Critical Care Flashcards
4 renal causes of acute abdomen
stones
RCC
pyelo
glomerulonephritis
pancreatic causes of acute abdomen
pancreatitis
pancreatic ca
3 gallbladder causes of acute abdomen
cholecystitis
choledocholithiasis
ascending cholangitis
2 hepatic causes of acute abdomen
hepatitis
cirrhosis
2 splenic causes of acute abdomen
rupture
infarct
3 gastric causes of acute abdomen
PUD/perforated ulcer
gastritis
GERD
intestinal causes of acute abdomen
obstruction
cancer
volvulus
appendicitis
gastroenteritis
ileus
hernia
mesenteric ischemia
diverticulitis
IBD
IBS
celiac
pelvic causes of acute abdomen
ovarian torsion
ectopic
ruptured ovarian cyst
PID
endometriosis
vaginitis
cystitis
tx for primary adrenal insufficiency (addisons)
- hydrocortisone
- fludrocortisone
t/f: fludrocortisone should be used for secondary adrenal insufficiency
f!
only for primary
tx for secondary adrenal insufficiency
pituitary adenoma resection
iatrogenic: wean steroids
presentation of upper GIB
hematemesis/coffee ground emesis
melena: black tarry stool
upper GIB’s originate proximal to the
ligament of treitz
6 causes of upper GIB
peptic ulcer
esophageal ulcer
mallory weiss tear
esophageal varices
malignancy
erosive esophagitis
odynophagia
GERD
dysphagia
esophageal ulcer
emesis, retching, or coughing -> hematemesis
mallory-weiss tear
odynophagia, dysphagia
retrosternal chest pain
erosive esophagitis
indications for blood transfusion
high risk pt: hgb < 9
low risk pt: hgb < 7
empiric tx for uppper GIB
IV PPI
hallmark presentation of lower GIB
hematochezia/BRBPR
6 causes of lower GIB
hemorrhoids
anal fissure
proctitis
polyps
colorectal ca
diverticulitis
painless bleeding w. wiping
hemorrhoids
severe rectal pain w. defecation
anal fissure
painless rectal bleeding
no red flag signs
polyps
increased IOP -> optic n damage decreased flow of aqueous humor thru trabecula -> increased pressure in anterior chamber
acute glaucoma
2 types of glaucoma
open angle - mc
angle closure - emergency
acute glaucoma triad
injected conjunctiva
steamy cornea
fixed, dilated pupil
sx of acute angle closure glaucoma
painful vision loss
tearing
n/v
diaphoresis
tx for acute angle closure glaucoma (4)
emergent ophto referral
IV acetazolamide
topical timolol
iridotomy
moa for acetazolamide
carbonic anhydrase inhibitor
med contraindicated in acute angle closure glaucoma
mydriatics
2 sx of open angle glaucoma
loss of peripheral vision
increased cup to disc ratio
management of angle closure glaucoma
ophto referral
1st line: latanoprost
timolol
acetazolamide
laser vs surgery
moa for latonoprost
prostaglandin analog
respiratory failure characterized by fluid collecting in the lungs and depriving organs of O2
ARDS
5 rf for ARDS
critically ill
sepsis - mcc
trauma
aspiration
near-drowning
hallmark presentation of ARDS (4)
-rapid onset of profound dyspnea 12-24 hr after precipitating event
-tachypnea
-pink frothy sputum
-crackles
CXR findings of ARDS
air bronchograms
bilat fluffy infiltrate
75% of episodes of cardiac arrest are caused by (2)
v tach
v fib
5 h’s of cardiac arrest
hypoxia
hypovolemia
hyperkalemia/hypokalemia
H+ (acidosis)
hypothermia
causes of cardiac arrest (5 t’s)
tamponade
tension ptx
toxins
thromboembolism
thrombosis
patient’s who are able to be resuscitated after cardiac arrest may have improved outcomes w. what treatment (2)
targeted temperature management
implantable defibrillator
what medication is contraindicated in stable, chronic diastolic HF
diuretics
decrease preload -> may further impair filling
how does morphine function in diastolic heart failure
reduces preload
how do nitrates work in diastolic heart failure
reduce preload O2
poor prognostic factors w. CHF
CKD
DM
lower LVEF
severe sx
old age
build up of fluid btw the pericardial sac and the heart that constricts the heart
cardiac tamponade
2 types of tamponade
-acute onset: trauma, MI, aortic dissection, pericardial effusion
-slow onset: cancer, chronic inflammation, uremic pericarditis, hypothyroidism, connective tissue dz
beck’s triad for cardiac tamponade
muffled heart sounds
JVD
hypotn
what is this showing
electrical alternans -> cardiac tamponade
hallmark PE finding of cardiac tamponade
pulsus paradoxus: 10 mmHg drop in SBP on inspiration
narrow pulse pressure
what is this showing
water bottle heart -> cardiac tamponade
tx for cardiac tamponade
pericardiocentesis
2 brainstem reflexes
pupillary light
eye movements
pathology behind pupillary light reflex defects
-anisocoria (asymmetric pupils): uncal herniation
-pinpoint pupils: narcotics, ICH
-bilat fixed, dilated pupils: severe anoxia
-unilateral fixed, dilated pupil: CN3 compression
what is the oculocephalic test
when head is turned to one side, eyes should move conjugately to the opposite direction if brainstem is intact
sure way to know brainstem is intact
pt can breathe on their own
how does DKA cause hypokalemia
insulin deficiency -> hyperglycemia -> dehydration -> ketonemia -> anion gap metabolic acidosis -> potassium deficit
hallmark labs of DKA
BG > 250
pH < 7.3
bicarb < 18
healthy pt w. fasting hypoglycemia
insulinoma
mc: adenoma of islet of langerhans
-sx of hypoglycemia usually occur at what BG level
-impaired brain fxn usually occrus at what BG leve
sx: <60
impaired brain fxn: <50
5 meds that cause hypoglycemia
FQ
quinine
ACEI
salicylates
bb
what is factitious hypoglycemia
self induced
mcc of postprandial hypoglycemia
gastric surgery
lifestyle management of postprandial hypoglycemia
small meals
increase complex carbs/fiber
reduce simple carbs
pharm for post prandial hypoglycemia
octreotide 30 min prior to meals
classifications of hypertensive crisis
urgency: >180/120 w.o organ damage
emergency: >180/120 w. organ damage
malignant: DBP > 140
malignant htn is associated w. (3)
papilledema
encephalopathy
nephropathy
tx for htn urgency vs emergency vs malignant
urgency: clonidine
emergency: sodium nitroprusside
malignant: hydralazine
in MI, troponin
appears at:
peaks at:
lasts:
appears: 2-4 hr
peaks: 12-24 hr
lasts: 7-10 days
in MI, CK/CK-MB
appears:
peaks:
lasts:
appears at: 4-6 hr
peaks at: 12-24 hr
lasts for: 48-72 hr
in MI, myoglobin
appears:
peaks:
lasts:
appears: 1-4 hr
peaks: 12 hr
lasts: 24 hr
management of MI
bb
NTG
asa + clopidogrel
heparin
ACEI
statins
PCI
management of MI
bb
NTG
asa + clopidogrel
heparin
ACEI
statins
PCI
timeline for 2 types of reperfusion in STEMI
- PCI w.in 90 min
- thrombolytics w.in 3 hr if PCI not available
causes of pleural effusion (lots!)
aortic dissection
heart failure
hypoalbuminemia
lymphatic obstruction
malignancy
radiation
renal failure
trauma
AI dz
acute pericarditis
myxedema
drugs
iatrogenic
idiopathic
ekg findings of pericardial effusion
low voltage QRS
electrical alternans
3 PE findings of PTX
decreased tactile fremitus
hyperresonance to percussion
diminished breath sounds
3 causes of secondary PTX
asthma
CF
ILD
management of PTX based on size
<15% diameter of hemithorax: resolve spontaneously
>15% diameter of hemithorax: chest tube
serial CXR q 24 hr
management of tension PTX
large bore needle decompression
pharm management of PE
acute: heparin
post acute: Xa inhibitors, DOACs
duration of anticoagulation with PE
reversible rf: 3 mos
unprovoked: 6 mos
2 episodes unprovoked: indefinite
s/sx of shock
weakness
hypotn
tachycardia
tachypnea
sweating
anxiety
increased thirst
anuria/oliguria
AMS
lactic acidosis
initial management of shock
fluid bolus (500-1,000 L NS vs LR)
pressors if hypotn persists depite fluids
4 types of shock
cardiogenic
hypovolemic
neurogenic
septic
2 types of hypovolemic shock
hemorrhagic
nonhemorrhagic
5 causes of non hemorrhagic hypovolemic shock
vomiting
diarrhea
dehydrtation
burns
third spacing
4 causes of neurogenic shock
SCI
head injury
spinal anesthesia
vascular tone
sz lasting > _ may result in permanent brain damage
60 min
thyroid storm is caused by (2)
graves dz
toxic multinodular goiter
5 precipitating factors for thyroid storm
infxn
trauma
embolism
DKA
preeclampsia
6 s/sx of thyroid storm
heat intolerance
palpitations
wt loss
tachycardia
anxiety
jaundice
why does jaundice occur w. thyroid storm
increased peripheral consumption of O2 -> hepatic tissue hypoxia
management of thyroid storm
bb
PTU vs methimazole
iodine
hydrocortisone
bile acid sequestrants (cholestyramine)
moa for PTU
inhibits conversion of thyroxine to triiodothyronine