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209 Cards in this Set
- Front
- Back
What are some associated symptoms during chest pain that indicate a twofold higher risk of ischemia?
|
Dyspnea, Diaphoresis, Nausea, and Vomiting
pg 362 radiation to jaw, should, arm, hand also increases probability but absence does not exclude AMI |
|
Which pt with stable angina is more more likely to experience pain at rest, sleep, or stress? (Men or Women)
|
Women
pg 362 |
|
Which drug is associated with AMI in young people, even without coronary artery dz?
|
Cocaine
pg 363 |
|
Chest wall tenderness with palpation is reported in ___ % of pts with confirmed MI.
|
15%
pg 363 |
|
What other life threatening conditions should be considered when working up chest pain? (6)
|
1) Aortic Dissection, 2)PE, 3)Hemo / Pneumothorax, 4) Pericardial Tamponade, 5) PNA, 6)Esophageal Rupture
pg 363 |
|
What are some chest wall pain syndromes (musculoskeletal) characterized by sharp, positional chest pain? (6)
|
1) Costochondritis, 2) Tietze Syndrome, 3) Texidor twinge (pericordial catch syndrome), 4) Esophageal Spasm, 5) PUD, 6) Panic Disorder
pg 364-65 |
|
Troponin levels are detectable as early as 2hrs in AMI, but not reliably elevated in all pts until __ - ___ hrs.
|
6-12hrs
pg 366 |
|
Troponin levels reach their peak by __hrs and remain elevated for __ to ___ days.
|
12hrs, 7 to 10 days
pg 366 |
|
2007 consensus guidelines state diagnosis of MI is troponin elevation with at least on of what additional criteria? (5)
|
1) ischemic symptoms (chest pain), 2) new ST and T-wave changes, 3) new Left Bundle Branch Block, 4) new Q-waves, 5) wall motion abnormality
pg 366 |
|
Creatine Kinase (CK) levels become elevated at __ to ___hrs after occlusion.
|
4 to 8 hrs
pg 366 |
|
CK levels peak btwn __ and ___ hrs, and return to normal at __ to __ days.
|
12 to 24hrs and 3 to 4 days
pg 366 |
|
Myoglobin levels are elevated in >80% of pts at __ to __ hrs.
|
6 to 8hrs
pg 366 |
|
Myoglobin peaks at __ to ___hrs and returns to baseline at __ day(s).
|
4 to 9 hrs and 1 day
pg 366-67 |
|
T/F: In the ED, cardiac risk factors are strong predictors of risk for MI or other ACS.
|
False: Poor Predictors
pg 369 |
|
Cardiac risk factors for CAD have significantly less predictive value for an acute event than the mere presence of _____.
|
symptoms
pg 369 |
|
Why is the presence of a new systolic murmur an ominous sign?
|
1) Signifies papillary muscle dysfxn, 2) Flail leaflet of the mitral valve w/ regurge or 3) a VSD
pg 370 |
|
What is the time frame for the initial 12-lead ECG to be interpreted by for pts with ACS symtpoms?
|
10 minutes
pg 370 |
|
_____ wall AMI's should have a right sided lead V4 (V4R) obtained.
|
Inferior Wall, V4R is an additional lead placed on the right side of the chest
pg 370 |
|
What leads will you see a Anteroseptal MI in?
|
V1 - V4
pg 370 |
|
What leads will you see a Anterolateral MI in?
|
V4 - V6 and aVL
pg 370 |
|
What leads will you see a Lateral MI in?
|
I and aVL
pg 370 |
|
What leads will you see a Inferior MI in?
|
II, III, and aVF
pg 370 |
|
What leads will you see a Inferolateral MI in?
|
II, III, aVF, and V5, V6
pg 370 |
|
How many mm or greater does new ST changes have to be in multiple leads to presume a high likelihood of ACS?
|
1mm
pg 370 see chart |
|
What is the percent chance that a person with a normal ECG can be having a AMI?
|
1-5% chance
pg 371 |
|
What is the percent chance that a person with evidence of ischemia that is age-indeterminate is having a AMI?
|
4-7% chance
pg 371 |
|
How do you choose which fibrinolytic to use for reperfusion therapy?
|
Based on Institution
pg 377 |
|
Pt w/ unstable angina/ NSTEMI with elevated troponins, new ST changes, + stress test, v-tach, or CABG in past 6 months?
|
Early invasive therapy
(w/in 48hrs) pg 378 |
|
How much ASA needs to be given to all STEMI/ NSTEMI, and unstable angina?
|
ASA 325mg
pg 378 |
|
Which medication is preferred for antiplatelet agents, clopidogrel or ticlopidine?
|
Clopidogrel
pg 378 |
|
T/F: Cardiac Troponins and CK-MB have independent predictive value for prediction of adverse events and diagnosis of ACS.
|
True
pg 373 |
|
Patients with persistent symptoms and STEMI should receive ______ therapy.
|
Reperfusion
pg 373 |
|
What are the two general cardiac reperfusion therapy options?
|
Percutaneous Coronary Intervention (PCI)
or Fibrinolytic Therapy pg 374 |
|
What the goals for time to have PCI or fibrinolysis accomplished?
|
PCI – 90minutes
Fibrinolytics – 30minutes pg 374 |
|
Which is the preferred reperfusion strategy?
|
PCI in 90 minutes
pg 374 |
|
Fibrinolytic therapy is indicated for STEMI pts if the time from symptom onset is < ___ to ___hrs.
|
6 to 12 hrs
pg 376 |
|
STEMI pts who receive fibrinolytic therapy should also receive full dose _____ for at least 48hrs.
|
Anticoagulants (UFH, enoxaparin, fondaparinux)
pg 376 |
|
What percent of cardiogenic shock after AMI is caused by mechanical complications?
|
25%
pg 386 |
|
What ancillary studies are important for cardiogenic shock?
|
ECG, CXR, Echo, Cardiac monitoring
pg 386 |
|
ED care is a _____ measure while arranging for revascularization.
|
temporizing
pg 387 |
|
When should ASA and Heparin be given in the setting of AMI?
|
Always, unless there is a contraindication.
pg 388 |
|
What time frame should BB be given to pts with STEMI/ NSTEMI in cardiogenic shock?
|
Beta Blockers SHOULD NOT be given
pg 388 |
|
What is the definitive treatment for cardiogenic shock?
|
Coronary intervention in the cath lab
pg 388 |
|
What pain features are in the low risk ACS group?
|
pleuritic, positional, reproducible, sharp/stabbing
pg 390 |
|
Does low risk exclude ACS?
|
No
pg 390 |
|
54yo M smoker w/ c/o heavy chest pain with exertion, ST changes in II, II, AVF. Negative stress test 3 months ago at cardiologist. What is the likely diagnosis that must be r/o?
|
ACS must be ruled out despite negative cardiac testing.
pg390 |
|
It is unlikely that a pt with previously normal or near-normal cath has developed stenosis w/in __ yrs of the procedure.
|
2yrs
pg 390 |
|
Plaque rupture is unpredictable and often occurs in lesions that were previously _____.
|
nonobstructive
pg 390 |
|
What symptoms put a pt in the probable high risk category, >2% likelihood?
|
Pressure, N/V, diaphoresis
pg 390 |
|
If the clinician feels the likelihood of ACS is > __% than the diagnosis of "possible" ACS is made.
|
2%
pg 391 |
|
What should be done for pts with > 2% risk for ACS.
|
further cardiac testing
pg 392 |
|
T/F: Negative cardiac biomarkers can exlcude unstable angina.
|
False: Cannot, unstable angina is chest pain at rest with no ECG changes or elevated biomarkers
pg 392 |
|
What types of "risks" pt will cardiac stress testing not help you with?
|
Very low or Very high risk groups, due to false negative and false positives
pg 393 |
|
T/F: A normal resting echo can exclude ACS in the ED.
|
False: Cannot
pg 394 |
|
What approach is the foundation of traditional cardiac observation units?
|
Serial cardiac markers and objective cardiac testing
pg 395 |
|
What medication is first line is ACS and should be given to all potential pts, no matter what stratification level, unless contraindicated?
|
ASA
pg 397 |
|
How long do pts need to be off antiplatelet therapy before undergoing a CABG?
|
5 days of Clopidogrel
pg 398 |
|
Who should make the decision to withhold dual oral antiplatelet therapy?
|
Multidisciplinary , institution-specific treatment protocols
pg 398 |
|
Pt's at immediate risk for adverse events may be given ____ if concerning features (T wave inversion, known CAD, indeterminate markers) are present.
|
antithrombin therapy
pg 398 |
|
The exact role of ____ medications in the treatment of patients with possible ACS is unclear.
|
Beta Blockers
pg 398 |
|
Which etiology of syncope is the most concerning due to a 6-mon mortality rate >10%?
|
cardiac
pg 400 |
|
What cardiac abnormality should be excluded as a cause of syncope in the elderly?
|
Aortic Stenosis
pg 400 |
|
This type of cardiac syncope is sudden and usually without prodromal symptoms.
|
syncope from dysrhythmias
pg 400 |
|
Elderly pts with recurrent episodes of syncope and negative cardiac workups should be suspected of having ______ _____ hypersensitivity.
|
carotid sinus
pg 401 |
|
When should you consider orthostasis as a cause for syncope?
|
when other life threatening conditions have been excluded.
pg 401 |
|
A ___ cause of syncope should be one of exclusion in addition to orthostasis.
|
pyschiatric
pg 401 |
|
Definition of Syncope is?
|
brief loss of consciousness with inability to maintain postural tone that spontaneously and completely resolves with medical intervention.
pg 399 |
|
T/F: pt with LOC with persistent neuro deficit or AMS is not true syncope.
|
True
pg 401 |
|
How do most medications contribute to syncope?
|
by orthostatic syncope
pg 401 |
|
What is the goal of the ED eval for syncope pts?
|
identify those at increased risk for immediate decompensation and future risks
pg 402 |
|
Pt are at increased risk if they have non-sinus rhythms, ECG changes, ___ or shortness of breath.
|
CHF
pg 403 |
|
What must always be considered as a potential cause of heart failure exacerbation until excluded?
|
AMI
pg 406 |
|
Approach to HTN acute heart failure steps are?
|
1) O2 and SL nitro, 2) if BP >150 add IV Nitro, 3)IV Furosemide, 4)if dyspnea start BiPAP, 5) assess severity (AMS, +troponins, SBP >210), 6) admit to ICU
pg 410 |
|
Approach to Hypotensive acute heart failure?
|
1) assess for low BP, cap refill, or AMS, 2) ECG for ST changes, 3) Inotrope (dobutamine or dopamine) goal 90-100 SBP, 4) admit to ICU, 5) consider vasodilator w/ inotrope
pg 411 |
|
Does normal O2 sats r/o PE?
|
No, diversion of blood to areas of high ventilation can cause a increase in O2 sats.
pg 431 |
|
Define Phlegmasia Alba Dolens.
|
Swollen painful and pale/ white limb due to proximal venous thrombosis
pg 433 |
|
Define Phlegmasia Cerulea Dolens.
|
Swollen painful and dusky/blue limb due to proximal venous thrombosis
pg 433 |
|
T/F: Phlegmasia Alba or Cerulea indicates a potential threat to loss of limb and requires aggressive txmt, thrombectomy.
|
True
pg 433 |
|
What is the McGinn-White sign on ECG indicative of?
|
PE
(S1, Q3, T3) pg 433 |
|
The D-Dimer's half life is ___ hrs but remain elevated for __ days in a PE pt.
|
8hrs and 3 days
pg 434 |
|
What are the Wells Score for PE?
|
1) suspected DVT, 2) Alt Dx < PE, 3) HR >100, 4) prior DVT, 5) Immobilized, 6) Cancer, 7) Hemoptysis
pg 434 |
|
What are the PERC rules?
|
1)Age <50, 2) O2> 94%, 3)HR <100, 4) No VTE hx, 5) No recent sug/trauma, 6) No hemoptysis, 7) No estrogen use, 8) No unilat leg swelling
pg 437 |
|
How many of the PERC rules have to be met for it to be low probability of PE?
|
All Eight
pg 438 |
|
Systemic fibrinolysis should be considered in which carefully selected pts?
|
1) cardiac arrest, 2) hypotension, 3) respiratory failure (O2 <90%) , 4) right sided heart strain on echo, 5) elevated troponins
pg 440 |
|
Which medication is contraindicated in pregnant pts with PE?
|
Warfarin (Coumadin)
pg 441 |
|
Define Hypertensive Emergency.
|
Elevated BP (>180/120) that results in end organ damage (heart, kidney, aorta, eyes, brain)
pg 442 |
|
Define Hypertensive Urgency.
|
severely elevated BP without end organ damage. BP >180/120 has been arbitrarily used with no clinical benefit of txmt
pg 442 |
|
Pt with BP 210/120, HA, N/V, and some diplopia is at risk for ?
|
Hypertensive encephalopathy
other sx: AMS, papilledema, seizures, or hematuria pg 443 |
|
What is the therapeutic goal in acute aortic dissection for BP?
|
<140 and >110
pg 443 |
|
What is the preferred initial txmt of an acute sympathetic crisis due to cocaine or amphetamine abuse?
|
IV Benzo's (Lorazepam or Diazepam) repeated IV doses as needed.
pg 445 |
|
What drug is contraindicated in acute sympathetic crisis?
|
Beta Blockers leaves unopposed alpha storm
pg 445 |
|
What is the antiHTN of choice in preeclampsia?
|
1) Labetolol, 2) Nifedipine
ACE-I are contraindicated pg 445 |
|
T/F: Blood pressure reduction is recommended for acute vascular lesions, SAH, and intracranial hemorrhage.
|
FALSE: it is controversial
pg 445 |
|
Dyspnea is a ___ feeling of difficult, labored, or uncomfortable breathing.
|
Subjective
pg 465 |
|
What is tachypnea?
|
Rapid breathing, may or may not be associated with dyspnea.
pg 465 |
|
What is orthopnea?
|
Dyspnea in the recumbent position.
pg 465 |
|
What is Paroxysmal Noctural Dyspnea?
|
orthopnea that awakens the pt from sleep.
pg 465 |
|
What is hypoxia?
|
Insufficient delivery of oxygen to the tissues.
pg 466 |
|
What is hypoxemia?
|
Abnormally low arterial oxygen tension. defined as PaO2 <60mmHg
pg 466 |
|
What is a normal P(A-a)O2 [aveolar arterial oxygen partial pressure gradient]?
|
<10mmHg in young healthy adults
pg 467 |
|
What are the five distinct mechanisms causing hypoxemia?
|
1) Hypoventilation, 2) Right to Left shunt, 3) Vent/ Perfus mismatch, 4) Diffusion impairment, 5) Low inspired Oxygen
pg 467 |
|
What is the hallmark of the Right to Left shunt?
|
failure of arterial oxygen to improve with supplemental O2
pg 467 |
|
Except in ______ arterial O2 responds to supplemental oxygen.
|
Right to Left shunts.
pg 467 |
|
A CXR is not indicated in which one of these patients; COPD, CHF, asthma?
|
Asthma
pg 469 |
|
Acute cough is cough lasting ____ weeks and is usually associated with self limiting URI.
|
< 3 weeks
pg 469 |
|
Chronic cough is present for _____
|
> 8 weeks
pg 469 |
|
The incidence of pertussis in adolescents has increased ____ percent to waning vaccine immunity with age.
|
400%
pg 469 |
|
What are the 5 most common causes of chronic cough?
|
1) Smoking with chronic bronchitis, 2) Upper Airway Cough Syndrome (post nasal drip), 3) Asthma, 4) GERD, 5)ACE-I
pg 469 |
|
Central cyanosis affects the mucous membranes and tongue and is due to ?
|
Inadequate Pulmonary Oxygenation or abnormal Hb.
pg 471 |
|
Peripheral cyanosis affects the fingers or extremities and is due to?
|
vasoconstriction and diminished peripheral blood flow
pg 471 |
|
What two situations will the pulse ox overestimate the O2 sats?
|
Carboxyhemoglobin and Methemoglobin
pg 471 |
|
In which case does the pulse ox read normal but O2 saturation is truely low?
|
Carboxyhemoglobin displaces O2 but is read by the pulse ox as normal.
pg 471 |
|
Two most common bacteria involved in dog bites to the hand and which abx to use?
|
Staph A. and Pasturella
Augmentin is best abx. |
|
What is the gold standard in the assessment of cyanosis?
|
ABG and co-oximetry.
pg 471 |
|
T/F: A significant pleural effusion is large enough to produce a pleural fluid strip >10mm wide on lat decub or US.
|
TRUE.
pg 472 |
|
Pneumococcal pneumonia responds to a variety of abx, but there is increased resistence to ___, ____, and _____ abxs.
|
PCNs, Macrolides, and Fluoroquinolone
pg 481 |
|
Legionella is most seen during what season?
|
No seasonality
pg 482 |
|
Which pneumonia is complicated by ab pain, N/V/D?
|
Legionella
pg 482 |
|
T/F: Most pts do not require ID of a specific organism through bld or sputum cx in order to direct abx txmt.
|
True. Most are treated with broad spec abx.
pg 482 |
|
Which pts are bld and sputum cx recommonded in?
|
1) ICU admissions, 2) leukopenia, 3) cavitary lesions, 4) liver dz or ETOH abuse, 5) asplenia
pg 482 |
|
What is the most common cause of pneumonia in alcoholics?
|
Strep. pneumo, but Klebsiella is important to consider
pg 483 |
|
What pathogens are seen mostly in DMII pts?
|
Staph aureus, Mycobacteruim tuberculosis
pg 483 |
|
Is CXR recommended in pregnant pts with respiratory tract infections and varicella exposure?
|
Yes.
pg 483 |
|
Which PNA typically presents in the elderly following a influenza illness?
|
Strep pneumo, Staph aureus, H. influenza
pg 483 |
|
Central cyanosis affects the mucous membranes and tongue and is due to ?
|
Inadequate Pulmonary Oxygenation or abnormal Hb.
pg 471 |
|
Peripheral cyanosis affects the fingers or extremities and is due to?
|
vasoconstriction and diminished peripheral blood flow
pg 471 |
|
What two situations will the pulse ox overestimate the O2 sats?
|
Carboxyhemoglobin and Methemoglobin
pg 471 |
|
In which case does the pulse ox read normal but O2 saturation is truely low?
|
Carboxyhemoglobin displaces O2 but is read by the pulse ox as normal.
pg 471 |
|
Two most common bacteria involved in dog bites to the hand and which abx to use?
|
Staph A. and Pasturella
Augmentin is best abx. |
|
What is the gold standard in the assessment of cyanosis?
|
ABG and co-oximetry.
pg 471 |
|
T/F: A significant pleural effusion is large enough to produce a pleural fluid strip >10mm wide on lat decub or US.
|
TRUE.
pg 472 |
|
What are the 7 risk factors associated with nursing home PNA?
|
1) tachycard, 2) RR > 30, 3)fever, 4)AMS, 5) Lung crackles, 6) No wheeze, 7) high WBCs
pg 483 |
|
Most common nursing home PNA?
|
Strep pneumo and H. Flu
pg 483 |
|
T/F: Nursing home pts are at risk for organisms linked to CAP and txmt for MRSA in generally not indicated.
|
FALSE: risk health care related PNA and MRSA coverage is recommended
pg 483 |
|
Most common cause of PNA in HIV pts?
|
Strep pneumo
pg 484 |
|
What is another concerning pathogen causing PNA in HIV pts?
|
Pseudomonas
pg 484 |
|
What are the 3 leading noninfectious causes of pleural effusions in HIV pts
|
Non-Hodgkin lymphoma, Kaposi sarcoma, and adenocarcinoma
pg 484 |
|
Renal, Liver, Heart, and Lung transplant pts are all at risk for PNA in the first 3 months after surgery, which is transplant is least common?
|
Renal
pg 484 |
|
After 6 months posttransplant, bacteria of ___ aquired PNA are most likely pathogens.
|
CAP
pg 484 |
|
Most common outpt txmt of PNA?
|
Levoquin 750mg or Augmentin +Azithromycin
pg 484 |
|
Most common inpt txmt of PNA?
|
Levoquin 750mg, or Ceftriaxone + Azithromycin
pg 484 |
|
CDC is concerned with building resistence to what abx type?
|
Fluoroquinoles
pg 486 |
|
Which type of abx should not be used in myasthenia gravis pts?
|
Flouroquinoles
pg 486 |
|
What does the CURB-65 rule apply to?
|
Eldery. C-confusion, U-uremia, R->30breathes/min, B- BP (diastolic <60), age >65
score < 2 is low risk pg 486 |
|
Gastric pH and volume aspirated are what to risk aspiration pneumonitis?
|
pH <2.5 and volume 20-30ml
pg 487 |
|
Prophylactic abx and steroids are / are not recommend to prevent lung injury after aspiration?
|
Are NOT
pg 488 |
|
What type anemia to r/o if MCV is low, RDW is high and ferritin is low?
|
Microcytic (Iron Deficiency)
Anemia pg 1459 |
|
What type of anemia to r/o if MCV is low, RDW is normal, and RBC is high?
|
Microcytic (Thalassemia)
pg 1459 |
|
What type of anemia to r/o if MCV is normal, reticulocyte count is normal, and RDW is normal?
|
Normocytic (Anemia of chronic dz)
pg 1459 |
|
What type of anemia to r/o if MCV is elevated, RDW is high?
|
Macrocytic (Folate or B12 deficiency)
pg 1459 |
|
What type of anemia to r/o if MCV is high, RDW is normal?
|
Macrocytic (ETOH abuse, Liver Dz)
pg 1459 |
|
At what platelet level does spontaneous bleeding more likely to occur?
|
Below 10,000 - 20,000
pg 1464 |
|
24yo F is sent from PCM to ED due to a routine lab screening showing platelets 50,000. She is otherwise healthy and has no complaints, what treatment is recommended?
|
None, asympatomatic pts otherwise healthy require no txmt
pg 1465 |
|
76yo M c/o unsteady gait and weakness x 1 month. CBC shows platelets of 30,000 but no other cell line abnormality. What treatment is recommended?
|
Platelets of <30,000 or <50,000 w/ bleeding or significant risk (organ dz, PUD, HTN or fall risk) require txmt.
Steroids or IV IG. pg 1465 |
|
At what point in the treatment process should platelets be given?
|
Steroids first, IV IG second then platelets; this order has shown the greatest rist in the platelet count
pg 1466 |
|
What are some mechanisms of thrombocytopenia?
|
Decreased platelet production, increased destruction, platelet loss (ie. hemorrhage), or splenic sequestration
pg 1464 |
|
What are organs involved in platelet disorders?
|
Renal (uremia inhibits platelet aggregation), Liver (liver dz affects all coag factors except Factor VIII), Spleen (sequesters or hepatic portal htn backs up flow), Bone marrow (low output)
pg 1465-66 |
|
Who does Hemophilia A or B affect more, men or women?
|
Men, X-linked recessive gene defect
pg 1475 |
|
How are platelet disorders different than hemophilia?
|
Platelet disorders present with easy bruising and capillary bleeding (gums, urine, nose) and Hemophilia is hemarthrosis, internal bleeding (abdomen or intracranial)
pg 1475 |
|
Which bleeding time could be affected by hemophilia, intrinsic (aPPT) or extrinsic (PT)?
|
Intrinsic (aPPT), though bleeding times are often normal and not helpful
pg 1476 |
|
22yo M with hx of Hemophilia A c/o knee pain and a pickup basketball game.Feels tight and painful. No swelling or discoloration on exam. ROM is limited by pain. Ligaments intact. What must be r/o?
|
Hemarthosis. clinical evidence may or may not be present but pt's report are reliable.
pg 1476 |
|
When should Factor replacement be given to a pt being transferred to another hospital before transport or after arrival?
|
Before
pg 1477 |
|
When should you contact a hemophilia center once a hemophiliac has entered the ED?
|
Everytime
pg 1477 |
|
What is Desmopressin's effect on bleeding disorders?
|
Desmopressin increases von Willebrand factor release from the endothelial walls, increasing the ability of vWF to carry more Factor VIII clotting proteins.
pg 1479-80 |
|
What are some potential causes of COPD exacerbation?
|
PNA, PTX, PE, asthma, CHF,
pg 513 |
|
For every increase of 10mmHg of PCO2 on ABG what does the serum Bicarb raise by in acute and chronic resp. acidosis?
|
acute - 1mEq
chronic - 3.5mEq pg 513 |
|
A PEF rate of < ___ L per minute in a COPD pt indicates severe exacerbation.
|
100 L
pg 514 |
|
What is the DDX for a pt with a thought to be severe COPD exacerbation that is not responding to standard therapy?
|
Asthma, CHF, PE, ACS, PTX, and PNA
pg 514 |
|
What is the goal PaO2 and SaO2 range when treating COPD exacerbation with O2?
|
PaO2 >60mmHg
SaO2 >90% pg 515 |
|
What is a danger with elevating a COPD pt's O2 level to high and what can be done?
|
Respiratory Acidosis - increased CO2 production from excess O2. Serial ABGs to monitor acid-base status, Increase ventilations
|
|
What are the initial txmt options for COPD exacerbations?
|
Beta agonists, Anticholinergics, and brief course of steroids.
(Albuterol + Ipratropium + prednisone) pg 515 |
|
When should abx be given and what are they covering for in COPD exacerbation?
|
increased sputum production or evidence of infection.
directed at Strep pneum. H flu, and Moraxella pg 515 |
|
What are some contraindications to NPPV (noninvasive positive pressure ventilation)?
|
AMS, inability to clear secretions, hemodynamic instability, respiratory arrest, extreme obesity, burns, poor mask fit
pg 516 |
|
What are normal starting levels for CPAP and BiPAP?
|
CPAP - 15cm H2O
BiPAP - 8 / 4 cmH2O pg 516 |
|
What is the effect of 2 units of PRBCs on the H/H?
|
Hemoglobin +2 and Hematocrit + 6% (1 and 3 per unit)
pg 1495 |
|
What are indications for FFP?
|
Rapid reversal of Warfarin, Active bleeding, Correct coag defects, massive transfusion, and angioedema (FFP contains C1 esterase)
pg 1496 |
|
T/F: In NONemergent blood transfusions, the initial rate of transfusion is high for the first 30min to allow for identification of a transfusion reaction.
|
FALSE: rate is slow
pg 1499 |
|
When should IV Vit K be given?
|
INR > 20 or symptomatic poisoning pts (warfarin suicide or rat poison ingestion).
pg 1502 |
|
What is the most reliable way for achieving therapeutic effect with Heparin?
|
Weight based dosing
pg 1503 |
|
How is Lovenox cleared and what pt type is it dangerous in?
|
Cleared Renally and dangerous in renal impairment pts
pg 1503-04 |
|
Pts who have a rxn to heparin (tachycardia, CP, dyspnea) should be evaluated for ___ and have an immediate ___ count.
|
Heparin Induced Thrombocytopenia (HIT) and platelet count
pg 1505 |
|
What type of ASA is not indicated in ACS?
|
Enteric-coated ASA
pg 1505 |
|
If pt has been treated with fibronytics what needs to be avoided (4)?
|
1) avoid unnecessary needle sticks, 2) avoid arterial punctures, 3) limit venous access, 4) avoid nasogastric or nasotracheal intubation
pg 1508 |
|
How the should the provider act towards the violent pt?
|
1) keep distance, 2) avoid excessive eye contact, 3) maintain submissive tone, 4) do not block exits
pg 1939 |
|
Sudden changes in behavior, mood, or thoughts in the psych pt should stimulate the provider to do?
|
eval for underlying medical condition
pg 1940 |
|
A pt w/ visual hallucinations should be assumed to have ______ pathology until proven otherwise.
|
Organic
pg 1942 |
|
Hostile behavior, verbal aggressiveness, and statements about violent intent are clues of what?
|
potential violence
pg 1943 |
|
Which age group after making a suicide attempt are higher risk of suicide (young, middle age, or old)?
|
Older patients
pg 1943 |
|
The most common suicide attempt is drug overdose (85%). It is important to ascertain the pt's knowledge of the ____ of the drug and their _____.
|
toxicity and intent
pg 1943 |
|
Pt dispo can be estimated by the _____ of the suicide attempt.
|
lethality
pg 1945 |
|
What is the purpose of the medical clearance exam in the psych pt?
|
determine if a medical condition exists that is worsening the psych illness
pg 1946 |
|
Define Axis I disorders.
|
clinical syndromes fo mental disorders (schizophrenia, malingering, anxiety, eating, sleeping, factious)
pg 1946 |
|
Define Axis II disorders.
|
personality disorders, developmental disorders (retardation, paranoid, schizoid, antisocial, boarderline, OCD)
pg 1946 |
|
Define Axis III disorders.
|
general medical conditions that could contribute to the psych illness (infectious, neoplasm, endocrine, pregnancy)
pg 1946 |
|
Define Axis IV disorders.
|
psychosocial and environmental stressors (housing, economic)
pg 1946 |
|
Define Axis V disorders.
|
overall functioning using global level of functioning scale
pg 1946 |
|
The presence of nonauditory hallucinations suggestion a ___etiology as the cause of psychosis.
|
Medical not psychiatric
pg 1949 |
|
An elderly pt with new onset psych issues (depression, anxiety, or psychosis) should increase suspicion for ____.
|
Dementia
pg 1948 |
|
Delirium is differentiated from Dementia by two major ways, which are?
|
reduction in awareness of environment and decrease in alertness
pg 1948 |
|
Schizophrenia is a d/o marked by delusions and hallucinations. Auditory hallucinations are the most common type. The presence of nonauditory hallucinations suggests what type of cause?
|
Medical cause, as opposed to psychosis
pg 1949 |
|
Schizophrenic's poor judgement and disorganization may lead to disregard of _____ problems, so attn must be given to their physical status.
|
medical
pg 1949 |
|
What is the best way to avoid frustration with the antisocial patient in the ED?
|
Set firm limits and focus on chief complaints
pg 1952 |
|
What is "cotton fever" in reference to IV drug users?
|
Fever and flu-like illness as a result of using cotton balls as filters for drug suspensions
pg 1991 |
|
What should you do first with a febrile, dyspnic IV drug user with abnormal findings on CXR?
|
Place in isolation, until TB is r/o
pg 1991 |
|
What is the likelihood for an IV drug user to acquire endocarditis compared to the population?
|
40x greater chance
pg 1993 |
|
Most common organism to cause infective bacterial endocarditis?
|
Staph aureus
pg 1993 |
|
What is the best initial txmt option for suspected bacterial endocarditis in the unstable IV drug user pt?
|
Vancomycin 15mg/kg q 12hrs +
Gentimycin 1mg/kg q 8 hrs pg 1994 |
|
What type of infxn is the most common in the IV drug user?
|
Skin and soft tissue infxns
pg 1995 |
|
Increased rates of ________ infxns have been found in injection drug users who engage in skin popping, particularly when using Mexican black tar heroin.
|
Clostridium botulinum
pg 1995 |