EKG Right Patient Right Date Rate Rhythm Axis Interval- PR <0.2, QRS <0.12, QT <0.4 ST elevation <1mm

Transcription

1 X- Ray Right Patient Right Date A- Airway/midline, Body Rotation, Carina B- Lung fields, including borders C- Cardiac silhouette <1/2 thoracic width, mediastinum width D- Diaphragm/costophrenic angles sharp E- Everything else! Rib fractures, lung expansion normal 8-9th rib Pneumo, Edema, Density (degree of white) Opacities- diffuse or localized? Where? EKG Right Patient Right Date Rate Rhythm Axis Interval- PR <0.2, QRS <0.12, QT <0.4 ST elevation <1mm Inotropes mcg/kg/min mcg/ml = mls/hr Amiodarone 150mg over 10min IV 360mg over the next 6hours Dobutamine 2-20mcg/kg/min é BP, ê O2 consumption Dopamine 2-20mcg/kg/min é BP, é CO Epinephrine mcg/min é BP and HR Lidocaine 2-4mg/min Antiarrhythmic,é HR Nitroglycerin 10-50mcg/min ê BP and CP Nitroprusside mcg/min ê BP Norepinephrine 0.1-2mcg/kg/min é BP and HR Discuss with Medical PGE Control Keeps PDA open Vasopressin <40KG units/kg/min é BP >40KG DI units/min units/kg/hr

2 Drug How to Mix Concentration Epinephrine 4mg in 250ml D5 16mcg/ml Neo 10mg in 500ml D5 or NS 20mcg/ml Nitro 50mg in 250ml D5 200mcg/ml Norepinephrine 4mg in 250ml NS 16mcg/ml Drug Pump Default Pump Conc LM Conc Pump CHANGE Dobutamine 2000mcg/ml 500mg/250ml 250mg/ 250ml 1000mcg/ml Dopamine 1600mcg/ml 400mg/ 250ml Premixed bag Same Epinephrine 16mcg/ml 4mg/250ml 4mg /250ml Same Heparin 50units/ml 25K unit/500ml 25K unit/ 500ml Same Nitro 200mcg/ml 50mg/ 250ml 50mg/ 250ml 200mcg/ml Norepi 16mcg/ml 4mg/250ml 4mg /250ml Same Sedation Bolus Adult Frequency Pediatric Frequency Fentanyl mcg q30min 1-3mcg/kg q20min Versed 1-2.5mg q5min mg/kg q30min Morphine 2-5mg q5min mg/kg q30min Sedation Drips How to mix.. Infuse At Fentanyl 200mcg (4ml) in 16ml NS= 10mcg/ml 1-3mcg/kg/hr 50mcg (1ml) in 4ml NS= 10mcg/ml Versed 1mg/ml mg/kg/hr Propofol Premixed 10mg/ml mcg/kg/min Narcan 0.4mg in 9ml NS= 40mcg/ml Intubation Supplies Pre- Oxygenate if possible BVM with appropriate mask Oral and/or Nasal Airway Laryngoscope and blade Appropriate ETT and 1 size smaller King or LMA Know where cric kit is Suction with appropriate attachments ETCO2 monitor Tube Tamer RSI Medications Fentanyl Etomidate Succ Vec Dose mcg/kg 0.3mg/kg 1-1.5mg/kg 0.1mg/kg

3 Prior To L- Look external E- Evaluate the M- Mallampati O- Obstruction N- Neck mobility After D- Dislodged/Displaced O- Obstruction P- Pneumo E- Equipment Class I (easy)- visualization of the soft palate, fauces, uvula, anterior and posterior pillars. Class II- visualization of the soft palate, fauces and uvula. Class III- visualization of the soft palate and the base of the uvula Class IV (difficult)- soft palate is not visible at all. Pediatrics How to estimate weight: 2x(age in years) + 8 Isolette Max: 5.5kg/12lbs SBP (low) Neo: 50-60mmHg >6mo: x (age in years) ETT- LifeMed cuffed ETT size the same as uncuff SIZE (ID mm): Term- 6mo: 3.5 6mo- 1yr: >1yr: (16 + age in years) Insert Depth: 3x tube size Suction/Urinary Cath Size: 2 x ETT size OG/NG Size: 3 x ETT size Chest Tube Size: 4 x ETT size 4 Maintenance IVF (ml/hr) 1-10kg: 4ml/kg 11-20kg: ml for each kg >10kg >20kg: ml for each kg >20kg

4 Phone List Anchorage Orange Medi Orange Nurs Blue Medic Blue Nurse Fairbanks Medic Nurse Soldotna Medic Nurse Wolf Lake Medic Nurse Bethel Day Medic Night Medic Hangar PAMC ED PICU NICU ANMC ED ARH ED MSRMC ED FMH ED CPH ED YKHC ED

5 EMS Charts Description Aircom Label Received Call Started Call Started Dispatched Notified Med Crew called Dispatched FW door seal BOF depart hangar En route FW wheels up BOF leave En route On Scene FW landing BOF arrive at Arrive at Pt. location referring facility At Pt. Bedside Leave with Pt. Leave bedside Depart Ref Lift off w/ Pt. Lift off w/ Pt. Arrive Rec Landing w/ Pt. Arrive at Pt. location Xfer Care At receiving bedside BOF: Base Originating Flight Preflight Briefing Seatbacks in Upright Position No Smoking Seatbelt Operation Emergency Exit Survival Equipment O2 Mask Fire Extinguishers Radio Operations Com 1: ATC/FAA Com 2: ATC/FAA FM1: FM Radios; LG base 9G base Seward Glennallen/Crossroads Statewide EMS Pilot Controls Frequency FM2: 800 radio; repeater zones; Knik Girdwood Anchorage To Reachj Hospital ED's Girdwood VFD Chugiak VFD Hope VFD Nurse Controlled Frequency: Sat phone 1111 access code. Then 001 area code # ICS knob: adjust intercom system volume. Large volume knob: 800 freq volumes.

6 Fetal Heart Rate Monitoring Normal HR bpm Baseline: Range +/- 5pbm over baseline Baseline Variability: Irregular fluctuations >2 cycles/min Absent/Minimal/Moderate/Marked Long Term Variability: Small fluctuations Accels: Abrupt increased, 10bpm above baseline onset- peak <30seconds Prolonged Acceleration: >2min, <10min Early Decels: Gradual decrease (0- nadir >30s) minor/associated w/ contraction, caused by head compression, cervix 4-7cm Late Decels: Gradual Decrease (0- nadir >30s) associated with contraction, contraction peak before deceleration of nadir BAD! Uteroplacental insufficiency Treatment: Position change, IV bolus, O2 Variable Decels: Abrupt decrease (<30s) Change >15s, <2min, V for Variable Cord compression, Treatment: Position change Prolonged Deceleration: >15pbm, 2-10min Hyper Stimulation: >5contraction in 10min OB/Maternal Patients Gestation wks Gravida Para. Fetal Movement Y N Contractions/Pain Y N Frequency Vaginal Bleeding Y N ROM/Leaking Y N Tocolysis Y N Prenatal care Y N Vitals- B/P! Labs- watch liver enzymes, think HELP syndrome PIH- HA, Changes in Vision, Reflexes (hyper w/ pre- ecp), clonis

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8 Revel Vent Pedi Tubing <20kg, Peds Setting (NEVER NEO) Adult Tubing >20kg, Adult Setting Vent Settings: If currently on vent, mimic settings to start TITRATE PC or TV to achieve adequate chest rise <12kg MUST use PC MODE (<100ml TV) IF pt does NOT tolerate PC on same settings check your rise time & look at exhale volume! Decrease your rise time! PRVC: Always set a volume first. Look at PIP and match Don't use sever ARDS b/c you want high fixed airway pressures Volume limitè look at exhale volume and min ventilation Decrease volume & increase rate to achieve same min ventilation SVHP alarmè high pressure check line occlusion Non- Invasive Positive Pressure (CPAP) 4 easy steps 1) Close ports on mask. Start IPAP 4 below: >12 by 4, <12 by 2 2) Turn low pressure and low min volume off 3) Vent contorlè rise timeè 2 (how fast flow goes into mask) 4) Vent contorlè flow terminationè 40 (stops flow to exhale, allows for faster exhale the higher the #) 5) Ativan, calm your patient! Goals PIP <30 (may be higher due to pathology) Tve 6-10ml/kg and CHEST RISE! FiO2 for Sat >92% or per protocol EtCO or per protocol Itime I:E 1:2 or 1:3 (with high rates 1:1) Change Oxygenation FiO2 PEEP PC or TV Itime (last choice) Change Ventilation Rate TV Alarms: Pediatrics +/- 5 of PIP Adults +/- 10 of PIP PEEP Defaults High 11 Low 3 Set high 5 above set PEEP

9 Age PC VC ml/kg PEEP Rate bpm Itime sec PS <5kg yr yr yr Adult