FPCFlashCardsv2.txt

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FPCFlashCardsv2.txt
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FPC prep course flash cards
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  1. Neonate: 1.PDA 2.Surfactant 3.Seizures 4.Scaphoid Abdomen
    • 1.Prostaglanding maintains the PDA open
    • 2.Indomethacin and long term use of high flow oxygen close the PDA
    • 3.32 weeks gestation or less receive surfactant
    • 4.Most common cause of seizures is hypoglycemia < 40 mg/dL or hypoxia
    • 5.Scaphoid abdomen = diaphragmatic hernia- manage with OG tube and PPV
  2. High-Risk OB: 1.Primary cause of PTL 2.Terbutaline ccontraindications 3.PIH Triad signs
    • 1. Infection
    • 2. IDDM, Maternal HR over 120, Vaginal bleeding
    • 3. HTN, edema, proteinuria
  3. Dalton's Law
    • Sum total of partial pressures equal to total atmospheric pressures (Dalton's Gang)
    • Examples: tissue swelling, altitude hypoxia, hypoxic hypoxia
    • This is why O2 is needed at altitude
  4. Boyle's Law on Ascent and Descent
    • Ascent - Barondontalgia, Barosinutis, Bariobariatrauma
    • Descent - Barotitis Media
  5. Bariobariatrauma
    • Obese patients; nitrogen in fat cells can expand causing the "bends"
    • Administer high flow O2 15 minutes prior to lift-off to remove nitrogen
  6. Charles' Law: Two Components and Effects
    • Temperature and volume proportional
    • Up 100 m = down 1 degree C
  7. Boyle's Law: Two Components and Effects
    • Increased volume = Decreased pressure
    • Can Affect: Cuffs, MAST, GI, ETT, IABP
  8. The volume of gas in the GI tract expands 3x at what altitude?
    25,000 feet (Boyle's Law)
  9. Henry's Law
    • Gas in liquid proportional to gas above liquid
    • Examples: The Bends, CO2 in blood, decompression
  10. Graham's Law: Definition and Effects
    • Gas moves from high to low concentration
    • Examples: Gas through liquid, cellular gas exchange
  11. Gay-Lussac's Law: Two Components and Example
    • Temperature increases and pressure increases
    • Temperature decreases and pressure decreases
    • Example: O2 tank at 2200 in the afternoon, 1800 in the evening (all that changed is temperature)
  12. Universal Law
    Combines Boyle's and Charles' Law
  13. Applied Gas Laws: BP Cuff, ETT cuff, MAST, IABP
    Boyle's Law - IABP purges with ascent/descent
  14. Applied Gas Laws: O2 tank pressure changes in heat/cold
    Gay-Lussac's Law
  15. Applied Gas Laws: The Bends, Decompression Sickness (DCS), AGE
    Henry's Law
  16. Arterial Gas Embolism Treatment
    • Position patient head down on left side
    • Administer 100% Oxygen
    • Recompression chamber
  17. Applied Gas Laws: Tissue swelling, hypoxic hypoxia, O2 available at altitude
    Dalton's Law
  18. Applied Gas Laws: Cellular gas exchange, diffusion
    Graham's Law
  19. Newton's Laws
    • 1. An object in motion tends to stay in motion
    • 2. F=MA
    • 3. Every action has an equal/opposite reaction
  20. Hypovolemic Shock: Values
    • CVP - low
    • CO - low
    • CI - low
    • PAWP - low
    • SVR - high
    • HR - tachycardic
  21. Differential diagnoses: 1.Pulmonary contusion 2.Ruptured Diaphragm 3.Tracheobronchial injury 4.Esophageal perforation 5.Fat embolus 6.Fractured larynx
    • 1. Low sats despite O2, Rales
    • 2. Chest/Abd pain radiating to left shoulder
    • 3. Hemoptysis, SQ air, Hamman's sign
    • 4. Fever, hematemesis
    • 5. Fever, rash after fracture
    • 6. Hoarse sounds when speaking
  22. Death from crush injury due to?
    Reperfusion injury, rhabddomyolysis and renal failure
  23. Complications of crush injury?
    DIC, compartment syndrom, renal failure, hyperkalemia
  24. Compartment Syndrome and Fasciotomy
    Fasciotomy required if pressures exceed 35 mmHg and must be performed within 6 hrs of injury
  25. Trauma/Kinematics: Velocity Definitions
    • High: Above 2000 FPS
    • Med: 1000-2000 FPS
    • Low: Under 1000 FPS
  26. Chest/ABD Trauma: 1.Chest tube location 2.Needle thorascotomy 3.Suspect with fracture of first 3 ribs? 4.Scaphoid abdomen indicates...
    • 1. Adult - 4th ICS, anterior-axillary Ped - 5th ICS, anterior-midaxillary
    • 2. 2nd or 3rd ICS midclavicular or the 5th anterior mid-axillary line
    • 3. Suspect aortic disruption
    • 4. Diaphragmatic rupture
  27. Pediatric SBP
    • BP is last to go!
    • Normal SBP: 80 + (2 x age)
    • Normal DBP: 2/3 the SBP
    • SBP drops after 25% loss
  28. Urinary Outputs/Blood Volumes
    • Normal UO adults: 30-50 cc/hr
    • Normal UO for peds: 1-2 mL/kg/hr
    • Electrical injury UO for adults: 100 mL/hr
    • Electrical injury UO for peds: 2-4 mL/kg/hr
    • Adult BV: 70 mL/kg
    • Ped BV: 80 mL/kg
    • Neonate BV: 60 mL/kg
  29. Body Temperatures and Hypothermia
    • Normal Temp 37.6 or 98.6
    • Mild Hypothermia: 32-36 - decreasing HR
    • Moderate Hypothermia: 29-32 - loss of shivering, ALOC
    • Severe Hypothermia: 20-28 - coma, VF
  30. What are the two major causes of heat loss?
    Radiation and evaporation
  31. What temperature does thermoregulation cease at?
    28 Centigrade
  32. Oxyhemoglobin Dissociation Curve: Right Shift
    • "R" = Raised
    • R - Releases oxygen = acidosis
    • Raised CO2
    • Raised temperature
    • Raised 2,3 DPG levels
    • pH is low
  33. Oxyhemoglobin Dissociation Curve: Left Shift
    • "L" = aLkaLosis
    • L - Hemoglobin Holding Oxygen = Alkalosis
    • Low CO2
    • Low temperature
    • Low 2,3 DPG levels
    • pH is high
  34. Ventilator Modes: CMV, AC, IMV/SIMV
    • CMV: Preset volume or PIP at set rate; patient cannot initiate breath
    • AC: Preset volume or PIP w/every breath; can trigger breath, cannot control TV, no pressure support
    • IMV: preset breaths, TV, PIP; patient breaths allowed
    • SIMV: Allows variation of support, back-up RR set, pressure support can be used
  35. PEEP: Effects and Normal physiologic value
    • Increased pulmonary vascular resistance; can cause hypotension if over 15 cmH2O
    • Normal Range: 3-5 cmH2O
  36. What is the primary cause of death in ventilator dependent patients?
    Ventilatory acquired PNA
  37. ARDS: Treatment and CXR
    • Treatment: PEEP
    • CXR reveals widespread pulmonary infiltrates, ground glass appearance
  38. What are the 3 killers of ventilator patients during flight?
    • Pericardial tamponade
    • Tension pneumothorax
    • Hypovolemia
  39. What are the first adjustments you should make on a ventilator?
    • If Ventilation Problem, TV first, then respiratory rate
    • If Oxygenation problem, FiO2 and PEEP
  40. Mild, Moderate, and Severe Hypertension?
    • Mild - 140-159/90-99
    • Moderate - 160-179/100-109
    • Severe - over 180/110
  41. IABP: 1.Action 2.Balloon inflates 3.Balloon deflates 4.Dicrotic notch indicates
    • 1. Increase cardiac output, coronary perfusion, and myocardial oxygen delivery
    • 2. Inflates during diastole
    • 3. Deflates during ventricular systole
    • 4. Aortic valve closing, synchronized with ECG most commonly or sometimes A-line
  42. When do we treat HTN?
    • BP above 220 systolic
    • MAP over 130
  43. Digoxin: 1.Class 2.Causes what electrolyte imbalance? 3.ECG changes
    • 1. Cardiac glycoside, other name Lanoxin
    • 2. Hypokalemia
    • 3. ECG - "dig dip" ST depression
  44. Cardiogenic Shock: Values
    • CVP - high
    • CO - low
    • CI - low
    • PAS/PAD - high
    • PCWP - high
    • SVR - high
    • HR initially fast, then slows down
  45. CHF Considerations: Preload, Lab Test, Medications
    • Many CHF patients are hypovolemic; be careful with diuretics and medications that can decrease preload
    • BNP is the lab test >100 positive
    • No beta-blockers, except for Carvidolol (Coreg)
    • Natracor (Neseritide) = synthetic version of BNP
  46. Contraindications for Thrombolytics
    • History of hemorrhagic stroke
    • CVA in last 12 months
    • SBP over 180
    • Pregnant/up to 1 month post partum
  47. Stages of Hypoxia related to Elevation with SxS
    • Indifferent - 10,000 feet MSL= increased HR & RR, decreased night vision (lost at 5,000 ft MSL)
    • Compensatory - 10-15,000 feet MSL= HTN, task impairment
    • Disturbance - 15-20,000 feet MSL= dizzy, sleepy, cyanosis
    • Critical - 20-30,000 feet MsL= ALOC, incapacitated
  48. Rotor-Wing Minimums Ceiling/Visibility
    • Day/Local - 500 and 1
    • Day/Cross Country - 1000 and 1
    • Night/Local - 800 and 2
    • Night/Cross Country - 1000 and 3
  49. Safety Requirements for Flight 1.ELT frequency 2.Confirm ELT working 3.Twin engine required off-shore?
    • 1. 121.5
    • 2. Tune in and listen
    • 3. Raft, vest
  50. CAMTS Regulations 1.Pilot orientation area day/night 2.Helipad required to have? 3.Fixed wing twin engine time 4.Ambulance fuel requirement 5.ELT set off at? 6.Uniform fit
    • 1. 5 hrs day/2 hrs night
    • 2. 2 paths, security, wind direction indicator, perimeter lighting
    • 3. 500 hrs
    • 4. 175 miles
    • 5. 4 G's
    • 6. 1/4 inch space between body and uniform
  51. More CAMTS Regulations 1.Medical director is not required to? 2.Intubation requirements? 3.Live intubations required during training? 4.Specialty team response time?
    • 1. Live in the same state
    • 2. Quarterly
    • 3. Five
    • 4. 45 minutes
  52. FARs, Local flying area, Cell phones prohibited when?
    • Part 91: no passengers
    • Part 135: passenger with 14 hr max for pilots
    • Certificate holder determines local flying area
    • Cell phones prohibited while airborne
  53. What is the survival sequence?
    • Shelter
    • Fire
    • Water
    • Food
  54. What are the rotor-wing pilot required hours?
    • 2000 hrs
    • 1000 PIC
    • 100 hrs at night
  55. What is Bottle to Throttle time according to FAA Part 135?
    At least 8 hrs
  56. ABG Values
    • pCO2 - 35-45 Respiratory
    • pH - 7.35-7.45 Metabolic
    • HCO3 - 22-26 Metabolic
    • pCO2 high = pH low (acidosis)
    • pCO2 low = pH high (alkalosis)
    • pH low = HCO3 low (acidosis)
    • pH high = HCO3 high (alkalosis)
    • BOTH HCO3 and PH must be affected for it to be metabolic in nature!
  57. What are the atrial waveform descents?
    • X - Decline in atrial pressure during atrial rela"X"ation
    • Y - Decline in atrial pressure during atrial empt"Y"ing
  58. What are the atrial waveform waves and correlations on QRS?
    • A - Rise in atrial pressure as a result of atrial contraction - PR interval on ECG
    • C - Rise in atrial pressure as a result of closure of tricuspid and mitral valves - mid to late QRS on ECG
    • V - Rise in atrial pressure as it refills during ventricular contraction - immediately after peak of T-wave on ECG
  59. If CPK is >20,000...
    Ominous indication of late DIC, acute renal failure, and potentially dangerous hyperkalemia in heatstroke patients
  60. How do you calculate Anion Gap?
    • Na - (Cl + HCO3) = AG
    • Normal is 12 + or - 4
    • >16 indicates metabolic acidosis
  61. Dicrotic Notch Indicates...
    • Closure of aortic valve on A-line and IABP inflation waveforms
    • Closure of the pulmonic valve on PA waveforms
  62. PA Catheter: 1.Other name 2.Proximal port is for? 3.S/S of bad placement? 4.Procedure for bad placement? 5.Measures? 6.Which port is used to measure PAP? 7.Pressure bag set to?
    • 1. Swan-Ganz
    • 2. CVP (blue) port, medications
    • 3. VT, ventricular ectopy
    • 4. Float forward to PA or pull back to RA
    • 5. Right heart directly, left heart indirectly
    • 6. Distal (yellow) port
    • 7. 300 mmHg
  63. Pediatric Age Guidelines: ETT cuffed vs uncuffed, Needle cric, Nasal intubation
    • "10, 11, 12 rules"
    • Uncuffed tube under 10
    • Needle cric under 11
    • No nasal intubation under 12
  64. Lab Values: 1.Normal K 2.Normal Na 3.Normal Cl 4.Normal Ca 5.Metabolic acidosis elevates which electrolyte?
    • 1. 3.5 - 5
    • 2. 135-145
    • 3. 95-105
    • 4. 8.8-10.4
    • 5. Potassium
  65. Normal ICP, CPP (head), MAP, other CPP (heart)
    • ICP 0-10
    • CPP 70-90
    • MAP 80-100
    • Heart CPP 50-60
    • Remember your HEAD is higher than your HEART
    • Goal in head injuries/ICP is to keep MAP and CPP within normal limits
  66. ECG: 1.Most common reperfusion dysrhythmia 2.Most common hypothermia dysrhythmia 3.Hypokalemia on ECG 4.Hyperkalemia on ECG
    • 1. Reperfusion: AIVR
    • 2. Hypothermia - VF, Osborne waves
    • 3. Peaked P's, flat T's, U waves
    • 4. Flat P's, Peaked T's (above 5 mm >7.0)
  67. Arterial Lines: Sites, Purpose, Dampening
    • Radial, femoral sites
    • Monitor pressure, blood draws, ABG's
    • Underdampened: Air in system, loose connections, low pressure bag, altitude changes
    • Overdampened: Caused by kinking, increased bag pressure, tip against the wall
  68. DRUGS: 1.Induction agent of choice with bronchospastic patients 2.Ativan, indication, dose, max 3.Mannitol dose 4.Drug choice for tricyclic antidepressant OD 5.Drug choice for beta blocker OD 6.Fentanyl dose 7.Treatment for malignant hyperthermia 8.Drug for GI bleeds
    • 1. Ketamine (Ketalar)
    • 2. Lorazepam, seizures, 1-2 mg, max 4 mg
    • 3. 1-2 g/kg
    • 4. Sodium bicarbonate
    • 5. Glucagon
    • 6. Sublimaze 3 mcg/kg
    • 7. Dantrium (Dantrolene)
    • 8. Sandostatin (Octreotide)
  69. Neurogenic Shock Values
    • CVP - low
    • CO - low
    • CI - low
    • PCWP - low
    • SVR - low
    • HR can be normal or bradycardic
  70. CVP: 1.Other names 2.Measures 3.Normal parameter 4.Which port to use
    • 1. RAP Right atrial pressure
    • 2. Preload
    • 3. 2-6 mmHg
    • 4. Proximal port (blue)
  71. Catheter Centimeter Placement Outside Line Markers
    • RA/CVP = 20-25 cm
    • RV = 30-35 cm
    • PA = 40-45 cm
    • Wedge = 50 cm or higher
  72. In what order do we assess the abdomen?
    • Inspect
    • Auscultation
    • Palpation
    • Percussion
  73. How do we calculate cardiac output?
    HR x SV
  74. What are some personal factors affecting stress of flight?
    • D.E.A.T.H.
    • Drugs
    • Exhaustion
    • Alcohol
    • Tobacco
    • Hypoglycemia
  75. Thrombolytics must be administered within how many hours of onset of CP?
    3 hours
  76. What is the volume for RBC administration?
    10 mL/kg
  77. IABP 1.SxS of balloon leak 2.Clot prevention 3.IABP increases CO by? 4.Balloon rupture sign 5.Migration/dislodged 6.Lethal IABP timing cycles
    • 1. Blood specs, rust colored flakes, alarm going off
    • 2. Cycle manually every 30 mins regardless of timing
    • 3. 10-20%
    • 4. Rusty flakes in the line/turn machine off
    • 5. Assess left radial artery and urine output
    • 6. Late deflation and early inflation
  78. What is the O2 adjustment calculation to maintain saturation at altitude?
    • % O2 at departure x barometric pressure at departure divided by pressure at altitude
    • Equals % O2 needed during flight
  79. Rules of Flight Following
    • Sterile cockpit during critical phase of flight
    • 15 minutes max between communication center during flight
    • 45 minutes maximum while on the ground
  80. Rotor-Wing Shut-Off Sequence
    Remember TFB
  81. What is the dose of Terbutaline?
    0.25 SQ
  82. Normal Values
    • CVP 2-6
    • CO = SV x HR 4-8 mL/min
    • CI 2.5-4..3
    • PAS/PAD 15-25/8-15 mmHg
    • PAWP 8-12
    • SVR 800-1200 dynes/sec/cm5
  83. CLINICAL SIGNS 1.Grey-Turner's 2.Coopernail's 3.Halstead's 4.Cullen's 5.Murphy's 6.Levine's
    • 1. Flank bruising - retroperitoneal bleeding
    • 2. Scrotum/labia - Abdominal/pelvic bleeding
    • 3. Marbled abdomen - bleeding
    • 4. Umbilical discoloration - pancreatitis
    • 5. RUQ pain with inspiration - gallbladder
    • 6. Fist to chest clutching - cardiac related pain
  84. CPP Formulas
    • Head MAP - ICP = CPP
    • Heart DBP - Wedge = Coronary PP
  85. What is the formula for MAP?
    2 x diastolic + systolic / 3
  86. More CLINICAL SIGNS 1. Kehr's 2. Kernig's 3. Brudzinski's
    • 1. Kehr's - referred shoulder pain possible splenic injury or ectopic pregnancy
    • 2. Kernig's - back, left pain on knee extension - bacterial meningitis
    • 3. Brudzinski's - back, leg pain on neck flexion - bacterial meningitis or subarachnoid bleed

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