common problems Flashcards
Workup of patient w/new onset migraines?
-BMP, CBC, -VDRL (r/o syphilis) -ESR -*CT head
Clinical presentation of basal cell carcinoma
waxy “pearly” appearance central depression or rolled edge
Second degree burn
** partial thickness -moist, BLISTERS, extends beyond epidermis
Pupil changes seen in narcotic toxicity
MIOSIS **cocaine causes Mydriasis
First degree burn
-dry, red, NO blisters, involves epidermis only
Management of hypercalcemia
Calcitonin (inc Ca reabsorption) if impaired CV or renal fxn *if >12, start NS infusion w/loop diuretics
Treatment of narcotic overdose
-gastric lavage/activated charcoal -Naloxone (narcan) -Butorphanol (stradol)
Tylenol OD equivalent medications?
Anacin-3 Panadol
Actinic keratoses
PREMALIGNANT to squamous cell carcinoma -asymptomatic
Which type of HA is a/w “cold-like” sxs?
cluster HA
which drugs may be causes of non-infectious post op fever?
-ampho B -Bactrim -beta lactam abx -isoniazid -alpha-methyldopa -quinidine
most common organisms causing cellulits- outpatients
strep pyogenes (Gp A strep) -usual cause S.aureus -less common
Treatment for antidepressant toxicity
*admit to ICU if CNS/cardiac toxicity
- gastric lavage/activated charcoal
- sodium bicarb
- Benzos to treat seizures
- Serotonin syndrome: dantrolene
Emergent treatment of Burns
**maintain normothermia (37-37.5)
Use sterile NS as initial tx & wrap burns w/sterile gauze
pain meds Silver Sulfadiazine (silvadene)-antifungal for 2nd &3rd degree burns
When evaluating a HA, what component is most important?
chronology
Clinical manifestations of severe hypokalemia (2.5)
flaccid paralysis tetany hyporeflexia rhabdo
Causes of normal anion gap metabolic acidosis
*diarrhea (CDIFF) -ileostomy -RTA -recovery from DKA
Causes of hypokalemia
-chronic use of diuretics -GI loss -excess renal loss & alkalosis -elevated serum epineprhine in trauma pts
If a patient with hypotonic, hypovolemic hyponatremia is symptomatic, what is the treatment?
NS & Loop diuretic **if CNS sxs–> 3%NS w/loop diuretic
S&S of narcotic toxicity
- drowsiness
- *hypothermia
- resp depression, shallow resp
- coma
First 3 steps in evaluating hyponatremia?
- determine urine Na 2. determine Serum Osmo 3. clinical status
Causes of hyperkalemia
Excess intake -renal failure -drugs (NSAIDS) -hypoaldosteronism -cell death
Drug of choice in treatment of organophosphate poisoning
*Atropine
activated charcoal if ingested
S&S of benzo overdose
drowsiness
confusion
slurred speech
resp depression
hyporeflexia
Causes of Hypocalcemia
hypoparathyroidism
hypomagnesemia
pancreatitis
renal failure
severe trauma
*multiple blood transfusions
Common causes of hypervolemic, hypotonic hyponatremia
-edematous states -CHF -liver dz -advanced renal failure
Limitations of gastric lavage?
limited use for ingestions >30 min use of 28-38F
somatic pain
non-localized, muscle, bones nerves, blood vessels, Soft tissues/Supporting tissues (ex: sprained ankle)
most common organisms causing cellulits- inpatients
-GN organisms: E coli, klebsiella, pseudomonas, enterobacter -S.aureus (MRSA, CA-MRSA)
Dose of narcan
0.04-2mg
Management of cluster HA?
PO drugs usu don’t work
- **inhalation w/100% O2
- Imitrex 6mg SQ may my effective
- Ergotamine tartrate (Ergostat) aerosol INH may be effective
Treatment for hyperkalemia
Exchange resins (I.e Kayexalate) If >6.5: Reg Insulin 10 U IV–> D5W calcium cl or calcium gluconate B2 agonist (albuterol) sodium bicarb
Treatment for salicylate OD?
gastric lavage/activated charcoal sodium Bicarb in severe acidosis (pH <7.1)
*monitor ABGs
What level of albumin indicates protein malnutrition?
<3.5
initial treatment of post op fever?
**hydration and measures to expand lung inflation
Two types of migraines?
class=migraine w/aura common=migraine wo/aura
Management of hypokalemia
>2.5–> PO replacement if unable to take PO–> 10meq/hr
*if <2.5 severe S&S–> can give 40meQ /hr—> check q3hr & continuous ECG monitoring
*ensure Mg WNL
Migraine HA involve which artery and which CN?
d/t excessive pulsations of branches of EXTERNAL CAROTID -CN IV (trigeminal)
When is prophylactic intubation needed in burn patients?
-burns to face -singed nares or eyebrows -dark soot/mucous from nares and/or mouth
3 types of hypotonic hyponatremia?
need to assess if patient is hypovolemic or hypervolemic –> if hypovolemic, need to determine if due to extrarenal salt losses or renal salt wasting hypovolemic hyponatremia w/Na <10 hypovolemic hyponatremia w/Na >20 hypervolemic, hypotonic hyponatremia
Examples of antimetabolites
Azathioprine (Imuran) Mycophenolate mofetil (cellcept)
S&S of salicylate (ASA) OD
N/V
*hyperthermia
*tinnitus
dizziness,
HA
dehydration
metabolic acidosis
inc LFTS
What serum osmo is indicative of hypertonic hyponatremia?
>290
Presence of an aura is only associated with which type of HA?
migraines
Fluid resuscitation management for burn patients
Give 1/2 of all fluid needed in 1st 8hr, w/remaining fluid over the next 16hr
SeBorrheic Keratoses
benign, not painful lesions “stuck on” appearance beige, brown/black in appearance
Cluster HA most commonly affect?
middle aged men
S&S organophosphate poisoning
N/V/D, cramping
*excessive salivation
*HA, *blurred vision
*MIOSIS
*bradycardia
mental confusion, slurred speech, coma