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49 Cards in this Set
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Generic fever w/u |
has to undergo blood cx (2-3 independent sites prior to starting Abx) CXR urinalysis |
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Basic tests to order on CCS |
CBC BMP Mg ABG etoh level tox screen LFT CT scan (if needed) LP (if needed) blood cx (p/w fever) urinalysis (p/w fever) |
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Delirium tremens presentation |
Sxs can start 9-12 hrs after last drink with peak at 48-72 hrs disoriented agitated hallucinating perspiring tx with benzodiazepine (eg chlordiazepoxide, diazepam, lorazepam, phenobarbital) and IV thiamine and folic acid acute confusion and fever --> meningitis |
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Alcoholic hallucinosis |
occurs ~48 hrs after stopping p/w visual hallucinations not auditory hallucinations not usually agitated, tachy, or hypertensive like in DT tx with benzodiazepine AND anti-psychotic |
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Liver failure with DT |
only benzos safe in liver failure is lorazepam or oxazepam |
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DT refractory to benzos |
barbiturates or propofol |
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Wernicke-Korsakoff syndrome |
Wernicke: confusion ataxia ophthalmoplegia due to thiamine deficiency & is reversible Korsakoff: amnesia with confabulation irreversible |
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Wet Beri Beri |
high output cardiac failure due to thiamine deficiency intense vasodilation of peripheral arterioles bc low ATP levels increases CO bc of low afterload (decr resistance) and increased venous return leads to eccentric hypertrophy |
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Pre-op labs |
T&S CBC PT, PTT, Fib |
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Intracranial hemorrage |
intubation and hyperventilate to pCO2 of 25-30mm Hg IV mannitol get neurosurgery consult |
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Acute altered mental status of unclear etiology |
naloxone thiamine dextrose |
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Salicylate intoxication |
respiratory alkalosis (CO2 low) with anion gap metabolic acidosis can also have: tinnitus pulmonary edema coma secondary to edema |
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Lactic acidosis secondary to aspirin toxicity |
poisons mitochondria that leads to anaerobic metabolism and production of lactate |
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Activated charcoal |
can give for any potential overdose even if specific ingested substance is not known |
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Tx of aspirin o/d |
activted charcoal IV fluids IV HCO3- to alkalinize urine that aids in drug excretion psych consult |
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Signs of upper GI bleed |
very high BUN hypotension hematochezia |
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Angiodysplasia |
characterized by painless bleeding, which can be mild to massive can be assoc with aortic stenosis |
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Hypoglycemia Sxs |
irritability tremulousness diaphoresis seizure stupor coma |
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Factitious use of insulin |
hypoglycemia elevated insulin low c-peptide level |
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Sulfonylurea o/d |
hypoglycemia elevated insulin elevated c-peptide check sulfonylurea level |
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W/u of pt in fire |
carboxyhemoglobin --> if elevated, give 100% O2 CXR CBC BMP |
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Degree of burns |
1st degree: erythematous and only superficial layer of skin with no blisters 2nd degree: blistering and a white fibrinous exudate 3rd degree: blackened, charred, or leathery w/no sensation |
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Ventricular fibrilliation |
defibrillate with 360 J then several cycles of CPR repeat 360 J IV access intubate epinephrine IV or vasopressin q5 mins amiodarone or lidocaine (prefer amiodarone) |
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V Fib algorithm |
defibrillate --> CPR (5 cycles) --> check rhythm --> defibrillate --> CPR (5 cycles) --> epinephrine --> check rhythm --> defibrillate --> CPR --> amiodarone --> check rhythm --> defibrillate |
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Synchronized shock |
defibrillation means UNSYNCHRONIZED synchronized does it to ventricular contraction aka QRS complex so can only do if QRS complex is present |
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3 conditions for defibrillation (unsynchronized shock) |
V Fib pulseless ventricular tachycardia torsades de pointes |
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Acetylcysteine |
acetomenophen toxicity antidote only beneficial when used up to 24 hrs after ingestion |
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Acetaminophen o/d Sxs |
anorexia nausea vomiting diaphoresis malaise hepatotoxicity peaks 72-96 hrs post ingestion |
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Alcohol hepatitis |
AST:ALT is 2:1 AST is NEVER >500 |
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Heart fluttering/palpitations vs chest pain |
1st step always EKG chest pain: 2nd step consider stress test fluttering/palpitations: 2nd step consider Holter monitor |
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A fib EKG |
tachycardia irregular rhythm no p waves tx with IV diltiazem & admit to telemetry unit |
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Supraventricular tachycardia |
tachycardia regular intervals no p waves 1st step is carotid massage --> then adenosine |
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Multifocal atrial tachycardia |
tachycardia irregular intervals p waves exist but have a different morphology normally occurs in pt with underlying pulmonary issue --> treat hypoxemia |
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A fib labs |
thyroid function test cardiac enzymes ECHO ABG |
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A Fib tx goals |
rate control HR < 110 @ rest IV diltiazam, metoprolol anticoagulation warfarin rhythm control cardioversion if hemodynamically unstable amiodarone, sotalol, dofetilide, ibutilide, propafenone, dronedarone, and flecainide |
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Anticoagulation with A fib |
A fib secondary to valve always get anticoagulation CHADS2 score Chf Htn Age >75 Dm Stroke or TIA (2 points) score 0 --> aspirin score 1 --> aspirin or anticoagulant score 2+ --> anticoagulant for life |
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Drugs for A fib anticoagulation |
warfarin with INR goal of 2-3 dabigatran --> direct thrombin inhibitor rivaroxaban, abixaban --> Xa inhibitors |
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Amiodarone side effects |
ataxia, parasthesias, peripheral neuropathy hypo/hyperthyroid hepatitis and cirrhosis corneal deposits cough with infiltrates on CXR |
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SA node conduction on EKG |
p waves (atrial contraction)
bc a fib u dont have atrial contraction u have no p waves |
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AV node conduction on EKG |
PR interval (part of diastole) heart block leads to slowing of AV firing so u have prolonged PR interval b-blockers and Ca channel blockers inhibit AV node conduction so lead to PR interval prolongation |
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Purkinje fibers conduction on EKG |
QRS complex (ventricular contraction) wide QRS complex indicates problem with ventricular conduction |
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Young pt with SOB tests |
pulse ox CXR EKG ProBNP Troponin Lactate ABG BMP D-dimer PT PTT Fib If suspecting PE --> CT angio OR V/Q scan in pts with renal failure or contrast allergy |
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Tx PE |
start LMWH and warfarin |
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Vitamin K-dependent factors |
II VII IX X Protein C and S II and X take > 5 days to decline so want to overlap with LMWH for 5-7 days |
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PE secondary to malignancy |
LMWH indefinitely NOT warfarin |
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Thrombolytics in PE |
only in persistent hypotension or shock |
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PE cause w/u |
elderly: thorough w/u for malignancy woman: antiphospholipid antibodies & FV Leiden (if FV Leiden, cannot get OCPs) |
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P2Y12 ADP receptor inhibitors |
clopidogrel, prasugrel, and ticagrelor inhibits plt aggregation used in pts with coronary stents, peripheral vascular dz, & strokes |
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Thromboxane A2 inhibitors |
abciximab, tirofiban, eptifibatide inhibits fibrinogen cross-links via GP IIB/IIIA receptors used to tx NSTEMI & STEMI |