Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
91 Cards in this Set
- Front
- Back
What are the three stages of ARDS?
|
Exudative, proliferative, fibrotic
|
|
What is the exudative stage
|
vasoconstriction, microthrombi, bs are clear
|
|
What is the proliferative stage?
|
agitation, fine crackles, hypoemia, ground glass look in xray
|
|
What is the fibrotic stage?
|
either get better or die if it gets worse it's MODS
|
|
How do we treat ARDS
|
treat underlying cause, promote gas exchange, circulatory support with fluids and nutritional support
|
|
What are the meds for ARDS?
|
corticosteroids, vasodialators, inotropic agents and bronchodialtors, mucolytics pain meds
|
|
What is a pneumothorax?
|
when part of the lung collapes
|
|
how do you treat a pneumo?
|
stab them with a needle which is a temp fix, chest tube or it can resolve itself
|
|
A tension pnuemo is different from a regular pneumo how?
|
a tension pneumo gets worse
|
|
What are crackles?
|
fluid in the lungs
|
|
What is the disassociative curve?
|
it's always better for the patient to shift right, if it shifts right it doesn't bind as much and you lease easier into the tissue
|
|
what does the shift to the left mean?
|
it is easier to bind at the lung but harder to release at the tissue level
|
|
What is ventilation?
|
neurochemical,mechanics of breathing, elasticity and compliance
|
|
What is perfusion?
|
gas exchange, oxygen transport, and CO2 transport and pulmonary circulation
|
|
What is the key to oxygenation?
|
cardiac output
|
|
what is the V/Q ratio?
|
the rate of ventilation to the rate of perfusion should be 1 to 1
|
|
What if you have a high V/Q ratio?p
|
it is probably a PE, pulmonary infarct, cardiogenic shock, mechanical vent
|
|
What if there is a low V/Q ratio?
|
it is probably pneumonia, actalactisis, tumors or mucos plug
|
|
what is the most important step in setting up an intubation?
|
preparation
|
|
What are the seven p's?
|
prepare, pre-oxgyenate, pre-treat, paralyze, protect and position, placement post intubation management
|
|
what is the most important step in the 7 p's?
|
pre-oxygenate
|
|
What's sellicks' manuever
|
hold cricoid pressure
|
|
What is BURP?
|
helps visualize cords go to the right
|
|
What happens if someone loses their o2 sats while intubated?
|
Remember DOPE
D- dislodged, O-obstruction, p-neumo, E-equipment failure |
|
What is FIO2?
|
the amount of oxygen delivered to the patient, if you have 50% or greater for longer than 24 hours you can have o2 toxicity
|
|
What is the disassociative curve?
|
it's always better for the patient to shift right, if it shifts right it doesn't bind as much and you lease easier into the tissue
|
|
what does the shift to the left mean?
|
it is easier to bind at the lung but harder to release at the tissue level
|
|
What is ventilation?
|
neurochemical,mechanics of breathing, elasticity and compliance
|
|
What is perfusion?
|
gas exchange, oxygen transport, and CO2 transport and pulmonary circulation
|
|
What is the key to oxygenation?
|
cardiac output
|
|
What is FI02?
|
amount of o2 delivered to patient
|
|
What causes O2 toxicity?
|
if the fi02 is greater than 50% for longer than 24 hours then you can get o2 toxicity
|
|
What is PEEP?
|
keeps alveoli open
|
|
What is PIP?
|
How much pressure is reached in the lung at the peak of inspiration
|
|
What happens if PEEP increases on vent?
|
air trapping, copd'ers to do this its common
|
|
What happens if you have high PEEP and PIP?
|
you have increased risk for volutrauma, pneumothorax, hypotension
|
|
What is MODS?
|
multi organ dysfunction syndrome
|
|
How does MODS progress?
|
first there is a primary cause temporary shock syndrome for the body, then becomes systemic global problem, organs all fail
|
|
What are the levels of survival?
|
1 or more organs fail = 40 %
2 or more = 60% 4 or more is DEAD |
|
What is the major cause?
|
chemical mediators, cells swich from aerobic to anaerobic, acidosis starts immediately
|
|
what are the 4 phases of MODS?
|
1. general increases capillary permeability, 2. hypermetabolic state, 3. organ malfx, 4. organs return to normal or death
|
|
How do you treat MODS?
|
treat underlying causes, adequate fluids, vasopressors, inotropics, support ventilation, adequate nutrition prevents sepsis
|
|
What's normal Hct?
|
3 x hgb
|
|
What is hemolytic anemia?
|
premature acceleration of red blood cells
|
|
What is HIT?
|
Heparin Induced Thrombocytopenia
|
|
What is FI02?
|
amount of o2 delivered to patient
|
|
What causes O2 toxicity?
|
if the fi02 is greater than 50% for longer than 24 hours then you can get o2 toxicity
|
|
What is PEEP?
|
keeps alveoli open
|
|
What is PIP?
|
How much pressure is reached in the lung at the peak of inspiration
|
|
What happens if PEEP increases on vent?
|
air trapping, copd'ers to do this its common
|
|
what are the classic s/sx of an epidural hematoma?
|
initial period of unconsciousness, BRIEF period fo consciousness, decrease of LOC, HA, N
|
|
what are classic s/sx of a subdural hematoma?
|
venous bleed very slow, very DANGEROUS patient appears drowsy, confused, episalateral pupil dilation, dilates on side of bleed. HIGH MORTALITY
|
|
What about chronic subdural?
|
older people who fall, may not show signs, easily confused with dementia, happens in 6-7 decade of life
|
|
what is an indicator of brain stem injury?
|
abnormal doll's eye movement
|
|
what is required for brain death?
|
blood flow study if there is blood flow wait 24 hrs, if not go ahead
|
|
what is the qualifier for organ donation?
|
no brain stem reflexes
|
|
what is ICP
|
intracranial pressure is 0-10, 15 is the absolute limit
|
|
what are the three types of cerebral edema?
|
vasogenic(white mater), cytotoxic(grey mater) and interstitial
|
|
what are the clinical manifestations of ICP
|
continous HA worse in AM, projectile vomiting not preceeded by nausea
|
|
what is the treatment?
|
keep airway patent and monitor VS
|
|
what is spinal shock?
|
temporary neurologic syndrome
|
|
what are s/sx spinal shock
|
decreased reflexes, loss of sensation and flaccid paralysis
|
|
what is good about spinal shock?
|
resolves in 7-20 days
|
|
what are the s/sx of neurogenic shock?
|
hypotensive and bradycardic
|
|
what is the brown-sequard syndrome?
|
damage on one side of cord, but sensation on the opposite side of injury
|
|
what is autonomic dysreflexia?
|
massive uncompensated cardiovasular reaction mediated by sympathetic nervous system
|
|
what is the most common factor?
|
distended bladder or rectum
|
|
what is the rule of 9's?
|
whole body surface is divided into 9%
|
|
how fluid is given to a burn victim in 24 hours?
|
% of burns x 4 x kg
|
|
what are the basics for a burn victim?
|
ventilate, fluid resusciate, control pain and transfer to burn center
|
|
what is the most important part of the resume?
|
projects...whatever
|
|
what should you never put on a resume?
|
every job you've had since you were 16
|
|
how do you treat s-t elevation?
|
STEMI - treat with MONA,
|
|
how do you treat s -t depression?
|
non-stemi treat with MONA
|
|
how do treat a-flutter?
|
aminoderone, cardioversion
|
|
how do you treat a-fib?
|
chemical cardioversion or shock
|
|
how do you treat v-fib?
|
ca+,lidocaine, cardiovert
|
|
how do you treat v-tach
|
02,lidocaine, ca cl 1 gm, shock
|
|
what leads do you look at on a 12 lead ekg?
|
lead I and AVR are lateral, left side is more important
|
|
on a pacemaker, how do you tell what the 5 letters mean?
|
first letter is the chamber being paced, second is the chamber being sensed, 3rd is the response to a heartbeat
|
|
what is inhibited?
|
it won't fire when heartbeat is sensed
|
|
what is triggered?
|
it is when an atrial beat is sensed an atrial is sensed
|
|
what is dual?
|
inhibited and triggered responses
|
|
if your patient is hiccuping after pacemaker?
|
turn them on left side and call dr. it means the pacewire has been dislodged or perforated the myocardium
|
|
what teaching do you send with pacemaker patient?
|
don't lift arm for two weeks
|
|
what is your PMI?
|
location of where heart contractions can be palpated, right under nipple
|
|
what is ape to man?
|
aortic,tricuspid, pulmonic, mitral,
|
|
what is diaphragm for?
|
higher heart sounds, bell is for lower
|
|
what is lub caused by?
|
closure of mitral and tricuspid valves, heard best in apex
|
|
what dub?
|
aortic and pulmonic closing 2 intercostals at base of heart
|
|
when is troponin elevated?
|
stays elevated for 1-3 weeks, detects in 3-4 hours specific to cardiac muscle
|