1
Q
2 Major Causes of heat loss
A
Radiation and Evaporation
2
Q
What is PaO2
A
O2 in plasma, Meased as a pressure
3
Q
Nomal Pediatric SBP?
A
(agex2) + 80
DBP = 2/3 of the SBP
4
Q
When does the normal SBP drop?
A
After 25 % Blood Loss
DBP = 2/3 of the SBP
5
Q
3 killers of a vent patient during flight
A
- Pericardia Tamponade
- Tension Pneumothorax
- Hypovolemia
6
Q
Death from a crush injury due to?
A
Death is due to a re-prefusion injury
- Rhabomyotysis
- Renal Failure
7
Q
Complication to a crush injury
A
- DIC
- Compartment Syndrome
- Renal Failure
- Hyperkalemia
8
Q
Compartment Syndrome
A
- Fasicotmy required if the pressure exeeds 33 MMhg
- Must be perfromed within 6 hours of injury
9
Q
CAMTS
- Pilot area oreintation day/night
- Helipads are required to have?
- Fixed wing twin engine time?
- Ground ambulance fuel requirments
- ELT set off at?
- Uniform fit?
A
- 5 hours for day/2 hours at night
- 2 paths, Security, Wind direction indicator, and Perimter lights
- 500 hours
- 175 miles
- 4 gs
- 1/2 in betwen body and uniform
10
Q
Cardiac Output
(Formula and normal range)
A
SV x HR
Normal 4-8 l/min
11
Q
Pulmonary Artery systolic and dyastolic pressures
A
PAS = 15-25
PAD = 8-15
12
Q
PAWD Presure
A
8-12
13
Q
What is the location of a chest tube?
Adults and Peds
A
Adults - 4 ICS Anterior Axillary
PEDS 5 ICS Anterior Midaxillary
14
Q
What does a scaphoid abdomin indicate and how to treat it?
A
Diaphragmatic Rupture
Treatment- Gastric decompression
15
Q
Plecento Abrupto
A
Tearing Pain with dark red blood loss
16
Q
Placenta previa
A
bright red blood loss with no pain
17
Q
Effects of altitude worsen with?
A
- Cold Upper latitudes
- PT that hace problems with low humidity and temp
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
19
Q
Universal gas law
A
Combines Chalres and Boyles law
- Boyles Law-Increase volume = decrease pressure
- Charles Law - Temp and volume are proportional
20
Q
Charles Law
A
Temp and volume are proportional
increase temp = increased volume
21
Q
Boyles Law
A
Increased volume = Decreased pressure
Examples - BP cuffs, MAST, GI, ETT, IABP
IABP purges with ascent/decent
22
Q
Henrys law
A
Gas in a liquid proportional to the gas above the liquide
Examples - CO2 in blood, The Bends, decompression
23
Q
Gramhams Law
Define and effects
A
Define - Gas moves from high to low concetration
Example - Cellular gas exchange
24
Q
Volume of gas in a the GI tract expans 3 times at what altitude?
Which law?
A
25,000 ft
Boyles las
25
**_Enviromental_**
1. Passive Rewarming
2. Active Rewarming
3. Warm and dead
4. Heat stroke
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
26
Thumb Print
Epiglottitis
Seen in the lateral neck view
27
Steeple Sign
Croup
Seen in the A/P view
28
What meds are used for a AAA?
Nipride and Betat blockers
29
# Vent vs oxgyenation
What are the first adjustments on a vent if there is issues?
If it is a Vent problem- TV first then Resp Rate
If it is an oxgyenantion problem - FiO2 then PEEP
30
Traumatic dislocations
1. Most Common Dislocation
Most Common spontaneous reocurrance
1. hip
2. Anterior shoulder
31
Brain Natriuretic Peptide or BNP
what is it used for and what are normal levels and elevated levels
It is a marker for heart failure
BNP is released by an over distended heart
Normal - less than 100
500-700 = heart failure
32
What are the required rotor wing pilot hours?
2000 total hours
1000 PIC
100 night hours
33
FAA bottle to throttle time and what FAA part?
At least 8 hours and it is part of FAA part 135
34
What are the other names for CVP?
Right aterial pressure (RAP)
35
What is the nomal CVP?
2-6 mmHg
36
What is the length in CM for a central catheter placement?
RA/CVP = 20-25 cm
RV = 30-35 cm
PA = 40-45 cm
Wedge = 50 cm or greater
37
Which port is used for measure CVP
Proximal or Blue port
38
What are the spinal cord syndromes?
| (ABC)
1. Anterior
2. Brown Sequord
3. Central Cord Syndrome
39
What are the signs for an anterior cord injury?
Complete motor, pain, and temp sensatoin loss below the lesion
40
Normal
* ICP
* CPP (head)
* MAP
* CPP (heart)
* ICP=0-10
* CPP (head) = 70-90
* MAP = 80-100
* CPP (heart) 50-60
41
**_GCS values_**
Mild
Moderate
Severe
Mild 14-15
moderate 9-13
severe 3-8
42
CPP formulas
Head and heart
_Head_
CPP=MAP+ICP
_Heart_
CPP=DBP-wedge
43
Rotor wing ceiling and visibility Minimums
_Day_
Local and crosscountry
_Night_
Local and crosscountry
_Day_
Local 500 and 1 mile
Crosscrountry 1000 and 1 mile
_Night_
Local 800 and 2 miles
Cross country 1000 and 3 miles
44
What is the #1 cause of airmedical crashes?
Controlled flight into terrain due to pushing the weather
45
_A-line_
Site
Purpose
Dampening (over and under)
_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
46
**_EKG_**
1. Most common reperfusion dysrhytmia
2. Most common hyopperfusion dysrythmia
3. Hypokalimia on EKG
4. Hyperkalmia on EKG
1. AIVR
2. VF
3. Peaked P's with flat P's
4. Flat P's with Peaked T's
47
1. What is the MAP goal in a closed head injury?
2. CPP goal with increased ICP?
1. MAP 80-100
2. CPP 70=90
48
Central Cord Syndrome
Greater motor weakness in the upper extremities then the lower extremities with a varying degree of sensery loss.
49
Brown Sequord Spinal cord syndrome
Ipsilateral loss of motor, position, and vibration sense; Contallateral loss of pain and temp perception
50
# Define and treatment of Autonomic Dysreflexin
Urine retention, masive increase in sympathetic tone which can lead to HTN.
Treated by insertion of a foly
51
Normal urine output
| (Peds and Aduls)
Adult 30-50 ml/hr
Peds 1-2 ml/kg/hr
52
Normal Blood Volume
Adult - 70ml/kg
peds 80 ml/kg
neonate 60 ml/kg
53
Cardiac index
2.5 - 4.3
54
Bariobariatrauma
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
55
**_Safety_**
1. ELT frequancy
2. Confirm ELT is working
3. Twin engine require off shore
1. 121.5
2. Tune in and listen
3. Raft and vests
56
**_High risk OB_**
1. _Primary cause of PTL_
2. _Terb Contridictions_
3. _PIH Triad_
1. Infection
2. IDDM, maternal HR over 120, Vag Bleeding
3. HTN-Edema-Proteinuria
57
Kehr's Sign
Refered shoulder pain.
Possible splenic injury or ectopic pregnacy
58
Kernig's Sign
Back, leg pain on knee extension.
Possible bacterial meningitis
59
Drudzinski's
Back, leg pain on _neck flexion_.
Possible bacterial meningitis or subarachnoid bleed
60
Hamman's
Crunching sound over the heart with auscultation over the anterior chest- Synchronized with heart beat-
Tracheobronchial injury
61
When does Thermoregulation cease?
28o C Drugs and Defib are not effective.
Warm PT uo to 30-32o C
62
Order of how to assess the abdomin?
1. Inspect
2. Auscultation
3. Palpation
4. Percussion
63
Contraindications for Thrombolytics
HX of hemorrahagic stroke
CVA last 12 months
SBP over 180
Pergnancy or 1 month post partium
64
Normal SVR
800-1200 Dynes/sec/cm5
65
# Define post partum hemorage
Over 500 ml within 25 hours of delivery
66
**_Cardigenic Shock_**
CVP
Cardiac output
Cardiac Index
PAS/PAD
PAWP
SVR
Heart Rate
CVP-high
CO-low
CI-low
PAS/PAD-high
PCWP-high
SVR-High
HR initiall fast then slows down
67
Gray's Sign
Flank Bruising
Retroperitoneal bleeding
68
Coopernails sign
Scotum/Labia
Abdominal/Pelvic bleeding
69
Halsteads Sign
Marbled Abdomen
Abd Bleeding
70
Cullen's Sign
Umbilical discolortion
Pancreatitis
71
Murphy's Sign
RUQ pain with inspiration-
Gallbladder
72
Levine's Sign
Fist to chest "Clutching" -
Cardiac
73
Types of hypoxia
1. Hypoxic Hypoxia
2. Hypemic Hypoxia
3. Histotoxic Hypoxia
4. Stagnant Hypoxia
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
Normal fetal heart rate
12-160
75
Primary cause of death with the vent dependent PT's
Vent aquired pneimonia
76
**_ARDS_**
Treatment
CXR
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
Treat HTN when BP?
220 Systolic
MAP over 130
78
Normal Sodium Level
135-145
79
Decreased sodium can cause what in the head injury patient
Decreased sodium can call increased intacranial pressure; Maintain sodium levels at 155
80
What is the preferred method for moving spinal injured patients
Scoop Stretcher
81
Blood loss with FX's
Humerus
Femur
Humerus 750 ml
Femur 1500 ml
82
Inadvertent Wedge
Do not keep fro more than 15 seconds.
Make sure that the balloon is deflated and have the patent cough forcefully
83
Differential DX
Pulmonary Contusion
Low sats despite O2 Rales
84
Differential DX
Ruptured Diaphragm
Chest/Abd pain radiating to the left shoulder
85
Differential DX
Esophageal performation
Fever, hematemesis
86
Differential DX
Fat embolus
Fever and rash after a fracture
87
Differentail DX
FX larynx
Hourse sounds when speaking
88
**_Tube depth_**
adult
peds
neonate
Adult: 3x ETT size, avg is 19-23 cm
Peds: 10 + age x ETT size
Neonate: 6 + age wieght in KG
89
Induction agent of choice with bronchospastic PT's
Ketamine
90
Ativan: indication dose and max dose
1-2 mg to a max of 4 mg
Other name lorazepam
91
Mannitol Dose
1-2 G/kg
92
Drug choice for cyclic antidepressant OD
Bicarb
93
Drug of choice fro beta blaocker OD
Glucagon
94
Fentanyl dose
3mcg/kg
Other name sublimaze
95
Treatment for malignant hyperthermia
Dantrium (dantrolene)
96
Drugs for GI bleeds
Sandostation (octreotide)
97
**_Neurogenic Shock_**
CVP
CO
CI
Wedge
SVR
HR
CVP: low
CO: low
CI: Low
Wedge: low
SVR:low
HR: slow or normal
98
CPP goal with increased ICP
CPP 70-90
99
**_Lab values_**
1. Potassium
2. Chloride
3. Calcium
4. Metabolic acidosis elevates which electtolyte
1. 3.5-5.5
2. 95-105
3. 8.5-10.5
4. Potassium
100
Time of useful consciousness with suden decompression at:
1. 30,000
2. 41,000
30,000 - 90 seonds
41,000 - 15 seconds
101
**_12 lead ECG_**
Inferior
Septal
Anterior
Lateral
Posterior
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
CVP-high
CO-low
CI-low
PAS/PAD-high
PCWP-high
SVR-High
HR initiall fast then slows down
**_Cardigenic Shock_**
103
CVP: low
CO: low
CI: Low
Wedge: low
SVR:low
HR: slow or normal
**_Neurogenic Shock_**
104
**_Cardiac_**
Ischemia
Injury
Infarct
Ischemia- ST depression (1mm in 2 contigious leads)
Injury- Elevation
Infact- Q wave \> 25% the height of the R wave
105
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
**_12 lead ECG_**
Inferior
Septal
Anterior
Lateral
Posterior
106
**_Pediatric age guildeline_**
ETT cuffed versus uncuffed
Needle cricothyrotomy
Nasal intubation
**"10 ,11,12" Rule**
Uncuffed under 10
needle cricothyrotomy
Na nasal intubation under 12 years old
107
**_Vent Modes_**
1. CVM
2. AC
3. IMV/SIMV
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
_IABP_
1. Action
2. Balloon inflates
3. Balloon defates
4. Dictrotic Notch
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
**_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
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
**_Oxyhemoglobin Dissaciation Curve_**
Right Shift
"R" stands for raised
Right = Raise / release oxygen Acidosis
Rised CO2
Raised temp
Raised 2,3 DPG levels
PH is low
111
Stages of Hypoxia in Elevation
* 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
Stressors of Flight
1. thrid spacing
2. fatigue
3. g-fources
4. noise
5. vibration
6. hypoxia
7. dehydration
8. temp changes
9. barometric pressure changes
113
Personal factors affecting stressors of flight
DEATH
1. Drugs
2. Exaustion
3. Alcohol
4. Tobacco
5. Hypoglycemia
114
**_Cardiac_**
Thrombolytics must be administered within
3 Hours of onset
115
**_Diving injures_**
Define ATM and ATA
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
**_Hypovolemic Shock_**
CVP
CO
CI
Wedge
SVR
HR
CVP: Low
CO: low
CI: Low
Wedge: Low
SVR: High
HR: High
117
# Define Acute Resitatory Failure
pO2 \> 60, pCO2 \< 50
118
CVP: Low
CO: low
CI: Low
Wedge: Low
SVR: High
HR: High
**_Hypovolemic Shock_**
119
**_Newtons Laws (3)_**
First: an object in motion tends to stay in motion...
Second: Force = mass x accerleration
Third: every action has a = and oppisite reaction
120
Tetralogy of Fallot
Remeber PROV
P = pulmonary stenosis
R = right vent hypertrophy
O = overriding aorta
V = Ventricaular septal defect
121
**_Atrial Wave forms_**
right atrial pressure (RAP) = ?
Left atrial pressure (LAP) = ?
"Filling Presures"
Right atrial ppressure = CVP
Left atrial pressure = PAWP/PCWP
122
Do atrial waveforms have dicrotic notches?
No
123
What waves do atrial waveforms have?
A, C and V waves
[![]()](https://s3.amazonaws.com/brainscape-prod/system/cm/052/385/604/a_image_thumb.png?1379869049)
Also x and y decents
124
**_Ventricular waveforms_**
When do get ventricular wave froms?
What does it look like?
When is ist the left ventricle pressure messured?
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
A wave
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
C Wave
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
V Wave
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
When do you measure CVP/PA?
At the end of exhalation
129
What does a "Z" point measre and how do you measure it?
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
What does the dicrotic notch indicate
Closure of the aortic valve for the arterial line and IABP inflation
Closure of the pulmonic valve for PA
131
What does CPK\>20,000 mean
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
Most common causes of seicures in neonates?
Hypoglycemia (\<40 mg/dl) and hypoxia
133
WHen do you use surfactant?
32 weeks or less gestation = surfactant
134
What does a Scaphoid abdomin indicate and how is it managed?
Diaphragmatic hernia and is managed with OG tube and PPV
135
Patent ductus arteriosus (PDA)
How does it maintain open?
What causes it to close?
maintains the PDA open = Prostaglandin (PGE1)
Closes due to Indomethacin and long term use of high O2
136
VEAL
CHOP
V - Variable = C - Chop
E - Early = Head Compression
A - Acceleration = Okay
L - Late = Placental insufficiently
137
What is the best indicator of fetal viability?
Fetal vaiability
Normal variablity is 10-15 beats
138
FHR interpretation system
Category 1
Normal
Baseline 110-160
Baseline vaiability - moderate
Late or variable decelterations - absent
Early decels - Absent
accelerations - present or absent
139
FHR interpretation systems
Catagory III
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
FHR interpretaion
Category II
everything that is not cat I or cat III
141
# Define varable decelerations
V or W shaped decelerations that can occur anytime during a contractions
Variable Decels = Cord Compresion
142
Sinusoidal Patteren Causes?
Fetal anemia associated with:
* Fetal hypoxia
* Rh isoimmunizations, chronic fetal bleeds, fetal-maternal hemorage
143
FHR paterns
| (Non-reassuring)
Fetal tach
Fetal Brady
Late Decels
Variable decels
144
PIH and Pre-ecalpsia Treatment
* 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
Mauriceau's Manuever
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
Stages of labor
* 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
Normal Mag Levels
1.5 - 2.5
148
HELLP syndrome?
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
how do you measure the frequency of contractions?
From the Begining of one contraction to the beining of the next.
150
What color does Nitrazine paper turn in the presence of amniotic fluid
Blue
151
What is labetalol?
is a mixed alpha/deta adrenergic antagonist agent that decreases systemic vascular resistance without changing CO.
152
What is Leopold's Maneuver used for?
to assess fetal position
153
Ped tube size formula?
age + 16 / 4
154
What is the most common side affect of transporting a PT on Prostaglandin E1?
Apnea and Hypotention
155
Persistant Pulmonary Hypertention (PPHN) is a syndrome characterized by by persistent elevated pulmonary vasculary resistance resulting in?
Right to left shunt
156
What lab test is done to DX Reye's syndrome?
Amomonia
157
What is the drug of choice for a ped pt profound hypotension due to sepsis?
Levophed
158
Formula for figuring weight based on age?
(age in years x 2) + 8
159
Tube depth formula for a Neonate?
6 + Wieght in KG
160
What is the sequence for blood flow through the valves of the heart
1. Tricuspid
2. Pulmonic
3. Mitral
4. Aortic
Remember
Toilet Paper My Ass
161
What does a tricyclic antidepressant look manifest on an EKG?
Prolonged QT interval
162
When the PA cath tracing has a dictoic notch on the left side, where is the tip?
Right Ventricle
163
CVP-High
CI-Low
Wedge-Low
SVR-High
RVMI
164
