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  1. Describe Boyle's Law
    • Boyle's = Balloon = Barotrauma
    • The pressure of a gas is inversely proportional to the volume of a gas at a constant temperature.
  2. What effects will Boyle's Law have on medical equipment during flight?
    • 1. ETT Cuffs
    • 2. MAST Trousers
    • 3. Air Splints
    • 4. IV Drip Rates (Increase)
  3. Define pneumocephalus and the effects of this during flight.
    Air inside the cranial vault after trauma (ball peen-hammer). During flight the intracranial pressure will increase.
  4. Describe Gay-Lussac's Law.
    Direct proportional relationship between temperature and pressure.
  5. Explain what would happen to an O2 bottle's pressure when the temperature drops.
    Pressure would drop.
  6. Describe Henry's Law.
    Henry = Heineken

    Is associated with the solubility of gas in a liquid.
  7. Decompression Sickness is also called what?
    The Bends
  8. Describe Graham's Law
    • Graham's = Grey Matter
    • It is the law of gaseous diffusion and effects the exchange of gas at the cellular level. 
    • Gas bubbles coming out of exposed grey matter at altitude.
  9. Differentiate between Type I and Type II Decompression Sickness.
    • Type I - Pain
    • Type II - Stroke like symptoms
  10. What type of transportation is preferred for Decompression Sickness patients?
    • Ground transport is preferred
    • If flown pt should be kept below 1000 ft
  11. How many atmospheres is a person at sea level exposed to?
  12. When making atmosphere calculations how many feet below the water equals an additional atmosphere?
    Every 33' down adds an additional atmosphere tour calculation.

    (depth dove/33) + 1 
  13. Describe effects of Dalton's Law.
    Dalton's Gang

    Soft tissue swelling at altitude
  14. What causes Arterial Gas Embolism?
    Breath holding during ascent on a dive, air pushes through the alveoli and enters the skin in neck/chest.
  15. What is the treatment for Arterial Gas Embolism (AGE)
    • Immediate hyperbaric treatment
    • Fly in pressurized aircraft or below 1000 MSL
  16. Regarding Atmosphere Zones what is the Physiologic Zone?
    • Sea level to 10,000ft MSL
    • Night vision is decreased beginning at 5,000 ft. MSL
    • No Oxygen required

  17. Regarding Atmosphere Zones what is the Physiologically Deficent Zone?
    • 10,000ft MSL to 50,000ft MSL
    • Oxygen is required to survive at these altitudes.
  18. What are 2 signs of compression loss?
    • Cooler Temperatures
    • Window Fogging
  19. At 30,000ft MSL how much time of useful consciousness (TUC) would with decompression vs rapid decompression?
    • 90 seconds during decompression 
    • 45 seconds during rapid decompression
  20. Regarding Atmosphere Zones what is the Space Equivalent Zone?
    • >50ft MSL
    • If you are here congratulations on becoming an astronaut!
  21. What is the Oxygen Adjustment Calculation?
    Image Upload 1
  22. What is the  pressure value a sea level (1 ATM)?
    760 torr
  23. What is the pressure value at 18,000ft MSL?
    380 torr
  24. You have a patient on a NRB mask at 0.5 FiO2 and you are at sea level. You will be flying to an altitude with a torr of 500. What will the O2 requirement be at this altitude?
    0.5 X 760/500 = 0.76 FiO2 (76% O2)
  25. What are the 4 types of Hypoxia?
    • Hypemic
    • Histotoxic
    • Hypoxic
    • Stagnant
  26. What would cause Hypemic Hypoxia?
    • Reduction of O2 carrying capacity of blood
    • Anemia
    • Hemorrhage
  27. What would cause Histotoxic Hypoxia?
    • "Poisoning"
    • Limits the use of available O2 due to poisoning
    • Cyanide, ETOH, CO, Nitroglycerin, Sodium Nitroprusside (Nipride)
  28. What would cause Hypoxic Hypoxia?
    • "Not enough oxygen in the air"
    • ↓partial pressure of oxygen at altitude
    • Deficiency in alveolar oxygen exchange
    • Cardiovascular/Pneumothorax patients are more susceptible to this type of hypoxia
  29. What would cause Stagnant Hypoxia?
    • "Blood isn't moving"
    • Reduced cardiac output or pooling of blood
    • High G force, Cardiogenic Shock
  30. What is the acronym for the stages of Hypoxia?
  31. How many stages of hypoxia are there?
  32. What are the stages of Hypoxia?
    • Indifferent
    • Compensatory
    • Disturbance
    • Critical
  33. What is the most important stage of Hypoxia and why?
    • Indifferent. 
    • Because you can still think.
  34. What are the symptoms of the Indifferent stage of Hypoxia?
    • Full reasoning abilities.
    • Some loss of night vision.
  35. What are the symptoms of the Compensatory stage of Hypoxia?
    • Increased HR
    • Increased Ventilations
    • Slowed Judgement
  36. What are the symptoms of the Disturbance stage of Hypoxia?
    • Slurred speech
    • Impaired judgement
    • "Drunk"
  37. What are the symptoms of the Critical stage of Hypoxia?
    • No longer able to physically move
    • Death imminent
  38. What are the "self-imposed" stressors of flight?
    • Dehydration
    • Exhaustion
    • Alcohol
    • Tobacco
    • Hypoglycemia
  39. What are the "inherent" stressors of flight?
    • Thermal changes
    • ↓ Humidity
    • G-forces
    • ↓ Partial pressure of oxygen
    • Barometric pressure change
    • Noise
    • Vibration
  40. The people most affected by G forces are:
    • On B/P Meds (Beta Blockers)
    • Dehydrated
  41. What 3 environmental conditions has the greatest negative outcome to your patient?
    • Cold
    • Dry
    • High Altitude
  42. Describe Barondontalgia. When does it occur?
    Air trapped in fillings expands due to Boyle's Law on Ascent.
  43. Describe Barotitis. When does it occur?
    Air trapped in the middle ear can't vent through the blocked Eustachian Tube on decent.
  44. Describe Barosinusitis. When does it occur?
    • Air trapped in the Sinus. Can occur both on accent and decent.
    • Can cause pain in the Maxillary teeth (Decent = Barosinusitis Acent = Barondontalgia)
  45. What are your typical Air Transport team Members?
    • Flight Nurse
    • Flight Paramedic
    • Respiratory Therapist
    • Flight Physician
  46. Why do most aircraft fly single pilot?
    Save weight and $$
  47. What is your typical crew mix?
    • Pilot
    • Flight Paramedic
    • Critical Care Nurse
  48. What does AMRM stand for?
    • Air
    • Medical
    • Resource 
    • Management
  49. What does AMRM do?
    • Distributes workload
    • Operational practice involving ALL members in mission planning, decision making, & mission safety
    • Same as CRM
  50. Define sterile cockpit.
    Only essential communications during all phases of flight except straight and level flight.
  51. What are your critical stages of flight?
    • Takeoff
    • Landing (Short final)
    • Refueling
    • Taxi (Ground or air)
  52. For flight following requirements how often are calls made while in flight?
    Every 15 minutes
  53. For flight following requirements how often are calls made while sitting on the ground?
    Every 45 minutes
  54. For flight following requirements when is the Emergency Action Plan activated?
    15 minutes after failure to report in.
  55. As per CAMTS how many intubations should you complete before starting missions?
    • 5
    • Should perform quarterly thereafter
  56. As per CAMTS what characteristics should your flight suit have?
    • Flame retardent
    • Must pull 1/4" away from body
  57. As per CAMTS which comes first aviation or patient care?
    • Safe operation of the aircraft comes first patient care comes next.
    • Aviate before we Medicate
  58. As per CAMTS define long range transport.
    Transport greater than 3 hours
  59. As per CAMTS when can you not wear a seatbelt?
    • Straight and level flight
    • When PIC directs you to
  60. Who has the ultimate authority of the mission?
  61. What are the Rotary Wing Pilot requirements as per CAMTS?
    • 2,000 total flight hours
    • 1,000 flight hours as PIC
    • 100 flight hours as PIC at night
    • 1,200 hours in R/W
  62. What are the Fixed Wing Pilot requirements as per CAMTS?
    • 2,000 total flight hours
    • 1,000 flight hours as PIC
    • 100 flight hours as PIC at night
  63. For the Rotary Wing Pilot how many hours must he obtain in area Orientation before a solo mission?
    5 hours total with at least 2 hours at night
  64. Who does FAR Part 91 rules apply to?
  65. What are some of the FAR Part 91 rules?
    • No duty day
    • No weather mins
    • 8 hours bottle to throttle
  66. Who do FAR 135 rules apply to?
    Flying passengers for $$
  67. What are FAR Part 135 regulations?
    • Max 14 hour duty day
    • 8 hour total flying time
  68. What are the non-mountainous day and night weather mins for R/W aircraft?
    • Day - 800' - 2 miles visibility
    • Night (W/NVGs) - 800' - 3 miles
  69. Define Marginal Weather. Can you fly in these conditions?
    • Weather close to or at mins
    • Yes, you can fly - but accepting risk
  70. Define below minimums. Can you fly in these conditions? What if you encounter this in flight?
    • Weather is UNDER Minimums
    • No, you can not fly
    • Divert to nearest facility
  71. What is the #1 cause of crashes?
    • Weather
    • (#2 is night flight)
  72. Define VFR.
    • Visual Flight Rules
    • Flight in weather where you can see where you are going
    • Visual Meteorological Conditions (VMC)
    • There are no intended instrument flying under these rules.
  73. Define IFR.
    • Instrument Flight Rules
    • Conditions do not allow safe flight by sight alone. Pilot must use instruments.
    • Instrument Meteorological Conditions (IMC)
    • If weather allows pilot may fly under VFR/VMC
  74. What is IIMC?
    • Inadvertent Instrument Meteorologic Conditions
    • Unexpected weather requiring instrument flight
    • Referred to as "double IMC"
  75. What 5 things must you have for a Helicopter Landing Zone (HLZ)?
    • Communications with the ground
    • HLZ large enough to land (100' X 100')
    • 1 approach and departure heading
    • 2 passes (One high & One low)
    • 2 Vehicles crossing headlights to mark HLZ
  76. What 5 things must you have for a Permanent Helipad?
    • 2 approach and departure headings
    • Perimeter lighting
    • landing beacon
    • windsock
  77. What are the 3 in-flight emergencies?
    • Land immediately
    • Land as soon as possible
    • Land as soon as practical
  78. What is the pre-crash sequence?
    • Lay patient flat
    • Turn off Oxygen
    • Assume Crash Position
  79. What is the crash position?
    • Seat belt secured
    • Sit up straight 
    • Helmet strap tight/visor down
    • Knees together, feet 6 feet apart, flat on the floor
    • Arms crossed on chest
    • Chin to Chest
  80. What is the post crash sequence?
    • Turn off Throttle
    • Turn off Fuel
    • Turn off Battery
    • Exit Aircraft - Meet at 12 o'clock position
    • Shelter, Fire, Water, Signal
  81. At what point is an ELT activated? What channel does it transmit?
    • 4 G's
    • Transmits on 121.5 MHz
    • Some on 406 MHz
  82. What does EMTALA stand for?
    • Emergency
    • Medical
    • Treatment
    • Active 
    • Labor
    • Act
  83. What does EMTALA ensure?
    • You must act if someone requires emergency care to sustain life or is actively giving birth.
    • If someone is injured within 150 yards of a hospital, they must be treated
    • Sending physician is responsible for the patient until they arrive at next facility
  84. What 6 things must be present to prove negligence?
    • Presence of Duty
    • Breach of Duty
    • Foreseeability
    • Causation
    • Injury
    • Damages
  85. What do you have a duty to report?
    • Child Abuse
    • Elder Abuse
    • Violent Crime
  86. Name 7 indications for intubation.
    • Unable to swallow
    • Pt can't ventilate/oxygenate
    • GCS < 8
    • Expected clinical course (inhalation burns, circumferential neck or chest burns, anaphylaxis)
    • Apnea
    • Airway Obstruction
    • Respiratory failure
  87. 3 Clinical findings indicating Respiratory failure:
    • pH<7.2, CO > 55, PaO2 < 60
    • (Any value off indicates intubation)
  88. Define Sellick's Maneuver.
    • Direct downward pressure on thyroid cartilage, occludes the esophagus and prevents aspiration during intubation.
  89. What is BURP?
    • Backward
    • Upward
    • Rightward
    • Pressure
  90. What is the failed airway algorithm?
    • Pt requires a secured airway
    • 3 attempts of direct laryngoscopy unsuccessful 
    • Ventilate pt w/ BVM/Simple Airway/ Blind Airway
    • Unable to ventilate/oxygenate SaO2 > 90%
    • Cricothyroidotomy Indicated
  91. What is the gold standard for verification of tube placement?
    • Chest X-Ray
    • ETT should be 2-3cm above carina (1")
    • Level with T2 or T3 vertebrae
    • (next most reliable confirmation method is visualization of the tube passing through the cords)
  92. What pressure do we inflate the distal cuff of the ETT to?
    20-30 mmHg to prevent mucosal tissue damage
  93. What are the 7 Ps of intubation?
    • Preparation - Make sure equipment is serviceable 
    • Pre-oxygenate - 3-5 min, 10-15 LPM
    • Pretreatment - LOAD
    • Paralysis w/ induction - Neuromuscular blockade, Induction agent, pain control
    • Protect & Position - Sniffing position, towel under shoulder blades
    • Placement w/ Proof - Tube passing, CO, Chest xray
    • Post intubation management - maintain sedation & Oxygenation
  94. Define the steps in LOAD
    • Lidocaine (head/lung injury) blunts cough reflex preventing ICP increase
    • Opiates - blunts pain response
    • Atropine for infants - prevents reflexive bradycardia in infants <1 y/o
    • Defasiculating dose - use Succinycholine, Rocuronium, or Vecuronium
  95. What is the dose of Succinylcholine?
    1-2 mg/kg
  96. What is the onset and duration of Succinylcholine?
    • Onset - 1-2 min
    • Duration - 4-6 min
  97. How long is Succinylcholine good for after removed from refrigeration?
    14 days
  98. What are the contraindications for Succinylcholine?
    • Crush injuries
    • Eye injuries
    • Narrow angle glaucoma
    • Hx of Malignant Hyperthermia
    • Burns > 24hrs
    • Hyperkalemia
    • Any Nervous System disorder (Guillain-Barre, Myasthenia gravis)
  99. What are the signs & symptoms of Malignant Hyperthermia?
    • Masseter spasm/trismus (lockjaw)
    • Sustained tetanic muscle contractions
    • Rapid increase in temperature
    • Increased ETCO2
    • Tachycardia/ HTN
    • Mixed acidosis
  100. What do you use to treat Malignant Hyperthermia? What dose?
    • Dantrolene Sodium (Dantrium)
    • Dose 3.0 mg/kg
  101. What is the dose for Vecuronium? What is the onset and duration?
    • Dose: 0.04 - 0.06 mg/kg (following Succinylcholine)
    • Onset: 4-6 min
    • Duration: 30-45 min
  102. What is the dose for Rocuronium? What is the onset and duration?
    • Dose: 0.1-0.2 mg/kg IV q20-30 min
    • Onset: 4-6 min
    • Duration: 30-45 min
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