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Tmc9
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Potassium Lab Value
3.5-5.0
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Calcium Lab Value
8.8-10.4
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Magnesium Lab Value
1.5-2.5
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Creatinine Lab Value
.6-1.4
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Serum Osmolarity Lab Value
285-295
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Ammonium (adult) Lab Value
15-45
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Ammonium (kids) Lab Value
40-80
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BNP Lab Value
less than 100
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Platelets Lab Value
140-400
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Urinary Output (adult) Lab Value
30-50
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Urinary (peds) Lab Value
1-2 ml/kg/hr
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Sodium Lab Value for CHI
Sodium greater than 155
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Sodium Lab Value for seizures
Sodium less than 120
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High BUN indicates (3)
1-Blood in GI 2-Dehydration 3-Renal failure
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High BUN (>23) and high Creatinine (>1.4)
Acute renal failure lab values
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CK/CPK >2000
Lab Value for Rhabdomylosis
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CHI Lab Value
Serum Osmolarity >320
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Liver Failure Lab Value
Ammonia >45
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Reyes syndrome with chicken pox Lab Value
Ammonia (peds) >80
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Dehydration Lab Value
HCT >52
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Thrombocytopenia Lab Value
Platelets <140
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Electrical injury urinary output (adult)
100ml/hr
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Electrical injury urinary output (peds)
2-4ml/kg/hr
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Central Venous Pressure measures
Right side heart reload measured by
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Pulmonary Vascular Resistance measures
Right sided afterload measured by
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Pulmonary Wedge Pressure measures
Left sided pre-load measured by
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Systemic Vascular resistance measures
Left sided afterload measured by
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PAC poximal port measures
CVP and CO of right atrium and right atrial pressure
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PAC distal port measures
Opens to pumonary artery/ PAP / Wedge
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PAC Balloon Port measures
PAWP / Wedge
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PAC poximal port color
Blue port on PAC
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PAC distal port color
yellow port on PAC
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PAC Balloon Port color
Red port on PAC
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Infusion Port color
White port on
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Phlebostatic axis
Nipple line/Midaxilary line 4th intercostal
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Zero Referencing
Stock cock off to patient and opened to air
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Normal fast flush for PAC
less than 2 oscillations
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Underdamening fast flush for PAC
more than 2 oscillations, slow return, Long or stiff tubing, air in system, loose connections, Overestimates BP
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Overdampening
no oscillations, slow return to baseline, tip of catheter against wall, low pressure bag, underestimates BP
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Pulmonary artery Dichrotic notch
closure of pulmonic valve
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Causes of increased PA pressure (5)
- Left ventriclar failure
- Increased pulmonary vascular resistance (cor pulmonae)
- mitral stenosis/regurgitation
- Left-right shunts
- Liver failure
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Positive Allens test
after occluding ulnar and radial arteries, when radial released palm turns pink
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Catheter whip
Waveform jagged and sharp, high BP, length of tubing, moving catheter tip
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Swan emergency ventricular waveform
- PAC falls into right ventricle
- Anacrotic notch correlates with QRS
- Rise in pressure
- Waveform loks like v-tach
- Inflate balloon and float back into PA
- If unable to float into PA pull back and switch meds to distal port
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a wave on CVP
- atrial contraction
- correlates with p wave
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c wave on CVP
- closure of tricuspid/ventricular contraction
- correlates with QRS
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x wave on CVP
- Descent atrial relaxation
- Depolarization of Right atrium
- Correlates after the QRS
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v waveon CVP
- Atrial passive filling
- Tricuspid is open
- correlates tiwh T wave
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y wave on CVP
- Atrial emptying
- correlates after t wave
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Absence of a waves
- Cannon a waves
- sharks in the water
- a-fib
- severe hypovolemia
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Large V waves
mitral regurgitation shows which type of CVP waveform
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How to measure CVP
- locate z-point (end of QRS or c wave)
- C wave to c wave
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Measure CVP at end of expiration
- nonintubated--inspiratory is down and expiratory is up
- intubated--inspiration is up and expiration is down
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Left atrial waveform measured (2)
- .08-.12 sec delay from CVP pressure wave
- measured at end of expiration
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PAWP in pulmonary congestion
- 20=mild
- 25=moderate
- 30=severe
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PAWP in ARDS
PAWP greater than 12 but less than 20
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How to perform a wedge
- inflate balloon with up to 1.5ml over 2-3 seconds
- stop with change in waveform
- keepp less than 8-15 seconds
- if there's blood in balloon, stop and clamp off port
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Cardiac tamponade signs/symptoms (5)
- If PAWP=PAD
- Pulsus Paradoxus
- Becks triad
- dresslers syndrome
- pericardial effusion
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Pulsus paradoxus
drop in pressure by 10-15 mmHg when pt takes a breath
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Becks triad
- hypotension
- Kussmaul sign
- Muffled heart tones
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Kussmaul sign
Rise in jugular venous pressure (JVP, the filling of the jugular vein) on inspiration
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Dresslers syndrome (8)
- pericarditis-->cardiac tamponade
- 2-3 weeks after heart surgery
- latent viral infection
- low grade fever
- chest pain
- pericardial friction rub
- pleural effusion
- increased Sed Rate
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Pericardial effusion (2)
- water bottle appearance
- electrical alternans (stops when effusion goes to tamponade)
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Ejection fraction formula
- systolic volume / diastolic volume
- normal range 58%-75%
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Coronary Persusion Pressure formula
- diastolic BP-wedge
- 50-60mmHg
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Cardiac output formula
- stroke volume x heart rate
- 4-8 lpm
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Cerebral Perfusion PRessure
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Mean aterial pressure
- (diastolic x2 + systolic)/3
- 80-100
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Intracranial pressure
0-10
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Pulse pressure
systolic BP-Diastolic BP
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Heparin overdose treatment
Protamin sulfate
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TCA OD Tx
sodium bicarb, physostigmine (sz)
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Acetaminophen OD Tx
- 150mg/kg
- tx with mucomyst (N-acetylcysteine)
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Salicylate poisoning Tx
forced diuresis with sodium bicarb to get alkaline urine to help excrete and not get reabsorbed
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Organophosphate poisoning
Atropine-->2Pam-->Praloxidime
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anisocoria
unequal pupils
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corectopia
- irregular shaped pupil
- ?cataract
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Janeway lesions
- red nonpainful areas on soles and palms
- ?Enocarditis
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Oslers nodes
- Painful sores on palms and soles
- ?endocarditis
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Roths spots
- retinal hemorrhage
- ?endocarditis
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Horners
- Ipsilateral ptosis
- miosis
- anhydrosis
- ?lesion in sympathetic pathway in brain stem/upper spinal cord
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Stevens Johnson Syndrome
Rash / skin sloughs off
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Trousseaus sign
- BP / carpal pedal spasms
- ?hypocalcemia
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Chirsteks Sign
- Cheek tap=rapid jerky movements
- ?hypocalcemia
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Grey Turners sign
- bruising -flank / retroperitoneal
- ?pancreatitis/retroperitoneal and intraperitoneal hemorrhage
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Halstead sign
- marbled abdomen
- ?necrotic pancreatitis
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Markles sign
- rebound tenderness on palpation to abdomen
- ?peritoneal irritation
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Halsted sign
- discoloration of breast
- ?ca
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Rovsings sign
- palpate LLQ and pain in RLQ
- ?appendicitis
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Aarons sign
- McBurney's point pressed and pain in epigastrum
- Appendicitis
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McBurney point
Middle between umbilicus and left iliac crest
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Psoas Sign
- lying on side flex or extend leg back+pain RLQ
- Heel tap on right heel+pain in RLQ
- ?appendicitis
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Kehrs sign
- referred shoulder pain while supine
- ?spleen injury
- ?ectopic pregnancy
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Murphys sign
- pain during deep palpation or RUQ
- ?Gallbladder/cholecystitis
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Coopernails sign
- eccymosis in peritoneum / scrotum / labia
- ?pelvic Fx
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Mount Fuji sign
- air is tented
- ?tension pneumocephalus
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Babinski reflex
- Abnormal-toes go up and flare
- normal-flexor plantar toes go down
- Peds--opposite due to cortical pathways not fully mylinated
- ?upper motor dysfunction
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Hammans sign
- auscultation of anterior breath sounds as a crunching or crackling
- ?tracheal bronchial injury (fixed with intentional right mainstem intubation)
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Jeffersons fracture
- axial loading
- ?c1 fracture
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Virchows triad
- pain
- Hot skin/ swelling
- deep muscle tenderness
- ?venous thrombosis
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Waddell's triad
- head, abdominal and lower extremity injury
- caused by auto vs pediatric pedestrian
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Neurogenic schock
- SVR less than 800
- Low CI
- Low HR
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Anaphylactic shock
- SVR less than 800
- CI low
- HR high
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Hypovolemic schock
- SVR more than 1200
- low CVP
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Cardiogenic shock
- SVR greater than 1200
- high CVP
- hich PWP
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C3, C4, C5
Keeps the diaphragm alive
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c6
index finger and thumb / above t6 + hyperreflexia
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c5, c6, c7
upper limbs (lateral)
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c8-t1
upper limbs (medial)
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epidural bleed presentation
- uncal herniation
- ipsilateral pupil dilation
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subarachnoid bleed presentation (5)
- severe HA
- vomiting
- brudzinski's sign
- confusion
- ALOC
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ponteen bleed presentation
constricted pupils
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intraparenchymal bleed (CVA)
- embolic
- hemorrhagic
- thrombic
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Damaged area for Cheyne stokes resp pattern
bilateral hemispheres
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Damaged area for central neurogenic resp pattern
Midbrain / above pons
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Damaged area for apneustic resp pattern
below pons
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Damaged area for ataxic resp pattern
medulla
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s/s of anterior cord injury
complete motor pain and temperature loss with proprioception vibrations and touch
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s/s of brown-sequard cord injury
ipsilateral loss of moto position and vibration. Central lateral loss of pain and temperature
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s/s of central cord injury
greater motor weaknes in upper extremities than lower.
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CHF on xray
fluffy margins / Kerley B Lines / silhouette appearance / cardiomegaly
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ARDS on xray
ground glass appearance / no pleural effusion
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Linear skull fx on xray
line extends to base of skull
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linear stellate fx on xray
central focal point with multiple fx outwards
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diastatic on xray
separation of bones at suture line / bone fragments
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depressed on xray
indentation--don't cover
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laforte 1 on xray
horizontal across maxilla
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laforte2 on xray
bridge of nose and down around mouth / jaw
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laforte3 on xray
transverse from ear to eyes to bridge of nose to ear
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thumb print on xray
- epiglottitis
- lateral chest xray
- bacterial
- supraglottic
- over 4 years
- high fever
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steeple on xray
- croup
- anterior chest xray
- 6mo-4yrs
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Angel wing on xray
thymus gland
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afib with WPW tx
- Amiodarone
- 1. 150mg d5w over 10 minutes
- 2. 1mg/min over 6hrs
- 3. .5mg/min over 8hrs maintenance drip
- contraindication-verapamil, cardizem, adenosine, digitalis
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hypercalemia tx
- insulin
- d50
- alb SVN
- CaCl,
- NaHCO3
- Kayexalate
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Pericardial effusion presentation
electrical alternans on ecg
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pericardial tamponade presentation
- becks triad
- tx with periocentesis-
- 3" needle with 3 way stop cock,angle 10-15 degrees to left shoulder just left of the subxiphoid process and aspirate unclotted blood
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pulmonary contusion presentation
hemoptysis (1-1 1/2 blood in alveolar tissue)
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Myocardial Contusion presentation
- decreased cardiac output
- dysrhythmias
- right ventrical is more commonly injured
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Parkland fluid replacement for burns
- 4ml x kg x BSA% in first 24 hours
- half in eight hours
- rest over sixteen hours
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Coagulation burn
- 3rd degree
- through to the bone
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Venous thrombosis
- Virchows triad:
- pain
- hotskin / swelling
- deep muscle tenderness
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Arterial thrombosis
- pain uncontrolled
- cool / pale skin
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Henry's gas law
- combo of boyle's and charles' law
- bends
- gas in liquid =bubbles
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daltons gas law
- parts make up total pressure
- increase pressure=increase partial pressure
- soft tissue swelling
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boyle's gas law
- volume and pressure
- expansion / contraction of gas at a constant temperature
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graham's gas law
- gas exchange at cellular level
- 20x CO2 then O2
- gas diffusion
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Gay Lussac's gas law
- pressure and temperature
- O@ pressure gauge tanks
- increase temperature / increase pressure
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Charle's gas law
- volume and temperature
- volume expands with increased temperature
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Atmospheric pressure
1 atm every 33 feet of water
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histoxic hypoxia
poisoning
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stagnant hypoxia
decrease cardiac output / pooling og blood (CHF)
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Local day flight restrictions
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local night flight restrictions
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Cross country day restrictions
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cross country night restrictions
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Emergency transmit frequency
121.5
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sterile cockpit
- flight crew on talks during take off and landing
- begin to lose night vicion
- 5000'
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Ketamine
- sedation of patient with asthma.
- decreases mucous plugging
- reflexes intact
- analgesic and amnesthic properties
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peds Foley, salem pump, and suction catheter sizes
2xETT
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peds chest tube size
4xETT
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Cricoid
narrowest portion of airway for kids under 10
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glottic opening
Narrowest opening after age 10
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neonate BP
over 60 systolic
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infant BP
over 70 systolic
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peds systolic BP
(age x2) + 70
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peds diastolic BP
2/3 systolic BP
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Mauricearu's maneuver
finger in baby's mouth with breech delivery
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McRoberts Position
Knees up to shoulders
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Turtle sign
seen with shoulder dystocia. Head comes out with contraction but goes back in
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Precipatate delivery
delivery within 2 hours of onset of contractions
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variable deceleration contractions
cord problems (hr110-160)
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early decelerations problem
- Head compression
- mirror image of mom's contractions
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late decelerations
Uterine placental insufficiency
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preeclampsia
- metabolic hypoxia
- U shaped contractions
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Sinusoidal waveform
fetal anemia
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omphalocele
abdominal contents protrude into base of the umbilical cord
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gastroschisis
doesn't involve umbilical cord
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chanal atresia
narrow blockage of nasal airway
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esophageal atresia
can't pass OG tube
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Pierre Robin syndrome
- small lower jaw with tongue that falls back
- high arched palate
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renal agenesis
no kidneys
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dobutrex
- inotropic
- tx to keep BP above 80 systolic
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dopamine
- inotropic, chronotropic, dromotropic
- tx to keep BP above 80 systolic
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lanoxin
- cardiac glycoside
- increase myocardial contraction and decrease HR in a-fib
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cardesartan
angiotensin II blocker
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valsartanAngiotenson II blocker
- carvedilol
- betablocker
- contraindicated in dig toxicity
- contraindicated in meth / cocaine OD
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labetolol
- betablocker
- no alpha and can be given to meth / cocaine OD
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nitroglycerin
vasodilator
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amiodare
- antiarrythmic
- afib with WPW history
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procainamide
- antiarrythmic
- max dose 17mg/kg
- cease if hypotension or QRS greater than 50% of original width
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KCL
- electrolyte balance
- tx hypokalemia
- 10 meq/hr
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deferoxamine
Iron supplement
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Iron toxicity
urine is pink
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praloxidime
- reactivation of acetylcholinestrase
- tx organophosphate poisoning
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prostagladin
PDA dependent patient
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indomethacin and o2
closes PDA after delivery
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methergine
- vasoconstrictor
- given for postpartum hemorrhage after oxytocin
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Sandostatin
- vasoconstrictor
- esophageal varices / GI bleed
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METHERGINE
METHYLERGONOVINE
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