Code

Front 1

versed

Back 1

2 mg, 4 mf
diazepam?

Front 2

epiniphrine

Back 2

1:000
sq im iv
1:10000

Front 3

etomidate

Back 3

20 mg

Front 4

succinocholine

Back 4

100 mg
refrigerator

Front 5

propofol

Back 5

Diprivan
Conc: 1ml/10mg
Induction: 2 mg/kg iv (10ml=100mg)
Maintenance: 5 to 50 mcg/kg/min
25/50 ratio
S.E. brady, hypotension
titrate to sedate

Front 6

versed

Back 6

2 mg, 4 mf
diazepam?

Front 7

epiniphrine

Back 7

1:000
sq im iv
1:10000

Front 8

ejection fraction 20%

Back 8

echo

Front 9

etomidate

Back 9

20 mg

Front 10

hard restraints

Back 10

RN can say order

Front 11

no eat after severe N/V

Back 11

soup

Front 12

meclizine mix with benzo to increase effect

Back 12

versed 2 mg

Front 13

3 way foley

Back 13

irrigate; clot; cold water stops bleeding

Front 14

pre op surgery

Back 14

chwcklist

Front 15

name all LFT's with values

Back 15

alt

Front 16

Gallbladder

Back 16

alt

Front 17

Pancreas

Back 17

alt

Front 18

dvt

Back 18

don't walk; lovenox

Front 19

haldol im

Back 19

fr

Front 20

hard restraints

Back 20

RN can say order

Front 21

no eat after severe N/V

Back 21

soup

Front 22

meclizine mix with benzo to increase effect

Back 22

versed 2 mg

Front 23

3 way foley

Back 23

irrigate; clot; cold water stops bleeding

Front 24

ct scan bladder

Back 24

fg

Front 25

ct IV contrast

Back 25

fg

Front 26

CT Scan consent form

Back 26

1)Needed for pts taking PO and IV coantrast (they will do IV contrast in CT room);
2)BUN CR & GFR if high

Front 27

diverticulitis

Back 27

sd

Front 28

immodium

Back 28

sd

Front 29

Dilantin

Back 29

Dilantin/Phenytoin Na
IV: give slowly 50mg/min; IV .9 NACL only over 30min-1hr
S.E: extravasation (use large vein!!), Steven Johnsons syndrome,
Nsg: use filter

Front 30

what to note

Back 30

in computer chart

Front 31

what to note

Back 31

in computer chart

Front 32

a/v fistula vs quinton cath

Back 32

df

Front 33

Pancreas

Back 33

There are different forms of pancreatitis, which are different in causes and symptoms, and require different treatment:

Front 34

Acute Pancreatitis

Back 34

sudden inflammation of the pancreas. can have severe complications and high mortality despite treatment.

Front 35

mild Pancreatitis

Back 35

While mild cases are often successfully treated with conservative measures, such as NPO (abstaining from any oral intake) and IV fluid rehydration,

Front 36

severe cases Pancreatitis

Back 36

severe cases may require admission to the ICU or even surgery (often more than one intervention) to deal with complications of the disease process.

Front 37

most common cause of acute pancreatitis

Back 37

1) gallstones
2) Excessive alcohol use is often cited as the second
A useful mnemonic for remembering the causes of acute pancreatitis is; 'GET SMASHED', that is:

* Gallstones
* Ethanol
* Trauma
* Steroids
* Mumps
* Autoimmune causes
* Scorpion venom
* Hyperlipidaemias
* ERCP
* Drugs (Such as Azathioprine) (AIDS drugs), Laix, chemo, estrogen

Front 38

S&S of Pancreatitis

Back 38

Severe upper abdominal pain, with radiation through to the back, is the hallmark of pancreatitis. Nausea and vomiting (emesis) are prominent symptoms. Bowel sounds may be reduced as a reflection of the reflex bowel paralysis (i.e. ileus) that may accompany any abdominal catastrophe.

Front 39

Diagnosis of Pancreatitis

Back 39

"two of the following three features: 1) abdominal pain characteristic of acute pancreatitis, 2) serum amylase and/or lipase ≥3 times the upper limit of normal, and 3) characteristic findings of acute pancreatitis on CT scan."[4]

Front 40

Laboratory tests

Back 40

amylase and/or lipase, and often one, or both, are elevated in cases of pancreatitis.
serum lipase is thought to be more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis".[4]

Front 41

Conditions other than pancreatitis /similar

Back 41

(e.g. cholecystitis, perforated ulcer, bowel infarction (i.e. dead bowel as a result of poor blood supply), and even diabetic ketoacidosis

Front 42

Imaging

Back 42

Although ultrasound imaging and CT scanning of the abdomen can be used to confirm the diagnosis of pancreatitis, neither is usually necessary as a primary diagnostic modality[14] . In addition, CT contrast may exacerbate pancreatitis,[15] although this is disputed.[16] See acute pancreatitis.

Front 43

Prognosis

Back 43

Ranson criteria

Main article: Ranson criteria

At admission:

1. age in years > 55 years
2. white blood cell count > 16000 /mcL
3. blood glucose > 11 mmol/L (>200 mg/dL)
4. serum AST > 250 IU/L
5. serum LDH > 350 IU/L

After 48 hours:

1. Haematocrit fall > 11.3444%
2. increase in BUN by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
3. hypocalcemia (serum calcium < 2.0 mmol/L (<8.0 mg/dL))
4. hypoxemia (PO2 < 60 mmHg)
5. Base deficit > 4 Meq/L
6. Estimated fluid sequestration > 6 L

The criteria for point assignment is that a certain breakpoint be met at anytime during that 48 hour period, so that in some situations it can be calculated shortly after admission. It is applicable to both biliary and alcoholic pancreatitis.

[edit] Interpretation

* If the score ≥ 3, severe pancreatitis likely.
* If the score < 3, severe pancreatitis is unlikely

Or

* Score 0 to 2: 2% mortality
* Score 3 to 4: 15% mortality
* Score 5 to 6: 40% mortality
* Score 7 to 8: 100% mortality

Front 44

Glasgow criteria

Back 44

Glasgow's criteria[17]: The original system used 9 data elements. This was subsequently modified to 8 data elements, with removal of assessment for transaminase levels (either AST (SGOT) or ALT (SGPT) greater than 100 U/L).

On Admission

1. Age > 55 yr
2. WBC Count > 15 10 exp 9 /Lit
3. Blood Glucose > 10 mmol/L (No Diabetic History)
4. Serum Urea > 16 mmol/Lit ( No response to IV fluids)
5. Arterial Oxygen Saturation < 60

Within 48 hours

1. Serum Calcium < 2 mmol/L
2. Serum Albumin <32 gm/L
3. LDH > 600 units/L
4. AST/ALT >200 Units/L

Front 45

Acute (early) complications of pancreatitis include

Back 45

* shock,
* hypocalcemia (low blood calcium),
* high blood glucose,
* dehydration, and kidney failure (resulting from inadequate blood volume which, in turn, may result from a combination of fluid loss from vomiting, internal bleeding, or oozing of fluid from the circulation into the abdominal cavity in response to the pancreas inflammation, a phenomenon known as Third Spacing).
* Respiratory complications are frequent and are major contributors to the mortality of pancreatitis. Some degree of pleural effusion is almost ubiquitous in pancreatitis. Some or all of the lungs may collapse (atelectasis) as a result of the shallow breathing which occurs because of the abdominal pain. Pneumonitis may occur as a result of pancreatic enzymes directly damaging the lung, or simply as a final common pathway response to any major insult to the body (i.e. ARDS or Acute Respiratory Distress Syndrome).
* Likewise, SIRS (Systemic inflammatory response syndrome) may ensue.

* Infection of the inflamed pancreatic bed can occur at any time during the course of the disease. In fact, in cases of severe hemorrhagic pancreatitis, antibiotics should be given prophylactically.

Front 46

Late complications

Back 46

Late complications include recurrent pancreatitis and the development of pancreatic pseudocysts. A pancreatic pseudocyst is essentially a collection of pancreatic secretions which has been walled off by scar and inflammatory tissue. Pseudocysts may cause pain, may become infected, may rupture and hemorrhage, may press on and block structures such as the bile duct, thereby leading to jaundice, and may even migrate around the abdomen.

Front 47

treatment of pancreatitis

Back 47

The preferred analgesic is morphine for acute pancreatitis.
ndeed, given meperidine's generally poor analgesic charactersitics and its high potential for toxicity, it should not be used for the treatment of the pain of pancreatitis

Front 48

Treatment

Back 48

morphine replacement fluids Limitation of oral intake (with dietary fat restriction the most important point). NG tube feeding is the preferred method to avoid pancreatic stimulation and possible infection complications caused by bowel flora. start antibiotics When necrotizing pancreatitis ensues and the patient shows signs of infection, it is imperative to start antibiotics such as Imipenem due to the high penetration of the drug in the pancreas. Floroquinolone + metronidazole is another treatment option.

Front 49

Lipase

Back 49

Lipases perform essential roles in the digestion, transport and processing of dietary lipid main enzyme responsible for breaking down fats in the human digestive system