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192 Cards in this Set
- Front
- Back
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What is the most common cause of red eye?
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viral conjunctivitis
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What causes viral conjunctivitis? What are the S/S? (9)
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adenovirus following URI-very contagious
red eye +/- FB sensation mild itch normal pupillary response thin/watery discharge global injection pattern preauricular adenopathy sudden onset rapid progression |
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How is viral conjunctivitis treated?
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Naphazoline/pheniramine (Visine A or Naphcon A)
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What is the causative agent of bacterial conjunctivitis? (4) What are the S/S? (7)
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Strep, Staph, Haemoph, Pseudomonas (contacts)
red eye +/- FB itch copious/purulent discharge lashes matt preauricular adenopathy acute onset |
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How is bacterial conjunctivitis treated?
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no contacts = topical polymyxin B-trimethoprim
contacts = Cipro + Erythromycin |
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What are the S/S of allergic conjunctivitis? (6)
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red eye
VERY ITCHY clear/watery discharge cobblestone appearance nasal conjestion no preauricular adenopathy |
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How is allergic conjunctivitis treated? (4)
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cool compresses
Olopatadine (Patanol) artificial tears diphendydrame |
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What are the S/S of acute angle closure glaucoma? (14)
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sudden onset
red eye eye pain unilateral vison loss IOP>40 (tono-pen) steamy cornea mid dilated pupils fixed pupils irregular pupils non-reactive pupils N/V sparked by ambient lighting *halos around lights no hypopion |
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How is acute angle closure glaucoma treated?
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Timolol gtts
Apraclonidine gtts Pilocarpine gtts Acetazolamide IV Mannitol IV |
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What are the S/S of central retinal vein occlusion? (4) Tx?
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painless
unilateral vison loss cotton wool spots many scattered retinal hemorrhages refer to ophthamologist |
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What are the S/S of central retinal artery occlusion? What is generally the cause? (5)
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painless
unilateral vision loss disc pallor cherry fovea "boxcar" veins usually from embolus |
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What is the treatment of central retinal artery occlusion? (3)
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acetazolamide IV
anterior chamber paracentesis inhaled carbogen |
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What are 2 causative agents of orbital cellulitis? What are the S/S? (5)
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Staph aureus (G+)
Strep pneumo (G+) red eye eye pain w/ eye movement vison loss proptosis fever |
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What may used in the diagnosis of orbital cellulitis? How is orbital cellulitis treated?
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CT scan?
Cefuroxime (G2) IV, opth consult Augementin (periorbital) |
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Of the following, which ones are emergent?
conjunctivitis, acute angle closure glaucoma, central retinal vein occlusion, central retinal artery occlusion, orbital cellulitis |
acute angle closure glaucoma
orbital cellulitis central retinal artery occlusion |
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What 2 eye conditions should NOT be patched?
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chemical burn
corneal ulcer (bacterial keratitis) |
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What are the 6 W'S that are going through your mind with post-op fever?
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WIND (pneumonia, aspiration, PE)
WATER (UTI) WALKING (DVT, PE) WOUND (surgical site infxn) WONDER drugs WHAT did we do (IV line infxn) |
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On what post-op days does WIND fever generally occur?
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1-2
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On what post-op days does WATER fever generally occur?
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3-5
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On what post-op days does WALKING fever generally occur?
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4-6
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On what post-op days does WOUND fever generally occur?
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5-7
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On what post-op days does "WONDER drugs/WHAT did we do" fever generally occur?
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7+
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What are post-op infectious causes of fever (<20% of pts w/in first 24hrs)? (8)
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contamination
bacterial pneumonia UTI abscess hepatitis osteomyelitis peritonitis |
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What are post-op non-infectious causes of fever? (8)
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*atelectasis
malignancy transfusion drug fever thrombophlebitis PE gout metabolic (thyrotoxicosis, Addisonian crisis) |
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What are the local signs of infection found on PE post-op? (4)
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dolor/pain
calor/heat rubor/red tumor/mass |
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What are 5 potential wound complications?
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hematoma
seroma infection dehiscence evisceration |
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What is the Salter-Harris classification of pediatric fractures?
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1- physis
2- physis, metaphysis 3-physis, epiphysis 4- physis, metaphysis, epiphysis 5- crush injury |
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What are the 3 types of deformity for ortho?
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RAD (distal ligament compared to proximal)
rotation (overlapping) angulation (bent) displacement |
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How do forearm fractures generally occur? How are they treated?
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FOOSH
double sugar tong splint |
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What are 6 types of forearm fractures?
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Colles
Smith Hutchinson/Chauffeur's Monteggia Galeazzi |
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Briefly describe a Colles fracture.
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transverse
distal radius dorsal angulation away from ulna "dinner fork deformity" wrist extended when fall also ulnar styloid process fx? |
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Briefly describe a Smith fracture.
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transverse fracture
distal radius volar displacement |
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Briefly describe a Barton fracture.
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oblique
intra-articular distal radius dorsal displacement dosal carpus subluxation |
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Briefly describe a Hutchinson (chauffeur's) fracture.
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intra-articular
radial styloid |
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Briefly describe a Monteggia fracture.
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ulna fracture w/ radial head disclocation
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Briefly describe a Galeazzi fracture.
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distal 1/3 of radius
dislocation of distal radioulnar joint |
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What are 7 tests included in the ligament exam of the knee?
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valgus/MCL
varus/LCL Lachman anterior drawer posterior drawer apprehension sag sign |
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What are 4 tests included in the meniscal exam?
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joint line point tenderness
McMurray Apley Bounce Home |
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What is the MC ligament injured in the ankle? Second?
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anterior talofibular
calcaneofibular |
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What is the best manipulation test for anterior talofibular ligament?
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anterior drawer test
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What does a grade 1 ankle inversion injury involve?
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atfl partial tear
stable pe |
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What does a grade 2 ankle inversion injury involve?
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complete tear of atfl
partial tear of lcfl positive anterior draw test negative talar tilt test |
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What does a grade 3 ankle inversion injury involve?
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complete tear of atfl/lcfl
positive anterior draw test positive talar tilt test |
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What x-ray imaging is done for an acute ankle?
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ankle-AP/lateral/Mortise
foot-AP/lateral/oblique leg-AP/lateral |
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What is a Mortise x-ray of the ankle?
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AP w/ foot internally rotated 10-15 degrees; space should be 2-3mm all the way around and symmetrical
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What action are the peroneal tendons responsible for?
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dorsiflexion
eversion |
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What are the possible results of an inversion injury?
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torn atfl
fibula fracture Jones fracture (5th metatarsal avulsion) |
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What does bacterial pharyngitis often resemble?
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mono
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What are the S/S of bacterial pharyngitis (Centor Criteria)?
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tonsilar exudates
"beefy red" uvula tender ant. cervial adenopathy fever absence of cough age <15 age >45y (subtract a pt) |
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What diagnostic test can be done for bacterial pharyngitis?
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rapid antigen test
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How is bacterial pharyngitis treated?
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PCN VK 500mg PO TID x 10days (or Clindamycin)
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Why is bacterial pharyngitis treated?
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prevent rheumatic fever
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Is viral pharyngitis more common in adults or children?
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adults
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What are the MCC of viral pharyngitis (3)?
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adenovirus (may get associated conjunctivitis)
rhinovirus infectious mono |
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What does the patient's throat with viral pharyngitis look like?
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erythematous
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How is viral pharyngitis treated?
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rest, oral fluids, salt-water gargling
analgesics/antipyretics |
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What is the DOC for viral pharyngitis?
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acetominophen
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What is the MC causative agent of bacterial pharyngitis?
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GABHS
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What is the causative agent of infectious mononucleosis?
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Epstein-Barr virus
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What are the S/S of mono? (5)
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exudative pharyngitis
fever posterior cervical adenopathy malaise enlarged spleen |
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How is a pt tested for mono?
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monospot which detects IgM antibodies to the viral capsid antigen (heterophile antibody) that produces agglutination of horse RBC
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What type of rash may show up with mono if pt took antibiotics for S/S?
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morbilliform rash (measle-like; maculopapular)
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What is included in Virchow's triad for a pulmonary embolism?
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endothelial injury
venous stasis hypercoagulability |
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What are 9 conditions that can cause hypercoagulability which can lead to a pulmonary embolism?
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vitamin K
DIC polycythemia vera birth control pregnancy cancer protein S/C deficiency thrombin 3 deficiency previous DVT/PE |
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What are 2 locations of clinically significant clots?
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iliofemoral & pelvic venous beds
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What is found on history taking for a pulmonary embolism? (4)
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#1 dyspnea
#2 pleuritic chest pain (doesn't have to be pleuritic though) tachycardia cough |
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Is pleuritic chest pain generally with inspiration or expiration?
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inspiration
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What may be found on PE with a pulmonary embolism? (10)
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tachypnea
tachycardia hypoxemia/hypocapnia rales/wheezing pleural friction rub low-grade fever diaphoresis DVT/phlebitis signs hypotension (late sign) severe hypoxia (late sign) Homan's sign (pain w/ dorsiflexion) |
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What ancillary studies are done for a suspected pulmonary embolism?
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ABG (res alkalosis, hypoxemia)
D-Dimer ELISA (not assay) ECG |
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For a pulmonary embolism, what does it mean if D-Dimer ELISA is negative? Positive?
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negative = no PE
positive = indeterminate |
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What may be seen on an ECG of a pulmonary embolism?
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*nonspecific ST-T wave changes
-S1Q3T3 (right heart strain) -->large S in lead I, Q inverted T in lead III |
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What may be seen on a CXR of a pulmonary embolism?
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"Wastermark sign" (specific but rare)
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What is the gold standard for a pulmonary embolism?
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pulmonary angiogram
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What types of diagnostic studies can be done for a pulmonary embolism?
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CXR
V/Q scan venous doppler U/S CT chest angiogram pulmonary angiogram |
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With V/Q scan for a pulmonary embolism, what confirms the diagnosis with a high probability?
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larger perfusion defect in area with normal ventilation
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With a V/Q scan, what should be done if there is low or indeterminate probability (high or low clinical suspicion) of a pulmonary embolism?
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LE venous doppler U/S or CT angio (to look for a DVT in extremities)
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What should be done for a negative venous doppler U/S in low risk patients? Moderate to high risk patients?
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repeat in 5-7 days
CT or angio |
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What is the study of choice to rule out pulmonary embolism in patient with underlying cardiopulmonary dz or abnormal CXR (superior to V/Q scan) and its purpose is to identify the location and size of clot?
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CT chest angiogram
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How is a pulmonary embolism treated?
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ABC's
O2 IV crystalloid & vasopressors unfractionated heparin (PTT) low molecular weight heparin (Lovenox) coumadin (PT/INR) thrombolytics |
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What may be included in the S/S of a pneumonia pt? (10)
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productive cough
pleuritic chest pain night sweats/rigors fever dyspnea rales, rhonchi wheezes dullness to percussion breath sounds infiltrate may be present on CXR |
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What type of organisms of pneumonia have a rapid onset?
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pnemococcal organisms
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What type of organisms of pneumonia have an insidious onset?
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atypical organisms (ex. Mycoplasma)
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What type of pneumonia generally occurs in college students?
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Mycoplasma
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What type of pneumonia is the most common in children? (2)
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adenovirus
RSV |
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What is the MCC of community-acquired pneumonia?
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Strep
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What is the MCC of viral pneumonia?
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influenza
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What type of pneumonia is mainly seen in aspiration pneumonia?
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Klebsiella
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What 3 groups of people generally get aspiration (Klebsiella) pneumonia?
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alcoholics
elderly COPD |
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What is seen on CXR of Klebsiella pneumonia? (2)
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lobar infiltrates
pulmonary abscess |
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Is pseudomonas pneumonia generally community or hospital acquired?
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hospital acquired
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What is seen on CXR of Pseudomonas pneumonia?
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bilateral lower lobe infiltrates
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What does BNP lab help differentiate pneumonia from?
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CHF
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How is outpatient pneumonia treated?
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antipyretics
cough suppressants *Doxycycline Fluroquinolone (Gatifloxacin or Levofloxacin) Macrolide (Erythromycin, Azithromycin) Tx 7-10 days, 5 days on Azithromycin |
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How is inpatient pneumonia treated?
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initiated w/in 4h of presentation
oxygen IV fluid blood/sputum culture fluoroquinolone macrolide + B-lactamase inhibitor (Imepenim) |
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What are the most common causes of viral pediatric pneumonia?
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parainfluenza (Fall)
RSV (Winter) influenza (Spring) |
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What type of pneumonia is common to occur in newborn <1mo old? (2)
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Group B Streptococci
G- bacilli |
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What type of pneumonia is common to occur in 1-3mo old? (2)
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Chlamydia trachomatis
Strep pneumoniae |
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What type of pneumonia is common to occur in 3mo-5yr old?
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Strep pneumoniae
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What type of pneumonia is common to occur in 5-18yo?
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Mycoplasma (atypical)
Strep pneumoniae |
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What may be included in the S/S of a pediatric pneumonia pt? (16)
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fever
lethargy cough HA vomitting rhinorrhea *dec feeding "baby not acting right" tachypnea tachycardia rales wheezing dec. breath sounds grunting accessory muscle use nasal flaring |
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What may a CXR for viral pediatric pneumonia show?
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diffuse
interstitial hyperinflation atelectasis |
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What may a CXR for bacterial pediatric pneumonia show?
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lobar
segmental perihilar infiltrate patch infiltrate |
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What is included in the Tx plan for pediatric pneumonia?
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humidified blow-by O2
IV hydration antimicrobial |
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How is a newborn pt for pneumonia treated?
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admit
Ampicillin IV OR Nafcillin + Gentamycin IV |
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How is a 1-3mo old pt for pneumonia treated?
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outpatient
afebrile -Erythromycin OR Amoxicillin |
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How is a 3mo-5yr old pt for pneumonia treated?
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outpatient
Amoxicillin OR Azithromax (macrolide) |
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How is a 5-18yo pt for pneumonia treated?
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outpatient
Azithromax x5d |
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What are 5 S/S that are included in the history/PE of an asthma patient?
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dyspnea
cough wheezing (expiratory) tachypnea tachycardia |
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What is the name of the sign that is a big warning in severe exacerbations of asthma?
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silent chest
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What diagnostic tests may be done for an asthma/COPD patient? (11)
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spirometry
peak expiratory flow rate ABG pulse oximetry CXR (pneumonia) EKG CBC w/ diff electrolytes serum theophylline blood culture (COPD) sputum culture (COPD) BNP (COPD vs CHF) |
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How are mild to moderate asthma/COPD exacerbations treated? (5)
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O2 w/ nasal cannula (want PaO2>60 & sat>90%)
B-adrenergic agonists (Albuterol w/ MDI or nebulizer) corticosteroid Ipatropium bromide (Atrovent) antibiotic (pneumonia) |
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How is moderate to severe asthma/COPD exacerbatoins treated? (6)
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O2 by nasal cannula
albuterol corticosteroid Ipatropium antibiotic (infection) positive airway pressure |
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How are severe to life-threatening asthma/COPD exacerbations treated? (5)
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intubation/mechanical ventilation
albuterol Ipatropium bromide (Atrovent) IV Methylprednisolone admit to ICU |
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What is an ominous sign of pediatric asthma?
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child tachypneic w/ normal PaCO2 (would expect a fall in PaCO2 due to hyperventilation)
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What are 4 risks of UTI?
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young children
immunocompromised elderly men (BPH) recently sexually active |
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What are key S/S of UTI (pertinent positives)? (3)
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dysuria
urinary frequency suprapubic discomfort |
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What labs point towards a UTI?
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pos leukocyte esterase
RBC (ex. 2/hpf) WBC (ex. 3/hpf) |
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What is the most common pathogen of UTI?
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E. coli (80%)
proteus Klebsiella enterobacter pseudomonas |
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What is the general Tx plan for UTI?
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Ciprofloxacin x 3days
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What would you prescribe a pt w/ UTI if cannot afford a flouroquinolone? (3)
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Bactrim
Amoxicillin Cephalexin |
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Your patient w/ UTI has already been treated with Bactrim and returns complaining of similar symptoms. What do you treat with?
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Flouroquinolone x 7-10days
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Your UTI patient has a positive bHCG, what do you treat her with?
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Amoxicillin-Clavulanate (Augmentin)
Nitrofurantoin |
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What can you use to treat UTI patients complaints of dysuria? What do you need to inform them of with this medication?
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Pyridium x 2-3days
urine may turn orange |
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What are the first 2 conditions you need to think about with elderly and altered mental status?
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UTI
pneumonia |
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What are key S/S of pyelonephritis (pertinent positives)? (6)
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fever
dysuria urinary frequency suprapubic discomfort chills? positive CVA tenderness |
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What are the key labs for pyelonephritis? (5)
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pos nitrites
pos leukocyte esterase RBC (ex 2/hpf) WBC (ex 3/hpf) WBC casts |
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How is sepsis r/o for pyelonephritis?
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CBC (look @ WBC & bandemia)
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Does FQ PO or IV have better bioavailability?
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same :)
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How is an uncomplicated pyelonephritis pt treated?
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Cipro or Levaquin PO x 10days
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What are the Tx options for complicated pyelonephritis pts? (3)
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IV FQ
ampicillin + gentamicin IV IV Rocephin |
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What do the diagnostic tests show for prerenal ARF?
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BUN/Cr > 20:1
FENa < 1% sp gravity > 1.020 hyaline casts in urine |
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What do the diagnostic tests show for intrarenal ARF?
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BUN/Cr 10:1-20:1
FENa > 1 sp gravity 1.010-1.020 US may help |
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What do the diagnostic tests show for postrenal ARF?
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US shows hydronephrosis
serum/urine tests have similar results to intrarenal cause |
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What type of diagnostic test is used for testicular torsion pts?
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DOPPLER US (duplex)
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What are pertinent positive S/S of testicular torsion?
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scrotal pain
acute gets worse w/ time does not change w/ position N/V? elevated, enlarged, tender testicle horizontal "sideline" testicle generally male <20yo |
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How is testicular torsion treated?
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urology consult
manual detorsion ice packs (grrrr???) |
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What is phren's sign?
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when you elevate testicle/scrotum pt's pain decreases
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What helps to differentiate epididymitis from testicular torsion? (4)
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epididymitis is more gradual, no associated vomiting, worsens with standing, positive phren's sign
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What is the common causative organism of epididymitis in pts <40yo? >40yo?
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<40yo Gonorrhea/Chlamydia
>40 UTI organisms (E. coli, proteus, Klebsiella) |
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What is it called if epididymitis coinfects the testes? What is the "uncommon" causative organism?
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epididymitoorchitis
mumps |
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What are key pertinent positive S/S of Fournier's gangrene?
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diabetic
itching discomfort of inner thighs/scrotum/labia edema of scrotum/labia global erythema US reveals gas in affected area eventually smelly travels along fascia |
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What are the S/S of acute cholecystitis?
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RUQ pain/tenderness
fever elevated WBC's inflammatory changes on US |
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What are 2 inflammatory changes that may show up on US of acute cholecystitis?
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gallbladder wall thickening
pericholecystic fluid |
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What is the Tx plan for cholecystitis?
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may include admission
fluid/electrolytes Cefotetan (2nd generation) cholecystetomy (may have to do open procedure) |
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How may ports are done for laparoscopic cholecystectomy? What is "clipped"? What type of imaging may be done intraoperatively?
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4
cystic artery & cystic duct cholangiogram |
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What are the leads that an anteroseptal MI will show?
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V1-V4
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What are the leads that an anterior MI will show? What are 2 conditions/rhythms that may precede this type of MI?
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V3-V4
Mobitz complete heart block |
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What are the leads that an anterolateral MI will show?
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V4-V6, I, aVL
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What are the leads that a lateral MI will show?
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V5-V6, I, aVL
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What are the leads that an inferior MI will show? What are 3 condtions/rhythms that may precede this type of MI?
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II, III, aVF
bradycardia 1st degree heart block Wenckebach |
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What are the leads that an inferiorlateral MI will show?
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II, III, aVF, V5-V6
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What are the leads that a posterior MI will show?
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V1 (mirror)
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What are the leads that a right ventricular MI will show?
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II, III, aVF, V4R
a lot of times along with inferior MI |
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What are the leads that a septal MI will show?
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V1-V2
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In general, what needs to be evaluated on EKG for MI? (4)
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-ST segment elevation > 1 mm in 2 contiguous leads
-Q wave presence in 2 contiguous leads -new LBBB -ST segment depression or T wave inversion in 2 contiguous leads |
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What are 8 contraindications for STEMI fibrinolytic therapy?
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-SBP > 180, DBP>110
-Hx of structural CNS disease -Closed head or facial trauma w/in past 3 mos -Recent (w/in 6 wks) surgery, trauma, GI bleed, laser eye surgery -Clotting disorders -CPR > 10 minutes -Pregnant female -Serious systemic disease (terminal CA, severe kidney or liver disease |
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What are the treatment options for acute coronary syndrome?
|
-ASA >160mg
-Clopidogrel (Plavix) (hold if going for emergent CABG) -nitrates 0.4mg q 5min x 3 or until pain relief or SBP <100 -morphine -beta-blocker (Lopressor) -unfractionated heparin (PTT) -Lovenox -Glycoprotein IIb/IIIa inhibitors (Aggrenox) (do no use w/ Clopidogrel or fibrinolytics) -tPA (w/ heparin) -retevase (w/ heparin) -TNKase -PCI (w/in 90mins) -CABG |
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How is unfractionated heparin and partially Lovenox reversed?
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protamine sulfate
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What are the Tx options for STEMI?
|
MONA
beta blocker Clopidogrel Heparin PCI (w/in 90 mins; <12h from onset) fibrinolytics (w/in 30 mins; <12h from onset) ACEI/ARB HMG CoA reductase inhibitor |
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What are the Tx options for unstable angina/non-STEMI?
|
MONA
beta blocker Clopidogrel heparin Glycoprotein IIb/IIIa inhibitor ACEI/ARB HMG CoA reductase inhibitor |
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What is included in the classification of left sided heart failure? (4)
|
pulmonary congestion
DOE PND cough |
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What is included in the classification of right sided heart failure? (2) What is the MCC?
|
peripheral edema
JVD > 3 (CVP-->preload) MCC = left heart failure |
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What is happening with systolic dysfunction? (5)
|
ventricles pumping <40-50%
dilated ventricles (first L) dilated cardiomyopathy secondary to ischemic heart dz worse w/ exercise |
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What is happening with systolic dysfunction? (4)
|
ventricle pump ~60% (but may have decreased amount)
long standing HTN ischemic heart dz ventricular hypertrophy |
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What are some of the S/S of CHF? (14)
|
DOE
orthopnea PND SOB @ rest chest pain abd. pain weakness JVD crackles rales S3/S4 murmur hepatojugular reflex peripheral edema AMS |
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What may be seen on CXR of CHF? (6)
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symptoms may lag up to 6hr (normal CXR does not exclude CHF)
Kerly B lines in periphery cephalization of blood flow cardiomegaly inc pulm vasculature pleural effusion interstitial edema |
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What may an echocardiogram show for CHF? (4)
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ejection fraction
wall motion abnormality valvular dz systolic vs diastolic |
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What BNP level rules out CHF? What BNP level rules in CHF?
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<100 rules out CHF
>250 rules in CHF |
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What are 7 conditions that may cause a falsely elevated BNP?
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elderly
women liver failure renal failure HRT pulmonary embolus pulmonary HTN |
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What is included in the Tx plan for CHF? (7)
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ABCs
CPAP/BiPAP sublingual nitrates nitroprusside (if BP stable and no relief w/ nitrates) Furosemide (Lasix) Bumetadine (Bumex) Morphine |
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What is included in the primary survey for ACLS?
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Airway
Breathing Circulation Defibrillation |
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For ACLS, where do you check for a pulse in adults? Children?
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carotid
brachial |
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If a pt has a definitive pulse, but is not breathing, then what do you do?
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give 1 breath q 5-6 seconds (8-10/min)
recheck q 2 mins |
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Explain how CPR should be given.
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5 cycles of 30 compressions (100/min) and 2 breaths
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What is included in the secondary survey for ACLS?
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Airway
Breathing Circulation Differential Diagnosis |
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What is the sequence of Tx for pulseless VF/VT?
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-ABCs
-shock (360J monophasic, 200J biphasic) -5 cycles of CPR -shock -CPR -Epinephrine 1mg q 3-5mins (may give 1 dose of Vasopressin 40U to replace 1st or 2nd dose of Epi) -5 cycles CPR -shock -CPR -Amiodarone 300mg then 150mg OR Lidocaine 1-1.5mg/kg then 0.5-0.75mg/kg (max 3 doses or 3mg/kg) |
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How is torsades de pointes treated?
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1-2g magnesium
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What meds can be givin down an ETT and what is the dosage?
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NAVEL (double dose)
Narcan Atropine Vasopressin Epinephrine Lidocaine |
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What is the sequence of Tx options for asystole/PEA?
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-5 cycles of CPR
-Epinephrine 1mg q 3-5mins (may give 1 dose of Vasopressin 40U to replace 1st or 2nd dose of Epi) -atropine 1mg q 3-5mins (max 3 doses or 0.4mg/kg) |
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What are the H's and T's that need to be thought about with PEA and bradycardia? (10)
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Hypovolemia
Hypoxia Hydrogen ion (acidosis) Hyper/Hypokalemia Hypothermia Toxins/Tablets Tamponade Tension pneumothorax Thrombosis Trauma |
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What are S/S of poor perfusion caused by bradycardia or unstable tachycardia? (4)
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acute AMS
ongoing chest pain hypotension other signs of shock |
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What is the sequence of Tx for poor perfusing bradycardia pts?
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-transcutaneous pacing (w/o delay if 2nd or 3rd degree block)
-atropine 0.5mg while awaiting pacer (up to 3mg) -Epinephrine 2-10ug/min or Dopamine 2-10ug/kg/min -transvenous pacing |
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What is the sequence of Tx options for stable narrow QRS (<.12) regular v-tach?
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-vagal manuevers
-Adenosine 6mg rapid IVP (if needed then 12mg then 12mg again) -expert consultation :) -if rhythm converts (reentry SVT): Tx recurrence w/ Adenosine, Diltiazem, or beta blockers) -if rhythm does not convert (a-flutter, ectopic atrial tach, juncitional tach): Diltiazem, beta blockers |
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What is the sequence of Tx options for stable narrow QRS (<.12) irregular v-tach?
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-expert consult
-possible a-fib/a-flutter/MAT -Diltiazem or beta blockers |
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What 2 conditions are beta blockers used w/ caution?
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pulmonary dz
CHF |
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What is the sequence of Tx options for stable wide QRS (>.12) regular v-tach?
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-expert consult
-Amiodarone 150mg over 10mins (max 2.2g/24h) -synchronized cardioversion if SVT w/ aberrancy give adenosine |
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What is the sequence of Tx options for stable wide QRS (>.12) irregular v-tach?
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-expert consult
-may Tx a-fib (beta blocker or Diltiazem) -pre-excited a-fib (AF+WPW): Amiodarone 150mg over 10mins (avoid AV nodal blocking agents: Adenosine, Digoxin, Diltiazem, Verapamil) |
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How is unstable tachycardia treated (rate >150bpm)?
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immediate synchronized cardioversion
-SVT & a-flutter may respond to lower energy (50J) |
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What are 11 causes of peritonitis?
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appendicitis
perforated peptic ulcer acute salpingitis diverticulitis perforation small bowel perforation gangrenous cholecystitis trauma large bowel perforation ischemic small bowel acute necrotizing pancreatitis post-op complication |
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What may be included in the S/S of peritonitis?
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acute abdomen
abdominal pain tenderness guarding rigidity distension free peritoneal air diminished bowel sounds fever chills/rigors N/V tachycardia sweating tachypnea restlessness dehydration oliguria disorientation shock |
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Is a cutting needle or reverse cutting needle used more often in cutaneous surgery?
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reverse cutting needle (sharp edge of outer curve of needle that is directed away from the wound)
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What is a subcuticular suture good for?
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wounds where tension is minimal
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