common problems in acute care Flashcards
1
Q
acute vs chronic pain
A
plus or minus 6 months
2
Q
cutaneous pain
A
skin
3
Q
visceral
A
poorly localized in the organs
4
Q
somatic
A
in muscle or soft tissue
5
Q
neuropathic
A
nerve pain
6
Q
step one pain control
A
asa, tylenol, nsaids, + adjuvants
7
Q
step two pain control
A
insitial nsaid plus codeine, oxy or hydro, tramadol (not with asa or tylenol)
8
Q
step three pain control,
A
nsaid plus morphene, dilaudid, methadone, fent
9
Q
break through cancer pain
A
fent patches
10
Q
causes of fever non bacterial
A
autoimmune disease, cns, neoplasm, blood disease, mi, gi disease, endocrine, nms
11
Q
38.3 =
A
101.5
12
Q
nms
A
antipsychotics, high fever, treat with fluids
13
Q
treatment of fever
A
abx when microbe is present, tylenol, treat underlying cause
14
Q
sux
A
not used with hyperkalemia
15
Q
post op fever (non infecitous) leading cause
A
post op atelectesis, increased metabolic rate, dehydration, drug reactions,
16
Q
infectious causes of post op fever
A
- leftshift, band formation lots of immature bands
2. wbc over 30K usually not infection
17
Q
treatment of post op fever
A
in abcence of infection, expand lungs and hydrate
18
Q
headache
A
chronology is most important history item
19
Q
tension
A
most comon, vice like, tx withtylenol, no focal neuro symptoms
20
Q
migrane
A
classic with aura- common without aura, related to diation and pulsation of external carotid, female > male, family history often present,
21
Q
migrane symptoms
A
unilateral pain, dull or throbbing, lasts for hours, + focal neuro disturbances,
22
Q
migrane tx
A
asa + sumatryptan iv or po- 6mg sq and up to three per day vs 25 po
23
Q
albumin <3.5
A
malnutrition
24
Q
albumin <2.7
A
edema
25
hgb repletion levels
8/24
26
need nutritional support for > 6 weeks <6weeks
peg tube ND nasoduedeanl tube if at risk of aspiration
27
need nutrition but cant use gi tract,
2 weeks or more or dex >10% central line, 2 weeks or less picc
28
Hyponatremia most common e abnormality determine and treat the cause eval includes
Urine NA- normal is 10-20
serum osmo 2xNA
Clinical status
29
hyponatremia urine
>20 renal salt wasting ie a kidney problem
| < 10 outside kidney
30
isotonic or psuedo hyponatremia
284-295 hiigh lipids, no symptoms, cut fat
31
fluid volume ranges
<280 is dry, 280-294 normal >290 is overloaded
32
hypernatremia cause and management
low volume
euvolemic
wet
145+ excess water loss,
dry- nss and 1/2 nss
nromal - free water
wet - free water and loop diuretics, may need HD
33
low K
| cause
>3.5 chronic use of diuretics, alkalosis , gi or renal loss
34
Low K sx
muscle weakness, constipation or illeus,
| flacid paralysis if <2.5 tetany hyperrelfexia and rhabdo
35
Low K on diagnostics
broad T, low amplitude EKG, prominent U waves, PVC, vtach or fib
36
Low K treatment
oral if >2.5
IV at 10meq/hr if cant do po
if <2.5 or with sx give 40 IV, check q3, fix the mag. (1.7-2.2)
37
High K >5 causes
renal failure, nsaids, excess intake, low aldosterone, cell death, acidosis
38
High K acidosis
ph drops .1 K increase 0.7
39
High K S and S
weak, facid paralysis
ab distention
diarrhea
40
labs K>5
peaked T but not all
41
K>5 management
kayexalate
| insulin 10uiv and and 1amp dex if >6.5
42
normal total ca
2.2-2.6mmol/L or 8.5-10.5mg/dl
43
normal ionized CA
1.1-1.4mmol/L or 4.5-5.5 mg/dl
44
if albumin is jacked up
use i calc cause it does not vary with serum albumin 3.4-5.4
45
50% of ca is bound to albumin so normal ca (2.2-2.6mmol/L or 8.5-10.5mg/dl) with low albumin <3.4
means that ca is high
46
ca <2.2 or 8.5 causes
hypoparathyroidism low mag >1.7, kidney failure, severe trauma, blood transfusion
47
management of ca .2.2 or <8.5
check ph looking for alkalosis
if acute IV calcium gluconate
if chronic - vitamin D, oral supplements, aluminum hydroxide,
48
CA >2.6 or 10.5 causes
hyper thyroid, vitamin D intox, prolonged immobilizaiton, rare with thiazide diuretics.
49
CA >2.6 or 10.5 S and S
fatigue, muscle weak, depression, aorxia, nausea, and emisis, sever >12 can lead to death. and is a medical emergency
50
CA >2.6 or 10.5 tx
calcitonin if poor cardiac or renal funciton
HD
if >12 loop diuretics and ns infusion
51
ca is opposite ie
low ca is up symptoms trusods - sustained carpal pedal spasm, cvostics wink or cheek, hi ca and ur sleepy
52
Resp acidosis
PH <7.35 and Pco2 >45
53
ph <7.35 and Pc02 >45 symptoms
sleepy, asteriskis myoclonus, increased csf pressure
54
Ph <7.35 and Pco2 >45 tx
narcan for pts with no obvious cause, 0.04 to 2mg, intubate or improve ventilation, up vent rate.
55
Resp alkalosis PH, >7.45 and pco2 <35
anxious, tingling, tetany if severe parastesia
56
resp alkalosis ph >7.45 and pco2 <35
serum bicarb is low if chronic, renal system wont kick in for a while
57
tx resp alkalosis,
retain more co2
58
metabolic acidosis hallmark sign is Bicarb below 22
yup
59
AG vs NAGM
NA + K - (bicarb+CL)
60
AG metabolic acidosis
DKA, alcoholic keto, lactic acidosis, drug or chemical reaction
61
Non anion gap acidosis
diarrhea, illy, renal tubular acidosis, dka recovery
62
AG metabolic acidosis treatment
fluid restriction, no bicarb repletion for hypoxia or dka, yes bicarb if significant hyperkalemia is present
63
non gap acidosis tx
common with chronic conditions like renal failure, treat with bicitral 10-30 with meals and hs
64
metabolic acidosis, high plasma hco3 >26 and Pc02 rarely above 55 (compensatinng) causes
post hypercapnea alkalosis,
ng suction
vomiting and diuretics
65
metabolic acidosis tx if salene responsive
correct volume deficit with nacl and kcl, discontinue diureticis, h2 blockers for nausea,
66
metabolic acodisis if cant replete with fluidis
acetazolamide 250-500mg IV every 4-6h
67
burns categories
1 dry no blisters epidermis only
2 moist blisters beyond epidermis
3 dry, black, down to fat or bone.
68
```
measuring extent of burn
arm
leg
thorax front
thorax back
head
perineum genitals
```
```
arm 9
leg each 18
thorax front 18
thorax back 18
head 9
perineum genitals 1
```
69
lund and broward chart for burns
most common, takes into account total body surface area according to age and area burned.
70
burns fluid recussitation calc
4ml/kg x tbsa during first 24 hours
71
burn fluid recussitation general rule
1/2 of all the fluid req during the first 24 hours, should go in within the first 8 hours, then 1/4 and 1/4 over the next 16
72
burns metabolic acidosis
seen early
73
burns and potasium
early is high, late is low and can happen up to three days out
74
burns and when to tube
face burns, singed eyes, dark soot in nares or mouth - indication is laryngeal edema
75
emergent burn managemnt,
submerge in water, no ice or lotion, wrap in clean dry towel, maintain normal temp 37-37.5 c, pain managemnt, fent and morphen, silvadine is used for abx
76
refer to burn center if
partial thickness over >10%of surface area, electrical or chemical burns, inhalation injury , third degree in any group.
77
cellulitus most commmon cause outpatient
group a strep strep pyogenes most common
staph a
other strepg group
78
abx for bite
augmentin ammox and clavulanate po 3-7days
79
cellulitis most comon inpatent
gram negs- ecoli, klebs, psudomonas, enterobacter
staph(mrsa)
strep
80
community associated mrsa
no fever - staph on foot, I&D culture and come backin 3
| boil + fever bactrim, doxy or clinda
81
group a strep
bactrim + beta lactam (pcn, ammox, or keflex)
or doxy/minocycline + ocn, ammox, keflex
clinda works alone,
82
solid ingestions
syrup of ipacac
83
gastric lavage in poisoing
lavge to clear then bind with charcole and sorbital to poop it out
84
ipicac never use
corrosivs, or detergents, emisis will erode esophogaus or lead to
85
benzo od
use flamozolil
86
aceytlcystine or acetaminophin or anacin-3 or panadol tox
asymptomatic early
RUQ pain
24hrs in nausea and emisis
hepatotoxiity
87
acetaminophen intox- tx
emisis for recent vs lavag and charcole
| N-acetylcystine or mucomyst with a loading dose po prn
88
asa tox s and s
nausea, tinnitis, dehydration, hyperthermia, apnea, met acodosis, elevated LFT
89
asa tox tx
emiss for recent vs levage and activated charcoe
| sodium bicarb to correct severe acodosis
90
insecticide tox (malathion, parathion
blurred vision and miosis
bradycardia
```
nausea emisis, cramps
diarrhea
salivation
headache
confusion
```
91
management of insecticide tox (ions)
wash skin charcole, atropine for organophosphate tox
92
antidepressant tox s and s
confusion, hallicunation, blurred vision, urinary retention,
hypotension, brady, dysrythmias, hypothermia, seizures
93
antidepressant tox managemtn
admit to ICU is cns or cardiac sx
gastric lavage and activated charcole
sodium bicarb to tx dysrythmias and hold ph
benzo for seizures
94
serotonin syndrome treatment
dantrium (dantrolene sodium) clonopin to treat rigor, cooling blankets for hyperthermia.
95
cocain pupils
big
96
heroin pupils
small
97
opiate od
narcan, emetics are contirindicated, lavage and charcole,, butorphanol
98
benzo od s and s
hyporeflexia and sleepy
99
benzo tx
Flumazenil (romazicon) IV breathing and bp support, gastric levage and activated charcole
100
BB od s and s
bronchospasm, hypo and brady delerium
101
BB od
charcole, glucagon, atropine, airway watch
102
transplant acute rejection
flu like prodrome plus immediate failure of the organ
103
transplant rejection first priority
call in expert for immediate biopsy of the organ
104
transplant meds classes
calcineurin inhibitor -tacrolimus or cyclosporine
antimetabolite- azathioprine Imuran or mycohenolate
steroids- prednisone
105
shingles
erythema and exudate alonge the dermatomal path grouped vesicles,
106
shingles tx
the ovirs, if eyes involved consult opthomolagist,
107
post herpetic neuralgia:
gaba, lyrica or neurontin,
108
actinic keratoses
small patches on sun exposed skin
premalignant- can progress to squamus cell
rough, flesh colored, hyperpigmented
freeze offf
109
squamous celll
arise out of AK, firm irregular pap or nodule, develop oer a few months
keratotic, scaly bleeeding
tx biopsy and mohs
110
seborrhec keratoses
benign
not painful
stuck on beigh brown or black
3-20mm in diameter
teatment maye none or liq nitrogen
111
basal cell ca
```
most common skin cancer
slow growing 1-2cm after years
waxy pearly or shiny red
centrel depression or rolled edge
may have telangietatic vessels
```
shave punch and surgical excision
112
malignant melanoma
highest mortality rate
median age at diagnosis is 40
may metastize to any organ
113
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A
B
C
D
E
```
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Asymmetyr
Border irregulairty
Color variation
Diameter >6mm
Elevation or enlargement
```
114
NMS cause, sypmtoms, priority treatment
antipsytotics, crazy high fever, fluids
115
best earlist lab sign of mal nutrition
pre- albumin 15 to 36 milligrams per deciliter (mg/dL) or 150 to 360 milligrams per liter (mg/L)
116
prolonged QT electrolyte imbalance
HYPO calcemia
