14 CEN: Medical emergencies Flashcards
14 items on exam
Causes of allergic reaction? S/S?
Hypersensitivity (allergic) reaction - exposure to allergen, IgE antibodies produced, histamine (urticaria) and leukotriene react, results in vasodilation and mucus production.
Causes: shellfish, Hymenoptera sting (bee)
S/S: hives, urticaria, itchy eyes, sneezing, runny nose
Anaphylaxis s/s? Tx?
Anaphylaxis - acute, rapidly progressive systemic reaction.
S/S: urticaria, pruritus, angioedema.
TX: airway management and oxygen (possible surgical airway), Epinephrine 1mg/ml 0.2-0.5 mg IM (SQ uneven absorption), progress to IV epinephrine infusion, if necessary, diphenhydramine (Benadryl) + H2 blockers (Cimetidine, Ranitidine, Famotidine), Albuterol, methylprednisolone (no immediate effect), IVF’s.
Anaphylactic Shock
- hypotension, decreased end-organ perfusion, multiple organ dysfunction (distributive shock/maldistribution).
What is Hemophilia? S/S? Tx?
Hemophilia - hereditary genetic disorder that impair the body’s ability to control blood clotting;
-Hemophilia A (Classic Factor VIII - most common)
-Hemophilia B (Factor IX) are recessive sex-linked, so occur in males;
-Von Willebrand is in men and women (most common).
S/S: decreased LOC if head injury (get CT); bleeding of soft tissues, muscles, or joints (hemarthrosis),
TX: Replace clotting factor or administer cryoprecipitate(liquid part of blood, has fibrinogen) or FFP, ice, compression, immobilization, and elevation of joints; topical thrombin for lacerations and observe for 4 hours post suturing; hold pressure on venipunctures for at least 5 minutes, no IM injections.
DC teaching: wear medic-alert bracelets, avoid aspirin and NSAIDs, always keep factor VIII with you, extra protection - helmets, elbow pads, etc.
What is Disseminated intravascular coagulation (DIC)?
S/S? Dx? Tx?
Disseminated intravascular coagulation (DIC) - abnormal activation of the body’s coagulation cascade from trauma, sepsis, pancreatitis, HELLP in OB. (Clotting factors used up, causes bleeding in other areas)
S/S: bruising, petechiae, purpura, hematuria, end-organ failure.
DX: prolonged coagulation times (PT, PTT), elevated D-dimer and fibrin degradation products; low hemoglobin, hematocrit, platelets, fibrinogen.
TX: treat underlying cause, control bleeding, antifibrinolytic agents (aminocaproic acid - Amicar and tranexamic acid - TXA), platelet transfusion.
→Treatment plan effective if platelets increasing.
What is Idiopathic Thrombocytopenia Purpura (ITP)?
Causes? S/S?
- low platelet count with normal bone marrow function.
Causes: autoimmune disorder seen after a viral infection seen in children 2-4 years old and spontaneously resolves; or chronic in adults.
S/S: indications of bleeding - bruising, petechiae, purpura, epistaxis, bleeding gums; bleeding from minor injuries is prolonged; brain hemorrhage.
Causes of anemia? Tx?
Anemia - low hemoglobin from blood loss, low iron, low vitamin B12, or low folic acid;
**a lack of vitamin B12 or folate causes the body to produce abnormally large RBCs that cannot function properly
TX: stop blood loss, oral iron replacement (dark stools, constipation), vitamin B12.
What is Polycythemia ? Secondary polycythemia? Tx?
Polycythemia - excess blood cells.
Secondary polycythemia - increased RBC in response to high altitudes and hypoxia seen in COPD, increased blood viscosity, aspirin for clotting risk,
TX: phlebotomy to remove whole blood and infuse NS
What is Polycythemia Vera? Tx?
Polycythemia Vera - overactive bone marrow results in increase in RBC, WBC, and platelets; hematocrit over 55%, hepatosplenomegaly (enlarged spleen and liver), increased blood
viscosity.
TX: chemotherapy to decrease blood cell
What is Sickle cell disease? Medication these pts take?
Sickle cell disease - congenital (gene from both parents) hemolytic anemia (SS) causing “sickling” of RBCs.
Patients take Hydroxyurea to decrease sickling and produce more Hgb.
ESI for sickle cell crisis? Acute chest syndrome?
Triggers for SCC?
Triage 2 (high risk) for sickle cell crisis.
Triage 1 Acute chest syndrome of chest pain and dyspnea is the main killer.
Triggers - low oxygen saturation, infection, dehydration, exposure to cold. Sequestration of cells in spleen causes abdominal pain. Vaso-occlusive crisis - most common, priapism.
Sickle cell disease S/S?
DX? TX?
D/C Education?
S/S: sudden explosive pain in abdomen, chest, back, and joints; splenic ischemia increases risk of infection; cardiac ischemia seen in acute chest syndrome.
DX: CBC to detect infection, reticulocyte count.
TX: high-flow 02, IVEs for rehydration, antibiotics for infection, opioids for pain; early stem cell transplantation is goal.
D/C education: avoid triggers, take Hydroxyurea as prescribed to decrease sickling and produce Hgb.
What ESI is neutropenia?
Causes? S/S?
Tx?
Neutropenia - low WBC count, increasing the risk of infection (Triage level 2)
Causes: immunosuppressive therapy (chemotherapy or radiation) or leukemia - bone marrow manufactures leukemic (abnormal) immature WBCs, that do not function properly, nor provide adequate protection from infection.
S/S: low-grade fever with low neutrophil count, fever may be absent, recurrent infections.
TX: protective (reverse) isolation; avoid invasive procedures; early antibiotics; bone marrow stimulants (Filgrastim - Neupogen).avoid raw and undercooked meat, well water, and unwashed produce;
Fluid replacement for adults? children? neonates?
NS or LR
30ml/kg (1-2L in adults)
20ml/kg bolus in children
10ml/kg bolus in neonates
Under what conditions is Hyperkalemia seen?
EKG presentation?
Hyperkalemia (> 5.0 mEq/L)
- Seen in renal failure, burns, crush injuries, ACE inhibitors, rhabdomyolysis.
EKG: Peaked T waves early, widening of QRS, loss of P waves, Sine wave.
Hyperkalemia TX
“C BIG K Drop”
- C Calcium gluconate 10% - 10 ml IV over 10 mins (cardiac stabilizer)
- B Beta agonists - Salbutamol 10-20 mg in 4 ml NS nebulized over 10 mins OR Bicarbonate 8.4% (50meq) IV over 5 mins (intracellular shift)
- I Insulin 10 units IVP (intracellular shift)
- G Glucose D50W 1 ampule over 5 mins (maintain glucose)
* K Kayexylate 15-30 g IN 15-30 ml (70% sorbitol) PO for GI
removal (for chronic renal failure)
* D Diuretics - Furosemide 40-80 mg IVP (renal removal)
* rop Renal unit for extracorporeal removal
Under what conditions is Hypokalemia seen?
EKG presentation? S/S? Tx?
Hypokalemia (3,5 mq/L.)
-Seen in metabolic alkalosis, overuse of diuretics, acute alcoholism, cirrhosis, intestinal tract diseases (malabsorption).
S/S: muscle weakness, NA, paralytic ileus/abdominal distension/gas, shallow respirations, mental depression, leg cramps;
EKG: tachycardia, flat T waves, possible U wave, ventricular irritability.
TX: Replace K+, correct alkalosis (R+ low = pH high), correct hypomagnesemia too, increase K+ in diet.
Hypercalcemia seen in? S/S? TX?
Hypercalcemia (> 10.5 mg/dl) - Seen in renal disease, prolonged immobility, malignancies, hyperparathyroidism.
S/S: Lethargy, DTR’s decreased, constipation, “metallic taste”, risk of kidney stones.
TX: IVF’s, furosemide, glucocorticoids to decrease GI absorption of Cat, dialysis
Hypocalcemia seen in? S/S? TX?
Hypocalcemia (<8.5 mg/di) (Need albumin) - Seen in pancreatitis, hypoparathyroidism, low albumin, bums, malignancy, and hyperventilation.
S/S: Chvostek’s sign - spasm of lip and cheek, Trousseau’s sign - carpopedal spasm; tetany, confusion.
Prolonged QTI - risk of Torsades VT (polymorphic VT).
TX: Replace Calcium, Vitamin D, and parathyroid hormone (as needed), increase calcium in diet.
Hypernatremia
Hypernatremia (>145 mEq/L) (Serum osmolality 2x Na+ > 295)
Seen in renal failure = sodium and water excess, treated with diuretics and dialysis.
Hypovolemic hypernatremia seen in DKA, HHS, Diabetes Insipidus.
S/S: Thirst, dry membranes, orthostatic, hypotension.
TX: Treat cause and correct slowly with D5W or .45 NS to prevent cerebral edema, sodium restriction; vasopressin (ADH) for DI.
Hyponatremia seen in? S/S? TX?
Hyponatremia (<135 mEq/L) (Serum osmolality < 275 - 2 x sodium)
Hypovolemia from vomiting, diarrhea, or burns treated with 0.9% NS replacement.
Hypervolemic hyponatremia seen in fluid overload, SIADH, excessive water ingestion.
S/S: fatigue, diarrhea, risk is seizures.
TX: Hypertonic saline, water restriction.
Hypermagnesemia seen in? S/S? TX?
Hypermagnesemia (>2.5 mEq/L)
Seen in renal failure and laxative abuse.
S/S: Respiratory depression, bradycardia, hypotension, decreased DTR’S.
TX: Stop magnesium if infusing, furosemide, calcium gluconate 10 ml or 10% over 10 minutes, dialysis.
Hypomagnesemia seen in? S/S? TX?
Hypomagnesemia (< 1.5 mEq/L)
Seen in acute and chronic alcoholism (most common), malnutrition, malabsorption, thiazide (HCTZ) and loop (Lasix) diuretics.
S/S: Ventricular dysthythmias like polymorphic ventricular tachycardia (Torsades de pointes), agitation, hyperreflexia.
TX: Magnesium sulfate administration - 1-2 grams IV (rapid if emergency, over 2 hours if non-emergent) or IM depending on severity (monitor for respiratory depression, hypotension, decreased DTR).
What is Pheochromocytoma? What happens?
Tx?
Adrenal glands - control the release of epinephrine (adrenalin) for fight-or-fight response; a tumor of the adrenal medulla - Pheochromocytoma stimulates release of adrenaline, resulting in tachycardia and hypertensive crisis.
TX: alpha-blocking agent like Phentolamine (Regitine), nitroprusside (Nipride), or labetalol (beta and alpha blocker). Beta-blocker without alpha blockade is contraindice.
