General (3-18) Flashcards
1
Q
When to consider spinal immobilization?
A
- Fall from height
- Axial load to head
- High speed collision, rollover, or ejection
- Explosion or blast
- Trauma resulting in amnesia/LOC
- Dangerous MOI
- Low risk MOI unable to rotate neck 45°
2
Q
What is MARCHES
A
Massive Bleeding Control
Airway
Respiratory
Circulation
Hypothermia Care
Eye Injuries
Spinal Motion Restriction
3
Q
Actions under universal patient guideline(Sic vis)
A
Scene Safety
Initial Assessment
Consider C-Spine
Record vital and make transport decision
Initial Interventions(IV, O2, Fluid/meds)
Secondary Assessment(12, CO2, pain)
4
Q
TACEVAC Ground pick-up phase highlights
A
- 360 security
- Information and pt documentation
- Triage
- Treat preventable causes of death
- Brief and guide litter teams
- Goal of <5 min
- Subdue/muzzle MWDs BEFORE treating humans
5
Q
TACEVAC In-flight Actions
A
- Triage and reassess
- Hemorrhage control and initiate blood
- Airway/Vent management, target SPO2 of 90-96%
- Chest Trauma: Vented chest seals, NCD, finger thor, chest tube
- Hypothermia
- TBI/AMS(Elevate head, 3% HTS, ETCO2
- Pain
- Consider ABX
- Document
6
Q
DCR Order of precedence
A
- Control hemorrhage
- Administer blood products
- Consider TXA < 3 hrs from injury
- Ca2+ upfront and after every 4th
- Pressors as last resort
7
Q
TQ over clothes from ground medic okay?
A
Absolutely not, 2-3 inches above the wound, on the skin
8
Q
No hostile fire, multi ship, where to put deceased?
A
Separate transport
9
Q
S&S of respiratory distress or failure
A
- SPO2 decreasing <90%
- Difficult breathing or excess work of breathing
- Airway obstruction
- Apnea
- Decreased LOC
- Pediatric is <12 YOA
10
Q
SPO2 < 90% do what
A
- Supplemental O2
- NPA/OPA
- q5 checks
- BVM or assist with respiration
11
Q
Advanced airway sequence
A
- ETI
- BIAD
- Cric
12
Q
Advance to Failed Airway Guideline IF?
A
- Unable to adequately open airway
- 2 failed ETI attempts by most proficient provider on scene and 1 BAID failure
- Intubation contraindicated
- Continued inability to ventilate pt with BVM
13
Q
Failed Airway Actions
A
- BVM if able
- Cric if > 10 YOA
- Ventilate pt per age-appropriate RR to maintain minute ventilation
14
Q
RSI hx/indications
A
- Airway compromise or inability to protect airway
- Resp failure(hypoxic, hypercapnic)
- > TBSA burns. sepsis, TBI w/AMS
- Pt/crew safety
15
Q
Contraindications for RSI
A
- High likelihood of failure(distorted anatomy)
- Penetrating neck trauma
16
Q
Induction agents(4)
A
- Ketamine(1-2 mg/kg)
- Etomidate(0.2-0.4 mg/kg)
- Midazolam(0.1 mg/kg)
- Propofol(1-2.5 mg/kg)
17
Q
Paralytics(3)
A
- Roc(0.6-1.2 mg/kg)
- Vec(0.08-0.15 mg/kg)
- Suc(1-1.5 mg/kg)
18
Q
Maintenance sedation(3)
A
- Ketamine(0.5-2 mg IVP or 0.5-2 mg/kg bolus then 1-3 mg/kg/hr)
- Propofol(10-75 mcg/min)
- Midazolam(0.05 mg/kg IVP or bolus then 0.05-1 mg/kg/hr)
19
Q
Push dose epi
A
5-20 mcg q2-5min
20
Q
7 Ps
A
- Prepare
- Pre-oxygen
- Positioning
- Pretreat
- Sedate/Paralyze
- Pass Tube
- Post-tube management
21
Q
SOAP MEE
A
Suction
Oxygen
Airways
Pharmacology
Monitor
Equipment
Evaluate cric landmarks
22
Q
Pre-Oxygen highlights
A
> = 3 mins to flush N2 or 8 VC breaths with 15 LPM
Goal is >=94%
23
Q
Position for RSI
A
- 30° then ear to sternal notch
- Consider c spine
24
Q
Pretreat how do?
A
- Resus with IVF/Blood, consider push dose pressors
- Target >100 mmHg
- Consider 3 mcg/kg fent to prevent hypertension in TBI, cardiac ischemia, or aortic dissection
- Atropine at 0.02 mg IV for peds
25
How to verify tube placement?
ETCO2 waveform capnography
26
Initial Vent settings
CMV+ or Assist Control
6 mL/kg
14 RR
1:2
100%
5
27
Only time Vt gets changed?
For lung protection, reduce vt by 1mL/kg at intervals <2 hrs until vt = 6 ml/kg
28
IBW
(ht-60)2.3 + 50
(ht-60)2.3 + 45.5
29
Normal oxygenation goal
PaO2 80-100 or SPO2 90-96%
30
ARDS oxygenation goal
PaO2 55-80 or SPO2 88-95%
31
Plateau pressure goal
<= 30 cmH2O
32
How often to check Pplat ?
at least q 4 hours
33
Pplat > 30
Decrease Vt by 1ml/kg increments minimum of 4
34
Pplat < 25
Increase vt by 1 ml/kg until Pplat > 25 or vt = 6 ml/kg
35
Pplat <30 and breath stacking
Increase vt in 1mL/kg increments to 7 or 8 if Pplat remains < 30
36
Alarm Settings
High Pressure Alarm: 10 above Peak airway pressure or 50% above baseline pip
Low Pressure Alarm: 5 below peak airway pressure or 50% below pip
37
You suspect breath stacking and there are no alarms present. Wat do?
Disconnect tubing and allow exhalation, increase I:E ratio
38
First step in troubleshooting
Disconnect ventilator and begin bagging
39
When to clamp ETT?
If conducting recruitment maneuvers or PEEP >10
40
When should ABGs be done and how long if possible should pt remain on T1 prior to transport?
Within 30 min of flight and at least 15 min
41
Immediate indication for blood
- SBP<100
- HR>100
- Amputation
42
Blood Product order of precedence
Whole blood
Plasma, RBCs, Platelets 1:1:1
Plasma and RBCs 1:1
Plasma or RBCs
43
Where to document blood product admin?
SF 518
44
You're inspecting blood, what are you looking for?
Gas, discoloration, clots, sediment, and verifying Safe-T-vue is white
45
How to make IO comply best?
2-3 mL of 2% lidocaine
46
Consider slowing all infusions during blood admin except for?
TXA or RFVIIa
47
Resus Goal
- Palpable pulses, improved LOC, SBP>100(110 TBI), an MAP <60
48
Blood Transfusion reaction suspected
Stop
- Apply O2, cardiac monitor
- Establish advanced airway
- SpO2 >93%
49
Blood transfusion anaphylaxis
- Epi 0.3 mg IM
- Diphenhydramine 25 mg IV/IM
- Airway
- IV fluids prn
- Consider methylprednisolone 125 mg
50
Acute Hemolytic Reaction(AHTR)
- Diphenhydramine 25-50 mg
- Consider 20 g mannitol 20 % or 250 mL 3% NaCl
51
Febrile Non-hemolytic reaction
- Consider 500 mg tylenol PO or 1 g IV
52
How rare of transfusion reactions?
<0.1%
53
Most common transfusion reaction
febrile non hemolylic
54
TRALI vs TACO
TRALI: leading cause of transfusion mortality, concern w/hx of surgery, massive transfusion, or active infection. tx is supportive
TACO: pulmonary edema secondary to congestive heart failure. Occurs in elderly, small children, and those w/hx of cardiac issues. Common precursor is large volumes of fluid. Tx is diuresis and tx of underlying condition.
55
Precedence for IO locations
Arm
High leg
Low leg
56
IO Sizes
Yellow(45) humerus or heavt sternal
Blue(25) adult sternum/tib
Pink(15) childrean and sternal/tib
57
