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Flight Test 1 Flashcards

1
Q

Le Forte I Fracture

A

Horizontal across the maxilla, the maxilla and maxillary teeth are moveable.

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2
Q

Le Forte II Fracture

A

Bridge of Nose and around mouth

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3
Q

Le Forte III Fracture

A

Transverse Fracture “Carniofacial Disassociation”

Goes theough the orbits

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4
Q

Pediatric Dose for Adenosin

A
  1. 1 mg/kg initial
  2. 2 mg/kg second
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5
Q

HHNK (Hyperglycemic Hyperosmolar Non Ketosis)

A

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

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6
Q

Spinal Shock

A

Due to swelling of spinal cord post trauma

Decreased SVR < 800

Hypotension

Treatment IV fluids and vasopressors

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7
Q

Neurogenic Shock (distributive)

A

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

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8
Q

Central Cord Injury

A

Motor weakness in upper extremities is greater than lower extremities

This is below the level of injury

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9
Q

Anterior Cord Syndrome

A

Loss of pain and temp sensation everywhere below level of injury

Worst prognosis

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10
Q

Important Dermatomes

A

T4 nipples

T10 umbilicus

C3-C5 innervates the diaphragm

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11
Q

Autonomic Dysreflexia/Hypereflexia

A

Common in the paralyzed pt without foley catheter

Bladder becomes extremely distended

Increases B/P, HR, ICP

Insert and drain foley catheter slowly

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12
Q

Subarachnoid Hemorrhage

A

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

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13
Q

Epidural Hematoma

A

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

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14
Q

Subdural Hematoma

A

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

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15
Q

Normal ICP

A

0 - 10 mmHg

ICP > 20 mmHg has high mortality (Monroe-Kellie)

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16
Q

CCP

A

MAP - ICP

Normal 60 - 80 mmHg

Keep above 60 mmHg

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17
Q

MAP

A

Diastolic B/P x 2 + systolic B/P /3

Normal 80 - 100 mmHg

ideally 90 mmHg

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18
Q

Tetrology of Fallot

A

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

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19
Q

Patent Ductus Arteriosis (PDA)

A

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.

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20
Q

HELLP (hemolysis/Elevated Liver Enzymes/Low Platelets)

A

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

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21
Q

Terbutaline (tocolytic)

A

Stops tetanic contractions immediately

0.25 SQ every 15 min

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22
Q

Pregnancy Induced Hypertension (PIH)

A

New onset HTN with pregnancy

Labetolol (beta blocker)

Hydralazine

Methyldopa

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23
Q

Rh Negative Mothers

A

Rhogam prevents mothers immune response from attacking the baby

If mother is Rh negative, ALWATS give Rhogam

Majority of the population is Rh positive

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24
Q

Cardiogenic Shock

A

Obstructive signs of shock due to heart failure

PAWP > 18-20

SB/P < 80 mmHg

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25
**IABP Late Deflation**
**_MOST DANGEROUS_** Increases Afterload Late Deflation = "Lethal Dose"
26
**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
27
**ASA Poisoning**
Respiratory Alkalosis followed by Metabolic Acidosis Can lead to Reye's Syndrome (liver and brain damage) Treat with bicarb
28
**Dilantin Overdose**
Overdose can cause SVT and Ventricular dysrhythmias Coma, confusion, tremors Can cause Diabetes Insipidus like symptoms
29
**Coagulation Panel**
PT 10 - 13 sec PTT 25 - 40 sec INR 09 - 1.3
30
**Right Heart Failure**
CVP elevated (2-6) PAP decreased (15-25s/8-15d) PCWP decreased (8-12) SVR elevated (800-1200)
31
**Administering 1 Unit PRBC's will**
Increase Hct 3% Hgb 1gdL
32
**Chest Tube Location**
Between 4th and 5th intercostal space mid-axillary
33
**Head Injury with Dilated and Fixed Pupils**
Cranial Nerve III
34
**Black and Blue Bruising Around Umbilicus**
Cullens Sign Acute Pancretitis Blount Trauma Ruptured AAA Ruptured Eptopic Pregnancy
35
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"**
36
What does Boyle's Law state
The pressure of a gas is inveresely proportional to the volume of gas at a sonstant temperature. "Boyle's = Balloon = Barotrauma"
37
Daltons Law
Total pressure of a gas mixture is the sum of the partial pressures **_of all the gases_** in the mixture. "Dalton's Gang"
38
Charles' Law
Absolute temperature of the gas "charging an oxygen tank, the tank gets hot"
39
Gay-Lussac's Law
Directly proportional relationship between temperature and pressure. O2 tank reading lower in cool temp and higher in warm temp.
40
**_Hypoxic Hypoxia_**
Cardiovascular/Pneumothorax pt's are moresusceptible to this type of hypoxia.
41
Effects of Altitude
Every 1,000 foot increase in elevation causes temp to drop 2 degrees C
42
Air Transport Team Members
Flight Nurse Flight Paramedic / EMT Respiratory Therapist Flight Physician
43
Sterile Cockpit
Only essential communication during all phases of flight except straight and level flight. Critical phases of flight: Takeoff, Landing (short final), Refueling, and taxi (ground or air)
44
CAMTS- How many live intubations are required?
5 live intubations before begining missions Quarterly intubations thereafter
45
The only time you don't need to wear your seatbelt
During straight and level flight Or when the PIC directs you to (PIC has ultimate authority of the mission)
46
What is the pre-crash sequence
Lay the patient flat Turn off any oxygen Assume the crash position (knees together, feet 6" apart flat on the floor)
47
What is the post-crash sequence
Turn off in order Throttle Fuel Battery Assembel at the 12 o'clock position
48
Indications for Intubation
pH \< 7.2, CO2 \> 55, PaO2 \< 60 Only ONE value needs to be off to indicate the need for intubation
49
Mallampati III
Only the base of the uvula can be seen Moderate difficulty
50
When inflating the distal cuff on an ETT the pressure should be?
Between 20-30 mmHg (only use the ammount of air required to make a good seal)
51
Succinycholine
**Depolarizing** Neuromuscualr blocking agent Dose: 1-2 mg/kg
52
Rocuronium
Non-Depolarizing Neuromuscular Agent **Zemeron**
53
Etomidate
Induction agent, preferred for awake sedation (fast onset, short half-life) **0.3 mg/kg**
54
Synchronized Intermittent Mandatory Ventilation (SIMV)
Assisted mechanical ventilation synchronized with the pt's breathing ## Footnote **Spontaneous breathin by the patient occurs between the assisted mechanical breaths, which occur at preset intervals**
55
With ARDS, Focus on oxygenation with:
Increased PEEP (\> 10) High Tidal Volumes (\> 10 cc/kg) "Pancreatitis and ARDS commonly occur together"
56
Cardiac Enzymes Troponin I
Specificity: High Detectable at: 2 hours Peak Levles: 12 hours
57
Pericarditis
Substernal C/P when breathing or laying supine Treat with NSAIDS (usually Indocin)
58
Fetal HR Variability
**_The single most important predictor of fetal wellbeing_** #1 cause of poor variability = fetal hypoxia 10-15 bpm = normal variability
59
Accelerations/Decelerations
**_Are in relation to uterine contraction_** **_Early deceleration means the fetus hear rate decelerates early in the uterine contraction cycle_** Accelerations are ALWAYS good
60
Late Decelerations
**_ALWAYS indicates ureteroplacental insufficiency_** Causing fetus to experience a hypoxic bradycardia
61
Preterm Delivery | (\< 38 weeks)
**_Terbutaline (fast acting, short half-life)_** Stop tetanic contractions IMMEDIATELY **_Subcutaneous 0.25 mg q 15 min_**
62
"Mag Check"
Deep Tendon Reflexes
63
Mauriceau's Maneuver
Fingers relieving pressure off the baby's nose so they can breath Downward suprapubic pressure while the baby is rotated out of the birth canal
64
HELLP Syndrome
**_Hemolysis/Elevated Liver Enzymes/Low Platelets_** Common with PreEclampsia and Eclampsia RUQ pain (liver), jaundice, malaise Give Mag Sulfate (4-6g over 30 min) Hypertension - use Labetalol, Hydralazine, or Methyldopa
65
PreEclampsia
**_HTN / Proteinuria / Edema_** NO SEIZURES Risk factors - extremes of age, 1st pregnancy
66
Placenta Abruption
**_Painful bleeding_** **_Any MVA or blunt trauma is placental abrubtion until proven otherwise_** **_EMERGENCY_**
67
Uterine Rupture
**_Fetal parts presenting under mothers skin_** "Stomach is as hard as a board" #1 cause of maternal death is trauma #1 cause of fetal death is maternal death
68
Infant Seizures
Lip smacking and tongue thrusting, eye fluttering and lowered SPO2 "Subtle Seizures" Common causes: Hypoglycemia
69
Ventriculoperitoneal Shunt "VP Shunt"
Hydrocephalus Fluid build up leading to increased ICP Often presents with: gastric distension, mental status changes decreased LOC, vomiting and seizures Give Mannitol Raise head of bed 30 degrees (semi-fowlers)
70
Pediatric Emergencies ETT Diameter
**_(Age +16) /4 = tube size_** **_If required ETT size is 5.5 or greater use a cuffed ETT_**
71
Pediatric Fluid Resuscitation
**_Neonate/Infant = 10cc/kg (\<1 y/o)_** Toddler/Child = 20cc/kg (\>1 y/o) Average circulating blood volume 75-80mL/kg
72
Pediatric Maintenance Fluids "4, 2, 1 Rule"
**1-10 kg = 4cc//kg/hr** 10-20 kg = 2cc/kg/hr \>20 kg = 1cc/kg/hr **(8kg)**
73
CROUP
**_Steeple Sign on A/P neck XR_** "Seal Like" Barking cough Treat with racemic epi and steroids (usually not life threatening)
74
Epiglottitis
**_Sudden onset of DROOLING_** **_Thumb Sign on lateral neck XR_** Do not disturb child due to possible rapid airway loss Treatment: Antibiotics, humidified O2
75
ICP Transducer
**_Placed at the Foramen of Monro_** (level of the ear)
76
Brainstem Herniation
Goal PaCo2 = 30-35mmHg Treat seizures with a benzo and then either Phenytoin (Dilantin) or Fosphenytoin (Cerberyx) **_DO NOT USE HYPOTONIC SOLUTIONS OR GLUCOSE!_** (hyponatremia is associated with brain edema) (hyperglycemia makes brain injuries worse)
77
Acute Mountain Sickness (AMS)
Typically occurs to those not acclimatized and have recently traveled to altitude within 24 hours. **_Symptoms: headache, nausea, vomiting, lassitude (feeling weak)_**
78
Cardiac Tamponade
**_Early Tamponade: Give IV fluids (improve preload)_** **_Late Tamponade_** (Beck's Triad) **_Pericardiocentesis_** **_Beck's Triad_** **_Muffled Heart Tones_** **_Hypovolemia (with narrowed pulse pressure)_** **_JVD_**
79
80
Oxygen Dissociation Curve
Right Shift **(High)** Hyperthermia Acidosis Hypercapnia Increased levles os 2, 3, DPG _(RELEASES OXYGEN)_
81
Pulmonary/Pleural Effusion
Buildup of fluid in the pleural space, an area between the layers of tissue that line the lungs and the chest wall.
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Flight Test (1 decks)

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