Medical Flashcards
(154 cards)
1
Q
normal base deficit/excess
A
+2 to -2
2
Q
vent settings
A
Vt = tidal volume
F = frequency = RR
3
Q
Cheyne-Stokes
A
progressively deeper and faster then decrease to tempoary apnea
4
Q
CO2 > 45
A
acid buildup
apnea or hypOventilation
5
Q
CO2 if apnea
A
> 45
6
Q
calculate minute ventilation
A
Vt x F
(tital volume x RR)
7
Q
base deficit indication for a blood transfusion
A
-4
8
Q
left shift mneumoni
A
Left = LOW
acidosis,
Temp,
“2,3-DPG”,
pCO2
9
Q
5 things that change in a right or left shift
A
Left = Low
Right = Raise
+H
temp
PCO2
2,3-DPG
10
Q
how to tell if the ABG is compensated
A
the compensatory mechanism is the opposite of the primary problem
- r. acidosis is compensated by bicarb
- m. alkalosis is compensated by CO2
11
Q
partially compensated
A
Ph, resp, and metabolic are outside of normal ranges
12
Q
fully compensated
A
abnormal pH
normal Co2 and bicarb
13
Q
classified as lactic acidosis
A
lactate over 4
14
Q
ABG in hypoventilatiobn
A
R. acidosis
CO2 over 45
15
Q
every ___ in pH, expect a change in K by __
A
0.1 pH
k shifts 0.6
opposite direction
16
Q
ABG results needing intubation
A
7.2 pH
CO2 over 55
PaO2 <60
intubate even if one is off
17
Q
PAT
A
Pediatric Assessment Triangle
- appearence
- WOB
- circulation
18
Q
pediatric ETT size
A
16 + age in years
divided by
4
19
Q
LEMON
A
difficult aireay predictor
look
evaluate with 3-3-2
Mallampati
obstruction
neck obstruction
20
Q
preferred intubation blade for pediatrics
A
Miller
(direct displacement of the epiglottis)
21
Q
CXR confirmation of ETT placement
A
distal tip 2-4 cm above carina,
level of T3-T4,
confirm by visualizing Murphy’s eye wher ethe clavicles meet
22
Q
waveform of the ETCO2
A
half square
expiration - expiratory plateau - ETCO2- inhalation - baseline
23
Q
where is the ETCO2 measured on teh ETCO2 waveform
A
right side of square
24
Q
pretreatment for RSI
A
LOAD
lidocaine
opiates
atropine
defasciculating
25
info about Etomidate
0.3 mg/kg
onset: 15 - 45
lasts = 3-12 min
26
RSI contraindicated in shock
Etomidate = don't use if adrenal suppression/Shock/COPD/asthma/Addisons
or if hemodynamically unstable
27
properties of Ketamine
hypnotic
analgesic
amnesic
28
benefit of Ketamine
unique ability to preserve laryngeal reflex
help with airway protectino
29
ketamine dose for RSI
1-2 mg/kg
30
info about Ketamine
onset = 40 - 60 seconds
duration = 10 - 20 minutes
31
reversal for benzos
Flumazenil 0.2mg
32
SE of Flumazenil
BP
33
good RSI choice if shock
Ketamine
34
what is propofol
hypnotic w/o analgesic properties
35
onset/duration of propofol
onset: 15-45 sec
duration: 5-10 minutes
36
who should not have propofol
decreases CPP & MAP
- NO head injury or hemodynamically unstable
37
RSI induction options
fentanyl
ketamine
etomidate
propfol
38
RSI dose of paralytic if pt is shock/hemodynamically unstable with a low CO
double paralytic
- bc low CO slows onset
39
what do you palpate when you cric
cricothyroid membrane
40
surface of airway not involved in gas exchange
dead space
41
Fick's concentration
gas travels from high to low concentration
42
Biot's
quick shallow inspiration followed by regular/irreglar apnea
43
respirations in Cushing's Triad
Cheyne-Stokes
44
ETCO2 as the gold standard
for ventilation
45
dx hypoxic respiratory failure
pO2 is under 60
46
treatment for hypoxic respiratory failure
increase oxygen concentration
(FiO2 & PEEP)
* this treatment plan assumes that you have adequate Vt and F)
47
increase SpO2
increase FiO2 (oxygen concentration ) & PEEP
48
calculate Vt for ventilator
Vt = 4-8 ml/kg ideal body weight
(volume of air delivered per breath)
49
purpose of PEEP
keep alveoli open so oxygen can diffuse
50
PIP
amount of resistence to overcome the ventilator circuit, appliances/ETT, and the main airway
51
pPLAT
measurement of the pressure applied during positive pressure ventilation to the small airways/alveoli
- represents the static end inspiratory recoid pressure of the repsirato[ry system, lung, and chest wall respectively
52
CMV
controlled mandatory ventilation
- all breaths are trigger/limited by ventilator
- pt unable to breathe on own
53
how does AC vent settings work
AC = assist control
- ventilator supports every breath whether it is initiated by the pt or the ventilator
- full Vt regardless of respiratory effort or drive
54
auto-PEEP
breath stacking
- predisposes to barotrauma/hemodynamic compromises, increased WOB, effort to trigger the ventilator
- diminishes the forces generated by the respiratory muscles
55
waveform if pt-ventilator dyssynchrony
curare cleft
56
troubleshooting the ventilator
- acute respiratory deterioration & PIP is increased
next needs to consider if the pPLAT is increased or no change
57
RASS
Richmond Agitation-Sedation Scale
+4 = combatitive
0 = alert & calm
-4: deeply sedated
58
problem in asthma
breathing out
- respiratory acidosis due to hypercarbic respiratory failure
59
CXR in asthma
flattened diaphragm,
chest cavity is overexpanded due to air trapping
60
interventions if asthma
&
on the ventilator
increase I:E ration to 1:4 (exhalation problem),
zero PEEP or under 5
61
inclusion criteria for ARDS
- PaO2/FiO2 under 300
- bilateral infiltrates consistent with p. edema
- no clinical evidence of left atrial HTN
62
3 stages of Tylenol overdose
1. Flu like (N/V, abd, sweat, pale)
2. liver injury (RUQ, LFT elevate)
3. peak liver enzymes, hepatic failure, encephalopathy, hypoglycemia, coma, death
63
what labs shoud you watch for in Tylenol overdose
LFT, liver
64
late stage serious complication of Tylenol overdose
hepatic failure,
encephalopathy,
coma,
death
65
treatment of aspirin overdose
sodium bicarbonate b/c liver damage causes high ammonia
&
dialysis
66
benzodiazeipines
diazepam = valium
lorazepam = ativan
midazolam = versed
67
differenecs between BB and CaChB overdoses
both have low HR/BP/conduction delays
BB = low glucose
CaChB = higher glucose
68
s/s of cocaine overdose
chest pain,
HTN,
Seizures,
rhabdo
69
aka anti-freeze
ethylene glycol
70
windshield wiper fluid
methanol
71
s/s nerve gases
cholinergic toxidrome
- SLUDGE
-DUMBELLS
72
DUMBBELS
diarrhea
urination
miosis
bronchorrhea & bronchospasm
emesis
lacrimination
sweating
73
how does 2-PAM work
crowbar that takes the organophosphate off the Ah
74
"mad as a hatter..."
anticholinergic overdose
75
most important thing to remember about treating overdoses
ABCs...
antidotes
76
dicrotic notch
notch in the a-l;ine that represents that represents the aortic valve closure
77
too much pressure in the a-line
overdampening
(typically from obstructions)
78
measures right heart preload
central venous pressure
=
2 - 6 mm hg
79
normal coronary perfusion pressure
50-60 mm hg
80
normal SVR
800 -1200
81
normal PVR
50 -250
82
indications for an IABP -6
acute MI w/cardigenic shock,
post CABG,
cardiogenic shock due to HF
PAWP over 18
decreased urine output
SBP under 80
83
contraindications to IABP
low plt (bc hemolysis of RBC smashing during inflation,
aortic insufficiency,
severe peripheral vascular disease
84
2 effects of IABP
increase cornary perfusion
decrease workload of the heart
85
check if the IABP is in the correct place
L. radial pulse (left subclavian blockage causes limb ischemia)
adequate UOP b/c renal arter injry decreases UOP
CXR
86
IABP early iinflation
inflation before the aortic valve closes,
forces blood back into the LV
87
what does IABP early inflation look like
U shape
88
worst IABP timing error
late deflation
89
S3
heart sound
excessive filling of the heart
CHF
Kentucky - Malcom
90
inferior MI
blocked RCA
(supplies the SA node in 90% of people)
91
symptom that often accompanies inferior MI
bradycardia
- b/c 90% of the population has their SA node innervated by the right coronary artery (inferior MI)
92
"widowmaker"
LCA block
- basically the entire left side of the heart is blocked
93
definition of STEMI
ST elevation in 2 contiguous leads over 2mm
94
non-STEMI
positive troponin,
ST depression in 2 contiguous leads
95
when do you need a right sided EKG
inferior MI
96
inferior MI leads
II, III, aVF
97
STEMI but DON'T give nitro
never if inferior MI b/c SA node is blocked = bradycardia
98
antior MI
LAD blocked
V2, V3, & V4
99
5 types of MI
posterior
anterior
inferior
lateral
septal
100
heart axis shifts
axis shifts TOWARDS hypertrophy,
AWAY from infarctions
101
BBB
STEMI mimic,
widened QRS/Bunny ears
look at V1 for changes
rabbit ears
102
EKG indicating BBB
V1
widened QRS over 0.12 like "bunny ears"
103
give fibrinolytics for a STEMI
within 12 hours of a MI
104
Adenosine
versus
Amidarone
Adenosine = narrow complex SVT (6 then 12 mg)
Amidarone - VF/pulseless VT (300 then150)
105
max dose of Atropine
0.5mg
up to 3mg
106
second line medication for bradycardia and low bp
dopamine
107
defibrillation dose
monophasic = 200 then 360 joules
biphasic = 120 - 20 j
108
frequency of epinephrine in a code
1mg q3-5 minutes
109
2 things beta blockers do
reduce HR,
reduce oxygen demand
110
beta 1 receptors
increased HR/contractility
"you have one heart"
111
effect of cholinergic
decrease HR
112
action of phenylephrine
alpha agonist = vasoconstrict
113
action of dobutamine
positive inotrop to improve contractility
114
indication for dobutamine
cardiogenic shock
115
action of nitroprusside
reduces preload/afterload by dilation
116
dx mild HF
BNP above 300
(severe is above 900)
117
aortic aneurysm
NOT dissection
"outpouching"
118
skin temperature of DVT
warm b/c blood can get to the limb but can't get out
119
risk factors for blood clots
Virchow's Triad
- vessel wall injury
- stasis
- hypercoagulability
120
skin temperature in arterial diseases
cool b/c blood can't get to the limb
121
pressure & volume
Boyle's Law
122
Henry's Law
"Heiniken"
solubility of a gas in a liquid is proportional to the partial pressure of the gas above it
123
martini rule
Q33 ft - 1 atm
ATM above the surface
1 ATM at sea level
18K ft up = 1/2 ATM
124
Gay-Lussac's Law
temp & pressure
125
oxygen adjustment calculation for flight
FiO2 x Pi
DIVIDED BY
P2 = FiO2 needed for flight
P1 = pressure you are at (ground)
P2 = pressure you are flying to/cruising altitutde
126
4 types of hypoxia
hypoxia = not enough O2 in the air (partial pressure)
stagnant = blood isn't moving
hypemic = anemia
histotoxic = hypoxia at the cellular level
127
4 stages of hypoxia
indifferent,
compensatory,
disturbance,
critical
128
SE of G-force
causes BP to drop
b/c
stagnant anemia
129
flight check-ins
Q15min in the air,
Q45 min on the groupd
** miss 2 check ins, launch Emergency Action Plan/SAR team
130
transponder code hijack
7500
131
transponder code for an emergency
7700
132
approach helicopter
11 o'clock
1 o'clock
AND
downhill
133
feet positioning if crash landing
knees together,
feet 6in apart and flat,
legs underneath the seat so they don't get broken
134
priorities after crash landing
shelter
fire
water
signal
135
First law of motion
body in motion stays in motion...
136
trauma diamond of death
coagulopathy,
hypothermia,
acidosis,
Hypopcalcemia
137
blood loss in Class III shock
1500-2000 ml
138
% blood loss in Class I shock
under 15%
139
% blood loss in Class III shock
30-40%
140
what 6 things does the classes of hemorrhage/hypovolemic shock look at
ml blood loss,
% blood lost,
HR,
BP,
RR,
urine output,
CNS
141
what two values are similiar onthe hypovolemic/hemorrhagic shock class table
RR and % blood loss have close to the same numbers
142
blood in the labia/scrotum
Coopernail's sign
143
high riding prostate
urethral frature
144
pathophysiology of a tension pneumothorax
mediastinal shift
145
suspect a pneumothorax if on mechical ventilation
sudden PIP or pPLAT increase
146
Beck's triad
muffled heart tones,
narrow pulse pressure,
JVD
147
EKG of rhabdo
peaked T,
prolonged QT
148
where is blood in a hyphema
anterior chamber of hte eye
149
use for FFP
coagulation,
reversal of warfarin
150
cryo
contains factors and created from FFP
151
s/s of a hemolytic reaction to blood
palpitations,
abd/back pain,
syncope,
sense of doom
152
transfusion reactions
Acute Hemolytic,
TACO (circulatory overload)
TRALI (acute lung injury)
153
formula for bicarbonate
HCO3
154
