Flight Test 1 Flashcards
Le Forte I Fracture
Horizontal across the maxilla, the maxilla and maxillary teeth are moveable.
Le Forte II Fracture
Bridge of Nose and around mouth
Le Forte III Fracture
Transverse Fracture “Carniofacial Disassociation”
Goes theough the orbits
Pediatric Dose for Adenosin
- 1 mg/kg initial
- 2 mg/kg second
HHNK (Hyperglycemic Hyperosmolar Non Ketosis)
Common with diabetes type II
Extremely elevated glucose (>600 mg/dL)
Normal ketones (non-ketotic)
Non-Acidotic
First line treatment is fluids, then insulin
Administer regular insulin IV (Humilin or Novolin)
Do not lower glucose > 100 mgdL per hour or less than 250 mgdL total
Spinal Shock
Due to swelling of spinal cord post trauma
Decreased SVR < 800
Hypotension
Treatment IV fluids and vasopressors
Neurogenic Shock (distributive)
Causes a decrease in sympathetic nervous system outflow
Unable to vasoconstrict and increase HR
Decreased systemic vascular resistance (SVR) and normal HR, SVR < 800
Hypotension
Warm red skin
No tachycardia
Treat with IV fluids and vasopressors
Central Cord Injury
Motor weakness in upper extremities is greater than lower extremities
This is below the level of injury
Anterior Cord Syndrome
Loss of pain and temp sensation everywhere below level of injury
Worst prognosis
Important Dermatomes
T4 nipples
T10 umbilicus
C3-C5 innervates the diaphragm
Autonomic Dysreflexia/Hypereflexia
Common in the paralyzed pt without foley catheter
Bladder becomes extremely distended
Increases B/P, HR, ICP
Insert and drain foley catheter slowly
Subarachnoid Hemorrhage
Life Threatning
Starfish pattern on CT
Keep systolic B/P below 140 mmHg
Treat with Nimodepine (Nimotop) (helps prevent cerebral vasospasm)
Persistent HTN, treat with Nipride
Epidural Hematoma
Arterial bleed (middle meningeal artery/MMA)
LOC followed by lucid interval and then second LOC
Pupil dilation after occulomotor nerve injury (CN III) due to loss of parasympathetic tone
Cheyne-Stokes Respirations common
Subdural Hematoma
Results from tearing of the bridging veins to the subdural space
Slow onset
Often in the elderly and kids
More common and lethal than epidural hemotoma
Normal ICP
0 - 10 mmHg
ICP > 20 mmHg has high mortality (Monroe-Kellie)
CCP
MAP - ICP
Normal 60 - 80 mmHg
Keep above 60 mmHg
MAP
Diastolic B/P x 2 + systolic B/P /3
Normal 80 - 100 mmHg
ideally 90 mmHg
Tetrology of Fallot
Right to Left Shunt
Consists of ; pulmonic stenosis, aortic coarctation, transposition of great vessels
ventricular septal defect
“Tet Spells” characterized by sudden cyanosis ans syncope
Treat with knees to chest , morphine
Patent Ductus Arteriosis (PDA)
Blood vessel connecting the pulmonary artery to the aortic arch
Allows most of the blood from the right ventricle to bypass fetus lungs
PGE1 (prostaglandin) is what keeps the PDA open (can cause apnea)
Indocin (indomethacin) drug of choice for closing PDA
Oxygen also closes PDA
If femoral pulses are absent, possible coarctation of the aorta, pt likely requires PDA to survive.
HELLP (hemolysis/Elevated Liver Enzymes/Low Platelets)
Common with PreEclampsia and Eclampsia
Right Upper Quadrant Pain (liver) Jaundice, Malaise
Platelet count < 100,000 mm3
> Liver serum billirubin >/= 1.2 mgdL
Give Mag-sulfate 4 - 6 g over 30 min
Terbutaline (tocolytic)
Stops tetanic contractions immediately
0.25 SQ every 15 min
Pregnancy Induced Hypertension (PIH)
New onset HTN with pregnancy
Labetolol (beta blocker)
Hydralazine
Methyldopa
Rh Negative Mothers
Rhogam prevents mothers immune response from attacking the baby
If mother is Rh negative, ALWATS give Rhogam
Majority of the population is Rh positive
Cardiogenic Shock
Obstructive signs of shock due to heart failure
PAWP > 18-20
SB/P < 80 mmHg
IABP Late Deflation
MOST DANGEROUS
Increases Afterload
Late Deflation = “Lethal Dose”
Aortic Dissection
“Ripping or Tearing” sensation between shoulder blades
Can also have pain in abdomen with same description
Ascending Aorta most common
A difference of 20 mmHg SB/P in the arms common
Treat first with Beta blocker (labetalol) then vasodilators (Nipride)
DO NOT use Nipride first due to Reflex Tachycardia
Pain meds - Morphine, Fentanyl, Ketamine
Restrict fluids unless hypotensive
ASA Poisoning
Respiratory Alkalosis followed by Metabolic Acidosis
Can lead to Reye’s Syndrome (liver and brain damage)
Treat with bicarb
Dilantin Overdose
Overdose can cause SVT and Ventricular dysrhythmias
Coma, confusion, tremors
Can cause Diabetes Insipidus like symptoms
Coagulation Panel
PT 10 - 13 sec
PTT 25 - 40 sec
INR 09 - 1.3
Right Heart Failure
CVP elevated (2-6)
PAP decreased (15-25s/8-15d)
PCWP decreased (8-12)
SVR elevated (800-1200)
Administering 1 Unit PRBC’s will
Increase
Hct 3%
Hgb 1gdL
Chest Tube Location
Between 4th and 5th intercostal space mid-axillary
Head Injury with Dilated and Fixed Pupils
Cranial Nerve III
Black and Blue Bruising Around Umbilicus
Cullens Sign
Acute Pancretitis
Blount Trauma
Ruptured AAA
Ruptured Eptopic Pregnancy
What Does Boyle’s Law Affect in Flight
ETT cuff’s
Mast Trousers, Air Splints (increases air)
IV Drip Rates (increases rate)
“Turn IV bag Upside Down”