,200 hours in a helicopter
How many hours does a pilot have to be in charge at night to qualify?
100 hours as a PIC at night?
For FAA rules what is part 91 in part 135?
Part 91-No duty, no weather minimums
Part 125-Max 14 hour duty, 8 hour flight time, 8 hours from last beer
What is the size of a hasty landing zone?
100’ x 100’
Which direction does a helicopter approach a scene?
Against the wind
How many passes are required prior to landing at a hasty landing zone?
Two passes, one high and one low
What is the post crash sequence?
Turn off:
Throttle
Fuel
Battery
Assemble at 12 o’ clock position
What is the pre-crash sequence?
- Lay the patient flat
- Turn off any oxygen
- Assume the crash position
How does the emergency locator transmitter activate?
Itself activates during a crash sequence at 4G’s
What are the weather minimums for non-mountainous LOCAL Day/Night?
Day = 800’ - 2 miles Night = 800’ - 3 miles
What are the weather minimums for non-mountainous CROSS COUNTRY Day/Night?
Day = 800’ - 3 miles Night = 1000’ - 3 miles
What are the weather minimums for mountainous LOCAL Day/Night?
Day = 800’ - 3 miles Night = 1000’ - 3 miles
what are the weather minimums for mountainous CROSS COUNTRY Day/Night? 
1000’ - 3 miles
1000’ - 5 miles
What is the number one and number two causes of crashes?
#1 weather #2 night flight
What is the glucose level for DKA?
Greater than 350 mg/dL
What respiratory pattern is common with DKA?
Kussmaul respirations
What is the glucose level for HHNK?
Greater than 600mg/dL
 How quickly can you lower glucose for DKA and HHNK patient’s?
No more than 100mg/dL per hour
MAX 250mg/dL
What is Diabetes Insipidis?
A condition where the kidneys are unable to conserve water
What is Mallory Weiss/Boerhaave’s Tears?
A rupture of the esophagus
What is the treatment for thyroid storm/Grave’s Disease?
IV Fluids first
Beta-blockers
Steroids
Tylenol (fever)
What is Cushing syndrome?
“Buffalo hump, Moon face, Thin arms/legs, purple striae abdomen”
It’s a mass on the abdomen
What are the signs of Addison’s/Adrenal insufficiency?
Patient presents with depression, malaise, salt craving, And Bronze colored skin
What is Gray Turner sign?
Flank ecchymosis caused by hemorrhagic pancreatitis
What is Cullen’s sign?
Periumbilical ecchymosis cause by hemorrhagic pancreatitis
What are the treatment steps for Hyperkalemia (K+ >5.0) ?
- Bicarbonate, Insulin, D 50, Albuterol (This pushes K+ back into the cells)
- Lasix (Gets rid of the excess K+)
- Calcium Gluconate (Prevents V-Tach)
For every 0.6 mEq Potassium change, how much does pH change?
0.1
What is Chvosteks Sign?
Cheek muscle spasms when the facial nerve is tapped
What is Trousseue’s sign?
Forearm tetany when B/P cuff is applied
What is the threshold hypothermia?
35°C = 95°F
At what temperature does shivering stop?
32°C = 89.6°F
What ekg changes do you find during hypothermia?
Osborn waves / J waves
What’s the threshold for Hyperthermia?
40°C = 104°F