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Medical Emergencies Final > Altered Consciousness > Flashcards

Altered Consciousness Flashcards

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USMLE® Step 1 flashcards
1
Q

Two acute complications of diabetes:

A

Hyperglycemia

Hypoglycemia: blood glucose less than 50 mg/dL

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2
Q

Manifestations of arteriosclerosis in chronic complications of diabetes:

A 
Heart: angina and MI
CNS: stroke/CVA
Kidneys: glomerulosclerosis
Lower extremities: gangrene
High blood pressure
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3
Q

Manifestions of microangiopathy in chronic complications of diabetes:

A

Eye: diabetic retinopathy (leading cause of blindness)
Kidney: arteriolar nephrosclerosis
Extremities: gangrene
Neuropathy

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4
Q

Classification of type 1 diabetes:

A
  1. destruction of beta cells of pancreas (autoimmune)
  2. more common in adolescents, usually non obese
  3. circulating and exogenous insulin required
  4. more severe than type 2
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5
Q

Classification of type 2 diabetes:

A
  • genetic interactions regulated by weight, exercise, diet, and stress but is not immune
  • patients endogenous insulin prevents ketoacidosis but does not meet increased needs
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6
Q

3 (triad) symptoms of undiagnosed diabetes:

A
  1. polydipsia (thirst)
  2. polyphagia (appetite)
  3. polyuria (urination)
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7
Q

Important dental considerations for Type 1 diabetic:

A
  1. early appts
  2. normal dietary habits
  3. use a short lasting anesthetic
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8
Q

For a pre-op IV sedation diabetic type 1 patient:

A

Do not eat; hold insulin and schedule early in morning

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9
Q

For a surgical post-op diabetic patient:

A
  1. reduce insulin if food is reduced
  2. check glucose more often
  3. antibiotics for type 1 and 2 if extensive surgical procedure
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10
Q

Clinical SYMPTOMS of hyperglycemia in T1 diabetic:

A
  1. the three polys (polydipsia, polyphagia, polyuria)
  2. weight loss
  3. headache, blurred vision, mental stupor
  4. fatigue to diabetic coma
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11
Q

Clinical SIGNS of hyperglycemia in T1 diabetic:

A

red, hot, and dry face
deep and rapid respirations, rapid heart rate, hypotensive
fruity, sweet breath- diabetic ketoacidosis

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12
Q

Early stage of hypoglycemia:

A
  • difficult conversation, calculations, mood change

- hunger, nausea

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13
Q

Advancing early stage of hypoglycemia:

A
  • skin is cold and wet (hyperglycemia was hot, dry)

- sweating, goosebumps (piloerection), tachycardia, anxiety, resembles intoxication

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14
Q

Late stage of hypoglycemia:

A
  • unconscious due to hypoglycemic come or insulin shock
  • seizures
  • hypotension
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15
Q

Blood glucose normal levels (what level does your brain need and at what level do you exceed renal absorption?):

A

50-150 mg/dl
brain needs 50 mg/dl
above 180 mg/dl, exceeds renal absorption

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16
Q

What occurs when glucose exceeds 180 mg/dl?

A

Glucose is excreted in the urine. It causes the excretion of water, Na, K –> polyuria, polydipsia and dehydration

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17
Q

What occurs in the absence of glucose (or when there’s not insulin to help uptake glucose into cells)?

A

muscle breaks down ketone bodies, acetone is a by-product that causes fruity breath; diabetic ketoacidosis

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18
Q

What happens when ketones exceed proper blood levels?

A

metabolic acidosis (7.3 and below), ketones excreted

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19
Q

What does the body due to compensate for a metabolic acidosis and what are these called?

A 
respiratory alkalosis (hyperventilate)
Kussmaul's respirations
20
Q

Management of a hyperglycemic patient:

A

p: Supine
abc: Airway most important
d: Activate EMS, O2

21
Q

Management of conscious, hypoglycemic patient:

A 
(patient seems intoxicated)
If conscious:
p: upright
abc:
d: oral glucose (orange juice, soda, candy bar)
patient CAN go home with escort
22
Q

Management of conscious but unresponsive hypoglycemic patient:

A 
patient refuses to ingest oral carbs or can't ingest
1. Activate EMS
2a. 50 ml of 50% dextrose IV (ONLY IV)
or 2b. 1 mg glucagon IM or IV
Monitor vitals every 5 mins
3. Discharge with EMS
23
Q

Management of unconscious hypoglycemic patient:

A

p: supine
abc: airway most important, no chest compressions
d: activate EMS
-administer IV 50% dextrose
-IM or IV glucagon
- .5mg of epinephrine (unless they have CV disease)
- decorative icing as last resort
Oral carbs once consciousness is regained, be prepared for hypoglycemic seizures, discharge with EMS

24
Q

What is the end stage of untreated hypothyroidism and what is a drug used to treat hypothyroidism?

A

myxedema coma

Synthroid- L-thyroxine

25
Q

Symptoms of hypothyroidism:

A
  1. parasthesia
  2. weakness and fatigue
  3. cold intolerance
  4. constipation and weight gain
26
Q

Signs of hypothyroidism:

A
  • pseudomyotonic reflex
  • Hypothermia with dry, scaly skin and puffy eyelids
  • menorrhagia (abnormal periods)
  • hoarse voice, thick tongue, slow speech
27
Q

Three types of drugs to be cautious in prescribing to patient with hypothyroidism:

A
  1. Opioid analgesics 2. Sedative-hypnotics 3. Antianxiety
28
Q

Another name for hyperthyroidism:

A

Graves disease

29
Q

Symptoms of hyperthyroidism:

A
  1. weight loss and weakness
  2. nervousness and sweating
  3. loose stools
  4. heat intolerance (hypo is cold intolerance)
30
Q

Signs of hyperthyroidism:

A
  1. tachycardia, wide pulse pressure
  2. fever, warm, moist, soft skin
  3. tremor
  4. exophthalamos and staring
31
Q

3 treatments for hyperthyroidism:

A
  1. Propylthiouracil
  2. subtotal thyroidectomy
  3. radioactive iodine ablation of gland
32
Q

characterization of thyroid storm:

A
  1. hyperpyrexia (really high fever)
  2. sweating, stupor, coma
  3. agitated and disoriented
  4. A Fib and tachycardia
33
Q

use of anesthetics in hyperthyroid patient:

A

anesthetics with vasoconstrictors, but use the least concentrated effective solution and smallest volume; AVOID atropine; contraindicated to use racemic epinephrine for gingival retraction

34
Q

Management of thyroid patients:

A 
P
-conscious: upright
-unconscious: supine
ABC
D- if patient does not become conscious with positioning, activate EMS, administer O2, vitals, IV infusion
35
Q

2 common causes of cerebral infarction (CVA) and two patients at higher risk:

A
  1. Atherosclerosis and thrombosis (81% of CVAs) (embolisms account for 7%) (intracranial hemorrhage 13%)
  2. patients with high BP and diabetes mellitus
36
Q

Common sites for embolism:

A 
Heart (A. fib, MI, prosthetic and path valves)
Neck veins (carotid bifurcation)
37
Q

Characterize the two types of intracranial hemorrhages:

A
  1. subarachnoid- w/in subarachnoid space
  2. intracerebral- w/in brain parenchyma
    Occurs most often when BP is elevated
38
Q

two sources of intracranial hemorrhage:

A
  1. ruptured arterial aneurysms

2. hypertensive vascular disease

39
Q

Predisposing factors for cerebrovascular accident:

A
  1. high BP (greatest risk)
  2. diabetes
  3. cardiac enlargement
  4. hypercholesterolemia
  5. smoking
  6. history of CVA
40
Q

When can a patient have elective dental treatment following a CV accident?

A
  • after 6 months, but if there is emergency, treat with medications and invasive procedures at hospitals
  • morning appts, use local with epi with caution, oral or nitrous sedation
  • be cautious of anticoagulants
41
Q

manifestations of transient ischemic attack:

A

1/2. abrupt onset but rapid recovery

  1. transient numbness and weakness of contralateral extremities (“pins & needles”)
  2. transient monocular blindness
42
Q

manifestations of infarction:

A
  • gradual onset (TIA is abrupt onset)
  • TIA precedes
  • headache limited to side of infarction
  • paralysis on one side of body (facial asymmetry) (pupils uneven in size)
  • difficulty breathing, swallowing, unable to speak or slurred speech (aphasia)
  • loss of bladder/bowel control
43
Q

manifestations of embolism:

A

-abrupt onset with mild headache before signs and symptoms

44
Q

manifestations of cerebral hemorrhage:

A
  • abrupt onset of signs and symptoms (seconds)
  • sudden and VIOLENT headache (your brain is bleeding, duh)- localized becoming generalized
  • nausea and vomiting
  • chills and sweating
  • dizziness and vertigo
  • half of patients lose consciousness
45
Q

management of CV accident (page 12-13)

A

P: Conscious- upright or semi-supine
ABC: BLS as needed
Vitals: Elevated BP, pulse rate normal or elevated and bounding; monitor every 5 mins
D: Activate EMS, O2, No CNS depressants (so NO nitrous oxide)– read page 13

Medical Emergencies Final (4 decks)

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