AACN Flashcards
1
Q
Anterior/Septal leads LAD
A
V1-4
2
Q
Inferior leads L circ or RCA
A
II III or AVF
3
Q
Anterior wall MI complications
A
VSD, LEFT HEART failure, acute MITRAL regurg
4
Q
Most likely etiology of aortic valve disease over vs under 70
A
over is calcified aortic stenosis
under is congenital bicuspid aortic valve
5
Q
Rheumatic fever and valves
A
most likely mitral vale
6
Q
Mitral valve murmur
A
regurg of blood from Left ventricle to left atria for the entire systolic time(HOLOSYSTOLIC murmur) described as blowing and associated with S3 gallop
7
Q
non mitral causes of holosystolic murmurs
A
VSD, Tricuspid regurg
8
Q
SYSTOLIC EJECTION murmur with click
A
aortic stenosis
9
Q
HYPERTROPHIC CARDIOMYOPATHY
ECG
MURMUR
SYMPTOM
A
SYNCOPY
ECG: Biphasic P in V1 and V2, deep narrow Q waves in 1, AVL, V5 and V6
MURMUR: non-radiating systolic
usually found in young adults
10
Q
Hypertensive encephalopathy for hypertensive emergency:
A
HE: blurred vision associated with profound HTN
reduce slowly like 20% in the first 1-2 hrs
11
Q
First steps in MI
A
NITRO, MORPHENE, antiplatelet
12
Q
A-fib in COPD post coronary revascularization or CABG
A
goal is rate control: Dilt, cardizem
NO AMIODORONE because of risk of pulmonary fibrosis, (worse in old, long term use, and COPD)
NO BB because of bronchospasm- metoprolol is caridioselective but still
13
Q
pericarditis
A
sharp CP worse on INSPIRATION
Diffuse ECG changes
pericardial friction RUB, muffled heart tones, and HYPOtension, maybe low temp
14
Q
Costocondritis pain
A
reproducable by appling pressure to chest,
15
Q
GERD sx
A
coorelate with eating or lying down
16
Q
PULM edema
card causes
non card causes
Clinical presentation
A
CC: Heart failure,
mitral STENOSIS
non card: infection, aspiration and ARDS
CP: dyspnea parox nocturnal dyps wheezing frothy sputum cephalization effusions Kerley B
17
Q
Pleurisy pleuritis
CP
A
worse on inspiration and no cough
18
Q
Tamponade triad
A
muffled heart sounds, jugular venous distension, hypotension
narrowing pulse pressure
radial and brachial pulses may be weak or absent
19
Q
HTN refractory to multiple meds think
A
pheocromocytoma: prolonged catecholane excess
or renal artery stenosis
OSA
20
Q
pheocromocytoma DX
A
TSH is normal
Pasma free metanephrines
normetanephrine: over 2.5
metanehrine ove 1.4
24 hr urine to look for urine CATECHOLAMINES
TX with ALPHA adrenergic: phentolamine, (regitine) or phenoxbenzamine(dibenzyline)
21
Q
valve disorder most associated with aortic aneurysm
A
associated with poorly controlled HTN, Ascending aneurysm can widen the aortic base and lead to regurg
22
Q
S4 gallop
A
AS from narrowing of valve outflow
23
Q
opening snap
A
mitral valve prolapse or regurg
24
Q
antiplatlet pre cath
A
plavix 300 then 75 daily
asa 81-325
25
ADHF causes
```
change in diet
(reversible)
not taking meds
dysthrymias
anemia
systemic infection
```
26
normal CVP
0-6
27
normal PAP
15-25sys /5-15dias )
28
PCWP
LVEDP
| 6-12
29
ISCHEMIC cardiomyopathy (in addition to ICD
antiplatelet and BBto reduce morbid and mortality but dont directly reduce the risk of sudden cardiac death
30
HTN urgency reduction schedule
10-20 in hr 1
| 5-15 in next 23
31
Constrictive pericarditis and restrictive cardiomypathy dx
cardiac MRI
CT or eccho
restrictive cardiomyopathy -
calcium deposits on pericardium
endomyocardial biopsy
32
bypass common complications
kidney dysfunction
throbocytopenia
systemic inflammatory response among other s
33
mechinical circulatory support indications
stabilization of cardiogenic shock with mechanical complication
mitral regurgitaiton
ventricular septal defect or free wall rupture
34
Lovenox and nstemi in the old
renally cleared and shuld be dose adusted based on creat
35
Angina therapies
BB< statin, and and ASA
36
supplemental 02 below
90
37
hyperoxia remote risk
vasoconstriction worsoning cardiac ischemia
38
secondary causes of dyslipidemia
hypothyroidism
DM
nephrotic syndrome
39
ischemic stroke HOB
less than 30 for 24 hrs
40
dialated left ventricle HF
heart failure with reduced EF
41
HFpEF mngmt
B control and diuresis but no therapy yet reduces morbidity and mortality
42
cardiogenic shock
epi
mirlinone, -primacor
dobutamine-dobutrex
or nitro
no BB beta ag vs beta antag
43
NSTEMI preferred treatment
not thrombolytics
| PCI is preferred
44
target for ablation of a-fib
pulmonary veins are foci over 90% of the time
anticoag for 2-3 months following ablaiton, evaluate at that point
sinus node dysfunction and need for pacer in necessary in 10% of cases
45
seat belt sign
indicates intra abdominal injury up to 1/3 of pts
46
gallstone pancreatitis
common cause
| CT with contrast most reliable can identify panc and complications to guide treatment
47
SBP dx
with para
Broad spectrum ABX
Cefotaximine
can also treat with NA restriction and diuretics
48
transudative fluid
```
protein pleural/serum
less than 0.5
LDH plerual/serum
less than 0.6
Pleural LDH less than two thrids upper limit of normal serum LDH 140-280
```
cirrhosis, nephrotic syndrome
CHF
Constrictive pericarditis
49
Exudative effusion
```
protein pleural/serum
more than 0.5
LDH plerual/serum
more than 0.6
Pleural LDH more than two thrids upper limit of normal serum LDH 140-280
```
50
murphys sign
acute cholecystitis - deep breath while palpating gallbladder which slips down producing pain
51
giradia incubation
7-21
| metro for 7 days
52
C difff incubation
12-36 hours
Gram plus
vanc and metro
53
e coli incubaiton
3-4 days
gram neg
ammox-
54
Staph aureus incubaiton
1-8 hours
gram positive
cefazolin, cephalothin and cephalexin
55
gastroparesis sx
common complication of uncontrolled hypoglycemia
early satiety
post prandial fullness
56
chrons def
inflammatory bowel disease afffecting ileum and colon,
diarrhea and bloody stool
endoscopy
treat with immunosuppressants
57
nutritional support guide
25-30x wght in KG
protein
1.2-1.6xkg
58
H pylori eradication
gram neg
MOC- metro, omep, clarithromycin (biaxin) for 7 days
AOC ammox, omepp, clarithromycin,
or metro and ammox 7-14
59
PUD
free ab air absent recet sx is perf
PUD is most common cause of stomach and duodonal perf
bowel perf tx is fluids NPO and broad spectrum abx
60
meld score calculation
creat
bili
inr
61
significant post cabg bleed
150mL in 1st 30 minutes
> 250mL in 1st hour (call surgeon and intensivist)
> 150mL in 2nd hour
> 100mL in subsequent hours
62
restrictive cardiomyopathy
least common
amaloidosis or sarcoid
Diffuse myocardial infiltration leads to low voltage QRS complexes.
Atrial fibrillation may occur due to atrial enlargement; ventricular arrhythmias are also common.
Infiltration of the cardiac conducting system (e.g. due to septal granuloma formation in sarcoidosis) may lead to conduction disturbance — e.g. bundle branch blocks and AV block.
Healing granulomas in sarcoidosis may produce “pseudo-infarction” Q waves
63
dialated cardiomyopathy most common
treat with prils
64
cholesterol screen
| goals
at 20 then q5
over 40 is every 2 or 3 or annualy with HLD
Total:
less than 200
200-239
greater than 240 is hi
HLD
men over 40
woman over 50
LDL
less than 100
greater than 190
65
Joint comission HTN class
```
Blood Pressure SBP DBP
Classification mmHg mmHg
Normal <120 and <80
Pre 120–139 or 80–89
Stage 1
140–159 or 90–99
Stage 2
Hypertension ≥160 or ≥100
```
66
HTN goal over 60
less than 150/90 unless ckd or DM
67
HTN urgency vs emergency
(ie, systolic BP >220 mm Hg or diastolic BP >120 mm Hg with or without end organ damage
68
carotid endartorectomy indicaton
over 70% stenosis with tia or stroke
69
pseudomonas infections abx
zosyn, cefe, imi, mero
plus
cipro or levoflox
70
m catorales
Amoxicillin-clavulanate, second- and third-generation oral cephalosporins, and trimethoprim-sulfamethoxazole (TMP-SMZ) are the most recommended agents
71
TB drugs
isoniazid, rifampin, pyrazinamide, ethambutol, if fully succiptable to INH and RIF then ethambutol can be dropped
2 monthos fo ISO, RIF, Pyrazin
then two of ISO, RIF
HIV for 9 weeks
72
postitive tb test
over 5 for HIV
over 10 for high risk,
over 15 for all other
73
Hospital aquired pnu
Hospital-acquired pneumonia (HAP) or nosocomial pneumonia refers to any pneumonia contracted by a patient in a hospital at least 48–72 hours after being admitted. It is thus distinguished from community-acquired pneumonia. It is usually caused by a bacterial infection, rather than a virus
74
low risk HCAP tx
> mild: augmentin or benzylpenicillin + gentamicin
| -> moderate/severe: ceftriaxone or cefotaxime or tazocin or timentin
75
HCAP high risk of MDR treatmet
cover MDR organisms
stop antibiotics for VAP at 6-8 days (evidence that longer courses lead to colonisation with MROs)
treat Pseudomonas aeruginosa, Acinetobacter species or Stenotrophomonas maltophilia for 15 days
-> tazocin or timentin or cefepime
-> if suspected MRSA add in vancomycin (pre-existing longterm lines, prior MRSA, in hospital > 7day or recent admission <3 months)
-> add gentamicin if critically ill (ventilated) to cover MDR organisms (use ciprofloxacin if age >65y, GFR <50 or recently on gentamicin)
-> add teichoplanin if VRE colonized
76
predicted post op pft for volume reduction
Predicted post-operative PFTs = Preop Value (5 – number of lobes resected)/5
77
aspergillus s and s
```
Fever and chills.
A cough that brings up blood (hemoptysis)
Shortness of breath.
Chest or joint pain.
Headaches or eye symptoms.
Skin lesions.
```
78
strep pnu treatment
macrolide (MYCINS)or tetra if healthy
floroquinolone (floxacin) + or betalactam (combos pip/tazo) plus macrolide if not
79
p aregunosa treatment
```
pip/tazo (betalactam)
or
mero- carbepenam
or
cefepime (cephalo sporin)
```
plus
AMG(gent)/azithro (macrolide
add
vanc or linezolid for MRSA
80
fever-sob-pleural effusion with blunting of costovetebrial angle
empayema
81
scleroderam
anti-centromere antibodies (80%)
```
mmunosuppression (methotrexate)
steroids
care with vasoconstrictors
risk of ileus, malabsorption, nutritional deficiencies, GORD, stress ulceration
optimise right ventricular function
```
82
COPD
quit smoking
no steroids for mild stable disease
LABA for moderate disease
83
COPD EKG
ECG: right heart strain, RV hyperthrophy, P pulmonale, RAD, RBBB, ST depression or inversion in V1-V3
84
COPD staging
In patients with FEV1/FVC < 0.70:
GOLD 1—mild: FEV1≥ 80% predicted
GOLD 2—moderate: 50% ≤ FEV1 < 80% predicted
GOLD 3—severe: 30% ≤ FEV1 < 50% predicted
GOLD 4—very severe: FEV1 < 30% predicted
85
laba for-sal
LABAs include: Salmeterol (Serevent Diskus) Formoterol (Perforomist) Arformoterol (Brovana)
86
saba
albuterol
87
lama
tio
88
ICS for eos over 300
```
beclomethasone dipropionate (Qvar Redihaler)
budesonide (Pulmicort Flexhaler)
ciclesonide (Alvesco)
flunisolide (Aerospan)
fluticasone propionate (Flovent)
mometasone (Asmanex)
```
89
normal creat clearence
Normal creatinine clearance is 88–128 mL/min for healthy women
and 97–137 mL/min for healthy men.
90
gfr
```
over 90 is good
60-90
30-59
15-30
under 15
```
91
indications for hd pneumonic
```
Acidosis
electrolyte
intox
overload
uremea
```
92
acute SOB and normal chest films
PE
gold standard is CT with contrast
vent perfusion substitue for CKD players
93
acute copd excerab
NON invasive positive pressure bipap 10/5
azithromycin
methylpred
94
taccy and tubed outside other causes
pneumothorax high plt
95
ARDS
```
lung protective vent
peep
sedation
prone
paralytic
```
96
pseudomonas
levoflox, ciproflox or mero
97
R heart cath
R side pressures and pulm art pressure
98
cardiac mri
congenital disease, structural disorders of the heart
99
L heart cath
CAD
100
needle decompress
2nd intercostal mid clavicular
101
cor pulmonale
R heatr failure from underlying lung disease
hypoxemea LT vasoconstriction and pulm htn LT afterload on RV LT peripheral edema and big liver/spleen
102
OBese hypo syndrom e
BMI over thirty, awake PC)2 over 45.
103
idiopathic pulmonary firbosis sound
fine crackles at bases
104
lung nodule treatment
surgical excision
one lobe only -no pneumonectomy
LYmph positive- may need chemo/rads
105
ppe for tb
airborn
| AFB to determine active TB
106
alpha 1 antityrpsan defficiency
COPD should get tested
107
angio edema
| laryngeal swelling
benedryl and H2 blocker
| epi -stridor etc
108
sulfonureal -glyburide
```
DiaBeta, Glynase, or Micronase (glyburide or glibenclamide)
Amaryl (glimepiride)
Diabinese (chlorpropamide)
Glucotrol (glipizide)
Tolinase (tolazamide)
Tolbutamide.
```
stims insulin scretion not for older adults -dehydration and AKI, not for gfr less than 60
109
DKA treatment
first correct fluid deficit
in most adults 1-3L in the first hour
serum electrolytes before initiation of insulin to make sure K is above 3.3
insulin
110
insulin prior to surgery
| hyperglycemic
yes basal yes correctional no prandial (NPO)
111
SIADH cold intolerance
retention of free water
LOW serum NA
LOW osmolality below 280
and HIGH urine osmo over 100 and urine NA over 40
causes stroke, CNS disorder, trauma, infection, malignancies some meds
112
siadh treatment
serum na over 120 1000ml restrict
over 110 under 120
500ml
under 110 hypertonic and lasix
113
hypothroid
High TSH
low t4
hashimotos
pituatiry or hypothalmus dysfuction
cold intolerance, britle nails, puffy eyes, hair loss
low NA and sugar
synthroid
114
hypothyroid crysis
myxedema
tube
iv synthroid
slow rewarm'
115
hyper thyroid
```
20-40 years
graves
smooth moist warm skin
lid lag
HEAT intolerance
```
TSH low
T3 and 4 up
radioactive iodie uptake
high is graves
low is subacute
```
treat with
propanool for tremor
pctu
tapazole
lugols
```
116
thyroid crisisi
```
extension of hyper
ptc uor tapazole
with
propanolol
lugols
sodium iodine
hydrocort
AVOID ASA
```
117
tacchy agitated tremor
thyroid storm, propanalol
118
adrenal insufficieny
early morning corticol less than 5 with increased ACTH (2 fold above normal limit ) is Primary
119
dex supression test
cushings - dex 1 time and then check in the morning
120
cushings
moon face and buffalo
121
urine metanephrines
```
pheocromocytoma
normal TSH
CT adrenals
alpha block for HTN- phentolamine - regitine
of phenoxybenzamine- dibenzyline
```
122
steroid for plama cortisol assy (does not interfere)
dexamethasone- can be given before ACTH test, switch to hydro or pred after test
123
Normal MCH
32-36
124
HCT
45% to 52% for men and 37% to 48% for women.
125
Normal MCV
80-96
126
coombs test
think hemolytic anemia
127
cancer and pE
lovonox
128
absolute contraindication to TPA
Significant head trauma or prior stroke in the previous 3 months.
Symptoms suggest subarachnoid hemorrhage.
Arterial puncture at a noncompressible site in previous 7 days.
History of previous intracranial hemorrhage.
Intracranial neoplasm,
AVM, or an aneurysm.
Recent intracranial or intraspinal surgery.
129
ANC
WBC x total neutrophils (segs% bands%)x10
normal is over 1000
An ANC (Absolute Neutrophil Count) measures the percentage of neutrophils (shown in this listing as Polys) in your white blood count. multiply your white blood count (WBC) x total neutrophils (segmented neutrophils% + segmented bands%) x 10 = ANC. A normal ANC is over 1,000.
130
transfuse hgb
between 7 and 8
131
most common risks in transfusion of blood
allergic reactions, volume overlaod, infection
132
bactericidal
beta-lactam antibiotics (penicillin derivatives (penams), cephalosporins (cephems), monobactams, and carbapenems) and vancomycin.
133
principles of abx
degree of imunocompromise, prior infection history, local resistance, bactericidal preffered
134
CLL
lymphadenopathy, increased WBC, LYMPHOCYTES over 5K
splenomegaly
dx with peripheral smear
135
serum protien electrophoreisis
confirms multiple myeloma with gama spike
136
serum hapto
low in hemolytic anemia
| below 50 or .5
137
clinical evaluation for staging
symptom directed with particular attention paid to non pulmonary symptoms that suggest mets
138
breast cancer genitic testing
DCIS and ca before 50
tow or more occurances of breast, ovarian, rostate, or panc on same side of family, maternal or paternal
male breast or triple neg breast.
139
multiple myeloma
| crab
bone marrow plasma cells over 10%
c: calcium of 11 or higher
Renal- creat over 2
Anemia: hgm less than 10
Bone lesions one or more on imaging
140
hodkins
Hodgkin lymphoma is marked by the presence of Reed-Sternberg cells, which a physician can identify using a microscope. In non-Hodgkin lymphoma, these cells are not present.
141
MICRO less than 80, hypo less than 32 with low iron and ferritin
iron deff
142
micro less than 80
| macro less than 32 with normal iron
thallasemia
no iron
splenectomy if severe
143
MCV 80-100
| MCHC 32-36
chronic disease 2nd most common
144
macro MCV over 100
| Normo MCHC over 32
with neuro is b12
| without neuro is folic (pernicious)
145
ALL
pancytopenia and circulaton of blasts
146
CML has
philadelphia
147
lymphoma stage
1 single node or group
2 more than one node but only one side of diaphgram
3 spleen involved, both sides of diaphgrm
4 liver or bone marrow
148
ITP
steroids to pump up platelets
| ivig for hi people
149
DIC
fibrin degraded products
150
hepatorenal syndrome
profound oliguria and na retention with liver dysfunction
oncentrated urine with low Na+ (<10mol/L)
few granular casts (doesn’t improve with fluid replacement)
no proteinuria
normal kidneys on U/S
151
pancreatitis
Symptoms consistent with pancreatitis (e.g. epigastric pain)
Elevation of serum amylase or lipase (to 3 times normal level)
Radiological features consistent with pancreatitis (e.g. CT or MRI)
152
refeeding syndrome
hypo phos
hypo k
hypo mag
153
resiliancy
ability to bounce back
154
complexity
two or more systems - body, family,
155
sability
ability to maintain equalibrium
156
vulnerabilty
suceptibility to actual or poential stresssors that may adversely affect outcomes
157
resource availability
what resources are around
158
participation in decision making
wht degree pt and family participate in decisions
159
clinical judgement
critical thinking, grasping of clinical situation, appling skills from guidelines, integrating ebp
160
clinical inqury
questioning, evaluating practice, creating change through research and learning
161
systems thinking
managing environmental, and system resources for pt fam and staff
162
caring practices
respond to the uniqueness of pt and family to promot comfort, limit suffering, respond to the patient as a unique individual
163
collaboraton
work with othes in a way that promots contribution from all
164
advocacy and moral agency
representing the needs of a patient or family or community and resolving ethical or clinical concerns
165
facilitator of learning
promote knowledge aquisition
166
nurse
physiological changes, presence or abcence of complications, attainment of care objectives
167
pt
functional change, behavioral change, trust, ratings, satisfactions, comfort, quality of life
168
system
recidivism, cost/resource utilization
169
delerium
```
t toxic situations
h ypoxemia
i nfection imobillazation
n on pharma, environmental stim
k potassium or electrolytes
```
170
high icp treatment
corticosteroids, mannitol and hypertonic salene
171
sbp goal after TPA
less than 180
172
GB
destruction of myelin sheath
173
viral LP
OP: normal
WBC: normal or mild elevatoin
Prot: normal or mild elevate
GLU: normal
174
SAH LP
elevated RBC and WBC with ration of 1RbC to 700 wbc
175
herpes LP
up wbc up rbc, up protein, normal or slightly down pressure
176
strep pneumoneae meningitis
cephalosporin and vanc
177
central cord injury
affects upper , lower is ok
178
brown sequard motor and nerv
same side motor, opposite side pain/propriaception
179
anterior cord
loss of all motor, pain and sensation below the level of injury
180
ICH on coum
always reverse first
| hematoma may expand for 72 hours
181
pupil change think
elevated ICP
182
SAH managment
non con CT
| LP
183
risk for early post traumatic seizure
over 65
amnesia
subdural hematoma
phenytoin for 7 days
184
cerebral edema from tumor
dexamethasone
185
pre tpa
less than 185/110
186
ICP monitoring in tbi
gcs 3-8
| abnormal ct
187
parkinsons
bradykinesia, tremor, rigidity, and postural instability also referred to as parkinsonism. Tremor is the most apparent and well-known symptom.
tret with levadopa
188
TBI treatment goals
avoid hypoension, adn hypovolemia
treat hyperthermia
avoid abumin
189
tbi who gets a evd
moderate -> severe head injury who can’t be serially neurologically assessed
severe head injury (GCS < 8) + abnormal CT scan
severe head injury (GCS < 8) + normal CT if 2 of the following are present:
Age > 40 yrs
BP < 90mmHg
Abnormal motor posturing
190
bacterial prostatitis abx
bactrim or levoquin with sulfa allergy
191
ileal conduit surgery
bicarb is peed out in ileal urine so pt gets metabolic acidosis
192
AKI determination
bun to creat ration
urine NA - over 20 is kidney
under 10 is extrarenal
193
turp e imbalance
dilutional hyponatremia
194
bun to creat over 20 vs under 20
bun to creat over 20 is pre real
| intrarenal is bun to creat of less than 20
195
pid
gon and clamid
gon dx: culture or gram neg
clymidia : culture is most definitive but Enzymime imunoassay EIA is preferred low cost and quick
treat ceftriaxone IM for gon
and azithromycin 1g po for clymidia
196
pid
sexual active female
pelvic or lower back pain
cervical or axonal tenderness
197
SJS/ten
painful red purple rash, peeling skin and mucosal lesisons
lamictal and anticonvulsants
sulfa abx
nasaids
198
nec fasch abx
carbapenem (mero) 0r beta lactam Combos- ammox/clauv
plus clinda
or a mrsa agent: vanc, linezolid, or dapto
199
indications for surgical debridment
Removal of the source of sepsis, mainly necrotic tissue
Removal of local infection to decrease bacterial burden, to reduce the probability of resistance from antibiotic treatment, and to obtain accurate cultures
Collection of deep cultures taken after debridement from the tissue left behind to evaluate persistent infection and requirements for systemic antibiotic treatment
Stimulation of the wound bed to support healing and to prepare for a skin graft or flap
200
diabetic foot ulcers
debridment, treatment of infection, pressure ofloading, meticulos wound care
201
abx for cellulitis
In mild cases of cellulitis treated on an outpatient basis, dicloxacillin, amoxicillin, and cephalexin are all reasonable choices. Clindamycin or a macrolide (clarithromycin or azithromycin) are reasonable alternatives in patients who are allergic to penicillin.
202
compartment syndrome
loss of sensation between first and second tows, weakness with dorsiflexion
associated with fractures
203
rhabdo triad
myalgia, gen weak, dark pee
204
cip
hyporeflexia, flaccid quadriparesis, SLOWED nerve conduction
205
mynsthenia g nerve conduction
is normal
206
fall prevention 9
1fix eyes-cataracts
2fix feet adn foot wear
3vitamin d
supplimentation
4rate and rythm abnormalities
5indiviually taylored exercise program
6minimize meds
7education and info
8 modify home environment
9: postural hypotension
207
tubing mg patinet
no rock, veck, or cist- unpredictable response, no sux- resistant- use etom
208
dominent vs non
People with left-sided strokes may have trouble with skilled movements, depression and speech. In contrast, the right side of the brain has a more big-picture, large-scale processing style. It pulls information together, seems better at handling new information, and is probably more responsible for negative feelings
209
spastic gait
```
dragging feet
Brain abscess.
Brain or head trauma.
Brain tumor.
Stroke.
Cerebral palsy.
Cervical spondylosis with myelopathy (a problem with the vertebrae in the neck)
Liver failure.
Multiple sclerosis (MS)
```
210
types of gait
Propulsive gait -- a stooped, stiff posture with the head and neck bent forward
Scissors gait -- legs flexed slightly at the hips and knees like crouching, with the knees and thighs hitting or crossing in a scissors-like movement
Spastic gait -- a stiff, foot-dragging walk caused by a long muscle contraction on one side
Steppage gait -- foot drop where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking
Waddling gait -- a duck-like walk that may appear in childhood or later in life
Ataxic, or broad-based, gait -- feet wide apart with irregular, jerky, and weaving or slapping when trying to walk
Magnetic gait -- shuffling with feet feeling as if they stick to the ground
211
alzheimers
requires a gradual onset of memory impairment plus one or more of the following: aphasia (language disturbance); apraxia (impairment of motor activities despite intact motor function); agnosia (failure to recognize objects despite intact sensory function); and executive functioning disturbance (planning, organizing, sequencing, abstracting). The deficits cause a significant impairment that represents a considerable decline from previous level of function.
212
uncrosmatched blood is
O neg
213
treatment of serotonin sindrome
cryohepadine
214
amphotericin B
central line, premedicate with tylenol and benedri: chills nausea, emissi and rigors in 70%
215
uncomplicated pnu
levoflox
216
sofa score
```
PF ratio
hypotension and pressor req
bili level
platelet count
creat
gcs
```
217
BB OD
atropine and ivf, if that fails insulin with glucagon
218
ethylene glycol
fomepizole
219
benzo
flumazenil
220
insecticide poision
atropine
221
failure to thrive
The Institute of Medicine as weight loss of more than 5%, decreased appetite, poor nutrition, and physical inactivity, often associated with dehydration, depression, immune dysfunction, and low cholesterol.
222
FUO
Background. The syndrome of fever of unknown origin (FUO) was defined in 1961 by Petersdorf and Beeson as the following: (1) a temperature greater than 38.3°C (101°F) on several occasions, (2) more than 3 weeks' duration of illness, and (3) failure to reach a diagnosis despite one week of inpatient investigation
223
FUO eitology and sub classees
classic, nosocomial, immune deficient, and human immunodeficiency virus–related. The four subgroups of the differential diagnosis of FUO are infections, malignancies, autoimmune conditions, and miscellaneous.
224
sepsis
Sepsis should be defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%.
225
septic shock
Septic shock should be defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (>18 mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%. I
