FP-C Flashcards
What does HEAVEN stand for
H-Hypoxia
E-Extremes of size
A-anatomic disruption/obstruction
V-vomit, blood, secretions in airway
E-exsanguination
N-neck mobility
What are the 8 P’s of intubation
Preparation
position
pre-oxygenation
pre-treatment
paralysis and induction
protection and positioning
placement and proof
post intubation management
What are the indications for an advanced airway
Can they follow commands
can they control secretions
what is their clinical coarse.
What is the Larson maneuver
placing firm pressure inward behind both earlobes while doing a jaw lift. This will help relax the vocal cords due to spasming.
What are the 3 airway assessments commonly utilized
3-3-2
Mallampati
Cormack-Lehane score
How to determine shock index
pulse rate / systolic BP
>0.9 = high shock index
Is a paralytic contraindicated if you can not oxygenate or ventilate
yes
How to determine ETT size for pediatric (greater than 1 yr)
(age + 16) /4
How to calculate Ideal body weight (IBW)
M- (# of inches above 60 x 2.3) + 50
F- (# of inches above 60 x 2.3) + 45.5
Oxyhemoglobin disassociation curve
Haldane effect
Left shift
Lowered PH, Temp, 2-3-DPG production, PaO2
Higher affinity for O2
poor cellular perfusion, less CO2 removal
Oxyhemoglobin disassociation curve
Bohr effect
Right shift
Raised PH, Temp, PaO2, 2-3-DPG production
Low affinity for O2
poor lung perfusion, removes more CO2
What is brown-Sequard syndrome
Hemi section of cord that is very rare and causes ipsilateral loss of motor position and vibratory sense with contralateral loss of pain and temperature perception.
What is central cord syndrome
Greater motor weakness in upper extremities than lower with varying degree of sensory loss.
What is anterior cord syndrome
displacement of bony fragments into the anterior part of the spinal cord. the result of flexion injuries or fractures.
complete motor, pain, and temp loss below the lesion with sparing proprioception vibration, and touch
What is Cushings triad
-increased systolic blood pressure
-decreased diastolic blood pressure
-bradycardia
Acute respiratory distress syndrome (ARDS) vent settings
-lower tidal volume 4-6 ml/kg
-increased respiratory rate
-normal PEEP 5-10
goal is to keep initial minute volume
What is subfalcine herniation
midline shift of the brain
What is SCIWORA syndrome
-spinal cord injury without radiographic abnormality.
-spinal shock/contusion
What is an epidural bleed.
-a bleed located between the skull and dura mater and pushes the dura mater into the brain.
- concave shape or looks like a football.
- edge will be smooth.
what is a subdural bleed
- a bleed that is located between the dura mater and the arachnoid and pushes the dura mater up towards the skull.
- concave shaper or look like a crescent moon.
-edge will be jagged.
What do you treat 1st in a TBI patient with a multisystem trauma.
-Treat the brain first by maintaining a MAP >90 mmHg.
-then you can assess the multisystem trauma.
What is the main goal with a TBI patient
Prevent the 3 H’s
1- hypoxia
2-hypotension
3-hyperventilation
what is the formula for tidal volume
-Based off of ideal body weight.
-6-8 ml/kg normally
-4-6 ml/kg for ARDS pt’s
what is the target minute ventilation formula, and breaths/minute to maintain that formula.
100 ml/kg/min 80 kg pt
100 x 80 = 8000 ml/min
tidal volume is 80 x 6 ml/kg = 480 ml
8000/480= 16.6 breaths/min
How do you determine anatomical dead space.
-1ml x ideal body weight in lbs
or 150 ml/breath
how do you determine alveolar minute ventilation
Delivered minute ventilation - anatomical dead space.
How do you count for mechanical dead space.
-2ml x PIP for adults
-1ml x PIP for peds
what is the adults average tidal volume
5 L/min
How do you figure inspiratory time for the vent
-60 sec / Respirations = breath cycle. (60/10= 6 sec cycle)
-add your I:E together (1:3 =4)
breathing cycle / I:E total
6/4= 1.5 sec is your inspiratory time
how do you figure your expiratory time for the vent
-take your inspiratory time and times it by the remainder of your I:E.
- Inp time is 1.5 sec. I:E is 1:3
-1.5 x 3= 4.5 is your expiratory time
What is PIP on the vent
-a reflection of airway resistance
-should remain <35 cmH2O
what is Pplat on the vent
-used to determine alveolar health
- <30 cmH2O is the goal
what is driving pressure on the vent? what is it used for.
-the difference between Pplat and PEEP.
-attempt to keep <15 cm H2O
-used for ARDS pt’s
how do we set up pressure mode on vent
-set based on inspiratory pressure (PIP)
-adult- 20 cmH2O
-peds- 10-15 cmH2O
what is Waddell’s triad
Common when a child is struck by a motor vehicle, injuries include those to the head, trunk, and extremities.
Why do we give prostaglandin (PGE1)
to keep the patent ductus arteriosus open
what do we give to close the patent ductus arteriosus (PDA)
Indomethacin
what is the left to right shunt defects
oxygenated blood shifts from the left to the right side of the heart
what is Atrial Septal Defect (ASD)
when the foramen ovale doesn’t close like it should.
what is Ventricular Septal Defect (VSD)
a defect in the septum between the ventricles that allows blood to flow between them.
what is Patent Ductus Arteriosus (PDA)
failure of the ductus arteriosus to close after pulmonary circulation has been established.
what is Mauriceu’s maneuver
-as the baby is being born you place the index finger and the middle finger over the maxillary prominence on either side of the nose.
- this is done to provide flexion while traction is made on the shoulders.
how to determine BP in neonate/pediatrics
-gestational age in weeks= neonate MAP
-peds- 70+(2xage in yrs) is normal
<70+(2xage in yrs) is hypotension
what size of ETT for neonates
<1kg=2.5 mm
1-3kg=3.0 mm
>3kg=3.5-4.0 mm
how to determine ETT size for >1 yr old
(age+16)/4
what size of NGT, Foley and Suction catheter
double the ETT
what size of chest tuber for neonate/pediatrics
quadruple the ETT
how much blood is circulating in the neonate/pediatric
75-80 ml/kg
how much fluid resuscitation is needed in a neonate/pediatric
-neonate is 10 ml/kg
-pediatric is 20 ml/kg
how much glucose should a pediatric get
2 cc/kg of D25
if NPO, how much glucose should a neonate get.
80-100 cc/kg/day
what is the cardioversion rate for neonate/pediatric
0.5-1.0 joules/kg
how much do we defibrillate a neonate/pediatric
2-4 joules/kg
how to determine maintenance fluids for pediatrics
4-2-1 rule
-4cc/kg/hr for the 1st 10 kg
-2cc/kg/hr for the 2nd 10 kg
-1cc/kg/hr for every kg after that
what is a neonate
an infant that is less than 28 days old
what is a preterm baby
baby born prior to 37 weeks
what is a normal blood glucose for a neonate
> 40 mg/dl
how to treat hypoglycemia in a neonate
administer D10 to get glucose >4 mg/dl
what is choanal atresia
a bony or membranous occlusion that blocks the passageway between the nose and pharynx
where do you park at a hazard material scene
at least 100 ft uphill and upwind
if involved in a wreck in an ambulance what should you do for safety
move to the side of the road/curb
If the ambulance is disabled on the road, where should you place the signals
100 ft in front and behind the vehicle
If the ambulance is disabled within 500 ft of a hill where do you place the signals
100 ft in front and back of the ambulance and a 3rd on top of the hill
what is the most common form of ambulance collision
intersection collisions.
