BOOK QUESTIONS Flashcards
SBP should be less than what to prevent rebleeding in patients with SAH?
<160 - prompt reduction in BP is critical
What is a SE of alendronate (Fosamax)
esophageal irritation - teach to sit/stand for 30 min after taking
What condition is associated with polymyalgia rheumatica?
Temporal arteritis
What is the blood loss from an unstable pelvic ring fracture? What class of hypovolemic shock is this?
3000ml +
Class IV
How do we emergently perform a periocardiocentesis?
Needle aspiration 1cm left of xiphocostal angle
What would indicate that an IO is placed correctly?
Red frothy substance (bone marrow)
Best way to assess patency of airway in patients with a GCS of 15?
Ask to talk - clear speech
Best indication that chest tube insertion has been successful in relieving tension PTX?
Improvement in hemodynamics
How should MAP be lowered for HTN emergency?
20-25% in first hour
Recommended pulse ox for COPD pt?
> 90%
This is an inherited sex-linked genetic disorder. Mother is usually carrier and active disease is usually expressed in males..
Hemophilia
What should never be put on a patient who is actively vomiting?
mask / NRB
Newborn target SpO2 after 1 minute?
3 minutes?
5 minutes?
10 minutes?
1 = 60-65%
3 = 70-75%
5 = 70-85%
10 = 85-95%
How do we administer TPA?
0.9mg/kg
Max dose 90mg
10% bolus over 1 minute
remainder given over 60 minutes
what are some things that may exclude pt from getting TPA?
Age >80, hx DM, prior CVA
What med should be given for SAH from an aneurysm to decrease vasospasm and possible cerebral infartion?
nimodipine
Skull fracture with highest risk for intracranial infection?
Basilar skull fracture
Priority action for ruptured bladder?
Give IVF
Peds defibrillation dose
initial 2 joules/kg, increase to 4, max 10
Intervention for snake bite
Immobolize area at or below level of heart
mark edges
avoid ice
When should critical incident stress management debriefing take place?
1-3 days after incident
START triage: what would put a patient in the red (immediate) category?
-RR >30 (>15, <45)
-cap refill >2 sec or no radial pulse
-unable to follow simple commands
What radiation particle can penetrate most objects and is most dangerous to life?
Neurons
Eye donation preparation
Elevate HOB 20 degrees, eyelids taped shut, artificial tears
Condition with too much ADH?
Condition with not enough ADH?
SIADH
DI
What is Trousseau’s sign? What does it indicate?
carpal spasm with BP cuff indicated hypocalcemia
What electrolyte abnormality causes hypoactive reflexes? Hyperactive?
Hypo = hypercalcemia
Hyper = hypocalcemia
Peds vomiting/diarrhea/gastroenteritis teaching
small amounts or clear liquid at frequent intervals, small amounts of glucose and electrolyte solution
Excessive artifact in leads II and III on EKG - change what electrode?
left leg
What may cause loss of ventricular capture for a patient with a transcutaneous pacemaker?
Lactic acidosis
Priority intervention pt with symptoms of endocarditis
antibiotics
What is the most common virus that causes pericarditis?
Coxsackie (hand/foot/mouth)
Characteristic sign of COPD
pursed lip breathing
C. Diff risk factors
-recent abx
-PPI use
-GI surgery
-long length of stay in healthcare setting
-immunosuppression
What is Kehr’s sign
LUQ pain radiating to the left shoulder - suggests diaphramatic irritation by peritoneal blood, as seen in splenic injuries
What is a side effect of trazodone?
priapism
Vent setting initially for ARDS
Pressure-controlled
Cor Pulmonale is a complication assoc with what?
COPD
Where do we hear bronchial breath sounds?
Bronchovesicular?
Vesicular?
B=over trachea/thorax
BV=over major bronchi
V=peripheral lung fields
Consists of the synthesis of revevant research, experience/expertise of practitioner, patient preferences and values
EBP
Medical errors esp medication errors are due to what?
inadequate communication
Radiation exposure injury with fatal outcome?
CNS syndrome
What do we do with a lost tooth?
Try to reimplant within 30 minutes
When do S&S of alcohol withdrawal often present?
6-8 hours after last drink was consumed
Lumbosacral strain muscle spasm d/c instructions?
HOB slightly elevated and knees flexed when resting in bed
How do we know when ready for wound closure after LET admin?
blanching around wound d/t vasoconstriction usually within 20 minutes
Symptoms assoc with catecholamine release d/t hypoglycemic episode
-diaphoresis
-anxiety
-dry mouth
-mydriasis
-tremors
Peds with sustained RR >___bpm are at risk for resp failure
60
What # motor score does a patient get when they localize pain by crossing the midline?
5
(6 = follows commands, 4 = withdraws)
What % of EACH SIDE burn BSA are head, chest, abdomen, legs?
Genitals?
Arms?
9%
1%
4.5%
What is the Parkland Burn Formula?
4ml LR x %BSA x weight (kg)
What electrolyte imbalance do hydroflouric acid burns have?
Hypocalcemia
Disaster management phase that includes actions to prevent or reduce cause, impact, consequences of disasters, includes hazard map
Mitigation
Disaster management phase that includes planning, training and educational ativities
Prepardness
Use of succinycholine in Guillain-Barre patients is contraindicated because it may cause what electrolyte abnormality?
Hyperkalemia
Severe aching of the back assoc with tetanus
Opisthotonos
What is hypoxia in COPD patients due to?
ventilation/perfusion mismatch
What should be performed to r/o urethral injury?
retrograde urethrogram
What kind of medications might cause urinary retention?
Antihypertensives
How do you describe critical incident stress?
A normal response to an abnormal event
Why do we use a LOW tidal volume in ARDS patients on a vent?
To prevent volutrauma
What ETCO2 reading during CPR demonstrates adequate compressions/good quality CPR?
> 10 (normal ETCO2 is 35-45)
During neonatal resus, what provides the most accurate eval of infants resp effectiveness?
cont cardiac monitoring
What kind of spider bite is necrotoxic - this may lead to DIC?
Which is neurotoxic - this may also cause abdominal rigidity/cramping?
Brown recluse
Black widow
Common symptom of diphtheria?
Findings of diphtheria indicating severe complication of the disease?
thick gray membrane covering throat and tonsils
ST-T wave changes, dysrhythmias may indicate myocarditis and other possible cardiac involvement
What can lead to an accelerated juntional rhythm?
Dig toxicity
2 assessment findings assoc with compensated shock
Narrowing pulse pressure
Bounding pulse
Diagnostic test for PE
Spiral CT
What is considered one of the most teratogenic drugs?
Valproic acid / depakote
What should we do to a frostbitten area
Protect and immobolize with loose dressing after thawing
do not massage/rub
rewarm with water b/t 99-102 degrees
V-fib amiodarone dose
300mg rapid IV bolus initially followed by 150mg rapid IV bolus
How is culture defined?
patterns of behaviors and beliefs shared by persons living in a social group
Particular spasm of the neck muscles that causes uncontrollable twisting of neck muscles assoc with dystonic reaction.
torticollis
what is used to treat a dystonic reaction related to the admin of haldol?
benztropine (cogentin)
What lactate level is considered abnormal for exam?
> or = 4
2 foods high in K that should be avoided with potassium sparing diuretics (spironolactone)?
bananas
avocados
Leukemia most commonly diagnosed in peds
ALL
hot potato voice
PTA
inflammatory response of the inner ear that can result from recent viral or bacterial infection. Inflammation affects the cochlea, resulting in tinnitus, nystagmus and dizziness.
Labyrinthitis
flunitrazepam (Rohypnol) anecdote
flumazenil (Romazicon)
What is the goal of wound are?
To maintain function
Recommended time to start antibiotics for septic shock? Sepsis without shock?
1 hour if shock, 3 hours if not
How do we confirm organophospate poisoning?
plasma pseudocholinesterase level
What does cyanide poisoning affect?
Lactate levels
Gastritis assoc with n/v expected abnormal lab?
Electrolytes - potassium b/c this is lost in vomit
When is pain experienced with a gastric ulcer? Duodenal ulcer?
Gastric = after eating
Duodenal = worse with empty stomach, relieved with eating
med class for vaginitis
antimicrobials (most commonly antibiotics for trich/BV and antifungals for yeast)
Untreated penile fracture from the rupture of the tunica albuginea may develop what complication?
Erecticle difficulities
Fracture = immediate pain, hematoma, swelling, audible popping sound. Requires surgery.
What needs to be used with clindamycin vag cream?
Back up birth control - weakens condoms for 72 hours
1st intervention for clear ruptured ectopic?
Emergency surgery
Blood glucose levels at 1 minute after birth in neonates below what require treatment with D10?
Below 40
Why do we give pitocin after delivery of a full term baby?
To reduce PP bleeding
Where should rabies vaccine be administered?
In the deltoid furthest from IG administration bc IG may suppress antibody production from the vaccine
Sick following camping trip.
Symptoms = single necrotic looking lesion
No rash. Symmetrical, ascending paralysis
Tularemia
Colorado tick fever
Firefigher with seizures, hypotension, hypoxia after fighting a house fire - symptoms likely due to what?
What med should we treat with?
Cyanide, hydroxocobalamin (vitamin B12)
Clinical manifestation of bronchitis
dry cough that develops into productive cough
While transferring a patient with a chest tube, the drainage system falls and breaks. What do you do?
Insert end of chest tube into sterile water
What can INH cause?
hepatotoxiity
Normal positive reading for PPD? Positive reading for immunocompromised patients?
10mm
5mm
Epiglottitis priority intervention
intubation
History if cliff diving 90 feet + pink, frothy sputum with cough
pulmonary edema
Patient becomes unconscious during scuba diving. What position do we put them in?
left lateral decub, head down
What are 3 categories of secondary traumatic stress?
-Intrusion (repeated reliving of disturbing events)
-Avoidance
-Arousal
What med for procedural sedation has the shortest duration of action?
Propofol (3-8 minutes)
What might someone cleaning out a cat litter box be at risk for?
What is a bacterial infection from animal bites, particularly cats?
Toxoplasmosis
Pasteurellosis
Multiple blood transfusion electrolyte abnormality
Hypocalcemia (anticoagulant citrate used in blood products binds to calcium)
What med should be avoided in patients with elevated T3 and T4?
aspirin
What age patient can experience PTSD?
Any age
What is the purpose of the GCS?
To assess level of consciousness in head-injured patients
What is true regarding intranasal administration of meds?
Onset of the drug action may be delayed
Hypoxia associated with near drowning will cause cerebral edema, leading to what?
An increase in ICP
This med is a vasodilator that decreases BP by relaxing vascular smooth muscle and dilating coronary arteries. It must be protected from light during administration.
Nitroprusside
Why do we give morphine to patients with an MI?
it decreases catecholamine release, which results in a decrease in HR and afterload
Bright red stools associated with lower GI bleeding/hemorrhoids
Hematochezia
What is the gold standard for diagnosing a kidney stone?
Noncontrast helical CT scan
What is the most common cause of cirrhosis?
Alcohol
What chemistry tests are elevated in patients with pancreatitis? (3)
-BUN
-creatinine
-glucose
What do we do for a prolapsed cord during an emergency delivery?
Place hand under the head of the fetus, with a gentle lift
Med most likely administered to a patient with a dermal burn from hydrofluoric acid
Calcium gluconate
What 3 meds are used to treat cyanide poisioning?
-HYDROXOCOALAMIN
-Sodium nitrate
-Sodium thiosulfate
What are 2 reasons for failure to capture while externally pacing a patient?
Metabolic Acidosis
Hypoxemia
This can occur from blunt trauma, direct blow, strangulation, or clothesline-type injury. Assessment findings include dyspnea, tachypnea, hoarseness, SQ emphysema, hemoptysis, airway obstrution. Tx = HOB 30 degrees, NPO, vocal rest, humidified oxygen.
Tracheobronchial Injury
The amount of blood in the left ventricle at the end of diastole
Preload
Urine output less than what is an indication of impaired renal function?
30ml/hr
Large FB impaled in eye. After visual acuity, what should you do?
Place a rigid eye shield over the affected eye
Should also patch other eye to minimize consensual movement
Eye pain, photophobia, purulent d/c and decreased vision that may occur after conjunctivitis; can l/t corneal ulceration and blindness if left untreated
Keratitis
Symptoms such as swelling in fat pad at the base of the neck (buffalo hump), moon face, abd swelling that is due to prolonged exposure to cortisone
Cushing’s syndrome
Complication of hypothyroidism. Rare and serious.
Myxedema Coma
What can decreasing a glucose level too quickly in DKA cause?
Cerebral edema (concerning symptom is HA)
This is associated with the use of antipsychotic meds. Symptoms include fever, muscle rigidity, altered level of consciousness. Treatment is to remove the offending agent.
Neuroleptic malignant syndrome
What are 2 common findings in chronic lymphocytic leukemia?
hepatomegaly, splenomegaly
Crutch training for stairs
-Going up: uninjured leg goes first, followed by injured leg and crutches
-Going down: place crutches down a step and step down the the injured leg, followed by the uninjured leg
