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78 Cards in this Set
- Front
- Back
Compelling indications to start HTN trmt in PreHTN pts.
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DM
CKD HF prior MI prior stroke |
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Life style modifications to lower HTN?
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weight loss
exercise smoking cessation low salt/cholesterol intake decrease EtOH intake |
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Avoid B blockers in pts with?
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Asthma
COPD Heart block sick sinus syndrome |
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What is sick sinus syndrome?
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damage to SA node conduction tract, causing symps of bradycardia: syncope, SOB, dizziness
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Anti-HTN meds for pregnancy?
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hydralazine
B-blockers alpha methyldopa Mg sulfate (lowers BP in pre-ecclampsia) |
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Causes of Secodary HTN?
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OCP
Renovascular (fibromuscular dysplasia, athersclerosis) Excessive EtOH Pheo PCKD Cushing dz Conn syn (aldosterone) Coarctation - all occur new b/t ages 30-55, hard to control w/ meds |
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HTN emergency
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= end organ failure
- trt with Nitroprusside, nitroglycerin, or labetalol |
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HTN epidemiology - 4 fun facts?
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- every 20/10 mmHg inc over 115/75 carries a doubling of CVD
- CAD MC cause of death if HTN untreated - control of HTN lowers stroke, MI, CHF, RF, Ao dissec, renal - if normal @ 55, still 90% chance of developing HTN |
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DM health maintenance issues? (5)
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- ACE inhib to prevent RF
- opthamology yearly - foot exam for neuropathy - BG monitoring, A1C - trt risks for HTN, athero aggresively |
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C peptide level with insulin
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- if high after hypogly episode, think insulinoma
- if low, think factitious disorder |
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DKA
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-hyperglycemia
-metabolic acidosis -hyperketonemia -ketonuria -trt with IVF, insulin, K+,Phos -r/o infection |
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NHH (nonketotic hyperglycemic hyperosmolality)
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-in Type II DM
-trt w/ IVFs, IV insulin, electrolytes -no ketones because insulin is present, preventing lipolysis |
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Longterm complications of DM?
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-Atherosclerosis
-Retinopathy -Nephropathy -Neuropathy (Charcot jts, silent MI, gastroparesis, impotence) -infections |
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Somogyi effect vs. dawn phenomenon
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-Somogyi=3 a.m. glucose is 40, causing inc in glucose release by 7 a.m; decrease p.m. NPH dose
-dawn=3 a.m. BG is 160; still have normal GH & cortisol a.m. surge; trt is inc in p.m. NPH |
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How do you measure LDL?
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LDL = total cholesterol - HDL - (TGs/5)
**not valid is TG is >500 |
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5 risk factors for CHD?
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-Age
-Smoking -HTN -FH of premature CHD -low HDL |
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Drugs for managing cholesterol?
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-niacin
-bile-acid binding resins -statins -fibrin |
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Cancers associated with smoking
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lung 90%
oral 90% esophagus 80% larynx 50% pharynx bladder kidney 30% pancreas 25% cervix vulva penis anus |
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smoking in pregnancy
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low birth weight
prematurity spontaneous abortion stillbirth infant mortality |
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Beuger disease
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-painful red fingers/cold toes in a heavy smoker
-thromboangiitis obliterans -inflam and thrombosis of medium arts & veins |
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Cancers associated with EtOH
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oral
larynx pharynx esophagus liver |
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Stages of EtOH withdrawal
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-12 to 24 hrs tremors, sweating, hyperreflexia, seizures
-24 to 48 hrs alcoholic hallucinosis -2 to 4 days DTs; hallucinations, illusions, confusion, poor sleep, fever |
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Signs/symptoms of cirrhosis/chronic liver dz
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varices/hemorrhoids
spider angiomas palmar erythema caput medusae ascites gynecomastia/testic. atrophy asterixis anemia spontaneous bacterial peritonitis |
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Dz's associated with EtOH
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gastritis
Mallory Weiss tears pancreatitis (acute & chronic) dilated cardiomyop. hepatitis cerebellar degen./ataxia rhabdomyolysis |
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Fetal alcohol syndrome
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MR
microcephaly microphthalamia midfacial hypoplasia cardiac defects |
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How to treat alcoholics with IVFs
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Give thiamine first
then fluid with glucose - prevents Wernicke enceph. |
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Chronic thiamine deficiency
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-alcoholic develops Korsakoff syn
-can't form new memories/makes up stories -chronic/irreversible |
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TIPS
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-transjugular intrahepatic portosystemic shunt
-trts portal htn by shunting flow from portal v. to hepatic v. |
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hepatorenal syndrome
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-rapid kidney func. decline in cirrhotic pts
-due to change in blood flow to kidneys -AMS, jaundice, oliguria, ascites -Type I is rapid, II is slow |
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Pickwickian syndrome
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-hypoventilation in obesity
-trt with CPAP -sleep apnea, somnolence during day, high CO2, low O2 sat due to shallow breathing |
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MC hypercoagulable conditions
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surgery (ortho, abd, pelvic)
neoplasm trauma immobile pregnancy/PCPs lupus anticoag/antiphospho factor V Leyden def in ATII, prot C or S |
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Studies to eval for PE?
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-CTA
-Vent-Perf scan if can't use IV contrast -cath pulm angiogram (invasive) |
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How does warfarin work?
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-inhibs epoxide reductase in liver, preventing gamma-carboxylation of Vit. K coags
-followed by PT (ext. pathway) -effects reversed by Vit. K |
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Uremia
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-renal azotemia (inc BUN & Cr)
-parenchymal damage to kidneys -ATN, CRF -BUN:Cr ratio <15 |
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ASA overdose and treatment?
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-causes primary metab. alkalosis and primary resp. acidosis = near normal pH
-alkalinize the urine to inc excretion -use bicarb |
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What does high O2 in COPDers do?
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-decreases resp drive
-will see inc in CO2, dec in pH -turn down O2 support |
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Acid base in a sleep apnea pt?
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-has high pH, high bicarb, normal CO2
-pt has chronic metab compensation for his CO2 retention at night |
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Symptoms of hypoNa?
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lethargy
MS changes seizures cramps disorientation coma |
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SIADH
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-caused by head trauma, surgery, meningitis, SCC of lung, pulm infections, painful states, opioids
-hypoNa -restrict H2O intake -Demecclcycline: induces DI, counteracting ADH |
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Initial stroke steps?
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-initiate stroke team/pager
-get emergent CT of brain -12 EKG -full neuro exam |
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Asystole/PEA steps?
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1- ABC and call for AED
2- 30 compressions/2 breaths 3- EPI 1 mg IV q3-5min **give vasopressin 40U at 2nd dose instead, then resume epi 4- Atropine 1 mg IV q3-5, max 3 mg |
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H's and T's?
(6 & 5) |
Hypovolemia
Hypoxia Hypothermia Hypoglycemia Hypo/Hyperkalemia Hydrogen (acidosis) Toxins Tamponade Tension PTX Thrombosis Trauma |
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VT/VF steps?
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1- ABC and crash cart
2- BLS 3- Biphasic shock @ 120-200J 4- EPI 1mg q3-5 **may use vasopress 40U once 5- 5 CPR cycles 6- shock 7- Amiodarone 300mg once 8- Consider Mg 1-2g for torsades |
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Nine indications for hemodialysis?
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- serum K > 5.5
- BUN > 80-90 - acute fluid overload - persistent metabolic acidosis -removal of toxins -uremia (pericarditis, encephalopathy, anorexia) -hyperPO4 with hyperCa -platelet dysfunc. w/ bleeding |
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List the signs of ARF?
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-decreased UOP (<20ml/hr) with inc. BUN
-discoloration of urine -FENa >2 is pre or post renal -too high/too low urine osmolality |
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Five types of ARF?
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-prerenal
-parenchymal -postrenal -oliguric -nonoliguric |
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Causes of ARF?
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-any disregulation effective glomeruli perfusion
-hypoTN (aff constrict) -NSAIDS (inhibs vasodilatation) -G- sepsis (dec PVresistence) -stenosis, thrombosis -outflow obstruction -ischemia/nephritis/toxins -IV contrast (w/in 48 hrs) -trauma (myoglob/hemogb) |
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treatment of ARF?
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-adequate hydreation
-mucomyst (pre-emptively) -insulin + glucose, aerosolized B2 agonist, Ca carbonate to correct hyperK -fleet Phospho-Soda for hyperPO4 to prevent rhabdo -hemodialysis if all fails |
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Clostridium colitis details
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-commonly occurs after Abx trmt (clindamycin, cephalasporins, fluoroquin's are more common)
-severe diarrhea, pain, leukocytosis -toxins A and B -high false neg = do multiple tests -DIC, hypoTN, BD, lactate inc |
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How to treat C. diff?
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-oral or IV Flagyl
-oral Vancomycin -colectomy if pt is septic/progressively worsening (toxic megacolon) |
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Describe relationship b/t CRP and prealbumin?
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-CRP is acute phase reactant that inc. in sepsis, injury, inflam.
-prealbumin is a constitutive prot made by liver -in times of stress, liver dec production of constitutive prots -if CRP is high, pre-alb might be falsely low= =don't use prealb for nutritional gauge until CRP=0 |
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How do you calculate Ideal Body Weight for a female?
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IBW=45kg + 2.3kg for each inch over 5 ft
IBW=100lbs + 5lbs for each in. over 5 ft |
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Calculation for IBW in males?
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IBW=50kg + 2.3kg for each in.>5ft
IBW=106lbs + 6lbs for each in. > 5ft |
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What components make up parenteral support?
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-lipids
-dextrose -amino acids -vitamins -minerals Pt generally needs 25kcal/kg/day and 1.5g protein/kg/day |
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Difference between SIADH and DI?
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-SIADH causes hyponatremia
-DI causer hyperNa |
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Treatment of DI?
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-Vasopressin to dx pituitary vs. nephrogenic
-thiazide diuretic decreases urine formation |
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Traits of hypokalemia?
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-muscle weakness, fatigue
-adynamic ileus -too little = vent failure -beware of after insulin trmt to DKA; give K+ prophylactically |
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Traits of hyperkalemia?
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-tall T waves, prolonged QRS and PR, loss of P
-sine wave: loss of ST segment -caused by RF, NSAIDS, ACE inhibs, hypoaldosteronism, adrenal insuff. |
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How to treat hyperK+ with EKG changes?
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1. Calcium gluconate
2. NaHCO3 -> shifts K+ back into cells (via alkalosis) 3. IV glucose and Insulin 4. Dialysis if emergent w/ RF |
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Signs of hypocalcemia?
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-Chvostek's sign
-depression, dementia, convulsion -Trousseau sign: hand spasm after arm BP cuff inflation - |
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Causes of hypoCa2+?
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-DiGeorge syn
-post thyroid/parathyroidectomy -Vit D deficiency -acute pancreatitis (Ranson's criteria) -psuedohypoparathyr: high PTH, but resistance -hypoalbuminemia: loss of prot-bound fraction |
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Ranson's criteria at admission?
"GA LAW" |
-age > 55
-WBC > 16000 -LDH > 350 -AST > 250 -glucose > 200 |
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Ranson's criteria at 48 hours?
"CHOBBS" |
-Calcium < 8
-Hematocrit fall > 10% -Oxygen <PO2 60% -BUN inc > 5 -BD > 4 **score > 3 is pancreatitis **score 7-8 is 100% mortality -Sequestration of fluid |
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Traits of hypercalcemia?
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-bones, moans, groans, and psychiatric overtones
-hyperPTH, sarcoidosis, malignancy, Hypervitaminosis of A or D, thiazides |
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Treatment options for hyperCa2+?
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-Lasix
-oral Phos -calcitonin -diphosphonates -prednisone in malignancy |
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Degrees of hypovolemia?
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I = 750cc or 15% loss
II = 1500cc or 30% loss III = 2000cc or 40% loss IV = >2000cc or >40% loss |
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What is the "sepsis 3"?
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hypoTN
documented infection organ dysfunction |
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What is the treatment options for sepsis?
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-Volume resus
-Abx trmt -Drainage of collections/abscess -Pressors -Zygris; active Prot C |
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Neurogenic shock parameters
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-low CO
-low PCWP -low SVR -low SvO2 |
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Hypovolemic shock parameters
*and late septic shock |
-low CO
-low PCWP -high SVR -low SvO2 |
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Cardiogenic shock parameters
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-low CO
-high PCWP -high SVR -low SvO2 |
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Septic shock parameters
**early |
-high CO
-low PCWP -low SVR -high SvO2 |
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Anaphylaxis
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-peanuts, shellfish, beestings, PCNs, sulfa drugs
-admin EPI and IVFs, O2 -beware of laryngeal edema--> intubate |
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Geriatrics
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-presbyopia, presbyacusis
-dec immunity -inc fat mass, dec muscle |
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Common causes of dementia
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- Alzheimer's (neurofib tangles)
-multiple cerebral infarcts -HIV -Pick disease -pseudodementia (due to depression) |
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Correcting calcium if hypoalbuminemia -- formula
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Serum calcium + 0.8(4 -Serum Albumin)
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How do you calculate Pt's H2O deficit?
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(Na+/140 - 1) X 0.6(body weight)
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Correcting Hypernatremia
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-dec. no faster than 0.5-1 mEq/L/hr, or 12 mEq/L/24hr
-Change in Na= Infusate Na - serum Na/ weight kg X 0.6 |