FP-C_Final_Review

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tamarkp
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FP-C_Final_Review
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2014-06-05 14:50:58
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FP Review
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FP-C Final Review
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  1. Boyle's Law
    • Balloon
    • Barotrauma
    • Affects ETT, MAST, Air Splints, IV Drip Rates
    • Pneumocephalus
  2. Dalton's Law
    • Total pressure of all gases
    • Swelling at altitude
  3. Gay-Lussac's Law
    O2 tank left out over night pressure lower due to temp drop
  4. Graham's Law
    • Grey Matter
    • Gas bubbles coming out of exposed grey matter
  5. Henry's Law
    The Bends
  6. Decompression sickness
    • Type I - Pain, Cutis marmorata
    • Type II - Neurologic signs (stroke like symptoms)
  7. Arterial Gas Embolism (AGE)
    • Boyle's Law
    • Causes pneumothorax
    • Stroke-like symptoms
    • Hyperbaric treatment!
    • Fly in pressurized aircraft or in R/W < 1000 MSL
  8. Atmosphere Calculations
    • Sea level = 1 ATM
    • Every 33' underwater add another ATM
  9. Physiologic Zones
    • 0 - 10,000' MSL
    • Night vision decreased at 5,000' MSL
  10. Physiologically Deficient Zone
    • 10,000' MSL - 50,000' MSL
    • Sudden decompressurization cuts TUR in half (45 sec)
    • Normal 90 seconds of useful consciousness
  11. Oxygen adjustment calculation
    (FiO2 X P1)/ P2
  12. Sea Level (1 ATM)(P) Value
    18,000' MSL (1/2 ATM)(P) Value
    • 760 torr
    • 380 torr
  13. 4 Types of Hypoxia
    • Hypemic - Anemic
    • Histotoxic - Poisoning
    • Hypoxic - Not enough O2 in the air
    • Stagnant - Blood isn't moving
  14. Stages of Hypoxia
    • Indifferent - Full reasoning, some N/V loss
    • Compensatory - ↑HR, ↑ ventilations, slowed judgement
    • Disturbance - Drunk, slurred speech, impaired judgement
    • Critical - No longer able to function, death imminent
  15. Self imposed stressors of flight
    • Dehydration
    • Exhaustion
    • Alcohol
    • Tobacco
    • Hypoglycemia
  16. People most affected by G-forces
    • On B/P meds (Beta Blockers)
    • Dehydrated
  17. Altitude effects
    • Cold, dry, high altitude - greatest negative
    • Every ↑1,000' = ↓2°C
    • Barodontalgia - Teeth - Ascent
    • Barotitis - Ears - Descent
    • Barosinusitis - sinus - Both Ascent & Decent
  18. AMRM
    • Air Medical Resource Management
    • Same as CRM
  19. Sterile cockpit
    • essential communications only during straight and level flight
    • Critical stages of flight: T/O, Landing, Taxi, Refuel
  20. Flight following
    • Flight - 15 minutes
    • Ground - 45 minutes
    • EAP is activated 15 minutes after a required check-in
  21. MISC CAMTS:
    • 5 intubation
    • Flame resistant flight suit - 1/4 pull away
    • Aviate before medicate
    • Long range flight > 3 hours
    • Don't need seat belt in straight and level flight or if PIC directs
  22. R/W PIC Quals
    • 2,000 hrs flight time
    • 1,000 hrs as PIC
    • 100 hrs at night 
    • 1,200 hrs R/W
  23. Far 91 Rules
    • No duty day
    • No weather mins
    • 8 hrs bottle to throttle
  24. FAR part 135 rules
    • Max 14 hr duty day
    • Max 8 hr flight time
  25. Non-mountainous weather mins
    • 800' - 2 miles (day)
    • 800' - 3 miles (night)
  26. Marginal weather
    Can fly but take risk
  27. Below minimums
    • Can't fly and must divert to nearest facility if encountered
    • #1 cause of crash is weather
  28. Hasty or unsecured HLZ
    • 1 approach and departure heading
    • 2 passes one high one low required
  29. Permanent Helipad
    Must have 2 approach/departure headings
  30. Post-crash sequence
    • Throttle
    • Fuel
    • Battery
    • Exit (help others)
    • 12 o'clock
    • Shelter, Fire, water, signal
  31. ELT
    • 121.5
    • 406
  32. Respiratory failure values
    pH<7.2, CO2>55, PaO2<60
  33. Failed Airway Algorithm
    • pt requires secured airway
    • 3 laryngoscopy attempts
    • Ventilate (simple/rescue airway)
    • Unable to ventilate/oxygenate SaO2 > 90%
    • Cric
  34. ETT placement confirmation
    • Chest X-ray
    • 2 - 3cm (1") above carina 
    • Level T2 or T3
    • ETT cuff pressure 20 - 30 mmHg
  35. LOAD
    • Lidocaine - Head/Lung
    • Opiates - Blunt pain response
    • Atropine - prevents reflex brady infants < 1 Y/O
    • Defasiculating dose - (Succs, Roc, or Vec)
  36. Succinylcholine Dose
    1-2 mg/kg
  37. Succinycholine Contraindications
    • Crush injuries
    • Eye injuries
    • Narrow Angle Glaucoma
    • Hx Malignant hyperthermia
    • Burns > 24 hrs
    • Hyper K
    • Nervous System disorder (Guillain - Barre, Myasthenia gravis
  38. S&S of Malignant Hyperthermia
    • Masseter Spasm/trismus (lockjaw)
    • Sustained tetanic muscle contractions
    • Rapid ↑ in temperature
    • ↑ETCO2
    • Tachycardia/HTN
    • Mixed acidosis
  39. Malignant hyperthermia treatment
    • Dantrolene Sodium
    • Do NOT give Calcium Channel Blockers
  40. Vecuronum dose
    0.04 - 0.06mg/kg IVP
  41. Rocuronium Dose
    0.1 - 0.2mg/kg IV
  42. Etomidate dose
    Contrindications
    • 0.3 mg/kg
    • Do not use in Septic shock or Addison's disease
    • Adrenal suppression
  43. Midazolam dose & reversal agent
    • 2.5 - 5 mg IV
    • Flumazenil (Romazicon)
  44. Drug for Asthmatic patient RSI
    Ketamine
  45. Morphine dose
    Reversal agent
    • 2 - 5 mg IV/IM/IO
    • Narcan
  46. Central chemoreceptors
    driven by CO2
  47. Peripheral Chemoreceptors
    driven by O2
  48. Fick's formula
    Tells you how much Oyour patient is using
  49. Hypercarbic
    can't remove CO2
  50. Hypoxic
    Inability to diffuse O2
  51. Cheyne-Stokes
    Cushing's Δ,brainstem herniation
  52. Kussmaul's
    Associated with DKA
  53. Gold Standard for oxygenation
    Pulse Oximetry (SpO2)
  54. Gold Standard for Ventilation
    ETCO2
  55. How do we confirm ventilator settings
    ABGs
  56. Ventilator acquired pneumonia (VAP) is the #1 cause of what?
    iatrogenic death (we cause it)
  57. Curare cleft
    • Tick marks seen on capnography
    • Pt Choking
    • Check ETT
    • Resedate & reparalyze
  58. Vent settings
    • Ve - 4-8
    • Vt - 7-8
    • Pplat - <30
    • PEEP - 5
    • F - 8-20
    • FiO2 - 0.21 - 1.0
    • FEFR - 500 - 700 (men) 380 - 500 (Women)
    • I:E - 1:
  59. Vent Settings - CMV
    • Sedated, apneic, or paralyzed pts
    • NO ability to breathe on their own
  60. Vent Settings - SIMV
    • Vent senses pt taking a breathe the delivers a breath
    • preferred setting if pt has ventilatory drive
    • Similar to CPAP and BIPAP spontaneously triggered by pt
  61. Vent Settings - AC
    • Leads to breath stacking
    • Auto PEEP
  62. Vent Settings - CPAP & BPAP
    Similar to SIMV
  63. Vent pressure alarms - LOW
    Pt disconnected from machine
  64. Vent pressure alarms - HIGH PRESSURE
    Kinked line
  65. DOPE
    • Dislodged (l/p alarm)
    • Obstructed (h/p alarm)
    • Pneumathorax (h/p alarm)
    • Equipment (machine failure, dead batteries)
  66. Pt to pre oxygenate before flight
    • Pedi
    • Obese
    • Prego
    • 10 Lpm via NRB for 15 minutes before takeoff
  67. Personal Protective measures (Meningitis/TB)
    • Both - Gloves, Mask, Gown
    • TB adds Respirator & Eye shield
  68. Asthma I:E
    Med for RSI
    • 1:4
    • Ketamine
  69. COPD Vent settings Vt & PEEP
    • Vt - 10cc/kg
    • PEEP - 10
  70. ARDS
    • Ards and Pancreatitis occur together
    • Chest X-ray - "Ground glass appearance", "Patchy infiltrates"
    • Vent Settings: Vt - 10cc/kg PEEP>10
  71. Systemic Vascular Resistance
    • Measures after load of LEFT HEART (800 - 1200 dynes)
    • ↑SVR: Hypothermia, Hypovolemic Shock, Decreased CO
    • ↓SVR: Anaphylaxis, Neurogenic(distributive)shock, Septic shock, Vasodilating drugs
  72. S3
    • Kentucky 
    • CHF
  73. S4
    • Tennessee
    • MI
  74. RCA
    • Right Coronary Artery
    • Inferior MI
    • Brady due to SA node involvement
  75. STEMI
    • ST elevation in 2 contiguous leads > 2mm
    • Cardiac death  happening now
    • Time is muscle
    • Often associated with new onset LBBB (V1)
    • (+) Cardiac markers/enzymes
  76. Non-STEMI
    • ST depression or dynamic T wave changes in 2 contiguous leads
    • ST depression caused = lack of O2 in cardiac tissue (new or old)
    • Dynamic T waves = T wave inversion
    • (+) cardiac markers/enzymes
  77. Unstable Angina
    • Angina not relieved by rest, nitro, or is different in quality than pt's "normal" chest pain
    • Should not have cardiac markers/enzymes
  78. Draw PAILS
    p. 48
  79. Bundle Branch Blocks
    • Widened QRS or "Rabbit ears"
    • RBBB - V1 - Amplitude UP
    • LBBB - V1 - Amplitude DOWN - MI - look for cardia markers
  80. ACLS Drugs
    Adenosine
    Amioderone
    Dopamine
    Vasopressin
    • Adenosine - Narrow complex SVT - 6mg/12mg
    • Amioderone - VF/Pulseless V-tach - 300mg/150mg
    • Dopamine - 2nd line brady/Hypotension - 2-20mcg/kg/min
    • Vasopressin - Alternate pressor to epi - 40 units
  81. NAVEL can be give ETT
    increase dose 2 - 2.5 time normal dose
  82. Is defibrillation safe in flight?
    Yes. Inform PIC
  83. Beta Blockers
    • Carvedilol
    • Labetolol
    • Propamolol
    • Timolol
    • Esmolol
    • Metoprolol
  84. When should I not use a Beta Blocker
    • Heart blocks
    • Inferior MI (II, III, aVF)
  85. Calcium Channel Blockers
    • Verapamil
    • Diltiazem
    • Cardizem
  86. Drugs that ↑ SVR
    Levophed NorEpi (Levophed) used for pt's with profound hypotension
  87. Drugs that ↓ SVR
    • Nitroprusside (Nipride)
    • Can cause Cyanide toxicity
  88. Drugs that ↑ Preload
    • Levophed
    • Fluids
  89. Drugs that ↓ Preload
    • Morphine
    • Lasix
    • Nitro
    • (make CO worse)
  90. Percutaneous Trans Luminal Coronary Angioplasty
    • Administer GP2B3A inhibitors - Reopro, Integrilin, Aggrastat
    • Keep leg straight during transport hold DIRECT pressure for 30 minutes after cath removal
  91. Heart transplant
    • If decompensating = immediate cardioversion
    • Dopamine and NS bolus if Brady
    • DO NOT USE Atropine
  92. Wolff-Parkinson-White Syndrome (WPW)
    Delta waves on EKG
  93. Endocarditis
    • New murmur
    • #1 cause is IV drug use
    • Osler Nodes (painful red fingertips)
    • Janeway Lesions (red lesions on the palm and soles
  94. Pericarditis
    • Uremic Pericarditis can be seen in a pt in renal failure (dialysis)
    • Dressler's Syndrome is pericarditis occurring post MI/cardiac surgery
    • GLOBAL ST ELEVATION
    • Colchicine is the treatment
  95. CHF
    • Butterfly pattern, Kerley B Lines, Bilateral Diffuse infiltrates
    • Heart > 50% width of chest
    • BNP = CHF
    • High dose Lasix
    • Nitro second
  96. Aortic Dissection
    • Ripping or tearing
    • A difference of 20 mmHg Systolic B/P in the arms
    • 1st - Beta Blockers - Labetalol (Normodyne)
    • 2nd - Vasodilators - Nitroprusside (Nipride)
  97. Hemodynamic Monitoring - Swann Ganz
    • Distal tip measures pressures
    • Do not exceed 1.5cc AIR in distal cuff
    • Do not take wedge pressure for > 15 sec or 3 breaths
    • Take reading at the END of EXHALE
    • PA port only for monitoring/lab sample blood draw (NO FLUID)
    • When transporting deflate balloon (balloon size would increase at altitude)
  98. Swan Ganz normal pressures
    • RA (Central Venous Pressure) - 2-6 mmHg
    • RV - 15-25 mmHg
    • PA - 15-25 mmHg
    • PWAP - 8-12 mmHg
  99. Coronary Perfusion Pressure (CPP)
    • DBP - PCWP = CPP
    • Norm 50-60 mmHg
  100. Swan Ganz's wave forms
    • RV - may or may not have dicrotic notch on Left (referred to as high amplitude waveform)
    • PA - Dicrotic notch on the Right (Also considered a high amplitude waveform)
    • PAWP - low amplitude rolling waveform
  101. Catheter Whip
    • Catheter is in RV and needs to be floated into the PA
    • Inflate cuff with 1.5 cc of air
    • Have pt cough
    • lay them on their side
  102. Cardiac Output Transducer
    • Placed at the phlebostatic axis
    • Overdamping = Obstruction/kinking
    • Underdamping = pressure bag not full/air in line
  103. Intra-Aortic Balloon Pump - Placement
    • Check LEFT radial pulse:
    • If too HIGH - block subclavian causing limb ischemia
    • Check UOP:
    • If too LOW - decreased Urinary Out Put
  104. IABP - Pearls
    • If power failure manually pump every 3-5 minutes to prevent blood from clotting on balloon 
    • No need to purge IABP when going to altitude (machine will purge itself)
    • Bring extra helium tanks (bad to run out)
    • Brown or rust colored flakes in IABP tubing = tube rupture
  105. Draw IABP wave forms Which is the MOST dangerous?
    • LATE deflation = Lethal dose
    • ↑ Afterload
  106. Pregnancy Terms
    • Preterm - before 38 weeks
    • Full term - 38 - 42 weeks
    • Post Term - after 42 weeks
  107. OB General Treatment Measures
    • Place pt in the right or left lateral recumbent position (left preferred)
    • Fever often indicates sepsis
  108. Normal Fetal Heart Rate (NFH)
    • 120 - 160 BPM
    • Fetal Tachycardia is most commonly caused by maternal fever (sepsis)
    • Fetal Bradycardia is most commonly caused by hypoxia
  109. Accelerations/Decelerations
    • Early Decelerations - Benign
    • Late Decelerations - PIH/DM/Smokers/Late deliveries/Pre Eclampsia
    • Variable Decelerations - Nucchal/Prolapsed Cord (Tocolytics)
    • Sinusoidal Variations - Emergency C-Section (looks like v-fib)
  110. Emergency C-section indications
    • Multiple decelerations with poor rate
    • Sustained bradycardia (<120 for >10 min)
    • Sinusoidal waveform
  111. Preterm Labor
    • Labor prior to 38 weeks
    • True labor presents with regular uterine contractions with cervical changes (effacement)
    • Most common cause of preterm labor is Hypovolemia
  112. Preterm Delivery Treatment
    • Terbutaline
    • Mag Sulfate
    • Steroids for fetal lung maturity (Celestone, Dexamethasone)
  113. Terbutaline
    • Terbutaline for tetany
    • Subcutaneous 0.25mg q 15 min
  114. Mag Sulfate
    • CNS depressant, smooth muscle relaxant
    • prevents seizures
    • tocolytic in preterm labor
    • 4-6 grams IV over 30 min
    • Antidote = Calcium gluconate
  115. Premature Rupture of Membranes
    • Prepare for delivery
    • Administer steroids to stimulate fetal lung development
  116. Meconium
    • Inactivates surfactant
    • Deep suction only if baby is not vigorous
    • intubate and suction before first cry
  117. Pregnancy Induced Hypertension - Treatment
    • Labetolol (Beta Blocker)
    • Hydralazine (Alpresoline)
  118. Shoulder Dystocia
    • McRobert's Maneuver - woman's knees to chest and applying suprapubic pressure
    • Turtle Sign - Appearance and retraction of fetal head
  119. Breech Delivery
    • Don't attempt a footling breech
    • Mauriceau's Maneuver - fingers relieving pressure from baby's nose so they can breath & downward suprapubic pressure while baby is rotated out of birth canal
  120. PreEclampsia
    • NO SEIZURES
    • Causes LATE DECELERATIONS
  121. Eclampsia
    SEIZURES - treat w/ valium
  122. Maternal Hemorrhage
    • Placenta Abruption - Painful bleeding
    • Placenta Previa - Painless bright red bleeding
  123. Maternal Hemorrhage - treatment
    • 1st line - fundal massage
    • Pitocin - causes contractions of uterus stops bleeding
    • Methergine - causes contractions of uterus stops bleeding
  124. Uterine Rupture
    • Stomach as hard as a board
    • Caused by peritonitis
    • Fetal parts presenting under the skin
    • #1 cause of maternal death is trauma
    • #1 cause of fetal death is maternal death
  125. Miscellaneous OB Pearls
    • Uterine inversion requires manual replacement
    • Gestational diabetic mothers are more likely to give birth to children w/ hypoglycemia
    • Hypoglycemia is a common cause of seizures in newborns
  126. Neonatal Airways
    • Neonates and infants are obligate nose breathers
    • Suction mouth first then nose
    • DeLee Suction
    • Consider NG tubes in all intubated neonates
  127. Isolette (incubator)
    • Preterm neonate < 5 lbs.
    • Distress in a baby less than 28 days from date of birth (neonate)
    • Preterm = incubator & surfactant
  128. Infant seizures
    • S & Sx lip smacking, tongue thrusting, eye fluttering, lowered O2 sats
    • Subtle seizures = Complex Partial Seizures
    • Hypoglycemia/Opiod withdrawal
  129. Choanal Atresia
    INTUBATION
  130. Respiratory Distress Syndrome or
    Hyaline Membrane Disease
    • Same thing
    • Surfactant deficiency
    • Consider use of surfactant when transporting preterm infants (given ETT)
  131. Omphalocele
    • "O" abdominal ring
    • Worse than gastroschesis
    • Treat like abdominal evisceration
  132. Gastroschesis
    • On one side of the umbilical cord
    • Treat like abdominal evisceration
  133. Ventriculoperitoneal Shunt
    • VP Shunt
    • Mental status change, ↓ LOC, vomiting, seizures
    • Treatment - Mannitol, Raise head 30° (Semi-fowlers)
  134. Shaken Baby Syndrome
    Retinal Hemorrhages
  135. Neonatal Cardiac Problems
    • Newborns with HR ≤ 60 & D-stick ≤ 60
    • Administer EPI 1st (1:10,000 0.1 - 0.3 ml,kg IV or ETT)
    • Then Glucose (2cc/kg D10)
    • Cardiomegaly + Heptomegaly = CHF (Stop IV Fluids administer Digitalis)
    • Most common cardiac defect is a Ventricular Septal Defect (VSD) (hole between ventricles)
  136. Patent Ductus Arteriosis
    • PGE1 (Prostaglandin E1) is what keeps PDA open
    • PGE1 can cause Apnea
    • PDA problems are often found on physical exam by checking femoral pulses
    • Possible coarctation of the aorta
  137. Tetralogy of Fallot
    • "Tet spells" are characterized by sudden cyanosis and syncope
    • TREATMENT: knees to chest & Morphine
    • If above fails: RSI, Intubate, 100% O2
  138. Miscellaneous Neonates
    • Umbilical cord - 2 Arteries & 1 Vein
    • 1 artery & 1 vein = single cord (renal System is likely to be affected)
  139. Write ETT diameter formula
    pg. 88
  140. 2/3/4 rule
    • 2 X ETT size = Suction/NG foley diameter
    • 3 X ETT size = ETT insertion depth
    • 4 X ETT size = Chest tube
  141. Normal & Hypotensive B/P formula
    • 90 + (2 X age) Normotensive
    • 70 + (2 X age) hypotensive
  142. Pediatric Fluid Resuscitation Formula
    • Neo/Infant - 10cc/kg
    • Child - 20cc/kg
    • Max 2 bolus
  143. Pediatric Maintenance Fluids
    4/2/1 rule
    0-10 kg    →    4cc/kg/hr

    11-20 kg  →    2cc/kg/hr

    20+ kg     →    1cc/kg/hr
  144. Pediatric Glucose Management
    • Neonate       2cc/kg    D10
    • Infant          2cc/kg    D25
    • Child           2cc/kg    D50
  145. Pediatric Airway Problems
    • Stridor - inhalation/upper airway
    • Wheezing - exhalation/lower airway
  146. Bronchiolitis
    • Caused by RSV
    • Isolation required
    • Watch for apnea
  147. Croup
    • Gradual onset w/ URI, NO DROOLING
    • "Seal-like bark"
    • "The crow lives in the steeple"
    • TREATMENT: Racemic Epi, Steroids (Decadron)
  148. Epiglottitis
    • Sudden Onset, DROOLING, Tripod Position
    • Thumb sign on x-ray
    • TREATMENT: DO NOT DISTURB, Antibiotic, humidified O2
  149. Waddel's Triad
    • Car hits kid
    • kid hits car
    • kid hits ground
    • strike heads first
    • Most trauma death - MVA
    • Most commonly injured organ = skin
    • 25% blood loss before signs of hypotension
  150. Accidental Ingestion
    • Flumazenil
    • Narcan
  151. Signs of pediatric abuse
    • Multiple fractures
    • bruising in different stages of healing
    • Retinal hemorrhages
  152. Miscellaneous Pediatric Pearls
    • Most narrow portion of airway is cricoid ring in children < 10 Y/O
    • Primary emotion is fear
  153. Map Pressure Formula
    Normal range
    • SBP + (2 X DBP) ÷ 3 = MAP
    • Normal 80 - 100 mmHg
  154. CPP Formula
    Normal range
    • MAP - ICP
    • Normal 60 - 80 mmHg
  155. ICP range
    0-10 mmHg
  156. ICP transducer location
    Foramen of Monro (level of ear)
  157. S&S of brainstem herniation
    • Change in LOC
    • Pupil reaction
    • Posturing (decorticate = to the core)
    • Cheyne-Stokes
  158. Cushing Triad
    • ↑ ICP
    • Hypertension
    • Bradycardia
    • Increased pulse pressure (systolic & diastolic numbers are far apart 180/60
  159. Treatment of Brainstem Herniation
    • Hyperventilate (Goal PaCO2 30-35 mmHg)
    • Mannitol
    • Hypertonic solution
    • Lasix can be used AFTER Mannitol
  160. Diastatic Fracture
    Along the suture lines of the skull
  161. Linear Fracture
    Extends towards the base of the skull
  162. Linear Stellate Fracture
    Spider web appearance
  163. Depressed Skull Fracture
    • Pneumocephalus (air trapped in the skull)
    • Sinus cavity
    • Boyle's Law
    • Head injury is the leading cause of death in the trauma victim
  164. Concussions
    Classic - Memory loss
  165. Hypertensive Urgency/Emergency
    • Headache, Nausea/vomiting, visual changes
    • creatine/RBCs in urine
    • TREATMENT: Labetolol and Nitro prusside (Nipride)
  166. Subdural Hematoma
    • Elderly, kids
    • Interventricular hemorrhage has increased mortality
  167. Epidural Hematoma
    • MMA (Middle Meningeal Artery)
    • Lucid interval
    • Pupil dilation after occulomoter nerve due to loss of parasympathetic tone
  168. Subarachnoid Hemorrhage
    • "Worst headache of my life"
    • Starfish pattern on CT
    • TREATMENT: Nimodepine (Nimotop)
    • Pts with persistent elevated BP in the setting of intracranial hemorrhage - Nitroprusside (Nipride)
  169. Autonomic Hyperflexia
    Insert and drain Foley catheter slowly
  170. Babinski's Sign
    • Spinal Cord injury
    • C3/4/5 keeps the diaphragm alive
  171. Brown Sequard Lesion
    Opposite sides
  172. Central Cord Injury
    • Motor weakness in upper extremities greater than lower.
    • Can walk to you but can't shake your hand
  173. Anterior Cord Syndrome
    Loss of pain & Temperature sensation everywhere below the level of injury
  174. Spinal Shock
    • Decreased SVR (SVE<800)
    • Treat w/ IV fluids & Vasopressors
  175. Neurogenic/Distributive Shock
    • Decreased SVR <800 and normal HR
    • Warm, Red skin
    • No Tachycardia
    • Treat w/ IV fluids and vaspressors
  176. Brudzinki's and Kernig's sign point to
    Meningitis
  177. Meningitis Triad
    • nuchal rigidity
    • photophobia
    • headache
  178. TPA =
    Ischemic Stroke
  179. Herpes Simplex Encephalitis Treatment
    IV Acyclovir
  180. Seizures
    Tonic-Clonic (Grandmal) epilepsy, affect whole brainComplex Partial = Subtle SeizuresStatus Epilepticus 30 mins without regain oc conciseness
  181. ABG Values
    • pH - 7.35 - 7-45
    • CO2 - 35 - 45
    • HCO3 - 22-26
  182. CO2 Transport and removal
    Minute Volume to blow off CO2
  183. Metabolic Alkalosis
    • pH > 7.35, HCO3 > 26
    • Vomiting, NG suction, Diuretics, Antacid Poisoning
  184. Metabolic Acidosis
    • pH < 7.35 HCO3 < 22
    • Lactic acidosis (lactate > 4)
    • Ketoacidos
  185. Respiratory Alkalosis
    • pH > 7.35, CO2 < 35
    • ASA poisoning, Hyperthermia
  186. Respiratory Acidosis
    • pH < 7.35, CO2 > 45
    • Chest wall injury, CNS depression, Lung injury
  187. Anion Gap
    ≥ 16 GOTO MUDPILES!
  188. Draw MUDPILES
    p. 105
  189. Anion Gap Acidosis Treatment
    • Ventilation
    • Underlying cause
    • Reversal Agent (Narcan, Flumazenil)
    • BiCarb if pH<7.0
  190. Metabolic Panel Values
    • Na+       - 135 - 145
    • K+         - 3.5 - 5
    • Glucose  - 80 - 120
  191. CBC
    HGB/HCT -  15/45
  192. Heparin - Low molecular weight
    Overdose treated with Protamine sulfate
  193. Coumadin (Warfarin)
    Overdose treated with Vitamin K
  194. Urine Output Norms
    • Infant    -    2cc/hr
    • Child      -   1cc/hr
    • Adult     -    0.5cc/hr
  195. Adult average urine output
    30 - 50 cc/hr
  196. Osmolarity
    • 280 - 295 mOsm/L
    • increases with dehydration
    • decreases with over hydration
  197. DKA
    • Type I
    • ↑ glucose (>350)
    • ↑ Ketones
    • ACIDOTIC (metabolic acidosis)
    • Kussmaul's respirations
  198. DKA Treatment
    • IV Fluids
    • IV insulin
    • SQ insulin
  199. HHNK
    • Type II
    • ↑ Glucose (>600)
    • Normal Ketones
    • NON-ACIDOTIC
    • Treat hypokalemia if present (60mg oral K+ 10mg IV)
  200. Syndrome of Inappropriate Anti-Diuretic Hormone
    Hyponatremia (<135)
  201. Diabetes Insipidus
    • Can be caused by a Dilantin overdose
    • Polydipsia - thirst
    • polyuria - pee
    • Polyphagia - hunger
  202. DI treatment
    • Vasopressin
    • Desmopressin (DDAVP)
  203. Esophageal Varicies
    • Hematemesis
    • Bright red diarrhea
    • syncope
  204. Treatment for Esophageal Varicies
    • Octreotide (sandostatin) Somastatin
    • DO NOT INSERT NG TUBE!
  205. Hyperthyroidism/Grave's Dz/ Thyrotoxicosis
    • Thyroid storm
    • Heat intolerance
    • Exophthalmos
    • Avoid ASA
  206. Hyperthyroidism/Grave's Dz/ Thyrotoxicosis - Treatment
    • IV Fluids
    • β-Blockers (Propanolol)
    • Steroids (Dexamethasone)
    • Tylenol for fever
  207. Hypothyroidism/Myxedema Coma
    • Cold intolerance
    • Winter
    • LOC Change
  208. Cushing's Syndrome
    • Buffalo Hump
    • Moon Face
    • Purple Striae on abd
  209. Adrenal Insufficiency/Adrenal Crisis
    • Addison's DZ
    • Salt craving
    • Negative Adrenocortocotropic Hormone (ACTH)
    • NO ETOMIDATE!
  210. Liver Failure
    • ↑ Ammonia leads to ↑ ICP
    • Treat w/ Lactulose
  211. Coarse "flapping" muscle tremor
    Hepatic Encephalopathy
  212. Hepatic Encephalopathy treatment
    Lactulose
  213. Septic shock
    • Hypotensive with normal HR
    • Hypotensive while being refractory to fluids
    • IV FLUIDS, Vosopressors, Levophed
    • NO ETOMIDATE IN RSI
  214. Grey Turner's Sign/Cullen Sign =
    Pancreatitis
  215. Pancreatitis treatment
    Demerol for pain
  216. Hyperkalemia
    • K+ > 5
    • Numbness in legs
    • Tall, Tented, T-waves
    • Lasix, Kayexalate, Calcium Gluconate
  217. HypoKalemia
    • K+ < 3.5
    • Depressed, Inverted, flattened T-waves
    • oral potassium 60 mEq
  218. Chvosteks Sign & Trroussue's sign =
    • HypoCalcemia
    • Treat w/ Calcium Gluconate
  219. Deep Venous Thrombosis (DVT)
    • Virchow = Venous
    • Loss of vein integrity
    • Stasis
    • hyperCoagulable state
    • Aching pain WARM, red & swollen
  220. DVT treatment
    Lovenox or Coumadin
  221. Arterial Occlusion
    • COLD limb
    • poikilothermia = "cold blooded"
  222. Pit Vipor
    DO NOT USE TOURNIQUETS
  223. Hypothermia
    • Shivering is limited by glycogen
    • Shivering stops @ 32°C
  224. After Drop
    • Return of cold blood to the core induced by external warming and peripheral vosodilation
    • Osborn wave, J wave, Hypothermia hump
  225. Hyperthermia
    • Heat cramps caused by Hyponatremia
    • Primary cation lost is Na+
    • Heat stroke is any heat injury + LOC change
  226. Hyperthermia treatment
    • Administer Crystalloid fluids
    • Never use collide for heat injuries
  227. Dehydration
    • ↑Hematocrit (HCT) in Blood
    • Ketones in Urine
  228. Dry Drowning
    Cold Water
  229. Wet Drowning
    Warm Water
  230. Acute Mountain Sickness (AMS)
    • 24 hours
    • 8,000' MSL
    • headache
    • Treatment - Descend, Diamox, Dexamethasone, D-Cylinder (O2)
  231. High Altitude Pulmonary Edema (HAPE)
    • 2-4 days
    • > 10,000' MSL
    • Dyspnea at rest, nonproductive cough (possible pink frothy sputum)
    • Treatment - Descend, Diamox, Dexamethasone, Nifedipine, D-Cylinder (O2)
  232. High Altitude Cerebral Edema (HACE)
    • Often concurrent w/ HAPE & HACE but not required
    • > 12,000' MSL
    • 5 days
    • LIFE THREATENING!
    • mental status change
    • Treatment - Descend, Diamox, Dexamethasone, D-Cylinder (O2)
  233. Rhabdomyolysis "Rhabdo"
    • dark or tea colored urine
    • Creatinine Kinase
    • Treatment: Crystalloid fluid, Bicarb, Lasix, Mannitol
  234. ASA Poisoning
    • Ringing in the ears
    • Respiratory alkalosis → metabolic acidosis
    • Reye's syndrome
    • TREATMENT: Bicarb
  235. Tylenol Poisoning
    • Stage III PEAK liver enzymes
    • Death Stage
    • TREATMENT: Mucomyst, Acetadote
  236. Dilantin Overdose
    Treat under Diabetes Insipidus protocols
  237. Iron Overdose
    • Common in children
    • Antidote - Defroxamine
  238. β-Blocker Overdose
    Glucagon
  239. Calcium Channel Blocker Overdose
    Calcium Gluconate
  240. Digitalis Toxicity
    • Yellow green halos
    • Digibind
  241. Trycyclic Antidepressant (TCA) Overdose
    • Prolonged QT intervals
    • TREATMENT: Bicarb
  242. Alcohol Poisoning
    • Supportive Care
    • Treat DT seizures w/ Valium
  243. Ethylene Glycol/Methanol Poisoning
    • IV Ethanol (ETOH)
    • Fomepizole
  244. Hydrocarbons
    • Gasoline, Diesal, Paint stripper
    • INTUBATE
    • DO NOT INDUCE VOMITING!
  245. Organophosphate Toxicity
    • Cholinergic poisoning
    • SLUDGE
    • TREATMENT: Atropine, 2-Pam Chloride
    • Seizures with Benzos
  246. Anticholinergic Poisoning
    Physotigmine is the antidote
  247. Cyanide Toxicity
    • Jewelers
    • TREATMENT: amyl nitrite, sodium nitrate, Sodium thiosulfate
  248. Cocaine Overdose
    • Valium, Ativan, Versed (Antidotes)
    • DO NOT GIVE β-Blockers
  249. Benzodiazepine Overdose
    ANTIDOTES: Romazicon (Flumazenil)
  250. Opiod Overdose
    Narcan
  251. Write the burn formulas
    • Brooke
    • Universal/Consensus
    • Parkland
  252. Draw What is the preferred burn formula
    Parkland
  253. What is the preferred IV fluids for burns
    Lactated ringers
  254. What degré burns get counted for burn formulas
    Only 2nd and 3rd
  255. Draw the pediatric rule of 9s
    p. 126
  256. Draw the adult rule of 9s
    p. 126
  257. What is the face worth in the rule of 9s
    4.5
  258. What is the average urine out put for an adult?
    30 - 50 cc/hr
  259. Predictors of severity
    • Flexor crease burns - hallmark of true conductivity
    • Oral Commissure (corners of mouth) children <2 (biting electrical cords)
  260. A/C Current
    • Unable to pull away
    • Explosive exit wound
  261. Direct Current (D/C)
    • able to pull away
    • discrete exit wound
  262. Myoglobinuria
    • Common in electrical burns
    • Maintain urine @ 100cc/hr
    • Sodium BiCarb to correct acidosis
    • Mannitol to increase UOP
  263. Chemical Burns
    • Flushed with copious water before transport
    • irrigation takes priority over transport
  264. Acid burns
    • Causes coagulative necrosis
    • Netralize hydrofluoric acid with calcium gluconate
  265. Alkalis Burns
    • Saponification (liquefaction necrosis)
    • Worse than acid burns
  266. Supraglottic Burns
    Thermal insult
  267. Infraglottic burns
    • Below the vocal cords
    • Hyperbatic chamber if available
  268. Carbon Monoxide Poisoning
    • Cherry red skin
    • Histotoxic Hypoxia
    • Headache
    • CO2 causes false SPO2 (Get ABG)
  269. Synthetic Material Fires
    • Hydrogen cyanide poisoning
    • Histotoxic Hypoxia
    • TREATMENT: Sodium Thiosulfate, Amy Nitrite, Sodium Nitrite
  270. Newton's 1st Law
    Object in motion stays in motion
  271. Trauma Killers in Flight
    • Tension Pneumothorax
    • Pericardial Tamponade
    • Hypovolemia
  272. Gunshot wounds
    • High velocity >2000 fps
    • Velociy is the most important factor in GSW damage
  273. Most definitive assessment of shock
    Lactic Acidosis (lactate >4)
  274. Injury patterns - Side impact
    • Splenic rupture
    • Hypovolemia 
    • (+) Kehr's Sign
  275. Injury patterns - Front impact
    Dislocated hips, acetabular fractures
  276. Injury patterns - Rear impact
    T12 - L1 most common back injury
  277. Injury patterns - Rollover
    • Unpredictable
    • Lapbelt injuries (Clasp knife effect)
  278. Injury patterns - Motorcycle - Side Impact
    Open lower extremities fracture
  279. Fall Trauma
    • Compression fractures T10, T12-L1
    • FOOSH (Fall on out-streched hand)
  280. Abdominal Trauma
    • Spleen Fracture/Rupture
    • Kehr's sign (splenic rupture)
    • Coopernails Sign
    • Halstead Sign
  281. Diaphragmatic Hernia
    • Left Side
    • Bowel sounds auscultated during chest exam
    • Scaphoid abdomen
  282. Genitourinary Trauma
    • Hematuria is the hallmark sign
    • Blunt trauma to bladder is highly associated with pelvic fractures
    • Blood at the urethral meatus is the most important sign
    • urinary cath is contraindicated
  283. Chest Trauma
    Kussmal's Sign Rise in venous pressure on inspiration

    Treat late tamponade w/ pericardiocentesis
  284. Early Tamponade
    Treat with IV fluids
  285. Late Tamponade
    Treat with Pericardiocentesis
  286. Beck's Triad (Tamponade)
    • Muffled heart tones
    • Hypovolemia w/ narrowed pulse pressures
    • JVD
  287. Electrical Alternans
    Heart getting closer and further from "camera" = Tamponade
  288. Pneumothorax
    Sudden increase in Pplat indicates Pneumo
  289. Pneumothorax - Treatment
    • Occlusive dressing over wound (Three sides)
    • Needle decompression if symptomatic
    • 2/3 ICS Mid clavicular
    • 5th ICS Mid-Axillary Line
    • Tube Thoracostomy
    • 5th or 6th ICS Anterior Axillary Line
  290. Facial Trauma
    Tracheobronchial injury - present with hoarseness, stridor, Hamman's Crunch (crunching, rasping sound synchronous with the heart beat.
  291. Leforte Fracture
    Watch for airway compromise
  292. Crystalloid fluid replacement ratio
    1:3
  293. Femoral Artery Cath Landmarks
    Nerve, Artery, Vein, Lymph (lateral to medial)
  294. Transfer reactions
    Stop if there is ANY adverse reaction
  295. Transfer Reaction - Anaphylatic
    • Rapid onset (30 min)
    • Stop transfusion
    • Epi
    • Steroids
    • Benadryl
  296. Transfer reactions - Overload
    • Stop transfusion
    • Lasix
    • Kidney/Cardiac disease
  297. Transfer reaction - Hemolytic
    • Sense of doom
    • ABO incompatibility
    • slow onset (45-90 min)
    • Keep urine output high (100cc/hr)
  298. Transfer related Acute Lung Injury
    Symptoms begin 1-6 hrs after transfusion
  299. Oxygen dissociation curve
    • Hemoglobin affinity for O2
    • Right is Raised
    • CADET face right
    • Large transfusion can lead to hypocalcemia and lead to lowered 2,3 DPG levels

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