Safety Requirements for Flight 1.ELT frequency 2.Confirm ELT working 3.Twin engine required off-shore?
2. Tune in and listen
3. Raft, vest
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
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
4. 45 minutes
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
What is the survival sequence?
What are the rotor-wing pilot required hours?
100 hrs at night
What is Bottle to Throttle time according to FAA Part 135?
At least 8 hrs
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!
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
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
If CPK is >20,000...
Ominous indication of late DIC, acute renal failure, and potentially dangerous hyperkalemia in heatstroke patients
How do you calculate Anion Gap?
Na - (Cl + HCO3) = AG
Normal is 12 + or - 4
>16 indicates metabolic acidosis
Dicrotic Notch Indicates...
Closure of aortic valve on A-line and IABP inflation waveforms
Closure of the pulmonic valve on PA waveforms
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?
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
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
Lab Values: 1.Normal K 2.Normal Na 3.Normal Cl 4.Normal Ca 5.Metabolic acidosis elevates which electrolyte?
1. 3.5 - 5
Normal ICP, CPP (head), MAP, other CPP (heart)
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
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)
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
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
6. Sublimaze 3 mcg/kg
7. Dantrium (Dantrolene)
8. Sandostatin (Octreotide)
Neurogenic Shock Values
CVP - low
CO - low
CI - low
PCWP - low
SVR - low
HR can be normal or bradycardic
CVP: 1.Other names 2.Measures 3.Normal parameter 4.Which port to use
1. RAP Right atrial pressure
3. 2-6 mmHg
4. Proximal port (blue)
Catheter Centimeter Placement Outside Line Markers
RA/CVP = 20-25 cm
RV = 30-35 cm
PA = 40-45 cm
Wedge = 50 cm or higher
In what order do we assess the abdomen?
How do we calculate cardiac output?
HR x SV
What are some personal factors affecting stress of flight?
Thrombolytics must be administered within how many hours of onset of CP?
What is the volume for RBC administration?
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
4. Rusty flakes in the line/turn machine off
5. Assess left radial artery and urine output
6. Late deflation and early inflation
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
Rules of Flight Following
Sterile cockpit during critical phase of flight
15 minutes max between communication center during flight