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Certified Emergency Nurse > CEN > Flashcards

CEN Flashcards

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1
Q

The pressure bag for an ART line should be inflated to what pressure?

A

300 mm/Hg

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2
Q

What is the most common cause of a dampened waveform on an ART line?

A

Air in the system

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3
Q

What are the papillary muscles?

A

Connect to the tricuspid and mitral valves via the chordae tendinae and prevent valve prolapse (regurgitation)

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4
Q

What color of stool would you expect with a patient who has a common bile duct blockage?

A

Gray

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5
Q

What STD often occurs concurrently with gonorrhea?

A

Chlamydia

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6
Q

What is normal d-dimer?

A

Less than 0.5

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7
Q

What is normal prothrombin time (PT)?

A

12-15 seconds

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8
Q

What is considered a positive PPD result (non-HIV patient)

A

Induration of 10mm

For HIV patients induration of 5mm

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9
Q

Amytriptyline is an antidepressant (tricyclic) that is sometimes prescribed for pain. How long does it take to achieve a therapeutic effect?

A

Up to 3 weeks

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10
Q

What time of day should TCA’s be taken?

A

Bedtime

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11
Q

A patient with Addison’s disease experiencing adrenal crisis (insufficient production of adrenal hormones) would experience which electrolyte imbalances?

A

Hypoglycemia due to reduced cortisol
Hyponatremia due to low aldosterone
Hyperkalemia due to low aldosterone (sodium and water lost, potassium retained)
Hypocalcemia

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12
Q

Symptoms of rubeola:

A

Koplik’s spots (bluish/white spots to mouth and throat) appear 1-4 days before rash on face and trunk

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13
Q

Rubella symptoms

A

Red rash starts on the face and spreads to trunk and extremities. Also may have swollen cervical lymph nodes

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14
Q

Donepezil (aricept) is used to treat:

MOI and potential adverse side effect?

A

Alzheimer’s

Potentially life threatening cholinergic crisis (sludge effects)

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15
Q

Carbidopa/levodopa

  1. Trade name?
  2. MOA?
  3. Primary disease it treats?
A
  1. Sinemet
  2. Converts levodopa to dopamine (inhibits cholinergic activity)
  3. Parkinson’s
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16
Q

Memantine:

  1. Trade name
  2. Primarily used to treat?
  3. MOI?
A
  1. Namenda
  2. Alzheimer’s
  3. Decreases the effects of glutamate, the principal excitatory neurotransmitter in the brain
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17
Q

Selegiline:

  1. Trade name
  2. Primarily used to treat?
  3. MOI?
A
  1. Eldepryl
  2. Parkinson’s
  3. Inhibits the enzyme monoamine oxidase (thereby increasing dopaminergic action)
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18
Q

List 3 cranial nerves involved in eye movement.

A

3 - Oculomotor
4 - Trochlear
6 - Abducens

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19
Q

Phenytoin:

  1. Trade name?
  2. How should it be administered?
A
  1. Dilantin
  2. Mixed with normal saline (1ml/50mg) and a filter should be used due to the likelihood of precipitation
  3. Administer slowly and monitor for hypotension
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20
Q

What is the difference between subdural hematomas and subarachnoid hemorrhage?

A

Subdural can take weeks to develop

Subarachnoid can be occur from aneurysm rupture often precipitated by an increase in ICP from straining or heavy lifting.

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21
Q

What type of headache is associated with an aura signaling the start of the headache?

A

Migraine

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22
Q

What type of headache is associated with dis function of the trigeminal nerve?

A

Cluster

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23
Q

Edrophonium:

  1. What type of drug
  2. Used for?
A
  1. Muscle strengthener

2. Used as a diagnostic test for myasthenia Travis

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24
Q

What are symptoms of autonomic dysreflexia in SCI?

A

Hypertension, bradycardia, severe distress, pupil dilation

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25
Q

Central cord syndrome symptoms.

A

Loss of function in upper extremities
Lower extremities not affected

Can’t type, but can dance

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26
Q

A patient complains that his new cast is too tight. What will likely be done?

A

Bi-valving the cast

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27
Q

A boxers fracture is a fracture of the?

A

Distal 5th metacarpal

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28
Q

What is a Colles’ fracture?

Evaluation of what nerve should be performed with a Colles’ fracture?

A
  1. Fracture of the distal third of the radius

2. Radial nerve

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29
Q

Peroneal nerve injury is associated with what injury?

A

Tib/fib fracture

Patient may have numbness to the top of the foot and be unable to dorsiflex

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30
Q

Median nerve injury is commonly associated with what injury?

A

Elbow dislocation

Or wrist fracture

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31
Q

Proper fitting of a walker results in elbows bent at?

A

30 degrees

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32
Q

Describe the drainage commonly associated with gas gangrene infections.

A

Thin, watery brown, or brown-gray

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33
Q

How would one test sensory function of the radial nerve?

A

Assessing for feeling on the dorsum of the hand or base of thumb. Or pinch the webbing between the thumb and index finger

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34
Q

Length of time sutures can be left in place for:

  1. Face, lips, eyelids?
  2. Eyebrows?
  3. Back, chest, arm, hands, thighs?
  4. Lower legs, feet?
A
  1. Face, lips, eyelids? 3-5 days
  2. Eyebrows? 5-7 days
  3. Back, chest, arm, hands, thighs? 7-10
  4. Lower legs, feet? 10-14 days
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35
Q

What are the symptoms of cyanide poisoning?

A

Restlessness, dizziness, tachycardia, and the odor of bitter almonds

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36
Q

Per HIPPA, a patient can request errors corrected in their medical records within how long?

A

60 days

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37
Q

Symptoms of benzo withdrawal:

A

Anxiety, confusion, tremors, temp, flu-like symptoms

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38
Q

Symptoms of lithium toxicity:

A

Lethargy, ataxia, nausea, vomiting

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39
Q

Normal bicarbonate levels:

A

22-26

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40
Q

How long in-between MDI dose 1 and 2?

A

1 minute pause

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41
Q

What is the antidote for heparin toxicity?

A

Protamine sulfate

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42
Q

Which products necessitate ABO compatibility?

Which do not?

A

Do: whole blood, PRBC’s, FFP

Don’t: leukocyte poor RBC’s, platelets, albumin

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43
Q

What is a grade a recommendation in surviving sepsis?

A

Initiate prophylactic measures to prevent DVT and stress ulcers

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44
Q

Tylenol overdose symptoms

Early (first 24hrs)
Mid (24-48 hrs)
Late (48-96hrs)

A

May be mild early on, May have mild gastric upset, nausea, vomiting

Mid: abnormal labs

Late signs: vomiting, hypoglycemia, right upper quadrant pain

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45
Q

Chlorofluorocarbon trade name?

Signs/symptoms of overdose?

A

Freon

Loss of consciousness, respiratory depression, thermal burns

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46
Q

What effect would narcan have on GHB overdose?

A

None. GHB has no antidote. Symptoms are similar to opioid overdose.

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47
Q

Enlarged liver can be a symptom of what type of heart failure?

A

Right sided

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48
Q

Becks Triad:

A
  1. Hypotension
  2. Muffled Heart Tones
  3. Distended neck veins
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49
Q

A patient has an inferior wall MI. What is the most likely dysthymia to occur?

A

Bradycardia

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50
Q

Bethanechol

  1. Trade name
  2. Mechanism
  3. Uses
A
  1. Urecholine
  2. Parasympathomimetic
    3a. Urine retention
    3b. GERD (stimulates gastric emptying)
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51
Q

Patients with IBS should avoid?

A

Sorbitol - causes gas bubbles in the intestines

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52
Q

How frequent/what size meals should the pt with esophigitishave?

A

Small, frequent

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53
Q

Should patients with IBS have water with meals?

A

No, it can cause distention

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54
Q

Discharge instructions for prostratitis should include:

A

Increase fluid intake to assist in elimination of bacteria.

No restrictions on sexual activity.

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55
Q

Name 3 foods that may cause dark red urine, and one that doesn’t.

A

Beets, rhubarb, blackberries.

Strawberries do not.

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56
Q

What type of discharge would you expect for trichomoniasis?

A

Gray or greenish discharge

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57
Q

What type of discharge would you expect for gonorrhea?

A

Yellow discharge

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58
Q

What sign (size) is an indication of a viable fetus?

A

Fundal height 26cm above the pubic symphysis (indicative of 26 weeks gestation which is viable)

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59
Q

How many “kicks per hour” are a good indication of fetal well being?

A

10/hr

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60
Q

What might you anticipate the pupil to look like with a globe rupture?

A

Peaked or teardrop

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61
Q

What are some education items for patients with Bell’s palsy?

A
  1. Cold exposure can be a precipitating factor
  2. Eye protection should be worn due to loss of normal blink response
  3. Artificial tears will need to be used on a regular basis
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62
Q

Lyme disease:

  1. Caused by?
  2. Potential symptoms/complications
  3. Treatment
A
  1. Borella burgdorferi, deer ticks
  2. Expanding bulls eye circle, flu-like symptoms, AV blocks, meningitis, hepatitis, arthralgia
  3. Antibiotics
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63
Q

What is myxedema coma?

Priority treatment?

A

Severe hypothyroidism

Supplemental oxygen and airway management

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64
Q

Classic symptoms for measles?

A

Rash on face spreading downward, bluish gray spots on oral mucosa (Koplik’s spots)

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65
Q

What would be the difference in leukocytes in Viral vs bacterial meningitis?

Difference in protein?

A

Viral: less than 1000
Bacterial: greater than 1000

Protein: <200 viral
>200 bacterial

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66
Q

In addition to severe headache, what other symptoms are typically present with temporal arteritis?

A

Red nodules over temples, weight loss, night sweats, aching joints, fever

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67
Q

What is a side effect of IV phenytoin?

What is the max dosage rate of phenytoin?

A

Hypotension and bradycardia

50mg/min (consider 25mg/min for elderly)

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68
Q

What are the exclusion criteria for iv administration of tPA?

A
  1. Uncontrolled hypertension 180/110
  2. Outside of 180 minute window
  3. Under 18 years old
  4. Intracranial hemorrhage
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69
Q

Fat emboli would typically present with petechiae in what area?

A

Anterior chest and neck

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70
Q

What is the HDVC vaccine for and what site should it always be administered?

A

Deltoid

Rabies

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71
Q

To test radial nerve function, children with an elbow injury are typically asked to perform what sign?

A

Thumbs up

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72
Q

What is the recommendation for the use of echinacea in cancer patients?

A

Contraindicated you’re give to patients with autoimmune disorders as it can stimulate the immune system.

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73
Q

Per EMTALA, the hospital property extends how far from the main building?

A

250 yards

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74
Q

What is the correct dosage for t-PA (alteplase)?

A

0.9mg/kg up to 90mg

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75
Q

Corticosteroids can contribute to what side effect, especially in the geriatric population?

A

Depression

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76
Q

What are the classic symptoms of hypothyroidism?

A

Confusion, hypotension, bradycardia, and cool/pale skin.

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77
Q

What are the characteristics of Cushing’s syndrome?

A

Hypertension, bradycardia, abnormal respiration’s

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78
Q

What is a priority intervention for flail chest?

What is proper positioning?

A

Pain management to promote adequate ventilation.

Position pt on the injured side in semi-Fowler’s position

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79
Q

Indications for a chest tube

A

Tension pneumo
Hemo-pneumo
Pneumothorax greater than 20%

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80
Q

What is the most common cause of acute bronchitis in the non-smoking patient?

A

Viral

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81
Q

What unique findings might you find in the ABG of a pregnant patient?

A

Decreased PaCO2 due to hyperventilation

Decreased bicarbonate as the kidneys compensate for the decrease in PaCO2

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82
Q

The development of coagulopathies after auto transfusion is most likely contributed to what?

A

Autotransfuaion of 25-50% of total blood volume can lead to dilution of clotting factors

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83
Q

What is the indication for Recombinant human activated protein C?

What is an absolute contraindication for this drug?

A

Indication: sepsis

Contraindication: risk of bleeding

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84
Q

What is a common treatment for stingray venom?

A

Warm to Hot water as it helps to dissipate the venom. Resolution of pain is the indication to stop treatment.

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85
Q

Indomethacin is what kind of drug?

What type of pain/diagnosis might it be prescribed for?

A

NSAID

Pericarditis

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86
Q

What is coarction of the aorta?

A

Narrowing or pinching anywhere in the aorta, most commonly just after the aortic arch, restricting blood flow to the lower part of the body resulting in lower BP in the lower extremities

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87
Q

What is intussusception?

What are the symptoms?

A

When part of the intestine telescopes into the other part.

Most commonly occurs in children.

Symptoms: colicky spasmodic pain and red currant jelly stool.

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88
Q

What are the side effects of loperamide?

A

Indication: anti-diarrhea

Side effects: sedation, dizziness, dry mouth, ileus, constipation

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89
Q

What is one of the most serious complications with bowel obstruction?

A

Peritonitis

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90
Q

Name one thing that will increase the odds of getting PID?

A

Having an intrauterine device.

Also adolescents are at increased risk due to immature immune system and thinner cervical mucus.

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91
Q

What type of drug is methotrexate? What are some common indications?

A

Immunosuppressant and chemo drug.

Treats cancer and may also be prescribed for ectopic pregnancy

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92
Q

A FAST exam cannot be used to identify ??

A

Retroperitoneal injury

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93
Q

What is the window for reimplanting an avulsed tooth or teeth?

A

30 minutes due to the death of periodontal ligament cells.

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94
Q

What are the typical symptoms of hypercalcemia?

A 
Hyporeflexia
Weakness
Weight loss
Shortened QT and wide T-wave
Polydipsia and polyuria
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95
Q

What are some classic lab findings of Reye’s Syndrome?

A 
Elevated ammonia 
Elevated SGOT
Elevated SGPT
Hypoglycemia
Lactic acidosis
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96
Q

Spinal fluid normal:

Pressure?
WBC’s?
RBC’s?
Glucose?

A

Pressure? - 50-200

WBC’s? - 0-5

RBC’s? - zero

Glucose? - 50-75

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97
Q

Classic symptoms of meningococcemia?

A

Rapid onset fever, petichial rash, purpura. It is a systemic bacterial infection.

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98
Q

Kawasaki disease

A

Primarily affects 5 and under

Erythematous rash, fever, swelling of hands and feet, cervical lymphadenopathy

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99
Q

What type of drug is aminocaproic acid (amicar)?

A

Promotes clotting

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100
Q

How does a hepatitis A infection affect the ability to work?

A

Most people are out of work at least 4-weeks.

Although it is fecally transmitted, blood banks will often not accept donations for up to one year after exposure.

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101
Q

Bluish-gray spots on the oral mucosa (Kopliks spots) are specific to what disease?

A

Measles

Kopliks spots appear 1-2 days prior to the rash

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102
Q

What is propylthiouracil?

A

Used to treat thyroid storm. It blocks thyroid hormone synthesis.

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103
Q

What is the drug edrophonium (tensilon)?

A

Anticholinesterase (inhibits breakdown of acetylcholine) and is used to assess for presence of myasthenia gravis.

Side effects could be respiratory depression and bradycardia

Reversal agent is atropine

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104
Q

What class of drug is nicardipine?

A

Calcium channel blocker

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105
Q

What spinal cord injury is more commonly associated with pediatric patients?

A

SCIWORA

Spinal cord injury without radiographic abnormality

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106
Q

What is autonomic dysreflexia?

A

Typically seen with injuries T6 or higher and results in excessively high BP. Foley placement is often necessary in addition to managing the BP.

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107
Q

Name 4 animals that are presumed rabid unless otherwise proven negative through testing?

A

Raccoons, skunks, foxes, bats

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108
Q

What is a Colles fracture and what is one identifying characteristic?

A

Distal radius fracture.

“Silver fork” deformity as the hump deformity resembles the shape of a fork.

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109
Q

Which complication is the most likely to occur 12-48hrs post femoral fracture?

A

Fat embolism

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110
Q

What lipid soluble drug can be administered via ET tube during cardiac arrest?

A

Lidocaine

2 doses of 2-3mg

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111
Q

Name 4 herbs that have been shown to affect platelet function and should be avoided by the patient taking aspirin.

A

Ginger
Garlic
Ginseng
Ginkgo Bilboa

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112
Q

This OTC herb is commonly taken for depression, but should be avoided in the post transplant patient due to increased risk of rejection.

A

St. John’s Wort

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113
Q

Digoxin toxicity can have what effect on potassium?

A

Increase

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114
Q

What is the DTaP schedule?

A

2, 4, 6 months

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115
Q

The first dose of Hib should be given when?

A

2 months

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116
Q

What is the MMR schedule?

A

1st - 12 months

2nd - 4-6 years

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117
Q

What type of drug is chlorpromazine?

Possible adverse effect?

A

Antipsychotic

Extrapyramidal symptoms or dystonic reactions

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118
Q

What sounds are typically described for a pleural rub?

A

Low-pitched grating sound.

Heard more on inspiration than expiration.

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119
Q

What is the standard pediatric fluid bolus for shock?

A

20ml/kg

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120
Q

Pediatric hypoglycemia dose

A

2-4ml/kg of d25

Which equals 0.5-1gm/kg

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121
Q

How many ml/kg is the best estimate of an infants circulating blood volume?

How does this compare to an adult?

A

90ml/kg

Adult: 70ml/kg

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122
Q

Class 4 shock:

A 
HR >140
Hypotension
Confusion
Lethargy
Blood loss > 2000ml
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123
Q

Signs/symptoms of chlorine gas exposure:

A

Chest tightness and burning

Cough, shortness of breath

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124
Q

In the case of iron overdose, how long does it take to reach peak iron levels?

A

3-4 hours

Symptoms may include nausea, vomiting, and bloody diarrhea.

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125
Q

Nutmeg can be abused through excessive ingestion and has gained a reputation as a/an?

A

Hallucinogen

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126
Q

Palpating under the right costal margin causing inability to take a deep breath is caused by what? What is this “sign” called?

A

Cholecystitis

Murphy’s sign

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127
Q

Epididymitis is most common at what age?

A

30-50 years

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128
Q

What is boerhaave syndrome?

A

Spontaneous effort rupture of the esophagus. Often caused by severe straining or vomiting.

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129
Q

Hyporeflexia is most commonly associated with what electrolyte imbalance?

A

Hypokalemia

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130
Q

What effect would Addison’s disease have on potassium?

A

Hyperkalemia

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131
Q

Hyperkalemia can lead to peaked t-waves on an EKG. As the hyperkalemia worsens, what are some changes you might notice on the EKG.

A

Lengthening or absent p-wave
Enlarging QRS
Sine wave

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132
Q

What are some ekg changes you might note in a patient with hypokalemia?

A

St depression
Biphasic t-wave
Prominent u-wave

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133
Q

What effect does hypermagnesemia have on deep tendon reflex?

A

Decreased reflexes

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134
Q

What is chovstek’s sign?

A

In a patient with suspected low magnesium, tap on the side of the face (temporal and zygomatic region) - due to low magnesium causing muscular irritability, they may scrunch that side of the face.

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135
Q

What is trousseau’s sign?

A

Another test for hypomagnesemia. Place a BP cuff on the patients arm and inflate to 20 above the known SBP. Leave it inflated and a positive sign is if the muscles in that extremity begin to contract, have tetany, an May even spasm violently.

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136
Q

Name some food that are high in magnesium.

A

Legumes, chocolate, nuts, grains, leafy greens

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137
Q

What is the treatment for hypermagnasemia?

A

IV fluids, loop diuretics, and in severe cases dialysis.

138
Q

What is the relationship to calcium and phosphate?

A

They exist in an inverse relationship

139
Q

Normal pressure of spinal fluid?

A

50-100

139
Q

Normal CSF
WBC’s?
RBC’s?
Glucose?

A

WBC’s = 0-5
RBC’s - zero
Glucose = 50-75

140
Q

What effect does high or low calcium have on the QT interval?

A

High calcium = shortened QT

Low calcium = prolonged QT

141
Q

What is the treatment for high phosphate levels?

A

Aluminum binding agents such as maalox

142
Q

Expected electrolyte abnormalities with renal failure:

Potassium:
Sodium:
Phosphorous:
Calcium:
Hydrogen:
A 
Potassium: high
Sodium: low (kidneys can’t retain)
Phosphorous: high (kidneys can’t excrete)
Calcium: low (inverse to phosphorus)
Hydrogen: high (metabolic acidosis)
143
Q

Define azotemia:

A

Elevated levels of creatinine and BUN

144
Q

What is myxedema coma?

A

Life threatening low thyroid levels

145
Q

Name 2 drugs that may be used to treat thyroid storm (not practical, only need to know for test)

A

PROP or Methimazole

  • inhibits thyroid hormone synthesis

One hour later give iodine which causes uptake of free thyroid hormone back into tissues.

The PROP or methimazole reduces likelihood of more hormone being produced when the reuptake occurs

146
Q

Hypoglycemia can cause sweating, anxiety, pallor, tachycardia. Why is this?

A

Hypoglycemia stimulates the release of epinephrine in order to stimulate the release of glycogen stores.

147
Q

What is a possible side effect of glucagon to be aware of?

A

Vomiting

148
Q

Which has a higher mortality rate?

DKA or HHS?

A

DKA: 3-10%

HHS: 20-60%

149
Q

What is the treatment for DKA & HHS?

A

Isotonic fluid:
Adults 1-2L/hr
Ped’s 20ml/kg/hr

IV insulin: bolus 0.1 units/kg then maintain at same dosage per hour

Watch potassium and other electrolytes and correct as needed.

150
Q

What effect does increased aldosterone and cortisol (Cushing’s) have on:

blood sugar?

Potassium?

Sodium?

A

Elevated blood sugar

Decreases potassium

Increases sodium

Addison’s will be the opposite

151
Q

What is the main cause of Cushing’s?

A

Chronic steroid usage

If a patient stops taking meds cold turkey they could have addisons symptoms

152
Q

Medical terminology

Elevated red blood cells?

Decreased red blood cells?

A

Polycythemia

Anemia

153
Q

Medical terminology

Elevated white blood cells?

Decreased white blood cells?

A

Leukocytosis or leukemia

Leukopenia/pancytopenia

154
Q

Medical terminology

Elevated platelets

Decreased platelets

A

Thrombocytosis

Thrombocytopenia

155
Q

Sickle cell treatment and discharge instructions

A

Warm moist heat
NSAIDs or opioids
Hydration
Avoid high altitudes and cold temps

156
Q

Normal platelets?

Thrombocytopenia is usually asymptomatic above what level?

A

150-450k

50k

157
Q

What is hemophilia and who does it primarily affect?

A

Hereditary clotting disorder that primarily affects males.

158
Q

What are the 3 types of hemophilia?

A

Hemophilia A (deficient factor 8) - most common

Hemophilia B (deficient factor 9)

Hemophilia C (deficient factor 11) - least common in USA, more common in Africa

159
Q

SIRS criteria

A

2 or more of the following:

Temp >38 or <36
HR >90
RR >20 or PaCO2 <32
AMS
WBC’s >12k or <4k 
Hyperglycemia >120 (no diabetes)
160
Q

What does MODS refer to in regards to the septic pathway?

A

Multi Organ Dysfunction Syndrome

161
Q

What is the recommended ED sepsis treatment bundle?

A

Within 3 hours:

  1. Measure lactate
  2. Blood cultures prior to antibiotics
  3. Admin of broad spectrum abx
  4. 30ml/kL fluids for hypotension or lactate >4

Within 6 hours

  1. Vasopressors if hypotension refractory to fluids
  2. Maintain MAP of 65 or greater
162
Q

What is the difference between mild anaphylaxis and severe anaphylaxis?

A

Mild: normal BP and mild respiratory distress. Treat with IM epi

Severe: hypotension and severe respiratory distress. Treat with IV epi

163
Q

What determines if psychotic behavior is “delirium”?

A

Positive lab tests that identify what is causing the psychosis

164
Q

What is the only type of psych patient you don’t encourage to talk?

A

Acute mania

165
Q

Suicide

  1. Which demographic is most likely to succeed with an attempt?
  2. Which season is most common for attempts?
A
  1. Older Caucasian males

2. Spring

166
Q

Define akasthesia

Treatment?

A

The constant need to move or inability to hold still

Benadryl or propranolol

167
Q

What is the potentially life threatening reaction to antipsychotics?

A

Neuroleptic Malignant Syndrome

More common in warm weather

Most common symptoms: AMS and muscle rigidity, sudden fever

168
Q

Symptoms of serotonin syndrome

A

AMS, tachycardia, diaphoresis, lower extremity rigidity

169
Q

Classic triad of symptoms for shaken baby syndrome

A

Subdural hemorrhage
Retinal hemorrhage
Decreased LOC

170
Q

What is Munchausen Syndrome

By proxy?

A

Someone who enjoys receiving medical care

By proxy: passes that need on to someone like a child

  • demands extensive work up
  • enjoys the hospital setting and staff
  • not concerned about subjecting child to to painful tests or treatment
171
Q

The signs of OCD typically begin to appear at what age?

A

Before 18 years

172
Q

Define cardiac output

Normal for an adult?

A

SVxHR = cardiac output

4-8L/min

173
Q

Normal stroke volume

A

60-130ml

174
Q

How is afterload measured?

A

MAP

(2x diastolic) + systolic
———————————
3

175
Q

When pacing, once you note capture, how should you check for pulse?

A

Don’t use carotid.

Use femoral or brachial

176
Q

If a pacemaker is “over sensing”, what is the treatment?

A

Treat bradycardia per protocol

Consider application of a donut shaped magnet to turn sensing function off

177
Q

What is the difference between hypertensive urgency and hypertensive emergency?

A

Both are classified as greater than 180/120, however it is an emergency when there are signs of end organ dysfunction.

178
Q

What is the goal for treatment of hypertensive crisis?

A

Drop BP 15-20% over the first hour. Often done with Beta-blockers or calcium channel blockers.

179
Q

What are the emergent treatment goals of dissecting aortic aneurysms?

A

Reduce HR to 60-80
Reduce systolic to 100-120

2 large bore IV’s
Type & cross

180
Q

If a vasoconstrictor extravasates, what is the correct drug and treatment?

A

Leave IV in
Administer phentolamine through the IV
Then administer additional phentolamine sub-cutaneously

181
Q

What leads are associates with the LAD coronary artery?

A

V1,v2,v3,v4

Anterior MI

182
Q

What leads are associated with the Circumflex coronary artery?

A

1, aVL, V5, V6

Anterior MI

183
Q

What leads are associates with the Right coronary artery?

A

II, III, aVF

Inferior MI

184
Q

What leads are associates with the Posterior descending coronary artery?

A

ST depression in V1, V2

or

R-wave reversal progression
(Tall r-wave in V1 that then progressively gets smaller)

185
Q

What is one possible complication with right sided MI?

A

Vagal stimulation

Nausea/vomiting
Bradycardia
JVD
Hypotension

186
Q

Classic triad of symptoms for endocarditis

A

Fever
Heart Murmur
Anemia

187
Q

Define claudication

A

a condition in which cramping pain in the leg is induced by exercise, typically caused by obstruction of the arteries.

Intermittent claudication is often a condition that happens in the presence of chronic peripheral vascular disease and is often relieved by rest.

188
Q

What is the difference in activity recommendations for arterial occlusion abs venous occlusion?

A

Arterial: activity encouraged

Venous: discourage activity

189
Q

What part of the heart is most commonly injured with blunt cardiac injury?

A

Right side

190
Q

Define pulses paradoxus

A

Decrease of greater than 10 systolic when holding breath

191
Q

Normal base excess?

A

-2 to +2

Direct relationship to bicarbonate

High bicarbonate, high base excess

Low bicarbonate, low base excess

192
Q

Pediatric ET tune calculation?

NG/OG or foley size?

ET tune insertion depth?

Chest tube size?

A

Pediatric ET tune calculation?
(Age/4)+4

NG/OG or foley size?
2x ETT

ET tune insertion depth?
3x ETT

Chest tube size?
4x ETT

193
Q

When are you most likely to see a fat emboli?

A

24-72hrs after a large bone fracture

194
Q

What symptoms might you see from a pulmonary fat embolism?

A

Classic PE symptoms

Plus

Petichiae to the chest and axilla

195
Q

What is the treatment for a pulmonary air embolism?

A

Place the patient on their left side (left lateral decubitus)

196
Q

Define Fremitus

A

A vibration felt through the body such as when a patient speaks you can hold your hand on their chest and feel the fremitus (vibration)

Fremitus is often INCREASED in lobes with pneumonia due to increased density in the lung parenchyma.

Fremitus can be DECREASED if air or fluid is in the pleural space.

197
Q

What lung sounds would you expect with a pulmonary contusion?

A

Crackles

198
Q

What different percussive sounds would you anticipate with a pneumothorax vs a hemothorax?

A

Pneumo: hyperresonance

Hemo: hyporesonance

Both will have decreased fremitus

199
Q

What is egophony and when might you hear it?

A

Increased resonance of voice sounds when auscultation lungs.

Would be present with fluid in the lungs such as a hemothorax.

200
Q

What happens to PH with massive blood loss?

A

It decreases - acidosis

201
Q

What happens to pulse pressure with hypovolemia?

A

Narrowing pulse pressure

202
Q

Difference between
“Paresis”
And
“Plegia”

A

Paresis = weakness

Plegia = paralysis

203
Q

What are biot’s respiration’s?

A

Fast, deep respiration’s with long periods of apnea.

204
Q

Normal ICP?

Increased ICP?

Serious/critical ICP?

A

0-10

> 20

> 30

205
Q

During a simple partial seizure, what mental status changes would you anticipate?

How is a complex partial different?

A

None. Cognition should be maintained.

Complex Partial: impaired cognition

206
Q

What discharge instructions are important for concussion?

A
  1. Avoid high risk activity until cleared by a physician to decrease the risk of 2nd impact syndrome
  2. Be aware of signs of increased ICP in case a subdural bleed was unrecognized as these can be slow onset.
207
Q

Describe the characteristics of DAI

Mild
Moderate
Severe

A

Mild: coma 6-24hrs, transient posturing, minimal or no permanent deficits

Moderate: >24hrs coma, transient posturing, amnesia and cognitive deficits

Severe: prolonged coma, persistent posturing, vegetative state or profound deficits

208
Q

How might someone describe the symptoms of a sub-arachnoid bleed?

A

Worst headache of my life

209
Q

Should O2 be administered with a suspected basilar skull fracture?

A

If needed, but not via nasal cannula due to risk of pneumocephalus.

210
Q

Anterior cord function?

A

Descending motor neurons

211
Q

Posterior cord function?

A

Ascending sensory neurons

  1. Soft touch
  2. Proprioception
  3. Vibration
212
Q

Lateral cord function?

A

Ascending sensory neurons

  1. Pain
  2. Temperature
  3. Crude touch
213
Q

Nerves from the brain cross over at some point offer control of the contra lateral side. The different parts of the cord cross over at different sections. Where do they cross over?
1. Anterior cord?

  1. Posterior cord?
  2. Lateral cord?
A
  1. Anterior: at base of brain
  2. Posterior: at base of brain
  3. Lateral: at entry point of spinal cord
214
Q

The name of the SCI (example T-6 or C7) is indicating what?

A

The level at which they HAVE function

215
Q

Anterior cord syndrome

A

Loss of motor function, retention of sensory

216
Q

Posterior cord syndrome

A

Loss of sensory, but still has motor function

217
Q

Brown adequate syndrome

A

Often from a penetrating injury.

Can move one side with no sensation

Can’t feel the other side but can still move

218
Q

What is poikelothermy?

A

Loss of ability to regulate temp and the body becomes the temperature of the environment

219
Q

How might a cluster headache be described?

A

Intense unilateral pain in the orbital or temporal region lasting 15-180 minutes.

Treatment: high flow O2

220
Q

List some triggers for migraine headaches

A

Weather/barometric changes

Stress/anxiety, menstruation, pregnancy

Hypoglycemia

Alcohol, aged cheese, chocolate, MSG, caffeine

Tagamet, nifedipine, theophylline

221
Q

Migraine treatment

A

dihydroergotamine (migranal)
and
Reglan

222
Q

What non-benzo seizure med can be given IM?

A

Fosphenytoin (cerebyx) - PH of 7

223
Q

Myasthenia gravis

  1. Average age of onset
  2. Mechanism of disease?
A
  1. 20-30 (more common in females)
  2. Reduction in acetylcholine resulting in weakness
  3. Airway support, edrophonium to differentiate between MG and cholinergic crisis.
    - if no improvement with edrophonium, give atropine to treat cholinergic crisis.
    - also may get steroids and plasmapheresis
224
Q

Bell’s palsy symptoms include hemifacial paralysis. What else might the patient complain of?

A

Intensification if noises in the ear of the affected side

225
Q

What treatment might be used for iritis?

A

Scopolamine drops

226
Q

A patient is suspected of having mastoiditis. What other finding might help confirm the diagnosis?

A

The patient recently was diagnosed with otitis media

227
Q

What intervention might be considered to aid the process of foreign body in the nose removal?

A

Administration of nasal decongestants

228
Q

What is the treatment for trigeminal neuralgia?

What nerve is the trigeminal nerve?

A 
Carbamazepine 
Phenytoin
Benzo’s
Lamictal 
gabapentin

(Adjuvant analgesia)

Nerve 5

229
Q

What nerve is involved with Bell’s Palsy?

Symptoms?

Treatment?

A

Cranial nerve 7 (motor and sensory) (usually caused by herpes simplex virus)

Unilateral paralysis
Cannot close eye on affected side
Inability to purse lips

Ipsilateral loss of taste and hypersensitive hearing

Treated with steroids

230
Q

Tooth fractures are named after?

What are the classes?

A

Ellis

Ellis 1: through the enamel, chalky white appearance

Ellis 2: into the dentin, yellow appearance

Ellis 3: into the pulp and nerve, bloody or pink appearance

Ellis 3 treatment: application of calcium hydroxide and emergency dental visit

231
Q

Maxillary fractures are classified how?

A

Lefort 1: maxilla fractures below the nose but above the teeth

Lefort 2: break is above the nose and to the sides of the maxilla in a pyramid shape

Lefort 3: complete craniofacial separation

232
Q

Symptoms of zygomatic fracture?

A

TIDES

Trismus (mouth is locked shut)
Infraorbital anesthesia (numbness)
Diplopia 
Epistaxis
Lack of symmetry
233
Q

Difference between mydriatic eye drops and miotic eye drops?

Cycloplegic drops?

A

Mydriatic: dilates

Miotic: constricts

Cycloplegic: dilates and paralyzes eye to stay open

234
Q

What is hyphema?

A

Eye injury that characteristic by blood accumulation in the front of the eye.

Treatment: bed rest 3-5 days, upright 30-45 degrees, eye rest

235
Q

What is considered increased intraocular pressure?

A

> 20

236
Q

Glaucoma treatment?

A

Goal is to decrease aqueous humor.

Timolol (topical betablocker)
Mannitol
Miotic eye drops (pilocarpine for constricting the pupil)

237
Q

What type of pain is associated with retinal emergencies?

A

None

238
Q

How soon must a central retinal artery occlusion be treated?

Treatment?

A

Irreversible blindness can occur in 1-2 hours

Vasodilation (permissive high CO2)
Nitroglycerin
Timolol
Fibrinolytic therapy

239
Q

Retinal detachment

Symptoms

Treatment

A

Painless vision loss, sudden bright light followed by floaters or cobwebs, curtain or veil-like vision

Absolute bed rest, bilateral patching, ophthalmology consult

240
Q

Inflammation of the cornea is called?

A

Keratitis

241
Q

What causes ultraviolet keratitis? Onset?

A

Welding arc or snow blindness.

6-10 hours after exposure

242
Q

What is iritis?

A

Inflammation of the iris and ciliary body

Very painful

Treatment: steroids and cycloplegics

243
Q

What is ludwig’s angina?

A

Cellulitis of the sun-mandibular and sub-lingual region of the face.

Often has an origin of molar infection

Has potential to occlude airway

244
Q

What is Vincent’s angina?

A

Trench mouth - mouth ulcerations, gingiva, halitosis, lymphadenopathy

245
Q

What causes epiglotitis?

A

Bacterial infection
Haemophilus B causes 90%

HiB vaccination

246
Q

Average age of croup?

Epiglottitis?

A

Croup: 6 months - 3 years

Epiglottitis: 2-5 years

247
Q

What is labyrinthitis?

A

Infection of the inner ear

248
Q

What is the treatment for mastoiditis?

A

Hospital admission for aggressive IV antibiotics

249
Q

What is Ménière’s disease?

A

Disease of the inner ear, not an infection.
Fluctuation of fluid in the inner ear usually ages 40-60
Vertigo, hearing loss, N/V, tinnitus

250
Q

Difference between anterior and posterior epistaxis?

A

Anterior: in front of nasal bones. Most commonly caused by nose picking (digital manipulation). Pinch nose for 10 minutes

Posterior: behind nasal bones (can be heavier bleeding, but much of the blood drips back to the hypopharynx. Has a higher risk of airway obstruction.

251
Q

What complication should be monitored for if topical cocaine is applied to help control a nose-bleed?

A

Hypertension

252
Q

What nerve runs along the back of the lower leg?

Symptoms?

A

tiBial nerve
Lack of sensation to Bottom of foot
Unable to point foot down

253
Q

What is the rule of 2’s for tourniquets?

A

2 inches above the wound
2 inches wide
2nd tourniquet applied 2 inches above 1st one if bleeding not controlled
Turning tourniquets get turned twice

254
Q

Kinetic energy formula

A

1/2Mass X (velocity squared)

255
Q

What will and will not show up in an X-ray in regards to imbedded objects

A

Will show: glass, metal

Will not: vegetative matter (splinters, thorns, cactus) and plastic

256
Q

Where should epinephrine not be used to control bleeding due to vasoconstriction risk of hypoxia?

A

Ears, nose, toes, and hose

257
Q

How many doses of tetanus are recommended?

When treating wounds, what is the recommendation for tetanus booster?

A

3 doses

Minor wounds - 10 years

All other wounds - 5 years

If tetanus status is unknown and is not minor: Tdap AND TIG

258
Q

What are the P’s of compartment syndrome from early to late

A 
Pain
Parathesia (numbness)
Paralysis
Pallor
Pulselessness
259
Q

Difference between sprain and strain?

A

Sprain: injury to ligament

Strain: injury to tendon

260
Q

What is a nursemaids dislocation?

Treatment?

A

Nursemaid’s elbow

Dislocation of radial head only

Treatment is supination: consider pain control first!

261
Q

What is a nightstick fracture?

A

Fracture of ulna

262
Q

Where is the scaphoid bone and what is a pain indication that it might be fractured?

A

It is the carpal bone between the hand and the wrist on the thumb side.

Pain when pressing on the “snuff box” is an indication

263
Q

What is the proper placement of a pelvic binder?

A

Over the greater trochanters and pubic symphysis

264
Q

Difference in appearance of an anterior vs posterior dislocated hip?

A

Anterior: externally rotated and abduction

Posterior: internally rotated and adducted

Either way must’ve be reduced <6hrs to prevent femoral head necrosis

265
Q

Which is weight bearing: tibia or fibula?

A

Tibia = weight bearing

Fibula = non-weight bearing

266
Q

Name 3 antibiotics that can weaken tendons and make more prone to rupture.

A

Fluoroquinolone’s

Levaquin
Cipro
Avelox

267
Q

Compartment syndrome vs no compartment syndrome

RICE

A

Compartment - elevate at the level of the heart

No compartment - above the level of the heart

Also no ice in presence of compartment syndrome

268
Q 
Blast injuries
Primary
Secondary
Tertiary
Quaternary
A

Primary: gas wave compressing organs

Secondary: flying debris

Tertiary: blunt injuries as body hitting other objects

Quaternary: burns, crushes, toxic inhalation’s, cancer

269
Q

What time of day are gout flare ups more common?

A

At night

270
Q

Name 2 drugs that should be avoided for gout patients

A

Thiazide diuretics

Aspirin

271
Q

Name some foods that can worsen gout

Name some things that can help

A

Mussels
Sardines, herring, salmon
Veal, bacon, organ meats, yeast

Can help:
Vitamin C, coffee, dairy, exercise

272
Q

What is the goal pH when administering bicarb to a TCA overdose?

A

Slightly alkaline

7.45-7.55

273
Q

Describe how Rocky Mountain Spotted fever typically progresses.

A

Starts in extremities and spreads to the trunk

274
Q

What type of precautions for pertussis?

A

Droplet

275
Q

Anti-cholinergic (atropine) overdose symptoms

A

Similar to sympathomimetic as it’s blocking the parasympathetic system

Blind as a bat
Mad as a hatter
Red as a beet
Dry as a bone
Hotter than hell
276
Q

Name 3 drugs used in the treatment of cholinergic overdose.

A

Atropine
2-PAM (pralidoxime)
Benzo’s (for seizure)

277
Q

What is the reversal agent for benzo’s?

A

Flumazenil (Romazicon)

but monitor for seizures, especially those that dependent on benzo’s, as benzo’s won’t stop the seizure

278
Q

Methanol and ethylene glycol are 2 other types of alcohol. Name 2 examples and what is the common problem/treatment?

A

Methanol: windshield washer fluid

Ethylene glycol: antifreeze

Both cause metabolic acidosis which can be treated with sodium bicarb and hemodialysis in extreme cases

279
Q

What would be a difference in symptoms between isopropanol (rubbing alcohol) and ethanol (normal alcohol?

A

Ethanol: hypoglycemia

Isopropanol: hyperglycemia and ketones in urine, fruity breath

280
Q

What is fomepizole given for?

A

Methanol or ethylene glycol ingestion.

Inhibits toxic metabolites

281
Q

Name 3 plants that can cause digoxin toxicity.

A

Foxglove
Oleander
Lily of the valley

282
Q

Symptoms of digoxin overdose

Treatment

A

Bradycardia
Hypokalemia
AMS

Treatment:

  • Digibind (Digoxin Immune Fab)
  • may cause a drop in potassium
  • atropine
  • pacing
283
Q

What is the antidote for arsenic, lead, gold, mercury

A

A chelating agent such as

Dimercaprol

284
Q

Symptoms of iron overdose?

What is the antidote for iron overdose?

A

Early 0-2 hours: Severe GInsymptoms

Mid (2-48 hours) - temp resolution of symptoms

Late: 48-96 hours - metabolic acidosis, coagulopathies, hemorrhagic shock, hepatic/renal failure.

Antidote: Deferoxamine (Desferal)
- urine may be orangish

285
Q

Metformin overdose will result in?

A

Surprisingly may not have hypoglycemia
but will have lactic acidosis

Treatment is bicarb

286
Q

Treatment for anti-hyperglycemic overdoses?

A

Glucose

Octreitide (50mcg SQ or IV)

287
Q

TCA overdose symptoms?

Treatment?

A

Anti cholinergic effects (dry skin and mouth, decreased LOC

Adrenergic blocking (hypotension)

Decreased cardiac conduction

Treatment: bicarb

288
Q

Treatment for cyanide overdose?

Discharge instructions for patients who received this drug?

A

hydroxocobalamin (Cyanokit)

289
Q

Chemical eye exposure treatment priorities

A

Do not delay treatment for vitals

  1. Flush immediately with water until Morgan lens available, then switch to isotonic crystalloid
  2. Flush for 30 minutes, then check with litmus paper. Goal pH: 7.4-7.6
  3. Recheck after 20 minutes
290
Q

How long do you decontaminate a radiation exposure?

A

Use tepid water until radiation levels are no higher than 2x background radiation.

291
Q

How does cyanide affect oxygenation?

A

Cyanide prevents oxygen uptake into the cells resulting in:

  1. High venous and arterial oxygen levels
  2. Metabolic acidosis
292
Q

What is in a cyanide kit?

A
  1. Amyl nitrate (crush and pt breathes it in.
  2. Hydroxycobalamin (converts cyanide to vitamin b12 (do not mix other drugs in same line!!)
  3. Sodium nitrite (300mg over 2-4 minutes)

**hydroxocobalamin may turn urine dark brown or red for a few days

293
Q

Modified parkland burn formula

A

TBSA x 2-4ml x kg

1/2 over 1st 8hrs
1/2 over next 16hrs

Don’t count 1st degree burns
LR is fluid of choice. Also consider D5LR

Adult 2
Pediatric 3
Electrical 4

Regular parkland formula is just 4ml for everyone

294
Q

Goal urine output for electrical burns

A

1ml/kg/hr

295
Q

Temperature difference between heat stroke and heat exhaustion

A

Stroke: >41 C
Exhaustion: >37 C

296
Q

When cooling down a heat stroke patient, you want to avoid shivering. What med can help treat shivering?

A

chlorpromazine (Thorazine)
or
Benzo’s

297
Q

Treatment for frostbite

A

Handle affected areas gently

IV analgesia

Immerse in circulating water 37-40 C until pink and warm

Once thawed, wrap in loose bulky dressing and monitor for compartment syndrome

298
Q

What is a unique EKG finding that may be present in hypothermic patients?

A

J-wave or Osborn wave (follows QRS) maybe looks like BERS

299
Q

What type of fluids should be used when warming hypothermic patients

A

NS with D5 if needed

Don’t use LR

300
Q

What’s different about defibrillation in the hypothermic patient?

Cardiac meds?

A

If initial shock is unsuccessful, warm to 30-32 before shocking again

Same with meds

301
Q

Treatment for envenomation from jellyfish, fire coral, man of war?

A
  1. Rinse with NS or salt water
  2. Remove tentacle if applicable
  3. Apply isopropyl alcohol, meat tenderizer, or vinegar
  4. Corticosteroids
302
Q

Pit vipers (rattle snakes) symptoms and treatment

A

Pain, swelling, ecchymosis, edema, blisters
Weakness, N/V, metallic taste, hypotension

45% of bites are “dry” and only require tetanus

Remove jewelry, clothing
Oxygen, IV’s, fluids
Antivenin, anaphylaxis treatment

303
Q

Symptoms/treatment for coral snakes (Elapidae)?

A

More neuro effects, less local effects
*diplopia, pros is, difficulty swallowing, respiratory distress, pharyngeal spasm, cyanosis, trismus

“Red on yellow kill a fellow, red on black venom lack”

Treatment: antivenin and supportive therapy

304
Q

Brown recluse bite symptoms

A

Immediate: painless bluish ring

8hrs-4days: erythema, necrosis

Weeks to months: eschar

Treatment - wound care, dapsone

305
Q

Black widow bite symptoms

A

Neurotoxic

Pinprick pain and local swelling
Localized cramping that spreads to the entire body

Treatment: ice, benzos, antivenin

306
Q

Treatment for Rocky Mountain spotted fever?

A

Doxycycline

307
Q

Treatment for rabies

A
  1. Scrub with viricidal agent
  2. Human rabies immunoglobulin
  3. Human diploid cell vaccine on days 0,3,7,14
308
Q

What causes scabies?

Symptoms

Treatment

A

Round mites (can live off body for up to 24hrs)

Red, pruritic rash

Treatment: lindane or permethrin

309
Q

Treatment for giardia?

A

Metronidazole

albendazole

310
Q

What diseases require airborne precautions?

A

My (measles)
Chicken (pox)
Hez (Herpes Zoster - shingles)
TB (tuberculosis)

311
Q

What type of precautions for RSV?

A

Contact

312
Q

Transmission period for measles?

A

5 days before and after rash

Incubation: 8-12 days

313
Q

Pertussis incubation period

A

7-10 days

314
Q

Pertussis treatment

A

It is bacterial

Treat with macrolide abx

315
Q

Most serious complication of diptheria?

Incubation

Treatment

A

Airway compromise due to membrane growing over pharynx or edema causing compromise

Incubation: 1-8 days

Can treat with antibiotics and/or antitoxin

316
Q

Chicken pox precautions

A

Contact

317
Q

Average age difference for duodenal vs gastric ulcers?

A

Duodenal: 30-55 - increased pain with empty stomach

Gastric: 55-70 - increased pain with full stomach

318
Q

What are 2 things the liver does with protein?

A

Protein is broken down into ammonia and the liver converts the ammonia into urea.

Protein is converted into albumin

319
Q

What causes urine to become cola colored in liver failure patients?

A

Bilirubin doesn’t pass into digestive tract and then will be excreted in the urine.

320
Q

A patient with duodenal trauma may have referred pain where?

A

Testicle

321
Q

Diverticulitis and ulcerative colitis most commonly present with pain in what region?

A

LLQ

322
Q

What lab changes would you expect with pancreatitis?

A

Elevated amylase 24-72 hours then returns to normal

Elevated lipase

Hypocalcemia

323
Q

A common precursor to epididymitis is?

A

UTI

324
Q

What positioning can reduce the pain associated with epididymitis?

A

Scrotal elevation (Prehn’s sign)

325
Q

Discharge instructions for flagyl

A

No alcohol while taking and for 7 days after last dose.

Can cause severe vomiting

326
Q

Gonorrhea discharge instructions

A

Avoid sex for 7 days after completing antibiotics

327
Q

Syphilis 3 stages

Treatment

A

Primary: firm, round, painless sore on penis that may last 3-6 weeks

Secondary: rough red or brown spots on palms and bottom of feet. May have flu like symptoms

Tertiary: incoordination, paralysis, blindness, dementia

Treatment: penicillin, doxycycline, tetracycline

328
Q

Genital herpes education

A

Always use protection even when asymptomatic

Keep lesions clean and dry (no creams)

No intercourse during outbreaks

Sitz baths and cool compresses for pain relief

Wear loose clothing and cotton underwear

Increased risk of cervical cancer: frequent pap-smears

329
Q

Testicular torsion treatment time frame?

A

<6 hours 80-100% salvage rate

> 12hours orchiotomy likely

330
Q

Normal menstrual blood loss

A

25-60ml per day for 4-5 days

Average pad or tampon holds 20-30ml

331
Q

Missed abortion

A

Prolonged retention of dead products of conception. Cervical os remains closed

332
Q

An ectopic pregnancy in the Fallopian tube may go as long as?

A

12 weeks

333
Q

Treatment for ectopic pregnancy

A

Hemodynamically stable: methotrexate

RhoGAM for RH negative mother

334
Q

What is HELLP syndrome

A

Found in pregnant patients, often pre-eclamptic, but not always

Hemolysis (elevated bilirubin)
Elevated Liver enzymes
Low Platelets

Symptoms can include N/V, RUQ pain, jaundice

Treatment can range from observation to immediate c-section

335
Q

Normal fetal heart tones

A

110-160

336
Q

Treatment for prolapsed cord

A

Position mother head down, butt high.
Don sterile gloves and insert fingers into vaginal canal to reduce pressure on cord. May need to maintain this position until delivery.

337
Q

Where do you clamp the umbilical cord?

A

4 centimeters from each attachment.

Wait for pulsating to stop, then cut

338
Q

APGAR

A 
Appearance
Pulse
Grimace (muscle tone)
Activity
Respiratory effort
339
Q

Normal HR, RR, and temp of newborn

A

100-160
40-60
97.7 (36.5)

340
Q

What should the uterus feel like after birth?

A

Firm like a grapefruit and centrally located.

Certified Emergency Nurse (1 decks)

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