Dale's Review Concepts III Flashcards
At what altitude do ppl start getting altitude sickness? What onset?
About 6500 ft, 6-10hr onset
What factors determine severity of altitude sickness
Rate & height of ascent
Prior Hx AMS & obesity
What height can ppl get acute mountain sickness (AMS)
< 6600ft
Pt has throbbing headache on side/back during a mountain ascent. They feel NVD, weak, and are breathing fast. What’s wrong?
What Rx?
Acute mountain sickness
Rx = acetazolamide (promotes metabolic acidosis) & descent
During an ascent, pt has SOB at rest, cough, tight chest, congestion, cyanosis w/ adventitious lung sounds. What’s wrong?
What Rx?
HAPE (high altitude pulmonary edema)
Rx = Pulmonary vasodilator (ex. Albuterol) , CPAP, & descent
During an ascent, pt has a change in mental status and has become confused. What’s wrong?
What Rx?
HACE (high altitude cerebral edema)
Rx = dexamethasone (8mg then 4mg/6hr)
During a dive, pt begins feeling drunk w/ AMS. What’s wrong?
What Rx?
Nitrogen narcosis (rapture of the deep) = AMS DT breathing compressed nitro
Rx = ascend & use better air mix next time
Why do pts feel drunk in nitrogen narcosis?
Nitrogen binds to the same brain receptors as ETOH
What gas law pertains to the pathophysiology of nitrogen narcosis?
Dalton’s law. Divers need to calculate what % of nitro vs O2 mix depending on depth of dive
What is barotrauma?
Gas pressure in body vs outside = compression or expansion injury
What parts of the body are very susceptible to barotrauma?
Sinuses, GI, lungs, stomach, skin, joints, ear
During ascent from a dive, pt experiences severe CP, sub Q emphysema, dysphagia, crackles in lungs w/ hemoptysis. What’s wrong?
What Rx?
Pulmonary Overpressurization syndrome (POPS) = most severe form barotrauma.
Rx = avoid PEEP. Be careful bagging. Give O2 & transport.
What are the complications of POPS
POPS result = alveolar rupture = possible pneumo, embolism, arterial gas embolism
Explain Arterial Gas Embolisms
Air bubbles from capillaries = MI or CVA
CVA = most common DT head being highest point in body
Any diver that has LOC or AMS following a dive, you must assume … what?
What Rx?
Arterial Gas Embolism (AGE)
Rx = L lateral poc, monitor, hyperbaric chamber
Following a dive, pt complains severe abdominal and joint pain, w/ mottled skin. What’s wrong?
What Rx?
Decompression sickness (the bends aka cassions disease)
Rx = hyperbaric chamber
How does decompression sickness affect the body? What gas law is it connected to?
Nitrogen bubbles out of your blood during an ascent (Henry’s law) and fucks w/ perfusion as well as the body.
What kind of people are at risk for experiencing decompression sickness (the bends)
Obese, dehydrated, flying after a dive
What are the 2 main families of snakes in the US?
- Crotalinae (pit vipers)
2. Elapidae (coral snakes)
What are the different types of pit vipers (crotalinae)?
Rattle, cottonmouth, diamondback
How can you differentiate a venomous coral snake from a harmless king snake?
“Red on yellow, kill a fellow” “red on black, venom lack”
Pt was bit by a snake, now has swelling, necrosis of wound, systemic bleeding, and coagulopathy. What kind of snake was it?
Pit viper (crotalinae)
Pt was bit by a snake, now has neuro seizures, paralysis, slurred speech, double vision, NV weakness. What kind of snake was it?
Coral snake
What general Rx for a snake bite?
IV, monitor, antivenin, clean & immobilize wound below heart level (minimize movement)
Pt was bit by a snake, now has pain, muscle spasms and seizures, paralysis w/ board like abdomen. What spider bit them?
What Rx?
Black widow = neuro SS
Rx = calcium gluconate w/ a benzo
Pt has bit by something less than 2 days ago. Now has scabbing and necrosis of wound site. What bit them?
What Rx?
Brown recluse spider
Rx = supportive Rx & transport. Definitive Rx = surgical debridement
Pt has hx being outside in hot, humid weather. Now has muscle spasms in legs & abdomen. What’s wrong? What Rx?
Heat cramps
Rx = restore salt and fluids (crackers & Gatorade)
Following several hours outside in hot, humid weather, pt CC syncope. What’s wrong?
What Rx?
Heat syncope (vessels dilate & BP drops DT heat stress)
Rx = supine position & fluids
Pt has Hx being outside in hot/humid weather now complains weak, NVD, positive orthostatic, mildly elevated temp, sweat skin. What’s wrong?
What Rx?
Heat exhaustion
Rx = supine, fluids, passive cooling.
What’s EAH? What Rx?
Exercise-associated hyponatremia = heat exhaustion where pt sweats & restores fluids but not sodium.
Rx = hypertonic w/ passive cooling
After a sporting event outside in hot humid weather, pt complains SOB, NVD, weakness w/ pulm edema. What happened?
Exercised - associated hyponatremia (EAH). Pt over compensated w/ drinking excessive water = fluid overload = pulmonary edema
What’s the difference between a classic vs exertional heatstroke?
Classic = passively overheat (dry red hot skin)
Exertional = actively overheat = pale sweaty skin
Following a hot day, pt has hot skin, AMS, CBT > 104F, bounding pulse. What’s wrong?
What Rx?
Heat stroke
Rx = rapid cooling, target 102F or lower temp, fluids, BGL, prep for seizures/rhabdomyolysis
Heat stroke can mimic what other emergencies?
Sepsis, fever, infection, anticholinergic OD
How to differentiate anticholinergic OD vs heat stroke
Anticholinergic OD = dilated pupils
Heat stroke pupils = pinpoint
What is neuroleptic malignant syndrome?
Antipsychotic & antiemetic meds cause heat stroke
What is malignant hyperthermia?
Anesthesia meds (Succ) causes heat stroke
What is somatic/parietal pain?
Localized & intense pain
*think: somatic = soDRAmatic
What is visceral pain?
Poorly localized, diffused
*think: visceral = viscerALL-over pain
You suspect pt has ICP. What SS to look for?
Cushings reflex: Bradycardia, HTN, Cheyenne stokes respirations
Pts w/ head injury becomes hypoxic DT lack of…
Lack of minute volume
Trauma pt shows Cushings reflex, Cheyenne-stokes, vomit w/ no nausea. What severity of ICP do they have?
Mild
Trauma pt shows biot respirations, blown pupils, flaccid paralysis… what severity of ICP do they have
Severe
Trauma pt has Cushings reflex, Central neurogenic hyperventilation, decerebrate posturing… what severity of ICP do they have?
Moderate
Pt has too much cortisol in their system DT a tumor or gland issue. What endocrine disease do they have?
Cushings disease
Pt complains weakness, depression, irritable mood, polydipsia polyuria, high BGL, weight gain, moon face/Buffalo hump, stretch marks. What’s wrong?
Cushings disease
Pediatric pt is in sniffing position, CC SOB: stridor, drooling, high work of breathing. Pt has previous Hx upper Resp infection. What’s wrong?
What Rx?
Epiglottitis
Rx = humidified O2, keep them calm, nothing in mouth, ask about Hib vaccine
Your epiglottis pt is rapidly decompensating and you anticipate intubation. How would you prepare?
Drop 1-2 sizes BELOW recommended size
What age kids typically get epiglottitis?
2-7Yrs
What’s the fancy medical name for croup
Laryngotracheobronchitis
Pt has stridor, seal bark cough, cold SS, low grade fever, work of breathing (worse at night). What’s wrong?
What Rx?
Croup (laryngotracheobronchitis)
Rx = expose to extreme air, no humidified O2, racemic epi, steroids, prepare BVM & ETT
During labor, mom suddenly feels a sharp tearing pain in her pubic area. You are now able to see an outline of the fetus through mom’s belly. What happened?
What Rx?
Ruptured Uterus
Rx = treat for shock and transport
Female pt complains severe pn during & after period, fetal position, shuffle gait, smelly discharge. What’s wrong?
What Rx
PID
Rx = transport
What is PID and who gets it usually?
Infection of women’s reproductive organs. Mostly sexually active girls <25 yrs
What are the risk factors for PID?
STDs, IUD, douching, abortion, multiple sex partners
What are the complications of PID?
MODS, sepsis, abscesses, infertility, ectopic pregnancy
Pt is anxious w/ NV thirst, SOB, weak rapid pulse, cool clammy skin. Compensated or decompensated shock?
Compensated. Pt will be altered not anxious.
How are skin signs different between compensated vs decompensated shock?
Compensated = cool clammy
Decompensated = ashen/mottled, cyanotic
Pt has no urine production, dilated pupils, thready pulse, hypotension. Compensated vs decompensated shock?
Decompensated shock
Pericardial tamponade, aortic dissection, PE, tension pneumo… all are what singular type of shock are they in?
Obstructive shock
What are the three types of distributive shock?
Anaphylaxis, neurogenic, septic
Distributive shock = ____ failure
Pipe failure
What is the medical word for a bladder infection
Cystitis
How do people usually get cystitis?
Bacteria from taint travel up urethra
Untreated cystitis can eventually spread upwards to the kidneys. What is this called?
Pyelonephritis
What is pyelonephritis and why is it serious?
A kidney infection secondary to an untreated bladder infection. Pt risks losing their kidney
Pt complains cloudy, painful urine. Pt has hematuria & polyuria, w/ Hx fever. What’s wrong?
Cystitis
What defines a 1st degree heart block?
No dropped QRS complexes, but prolonged PRI (normal = 0.12-0.20s)
Second degree type I vs Type II heart blocks?
Type I (wenchbach) = progressively longer PRI then dropped QRS
Type II = consistent PRI then dropped beat
2nd degree heart blocks are commonly caused by what location of MI?
Anterior/anteroseptal wall MI because it supplies the AV node
Geriatric pt has CC: dizziness, syncope, palpitations, w/ ECG that alternates between Bradycardia & tachycardia. What’s wrong?
What Rx?
Sick sinus syndrome
Rx = pacemaker
How can you tell if someone has a 3rd degree heart block?
QRS complexes are regular, P waves are also regular but neither of them sync up
What is Prinzmetals angina? What is another name for it?
AKA vasospastic angina = angina/CP DT coronary arteries spasming
How can you assess for L side hypertrophy on a 12-lead?
V1 or V2 (biggest S depth) + V5 or V6 (biggest R height) = >7 boxes
How can you assess for R side strain on a 12-lead ECG?
S1QT3
Also, V1 = R wave > S wave
How does ICP present on a 12-lead?
ICP = cerebral T waves = deep inverted symmetrical T waves on V-leads & prolonged QT interval
What do alpha 1 receptors do?
Vasoconstriction of arteries & veins
What do alpha 2 receptors do?
Less insulin/norepi
More glucagon
What do Beta 1 receptors do?
More Heart stuff (ino/chromo/dromotropic)
Renin
What do beta 2 receptors do?
Bronchiole relaxation/dilation
More insulin
Uterine relax
Arterial dilation of some organs
What’s Brugatta syndrome
Rare genetic heart disease w/ sodium channel issue = syncope or Cardiac arrest occurs in their 40-50s
You suspect your geriatric syncope pt to have brugatta syndrome. How to assess?
Incomplete RBBB (rSR pattern in V1, QRS
What’s babinski’s sign?
Fanning toes when heel is stroked w/ pen = upper motor neuron damage
What’s brudinski’s sign?
flex the neck = knees flex up
Sign of meningitis
*think: Brudinski sounds Russian. Russians do sit ups
What’s kernig’s sign
Cant straighten & pull leg up = meningitis
*think: kernig… Kermit the frog is a puppet, cant lift His leg up
What’s eyelash sign
No movement when stoke eyelash = no gag reflex
What’s joffroy’s sign
No forehead wrinkles when eye brows raise DT fluid buildup under forehead = Graves’ disease
Cullens vs grey turners sign
Grey turners = flank bruising = kidney injury
Cullens = belly button bruising = ab internal bleeding
*think: grey TURN to your SIDE
What’s Rovsing’s sign
Pn on RLQ when pushing on LLQ = appendicitis
What’s hamman’s sign
Crunching sound in heart when auscultation = pneumopericardium or mediastinum
What’s kussmaul’s sign
Bilateral or paradoxical increase in JVD during inhalation = COPD
What’s Levine’s sign
Levine’s sign = clutch chest = MI
What’s trousseaus sign
When BP on arm squeezes, wrists spasm DT hypocalcemia
What’s exophthalmos
Bulging eyeballs = Graves’ disease
What’s kehrs sign
Pn in L shoulder (& ab pn) = ruptured spleen
What’s another term for false labor contractions
Braxton hicks contractions
What’s Lloyds sign?
Pn when tap over kidneys = possible kidney stone or pyelonephritis
What’s McMurray’s sign
Rotate ankle internally & hear clicking sound in knee = meniscus tear
*think Murray .. MurrANKLE
What’s the Romberg’s test
When you stand up & close your eyes = lose balance = neuro proprioception deficit
*Think Romberg. Ron burgandy cant keep his balance
What’s Homan’s sign
If possible DVT, Dorisflex foot = calf hurts where Thrombus is
Which endocrine disease has the moon face and the buffalo hump? Why is that?
Cushings. Excess stress hormone = excess fat storage in back hump and face
What’s Bell’s palsy
Lesion on cranial nerve VII (facial) = face droop
Pt has brown/dark red lines going up their finger nails. What condition do they have? What is this called?
Splinter hemorrhage = endocarditis
Pt has clubbed finger nails. What does this tell you?
COPD (chronic hypoxia)
If a pt has white finger nails, what does this mean?
Anemia
Pt has a thick black/purple vertical streak up their finger nail. What’s wrong?
Nail bed cancer
What skin disease/condition is associated with aids?
Kaposi sarcoma
What’s Dahls sign?
discolored/thick skin at elbow & knees DT chronic tripod position from COPD.
*think: strippers get on their knees for DAHLERS $
What’s Thompson’s sign
Grab the calf & squeeze = foot will move. No foot movement = Achilles’ tendon rupture
Pt has an “atrogenic” injury. What does this mean?
It was caused by the doctor/hospital
What’s the principle source of hydration in the body?
Food
What does the cation Calcium do?
Stabilizes cell membrane for impulses & muscle contractions
Oropharynx + Nasopharynx = ?
Laryngopharynx
What’s spasmatic croup
Quick onset croup that dissipates <2 hours w/ no fever
You can’t tell if your pt has anaphylaxis vs asthma. Would benedryl help or hurt the pt?
Benedryl exacerbates asthma by drying out membranes & increasing overall mucous
Classic signs of shaking baby syndrome
Detached retina & brain trauma
What is sinus dysrhythmia? (HR?)
Exhale = slower HR, inhale = faster HR DT intrathoracic pressure
HR = 60-100
Wandering Atrial Pacemaker (HR, rhythm, P wave, PRI)
HR <100, irregularly irregular w/ @ least 3 P wave Morphologies
Common in kids, old people & athletes
What is MAT (HR, Rhythm, Pwave)
Multifocal atrial tachycardia = 100+, irregularly irregular w/ @ least 3 P wave morphologies.
Common in terminal COPD/lung disease pts
How do you know a rhythm is SVT? What about in kids and infants?
Fast narrow, regular
Adult = +150bpm Kid = +180bpm Infant = +220bpm
How do you know a rhythm is atrial flutter?
Usually Regular w/ a ratio (atrial = 300, ventricle = variable) and Saw teeth (F waves)
How do you know if a rhythm is A-fib
It’s irregularly irregular; can’t tap your feet to it
PVC vs PAC vs PJC
*all occur earlier
PVC = wide QRS w/ no p wave
PAC = narrow QRS w/ different shaped p wave
PJC = inverted or no p wave w/ narrow QRS
What’s a Junctional escape rhythm
Beat occurs longer than normal rhythm w/ no p wave
Junctional rhythm vs accelerated junctional vs junctional tachycardia
They all look the same (inverted or no p wave / narrow QRS). except HR…
Junctional = 40-60
Accelerated junctional = 60-100
Junctional tachy = >100
Sinus block vs sinus Arrest vs sinus pause
Sinus block = no pwave or beat but unbroken P-P interval
Sinus pause = no pwave/beat w/ broken P-P interval
Sinus arrest = longer sinus pause
How can you tell if a rhythm is Idioventricular?
Regular rate of 20-40Bpm w/ wide QRS no pwave
How can you tell if a rhythm is Ventricular Tachycardia?
Rate 110-250 regular w/ wide QRS (often > .16s) and no Pwave
What constitutes a STEMI?
ST elevation in 2+ contiguous leads or new/suspected LBBB
How to diagnose a LBBB
Both BBB Look at I, V1, V6
LBBB
- QRS > 0.12s
- I & V6, wide monomorphic R wave
- V1 wide monomorphic S wave
How to diagnose RBBB
Both BBBs Look at I, V1, V6
RBBB=
- QRS >0.12s
- I & V6 = slurred S wave
- V1 = RSR pattern
How to determine axis deviation in a 12-lead
Look @ QRS in Lead I & avF
R hand = I, L hand = avF
Pos. = thumb up, Neg = thumb down
Both ++ = normal
Both neg = extreme right
Turn towards thumb = R or L deviation
What conditions can mimic a STEMI
LBBB Percarditis Brain bleed Brugada syndrome Paced rhythm
What’s the average cardiac output? Average minute volume?
CO = 4.9-5L blood
Minute vol = 5-6L
How big are the capillaries?
Only 1 cell thick
Fluids from the lymphatic system empty into the…
Subclavian vein
Average tidal volume is 500ml. How much of that actually reaches the alveoli?
350mL. 150mL is dead space
Where is the base vs apex of the heart?
Base = top
Apex = bottom
What’s it called when there’s fluid in the pleural space of the lungs?
Pleural effusion
The endocardium (inner heart layer) secretes chemicals that do what?
Chemicals to increase contractility
What’s starling’s law?
Muscle contracts more powerfully when pre-stretched
What is the foramen ovale?
Hole between atriums to bypass lungs. Found in fetus
What is the “cardiac skeleton”?
Dense connective tissue in heart that the valves attach to
Coronary sinus vs coronary sulcus?
Sinus = large coronary vein drains blood from coronary arteries back into R atrium
Sulcus = separates atrium vs ventricles
Pulmonary edema = Number one sign of…
L ventricular failure
What do S3 & S4 indicate?
S3 = CHF or high school kids
S4 = MI or failure
What is rheumatic fever? How does it affect the heart?
Rheumatic fever = scarlet fever
Autoimmune response = inflammation of heart = most common cause of valve problems
Coronary arteries fill during what contraction phase?
Diastole
What is anastomosis
Aka collateral circulation.
Interconnections between coronary arteries that help bypass a clot
The membrane of a cardiocyte is always positive or negative?
Positive
Intrinsic rates of SA node, AV node, Purkinje fibers
SA = 60-100
AV = 40-60
Ventricles = 20-40
Where is the cardiac plexus located at?
Next to aorta
Muscarinic type II receptors are located where and do what?
Located in SA node for parasympathetic stimulation
Sympathetic NS is AKA …
Adrenergic system
Parasympathetic NS is AKA …
Cholinergic system
Prinzmetals angina is often caused by what defect? How do we Rx?
Defect in Calcium channels
Rx = calcium channel blocker
What’s the significance of a pathological Q wave?
Yes Q wave = transmural (full thickness MI)
No Q wave = MI normally in subendocardial tissue
What’s wellens syndrome
Predicts imminent MI:
Deeply inverted T waves in V2 & V3 (LAD stenosis)
What’s the cardiac notch?
Pocket in the L lung where the heart sits
What’s the muscle cell of the heart called?
Cardiomyocyte
What’s the fossa ovalis?
Depression in interatrial septum where the foramen ovale used to be
What is the pulmonary trunk?
Large arterial vessel carries blood from R ventricle
What is the polarity of aVF (positive vs negative end)
Looks straight down
Positive = L foot
Neg = between R & L arms
What is the polarity of aVL? (Positive vs negative lead placement)
Looks up towards L hand
Positive = L hand Negative = between R hand & L foot
What is the polarity of aVR? (Positive vs negative lead placement)
Looks towards R hand
Positive = R hand
Negative = between L hand & L foot
