CFRN Back to Basics Book Flashcards
(249 cards)
1
Q
Clinical Signs: Kehr’s, Kernig’s, Brudzinski’s, Hamman’s
A
Kerr’s: L shoulder pain - Splenic injury/ectopic. Kernig’s: back, leg, pain on knee extension - meningitis. Brudzinski’s: Back, leg pain on flexion - Meningitis, SA Hemorrhage. Hamman’s: Crunching on anterior chest - tracheobronchial injury
2
Q
Xrays: Steeple, Thumbprint
A
Steeple: Croup. Thumbprint: Epiglottitis
3
Q
Drugs given for AAA
A
Nipride, beta blockers
4
Q
What do you adjust first on vent settings?
A
Tidal volume first
5
Q
Most common dislocation
A
Hip
6
Q
Most common spontaneous reoccurrence
A
Anterior shoulder
7
Q
Values for BNP
A
Below 100 is normal, 500-700+ = <3 failure
8
Q
Rotor wing pilot required hours
A
2000 hours. 1000 PIC, 100 night hours
9
Q
Bottle to throttle?
A
8 hours
10
Q
What does CVP measure
A
Preload, aka R atrial pressrue
11
Q
Normal CVP
A
2-6 mmhg
12
Q
Which port do you use on CVP catheter
A
Proximal port
13
Q
CVP Catheter placement outside line marker, RA/CVP
A
25-30 cm
14
Q
CVP Catheter placement outside line marker, RV
A
35-45 cm
15
Q
CVP Catheter placement outside line marker, PA
A
50-55
16
Q
Anterior cord syndrome
A
Complete motor, pain, and temp loss below the lesion
17
Q
Brown-sequard syndrome
A
ipsilateral loss of motor, position, and vibration sense; contralateral loss of pain and temp perception
18
Q
Central cord syndrome
A
Greater motor weakness in UE than LE with varying degrees of sensory loss
19
Q
Autonomic dysreflexia
A
urinary retention, massive increase in sympathetic tone which causes HTN. Tx - foley
20
Q
Normal urinary output (adult & ped)
A
30-50mL/hr
1-2 mL/kg/hr
21
Q
Normal blood volume (adult & ped)
A
70 mL/kg
80 mL/kg
22
Q
Normal temps, mild, moderate, severe hypothermia sx
A
37.6
Mild: 32-36
Moderate 29-32 (Loss of shivering, ALOC)
Severe: 20-28 (coma, vf)
23
Q
Major causes of heat loss and when thermoregulation ceases
A
Radiation & evaporation. Ceases at 28 degrees
24
Q
Rules of flight
A
Sterile cockpit during phase of flight, 15 min. max between comm center during flight, 45 min max while on ground
25
Rotor wing shut off sequence
Throttle, fuel, battery (TFB), survival bag, meet at 12 o'clock
26
Survival sequence
Shelter, fire, water, food
27
Abdomen inspection order
Inspect, auscultate, palate, percuss
28
Contraindications for thrombolytics
Hx hemorrhagic CVA, CVA < 12 months, SBP > 180, pregnancy or 1 month post partum
29
FARs
Part 91: No passengers. Part 135: Passengers (14 hours max for pilots)
30
Local flying area determined by
Certificate holder
31
Cell phones are prohibited when
while airborne
32
What is PaO2
Plasma measured as pressure
33
What is SaO2
Hemoglobin measured as percentage
34
Bariobariatrauma
Nitrogen release in obese patients, administer high flow O2 within 15 minutes to lift for nitrogen wash out
35
When does pediatric BP drop?
Last to go
36
Normal pediatric SBP/DBP
90 + (2 x age) | DBP 2/3 SBP
37
3 killers of vent patients during flight
Pericardial tamponade, tension pneumo, hypovolemia
38
Death from crush injuries is due to
renal failure
39
Complications of crush injuries
DIC, compartment syndrome, renal failure, hyperkalemia
40
CAMTS: Medical director not required to
live in same state
41
CAMTS: Intubation requirements
Quarterly
42
CAMTS: Live intubation required during training
5
43
CAMTS: Specialty team response time
45 min
44
CAMTS: Pilot area orientation day/night
5 day hours, 2 night hours
45
CAMTS: Helipad required to have
2 paths, security
46
CAMTS: Fixed wing twin engine time
500 hours
47
CAMTS: Ambulance fuel requirement
175 miles
48
CAMTS: ELT set off at
4 g's
49
CAMTS: Uniform fit
1/4 in space between body/uniform
50
Henry's law
The bends, decompression, soda can, CO2 in blood
51
Dalton's law
Tissue swelling, hypoxic hypoxia, O2 available @ altitude
52
Graham's law
Cellular gas exchange, diffusion
53
Gay-Lussac's law
Oxygen tank pressure in heat/cold
54
Boyle's law on IABP
purges with ascent and descent
55
High velocity
above 2000 fps
56
medium velocity
1000-2000 fps
57
low velocity
below 1000 fps
58
tumbling & yaw
tumbling is rotation 360 degree axis. yaw is deviation up to 90 degrees from straight path
59
Normal CVP
2-6
60
Normal cardiac output
SV x HR (4-8 L/min)
61
Normal cardiac index
2.5-4.2
62
Normal pulmonary artery systolic/diastolic
15-25/8-15
63
Normal PAWP/wedge
8-12
64
Normal SVR
800-1200 dynes/sec/cm
65
When do you assess CVP or PA on vent pt
Pressure @ end of exhalation
66
Chest tube location
4th intercostal space anterior axillary line
67
Normal needle thoracostomy
Second intercostal space mid clavicular (anterior, 5th ICS)
68
Scaphoid abdomen indication
aortic disruption/diaphragmatic rupture
69
Abruptio placenta
Dark red & painful
70
Placenta previa
Bright red, painless
71
Terbutaline dose/route
0.25 SQ
72
PP hemorrhage
500 mL >
73
Uterine rupture
Can palpate fetal parts over abdomen
74
When do effects of altitude worsen
Cold upper latitudes
75
Components of Gay Lussac's law
Temperature/pressure increases. Temperature/pressure decreases
76
Example of gay lussac's law
O2 take pressure 2200 in afternoon, drops to 1800 in evening due to temperature/pressure decline
77
Universal law
Combines Boyle's and Charles' laws
78
Graham's law definition
Gas moves from high to low concentration
79
Graham's law effects
Gas through liquid, cellular gas exchange
80
Henry's law definition
Gas in liquid proportional to gas above liquid
81
Henry's law example
The bends, CO2 in blood, decompression
82
Golume of gas in GI expands thrice at what altitude?
25,000 feet
83
What law affects the GI the most
Boyle's law
84
2 components of boyle's law
Increased volume = decreased pressure
85
Examples of boyle's law
Cuffs, MAST, GI, ETT, IABP
86
Charles' law components
Temperature and volume are proportional
87
Effects of Charles' law
Up to 100 meters = down 1 degree C
88
Passive rewarming
Mild hypothermia only! Blankets, heater
89
Active rewarming
Apply heat to body
90
Warm and dead?
32 celcius
91
Heat stroke
> 42 celcius
92
Grey turner's sign
Flank bruising (retroparitonal bleeding)
93
Coopernail's sign
Scrotum/labia (abdominal/pelvic bleeding)
94
Halstead's sign
Marbled abdomen (Bleeding)
95
Cullen's sign
Umbilical discoloration (pancreatitis)
96
Murphy's sign
RUQ pain with inspiration (gallbladder)
97
Levine's sign
Fist to chest (cardiac)
98
Hypoxic hypoxia
Altitude hypoxia, decreased alveolar oxygen, tension pneumo (altitude! )
99
Hypemic hypoxia
Decreased O2 carrying capacity in blood
100
Hisotoxic hypoxia
Poisoning (nitrates)
101
Stagnant hypoxia
Decreased cardiac output (g-forces, CHF)
102
Cardiogenic shock: CVP, cardiac output, cardiac index, PAS/PAD, PAWP, SVR, HR
high, low, low, high, high, high, HR fast then slows
103
Normal fetal heart rate
120-160
104
Factors in fetal well being
FHR, movement, variability
105
Most important factor
Variability
106
Treatment for fetal distress
LOCK: Left lateral recumbent, oxygen, correct factors, keep reassessing
107
CHF considerations:
Most are hypovolemic, be cautious of diuretics or meds that < preload
108
Meds for CHF
No beta blockers except for carvidolol or coreg. Neseritide is the synthetic version of BNP
109
#1 cause of death for vent dependent pts
Vent acquiried pneumonia
110
Digoxin class
Cardiac glycoside
111
Digoxin causes what electrolyte imbalance
Hypokalemia
112
Dig causes what EKG changes
ST depression (dig dip)
113
Treatment for ARDS
PEEP
114
Effects of PEEP & normal range
Increased pulmonary vascular resistance. Normal range 3-5 cm h2o
115
Normal physiologic of PEEP
Cause cause hypotension over 15 cm h2o
116
When do you treat HTN
Systolic over 220 or map over 130
117
Dehydration raises what electrolyte
Sodium. Normal is 135-145
118
Objective data is
ABCs, neuro assessment, AEIOUTIPS
119
Bowel sounds in chest cavity mean
diaphragmatic rupture, most common in L chest
120
Crunching sound heard over chest with auscultation may be synced with heart beat
Tracheobronchial injury, hamman's sign
121
Preferred method for moving injured pts
Scoop stretcher over log roll
122
Differential diagnosis: pulmonary contusion
Low sats despite O2, rales
123
Differential diagnosis: ruptured diaphragm
Chest pain/abd pain to L shoulder
124
Differential diagnosis: Tracheobronchial injury
Hemoptysis, sub-q air, air leak with chest tube
125
ET tube with tracheobronchial injury
Advance tube below level of injury into right mainstem
126
Differential diagnosis: Esophageal perforation
Fever, hematemesis
127
Differential diagnosis: Fat embolus
Fever, rash after fracture
128
Blood loss in humerus fracture
750 mL
129
Blood loss in femur fracture
1500 mL
130
What does PAWP/PCWP mean
Pulmonary artery wedge pressure/pulmonary capillary wedge pressure
131
Function of PAWP/PCWP
Looks at L side of heart, if high can indicate pulmonary congestion, CHF, and cardiogenic shock
132
Normal PAWP/PCWP
8-12 mm Hg
133
Do not keep wedged for more than 15 seconds, make sure that balloon is deflated and have pt cough forcefully
.
134
ETT depth in adults
3 x ETT size or average is 19-23 cm
135
ETT depth in kids
10 + age in years
136
ETT depth in neonates
6 + weight in kg
137
How to adjust CO2 in vent
Adjust rate, TV
138
How to change oxygenation in vent
Adjust PEEP, PAP
139
Parkland formula
4 mL x kg x BSA
140
How to administer fluids using parkland formula
1/2 over first 8 hours, rest over 16 hours
141
Concensus formula
2-4 mL x kg x TBSA
142
How to administer fluids using concensus formula
1/2 over 1st 8 hours, rest over next 16 hours
143
ELT frequency
121.5
144
How to confirm ELT working
Tune in, listen
145
Twin engine requirements off shore
Raft, vest
146
Induction agent of choice with bronchospastic patients
ketamine
147
Indications for Ativan, dose, max
seizures. 1-2 mg with a max of 4 mg
148
Mannitol dose
1-2 g/kg
149
Drug choice of tricyclic antidepressant overdose
Sodium bicarb
150
Drug choice for beat blocker OD
glucagon
151
Dose of fentanyl
3 mcg/kg
152
Treatment for malignant hyperthermia
Dantrium (dantrolene)
153
Drug used for GI bleeds
sandostatin (octerotide)
154
Neurogenic shock: CVP, CO, CI, PAWP/PCWP, SVR, HR
down, down, down, down, down
155
What kind of shock is neurogenic shock
distributive
156
Sites for art lines
radial & femoral
157
Purpose of art lines
Monitor pressure, blood draws, abgs
158
Pressure bag for art line needs to be maintained at
300 mgHg
159
Underdampening
Caused by air in system, loose connection, low pressure bag, altitude changes
160
Overdampening
Kinking, increased bag pressure, tip against the wall
161
Most common reprofusion dysrhythmia
AVIR
162
Most common hypothermia dysrhythmia
VF with an Osborn wave
163
Hypokalemia presents on EKG with
Peaked P's, flat T's
164
Hyperkalemia presents on EKG with
flat P's, peaked T's
165
Treatment for hyperkalemia
calcium
166
MAP goal with CHI
80-100
167
CPP goal with increased ICP
70-90
168
Normal ICP
0-10
169
Normal CPP (head)
70-90
170
Normal MAP
80-100
171
Normal for the other CPP (heart)
50-60 (head higher than heart)
172
CPP (head) formula
MAP-ICP
173
MAP formula
2 x diastolic + systolic / 3
174
CPP (heart) formula
DBP - wedge
175
Rotor wing minimums ceiling/visibility: Day/local
500 foot ceiling 1 mile visibility
176
Rotor wing minimums ceiling/visibility: Day/cross country
1000 foot ceiling 1 mile visibility
177
Rotor wing minimums ceiling/visibility: Night/local
500 foot ceiling 2 mile visibility
178
Rotor wing minimums ceiling/visibility: Night/cross-country
1000 foot ceiling 3 mile visibility
179
Number one cause of air med crashes
controlled flight into terrain, pushing the weather
180
Normal potassium
3.5-5.5
181
Normal sodium
135-145
182
Normal choloride
95-105
183
Normal calcium
8.5-10.5
184
What does metabolic acidosis elevate
Potassium
185
Time of useful consciousness with sudden decompression at 30,000 feet
90 seconds
186
Time of useful consciousness with sudden decompression at 41,000 feet
Under 15 seconds (least amount of time is exam answer!)
187
Cardic ischemia
ST depression
188
Cardiac injury
ST elevation
189
Cardiac infarct
Q wave > 25% of the R wave
190
Peds ETT cuffed vs uncuffed
Uncuffed under 10
191
Needle cricothyrotomy in peds
Only under 11
192
Nasal intubation in peds
Not under 12
193
Primary cause of PTL
Infection
194
Terbutaline contraindications
IDDM, maternal HR > 120, vag bleeding
195
PIH triad signs
HTN, edema, proteinuria
196
O2 adjustment calculation to maintain sats at altitude
% O2 patient is already on times pressure at departure pressure at ????????????????????????????????????????????????????????????????
197
Vent modes: CMV
present volume or PIP at set rate, can't initiate breath
198
Vent modes: AC
Preset volume or PIP with every breath, can trigger breath, can't control tidal volume
199
Vent modes: IMV/SIMV
Preset breaths, TV, PIP, patient breaths allowed
| SIMV allows variation of support
200
IABP: Action
Increases cardiac output, coronary profusion
201
IABP: Deflates
During ventricular systole
202
IABP: Dicrotic notch
Aortic valve closing, sync with a line or EKG (most common trigger)
203
IABP: S/s of balloon leak
Blood specs in tubing, alarm
204
IABP: Clot prevention
Cycle manually q 30 min
205
IABP increases CO by
10-20%
206
IABP: Balloon rupture
Rusty flakes in line, turn machine off
207
IABP: migration/dislodged
Assess left radial and urine output
208
Lethal IABP timing cycles
Late deflation/early inflation
209
Oxyhemoglobin disassociate curve left shift
Alkalosis, low hgb holding oxygen. L STANDS FOR ALKALOSIS. Low CO2, low temp, low DPG, myxedema coma
210
Oxyhemoglobin disassociation curve right shift
R stands for raised. Acidosis. Raise = right = releases oxygen. Raised CO2, raised temp, raised DPG, thyroid storm
211
Where is the phlebostatic axis and what is it
Where pressure measurements made with invasive line. Fourth intercostal space, level of atria
212
Boyle's law on ascent
Barondontalgia (tooth ache), Barosinusitis can occur. Bariobariatrauma = nitrogen in fat cells can expand causing the bends, give high flow o2 15 minutes prior to lift off to remove nitrogen to prevent this
213
Boyle's law on descent
Barotitis media can affect pts
214
Mild hypertension
140-159/90-99
215
Moderate htn
160-179/100-109
216
Severe htn
180+/110+
217
Volume for RBC administration
10 mL/kg
218
Volume for WBC's
20 mL/kg
219
ABG rules: CO2 and pH
CO2 up 10 = pH down 0.08
220
ABG rules: Bicarb and pH
HCO3 up 10 = pH up 15 (proportional)
221
Bicarb replacement
kg/4 x base deficit = meq of bicarb to give
222
PaO2 at altitude drops
drops 5 for every 1000 feet elevation
223
Hypoxia: elevation & s/s: Indifferent
10,000 feet MSL: increased HR and RR, decreased night vision
224
Hypoxia: elevation & s/s: Compensatory
10,000-15,000 feet MSL: HTN, task impairment
225
Hypoxia: elevation & s/s: Disturbance
15,000-20,000 feet MSL: Dizzy, sleepy, cyanotic
226
Hypoxia: elevation & s/s: Critical
20,000-30,000 feet MSL: ALOC, incapacitated
227
Night vision is lost at
5,000 MSL
228
PA Catheter: Named
Swan-ganz
229
PA Catheter: Proximal port use
CVP, meds
230
PA Catheter: S/s for bad placement
VT, ventricular ectopy
231
PA Catheter: What do you do for bad placement
Float forward to PA or pull back to RA
232
PA Catheter: Measure?
R heart directly, L heart indirectly
233
PA Catheter: Which port is used
Distal
234
PA Catheter: Pressure bag set to
300 mmHg
235
Normal cardiac index
2.5-4.3
236
Stressors of flight (9)
third spacing, fatigue, g-forces, noise, vibration, hypoxia, dehydration, temp changes, barometric pressure changes
237
Dalton's law definition
Sum total of partial pressures equal to total atmospheric pressures
238
Examples of Dalton's Law
Tissue swelling, altitude hypoxia, hypoxic hypoxia
239
What law shows why we need O2 at altitude
Dalton's law
240
Cardiac thrombolytics must be administered within
3 hours of chest pain onset
241
Hypovolemic shock: CVP, CO, CI, Wedge, SVR, HR
Down, down, down, down, high, fast
242
Values for acute respiratory failure
pO2 below 60, pCO2 above 50
243
Newton's first law
An object in motion tends to stay in motion
244
Newton's second law
Force = mass x acceleration
245
Newton's third law
Ever action has an equal and opposite reaction
246
Tetralogy of fallot
PROV: Pulmonary stenosis, right ventricular hypertrophy, overriding aorta, ventral septal defect VSD
247
Tet spell
Right ventricular outflow of blood is decreased, causing right to left shunt out of VSD out of aorta, bypassing lungs
248
Atrial waveforms: CVP
R atrial pressure
249
Atrial waveforms: PAWP/PCWP
Left atrial pressure
