CCP-C Prep Flashcards

right atrial pressure
Terms Definitions
CLINICAL SIGNS:Kehr's
Referred left shoulder pain - possible splenic injury or ectopic pregnancy
CLINICAL SIGNS:Kernig's
Back, leg pain on knee extension - possible bacterial meningitis
CLINICAL SIGNS:Brudzinski's
Back, leg pain on neck flexion - possible bacterial meningitis or subarachnoid bleed
CLINICAL SIGNS: Hamman's
crunching sound heard with auscultation over the anterior chest synchronized with heartbeat - tracheobronchial injury
X-RAY FNDINGSSteeple sign
Possible croup (laryngotracheaobonchitis) A/P neck view
X-RAY FINDINGSThumbprint sign
Possible epiglottitis lateral neck view
ABG VALUES
pCO2 high = pH low (acidosis)pCO2 low = pH high (alkalosis)pH low = HCO3 low (acidosis)pH high = HCO3 high (alkolosis)pCO2 = 35-45 respiratorypH = 7.35-7.45 metabolicHCO3 = 22-26 metabolic
DRUGS FOR AAA
Nipride and beta-blockers
FIRST ADJUSTMET ON VENTILATOR
TV first, not rate
TRAUMA1. Most common dislocation2. Most common spontaneous recurrence
1. Hip2. Anterior shoulder
BRAIN NATRIURETIC PEPTIDE (BNP)
Heart failure marker that measures BNP released by an overdistension of the heartBelow 100 = normalAbove 500-700 = heart failure
ROTOR-WING PILOT REQUIRED HOURS
2000 hours1000 PIC100 hours at night
"BOTTLE-TO-THROTTLE" TIME
At least 8 hours
CVPMEASURES NORMAL PARAMETERWHICH PORT TO USE
Measures: preload (right atrial pressure)Norm: 2-6 mmHgPort: proximal port
SPINAL CORD SYNDROMES(ABC)"A"ANTERIOR CORD
Anterior: complete motor, pain and temperature loss below the lesion
SPINAL CORD SYNDROMES(ABC)"B"BROWN-SEQUARD
Brown: ipsilateral loss of motor, position and vibration sense;contralateral loss of pain and temperature perception
SPINAL CORD SYNDROMES(ABC)"C"CENTRAL CORD SYNDROME
Central: great motor weakness in UE than LE with varying degrees of sensory loss
SPINAL CORD SYNDROMES(ABC)AUTONOMIC DYSREFLEXIA
Auronomic: Urinary retention, massive increase in sympathetic tone which can cause HTN, treated by insertion of foley
NORMAL URINARY OUTPUT
UO: 30-50 mL/hr (adult)UO: 1-2 mL/hr (peds)
NORMAL BLOOD VOLUME
Blood volume: 70 mL/kg (adult)Blood volume: 80 mL/kg (peds)
NORMAL TEMPERATUREMILD HYPOTHERMIAMODERATE HYPOTHERMIASEVERE HYPOTHERMIA
Normal: 37.6/98.6Mild 32-36 (decreasing HR)Moderate: 29-32 (loss of shivering, ALOC)Severe: 20-28 (coma, VF common)
TWO MAJOR CAUSES OF HEAT LOSS?THERMOREGULATION CEASES AT?
Radiation, evaporation28 degrees
RULES OF FLIGHT FOLLOWING
Sterile cockpit during critical phase of flight15 minutes maximum between communication center during flight45 minutes maximum while on the ground
ROTOR WING SHUT-OFF SEQUENCE
Remember "TFB"throttlefuel batteryTake survival bag and meet at twelve o'clock position
SURVIVAL SEQUENCE
ShelterFireWaterFood
ORDER OF HOW TO ASSESS THE ABDOMEN
InspectAuscultationPalpationPercussion
CONTRAINDICATIONS FOR THROMBOLYTICS
History of hemorrhagic strokeCVA last 12 monthsSBP over 180Pregnancy or 1 month postpartum
FARsLOCAL FLYING AREADETERMINED BY CELL PHONES PROHIBITED
Part 91: no passengersPart 135: passengers (14 hours max for pilots)Certificate holderWhile airborne
PaO2SaO2BARIOBARIATRAUMA
PaO2: plasma-measured as preasureSaO2: hemoglobin-measured as percentageNitrogen release in obese patients, administer high flow O2 15 minutes to lift off to wash out nitrogen
NORMAL PEDIATRIC SBP?WHEN DOES IT DROP?
"BP last to go"SBP: 90+(2 x age)After loss of 25%DBP: 2/3 the SBP
THREE KILLERS OF VENTILATOR PATIENTS DURING FLIGHT
Pericardial tamponadeTension pneumothoraxHypovolemia
DEATH FROM CRUSH INJURY DUE TO?COMPLICATIONS OF CRUSH INJURY?
Death due to: renal failureComplications: DIC, compartment syndrome, renal failure, hyperkalemia
CAMTS1. MEDICAL DIRECTORS NOT REQUIRED TO:2: INTUBATION REQUIREMENT:3. LIVE INTUBATION REQUIRED DURING TRAINING:4. SPECIALTY TEAM RESPONSE TIME:
1. Live in same state2. quarterly3. Five4. 45 minutes
CAMTS1. PILOT AREA ORIENTATION DAY/NIGHT2. HELIPAD REQUIRED TO HAVE:3. FIXED WING TWIN ENGINE TIME:4. AMBULANCE FUEL REQUIREMENT:ELT SET OFF AT:UNIFORM FIT:
1. 5 hours day/2 hours night2. 2 paths, security3. 500 hours4. 175 miles5. 4g's6. 1/4 space between body and uniform
APPLIED GAS LAWSTHE BENDS, DECOMPRESSION, SODA CAN, CO2 IN BLOOD
Henry's Law
APPLIED GAS LAWSTISSUE SWELLING,HYPOXIC HYPOXIA, O2 AVAILABLE AT ALTITUDE
Dalton's Law
APPLIED GAS LAWSCELLULAR GAS EXCHANGE, DIFFUSION
Grahams's Law
APPLIED GAS LAWSOXYGEN TANK PRESSURE IN HEAT OR COLD
Gay-Lussac's Law
APPLIED GAS LAWSBP CUFF, ETT CUFF, MAST
Boyle's law IABP purges with ascent or descent
APPLIED GAS LAWSTRAUMA AND KINEMATICSHIGH VELOCITYMEDIUM VELOCITYLOW VELOCITY
High = above 2000F FPSMedium = 1000-2000 FPSLow = under 1000 FPS
TUMBLING YAW
Tumbling: rotation on 360 degree axisYaw: deviation up to 90 degrees from straight path
NORMAL VALUESCVP/RAPCARDIAC OUTPUTCARDIAC INDEXPULMONARY ARTERY SYSTOLIC/DYSTOLICWEDGE (PAWP/PCWP) SVR
CVP = 2-6CO: SV x HR (4-8 L/min)CI: 2.5-4.2PAS/PAD: 15-25/8-15PAWP/wedge: 8-12SVR: 800-1200 dynes/sec/cm-5When assessing CVP or PA, pressures on a mechanically ventilated patient, assess pressures at the end of exhalation
CHEST/ABD TRAUMACHEST TUBE LOCATION?NEEDLE THORACOSTOMY?SUSPECT WITH FRACTURE OF FIRST 3 RIBS?SCAPHOID ABDOMEN INDICATES?
Fourth IC space, anterior-axillary (chest tube)Second ICS midclavicular or the fifth ICS anteriormid-axillary line (needle thoracostomy)Aortic DisruptionDiaphragmatic rupture
HIGH RISK OBABRUPTIO PLACENTAPLACENTA PREVIATERBUTALINE DOSEDEFINE POSTPARTUMHEMORRHAGEUTERINE RUPTURE
Abruptio: dark red, painfulPlacenta previa: red, painlessTerbutaline: 0.25 SQPP hemorrhage: over 500 mLFetal parts can be palpated over abdomen
EFFECTS OF ALTITUDE WORSEN WITH:
Cold upper latitudes
GAY-LUSSAC'S LAWTWO COMPONENTS
Temperature increases and pressure increasesTemperature decreases and pressure decreasesEXAMPLE:oxygen tank pressure at 2200 in the afternoon, pressure drops to 1800 in the evening (temperature declined in the evening, pressure decreased)
UNIVERSAL LAW
Combines Boyle's and Charlie's laws
GRAHAM'S LAWDEFINITIONEFFECTS
Gas moves from high to low concentrationEXAMPLESgas through liquid, cellular gas exchange
HENRY'S LAW
gas in liquid proportional to gas above liquidEXAMPLES:"the bends" CO2 in blood, decompression
VOLUME OF GAS IN GI EXPANDS THRICE AT WHAT ALTITUDE?WHAT LAW EFFECTS THE GI THE MOST?
25,000 feetBoyle's law
CARDIOGENIC SHOCKCVPCARDIAC OUTPUTCARDIAC INPUTPAS/PADPAWPSVRHEART RATE
CVP: highCO: lowCI: lowPAS/PAD: highPCWP: highSVR: highHeart rate initially fast, then slows down
BOYLES LAWTWO COMPARTMENTS EFFECTS
increased volume = decreased pressureExamples:cuffs, MAST, GI, ETT, IABP
CHARLES' LAWTWO COMPONENTS EFFECTS
Temperature and volume proportional (increased temperature = increased volume)Up 100 meters = down 1 degree C
ENVIRONMENTAL1. PASSIVE REWARMING?2. ACTIVE REWARMING?3. WARM AND DEAD?4. HEAT STROKE
1. Mild hypothermia only. Up 1 degree C/hr with blankets, heater2. apply heat to body3. 32 degrees C4. over 42 degrees C
CLINICAL SIGNS1. GREY TURNER'S SIGN2. COOPERNAIL'S SIGN3. HALSTEAD'S SIGN4. CULLEN'S SIGN5. mURPHY'S SIGN6. LEVINE'S SIGN
1. Flank bruising (retroperitoneal bleeding)2. scrotum/labia (abdominal/pelvic bleeding)3. marbeled abdomen (bleeding)4. Umbilical discoloration (pancreatitis)5. RUQ pain with inspiration (gallbladder)6. Fist to chest "cluthing" (cardiac)
TYPES OF HYPOXIA1. HYPOXIC HYPOXIA2. HYPEMIC HYPOXIA3. HISTOTOXIC HYPOXIA4. STAGNANT HYPOXIA
1. Altitude hypoxia, decreased alveolar oxygen, tension pneumo (e.g., altitude)2. Decreased 02 carrying capacity in blood3. poisioning (e.g., nitrates)4. decreased cardiac output, poor circulation (e.g., g-forces, CHF)
High Risk OB1. Normal FHR2. factors fetal well-being3. Most important factor4. TX for fetal distress
1. 120-1602. FHR, fetal movement, variability3. variability4. LOCK: Left lateral recumbent, 02, correct contributing factors, keep reassessing
CHF considerationspreloadlab testmedications
many CHF patients are relatively hypovolemic. Careful with diuretics and mediations that can decrease preloadBNP= lab test nonspecific >500No beta-blockers, except for carvidolol (coreg)natractor (neseritide)= synthetic version of BNP
Primary cause of death with ventilator dependent patients
Ventilator acquired pneumonia
Digoxinclasscauses what electrolyte imbalanceECG changes
cardiac glycosidehypokalcemiaECG- "dig dip" ST depression
ARDStreatment CXR
PEEPCXR reveals widespread pulmonary infiltrates; glass like appearance
PEEPeffects of PEEPnormal physiological PEEP
PEEPincreased vascular resistanceCan cause hypotension over 15 cm H2ONormal range: 3-5 cm H2O
Treat HTN when BP?
Over 220 systolicMAP over
Dehydraion raises serum?
SodiumNormal sodium 135-145
Objective data?
ABCs, neurological assessment, Differential diagnosis for altered mental status: AEIOUTIPS
A.E.I.O.U.T.I.P.S.
A= AlcoholE= Electrolytes Encephalopathy ElectrolytesI: InsulinO: 0-2U: UremiaT: Toxidromes Trauma TemperatureI: InfectionP: Psych Pyphoria PharmacyS. Space occupying lesions Subarachnoid hemmorage Stroke Sepsis
Bowel sounds in chest cavity?Crunching sound heard over chest with auscultation, may be synchronized with heartbeat?
Bowel sounds heardDiaphragmatic upture most common in the left chestCrunching sounds heardassociated with tracheobronchial injury and is called hamman's sign
Preferred method for moving spinal injured patients
Scoop stretcher preffered rather then performing a log roll
Differential diagnosis1. Pulmonary contusion2. Ruptued diaphragm3. Tracheobronchial injury4. Esophageal perforation5. Fat embolus
1. low sats despite 02, rales2. chest/abd pain radiated to left shoulder3. Hemoptysis, sub-q air, air leak with chest tube, advanced ETT below level of injury into right mainstem4. fever, hematamesis5. fever, rash after fracture
Blood LossHumerusFemur
Humerus: 750 mLFemur: 1500 mL
PAWP/PCWPFunctionNormal
Pulmonary Artery Wedge PressurePulmonary Capillary Wedge PressureLooks at the left side of the heart, if high can indicate pulmonary congestion, CHF, and cardiogenic shockPAWP/PCWP: 8-12 mmHgDo not keep wedged for more than 15 seconds, make sure that balloon is deflated and have patient cough forcefully
ETT Depth
Adult: 3X ETT size or average is 19-23cmPeds: 10 + age in yearsNeonatal: 6 + age weight in kg
Ventilator miscellaneous1. To change CO22. To change oxygenation
1. adjust rate, TV2. adjust PEEP, PAP
BurnsRules of nines for adult and pediatricsParkland FormulaConsensus Formula
Know your rules of nines for both adult and pediatric patientsParkland: 4mL x kg x TBSA. 1/2 over 1st 8 hrs, rest over next 16Consensus: 2-4 mL x kg x TBSA. 1/2 over first 8 hrs, rest over next 16
Safety1. ELT frequency2. Confirm ELT working3. Twin engine required offshore
1. 121.52. Tune it in and listen3. Raft, vest
Drugs1.Induction agent of choice with bronchospastic patients2.Ativan: indication dose, max3. mannitol dose4. Drug choice for cyclic antidepressant OD5. Drug choice for beta-blocker OD6. Fentanyl dose7. Treatment for malignant hyperthermia8. Drug for GI b
1. Ketamine (ketalar)2. Lorazepam, seizures, 1-2 mg, max 4 mg3.1-2 g/kg4. Sodium bicarbonate 5. Glucagon6. Sublimaze (3ug/kg)7. dantrium (dantrolene)8. Sandostatin (octreotide)
Neurogenic shockCVPCardiac outputCardiac indexPAWP/PCWP "wedge"SVRHeart rate
CVP: downCO: downCI: downPCWP: downSVR: down (distributive shock)Heart rate can present as normal or slow
Arterial lineSitesPurpose
Radial, FemoralMonitor pressure, blood draw,ABG'smaintain pressure bag at 300 mmHgUnderdampening: caused by having air in the system, loose connection, a low pressure bag, and altitude changesOverdampening: caused by kinking, increased bag pressure, and tip against the wall
ECG1. Most common reperfusion dysrhythmia2. Most common hypothermia dysrhythmia3. Hypokalemia on ECG4. Hyperkalemia
1. Reperfusion: AIVR2. Hypothermia: VF, (osborn wave)3. Peaked P's, flat T's4. Flat P's, Peaked T's (treat with calcium)
MAP goal with CHICPP goal with increased ICP
MAP: 80-100CPP: 70-90
Normal ICPNormal CPP (head)Normal MAPNormal for the other CPP (heart)
ICP: 0-10CPP: 70-90MAP: 80-100Heart CPP: 50-60"your head is higher than your heart"
GCS Mild, Moderate, severe
GCS Mild: 14-15Moderate: 9-3Severe: 3-8
CPP (head) formulaMAP formulaCPP (heart) formula
CPP: MAP-ICPMAP: x 2 + systolic/3Heart CPP: DBP-wedge
Rotor-wing minimums ceiling/visibiltyday/localday/cross-countrynight/localnight/cross-country
day/local: 500 ft (ceiling) and 1 mile (visibility)day/x-country: 1000 foot Cceiling) and 1 mile (visibility)Night/local: 500 foot (ceiling) and 2 mile (visibility)Night/x-country: 1000 ft (ceiling) and 3 mile (visibility)
Number one cause of air medical crashes
Controlled flight into terrain, pushing the weather
lab values1. Normal potassium2. Normal sodium3. normal chloride4. normal calcium5. metabolic acidoses elevates?
1. 3.5-5.52. 135-1453. 95-1054. 8.5- 10.55. potassium
Time of useful conciousness with sudden decompression at:30,000 ft41,000 ft
30,000: 90 seconds41,000: 15 secondsleast amount of time is your answer on the exam
12 lead ECGInferiorSeptalAnteriorLateralPosterior
Inferior: II, III, aVfSeptal: V1, V2Anterior: V3, V4Lateral: I, aVL, V5, V6, Posterior: ST segment depression or reciprical changes noted in V1-V4, ST elevation in V6
CardiacIschemiaInjuryInfarct
Ischemia: ST depression (1mm in 2 leads)Injury: ST elevation (imm in 2 leads)Infarct: Q-wave >25% the height of the R wave
Pediatric age guidelinesETT cuffed versus uncuffedneedle cricothyrotomyNasal Intubation
"10, 11, 12" rulesUncuffed tube under 10Needle cricothyrotomy only under 11No nasal intubation under 12
High risk OB1.Primary cause of PTL2. terbutaline contraindications3. PIH triad signs
1. infection2. IDDM, maternal HR over 120, vaginal bleeding3. HTN, edema, proteinuria
O2 adjustments calculation to maintain saturation at altitude
% oxygen patient is already on X pressure at departure (mmHg)Pressure at altitudeThis equals percentage needed in flightexample:patient on FIO2 of 0.40Depart: 681 mmHgaltitude: 565 mmHgAnswer: patient needs 48% oxygen
Ventilator modesCMVACIMV/SIMV
CMV: preset volume or PIP at set rate: patient cant initiate breathAC: preset volume or PIP with every breath. Can trigger breath, cant control TVIMV: preset breaths, TV, PIP. patient breaths allowedSIMV: allows variation of support
IABP1. Action2. Deflates3. Dicrotic Notch
1. Increases cardiac output, coronary artery perfusion2. During ventricular systole3. aortic valve closing, synchronizedwith aline or ECG(most common trigger)
IABP1. Action2. Deflates3. Dicrotic Notch
1. Increases cardiac output, coronary artery perfusion2. During ventricular systole3. aortic valve closing, synchronizedwith aline or ECG(most common trigger)
IABP1. Signs and symptoms of balloon leak2. clot prevention3. IABP increases CO by4. Balloon rupture5. Migration/dislodged6. Lethal IABP timing cycles
1. blood specs in tubing, alarm2.cycle manually every 30 minutes3. 10-20%4. rusty flakes in line or turn machine off5. assess left radial pulse ine output6. late deflation and early inflation
Oxyhemoglobin disassociation curveleft curve
"L" stands for AlkalosisLeft shift = lowHemaglobin holding oxygen AlkalosisLow CO2Low temperatureLoe DPGMyxdema coma
Oxyhemoglobin disassociation curveRight Shift
"R" stands for raisedRight= raise/releases oxygenAcidosisRaised CO2Raised temperature Raised DPGThyroid storm
Phlebostatic axiswhere?what?
Where pressure measurements are made with an invasive lineFourth intercostal space, level of atria
Boyle's LawAcentDescent
AscentBarondontalgia toothache)Barosinutis can occur on ascentBariobariatrauma (obese) = Nitrogen in the fat cells can expand causing the "bends" administer high flow oxygen for 15 minutes prior to lift-off to remove nitrogenDescentBarotitis media (middle ear) can effect the patient during decent
Hypertensionmildmoderatesevere
Mild: 140-159/90-99MOderate: 160-170/100-109SEvere: 180/110
Volume for RBCadministrationVolume for WBC
RBC: 10 mL/kgWBC: 20 mL/kg
ABG rules1. CO2 and pH2. Bicarb and pH3. Bicarb replacement4. PaO2 at altitude
1. CO2 up 10= pH down .08(inverse)2. HC03 up 10 = pH up 15(proportional)3. kg/4 x base deficit = meq of bicarb needed4. PaO2 drops 5 for every 1000 feet elevation
Stages of HypoxiaElevationSigns or symptoms
Indifferent:(10,000 feet MSL):increased HR and RR, decreased night visionCompensatory: (10,000-15,000 feet MSL): HTN, task impairmentDisturance: (15,000-20,000 feet MSL): dizzy, sleepy, cyanosisCritical: (20,000-30,000 feet MSL): ALOC, incapacitated
Night vision lost at:
5,000' MSL
PA Catheter1. named?2. Proximal port is for?3. S/S of bad placement?4. Procedure for bad placement?5. Measures?6. Which port is used?Pressure bag set to?
1. Swan-Ganz2. CVP, medications3. VT, ventricular ectopy4. Float forward to PA or pull back to RA5. Right heart directly, left heart indirectly6. Distal port7. 300mmHg
Normal cardiac index
CI:2.5-4.3
Stressors of flight
1. third spacing2. fatigue3. g-forces4. noise5. vibration6. hypoxia7. dehydration8. temp changes9. barometric pressure changes
Personal factors affecting stressors of flight?
Deathdrugsexhaustionalcoholtobaccohypoglycemia
Dalton's law
Sum total of partial pressures equal to total atmospheric pressures (Daltons gang)examples:tissues swelling, altitude hypoxia, hypoxic hypoxiaThis is why 02 is needed at altitude
CardiacThrombolytics must be administered within?
Three hours of onset of chest pain
Diving injuriesATM
1 ATM for every 33 feet descentandAdd 1 if asking for a total ATM versus water pressure
Hypovolemic shockCVPCOCardiac index WedgeSVRHeart rate
CVP: downCO: downCI: downPAWP: downSVR: highHeart rate: fast
Acute respiratory failure
pO2, below 60, pCO2 above 50
Newton's Laws
First law: an object in motion tends to stay in motion...Second law: force= mass x accelerationThird law: every action has = and opposite reaction
Tetralogy of Fallot (TOF)
Remember PROVP = pulmonary stenosisR = right ventricular hypertrophyO = overriding aortaV = ventricular septal defect
What is a tet spell?
During a "tet" spell, blood flow across the right ventricular outflow tract is significantly decreased, resulting in shunting right-to-left through the VSD out of the aorta, thus bypassing the lungs. Causes include: spasms, sudden decrease in systemic vascular resistance secondary to hypovolemia, dehydration, hot weather, or defecation. tet spells are usually seen in the neonatal period, and peak in incidence between two and four months of life.
Atrial waveforms
"filling pressures"right atrial pressure (CVP)Left atrial pressure (PAWP/PCWP)
Ventricular waveforms
ight ventricular pressure obtained upon insertion of PA catheter or if the catheter has been dislodged backward into the right ventricle resulting in a right ventricular waveformLooks like VT, no dicrotic notch seen on the downslope of the right side of the waveformleft ventricular pressure measured during cardiac catheterization
Arterial waveforms
Arterial linesPulmonary artery pressure (PAP)Dictrotic notch seen n the downslope of the right side of the waveform
Waves
"A" wave = rise in atrial pressure as a result of atrial contraction"C" wave = not always visible on the tracing, rise in the atrial pressure which closure of the AV valves (tricuspid and mitral) buldge upward into the atriium following valve closure"V" wave = rise in atrial pressure as it refills during ventricular contraction
A WaveCorrelation to ECG
"A" wave generally coincides with the PR interval on the ECG in a right atrial pressure waveformIt will be slightly delayed in a left atrial pressure waveform
C WaveCorrelation to ECG
C wave generally coincides with mid to late QRS on the ECG in a right atrial pressure waveformIt will be slightly delayed in a left atrial pressure waveform
V WaveCorrelation to ECG
V wave generally seen immediately after the peak of the T wave on the ECG in a right atrial pressure waveformIt will be slightly delayed in a left atrial pressure waveform
Wave descents
Decline in right atrial pressure during atrial relaxation (remember "X" in relaXation)Decline in the right atrial pressure resulting from atrial emptying (remember "Y" in emptYing)
Breathing and waveforms
Record pressure measurements at the end of exhalationin a spontaneously breathing patient, inspiration is the fall in pressure, expiration is the rise in pressure. End-expiration occurs just prior to the respiratory drop in pressurePositive pressure mechanical ventilated patients will cause vardiac pressure to rise upon inspiration
Measuring waveforms
The end-diastolic pressure can be eatimated by identifying the "Z" pointA line is drawn from the end of the QRS to the hemodynamic tracing. The point where the line intersects with the waveform is the "Z" point. The "Z" point on the PAWP tracing will be delayed by 0.08-0.12 seconds from the QRS
Cardiac output
Heart rate x stroke volume = CO
Dicrotic notch
closure of the aortic valve
Neonatal
Maintains the PDA open = prostaglandin (PGEI)Closed the PDA = indomethacin and long term use of high oxygen delivery32 weeks or less in gestation = surfactantCommon cause of seizures = hypoglycemia Scaphoid abdomen = diapheretic hernia managed with orogastric tube and PPV
CPK >20,000
CPK (muscle enzyme) levels greater than 20,000 is ominous and is an indication of later DIC, acute renal failure and is potentially dangerous hyperkalemia in the heatstroke patient
Anion gap
Na - (CI + Bicarb/CO2)= AGNormal 12 + or - 4>16 indictes an underlying metabolic acidosisRemember "MUDPILES"MethanolUremiaDKAParaldehydeIsoniazide/IronLactateEthylene glycolSalicylate
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