aasFPCFlashCardsv3.txt

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aasFPCFlashCardsv3.txt
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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. Newton's Laws
    • 1. An object in motion tends to stay in motion
    • 2. F=MA
    • 3. Every action has an equal/opposite reaction
  4. Hypovolemic Shock: Values
    • CVP - low
    • CO - low
    • CI - low
    • PAWP - low
    • SVR - high
    • HR - tachycardic
  5. 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
  6. Death from crush injury due to?
    Reperfusion injury, rhabddomyolysis and renal failure
  7. Complications of crush injury?
    DIC, compartment syndrom, renal failure, hyperkalemia
  8. Compartment Syndrome and Fasciotomy
    Fasciotomy required if pressures exceed 35 mmHg and must be performed within 6 hrs of injury
  9. Trauma/Kinematics: Velocity Definitions
    • High: Above 2000 FPS
    • Med: 1000-2000 FPS
    • Low: Under 1000 FPS
  10. 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
  11. Pediatric SBP
    • BP is last to go!
    • Normal SBP: 80 + (2 x age)
    • Normal DBP: 2/3 the SBP
    • SBP drops after 25% loss
  12. 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
  13. 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
  14. What are the two major causes of heat loss?
    Radiation and evaporation
  15. What temperature does thermoregulation cease at?
    28 Centigrade
  16. Oxyhemoglobin Dissociation Curve: Right Shift
    • "R" = Raised
    • R - Releases oxygen = acidosis
    • Raised CO2
    • Raised temperature
    • Raised 2,3 DPG levels
    • pH is low
  17. Oxyhemoglobin Dissociation Curve: Left Shift
    • "L" = aLkaLosis
    • L - Hemoglobin Holding Oxygen = Alkalosis
    • Low CO2
    • Low temperature
    • Low 2,3 DPG levels
    • pH is high
  18. 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
  19. PEEP: Effects and Normal physiologic value
    • Increased pulmonary vascular resistance; can cause hypotension if over 15 cmH2O
    • Normal Range: 3-5 cmH2O
  20. What is the primary cause of death in ventilator dependent patients?
    Ventilatory acquired PNA
  21. ARDS: Treatment and CXR
    • Treatment: PEEP
    • CXR reveals widespread pulmonary infiltrates, ground glass appearance
  22. What are the 3 killers of ventilator patients?
    • Pericardial tamponade
    • Tension pneumothorax
    • Hypovolemia
  23. 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
  24. Mild, Moderate, and Severe Hypertension?
    • Mild - 140-159/90-99
    • Moderate - 160-179/100-109
    • Severe - over 180/110
  25. 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
  26. When do we treat HTN?
    • BP above 220 systolic
    • MAP over 130
  27. 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
  28. Cardiogenic Shock: Values
    • CVP - high
    • CO - low
    • CI - low
    • PAS/PAD - high
    • PCWP - high
    • SVR - high
    • HR initially fast, then slows down
  29. 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
  30. Contraindications for Thrombolytics
    • History of hemorrhagic stroke
    • CVA in last 12 months
    • SBP over 180
    • Pregnant/up to 1 month post partum
  31. 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!
  32. 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
  33. 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
  34. If CPK is >20,000...
    Ominous indication of late DIC, acute renal failure, and potentially dangerous hyperkalemia in heatstroke patients
  35. How do you calculate Anion Gap?
    • Na - (Cl + HCO3) = AG
    • Normal is 12 + or - 4
    • >16 indicates metabolic acidosis
  36. Dicrotic Notch Indicates...
    • Closure of aortic valve on A-line and IABP inflation waveforms
    • Closure of the pulmonic valve on PA waveforms
  37. 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
  38. 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
  39. 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
  40. 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
  41. 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)
  42. 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
  43. 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)
  44. Neurogenic Shock Values
    • CVP - low
    • CO - low
    • CI - low
    • PCWP - low
    • SVR - low
    • HR can be normal or bradycardic
  45. 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)
  46. Catheter Centimeter Placement Outside Line Markers
    • RA/CVP = 20-25 cm
    • RV = 30-35 cm
    • PA = 40-45 cm
    • Wedge = 50 cm or higher
  47. In what order do we assess the abdomen?
    • Inspect
    • Auscultation
    • Palpation
    • Percussion
  48. How do we calculate cardiac output?
    HR x SV
  49. What are some personal factors affecting stress of flight?
    • D.E.A.T.H.
    • Drugs
    • Exhaustion
    • Alcohol
    • Tobacco
    • Hypoglycemia
  50. Thrombolytics must be administered within how many hours of onset of CP?
    3 hours
  51. What is the volume for RBC administration?
    10 mL/kg
  52. 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
  53. 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
  54. 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
  55. CPP Formulas
    • Head MAP - ICP = CPP
    • Heart DBP - Wedge = Coronary PP
  56. What is the formula for MAP?
    2 x diastolic + systolic / 3
  57. 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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