deck 39 Flashcards
impt complication of implantable pacemakers or cardioverter-defribillator placement
transvenous lead placement through the tricuspid valve can cause severe tricuspid regurg due to direct valve leaflet damage or inadequate leaflet coaptation
cause of SOB in pt with ascending aortic aneurysm
aortic regurg (can propagate proximally from site of intimal tear to involve the aortic valve)
other lab to order for new-onset AF
TSH + T4 to screen for occult hyperthyroidism
most common bugs for brain abscesses
viridans streptococci
staph aureus
gram-negative organisms
PE algorithm to remember
In patients with likely probability of acute PE, especially those in moderate to severe distress, need to anticoagulant BEFORE diagnostic testing (has been shown to decrease mortality risk)
peak airway pressure
- max pressure measured as tidal volume is being delivered
- = resistive pressure + plateau pressure
how to calculate PEEP
end-expiratory hold maneuver
plateau pressure
sum of elastic pressure and PEEP
elastic pressure
lung’s elastane X volume of gas delivered
aspiration pneumonitis
acute lung injury due to aspiration of acidic and sterile stomach contents (gastric acid induces a chemical burn and consequent inflammatory response)
presentation of aspiration pnuemonitis
- presents hours after aspiration event
- ranges from no symptoms to nonproductive cough, hypoxia, respiratory distress
- CXR infiltrates (one or both lower lobes)
radiograph of pseudogout
chondrocalcinosis (calcified articular cartilage) (the arthritis is caused by release of calcium pyrophosphate dehydrate crystals from calcification of articular cartilage into the joint space)
how to tell if you’ve overdiuresed someone
look at k (hypokalemia)
also see hypomagnesemia
timeline of amiodarone toxicity
can occur months to years after therapy
pulmonary presentation of amiodarone toxicity
interstitial pneumonitis – dyspnea + nonproductive cough + new reticular or ground glass opacities on CXR
acute optho complaint commonly seen in poorly controlled diabetes
ischemic oculomotor (CN III) palsy, presenting with “down and out” gaze + diplopia + normal pupillary response
CSF with guillain bairre
elevated protein + normal cell count (albuminocytologic dissociation)
complete heart block on ECG
- P waves unassociated with QRS complexes
- R-R interval constant and independent of P-wave occurrence
management of symptomatic third-degree AV block
- temporary pacemaker insertion while undergoing further evaluation to identify and correct reversible causes
painless thyroiditis presentation
acute thyrotoxicosis + mild thyroid enlargement + contender + suppressed TSH + decreased RAI uptake
pathophys of hypertensive heart disease
vascular remodeling –> impaired myocardial relaxation + increased LV wall stiffness –> increase in LV end-diastolic pressure
cardiac auscultation with AS
- soft second heart sound (thickening and calcification of the aortic leaflets leads to reduced mobility) (as a result of reduced mobility, A2 is delayed and occurs simultaneously with pulmonic valve closure leading to a single S2)
- mid to late systolic murmur with maximal intensity at the 2nd right intercostal space
cause of S2
aortic valve closure
why modify FiO2 on ventilator + what FiO2 should ideally be
Once patient is stable, need to reduce FiO2 ASAP below levels that predispose to yxgen toxicity (i.e. below 60%).
