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If your pregnant patient experiences initial "tearing" pain, then has relief from pain, then experiences pain during contractions only, what may she be presenting with?
If your pregnant patient experiences a "tearing" pain without relief between contractions, what may she be presenting with?
How should you treat a pregnant patient with third trimester bleeding?
- Treat for shock
- Rapid transport
- Aggressive tocolytics if contracting
What sign may be present in a patient presenting with uterine rupture?
Kehr's sign - referred shoulder pain
What position should a pregnant patient be placed in to avoid supine hypotensive syndrome?
Left lateral recumbent >24 weeks gestation
What is Coopernail's sign and what does it indicate?
- Bruising to the genitalia
- Indicates pelvic fracture
What is McDonald's rule?
- Estimates weeks gestation by fundal height
- 20-24 weeks the height of the fundus should be at the umbilicus
What are some changes that take place in the pregnant female?
- Tidal volume increases by 20%
- Blood volume increases by 30-50%
- Delayed gastric emptying
- Slight respiratory alkalosis
- Hormones soften joints
What does LOCK stand for in treating OBGYN patients?
- Left lateral recumbent position
- Correct or improve contributing factors
- Keep reassessing FHR and intervene when indicated
What are the drugs of choice when treating hypertension in pregnant patients?
What is Leopold's manuever for?
- Determining placement of fetal monitoring transducers
- Find the top of the fundus, the spine of the fetus, and the presenting fetal part
Where should the Tocotransducer be placed?
Approximately 2 cm from the top of the fundus
Where should the Ultrasound transducer be placed?
- Over the fetal back
- It will be below the umbilicus for a term fetus, who is head down
- Or above the umbilicus for a fetus who is breech
- THIS ONE GETS GEL
What do the lines on the fetal heart rate paper indicate?
- Thick red lines are at one minute intervals
- Each small horizontal square represents 10 seconds
What is nadir?
Nadir is defined as the lowest point of the deceleration
What criteria indicates a Category 1 Normal FHR tracing?
- Baseline rate 110-160
- Baseline variability moderate
- Late or variable decels are absent
- Early decels can be present or absent
- Accelerations can be present or absent
What is DR. C BRAVADO and what is it used for?
- OBGYN patients in the first 20 mins of contact
- DR - determine risks
- C - contractions
- BR - baseline rate
- A - accelerations
- VA - variability
- D - decelerations
- O- overall impression and treatment plan
What is the best indicator of fetal viability?
What criteria indicates a Category 3 Abnormal FHR tracing?
- Absent baseline FHR variability AND any of the following
- Recurrent variable decels
- Recurrent late decels
- OR Sinusoidal pattern (wave-like pattern with cycle frequency of 3-5/min persisting for >20 minutes)
What are some common causes of fetal tachycardia?
- Maternal fever - most common
- Methamphetamine use
- Sympathomimetic use
What are the four classifications of fetal heart rate variability?
- Absent - Undectable
- Minimal - Undetectable or less than or equal to 5 beats per minute
- Moderate - 6 to 25 beats per minute
- Marked - More than 25 beats per minute (AKA Saltatory pattern)
What should you consider if you are seeing minimal FHR variability?
What should you consider if you are seeing marked FHR variability?
- Mechanical cord compression
What is a variable decleration and what does it indicate?
- V or W shaped decelerations that can occur any time during a contraction
- Indicate cord compression i.e. prolapsed cord
What is a late deceleration and what does it indicate?
- Deceleration that begins at the top of the contraction
- Indicates uteroplacental insufficiency (i.e. pre-eclampsia, diabetes, and cardiovascular disease)
What are some causes of sinusoidal pattern?
- Fetal anemia
- Severe acidosis
- Associated with a high rate of fetal death
What is a pseudosinusoidal pattern?
- Wave-like pattern with less regularity
- Generally benign and transient
- Can occur in presence of narcotics
What criteria indicates a Category 2 Indeterminate FHR tracing?
- All tracings not categorized as Cat 1 or Cat 3
- Require surveillance and re-evaluation
What is the goal DBP in PIH and Pre-Eclampsia?
What medication should not be administered to insulin-dependent diabetic mothers?
Terbutaline - transient hyperglycemic response
What is HELLP syndrome?
- ELevated liver enzymes
- Low Platelet ccount
What are three factors that assist in confirming SROM?
- Positive pooling in vaginal vault with speculum exam
- Nitrazine paper
- Positive ferning
What is macrosomia?
Large baby for gestational age
What is Chadwick's sign?
- Darkening of cervix, vagina, and vulva
- Indicates pregnancy
What defines PPH post partum hemorrhage?
- Decrease in/absent uterine tone
- Vaginal bleeding >500 cc/24 hrs
What is the treatment of PPH?
- Shock treatment and rapid transport
- Infusion of oxytocics (only after placenta delivered)
- Bimanual compression of uterus maintained for 2-5 mins
What are some causes of uterine inversion?
- Inappropriate fundal pressure
- Excessive traction on umbilical cord
- Mass in the vagina
- Uterine atony
What is the treatment for uterine inversion?
- Treat for shock and rapid transport
- Manual replacement of the uterus
- Oxytocics should follow replacement of uterus
What is the formula for ETT depth in neonates?
6 + weight in kg = cm at the gums
What is the most common cause of neonatal seizure?
A PDA dependent patient may require the administration of which drug during transport?
- Primary complication is apnea
What can cause closure of a PDA?
- High concentrations of oxygen
- Indomethacin (Indacin)
What four defects make up the Tetralogy of Fallot?
- Pulmonary stenosis
- Right ventricular hypertrophy
- Over-riding aorta
- Ventricular septal defect
- Surgical repair is called Rastelli
What is a TET spell?
- VSD resulting in bluish skin during episodes of crying or feeding
- Peak incidence between 2 to 4 months of life
What is a scaphoid abdomen indicative of in a neonate?
- Diaphragmatic hernia
- Requires oral gastric tube and oral intubation
What is an omphalocele?
Malformation in which abdominal contents protrude into the base of the umbilical cord
What is a gastroschisis?
- Opening in the abdominal wall that allows stomach and intestines to extend outside of the body
- Does not involve the umbilical cord
What are the risks of an omphalocele or gastroschisis?
- Infection and hypothermia
- Cover the contents and administer antibiotics
What is Potter's syndrome?
- Renal agenesis (absence of the kidney(s))
- Deformed lower extremities
- Pulmonary hypoplasia caused by enlarged bladder
The pediatric patient may be pre-treated with which medication prior to administering Anectine?
- All children under 12 years due to increased vagal response to laryngoscopy
- Given ideally 2-3 mins prior to paralytic
What is the formula to estimate ET tube size in peds?
16 + age in years / 4
What is the formula to estimate ET tube depth in peds?
ETT size x 3
What is the age of pediatric patient on which a needle cric may be performed?
What is the age of pediatric patient on which a nasal intubation may be performed?
What mechanical ventilation adjustments may be needed in a patient presenting with status asthmaticus?
- Large tidal volumes may be required
- Longer expiratory tims required
What is the drug of choice in pediatric asthma sedation?
- Has bronchodilatory properties
- Decreases the incidences of mucus plugging in pediatric patints with asthma
How do we manage status asthmaticus?
- Humidified oxygen
- IV rehydration
- Continuous nebulized beta-2 agents
- Atrovent, corticosteroids, Terbutaline, intubation
What is steeple sign?
- Narrowing of the airway seen on an A/P chest radiograph
- Laryngotracheobronchitis (croup)
What is thumb print sign?
- Thumb print seen on lateral neck radiograph
What is Waddell's sign?
- Injury pattern seen in pediatric pedestrian vs MVC
- Head, abdomen, lower extremities
What are the most commonly injured internal organs in pediatric trauma?
Spleen and liver
What does LEMONS stand for?
- Look externally
- Evaluate 3:3:2 rule
- Neck mobility
What is the 3:3:2 rule?
- 3 finger mouth opening
- 3 finger chin to hyoid bone
- 2 finger floor of mouth to thyroid cartilage
What does BOOTS stand for?
- Beards, beware of full stomach
- Older patients
- Snores/stiff lungs
What does CHANGES stand for?
- Change blade, smaller tube
- Help of another provider
- Alternative airway
- Neck alignment/release of C-collar
- Gum-elastic bougie
- External laryngeal manipulation
What is the LOAD mnemonic used for and what does it stand for?
- RSI prepatory steps
- Atropine for peds
- Defasiculating dose prior to Sux administration
What are the 7 P's of RSI?
- Protection and induction
What are the primary and secondary causes of bradycardia?
- Primary is hypoxia
- Secondary is ICP
What is Hamman's sign?
- Crunching sound heard with chest auscultation, synchronized with heartbeat
- Indicates tracheobronchial injury
What are the sxs of tracheobronchial injury?
- Hamman's sign
- Persistent hypoxia despite needle decompression
- Increasing SQ air/crepitus
What is the treatment of tracheobronchial injury?
Intentional right mainstem intubation below level of injury
What are the most commonly injured areas of the heart in myocardial contusion?
Right ventricle and right atrium
What are predictable injuries in a rear-end collision?
- C2 fx Hangman's fx
- T12-L1 injuries
- Femur fx
- Tib/fib fx
- Ankle fx
What are predictable injuries in a motorcycle side impact or lay-it-down collision?
- Open femur fx
- Pelvic fx
- Trapped arms break ribs
What is a Colles' fracture?
- Distal radius fx with posterior displacement of the wrist and hand
- Common in falls
Which is the most common type of hip dislocation?
- Extremity flexed and adducted
- Internal rotation
What is the primary treatment of any fracture?
Immobilize above and below the injury
What is the formula for CPP?
CPP = MAP - ICP
What is the formula for MAP?
MAP = DBP + 1/3 PP
What is cavitation?
Formation of air bubbles in a liquid at low pressure when the liquid is accelerated
What does TOES stand for and what does it mean?
- Possible bones associated with basilar skull fractures
What is Brudzinski's sign?
- Nuchal rigidity causes a patient's hips and knees to flex when neck is flexed
- Can indicate meningitis or subarachnoid hemorrhage
What is Kernig's sign?
- Inability to straighten the leg when hip is flexed to 90 degrees
- Indicates meningitis
What is the most severe type of LeFort fracture?
- Transverse or cranioacial dissociation
- Involves the zygomatic arch
What are the sxs of subarachnoid hemorrhage?
- Severe HA
- Nuchal rigidity
- Brudzinski's sign
What artery does an epidural bleed typically involve?
What are some target lab values to maintain an ICP patient at?
- pCO2 at 35-45, no less than 30
- Sodium at 155
- Serum Os <320 mOsm/kg
What is the doll's eyes reflex?
- Eyes move with head turning
- Also known as oculocephalic reflex
- Negative is BAD - eyes remain in mid-position
- Can indicate brainstem dysfunction
What is Babinski reflex?
- Initial inflection of great toe in response to stroking of sole
- Abnormal response is extensor plantar response
- Can indicate upper motor neuron lesion if abnormal
What is consensual response?
- Normal pupil will constrict in direct and indirect light
- No response to either indicate a brain problem
What is autonomic dysreflexia?
- Massive imbalanced reflex sympathetic discharge which can be caused by fecal impaction or bladder distention
- Occurs in patients with spinal cord injuries above T6
What cardiac rhythm is common in AC electrical injuries?
What cardiac rhythm is common in DC electrical injuries?
Asystole (D for Dead)
What are the three drugs contained in the cyanide antidote kit?
- Amyl nitrite
- Sodium nitrite
- Sodium thiosulfate
What drug administered for hypertensive emergencies can result in cyanide toxicity?
Nipride in absence of sufficient thiosulfate
What is the antidote for hydroflouric acid burns?
What is the hallmark indicator that rhabdomyolysis is occurring in a patient?
Elevated CK/CPK >20,000
What is Boyle's law?
- Expansion and contraction of gases at a constant temperature due to pressure changes
- Ascent - Expansion
- Descent - Contraction
What is Gay Lussac's law?
- Temperature increases, pressure increases
- Temperature decreases, pressure decreases
What is Henry's law?
- Gas in liquid
- The mass of a gas which dissolves in a volume of liquid is proportional to the pressure of the gas
- AGE (arterial gas embolism)
What is Charles' law?
- Volume of gas is directly proportional to temperature of gas
- Gas volume expands as temp increases
- Gas volume contracts as temp decreases
What is Dalton's law?
- Decreased amounts of oxygen with increased altitude
- The total prssure of gas mixture is the sum of the partial pressures in the mixture
What temperature change should you expect while flying?
Every 1,000 feet of altitude gained = 1-2 degree decrease in temperature
What is Graham's law?
- Gas diffusion from higher to lower area of concentration
- Gas exchange at the cellular level
One ATM (atmosphere) of water pressure equals how many feet of depth?
What is the number one cause of aeromedical crashes?
Pushing the weather
What are the weather minimums for local day flights for rotor-wing?
500 ceiling feet and 1 mile visibility
What are the weather minimums for local night flights for rotor-wing?
800 ceiling feet and 2 miles visibility
What are the weather minimums for cross-country day flights for rotor-wing?
1000 ceiling feet and 1 mile visibility
What are the weather minimums for cross-country night flights for rotor-wing?
1000 ceiling feet and 3 miles visibility
What is TUC?
- Time of useful consciousness
- 15 seconds or less at 40,000 feet or above in an oxygen deprived environment
What is sterile cockpit?
Only discussion pertinent to flight operations in all phases of flight, except cruise level
If you have experienced a crash landing, what do you do first?
- Remember TFB
- Throttle, fuel, battery
Where should you meet in event of a crash landing?
- Nose of the aircraft
- aka 1200 position
What is your survival priority order in case of a crash?
What organs are the first to be affected in an oxygen deprived atmosphere?
What are the cones of the eyes responsible for?
What are the rods of the eyes responsible for?
- Dimly lit areas
- Do not detect color or detail
How long does it take to achieve complete dark adaptation?
What color light retains dark adaptation?
What is the time limit between communications with ground while in flight?
15 mins (45 on ground)
When should the PAIP be implemented?
15 mins after an aircraft fails to give a position report or is overdue to arrive
What is hypoxic hypoxia?
Altitude hypoxia, decrease in alveolar oxygen
What is hypemic hypoxia?
Decreased oxygen carrying capacity in the blood, anemia
What is histotoxic hypoxia?
Inability of cells to take up or utilize oxygen, poisoning
What is stagnant hypoxia?
Decreased cardiac output results in blood pooling, CHF
What are some stressors of flight?
- Decreased partial pressures of oxygen
- Decrease in barometric pressure
- Decrease humidity
- Thermal changes
The type of radio band most frequently used for air to ground communication is?
- Limited range, fluctuates with terrain
A repeater system is which type of radio system?
What is simplex?
One frequency for transmission and reception - one at a time
What is duplex?
TWo frequencies used to transmit and receive simultaneously
What is multiplex?
Combines signals to transmit simultaneously on one frequency
Which radio signal follows the curvature of the earth and has the greatest range?
VHF low-band FM
Which radio signal follows a straight line?
VHF high-band FM
Which radio signal is typically used for aviation-related communication?
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