EM, ICU, and surgery 2 Flashcards
How is Vfib/Pulseless Vtach managed?
Monophasic shock (360J) and CPR (30:2) –> then recheck…and repeat if still no pulse –> Epi 1mg q3-5m (can give vasopressin 40U in place of 1st or 2nd epi) –> recheck –> Shock/CPR –> consider Amiodarone or lidocaine
Magnesium for torsades
How is PEA/Asystole managed?
CPR at 30:2 –> epi 1mg q3-5m (consider vasopressin 40U for 1st or 2nd dose)
Evaluate and treat causes
What causes PEA?
H’s and T’s
Hypoxia, hyperkalemia, hypokalemia, hypothermia, hydrogein ions (acidosis)
Tamponade, Tension pneumo, Thrombosis, Tablets/Toxins
How is a suspected acute stroke initially managed?
ABCs [Airway (assess), Breathing (give O2), Cardiac (ECG, IV access, blood glucose)]
Determine time of onset
Neurological exam
CT
What do you do with a suspected acute stroke that shows a hemorrhage on CT?
Stop anticoagulant drugs
Neurosurgery
A patient comes in with an expected stroke. A CT does not show a hemorrhage, but an LP is positive. What is the likely diagnosis? What should be done?
Subarachnoid hemorrhage
Stop anticoagulants
Neurosurgery
A patient comes in with an expected stroke. A CT does not show a hemorrhage, but a subarachnoid hemorrhage is expected so an LP is gotten. The LP is found to be negative. What should be done?
Anticoagulation
Supportive cares
A patient comes in with an expected stroke. A CT does not show a hemorrhage. The symptoms started less than 3hrs ago, the patient has not had intracranial surgery in the last 3 months, has not had an LP in the past 7 days, and has no history of brain aneurysm. What should be done?
Make inpatient
Fibrinolytic therapy (tPA, urokinase, or streptokinase)
No anticoagulation
REMEMBER the requirements…basically make sure no risk of a brain bleed
How can high intracranial pressure be decreased?
Mannitol
Hypertonic saline
Hyperventilation
A patient comes in with blood at the urethral meatus and a high-riding prostate. What shouldn’t be done?
Don’t cath this patient…unless under cystoscopic guidance
Why can BP drop more in pregnant women after trauma? With this in mind, in what position should mother be in during exam?
Uterus compresses IVC –> decreased venous return –> poor cardiac output
Left lateral decubitus position…minimizes compression of IVC
What needs to be seen in pregnancy women before they can be discharged after trauma?
Contractions less frequent than q10m
No vaginal bleeding
No abdominal pain
Normal fetal heart tracing
What is the most common form of child abuse?
Neglect
What kinds of abuse are physicians REQUIRED to report?
Child abuse
Elder abuse
Where are Swan-Ganz catheters often inserted? What do the measure?
Left subclavian or right internal jugular
Right atrial pressure
Pulmonary artery pressure
Wedge pressure (equals left atrial pressure)
Also, CO, mixed venous O2 saturation, and systemic vascular resistance
A patient had a transfusion 1-6 hours ago and now has fever, chills, rigors and malaise. What is going on? What caused it? What should be done?
Nonhemolytic febrile transfusion reaction (most common; 3% of transfusions)
Caused by antibodies to human leukocyte antigens
Treat with tylenol
While a patient is being transfused, she develops fever, chills, nausea, flushing, tachycardia, tachypnea, and hypotension. What is going on? What caused it? What should be done?
Acute hemolytic transfusion reaction (1:250,000 transfusions)
Caused by ABO incompatibility
Aggressive supportive cares
2-10 days after a transfusion, a patient develops a slight fever, falling hgb/hct, and mild increase in indirect bilirubin. What is going on? What caused it? What should be done?
Delayed hemolytic transfusion reaction
Caused by antibodies to Kidd or D (Rh) antigens
No acute therapy, but determine antibody type to prevent recurrence
While a patient is being transfused, he develops rapid onset of shock and hypotension. What is going on? What caused it? What should be done?
Anaphylactic transfusion reaction
Caused by anti-IgA antibodies (in patient with IgA deficiency)
Give epi, volume maintenance, and airway maintenance
A pregnant woman develops purport 5-10 days after a transfusion. What should be done?
IVIG or plasmapharesis
Which inotrope can be used for CHF? Besides inotropic effects, what else does it do?
Dobutamine
It also causes mild reflex vasodilation
