Critical care Flashcards by Briana Echols

What is Addisonian crisis?

worsening of diagnosed or undiagnosed chronic adrenal insufficiency precipitated by a stressful even

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What is the MC cause of Addison crisis?

abrupt withdrawal of steriods

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What lab values are seen in adrenal crisis?

hyponatremia
hypoglycemia
hyperkalemia

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What is the tx for adrenal crisis?

Normal saline/D5N5 + IV hydrocortisone (Dexamethasone)

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Cloudy “steamy” cornea, mid-dilated fixed pupil?

acute narrow angle closure glaucoma

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What is the txt for acute angle glaucoma?

Topical (Timolol, Pilocarpine) + systemic lower intraocular pressure (PO or IV Acetazolamide or IV mannitol)

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What is the definitive txt for acute angle glaucoma?

Iridotomy

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What is the consequence of untreated glaucoma?

optic nerve damage

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What is seen on chest xray for ARDS?

bilateral diffuse pulmonary infiltrates

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What is the difference between findings in CHF and ARDS?

ARDS spares the costophrenic angles

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What is the pulmonary capillary wedge pressure in ARDS?

< 18 mmHg

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What is the txt for ARDS?

Mechanical ventilation + txt underlying cause (low tidal vlm and CPAP)

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What causes 75% of cardiac arrest?

V-tach

V-fib

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What is the txt for cardiac arrest?

CPR and defibrillation

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What is the definitive txt for cardiac arrest?

implantable cardiac defibrillator

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What intervention may improve outcomes in cardiac arrest?

temperature management

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T/F the rate of accumulation of fluid in cardiac tamponade is less critical than the volume?

False

more critical

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What is Beck’s triad seen in?

cardiac tamponade

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Beck’s triad?

decreased heart sounds
increased JVP
hypotension

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What pulse phenomenon is seen in Beck’s triad?

pulsus paradoxus

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What is seen on echo for cardiac tamponade?

pericardial effusion + diastolic collapse of cardiac chamber

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TOC of cardiac tamponade?

pericardiocentesis immediate

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MC cause of diabetic ketoacidosis?

infection

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What 2 things are seen on PE for DKA?

fruity acetone breath, Kussmaul signs

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What anion gap is seen in DKA?

metabolic acidosis

What is the txt for DKA?

``` SIPS Normal saline (0.9%) Insulin Potassium Search for underlying cause ```

What is the most important level to measure to determine the severity of DKA?

Bicarb

What electrolyte should be consistently checked in DKA?

K+ (due to hypokalemia)

Who is Hyperosmolar hyperglycemic usually seen in?

Type II DM

T/F HHS is usually associated w/ severe ketosis or acidosis?

False

Txt for HHS?

Saline Insulin Potassium Search for underlying cause

What is the most important txt for HHS?

Saline

Serum glucose is usually over ?? in HHS?

>600

What glucose level is consider hypoglycemic?

<70mg/dl

Txt for mild/moderate hypoglycemia?

15-20g of fast acting carb, fruit juice, hard candy

Txt for severe hypoglycemia?

IV bolus of D50 or IV glucagon

Txt for hypertensive urgency?

Oral meds (Clonidine, Captopril, Labetalol, Nicardipine, Furosemide)

What is the blood pressure txt goal in hypertensive urgency?

160/100

Txt for hypertensive emergency?

IV Sodium Nitroprusside

What is Malignant hypertension?

Diastolic reading > 140 associated with papilledema and either encephalopathy or nephropathy

Txt for malignant hypertension?

Hydralazine

What is the targeted door to PCI time in MI?

<90 mins

What is the targeted door to thromboloytic time in MI?

<30mins

What thrombolytic is used in a MI?

Clopidogrel

What is the MC cause of pericardial effusion?

lung cancer

TOC for pericardial effusion?

echocardiogram

What is seen on ECG for pericardial effusion?

electrical alternans and low voltage QRS complexes

Txt for pericardial effusion?

txt underlying cause (pericarditis) | pericardiocentesis

What is seen on PE for pneumothroax?

hyperresonance to percussion decreased fremitus decreased breath sounds

What might be seen on Chest xray in a pneumothorax?

companion lines

What is the txt for small spontaneous pneumothorax?

observation + oxygen

What is the txt for large spontaneous pneumothorax?

needle or catheter aspiration

What is txt for stable secondary pneumothorax?

chest tube or catheter thoracostomy

What is txt for tension pneumothorax?

needle aspiration followed by chest tube thoracostomy

Patient education for pneumothorax?

avoid pressure changes for 2 weeks

Tall thin man with Marfan is at risk for what?

spontaneous pneumothorax

What is Virchow's triad?

Intimal damage Stasis Hypercoagulability

What is the MC symptom of PE?

dyspnea

What are symptoms of PE?

Dyspnea, pleuritic chest pain, hemoptysis (rare)

What is the MC abnormal finding in PE?

Atelectasis

What EKG change is most specific for PE?

S1Q3T3

What is the best initial test to confirm PE?

helical spiral CT angiography

What is the gold standard test for PE?

pulmonary angiography

Which test is used in pts with a PE when CT can't be preformed?

V/Q scan

In a hemodynamic stable PE what is 1st line therapy?

anticoagulation (heparin bride plus warfarin)

Who recieves IVC filter in PE?

- anticoag is contraindicated - anticoag is unsuccessful - RV dysfunction is seen on echocardio

Txt for unstable PE pts?

Thrombolysis or thrombectomy or embolectomy

What is hampton's hump?

wedge shaped infiltrate due to infarction

What is westermark's sign?

avascular markings distal to PE

What is PE prophylaxis?

early ambulation elastic stockings/ compression LMWH

What is the difference between a focal simple or complex seizure?

consciousness

What type of seizure is repetitive behaviors such as lip smacking, facial grimacing seen in?

focal partial seizures

What is the most common seizure seen in childhood?

absence petit mal

What is seen on EEG for absence seizures?

bilateral symmetric 3 Hertz spike and wave activity

Txt for absence seizures?

Ethosuximide

2nd line txt for absence seizures?

Valproic acid

Long term txt of Grand mal seizures?

Levetiracetam and Lamotrigine (preggo)

What classifies as a status epilepticus?

seizures > 5 mins or >1 seizure within 5 min w/o recovery

Initial TOC for status epilepticus?

Benzo (Lorazepam)

2nd line TOC for status epiplepticus?

Phenytoin

3rd line TOC for status epilepticus?

Phenobarbital

What if all 3 txt failure in status epilepticus?

use sedation (Midazolam and Propofol)

1st line txt for generalized seizures?

Lorazepam

A "drop attack" is seen in which type of seizure?

Atonic seizure

Symptoms of thyroid storm?

palpitations, tachycardia, atrial fib, fever, tremors, delirium

Txt for thyroid storm?

IV fluids + Propranolol + antithyroid med (PTU) + IV glucocorticoids

What med should be avoided in thyroid storm?

Aspirin

What txt comes after the initial txt in thyroid storm?

oral or IV sodium iodide

Gold standard for dx acute angle glaucoma?

Gonioscopy

Honeycombing of the lung parenchyma?

Idiopathic pulmonary fibrosis