FP-C cheat sheet

RSI induction: etomidate 0.3 mg/kg IV or ketamine 1.5-2 mg/kg IV; paralysis with rocuronium 1.2 mg/kg IV or succinylcholine 1.5 mg/kg IV.

Succinylcholine is contraindicated in hyperkalemia, burns or crush injury beyond 24-48 hours, denervation injury, and known or family history of malignant hyperthermia.

Rocuronium 1.2 mg/kg produces intubating conditions in about 60-90 seconds with paralysis lasting roughly 45-60 minutes.

Continuous waveform capnography is the gold standard for confirming and continuously monitoring endotracheal tube position.

DOPE for post-intubation deterioration: Displacement, Obstruction, Pneumothorax, Equipment failure.

Average adult tube depth is 21 cm in women and 23 cm in men at the incisors; uncuffed pediatric size = (age in years / 4) + 4.

Needle decompression for tension pneumothorax: 2nd intercostal space midclavicular line or 4th-5th intercostal space anterior axillary line.

Preoxygenation with 100% oxygen for 3-5 minutes plus apneic nasal cannula oxygen at 15 L/min lengthens safe apnea time.

Surgical cricothyrotomy is the adult rescuer airway when intubation fails; transtracheal jet insufflation is preferred in small children.

Glasgow Coma Scale: eye 1-4, verbal 1-5, motor 1-6; total 3-15, and a score of 8 or less indicates coma requiring airway control.

Shock index = heart rate divided by systolic blood pressure; a value above 0.9 suggests occult hypoperfusion in adults.

ST-elevation MI: at least 1 mm in two contiguous limb leads; V2-V3 thresholds are 2 mm in men 40 and older, 2.5 mm in men under 40, and 1.5 mm in women.

FAST windows: subxiphoid pericardial, right upper quadrant perihepatic, left upper quadrant perisplenic, and suprapubic pelvic views.

Lactate above 2 mmol/L or an elevated base deficit indicates hypoperfusion and occult shock.

Pulse oximetry reads falsely high with carboxyhemoglobin and falsely low with methemoglobin, poor perfusion, motion, and dark nail polish.

Normal end-tidal CO2 is 35-45 mmHg; a sudden sustained drop suggests disconnection, obstruction, low cardiac output, or arrest.

Pediatric systolic hypotension: less than 70 + (2 x age in years) for ages 1-10; less than 60 mmHg in a term neonate.

Boyle's law: at constant temperature, gas volume is inversely proportional to pressure, so trapped gas expands as altitude increases.

Dalton's law: total gas pressure equals the sum of partial pressures, so falling barometric pressure lowers oxygen partial pressure.

Henry's law: the amount of gas dissolved in a liquid is proportional to its partial pressure, explaining nitrogen bubble formation in decompression sickness.

Most pressurized air medical cabins are held near 8,000 feet, where ambient oxygen partial pressure is roughly 25 percent lower than at sea level.

Decompression sickness treatment: 100% oxygen, descent to lower altitude, immobilization, and hyperbaric recompression.

Gas-filled devices expand with altitude: endotracheal tube cuffs, air splints, pneumatic antishock garments, and balloon catheters require pressure adjustment.

Altitude hypoxia presents with tachypnea, confusion, and tachycardia; cyanosis is a late sign, and an SpO2 below 90 percent at altitude indicates a need for oxygen.

Cabin noise commonly reaches 80-95 dB, degrading auscultation and radio communication and increasing crew fatigue.

Tension pneumothorax is treated with needle decompression followed by tube thoracostomy; positive pressure ventilation worsens the condition until decompressed.

Beck's triad of hypotension, jugular venous distension, and muffled heart sounds suggests cardiac tamponade.

Nitroglycerin is withheld in suspected right ventricular infarction, systolic pressure under 90 mmHg, and within 24-48 hours of PDE5 inhibitor use.

Severe asthma: albuterol, ipratropium, systemic corticosteroids, and magnesium sulfate 2 g IV over 20 minutes, watching for hypotension.

COPD oxygen target is SpO2 88-92 percent; cardiogenic pulmonary edema is managed with CPAP, nitrates, and diuretics.

Pulmonary embolism presents with acute dyspnea, pleuritic pain, tachycardia, hypoxemia, and a low end-tidal CO2.

Aortic dissection: tearing chest or back pain with a pulse deficit or interarm systolic pressure difference greater than 20 mmHg.

Flail chest with respiratory failure may require positive pressure ventilation, which splints and stabilizes the flail segment.

Pelvic fracture can bleed 2-3 L; a pelvic binder is applied at the level of the greater trochanters.

Femur fracture blood loss is 1-1.5 L; traction splinting reduces bleeding, pain, and muscle spasm.

Tourniquet: 2-3 inches proximal to the wound, never over a joint, tightened until bleeding stops, with application time documented.

Compartment syndrome early signs are pain out of proportion, pain with passive stretch, and paresthesia; pulselessness is a late finding.

Amputated part: wrap in saline-moistened gauze, seal in a plastic bag, then place the bag in ice water, never directly on ice.

Crush injury risks rhabdomyolysis, hyperkalemia, and renal failure; management includes volume replacement and cardiac monitoring.

Hypotension (SBP under 90 mmHg) and hypoxia each roughly double mortality after traumatic brain injury.

Open fracture management: cover the wound, immobilize, and give antibiotics and tetanus prophylaxis per protocol.

Uncuffed endotracheal tube size = (age in years / 4) + 4; cuffed size = (age / 4) + 3.5.

Neonatal resuscitation with an advanced airway uses a 3:1 ratio, delivering 90 compressions and 30 breaths per minute.

Neonatal compressions begin when the heart rate stays below 60 per minute after 30 seconds of effective ventilation.

Two-rescuer pediatric CPR uses a 15:2 compression-to-ventilation ratio; a single rescuer uses 30:2.

Pediatric epinephrine: 0.01 mg/kg IV/IO of 1:10,000; 0.1 mg/kg of 1:1,000 via the endotracheal tube.

Pediatric defibrillation: 2 J/kg for the first shock, 4 J/kg for subsequent shocks.

Hypotension in children 1-10 years is SBP below 70 + (2 x age); below 60 mmHg in term neonates.

Children have proportionally larger heads, shorter airways, and compliant chest walls, so excessive head tilt can occlude the airway.

A Glasgow Coma Scale score of 8 or less warrants definitive airway management.

Cushing's triad: hypertension with widened pulse pressure, bradycardia, and irregular respirations indicates rising intracranial pressure.

Target PaCO2 in brain injury is 35-40 mmHg; hyperventilation to 30-35 mmHg is reserved for signs of active herniation.

Status epilepticus: benzodiazepine first (midazolam 0.2 mg/kg IM or lorazepam 0.1 mg/kg IV), then a longer-acting anticonvulsant.

Acute ischemic stroke thrombolysis window is up to 4.5 hours from last known well; blood pressure must be below 185/110 mmHg before lysis.

Neurogenic shock: hypotension with bradycardia after spinal cord injury; treated with fluids, vasopressors, and atropine for bradycardia.

Fixed and dilated pupils indicate brainstem herniation; pinpoint pupils suggest opioid toxicity or pontine injury.

Head elevation of 30 degrees with the head midline promotes venous drainage and lowers intracranial pressure.

Sterile cockpit: nonessential conversation and tasks are suspended during taxi, takeoff, approach, and landing.

Weight and balance must be computed before flight; exceeding center of gravity limits degrades performance and controllability.

Equipment is secured to withstand crash loads on the order of 25 g; unrestrained items become lethal projectiles.

Oxygen duration formula: cylinder factor x gauge pressure / flow rate = minutes of oxygen remaining.

Pre-transport check confirms battery charge, oxygen quantity, drug bag, suction, and communication with the receiving facility.

SBAR (Situation, Background, Assessment, Recommendation) is the standard structured clinical handoff.

Pneumothorax and recent abdominal or bowel surgery require gas volume assessment before flight because trapped gas expands with altitude.

Crew resource management relies on assertiveness, closed-loop communication, and post-mission debriefing.

Push-dose epinephrine: 1 mL of 1:10,000 epinephrine in 9 mL saline yields 10 mcg/mL; boluses are 0.5-2 mL for hypotension.

Amiodarone: 300 mg IV/IO for pulseless VF/VT after the third shock; 150 mg over 10 minutes for stable VT with a pulse.

Naloxone 0.04-0.4 mg titrated to restore adequate respiration rather than full consciousness.

Dopamine 5-20 mcg/kg/min and norepinephrine 0.05-0.5 mcg/kg/min are used for vasodilatory shock.

Ketamine 1-2 mg/kg IV for RSI and 0.1-0.3 mg/kg IV for analgesia, with bronchodilation preserved.

Dextrose dosing: D10 at 5 mL/kg in children and D50 25 g in adults, with glucose recheck after administration.

Lidocaine 1-1.5 mg/kg IV, with reduced dosing in hepatic dysfunction and heart failure.

High-alert medications (vasopressors, insulin, anticoagulants, paralytics) require independent double-check and infusion pump delivery.

Shock categories: hypovolemic, cardiogenic, distributive, and obstructive.

Permissive hypotension (SBP 80-90 mmHg) applies to penetrating trauma without traumatic brain injury.

Damage control resuscitation uses balanced 1:1:1 red cells, plasma, and platelets with minimal crystalloid.

Adult cardiac arrest: epinephrine 1 mg every 3-5 minutes; amiodarone 300 mg after the third shock in refractory VF/VT.

Defibrillation: biphasic 120-200 J per manufacturer recommendation, or monophasic 360 J.

Reversible causes: hypovolemia, hypoxia, hydrogen ion, hypo/hyperkalemia, hypothermia, tension pneumothorax, tamponade, toxins, pulmonary thrombosis, coronary thrombosis.

Post-ROSC targets: SpO2 94-98 percent, PaCO2 35-45 mmHg, MAP at least 65 mmHg, and targeted temperature management 32-36 C.

Septic shock: 30 mL/kg crystalloid, lactate measurement, and antibiotics within the first hour.

Class III hemorrhage (30-40 percent blood loss) presents with hypotension, tachycardia, tachypnea, and altered mental status.