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66 Cards in this Set
- Front
- Back
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Mrs. Smith, a lively 78 yr old woman, successfully receiving Lasix (a diuretic) for hypertension comes in to the office…complaining of UTI symptoms. She wants to know why the doctor did not prescribe Gentamicin. “I used to always take Gentamicin”…..what do you explain to her?
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Gentamicin is an aminoglycoside antibiotic…aminoglycosides and Lasix can cause severe ototoxicity
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Senator X receives a letter with a suspicious powder substance. What cephalosporin will he take for anthrax expsoure?
The Nurse warns Senator X not to go to Happy Hour, why? |
CeClor (cefaclor) 250 mg PO q8h
Senator X should not consume alcohol while taking cephalosporins because of a possible disulfiram-like reaction-- Flushing, nausea, vomiting, chest pain, palpitations, dyspnea, blurred vision, even seizures! |
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Uncle Larry seems confused lately…It’s a good thing the doctor prescribed Zithromax for his upper respiratory infection…..
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Half-life is 68 hours so patients only need to take it once a day….usefull for patients who have trouble remembering to take their pills.
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Carrie’s husband has an abscessed tooth. The dentist prescribed Clindamycin (lincosamide)…
Great wife that she is, she is bummed because she just cleaned her toilets…what side effect is she thinking of? |
Clindamycin may allow
Clostridium difficile (C. diff) to infect the colon. |
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Michael volunteers at a health clinic for refugees from other countries…He is surprised to see so many patients with T.B.
He explains the treatment lasts from 6 months to two years…why? |
The slow growing bacteria form a mycolic acid outer coating. Isoniazid, rifampin and ethionamide are the first line of defense….
your pee will be orange” for patients taking rifampin |
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Isoniazid (INH)
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Treatment for tuberculosis
Can cause lupus and jaundice from liver toxicity Signs of jaundice: Yellow skin Discolored sclera |
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Jennifer says, “if it’s the flu and its been less than 2 days, you should try….
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Tamiflu (oseltamivir)
75 - 150 mg PO b.I.d. for 5 days |
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Relenza
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For the Flu
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Hepsera
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Hepatitis B
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Acyclovir
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For Herpes
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Aldara
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Skin Cancer
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Retrovir
(AZT) |
For HIV
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What common antifungal is used topically for onychomycosis ?
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Lamisil is commonly used cream
and is pretty safe |
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Why would anyone need to take pills for fungus?
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Superinfections
Azoles are used to treat Candidiasis, systemic fungal infecitons and to prevent candidiasis in bone marrow transplants |
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Systemic antifungals like azoles may become toxic with:
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digoxin
oral hypoglycemics warfarin phenytoin cyclosporine |
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Xanax
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anxiety, panic
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Librium
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anxiety, alcohol withdrawal
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Klonopin
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restless leg syndrome, panic
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Valium
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muscle relaxant, antiepiletptic
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ProSom
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hypnotic, insomnia
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Ativan
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anxiety, preanesthesia
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Kim requests only 1 mg/day PO Ativan
for Mr. Mason The normal dosage is 2 -6 mg/day Mr. Mason is an African American |
Kim knows special care needs to be taken because he may have a genetic predisposition to delayed metabolism of benzodiazepines.
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Amytal sodium
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convulsions, sedative
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Luminal
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preanesthetic, seizures
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Seconal
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preanesthetic, seizures
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Trauma is d/t to lack of what?
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Heat and Oxygen
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Tensile Strength
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Amount of force or strength put on something before it breaks or tears.
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Compressive strength
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amount of compression tissue or bone can take before it breaks or tears.
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Shearing
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when stretching forces exceed the elasticity of the vessels, can tear, rupture, disect or form aneurysm.
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Management of patient with multiple injuries
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1. Airway
2. Hemorrhage 3. Prevent and treat hypovolemic shock by replacing blood loss with blood/fluid, monitor urine output, rapid infuser, 1 liter in 1 minute, use 8G IV. 4. Asses for head/neck injuries maintain spinal immobilization 5. Evaluate for other injuries. 6. Splint fractures 7. Carryout ongoing assessment. |
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ABCDE
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Airway and Cervical Spine- Patent airway?
Breathing- Bleeding out? Circulation- Position? Disability Exposure- Weather, hypothermia |
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S/S of hypothermia
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Respiratory acidosis- pH less than 7.35, inadequate excretion of CO2 and inadequate ventilation, increased pule, resp., and BP. decreased pulse
Coagulopathy- blood fails to clot |
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Benefits of hypothermia
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Slows metabolism down, in head injury slows down swelling
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What to asses in chest injury
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Airway compromise, swelling trachea deviation, air hungry, use of acessory muscles, bleeding, cardiac arhythmias
Palpate for crepitis- air leaking into pleural space |
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Patho of rib fractures
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Pain @ fracture site causes limited respiratory effort/ coughing by shallow and rapid breathing causing diminished ventilation collapse of aveoli and ateletasis(dead space in lung) causing accumulation of secretions d/t unwillingness to C/DB and pain causing respiratory insufficency or failure.
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Flail Chest
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happens when 2 or more ribs fracture in 2 or more places. Usually the result of massive blunt trauma to chest wall. Paradoxical( balloons out during expiration) chest movements d/t increase neg. intrathoracic pressure. When breath in chest deflates. Stand @ HOB to see.
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Patho of Flail chest
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Paradoxical movement impairs the ability to produce sufficient breath causing mediastinal shift to the uninjured side during inspiration and injured side during expiration during expiration the flail chest bulges out making it difficult to expel air causing increased dead space ventilation, retained airway secretions, increased lung resistance and compliance, decreased alveolar ventilation, rapid pt. fatigue, increase effort in breathing and decreased effectiveness, severe anoxia and death if not trea
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Management of Flail Chest
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Vent support with PEEP ( POSITIVE EXPIATORY PRESSURE) allows for alveoli to stay open so gas exchange can occur. Daily CXR and ABG, chest tube between 4th and 5th rib, ETT (endotracheal tube) suction, and pain management.
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Pneumothorax
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accumulation of air in pleural space from blunt/penetrating trauma.
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Simple Pneumothorax
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Air trapped in pleural space causing lung to collapse usually associated with rib fractures. Assessment will show decrease breath sounds of affected side and SOB. Diagnose with CXR and treat with chest tube to suction removal of air. Goes into space where lung was not in lung.
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Tension Pneumothorax
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Accumulation of air in pleural space that collapse the lung and displaces the mediastinum toward the opposite side compressing the thoracic aorta and contra lateral lung. No lung sounds.Can also be caused by using too much PEEP. Occurs when pressure enters the thoracic cavity during inspiration but cannot be released during expiration.
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Assessment Of Pneumothorax
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Severe SOB, deviated trachea toward unaffected side, distended jugular vein, treated by needle thoracostomy with at least 16 Gauge placed in the pleural space between 2 and 3 intracostal space, prepare for chest tube placement can hear audible woosh
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Communicating AKA Sucking Chest Wound
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Large opening wound to chest with audible air entering and leaving. Temp seal with Vaseline gauze and prepare for surgery.
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Heamothorax
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Blood in pleural space. Thoracotomy ( removal of part or all of damaged lung) will be needed if initial blood loss after chest tube placement exceeds 1500 ml or initial loss of 1 liter followed by 200 ml each hour *4 hours.
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Assess Heamothorax
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Pt for hypovolemic shock treat with fluids. Consider auto transfusion. Pt. will be restless Must act quickly may not want to wait four hours.
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Pleural Effusion
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Excess fluid in pleural space..
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Patho of Pleural Efussion
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Increased hydrostatic ( fluids @ rest) pressure or decreased osmotic pressure allows fluid to pass across intact capillaries.
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Drugs to increase Cardiac output
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Dobutamine
Dopamine |
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Drugs to decrease Cardiac output
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Beta Blockers
Calcium Channel Blockers |
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Cardiac Preload
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The pressure in the ventricle just prior to contraction. If high preload will have High BP.
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Drugs to increase cardiac preload
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Colloids ( albumin, hetastarch)
Crystalloids (0.9, LR) |
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Drugs to decrease cardiac preload
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Diuretics
Vasodilators Cardizem |
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Cardiac Afterload
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Resistance Ventricle faces when trying to eject blood into the circulatory system.
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Drugs to increase Cardiac afterload
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Norepinepherine (Levophed)
Dopamine Phenylephrine |
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Drugs to decrease Cardiac afterload
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Nitroprusside (nipride)
Apresoline Capoten Mifedipine (procardia) |
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When to suspect Aortic Rupture in trauma
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1st or 2nd rib is fractured
Sternum is fractured Extensive bruising to chest Tracheal deviation Only way to confirm is with Angiogram |
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Esophageal Rupture
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Assessment will reveal mediastinal emphysema. Pain in anterior neck. Almost always in presence of pneumothorax, will see food particles in chest tube drainage.
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Tracheobronchial Rupture
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Tear at the bifurcation of main stem bronchus 1 inch above carina. Assesment will show Crepitus, Hemoptysis ( coughing up blood) Respiratory distress, subcutaneous emphysema.
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Diaphragmatic Rupture
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Tear of diagram
Blunt trauma is large linear tear Penetrating is smaller tear |
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Assessment of Diaphragmatic rupture
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Bowel sound heard in chest, abdominal pain and chest pain that may be referred to one shoulder, difficulty breathing, inability to pass NG tube, emergent surgery, will be intubated
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Pericardial Tamponade
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Compression of heart and output decreases. Blood flows into the sac but cannot get out. Usualy result of penetrating injury. Suspected when pump failure does not respond to fluid replacement. Low cardiac output low BP.
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S/S of Pericardial Tamponade
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Pulsus Paradoxus ( diff. between apical and prephiral)
Becks Triad ( Hypotension, muffled or distant heart sounds, distended neck veins) |
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Pericardial Tamponade treatment
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Pericardiocentesis (procedure that uses a needle to remove fluid from the pericardial sac)
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Pulmonary Contusions
What to look for when suspected |
Decreasing PCO2 and PO2.
Susceptible to infection/ pneumonia b/c lungs defense has been comprmised |
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ARDS ( Acute Respiratory Distress Syndrome)
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inflames the alveoli, causing them to fill with liquid and collapse. Once the alveoli collapse, gas exchange ceases, and the body becomes starved of oxygen. ARDS requires treatment with mechanical ventilation or some other form of assisted breathing.
Causes protein (golden) to leak out of lung fields. |
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S/S of ARDS
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Tachypnea, progressive hypoxemia, will need increasing PEEP, can have 100% o2 and still will have low pulse ox.
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