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85 Cards in this Set
- Front
- Back
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True/False: Changes in pupillary response are an early sign of brain injury?
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• Changes in pupillary response is a late sign of brain injury
• The correct answer is: False |
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After assessing the ABCs in trauma, what are the "DEFGs"?
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• D: disability (neurologic status)
• E: exposure/environmental control • F: foley/finger (rectal) • G: gastric intubation/girl (pregnant?) |
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What are the Glascow Coma scores that suggest mild, moderate, and severe injury?
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• mild: 3-8
• moderate: 9-12 • severe: 13-15 |
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What is considered adequate urine output for an adult and child?
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• Adult: 0.5 cc/kg/hr
• Child (> 1 y/o): 1.0 cc/kg/hr • Child (< 1y/o): 2.0 cc/kg/hr |
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Foley is contraindicated if urethral transection is suspected. What are signs of urethral transection?
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• blood at the meatus
• "high-riding" prostate • perineal or scrotal hematoma |
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What test should be done if urethral transection is suspected?
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retrograde urethrogram
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How much fluid should pediatric patients receive IV bolus?
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20 cc/kg
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What is the treatment for asystole?
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• transcutaneous pacing
• epinephrine • atropine |
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What is the treatment for symptomatic bradycardia?
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• atropine
• transcutaneous pacing (definitive tx) • dopamine • epinephrine • isoproteronol * dopamine & epi increase contractility |
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What is the treatment of V-tach (with a pulse)?
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• Amiodarone
OR • Lidocaine |
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What is the treatment for patients with unstable atrial fib?
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cardioversion
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What are treatment options for rate control of A-Fib?
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• Diltiazem (1st line?)
• Metoprolol • Amiodarone • Verapamil • Digoxin |
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What are treatment options for rate and rhythm control for Wolf-Parkinson White?
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• Rate control: amiodarone or procanamide
• Rhythm control: cardiovert only < 48 hrs |
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What is the treatment for PSVT?
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• vagal maneuvers (1st intervetion in stable patients)
• Adenosine • other options: - Diltiazem - Esmolol - Metoprolol - Propanolol - Digoxin |
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What are the most common causes of V-tach?
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• ischemic heart disease
• acute MI |
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What is the treatment for pulseless V-tach?
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defibrillation
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What is the treatment for unstable patients in V-tach who are not pulseless?
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cardioversion
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What are treatment options for hemodynamically stable patients (with normal cardiac function) in V-tach?
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• Amiodarone
• Other options: - sotalol - procainamide - lidocaine |
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What are treatment options for hemodynamically stable patients (without normal cardiac function) in V-tach?
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• Amiodarone
• Lidocaine (alternative) |
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What are causes of PEA or asystole?
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PATCH(5) MD
• P: PE • A: acidosis • T: tension PTX • C: Cardiac Tamponade • H(5): Hyperkalemia, hypokalemia, hypovolemia, hypothermia, hypoxia • M: myocardial infarction • D: drug overdose |
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What is the definition of shock?
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inadequate delivery of oxygen on the cellular level secondary to hypoperfusion
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What are causes of hypovolemic shock?
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• hemorrhage (most common)
• burns • diarrhea • pancreatitis • SBO • vomiting |
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What are characteristics of hypovolemic shock?
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• peripheral vasoconstriction (to perfuse central organs)
• tachycardia • narrowed pulse pressure |
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Describe the different classes of hemorrhagic shock
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• Class I: up to 15% blood loss; up to 750 cc
• Class II: 15-30% blood loss; 750-1500 cc • Class III: 30-40% blood loss; 1500-2000 cc • Class IV: > 40% blood loss; > 2000 cc |
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Which form of shock produces a wide pulse-pressure, near-normal blood pressure, and tachycardia?
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septic shock
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Which form of shock produces distended neck veins, hypotension, and tachycardia?
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cardiogenic shock
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What are causes of cardiogenic shock?
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• acute myocardial infarction
• air embolus • blunt myocardial injury • cardiac tamponade • tension pneumothorax |
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Which form of shock produces vasodilation, hypotension, and bradycardia?
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neurogenic shock
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What causes neurogenic shock?
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occurs when spinal cord injury causes loss of peripheral sympathetic tone
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What is included in the "trauma series"?
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• lateral c-spine
• AP chest • AP pelvis |
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Which tools are used for rapid detection of intra-abdominal bleeding?
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• diagnostic peritoneal lavage (DPL)
• focused abdominal sonogram for trauma (FAST) |
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Which pain medication is good for renal colic?
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Toradol
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Which pain medication is good for treating pain with suspected gallbladder etiology?
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demerol
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What is the max dose of lidocaine?
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• with Epi: 7 mg/kg
• w/out Epi: 4.5 mg/kg |
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What is the duration of action for Lidocaine?
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2 hrs
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What is the duration of action of Bupivicaine?
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4 hrs
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What is the max dose of Bupivicaine?
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• w/ epi: 2 mg/kg
• w/out epi: 3 mg/kg |
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What parts of the body should not be injected with epinephrine?
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• ears
• fingers • nose • penis • toes |
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How can patients with metabolic acidosis clinically present?
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• AMS
• Abdominal Pain • Nausea • Vomiting • Shock • Tachypnea (Kussmaul) |
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What are causes of anion gap metabolic acidosis?
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A MUDPILES
• Alcohol • Methanol • Uremia • DKA • Paraldehyde • INH/Iron • Lactic Acidosis • Ethylene Glycol/Ethanol • Salicylates |
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What are causes of non-anion gap metabolic acidosis?
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• Ureterostomy
• Small bowel fistulas • Extra chloride • Diarrhea • Carbonic anhydrase inhibitors • Adrenal insufficiency • Renal tubular acidosis • Pancreatic fistula |
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What is the expected change in PCO2 in acute metabolic acidosis?
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PCO2 decreases by 1mm Hg for every 1 mEq/dL decrease in bicarbonate
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What are causes of metabolic alkalosis?
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• excessive diuresis
• excessive loss of gastric secretions (ex. vomiting) |
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How can patients with metabolic alkalosis clinically present?
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• dehydration-type symptoms
• impaired oxygen delivery • muscle irritability • tachydysrhythmia |
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What are other differential diagnosis for patients presenting w/ metabolic alkalosis symptoms?
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• dehydration
• excessive diuresis • glucocorticoid administration • hypercapnia • hypokalemia • increased intake of citrate or lactate • loss of gastric acid • severe hypoporteinemia |
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What are treatment options for metabolic alkalosis?
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• IV fluids (normal saline)
• KCL (no faster than 20 mEq/h, unless serum K+ > 5.0 mEq/L |
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Respiratory acidosis may be a precursor to what?
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respiratory arrest
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How can patients with respiratory acidosis present?
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• AMS
• unconscious |
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What lab test is essential for diagnosing respiratory acidosis?
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ABG
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What are treatment options for respiratory acidosis?
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• increase ventilation (intubation if necessary)
• treat underlying disorder |
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What are other disorders that need to be rule-out for patients presenting with hyperventilation?
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• asthma
• ASA overdose • DKA • fever • hyperthyroid • liver disease • pulmonary embolism |
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How can patients in respiratory alkalosis clinically present?
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• dizziness
• carpal-pedal spasm (painful flexion of the wrists, fingers, ankles, and toes) • chest tightness/pain * symptoms caused by cerebral and peripheral hypoperfusion |
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What are symptoms of hyponatremia?
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• agitation
• AMS • cramps • hallucinations • headache • lethargy • seizures |
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What are causes of hyponatremia?
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• dilutional (MCC)
• elevated protein • hyperglycemia • hyperlipidemia |
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What are treatment options for hyponatremia?
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• IV fluids (NS)
• fluid restriction (in normotensive patients) • severe hyponatremia - hypertonic saline - lasix |
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What are complications of rapid correction of hyponatremia?
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• Central pontine mylelinolysis
• CHF |
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An osmolarity increase of __ will cause thirst
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2%
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What are symptoms of hypernatremia and at what osmolarity do symptoms occur?
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• symptoms occur when osmolarity is > 350
• symptoms include: - ataxia - irritability - lethargy - seizures |
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What are causes of hypernatremia?
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• excessive water loss
- vomiting/diarrhea - diabetes insipidus - dialysis - diuresis • increase sodium • mineralcorticoid or glucocorticoid excess |
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What is the treatment for hypernatremia?
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• NS or lactated ringer
* change to ½NS after a urine output of 0.5 ml/kg/hr is reached |
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What is the treatment for hypernatremia if no urine output is observed after NS or lactated ringer solution rehydration?
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• ½ NS
• Lasix |
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What is the treatment for central diabetes insipidus?
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desmopressin
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How can patients with hypokalemia clinically present?
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• CNS
- cramps - hyporeflexia - weakness • Cardiovascular - dysrhythmias - EKG changes - hypotension or hypertension - worsening of dig toxicity • GI (ileus) • Glucose intolerance • Renal - metabolic alkalosis - worsening hepatic encephalopathy |
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What are causes of hypokalemia?
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• diuretics (MCC)
• decreased intake • increased loss • shift into cell |
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What are EKG changes caused by hyperkalemia and what are serum K+ level do they occur?
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• K+ > 6.5-7.5
- Peaked T waves - Prolonged PR/ short QT • K+ > 7.5-8.0 - QRS widens - P waves flatten • K+ > 8.0 - Sine wave - V-fib - Heart blocks |
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What are clinical symptoms of hyperkalemia?
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• Neuromuscular symptoms
- paralysis - weakness • GI symptoms - colic - diarrhea - vomiting |
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What is the MCC of hyperkalemia?
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renal failure with oliguria
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What is pseudohyperkalemia?
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elevated K+ caused by hemolysis after blood draw
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What is first line treatment for severe hyperkalemia?
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calcium gluconate
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How can patients with hypocalcemia clinically present?
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• confusion
• cramps • increased DTRs • parasthesias • seizures • weakness |
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What are 2 clinical signs that can be seen in hypocalcemia?
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• Chovstek sign
• Trousseau sign |
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What are causes of hypocalcemia?
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• drugs (ex. cimetadine)
• hypoparathyroidism • hypomagnesemia • pancreatitis • phosphate overload • renal failure • sepsis • shock • tetanus toxin • Vit D deficiency |
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What are treatment options for hypocalcemia?
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• Calcium gluconate OR Calcium Cloride (IV/PO)
• Vitamin D |
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What are causes of hypercalcemia?
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PAM P SCHMIDT
• PTH, • Addison’s ds • Multiple Myeloma • Paget’s ds • Sarcoidosis • Cancer • Hyperthyroid • Milk-alkali syndrome • Immobilization • Vitamin D increase • Thiazides |
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What wil 1/3 of patients with hypercalcemia also develop?
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hypokalemia
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How can patients with hypercalcemia present clinically?
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• Stones (renal calculi)
• Bones (malign bone destruction) • Moans (psych, lethargy, weakness, fatigue, AMS) • Groans (abd pain, constipation, polyuria/dipsia) |
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What are EKG changes seen in hypercalcemia?
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• Short QT
• Wide T wave • Depressed ST • Heart blocks |
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What are treatment options for hypercalcemia?
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• NS
• Lasix (Furosemide) • Calcitonin • Hydrocortisone |
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What are clinical findings of hypomagnesemia?
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• Anemia
• CNS - ataxia - depression - increased DTRs - tetany - vertigo • Cardiac - arrhythmias - prolonged QT/PR - worsening of digitalis • Dysphagia • Hypotension • Hypothermia |
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What are causes of hypomagnesmia?
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• alcoholism (MCC in US)
• correction of DKA • cirrhosis • excess GI loss • pancreatitis • poor nutrition |
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What is treatment for hypomagnesmia?
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• correct volume deficit and any decreased K+, Ca++, Phosphate levels first
• Magnesium sulfate (if patient is an alcoholic in DTs) - check DTRs q 15 mins, stop when DTRs normalize |
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What is a normal magnesium level?
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1.3-2.1
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What are clinical findings of hypermagnesemia?
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• no DTRs (Mg > 3.5)
• muscle weakness ( > 4.0) • hypotension (> 5.0) • respiratory paralysis (> 8.0) |
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What are causes of hypermagnesemia?
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renal failure with ingestion of antacids or lithium
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What are treatment options of hypermagnesemia?
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• rehydrate with NS and Lasix (in absence of renal failure)
• correct acidosis with ventilation and sodium bicarbonate • Calcium chloride in symptomatic patients to antagonize Mg++ effects |
