Back to Basics - Critical Care Transport Review - Flash Cards
(249 cards)
1
Q
Clinical Signs of
Kehr’s Sign
A
Referred left shoulder pain
Possible splenic injury or ectopic pregnacy
2
Q
Clinical Signs of
Kernig’s Sign
A
Back, leg pain on knee extension from 90 degrees
Possible bacterial meningitis.
3
Q
Clinical Signs of
Brudzinski’s Sign
A
Flexion of knees on neck flexion
Possible bacterial meningitis (or subarachnoid bleed)
“Chin to chest will cause knees to flex.”
4
Q
Hamman’s Sign
A
Crunching sound heard with auscultation over the anterior chest synchronized with heartbeat -
TRACHEOBRONCHIAL INJURY
5
Q
X-Ray Findings
Steeple Sign
A
Possible Croup (laryngotracheobronchitis)
A/P neck view
6
Q
X-Ray Findings
Thumbprint Sign
A
Possible epiglottitis
lateral neck view
7
Q
when pCO2 is high, pH is
A
low (acidosis)
8
Q
When pCO2 islow, pH is
A
high (alkalosis)
9
Q
When pH is low, HCO3 is
A
low (acidosis)
10
Q
When pH is high, HCO3 is
A
high (alkalosis)
11
Q
Normal range:
pCO2
A
35-45 (respiratory)
12
Q
Normal Range:
pH
A
7.35-7.45 (metabolic)
13
Q
Normal Range:
HCO3
A
22-26 (metabolic)
14
Q
Rx for AAA
A
Nipride and beta-blockers
15
Q
First adjustment on ventilator
A
VT first, not rate
16
Q
Most common joint dislocation
A
Hip
17
Q
Most common spontaneous dislocation recurrance
A
Anterior Shoulder
18
Q
Significance
Brain natriuretic peptide
A
Heart failure marker. BNP released by an overdistension of the heart
19
Q
Normal Range
Brain natriuretic peptide
A
Below 100 = Normal
20
Q
Brain natriuretic peptide
Critical Range
A
Above 500-700 = Heart failure
21
Q
Rotor-wing pilot required hours
A
2000 hours
1000 PIC
100 hours at night
22
Q
“Bottle-to-throttle” Time
A
At least 8 hours
23
Q
CVP
Measures:
A
preload (right atrial pressure)
24
Q
CVP
Normal parameter:
A
2-6 mmHg
25
**CVP**
Which port to use:
Catheter placement outside line markers:
RA/CVP = 25-30 cm
RV = 35-45 cm
PA = 50-55 cm
26
**Spinal Cord Injury S/Sx**
Anterior cord:
complete motor, pain and temperature loss below the lesion
27
**Spinal Cord Injury S/Sx**
Brown-Séquard
ipsilateral loss of motor, position and vibration sence; contralateral loss of pain and temperature perception
28
**Spinal Cord Injury S/Sx**
Central cord syndrome
greater motor weakness in UE than in LE with varying degrees of sensory loss
29
**Spinal Cord Injury S/Sx**
Autonomic dysreflexia
urinary retention, massive increase in sympathetic tone which can cause HTN, treated by insertion of foley
30
**Normal urinary output:**
Adult: 30-50 mL/hr
Pedi: 1-2 mL/kg/hr
\*If suspected myoglobinuria: (lightning strike, electrical injury, rabdo) 100 mL/hr
31
**Normal Blood Volume:**
Adult: 70 mL/kg
Pedi: 80 mL/kg
32
**Normal temperature:**
37. 0°C
98. 6°F
33
**Mild hypothermia:**
32-36°C (~90-95F, decreasing HR)
34
**Moderate hypothermia:**
29-32° (~84-89F, loss of shivering, Altered LoC)
35
**Severe hypothermia:**
20-28°C (\<83F, coma, VF common)
36
**Two major causes of heat loss?**
Radiation/Evaporation
37
**Thermoregulation ceases @ what temperature?**
28°C (83F)
38
**Rules of flight following**
Sterile cockpit during critical phase of flight
15 minutes maximum between communication center, during flight
45 minutes maximum while on the ground
39
**Rotor-wing shut-off sequence**
Remember **TFB**
**T**hrottle
**F**uel
**B**attery
Take survival bag and meet at 12 o'clock position
40
**Survival sequence**
Shelter
Fire
Water
Food
41
**Order of how to assess the abdomen**
Inspection
Auscultation
Palpation
Percussion
42
**Contraindications for thrombolytics**
* History of hemorrhagic stroke
* CVA in last 12 months
* SBP over 180
* Pregnancy
* 1 month post partum
43
**FARs (Federal Aviation Regulations):**
**Local flying area determined by: **
**Cell phones prohibited:**
Part 91: no passengers
Part 135: passengers (14 hours max for pilots)
Certificate holder
While Airborne
44
**Definition:**
**PaO2 **, **SaO2**
PaO2: partial presure of oxygen (plasma)
SaO2: saturation of arterial oxygen (hemoglobin)
45
**Bariobariatrauma**
Nitrogen release in obese patients at altitude (administer high flow oxygen \>15 minutes before to lift off to wash out nitrogen)
46
**Normal Pedi SBP, DBP?**
**When does it drop?**
SBP: 90 + (2x age)
DBP: 2/3 the SBP
BP last to go...
47
**Three killers of ventillator patients during flight?**
Pericardial tamponade
Tension pneumothorax
Hypovolemia
48
**Death from crush injury due to?**
Renal failure
49
**Complications of crush injury?**
DIC
compartment syndrome
renal failure
hyperkalemia
50
**CAMTS**
**Medical director not required to:**
Live in the same state
51
**CAMTS**
**Intubation requirement:**
Quarterly
52
**CAMTS**
**Live intubation required during training:**
Five
53
**CAMTS**
**Specialty team response time:**
45 minutes
54
**CAMTS**
## Footnote
**Pilot area orientation day/night:**
5 hours day / 2 hours night
55
**CAMTS**
## Footnote
**Helipad required to have:**
2 paths, security
56
**CAMTS**
## Footnote
**Fixed wing twin engine time:**
500 hours
57
**CAMTS**
## Footnote
**(Air) Ambulance fuel requirments:**
175 miles
58
**CAMTS**
**ELT set off at:**
4 g's
59
**CAMTS**
**Uniform fit:**
1/4 in space between body and uniform
60
**Applied gas laws:**
The bends, decompression soda can, CO2 in blood
Henry's Law
61
**Applied Gas Laws**
Tissue swelling
Hypoxic
Hypoxia
O2 available at altitude
Dalton's Law
62
**Applied gas laws:**
Celular gas exchange
Diffusion
Graham's law
63
**Applied gas laws**
Oxygen tank pressure in heat or cold
Guy- Lussac's law
64
**Applied gas laws**
BP cuff, ETT cuff, MAST
Boyle's Law
IABP purges with ascent or descent
65
**Trauma & Kinematics**
**High Velocity:**
\>2000 FPS
66
**Trauma & Kinematics**
**Medium Velocity**
1000-2000 FPS
67
**Trauma & Kinematics**
**Low Velocity**
\<1000 FPS
68
**Tumbling**
Rotation on 360 degree axis
69
**Yaw**
deviation up to 90 degrees from straight path
70
**Normal Values:**
**CVP/RAP**
CVP: 2-6
\*When assessing CVP or PA, pressures on a mechanically ventillated patient, assess pressures at the end of exhalation
71
**Normal Values:**
**Cardiac Output**
4-8 L/min
(CO: SV x HR)
72
**Normal Values:**
**Cardiac Index**
2.5-4.2
(CI = CO / BSA)
73
**Normal Values:**
**Pulmonary Artery Systolic/Diasolic**
PAS = 15-25
PVD = 8-15
\*When assessing CVP or PA, pressures on a mechanically ventillated patient, assess pressures at the end of exhalation
74
**Normal Values:**
**Wedge (PAWP/PCWP)**
PAWP/wedge: 8-12
75
**Normal Values:**
**SVR**
800-1200
76
**Chest/ABD trauma**
**Chest tube location?**
**Chest tube**: Fourth IC space, anterior-axillary
77
**Chest/ABD trauma**
**Needle thoracostomy?**
Second ICS midclavicular or the fifth ICS mid-axillary line
78
**Chest/ABD trauma**
**Suspect with fracture of first 3 ribs?**
Aortic disruption
79
**Chest/ABD trauma**
**Scaphoid abdomen indicates**
Diaphragmatic rupture
80
**High-risk OB - S/Sx**
**Abruptio placenta**
**Placenta previa**
**Abruptio**: dark red, painful
**Previa**: bright red, painless
81
**High-risk OB**
**Terbutaline dose:**
0.25mg SQ
82
**High-risk OB**
**Postpartum hemorrhage (abnormal volume of blood loss)**
\>500 mL
83
**High-risk OB**
**Uterine rupture**
Uterine Rupture: Fetal parts can be palpated over abdomen
84
**Effects of altitude worsen with**
Cold upper latitudes
85
**Gay-Lussac's law**
**(two components)**
**Example**
Temperature increases & pressure increases
Temperature decreases & pressure decreases
**Example:**
Oxygen tank pressure at 2200 in the afternoon, pressure drops to 1800 in evening (temp declined in eveining, pressure decreased)
86
**Universal Law**
Combines **Boyle's & Charles' **laws
87
**Graham's Law**
**Definition**
**Effects/Examples**
Rate gas moves from high to low concentration based on size and solubility
gas through liquid, cellular gas exchange
88
**Henry's Law**
Gas in liquid proportional to gas above liquid
**Example:**
"The Bends," CO2 in blood, decompression
89
**Volume of gas in GI expands thrice at what altitude?**
25,000 feet
90
**What law affects GI the most?**
Boyle's law
91
**Cardiogenic shock**
**CVP Cardiac output Cardiac index PAS/PAD PAWP SVR HR**
CVP: High
Cardiac output: Low
Cardiac index: Low
PAS/PAD: High
PAWP: High
SVR: High
HR: initially fast, then slows down
92
**Boyle's law**
**Two components**
**Effects**
Increased Volume = decreased pressure
**Examples**
Cuffs, MAST, GI, ETT, IABP
93
**Charles' Law**
**Two Components**
**Effects**
Temperature and Volume **Proportional**
(Increased temperature = increased volume)
Up 100 meters = down 1 degree C
94
**Environmental**
## Footnote
**1. Passive rewarming?**
**2. Active rewarming?**
**3. Warm & Dead?**
**4. Heat Stroke?**
1. mild hypothermia only. Up 1˚C/hr with blankets, heater
2. apply heat to body
3. 32˚C
4. over 42˚C
95
**Clinical Signs**
**Grey Turner's sign**
Flank brusing (retroperitoneal bleeding)
96
**Clinical Signs**
**Coopernail's sign**
Scrotem/labia (abdominal/pelvic bleeding)
## Footnote
97
**Clinical Signs**
**Halstead's sign**
Marbled abdomen (bleeding)
98
**Clinical Sign's**
**Cullen's sign**
Umbilical discoloration (pancreatitis)
99
**Clinical Sign's**
**Murphy's sign**
RUQ pain with **inspiration** (Gall bladder)
100
**Clinical Sign's**
**Levine's sign**
Fist to chest "Clutching" (Cardiac)
101
**Types of hypoxia**
**Hypoxic hypoxia**
**deficency in alveolar oxygen exchange**
altitude hypoxia
decreased alveolar oxygen
tension pneumo
102
**Types of hypoxia**
**Hypemic hypoxia**
**reduction in the oxygen carrying capacity of the blood**
carboxyhemoglobin (CO poisoning)
methemoblobin (excessive use of benzocaine, nitrates)
103
**Types of hypoxia**
**Histotoxic hypoxia**
**cellular inability to use molecular oxygen**
cyanide poisoning
104
**Types of hypoxia**
**Stagnant hypoxia**
**occurs when conditions exist that result in the reduced total cardiac output**
Decreased cardiac output
Poor circulation
(e.g. g-forces, CHF)
105
**High-risk OB**
**Normal Fetal HR**
120-160
106
**High-risk OB**
Factors in fetal well-being?
**Most important factor?**
FHR
Fetal movement
**Variability**
107
**High-risk OB**
**TX for fetal distress**
**LOCK**:
## Footnote
** L**eft lateral recumbent
**O2**
** C**orrect contributing factors
**K**eep reassessing
108
**CHF considerations**
Preload
Many CHF patients are relatively hypovolemic.
Careful with diuretics and medications that can decrease preload.
109
**CHF considerations**
Lab Test
**Lab Tests**
BNP = lab test nonspecific \> 500
110
**CHF considerations**
Medications
No beta-blockers, except for carvidolol (coreg)
## Footnote
Natracor (neseritide) = synthetic version of BNP
111
**Primary cause of death with ventilator dependent patients**
Ventilator acquired pneumonia
112
**Digoxin**
**Class**
**Causes what electrolyte** **imbalance**
**ECG changes**
Cardiac glycoside
Hypokalemia
ECG - "dig dip" ST depression
113
**ARDS**
**CXR**
CXR reveals widespread pulmonary infiltrates;
glass-like apperance
114
**ARDS**
**TX**
PEEP
115
**PEEP**
**Effects of PEEP**
**Effects of PEEP:**
Increased pulmonary vascular resistance can cause hypotension over 15 cm H2O
116
**PEEP**
**Normal physiologic PEEP**
**Normal PEEP: **3-5 cm H2O
117
**Treat HTN when SBP?**
**MAP?**
SBP \> 220
MAP \> 130
118
**Dehydration raises serum?**
Sodium
Normal sodium: 135-145
119
**Objective data?**
**things you can observe**
ABC's
Neurological assessment
Differential Diagnosis for altered mental status: AEIOUTIPS
120
**Bowel sounds in chest cavity?**
Diaphragmatic rupture
Most common in the **left** chest
121
**Crunching sounds heard over chest with auscultation, may be syncronized with heartbeat?**
Associated with tracheobronchial injury aka ***Hamman's sign***
122
**Preferred method for moving spinal injured patients?**
Scoop stretcher is prefered to log rolling paitent
123
**Differential diagnosis**
**Pulmonary contusion**
Low sats despite O2
Rales
124
**Differential diagnosis**
**Ruptured diaphram**
Chest/abdomen pain radiated to left shoulder
125
**Differential diagnosis**
**Trachobronchial injury**
Hemoptysis
Sub-q air
Air leak with chest tube
Advance ETT below level of injury into right mainstem
126
**Differential diagnosis**
**Esophageal perforation**
Fever
Hemaremesis
127
**Differential diagnosis**
**Fat embolus**
Fever
Rash after fracture
128
**Blood loss**
**Humerus**
Humerus: 750 mL
129
**Blood loss**
**Femur**
Femur: 1500 mL
130
**PAWP/PCWP**
Function?
Normal Range
Pulmonary artery wedge pressure/
Pulmonary capillary wedge pressure
**Function:** Looks @ L side of heart, if high can indicate pulmonary congestion, CHF, and cardiogenic shock
**PAWP/PCWP**: 8-12 mmHg
Do not keep wedged for more than 15 seconds, make sure that baloon is deflated and have patient cough forcefully
131
**ADULT ETT Depth**
**Adult**
3 x ETT size or average is 19-23
132
**Pedi ETT Depth**
**Pedi: **10 + age in years
## Footnote
133
**Neonatal ETT Depth**
**Neonatal: **6 + age weight in kg
134
**Ventillator miscellaneous**
**To change CO2...**
Adjust rate (*f *), then VT
135
**Ventillator miscellaneous**
**To change oxygenation**
Adjust PEEP, PAP
136
**Burns - Rule of 9's for Pedi**
**Head**
**Torso**
**Arms**
**Legs**
**Perineum**
**Pedi**
Head - 18%
Torso - 18% Front/Back
Arms - 9%
Legs - 13.5%
Perineum - 1%
137
**Burns - Rule of 9's for Adult**
**Head**
**Torso**
**Arms**
**Legs**
**Perineum**
**Adult**
Head - 9%
Torso - 18% Front/Back
Arms - 9%
Legs - 18%
Perineum - 1%
138
**Burns**
**Parkland Formula**
**Parkland**:
4 mL x kg x TBSA
1/2 of first 8 hr's, rest over next 16 hours
139
**Burns**
**Consensus formula**
**Consensus**:
***2-4*** mL x kg x TBSA
1/2 of first 8 hr's, rest over next 16 hours
140
**Saftey**
1. **ELT Frequency**
2. **Confirm ELT working**
3. **Twin engine required offshore**
1. ELT Frequency - 121.5
2. Tune it in and listen
3. Raft, vest
141
**Drugs**
Induction agent of choice with bronchospastic patients
Ketamine (ketalar)
142
**Drugs**
**Ativan aka:**
**Indication:**
**Dose:**
**Max.**
**Lorazapam**
**Indication: **Seizures
**Dose: **1-2 mg
**Max: **4 mg
143
**Drugs**
Mannitol Dose
1-2 g/kg
144
**Drugs**
**Drug of choice for cyclic antidepressant OD**
Sodium bicarbonate
145
**Drugs**
**Drug of choice for beta-blocker OD**
Glucagon
146
**Drugs**
**Fentanyl aka:**
**Dose:**
Sublimaze
3µg/kg
147
**Drugs**
**Treatment for malignant hyperthermia**
Dantrium (dantrolene)
148
**Drugs**
**Drugs for GI bleeds**
Sandostatin (octreotide)
149
**Neurogenic Shock**
**CVP:**
**CO:**
**CI:**
**PCWP:**
**SVR:**
**HR:**
**Neurogenic Shock**
## Footnote
**CVP: **down
**CO: **down
**CI: **down
**PCWP: **down
**SVR: **down (distributive shock)
**HR: **Can be present as normal or slow
150
**Arterial Line**
Sites:
**Sites: **
Radial
Femoral
151
**Arterial Line**
Purpose
**Purpose: **
Monitor pressure
Draw blood
ABG's
Maintain pressure bag @ 300 mmHg
152
**Arterial Line**
Underdampening:
**Underdampening:**
Caused by having air in the system,
Loose connection
Low pressure bag
Altitude changes
153
**Arterial Line**
Overdampening
**Overdampening:**
Caused by kinking
Increased bag pressure
Tip against the wall
154
**ECG**
**Most common reperfusion dysrhythmia**
AVIR
155
**ECG**
**Most common hypothermia dysrhythmia**
VF
| (osborn wave)
156
**Hypokalemia on ECG**
Hypokalemic - Peaked P's, flat T'
157
**Hyperkalemia on ECG**
**Hyperkalemic**
Peaked T's (treat with calcium)
158
**MAP goal with CHI **
MAP: 80-100
159
**CPP goal with increased ICP**
CPP: 70-90
160
**Normal ICP**
**Normal CPP (head)**
**Normal MAP**
**Normal for the other CPP (heart)**(Cornary Perfusion Pressure)
**ICP: **0-10
**CPP (head): **70-90
**MAP: **80-100
**Heart CPP:** 50-60
Remember your head is higher than your heart
161
**_GCS_**
**Mild
Moderate
Severe**
GCS or Scale
Mild: 14-15
Moderate: 9-13
Severe: 3-8
162
**CPP (head) formula**
CPP: MAP-ICP
163
**MAP formula**
SBP + 2 DBP
------------------------
3
164
**CPP (heart) formula**
Heart CPP: DBP - wedge
165
Rotor-wing minimums ceiling/visibility
Day/local
Day/cross-country
Day/local: 500 foot (ceiling) and 1 mile (visibility)
Day/cross-country: 1000 feet and 1 mile
166
Rotor-wing minimums ceiling/visibility
Night/local
Night/cross-country
Night/local: 500 feet and 2 miles
Night/cross-country: 1000 feet and 3 miles
167
**Number one cause of air medical crashes**
Controlled flight into terrain,
***Pushing the weather***
168
Lab Values:
## Footnote
**Normal Potassium**
K: 3.5-5.5
169
Lab Values:
**Normal Sodium**
Na: 135-145
170
Lab Values:
**Normal Chloride**
Cl- : 95-105
171
Lab Values:
## Footnote
**Normal Calcium**
Ca: 8.5-10.5
172
**Metabolic acidosis elevates which electrolyte?**
Potassium
173
Time of useful consciousness with sudden decompression at:
**30,000 feet
41, 000 feet**
30,000: 90 seconds
41,000: under 15 seconds
\*Least amount of time is your answer on the exam
174
# Which Leads?
12-lead ECG:
**Inferior**
Inferior – II, III, aVF
175
# Which Leads?
12-lead ECG:
**Septal**
Septal – V1, V2
176
# Which Leads?
12-lead ECG:
## Footnote
**Anterior**
Anterior – V3, V4
177
# Which Leads?
12-lead ECG:
## Footnote
**Lateral**
Lateral – I, aVL, V5, V6
178
# Which Leads?
12-lead ECG:
## Footnote
**Posterior**
Posterior – ST segment depression or reciprocal changes noted in V1-V4, ST elevation V6
179
**Cardiac Ischemia**
**Ischemia**: ST depression (1 mm in 2 leads)
180
**Cardiac Infarct**
**Infarct**: Q wave \> 25% the height of R wave
181
**Cardiac Injury**
**Injury**: ST elevation (1mm in 2 leads)
182
Pediatric age guidelines
* **ETT cuffed vs. uncuffed**
* **Needle Cricothyrotomy**
* **Nasal intubation**
**“10, 11, 12” Rules**
* Uncuffed tube under 10
* Needle cricothyrotomy only under 11
* No nasal intubation under 12
183
High-risk OB:
## Footnote
**PIH triad signs**
HTN
Edema
Proteinuria
184
High-risk OB
## Footnote
**Terbutaline contraindications**
IDDM
Maternal HR over 120
Vaginal bleeding
185
High-risk OB
**Primary cause of PTL**
Infection
186
**O2 adjustment calculation to maintain saturation at altitude**
**FiO2 \* ****_Pressure at departure (mmHg)_**
** Pressure at altitude**
Example: Patient on FiO2 of 0.40
Depart: 681 mmHg
Altitude: 565 mmHg
*0.40 \* (681/565) = 0.48*
187
**Ventilator modes: IMV & SIMV**
**IMV:** preset breaths, TV, PIP.
Patient breaths allowed.
**SIMV:** allows variation of support.
188
**Ventilator modes: AC**
**AC**: preset volume or PIP with every breath.
Can trigger breath, can’t control TV.
189
**Ventilator modes: CMV**
**CMV**: preset volume or PIP at set rate.
Patient can’t initiate breath
190
IABP: Action
Increase cardiac output coronary perfusion
191
**IABP**: Deflates
During ventricular systole
192
**IABP: Dicrotic Notch**
Aortic valve closing, synchronized with a-line or ECG
(most common trigger)
193
**IABP: Signs/Symptoms of balloon leak**
Blood specs in tubing
Alarm
194
**IABP: Clot prevention **
Cycle manually every 30 minutes
195
**IABP increases CO by**
Increases CO by 10-20%
196
**IABP: Balloon rupture**
Rusty flakes in line or turn machine off
197
**IABP: Migration/dislodged**
Assess left radial and urine output
198
**Lethal IABP timing cycles**
Late deflation and early inflation
199
Oxyhemoglobin disassociation curve
**Left Shift**
“L” stands for Alkalosis
Left shift = low Hemoglobin holding oxygen Alkalosis
Low CO2
Low temperature
Low DPG
Mxydema Coma
200
Oxyhemoglobin disassociation curve
**Right Shift**
“R” stands for raised
Right = raise/releases oxygen, Acidosis, Raised CO2
Raised temperatures
Raised DPG
Thyroid Storm
201
**Phlebostatic axis
Where?
What?**
Where pressure measurements are made with invasive line
Fourth ICS, level of atria
202
**Boyle’s Law
Ascent**
**Ascent**
**Barondontalgia** (toothache)
**Barosinusitis** can occur on ascent
**Bariobariatrauma** (obese) = Nitrogen in the fat cells can expand causing the “bends” administer high flow oxygen for 15 minutes prior to lift-off to remove nitrogen
203
**Boyle’s Law
Descent**
**Descent**
**Barotitis media** (middle ear) can affect the patient during descent
204
**Hypertension:**
Mild
Moderate
Severe
**Mild**: 140-159/90/99
**Moderate**: 160-179/100-109
**Severe**: over 180/110
205
**Volume for RBC
administration
Volume for WBC**
RBC 10 mL/kg
WBC 20 mL/kg
206
**ABG rules: CO2 and pH**
CO2 up 10mmHg = pH down .08 (**inverse**)
207
**ABG rules: Bicarb and pH**
HCO3 up 10 = pH up 0.15 (proportional)
208
**ABG rules: Bicarb replacement**
Kg/4 x base deficit = mEq of bicarb needed
209
**ABG rules: PaO2 at altitude**
PaO2 drops 5 for every 1000 feet elevation
210
Stages of Hypoxia elevations
Signs and Symptoms:
## Footnote
**Indifferent**
**Indifferent**: (10,000 feet MSL)
Increased HR and RR, decreased night vision
211
Stages of Hypoxia elevations
Signs and Symptoms:
## Footnote
**Compensatory**
**Compensatory**: (10,000-15,000 feet MSL)
HTN, task impairment
212
Stages of Hypoxia elevations
Signs and Symptoms:
**Disturbance**
**Disturbance**: (15,000-20,000 feet MSL)
dizzy, sleepy, cyanosis
213
Stages of Hypoxia elevations
Signs and Symptoms:
## Footnote
**Critical**
**Critical**: (20,000-30,000 feet MSL)
ALOC, incapacitated
214
**Night vision lost at:**
5,000’ MSL
215
PA Catheter: **Named?**
Swan-Ganz
216
PA Catheter: **Proximal port is for?**
CVP
Medications
217
PA Catheter: **S/S of bad placement?**
VT
Ventricular ectopy
218
PA Catheter: **Proceedure for bad placement?**
Float forward to PA or pull back to RA
219
PA Catheter: **Measures?**
Right heart directly
Left heart indirectly
220
PA Catheter: **Which prt Used?**
Distal port
221
PA Catheter: **Pressure bag set to?**
300 mmHg
222
**Normal cardiac index**
CI: 2.5-4.3
223
**Stressors of flight**
1. Third spacing
2. Fatigue
3. G-forces
4. Noise
5. Vibration
6. Hypoxia
7. Dehydration
8. Temp changes
9. Barometric pressure changes
224
Personal factors affecting stressors of flight?
**DEATH**
**D**rugs
**E**xhaustion
**A**lcohol
**T**obacco
**H**ypoglycemia
225
**Dalton’s law**
Sum total of partial pressures equal to total atmospheric pressures (Dalton’s gang)
Examples:
Tissue swelling, altitude hypoxia, hypoxic hypoxia
This is why O2 is needed at altitude
226
**Cardiac Thrombolytics**
must be administered within
**Three hours** of onset of chest pain
227
Diving injuries
ATM
ATM for every 33 feet descent
&
Add 1 if asking for total ATM versus water pressure
228
**Hypovolemic shock**
CVP
CO
Cardiac Index
Wedge
SVR
Heart Rate
CVP: down
CO: down
Cardiac Index: down
Wedge: down
SVR: high
Heart Rate: fast
229
# pO2 & pCO2
**Acute Respiratory failure**
pO2 below 60
pCO2 above 50
230
Newton’s laws
**First law**: an object in motion tends to stay in motion
**Second law**: force = mass x acceleration
**Third law**: every action has = and opposite reaction
231
**Tetralogy of Fallot (TOF)**
Remember **PROV**
## Footnote
**P** = pulmonary stenosis
**R** = right ventricular hypertrophy
**O** = overriding aorta
**V** = ventricular septal defect
232
**What is a tet spell?**
During a “tet” spell, blood flow across the right ventricular outflow tract is significantly decreased, resulting in shunting right to left through the VSD out of the aorta, thus bypassing the lungs.
**Causes include**: spasms, sudden decrease in systemic vascular resistance secondary to hypovolemia, dehydration, hot weather, or defecation.
Tet spells are usually seen in the **neonatal** period,
& **peak** in incidence between **two and four months** of life.
233
**Atrial waveforms**
**“Filling pressures”**
Right atrial pressure (**CVP**)
Left atrial presure (**PAWP/PCWP**)
234
**Ventricular waveforms**
Right ventricular pressure obtained upon insertion of PA catheter or if the catheter has been dislodged backward into the right ventricle resulting in a right ventricular waveform.
Looks like “VT,” no dicrotic notch seen on the downslope of the right side of the waveform
Left ventricular pressure measured during cardiac catheterization
235
**Arterial waveforms**
Arterial lines
Pulmonary artery pressure (PAP)
Dicrotic notch seen on the downslope of the right side of the waveform
236
Waves:** A wave**
**A wave** = rise in atrial pressure as a result o atrial contraction
237
Waves: **C wave**
**C wave** = not always visible on the tracing, rise in the atrial pressure which closure of the AV valves (tricuspid and mitral) bulge upward into the atrium following valve closure
238
Waves: **V wave**
**V wave** = rise in atrial pressure as it refills during ventricular contraction
239
A Wave correlation to ECG
A wave generally coincides with PR interval on the WCG in a right atrial pressure waveform
It will be slightly delayed in a left atrial pressure waveform
240
C Wave correlation to ECG
C wave generally coincides with mid to late QRS on the ECG in a right atrial pressure waveform
It will be slightly delayed in a left atrial pressure waveform
241
V Wave correlation to ECG
V wave is generally seen immediately after the peak of the T wave on the ECG in a right atrial pressure waveform.
It will be slightly delayed in a left atrial pressure waveform
242
**Wave descents**
Decline in right atrial pressure during atrial relaxation (remember “x” in relaXation)
Decline in right atrial pressure resulting from atrial emptying (Remember the “Y” in emptYing)
243
Breathing and waveforms
Record pressure measurements at the end of exhalation
In a spontaneously breathing patient, inspiration is the fall in pressure, expiration is the rise in pressure. End-expiration occurs just prior to the respiratory drop in pressure
Positive pressure mechanical ventilated patients will cause cardiac pressure to rise upon inspiration
244
**Measuring waveforms**
The end-diastolic pressure can be estimated by identifying the “Z” point
A line is drawn 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 by 0.08-0.12 sec from the QRS
245
Cardiac output formula
HR x SV = CO
246
Diacrotic notch
Closure of the aortic valve
247
Neonatal
Maintains the PSA open = prostaglandin (PGE1)
Closed the PSA = indomethacin and long-term use of high oxygen delivery
32 weeks or less in gestation = surfactant
Common cause of seizures = hypoglycemia \< 40 mg/dL and hypoxia
Scaphoid abdomen = diaphragmatic hernia managed with orogastric tube and PPV
248
**CPK \> 20,000**
CPK (muscle enzymes) levels greater than 20K is ominous and is an indication of later DIC, acute renal failure and is potentially dangerous hyperkalemia in the heatstroke patient
249
**Anion gap**
Na – (Cl + Bicarb/CO2) = AG Normal 12 (+/-) 4 \>16 indicates an underlying metabolic acidosis
Remember: “**MUDPILES**" **M**ethanol **U**remia **D**KA **P**araldehyde **I**soniazide/Iron **L**actate **E**thylene glycol **S**alicylate
