Ecclectic Flashcards
1
Q
4 types of cardiomyopathies
A
Dilated
Hypertrophic
Stress/Takotsubo
Restrictive
2
Q
definition of dilated hypertrophy
A
less than 40% EF in the presence of increased left ventricular end-diastolic volume
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.
4
Q
pathology: dilated hypertrophy
A
chamber enlarges (w/o hypertrophy) , the myocardial fibrils overstreatch, and their ability to effectively contract is impaired
5
Q
progression of dilated hypertrophy
A
- weakened contractility r/t weakened myocardial fibrils
- decreaed CO b/c can’t effectively eject blood forward which creates backwards pressure
- pulmonary/systemic congestion from backward pressrue
6
Q
what happens when contractility decreases?
A
SNS/baro & chemoreceptors/RAAS to compensate
ALL TO PRESERVE CO & TISSUE PERFUSION!
7
Q
vessel diameter & afterload
A
vasoconstriction increases afterload
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
9
Q
s/s of dilated cardiomyopathy
A
causes systolic dysfunction so they show s/s of heart failure (pulmonary *& systemic
10
Q
common EKG w/ dilated left ventricle
A
LBBB
11
Q
s/s of hypertrophic cardiomyopathy
A
SOB
CP
palpitations
syncope
12
Q
SOB
CP
palpitations
syncope
A
s/s of hypertrophic cardiomyopathy
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
14
Q
most common reason for sudden cardiac death in young adults
A
hypertrophic cardiomyopathy
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
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
17
Q
rx for hypertrophic cardiomyopathy
A
BB & CaChB b/c it will improve diastrolic dysfunction to increase ventricualr filling and optimize SV
18
Q
rx that decreases ventricular wall tension
A
CaChB
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
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
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
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
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
24
Q
5 treatment priorities for stress induced cardiomyopathy
A
optimize fluid minimize myocardial oxygen demand decrease afterload prevent complications monitor for dysrhythmias
25
3 potential complications of stress-induced cardiomyopathy
low bp
cardiogenic shock
chronic HF
*fast onset so heart can't compensate for rapid decrease in function
26
what type of dysfunction is restrictive cardiomyopathy
diastolic b/c rigid walls so can't expand to fill
27
s/s of restrictive cardiomyopathy
fatigue
weak
acrivity intolerance
s/s of congestion
28
Long QT syndrome
repolarization disorder
| *risk torsades & sudden cardiac death
29
QTc
QT corrected. QT measurement corrected to the ventricular HR changes
30
5 types of rx that cause Long QT
```
antiemetics
ABX
antidepressants
antipsychotics
antidysrhythmics
```
*low K or low Mg, bradydysrhythmisas, subarachnoid hemorrhages
31
how to measure Long QT
beginning of QRS to end of T
32
normal QTc
QT intervals by HR so it must be "corrected" for HR.
| *0.44 seconds are less
33
risk of Long QT
ventricular arrythmias
34
do not do if snake bite
NO tourniquet!
35
complications of snakebite -4
coaguloathy
high RR/HR
oral numbness
36
treat scorpion bite
Anascorp
| OR: benzo & atropine
37
s/s of scorpion bite
```
mild = pain/paresthesia
severe = cranial nerve dysfunction (abnormal ocular movements) & neuromuscular dysfunction
```
38
blood tests arffected by heat injuries
increased Hct
| increased BUN
39
IVF for heat injuries
NS b/c often already low Na
40
urine in heat injuries
incresed specific gravity
ketones
more concentrationed b/c fluid loss
41
how to labs/urine look in heat injuries
reflect concentration b/c fluid loss
42
3 types of heat related injuries
cramps
exhaustion
stroke
43
ABG in hyperthermia
respiratory alkalosis b/c hyperventilation (blow off CO2)
44
difference between heat exhaustion & heat stroke
exhaustion = no neuro impairment
stroke = AMS
*DO NOT NEED TO STOP SWEATING IN ORER FOR IT TO BE heat stroke!
45
mild hypothermia range
90-95F
| 32.2 to 35C
46
core temp that = hypothermia
under 35C/95F
47
when does shivering stop
temps below 32C/89.6F
48
hallmark sign of hypothermia
paradoxical undressing r/t delirum
49
IVF temperature to rewarm
39C/102.2
50
risk of rewarming
afterdrop = return of cold blood to the core
51
EKG in hypothermia
osborn wave/j wave
52
osborne wave
EKG in hypothermia
53
cause of dysrhythmias in hypothermia
increase in lactate & K
54
mamillian diving reflex
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
55
needed s/p drowing
watch for: hypothermia & spinal immobilazation & increase PEEP & bronchospasm w/beta2 agonsit
vasoC to maintain CPP
56
initiate ventilation if drowing
widespread atelectasis & pulmonary shunt possible
increase PEEP: treat bronchospasm with beta2 agonist
57
when can you fly s/p diving
12hrs later
58
goal of giving oxygen s/p decompression sickness
promotes nitrogen washout
59
aka diving associated barotrauma
POPS = pulmonary overpressurized syndrome
60
where do the greatest pressure changes occur
4ft belwo surface
61
pt looks like they are having a stroke s/p diving
arterial gas embolism
62
pt has a nosebleed s/p diving
arterial gas embolism
63
flying s/p diving complications like decompression sickness & arterial gas embolism
pressurized cabin or rotary wing under 1K ft
| **ground transportation is preferred
64
HAPE
high altitude pulmonary edema
65
s/s of HAPE
```
rales
elevated: HR, RR
SOB at rest
fever
nonproductive cough w/pink frothy spuntum
```
66
vitals in HAPE
elevated HR/RR
SOB at rest
fever
67
treat HAPE
```
descend
supplemental O2
CPAP
yperbaric
nifedipine to promote pumlonary vascularture dilation
```
68
Rx for HAPE
nifedipine to vasoD
69
HACE
high altitue cerebral edema
70
what altititude sickness occurs the latest
HACE = high altitude cerebral edema
| up to 5 days later
71
trigger for HACE
after 5 days of sustained high altitude over 12kFt
72
s/s of HACE
AMS
ataxia
visual changes
coma
73
treatment of HAPE
```
descend
oxyten
NO DIURETICS
hyperbaric
dexamethasone
```
74
rx for HAPE
dexamethasone
| NO dieuretics!`
75
bruise behind ear
battle sign
76
Bruddzinski sign
flex neck results in flexed hip
| meningitis
77
sign in pelvic fracture
Coopernail's sign
| ecchymosis of perineum around scrotum/labia
78
bluish discoloration around U
Cullen's sign
79
sign seen in ectopic
cullen's
80
sign in ICP/herniation
Cushing's triad
81
Cushing's triad
HTN
wide pulse pressure
bradycardia
irregular respirations
82
sign in pancreatitis
Grey-Turner
83
discoloration around the flank
Grey-TUrner
| flank discoloration
84
Hamman's Sign
crunching sound with asynchronous heart beat
85
crunching sound with asynchronous heart beat
Hamman's sign
86
sign in mediastinal emphysema
Hamman's sign: crunching sound
87
signs that begin w/ "K"
Kehr: left shoulder pain. spleen rupture
| Kernig sign: pain/resistance to knee estension when the hip is 90 degrees. menigntyitis
88
left shoulder pain
Kehr's sign. ruptured spleen
89
sign of ruptured spleen
Kehr's sign
90
Kernig's sign
pain/resistance to knee extension when the hip is fledded 90 degrees.
meningitis
91
pain to knee extension when the hipo is flexed 90 degrees
Kernig sign. meningitis
92
sign of cardiac chest pain
Levine sing. pt demonstrates pain w/clutched fist over middle of hte chest
93
pt demonstrates pain w/clutched fist over the middle of hte chest
Levine sing. cardiac chest pain
94
sign that indicates appy
McBurney: tenderness 2/3 the distance ebtween U and the ikleum
95
sign that indicates choley
Murphy's
96
Murphy's sign
gallbladder
| pt unable to take a deep breath on inspiraiton with deep lalpation beneath right costal margin
97
unable to take a deep breath on inspiration w/deep palpitation beneath right costal margin
Murphy's. gallbladder
98
T12 fracture
ChaNCE fRACTURE
99
Chance Fracture
T12
100
Hangman's Fracture
C2
101
3 special names for spinal fractures
```
C1 = Jefferson
C2 = Hangman
T123 = Chance
```
102
distal radius fracture
Colle's Fracture
103
COlle's Fracture
distal radial fracture
104
2 signs of splenic rupture
Kehr
| Ballance
105
how long can you leave REBOA in place
up to 4hrs
106
internal tourniqu3 to occlde blood flow form the aorta
REBOA = resuscitative endovascular balloon occlusion of the aorta
107
ventilator indication fo probable tension pneumoa
sudden increase in PIP & pPLAT
108
physiology of tension pneumo
medistinal shift
109
CXR of diaphragmenic hernia
scaphopid abdomen
110
when do you see Kussmaul's sign
cardiac tamponade
| *rise in venous pressure on inspiration s
111
early sign cardiac tamponade
pulsus paradoxus
| tachycardia
112
late signs cardiac tamponade
Beck's triad
113
Beck's triad
muffled HS
narrow pulse pressure
JVD
114
pulse pressure in cardiac tamponade
narrow PP
115
EKG of cardiac tamponade
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
suspect if R wave on EKG changes in height
electrical alternans = cardiac tamponade
| *the heart moves around b/c of the excess fluid and moves closer to/away from the camera
117
tracheobronchial disruption =2
SC emphysema
| Hamman's crunch: cruntching, raspy sound syncronous with the heARTBEAT
118
suspect if Hamman's crunch
tracehobronchial disruption
119
blood in eye chamber
hyphema
120
hyphema
blood buildup in teh anterior chamber of the eye
121
femoral line landmarks
NAVAL= (lateral to medial)
| *nerve, artery, vein, lymph node
122
how to match plt to pt
doesn't need ABO/Rh matching but good idea
123
how to match FFP to pt
NEEDS ABO
| doesn't need to match Rh
124
what is FFP
plasma w/o RBC
| clotting factos
125
blood product to give if you need clotting factors
plt
FFP (plasma w/o RBC and has clotting factors)
cryo (created from FFP & has certain factors)
126
most commonly used product to treat DIC
cryop
127
product used to treat hemorphilia
cryop
128
uses for cry
DIC, hemophila, vonWillebrand disease
129
how to make cryo
FFP
130
in Cryo
factor 8, 13, fibrogen, von willebrand factor
131
who can cave cryo
no ABO/Rh mathcing
132
TACO
transfuion associated circulatory overload
133
rx for TACO
lasix
134
s/s of TACO
HTN, distended neck veins
135
TRALI
Transfusion related acute lung injury
136
2 "T" complications of blood transfusions
```
TACO = circulatory overload
TRALI = acute lung injury
```
137
leading cause of transfusion related deaths
TRALI
138
cause of TRALI
reaction ot the leukocyte antibodies in teh plasma
139
what does TRALI cause
acute pulmonary edema
140
CO increase in pregnancy
20-40%
141
pulse increase in pregnancy
10-15bpm
142
BP change in pregancy
decrease 1--15
143
blood changes in pregancy
dilution anemi
| hct value decreasesa
144
GI in pregnancy
delayed GI emptying so increased risk of aspiration
145
how to describe G/P/.... if pregnant
GTPAL = gravity, term birth, preterm,, abortions, living kids
146
thin/thikness of cervix during labor
effacement
147
true labor
contractions w/cervical change
148
DTR scale
```
0 = absent
1- hypoactive
2-normal
3= hyperactive
4= clonus
```
149
rx for HTN in pregnancy
labatalol
hydralazine
methyldopa
150
treatment for amniotic fluid PE
IVF
increase PEEP
FFP/plt/cryo
151
invervention for shoulder dystocia
McROberts : knees to chest
| suprapubic pressrue
152
sign of shoulder
turtle sign = appearance/retraction of fetal head like turtle going back into shell
153
maneuver during breech
Mauriceau's maneuver
*finger s relieving prssure off bab's nose
downward suprapubic while bay rotates out of brith canal
154
Mauriceau's maneuver
for breech
fingers relieve pressure off of baby's nose
downward suprapubic pressure while the baby rotates out of the brith canal
155
painful bleeding if pregnant
abriptio placenta
156
bleeding if abruptio placentae
painful
157
suspect if pregnant lady is in a MVC
r/o abruptio placentae = painfull bleed
158
what msut be confirmed before you do a vaginal exam on pregnant
r/o placenta previa = placenta covers os
159
placenta covers the cervical os
placenta previa
160
contraindication to vaginal exam if pregnant
placenta previa = covers os
| could cause red bleeding
161
consider if brigh red bleeding & pregnant
placenta previa
162
bleeding if placenta previa
bringht red and painless
163
assessment if uterine rputre
feel baby's parts
| stomach as hard as a board
164
abdominal assessment if uterine rupture
feel baby parts
| stomach as hard as aboard
165
IVF __ml/kg for neonate IVF
10ml/kg
166
neonatal condition where the back of hte nasal pasage is blocked
choanal atresia
167
choanal atresia
back of hte nasal passage is blockedq
168
characterization of persistant pulmonary HTN (neonate)
right to left shunt
marked pulmonary hypertension that causes hypoxia
(PVR > SVR)
169
neonate's PVR > SVR
persistent pulmonary HTN
| b/c right to left shunt
170
neonate's abdominal contents are coming out of one side of hte umbilical cord
gastrochisis
171
gastrochisis
neonate
abd contents are coming out of one side of hte umbilical cord
treatment: like abdomianl evisceration & OG tube to decompress
172
"O" abdominal rign protersion of hte viscera. attached to umbilical cord
omphalocele
173
omphalocele
"O" abdimal ring, protusion of hte viscera, attach to umbilical
174
neonate complications where there is a protusion around the umbilical cord
gastrochisis
omphalocele
TREAT LIKE EVISCERATION
175
relationship between HR & temperature
every 1C over 37, HR increases 10bpm
176
3 s/s of shaken baby syndrome
bulging fontannels
icnreased ICP
retinal hemorrhage
177
indicates CHF in babies
enlarged heart and liver
178
interventions for CHF in babies
stop IVF
| give digitalis
179
worsening crying in a crying infant
= cardiac problem
| ventricular septal defect
180
what might a baby w/patent ductus ateriorsus need
PGE1 to keep ithe PDA open
181
needs PGE1
patent ductus arteriosus to keep it open
182
2 medications affecting the patent ductus arteriosus
PGE1 to keep open
| INdomethasin to close
183
use of PGE1 in kids
keep the PDA open
184
SE of PGE1 in kids
keeps PDA open but can cause apnea
185
use of INdomethasin in kids
close PDA
186
how do you open teh PDA
PGE1
| *can cause apnea
187
how do you close the PDA
oxygen or indomethasin
188
problem of coarctation of hte aorta
aorta is narrowed so heart must pump harder
189
aorta and pulmonary artery are swapped
aorta connects to right ventricle
| pulmonary artery to elft venticle
190
neonate right to left shunt
tetraology of fallot
191
tet spells
sudden cyanosis & syncope
192
pathophysiology of Tetralogy of fallot
*right to left shunt*
pumonary stenosis
right ventriucle hypertrophy
overriding aorta
ventricular septal defect
193
treatment of Tetralogy of Fallot
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
closure of fontannels
```
anterior = 16-18m
posterior = 2m
```
195
pediatric urinary output
```
infant = 2ml/kg/hr
peds = 1
```
196
pediatric assess
PAT
| TICLS=tone, interactiveness, consolability, look/gaze, speech/cry
