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critical care 1 > Ecclectic > Flashcards

Ecclectic Flashcards

1
Q

4 types of cardiomyopathies

A

Dilated
Hypertrophic
Stress/Takotsubo
Restrictive

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2
Q

definition of dilated hypertrophy

A

less than 40% EF in the presence of increased left ventricular end-diastolic volume

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3
Q

difference between dilated & hypertrophic cardiomyopathy

A

NO HYPERTROPHy IN DILATED CARDIOMYOPATHY!

(DOES HAVE: less than 40% EF and increased left ventricular end-diastolic volume.

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4
Q

pathology: dilated hypertrophy

A

chamber enlarges (w/o hypertrophy) , the myocardial fibrils overstreatch, and their ability to effectively contract is impaired

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5
Q

progression of dilated hypertrophy

A
  1. weakened contractility r/t weakened myocardial fibrils
  2. decreaed CO b/c can’t effectively eject blood forward which creates backwards pressure
  3. pulmonary/systemic congestion from backward pressrue
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6
Q

what happens when contractility decreases?

A

SNS/baro & chemoreceptors/RAAS to compensate

ALL TO PRESERVE CO & TISSUE PERFUSION!

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7
Q

vessel diameter & afterload

A

vasoconstriction increases afterload

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8
Q

RAAS activation & hemodynamics

A

RAAS increases preload (augments SV/CO) and afterload but over time, the increased workload leads to a oxygen demand increase

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9
Q

s/s of dilated cardiomyopathy

A

causes systolic dysfunction so they show s/s of heart failure (pulmonary *& systemic

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10
Q

common EKG w/ dilated left ventricle

A

LBBB

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11
Q

s/s of hypertrophic cardiomyopathy

A

SOB
CP
palpitations
syncope

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12
Q

SOB
CP
palpitations
syncope

A

s/s of hypertrophic cardiomyopathy

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13
Q

definition: hypertrophic cardiomyopathy

A

hypertrophy limited to the left ventricle only (dilated cardiomypathy can be any chamber) & it isn’t dilated
*leading cause of sudden cardiac death in young adults & causes outflow obstruction
DIASTOLIC DYSFUNCTION

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14
Q

most common reason for sudden cardiac death in young adults

A

hypertrophic cardiomyopathy

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15
Q

treatment goals for hypertrophic cardiomyopathy 4

A

improve ventricular filling
optimize SV
reducing obstructions to ventricular ejection
reducing risk of sudden cardiac death

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16
Q

what type of problem is dilated versus hypertrophic cardiomyopathy

A 
dilated = systolic disfunction (HF under 40%)
hypertrophic= diastolic. leading cause of sudden cardiac death in young adults
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17
Q

rx for hypertrophic cardiomyopathy

A

BB & CaChB b/c it will improve diastrolic dysfunction to increase ventricualr filling and optimize SV

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18
Q

rx that decreases ventricular wall tension

A

CaChB

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19
Q

rx to avoid in hypertrophic cardiomyopathy

A

anything that increases or decreases afterload

*problem b/c they decrease CO by increasing outflow obstruction

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20
Q

why do you give a BB for hypertrophic cardiomyopathy

A

b/c it will decrease HR & contractility which will improve her s/s

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21
Q

definition: stress induced cardiomyopathy

A

non-ischemic cardiomyopathy caused by a suden tempoary dysfunction of hte myocardiou
*possibly r/t ANS and exxcessive release of adrenalin

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22
Q

takotsubo

A

aka stress induced cardiomyopathy
aka broken heart syndrome
b/c the characteristic bulging of the LV apex w/preserved function of hte base looks like the octopus pot = takotsubo

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23
Q

prognosis of stress induced cardiomyopathy

A

unique b/c it is sudden, tempoary, and the heart returns to normal function in 2 months

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24
Q

5 treatment priorities for stress induced cardiomyopathy

A 
optimize fluid
minimize myocardial oxygen demand
decrease afterload
prevent complications
monitor for dysrhythmias
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25
Q

3 potential complications of stress-induced cardiomyopathy

A

low bp
cardiogenic shock
chronic HF
*fast onset so heart can’t compensate for rapid decrease in function

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26
Q

what type of dysfunction is restrictive cardiomyopathy

A

diastolic b/c rigid walls so can’t expand to fill

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27
Q

s/s of restrictive cardiomyopathy

A

fatigue
weak
acrivity intolerance
s/s of congestion

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28
Q

Long QT syndrome

A

repolarization disorder

*risk torsades & sudden cardiac death

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29
Q

QTc

A

QT corrected. QT measurement corrected to the ventricular HR changes

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30
Q

5 types of rx that cause Long QT

A 
antiemetics
ABX
antidepressants
antipsychotics
antidysrhythmics

*low K or low Mg, bradydysrhythmisas, subarachnoid hemorrhages

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31
Q

how to measure Long QT

A

beginning of QRS to end of T

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32
Q

normal QTc

A

QT intervals by HR so it must be “corrected” for HR.

*0.44 seconds are less

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33
Q

risk of Long QT

A

ventricular arrythmias

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34
Q

do not do if snake bite

A

NO tourniquet!

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35
Q

complications of snakebite -4

A

coaguloathy
high RR/HR
oral numbness

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36
Q

treat scorpion bite

A

Anascorp

OR: benzo & atropine

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37
Q

s/s of scorpion bite

A 
mild = pain/paresthesia
severe = cranial nerve dysfunction (abnormal ocular movements) & neuromuscular dysfunction
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38
Q

blood tests arffected by heat injuries

A

increased Hct

increased BUN

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39
Q

IVF for heat injuries

A

NS b/c often already low Na

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40
Q

urine in heat injuries

A

incresed specific gravity
ketones
more concentrationed b/c fluid loss

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41
Q

how to labs/urine look in heat injuries

A

reflect concentration b/c fluid loss

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42
Q

3 types of heat related injuries

A

cramps
exhaustion
stroke

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43
Q

ABG in hyperthermia

A

respiratory alkalosis b/c hyperventilation (blow off CO2)

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44
Q

difference between heat exhaustion & heat stroke

A

exhaustion = no neuro impairment
stroke = AMS
*DO NOT NEED TO STOP SWEATING IN ORER FOR IT TO BE heat stroke!

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45
Q

mild hypothermia range

A

90-95F

32.2 to 35C

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46
Q

core temp that = hypothermia

A

under 35C/95F

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47
Q

when does shivering stop

A

temps below 32C/89.6F

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48
Q

hallmark sign of hypothermia

A

paradoxical undressing r/t delirum

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49
Q

IVF temperature to rewarm

A

39C/102.2

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50
Q

risk of rewarming

A

afterdrop = return of cold blood to the core

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51
Q

EKG in hypothermia

A

osborn wave/j wave

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52
Q

osborne wave

A

EKG in hypothermia

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53
Q

cause of dysrhythmias in hypothermia

A

increase in lactate & K

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54
Q

mamillian diving reflex

A

causes HF to drop to 10-25% . slowing down the HR allows the herat/brain to consumew less oxygen so you can stay under water for a longer period of time
**apnea/bradycardia

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55
Q

needed s/p drowing

A

watch for: hypothermia & spinal immobilazation & increase PEEP & bronchospasm w/beta2 agonsit
vasoC to maintain CPP

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56
Q

initiate ventilation if drowing

A

widespread atelectasis & pulmonary shunt possible

increase PEEP: treat bronchospasm with beta2 agonist

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57
Q

when can you fly s/p diving

A

12hrs later

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58
Q

goal of giving oxygen s/p decompression sickness

A

promotes nitrogen washout

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59
Q

aka diving associated barotrauma

A

POPS = pulmonary overpressurized syndrome

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60
Q

where do the greatest pressure changes occur

A

4ft belwo surface

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61
Q

pt looks like they are having a stroke s/p diving

A

arterial gas embolism

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62
Q

pt has a nosebleed s/p diving

A

arterial gas embolism

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63
Q

flying s/p diving complications like decompression sickness & arterial gas embolism

A

pressurized cabin or rotary wing under 1K ft

**ground transportation is preferred

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64
Q

HAPE

A

high altitude pulmonary edema

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65
Q

s/s of HAPE

A 
rales
elevated: HR, RR
SOB at rest
fever
nonproductive cough w/pink frothy spuntum
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66
Q

vitals in HAPE

A

elevated HR/RR
SOB at rest
fever

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67
Q

treat HAPE

A 
descend
supplemental O2
CPAP
yperbaric
nifedipine to promote pumlonary vascularture dilation
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68
Q

Rx for HAPE

A

nifedipine to vasoD

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69
Q

HACE

A

high altitue cerebral edema

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70
Q

what altititude sickness occurs the latest

A

HACE = high altitude cerebral edema

up to 5 days later

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71
Q

trigger for HACE

A

after 5 days of sustained high altitude over 12kFt

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72
Q

s/s of HACE

A

AMS
ataxia
visual changes
coma

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73
Q

treatment of HAPE

A 
descend 
oxyten
NO DIURETICS
hyperbaric
dexamethasone
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74
Q

rx for HAPE

A

dexamethasone

NO dieuretics!`

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75
Q

bruise behind ear

A

battle sign

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76
Q

Bruddzinski sign

A

flex neck results in flexed hip

meningitis

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77
Q

sign in pelvic fracture

A

Coopernail’s sign

ecchymosis of perineum around scrotum/labia

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78
Q

bluish discoloration around U

A

Cullen’s sign

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79
Q

sign seen in ectopic

A

cullen’s

80
Q

sign in ICP/herniation

A

Cushing’s triad

81
Q

Cushing’s triad

A

HTN
wide pulse pressure
bradycardia
irregular respirations

82
Q

sign in pancreatitis

A

Grey-Turner

83
Q

discoloration around the flank

A

Grey-TUrner

flank discoloration

84
Q

Hamman’s Sign

A

crunching sound with asynchronous heart beat

85
Q

crunching sound with asynchronous heart beat

A

Hamman’s sign

86
Q

sign in mediastinal emphysema

A

Hamman’s sign: crunching sound

87
Q

signs that begin w/ “K”

A

Kehr: left shoulder pain. spleen rupture

Kernig sign: pain/resistance to knee estension when the hip is 90 degrees. menigntyitis

88
Q

left shoulder pain

A

Kehr’s sign. ruptured spleen

89
Q

sign of ruptured spleen

A

Kehr’s sign

90
Q

Kernig’s sign

A

pain/resistance to knee extension when the hip is fledded 90 degrees.
meningitis

91
Q

pain to knee extension when the hipo is flexed 90 degrees

A

Kernig sign. meningitis

92
Q

sign of cardiac chest pain

A

Levine sing. pt demonstrates pain w/clutched fist over middle of hte chest

93
Q

pt demonstrates pain w/clutched fist over the middle of hte chest

A

Levine sing. cardiac chest pain

94
Q

sign that indicates appy

A

McBurney: tenderness 2/3 the distance ebtween U and the ikleum

95
Q

sign that indicates choley

A

Murphy’s

96
Q

Murphy’s sign

A

gallbladder

pt unable to take a deep breath on inspiraiton with deep lalpation beneath right costal margin

97
Q

unable to take a deep breath on inspiration w/deep palpitation beneath right costal margin

A

Murphy’s. gallbladder

98
Q

T12 fracture

A

ChaNCE fRACTURE

99
Q

Chance Fracture

A

T12

100
Q

Hangman’s Fracture

A

C2

101
Q

3 special names for spinal fractures

A 
C1 = Jefferson
C2 = Hangman
T123 = Chance
102
Q

distal radius fracture

A

Colle’s Fracture

103
Q

COlle’s Fracture

A

distal radial fracture

104
Q

2 signs of splenic rupture

A

Kehr

Ballance

105
Q

how long can you leave REBOA in place

A

up to 4hrs

106
Q

internal tourniqu3 to occlde blood flow form the aorta

A

REBOA = resuscitative endovascular balloon occlusion of the aorta

107
Q

ventilator indication fo probable tension pneumoa

A

sudden increase in PIP & pPLAT

108
Q

physiology of tension pneumo

A

medistinal shift

109
Q

CXR of diaphragmenic hernia

A

scaphopid abdomen

110
Q

when do you see Kussmaul’s sign

A

cardiac tamponade

*rise in venous pressure on inspiration s

111
Q

early sign cardiac tamponade

A

pulsus paradoxus

tachycardia

112
Q

late signs cardiac tamponade

A

Beck’s triad

113
Q

Beck’s triad

A

muffled HS
narrow pulse pressure
JVD

114
Q

pulse pressure in cardiac tamponade

A

narrow PP

115
Q

EKG of cardiac tamponade

A

electric alternans: heart is getting closer to & further away from the camera as it moves around inside the sac of fluid (pericardial)
*R wave changes in height

116
Q

suspect if R wave on EKG changes in height

A

electrical alternans = cardiac tamponade

*the heart moves around b/c of the excess fluid and moves closer to/away from the camera

117
Q

tracheobronchial disruption =2

A

SC emphysema

Hamman’s crunch: cruntching, raspy sound syncronous with the heARTBEAT

118
Q

suspect if Hamman’s crunch

A

tracehobronchial disruption

119
Q

blood in eye chamber

A

hyphema

120
Q

hyphema

A

blood buildup in teh anterior chamber of the eye

121
Q

femoral line landmarks

A

NAVAL= (lateral to medial)

*nerve, artery, vein, lymph node

122
Q

how to match plt to pt

A

doesn’t need ABO/Rh matching but good idea

123
Q

how to match FFP to pt

A

NEEDS ABO

doesn’t need to match Rh

124
Q

what is FFP

A

plasma w/o RBC

clotting factos

125
Q

blood product to give if you need clotting factors

A

plt
FFP (plasma w/o RBC and has clotting factors)
cryo (created from FFP & has certain factors)

126
Q

most commonly used product to treat DIC

A

cryop

127
Q

product used to treat hemorphilia

A

cryop

128
Q

uses for cry

A

DIC, hemophila, vonWillebrand disease

129
Q

how to make cryo

A

FFP

130
Q

in Cryo

A

factor 8, 13, fibrogen, von willebrand factor

131
Q

who can cave cryo

A

no ABO/Rh mathcing

132
Q

TACO

A

transfuion associated circulatory overload

133
Q

rx for TACO

A

lasix

134
Q

s/s of TACO

A

HTN, distended neck veins

135
Q

TRALI

A

Transfusion related acute lung injury

136
Q

2 “T” complications of blood transfusions

A 
TACO = circulatory overload
TRALI = acute lung injury
137
Q

leading cause of transfusion related deaths

A

TRALI

138
Q

cause of TRALI

A

reaction ot the leukocyte antibodies in teh plasma

139
Q

what does TRALI cause

A

acute pulmonary edema

140
Q

CO increase in pregnancy

A

20-40%

141
Q

pulse increase in pregnancy

A

10-15bpm

142
Q

BP change in pregancy

A

decrease 1–15

143
Q

blood changes in pregancy

A

dilution anemi

hct value decreasesa

144
Q

GI in pregnancy

A

delayed GI emptying so increased risk of aspiration

145
Q

how to describe G/P/…. if pregnant

A

GTPAL = gravity, term birth, preterm,, abortions, living kids

146
Q

thin/thikness of cervix during labor

A

effacement

147
Q

true labor

A

contractions w/cervical change

148
Q

DTR scale

A 
0 = absent
1-  hypoactive
2-normal
3= hyperactive
4= clonus
149
Q

rx for HTN in pregnancy

A

labatalol
hydralazine
methyldopa

150
Q

treatment for amniotic fluid PE

A

IVF
increase PEEP
FFP/plt/cryo

151
Q

invervention for shoulder dystocia

A

McROberts : knees to chest

suprapubic pressrue

152
Q

sign of shoulder

A

turtle sign = appearance/retraction of fetal head like turtle going back into shell

153
Q

maneuver during breech

A

Mauriceau’s maneuver
*finger s relieving prssure off bab’s nose
downward suprapubic while bay rotates out of brith canal

154
Q

Mauriceau’s maneuver

A

for breech
fingers relieve pressure off of baby’s nose
downward suprapubic pressure while the baby rotates out of the brith canal

155
Q

painful bleeding if pregnant

A

abriptio placenta

156
Q

bleeding if abruptio placentae

A

painful

157
Q

suspect if pregnant lady is in a MVC

A

r/o abruptio placentae = painfull bleed

158
Q

what msut be confirmed before you do a vaginal exam on pregnant

A

r/o placenta previa = placenta covers os

159
Q

placenta covers the cervical os

A

placenta previa

160
Q

contraindication to vaginal exam if pregnant

A

placenta previa = covers os

could cause red bleeding

161
Q

consider if brigh red bleeding & pregnant

A

placenta previa

162
Q

bleeding if placenta previa

A

bringht red and painless

163
Q

assessment if uterine rputre

A

feel baby’s parts

stomach as hard as a board

164
Q

abdominal assessment if uterine rupture

A

feel baby parts

stomach as hard as aboard

165
Q

IVF __ml/kg for neonate IVF

A

10ml/kg

166
Q

neonatal condition where the back of hte nasal pasage is blocked

A

choanal atresia

167
Q

choanal atresia

A

back of hte nasal passage is blockedq

168
Q

characterization of persistant pulmonary HTN (neonate)

A

right to left shunt
marked pulmonary hypertension that causes hypoxia
(PVR > SVR)

169
Q

neonate’s PVR > SVR

A

persistent pulmonary HTN

b/c right to left shunt

170
Q

neonate’s abdominal contents are coming out of one side of hte umbilical cord

A

gastrochisis

171
Q

gastrochisis

A

neonate
abd contents are coming out of one side of hte umbilical cord
treatment: like abdomianl evisceration & OG tube to decompress

172
Q

“O” abdominal rign protersion of hte viscera. attached to umbilical cord

A

omphalocele

173
Q

omphalocele

A

“O” abdimal ring, protusion of hte viscera, attach to umbilical

174
Q

neonate complications where there is a protusion around the umbilical cord

A

gastrochisis
omphalocele
TREAT LIKE EVISCERATION

175
Q

relationship between HR & temperature

A

every 1C over 37, HR increases 10bpm

176
Q

3 s/s of shaken baby syndrome

A

bulging fontannels
icnreased ICP
retinal hemorrhage

177
Q

indicates CHF in babies

A

enlarged heart and liver

178
Q

interventions for CHF in babies

A

stop IVF

give digitalis

179
Q

worsening crying in a crying infant

A

= cardiac problem

ventricular septal defect

180
Q

what might a baby w/patent ductus ateriorsus need

A

PGE1 to keep ithe PDA open

181
Q

needs PGE1

A

patent ductus arteriosus to keep it open

182
Q

2 medications affecting the patent ductus arteriosus

A

PGE1 to keep open

INdomethasin to close

183
Q

use of PGE1 in kids

A

keep the PDA open

184
Q

SE of PGE1 in kids

A

keeps PDA open but can cause apnea

185
Q

use of INdomethasin in kids

A

close PDA

186
Q

how do you open teh PDA

A

PGE1

*can cause apnea

187
Q

how do you close the PDA

A

oxygen or indomethasin

188
Q

problem of coarctation of hte aorta

A

aorta is narrowed so heart must pump harder

189
Q

aorta and pulmonary artery are swapped

A

aorta connects to right ventricle

pulmonary artery to elft venticle

190
Q

neonate right to left shunt

A

tetraology of fallot

191
Q

tet spells

A

sudden cyanosis & syncope

192
Q

pathophysiology of Tetralogy of fallot

A

right to left shunt

pumonary stenosis
right ventriucle hypertrophy
overriding aorta
ventricular septal defect

193
Q

treatment of Tetralogy of Fallot

A

watch for Tet Spells = sudden cyanosis/syncope
knee to chest, morphine, fentanyl
IF knees to chest/morphine doesn’t resolve the tet spell, RSI/intubate/oxygen

194
Q

closure of fontannels

A 
anterior = 16-18m
posterior = 2m
195
Q

pediatric urinary output

A 
infant = 2ml/kg/hr
peds = 1
196
Q

pediatric assess

A

PAT

TICLS=tone, interactiveness, consolability, look/gaze, speech/cry

critical care 1 (14 decks)

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