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BCEN Flashcards

1
Q

Requiring bag-mask ventilation / intubation / mechanical ventilation | SCI

A

C5 and above
C4 diaphragm

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2
Q

Cause loss of intercostal muscle function with hypoventilation - may require O2

A

Above T11

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3
Q

Cause loss of abdominal muscles with hypoventilation and inability to cough

A

T7

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4
Q
  1. Hypotension (widening pulse pressure)
  2. Bradycardia
  3. Abnormal respiratory pattern
A

Cushing’s Triad found in late ICP

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5
Q

Bulging fontanelles
Sunset eyes
Vomiting, anorexia, poor feeding
High pitched cry
Biot’s respiration

A

S/s of pediatric ICP

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6
Q

Deep rapid respirations interrupted with long, apneic pauses

A

Biot’s respirations found in increased ICP (pediatrics)

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7
Q

MAP - ICP

A

CCP | >70 GOOD

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8
Q

Diuretic used to decrease ICP

A

Mannitol | Risk to kidney damage & electrolyte imbalance

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9
Q

Pulse oximetry >95%
PaO2 >100 mm Hg
Sys BP >100
ICP <15
CCP >60
Temp 36-38
Glucose 80-100
Serum sodium 135-145
Hemoglobin >7

A

Goals of care for ICP
Avoid crystalloids | blood products and colloids preferred.
Colloid solutions contain large insoluble molecules
Proteins
Complex polysaccharides
Albumin, starches, dextrans

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10
Q

80% of basilar fractures

A

Anterior Fossa Fracture

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11
Q

Bleeding or CSF leak will cause epistaxis, rhinorrhea, subconjunctival hemorrhage, hemorrhage in the periorbital spaces

A

Anterior Fossa Fracture

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12
Q

Bleeding or CSF leak will cause otorrhea, hemotympanum, nerve injury leading to deafness and vertigo

A

Middle Fossa Fracture

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13
Q

Ecchymosis behind the ear (Battle signs)
Bleeding around medulla causes bradypnea, respiratory irregularities, hypertension, bradycardia.
Gag reflex impaired

A

Posterior Fossa Fracture | Rare | More severe, no where for bloodto go

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14
Q

Ecchymosis behind the ear (Battle signs)
Bleeding around medulla causes bradypnea, respiratory irregularities, hypertension, bradycardia.
Gag reflex impaired

A

Posterior Fossa Fracture | Rare | More severe, no where for bloodto go

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15
Q

Bleeding is ARTERIAL (middle meningeal artery) caused by a blow to temporal region with RAPID decline in LOC (often over 6 hours or less)

A

Epidural Bleed

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16
Q

Unconscious immediately after incident followed by lucid period with onset of severe headache then rapid decline in LOC with signs of increased ICP

A

S/s of Epidural Bleed

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17
Q

Evacuation of blood with burr holes or surgical evacuation

A

Tx of Epidural Bleed

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18
Q

Bleeding is VENOUS with SLOWER onset of symptoms of ICP

A

Subdural Bleed

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19
Q

Symptoms within 48 hours

A

Acute Subdural Bleed

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20
Q

Symptoms within 48 hours - 2 weeks

A

Subacute Subdural Bleed

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21
Q

Symptoms more than 2 weeks after injury

A

Chronic Subdural Bleed

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22
Q

May be rupture of aneurysm or traumatic

A

Subarachnoid Bleed

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23
Q

Meningeal irritation causing “worst headache of my life”, nuchal rigidity and photophobia. Decrease LOC, Motor deficits (hemiparesis) | Pupil abnormalities

A

S/s of Subarachnoid Bleed

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24
Q

Preventing complications:
1. Rebleeding (keep SBP <160 mmHg with labetalol or nicardipine
2. Reducal local vasospasms by administrating IV calcium channel blockers

A

Tx of Subarachnoid Bleed`

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25
Q

Unconscious | GCS 3 | Posturing | Elevated ICP | SBP 140-160 | Hyperthermia | Excessive Sweating

A

Severe TBI (Diffuse Axonal Injury DAI)

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26
Q

Unconscious | GCS 3 | Posturing | Elevated ICP | SBP 140-160 | Hyperthermia | Excessive Sweating

A

Severe TBI (Diffuse Axonal Injury DAI)

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27
Q

Hypovolemic Shock = ____ pathetic

A

Sympathetic

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28
Q

Neurogenic Shock = _____pathetic

A

Parasympathetic

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29
Q

SCI above the level of ___ disrupt the sympathetic fibers that transmit through the spinal cord yet leave the parasympathetic pathways intact

A

Above T6

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30
Q

1-2L Bolus
Vasopressors
Atropine
Aggressive warming measures

A

Tx Neurogenic Shock

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31
Q

Vasodilation
Bradycardia
Skin warm/dry
Priapism

A

Neurogenic shock / Parasympathetic stimulation

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32
Q

Descending Motor nerves

A

ANTERIOR Cord

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33
Q

Ascending Sensory nerves

A

POSTERIOR Cord

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34
Q

Proprioception, fine touch, fine pressure, and vibration

A

POSTERIOR Cord (ASCENDING sensory nerves)

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35
Q

Ascending Sensory nerves - pain / temp /crude touch

A

LATERAL CORD (Ascending sensory nerves)

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36
Q

Loss of motor function, loss of pain, temperature, crude touch, and crude pressure

A

ANTERIOR cord injury

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37
Q

Loss of proprioception, vibration, fine touch, and finre pressure

A

POSTERIOR cord injury

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38
Q

Loss of motor function, proprioception, and vibration sense on side of injury but loss of pain and temperature on opposide side of injury

A

Brown-Sequard (lateral injury to the cord usually from penetrating trauma)

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39
Q

Greater loss of motor function in upper extremities than lower extremities with variable sensory sparing

A

Central Cord Syndrome

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40
Q

Difference between lateral cord and anterior/posterior cord nerve crossings

A

Anterior / posterior cords cross at the base of the brain while lateral cords cross at the point of insertion in the spine.

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41
Q

Difference between lateral cord and anterior/posterior cord nerve crossings

A

Anterior / posterior cords cross at the base of the brain while lateral cords cross at the point of insertion in the spine.

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42
Q

Stuttering start

A

Thrombolytic Stroke

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43
Q

Sudden onset of stroke s/s. 50% have a-fib | Can be caused by ENDOCARDITIS

A

EMBOLIC Stroke

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44
Q

Triggers include food, dieting, emotion, menses, medications, weather changes, sleep disturbances, bright lights, aggravated by activity

A

Migraines

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45
Q

Unilateral headache with pulsating quality | 4-72 hours | Nausea, photophobia, phonophobia, LIE STILL

A

Migraine S/s

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46
Q

Metoclopramid, prochlorperazine, Ketorolac, valproate | Prevention: Dexamethasone, BB, Triptans, Anti-epileptic | Anti-depressants

A

Migraine Tx and Prevention

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47
Q

Precipitated by alcohol, antihistamine or nitroglycerin

A

Cluster HA

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48
Q

Unilateral, excruciating, burning PERIORBITAL or temporal pain often waking the patient from sleep

A

Cluster HA s/s

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49
Q

15-180 minutes, 1-8/day, spring / fall, pain-free for periods of months/years

A

Cluster HA

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50
Q

100% oxygen NR for 15 minutes or until pain subsides

A

Cluster HA Tx

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51
Q

Rapid onset of symptoms causing death in 15% of cases and long term disability. ______ Meningitis

A

Bacterial Meningitis

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52
Q

Tightening of meninges spinal cord

A

Opisthontonos - bacterial meningitis

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53
Q

Petechial rash on trunk and thighs unique to _____

A

Bacterial Meningitis

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54
Q

Paradoxical crying in infants - cries when held but not when laid down

A

Bacterial Meningitis

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55
Q

_____ Meningitis associated with immunocompromise

A

Fungal Meningitis

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56
Q

Impairment of cognition (may remain responsive) with amnesia of the event. Demonstrates automatism - performs actions without thought

A

Focal Complex partial seizures

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57
Q

Tonic-clonic movements

A

Generalized convulsive seizures

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58
Q

Absence seizure, myoclonic seizures, tonic seizure atonic seizure \ FREEZE IN TIME

A

Generalized non-convulsive seizures

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59
Q

Post-ictal state which may include Todd’s paralysis and neurogenic pulmonary edema

A

Focal complex partial / generalized tonic-clonic seizure

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60
Q

Focal activity in one hemisphere ( focal clonic movements, sensory disturbances, deja vu, etc.) WITHOUT LOC

A

Focal simple partial seizures

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61
Q

Affecting one limb or side of the body which can last for 24 hours

A

Todd’s paralysis

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62
Q

IV Fosphenytoin (Cerebryx)
IV Phenytoin
IV Levetiracetam

A

Tx Status Epilepticus

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63
Q

Progressive nervous system disease that affects nerve cells in the brain and spinal cord causing loss of muscle control.

A

Amyotrophic Lateral Sclerosis (ALS / Lou Gehrig’s disease)

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64
Q

Distal muscles more affected than proximal muscles
Upper extremities more affected than lower extremities
Results in muscular spasticity, hyperreflexia and muscle paralysis. CNS ofen unaffected. 15% develop Dementia

A

ALS

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65
Q

Sporadic attacks brought by triggers such as changes in body temperature, (fever, taking hot bath, hot weather, exercise). Blurred vision, double vision, red-green color distortion, blindness in one eye, weakness, difficulty with coordination and balance. Paresthesia, pain, speech impairment, tremors, dizziness.

A

MS

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66
Q

Interferon Beta (Rebrif) / immunosuppressants minimize symptoms

A

MS

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67
Q

Weakness more pronounced in proximal muscles compaired to distal muscles and to muscles of upper body than lower body

A

Myasthenia Gravis

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68
Q

Acute autoimmune polyneuropathy that primarily affects the motor component of the peripheral nerves. Often follows viral illness / immunization.

A

Guillain Barre Syndrome

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69
Q

Oh once one takes the anatomy final a good vacation seems heavenly

A

Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Acoustic
Glossopharyngeal
Vagus
Spinal Hypoglossal

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70
Q

Some say marry money but my brother says big boobs matter more

A

Sensory vs Motor Vs Both

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71
Q

AKA tic douloureux, sudden usually unilateral severe brief, stabbing recurrent pain in the distribution of one or more branches of 5th cranial nerve. May cause facial spasms.

A

Trigeminal Neuralgia | Neuropathic pain

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72
Q

Adjuvant analgesics for what kind of pain?

A

For neuropathic pain - antileptics, anti-depressants, antiarrhythmics

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73
Q

Carbamazepine, Phenytoin, Oxcarbazepine, Clonazepam, Lamotrigine, Valproic acid, gabapentin

A

Adjuvant analgesics - antileptics, anti-depressants, anti-arrhythmias

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74
Q

Paralysis to one side of the face is often caused by HSV

A

Bell’s Palsy

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75
Q

Unable to blink in one eye resulting in cornea ulceration and unable to purse lips

A

Bell’s Palsy

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76
Q

No airway sounds, inspiratory stridor, EXPIRATORY wheezing with prolong\ation of the expiratory phase, medium to coarse Ronchi, tachypnea, nasal flaring / retraction

A

Partial obstruction ABOVE vocal cords

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77
Q

Weak airway sounds, , inspiratory stridor, EXPIRATORY wheezing wtih prolong\ation of the expiratory phase, medium to corase ronchi, tachypnea, nasal flaring / retractions, HEAD BOBBING

A

Partial obstruction BELOW vocal cords

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78
Q

Wheezing auscultated on one side, unilateral retractions, new-onset asthma, bronchitis or pneumonia that doesn’t respond to appropriate treatment

A

Obstruction in the BRONCHUS

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79
Q

Absent breath sounds on ONE side, Unilateral retractions

A

Complete obstruction in BRONCHUS

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80
Q

Viral inflammation of the UPPER airways often associated with an upper resiratory tract infection

A

Bronchitis

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81
Q

Viral infection of the LOWER airways that affects children under 24 months of age, most often caused by RSV

A

Bronchiolitis

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82
Q

Infection of the lung parenchyma (bacterial, fungal, viral, aspirate

A

PNeumonia

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83
Q

Copious nasal secretsions, atelectasis causing respiratory distress, high-risk infants can have apneic spells

A

Difference between bronchitis & bronchiolitis

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84
Q

S/s of this condition tend to occur within hours (6) of aspiration and resolve within 48 hours

A

Aspiration PNA

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85
Q

Changes including diffuse pulmonary edema seen on CXR

A

Respiratory Distress Syndrome

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86
Q

Visualization of neck veins is assessing the effectiveness of treatment of ____

A

Pulmonary Hypertension

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87
Q

Risk factors: immboility, pregnancy, and increasing age

A

Blood Emboli

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88
Q

S/s unique to ____ caused by a blood clot: Elevated D-Dimer

A

PE

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89
Q

S/s unique to ___ emboli: petechial rash to the chest anda axilla (transient)

A

FAT

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90
Q

S/s unique to ___ emboli: signs of R sided HF and continuous drum-like mill-wheel murmur

A

AIR

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91
Q

LEFT lateral decubitis positioning & Aspiration of the R ventricle

A

Tx Air Embolism

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92
Q

Prevention: early splinting and reduction of fractures & supportive therapy up to mechanical ventilation

A

Tx: FAT emboli

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93
Q

TX:
Positive inotropes (Dobutamine / Milrinone)
Vassopressors (Improve LEFT ventricular function by increasing left ventricular afterload | Norepinephrine preferred)
Inhaled nitric oxide
Diuretics

A

Tx: Pulmonary Hypertension

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94
Q

Emphysema
PE
L sided HF
High Altitude
Connective tissue disease
Liver Disease

A

Causes of pulmonary HTN

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95
Q

Accumulation of of more than 1000 mL of blood initially, OR more than 200 mL/hour over 2-4 hours

A

Arterial bleeding causing hemothorax

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96
Q

Treatment for simple pneumothorax

A

<20% - 100% O2 | >20%, needle aspiration, pigtail catheter, chest tube

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97
Q

Occlusive dressing placed over wound, taped on 3 sides | Monitor for tension pneumothorax and remove dressed as needed to relieve pressure

A

Open Pneumothorax

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98
Q

What makes tension pneumothorax unique?

A

Decreasing CO, tachycardia, hypotension, poor peripheral perfusion, JVD, Deviated trachea (away from the tension pneumothorax)

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99
Q

2nd intercostal space / mid clavicular line or 5th interconstal space / mid axillary line | Chest tube ASAP

A

Tx for tension pneumothorax

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100
Q

Absent over fluid & Decreased over air

A

Fremitus

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101
Q

Hyporesonance over fluid & Hyperesonance over air

A

Percussion

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102
Q

Decreased over fluid & Decreased over air

A

Breath Sounds

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103
Q

Near top of fluid line & not present over air

A

Air accumulation

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104
Q

Have patient say “99” while holding hands against the chest, Vibrations will transmit through air but not fluid

A

Fremitus

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105
Q

Have patient say “e” while holding a stethoscope ne=ar the top of the fluid line. The “e” will wound like an “a” through fluid line

A

Egophony

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106
Q

One adverse effect of _____ is transient hypertension, therefore blood pressure should be carefully monitored.

A

Hydroxocobalamin

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107
Q

An arterial dilator with little venous dilation. Arterial dilation causes reductions in afterload whereas venous dilation causes reductions in preload.

A

Hydralazine

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108
Q

An angiotensin converting enzyme (ACE) inhibitor and causes reductions in both preload and afterload.

A

Enalapril

Also nitroprusside

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109
Q

Venous dilator causing reductions in preload but very little reductions in afterload (except in high doses)

A

Nitroglycerin

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110
Q

_____ is used in treatment of HF. It is unlikely to have any therapeutic effects in the treatment of hematuria, narrow complex tachycardia or elevations in core body temperature.

A

Nesiritide (Natrecor)

111
Q

_____ is known to be a venous dilator decreasing preload and reducing workload on the heart. Also a pain medication.

A

Morphine

112
Q

_____ causes a systemic inflammatory reaction, Respiratory distress syndrome is a manifestation of an inflammatory reaction in the lungs causing severe pulmonary edema and other changes in the lung.

A

Pancreatitis

113
Q

Testicular pain may be associated with which diagnosis?

A

Renal colic. The pain associated with renal colic sometimes referred to the external genitalia. In men, this can result in testicular pain, in women, this can result in pain the labial folds.

114
Q

____ Causes a painless sore on the genitals as opposed to testicular pain.

A

Syphyllis

115
Q

____ is associated with lower abdominal or rectal pain rather than testicular pain.

A

Prostatitis

116
Q

_____ trauma is more likely to cause suprapubic pain with voiding difficulties as opposed to testicular pain.

A

Bladder

117
Q

EKG changes including ST segment elevation in multiple leads, PR depression in multiple leads and tall peaked T waves in multiple leads is indicative of?

A

Pericarditis

118
Q

What condition is known to cause nystagmus?

A

Labyrinthitis - disorder of the inner ear.

119
Q

_____ is frequently used to treat stable wide complex tachycardias.

A

Procainamide

120
Q

____ is treated with synchronized cardioversion or defibrillator (if pulseless)

A

Unstable wide complex tachycardia

121
Q

The pain associated with an _____ is often exacerbated by reduced blood flow. Elevating an extremity with an ____ reduces blood flow to the area causing increased pain. Elevation of the limb will cause the extremity to become cooler rather than warmer, decrease pulse strength and cause the extremity to become pale when elevated.

A

Arterial Occlusion arterial occlusion

122
Q

The emergency nurse knows that which of the following conditions may be a precursor to iritis?

A

Rheumatoid Arthritis.

Systemic inflammatory conditions such as inflammatory bowel syndrome, lupus and rheumatoid arthritis have all been linked to iritis.

123
Q

What contributes to Ludwig’s agina?

A

Dental abscesses

124
Q

Hepatitis ___ is more likely to cause RUQ pain.

A

E

125
Q

Which type of infarction is most associated with heart block?

A

Inferior Myocardial Infarction which is caused by occlusion of the R marginal artery. In many patients, this artery provides blood flow to the atrioventricular node. Hypoxia to this node can lead to heart blocks.

126
Q

Elevations in the peak end expiratory pressure (PEEP) increase intrathoracic pressure which will decrease _____?

A

Return of blood to the left ventricle AKA BP. CO2 levels are relatively unaffected by changes in PEEP.

127
Q

Which position is ideal for a patient in neurogenic shock?

A

Supine. Pt’s with neurogenic shock usually have a spinal cord injury and spinal motion restriction should be maintained. Patients with neurogenic shock tend to be hypotensive, so supine is also ideal.

128
Q

The goal of treatment for someone with costochondritis is?

A

Decrease in pain, there is no fever associated with this condition.

129
Q

Patient with manic-bipolar disorder is most likely to also have?

A

STIs

130
Q

Infected facial structures provide a source for bacteria to cause _____?

A

Meningitis

131
Q

Respiratory failure secondary to an inhalation injury tends to take as long as ____ hours to develop.

A

24

132
Q

Atrovent (Ipratopium Bromide) is a broad classification of _____ drugs and therefore the symptoms most closely aligned with this drug would be _____ & _____.

A

Anticholinergic - dry mouth and blurred vision.

133
Q

Abduction and external rotation

A

ANTERIOR hip dislocation

134
Q

Adduction and internal rotation

A

Posterior hip dislocation

135
Q

Reversal agent for the effects of dabigatran (anticoagulant)

A

Idarucizumab

136
Q

Findings associated with ____ include decreased vertical ocular rotary movements, pain on upward gaze and the inability to look above the midline.

A

Ocular Entrapment

137
Q

Effective treatment for carbon monoxide poisoning is _____.

A

Hypotension. Monitor BP and ensure increase in BP to assess effective treatment. O2 are often normal with CO poisoning.

138
Q

Renal failure will result in what electrolyte imbalances?

A

Hyperkalemia, Hyponatremia, Hyperphosphatemia, therefore hypocalcemia.

139
Q

Epigastric pain that radiates to the back, severe nausea and vomiting as well as a history of alcoholism are all associated with ______.

A

Pancreatitis which can cause retroperitoneal bleeding that can lead to bruising in the flanks (and sometimes around the belly button).

140
Q

Costovertebral angle tenderness is associated with ____?

A

Kidney infections.

141
Q

Decrease in the amplitude of the QRS complex can be seen in?

A

Pericardial Tamponade. The presence of fluid around the heart may decrease the amount of electricity that is transmitted to the leads and this can decrease the amplitude of the QRS complex.

142
Q

Do you encourage movement in DVTs or chronic arterial vein occlusions?

A

Pt’s with chronic arterial occlusion (Buerger’s disease) may benefit from movement of the extremity by increasing O2 delivery to the limb though the collateral circulation. A patient with DVT may dislodge the thrombosis and cause a PE.

143
Q

Associated with spinal cord injury that can increase BP, bradycardia, leading to stroke, seizure, and cardiac arrest.

A

Autonomic Dysreflexia. It is also a sympathetic response to pain limited to patients who have had spinal cord injuries.

144
Q

Administered to women who are likely to have preterm birth as the steroids speed fetal lung maturity and reduce the incidence of intraventricular hemorrhage and necrotizing enterocolitis.

A

Corticosteroids

145
Q

Use of anti-coagulants and oral contraceptives increase the risk for?

A

Dysfunctional uterine bleeding

146
Q

Ketonemia and Ketonuria can be associated with?

A

Hyperemesis gravidarum due to severe dehydration and starvation

147
Q

Hematospermia, urinary retention, rectal pressure is associated with _____.

A

Prostatitis.

148
Q

Test used to determine the presence of fetal blood in maternal circulation.

A

Kleihauer-Betke test

149
Q

Liver enzyme useful in detecting liver illness or injury.

A

GGT Gamma-glutamyl-transpeptidase

150
Q

Which finding is consistent with effective treatment of PTSD?

A

Re-establishment of strained personal relationships and the desire to connect with others.

151
Q

Heart medications known to cause heart blocks and bradycardia.

A

Calcium channel blockers such as Verapamil.

152
Q

Claritin and Doxepin

A

Anticholinergics associated with tachycardia.

153
Q

Is there narrow or wide pulse pressures in pericardial tamponades?

A

Narrow pulse pressure

154
Q

Represented by pressures in the pulmonary circulation (e.g., pulmonary artery wedge pressure)

A

RIGHT ventricular afterload

155
Q

Represented by the patient’s mean arterial pressure (MAP)

A

LEFT ventricular afterload

156
Q

How to measure RIGHT ventricular preload?

A

Invasive (Central Venous Pressure) | Non-invasive - JVD

157
Q

How to measure LEFT ventricular preload?

A

Invasive - Pulmonary wedge pressure (PWP) | Non-invasive - Lung sounds

158
Q

Drugs which influence the HR

A

Chronotropic drugs

159
Q

Drugs which increase the automaticity of the heart. Automaticity - the speed at which electricity moves through the heart

A

Dromotropic drugs

160
Q

Drugs that influence the contractility of the heart

A

Inotropic drugs

161
Q

HR between 40 and 60 beats per minute with either inverted P waves before or after the QRS complex or absent P waves

A

Junctional Rhythm

162
Q

Elongating distance between the P wave and QRS complex

A

Wenckebach heart block AKA Mobitz Type I

163
Q

Presence of P waves without corresponding QRS complexes after each one

A

Mobitz Type II heart block

164
Q

Regular P waves and regular QRS complexes that are not coordinated (heart rate usually less than 40 bets per minute)

A

Third Degree Heart Block

165
Q

Is patient stable? Is QRS complex narrow or wide?

A

2 questions to ask when pt has tachyarrhythmias.

Narrow (<0.12 seconds, and likely arising from the AV node or above)

Wide (>0.12 seconds, and likely arising from below the AV node).

166
Q

Treatment for stable narrow complex tachycardias
- Regular Rhythm
- Irregular rhythm (usually a-fib / a-flutter)

A

Regular Rhythm
- Vagal Maneuvers
- Adenosine 6 mg - 12 mg ( Rapid IV push followed by a 20-mL bolus, may cause transient heart block or asystole)

Irregular Rhythm
- Calcium channel blockers (drugs that end in depine)
- Beta-blockers (drugs end in -lol)
Consider anticoagulation if artiral fibrillation is the cause and has been present for a period of time before presentation to the ED

167
Q

Treatment for UNSTABLE narrow complex tachycardias

A

CARDIOVERSION
Narrow QRS with regular rhythm: start with 50J (monophasic and 100 J biphasic)

Narrow QRS with irregular rhythm: 120 (mono) vs 200 (biphasic) - consider anticoagulant or low molecular weight heparain (LMWH) as part of treatment

Pediatric: 0.5-1 j/kg increased to 2 j/kg

Deliver shock, increase energy if unsuccessful

168
Q

Treatment for STABLE WIDE complex tachycardia

A

Procainamide preferred but must be administered slowly to prevent hypotension, If rapid conversion is needed, consider AMIODARONE
- Lidocaine
- Magnesium (mainly for TORSADES DE POINTE) - polymorphic
- Cardioversion
- QRS complexes are regular, start 100 J
- QRS complexes are irregular 200 j bi . 360 monophasic

169
Q

Treatment for pulseless with a wide complex tachycardia

A

No defibrillator - consider precordial thump
Defibrillator - TURN OFF SYNC
Do not interrupt CPR when defibrillator charging

170
Q

Drugs that increase PRELOAD

A

Volume
Vasoconstrictors:
norepinephrine, phenylephrine, vasopressin, epinephrine, dopamine

171
Q

Drugs that decrease PRELOAD

A

Diuretics
Venous Dilators:
nitroglycerin, ACE inhibitors, angiotensin receptor blockers, morphine

172
Q

Drugs that increase AFTERLOAD

A

Arterial vasoconstrictors:
Vasopressin / phenylephrine

173
Q

Drugs that decrease AFTERLOAD

A

Arterial vasodilators:
Nitroprusside, milrinone, ACE inhibitors, hydralazine

174
Q

Venous / arterial dilation and diuresis

A

ACE inhibitors (-pril)

175
Q

Venous / arterial dilation

A

Angiotensin receptor blockers (-sartan)

176
Q

Alpha-adrenergic blocker (different drugs have varying reffects of beta blockade as well)

A

Beta-blockers

177
Q

Relax vascular smooth muscle, reduce pacemaker activity and decrease cardiac contractility

A

Calcium channel blockers

178
Q

Potent venodilator (arterial dilator in higher doses), coronary artery dilator

A

Nitroglycerin

179
Q

Potent venous AND arterial dilator with onset of action in seconds

A

Nitroprusside (Nipride)

180
Q

Arterial vasodilator with little venous dilation

A

Hydralazine

181
Q

Difference between hypertension, hypertensive urgency, and hypertensive emergency?

A

Hypertension <180/ 120
Hypertensive urgency >180/120
Hypertensive emergency >180/120 with end organ dysfunction
- Hematuria / decrease UO
- Altered LOC, HA, stroke, seizures
- CP, EKG changes, S3/S4 heart sounds
- Retinal hemorrhage
- Papilledema
- Epistaxis

182
Q

Which is more common and deadly? Ascending or descending acute aortic dissection / aneurysm?

A

Ascending - accounts for 2/3 of cases

183
Q

S/s of ascending aortic dissection?

A

Altered LOC
Stroke symptoms
Cardiac tamponade
Acute MI
Acute aortic insufficient (dyspnea, left ventricular failure, systolic murmur)

184
Q

S/s of descending aortic dissection?

A

Anuria / renal failure
Paraplegia
Loss of distal pulses

185
Q

Acute onset of severe tearing or ripping chest pain that may radiate to the back, flank, or shoulders, not relieved by analgesia. Difference of more than 20 mm Hg when comparing BP in both arm and legs

A

S/s of both ascending and descending aortic dissection or aneurysm

186
Q

Positive inotrope, dromotrope, chronotrope as well as vasoconstrictor. Reserved for cardiac arrest and anaphylaxis

A

Epinephrine
CO ++, SVR either neutral or +

187
Q

Use for refractory shock despite adequate fluid resuscitation. May cause splanchnic vasoconstriction and decreased CO

A

Vasopressin (Pitressin)
CO neutral or -, SVR ++

188
Q

Increase alpha / beta one & two stimulation
5-10 mcg/kg/minute to increase CO
>10 mcg/kg /minute incraese BP

A

Dopamine
Low dose: CO + SVR +
Higher dose: SVR ++

189
Q

Peripheral venous and arterial vasoconstrictor and cardiac stimulant considered in the treatment of hypotension or shock

A

Norepinephrine bitartrate (Levophed)
CO neutral or +
SVR ++

190
Q

Pure alpha-agonist

A

Phenylepinephrine
CO neutral or +, SVR ++

191
Q

Leave IV in place
Administer Regitine (Phentolamine) into IV so it infiltrates locally,

A

Treatment of infiltration of vasoconstrictors

192
Q

Dopamine
Dobutamine
Epinephrine
Norepinephrine
Milrinon

A

Positive Inotropes

193
Q

Calcium channel blocks
Beta-blockers
(Antidysrhythmic, Anesthetics, Propofol, Chemotherapy)

A

Negative Inotropes

194
Q

Neurogenic shock
Sepsis
Anaphylaxis

A

3 types of distributive shock

195
Q

V1, V2, V3, V4 (Septal infarction causes changes in V1, V2)

A

LEFT anterior artery descending / ANTERIOR WALL MI

Complications: LEFT ventricular failure

196
Q

I, aVL, V5, V6

A

Circumflex artery (part of L coronary artery), LATERAL WALL MI

Complications: Cardiogenic Shock

197
Q

II, III, aVF

A

RIGHT marginal artery (inferior wall MI) - varying degrees of heart block.

198
Q

Tall R waves in VI and V2

A

Posterior descending artery, Posterior wall MI. R ventricular failure. Normal R wave progressions go from V1 - V6, but in posterior MI, R waves tallest in V1 / V2

199
Q

S/s of R sided MI

A

Nausea / vomiting / JVD / bradycardia / Hypotension

200
Q

S/s of L sided MI

A

Diaphoresis, dyspnea / orthopnea / Tachycardia / Hypertension

201
Q

Tender subcutaneous nodules, often in the pulp of the digits

A

Osler’s nodes - Endocarditis

202
Q

non-tender erythematous, hemorrhagic, or pustular lesions often on the palms or soles

A

Janeway Lesions - Endocarditis

203
Q

Widespread ST elevations
Tall, peaked T waves in all leads except a VR and V1
PR depression (especially in lead II)
Lack of reciprocal changes

A

S/s of pericarditis

204
Q

Hypotension, distended neck veins, muffled/distant heart sounds

A

Beck’s Triad - sign of pericardial tamponade

205
Q

Electrical Alternans

A

Alternating amplitude of QRS complexes as seen in pericardial tamponade. EKG changes alsow show low voltage QRS, PEA.

Pulsus paradoxus also seen in pericardial tamponade

206
Q

Infusion of IV fluids as needed to increase cardiac pressures
Needle pericardiocentesis
Sub-xyphoid window (trauma)

A

Tx pericardial tamponade

207
Q

Homan’s sign?

A

Affected leg is dorsiflexed and if there is pain, it is indicative of venous occlusions.

208
Q

Inhibition of Gestational Diabetes

A

Inhibition of insulin is designed to ensure adequate glucose to the growing fetus, but this insulin resistance means taht pregnant women must produce more insulin for homeostasis and some women’s pancreatic function cannot ramp up enough leading to gestational diabetes.

209
Q

Known as hyperresonance, noted when percussing over air. The center of the abdomen contains the large and small bowel, both of which are filled with air.

A

Tympany

210
Q

Inhibition of Gestational Diabetes

A

Inhibition of insulin is designed to ensure adequate glucose to the growing fetus, but this insulin resistance means taht pregnant women must produce more insulin for homeostasis and some women’s pancreatic function cannot ramp up enough leading to gestational diabetes.

211
Q

Reversal agent for Heparin

A

Protamine Sulfate, given slowly and cannot be used in those allergic to fish.

212
Q

Reversal agent for Coumadin (Warfarin)

A

Vitamin K (Aqua Mephyton)

213
Q

Reversal for magnesium toxicities

A

Calcium gluconate

214
Q

Cyanide poisoning Tx

A

Hydroxocobalamin

215
Q

A test done to make sure the ulnar artery is functioning well. Done prior to carrying out ABG collection from the radial artery.

A

Allen’s Test. The rational is that the ulnar artery must be functioning properly in case collection of blood from the radial artery causes damage or obstruction to that artery leaving the ulnar artery as the only option to deliver oxygen to the hand.

216
Q

Normal intraocular pressure?

A

10-20 mm Hg. <10 increases the risk of retinal detachment

217
Q

A test done to make sure the ulnar artery is functioning well. Done prior to carrying out ABG collection from the radial artery.

A

Allen’s Test. The rational is that the ulnar artery must be functioning properly in case collection of blood from the radial artery causes damage or obstruction to that artery leaving the ulnar artery as the only option to deliver oxygen to the hand.

218
Q

_____________ is used as a competitive inhibitor that works on the enzyme alcohol dehydrogenase. This enzyme metabolizes toxic alcohols such as ethylene glycol and methanol to their toxic end products. When this medication is utilized for toxicities related to these forms of alcohol, they will preferentially metabolize these products instead of the alcohol, decreasing resulting toxicities.

A

Fomepizole

219
Q

Situational crisis can lead to?

A

Drug abuse, excessive alcohol intake, suicidal ideation and criminal activities. This patient may present with law enforcement.

220
Q

Posterior Lead Placement

A

V4 –> V7 posterior axillary line
V5 –> V8 tip of the LEFT scapula
V6 –> V9 next to mid thoracic spine

221
Q

Mixing of anti-depressant medication such as paroxetine (Paxil) and fluoxetine (Prozac) with dextromethorphan (cough suppresant).

A

Serotonin Syndrome

222
Q

S/s of intussusception

A

Abdominal pain, draw up knees towards the abdomen, hypoxia to bowel wall causing mucosal lining to shed which may result in stools that appear like currant or grape jelly

223
Q

Tx Prolapsed Cord

A

When caring for a patient with a prolapsed cord, it is important to place the hand between the baby’s head and the cord and lift upward. The feeling of pulsations underneath the nurse’s hand would indicate that blood flow is continuing. If the nurse manipulates the cord and causes it to spasm, blood flow would cease. An emergent cesarean section is the definitive treatment.

224
Q

S/s of intussusception

A

Abdominal pain, draw up knees towards the abdomen, hypoxia to bowel wall causing mucosal lining to shed which may result in stools that appear like currant or grape jelly

225
Q

Tx Prolapsed Cord

A

When caring for a patient with a prolapsed cord, it is important to place the hand between the baby’s head and the cord and lift upward. The feeling of pulsations underneath the nurse’s hand would indicate that blood flow is continuing. If the nurse manipulates the cord and causes it to spasm, blood flow would cease. An emergent cesarean section is the definitive treatment.

226
Q

When do withdrawal seizures occur?

A

36 to 72 hours after their last drink, prior to delirium tremens which often occurs 72-96 hours after the last drink of alcohol.

227
Q

Colle’s fx

A

Distal radius fracture often associated with falling on an outstretched hand

228
Q

Smith’s Fx

A

Fall involves a flexed hand

229
Q

Buckle Fx

A

Torus Fx

230
Q

Fx occuring in children under the age of 10 in which there is a fracture on one side of the bone, but the other side of the bone. remains intact

A

Greenstick

231
Q

Curtain or veil obscuring the upper visual field

A

Retinal detachment

232
Q

Blurry vision or seeing haloes around lights

A

Glaucoma

233
Q

Children should be kept home for 5 days after antibiotics is started. This disease may cause pneumonia and therefore death in children. A petechial rash on the upper body above the nipple line can occur due to paroxysmal coughing associated with this illness.

A

Pertussis

234
Q

Blurry vision or seeing haloes around lights

A

Glaucoma

235
Q

Children should be kept home for 5 days after antibiotics is started. This disease may cause pneumonia and therefore death in children. A petechial rash on the upper body above the nipple line can occur due to paroxysmal coughing associated with this illness.

A

Pertussis

236
Q

A patient is brought in by family members delirious and confused. The patient has flushed skin, dry, cracked oral mucosa, hyperthermia, hypotension, and dilated pupils. The cardiac monitor displays prolongation of the QRS and PR intervals and tachycardia at 140 beats per minute. This scenario is most closely associated with an overdose of:

A

Tricyclic antidepressants

Tricyclic antidepressants cause cardiotoxic, neurotoxic, and anticholinergic symptoms. Cardiotoxic symptoms range from sinus tachycardia and A-V blocks to ventricular tachycardia and fibrillation as well as ECG changes such as QRS, QT, and PR interval prolongations. Neurotoxic symptoms include lethargy and confusion with delirium and possible hallucinations. Anti-cholinergic symptoms include mydriasis (dilated pupils), flushed skin, anxiousness, hyperthermia, and dry mucosal membranes

237
Q

Pt presents with IV illicit drug use presenting with dental pain, loss of peripheral vision, fever, clubbing, and splinter hemorrhages of the nailbeds. Which disease and what diagnostic test?

A

Endocarditis / EKG

238
Q

A patient is brought in by family members delirious and confused. The patient has flushed skin, dry, cracked oral mucosa, hyperthermia, hypotension, and dilated pupils. The cardiac monitor displays prolongation of the QRS and PR intervals and tachycardia at 140 beats per minute. This scenario is most closely associated with an overdose of:

A

Tricyclic antidepressants

239
Q

Classic signs of opiate overdose?

A

Pinpoint pupils (miosis), coma, decreased respirations

240
Q

Organophosphate poisoning causes?

A

Cholinergic stimulation leading to increased secretions - lacrimation, salivation, urination, and diarrhea, and bradycardic rhythms

241
Q

Ethylene Glycol s/s

A

Seizure activity, nystagmus, coma, dysrhythmias

242
Q

Which nerves control EOM - extra-ocular eye movements?

A

Oculomotor (III) which controls 5 of the 7 muscles that move the eye

Trochlear (IV)
Abducens (VI)

243
Q

Bleeding into the posterior chamber of the eye

A

Vitreous hemorrhage

vs Hyphema which is bleeding into the ANTERIO Chamber of the EYE

244
Q

Which nerves control EOM - extra-ocular eye movements?

A

Oculomotor (III) which controls 5 of the 7 muscles that move the eye

Trochlear (IV)
Abducens (VI)

245
Q

A “Salter-Harris Type III” classification is an indication of which of the following fractures?

A

Epiphyseal fracture

The Salter-Harris classification is a specific system of identifying varying degrees of epiphyseal fractures found in children.

246
Q

Which of the following groups of medications would most likely be prescribed for a non-penetrating hyphema to the eye?

A

Beta Blockers

Beta blockers such as timoptic or betoptic may be administered in the eye to help to control intraocular pressure. A mydriatic medication might be ordered to help with patient comfort once increased IOP has been ruled out – rather than a miotic agent. Anti-fibrinolytic agents would be utilized instead of fibrinolytics to discourage the potential of rebleeding. Antibiotics would have no therapeutic effect for this condition

247
Q

Cushing’s Triad vs Beck’s Triad

A

Associated with increased ICP
1. Hypertension / widening pulse pressure
2. Bradycardia
3. Decreased respiratory rate

Beck’s Triade - Cardiac Tamponade
1. JVD
2. Muffled Heart Sounds
3. Hypotension

248
Q

Tactile hallucinations are most associated with?

A

Alcohol withdrawal may cause tactile, auditory or visual hallucinations. Most hallucinations associated with schizophrenia are auditory. Patients experiencing delirium are more likely to have auditory and visual hallucinations. Hallucinations are uncommon with acute mania.

249
Q

Cushing’s Triad vs Beck’s Triad

A

Associated with increased ICP
1. Hypertension / widening pulse pressure
2. Bradycardia
3. Decreased respiratory rate

Beck’s Triade - Cardiac Tamponade
1. JVD
2. Muffled Heart Sounds
3. Hypotension

250
Q

MRSA risk factors?

A

MRSA has several risk factors associated with it including incarceration and intravenous drug use as well as dialysis, diabetes mellitus, recent surgery, living in a long-term care facility, and recent (within past 12 months) hospitalization.

251
Q

Reversal agent for diltiazem?

A

Calcium gluconate

252
Q

Reversal agent for tylenol?

A

N-acetylcysteine (Mucomyst)

253
Q

What blood test can be associated with cocaine use?

A

Cocaine abuse can release myoglobin into the blood stream, (potentially leading to rhabdomyolysis). Rhabdomyolysis causes high CK (creatinine kinase) levels. The risk of this increases if the patient is physically restrained as they will become more agitated with greater muscular activity. Liver enzymes, D-Dimer, and hemoglobin levels will not uncover complications associated with cocaine abuse.

254
Q

TPA rulse

A

If a patient’s blood pressure exceeds 185/110 mm Hg, it should be reduced pharmacologically before the administration of TPA. Labetalol or nicardipine are frequently used to facilitate this. TPA may be given to patients of any age and if the patient is less than 80 years of age, it may safely be given if the onset of symptoms is less than 4.5 hours. The fact that the patient had a myocardial infarction seven years previously does not influence the decision to give TPA for stroke symptoms

255
Q

Sinusitis in the frontal sinuses causes pain where?

A

Cheeks

256
Q

Sinusitis in the ethmoid region causes pain where?

A

Behind the eyes

257
Q

Sinusitis in the frontal sinuses causes pain where?

A

Cheeks

258
Q

Geodon can cause?

A

Geodon (Ziprasodone) can cause a prolonged QT interval which can then cause Torsades de Pointes. A past cardiac history should be of concern for patients receiving this medication

259
Q

What is Vincent’s angina?

A

Vincent’s angina is a bacterial infection of the lining of the mouth and is caused by a bacterial infection but does not have a genetic component.

260
Q

Which of the following medications would be used to prophylactically treat a child for respiratory syncytial virus (RSV)?

A

Synagis (Palivizumab) is the vaccine for RSV (respiratory syncytial virus) and would be used as a preventive measure for this virus. RSV is a virus and therefore an antibiotic would not be used unless a secondary bacterial infection was suspected. Supportive therapy such as acetaminophen (Tylenol) for fever could be used as part of the treatment for RSV. Ribavirin (Rebetol) is an antiviral that might be used for extremely ill infants with RSV (respiratory syncytial virus) or those who are immunocompromised.

261
Q

What is Vincent’s angina?

A

Vincent’s angina is a bacterial infection of the lining of the mouth and is caused by a bacterial infection but does not have a genetic component.

262
Q

Which of the following medications would be used to prophylactically treat a child for respiratory syncytial virus (RSV)?

A

Synagis (Palivizumab) is the vaccine for RSV (respiratory syncytial virus) and would be used as a preventive measure for this virus. RSV is a virus and therefore an antibiotic would not be used unless a secondary bacterial infection was suspected. Supportive therapy such as acetaminophen (Tylenol) for fever could be used as part of the treatment for RSV. Ribavirin (Rebetol) is an antiviral that might be used for extremely ill infants with RSV (respiratory syncytial virus) or those who are immunocompromised.

263
Q

Hyperactivity, enuresis, and regressive behavior

A

Signs of depression in children

264
Q

Atypical HA are associated with?

A

Subarachnoid hemorrhages, 1-2 weeks prior to rupture of aneurysm, pt will experience atypical HA (sentinel HA). These are sudden, severe headaches that are unusual for the patient. Subarachnoid hemorrhages are sudden in onset.

265
Q

Brown recluse spider bites can cause complications such as?

A

Hemolytic anemia, DIC, hematuria, kidney failure

266
Q

Which of the following findings would indicate myocardial reperfusion after administration of TNK (Tenecteplase)?

A

Accelerated idioventricular rhythm

267
Q

Once the initial crisis is resolved, which of the following oxygen delivery products would be most appropriate to utilize in the patient with an acute exacerbation of chronic bronchitis?

A

Venturi mask.

The venturi mask is the best delivery option for patients with chronic obstructive pulmonary disease with chronic bronchitis as it can deliver specified, precise doses of oxygen and reduce the negative impact of high doses of oxygen for this diagnosis.

268
Q

A patient complains of chest pain exacerbated in the supine position yet the pain improves when the patient is upright. Which ECG changes are most consistent with this complaint?

A

ST segment elevation in all leads except AVR and V1

Pericarditis will present with either sharp or dull pain that is worse with lying flat, swallowing, coughing or activity. Sitting upright will help the pain to dissipate. 90% of all patients with pericarditis will present with ECG changes that includes ST segment elevation in all leads except aVR and V1 in the first phase of this disease. T wave inversion in II, III, and aVF is indicative of inferior ischemia. Pathologic Q waves in I, aVL, V5, and V6 would indicate a lateral infarct. A J wave (Osborn wave) is present with hypothermia

269
Q

Five days after a healthy vaginal delivery, the mother presents with increased respiratory rate and objective dyspnea. Which of the following diagnoses is the highest probability?

A

Pulmonary embolus due to high fibrinogen levels during pregnancy

270
Q

A patient complains of chest pain exacerbated in the supine position yet the pain improves when the patient is upright. Which ECG changes are most consistent with this complaint?

A

ST segment elevation in all leads except AVR and V1

271
Q

Which of the following assessment parameters is a part of the classic triad for a ruptured abdominal aneurysm?

A

Hypotension.

Abdominal pain with or without back pain, hypotension, and a pulsatile abdominal mass encompass the classic triad of symptoms for a ruptured abdominal aneurysm. Vomiting, diaphoresis, and tachycardia can be present, but are not part of the classic triad

272
Q

Meningeal signs such as nuchal rigidity are caused by bleeding between which of the following two structures?

A

Subarachnoid bleeding occurs between the arachnoid and the pia mater. The accumulation of blood in this space creates a chemical irritant which then cause the meningeal signs.

273
Q

Spinal shock vs neurogenic shock

A

Spinal shock occurs when there is an interruption in the impulses to and from the spinal cord. This causes loss of motor function including loss of bowel and bladder function and reflexes and flaccidity below the level of the lesion involved. It will usually last hours to days and can complicate the full diagnosis. Hypotension, bradycardia, and anhidrosis (loss of sweating) are manifestations of neurogenic shock which occurs due to loss of the sympathetic nervous system innervation following a spinal cord injury.

274
Q

Sarin gas

A

Toxicity with sarin gas, a nerve agent, causes a cholinergic crisis (which can also occur with insecticides). Symptoms include an increase in all body fluids including urination, defecation, sweating, tearing, salivation as well as pinpoint pupils (miosis). Drying of secretions would therefore indicate improvement as well as a reduction in urine output (rather than an increase). Bradycardia occurs in a cholinergic crisis and a decrease in pulse rate is not associated with effective treatment

CEN (1 decks)

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