chapter 36 shock Flashcards
patients who are hypotensive – what fluids should you give?
fluid bolus of LR
if fluids don’t raise BP
intravascular monitoring
if laryngeal edema?
teach or cricket
IM epinephrine + fluids if anaphylactic
dopamine dosages
low = renal dilation, vasodilation
higher = contractility = beta1
highest - vasoconstriction = alpha1
what do you give patients w/ hypotension to increase peripheral resistance?
norepinephrine (mostly alpha 1 effects)
what do you give patients w/ hypotension w/ bradycardia?
isoproterenol == both inotrope and chronotope (beta1/2 effects)
what do you give patients w/ cardiac arrest and anaphylaxis?
epinephrine (alpha = beta)
second hand smoke increases risk of
asthma and URI, otitis media in children
smoking slows the healing of peptic ulcer disease, and cessation stops the development in
burger disease
what is the best way to decrease the risk of post op pulmonary complications?
cessation of smoking preoperatively
if a woman is over the age of 35 or is younger than 35 and smokes 15+ cigarettes?
no OCP but could take estrogen if postMP
TESTICULAR TORSION VERSUS EPIDIDYMITIS
pain decreases w/ testicular elevation + may be urethral discharge w/ epididymitis
diagnostic test of choice in testicular pain
ultrasound!
bph tx
terazosin/dozasoin, tamsulosin
finasteride
TURP = if repeated UTIs, urosepsis , urinary retention, hydronephrosis
signs of urethral injury
absent or abnormally positioned prostate on exam
hydrocele versus varicose
hydrocele = remnant of vaginalis, no tx needed varicocele = no transillumination, prominent when standing
noncontrast helical CT scan
diagnostic test of choice
tx of nephrolithiasis
tamsulosin
stones<= 4 mm pass spontaneously
4-10 mm doesn’t mass
if no pass, tx w/ lithotripsy, uteroscopy w/ stone retrieval, open surgery
after 1 year, do surgical intervention to preserve fertility and facilitate future testicular exams
cryptorchidism
oligohydramnios
pull hypoplasia
renal defects
twisted face/extremities
most common cause of death during vascular surgery>
MI
AAA
pulsatile abdominal mass causing abdominal or back pain’
<5 cm = SERIAL ULTRASOUND EXAMS (RF reduction) >5 cm = surgical correction
if pain is present, rupture or leak should be suspected
leriche syndrome
claudication in buttocks, atrophy, impotence
claudication
cessation of smoking
exercise
aspirin is preferred
clopidogrel for its who can’t use aspirin
if progresses to rest pain: arterial duplex for dx
tearing ripping pain in chest or back w/ FND
aortic dissection >20mmg upper extremities aortic regurgitation widened mediastinum smoking CT angiogram type A = surgery type B = med management
acute mesenteric ischemia versus chronic versus colonic
acute = red currant jelly, POOP chronic = intestinal angina = atherosclerosis in IMA, SMA = postprandial epigastric pain colonic = reduction in intestinal blood flow causing ischemia acutely at watershed areas angiodysplasia = tortuous dilation
necrotizing enterocolitis
premature, formula-fed infants w/ immature immune systems
abdominal bruit fear of eating food extensive atherosclerosis negative CT scan \+ selective angiogram of the SMA
chronic mesenteric ischemia
thickened bowel walls resembling thumb prints + afib, bloody diarrhea
acute bowel ischemia
varicose veins w/ palpable cord
superficial thrombophlebitis
left subclavian artery obstruction proximal to vertebral artery origin
to perfuse an exercising arm, blood is stolen from vertebrobasilar system and flows backward into distal subclavian artery
CNS sx + UE claudication during exercise
most common cause of B12 deficiency
pernicious anemia in which anti parietal cell antibodies destroy IF
phenytoin
tmp mtx
folate deficiency (normal MMA, high homo) unlike B12 where both are high
how to treat vitamin K def due to severe liver disease
FFP
sudden sensorineural hearing loss
idiopathic
steroids are first line therapy
common cause of a neck mass
children == thyroglossal duct cysts = midline location + elevation w/ tongue protrusion
branchial = lateral infected
cystic hygroma = lymphangioma = Turner syndrome = surgical resection
cervical lymphadenitis
strep
ebb in teens
cat scratch
leukemia
otitis externa
** pseudomonas aeruginosa **
manipulation of auricle + erytematous swollen skin in auditory canal
otitis media
spneumo
hflu moraxella
no pain w/ manipulation
earache, fever, erythematous + bulging tympanic membranes + N/V
recurrent otitis media
ppx abx + tympanovstomy
infectious myringitis = vesicles on the tympanic membrane due to inflammation and infection
inflamed tympanic membranes (mycoplasma)
erythromycin or clarithromycin to cover mycoplasma and stir pneumonia
sinusitis is due to?
spneumo flu for 6 weeks tx if chronic
otic bones come fixed together = progressive conductive hearing loss
otosclerosis
parotid gland swelling
bulimia sarcoid sialolithiasis sjogre pleomorphic adenoma sjogren syndrome
burns related to a fire
give 100% O2
ELECTRICAL BURN
- EKG, seizures
- posterior shoulder dislocation
hypothermia management <95F
conscious - rewarm
unconscious - gastric lavage warm
sinus Brady
tsh - myxedema coma
high CK, autonomic instability, rigidity in pt taking antipsychotics
NMS
stop med
fluids admin
dantrolene admin
how to deal with near drowning episodes
intubate pt if unconscious
monitor ABG
causes of hyperthyroidism
graves
TMN Goiter = hot nodules
adenoma
subacute thyroiditis = tender, painful thyroid gland
factious hyperthyroidism = patient takes thyroid hormone
hypothyroidism ass w/
vitiligo pernicious anemia DM coma
CTS
hypothyroidism lab findings
high TSH low T3/T4 antithyroid + antimicrosomal antibodies hypercholesterolemia anemia
sick euthyroid syndrome
a pt w/ illness has mild derangements in TSH == hypothyroidism like
ACTH = high
cortisol = inappropriately low
post-operative pt crashes = hypotension, shock, hyperkalemeia
GIVE STEROIDS to prevent adrenal crisis
most common primary cause of hypoadrenalism
autoimmune disease
