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Critical Care 1 > TPATC > Flashcards

TPATC Flashcards

1
Q

low ETCO2

A

hypocapnia. less CO2 out w/each breath

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2
Q

ultimate state of shock

A

cardiac arrest b/c there is no circulation, metabolism, and no CO2 production unless effective chest compressions

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3
Q

ETCO2 in severe sepsis

A

poor perfusion leading to buildup of serum lactate/m. acdosis
-increae minute ventilation to blow off CO2 and lower ETCO2

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4
Q

TRALI

A

transfusion related acute lung injury

-sudden resp distress within 6hrs of a b. transfusion

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5
Q

suspect if sudden r. distress after b. transfusion

A

TRALI; transfusion related acute lung injury

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6
Q

s/s of TRALI

A

within 6hrs of blood transfusion

-low bp, fever, transient leukopenia

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7
Q

TACO

A

HTN w/o fever and leukopenia after b. transfusion

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8
Q

difference between TRALI & TACO

A

both have respiratory distress due to acute onset p. edema post blood transfusion
*only TRALI has fever & leukopenia

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9
Q

problem of too high PEEP

A

low bp

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10
Q

indication of ETCO2 of 18mm hg

A

severe hypoperfusion so need IVF

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11
Q

what type of patients need padded stretchers

A

hypothermia pt b/c that decreases sensations of vibrations. ncreased sensitivity to vibrations can trigger life threatening arrythmias

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12
Q

s/s of flicker vertigo

A 
N/V
vertigo
motion sickness
lightheadedness
seizures
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13
Q

levels of SCI that needs m. ventilation

A

above C4

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14
Q

causes of increased difficulty w/BVM

A

BMI over 30
Mallampati 3-4
facial hair
over 57yrs

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15
Q

just culture model

A

focuses on risk, system design, management of behavioral choices
less focus= errors, punitive

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16
Q

problem of rx/alcohol in your system while flying

A

hypoxia risk

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17
Q

blood donation & flying

A

no fly in under 72hrs post BT
1 pt donation = lose 13% b. volume
so your ability to carry oxygen is decreased and fatigue/tired

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18
Q

impaired alertness/performance immediately after waking

A

sleep intertia

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19
Q

space between garmets for flight suits

A

1/4

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20
Q

rules for flying w/night vision goggles

A

should be worn by at least 2 staff

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21
Q

ELT frequencies

A
  1. 025
  2. 5
  3. 0
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22
Q

radio in an emergency

A

keep on, not intermittently

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23
Q

timeline of survival in wilderness

A

3h w/o shelter
3 days w/o water
3wks w/o food

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24
Q

oxygen for pilots of unpressurized cabins

A

use oxgen continuously if flying over

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25
Q

when should a pilot continuously wear oxygen

A

if unpressurized over 12K ft

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26
Q

when should a pilot intermittently wear oxygen

A

continuous oxygen if over 12K ft

10-12K if spend over 30min at that altitutde

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27
Q

at what altitude do pilots start wearing oxygen

A

unpressurized 10-12K ft if over 30min

continuously over 12K

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28
Q

rate temperature changes with increase/decrease in altitude

A

lapse rate

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29
Q

manage OG/NG tube if flying

A

leave open b/c Boyle’s rule

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30
Q

Charle’s law

A

volume & temperature

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31
Q

volume & temperature

A

CHarles law

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32
Q

pressure & temperature

A

Gay-Lussac

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33
Q

Gay-Lussac Law

A

pressure & temperature

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34
Q

key feature of the Ideal Gas Law

A

effects of pressure are greater than the effects of temperature
*as barometric pressure decreases gas expands and temperature decreases

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35
Q

use of Dalton’s law in transport physiology

A

explains hypoxia. driving pressure to get oxygen into lungs. mountaineers

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36
Q

gas law that explains why mountineers get hypoxia

A

Dalton’s law

*% of oxygen is the ame at 21% but the pressure driving oxygen into the lungs changes

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37
Q

when do significant effects of altitude on the body begin

A

significant effects not below 12K

BUT night vision deteriorates at 5K ft

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38
Q

altitude where night vision decreases

A

5K ft

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39
Q

diffusion of high to low

A

Graham’s law

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40
Q

explains decompression sickness

A

Henry’s law

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41
Q

pressure above a liquid causes gas to dissolve in a liquid

A

Herny’s law

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42
Q

pressure & solubility

A

Henry’s law

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43
Q

hrs of rest prior to a flight transport mission

A

10hrs

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44
Q

what type of tissue stores nitrogen

A

adipose tissue acts as a reservoir of nitrogen and stores overt 1/2 of the body’s nitrogen. ability to dissolve 5-6 more nitrogen than other body tissues

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45
Q

barobaritrauma

A

form of barotrauma in which a large release of nitrogen from adipose tissue enters the bloodstream

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46
Q

trigger for decompression sickness

A

too rapid descention

fly to 30K too quickly

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47
Q

predisposing factors for decompression sickness

A
  • frequent exposure to over 18K ft
  • rapid rate of rise/drop
  • lots of adipose tissue
  • age extremes
  • alcohol consumption
  • preexisting ardiopulmonary disease
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48
Q

effects of altitude on the obese

A

100% oxygen for 15min prior to flight b/c nitrogen is stored in adipose tissue and could cause decompression sickness

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49
Q

when does everyone involved in a flight need O2 prior to flight

A

if over 18K unpressurized, breathe 100% oxygen for 30minutes prior to flight to provide washout of nitrogen w/oxygen

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50
Q

how soon after scuba diving can you fly

A

after 24hrs b/c compressed air causes excessive nitrogen uptake

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51
Q

how soon after hyperbaric chamber can you fly

A

12 hrs post

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52
Q

bends

A

decompression sickness in joints

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53
Q

s/s of skin bends

A

nitrogen gas bubbles under the skin or along nerve tracks

*itch, tingle, rash,, swelling

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54
Q

type 2 decompression sickness

A

chokes = lungs

CNS trauma

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55
Q

“chokes”

A

decompression sickness

  • nitrogen gas bubbles in the lungs taht obstruct smaller pulmonary vessels
  • burning sensation under the sternum and is associated w/coughing and sensation of suffering
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56
Q

CNS & decompression sickness

A

nitrogen bubbles in teh brain/spinal cord. obstruct blood flow to the brain and SCI

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57
Q

s/s of CNS decompression sickness

A 
visual disturbance
HA
face/jaw pain
can't hear/speak
numb/tingle
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58
Q

treat decompression sickness-5

A 
descend
100% oxygen
splint affected limbs
avoid weight bearing
consider hyperbaric
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59
Q

4 categories of the decompression system

A

type 1: “bends” (joints), paresthesia (skin)

type 2: chokes (lungs) neurologic (brain/SCI)

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60
Q

dysbarisms

A

s/s from xpsoure to changing air pressure arise when expanding or contracting gas ca ‘t escape or equalize to ambient pressure

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61
Q

use of vasoconstrictive nasal spray during air transport

A

to help w/facial sinus and inner ear pressure

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62
Q

when does sinus squeeze occur

A

excrucinating pain on descent

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63
Q

sinus squeeze

A

excruciating pain on descent

inflammation of sinus cavity w/gas expansion and contraction b/c barometric pressure changes

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64
Q

intervention for sinus squeeze

A

apply direct pressure, valsalva, decongestants, descent gradually

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65
Q

flight transport pt w/increased lacrimination during flighyt

A

if can’t communicate, increased lacrimation is a sign that they may be experiencing barotrauma

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66
Q

tooth pain during flight

A

ascent -gas expansion due to changes in barometric pressure

pain decreases w/descent b/c air contracts

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67
Q

4 stages of hypoxia r/t altitude

A

inefficient
compensatory
distrubance
critical

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68
Q

stage 1 hypoxia

A

stage 1 = enefficient
up to 10K ft
slight vital sign increase
decreased night vision

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69
Q

stage 2 of hypoxia

A 
compensatory
10-15K ft
increased vitals
increased depth RR
more difficult to perform tasks
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70
Q

stage 3 hypoxia

A 
disturbance
15-20K ft
dizzy
sleepy
tunnel vision
cyanosis
poor muscle coordination
slow thinking
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71
Q

stage 4 hypoxia

A 
critical
over 20K
confusion
LOC
incapicitation
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72
Q

2 measures of hypoxia on personnel in flights

A

Effective Performance Time

Time of Useful Consciousness

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73
Q

Effective Performance Time

A

availabel time to perform flight duties in an environment w/ inadequate oxygen

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74
Q

loss of effective performance measured from the time oxygen is deprived to deliberate loss of function

A

TUC

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75
Q

TUC

A

loss of effective performance measuring the time from deprivation of oxgyen to deliberate loss of function

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76
Q

18K ft & TUC/EPT

A

20-30min

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77
Q

22K ft and TUC/EPT

A

10min

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78
Q

25K ft & TUC/EPT

A

3-5min

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79
Q

30K ft & TUC/EPT

A

1-2 min

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80
Q

40K ft & TUC/EPT

A

15-20 sec

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81
Q

TUC/EPT is 10 minutes

A

22K ft

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82
Q

TUC/EPT is 1-2min

A

30K fty

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83
Q

seizures in flight

A

flicker vertigo

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84
Q

what is flicker vertigo sometimes confused w/

A

hypoxia, seizrues

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85
Q

what does EMTALA say about stablization

A

pt does NOT need to be stablized prior to transfer and DOES say the stabilization within the capability fo the hospital must be done prior to transfer

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86
Q

fear that touching will lead to harm

A

assault

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87
Q

actual physical touch leading to harm

A

battery

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88
Q

spalling

A

pressure wave on teh air-fluid interfaces on the human body

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89
Q

implosion

A

compression of gas containing areas of the body exceeding the organ to contain the pressure (bubble wrap squeeze)

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90
Q

what is affected in primary blast injuries

A

gas filled organs (lungs, GI, lungs, tympanic membrane)

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91
Q

4 phases of disaster managemnet

A

preparednes
mitigaytion
response
recovery

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92
Q

START triage

A

simple triage and rapid assessment

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93
Q

4 catagories of START

A

delayed, urgent, emergent, expectant

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94
Q

goal of mass care

A

greatest good for the greatest number

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95
Q

red color in mass casualty

A

immediate

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96
Q

yellow color in mass causalty

A

urgent

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97
Q

purpose of knowing MOI

A

describes energy transfer

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98
Q

when should you suspect spleen injury post car accident

A

T-boned on left side b/c spleen on left

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99
Q

what organ injury should you suspect if a pt is T-boned on left

A

spleen

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100
Q

what injury to suspect if t-boned on right

A

liver, right shouldler/clavi le

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101
Q

interventions to do in “B” of the algorithm

A

needle D

seal open pneumothroax

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102
Q

what non-A item should you do in “A”

A

c-spine

hemorrhage

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103
Q

interventions in “C”

A

direct pressure
hemostatic dressing
blood transfusion/TXA

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104
Q

assessment in “C”

A 
skin color
skin temp
moisture
pulse: rate, quality, location
cap refill
LOC represents brainn perfusion
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105
Q

items in “D”

A

neuro

AVPU

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106
Q

what does LOC represent

A

brainperfusion

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107
Q

intervention to consider if mental status is decreasing

A

airway management

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108
Q

triad of death

A

hypothermia
acidosis
coagulopathy

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109
Q

“L” in sample

A

LMP
pregnant
last I&O

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110
Q

most reliable way to confirm ET placement

A

capnography

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111
Q

4 physical s/s of pain in AMS

A

grimacing
tearing
vital signs change
diaphoresis

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112
Q

order of RSI rx

A

pretreat
sedate
paralyze
**sedate prior to paralyze b/c most anxiolyutics/hypnotics expcept ketamine dont’ have analgesic properties

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113
Q

hoarse voice

A

suspect airway compromise

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114
Q

when should you be concerned about airway patency

A

combative, confused, injuu8resd

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115
Q

backup plans if intubation fails

A

BVM, LMA, cric

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116
Q

BMI that predicts difficult airway

A

over 30

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117
Q

age that predicts difficult airway

A

over 57yo

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118
Q

2 airway assessments to identify a difficult airway

A

Mallampati

3-3-2

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119
Q

3-3-2

A
  • oral opening 3 of pt fingers (less than that can be difficult to visualize larynx)
    *tip of mentum to hypoid bone (fingers in front of neck. less than 3 fingers means limited space for tongue.)(measure looks at space availabe to accommodate tongue)
    2
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120
Q

purpose of bougie

A

tracheal introducer

*thread over ET, take out introducer. that’s how to change out old ET tube for a new one

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121
Q

complication of obtunded pt

A

might not have complex coordinated muscular actions to direct blood/secretions/emesis away from airway

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122
Q

consideration of pt needs RSI and has a chest injury

A

chest injuries can limit pt safe apnea time during RSI

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123
Q

inability to open jaw

A

trismus

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124
Q

sizing of OPA

A

corner of mouth to angle of mandible

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125
Q

assessment of BVM

A

ensure tongue isn’t falling back and obstructing

can use 2NPA & OPA

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126
Q

tip of Mac blade during intubation

A

vallecula

curved tip = MAC

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127
Q

tip of the straight miller blade

A

under/beyond epiglottis

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128
Q

intubation but can’t see vocal cords

A

BURP, crioid pressure, ET introducer< external laryngeal manipulation

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129
Q

external laryngeal manipulation

A

finger on teh thyroid and move until optimal position is found then hold spot until passage of ETT intubatior can put hand on assistant to bring larynx into view

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130
Q

well executed BURP maneuver

A

specific type of external laryngeal manipulation

*can improve laryngoscopic view by one COrmack-Lehane grade

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131
Q

tool that feels for “clicks” during intubation

A

bougie

clicks are against the tracheal rings

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132
Q

position for intubation

A

see a line from the air tragus to zyphoid
ramp
elevate head

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133
Q

sizing combitube to LMA

A 
LMA = weight
Combitube = height
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134
Q

insert Combitube

A

sized by height
blind insert
very stiff tube so soft tissue damage
basic EMT can use for CPR

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135
Q

contraindication of Combitube

A

esopheageal

ingestion of caustic substance b/c the tube is stiff and can cause trauma

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136
Q

how far do you insert combitube

A

lube
blindly until teeth are inbetween 2 black marks,
insert air

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137
Q

how much air is inserted into combitube

A

1st: 85ml. located in te posterior pharynx above the epiglottis

2nd 12ml air. esopagus

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138
Q

taking out combitube

A

deflate both balloons (one in posterior pharynx above the epiglottis, other in esophagus)

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139
Q

how to put in an ET tube if you have a combitube in

A

deflate balloon in the posterior pharynx but leave the esophagus one inflated. so you have a marker for inserting the ET tube

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140
Q

3 indications for cric

A

angioedema
facial burn
foreign body obstruction

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141
Q

2 types of ric

A

needle

surgical

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142
Q

why don’t kids get cric

A

small pliable and mobile larynx/cricoid

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143
Q

ETCO2 when the device is first set up

A

may briefly detect w/normal capnography if the tube is placed into the esophagus due to exhaled gases forced into the stomach during BVM

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144
Q

how to interpret properly placement of ETCO2 via capnography

A

need 6 breaths before the colorimeter an tell you

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145
Q

CXR that indicates correct ET placement

A

tip in teh trachea

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146
Q

ways to confirm ET is in correct place-5

A 
capnography
US
direct visualize tube pass vocal cords
ausculatate
CXR
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147
Q

how far past the vocal cords should the ET go

A

2cm beyond vocal cords

2-6cm above carina

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148
Q

vital signs post intubation

A

change from negative to positive vent can precipitate low bp bc increased intrathoracic pressure of convert a simple lung injury/small pneumo to t. pneomo

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149
Q

goal of RSI

A

achieve optimal conditions for intubation w/rapid onset of paralysis and sedatives while mitigating complications

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150
Q

goal of preoxygenation before RSI

A

preoxygenate w/NC at 10L/min for minimum 3min,

washes out nitrogen and establishes an oxygen reservoir so safer for longer periods of safe apnea

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151
Q

RSI classes

A

preinduction
sedative hyponotics
neuromuscuearl bockers

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152
Q

timeline when you treat for RSI

A

1-3min prior only if you have time to spare

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153
Q

steps in delayed sequence intubation

A
  1. give sedative that preserves respiratory drive and airway reflex like ketamine to safely control pt
  2. oxygenate for 2min then give neuromuscualr blocking agent
  3. intubate
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154
Q

effect of PPV on lungs

A

PPV of injured lung can transform a simple pneumo to tension pneumo

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155
Q

why might someone develop rapid cardiovasular complications duidrng RSI

A

intubation postivie pressure ventilation can lead to rapid cardiovasualr collapse

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156
Q

“M” in LEMON

A

Mallenpati

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157
Q

“O” in Mallempati

A

obstruction

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158
Q

vitals in propofol

A

low bp

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159
Q

goal of preoxygenate prior to intubation

A

3 mnin nitrogen washout and get alveoli enough reserves

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160
Q

last step of LMA placement

A

inflate balloon. the amount of ml is on teh balloon itself

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161
Q

ECMO

A

extraorporeal membrane oxygenation

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162
Q

body contour during BVM

A

look for chest rise and flat abdoment

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163
Q

consideration of using PEEP w/m. vent

A

trade off between PEEP and cardiac filling pressure

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164
Q

what type of pressure is m. ventilation

A

postivie

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165
Q

positive pressure ventilation

A

transition to it when you start m. vent

  • decrease muscle work
  • affects venous return/CO
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166
Q

PaO2 considered hypoxia

A

less than 80mm hg

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167
Q

hypoxemia vs hypoxia

A

hypoxemia: less than normal PaO2
hypoxia: failure to deliver oxygen at the tissue level

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168
Q

anatomic shunting

A

alveoli are bypassed

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169
Q

right to left shunt

A

blood passes from R to L w/o being oxygenated

m. vent settigs that principally affect oygenation

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170
Q

m. vent settigns the principally affect oxygenation

A

FiO2
PEEP
I:E

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171
Q

what must be good in order for FiO2 to be helpful

A

FiO2 is only as good as the alveoli it reaches
*oxygen delivered to nonperfused/collapsed aleoli is unable to be diffused into the blood and is considered part of dead space ventilation

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172
Q

FiO2 and lung injury

A

avoid FiO2 over 0.6 for prolonged periods of time

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173
Q

normal PEEP

A

3-5cm water

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174
Q

goals of PEEP

A

enhances alveolar recruitment

improved gas exchange

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175
Q

PEEP setting for hypoxia

A

6-10mm hg

for hypoxia, atelectasis, p. edema

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176
Q

auto-peep

A

unintentional air trapping which occurs when inspiration begins before the previous bcomes breath expiration has ended

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177
Q

compliations of PEEP

A

increased intrathoroacic pressure

increase ICP

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178
Q

PEEP & ICP

A

increases

not normally a reason to withhold peep is needed b/c hypoxia might be worse for a pt w/TBI than the mild increase in ICP

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179
Q

PEEP’s effect on the heart

A

increases intrathroacic pressure which impeds b. flow from the vena cava so affects preload and decreases CO

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180
Q

PEEP in a shock state

A

b/c of increased intrathroacic pressure decreases CO, you may need to stop PEEP and initaite aggressive IVF

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181
Q

when would you use PEEP over 20

A
  • normally 3-5cm water

* ARDS may need over 20

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182
Q

PEEP in ARDS

A

in ARDS, may need PEEP as high as 20mm water due to noncaridogenic p. edema and poor lung compliance

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183
Q

indication of longer expiratory time

A

poor lung ompliance (over 1.2 sec in adults)

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184
Q

indication of shorter inspiratory time

A

under 0.9sec in adults.

shorter inspiratory time in COPD b/c need more time to exhale r/t air trappign

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185
Q

how to adjust I:E time on m. ventilator

A

change I time or RR

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186
Q

Ve formula

A

Ve (minute ventilation)

= RR x exhaled tidal vomume

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187
Q

normal Ve

A

10ml/lg of ideal body weight

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188
Q

calculate male predicted body weight

A

50 + 2.3(height in in) -60

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189
Q

calculate female predicted body weight

A

45.5 + 2.3(height in) -60

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190
Q

calculate M/F predicted body weight

A

__ + 2.3(height in in) -60 = _____
M = 50
F= 45.5

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191
Q

produces ETCO2

A

product of ventilation, perfusion, metabolism

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192
Q

tool to determine ROSC during chest ompression

A

ETCO2

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193
Q

application fo ETCO2

A
  • verify/continuously monitor ET tube placement
  • gague effectiveness/progonosis during cardiac arrest
  • ROSC during chest compressions
  • adequacy fo vnetilation
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194
Q

high ETCO2

A

hypercapnia

hypoventilation

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195
Q

low ETCO2

A

hypocapnia

hypervwnetilation

196
Q

interventions of ETCO2 is too high/low

A

adjust Vt or F

avoid lowing Vt too much b/c that can lead to nonalveolar or dead space ventilation

197
Q

difference between pPlat and PIP

A

pPLAT: pressure in lower airways/alveoli
PIP: measures pressure in upper airway/bronchus

198
Q

ventilator setting that measures pressure in the lower airway/alveoli

A

pPLAT

199
Q

when is pPLAT measured

A

breaht hold maneuver

200
Q

ventilator setting that measures pressure in the upper airways/bronchus

A

PIOP

201
Q

complications of high airway pressure

A

acute lung injury

negative affect preload

202
Q

intervention if PIP is high due to DOPE or bronchospasms

A

tital volume should be increased to at least 8ml/kg of predicted body wt, slow F, decrease inspriatory time to 1:4

203
Q

cause of pPLAT high

A

over 30
*lower airway complicaiton issues
pneumoT, ARDS, pneumonia, excessive Vt, overventilation,

204
Q

action to take if pPLAT is high despte normal Vt

A

decrease Vt to 4-6ml/kg of predicted body wt

increase F to meet Vt needs

205
Q

causes of low PIP

A

displaced ET tube
too small ETT w/air leak or uninflated/ruptured balloon
equipment fail like circuit leak
underventilation w/insufficent Vtt

206
Q

insert LMA

A

blindly as far as you can. inflate using ml ari written on ballon

207
Q

assumption you should make about all truma pt

A

assume all are in shock

208
Q

shock

A

inaedequate oxygen supply for metabolic needs so energy production shifts to anaerobic
*a continuum of pathyphysilogy changes caused by hypoperfusion to cells

209
Q

2 primary means of compensating in shock

A

activated SNS, fluid shifts

210
Q

what happens when the body is experiencing widespread hypoperfusion

A

hyperglycemia and that shifts the osmotic gradient within the vascualr space in an effort to pull fluids from teh other 2 compartment

211
Q

SCI w/risk for respiratory compromsie

A

above T6

212
Q

SCI where you have complete ventilation paralysis

A

over C5 so m. ventilator

213
Q

what happens in neurogenic shock

A

unopposed PNS response post injury T6 and above

214
Q

Temp in SIRS criteria

A

over 100.4

under 96.8

215
Q

HR in SIRS

A

over 90

216
Q

SBP in SIRS

A

below 90

217
Q

RR in SIRS

A

over 20

218
Q

PaCO2 in SIRS

A

below 32

219
Q

WBC in SIRS

A

over 12

under 4

220
Q

glucose in SIRS

A

hyperglycemia in absence of diabetes

221
Q

s/s of hypoperfusion

A

high lactate
abnormal base deficit
low urine output
AMS

222
Q

what happens in severe sepsis

A

organ dysfunction
hypoperfusion
low bp

223
Q

what happens in septic shock

A

low bp

high lactate/base deficit despite adequate IVF resuscitaiton

224
Q

why would you intubate for sepsis

A

optimizes oxygen delivery even if pt has optimal airway

225
Q

when do you use NE in septic shock

A

if IVF of 20ml/kg doesn’t achieve MAP of at least 65, add NE

226
Q

early vs of shock

A

elevated

227
Q

shock index -3

A

-detect changes in cardiovasuclar system prior to systemic low bp
HR/SBP
helps predict need for blood products

228
Q

calculate shock index

A

HR/SBP

229
Q

helps predict the need for blood products in shock

A

shock index = HR/SBP

230
Q

normal adult shock index

A

HR/SBP
normal is 0.5-0.7
over 0.9 increases risk of mortality in shock and you should give blood products

231
Q

FAST

A

focused assessment with sonography for trauma

  • look at 4 spots: perispelnic, pelvis, perihepatic, pericardium
  • dark (anechoic) stripe in teh dependent areas = free fluid
232
Q

dark strip in FAST

A

free fluid = anechoic

233
Q

morrison’s pouch

A

between liver and right kidney

234
Q

how do you gauge effectiveness of shock resuscitation

A

lactate
base deficit
both are normal if below 2

235
Q

intervention for tachycardia

A

IVF to r/o dehydration

236
Q

weak peripheral pulse in shock

A

vasoC b/c SNS activation

237
Q

“C” assessment

A

skin color
temp
central/peripheral pusles
cap refill

238
Q

body temperatur e and IVF

A

hypothermia makes you less responsivenes sto IVF resuscitation

239
Q

best IV gague in trauma

A

shoert tubing, large gague so all infuses faster

240
Q

consideration if give lot of IVF in trauma

A

bust clot

no oxygen carrying capacity

241
Q

when do you do permissive hypotension post trauma

A

penetrating trauma w/o brina injury

SBP 80-100 until bleeding is control

242
Q

BP control in TBI

A

no permissive hypotension! avoid cerebral hypoperfusion bc/ cerebral perfusion pressure of at least 60 is needed

243
Q

why don’t you do permissive hypotension in TBI

A

b/c CPP of at least 60 is needed for brain perfusion

244
Q

contraindication to permissive hypotension

A

TBI b/c need CPP of at elast 60 to perfuse the brain

245
Q

CPP needed to perfuse the brain

A

at least 60

246
Q

reverses warfarin

A

vitamin K

FFP

247
Q

lifespan of plt

A

10 days

248
Q

relationship betwene IVF resuscitation and coaguulopathy

A
  • consumption of clotting factor

- clotting factor dilution

249
Q

intervention for high INR

A

INR over 1.5 = transfuse FFP of at least 15ml/kg

250
Q

definition of massive transfusion

A

replace pt complete blood volume in 24hrs

10 units for audlts

251
Q

characteristics of 1 unit whole blood

A

500ml
hct 40%
plt 175K
fibrogen 1500mg

252
Q

electrolyte imbalance with blood transfusions

A

lwo CA

253
Q

DIC

A

active bleeding b/c consumption of coagulation factors, widespread depletion of plt, diffuse fibrolsysis
*bleed form all orifics

254
Q

consider if a trauma pt is bleeding from all orifices

A

DIC

abruptio placentae, head injyr, sepsis, cancer, sna,e bites

255
Q

suspicion if bleeding from orifices/IV

A

DIC

256
Q

LOC in early versus late shock

A 
early = hyperarousal
late= hypoarousal
257
Q

labs that guides resuscitation of shock

A

lactate

base deficit

258
Q

3 categories of Rx that mask shock s/s

A

BB
antidysrhythmiss
antiHTN

259
Q

what cardiac med class might not work for obese

A

inotrophs might not work b/c already increased contractility form increase dCO needs

260
Q

most critical mass transfusion complication

A

cogulopathy

261
Q

principle goal of shock

A

restore cellular perfusion

262
Q

electrocal current & dysrhythmias

A

AC more likely to cause VF than DC

263
Q

complications of lightening strikes

A

respiratory arrest in pt struck by lightening (electrical burn) b/c it tempoarily renders the medulla oblongata inactive from teh electrical discharge disrupting neurologic implu.ses

264
Q

dessication

A

drying

265
Q

s/s of electrical injury

A

LOC
paralysis of extremities
myoglobinuria
cardic/resp arrest at scene

266
Q

what type of energy is lightening

A

high voltage DC which can depolarize the myocaridum leading to cardiac arrest from sustained asystole

267
Q

skin complication of alkali burns

A

liquefication necorsis

268
Q

liquefication necorsis

A

alkali burns

269
Q

3 ways chemical burns harm skin

A

denature tissue proteins
liquefaction necrosis
dessication fo celsl

270
Q

use for hydrofluoric acid

A

etched glass
teflon
leather tanning
Resut remover

271
Q

first aid for chemical burns

A

flick power away

rinse w/water

272
Q

effect of hydrofluoric acid on thge body

A

fluoride ion binds w/free calcium in teh blood depleating serum Ca
s/s: dysrhythmias, low bp, low Ca

273
Q

electrolyte affected by hydrofluoric acid

A

fluoride ion binds with free Ca = low Ca

274
Q

only skin burn that requires a neutralizing agent

A

hydrofluoric burns need topical Ca gel

  • unusual treatment b/c other topicals cause heat production
  • cover w/gauze to hold the gel in palce
275
Q

second degree frostibite

A

clear fluid blisters
swelling
red-blue-gray discoloration

276
Q

appearence of blisters in frostbite

A

1st: none
2nd: clear
3rd: bloody purpole

277
Q

appearance of 4th degree frostbite

A 
black
hard
mummified
gangrene
necrosis
278
Q

when do you delay frostbite rewarming

A

if you suspect risk of refreezing

279
Q

treat frostbite

A

104F water until pink/perfusion

no dry heat/rub/massage

280
Q

TBSA of burns where the body will have systemic responses

A

over 20%

281
Q

G tube for burns

A

use a g tube for over 20% TBSA b/c risk of ileus. over 20% has systemic responses

282
Q

metabolism in burns

A

hypermetabolism which increases oxygen consumption

283
Q

difference in cause in burns based on relation to glottis

A

above glottis = thermal

below glottis = chemical

284
Q

question to ask someone who is burned

A

location and considered in a confined space w/productions of compustion

285
Q

priority in thermal injury to upper airway

A

risk of edema/obstruction so prioritize patent airway

286
Q

excessive discharge of mucous from the bronchi

A

bronchorrhea

287
Q

treatment if circumferential burn around chest

A

escharotomy to release tight leathery eschar. expect chest wall expansion to immedialtely improve

288
Q

result of CO poisioning

A

hgb bound to CO so tissue hypoxia

289
Q

half life of carbon monoxide

A

1/2 life of CO is 4hr on room air
40 min nonrebreather
23 minutes in hyperbaric chamber

290
Q

products of incomplete combusion

A

CO

cyandide

291
Q

s/s of cyanide poisioning

A 
fire in enclosed space
RR changes
SOB
CNS exictation
HA
eye/mucous irritability
292
Q

CNS in cyanide poisioning

A

CNS exictaiton

293
Q

rx for cyanide

A

hydoxocobalamin

294
Q

hydroxocobalamin

A

cyanide poisning

295
Q

suspect if lactate over 10

A

cyandie poisining

296
Q

IV and burned skin

A

can put an IV through burned skin

297
Q

cold water/climate and burns

A

vasoC
decrease circualtion
hypothermia

298
Q

pediatric burn chart

A

Lund-Browder

299
Q

rx if burn injury

A

may need higher than normal doses of opioids b/c hypermetabolism

300
Q

IVF choice for burns

A

LR

301
Q

first priorities in burns

A

stop burning process

airway

302
Q

pathology of burn injuries -4

A

hypovolemia from fluyid los
increased capillary permeability
third spacing
vasoD

303
Q

interventions in “C”

A

start IV/IVF

after IVF, check to see if hemodynamic status improves

304
Q

intubation strategy if pregnant

A

nasal isn’t reommended b/c increased blood volume and vasoD. capillaries ai

305
Q

options to drop the trachea into view during intubation

A

jaw thrust
BURP
cricoid pressure
external laryngeal manipulation

306
Q

normal acid-base status in pregnany

A

compensated r. alkalosis is normal in late pregnancy

307
Q

site for thoracostomty if pregnant

A

3-4th intercostal antierior midclavi ualr b/c uterus forces diaphragm to rise 4cm so go higher to prevent internal organ damage w/procedure r/t expanding uterus
NORMAL = 5th ICS

308
Q

CO increase in pregnancy

A

25-50%

309
Q

blood volume expansion in pregancy

A

40-50% by 34wga

310
Q

H&H in pregnanccy

A

sblood volume increases 40-50% by 34wga but no increase in RBC so H&H shows dilutional anemia

311
Q

hemodynamic state in pregnancy

A

high flow = increased b. volume
low resistance = low SVR
shock state reverses low flow/high resistance and decreases b. flow to uterus

312
Q

pulse pressure in pregnancy

A

normal is wide pulse pressure r/t low SVR

313
Q

what does placental/uterus pressure depend on

A

MAP

314
Q

hypovolemic shock & pregnancy

A

pregnancy may lose up to 35% of bood loss (class II-III) prior to shoing s/s of shock

  • moms vs look normal but fetal destress/underpfused placenta
  • mom/fetus tachycardia prior to BP drop
315
Q

pulse pressure in hypovolemia

A

wide pulse pressure in hypovolemia

316
Q

CPR on pregannt woman

A

manually displace uterus to the side

317
Q

blood loss into the retroperitoneal space

A

retroperitoneal space can hold up to 2L

318
Q

how frequently does the entire blood supply pass thorugh uterus

A

under 10min

319
Q

when does the uterus rise out of the pelvis

A

12wga

320
Q

wga when the uterus is at the level of U

A

20wga

321
Q

GPTAL

A 
gravity
term
preterm
abortions
living children
322
Q

what should you note when you look at the stomach of a trauma pregnant woman

A

contour

323
Q

monitor pregnant women post trauma

A

4hr

324
Q

s/s of abruptio placentae

A 
tender tuerus
vag beed
mom shock
600-800ml/min so rapid exsanguation
visible vag bleed or hiding behind
life-threatning to both
325
Q

type of pregnancy bleeding that can be hiddening and lead to death

A

abruptio placentae

326
Q

why is perimortem c-sec so quick

A

5min for fully intact fetus

mom may immprove b/c immediate increase in venous return to heart, in crease CO, decrease O2 demand

327
Q

Chance fraccture

A

horizontal freaccture of hte vertebral body due to hypoflexion of the spine

328
Q

how fast does an airbag go off

A

150mph

329
Q

SCIWORA

A

ska-wohr-ah

SCI w/o radiographic abnormalities

330
Q

most common cause of airway obstruction in kids

A

CO

331
Q

5 s/s of adequate circualtion

A 
normal mental status
adequate perfusion
warm extremities
Cap refill under 2 sec
normal urine oputyut 0.5
332
Q

pediatric IV bolus

A

20ml/kg

333
Q

temperature & resuscitation success

A

hypothermia has an adverse effect on eresuscitaiton and potentioal for coagulaopathies

334
Q

rx for seizure control in kids

A

benzos

335
Q

axonal shearing

A

condition of damage to axons, as a result of being rtwisted and disconencted in a violent agitating motion

336
Q

Rx for seizure control

A 
benzos = immediate
phenyotin= prolonged
337
Q

MOI suspicious for SCI

A 
high speed MV
falls over 3x height
axial load
diving
penetrating wound enar SCI
sports injury to head/neck
focal point/tender
intoxication
unresponsiveness
motor/sensory deficit
338
Q

when can you get CT

A

onlyy if hemodynamically stable

if not, FAST

339
Q

vital signs out of range

A

hemodynamically unstable

340
Q

intervention if obvious deformity

A

neuro check

341
Q

intervention if rapid extremity swelling

A

more frequent neuro checks

342
Q

fix a fracture

A

reduction

343
Q

epidural hematoma

A

meningeasl aretery
by the temporal bone secureed tightly in place by dura
*temporal bhone

344
Q

suspect if a person has a blow to the side of their head

A

epidural hematoma: meningeal artery by temporal bone

345
Q

most common site of epidural hematomas

A

meningeal artery is by the temporal bone

346
Q

injury associated to a blow to the meningeal artery

A

epidural hematoma

347
Q

where is CSF located

A

subarachnoid space: pia & arachnoid

348
Q

how many cervical vertebrae

A

C7

349
Q

how many thoracic vertebrae

A

T12

350
Q

how many lumbar vertebrae

A

L5

351
Q

C1

A

atlas. supports head

352
Q

C2

A

axis

353
Q

C1-2

A

atlas

axis

354
Q

secretes catecholamines

A

adrenals

355
Q

role of the spinal cord

A

regulates body movements, fun tions, transmits nerve impusles

356
Q

how does hyperoxia affect the body

A

hyperoxia is associated w/contributing to oxygen free radical damage

357
Q

what also decreases when BP decreases

A

cerebral perfusion pressure

CPP: represents the pressure bradient driving cerebral blood flow

358
Q

calculate CPP

A

ICP-MAP

359
Q

ICP-MAP

A

cerebral perfusion pressrue

360
Q

normal ICP

A

0-15mm hg

361
Q

BP goal in early TBVI

A

SBP above 90

362
Q

early TBI interventions

A

focus on optimizing CPP
SBP not below 90
CPP at least 60

363
Q

GCS of coma

A

8

364
Q

interventions in high ICP

A

hyperventilate
mannitol
increased HOB

365
Q

prolonged posttrauma coma post TBI

A

diffuse axonal injury

366
Q

CT in diffuse axonal injury

A

normal/brain appears unusually swollen w/loss of normal gray-white distribution

367
Q

intervention for subdural hemorrhage

A

may need to evacuate the hematoma b/c pressure, edema, and toxic effects of blod on brain tissue

368
Q

suspect subdural hematoma

A

neuro changes
unexplained HA
personality change
seizures

369
Q

laceration of temporal

A

epidural heamtoma = laceration of meningeal artery/meningeal aretery

370
Q

predicts favorable outcome for epidural hematoma

A

90-100% if no LOC
BUT…can create a lesion that expands and pushes tghe brainstem down into herniation. pressure on teh reticualr formation so LOC

371
Q

classic s/s of epidural hematoma

A

33% have classic LOC, lucid, coma

372
Q

head injury with LOC, lucid, coma

A

epidural hematoma

373
Q

endstage of epidural hematoma

A

coma. untreated mass lesion pushes down into brainstem, 3rd crainial nerve so iipsilatereal pupil dialtion, presure on reticualr formation so LOC

374
Q

s/s of near terminal epidural hematoma

A

untreated lesion expands and pushes brainstem down into herniation
pressure on reticualr formation so LOC
pressure on 3rd CN so ipsilatereal pupil dialtion & contralateral motor weakness/hyperreflexia

375
Q

outcome of subarachnoid hemorrhage

A

most are vegetative state/seivere disability

376
Q

s/s of basilar skull fracture

A

periorbital ecchymosis
battle sign
CSF leak

377
Q

battle sign in…

A

basilar skull fracture

378
Q

causes of secondary SCI trauma

A

ischemia
edema
hypoxia
injury r/t inadequate spinal immobilization

379
Q

Brown-Sequard

A

hemisection of spinal cord
ipsilateral-paralyusis
contralateral-decreased sensitivity to pain/temp

380
Q

side of paralysis in Brown-Sequard

A

ipsilateral

381
Q

decreased sensitivity to pain/temp in Brown-Sequard

A

contralateral

382
Q

best RSI for head inuury

A

Ketamine

383
Q

when is Ketamine ideal for RSI

A

head injury

384
Q

best RSI for head injury

A

Ketamine b/c it won’t worsen CPP

385
Q

positioning for TBI

A

HOB up and head midline

promotes venous drainage. even brief assymetry impacts ICP by reducing venous return

386
Q

what level of SCI is associated with neurogenic shock

A

above T6

387
Q

vasopressors are need for SCI neurogenic shock

A

loss/disrpution of descending SNS pathway

  • low bp due to massive vasoD despite normal b. volume
  • peripheral vaso D, brady C, hypothermia
388
Q

BP in neurogenic

A

neurogenic shock loses SNS. low bp b/c masive vasoD despite normal blood volume
peripheral vasoD
bradyC

389
Q

causes transient spikes in ICP

A

position
suction
cough

390
Q

2 signs of impending herniateion

A

pupil changes

possturing

391
Q

CO2 on cerebral blood flow

A

hypocapia changes cerebral blood flow by 4% for 3very 1mm hg in PaCO2

392
Q

Cushing’s triad

A

HTN
bradycardia
irregular respirations
*sign of impending herniation

393
Q

sign of an impending herniation

A 
Cushing
s
HTN
bradycardia
irregular resp
394
Q

vertebrae at nipple line

A

T4

395
Q

dermatome of nipples

A

T4

396
Q

dermatome of great toe

A

L4

397
Q

use of peneyotoin in seizures

A

decrease seisure in first 7 days

398
Q

clear SCI

A

NEXUS - National Emergency Xrayography utilizaiton study

399
Q

NEXUS 5 criteria

A 
to r/o SCI
no midline tender w/palp
no AMS from trauam/intoxic/rx
no s/s referable to neck injury, paralysis, sensory
no distracting painful injury
last: ROM w/collar off
400
Q

occurs in 25% of subarachnoid hemorrhages

A

up to 25% have seizures

401
Q

cause of acidosis in shock

A

hypoperfusion

402
Q

bleeding into the pleural space

A

each pleural space has the capacity to hold up to 3L blood

403
Q

where do you bleed if a pelvic fracture

A

retroperiotneal space

404
Q

bruising at U

A

CUllens

405
Q

flank/groin bruise

A

Grey Turner

retroperitoneal hemorrhage

406
Q

3 causes of pleural friction rub

A

PE
pneumonia
pleurissy

407
Q

normal percussion over liver

A

dull

408
Q

normal percussion over stomach

A

dull

409
Q

normal percussion over intestines

A

dull

410
Q

percussion over stomach that indi cates gastri dilation

A

tympany

411
Q

bad percussion over lungs

A

hyperresonance - overinflation of lungs

412
Q

location of pneumothraox

A

air betwen the viscaeral and parietal

413
Q

most common cause of pneumothraox

A

rib fracture punctures the lung also

“paper bag” effect

414
Q

when does the lung collapse

A

lungs collapse when air enters the ptential space betwen the visceral and parietal pleura

415
Q

location of chest tube in pneumothroax

A

4-5th intercostal space anterior midaxilary

416
Q

percussion of a pneumothorax

A

hyperresonance

417
Q

what happens in sucking chest wound

A

air colection in the pelural space so lung collapse due to loss of negative pressure *need occlusive dressing toi create flutter valuve

418
Q

intervention for sucking chest wound

A

occlusive dressing traped to create flutter valve

419
Q

what happens when air collects in the pleural space

A

lung collapse (pneumothraox) b/c loss of negative pressure

420
Q

pathology of t. pneumo

A

mediastinal shift affects vena cava
-dec rease venous return to heart
-decreased preload/BP/CO/SVR leading to hypoxia
= obstrucctive shock

421
Q

shock in pneumothroax

A

obstructive

422
Q

how does m. ventilation cause t. pneumothorax

A

positive pressure

423
Q

percussion of t. pneumothraox

A

hyperinflatiohn/hyperresonance on affected siede w/desita nc/absen LS

424
Q

site for needle D

A

needle to convert t. pneumo to simple pneumo

*2nd ISVCS midclaviular followed by CT

425
Q

percussion in the different types of pneumothorax

A 
tension = hyperresonance
hemo= dull
426
Q

BP if hemothroax

A

permissive hypotension

427
Q

noteworthy chest tube drainage

A

ovaer 1500ml immediately

200ml/hr for 2-4hrs

428
Q

considered “massive” hemothroax

A

over 2.5L

hypovolemia/hypoxai

429
Q

suspect massive hemothrax

A

1.5L chest tube drainage imemdiately
no breath sound
dull percussion
s/s hypovolemic shock

430
Q

CXR s/s of hemothroax

A

blunting of costphrenic angle on upright radiograph

431
Q

dx hemothroax on CXR

A

blunting of hte costophrenic angle on upright radiograph

-supine might make the 1L look hazy

432
Q

what is the most hazardous component of a helicopter

A

tail rotor = 2000rpm

433
Q

load passenters into a helicoper while it is running

A

hot loading

434
Q

how to approach a helicopter on a hill

A

approach/depart from downhill in crouched ppsition

435
Q

how to appreach a helicopter w/brades running

A

crouched psition

wind gusts may drop blades to choulder level

436
Q

when do helicopter blades flap down

A

startup/shutdown at lower speeds

wind gusts

437
Q

speed of helicopter blades

A

main rotor = 400rpm

rotor tips=500rpm

438
Q

helicopter shopping

A

if a company declines a mission do to a factor like weather, LZ availability…safety, other agencies approached must be told about why they were refused

439
Q

tactical breathing

A

targeted reduction in HR/stress during acute stress
“box breathing”: breathe in 4 seconds, hold 4 sec, exhale 4 sec,
regulates SNS surge and keeks HR range for the situation

440
Q

bandwith for aviation related communication

A

GVHF 118-136mHz

441
Q

mHZ of radio signal bandwith that follows a straight line

A

very high frequency low band FM

20-50mHz

442
Q

very high frequency (high band versus low band FM)

A 
high band (148-174mhz) = straight line
low band (30-50): follows the curvature of the earth
443
Q

radio that follows the curvature of hte earth

A

very high frequency low band FM (30-50mHz)

444
Q

warning sign if you are near a downed power line

A
  • lower extremity tingle signals energized groun
  • current enters throu one foot, pases through lwoer body, leaves thorugh the other foot
  • INtervention: bend one leg at knee, grasp the foot of that leg with one hand, turn around, and hop to a safe place on one foot (purposeP to ensrue the body does not complete a circiut between secitons of the round energized w/different voltages
  • similarily, don’t leave a vehilce until conductions that are either touching or surrounding teh wreckage can be denergerized
445
Q

important thing to remember about downed aircraft if military

A

avoid front/rear b/c externally mounted tanks or pods b/c they may be containers for missles or rockets

446
Q

awareness when extracating pt from car

A

don’t mechanically dispalce/cut through the sterign columnb until the system has been deactivated
some airbags may take 30min to deploy

447
Q

basic principle of extrication from car

A

remove vehicle from around vicftim, not victim rrom vehicle

448
Q

trigger for flicker vertigo

A

sunlight flickers through the rotor blades of helicpoper/airplane propeller or via the rotating beacons agaisnt overcast sky

449
Q

worst case presentaiton of decompression sickness

A

coma

450
Q

basic of what happens in decompression sickness

A

supersaturated tissue w/N

451
Q

immediate inte4rvention for rapid decompression

A

100% oxyten
oxyten on yourwelf the4n pt
descend to 10K ft

452
Q

s/s of slow decompression

A

gradual. s/s same as hypoxai. cool

check cabin altometer

453
Q

tactical military aircraft

A

don’t use isobaric b/c added wt severely limits aircraft range and the large prssure differential increases the danger of rapid decompression during combat situations

454
Q

pressurization of commercial panes

A

pressurize to 5-8K ft when aircraft ascends to 40K ft

455
Q

plane nose up/down

A

yaw

456
Q

plane nose fore-aft

A

roll

457
Q

plane nose right-left

A

pitch

458
Q

3 directional planes for a plane’s nose

A

roll = longitudinal (fore/aft)
pitch- lateral (R-L)
yaw= verticle (up/down)

459
Q

3rd law motion

A

for every action there is an equal and opposite reaciton

460
Q

first law of motion

A

law of intertia (stay at rest)(

461
Q

maass

A

measure of the intertia of an object. its resistance to acceleration

462
Q

acceleration

A

rate of change of velocity of an object

vector cquality

463
Q

3 examples of vector quantities

A

acceleration
velocity
force

464
Q

velocity

A

rate(magnitude) of a chance of distance for an object to rravel
vector quality

465
Q

1Hz = __

A

cycle per sec

466
Q

effect of hypothermia

A

increases metabolic rate, energy needs, oxygen consuption

467
Q

relationship in temperature and altitude

A

temp decrease by 1C for ever 330ft increase in altitude

468
Q

flying post surgery

A

24-48hr b/c insufflation

G tube not clampted

469
Q

fly post dental work

A

72hr

470
Q

tooth pain during flight

A

ascent

helps with descent

471
Q

tooth pain during descent

A

usually barosinusitis

barodontalgia (toothpain) on ascent

472
Q

help tooth pain in flight

A

worse w/ascent

decent relief

473
Q

how to prevent ear block during flight

A

valsalva

474
Q

delayed ear block during flight

A

breathing 100% oxygten during flight. aas ear clears during descent, 100% oxygen is forced into middle ear cavity. pt may be symptom free immediately after flight but they will have ear pain from negative pressure in the cavity if the oxygen in the middle ear isn’t repalce w/air

475
Q

Politzer bag

A

helps w/ear block
-olive tip is placed in one nostril, the nose is compressed between the air medical crew member’s fingers, pt is instructed to say “kick, kick kick” while the bag is wqueezed, increasing the pressure in the nasopharhygeal caivyt to the point at which teh suschacian tube is opend and the middle ear is ventilated

476
Q

intervention for ear block whikle flying

A

mild vasoC spray to vasoC

higher altitude until symptomo lessens

477
Q

flying when you have a cold/upper respiratory issue

A

-monitor closely during ascent/descent for swollen eustachian tube which interfers w/normal equalizaiton pressure

478
Q

should pt be awake or asleep during descent

A

awake so they can clear their ears in a normal manner to prevent ear block

479
Q

ear blcok

A

failure of middle ear space to ventilate when going from high to low
0pressure in the middle ear becomes increasingly negative
-tympanic membraen is depressed inward and becomes inflammed/petechial hemorrhage

480
Q

why shouldln’t you chew gum while fying

A

gum chewing is not recommended as a method of pressure equalization bc/ it causes swallowing of air, cuasing gastric distension and discomfort

481
Q

pop ear on descent

A 
yawn
valsalva
swallow
move lower jaw
BVM
topical vasoconstrictors
482
Q

how to correct hypoxia when altitude is over 40K

A

cannot be corrected wo addition of positive pressure

483
Q

cyanosis as a sign of hypoxia

A

cyanosis is unreliable as a sign of hypoxia b/c SpO2 must be below 75% in people w/normal hgb before it is deteched

484
Q

consider if pt has tunnel vision

A

hypoxia

485
Q

er if pt ha a change in judgment or behavior

A

hypoxai

Critical Care 1 (14 decks)

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