More critical care Flashcards
online repository for free transport related safety tools
Vision Zero
Vision Zero
online repository for free transport related safety tools
what is an important component of safety culture
data management system full of honest meaningful information
FAA’s Management System
top down approach to measuring safety and risk
Just Culture
system used to implement organization improvement presenting a set of designated laws that influence an organization’s ability to create the effect it desires
4 Pillars of FAA’s Safety Managment System
policy
risk managment
safety assurance & promotion
how do you prioritize risk
risks are prioritized by likelihood and conse4quence severity
hazards
conditions that have the potential to cause harm/damage/decrease teh functionality of personnel
IIMC
inadvertent instrument meterological conditoins
problems of using lights and sirens
increases risk w/o increaseing outcomes
what must be done if you lights/sirens during transport
CAMTS requires that all uses of lights and sirens be reported
IFR
instrument flight rules
how do you determine risk
determien risk by asking “does the benefit exceed the risk identified by hazard assessment w/added controls”
what should a pilot do if he is unsure if he should accept a medical trnasport
call the OCC (operational control center) who will make the final go/no go call
3 elements of safety assurance
safety performance monitoring & management
management of chance
continuous improvement of safety management system
how do you promote safety
lead by example
rehearse exit
egress training
major cause of accidents
human error
explain the swiss cheese model
for every major incident, there are multiple opportunities to prevent yet those opportunities are missed b/c inadequate team interaction/communication that leads to underappreciated/underreporting/failure to detect
stance on helicopter shopping
acceptable
how much uninterrupted rest before flying
10 hours
what do you do immediately before take off
vehicle walk around
situational awareness
understanding of what is occurring in the present,
how it relates to what has happened,
how likely it is to affect the future
idea of AMRM
when you know normal operations, you can detect deviations in weather/routes/speed/slope of ascent. training gets you in the habit of speaking up
not speaking to the pilot during critical phases
sterile cockput
Just Culture
program to focus organizations less on events/errors/outcomes
focus more on risk/system design and managment of behavioral change
frequent cause of major incidents
poor communication
safety culture =
attitude + proven policies
5 transport physiological stressors
g force
transport physiology
dehydration
noise
vibration
problem of alcohol when flying
risk hypoxia
how much time in between flying and alcohol
12 hours
flying after donating blood
72 hours
b/c
risk of 1 pint donated = 13% of blood volume lost. which decreases capacity of hte blood to carry oxygen so you feel tired
failure to manage cumulative stress
= burnout
sleep debt
accumulation of less than ideal sleep over time affects metabolism/endocrine leading to stroke, MI, diabetes, HTN, ulcers, depression…
sleep latency
time it takes you to fall asleep in a quite environment
sleep intertia
impaired alertness from the time you awake
time it takes to fall asleep versus impaired alertness when you awake
sleep latency = time it takes to fall asleep
sleep inertia = impaired alertness from the time you awake
normal AFI (L&D)
5-25 cm
purpose of AFI (L&D)
cushions fetus and the cord
- normal fetal growth, movement, and development
oligohydramnios
AFI 0-5cm
- slow amniotic leak, uteroplacental insufficincy, fetal kideny problems
- potentially poor fetal outcomes
- fetal deformity, cord compression, inadequate lung development
instructions post amniocentesis
light activity for 24hrs
- uterine irritability
- increased po intake to icnrese uteroplacental circulation which will help replace losses during the procedure
got OSCAR for LINCOLN
Daniel Day Lewis
when does fetal blood circulation start
4th week
PO2 of fetal blood
hypoxemic. PaO2 20-30
PVR in fetus
PVR in fetus is high b/c alveoli are filled w/fluid
SVR in fetus
SVR is low b/c substantial portion of fetal systemic venous blood enters the placenta where it is a low resistance pathway
SVR when the fetal cord is cut
SVR is low in utero
SVR increases when the cord is cut and blood flow shifts from teh previous low resistence placental circuit
what happens when a baby takes first breath
fluid from alveoli is expelled and absorpbed by pulmonary capillary
PVR post delivery
pulmonary vascular resistances decreasss 80% post delivery but doesn’t reach normal levels until day 14-21 psot birth
PDA closes
PDA closes = blood ejects from R ventricle into pulmoanry circulation which leads to decreased PVR
complete PDA closure
compelte PDA closure in 2 wks but immediate closure in repsonse to increased PaO2 levels from frist breath and loss of prostaglanding function
3 classifications of congenital heart defects
increased pulmonary blood flow,
decreased pulmonary blood flow,
obstruction to systemic blood flow
acyanotic congenital cardiac defect
“PINK”
increased blodo flow to lugns, damages lung tissue and vaculature leading to fibrosis-pulmoanry HTN and increased pulmonary
problem of increased PVR
leads to increased heart workload b/c pump against high pressure
cyanotic congenital heart defect
BLUE.
low/no blood flow to lungs. might have collateral flow
R to L shunt
decreased b. flow = underdeveloped lungs
- might develop polycythemic to increase oxyugen carryign capacities
obstructive congenital heart defect
lesion decreases CO to periopherial so they are dependent on an open PDA
- incerase dleft heart so the L. ventricular hypertrophy over time. heart failure
nICP
noninvasive ICP monitoring
- IOP
- near infared spectorscopy. measur eblood hgb level w/light
- transcranial doppler US
- tympanic membrane displacement
sometimes the cause of IOP
raised ICP
- raise in level ofoptic nerve
impaired venous drainage from orbit
shortening in length of hte eye
NPi
neurology pupil index
(pupil size and reaction to light)
HOB if head injury
15-30%
general management principle of neuro emergencies
monitor perfusion
preserve cerebral function
