FP-C Flashcards by brian lawrence

What does HEAVEN stand for

H-Hypoxia
E-Extremes of size
A-anatomic disruption/obstruction
V-vomit, blood, secretions in airway
E-exsanguination
N-neck mobility

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What are the 8 P’s of intubation

Preparation
position
pre-oxygenation
pre-treatment
paralysis and induction
protection and positioning
placement and proof
post intubation management

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What are the indications for an advanced airway

Can they follow commands
can they control secretions
what is their clinical coarse.

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What is the Larson maneuver

placing firm pressure inward behind both earlobes while doing a jaw lift. This will help relax the vocal cords due to spasming.

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What are the 3 airway assessments commonly utilized

3-3-2
Mallampati
Cormack-Lehane score

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How to determine shock index

pulse rate / systolic BP
>0.9 = high shock index

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Is a paralytic contraindicated if you can not oxygenate or ventilate

yes

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How to determine ETT size for pediatric (greater than 1 yr)

(age + 16) /4

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How to calculate Ideal body weight (IBW)

M- (# of inches above 60 x 2.3) + 50
F- (# of inches above 60 x 2.3) + 45.5

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Oxyhemoglobin disassociation curve
Haldane effect

Left shift
Lowered PH, Temp, 2-3-DPG production, PaO2
Higher affinity for O2
poor cellular perfusion, less CO2 removal

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Oxyhemoglobin disassociation curve
Bohr effect

Right shift
Raised PH, Temp, PaO2, 2-3-DPG production
Low affinity for O2
poor lung perfusion, removes more CO2

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What is brown-Sequard syndrome

Hemi section of cord that is very rare and causes ipsilateral loss of motor position and vibratory sense with contralateral loss of pain and temperature perception.

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What is central cord syndrome

Greater motor weakness in upper extremities than lower with varying degree of sensory loss.

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What is anterior cord syndrome

displacement of bony fragments into the anterior part of the spinal cord. the result of flexion injuries or fractures.

complete motor, pain, and temp loss below the lesion with sparing proprioception vibration, and touch

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What is Cushings triad

-increased systolic blood pressure
-decreased diastolic blood pressure
-bradycardia

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Acute respiratory distress syndrome (ARDS) vent settings

-lower tidal volume 4-6 ml/kg
-increased respiratory rate
-normal PEEP 5-10

goal is to keep initial minute volume

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What is subfalcine herniation

midline shift of the brain

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What is SCIWORA syndrome

-spinal cord injury without radiographic abnormality.
-spinal shock/contusion

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What is an epidural bleed.

-a bleed located between the skull and dura mater and pushes the dura mater into the brain.
- concave shape or looks like a football.
- edge will be smooth.

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what is a subdural bleed

a bleed that is located between the dura mater and the arachnoid and pushes the dura mater up towards the skull.
concave shaper or look like a crescent moon.
-edge will be jagged.

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What do you treat 1st in a TBI patient with a multisystem trauma.

-Treat the brain first by maintaining a MAP >90 mmHg.
-then you can assess the multisystem trauma.

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What is the main goal with a TBI patient

Prevent the 3 H’s
1- hypoxia
2-hypotension
3-hyperventilation

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what is the formula for tidal volume

-Based off of ideal body weight.
-6-8 ml/kg normally
-4-6 ml/kg for ARDS pt’s

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what is the target minute ventilation formula, and breaths/minute to maintain that formula.

100 ml/kg/min 80 kg pt

100 x 80 = 8000 ml/min
tidal volume is 80 x 6 ml/kg = 480 ml

8000/480= 16.6 breaths/min

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How do you determine anatomical dead space.

-1ml x ideal body weight in lbs or 150 ml/breath

how do you determine alveolar minute ventilation

Delivered minute ventilation - anatomical dead space.

How do you count for mechanical dead space.

-2ml x PIP for adults -1ml x PIP for peds

what is the adults average tidal volume

5 L/min

How do you figure inspiratory time for the vent

-60 sec / Respirations = breath cycle. (60/10= 6 sec cycle) -add your I:E together (1:3 =4) breathing cycle / I:E total 6/4= 1.5 sec is your inspiratory time

how do you figure your expiratory time for the vent

-take your inspiratory time and times it by the remainder of your I:E. - Inp time is 1.5 sec. I:E is 1:3 -1.5 x 3= 4.5 is your expiratory time

What is PIP on the vent

-a reflection of airway resistance -should remain <35 cmH2O

what is Pplat on the vent

-used to determine alveolar health - <30 cmH2O is the goal

what is driving pressure on the vent? what is it used for.

-the difference between Pplat and PEEP. -attempt to keep <15 cm H2O -used for ARDS pt's

how do we set up pressure mode on vent

-set based on inspiratory pressure (PIP) -adult- 20 cmH2O -peds- 10-15 cmH2O

what is Waddell's triad

Common when a child is struck by a motor vehicle, injuries include those to the head, trunk, and extremities.

Why do we give prostaglandin (PGE1)

to keep the patent ductus arteriosus open

what do we give to close the patent ductus arteriosus (PDA)

Indomethacin

what is the left to right shunt defects

oxygenated blood shifts from the left to the right side of the heart

what is Atrial Septal Defect (ASD)

when the foramen ovale doesn't close like it should.

what is Ventricular Septal Defect (VSD)

a defect in the septum between the ventricles that allows blood to flow between them.

what is Patent Ductus Arteriosus (PDA)

failure of the ductus arteriosus to close after pulmonary circulation has been established.

what is Mauriceu's maneuver

-as the baby is being born you place the index finger and the middle finger over the maxillary prominence on either side of the nose. - this is done to provide flexion while traction is made on the shoulders.

how to determine BP in neonate/pediatrics

-gestational age in weeks= neonate MAP -peds- 70+(2xage in yrs) is normal <70+(2xage in yrs) is hypotension

what size of ETT for neonates

<1kg=2.5 mm 1-3kg=3.0 mm >3kg=3.5-4.0 mm

how to determine ETT size for >1 yr old

(age+16)/4

what size of NGT, Foley and Suction catheter

double the ETT

what size of chest tuber for neonate/pediatrics

quadruple the ETT

how much blood is circulating in the neonate/pediatric

75-80 ml/kg

how much fluid resuscitation is needed in a neonate/pediatric

-neonate is 10 ml/kg -pediatric is 20 ml/kg

how much glucose should a pediatric get

2 cc/kg of D25

if NPO, how much glucose should a neonate get.

80-100 cc/kg/day

what is the cardioversion rate for neonate/pediatric

0.5-1.0 joules/kg

how much do we defibrillate a neonate/pediatric

2-4 joules/kg

how to determine maintenance fluids for pediatrics

4-2-1 rule -4cc/kg/hr for the 1st 10 kg -2cc/kg/hr for the 2nd 10 kg -1cc/kg/hr for every kg after that

what is a neonate

an infant that is less than 28 days old

what is a preterm baby

baby born prior to 37 weeks

what is a normal blood glucose for a neonate

>40 mg/dl

how to treat hypoglycemia in a neonate

administer D10 to get glucose >4 mg/dl

what is choanal atresia

a bony or membranous occlusion that blocks the passageway between the nose and pharynx

where do you park at a hazard material scene

at least 100 ft uphill and upwind

if involved in a wreck in an ambulance what should you do for safety

move to the side of the road/curb

If the ambulance is disabled on the road, where should you place the signals

100 ft in front and behind the vehicle

If the ambulance is disabled within 500 ft of a hill where do you place the signals

100 ft in front and back of the ambulance and a 3rd on top of the hill

what is the most common form of ambulance collision

intersection collisions.