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182 Cards in this Set
- Front
- Back
What is the slippage of the femoral head on the femoral neck at the growth plate?
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-slipped capital epiphysis
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-What is a hyperextension childhood injury with a positive lachman and drawer test on PE?
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-avulsion acl injury
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-What condition is an inflammation of growth plate at the tibial tuberosity?
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-osgood-schlatters
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-What causes Osgood-schlatters?
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-repetitive over use injury to tibial apophysis
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-What causes sinding-larsen syndrome?
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-repetitive stress injury to junction of patella and patellar tendon
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-How do you treat Osgood-schlatters and sinding-larsen?
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-rest 4-6 wks
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-What is little league elbow injury called?
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-avulsion medial epicondyle
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-If little league elbow heals improperly what problem could occur?
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-flexion contracture (elbow cant extend all the way)
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-At what size of avulsion does surgery need to be done in avulsion medial epicondyle injury?
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->5mm
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-What injury is caused by repetitive stress injury to the calcaneal apophysis?
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-severs disease
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What condition is idiopathic osteonecrosis of femoral head?
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-legg-calves disease
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-What is the treatment for meniscal tears?
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-arthroscopic debridement, quad strengthening
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-What PE tests are positive in meniscus tears?
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-mcmurrays, apleys compression
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-What is the treatment for 1st degree collateral ligament injury?
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-ROM therapy, quad strengthening for 4-6 wks, early weight bearing
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-What is the treatment for 2nd degree collateral ligament injury?
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-60 degree locked brace for 4 wks, therapy for 16 wks
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-What is the treatment for 3rd degree collateral ligament injury?
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-surgical reapair
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-What syndrome has chronic pain with aerobic events and climbing stairs?
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-patellofemoral syndrome
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-What feature of womens anatomy causes patellofemoral syndrome?
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-increased Q angle
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-What PE tests are positive in patellofemoral syndrome?
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-patellar apprehension test, patellar inhibition test
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-What is the treatment for patellofemoral syndrome?
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-vastus medialus strengthening
-nsaids -patella stabilizing brace, mcconnell taping |
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What surgery is done if treatment for PF syndrome failed after 2 years?
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-lateral retinacular release
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-What condition is dead area in femoral condyle?
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-osteochondritis dessicans
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-How do you treat O.D.?
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-cylinder cast 6-8 wks
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-What is the most common cause of ankle sprains?
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-inversion injuries (85%)
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-What criteria decides if an ankle sprain needs to be xrayed?
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-ottawa rules
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-What is a grade 1 ankle sprain?
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-lateral injury, negative xray, negative drawer test
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-How is grade 1 ankle sprain treated?
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-early motion, early wt bearing, therabrand ex’s, full activity
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-What is a grade 2 ankle sprain?
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-both medial and lateral ligaments involved
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-How do you treat a grade 2 ankle sprain?
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-immobilize 2-4 wks, PT, full activity > 6wks
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-What is a grade 3 ankle sprain?
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-medial and lateral injury, positive drawer test, instability
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How do you treat a grade 3 ankle sprain?
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-surgical repair
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-What type of shoulder dislocation is caused by falling on an outstretched arm?
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-glenohumeral
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-What type of shoulder dislocation is caused by a direct blow?
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-acromioclavicular
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-Which type of shoulder dislocation needs xray and reduction?
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-glenohumeral
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-What are impingement signs in rotator cuff strains?
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-inpingement arc, pain at ROM extremes, negative drop arm test
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-What is the treatment for a scaphoid fracture?
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-long arm cast 10-20 wks
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-What injury presents as shin splints after prolonged activity?
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-stress fracture
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-What system classifies fractures surrounding a growth plate?
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-salter-harris classification
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-What 3 things are evaluated in the glascow coma score?
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-eye response, verbal response, motor response
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-What is cushings triad (sign of increased ICP)?
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-hypertension, bradycardia, hyperpnea
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What are other signs of increased ICP on PE?
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-bulging fontanel, unequal pupils, decorticate/decerebrate posturing
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-What is given if pts blood sugar is <60?
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-bolus of D25, or 0.5-1 mg glucagons if no IV access
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-What does AEIOU TIPS stand for?
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-alcohol/abuse, electrolytes/encephalopathy, infection/ingestion, overdose, uremia, trauma, insulin/inborn errors of metabolism, psychogenic, seizures/stroke/shock/shunts
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-What is the most common cause of death in pediatrics?
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-trauma (head injuries)
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-What are 6 poor outcome predictors in trauma?
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-cardiac arrest > 25 min, blood sugar >250, found unresponsive, GCS <8, pH <7.1, coma > 24hrs
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-When is emesis never used in pts with toxic ingestion?
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-comatose, seizing pts
-absent gag reflex -swallowed sharp objects -swallowed strong acids, bases or hydrocarbons |
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-When can emesis be used in toxic ingestions?
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-if patient ingested substance within 30-60 min
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-Lavage as a treatment for toxic ingestion is most effective in what timeframe?
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-within one hour
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-Whole gut lavage with polyethelene glycol is used for what types of ingestion?
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-sustained release medications, substances poorly absorbed by charcoal, to get mechanical movement of items through bowel
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-What is the dose of activated charcoal used?
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1-2 g/kg repeated every 2-6 hrs
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Charcoal is not effective for what kinds of ingestion?
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-iron, lithium, caustics
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-What are the 3 methods for enhancing excretion of toxic substances?
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-urinary alkalinization, dialysis, natural diuresis
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-Sodium bicarb is administered when what 2 substances are ingested?
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-ASA, Phenobarbital (pKa < 7.5)
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-Dialysis may need to be done after high levels of ingestion of what 3 things?
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-ethanol, ASA, lithium
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-What is the most common co-ingestion in a suicide attempt?
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-ethanol
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-What is the metabolic degradation rate of ethanol?
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20 mg/hr
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-What is the toxic metabolite of acetaminophen?
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NAPQI
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-How does the pt appear in Phase I (first 24 hrs) of acetaminophen ingestion?
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nausea, vomiting, anorexia
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- How does the pt appear in Phase II (second 24 hrs) of acetaminophen ingestion?
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asymptomatic
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- How does the pt appear in Phase III (48-96 hrs) of acetaminophen ingestion?
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elevated LFTs, bilirubin, PT, RUQ pain, nausea, vomiting, fulminant hepatic failure
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How does the pt appear in Phase IV (7-8 days) of acetaminophen ingestion?
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-recovering
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-What is the treatment for acetaminophen overdose and in what forms does it come?
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-N-acetylcysteine
-Mucomyst PO, Acetadote IV |
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-N-acetylcysteine is most effective if given when?
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-within 8 hrs
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-If pt presents after 4 hrs of acetaminophen ingestion what do you do?
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-give charcoal, draw blood levels and plot on rumack-matthew nomogram, maybe give mucomyst if blood level is hepatotoxic
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-If pt arrives after 24 hours after ingestion and acetaminophen level is >10 or AST is elevated, what do you give?
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-N-acetylcysteine
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-What are the symptoms of aspirin intoxication?
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-hyperventilation, sweating, dehydration, fever, nausea, vomiting, tinnitus
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-What is the toxic dose of aspirin?
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-150 mg/kg
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-An ABG on a pt with an aspirin ingestion may show what?
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-metabolic acidosis
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-What treatment is given to pt with an aspirin ingestion?
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-charcoal within 4 hrs, sodium bicarb to raise urine pH to > 7.5
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-Hemodialysis is needed when serum aspirin levels are what level?
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> 100 mg/dl
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What is the treatment for a kid that ingested less than 100 mg/kg of ibuprofen?
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-drink 4 ounces of milk or water
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-What is the treatment for a kid that ingested more than 400 mg/kg of ibuprofen?
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-gastric lavage or activated charcoal
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-What are the symptoms of Beta blocker ingestion within 6 hrs?
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-bradycardia, cardiogenic shock, arrhythmias, hyper/hypo glycemia, ECG changes: wide QRS, increased PR interval, BBB
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-What is the treatment for beta blocker ingestion?
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-supportive care, monitor vitals/EKG/lytes/glucose, charcoal if < 4 hrs
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-What are the symptoms of digoxin or cardiac glycoside ingestion?
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-nausea, vomiting, diarrhea, headache, MS change, dysrhythmias
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-What should you not give to pt with digoxin ingestion?
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-potassium
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-What is the antidote for digoxin ingestion?
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-digoxin immune Fab (Digiband)
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-What will appear on CBC with lead intoxication?
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-normo or microcytic with basophilic stipling (small dots at periphery of RBCs which are accumulations of rRNA)
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-What is the treatment for lead ingestion if pt is asymptomatic and lead level is 45-69?
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-outpatient chelation with oral dimercaptol, check blood levels in 48 hrs
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- What is the treatment for lead ingestion if pt is symptomatic and lead level is >69?
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-admit pt, IV dimercaptol and edentate
-monitor lytes, calcium, creatinine, and UA |
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What symptoms could develop in a pt with lead blood levels > 60?
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-GI/renal effects, encephalopathy, ICP, seizures
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-What are the 5 most common sites for a foreign body to become lodged?
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-cricopharyngeal area
-middle 1/3 of esophagus -lower esophageal sphincter -pylorus -ileocecal valve |
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-What is the best way to remove an ingested foreign body?
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-endoscopy
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-What foreign bodies cause symptomatic patients and need to be removed?
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-batteries, caustic or sharp objects
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-What could be symptoms of a lower respiratory tract foreign body?
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-episode of choking followed by no sx for days
-then fever/cough, and signs of pneumonia and atelectasis |
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-How would a coin in the trachea appear on xray?
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-sideways (sitting in between rings of cartilage)
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-What should not be done for a pt with a nasal foreign body?
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-decongest area with topical pseudoefedrine or oxymetazoline
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-What should you always consider in child burns?
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-child abuse
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-What differentiates a 1st degree from a 2nd degree burn?
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-no blistering in 1st degree
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-How deep do 3rd degree burns extend into the tissue?
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-“full thickness” though epidermis and dermis
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Why are circumferential burns very serious?
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-can lead to compartment syndrome
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-What defines a major burn?
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- > 10% of BSA consisting of 1st and 2nd degree burns
- or > 2% of BSA of 3rd degree burn -or any burn to face, hands, feet, or perineum |
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-What is the parkland formula for fluid resuscitation for first 24 hrs after burn?
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-total lactated ringers 4 ml/kg x BSA
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-What is the rate of infused lactated ringers solution over the first 8 hours, and then next 16 hrs?
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-50% over first 8 hrs
-remaining 50% over next 16 hrs |
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-What Is near drowning?
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-survival (even if temporary) beyond 24 hrs after a submersion episode
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-Aspiration of water causes dilution and wash out of what in the lungs?
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-alveolar surfactant
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-Hypothermia is defined as a core temp of what?
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- < 35 celcius
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-What are the 7 poor prognostic indicators from drowning?
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-submersion longer than 10 min
-resucitation duration greater than 25 min -GCS < 5 -Age < 3 -water temp > 10 celcius -ABG pH <7.1 -CPR needed in ED |
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-What are the battle signs in head injuries?
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-bruising behind ears, raccoon eyes
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-What 5 things in a head injury indicate that a CT should be done?
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-LOC, persistent vomiting, mental status change, signs of skull fracture, abnormal PE findings
|
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What rectal temp constitutes a fever?
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-38 celcius (101 F)
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-Despite the cause of a fever they should all be treated with what?
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-tylenol q4, or motrin q6
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-A full septic work up should be done in all infants at what age with a fever?
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-less than 28 days
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-What infection and fever is most common in 5-10 y.o.?
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-strep throat
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-What infection and fever is most common in children < 2 years?
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-otitis media
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-What kind of bacteria cause meningitis at 0-2 months?
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-Group B strep, E.coli, listeria monocytogenes
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-What kind of viruses cause meningitis at 0-2 months?
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-herpes simplex, cytomegalovirus, enterovirus
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-What kind of bacteria cause meningitis at 2 mo-5yrs?
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-strep pneumoniae, meisseria meningitides, beta hemolytic strep, haemophilus influenza B, rickettsia, salmonella, E.coli
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-What viruses cause meningitis at 2 mo – 5 yrs?
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-HSV, enterovirus, arbovirus
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-What bacteria cause meningitis in 5-21 y.o.?
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-strep pneumoniae, neisseria meningitidis
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What viruses cause meningitis in 5-21 y.o.?
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-HSV, entero/arbovirus, EBV, Influenza A/B
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-What are symptoms of meningitis in infants?
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-irritability, inconsolability, hypotonia, lethargy, bulging fontanelle
|
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-What are symptoms of meningitis in older children?
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-headache, photophobia, nausea, vomiting, neck stiffness
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-What are 4 severe symptoms of meningitis?
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-shock, seizure (20-30%), coma, SIADH (30-60%)
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-What is seen on CSF analysis in a case of bacterial meningitis?
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-WBC >1000, PMN > 50
-Glucose < 30 -Protein >100 |
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-What empiric abx are given to child < 8 wks old with meningitis?
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-ampicillin + cefotaxime, maybe add acyclovir for herpes
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-What empiric abx are given to child 2 mo or older with meningitis?
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-ceftriaxone, consider vancomycin for pneumococcal meningitis
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-What med is given to increase glucose and decrease protein/lactate in CSF in a case of meningitis?
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-dexamethasone
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-When do you give dexamethasone to a patient with meningitis?
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-20 minutes before first does of abx, then every 6 hrs
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-CF is caused by defects in a transmembrane conductance regulator. What does this defect cause?
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-decreased hydration of mucus, stickier mucus leading to infection
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What is the principal cause of death in CF?
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-end-stage lung disease
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-What enzyme causes persistence of inflammation, structural damage, and impaired gas exchange in CF patients?
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-neutrophil elastase
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-What mechanical bowel problems are seen in CF patients?
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-sludging of intestinal contents, intestinal obstruction, impaction, intussusception
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-What causes pancreatic insufficiency in CF patients?
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-reduced bicarbonate secretion in response to secretin stimulation
-pancreatic enzymes cant work at their optimal pH |
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-What liver/gallbladder problems result in CF?
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-increased bile viscosity, gallstones, obstructive cirrhosis
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-What are some early presentations that point towards a diagnosis of CF?
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-meconium ilius, recurring respiratory infections/pneumonia, steatorrhea, failure to thrive
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-What test for chloride content in sweat is used to diagnose CF?
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-quantitative pilocarpine iontophoresis test
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-What level of chloride in sweat is consistent with a diagnosis of CF?
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> 60 mmol/L
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-What neonatal enzyme is screened for CF?
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-immunoreactive trypsinogen
|
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-What is the hallmark of CF lung disease?
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-airway inflammation
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What type of diet should a CF patient have?
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-high energy, high –fat, fat soluble vitamins and minerals
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-What is the best activity for a CF patient?
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-canoe paddling (seriously go buy a canoe)
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-What medication is given to CF pt to assist in digestion of proteins, starches, and fats?
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-pancrelipase (creon, pancrease, ultrase, viokase)
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-Taking pancrelipase with what other meds may increase the effect of the enzymes?
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-H2 antagonists, proton pump inhibitors
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-CF patients are unable to absorb what vitamins properly?
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-A,D,E,K (fat soluble)
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-What med is given for airway clearance in CF patients?
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-albuterol neb
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-What mucolytics help to improve airway clearance in CF patients?
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-Dornase alfa (pulmozyme) via nebulizer
-hypertonic saline |
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-What inhaled antibiotic is effective in CF pts > 6 mo?
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-tobramycin
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-What abx is combined with penicillins to treat pseudomonad infections in CF pts?
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-gentamicin
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-What abx are effective against pseudomonas, streptococci, and MRSA infections in CF?
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-ciprofloxacin
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What is the definition of flail chest?
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-2 or more consecutive ribs broken in 2 or more places
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- Any injured patient who is cool and tachycardic is considered to be in shock unless proven otherwise T/F?
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-True
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-What is the most common cause of shock in an injured patient?
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-hemorrhage
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-How do treat shock by giving fluids?
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-start 2 large bore IVs (at least 16G), warm isotonic solution (NS or LR), blood products
|
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-What is the best GCS, and what is a severe GCS?
|
-15 is best, severe is 3-8
|
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-If you suspect neurologic deterioration because of ICP what do you do?
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-Mannitol, controlled hyperventilation, anticonvulsants, deep sedation, raise head of bed to 30 degrees, neurosurgery consult
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-What are the 4 areas of FAST obtained during primary survey in a trauma?
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-ultrasounds of the RUQ, LUQ, Pelvis, sub-xiphoid
|
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-Ultrasound of the RUQ could show fluid accumulation in what area?
|
-Morison’s pouch (hepatorenal recess)
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-Hyperechoic areas on an ultrasound could indicate what in a trauma?
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-accumulation of blood or fluid
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-Ultrasound of the sub-xiphoid area could show what in a trauma?
|
-pericardial effusion
|
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During the head to toe secondary survey of a trauma, what does DCAP BTLS stand for?
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-deformities, contusions, abrasions/avulsions, penetrations/punctures, burns, tenderness, lacerations, swelling
|
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-What describes the first class of hemorrhagic shock?
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-15% blood volume loss, HR < 100, BP= normal
-Replace fluid PO or IV |
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-What describes class II of hemorrhagic shock?
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-15-30% blood loss, HR 100-120, BP normal, CNS mildly anxious
-Replace fluid IV |
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-What describes class III of hemorrhagic shock?
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-30-40% blood loss, HR 120-140, BP decreased, CNS anxious/confused
-Replace fluid IV + Blood |
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-What describes class IV hemorrhagic shock?
|
- >40% blodd loss, HR >140, BP decreased, CNS confused/lethargic
-Replace fluid IV + Blood |
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-“Blood on the floor and 4 more” describes obvious signs of bleeding plus what 4 things?
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-bleeding in the chest (hemothorax), abdomen (do FAST), pelvis (fractures), long bones (femur)
|
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-What are 3 causes of obstructive non-hemorrhagic shock?
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-tension pneumothorax, pericardial tamponade, massive PE
|
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-What are 5 causes of cardiogenic non-hemorrhagic shock?
|
-dysrhythmia, MI, cardiomyopathy, valvular dysfunction, septum rupture
|
|
-What is the classic display of neurogenic non-hemorrhagic shock?
|
-hypotension without tachycardia or cutaneous vasoconstriction
|
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-How do you threat neurogenic shock?
|
-fluids, vasopressors, atropine
|
|
What is the most common cause of distributive shock?
|
-sepsis
|
|
-What are the symptoms of sepsis?
|
-fever, rigors, hypotension, hyperglycemia, altered MS
|
|
-Stephen Johnson syndrome is a type of this 3rd degree burn?
|
-toxic epidermal necrolysis
|
|
-IV fluids should be given to patients with burns over how much of their body?
|
- >20% BSA
|
|
-Which type of burn appears wet and is hypersensitive?
|
-2nd degree
|
|
-Which type of burn does not blanch with pressure?
|
-3rd degree
|
|
-How is the Baux score calculated for predicting burn mortality?
|
-Age + percent burn
|
|
-What are the more serious cause of chemical burns?
|
-alkali burns
|
|
-Rhabdomyolysis from electrical burns cause release of what?
|
-myoglobin
|
|
-What can be given to help flush pigments such as myoglobin out of the body?
|
-mannitol
|
|
What can be given to trap myoglobin in the urine and aid in excretion?
|
-sodium bicarb
|
|
-Acute mesenterich ischemia may produce elevations of what enzyme in the blood?
|
-lactate (from conversion of aerobic to anaerobic metabolism)
|
|
-Plain film xrays can be used to diagnose what abdominal conditions?
|
-bowel obstruction, perforation, foreign body
|
|
-CT can be used to diagnose what abdominal conditions?
|
-looks at organs and vasculature, mesenteric ischemia
|
|
-Ultrasound can be used to diagnose what abdominal conditions?
|
-abdominal aortic aneurism, ovarian/testicular torsion
|
|
-What multiple organ dysfunction syndromes may result from sepsis?
|
-ARDS, tubular necrosis and kidney failure, hepatic injury/failure, DIC
|
|
-What parameters are seen in systemic inflammatory response syndrome (in sepsis)?
|
-temp >100.4 or < 96.8, HR >90, RR >20 or PaCO2 <32, WBC >12,000 or <4,000 or >10% bands
|
|
-2 or more of these criteria =
|
sepsis
|
|
-What is the BP in septic shock?
|
systolic < 90 or reduction of > 40 mmHg from baseline
|
|
-How much fluid should be given for every 1L of blood loss?
|
-3 L
|
|
What abx are given for sepsis?
|
-3rd or 4th gen cephalosporin, flagyl, vancomycin
|
|
What kind of electrical current is more likely to cause ventricular fib?
|
AC
|