EM, ICU, and surgery 2 Flashcards

1
Q

How is Vfib/Pulseless Vtach managed?

A

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

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2
Q

How is PEA/Asystole managed?

A

CPR at 30:2 –> epi 1mg q3-5m (consider vasopressin 40U for 1st or 2nd dose)

Evaluate and treat causes

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3
Q

What causes PEA?

A

H’s and T’s

Hypoxia, hyperkalemia, hypokalemia, hypothermia, hydrogein ions (acidosis)

Tamponade, Tension pneumo, Thrombosis, Tablets/Toxins

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4
Q

How is a suspected acute stroke initially managed?

A

ABCs [Airway (assess), Breathing (give O2), Cardiac (ECG, IV access, blood glucose)]
Determine time of onset
Neurological exam
CT

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5
Q

What do you do with a suspected acute stroke that shows a hemorrhage on CT?

A

Stop anticoagulant drugs

Neurosurgery

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6
Q

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?

A

Subarachnoid hemorrhage

Stop anticoagulants
Neurosurgery

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7
Q

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?

A

Anticoagulation

Supportive cares

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8
Q

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?

A

Make inpatient
Fibrinolytic therapy (tPA, urokinase, or streptokinase)
No anticoagulation

REMEMBER the requirements…basically make sure no risk of a brain bleed

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9
Q

How can high intracranial pressure be decreased?

A

Mannitol
Hypertonic saline
Hyperventilation

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10
Q

A patient comes in with blood at the urethral meatus and a high-riding prostate. What shouldn’t be done?

A

Don’t cath this patient…unless under cystoscopic guidance

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11
Q

Why can BP drop more in pregnant women after trauma? With this in mind, in what position should mother be in during exam?

A

Uterus compresses IVC –> decreased venous return –> poor cardiac output

Left lateral decubitus position…minimizes compression of IVC

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12
Q

What needs to be seen in pregnancy women before they can be discharged after trauma?

A

Contractions less frequent than q10m
No vaginal bleeding
No abdominal pain
Normal fetal heart tracing

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13
Q

What is the most common form of child abuse?

A

Neglect

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14
Q

What kinds of abuse are physicians REQUIRED to report?

A

Child abuse

Elder abuse

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15
Q

Where are Swan-Ganz catheters often inserted? What do the measure?

A

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

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16
Q

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?

A

Nonhemolytic febrile transfusion reaction (most common; 3% of transfusions)

Caused by antibodies to human leukocyte antigens

Treat with tylenol

17
Q

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?

A

Acute hemolytic transfusion reaction (1:250,000 transfusions)

Caused by ABO incompatibility

Aggressive supportive cares

18
Q

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?

A

Delayed hemolytic transfusion reaction

Caused by antibodies to Kidd or D (Rh) antigens

No acute therapy, but determine antibody type to prevent recurrence

19
Q

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?

A

Anaphylactic transfusion reaction

Caused by anti-IgA antibodies (in patient with IgA deficiency)

Give epi, volume maintenance, and airway maintenance

20
Q

A pregnant woman develops purport 5-10 days after a transfusion. What should be done?

A

IVIG or plasmapharesis

21
Q

Which inotrope can be used for CHF? Besides inotropic effects, what else does it do?

A

Dobutamine

It also causes mild reflex vasodilation