Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery and Emergency Med > Cardio, Pulm, and Vascular > Flashcards

Cardio, Pulm, and Vascular Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

Chest pain questions….

A

when did pain start?

where is it? what does it feel like? how severe?

does it radiate?

have you felt like this before?

at rest? with exertion? both?

constant? intermittent?

SOB, N/V, diaphoresis, palpitations, fatigue, dizziness, syncope, sense of impending doom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

dx tests for chest pain

A

EKG

CXR

Pulse ox

CBC, CMP, D-dimer, cardiac enzymes, BNP

Echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

if pt has chest pain, what do we do first?

A

assess vitals

cardiac monitor, IV access, O2

focused hx and physical exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

if pt is stable with chest pain, what do you do

A

obtain 12 lead EKG and CXR

Administer aspirin if pt is at low risk for aortic dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

if pt is unstable with chest pain, what do you do?

A

stabilize ABCs

tx arrhythmias according to ACLS

check for life-threatening chest pain dx: AMI, massive PE, tension pneumothorax, pericardial tamponade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is this?

pressure, heaviness, tightness, fullness, squeezing in the center or left of the chest precipitated by exertion and relieved by rest

can radiate shoulders, arms, neck, jaw

A

ANGINA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

angina is indicative of what

A

some type of ischemic event happening in coronaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

anginal equivalents occur in whom

what is it?

A

women, elderly, diabetic pts

atypical presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

examples of atypical angina presentation

A 
SOB
N/V
Diaphoresis
Fatigue
Dizzy/lightheadedness
Weak
Palpitations
Syncope
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

symptoms are stable and resolve with rest

stable or unstable angina

A

stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

increasing severity/frequency/duration OR occurs at risk

stable or unstable angina

A

unstable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

non-occlusive thrombus

ischemia with elevated cardiac enzymes

NSTEMI or STEMI

A

NSTEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

occlusive thrombus

transmural infarction

NSTEMI or STEMI

A

STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

CAD risk factors

A

Male sex

Age over 55 yrs

DM

HLD

HTN

Family hx of CAD

Tobacco

Obesity

History of atherosclerotic disease, prior MI, CVA/TIA, peripheral arterial disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

two things used to calculate MI risk

A

HEART score

TIMI score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

HEART SCORE: what 5 parts of it

A
  1. how suspicious is the hx for ACS (0-2)
  2. EKG changes (0-2)
  3. Age (0-2)
  4. # of risk factors (0-2)
  5. Initial troponin value (0-2)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

EKG and CAD - what do we see

A

resting EKG may be normal

ST-T wave changes: T wave inversions, ST depression or elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cardiac enzymes and CAD

A

initial troponin then TREND

can’t rule out MI based on single set or just the initial cardiac enzymes – trend!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Stress test and CAD

A

exercise or pharmacologic

only do if you’re UNSURE if pt is having ACS

do NOT do with STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

high sensitivity troponin (hs-cTN assay) is ____ and ____ determinant of myocardial injury

A

sensitivity and specific

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what lab results are indicative of acute MI

A

acutely elevated hs-cTN over 100

or

values less than 100 ng/L BUT have a 2 hour change of greater than 10 ng/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

chronic elevations of hs-cTn are indicative of what

A

chronic heart issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

for regular troponins, we trend the value every ___ hours for a total of ___ values

A

6 hours

3 values

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

ACS possible + EKG complete

high sensitivity troponin testing at time 0 is LOW (15 or below for men, 10 or below for women)

what do you do next?

A

you assess if it has been over 6 hours since chest pain/angina onset

if it is –> acute MI ruled out

if it is not – test troponins again at 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

troponin testing at 2 hours

what happens?

delta 3 or less

delta 4-9

A

3 or less: acute MI ruled out

4-9: tropnin test again at 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

troponin test at 6 hours (since chest pain)

delta < 12 ng/mL from time 0

delta 12+ ng/mL from time 0

A

less than 12: acute MI ruled out

12+: acute MI present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

if at time 0, troponin is high (over 100 ng/mL WITHOUT ESRD, what is it?

A

MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

if at time 0, high troponin (over 100) + ESRD - what do you do

A

repeat troponin testing at 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

if chest pain began over 12 hours ago, what does a negative delta mean?

A

it does not rule out recent MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Clinical features of acute coronary syndrome - what do you do next? (3 things)

A

aspirin + analgesia + EKG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

EKG shows ST elevation or new LBBB or true posterior MI

STEMI or NSTEMI

A

STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

EKG shows ST depression or T inversion - what do you do?

what does that tell us?

A

raised troponin

if raised - NSTEMI

if normal - unstable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what do we monitor during a stress test?

A

BP

EKG changes

Echo changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

when do we stop a stress test?

A

if pt develops chest pain, SOB, ST changes (elev or dep) or has decreased BP or ventricular arrhytmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

when observing a pt for “ACS rule-out”, what do you do

A

serial cardiac enzymes

stress testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

substernal chest pain lasting 2-5 minutes only with activity and never with rest

A

stable angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

EKG changes/enzyme changes/exercise stress test with stable angina

A

NO EKG CHANGES

NO ENZYME ELEVATION

STRESS TEST USUALLY NEG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

medical management of stable angina

A

nitrates - sublingual nitro PRN for chest pain (if no relief call 911) - can take every 5 min for 3 doses in 15 min

beta blockers

+/- calcium channel blockers

antiplatelet medications:
aspirin, plavix or both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

variant angina or vasospastic angina

angina 5-15 min usually at rest and often between midnight and early AM

A

prinzmetal angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

EKG of prinzmetal angina

A

ST elevation ONLY during chest pain episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

tx of prinzmetal angina

A

nitrates + calcium channel blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

dx prinzmetal angina

A

coronary angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

you are about to give a pt nitroglycerin…. what should you ask?

A

if they recently took sildenafil, vardenafil, tadalafil

WOMEN TAKE THESE TOO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

clinical presentation of acute coronary syndrome

A

chest pain, heaviness, or pressure

SOB

radiates

weakness or fatigue

N/V

diaphoresis

palpitations

dizziness or syncope

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

when high sensitivity troponin is high (like 200), what do you think?

A

MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

STEMI initial mgmt

A

ABCs

Cardiac monitoring (telemetry)

IV access

SL nitro

Aspirin - chewed

+/- beta blocker

anticoag (unfractionated heparin)

Call cardiology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

acronym used for initial ACS tx

what has changed?

A

MONA

Morphine

Oxygen

Nitro

Aspirin

M and O are slowly becoming less used

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

morphine with STEMI is assoc with what?

A

increased mortality in STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

oxygen with STEMI is assoc with what

A

increased early myocardial injury and increase infarct size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

why must you call cardiology ASAP with a STEMI

A

because they need to be sent to cath lab ASAP - door to percutaneous coronary intervention is important to improve outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

when do you consider fibrinolytics with a STEMI

A

if PCI is not readily available within 120 minutes

** unless contraindicated! **

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

gold standard for dx CAD

A

coronary angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

PCI interventions (2)

A

angioplasty and stenting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

factors to consider for CABG

A

number of vessels that are occluded

anatomic complexity of lesions

likelihood to have successful revascularization with PCI

Co-morbidities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

initial mgmt for NSTEMI

A

same as STEMI except:

no thrombolytics

PCI if not contraindicated

can medically manage with heparin continuous infusion and aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

PCI contraindications

A

renal failure

sepsis

unstable pt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

do you use MONA with UA/NSTEMI or STEMI or both

A

BOTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

do you use nitrates with UA/NSTEMI or STEMI or both

A

both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

do you use beta blockers with UA/NSTEMI or STEMI or both

A

both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

do you use anticoagulation with UA/NSTEMI or STEMI or bith?

A

both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

do you use thrombolytics with UA/NSTEMI or STEMI or both

A

only STEMI and only if PCI is not avail

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

do you use revascularization with UA/NSTEMI or STEMI or both

A

later with UA/NSTEMI

early with STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

contraindications to nitro

A

hypotension, right ventricle infarction/inferior MI, recent PDE5 inhibitors (sildenafil)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

6 peri-infarction emergencies

A

Peri-infarction pericarditis***

Acute mitral regurg***

Dressler’s Syndrome ***

Hemorrhage/bleeding

Arrhythmias (bradycardia)

Rupture of LV free wall or intraventricular septum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

usually occurs soon after MI (first 2-3 days)

transient

pericardial rub on physical exam

pericardial inflammation +/- effusion

what dx?

A

PIP - peri-infarctino pericarditis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

tx of peri-infarction pericarditis

A

supportive - self-limited

tylenol

aspiring +/- colchicine

NO NSAIDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

what should be avoided in peri-infarction pericarditis

A

NSAIDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

pericarditis can happen for many reasons other than post-MI

what are they?

A

infectious, radiation, post-cardiac injury syndrome, drugs/toxins, metabolic, malignancy, collagen vascular disease, immune-related, idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

how does cardiac tamponade present

A

chest pain

tachypnea

dyspnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

physical exam of cardiac tamponade

A

hypotension

JVD/distended neck veins

muffled heart sounds

tachycardia

pericardial rub

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what will EKG show on cardiac tamponade

A

sinus tachy

low voltage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what will CXR show with cardiac tamponade

A

enlarged cardiac silhouette

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what will echo show with cardiac tamponade

A

effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

tx of cardiac tamponade

A

drainage of pericardial effusion: pericardiocentesis

percutaneous or surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

monitoring of cardiac tamponade

what needs to be done prior to discharge

A

continuous telemetry

frequent vital signs for 24-48 hours

repeat echo prior to discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

causes of acute mitral regurg

A

ischemia to papillary muscle

left ventricle dilation or true aneurysm

papillary muscle or chordal rupture (2-7 days after infarct)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

physical exam on acute mitral regurg

A

hypotension and new murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

dx of acute mitral regurg

A

transthoracic or transesophageal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

tx of acute mitral regurg

A

emergency surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

dressler’s syndrome AKA

A

post-cardiac injury syndrome

81
Q

when does dressler’s syndrome develop

A

weeks to months post MI

82
Q

how does dressler’s syndrome present

A

pleuritic chest pain, fever, malaise

83
Q

physical exam of dressler’s syndrome

A

pericardial friction rub

84
Q

labs of dressler’s syndrome

A

leukocytosis, elevated ESR

85
Q

CXR of dressler’s sydnrome

A

pleural and/or pericardial effusion or pulm infiltrates

86
Q

tx of dressler’s syndrome

A

NSAIDS

Corticosteroids or colchicine if refractory

87
Q

endocarditis physical exam findings

A

osler nodes (on fingers)

janeway lesions (on hands)

splinter hemorrhages (nails)

roth spots (eyes)

88
Q

endocarditis clinical presentation

A

fever, chills, cough, dyspnea, orthopnea, fatigue

89
Q

physical exam of endocarditis

A

palatal, conjunctival, or subungual petechiae: splinter hemorrhages, osler nodes, janeway lesions, roth spots, pallor, splenomegaly, heart murmur

stroke or emboli can occur

90
Q

labs for endocarditis

A

blood culture (3 times) before antibiotics

leukocytosis

elevated ESR

91
Q

echo for endocarditis

A

vegetation of valves

get transesophageal or transthoracic (if TEE is inconclusive)

92
Q

risk factors for endocarditis

A

artificial heart valves

congenital heart defects

history of endocarditis

damaged heart valves

IV drug use

Poor dentition/dental infection

93
Q

how many major and minor criteria are needed for endocarditis

A

2 major

1 major + 3 minor

or 5 minor

94
Q

what are major criteria for endocarditis

only need 2 major

1 major + 3 minor

A

blood culture

vegetation

new valvular regurg

95
Q

tx of endocarditis

A

antibx (prolonged: 6 weeks) of vancomycin + rocephin (good empiric tx)

if antibx don’t work, surgery needed (50% of cases)

96
Q

presentation of HF

A

dyspnea

fatigue

diaphoresis

early satiety

cough

orthopnea

PND

edema

97
Q

physical exam with HF

A

tachycardia

tachypnea

rales

JVD

S3-4

Lower extremity edema

ascites

98
Q

EKG heart failure

A

maybe arrhythmias

ischemia

heart block

99
Q

Labs heart failure

A

CBC

CMP

TSH

cardiac enzymes

BNP

100
Q

CXR HF

A

cardiomegaly, cephalization, kerley B lines, maybe pulm edema

101
Q

echo HF

A

ejection fraction

valves

pericardium

wall motion abnormalities

ECHO BEST WAY TO ASSESS***

102
Q

tx for HF

A

IV access

control of airway, oxygen

telemetry

sodium and fluid restriction

strict I&Os, daily weights

+/- inotrope (dep on severity)

chronic HF meds (once stable); beta blocker; ACE-I; diuretics, +/- digoxin

DIURETICS: FUROSEMIDE

103
Q

first line tx for HF

A

furosemide

104
Q

definition of hypertensive urgency

A

systolic: 180+
diastole: 120+

no end organ damage

105
Q

definition of hypertensive emergency

A

systolic: 180+
diastolic: 120+

acute end-organ damage: cerebrovascular, ophthalmologic, cardiac, renal

106
Q

primary causes of HTN

A

new dx of HTN

non-adherence of meds

107
Q

secondary causes of HTN

A

sleep apnea

renal artery stenosis

pheo

coarctation of aorta

pseudotumor cerebri

chronic steroid therapy

cushings

thyroid/parathyroid

primary hyperaldosteronism

preg

108
Q

end-organ compromise signs of HTN

neuro

A

loss of consciousness, visual fields, focal motor/sensory deficits

109
Q

end-organ compromise signs of HTN

ophthalmologic

A

fundoscopic exam: retinal hemorrhages, papilledema, AV nicking

110
Q

end-organ compromise signs of HTN

cardiovascular

A

elevated JVP

lung crackles

murmur

asymmetrical pulses

111
Q

end-organ compromise signs of HTN

renal

A

urine output

BUN/Cr on labs

112
Q

HTN urgency tx

established htn pts

A

rest

increase dose

add add’l med

adhere to Na+ restriction

113
Q

HTN urgency tx

new htn pt

A

bp reduction over several hours

rest

114
Q

HTN emergency tx

A

hospitalized (usually ICU)

workup secondary htn causes

tx end-organ damage not just bp

reduce bp

switch from iv to oral once bp stable

115
Q

how to reduce BP in HTN emergency

A

reduce MAP by 20-25% within 1 hour

IV labetalol

116
Q

IV labetalol tx what

A

HTN emergency

117
Q

elderly male smoker with CAD, emphysema, and/or renal impairment

not always symptomatic

if symptomatic:

substernal, back or neck pain, +/- dyspnea, stridor, cough, dysphagia, hoarseness, SVC syndrome

TEARING CHEST PAIN

what dx?

A

classic aortic aneurysm - thoracic

118
Q

elderly male smoker with CAD, emphysema, and/or renal impairment

not always symptomatic

if symptomatic:

pulsating abdominal mass +/- abdominal/back pain

what dx?

A

classic abdominal aortic aneurysm

119
Q

what dx?

hypotension/hemodynamic instability with pulsating abdominal mass +/- abdominal/back pain

A

ruptured aortic aneurysm in abdomen

120
Q

which is more common: abdominal or thoracic aortic aneurysm

A

abdominal

121
Q

risk of thoracic aortic aneurysm is determined by what

A

size of aneurysm

122
Q

if thoracic aortic aneurysm is asymptomatic - how is it found and how is it managed?

A

found: incidentally CXR/CT - widened mediastinum
managed: aggressive BP and HR control (systolic under 120, HR between 60-80) through beta-blockers, symptom surveillance

123
Q

what must BP and HR control be in thoracic aortic aneurysm

A

BP: less than 120

HR: 60-80

124
Q

mgmt of thoracic aortic aneurysm if symptomatic, rapid aneurysm expansion, size

A

surgical

125
Q

surgical mgmt of thoracic aortic aneurysm if:

A

symptomatic

rapid aneurysm expansion (growth of more than .5 cm in 6 mos)

greater than 5.0 cm

126
Q

mgmt for asymptomatic AAA less than 5.5 cm

A

observation

surveillance and risk factor modification: US every 6 mos - 1 yr

127
Q

complications of AAA

A

rupture (high mort/morb)

aneurysm thrombosis

thromboembolism (acute limb ischemia can result)

128
Q

when do you do surgical management of AAA

A

asymptomatic but over 5 cm

rapidly expanding (growth of .5+ cm in 6 mos)

assoc with peripheral arterial aneurysm or PAD

129
Q

emergent condition in which the inner layer of the aorta tears, blood then surges through the tear, causing the rest of the aorta layers to dissect

what dx

A

aortic dissection

130
Q

if the blood filled channel ruptures through the outside aortic wall of aortic dissection, what happens

A

often fatal

131
Q

symptoms of aortic dissection

A

ripping or tearing chest pain radiating to the back

severe back, abdominal, or flank pain + hypotension and shock

signs of hemodynamic compromise

132
Q

risk factors for aortic dissection

A

uncontrolled HTN

atherosclerosis

pre-existing aortic aneurysm

bicuspid aortic valve

aortic coarctation

connective tissue disease (marfan syndrome)

cocaine use

preg

male gender with advanced age

133
Q

De Bakey Aortic Dissection Type 1 originates in ____ aorta, propagates at least to aortic arch and often beyond it distally

A

ascending

134
Q

De Bakey Aortic Dissection Type II originates in _____ aorta and is/is not confined to ascending organ

A

ascending

IS CONFINED

135
Q

De Bakey Aortic Dissection Type III originates in ____ and extends distally down aorta or rarely retrograde into aortic arch and ascending aorta

A

descending aorta

136
Q

Stanford Type A aortic dissection

A

all involve the ascending aorta regardless of site of origin

137
Q

Stanford Type B aortic dissection

A

NOT involving ascending aorta

138
Q

ascending or descending aorta dissection – emergency

A

ASCENDING

139
Q

how is descending thoracic aortic dissection (type B) managed?

A

medically

as long as hemodynamically stable and without end-organ complications

140
Q

how to distinguish between the type A (ascending) and type B (descending) aortic dissection in hemodynamically stable pt

A

CT angiography - initial screening study in hemodynamically stable pt

141
Q

how to distinguish between the type A (ascending) and type B (descending) aortic dissection in hemodynamically UNstable pt

A

multiplanar transesophageal echo

142
Q

hemodynamically unstable aortic dissection: management

A

intubate - airway compromise

bedside TEE

emergency vascular surgery consult

admit to ICU

morphine for pain

BP control: 100-120 SP; HR < 60

IV beta blocker

143
Q

medication for hemodynamically UNSTABLE aortic dissection - this is for BP control and HR control

include ideal limits

A

beta blocker IV

SBP: 100-120

HR: <60

144
Q

2 kinds of acute arterial occlusion

A

acute limb ischemia

acute mesenteric ischemia

145
Q

3 causes of acute arterial occlusion

A

embolus

thrombosis

trauma

146
Q

sudden decrease in limb perfusion that causes a potential threat to limb viability

symptoms appear from hours to days - new or worsening claudication to paralysis

A

acute limb ischemia

147
Q

clinical presentation of acute limb ischemia

sudden, dramatic onset: embolus or thrombosis

A

embolus

148
Q

clinical presentation of acute limb ischemia

gradual: embolus or thrombosis

A

thrombosis

149
Q

Six Ps of acute limb ischemia

A

pain

pulselessness

pallor

paresthesias

paralysis

poikilothermia (difficult to regulate body temp)

150
Q

should you do a neuro exam for acute limb ischemia?

if so, what do you assess?

A

YES - BILATERALLY

assess sensation

assess strength

pulses

151
Q

what do you do to measure pulses with acute limb ischemia

A

doppler for posterior tibialis and dorsalis pedis

ankle-brachial index of less than .4 indicates significant ischemia

152
Q

what vascular imaging for acute limb ischemia

A

CTA, MRA - performed in pts with viable limbs

anticoagulate prior and monitor progression

153
Q

threatened limbs require what

A

immediate surgical revascularization - intraoperative arteriography

154
Q

initial mgmt of acute limb ischemia

A

anticoag

close monitoring

surgery as soon as exam worsens

155
Q

what must you do ASAP with acute limb ischemia

A

consult vascular surgery!

156
Q

acute suddent onset of intestinal hypoperfusion

A

acute mesenteric ischemia

157
Q

elderly pt with afib

severe abdominal pain, out of proportion to physical exam

what dx?

A

acute embolic occlusion

158
Q

PAD aka

A

mesenteric thrombosis

159
Q

mesenteric thrombosis symptoms

A

chronic post-prandial pain, food aversion, weight loss, +/- hematochezia

160
Q

imaging for acute mesenteric ischemia

A

KUB - more for complications

CT angiography - imaging of choice

161
Q

tx of acute mesenteric ischemia

A

systemic anticoagulation and pain mgmt

+/- angioplasty with stent

+/- exploratory laparotomy if peritoneal signs

162
Q

risk factors for DVT

A

recent surgery

prolonged bed rest

oral contraceptives

hormone replacement therapy

recent trip

malignancy

factor V leiden, hypercoagulable states

163
Q

Virchow’s triangle assoc with what

A

DVT

164
Q

Virchow’s triangle (assoc with DVT) is what

A

endothelial damage

hypercoagulability

stasis

165
Q

clinical presentation of DVT

A

swelling, pain/discomfort, edema (unilateral usually)

166
Q

physical exam of DVT

A

erythema, warmth, swelling

167
Q

labs with DVT

A

D-Dimer elevated

168
Q

D-Dimer elevated with what

A

DVT

169
Q

dx test of choice for DVT

A

duplex ultrasound

170
Q

tx of DVT

A

anticoag: heparin, bridge to warfarin

171
Q

acute onset of chest pain and/or dyspnea

pleuritic chest pain, dyspnea, cough, hemoptysis, syncope

what dx?

A

PE

172
Q

physical exam of PE

A

tachypnea, tachycardia, hypoxia, unilateral extremity, edema

173
Q

PE labs

A

d-dimer elevated

174
Q

EKG labs for PE

A

sinus tachy

175
Q

CXR for PE

A

normal

sometimes Hampton’s hump and Westermark sign

176
Q

gold standard for dx of PE

A

pulm angiography

177
Q

Well’s critera for what dx

A

PE

178
Q

What is well’s criteria?

A

clinical signs/symptoms of DVT

PE is most likely dx

tachy (over 100 bpm)

immobilization/surgery in previous 4 weeks

prior DVT/PE

hemoptysis

active malignancy (tx within 6 months)

179
Q

using well’s criteria - what is low risk, intermediate risk, and high risk

A

low: less than 2 pts
intermediate: 2-6 points

high risk: over 6 points

180
Q

using well’s criteria

pe is unlikely if below what number

pe is likely if over what number

A

4 or below - unlikely

above 5 - likely

181
Q

If Well’s criteria suggests that a PE is unlikley, what do you do

A

start with D dimer

182
Q

If well’s criteria suggests PE is likely, what do you do?

A

check CTA

183
Q

tx of PE

A

supplemental O2

IV access

cardiac monitoring

anticoag

184
Q

any breech of the lung surface of chest wall allowing air to enter the pleural cavity causing what

A

lung to collapse

185
Q

primary pneumothorax =

A

spontaneous

186
Q

secondary pneumothorax =

A

related to COPD, CF, pneumonia, malignancy

187
Q

when is primary pneumothorax most common

A

in tall, young males

188
Q

____ forms due to one-way valve where air can enter but cannot leave

A

tension pneumothorax

189
Q

tension pneumothorax is most commonly ___

A

traumatic

190
Q

what kind of pneumothorax is a medical emergency

A

tension

191
Q

tx of primary spontaneous pneumothorax

A

resolve on own sometimes

can observe and repeat CXR if less than 15-20% lung involvement

192
Q

preferred tx for symptomatic pneumothorax

A

tube thoracostomy

193
Q

tx for tension pneumothorax

A

needle decompression first then chest tube placement

194
Q

condition characterized by paroxysmal attacks of reversible bronchospasm, mucus plugging, and inflammation of the trachobronchial tree

A

asthma

195
Q

physical exam of acute exacerbation of asthma

A

SOB

wheezing

cough

resp distress

use of accesspry muscles/nasal flaring

196
Q

what should you NOT be fooled by with ashtma

A

quiet chest!

197
Q

tx of asthma

A

airway - oxygen

beta 2 agonist

steroids

nebulized anticholinergic

198
Q

refractory asthma attack that does not respond to initial tx

A

status asthmaticus

199
Q

asthma complication that is medical emergency

A

status asthmaticus - ICU usually

Surgery and Emergency Med (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions