CFRN Flashcards
1
Q
3 things that high CO2 indicates
A
acid buildup
low pH
apnea/hypoventilation
2
Q
what is CO2 regulation a function of
A
minute ventilation (Ve) = Vt x F
3
Q
base deficit >-4
A
need a blood transfusion
4
Q
how can you use base deficit to predict need for blood transfusion
A
> -4 needs a blood transfusion
5
Q
replacement formula for bicarbonate
A
0.1 x base excess x wt in kg = # bicarbonate needed
6
Q
left shift affinity
A
increased
7
Q
mneumonic for left shift
A
LEFT = LOW
acidosis, temp, 2,3-DPG, pCO2
8
Q
mneumonic for right shift
A
RIGHT = RAISE
alkalosis, temp, 2,3-DPG, pCO2
9
Q
how to tell if ABG is compensated
A
the compensation mnechanism is the opposite of the primary problem
- R. acidosis is compensated by bicarbonate
- m. alkalosis is compensated by CO2
10
Q
partially compensated
A
pH, resp, & metabolic are all out of range
11
Q
pH, CO2 & bicarbonate are all out of range
A
partially compensated
12
Q
fully compensated
A
pH is normal
CO2 & bicarbonate are out of range
13
Q
pH is normal
CO2 & bicarbonate are out of range
A
fully compensated
14
Q
critical pH for intubation
A
under 7.2
15
Q
critical CO2 to intubate
A
pCO2 over 55
16
Q
critical pO2 to intubate
A
under 60
17
Q
considered lactic acidosis
A
over 4
18
Q
acid base in hyperthermia
A
m. acidosis
19
Q
acid base in rhabdo
A
m. acidosis
20
Q
acid base at high altitudes
A
r. alkalosis
21
Q
increased minute ventilation
A
increased to blow off CO2 (Vt x F)
22
Q
every __ in pH, expect the bicarbonate to change by ___ in the ___ direction
A
0.15 pH
10 bicarbonate
same direction
23
Q
every __ in pH, expect change in K by __ in the ___ direction
A
0.1 pH
K shifts 0.6
opposite direction
- as pH lowers, K shifts outside the cell giving a falsely elevated K.
- when correct imbalance by raising pH, K shifts intracellularly so life threatbning low K
24
Q
every change in ___ ETCO2, expect pH to change by ___ in the ___ direction
A
10 mm hg
0.08
opposite direction
25
every change in ___ CO2 K shifts ___ in the ___ direction
10 CO2
0.5K
same direction
26
ABG to intubate
7.2 pH
CO2 over 55
PaO2 under60
27
ETT size pediatrics
16 + age in years
| divided by 4
28
3-3-2 rule
difficult airway predictor
3 in mouth
3 between jaw & hyoid
2 betweenhyoid and thyroid
29
Mallampati II
tonsilar pillars are hidden by tongue
30
Mallampati III
only the base of hte uvula is seen
31
HEAVEN
```
difficult airway predictor
hypoxemia under 93%
extremes of size (under 8/obese)
anatomic
vomit/blood/fluid
exsanguination/anemia
neck mobility
```
32
failed airway algorithm
3 failed attemps,
| cric
33
post intubation management
fent
ketamine
versed
34
SALAD technique
suction assisted laryngoscopic airway decontaminatin
| *clean airway w/suction, place suction in esophagus, as the intubation tube is passed
35
RSI dose of paralytic if shock
double paralytic b/c low CO slows the onset
36
RSI pathology consideration when planning the paralytic dose
double paralytic if low CO/shock b/c low CO slows the onset
37
RSI dose of induction agent if in shock
1/2 induction dose
| less is needed due to depletion of catacholamine stores
38
RSI dose if low CO/shock
* 1/2 induction dose. less is needed b/c depletion of catecholamine stores
* double the paralytic bc low CO slows onset
39
onset/duration of ROc
onset under 2 min
| duration 30-60 min
40
reverses Roc
Sugammadex
41
Sugammadex
reverses Rocuronium
42
ABG in Malignant Hyperthermia
mixed acidosis
high RR
increased COw
43
DO NOT give in Malignant Hyperthermia
CaCHB b/c problem w/calcium removal from the muscle
44
contraindications for succ - 7
```
burns over 24hrs
rhabdo
high K
crush
eye injuries
hx of malignant hyperthermia
any nervous system injury like GB or MG
```
45
burn contraindication for succ
contraindicated if burns over 24hrs
46
SE of Succ
high K
| malignant hypertheria
47
K in succ
high K
48
4 RSI induction
fentanyl
etomidate
ketamine
propofol
49
RSI & their complications
Fentanyl - chest wall rigidity, low bp
etomidate - adrenal suppression
propofol - decrease CPP/MAP so not for head injury/hemodynamically unsatable
Ketamine - preserves larungeal function os airway protection
50
problem of ETomidate
adrenal suppression
51
RSI w/adrenal suppression
Etomidate
52
RSI that decreasnes CPP/MAP
propofol
53
who should not get ETomidate
anyone w/adrenal suppressio
54
who should not get propofol
decreases CPP/MAP so not for head injury/hemodynamically unstable
55
RSI that decreases CPP/MAP
propofol
| don't give to head injury/hemodynamicaly unstable
56
RSI that shoudl not be given to head injuries
NO propofol! b/c decreases CPP/MAP
57
RSI that should NOT be given to hemodynamically unstable
NO propofol! decreases CPP/MAP
58
important things to remember w/Propofol
milk of amnesia
NO analgesiaproperties
decreases CPP/MAP so don't give to head injury or hemodyanmically unstable
59
good RSI if in shock
ketamine
60
SE of FLumazenil
low bp
61
position for ramping
ear to sternal notch
62
MacIntosh versus Miller blades
```
Mac = lifts epiglottis via the vallecula
Miller = direct displacement of the epiglottis
```
63
preferred intubation blade for a pediatric
Miller = direct displacement of hte epiglottis
64
bougie size for adults versus kids
```
adults = 15Fr
kids = 10F
```
65
confirm ETT placement -3
distal tip 2-3cm above carina
level T3-T4
visualizeing Murphy's eye where teh clavicle meets
66
intubation pretreatment
LOAD
| airway manipulation may cause relfexive sympathetatic response so elevate vials
67
best RSI for asthmatics
Ketamine b/c bronchoD
68
onset & duration of Ketamine
```
onset = 40 - 60 seconds
duration = 10-20 minutes
```
69
3 properties of KEtamine
hypnotic
analgesic
amnesic
70
common SE w/Etomiate
common to vomit when awaken
71
contraindications to Etomidate
don't use if adrenal suppresision, COPD, shock, Addisons or if hemodynamically unstable
72
onset & duration of ETomidate
15-45 second onset
| lasts 3- 12 minutes
73
dosing of defasciculating rx as RSI pretreatmetn
1/10 dose of Roc/Vec prior to SUcc
74
atropine as RSI pretreatment
prevents reflexive bradycarida in under 1yo
75
lidocaine as RSI pretratment
blunts the cough reflex to prevent ICP increase
76
when do you hear apneurisitic respirations
decerebrate posturing
77
irregular breathing w/pauses & apnea
ataxic
78
BIot's
quick shallow inspiration w/apnea
| stroke & pressure on medulla during herniation
79
respirations in stroke
Biot's
80
progressively deeper/faster then apnea
Cheyne-SToke
81
respirations in herniation
Cheyne-STokes *Cushings Triad
| Biots medulla pressure
82
respirations in posturing
Cheyne-STokes - decorticate
| apneurisitic - decerebrate
83
respiratory failure in ARDS
hypoxic respiratory failure
84
respiratory failure in pneumonia
hypoxic respiratiory failure
85
respiratory failure in CHF
hypoxic respiratory failure
86
diagnose hypoxic respiratory failure
pO2 under 60
87
treat hypoxic respiratory failure
increase oxygen concentration (FiO2 & PEEP)
| *treatment assumes you have adequate tidal volume & rate
88
dx hypercarbic respiratory failure
ETCO2 over 45
89
ETCO2 over 45
hypercarbic respiratory failure
90
treatment of hypercarbic respiratory failure
increase tidal volume (pPLAT)
then rate increase
(double the minute volume (Ve - normal is 4-8L/min)
91
how to change Vt settings
over 8ml/kg can cause barotrauma
| *slowly increae and reassess every 15min
92
Vt setting
4-8ml/kg of ideal body weight
93
pressure versus volume delivery
volume = preset volume is consistent. once Vt is reached, exhalation begins
pressure = preset inspiratory pressure. once the pressure is reached, exhalation begins
94
pPLAT
measures the pressure applied during PPV to smal airways/alveoli
*represents the end of inspiratory recoil
95
when is pPLAT mesured
during an inspiratory pause while on m. ventilation
96
ventilator setting where all aspects of the respiratory cycle are controlled & pt cannot override
controlled mandatory ventilationh
97
best ventilator setting for paralyzed or apneic
CMV
98
peferred ventilation setting for respiratory distress
Assist Control
99
who benefits from Assist Control
preferred ventilation setting for respiratory distress
100
trigger for breaths in Assist Control
pt or elapsed time
101
how does Assist Control work
full Vt each time regardless of if it is initiated by pt or the machine. will be supported each time
*irrespective of respiratory effort/drive
102
anxiety while on Assist Control
breath stacking/auto-PEEP
103
what ventilator setting can cause auto-peep
assist control
104
preferred ventilator setting for ARDS
assist control
105
ventilator supports every breath regardless of it is initiated by pt or the machine
Assist COntrol
106
problem of auto-peep
predisposes to barotrauma/hemodynamic compromise
increases WOB/effort to trigger the vnetilato
diminishes the forces generated by the respiratory muscles
107
how does SIMV work
if pt fails to take a breath, the ventilator will do it
| *spontaneous breathing in-between breaths set to pre-set intervals
108
ventilator that allows pt to breathe in-between preset breaths
SIMV
109
ventilator lets pt breathe in-between preset intervals OR ventilator supports every breath but the pt can initiate
breathe in-between = SIMV
support each time but pt can initiate= AC
no pt control, all ventilatior = CMV
110
who benefits from SIMV
intact respiratory drive. can take their own breathes between pre-set intervals
111
best ventilator setting for intact respiratory drive
SIMV
112
how to use pressure support ventilation
makes it easier to overcome resistance of hte ET tube. often used during weaning b/c decreases WOB
113
good ventilator setting to help pt wean
pressure support ventilation (PSV)
114
good ventilator setting to help decrease WOB
Pressure Support Ventilation (PSV)
115
what does the pt determine in PSV
pressure support ventilation
| *Vt & F
116
what does PSV do
pressure support ventilation
| provides pressure during inspiration to decrease pt overall WOB
117
what does pt need to be able to do in order to use PSV
consistent vnetilation effort
| pt determiens Vt, F (minute volume)(
118
pressure alarm if pneumo
high
119
pressure alarm if pt is hypovolemic
low
120
pressure alarm if ARDS
high
121
pt is bucking the ventilator
pt-ventilator dysynchrony
122
problem of pt bucking the ventilator
increased oxygen demand, WOB, vitals up. ICP up
123
how do you know if the pt-ventilator dyssynchrony is occurring
curare cleft
124
curare cleft
pt-ventilator dyssynchrony
125
6 ways to intervene w/pt-ventilator dyssynchrony
```
manage auto-peep
adjust rate to pt demand
adjust sensitivity/Ve
suction
analgesia/sedation
```
126
what settings should you look at if you have sudden acute respiratory deterioration while on m. ventilation
PIP (decrease/increase/no change)
| pPLAT (no change or increased)
127
Ventilator Troubleshoot for acute resp deterioration
| *PIP is decreased
3: air leak, hypo/hypervent
128
Ventilator Troubleshoot for acute resp deterioration
| *no PIP change
consider PE
129
Ventilator Troubleshoot for acute resp deterioration
| *PIP increased
next you must consider if the pPlat is increased or no change
130
Ventilator Troubleshoot for acute resp deterioration
* PIP increased
* pPLAT increased
```
abd distension
atelectasis
pneumo
p. edema
atelectasis
pleural efflusion
```
131
Ventilator Troubleshoot for acute respiratory deterioration
* PIP increased
* pPLAT no change
airway obstruction
bronchospasm
ET cuff herniation
132
RASS scale
richmond agitation-sedation scale
+4 = combative
0= alert/calm
-4: deeply sedated
133
V/Q decreased
ventilation not keeping up w/perfusion
| resp fail/pneumonia/ARDS/paO2, high pCO2
134
formula for V/Q
alveolar ventilation/CO
| ~0.8
135
low V/Q
normal V/Q
high V/Q
SAD
low: shunted. alveoli are ventilated but not perfused
A= ventilated and perfused
D= deadspace. alveoli are ventilated but not perfused
136
example of low V/Q
under 0.8
shunt
alveoli are perfused but not vented
ET in mainstem bronchus
137
V/Q if ET is in the mainstem bronchuis
low V/Q
shunted
perfusion w/o ventilation
138
acid-base in asthma
breathing out problem
| r. acidosis b/c hypercarbic respiratory failure
139
CXR in asthma
flatted diaphragm
| chest cavity is overexpanded due to air trapping
140
appearence of asthma on ETCO2
shark fin
141
shark fin ETCO2
asthma
142
ventilator intervention for asthma
increase I:E ratio to 1:4
b/c this is an exhalation problem
zero peep if possible
143
I:E setting on ventilator in an asthma attack
1:4 b/c this is an exhalation problem
144
PEEP if asthma attack
zero if possible
145
CXR of COPD
flattened diaphragm
| chest cavity is expanded form air trapping
146
problem of COPD
breathing out
| r. acidosis b/c hypercarbic rspiratory failure
147
benefit of increased I:E
more expiratory time increases CO2 clearence but it does carry a risk of atelectasis
*
148
CXR of pneumonia
patchy infiltrates
| lobular consolidation
149
pathology of ARDS
diffuse alveolar injury
increased permeability of the alveolar-capillary barrier
influx of fluid into the alveolar space
150
CXR of ARDS
ground glass appearence
patchy infiltrates
bilateral diffuse infiltrates
151
CXR shows ground glass appearence
ARDS
152
Swan-Ganz findings in ARDS
high PAWP (18-20) b/c the right heart is pumping against the increased resistance in the lung vasculature)
153
consider if PAWP is high (18-20 range)
ARDS/ b/c the right heart is pumping against the increased resistance in the lung vasculature)
154
ARDS treatment -5
```
focus on oxygenation
increase PEEP
increase FiO2
lower Vt
increase rate
```
155
PEEP setting in ARDS
increase
| minimum 5
156
FiO2 setting in ARDS
increase
157
Vt setting in ARDS
decrese
158
F setting in ARDS
increase
159
IBW males
50 + 2.3(hight in inches - 60)
160
IBW females
45.5 + 2.3(height in inches -60)
161
3 criteria for ARDS
1. PaO2/FiO2 under 300
2. bilateral infiltrates consistent w/p. edema
3. no clinical evidence of left arterial HTN
162
what lab indicates ARDS
PaO2/FiO2 under 300
163
pPLAT goal in ARDS
under 30
164
how often should you check pPLAT if on a ventilator for ARDS
q4 hrs
| after each change in PEEP/Vt
165
intervention for ARDS if pPLAT is over 30
decrease Vt by 1ml/steps
166
intervention for ARDS if pPLAT is under 25 and Vt under 6ml;kg
increase Vt by 1ml/kg until pPlat is over 25 or Vt 6ml/kg
167
intervention for ARDS if pPLAT is under 30 & breath stacking is occurring
increase Vt in 1mk/kg increments to 7 or 8
168
abnormal labs in Tylenol overdose
LFT elevated
low glucose
phosphate abnormal
169
acid base in ASA overdose
r. alkalosis
| can progress to m. acidosis
170
complications of ASA overdose
liver & brain damage
| hepatic encephalopathy so high ICP
171
s/s of BB overdose
```
low bp/hr
conduction delays
low glucose
p. edema
bronchospasms
```
172
s/s of CaChB overdose
low bp/hr/conduction delays
high glucose
m. acidosis
173
treat CaChB overdsoe
activated charcoal
atropine/pacing
gluconate
IV F
174
EKG of digoxin overdose
slurred upstroke on QRS
| risk of high K
175
overdose that has a slurred upstroke on the QRS
digoxin
176
K in digoxin overdose
high
177
avoid if digoxin overdose
avoid electricity like pacing/cardioversion
178
s/s of DIlantin overdose
```
SVT
coma
confusion
tremors
DI-like
```
179
4 s/s of cocaine overdose
CP
HTN
seizures
rhabdo
180
treat PCP
sedatives
| no ketamine b/c delirum worsens
181
treat anticholinergic
physostigimine
182
physostigimine
anticholinergic overdose
183
amyl nitrite
sodium nitrite
sodum thiosulfate
cyanide
184
treat hydrocarbon overdose
intubation
185
overdose that is treated w/vitamin B6
INH
186
treat INH overdose
vitamin B6 (pyridoxine)
187
treatment is 2-PAM
organosphosphates
188
organophosphate treatment
atropine
| 2-PAM
189
what does tricyclic antidepressant overdose look like
anticholinergic
190
EKG of tricyclic antidepressant overdose
widened QRS
| prolonged QT
191
treatment of tricyclic antidepressnat overdose
bicarb to get pH 7.5 - 7.55
| vasopressors if low bp
192
ABG of toxic alcohols
lethal anion-gap of over 16
193
aka antifreeze
ethylene glycol
194
aka windshield wiper fluid
methanol
195
complications of hydrocarbon overdsoe
chemical pheumoitis
decreased viscosity causes aspiraiton
NO induce vomiting
196
toxidrome of pesticides
cholinergic
197
toxidrome is SLUDGE/DUMBELS
cholinergic
organophosphates
nerve gases like Vx/Sarin
198
toxidrome of VX/Sarin
SLUDGE?DUMBELS
| cholinergic
199
examples of cholinergic toxidrome
organophosphates
| nerve gases like VX, Sarin
200
s/s of nerve agents
cholinergic toxidrome
SLUDGE
DUMBBELS
nicotinic stimulation = tachycardia, HTN, fascuculations, paralyskis of respiratory muscles
201
DUMBBELS
```
diarrhea
urinatino
miosis
bronchorrhea, bronchospasm
emesis
lacrimination
sweating
```
202
death from organophosphates
respriatory muscle paralysis
203
treatment of organophosphate oversoe
atropine - decrease airway secreations
pralidoxime
2-PAM to crowbar organophsphate off of ACh
benzos for seizures
204
what type of overdose is atropine
anticholinergic
205
what type of overdose is benadryl
anticholinergic
206
what type of overdose is antidepressants
anticholinergic
207
mad as a hatter....
anticholinergic
208
anticholinergic oversoe s/s
```
mad as a hatter...
blind as a bat -mydriasis
red as a beet
hot as a hare
dry as a bone
```
209
mad as a hatter...
anticholinergic
| atropine, benadry, antidepressants
210
level a-line
phlebostatic axis
| 4th ICS midaxillary
211
dicrotic notch
represents aortic valve closure
212
represents aortic valve closure
dicrotic notch
213
how to determine proper a-line pressure
no more/less than 3 ossilations before returning to normal
pressure = determine dampening
many ossillations = too little dampening so the ossilations won't die and continue to reverbrate
to much prssure = overdampening
too little pressure - underdampening. system is too dynamic
214
air in a-line
too much pressure so overdampened
215
air in a-line if the tubing is noncompliant
underdampened = too little pressure
216
what does Swan-Ganz measure?
pulmonary artery catheter
R heart preload/afterload
L heart preload
217
insertion site of Swan-Ganz
central line into subclavian vein
218
PA catheter tips
distal tip = pressure
PA port = monitoring/lab samples
proximal = infusions/fluids
219
take wedge pressure
distal tip
1.5ml
end of exhalation
not for longer than 15 sec or 3 breaths
220
how to transport a PA catheter
deflate balloon to prevent inadvertent wedge with advance
| balloon increases at altitude b/c BOyle's law
221
dicrotic notch on left side of PA catheter waveform
RV waveform = tricuspid valve closing
222
dicrotic notch on the right side of the PA catheter waveform
PA waveform = pulmonic valve clsoing
223
measure R heart preload
CVP 2-6
224
Right ventricular pressure
15-25
| 0-5
225
Pulmonary Artery pressure
15-25
| 8-15
226
PAWP
8-12
right heat afterload
left heart preload
227
measure left heart preload
PAWP
228
measure right heart afterload
PAWP
229
normal coronary perfusion pressure
50-60
| DBP - PAWP
230
normal CO
4-8 L/min
231
catheter whip
exaggereated waveforms w/elevated systolic pressure and additional peaks = excessive movement of the catheter within the artery
232
PA catheter has excessive movement within the artery
catheter wip
| exaggerated waveforms & elevated systolic pressure
233
consider if PA catheter shows elevated systolic pressures
catheter whip
| excessive movement within the artery
234
how to handle catheter whip
```
excessive movement of the catheter in teh artery
elevated systolic pressure
1. inflate cuff w/1.5ml of air
2. cough
3. lay o right side
```
235
2 causes of inadvertent PA catheter wedge
balloon migration
| Boyle's law inflation
236
treat inadvertent wedge
you'll see a PAWP waveform
1. deflate the balloon
2. cough
3. reposition pt
4. withdraw until you see a PA waveform
237
proper waveform to see if using PA catheter
PA waveform
238
SVR in hypovolemia
increaed
239
indirect estimate of left arterial pressure
PCWP = pulmonary capillary wedge pressure
240
CVP in cardiogenic shock
decreased
241
PAWP in hypovolemic shock
decreased
242
PACP in cardogenic shock
increased
243
normal SVR & PVR
SVR is 800 -1200
244
CVP in late septic shock
decreased
245
SVR in late septic shock
increased
246
CO in anaphylaxis
increaed
247
`CVP in anaphylaxis
decreased
248
PAWP in late anaphylaxis
decreased
249
PAWP that indicates IABP
PAWP over 18
250
2 effects of IABP
increase coronary perfusion
| decrease heart workload
251
IABP during systole & diastole
deflated
| inflated
252
insertion of IABP
into femoral vein towards teh heart into descending aorta. above renal arteries/below left subclavian
253
IABP in power failure
manually pump every 3-5 minutes to prevent clots
254
early IABP inflation
inflation before the aortic valve closes
| forces blood back into the LV
255
IABP timing error when blood is forced back into the left ventricle
early inflation
256
effects of early IABP inflation
harmful
aortic regurgitation
decreased CO
increased SVR
257
shape of early inflantion of IABP
U
258
when does late inflation of IABP occur
inflation after the aortic valve closes
259
inflation of IABP after the aortic valve closes
late inflation
260
shape of late inflation of IABP
W
261
problem of late inflation
suboptimal augmentation
| decreased coronary pressure
262
4 shapes of IABP timing errors
early inflate - U
late inflate W
early deflate- deflate
late deflate- widened
263
problems of early deflation
decreased negative pressure
deflation of bloon before systole
increaed afterload
264
when does the IABP deflate in early deflation
deflate before systole
265
worst IABP timing error
late deflation
266
what happens in late deflation of IABP
inflation of hte balloon during systole
| thus increases afterload & workload
267
Impella
continuous flow pump
| pulls blood from left ventricle and propels it back into the aorta
268
uses for ECMO
external oxygenation w/o PPV messing w/hemodynamics
| ARDS, hypoxemia refraxtory to m. ventilation
269
pacing spikes are present but not followed by QRS
failure to capture
270
failure to capture
pacing spikes are present but not followed by QRS
271
3 causes of failure to capture
lead dislodged
low output
lead/pacer failure
272
pacemaker problem if low output
failure to capture
273
decreased or absent pacemaker function
failure to pace
274
failure to pace
decreased or absent pacemaker function
275
pacemaker problem if interference
failure to pace
276
pacemaker problem if wire fracture
failure to pace
277
causes of failure to pace
oversensing
wire frature
interference
lead displacement
278
undersensing
pacemaker fails to sense native cardiac activity
279
pacemaker fails to sense native cardiac activity
undersensing
280
pacemaker if new LBBB
undersensing
281
pacemaker if increased stimulus threshold at the electorde site
failure to sense/undersensign
282
pacemaker failure if poor lead contact
undersensing/failure to sense
283
causes of failure to sense
poor lead contact
new LBBB
increased stimulation threshold at electrode site
284
PVR
right heart afterload
285
SVR
left heart afterload
286
measures PVR/SVR
afterload of right versus left heart
287
measure afterload
PVR/SVR
288
3 causes of decreased afterload
alkalosis
hypocapnia
vasoD
289
pH & PVR
increased PVR = acid
| decreasded PVR = alkalosis
290
CO2 & PVR
increased PVR in high CO2
291
PVR in ARDS
increased over 250
292
PVR in atelectasis
increased over 250
293
heart sound heard in hypertrophic cardiomyopathy
S4 b/c blood forced back into noncompliant
294
heart if high K
decreased conduction
295
inferior MI
blocked RCA
| II, III, AvL
296
widowmaker
LCA block
| basically the entire left sid eof hte heart is blocked
297
LAD block
anterior
septal
anteriorseptal
298
blocked in anterior MI
LAD
299
blocked in septal MI
LAD
300
LCX block
lateral
| posterior
301
troponin times
onset 4
peak 14-2
duation 3-5
302
CK-MB times
onset 3-6
peak 12-24
duration 2-3
303
V2, V3, V4
anterior
| LAD
304
anterior MI
V2, V3, V4
| LAD
305
V1, V2, V3, V4
anteriorseptal
306
anteriorseptal MI
V1-V4
307
anterior versus anterioseptal
anterior V2-V4
| anteriorseptal V1-V4
308
I, aVL, V5, V6
lateral MI
| LCX
309
lateral MI
I, aVL, V5, V6
| LCX
310
posterior MI
V1-V3
| dominant R wave in V2
311
V1-V3
| dominant R wave in V2
posterior MI
312
5 types of MI
posterior. V1-V4. LCX
anterior. V2-V4. LAD
inferior. II, III, aVL. RCA
lateral. I, aVL, V5, V6. LCX
septal. V1, V2. LAD
313
BBB
STEMI mimic
| widened QRS in V1
314
Sgarbossa's criteria
to determine if EKG changes are a variant of LBBB or a STEMI
315
when do you give fibrinoilytics s/p STEMI
within 12 hours of MI
316
contraindication fo fibrinolytics s/p STEMI
cannot be in cardiogenic shock
317
second line rx for bradycardia
dopamine
318
classes antiarrhythmics
Na Channel BLockers
BB
K Channel BLockers
CaChB
319
examples of K Channel BLockers
Amidarone
| Sotalol
320
CaChB
vasoDI
| negative I/D/C
321
HR & cholinergic
decreae HR
322
dobutamine
positive inotroph
323
pressors for hypovolemic shock
NE
| dpoamine
324
pressors for cardiogenic shock
dobutamine
| milrinone
325
indication for NE
hypovolemic shock
326
indication for dopamine
hypovolemic shock
327
indication for dobutamine
cardiogenic shock
328
indication for milrinone
cardiogenic shock
329
action of nitroprusside on preload/afterload
dilates so decreases
330
SVR and dopamine
increae SVR
331
SVR and nicardipine
decrease
332
s/s of endocarditis
osler nodes = painful red fingertips
| janeway lesions - red lesions on palm/soles
333
EKG of Dressler Syndrome
global ST elevation
334
CXR of HF
butterfly/Kerly B lines
| bilateraldiffuse infiltrates
335
dx mild HTN
BNP over 300
336
CXR of aortic dissection
widened mediastinum
loss of aortic knob
pleural efflusion
337
Graham's Law
gaseous exchange at the cellular level
* rate of diffusion directly related to solubility
* inversely proprotional to square root of density
338
when does TUC change
1/2 if rapid decompression
339
gas law that explains soft tissue swelling at altitude
Daltons
340
Fick's Law
diffusion of gas
* partial pressure, area of membrane
* inversely proprotional to the membrane thickness
341
Graham's versus Fick's Law
Graham: gas exchange at cellular level
(diffusion rate, solubility, density)
Fick's
*partial pressure, area, membrane thickness)
342
Henry's Law
solubility of gas r/t pressure above it
| increased pressure = increased gas solubility
343
Gay-Lussac's Lw
temp & pressure
344
increased diffusion = decreased molecular weight
Graham's law
| lower molecular weight diffuses easier
345
oxygen adjustment calculation for flight
FiO2 x P1
| divided by P2
346
tooth pain when flying
pain on ascent as air trapped in fillings expands
347
ear pain when flyign
barotitis
348
face pain when flying
ascent & descent
349
mottled skin that looks like a sunburn: skin bends
cutis mamorata
350
skin bends s/s
cutis mamorata = sunburn
| ants on skin
351
transport a diving injury
ground
| pressurize to 1K
352
obese prior to flight
breathe 10L/min nonrebreather for 15min to nitrogen washout
353
anemic hypoxia
aka hypemic
| hypoxic would be low oxygen
354
anemia in cardiogenic shock
stagnant
355
anemia in hemorrhage
hypemic
356
4 stages of hypoxia
indifferent
compensatory
disturbance
critical
357
stage of hypoxia where you act drunk
stage 3- disturbance
358
vitals in g force
low bp
359
2 types of peopel who are the most severely affected by high F forces
dehydrated
| BP meds like BB
360
COBRA
protects uninsured pt from being denied hospital care or transfer inappropriately for inability to pay
361
distance from a hospital when you must treat on campus
250 yd rule
362
pilot rules
- training
- Area orientation
2K total hours
1K as pilot in charge
100 at night
5hr area orientation/2 night
363
general operating flight rules
Part 91
364
weather minimums under Part 91
none
365
flying passengers rules
Part 135
14hr day
8hr fly
366
squak code 1200
VIsual Flight RUles
367
squak code for gliders
1202
368
squak code 1202
gliders
369
squak code for hijack
7500
370
squak code for communication failure
7600
371
squak code 7600
communication failure
372
transponder code for emergency
7700
373
squak code 7700
emergency
374
air movement in autorotation
air moves up from below as the helicopter descends
375
pre/post crash sequence
pt flat
turn off oxygen
crash position
TFB
376
transmitter frquency of emergency locator
121.5 MHz
| 406
377
who does search and rescue
CONUS - civil air patrol
| uswaters - coast guard
378
radio frequency blocked by hills/mt
VHF
379
limitation of VHF
radio frequency blocked by hills/mt
380
distance of VHF
long range line of sight 100km
381
air traffic control frequency
118-137 VHF
382
range of ultra high frequency
300MHz to 1GH
383
limits of ultra high frequency
blocked by hills/large bilidings
limited to visual horizon of 30-40 miles
can penetrate foliage/buildings for indoor
384
public safety radio system frequency
800 MHz
385
lights on aircraft wings
red is port
green is starboard
white is tail
386
ambient temperature of an ambulance
68-78 degrees
387
fuel range capacity of an ambulance
178 miles
388
ground clearnance of an ambulance
6 inches
389
range of audible siren & strobe light
>500ft
390
how often shoudl you check fluid of an ambulance
twicea week
391
how often should you check tire pressures of an ambulance
twice a week
392
first law of motion
body in motion stays...
393
second law of motion
mass x accelertion
394
thrid law of motion
every action has an equal/opposite reaction
395
red & yellow catagory of STAT
immediate
| delayed
396
blood loss inj class III shock
1500 - 2L
397
blood loss %
1 - under 15%
2- 15-30%
3- 30-40%
4. over 40%
398
what 2 values in blood hemorrhage chart are similar
RR & % blood loss
399
specific spinal cord fractures
C1- JEfferson
C2 = hangman
T12 - chance
burst fraxcture = severely compressed
400
ballance sign
dullness in LUQ tha tshifts
401
2 signs in spleen injuries
balance - dullness in LUQ that shifts
right flank dull
Kehr's
402
dullness ot percussion in LUQ
Ballance sign
403
REBOA
resuscitative endovascualr balloon occlusion of hte aorta
| *internal tourniquet to occlude blodo flow from the aorta until go to OR
404
blood in labia/scrotum
COopernail's sign
| suspect pelvic fracture
405
when do you suspect tension pneumo if on m. ventilation
sudden PIP/pPLAT increase
406
scaphoid abdomen on xcary
diaphragmic hernia
407
dxray of diaphragmic hernia
scaphoid hernia
408
Kussmaul's sign
rise in venous pressure on inspiration
| cardiac tamponade
409
when do you see paradoxial pusle
cardia tamonade
410
5 s/s in cardiac tamponade
```
pulsus paradous
tachyardia
Beck's Triad
Kussmaul's sign
electrical alternans
```
411
Beck's Triad
in cardiac tamponade
JVD
narrow p[ulse pressure
muffled heart sounds
412
electrical alternans
EKG of cardiac tamponade
| heat gets closer to and further away as it moves around inside the sac of fluid
413
pulmonary edema in blood transfusions
TRALI
414
treatment of TRALI
reaction to leukocyte antibodies
up to 6hr post transfusion
causes acute pulmonary edema
415
treat TACO
circulatory ocverload so give Lasix
416
uses of cryoprecipitate
hemophilia
DIC in trauma
von willebrand
417
treat von willebrand
cryo
418
treat hemophilia
cryo
419
what is cryo
created from FFP
| conains factors
420
created from FFP
cryo
421
most common rd for trauma related DIC
cryo
422
acceptance of FFP
requires ABO compatibility but not Rh matching
423
needs ABO compatibility but not Rh matchin
FFP
424
reverses warfarin
FFP
425
uses for FFP
coagulation
reverse warfarin
make cryo
426
what is FFP
PRBC with RBC suspended
427
T&C for plt
not needed
428
T&C for FFP
ABO compatible but not Rh match
429
blood in anteior chamber of eye
hyphema
430
s/s of tracheobrachial disruption
occurs within 1.5 of carina
SC emphysema
Hamman's Crunch
431
EKG of Rhabdo
peaked T
| prolonged QT
432
landmarks for femoral line insertion
lateral to medial = NAVEL
| nerve, artery, vein, lymph nose
433
rules for pilots wearing oxygen
10-12K if unpressureized over 30 minutes
| always over 12K
434
rules for passengers weraing oxygen
12-14K minimum crew wars if over 30min
| all over 15
435
rate at which temperature and altitude change
lapse rate
| 3.5F per 1K ft
436
pain in GI w/altitude
```
ascend = pain worse
descend = pain better
```
437
4 stages of hypoxia
indifferent = up to 10K
compensatory = 10-15
disturbance= 15-20K
critical - over 20K
438
TUC 18K ft
20/30min
| 10-15 if rapid decompression
439
TUC i25K ft
3-5min
440
TUC 30K ft
1-2 minutes
441
TUC ar 35Kft
30-60sec
442
decibels of a single engine cockpit
70-90 db
443
F if on a ventilator for ARDS
18-22
444
PEEP if on a ventilator for ARDFS
over 10
445
Vt if ARDS
low
| 4ml/kg
446
ventilator settings for ARDS
peep over 10
high FIO2
low Vt like 4ml/kg
increase F to 18-22
447
Swan-Ganz of ARDS
```
high PAWP (18-20)
pressure is higher than normal b/c right heart is pumping against increased resistance in teh lung vasculature
```
448
CXR of ARDS
ground glass
patchy infiltates
bilaterlal diffuse infiltrates
449
rule of 9's legs
9%
450
rule of 9's chest/abdomen
each are 9%
451
rule of 9's head
4.5%
452
rule of 9;s arms
4.5%
453
burn transfer center critieria for parital thickness
transfer if partial thickness is over 10% TBSA
454
gas law that explains hypoxic hypoxia
Graham's
455
R on T phemenon
```
A PVC close to or at the same time as T so R & T at the same time.
Ventricular repolarization (T) at the same time as the PVC so the cells assume thr ventricular rhythm as the dominant one which can lead to Hemodynamic instability
```
456
R on T phemenon
```
A PVC close to or at the same time as T so R & T at the same time.
Ventricular repolarization (T) at the same time as the PVC so the cells assume thr ventricular rhythm as the dominant one which can lead to Hemodynamic instability
```
457
3 causes of PVC
Low K, heart disease, hypoxia
