Flight Crew Buddy

REFERENCE — NOT A PROTOCOL BINDER

What we train to.

Summaries of AHA 2025, SSC 2026, SCCM RSI, Hamilton T1 strategy, and CCT classics. Your medical director owns the real book. This page exists so the simulator's scoring is not a mystery.

AHA 2025 — Adult ALS

  • IV access is first-line for arrest drugs; IO if IV is not feasible.
  • Shockable rhythms: defibrillate first. Epinephrine after initial shocks have failed — not before the first shock.
  • Amiodarone or lidocaine remain the antiarrhythmics for shock-refractory VF/pVT. Vasopressin is not a substitute for epinephrine.
  • Do not use ETCO2 in isolation to terminate resuscitation.
  • Post-ROSC: MAP ≥65 mmHg in adults. Avoid hypoxia and hypotension.
  • AF cardioversion: initial energy ≥200 J is preferable.

SSC 2026 — Sepsis & septic shock

  • Septic shock: antimicrobials immediately, ideally within 1 hour of recognition.
  • Probable/definite sepsis without shock: also immediately, ideally <1 hour.
  • Possible sepsis without shock: rapid investigation; antimicrobials within 3 hours if concern persists.
  • Norepinephrine is first-line over dopamine, epinephrine, or selepressin. Add vasopressin when escalating.
  • Measure lactate; serial lactate (or cap refill) to guide resuscitation.
  • Balanced crystalloid. Do not delay pressors for a mythical full 30 mL/kg if the lungs are already wet.

RSI — SCCM / CCT practice

  • Always pair a sedative-hypnotic with an NMBA.
  • Rocuronium 1.2 mg/kg IBW or succinylcholine 1.5 mg/kg TBW. Avoid succs in hyperK, burns >24h, NMD.
  • Shock: reduce induction dose, increase paralytic, have a push-dose / norepi running.
  • Ketamine 1–2 mg/kg or etomidate 0.3 mg/kg. Confirm with waveform ETCO2 — not by chest rise alone.

Hamilton T1 — protective vs obstructive

  • IBW first. Adult male 50 + 2.3×(in−60). Target 6–8 mL/kg IBW.
  • Protective / ARDS: PCV+ or ASV 100–120% MinVol, PEEP/FiO2 table, Pplat <30, driving pressure <15, SpO2 88–95%.
  • Obstructive: slow rate (8–12), long Te, disconnect and compress if auto-PEEP crashes MAP.
  • ASV 100% MinVol ≈ 100 mL/kg IBW/min. P-ASV limit 30 in normals.
  • Altitude: unpressurized rotor at 5–8,000 ft drops PiO2. Ask for a lower level-off in ARDS.

STEMI / RV infarct

  • 12-lead in <10 minutes. Inferior STE — obtain V4R before nitrates.
  • RV infarct: preload dependent. No nitro. 250–500 mL then norepinephrine.
  • Aspirin 324 mg if not given. Heparin / PCI activation per medical direction.

TBI / herniation

  • No hypoxia, no hypotension (adult SBP >100). ETCO2 ~35.
  • HOB 30, head midline, collar loose enough for venous drainage.
  • 3% saline 250 mL (2–5 mL/kg) for blown pupil. Hyperventilation is a minutes-long bridge.

Hemorrhage / PPH / trauma

  • TXA 1 g within 3 hours (CRASH-2 / WOMAN).
  • Blood > crystalloid once class III. Keep warm.
  • Tension: needle, then finger/tube. Don't RSI a tension.
  • PPH: fundal massage, oxytocin, TXA, blood.

HyperK

  • Calcium chloride 1 g for wide QRS / sine wave — membrane, not a shift.
  • Then insulin + D50, albuterol, bicarb if acidotic. Dialysis is the sink.
  • Never succinylcholine.