Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/49

Click to flip

49 Cards in this Set

  • Front
  • Back

Generic fever w/u

has to undergo blood cx (2-3 independent sites prior to starting Abx)




CXR




urinalysis

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)

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

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

Liver failure with DT

only benzos safe in liver failure is lorazepam or oxazepam

DT refractory to benzos

barbiturates or propofol

Wernicke-Korsakoff syndrome

Wernicke:


confusion


ataxia


ophthalmoplegia


due to thiamine deficiency & is reversible




Korsakoff:


amnesia with confabulation


irreversible

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

Pre-op labs

T&S


CBC


PT, PTT, Fib

Intracranial hemorrage

intubation and hyperventilate to pCO2 of 25-30mm Hg




IV mannitol




get neurosurgery consult

Acute altered mental status of unclear etiology

naloxone


thiamine


dextrose

Salicylate intoxication

respiratory alkalosis (CO2 low) with anion gap metabolic acidosis




can also have:


tinnitus


pulmonary edema


coma secondary to edema

Lactic acidosis secondary to aspirin toxicity

poisons mitochondria that leads to anaerobic metabolism and production of lactate

Activated charcoal

can give for any potential overdose even if specific ingested substance is not known

Tx of aspirin o/d

activted charcoal




IV fluids




IV HCO3- to alkalinize urine that aids in drug excretion




psych consult

Signs of upper GI bleed

very high BUN


hypotension


hematochezia

Angiodysplasia

characterized by painless bleeding, which can be mild to massive




can be assoc with aortic stenosis

Hypoglycemia Sxs

irritability


tremulousness


diaphoresis


seizure


stupor


coma

Factitious use of insulin

hypoglycemia


elevated insulin


low c-peptide level

Sulfonylurea o/d

hypoglycemia


elevated insulin


elevated c-peptide




check sulfonylurea level

W/u of pt in fire

carboxyhemoglobin --> if elevated, give 100% O2


CXR


CBC


BMP

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

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)

V Fib algorithm

defibrillate --> CPR (5 cycles) --> check rhythm --> defibrillate --> CPR (5 cycles) --> epinephrine --> check rhythm --> defibrillate --> CPR --> amiodarone --> check rhythm --> defibrillate

Synchronized shock

defibrillation means UNSYNCHRONIZED




synchronized does it to ventricular contraction aka QRS complex so can only do if QRS complex is present

3 conditions for defibrillation (unsynchronized shock)

V Fib




pulseless ventricular tachycardia




torsades de pointes

Acetylcysteine

acetomenophen toxicity antidote




only beneficial when used up to 24 hrs after ingestion

Acetaminophen o/d Sxs

anorexia


nausea


vomiting


diaphoresis


malaise




hepatotoxicity peaks 72-96 hrs post ingestion

Alcohol hepatitis

AST:ALT is 2:1




AST is NEVER >500

Heart fluttering/palpitations vs chest pain

1st step always EKG




chest pain:


2nd step consider stress test




fluttering/palpitations:


2nd step consider Holter monitor

A fib EKG

tachycardia




irregular rhythm




no p waves




tx with IV diltiazem & admit to telemetry unit

Supraventricular tachycardia

tachycardia




regular intervals




no p waves




1st step is carotid massage --> then adenosine

Multifocal atrial tachycardia

tachycardia




irregular intervals




p waves exist but have a different morphology




normally occurs in pt with underlying pulmonary issue --> treat hypoxemia

A fib labs

thyroid function test


cardiac enzymes


ECHO


ABG

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

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

Drugs for A fib anticoagulation

warfarin with INR goal of 2-3




dabigatran --> direct thrombin inhibitor




rivaroxaban, abixaban --> Xa inhibitors

Amiodarone side effects

ataxia, parasthesias, peripheral neuropathy




hypo/hyperthyroid




hepatitis and cirrhosis




corneal deposits




cough with infiltrates on CXR

SA node conduction on EKG

p waves (atrial contraction)



bc a fib u dont have atrial contraction u have no p waves



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

Purkinje fibers conduction on EKG

QRS complex (ventricular contraction)




wide QRS complex indicates problem with ventricular conduction

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

Tx PE

start LMWH and warfarin

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

PE secondary to malignancy

LMWH indefinitely NOT warfarin

Thrombolytics in PE

only in persistent hypotension or shock

PE cause w/u

elderly: thorough w/u for malignancy




woman: antiphospholipid antibodies & FV Leiden (if FV Leiden, cannot get OCPs)

P2Y12 ADP receptor inhibitors

clopidogrel, prasugrel, and ticagrelor




inhibits plt aggregation




used in pts with coronary stents, peripheral vascular dz, & strokes

Thromboxane A2 inhibitors

abciximab, tirofiban, eptifibatide




inhibits fibrinogen cross-links via GP IIB/IIIA receptors




used to tx NSTEMI & STEMI