Emergency Med & ICU Flashcards
Positive end-expiratory pressure (PEEP):
- refers to pressure in the airway at the end of passive expiration that exceeds atmospheric pressure
- PEEP is used to increase the functional residual capacity and stent open collapsable alveoli, thus reducing atelectatic trauma.
- The level of PEEP is usually set at 5 cmH2O and titrated based on the underlying condition and oxygenation needs.
Moderate or severe hyperkalemia + ECG changes →
→ administer 10 ml of 10% calcium chloride IV
OR
→ 30 ml of 10% calcium gluconate
The Glasgow-Blatchford scale is
- The Glasgow-Blatchford scale is used to assess the severity of bleeding and predict its course .
The Glasgow-Blatchford scale is used to assess the severity of bleeding
- what are the risk factors:
The following risk factors are assessed:
- blood urea concentration ,
- hemoglobin concentration ,
- systolic blood pressure ,
- heart rate ,
- presence of tarry stool ,
- loss of consciousness
- liver failure ,
- heart failure
- gastrointestinal bleeding
Management of regular tachycardia with narrow QRS complexes:
- VAGAL NERVE STIMULATION (carotid sinus massage and Valsalva maneuver),
- ADENOSINE in the scheme 6 mg → 12 mg → 12 mg.
- on the third attempt, the suggested dose was increased to 18 mg.
Sinus tachycardia often occurs as a physiological response to
- exercise and anxiety
or - secondary to pathological stimuli (e.g. fever, anemia) .
- Treatment should be CAUSAL .
acute radiation syndrome
tissues in order of decreasing sensitivity to ionizing radiation
following series:
- lymphatic tissue,
- testicular epithelium,
- bone marrow,
- gastrointestinal epithelium,
- ovaries,
- skin,
- connective tissue,
- bones,
- liver,
- pancreas,
- kidneys,
- nerves,
- brain
- muscles (ex: heart)
hemoptysis.
refers to coughing up blood from some part of the lungs (respiratory tract)
If blood loss exceeds 1/3 of the circulating blood volume (in an adult male weighing 70-80 kg it is approximately 1500 ml) leads to ?
- hypovolemic shock develops ,
- further loss exceeding 50% of the circulating blood volume leads to loss of consciousness.
Numerous doses of activated charcoal are most often used after an overdose of
- theophylline
- phenobarbital
- carbamazepine
- quinine
- barbiturates
- cardiac glycosides
If the seizure persists or further seizures occur, repeat administration of
- diazepam 10 mg IV
or - clonazepam 1 mg IV at 5-minute intervals and continue monitoring of vital signs
-
Diazepam may be continued up to a maximum dose of 50 mg
and - clonazepam up to a maximum dose of 5 mg
The golden hour for the use of hyperbaric oxygen (HBO) in severe CO poisoning is
6 hours
- 2.5 - 3.0 atmospheres for 90 minutes,
Symptoms of neurogenic shock include:
1) hypotension - results from loss of vascular tone .
2) bradycardia - results from the predominance of the action of the vagus nerve on the heart .
3) warm and well-circulated skin - the main feature that distinguishes this shock from others.
4
Intravenous antihypertensive drugs used in Poland:
– Urapidil
– Nitroglycerin
– Esmolol
– Furosemide
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According to the table from [ Szczelik’s Internal Medicine ] presenting antihypertensive drugs used parenterally in the treatment of hypertension for urgent indications, the onset of action of individual drugs is as follows:
sodium nitroprusside - immediate effect
nicardipine - 5-15 min
clevidipine - 2-3 min
fenoldopam - 5-15 min
nitroglycerin - 1-5 min
enalaprilat - 5-15 min
labetalol - 5-10 min
esmolol - 1-2 min
metoprolol - 1-2 min
phentolamine - 1-2 min
urapidil - 3-5 min
conidine - 30 min
According to the table from [ Szczelik’s Internal Medicine ] presenting antihypertensive drugs used parenterally in the treatment of hypertension for urgent indications, the onset of action of individual drugs is as follows:
onset -immediate effect
Sodium nitroprusside -
According to the table from [ Szczelik’s Internal Medicine ] presenting antihypertensive drugs used parenterally in the treatment of hypertension for urgent indications, the onset of action of individual drugs is as follows:
name 3 drugs with onset of 5-15 min
nicardipine -
fenoldopam -
enalaprilat -
According to the table from [ Szczelik’s Internal Medicine ] presenting antihypertensive drugs used parenterally in the treatment of hypertension for urgent indications, the onset of action of individual drugs is as follows:
onset of - 2-3 min
clevidipine
According to the table from [ Szczelik’s Internal Medicine ] presenting antihypertensive drugs used parenterally in the treatment of hypertension for urgent indications, the onset of action of individual drugs is as follows:
Onset of action after: 1-2 min (4)
nitroglycerin -
esmolol -
metoprolol -
phentolamine -
According to the table from [ Szczelik’s Internal Medicine ] presenting antihypertensive drugs used parenterally in the treatment of hypertension for urgent indications, the onset of action of individual drugs is as follows:
onset of action after 3-5 min
urapidil -
According to the table from [ Szczelik’s Internal Medicine ] presenting antihypertensive drugs used parenterally in the treatment of hypertension for urgent indications, the onset of action of individual drugs is as follows:
onset of action after 30 min
conidine -
The advanced trauma life support course teaches that if only the patient’s carotid pulse is palpable, the systolic blood pressure is ?
(The lowest systolic blood pressure at which the carotid pulse is felt)
60 mmHg
if carotid and femoral pulses are palpable, the systolic blood pressure is
70-80 mm Hg
if the radial pulse is also palpable, the systolic blood pressure is more than
80 mm Hg
Hodgkin’s disease is the cause of
hypercalcemic crisis
Toxic megacolon - treatment
Short-term (<48h) intensive conservative treatment :
- insertion of a tube into the stomach and suction of the contents,
- total parenteral nutrition,
- intravenous broad-spectrum antibiotics and glucocorticoids,
- fluid therapy ( IV crystalloids )
Toxic megacolon - treatment
Indications for surgery :
- no improvement within 24-48 hours or deterioration of the patient’s condition despite conservative treatment,
- septic shock,
- massive hemorrhage,
- intestinal perforation and symptoms of diffuse peritonitis.
Toxic megacolon
The improvement in the condition is evidenced by:
- reducing abdominal circumference
-appearance of peristaltic sounds
The width of the colon should be monitored with repeated abdominal X-rays.
Indications for head CT before lumbar puncture
- Immune deficiencies .
- History of CNS disease .
- Seizure within the last week .
- Swelling of the optic disc .
- Disturbances of consciousness .
- Focal neurological symptoms (paresis, unresponsive pupil, etc.).
- The absence of the above risk factors allows for the exclusion of brain edema or tumor with a 97% effectiveness in adults with suspected CNS infection.
Mallampati scale:
Stage I - visible palatal rings, soft palate and uvula.
Grade II - soft palate and uvula visible.
Grade III - only the soft palate is visible.
Stage IV - soft palate invisible .
Shock
General rules of conduct
- Place the patient in the TRENDELENBURG position .
- Insertion of vascular cannulas :
- 2 LARGE DIAMETER cannulae into peripheral veins, ≤ 16 G (≥ 1.8 mm),
- radial artery catheter (for invasive measurement of blood pressure) ,
- central line.
Large-diameter peripheral venous cannulas (preferably ≥1.8 mm [ ≤16 G ]; insert 2 cannulas) are suitable for rapid transfusion of fluids and blood components , rather than conventional (standard) vena catheters.
If you cannot access peripheral veins for rapid transfusion of fluids and blood components, use a large-diameter central venous catheter (such as for renal replacement therapy or angiography, or endocavitary electrode [vascular sheath] insertion).
Wounds in direct contact with organs or functional structures of the body (e.g. joints) and wounds containing a foreign body are classified as
- a class III risk factor for wound infection and are an indication for the use of antibiotic therapy .
Clinical symptoms of hypokalemia result from its impact on
- the resting potential of myocytes and neurocytes.
- Hypokalemia causes hyperpolarization of the cell membrane and an increase in the excitability threshold for the action potential , which may lead to complete blocking of action potentials.
- This results in weakening of skeletal muscles and tendon reflexes .
- Hypokalemia occurs in 2.6-5.2% of hospitalized patients. It is associated with dangerous?
- heart rhythm disorders in the form of supraventricular and ventricular tachycardia. It increases heart failure and causes fainting.
- When potassium levels are below 2 mmol/l, respiratory muscles and tendon reflexes become weakened .
- In hypokalemia, nausea, vomiting, anorexia, and paralytic intestinal obstruction are also observed.
If you have diagnosed a tension pneumothorax, you need to act as soon as possible….3 facts are most important:
- it is supposed to be a *puncture *, not drainage
- the place is the *2nd intercostal space *(but don’t be fooled, if the answer was “over the 3rd rib “ it will also be correct)
- the injection should take place on the upper edge of the rib (if you aim the needle at the lower edge of the rib, you risk puncturing the neurovascular bundle)
Pneumothorax
symptoms in tension pneumothorax
1) Rapidly increasing shortness of breath.
2) Hypotension .
3) Symptoms of hypoxemia: cyanosis, tachypnea, tachycardia .
4) Widening of the jugular veins.
5) Cardiac arrest.
Pneumothorax
Treatment - life-threatening condition
Give me the oxygen!
1) Tension pneumothorax:
- through the 2nd intercostal space in the midclavicular line
(on the upper edge of the 3rd rib) immediately insert a cannula (such as for peripheral veins)
4–5 cm long and ∅ 2.0 mm (14 G ) or 1.7 mm (16 G )
and leave it on until the drain is inserted.
Classic triad of symptoms of pulmonary embolism,
occurring in 25% of patients, include:
1) shortness of breath - about 50% of patients,
2) chest pain - about 50% of patients, usually pleuritic in nature , coronary time,
3) cough – 20% of patients, usually dry,
Pleural pain
- The lung tissue and the visceral (lung) pleura do not have sensory innervation, so in pneumonia pain occurs only when the inflammation affects the parietal pleura .
- Suddenly appearing pleural pain, correlated with decreased or absent breath sounds on the side of pain, suggests suspicion of pneumothorax .
Pleural pain
Factors that intensify pain :
- deep inhalation, coughing, torso movements.
Pleural pain
- Factors that reduce the intensity of pain
- positioning on the side where the pain occurs.
Pleural pain- in Pulmonary embolism
- Character : sharp, prickly.
- Location : usually unilateral.
- Radiation : may radiate to the interscapular area. When the diaphragmatic pleura is involved, the pain radiates to the upper abdomen, most often the right one.
What is pseudohyponatremia?
This is a reduction in sodium concentration while maintaining normal plasma osmolality.
In cyanide poisoning, the antidote is:
- HYDROXYCOBALAMINA ,
- NITRITE – THIOSULFATE set .
diagnosis/antidote
Poisoning
Toxidromes - Cholinergic syndrome - Management
- Diagnosis:
- determination of AChE activity in blood cells or serum. - Decontamination and accelerated elimination, if indicated.
- Antidotes:
- ATROPINE - muscarinic receptor antagonist,
- PRALIDOXYME , OBIDOXYME in case of poisoning with ORGANIC PHOSPHORUS COMPOUNDS .
- Symptomatic treatment.
initial treatment,antidote
Poisoning
Drugs - β-blockers, calcium channel inhibitors and insulin .
- Initial treatment:
- ATROPINE ,
- fluid therapy.
- Decontamination and accelerated elimination, if indicated.
- Antidote: GLUCAGON .
Basics of traumatology
Triad of death
- Coagulopathy
- Hypothermia - reduces citrate metabolism, thus intensifying hypocalcemia. Additionally, hypothermia and hypocalcemia depress the myocardium,
- Metabolic acidosis - reduced cardiac output (caused by, among others, hypocalcemia) and hypotension worsen acidosis. Moreover, acidosis disturbs the functioning of the coagulation system)
