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FPC-1 Flashcards

1
Q

2 Major Causes of heat loss

A

Radiation and Evaporation

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2
Q

What is PaO2

A

O2 in plasma, Meased as a pressure

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3
Q

Nomal Pediatric SBP?

A

(agex2) + 80

DBP = 2/3 of the SBP

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4
Q

When does the normal SBP drop?

A

After 25 % Blood Loss

DBP = 2/3 of the SBP

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5
Q

3 killers of a vent patient during flight

A
  1. Pericardia Tamponade
  2. Tension Pneumothorax
  3. Hypovolemia
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6
Q

Death from a crush injury due to?

A

Death is due to a re-prefusion injury

  1. Rhabomyotysis
  2. Renal Failure
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7
Q

Complication to a crush injury

A
  • DIC
  • Compartment Syndrome
  • Renal Failure
  • Hyperkalemia
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8
Q

Compartment Syndrome

A
  • Fasicotmy required if the pressure exeeds 33 MMhg
  • Must be perfromed within 6 hours of injury
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9
Q

CAMTS

  1. Pilot area oreintation day/night
  2. Helipads are required to have?
  3. Fixed wing twin engine time?
  4. Ground ambulance fuel requirments
  5. ELT set off at?
  6. Uniform fit?
A
  1. 5 hours for day/2 hours at night
  2. 2 paths, Security, Wind direction indicator, and Perimter lights
  3. 500 hours
  4. 175 miles
  5. 4 gs
  6. 1/2 in betwen body and uniform
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10
Q

Cardiac Output

(Formula and normal range)

A

SV x HR

Normal 4-8 l/min

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11
Q

Pulmonary Artery systolic and dyastolic pressures

A

PAS = 15-25

PAD = 8-15

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12
Q

PAWD Presure

A

8-12

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13
Q

What is the location of a chest tube?

Adults and Peds

A

Adults - 4 ICS Anterior Axillary

PEDS 5 ICS Anterior Midaxillary

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14
Q

What does a scaphoid abdomin indicate and how to treat it?

A

Diaphragmatic Rupture

Treatment- Gastric decompression

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15
Q

Plecento Abrupto

A

Tearing Pain with dark red blood loss

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16
Q

Placenta previa

A

bright red blood loss with no pain

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17
Q

Effects of altitude worsen with?

A
  • Cold Upper latitudes
  • PT that hace problems with low humidity and temp
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18
Q

temp

Guy Lussacs law

A

increase in temp = increase in presure

Decrease in temp = decrease in pressure

IE O2 tank pressure in cold/heat

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19
Q

Universal gas law

A

Combines Chalres and Boyles law

  • Boyles Law-Increase volume = decrease pressure
  • Charles Law - Temp and volume are proportional
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20
Q

Charles Law

A

Temp and volume are proportional

increase temp = increased volume

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21
Q

Boyles Law

A

Increased volume = Decreased pressure

Examples - BP cuffs, MAST, GI, ETT, IABP

IABP purges with ascent/decent

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22
Q

Henrys law

A

Gas in a liquid proportional to the gas above the liquide

Examples - CO2 in blood, The Bends, decompression

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23
Q

Gramhams Law

Define and effects

A

Define - Gas moves from high to low concetration

Example - Cellular gas exchange

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24
Q

Volume of gas in a the GI tract expans 3 times at what altitude?

Which law?

A

25,000 ft

Boyles las

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25
Q

Enviromental

  1. Passive Rewarming
  2. Active Rewarming
  3. Warm and dead
  4. Heat stroke
A
  1. Mild hypothermia - up 1o /hr to prevent afterdrop
  2. Apply heat to the body
  3. 32o C / meds do not work less than 30oC
  4. Over 42oC
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26
Q

Thumb Print

A

Epiglottitis

Seen in the lateral neck view

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27
Q

Steeple Sign

A

Croup

Seen in the A/P view

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28
Q

What meds are used for a AAA?

A

Nipride and Betat blockers

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29
Q

Vent vs oxgyenation

What are the first adjustments on a vent if there is issues?

A

If it is a Vent problem- TV first then Resp Rate

If it is an oxgyenantion problem - FiO2 then PEEP

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30
Q

Traumatic dislocations

  1. Most Common Dislocation

Most Common spontaneous reocurrance

A
  1. hip
  2. Anterior shoulder
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31
Q

Brain Natriuretic Peptide or BNP

what is it used for and what are normal levels and elevated levels

A

It is a marker for heart failure

BNP is released by an over distended heart

Normal - less than 100

500-700 = heart failure

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32
Q

What are the required rotor wing pilot hours?

A

2000 total hours

1000 PIC

100 night hours

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33
Q

FAA bottle to throttle time and what FAA part?

A

At least 8 hours and it is part of FAA part 135

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34
Q

What are the other names for CVP?

A

Right aterial pressure (RAP)

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35
Q

What is the nomal CVP?

A

2-6 mmHg

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36
Q

What is the length in CM for a central catheter placement?

A

RA/CVP = 20-25 cm

RV = 30-35 cm

PA = 40-45 cm

Wedge = 50 cm or greater

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37
Q

Which port is used for measure CVP

A

Proximal or Blue port

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38
Q

What are the spinal cord syndromes?

(ABC)

A
  1. Anterior
  2. Brown Sequord
  3. Central Cord Syndrome
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39
Q

What are the signs for an anterior cord injury?

A

Complete motor, pain, and temp sensatoin loss below the lesion

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40
Q

Normal

  • ICP
  • CPP (head)
  • MAP
  • CPP (heart)
A
  • ICP=0-10
  • CPP (head) = 70-90
  • MAP = 80-100
  • CPP (heart) 50-60
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41
Q

GCS values

Mild

Moderate

Severe

A

Mild 14-15

moderate 9-13

severe 3-8

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42
Q

CPP formulas

Head and heart

A

Head

CPP=MAP+ICP

Heart

CPP=DBP-wedge

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43
Q

Rotor wing ceiling and visibility Minimums

Day

Local and crosscountry

Night

Local and crosscountry

A

Day

Local 500 and 1 mile

Crosscrountry 1000 and 1 mile

Night

Local 800 and 2 miles

Cross country 1000 and 3 miles

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44
Q

What is the #1 cause of airmedical crashes?

A

Controlled flight into terrain due to pushing the weather

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45
Q

A-line

Site

Purpose

Dampening (over and under)

A

Site - Radial or Femoral

Purpose - Monitor pressure, Blood draws,a nd ABG’s

Dampening -

Underdamping - Caused by having air in the system, loose conections, a low pressure bag, and altitlude changes

Overdampening - Kink. increased pressure in the pressure bag, and tip against the wall

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46
Q

EKG

  1. Most common reperfusion dysrhytmia
  2. Most common hyopperfusion dysrythmia
  3. Hypokalimia on EKG
  4. Hyperkalmia on EKG
A
  1. AIVR
  2. VF
  3. Peaked P’s with flat P’s
  4. Flat P’s with Peaked T’s
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47
Q
  1. What is the MAP goal in a closed head injury?
  2. CPP goal with increased ICP?
A
  1. MAP 80-100
  2. CPP 70=90
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48
Q

Central Cord Syndrome

A

Greater motor weakness in the upper extremities then the lower extremities with a varying degree of sensery loss.

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49
Q

Brown Sequord Spinal cord syndrome

A

Ipsilateral loss of motor, position, and vibration sense; Contallateral loss of pain and temp perception

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50
Q

Define and treatment of Autonomic Dysreflexin

A

Urine retention, masive increase in sympathetic tone which can lead to HTN.

Treated by insertion of a foly

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51
Q

Normal urine output

(Peds and Aduls)

A

Adult 30-50 ml/hr

Peds 1-2 ml/kg/hr

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52
Q

Normal Blood Volume

A

Adult - 70ml/kg

peds 80 ml/kg

neonate 60 ml/kg

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53
Q

Cardiac index

A

2.5 - 4.3

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54
Q

Bariobariatrauma

A

Build up of nitrogen in the adipose tissue.

Nitogen releases at altitude with the obese patient.

Administer high flow O2 15 min prior to transport to wash out the nitrogen

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55
Q

Safety

  1. ELT frequancy
  2. Confirm ELT is working
  3. Twin engine require off shore
A
  1. 121.5
  2. Tune in and listen
  3. Raft and vests
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56
Q

High risk OB

  1. Primary cause of PTL
  2. Terb Contridictions
  3. PIH Triad
A
  1. Infection
  2. IDDM, maternal HR over 120, Vag Bleeding
  3. HTN-Edema-Proteinuria
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57
Q

Kehr’s Sign

A

Refered shoulder pain.

Possible splenic injury or ectopic pregnacy

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58
Q

Kernig’s Sign

A

Back, leg pain on knee extension.

Possible bacterial meningitis

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59
Q

Drudzinski’s

A

Back, leg pain on neck flexion.

Possible bacterial meningitis or subarachnoid bleed

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60
Q

Hamman’s

A

Crunching sound over the heart with auscultation over the anterior chest- Synchronized with heart beat-

Tracheobronchial injury

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61
Q

When does Thermoregulation cease?

A

28o C Drugs and Defib are not effective.

Warm PT uo to 30-32o C

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62
Q

Order of how to assess the abdomin?

A
  1. Inspect
  2. Auscultation
  3. Palpation
  4. Percussion
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63
Q

Contraindications for Thrombolytics

A

HX of hemorrahagic stroke

CVA last 12 months

SBP over 180

Pergnancy or 1 month post partium

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64
Q

Normal SVR

A

800-1200 Dynes/sec/cm5

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65
Q

Define post partum hemorage

A

Over 500 ml within 25 hours of delivery

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66
Q

Cardigenic Shock

CVP

Cardiac output

Cardiac Index

PAS/PAD

PAWP

SVR

Heart Rate

A

CVP-high

CO-low

CI-low

PAS/PAD-high

PCWP-high

SVR-High

HR initiall fast then slows down

67
Q

Gray’s Sign

A

Flank Bruising

Retroperitoneal bleeding

68
Q

Coopernails sign

A

Scotum/Labia

Abdominal/Pelvic bleeding

69
Q

Halsteads Sign

A

Marbled Abdomen

Abd Bleeding

70
Q

Cullen’s Sign

A

Umbilical discolortion

Pancreatitis

71
Q

Murphy’s Sign

A

RUQ pain with inspiration-

Gallbladder

72
Q

Levine’s Sign

A

Fist to chest “Clutching” -

Cardiac

73
Q

Types of hypoxia

  1. Hypoxic Hypoxia
  2. Hypemic Hypoxia
  3. Histotoxic Hypoxia
  4. Stagnant Hypoxia
A
  1. Altitude hypoxia, decreased alveolar oxygen, Tension Pneumo
  2. Decreased O2 carrying capacity in blood
  3. Poisoning
  4. Decreased cardiac output, poor circulation. ex-G-fources, CHF
74
Q

Normal fetal heart rate

75
Q

Primary cause of death with the vent dependent PT’s

A

Vent aquired pneimonia

76
Q

ARDS

Treatment

CXR

A

Treatment PEEP

CXR reveals widespread pulmonary infilitrates; ground glass-like appearance

Kerley B lines and pleural effusions are not commonly seen in ARDS; but can be seen in CHF/Pulmonary edema

77
Q

Treat HTN when BP?

A

220 Systolic

MAP over 130

78
Q

Normal Sodium Level

79
Q

Decreased sodium can cause what in the head injury patient

A

Decreased sodium can call increased intacranial pressure; Maintain sodium levels at 155

80
Q

What is the preferred method for moving spinal injured patients

A

Scoop Stretcher

81
Q

Blood loss with FX’s

Humerus

Femur

A

Humerus 750 ml

Femur 1500 ml

82
Q

Inadvertent Wedge

A

Do not keep fro more than 15 seconds.

Make sure that the balloon is deflated and have the patent cough forcefully

83
Q

Differential DX

Pulmonary Contusion

A

Low sats despite O2 Rales

84
Q

Differential DX

Ruptured Diaphragm

A

Chest/Abd pain radiating to the left shoulder

85
Q

Differential DX

Esophageal performation

A

Fever, hematemesis

86
Q

Differential DX

Fat embolus

A

Fever and rash after a fracture

87
Q

Differentail DX

FX larynx

A

Hourse sounds when speaking

88
Q

Tube depth

adult

peds

neonate

A

Adult: 3x ETT size, avg is 19-23 cm

Peds: 10 + age x ETT size

Neonate: 6 + age wieght in KG

89
Q

Induction agent of choice with bronchospastic PT’s

90
Q

Ativan: indication dose and max dose

A

1-2 mg to a max of 4 mg

Other name lorazepam

91
Q

Mannitol Dose

92
Q

Drug choice for cyclic antidepressant OD

93
Q

Drug of choice fro beta blaocker OD

94
Q

Fentanyl dose

A

3mcg/kg

Other name sublimaze

95
Q

Treatment for malignant hyperthermia

A

Dantrium (dantrolene)

96
Q

Drugs for GI bleeds

A

Sandostation (octreotide)

97
Q

Neurogenic Shock

CVP

CO

CI

Wedge

SVR

HR

A

CVP: low

CO: low

CI: Low

Wedge: low

SVR:low

HR: slow or normal

98
Q

CPP goal with increased ICP

99
Q

Lab values

  1. Potassium
  2. Chloride
  3. Calcium
  4. Metabolic acidosis elevates which electtolyte
A
  1. 3.5-5.5
  2. 95-105
  3. 8.5-10.5
  4. Potassium
100
Q

Time of useful consciousness with suden decompression at:

  1. 30,000
  2. 41,000
A

30,000 - 90 seonds

41,000 - 15 seconds

101
Q

12 lead ECG

Inferior

Septal

Anterior

Lateral

Posterior

A

Inferior- II, III, AVF

Septal- V1, V2

Anterior- V3, V4

Lateral- I, aVL, V5, V6

Posterior- ST depression/reciprocal changes noted in V1-4, Tall R waves, ST elevation in V6

102
Q

CVP-high

CO-low

CI-low

PAS/PAD-high

PCWP-high

SVR-High

HR initiall fast then slows down

A

Cardigenic Shock

103
Q

CVP: low

CO: low

CI: Low

Wedge: low

SVR:low

HR: slow or normal

A

Neurogenic Shock

104
Q

Cardiac

Ischemia

Injury

Infarct

A

Ischemia- ST depression (1mm in 2 contigious leads)

Injury- Elevation

Infact- Q wave > 25% the height of the R wave

105
Q

II, III, AVF

V1, V2

V3, V4

I, aVL, V5, V6

ST depression/reciprocal changes noted in V1-4, Tall R waves, ST elevation in V6

A

12 lead ECG

Inferior

Septal

Anterior

Lateral

Posterior

106
Q

Pediatric age guildeline

ETT cuffed versus uncuffed

Needle cricothyrotomy

Nasal intubation

A

“10 ,11,12” Rule

Uncuffed under 10

needle cricothyrotomy

Na nasal intubation under 12 years old

107
Q

Vent Modes

  1. CVM
  2. AC
  3. IMV/SIMV
A
  1. CMV-Preset volume or PIP at a set rate; PT can not initiate breath
  2. AC-Preset volume or PIP with every breath; Can trigger a breath, Can not controll TV, No pressure support
  3. IMV- Preset breaths, TV, PIP; PT breaths allowed
  4. SIMV- Allows variation of support; Back-up RR set; Pressure suport can be used
108
Q

IABP

  1. Action
  2. Balloon inflates
  3. Balloon defates
  4. Dictrotic Notch
A
  1. Increase CO, Cornary Perfusion, Myocardial O2 delivery
  2. Inflates during diastole
  3. Deflates during ventrical systole
  4. Aortic valve closing, Snychronized with a-line or EKG. (most common trigger)
109
Q

IABP

  1. Signs/symtoms of a balloon leak
  2. Clot Prevention
  3. IABP increases CO by how much
  4. Balloon rupture
  5. Migration/Dislodged
  6. Lethal IABP timing cycles
A
  1. Blood specs “rust colored flakes” in tubing, alarms going off
  2. Cycle manually every 30 min
  3. 10-20%
  4. Rust flakes in line/ Turn off machine
  5. Assess left raial artery and urine output
  6. Late defaltion and early inflation
110
Q

Oxyhemoglobin Dissaciation Curve

Right Shift

A

“R” stands for raised

Right = Raise / release oxygen Acidosis

Rised CO2

Raised temp

Raised 2,3 DPG levels

PH is low

111
Q

Stages of Hypoxia in Elevation

A
  • Indifferent: 10,000: Increased HR and RR, Decreased night vision
  • Compensatory: 10-15,000: HTN and task inpairment
  • Disturbance: 15-20,000: Dizzy, sleepy, cyanosis
  • Critical: 20-30,000: ALOC, incapacaitated
112
Q

Stressors of Flight

A
  1. thrid spacing
  2. fatigue
  3. g-fources
  4. noise
  5. vibration
  6. hypoxia
  7. dehydration
  8. temp changes
  9. barometric pressure changes
113
Q

Personal factors affecting stressors of flight

A

DEATH

  1. Drugs
  2. Exaustion
  3. Alcohol
  4. Tobacco
  5. Hypoglycemia
114
Q

Cardiac

Thrombolytics must be administered within

A

3 Hours of onset

115
Q

Diving injures

Define ATM and ATA

A

1 ATM for every 33 ft of decent; A diver at 66ft will be at 2 ATM

ATA- total atmospheric pressure.

Add 1 to the total ATM. A diver that is at 33 ft has a ATA of 2

116
Q

Hypovolemic Shock

CVP

CO

CI

Wedge

SVR

HR

A

CVP: Low

CO: low

CI: Low

Wedge: Low

SVR: High

HR: High

117
Q

Define Acute Resitatory Failure

A

pO2 > 60, pCO2 < 50

118
Q

CVP: Low

CO: low

CI: Low

Wedge: Low

SVR: High

HR: High

A

Hypovolemic Shock

119
Q

Newtons Laws (3)

A

First: an object in motion tends to stay in motion…

Second: Force = mass x accerleration

Third: every action has a = and oppisite reaction

120
Q

Tetralogy of Fallot

A

Remeber PROV

P = pulmonary stenosis

R = right vent hypertrophy

O = overriding aorta

V = Ventricaular septal defect

121
Q

Atrial Wave forms

right atrial pressure (RAP) = ?

Left atrial pressure (LAP) = ?

A

“Filling Presures”

Right atrial ppressure = CVP

Left atrial pressure = PAWP/PCWP

122
Q

Do atrial waveforms have dicrotic notches?

123
Q

What waves do atrial waveforms have?

A

A, C and V waves

Also x and y decents

124
Q

Ventricular waveforms

When do get ventricular wave froms?

What does it look like?

When is ist the left ventricle pressure messured?

A

Right ventrical pressure obtained upon insertion of the PA catheter ot if the catheter has been dislodged backwards into the right ventricle resulting in a right ventricular waveform

Looks like “VT”, anacrotic notch seen on the left side of the wave form and corrlates to the QRS on the ECG

Left ventricular pressure measered durning cardiac catheterization

125
Q

A wave

A

A wave = rise in atrial pressure as a result of atrial contraction

Generally coincides witht the PR interval on the ECG in the right atrial pressure waveform

It will be slightly delayed in the left atrial pressure waveform by .08-.12 secs

126
Q

C Wave

A

C wave = Not always visible on th tracing, rise in atrail pressure which closure of the AV valves (tri and mitrial) buldge upwards into the atrium following valve closure

Generally coincides witht he mid to late QRS in the right atrial pressure waveform

it will be slightly delayed i the left atrial pressure waveform by .08-.12

127
Q

V Wave

A

V wave = rise in atrial pressure as it refills during ventricular contraction

Generally seen immediatly after the peak of teh T wave on the ECG in the right atrial pressre waveform

It will be slightly delayed in the left atrial pressure waveform by .08-.12

128
Q

When do you measure CVP/PA?

A

At the end of exhalation

129
Q

What does a “Z” point measre and how do you measure it?

A

Z point measures the end-diastolic pressure

Draw a line from the end of the QRS to the hemodynamic tracing. The point where the line intersects with the waveform is the “Z” point.

The Z point on the PAWP tracing will be delayed bu .08-.12 sec

130
Q

What does the dicrotic notch indicate

A

Closure of the aortic valve for the arterial line and IABP inflation

Closure of the pulmonic valve for PA

131
Q

What does CPK>20,000 mean

A

CPK (muscle enzyme) levels greater than 20.000 is ominous and is an indication of later DIC, acute renal failure and is potentially dangerous hyperkalemia in the heatstroke pt.

Other names for CPK is creatinine phosphokinase,

CK; creatinine kinase

132
Q

Most common causes of seicures in neonates?

A

Hypoglycemia (<40 mg/dl) and hypoxia

133
Q

WHen do you use surfactant?

A

32 weeks or less gestation = surfactant

134
Q

What does a Scaphoid abdomin indicate and how is it managed?

A

Diaphragmatic hernia and is managed with OG tube and PPV

135
Q

Patent ductus arteriosus (PDA)

How does it maintain open?

What causes it to close?

A

maintains the PDA open = Prostaglandin (PGE1)

Closes due to Indomethacin and long term use of high O2

136
Q

VEAL

CHOP

A

V - Variable = C - Chop

E - Early = Head Compression

A - Acceleration = Okay

L - Late = Placental insufficiently

137
Q

What is the best indicator of fetal viability?

A

Fetal vaiability

Normal variablity is 10-15 beats

138
Q

FHR interpretation system

Category 1

A

Normal

Baseline 110-160

Baseline vaiability - moderate

Late or variable decelterations - absent

Early decels - Absent

accelerations - present or absent

139
Q

FHR interpretation systems

Catagory III

A

Cat III FHR tracings include either:
absent baseline FHR variability and any of the following

  • Bradcardia <110
  • Recurent variable decels
  • recurrent late decels
  • sinusoidal pattern (sine wave-like pattern with cycle frequency of 3-5/min persisting form >= 20 min0
140
Q

FHR interpretaion

Category II

A

everything that is not cat I or cat III

141
Q

Define varable decelerations

A

V or W shaped decelerations that can occur anytime during a contractions

Variable Decels = Cord Compresion

142
Q

Sinusoidal Patteren Causes?

A

Fetal anemia associated with:

  • Fetal hypoxia
  • Rh isoimmunizations, chronic fetal bleeds, fetal-maternal hemorage
143
Q

FHR paterns

(Non-reassuring)

A

Fetal tach

Fetal Brady

Late Decels

Variable decels

144
Q

PIH and Pre-ecalpsia Treatment

A
  • decrease noxious stimuli
  • DBP goal of 90-110
  • Apresoline (hydralizine)
  • latetalol (trandate)
  • Mag levels of 4-8 mg/dl

(Mag contraindicated in myasthena gravis)

145
Q

Mauriceau’s Manuever

A

Gloved finger into teh newborn’s moth while lifting the body upward and application of supra-pubic pressure over the symphysis with McRobert’s position of the mother (Increased pelvic diameter)

146
Q

Stages of labor

A
  • Stage - 1 Intial (latent) and active phase, onset of contractions to full dialation
  • Stage - 2 Full Dialation
  • Stage - 3 Delivery of the infant to delivery of the placenta
  • Stage - 4 First 2 hours of post partum
147
Q

Normal Mag Levels

148
Q

HELLP syndrome?

A

H = Hemolysis is confirmed by evidence of red cell fragmentation

EL = Elevated liver enzymes as high as 4,000

LP = low platlets, lower than 100,000

149
Q

how do you measure the frequency of contractions?

A

From the Begining of one contraction to the beining of the next.

150
Q

What color does Nitrazine paper turn in the presence of amniotic fluid

151
Q

What is labetalol?

A

is a mixed alpha/deta adrenergic antagonist agent that decreases systemic vascular resistance without changing CO.

152
Q

What is Leopold’s Maneuver used for?

A

to assess fetal position

153
Q

Ped tube size formula?

A

age + 16 / 4

154
Q

What is the most common side affect of transporting a PT on Prostaglandin E1?

A

Apnea and Hypotention

155
Q

Persistant Pulmonary Hypertention (PPHN) is a syndrome characterized by by persistent elevated pulmonary vasculary resistance resulting in?

A

Right to left shunt

156
Q

What lab test is done to DX Reye’s syndrome?

157
Q

What is the drug of choice for a ped pt profound hypotension due to sepsis?

158
Q

Formula for figuring weight based on age?

A

(age in years x 2) + 8

159
Q

Tube depth formula for a Neonate?

A

6 + Wieght in KG

160
Q

What is the sequence for blood flow through the valves of the heart

A
  1. Tricuspid
  2. Pulmonic
  3. Mitral
  4. Aortic

Remember

Toilet Paper My Ass

161
Q

What does a tricyclic antidepressant look manifest on an EKG?

A

Prolonged QT interval

162
Q

When the PA cath tracing has a dictoic notch on the left side, where is the tip?

A

Right Ventricle

163
Q

CVP-High

CI-Low

Wedge-Low

SVR-High

FPC (1 decks)

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