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Critical Care 1 > Additional information > Flashcards

Additional information Flashcards

1
Q

normal SBP in pediatrics

A

90 + 2(age)

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2
Q

hypotension in pediatrics

A

70 +2(age)

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3
Q

blood loss before a kid becomes hypotesnsive

A

up to 30% of blood volume b efore low bp

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4
Q

estimate circulatory blood volume in pediatrics

A

80ml/kg

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5
Q

blood replacement for pediatrics

A

10ml/kg

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6
Q

IVF replacement in pediatrics

A

20ml/kg

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7
Q

of IVF versus blood for pediatrivs

A

blood = 10ml/kg

pediatrics =20ml/kg

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8
Q

calculate maintence fluids for kids

A

1-10kg = 4ml/kg/hr

10-20kg = 2ml/kg/hr

over 20kg = 1ml/kg/hr

**shortcut = if over 20kg, do 40 + wt in kg

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9
Q

Dextrose given to pediatrics if hypoglycemic

A

all get 2ml/kg
neonate = D10
infant/toddler = D25
child= D50

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10
Q

cric for pediatrics

A

needle cric if under 8yo

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11
Q

NG diameter for pediatrics

A

ETT x2

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12
Q

depth of ETT for pediatrics

A

ETT x3

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13
Q

chest tube for pediatrics

A

ETT x4

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14
Q

pediatric adenosine dose

A

0.1mg/kg

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15
Q

cardioversion dose for pediatrics

A

0.5 - 2 j/kg

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16
Q

defibrillator dose for pediatrics

A

2,3,4,8j/kg

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17
Q

CXR of epiglottis

A

thumb sign

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18
Q

thumb sign on CXR

A

epiglottis

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19
Q

s/s of epiglottis

A

4 D’s = drooling, dysphagia, dysphonia, distres

rapid onset fever, stridor

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20
Q

respiratory sounds of epiglottis

A

stridor

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21
Q

difference between epiglottis & croup

A 
croup = barking
epiglottis = stridor
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22
Q

interventions for epiglottis

A

life threatening
clam b/c possible rapid airway loss
abx, humidified oxygen

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23
Q

lung sounds of bronchio.litis

A

90% are from RSV

wheeze/crackles

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24
Q

Waddle’s Triad

A

specifi pattern of injury when ichild is hit by car

  • fracture of femoral shaft (initial impact by bumper)
  • intra-abd/thoracic when body hits car hood
  • contralateral head injuury when thrown and hit groud/other object
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25
Q

specific pattern of injuries for pediatrics when they are hit by a car

A

Waddle’s Triad

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26
Q

breathing if DKA

A

Kussmau;s to blow off CO2 in anttempt to orect acidosis

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27
Q

fruity breath

A

DKA

from ketones

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28
Q

how quickly can you lower glucose in DKA

A

no more than 100 per hr b/c cerebral edema

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29
Q

fluids in DKA

A

average pt is 3-6L deficit

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30
Q

when do you swap fluids if HHS

A

swap to D5 once 250-300mg/dl

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31
Q

rx tat can cause diabetes insipitus

A

phenytoin (Dilantin) overdose b/c suppresses ADH release

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32
Q

overdose that can cause diabetes insipitus

A

phenytoin (Dilantin) overdose

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33
Q

treatment of DI

A 
first line is IVF b/c often 9L fluid deficit
then DDAVP (synthetic vasopression w/o cardiac response)
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34
Q

abnormalities r/t ADH

A

DI

SIADH = too much

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35
Q

using DDAVP

A

for diabetes insipitus = synthetic vasopression w/o the cardiac resonse

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36
Q

rx that can cause SIADH -3

A

tricyclic antidepressants
narcotics
oral hyopglycemics

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37
Q

level of Na when you go into a coma

A

below 120

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38
Q

correction of low Na

A

hypertonic saline

no more than 0.5mEq/hr

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39
Q

what happens if you correct low Na too quickly

A

central pontine myelinolysis

*irreversible brain damage w/cerebal palsy, quadraplegia, death

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40
Q

eye bulging

A

hyperthyroidism

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41
Q

consider if heat intolerance

A

hyperthyroidism

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42
Q

treatment of hyperthyroidism

A

IVF
BB
steroids

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43
Q

rx to avoid if hyperthyroidism

A

asprin b/c it will prevent the binding of thyroglobulin, making the situation worse

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44
Q

Grave’s Diseae

A

hypERthyroidism

*risk thyroid storm/thyrotoxicosis

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45
Q

takes synthroid

A

hyPOthyroidsm

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46
Q

rx for hypOthryoidism

A

synthroid

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47
Q

bright red diarrhea

A

hematochezia

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48
Q

Octreotide

A

for esophagelal varices

  • synthetic form of somatostatin
  • reduces spleen & liver blood flow which reduces variceal pressures
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49
Q

rx given for esophageal varices

A

Octreotide

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50
Q

esophgeal bleeding

A

varices

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51
Q

location that differentiates lower from upper GI bleed

A

ligament of Treitiz

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52
Q

DO NOT DO if esophageal varices

A

no NG tube b/c can cause a lethal rupture of varices

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53
Q

consideration if esophageal varices but you need to intubate

A

NO NG tube b/c that can cause a lethal rupture of the varices

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54
Q

intervention for esophageal varices

A

Sengstaken Blakemore tube

*tamponade

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55
Q

non-lifethreatening rupture of the esophagus

A

Mallory-Weiss

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56
Q

causes of Mallory-Weiss tears

A

non=life threatening rupture of the esophagus

*chronic forceful vomiting like alcoholism/bulemia

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57
Q

Boerhaave’s Tears

A

complete transmural rupture of hte lower thoracic esophagus

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58
Q

s/s of Boerhaave’s Tears -4

A

complete rupture of lower esophagus

*shock, CP, Hamman’s sign, SC emphysema

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59
Q

gold standard for Boerhaave’s Tears

A

EGD

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60
Q

BUN to creatinine ratio in GI bleed

A

gover 30:1

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61
Q

problem of increased ammonia

A

liver breaks down ammonia

increased ammonia leads to increased ICP

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62
Q

treatment for increased ammonia

A

lactulose

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63
Q

IRN in liver disease

A

INR over 1.5 b/c decreased albumin & coagulation factor

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64
Q

normal ALT

A

under 55

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65
Q

normal AST

A

under 48

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66
Q

sign of increased serum ammonia

A

ICP, LOC changes

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67
Q

neuro complication of liver disease

A

hepatic encephalopathy

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68
Q

flapping muscle tremor

A

asterixis = indicates liver issues

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69
Q

what happens in pancreatitis

A

digestive enzymes destory the pancreas

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70
Q

what might happen in untreated pancreatitis

A

SIRS

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71
Q

2 common auss of pancreatitis

A

alcohol abuse, gallstones

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72
Q

2 signs of pancreatitis

A

Cullen

Grey-turner

73
Q

what makes pancreatitis pain worse

A

begins/worsens after eating

may worsen if flat

74
Q

where is the pain in pancreatitis

A

epigastric to upper left abd and radiates to back

75
Q

LUQ pain

A

pancreatitis

76
Q

pain rx in pancreatitis

A

no morphine b/c spasms lead to obstruction in the sphincter of oddi
NSAIDS?KEtamine/Demoerol for pain

77
Q

contraindication to morphine

A

pancreatitis b/c morphine leads to spasms that obstruct the spincter of oddi

78
Q

rx that obstructs the spincter of oddi

A

morphine

79
Q

what does deep tendon reflexes tell you

A 
info about he integrity of spinal nerves
0 = absent
1= hypoactive
2= normal
3= hyperactive
4= cp;pmis
80
Q

what does Babinski’s reflex reflect

A

pyradimal tract disease

81
Q

2 meningitis signs

A

Brudzinski’s

kernig

82
Q

severe stiffness of hamstring & inability to straighten leg when the hip is flexed 90 degrees

A

Kernig

83
Q

how to remember Kernig’s sign

A

“kicking kernig’s”
*severe stiffness of hte hamstrings causes an inability to straighten the leg when teh hiop is flexed 90 degrees
meningitis

84
Q

involuntary lifting of the legs when liftin a pt’s head

A

Brudzsinski’s sign

meningitis

85
Q

minimal acceptable cerebral perfusion pressure

A

normal is 70-90

cannot go below 70

86
Q

ICP with high mortality rate

A

over 20

87
Q

location of ICP tranducer

A

foramen of Monro

88
Q

what is located at teh foramen of MOnro

A

ICP transfucer

89
Q

goal of ICP monitoring

A

ensure adquate CPP and oxytenation

90
Q

benefit of ICP monitoring

A

gives early detection of intracrantial HTN (ICP over 15)

91
Q

ICP waveform parts

A 
P1 = perfussion wave. arterial pulsation
P2= tidal wave. intracranial compliance
P3= diacrotic wve-venous> 
P2-P3= aortic valve closing
92
Q

risk of depressed skull fracture & transport

A

pneumocephalus if sinus cavities are fractured

93
Q

when is an orbital fracture a surgical emergency

A

have pt look up. if the injured eye does not move consensually plus pt has double vision, it is a surgical emergency

94
Q

brain bleed w/torn veins

A

subdural hemtoma

95
Q

venous lakes in brain

A

subdural hematoma

torn veins

96
Q

subdural hematoma

A

tearing of briding veins into the subdural space

97
Q

shape of epidural hematoma

A

“lenticular” in shape

98
Q

“lenticular” in shape

A

epidural hematoma

99
Q

arterial versus venous brain bleed

A

epidural = arterial

subdual - venous

100
Q

head injury w/a lucid period

A

epidural = arterial

101
Q

consider if a blow to the side of the head

A

epidural = arterial

102
Q

sign of tentorial herniation

A

pupil changes b/c increased pressure against CN3 (0culomotor)

103
Q

“worst headache of my life”

A

subarachnoid hemorrhage

104
Q

describe subarachnoid hemorrhage

A

worst headache of life

105
Q

CT if subarachnoid hemorrhage

A

“worst HA of my life”

starfish pattern

106
Q

starfish pattern on CT

A

subarachnoid hemorrhage

107
Q

BP goal if subarachnoid hemorrhage

A

SBP under 140

108
Q

treatment of subarachnoid hemorrhage

A

SBP under 140

nicardipine, nitroprusside

109
Q

respirations in Cushing’s triad

A

Cheyne Stokes

110
Q

pulse pressure if Cushing’s triad

A

wqide pusle pressure

111
Q

minute ventilation goal of increased ICP

A

CO2 30-34

112
Q

“keep the diaphragm alive”

A

CC3-4-5”

113
Q

anterior cord compression

A

incromplete SI from displament of bony fragments into anterior cord

114
Q

what can the anterior cord do

A

pain
temp
motor

115
Q

what can the posterior cord do

A

vibration
touch
position in space

116
Q

cause of Brown-Sequard

A

incomplete penetrating lesion

117
Q

contralateral in Brown-Sequard

A

loss of pain and temperature sensation

118
Q

loss of pain/temp sensation in Brown-Sequard

A

contralateral

119
Q

same side loss in BRown-Sequard

A

motor, sensation to touch, proprioception, vibration

120
Q

what happens in a central cord injury

A

greater loss of function in upper extremities than in the lower extremiteis with variable loss of sensaiton ot pain/temp

121
Q

SVR in neurogenic shock

A

SVR udner 800

122
Q

spinal shock

A

paralysis/absent reflexes for up to 72hrs

123
Q

classic triad of neurogenic shock s/s

A

low bp
low hr
warm flushed, dry below lesion
SVR under 800

124
Q

good pressor for spinal cord injuries

A

phenylephrine
fluids
treat bradycardia

125
Q

most common cause of autonomic dysreflexia

A

bladder distension

126
Q

level of autonomic dysreflexia

A

over T6

127
Q

BP goals in HTN crisis

A

lower no more than 25% per hr and now lower than pt normal

128
Q

HOB in stroke

A

30 degrees

129
Q

thrombolytics for eligible strokes

A

within 3hr

130
Q

treat seizures

A

Keppra and benzos

check glucose

131
Q

most common cause of encephalitis in uS

A

herpes simplex

132
Q

what does encephalitis look like

A

flu

133
Q

myasthenia gravis

A

AcH

common acute respiratory faioure

134
Q

Guillain-Barre

A

peripheral nerve syndrome

hyporeflexia, pain, umb

135
Q

antidote for cocaine

A

benzodiazepines

136
Q

amyl nitrite
sodium nitrite
sodium thiosulfate

A

treat cyanide

137
Q

treat cyanide

A

amyl nitrite
sodium nitrite
sodium thiosulfate

138
Q

hydrocarbon overdose

A

intubate

139
Q

Deferoxamine

A

for Fe overdose

140
Q

atropine/2-PAM

A

for organophosphates

141
Q

organophosphate overdose

A

atropine

2-PAM

142
Q

methanol overdose

A

aaaaaaaFomepizole (ANtizole)

143
Q

Antizole

A

alcohol overdose

144
Q

INH overdose

A

B6/pyridoxine

145
Q

antidote is Ba6 (pyrridoxine)

A

INH overdose

146
Q

ETT diameter for pediatrics

A

(16 + age)/4

147
Q

non-emergency maintence fluids for pediatrics

A

4-2-1m rule

148
Q

normal PT

A

10-13 seconds

149
Q

normal PTT

A

25-40 seconds

150
Q

normal INR

A

0.9 - 1.3

151
Q

normal troponin I

A

under 0.04

152
Q

normal CK

A

20-200

153
Q

normal CK-MB

A

under 3

154
Q

normal troponin T

A

under 0.01

155
Q

normal troponin I and T

A 
I = under 0.04
T= under 0.01
156
Q

normal albumnin

A

3.5-5.5

157
Q

normal ALT8-48

A

7-55

158
Q

normal AST

A

8-48

159
Q

normal bi,irubin

A

.1-1.2

160
Q

normal BUN

A

8-23

161
Q

normal creatinine

A

0.7-1.4

162
Q

treatment for SIADH

A

hypertonic saline

163
Q

treatment of Grave’s disease

A

IVF, BB, dexamethasone, tylenol

164
Q

treatment of Addioson

‘s disease

A

steroids

165
Q

septic shock treatment

A

levelpohed

166
Q

treat high K

A 
albuterol
bicarbonate
insulin
dextrose
lasix
kayexelate
calcium gluconate
167
Q

treatment of asprin overdsoe

A

dialysis

168
Q

causes of anion gap acidossi

A 
MUDPIILES
methanol
uremia
DKA
propylene glyol
INH
Iron
ethylene glycol
salicylates
169
Q

what is propylene gluycol

A

liquid angent used in diasepam/lorazepam

170
Q

treatmnet fo propylene glycol

A

it is a liquid agent in diazepam/lorazepam

treat with flumazeinil

171
Q

aka antifreeze

A

ethylene glycol

172
Q

Oxygen adjustment calculation at altitude

A

FiO2 x P1/P2

173
Q

FIO2 x P1/P2

A

oxygen adjustment at alititude

174
Q

1 ATM
2 ATM
1/2 ATM

A

1 ATM = sea level. 760 torr
2 ATM = 33 ft down
1/2 ATM = 380 torr = 18K

175
Q

altitude where you have 1/2 ATM

A

18 K = 380 torr

176
Q

normal Vt

A

4-8mlkg

177
Q

Ve

A

minute ventilation
F x VT
4-8L/min

178
Q

normal PPLAT

A

under 30

179
Q

normal PEEP

A

0-20

Critical Care 1 (14 decks)

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