Flight Paramedic Certification: Antidotes, Pediatrics, Gas Laws, Aviation Safety, Exams of Nursing

Download Flight Paramedic Certification: Antidotes, Pediatrics, Gas Laws, Aviation Safety and more Exams Nursing in PDF only on Docsity!

Flight Paramedic Certification Exam

Agent Aspirin (ASA) - Antidote Bicarb Agent Benzodiazepines - Antidote Flumazenil (Romazicon) Agent Beta Blockers - Antidote Glucagon Agent Calcium Channel Blockers - Antidote Calcium Gluconate Agent Cocaine - Antidote Benzodiazepines Agent Pit Vipers - Antidote CroFab, FabAV Agent Cyanide - Antidote Amyl Nitrate (inhaled), Sodium Nitrate (IV), Sodium Thiosulfate (IV) Agent Digitalis - Antidote Digibind, Digoxin Fab Agent Dilantin - Antidote Supportive care Agent

Ethylene Glycol (Anti-Freeze) - Antidote IV Ethanol, Fomepizole (Antizol) Agent Hydrocarbons - Antidote Intubate Agent Isoniazid (INH) - Antidote Pyridoxine Agent Iron - Antidote Defroxamine Agent Methanol - Antidote IV Ethanol Agent Opiods - Antidote Naloxone (Narcan) Agent Organophosphates - Antidote Atropine, 2 Pam Chloride Agent Tricyclic Antidepressants - Antidote Bicarb Agent Tylenol - Antidote Mucomyst, Acetadote Pediatric age range Neonate - Birth to 28 days Pediatric age range Infant -

28 days to 1 year Pediatric age range Toddler - 1 to 2 years Pediatric age range Child -

2 years Pediatric Normal BP formula - 90 + (2 x age) Pediatric Hypotensive BP formula - 70 + (2 x age) Neonate/Infant Emergency Fluid Resuscitation dose - 10cc/kg Toddler/Child Emergency Fluid Resuscitation dose - 20cc/kg Max number of fluid bolus infusion for a pediatric - 2 Glucose management for all pediatrics - D-Stick< 60mg/dL, all ages 2cc/kg Glucose management DOC for a neonate - D Glucose management DOC for an infant - D Glucose management DOC for a toddler - D ABG value PH - 7.35-7. ABG value CO2 - 35- ABG value HCO3 - 22- ABG value

PaO2 - 80-100 mmhg ABG value SaO2 -

95% ABG value Base (excess/deficit) - (-2) to (+2) Chem 7 Basic Metabolic Panel value Na+ (sodium) - 135 - 145 mEq/L Chem 7 Basic Metabolic Panel value K+ (potassium) - 3.5 - 5 mEq/L Chem 7 Basic Metabolic Panel value Cl- (chloride) - 95-105 mEq/L Chem 7 Basic Metabolic Panel value CO2 (Carbon Dioxide) - 22-26 mEq/L Chem 7 Basic Metabolic Panel value BUN (Blood Urea Nitrogen) - 6-24 mg/dL Chem 7 Basic Metabolic Panel value Cr (creatinine) - .7-1.4 mg/dL Chem 7 Basic Metabolic Panel value Glucose - 80-120 mg/dL Chem 7 Basic Metabolic Panel Sodium is... - The primary extracellular cation, helps nerves and muscles interact Chem 7 Basic Metabolic Panel Potassium is... - The primary intracellular cation, responsible for cell excitability, resting membrane potential (MOST DANGEROUS ABNORMALITY) Chem 7 Basic Metabolic Panel Chloride is... -

An extracellular cation, maintains osmotic pressure, helps stomach produce hydrochloric acid Chem 7 Basic Metabolic Panel Carbon Dioxide is... - Important for helping maintain the acid-base balance Chem 7 Basic Metabolic Panel Blood Urea Nitrogen... - Helps provide a picture of renal clearance Chem 7 Basic Metabolic Panel Creatinine... - Help provide a picture of renal clearance Chem 7 Basic Metabolic Panel Glucose... - Shows how much glucose is circulating in the blood Gas Laws Boyle's Law Equation - P1 x V1 = P2 x V Gas Laws Boyle's Law Definition - The pressure of a gas is inversely proportional to the volume of a gas at a constant temperature Gas Laws Dalton's Law Definition - The total pressure of a gas mixture is the sum of the partial pressures of all the gases in the mixture Gas Laws Charle's Law Equation - V1 x T2 = V2 x T Gas Laws Charle's Law Definition - At a constant pressure, the volume of a gas is directly proportional to the absolute temperature of the gas Gas Laws Gay-Lussac's Law Equation - P1 x T2 = P2 x T Gas Laws Gay-Lussac's Law Definition - Directly proportional relationship between temperature and pressure

DCS is related to what gas law? - Henry's Law DCS Type 1 S/S, Tx - Pain Itching Swelling Recompression on TT DCS Type 2 S/S, Tx - Any neurologic sign Pain in two or more joint Pain the t-shirt or shorts area Hypovolemic Shock Recompression on TT Cutis Marmorata S/S, Tx - Mottled Skin Recompression on TT AGE is due to what gas law? - Boyle's Law What happens with an AGE - Breath holding on ascent, over inflation of alveoli, possible pneumothorax, gas pushes through membrane into pulmonary capillaries, gas bubbles block vessels, lead to ischemia and infarct of tissues AGE S/S, Tx - Any neurologic sign with Hx of hyperbaric exposure Recompression on TT Atmospheric calculations 33ft of sea water = - 1 atmosphere Atmospheric calculations surface atmosphere + 33ft of sea water = - 2 atmospheres absolute (2ATA) Atmospheric zones Physiologic Zone -

Sea level to 10,000 ft MSL Night vision decreased beginning at 5,000 ft MSL Atmospheric zones Physiologically Deficient Zone - 10,000 ft - 50,000 ft MSL Oxygen required to survive Atmospheric zones Physiologically Deficient Zone Time of Useful Consciousness at 30,000 ft MSL - 90 Seconds Atmospheric zones Physiologically Deficient Zone Rapid cabin depressurization leads to... - Cutting Time of Useful Consciousness in HALF Atmospheric Zones Space Equivalent Zone -

50,000 ft MSL Types of hypoxia Hypemic - Reduction in O2 carrying ability Anemia, hemorrhage Types of hypoxia Histotoxic - Poisoning of the cytochrome oxidase system Cyanide, CO, alcohol Types of hypoxia Hypoxic - Not enough oxygen in the air altitude, deficiency in alveolar O2 exchange, pneumothorax Types of hypoxia Stagnant - Reduced cardiac output High G forces, cardiogenic shock Stages of hypoxia - Indifferent - some loss of night vision Compensatory - ⇧HR, vent, slowed judgement Disturbance - drunk Critical - death

Stressors of flight Self imposed - Dehydration Exhaustion Alcohol Tobacco Hypoglycemia Stressors of flight Inherent - Thermal Changes ⇩ Humidity Gravitational forces Fatigue ⇩ Partial pressure of O Barometric pressure change Noise Vibration G Forces - Gx Direction of Force Toleration Example - Anterior/Posterior Best tolerated Accelerating/decelerating in your car G Forces - Gz Direction Toleration Example - Vertical Falling from a roof and landing on your feet G Forces - Gy Direction Toleration Example - Lateral Least tolerated Being T-Boned in a car wreck Altitude Effects Every 1,000 ft increase causes temp to drop... - 2° Celcius Altitude Effects Barondontalgia - Occurs on ascent Air trapped in filling expands (Boyle's Law)

Altitude Effects Barotitis - Occurs on descent Air trapped in middle ear unable equalize due to blocked Eustachian Tube Altitude Effects Barosinusitis - Occurs both ascent and descent Air blocked in sinuses unable to equalize CAMTS stands for... - Commission for the Accreditation of Medical Transport Systems CAMTS Air Transport Team Members - Flight nurse Flight Paramedic Respiratory Therapist Flight Physician CAMTS Air Medical Resources Management - Distributes workload The operational practice of involving ALL members of the flight team in the mission planning, decision making, and mission safety Crew Resource Management in the military CAMTS Critical phases of flight - Take off Landing (short final) Refueling Taxi (ground or air) CAMTS Distance you must be able to pull your flight suit away from your body - 1/4" CAMTS Safe operation of the air craft comes before... - Patient care CAMTS Long range flights are anything over... - 3 hours CAMTS The only time you do not need to wear a seatbelt is... - Straight and level flights (or when PIC (pilot in charge) directs you)

CAMTS

Rotary wing PIC qualifications - 2,000 hours total flight time 1,200 hours in rotary wing A/C 1,000 hours as PIC 100 hour as PIC at night Must be instrument rated Airline Transport Pilot (ATP) cert strongly encouraged Area Orientation - 5 hours total with 2 at night before solo mission CAMTS Fixed wing PIC qualifications - 2,000 hours total flight time 1,000 hours as PIC 100 hours as PIC at night Must possess Airline Transport Pilot cert Must be instrument rated CAMTS Federal Aviation Regulation Part 91 - Applies to everyone No duty day No weather minimums CAMTS Federal Aviation Regulation Part 135 - Applies to flying passengers for money Max duty day 14 hours 8 hours total flying time 8 hours "bottle to throttle" CAMTS Weather minimums Non mountainous - Local Day - 800' ceiling 2 mile visibility CAMTS Weather minimums Non mountainous - Local Night w/ NVGs or TAWS - 800' ceiling 3 mile visibility CAMTS Weather minimums Non mountainous - Cross Country Day -

800' ceiling 3 mile visibility CAMTS Weather minimums Non mountainous - Cross Country Night w/ NVGs or TAWS - 1000' ceiling 3 mile visibility CAMTS Weather minimums Mountainous - Local Day - 800' ceiling 3 mile visibility CAMTS Weather minimums Mountainous - Local Night w/ NVGs or TAWS - 1000' ceiling 3 mile visibility CAMTS Weather minimums Mountainous - Cross Country Day - 1000' ceiling 3 mile visibility CAMTS Weather minimums Mountainous - Cross Country Night w/ NVGs or TAWS - 1000' ceiling 5 mile visibility CAMTS If bad weather is encountered in flight... - divert to the nearest facility CAMTS #1 cause of crash... - Bad weather CAMTS #2 cause of crash... - Night flight

Diagnostic Signs S3 - Congestive Heart Failure Diagnostic Signs S4 - Myocardial Infarction Diagnostic Signs Turtles Sign - Shoulder dystocia When the fetus crowns and then goes back in Diagnostic Signs McRobert's Maneuver - Shoulder dystocia Hyperflex the mother's legs to abdomen Diagnostic Signs Mauriceau's Maneuver - Breech delivery A method of delivering the head in an assisted breech delivery in which the infant's body is supported by the right forearm while traction is made upon the shoulders by the left hand. Diagnostic Signs Steeple Sign - Croup The radiologic image of subglottic narrowing from edema, suggestive of a steeple Diagnostic Signs Waddell's Triad - Pediatric hit by car Femur fracture Head injury Intra-abdominal or intra-thoracic injury Diagnostic Signs Cushing's Triad - ICP Irregular breathing Widening pulse pressures Bradycardia Diagnostic Signs Babinski's Sign - Spinal cord injury

The big toes goes up and the toes fan out when the sole of the foot is firmly stroked Diagnostic Signs Brudzinski's Sign - Meningitis Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed. Diagnostic Signs Kernig's Sign - Meningitis Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees. Diagnostic Signs Grey-Turner's Sign - Pancreatitis Bruising of the flanks Diagnostic Signs Cullen's Sign - Pancreatitis Periumbilical swelling and bruising Diagnostic Signs Chvostek's Sign - Hypocalcemia Tapping on the face at a point just anterior to the ear and just below the zygomatic bone leading to twitching of the ipsilateral facial muscles Diagnostic Signs Trousseau's Sign - Hypocalcemia Inflating a sphygmomanometer cuff above systolic blood pressure for several minutes causing muscular contraction including flexion of the wrist and metacarpophalangeal joints, hyperextension of the fingers, and flexion of the thumb on the palm Diagnostic Signs Virchow's Sign - DVT Hypercoagulability Hemodynamic changes (stasis, turbulence) Endothelial injury/dysfunction

Diagnostic Signs Kehr's Sign - Splenic injury Referred pain to the left shoulder Diagnostic Signs Ballance's Sign - Coagulated blood in the abdomen A dull percussion resonance sound heard on the right flank of a patient lying in the left decubitus position, an indication of a ruptured spleen. The sound is caused by an accumulation of liquid blood on the right side and coagulated blood on the left. Diagnostic Signs Coopernail's Sign - Pelvic fracture Bruising of the skin of the perineum, scrotum, or labia. Diagnostic Signs Kussmaul's Sign - Chest trauma JVD on inspiration Diagnostic Signs Beck's Triad - Cardiac Tamponade Low arterial blood pressure Distended neck veins Muffled heart tones Diagnostic Signs Hamman's Crunch - Mediastinal Emphysema Crunching, raspy sound that is synchronous with the heart beat Diagnostic Signs Murphy's Sign - Cholecystitis Pain on taking a deep breath when the examiner's fingers are on the approximate location of the gallbladder. Diagnostic Signs McBurney's Sign -

Appendicitis Palpation of the McBurney's point, midway between the umbilicus and the anterior iliac crest in the right lower quadrant of the abdomen CAMTS Visual Flight Rules (VFR) means... - You can only fly in weather conditions that you can where you are flying CAMTS Instrument Flight Rules (IFR) means... - The weather conditions do not allow for safe flight by sight alone and the pilot must be able to use their instruments. CAMTS Inadvertent Instrument Meteorological Conditions (IIMC) means... - The pilot started flying in VFR and the weather changed unexpectedly requiring the pilot to fly by instrument. CAMTS Hasty or Unsecured helicopter landing zones - Must have coms with the ground generally 100' x 100' 1 approach and departure heading 2 passes required prior to landing During hours of limited visibility have 2 vehicles cross their headlights to mark HLZ CAMTS Permanent helicopter landing zones - 2 approach and departure headings Perimeter lighting Landing beacon Windsock CAMTS In-flight emergencies Land immediately - Engine failure Fire CAMTS In-flight emergencies Land ASAP - Low transmission pressure Chip light CAMTS In-flight emergencies Land as soon as practical - go to the closest convenient place to "check this thing out"

CAMTS

Crash Procedures Pre-crash sequence - Lay the patient flat Turn off the oxygen Assume crash position CAMTS Crash Procedures Crash position - Seat belt secured Sit straight up Chin strap tight/visor down Knees together, feet 6" apart, flat on floor, not under seat Arms crossed on chest Chin to chest CAMTS Crash Procedures Post-crash sequence - Turn off throttle, fuel, battery Exit aircraft Assemble at the 12 o'clock Build a shelter, fire, water, signal CAMTS Emergency Locator Transmitter - Self activated at 4Gs Transmit freq 121.5 MHz Upgraded transmit freq 406 MHz Emergency Medical Treatment and Active Labor Act - You must act if someone requires emergency care to sustain life or is in active labor "150 yard" rule Sending physician is responsible until they arrive at the next facility Standard of Care - Presence of Duty Breach of Duty Foreseeability Causation Injury Damages Duty to Report - Child abuse Elder abuse Violent crime

Intubation indications - Unable to swallow Patient can not ventilate GCS< Inhalation burns Anaphylaxis Apnea Obstruction Respiratory failure LEMON stands for... - Look Evaluate 3-3- Mallampati (I-IV) Obstructions Neck mobility Mallampati I - Soft palate, uvula, anterior/posterior tonsillar pillars visible Mallampati II - Tonsillar pillars hidden by tongue Mallampati III - Only the base of the uvula can be seen Mallampati IV - Uvula can not be seen Macintosh blade interacts with... - Lifts the vallecula Miller blade interacts with... - Lifts the epiglottis Sellick's Maneuver is... - Direct downward pressure on the thyroid cartilage BURP Maneuver is... - Backward Upward Rightward Pressure Failed airway algorithm - Patient requires a secured airway 3 attempts of direct laryngoscopy unsuccessful Ventilate the patient by BVM Unable to ventilate/oxygenate SaO2>90% Cricothyroidotomy indicated

Chest X-ray for placement of ETT should place the tip at... - 2-3 cm above the carina T2 T3 vertebrae The distal cuff of an ETT should be inflated to _________ to _____________ - 20-30 mmHg, prevent mucosal tissue damage 7 Ps of intubation - Preparation Preoxygenate Pretreatment Paralysis with induction Protect and position Placement with proof Post intubation management LOAD (RSI Pretreatment) - Lidocaine Opiates Atropine for infants Defasiculating Dose NMB Succinylcholine - Depolarizing Neuromuscular Blocking Agent Causes fasiculations Requires refrigeration NMB Succinylcholine Dose Onset Duration - 1-2 mg/kg 1-2 min onset 4-6 min duration NMB Succinylcholine Contraindications - Crush injuries Eye injuries Narrow angle glaucoma History of malignant hyperthermia Burns > 24 hrs Hyperkalemia Any nervous system disorder Malignant hyperthermia

S/S

Tx - Masseter spasm/trismus Sustained tetanic muscle contractions Rapid increase in temp Increased ETCO Tachycardia Mixed acidosis Dantrolene Sodium (Dantrium) 3.0 mg/kg Do not give calcium channel blockers NMB Vecuronium (Norcuron) - Non-depolarizing NMB Does not cause fasiculations Does not need to be refrigerated NMB Vecuronium Dose Onset Duration - 0.04-0.06 mg/kg IVP following Succ. 0.01-0.015 mg/kg maintenance 4-6 mins 30-45 mins NMB Rocuronium (Zemeron) - Non-depolarizing NMB Does not cause fasiculations Requires refrigeration NMB Rocuronium Dose Onset Duration - 0.1-0.2 mg/kg IV maintenance q20-30 mins 4-6 mins 30-45 mins Induction agent Etomidate (Amidate) Dose Onset Duration Notes -

0.3 mg/kg 30-60 seconds 3-12 mins No analgesia Don't use in septic shock or Addison's disease Induction agent Midazolam (Versed) Does Onset Duration Notes - 2.5-5 mg IV 60-90 seconds 15-30 mins Flumazinel for reversal Induction agent Propofol (Diprovan) Dose Onset Duration Notes - 1.5 mg/kg 15-45 seconds 5-10 mins Use lowest possible dose ⇩ cerebral perfusion pressure and mean arterial pressure Do not use in pts with head injuries or shock Analgesic Ketamine (Ketalar) Dose Onset Duration Notes - 1 mg/kg IV 1.5 mg/kg IM 45-60 seconds 11-17 mins Increases secretions Bronchodilator Hallucinations Can be given IO Analgesic

Morphine Dose Onset Duration Notes - 2 mg IV/IM/IO for mild pain 5 mg IV/IM/IO for moderate pain Onset within mins Last 2-3 hours Respiratory depression Requires antiemetic Naloxone for reversal Analgesic Fentanyl Dose Onset Duration Notes - 50-100 mg IV 1-2 mins 45-60 mins Avoid ⇧ ICP Chest wall rigidity Requires antiemetic Naloxone for reversal Vt Tidal Volume is... - The amount of air the patient breathes in a normal breath IRV Inspiratory Reserve Volume is... - The amount of air that can be forcefully inhaled in addition to normal tidal volume ERV Expiratory Reserve Volume is... - The amount of air that can be forcefully exhaled in addition to normal tidal volume VC Vital Capacity - IRV + Vt + ERV = VC RV Residual Volume - The amount of air left in the respiratory tract following forceful exhalation TLC

Total Lung Capacity - IRV + Vt + ERV + RV = TLC Respiratory dead space - The surfaces of the airway that are not involved in gas exchange Central chemoreceptors are located in the________ and are driven by ________ - Medulla/Pons, CO2 and H+ levels Peripheral chemoreceptors are located in the _______ and are driven by ________ - Aortic arch/carotid bodies, O2, CO2, H+ Hypercarbic respiratory failure is... Evidenced by... Treated by... - Inability to remove CO2 Respiratory acidosis ⇧ Vt, then rate Hypoxic respiratory failure is... Evidenced by... Treated by... - Inability to diffuse O2 Low PaO2 ⇧ Vt and O2 concentration, then rate Apneustic respirations are... - An abnormal pattern of breathing characterized by deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release. Decerebrate posturing

• Apneustic respirations Ataxic respirations are... - An abnormal pattern of breathing characterized by complete irregularity of breathing, with irregular pauses and increasing periods of apnea Caused by damage to the medulla secondary to trauma

Ataxic respirations Biots respiration are... - An abnormal patter of breathing characterized by groups of quick, shallow inspirations followed by regular or irregular periods of apnea Opioids, TBI, stroke

-

Biots respirations Cheyne-Stokes respirations... - Are a progressively deeper sometimes faster breathing, followed by a gradual decrease that results in a temporary apnea Decorticate posturing, Cushing △, herniation

• Cheyenne-Stokes respirations Kussmaul's respirations... - Gradually become deep, labored, and gasping Associated with DKA Gold standard for oxygenation - SpO2 Gold standard for ventilation - ETCO2 Ventilator acquired pneumonia is... - The number one cause of iatrogenic death in the U.S. Curare cleft are... - Tick marks seen on capnography, the patient is choking, check ETT Pt needs to be resedated and reparalyzed Ventilator settings Vt (tidal volume) - 7-8 cc/kg Ventilator settings F (rate) - 8-20/min Ventilator settings Ve (minute volume) - F x Vt (4-8 L/min) Ventilator settings I:E (inspiratory:expiratory ratio) - 1:2 Ventilator settings FiO2 (fraction of inspired oxygen) - 0.21 to 1.0 (21% - 100%)

Ventilator settings Pplat (plateau pressure) - <30 Ventilator settings PEEP (positive end expiratory pressure) - 5 Ventilator settings PEFR (peak expiratory flow rate) - 500 to 700 L/min males, 380 to 500 L/min females Ventilator modes Controlled mandatory ventilation (CMV) - Sedated, apneic, or paralyzed patients Patient has no ability to initiate breaths Like "sucking on an empty bottle" Ventilator modes Synchronized intermittent mandatory ventilation (SIMV) - Senses patient is taking breath and assists Back up rate setting possible Preferred for patients with respiratory drive Like CPAP or BPAP Ventilator modes Assist-control ventilation (AC) - Patient can initiate Machine can initiate Full tidal volume regardless of effort Used with ARDS Can hyperventilate Ventilator modes Pressure support ventilation (PSV) - Assists the patient Patient determines minute volume Ventilator modes Continuous positive airway pressure (CPAP) - Uses mild air pressure to keep airway open Ventilator modes Bilevel continuous positive airway pressure - Used in pneumonia, COPD, and asthma Pressure alarms Low pressure - Disconnected from machine

Chest tube leaks Circuit leaks Airway leaks Hypovolemia Pressure alarms High pressure - Kinked line Coughing Secretions in airway Biting tube Reduced lung compliance (pneumo, ARDS) ⇧ airway resistance Pressure alarms "DOPE" - Dislodged tube (low) Obstruction (high) Pneumothorax (high) Equipment (machine failure) Preoxygenation requirement - Give 10L/min nia NRB for 15 mins prior to takeoff Personal protective measures Meningitis - Gloves Mask Gown Personal protective measures TB - Gloves Mask Gown Respirator Eye shield Asthma "The problem is..." - "Breathing out" Asthma -