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459 Cards in this Set
- Front
- Back
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ADH is formed in the ------------
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Hypothalamic supraoptic nuclei
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ADH is stored in the -------------
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Posterior Pituitary
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ADH release is stimulated by:
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Increased Serum Osmolarity, Anesthesia/Analgesics, Stress/Pain
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S/S of SIADH:
1. 2. 3. |
Increased Urine Osmolarity
Decreased Serum Sodium Decreased Serum Osmolarity |
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ADH works on the --------
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Distal convoluted and collecting tubule of the kidney to reabsorb water, thus concentrating urine.
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Normal Serum Osmolarity ------
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275-295 mOS/L
Osmol = 2(NA) + BUN/5 + GLU/20 |
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Treatment for SIADH:
1.) --------- 2.) -------- 3.) -------- |
1.) Fluid Restriction
2.) 3% NaCl (increase Na) 3.) Lithium/Phenytoin (inhibits ADH) |
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Causes of SIADH:
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Cancer and Chemotherapy
(Oat Cell Carcinoma, Prostatic, Pancreatic) Viral PNA Brain problems |
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Observe for ST depression/angina or abdominal cramps (mesenteric ischemia) with the administration of:
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ADH = Vasopressin = Pitressin
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DI results from:
1.) ------------- 2.) ------------ 3.) ------------ |
1.) Head Trauma
2.) Dilantin 3.) Hypophysectomy |
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Diabetes Insipidus is caused by ------------
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- decreased levels of ADH
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Complications of DI include:
1.) ---------- 2.) ---------- |
1.) Dehyrdation / Hypernatremia
2.) Hypovolemic Shock |
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S/S of DI:
1.) --------- 2.) --------- 3.) --------- 4.) --------- |
1.) Decreased SpGr 1.000-1.005
2.) Increased Serum Osmolarity 3.) Increased Serum Sodium 4.) Increased UOP |
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An ABG of a DKA patient shows
CO2 levels are ------- due to -------- ---------- stimulated by the state of acidosis. |
1.) Decreased
2.) Kussmaul Respirations |
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Acidosis with DKA causes a shift of cellular ------- into the serum.
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potassium
(a good sign in DKA) |
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5 Risk Factors for HHNK:
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1.) Elderly
2.) Diet-controlled diabetics 3.) Steroid usage 4.) TPN usage 5.) Pancreatitis |
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S/S of HHNK:
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Severe Dehydration (brain)
Shallow Respirations Increased NA, GLU, BUN resulting in a hyperosmolar state. |
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This drug can mask the CVS signs of hypoglycemia: -----------
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Propanolol (Inderal)
--Beta-blocker |
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HHNK causes ______ respirations
DKA causes ____ and _____ respirations. |
shallow
deep, rapid (Kussmaul Respiration) |
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Hypotonic Solutions push fluid
________ |
- into the cell.
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Hypertonic Solutions push fluid
_________ |
- out of the cell and into the intravascular space
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Hypotonic Solutions:
1.) ______ 2.) ______ 3.) ______ 4.) ______ |
1.) 0.23-0.45 NS
2.) D5 1/4 NS 3.) D2.5W 4.) D5W |
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Isotonic Solutions:
1.) _____ 2.) _____ |
1.) NS
2.) LR |
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Hypertonic Solutions:
1.) ________ 2.) ________ 3.) ________ |
1.) D5NS
2.) D51/2NS 3.) D5LR |
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The somogyi effect is : ______
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- rebound hyperglycemia d/t stress hormone release in response to insulin-induced hypoglycemia.
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Symptoms associated with a rapid decline in blood sugar are due to release of _______.
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- Epinephrine
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When the GLU falls below 250 in the DKA PT switch fluids from NS to______ to prevent ______ _____.
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- D51/2NS
- cerebral edema |
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Temperature controlled by ______
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- Hypothalamus
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Normal ICP
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0-10
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Mildly Elevated ICP
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10-15
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Moderately Elevated ICP
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15-20
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Ways to decrease ICP:
1.) _______ 2.) _______ 3.) _______ |
1.) HOB 15-30
2.) Mannitol 3.) Hyperventilate to maintain CO 25-30...causes alkalosis/vasoconstriction |
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CSF is formed in the _________
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- choroid plexus
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CSF is reabsorbed in the _______
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- aracnoid villi
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______ solutions are contraindicated in PTs with increased ICP.
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-Hypotonic
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The primary cause of HHNK is related to a markedly elevated ______ _______.
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serum glucose
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Epidural bleed is caused by a:
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skull fracture affected the meningeal artery.
Look for an UNCAL herniation(change in pupil first). |
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Venous head bleed
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Subdural Hematoma
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Arterial head bleed
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Epidural Hematoma
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_____ percent of the population has unequal pupil size (*1mm) without the presence of pathology.
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17
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Damage to the upper motor neurons causes ________.
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spasticity
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Damage to the lower motor neurons causes ________.
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flaccidity
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Decorticatation
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Flexion towards the core, caused by damage above the brain stem.
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Decerebration
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Extension away from the core, caused by damage to the brain stem.
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A decreased LOC relates to damage to the the _______ ______ _______.
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Reticular Activating System (RAS)
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Dolls Eyes/Oculocephalic Reflex
Involves 3 Cranial Nerves: |
Eyes stay midline when the head is turned. Indicates brain stem integrity.
CN 3,6,8 |
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Glasgow Coma Scale
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Eye Opening, Verbal Response, and Motor Response
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GCS Eye Opening
1-4 |
4. Spontaneously
3. To Speech 2. To Pain 1. None |
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GCS Verbal Response
1-5 |
5. Oriented 1. None
4. Confused 3. Inappropriate 2. Incomprehensible |
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GCS Motor Response
1-6 |
6. Obeys Commands 2.Extension
5. Localises Pain Pain 4. Withdrawls Pain 1. None 3. Flexion Pain |
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Parasympathetic Response to
CN III |
Pinpoint Pupils
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Sympathetic Response to CN III
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Dilated Pupils
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Pressure increase on the midbrain will decrease _____ ______ to CN III and cause _____ ______.
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Parasympathetic Response
Dilated Pupils |
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Babinski Reflex
-fanning of the toes (abnormal finding in adults) |
-indicates pressure on pyramidal/motor tracts in cerebrum
-found on opposite side of injury |
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After 12 hours of symptoms a concussion is termed a ________.
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contusion
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S/S of a basilar skull fracture:
1-5.) |
Raccoon Eyes & Battle Sign
Rhinorrhea & Otorrhea No sense of smell (CN I) |
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Immediate treatment for a rhinorrhea/otorrhea:
1.) 2.) |
1.) Elevate HOB
2.) Apply dry sterile dressing (observe otorrhea for halo sign) (test rhinorrhea for dextrose) |
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Drug prescribed to alleviate risk of a rebleed of a cerebral aneurysm
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Aminocaproic Acid (Amicar)
-slows the breakdown of clots (highest risk up to 10 days post) |
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Grade I-II Cerebral Aneurysm
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awake with slight to moderately severe headache and neck stiffness
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Grade III Cerebral Aneurysm
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drowsiness and confusion
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Left sided CVA S/S:
1.) 2.) 3.) |
1.) Right sided weakness
2.) Aphasia 3.) Right homonymous hemianopia |
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Cerebral Perfusion Pressure
Normal CPP |
CPP = MAP- ICP
MAP =DBP + 1/3(SBP-DBP) 60-80 mm Hg |
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Right sided CVA S/S:
1.) 2.) 3.) |
1.) Left sided weakness
2.) Problem with depth perception 3.) Left homonymous hemianopia |
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Carbon Dioxide effects ICP by:
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-increased CO2 causes vasodilation which in turn causes increased ICP
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Treatment for DKA
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Insulin Drip and IVF
(Isotonic to Hypotonic to Hypertonic) |
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Adrenal medulla
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releases adrenaline which causes the liver to convert glycogen into glucose
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Azotemia
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a temp increase in nitrogen compounds (BUN, Creatinine) caused by dehydration, associated with HHNK
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Cerebral Vascular Accident (CVA)
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caused by an ischemic (TIA, RIND, or CI) or a hemorrhagic event (aneurysm)
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Transient Ischemic Attack (TIA)
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up to 24 hours
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Reversible Ischemic Neurological Deficit (RIND)
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greater than 24 hours
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Cerebral Infarction (CI)
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Permanent loss
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Uncal Herniation
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Lateral shifting of the brain,
Ipsilateral dilated pupil Contralateral Babinski Reflex No change in LOC |
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Supratentorial Hernation
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Downward shifting of the brain; causing change in LOC, then dilated pupils and Cushing's Reflex
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Central Cord Syndrome:
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- (greater upper) motor loss and varying sensory loss, usually caused by compression type injuries
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Brown Sequard Syndrome:
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- ipsilateral motor loss and contralateral sensory loss caused by hemi-section of the spinal cord
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Cushing's Triad/Reflex:
1.) 2.) 3.) |
1.) Increased SBP (Widening Pulse Pressure)
2.) Decreased HR 3.) Decreased RR |
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Bacterial Meningitis:
Common Agent- Protein/Glucose- S/S- |
Staph Aureus
Markedly increased protein Decreased Glucose Purulent CSF & ^ Leukocytes |
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Viral Meningitis:
Common Agent- Protein/Glucose- S/S- |
Enterovirus & Herpes
Slightly increased protein Normal Glucose Clear CSF & ^ Lymphocytes |
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Normal opening LP pressure:
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80-180 mm H2O
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Signs associated with Meningitis:
Nuchal rigidity, Brudinski's sign, and Kernig's Sign |
Brudinski: flexing the neck causes pain and flexion of the hip
Kernig: flexing thigh at waist causes neck pain |
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Spinothalamic tract:
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pain and temperature tract.
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Pontine Lesions
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causes apneustic breathing and pinpoint pupils (that react to light if viewed with a magnifying glass).
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Midbrain Lesions
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causes hyperventilation
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Normoactive Bowel Sounds
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5-34
-must listen for 5 minutes per quadrant. |
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Complication of Neomycin therapy:
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Kills enteric vitamin producing bacteria resulting in a vitamin deficiency.
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4 things to avoid with elevated ICP:
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1.) Acidosis (causes vasodilation)
2.) Hypotonic IV (cerebral edema) 3.) Hyper-extension/Flexion 4.) Decreased Protein Intake |
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Level of diaphragmatic breathing innervation:
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Below C4
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Lesion level of quadriplegia
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Below C5
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Autonomic Reflexia/Spinal Shock:
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-loss of autonomic nervous control & sensation, causes areflexia and flaccid paralysis, HTN, decreased HR & RR, urinary retention
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Guillain Barre Syndrome (GBS) :
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AI process that causes demyelination of spinal nerve roots with edema. Starts distally and ascends symetrically
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Four findings with GBS:
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Ascending Paralysis with return of distal function, urinary retention,
Increased protein in CSF, and No change in LOC |
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Precipitating factors for MG
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stress, illness, menstruation, and drugs (quinidine, gentamycin, procainimide)
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Myasthenia Gravis (MG)
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-autoimmune disorder of neuromuscular transmission to voluntary muscles which improves with rest
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S/S of MG:
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fatigability
ptosis (drooping eyelid) hoarseness / difficulty swallowing laryngospasm |
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Pharmacological treatment for status epilepticus.
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Diazepam (Valium) & Phenytoin (Dilantin)
***Dilantin does not actually stop seizure activity. |
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Anti-seizure medications:
-Diazepam (Valium) -Phenobarbital (Luminal) -Lorazepam (Ativan) |
Valium 0.2mg/kg @ 5mg/min
Luminal 5-8mg/kg @ 60mg/min Ativan 0.1mg/kg @ 2mg/min |
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Cranial nerves responsible for the gag reflex:
1.) --------------- 2.) --------------- |
1.) CN IX Glossopharyngeal
2.) CN X Vagus |
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Two side effects of atropine administration include:
1.) 2.) |
1.) Dilated Pupils
2.) Tachycardia |
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The single most important index of neurological status is ______.
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Level of Consciousness (LOC)
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Recommended pain control drug in Pancreatitis is _______.
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Meperidine (Demerol) because it was believed that morphine would affect the Sphincter of Odi
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Worst headache ever...
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Subarachnoid hemmorrhage; bleeding in between brain and meninges
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Kupper Cells:
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-found in the liver, detoxify the blood at a rate of 1.5 Lpm
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Most common cause of death from Pancreatitis is _______.
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ARDS
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Causes of Pancreatitis:
(auto-digestion of the pancreas) |
- obstruction of ducts (gallstones, infection), alcoholism, drug toxicity (cyclosporines, steroids, thiazides, tetracyclines) or trauma
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(change in) pH in relation to (change in) K+
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increase in pH of 0.1
= decrease of K+ of 0.6 |
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Grade IV Aneurysm
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Stuporous; moderate to severe hemiparesis; possibly early decerebrate rigidity
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Grade V Aneurysm
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Deep coma; decerebrate rigidity
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Grade VI Aneurysm
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Dead
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Grade I Aneurysm
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Asymptomatic; or minimal headache and slight nuchal rigidity
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Linear skull fractures are not usually serious unless they:
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-transverse a meningeal artery
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This neurological test does not evaluate brain stem integrity ______.
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Babinski Reflex
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Head injury characterized by an initial lucid period followed by deteriorating neurological status.
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Epidural Hematoma
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Hypothermia following an acute spinal injury is often associated with _______.
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Peripheral vasodilation
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The inability to identify an object by touch:
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-astereognosis
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12 Cranial Nerves:
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Oh, Oh, Oh, To, Touch, And, ****, Vaginas, Gets, Vinnie, All,
Hard |
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This neurological test does not evaluate brain stem integrity ______.
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Babinski Reflex
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Head injury characterized by an initial lucid period followed by deteriorating neurological status.
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Epidural Hematoma
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Hypothermia following an acute spinal injury is often associated with _______.
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Peripheral vasodilation
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The inability to identify an object by touch:
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-astereognosis
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Avoid ______ in PTs with hypovolemic shock, because they will further impair tissue perfussion.
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-vasopressors
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In PTs s/p multiple blood transfusions, it is very important to replace _________.
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-calcium
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Do not mix ______ in normal saline.
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-calcium
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Alpha-adrenergic drugs used for __________.
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vasoconstricion
(Dopamine 10mcg/kg/min) |
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PTs with _______ are prone to develop nipride toxicity (used to decrease afterload)
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-liver failure
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Quinidine toxicity will result in:
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-prolonged QT intervals (ventricular tachycardia)
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The Parietal cells (oxyntic cells) are located in the ______ _____ and produce ______ and ______.
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-proximal stomach
-HCL and intrinsic factor |
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Function of intrinsic factor:
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-to facilitate the absorption of vitamin B 12 by the the ileum
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The Chief cells are located in the _____ _____ and produce ______ and _______.
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-proximal stomach
-pepsin and mucous |
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Typical gastric secretion pH:
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1-3
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Procedure performed for a gastric ulcer/peptic ulcer disease:
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-Vagotomy-removes vagus nerve stimulation to parietal cells, thus decreasing acid production
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Side effect of vagotomy:
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decreased intrinsic factor produced, leading to a vitamin B 12 deficiency
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Brunners glands are located in the gastric submucosal layer and produce a _______
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-secretion of a protective mucous
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Bile salts are needed for the absorption of _______ and the synthesis of ______
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-fat soluble vitamins (A,D,E,K)
-vitamin K |
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Bend in the colon RUQ:
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Hepatic flexure
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Bend in the colon LUQ
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Splenic flexure
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E. Coli found in the colon synthesize:
1-3.) |
1.) Folic Acid (Vit B12)
2.) Riboflavin (Vit B2) 3.) Quinone (Vit K) |
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2 S/S of esophageal cancer:
1.) _______ 2.) _______ |
1.) Dysphagia
2.) Substernal Fullness |
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Arterial perfusion of the small intestine is provided by the _____ ______ ______.
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-Superior mesenteric artery
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Venous drainage of the the GI tract:
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Portal Vein to the liver to the hepatic vein to the inferior vena cava
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Phagocytosis is performed in the liver by ____ ____.
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Kupffer Cells
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The flappy tremor associated with liver failure:
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-Asterixis
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The liver synthesizes _____ in order to remove ammonia.
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UREA
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Signs of pancreatitis
1.) _________ 2.) _________ |
1.) Grey Turner's Sign
2.) Cullen's Sign |
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Grey Turner's Sign:
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-a sign of retroperitoneal bleeding and pancreatitis; a blue/green flank and groin
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Cullen's Sign:
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-indicates peritoneal bleeding and pancreatitis; a blue/black umbilicus
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A small abdominal distension and N/V are associated with ______.
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-a small bowel obstruction.
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5 side effects of Pancreatitis:
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1.) Hypocalcemia/Hyperphos
2.) HHNK 3.) Atelectasis 4.) L pleural effusion 5.) Bilateral Rales |
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High ammonia levels result in ______ ______, levels increased by _____, ______, ______, and _______.
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Hepatic Encephalopathy
1.) Hypokalemia 4.) Acidemia 2.) Increased BUN 3.) Increased Protein intake |
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Laboratory finding associated with liver disease:
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-increased indirect/unconjugated bilirubin
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Laboratory finding associated with biliary tract/ gallbladder disease:
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-increased direct/conjugated bilirubin
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One cause of decreased bowel sounds is _______
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-peritonitis
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Increased amylase levels associated with pancreatitis are found in the serum for _____ and in the urine for _____.
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-elevated serum amylase for 2-3 days
-elevated urine amylase for 5-7 |
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3 Pulmonary Complications of Pancreatitis:
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1.) L sided atelectisis and pleural effusion
2.) bilateral rales 3.) ARDS |
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Diuretics, increased BUN, acute infection, increased protein, and GI bleeding may all precipitate:
|
hepatic encephalopathy
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What H2 receptor blocker is contraindicated with antacid use:
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-Cimetidine (Tagamet)
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Mallory-Weiss tear
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-a painless esophageal hemorrhage caused by increased abdominal pressure (coughing/vomiting)
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Kehr's Sign
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-left sided shoulder pain d/t diaphragmatic irritation associated with splenic rupture
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TPN sepsis is initially characterized by:
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-an increased serum glucose
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TPN can cause refeeding syndrome resulting in a decreased ____,_____, and ____.
Causing ________. |
-phosphate, potassium, magnesium
-arrhythmias |
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These antacids are prescribed to _______ PTs, in order to decrease _______
|
Aluminum Hydroxide (Amphojel)
-hemodialysis -phosphate |
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Inflammation in the small intestine, stomach, and colon indicate
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Chron's Disease
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Chvostek's Sign:
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facial twitch when the facial nerve is tapped; indicates low calcium, low magnesium, or high phosphate
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Trousseau's Sign:
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a bp cuff on the arm inflated to greater than the SBP for 3 mins causes a hand spasm; low calcium or high phosphate
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Normal Urinary Sodium Levels:
|
40-100
|
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Structure responsible for the concentration/dilution of urine
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Loop of Henle
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Responsible for the re-absorption of Na, Cl, HCO3, Glucose, H, Ca, and P
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Proximal Tubule
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Site of water re-absorption in the kidney
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Distal convoluted tubule
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Acute renal failure is characterized by UOP less than:
|
<400 ml in 24 hours
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The Pre-renal stage of kidney failure is sometimes caused by
1.) _______ 2.) _______ |
1.) CHF
2.) Hypotension decreased blood supply to kidney |
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The renal stage of kidney failure is caused by actual damage to the kidney caused by _______ or _________.
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-ischemia
-nephrotoxicity |
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Characteristics of Pre-renal:
1.) Urine Sodium 2.) BUN:Creatinine 3.) Lasix/fluid challenge |
1.) 20 (decreased)
2.) 20:1 3.) increased UOP |
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Characteristics of Renal (oliguric):
1.) Urine Sodium 2.) BUN:Creatinine 3.) Lasix/fluid challenge |
1.) 40-100 (normal)
2.) 10:1 3.) no increase in UOP |
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Three stages of ATN:
1.) ______ 2.) ______ 3.) ______ |
1.) Oliguric ( up to 2 weeks)
2.) Polyuric (2 wks - 3 months) 3.) Recovery (3 months - 1 year) |
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BUN and Creatinine are elevated in ATN, but potassium is elevated in the _____ stage and decreased in the _____ stage.
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-oliguric
-polyruric |
|
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Signs of hyperkalemia:
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-peaked T-wave, prolonged PR interval, widened QRS and eventual loss of the P wave (abdominal cramps & diarrhea)
|
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Treatment for hyperkalemia without the presence of EKG changes:
|
-Insulin+Glucose drips to drive K into the cell
-Sodium bicarbonate -K excelate |
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Treatment for hyperkalemia with EKG changes:
|
-Calcium chloride to allow electricity to correctly flow through cardiac tissue
|
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Symptoms of hypokalemia:
|
the presence of a U-wave, ST segment depression and ventricular irritability
|
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Hypocalcemia & Hyperphosphatemia
|
Ca (8-10)
P (2.5-4.5) -Chvostek & Trousseau (twitch, twitch, seize) |
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Hypercalcemia & Hypophosphatemia
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Ca (8-10)
P (2.5-4.5) -muscle weakness & apathy |
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People with kidney disease do not produce ______ _ which results in decreased ______.
|
-Vitamin D
-Calcium |
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Weight gain of 1kg in 24 hours may indicate fluid retention of ____
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- 1000 ml
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GFR is best measured by:
|
24 hour creatinine clearance
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Ischemia injury to the kidney usually results when the MAP is less than ____ for ___ _____.
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-60
-40 minutes |
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DIC is common with OB problems and Neuro problems d/t high levels of _____ in the placenta and the brain.
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-throboplastin
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The intrinsic pathway of clotting is triggered by _____ _____ and activated by_____ ___.
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-endothelial injury
-factor 12 |
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The extrinsic pathway of clotting is triggered by _____ ____ and activated by _______.
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-tissue injury
-thromboplastin |
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DIC is the overstimulation of the clotting cascade. Widespread ______ _____ that triggers _____.
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-inappropriate clotting
-bleeding |
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Lab findings with DIC:
1.) Decreased ______ 2.) Increased _______ |
1.) Fibrinogen and PLTs
2.) PT, aPTT, Fibrin Split Products, and D-dimer |
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Cryoprecipitate is made up of:
1.) ________ 2.) ________ 3.) ________ |
1.) Factor 8
2.) Factor 13 3.) Fibrinogen |
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Treatments for DIC
|
-Heparin then FFP and Cryoprecipitate; find and treat underlying cause
|
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Why is heparin given for DIC treatment?
|
It accelerates formation of antithrombin III and it inhibits the conversion of prothrombin into thrombin, deactivates circulating thrombin, and inhibits conversion of fibrinogen into fibrin
|
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What is Heprain Induced Thrombosis-Thrombocytopenia Sydrome (HITTS)
|
-paradoxical effect creating clots, due to the lack of anti-thrombin III
and increased antibodies to Heparin |
|
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Brainstem:
|
MPM
1.) Midbrain 2.) Pons 3.) Medulla Oblingota |
|
|
Treatment for HITTS:
|
Argatrobon (ACOVA) - a thrombin inhibitor that doesn't require anti-thrombin III
|
|
|
The pyramidal tracts cross over in the ______ ______.
|
-medulla oblingata
|
|
|
The pathway of sympathetic innervation of the pupil
|
-medulla oblingata to pons
|
|
|
Hypokalemia will increase ammonia levels, which is bad for PTs with liver disease. ______ is given to help prevent hypokalemia
|
Spironolactone (aldactone)
-potassium sparing diuretic |
|
|
Lymphocyte responsible for humoral immunity, making immunoglobins and attacking bacteria.
|
B Cells
(*the Navy) |
|
|
Lymphocyte responsilbe for tissue immunity, attacking viruses and organ transplants
|
T Cells
(*the Army) |
|
|
Enhanced production of intravascular _______ resulting in increased _____ and PLT aggregation is the Patho for ____
|
-thrombin
-fibrin -DIC |
|
|
Accelerated HTN has a DBP range of ______ and a common symptom seen is _____ _____.
|
-120-140 mm Hg
-retinal hemorrhages |
|
|
Malignant HTN has a DBP _____ and common symptoms seen are _____ ____ and _____.
|
- >140 mm Hg
-retinal hemorrhages -papilledema |
|
|
PAP must be measured during _____ _______ and occurs during the QRS complex.
|
-end exhalation
|
|
|
A pulmonary artery catheter or Swan-Ganz will show three waves: A, C, V
|
A- aterial constriction (after QRS)
C- mitral valve closing V- aterial relaxation (after T wave) |
|
|
Symptom: Severe epigastric pain radiating to the back
|
-Acute pancreatitis
|
|
|
Laboratory finding most specific to pancreatitis:
Another common finding: |
-Elevated amylase
(serum & urine) -Hypocalcemia |
|
|
Two most common causes of intrinsic renal failure:
|
1.) ATN
2.) Parenchymal Disease (glomerulonephritis, SLE) |
|
|
-Hypoactive BS
-Luekocytosis and tenderness -Hyperresonance -Absence/dullness near liver |
--Assessment findings indicative of a bowel infarction
|
|
|
This drug works on the loop of Henle, and can cause ototoxicity if given to rapidly:
|
-Furosemide (Lasix)
|
|
|
Complications of ARF:
1.) _________ 2.) _________ |
1.) Anemia (decreased erythropoietin production)
2.) Hypocalcemia (inability to convert Vit D into a usable form) |
|
|
Avoid ______ in patients with hypocalcemia, because decreased ___ levels with further deplete calcium.
|
-hyperventilation
-CO2 |
|
|
Hyponatremia causes _______ release to reabsorb more sodium and excrete more potassium.
|
-Aldosterone
(produced in the adrenal cortex) |
|
|
Hypernatremia causes _____ release
Hyponatremia causes _____ release |
1.) Hyper = ADH
2.) Hypo = Aldosterone |
|
|
_______ stimulates the bone marrow to produce RBCs, and is made in the kidneys.
|
-Erythropoietin
|
|
|
The most sensitive indicator of fluid retention in critically ill patients is __________.
|
--daily weights
|
|
|
An increase in segs and bands (neutrophils) indicates _______
|
--acute infection
|
|
|
Universal Recipient:
Universal Donor: |
- AB+
- O- |
|
|
Venous drainage from the heart is performed by the ______ ____ into the ____ _____.
|
-Coronary sinus
--Right atrium |
|
|
Hallmark sign of infection in neutropenic/immunosuppressed patients
|
--fever
|
|
|
Per unit of PRBC's:
Hgb increased by ___ Hct increased by ____ |
Hgb up 1 gm
Hct up 2-3 gm |
|
|
FFP contains all clotting factors except ______
|
PLTs
(lifespan of 9-12 days) |
|
|
Most common cause of anaphylaxis:
|
-PCN
|
|
|
Factors --------- are Vit K dependent and produced in the _______.
|
2, 7, 9, 10
--liver |
|
|
Active enzyme of fibrinolytic system:
|
--plasmin
|
|
|
Blood product with lowest risk for hepatitis is ________.
|
--plasmanate
|
|
|
Burns appearing red and moist with blister formation
|
2nd degree burn
Superficial partial thickness burn |
|
|
Burns appearing mottled dry and waxy white
|
2nd degree burn
Deep partial thickness burn |
|
|
Parkland Formula
|
-Ringer's Lactate
-4ml/percentage of burned tissue -1/2 replaced in the first 8 hours -1/2 replaced in the next 16 hours |
|
|
The most common cause of accidental poisonings _______.
The most deadly poisoning are caused by ______. |
-household cleaning products
--analgesics |
|
|
For a suspected OD/poisoning comatose PT be prepared to administer these five things:
|
1.) D50 100ml 5.) Antidote
2.) Thiamine 100mg 3.) Naloxone 2mg 4.) Charcoal 1GM/kg |
|
|
Acetaminophen OD Tx:
(Hepatotoxicity) |
1.) Charcoal if <4HRS
2.) N-Acetyl-Cysteine (Mucomyst) 140mg/kg loading dose 70mg/kg Q4 for 17 doses |
|
|
Grade I APAP OD:
Grade II APAP OD: Grade III APAP OD: |
-nausea and vomiting
-plus RUQ pain -plus liver function abnormalities |
|
|
Salicylate OD Tx:
(Nephrotoxicity) |
1.) Gastric lavage/emesis
2.) Charcoal 3.) Sodium Bicarb to alk. urine 4.) Hemodialysis |
|
|
Observe for ________ with salicylate OD.
|
-renal tubular acidosis
|
|
|
Cocaine OD Tx:
|
Benzo for sedation, Vasodilators for HTN, Nitrates or CCB for ischemia, cooling measures, ascorbic acid for + excretion
|
|
|
Benzodiazepine OD Tx:
|
STD treatments plus
Flumazenil (Romazicon) --place is recovery position to prevent aspiration |
|
|
Laboratory finding with massive blood transfusions:
|
-Hypocalcemia
|
|
|
Pacemaker Codes:
1.)- 5.) |
Paced, Sensed, Response, Rate Modulation, Multi-pacing
Pacemakers Sense Rates |
|
|
How do you drain the LLL ?
|
Left Lateral Trendelenburg
|
|
|
In a Left VAD the blood is diverted from the ___ _____ and returned to the PT via the ______ _______.
|
-Left atrium
--Ascending aorta |
|
|
ACUTE renal transplant rejection occurs at?
|
-- 1-2 weeks
|
|
|
The dicrotic arch on the waveform from an A-line represents?
|
-closure of the aortic valve
|
|
|
Lactate Dehydrogenase rises with:
|
cardiac damage
|
|
|
PTs with ARDs should be kept fluid ______.
|
-depleted
|
|
|
An IABP augments cardiac output by ______
|
-15% increase in CO
-decreases afterload |
|
|
Contraindications for an IABP:
1.) _________ 2.) _________ |
1.) Aortic insufficiency
2.) Peripheral Vascular Disease |
|
|
Interventions with an IABP:
1.) _________ 2.) _________ 3.) _________ |
1.) Don't elevate HOB >30
2.) Assess pulses 3.) Monitor for bleeding |
|
|
Complications of an IABP:
1.) ___________ 2.) ___________ 3.) ___________ |
1.) Ischemia of limb
2.) Aortic dissection 3.) Infection |
|
|
IABP:
LV Systole = ______ LV Diastole = _______ |
S = deflated balloon
D = inflated ballon |
|
|
Lead needed to differentiate between ventricular arrhytmias and supraventricular arrhythmias?
|
MCL1
|
|
|
Hypertrophic Cardiomyopathy (HCM), Idiopathic H. Subaortic Stenosis (iHSS),H. Obstructive Cardiomyopathy (HOCM)
|
-a big fat ventricular septum that protrudes into the left ventricle, reducing cardiac output
|
|
|
Tx for HCM/iHSS/HOCM:
|
BB or CCB to slow cardiac contractility allowing for increased filling time and CO
|
|
|
Preload is:
Preload is related to: Preload is most affected by: |
1.) End Diastolic Volume
2.) Right Atrial Pressure 3.) Venous Return |
|
|
Afterload is:
|
1.) The arterial pressure that must be overcome by the ventricle to pump out blood
|
|
|
Normal Systolic PAP
|
20-30 mmHg
|
|
|
Normal Diastolic PAP
|
6-12 mmHg
|
|
|
An increased systolic PAP is caused by:
|
--a lung problem
(ARDS, COPD, PE) |
|
|
An increased diastolic PAP is caused by:
|
--a heart problem
(Tamponade, LVF, Mitral Valve Disease) |
|
|
Pulmonary Artery Wedge Pressure (PAWP)
|
4-12 mmHg
-reflects left atrial pressure |
|
|
PAWP is always ____ lower than the PAD.
PAWP catheter needs to be in Zone ____. |
1-4 mmHg
3 |
|
|
PAP is measured during ___ ______ and occurs during the _____.
|
-end exhalation
-QRS complex |
|
|
A PEEP >10 cm H20 affects PAWP readings.
Formula: |
PAWP - (PEEP/1.36)
------------------ 2 |
|
|
Locations for Murmurs (All Physicians Must Try):
|
1.) Aortic- R 2nd ICS
2.) Pulmonic - L 2nd ICS 3.) Mitral - L 5th MCL 4.) Tricuspid - L 4th ICS LSB |
|
|
S1 Heart Sound:
|
--closure of the mitral and tricuspid valves
|
|
|
S2 heart sound
|
--closure of the pulmonic and aortic valves
|
|
|
Systolic Murmur Sounds:
|
Lub, Murmur, Dub
|
|
|
Diastolic Murmur Sounds:
|
Lub, Dub, Murmur
|
|
|
Compensated Acidosis:
Compensated Alkalosis: |
7.35-7.40
7.40-7.35 |
|
|
Normal BiCarb (HCO3)
|
23-27
|
|
|
Method to drain upper lung lobes:
|
OOB to reclined chair with chest PT
|
|
|
TPN causes what electrolyte abnormality?
What is the treatment? |
1.) Hyperphosphatemia
2.) Amphogel |
|
|
MVA PT's are a high risk for a ___ _______.
|
--fat embolism
|
|
|
Normal A-a (Alveolar to arterial) gradient for an adult breathing room air is:
|
5-10 mmHg
|
|
|
Normal Tidal Volume:
Setting for Respiratory Failure: |
1.) 10ml/kg
2.) 10ml/kg x 2 |
|
|
Complications of burns:
|
Compartment syndrome, Hemoconcentration, ARDS, Decreased CO, ATN and Hypovolemic shock
|
|
|
ARDS causes damage to _______ with a decrease in ________.
|
-type II pneumocytes
--surfactant |
|
|
Early findings in ARDS include:
1.) ________ 2.) ________ 3.) ________ |
1.) Tachypnea
2.) Normal PAWP 3.) Respiratory alkalosis |
|
|
Four Common causes of respiratory acidosis:
|
Drugs, Cardiac Arrest, Muscle Weakness (MG,ALS,GB) and COPD
|
|
|
Five Common causes of respiratory alkalosis:
|
Hypoxemia, CNS disorder, Salicylate Intoxication, Cirrhosis, Sepsis
|
|
|
Four Common causes of metabolic acidosis:
|
Ketoacidosis, Lactic Acidosis, Diarrhea, Renal Failure
|
|
|
Three Common causes of metabolic alkalosis:
|
Blood Transfusions, Hypokalemia, Vomiting (contraction alkalosis)
|
|
|
Breath sounds are _____ in PNA.
|
--louder
|
|
|
A shift to the left on the oxygen-hemoglobin disassociation curve:
|
--Increased "measured" SaO2%, RBC has a higher affinity for oxygen
|
|
|
A shift to the right on the oxygen-hemoglobin dissociation curve:
|
--Decreased "measured" SaO2%, RBC has a decreased affinity for oxygen
|
|
|
PaCO2
|
35-45
|
|
|
PaO2
|
80-100
|
|
|
A shift to the right on the oxygen-hemoglobin disassociation curve:
(CADET, face right) |
An increase in CO2, Acidosis,
2,3 DPG, Exercise, and Temperature will cause a right shift. |
|
|
Normal breath sounds _____, _____, and ______ are heard loudest on:
|
1.) Bronchial - Exhalation
2.) Bronchio-vesicular - E/I 3.) Vesicular - Inhalation |
|
|
Three drugs contraindicated with mysthenia gravis:
|
1.) Procainamide
2.) Gentamycin 3.) Quinine Derivatives |
|
|
Type I ARF
|
AKA Hypoxemic Failure
Decreased 02 (<60), normal to low CO2, Increased PA-aO2 V/Q mismatch |
|
|
Type II ARF
|
AKA Hypercapnic Failure
Decreased 02, Increased CO2 >50 normal PA-aO2, Decreased pH Decreased RR, Increased Resist. |
|
|
Drug of choice for wide complex tachycardia?
|
--Amiodarone
|
|
|
Four drugs contraindicated in wide complex tachycardia:
|
1.) CCB C-BAD
2.) BB 3.) Adenosine 4.) Digoxin |
|
|
Modified Central Lead 1 - MCL1
-useful in differentiating a ventricular from a supraventricular arrhythmia |
Placement:
+ 4th ICS RSB - below outer 3rd of L clavicle |
|
|
V Fib / Pulseless V Tach
|
Please, Shock, Shock, Shock, Everybody, Shock, And, Let's, Make, Patients, Dance, Better
|
|
|
Please, Shock, Shock, Shock, Everybody, Shock, And, Let's, Make, Patients, Dance, Better
|
cPr, Shock x3, Epi or Vasopressin, Shock/Drug pattern, Amiodarone, Lidocaine, Mag, Procainamide, Defib, Bicarbonate
|
|
|
Amiodarone
(anti-arrhythmic of choice for wide complex tachycardia) |
300mg IV push. May repeat once at 150mg in 3-5 min. (max. cumulative dose: 2.2g IV/24hrs.)
|
|
|
Lidocaine
|
1.0-1.5 mg/kg IV. May repeat in 3-5 min. (max. loading dose: 3 mg/kg)
(decrease dose in PTs with CHF & liver dysfunction) |
|
|
Magnesium Sulphate
|
1-2 g IV (2 min. push) for suspected hypomagnesemia or torsades de pointes
|
|
|
Procainamide
|
30 mg/min up to 17mg/kg
"acceptable but not recommended" in refractory VF" |
|
|
Sodium Bicarbonate
|
1 mEq/kg IV
|
|
|
Vasopressin for VF/ pulseless VT
|
40 Units IV x1
|
|
|
Epinephrine
|
1mg IV Q 3-5 minutes for VF/VT
2-10 mcg/kg/min for bradycardia |
|
|
Bradycardia
|
All Trained Dogs Eat Iams
Atropine Transcutaneous Pacing Dopamine, Epi, Isoproterenol |
|
|
Atropine
(anticholinergic that blocks vagus nerve stimulation) |
1mg IV Q 3-5 mins
(max dose of 0.4 mg/kg) |
|
|
Isoproterenol
(beta-adrenergic agonist with chronotropic and inotropic effects) |
2-10 mcg/kg/min
|
|
|
Asystole/PEA
|
PPE
Problem, Pacing, Epinephrine |
|
|
The ______ of shock, is the only type of shock that results in an increased cardiac output.
|
The initial or "warm" stage of septic shock which can last from 30 mins - 72 hours until levels of endotoxins drop off.
|
|
|
Cardiogenic Shock
|
Preload - Increased
Afterload - Increased Cardiac Output - Decreased |
|
|
Distributive Shock:
1.) _______ 2.) _______ 3.) _______ |
1.) Anaphylactic
2.) Septic 3.) Neurogenic |
|
|
Anaphylactic Shock
|
Preload - Decreased
Afterload - Decreased Cardiac Output - Decreased |
|
|
Septic Shock
|
Preload - Decreased
Afterload - Dec (warm) Inc (cold) CO - Inc (warm) Dec (cold) |
|
|
Hypovolemic Shock
|
Preload - Decreased
Afterload - Increased Cardiac Output - Decreased |
|
|
Sepsis is typically caused by:
|
--gram negative bacteria
(E. coli, Klebsiella, Enterobacter, Pseudomonas, and Serratia Marcescens) |
|
|
Initial Stage of Shock
|
Hypoperfusion - Hypoxia - Anaerobic metabolism - Lactic Acidosis
|
|
|
Compensatory Stage of Shock
|
Acidosis - Hyperventilation
Hypotension - Adrenaline release Cushing's Triad (HTN, Widened PP, Bradycardia, and Irregular RR) |
|
|
Progressive Stage of Shock
|
Compensatory mechanisms begin to fail
|
|
|
Refractory Stage of Shock
|
Irreversible stage that will result in death r/t to the body's inability to make adenosine for ATP production and use.
|
|
|
Causes for a failure to capture:
1.) ________ 2.) ________ 3.) ________ |
1.) Lead displacement
2.) Battery failure 3.) Faulty connections |
|
|
Failure to sense:
1.) _______ 2.) _______ 3.) _______ |
1.) Sensitivity settings
2.) Battery failure 3.) Catheter position incorrect dangerous malfunction R on T |
|
|
Most common valve rupture s/p cardiac trauma ?
|
--Aortic valve
|
|
|
Cardiac trauma can result in a ______ denoted by ST elevation in _____ leads or ______ denoted by ST elevation in ____ leads.
|
1.) Myocardial contusion
(ST elevation in specific leads) 2.) Pericarditis (ST elevation in all leads) |
|
|
A myocardial contusion can result in _____ evidenced by cardiac arrhythmias.
|
tissue death
|
|
|
Pericarditis can result in ________ evidenced by cardiac arrhythmias.
|
cardiac tamponade
|
|
|
Dressler's Syndrome
|
--pericarditis caused by a myocardial infarction
|
|
|
S&S of Pericarditis:
|
ST elevation in all leads, Sharp stabbing pain that increases on inspiration, low fever, chest pain is relieved by sitting up & leaning forward
|
|
|
Three Complications of an Anterior-Septal Wall MI:
|
1.) Bundle of His: Mobitz II
2.) Bundle Branches: RBBB 3.) Ventricular Septum: VSD |
|
|
Four Complications of an Inferior Wall MI:
|
1.) Sinus Node: Bradycardia
2.) AV Node: CHB, 3rd HB AV Dis. 3.) RA/RV: RV infarction 4.) Mitral Valve:Mitral Insufficiency |
|
|
Main blood supply for the heart's inferior wall
|
Right coronary artery (RCA)
|
|
|
Main blood supply for the heart's anterior septal wall:
|
Left Anterior Descending Artery
(LAD) |
|
|
Diastolic Murmurs:
1.) ____________ 2.) ____________ |
1.) Mitral Stenosis
2.) Aortic Insufficiency |
|
|
Systolic Murmurs:
1.) ___________ 2.) ___________ |
1.) Aortic Stenosis
2.) Mitral Insufficiency |
|
|
Diastolic Murmur; Low-pitched rumbling noise heard at the apex of the heart that will increase in the L Lateral position
|
Mitral Stenosis
|
|
|
Diastolic Murmur; High-pitched blowing noise heard at the 2nd R ICS that increases on exhalation
|
Aortic Insufficiency
|
|
|
Holosystolic/Pansystolic; medium pitch radiates to neck and right carotid which increases while sitting and holding one's breath
|
Aortic Stenosis
|
|
|
Holosystolic/Pansystolic; high pitched blowing noise heard at the apex radiating to the axilla; increases while squatting
|
Mitral Insufficiency
|
|
|
Lateral wall leads:
|
I, aVL
|
|
|
Inferior wall leads:
|
II, III, aVF
|
|
|
Anterior Septal-Lateral Wall
|
V1-V6
|
|
|
Pre-renal kidney failure is caused by conditions that ________
|
-decrease blood supply to the kidneys.
|
|
|
Four causes of Pre-renal kidney failure:
|
1.) CHF
2.) Hypovolemia 3.) Dehydration 4) Shock |
|
|
Urinary sodium in pre-renal kidney failure:
|
< 20
|
|
|
Specific gravity in pre-renal kidney failure:
|
Increased
|
|
|
BUN: Creatinine ratio in pre-renal kidney failure:
|
20:1
|
|
|
Causes of parenchymal kidney disease:
1.) _________ 2.) _________ |
1.) Glomerulonephritis
2.) SLE |
|
|
Urinary sodium in renal kidney failure:
|
> 40
|
|
|
BUN: Creatinine ratio in renal kidney failure:
|
10:1
|
|
|
Specific gravity in renal kidney failure:
|
Increased
|
|
|
ATN results from:
1.) _______ 2.) _______ |
1.) Ischemia(MAP <60 for 40+ min)
2.) Nephrotoxicity |
|
|
Complications of ARF:
1.) _______ 2.) _______ 3.) _______ |
1.) Anemias-lack of erythropoietin
2.) Coagulopathies 3.) Hypocalcemia-lack of Vit D conversion in the kidneys |
|
|
Four treatments for hyperkalemia:
|
1.) Sodium Bicarb
2.) Glucose + Insulin 3.) Calcium chloride *EKG* 4.) Kayexalate |
|
|
Peritoneal dialysate is a ______ glucose solution. Observe for ______ and _______.
|
-4.25%
-hypovolemia --hyperglycemia in diabetics |
|
|
Loop of Henle is responsible for:
|
-concentration/dilution of urine
|
|
|
Complication of rapid administration of furosemide (lasix):
|
-ottotoxicity
|
|
|
Furosemide (lasix) works on this part of the kidney:
|
-Loop of Henle
|
|
|
Proximal tubule is responsible for:
|
-reabsorption of electrolytes, glucose, and amino acids
|
|
|
Distal/Convoluted tubule is responsible for:
|
-water reabsorption under ADH control
|
|
|
ADH works on this part of the kidney:
|
-distal/convoluted tubule
|
|
|
Three renal responses to acidosis:
|
Bicarb reabsorbed at the proximal tubule, increased ammonia to facilitate H+ loss, increased H+ secretion at distal tubule
|
|
|
Symptoms of hyponatremia:
1.) ______ 2.) ______ 3.) ______ |
1.) muscle twitching & seizures
2.) altered LOC 3.) irritability |
|
|
Normal serum osmolarity:
|
275-295
(2x Na) |
|
|
Oliguria:
|
UOP < 400ml in 24 hours
|
|
|
Avoid _____ in hypocalcemic PTs, because a low ___ decreases Ca levels further.
|
-hyperventilation
--CO2 |
|
|
Best indicator of renal function:
|
-Creatinine level
|
|
|
The most sensitive indicator of fluid retention in critically ill patients is:
|
--Daily weights
|
|
|
Approximately 60-80% of Na and H20 is reabsorbed at the:
|
-Proximal tubule
|
|
|
Functions of the spleen:
1.) ______ 2.) ______ 3) _______ |
1.) stores RBCs
2.) produces antibodies 3.) recycles iron from old Hgb |
|
|
Cold aglutins:
|
-antibodies that cause RBC coagulation when body temp decreases below normal
|
|
|
Hallmark sign of infection in neutropenic PTs:
|
Fever
|
|
|
________ is responsible for the respiratory drive in a person with normal lungs.
|
--pH of the CSF
|
|
|
______ chemoreceptors detect _____ increases and cause increased ventilation.
|
-Medullary
--CO2 |
|
|
Position that provides for opitmal ventilation_________.
|
-(Tripod-ing)
-sitting up in a supported, leaning forward position |
|
|
Renal Failure results in this acid-base imbalance:
|
-Metabolic acidosis
|
|
|
Hyperventilation results in this acid-base imbalance:
|
-Respiratory alkalosis
|
|
|
DKA results in this acid-base imbalance:
|
-Metabolic acidosis
|
|
|
Multiple blood transfusions result in this acid-base imbalance:
|
-Metabolic alkalosis
|
|
|
Hypovolemic shock results in this acid-base imbalance:
|
-Metabolic acidosis
|
|
|
In order to posturally drain the apical lung, position the PT __________.
|
-sitting upright, leaning backward
|
|
|
Notable characteristic of mucous during an asthma attack:
|
Tenaciousness
|
|
|
What is an ominous finding in status asthmaticus ?
|
-Hypercapnia
|
|
|
Normal A-a gradient
(alveolar to arterial) |
<10 mm Hg
|
|
|
Tidal Volume Vt - for PTs in respiratory failure: ________
|
10 ml/kg or twice normal
|
|
|
Treatment modalities for ARDs
(ARDs-net) |
Plateau pressure < 30 cm H2O. The goal is to titrate the Vt to 6 mL/kg. FiO2 and PEEP are titrated to achieve an oxygen saturation level of 88% to 95% or a PaO2 value of 55 to 80 mm Hg at the lowest possible FiO2, PEEP should be kept between 5 and 20 cm H2O.
|
|
|
Calculate P/F ratio:
|
PaO2
_____ = P/F ratio FiO2 |
|
|
Normal P/F ratio:
|
>300 mm Hg
(<200 mm Hg indicates ARDS) |
|
|
PAWP in ARDs:
|
Normal (12-18 mm Hg)
|
|
|
Newest Tx modality for ARDs:
|
-Permissive hypercapnia d/t low tidal volume
Current limit is a pH as low as 7.2 |
|
|
Calculation of minute ventilation (Ve):
|
Ve = Vt x RR
|
|
|
Calculation of minute alveolar ventilation (Va):
|
Va = ( Vt - Vd ) x RR
|
|
|
Dead air space (Vd) :
|
Vd = 1/3 X Vt
|
|
|
CNS control of respirations:
|
Medullar responds to to changes in CO2 and pH
|
|
|
Carotid & Aortic bodies control of respirations:
|
--respond to changes in oxygen tension
|
|
|
In a right shift of SaO2%
|
-RBC releases more O2
|
|
|
In a left shift of SaO2%
|
-RBC holds more O2
|
|
|
Three PNA/consolidation assessment findings:
|
1.) Bronchial breath sounds in lung fields
2.) Dull percussive note 3.) Tactile fremitus increased |
|
|
Pancuronium Bromide(Pavulon) OD
{muscle relaxant for intubation} |
Atropine and Prostigmine
|
|
|
Emergency treatment for pneumothorax
|
14G above 3rd rib in 2nd ICS
|
|
|
Anemic PTs will not develop this respiratory failure sign:
|
-cyanosis
|
|
|
COPD PTs respiratory drive is driven by:
|
-Oxygen demand
|
|
|
This artery supplies oxygenated blood to the lungs:
|
--Bronchial artery
|
|
|
Cor pulmonale will result in:
|
RVF d/t pulmonary hypertension with peaked P waves on EKG
|
|
|
Extubation criteria
|
1.) Negative inspiratory force (NIF) of -20 cm H20
2.) Adequate vital capacity (VC) = VT + IRV + ERV |
|
|
Bronchospams during anaphylaxis results from:
|
-histamine release
|
|
|
Three workups for neoplastic lung lesion:
|
1.) CXR
2.) Sputum cytology 3.) Fluoroscopy/Brochoscopy with pleural biopsy |
|
|
Position for postural drainage of lower lung lobes:
|
Trendelenburg, laying on opposite side of fluid
|
|
|
Most definitive test for pulmonary embolism:
|
--Pulmonary angiography
|
|
|
Superior vena cava syndrome from lung cancer:
1.) ________ 2.) ________ |
1.) JVD
2.) Edema of eyelids & hands |
|
|
During assessment of a PT with a pneumothorax there will be a tracheal shift in the direction ________.
|
-opposite side of the Ptx
|
|
|
HIV is a _______.
|
- T-cell retrovirus
|
|
|
ST depression and T wave inversion denotes :
|
-ischemia
|
|
|
ST elevation denotes:
|
-injury
|
|
|
Arrythemias denoting need for a pacemaker after AWMI:
|
1.) RBBB
2.) 3rd degree HB 3.) Mobitz type II |
|
|
Avoid _____ in PTs s/p IWMI because of ______ and _______.
|
-Lopressor
--bradycardia ---hypotension |
|
|
The most common systolic mumur seen in a recent MI PT:
|
-Mitral Insuffiency
|
|
|
Wolf-Parkinson White Syndrome:
|
An abnormal pathway that bypasses the AV node that results in a pre-excitation of the ventricles (PR <0.12)
|
|
|
Most common causative organism of endocarditis:
|
-Strep. Viridens
|
|
|
Painless lesions on the palms and soles:
|
-Janeway lesions
(found with endocarditis) |
|
|
Painful nodules on the fingers and toes:
|
-Osler's nodes
(found with endocarditis) |
|
|
Amrinone (Inocor)
|
-a phosphodiesterase inhibitor recommended for the short-term management of CHF
(mix only with NS) |
|
|
Streptokinase:
|
-catalyst in converting plasminogen to plasmin, (higher risk for hemorrhage and allergic reactions)
|
|
|
Urokinase:
|
-directly converts plasminogen to plasmin (lower risk for hemmorrhage and no risk for allergic reactions)
|
|
|
Tissue Plasminogen Activator:
|
-converts to plasmin when it comes in contact with fibrin clot surface (shortest half-life, no risks, 0.5-1mg/kg - 60 mins
|
|
|
Three characteristics of S3:
|
1.) Normal finding in children
2.) Indicates resistance to diastolic ventricular filling 3.) Indicates failure of the LV |
|
|
A normal splitting of the S2 occurs with ________.
|
-inspiration
|
|
|
Earliest clincial manifestion of right ventricular failure:
|
-JVD
|
|
|
Development of a holosystolic murmur in a recent MI PT may indicate: 1.) ________
2.) ________ |
1.) Mitral insufficiency
2.) VSD |
|
|
Most common complication of an MI:
|
-arrhythmias
|
|
|
Absolute contraindication to IABP therapy:
|
--Aortic insufficiency
|
|
|
Postcardiotomy psychosis most frequntly occurs:
|
-- 2-3 days post-op
|
|
|
Drug of choice in idiopathic hypertrophic subaortic stenosis (IHSS):
|
Inderal or Verapamil
|
|
|
Printzmetals Angina:
|
-pain at rest
|
|
|
The most dangerous lesion in coronary artery disease:
|
--stenosis of the left main coronary artery
|
|
|
Mitral Insufficiency ________ preload.
|
-increases
|
|
|
Mitral Stenosis ________ preload.
|
-decreases
|
|
|
Aortic Insufficiency ________ preload.
|
-increases
|
|
|
Hypervolemia _______ preload.
|
-increases
|
|
|
Hypovolemia ________ preload.
|
-decreases
|
|
|
Vasoconstrictors ______ preload.
|
-increase
|
|
|
Vasodilators ______ preload.
|
-decrease
|
|
|
Aortic stenosis ________ afterload.
|
-increases
|
|
|
Hypertension ______ afterload.
|
-increases
|
|
|
Polycythemia ________ afterload.
|
-increases
|
|
|
CVP (RA pressure)
|
2-6 mm Hg
|
|
|
PAP systolic (RVP)
|
20-30 mm Hg
|
|
|
PAP diastolic
|
10-20 mm Hg
|
|
|
PAWP
|
4-12 mm Hg
|
|
|
LVEDP
|
5-12 mm Hg
|
|
|
CO
|
4-8 L/min
|
|
|
All infarctions ______ CVP.
|
-increase
|
|
|
All infarctions ______ SVR
|
-increase
|
|
|
RV Infarctions _______ PAP, PAWP, and LVEDP.
|
-decrease
|
|
|
LV Infarctions ______ PAP, PAWP, and LVEDP.
|
-increase
|
|
|
The PAWP is always _____ less than the PAP diastolic.
|
1-4 mm Hg
|
|
|
LDH1 ____ LDH2 indicates myocardial damage.
|
>
|
|
|
Calculation of Coronary Artery Perfusion Pressure (CPP):
|
DBP-PAWP
Normal values: 60-80 mm Hg |
|
|
Normal Hct levels:
|
Male: 42-52%
Female: 36-48% |
|
|
Normal HGB levels
|
Male: 12-17
Female: 11-16 |
|
|
Normal Lactate levels:
|
0.5 - 1.6
|
