Equations Flashcards
Anion gap
Na - (Cl + HCO3) <= 12
MUDPILES
Methanol, Uremia, DKA/AKA, Paraldehyde/phenformin, Iron/INH, Lactic acidosis, Ethylene glycol, Salicylates
Osmolar gap
2Na + BUN/2.8 +glucose/18 + ETOH/4.6 = 285-295
>10: toxic alcohols, mannitol, lorazepam drip
Total body water (L)
Wt (kg) x 0.6
Parkland formula
4 mL x Wt (kg) x %BSA
1st 1/2 in 8 hours
2nd 1/2 in 16 hours
MAP
1/3 SBP + 2/3 DBP or DBP + (SBP - DBP)/3
Pediatric ETT size
Age/4 + 4 (uncuffed) and age/4 + 3 (cuffed) (or minus 0.5)
2 x ETT = NG/OT/foley
3 x ETT + depth of ETT
4 x ETT = chest tube
Neonate: premature 2.5 uncuffed, full-term 3.0 uncuffed
A-a gradient
140 - (PaO2 + PaCO2)
normal = (age +10)/4
Corrected Na in hyperglycemia
Na + 2.4 (glucose-100)/100
Or use 1.6
Winters formula (expected pCO2)
1.5 x HCO3 + 8 (+/- 2)
To assess respiratory compensation in metabolic acidosis
“Rule of 15” - if there’s a metabolic acidosis
HCO3 + 15 (+/-2) = pCO2 + last 2 digits of pH (non mixed)
GCS
Eye (spontaneous 4, verbal 3, pain 2, none 1)
Voice (oriented 5, confused 4, inappropriate 3, moaning 2, none 1)
Movement (obeys 6, localize pain 5, withdraws 4, flex 3, extend 2, none 1)
Fluid maintenance
“4 - 2 - 1”
0-10 kg: + 4 ml/kg/hr
10-20 kg: + 2 ml/kg/hr
>20 kg: 1 ml/kg/hr
Ranson criteria
On admission - GLOWS
Glucose >200, LDH >350, older age >55, WBC >16k, AST (SGOT) >250
At 48 hours - BOB CHF
Base deficit (24 - HCO3) > 4, O2 < 60, BUN increase >5, Ca < 8, Hct drop > 10%, fluid deficit > 6L
Jones criteria
2 major or 1 major + 2 minor
Major: polyarthritis, carditis, subcutaneous nodules (wrist/elbow/knees), erythema marginatum, syndeham chorea
Minor: fever, arthralgia, h/o RF, prolonged PR, elevated CRP/ESR, GBS infection
Diabetes diagnosis
Fasting blood glucose > 126
Random blood glucose > 200 + symptoms
Blood glucose > 200 after glucose tolerance test
Hgb A1c > 6.5%
DKA diagnosis
Serum glucose > 250 pH < 7.3 Serum bicarb < 12 AG > 10 \+ serum/urine ketones
Water deficit
0.6 x wt (kg) x [Na/140 - 1]
50% in first 12 hours, rest over next 24 hours
Hypernatremia goal, decrease 1-2 meq/hour
Hypercalemia symptoms
Bones, stones, moans, thrones, and psychic overtones
Bone pain, urinary/biliary stones, abdominal pain, N/V, polyuria (porcelain throne), depression, anxiety, insomnia
Shortened QT
< 12 no treatment, 12-14 symptoms based, >14 treat
Lithium causes hypercalcemia
Hypocalcemia symptoms
Tetany Trousseau's sign (BP cuff) Chvostek sign (cheek) Seizure QT prolongation
Pituitary hormones
GOATFLAPS
Growth hormone, Oxytocin, Antidiuretic hormone, TSH, FSH, LH, ACTH, prolactin
FLAT PiG - FSH, LH, ACTH, TSH, prolactin, GH and ADH and oxytocin (posterior pituitary)
Prolactinomas = treated with bromocriptine
Scarbossa criteria in LBBB (>=3 points)
> 1 mm concordant ST elevation = 5 points
1 mm ST depression in V1-V3 = 3 points
5 mm discordant ST elevation = 2 point
Causes of infant cyanosis
1,2,3,4,5 truncus arteriosus, transposition of the great vessels, tricuspid atresia, tetralogy of Fallot, total anamolous pulmonary venous return
Salter-Harris
I: straight/slip through
II: metaphysis –> physis (above - *think femur)
III: epiphysis –> physis (low)
IV: both metaphysis and epiphysis (through)
V: crush/ram
Indication for thoracotomy in traumatic hemothoraces
Initial output > 1.5L 250mL/hour x 4 hours Worsening hemothorax Hemodynamic instability Cardiac arrest
APGAR
Activity (active 2, flexed 1) Pulse (>100 2) Grimace (strong cry 2, whimper 1) Appearance (pink 2, peripheral cyanosis 2) Respiration (normal 2, slow 1)
Most common cause of death in sickle cell anemia?
Sepsis (especially pneumonia) – asplenia –> infection due to encapsulated organisms (ie strep pneumoniae, e coli, H flu)
Stroke also common > aplastic crisis > splenic sequestration
Non-anion gap
HARDUP - GI and renal causes
Hypoaldosteronism, Acetazolamide, Renal tubular acidosis, Diarrhea, Ureterosigmoidostomy, Pancreatic fistula
Criteria for anaphylaxis
1) acute onset derm/mucosal reaction + respiratory compromise or hypotension
2) acutely at least 2 of the following with known allergen: derm/mucosal involvement, respiratory compromise, hypotension, GI symptoms
3) hypotension in setting of unknown allergen
Indications for perimortem C-section
> 24 weeks (or 4 finger breaths above umbilicus)
Witnessed arrest and can be done in 4-5 minutes
DIC lab findings
Hemolytic anemia –> decreased haptoglobulin, increased indirect bili, increased LDH, schistocytes
Increased thrombin generation –> decreased fibrinogen, elevated coags
Increased fibrinolysis –> elevated Ddimer and fibrin degradation products
Moderate-severe thrombocytopenia
Kocher criteria for septic arthritis in pads
Fever > 101.3F non-weight bearing ESR > 40 serum WBC > 12K All 4 --> 99% specific
Sudden unexplained infant death risks
3rd leading cause of infant death
Most common at age 2-4 months
Prone sleeping, sleeping on soft surface, maternal smoking during or after pregnancy, overheating from heavy bedding/clothing, late or no prenatal care, long maternal age, prematurity, low birth weight, male sex
EKG findings in PE
Sinus tach
Twave inversions V1-V3
RBBB
S1Q3T3
Endocarditis pathogens
Prosthetic valves: < 2 months, staph aureus, coag-neg staph, staph epidermis –> late: strep viridans, serratia pseudomonas
Native valve: staph aureus, older patients strep viridian’s
Encapsulated bacteria
Klebsiella (gram neg bacilli), Neiserria (diplococci), Salmonella, Gp B strep (gram pos cocci in pairs), H flu
Ectopic pregnancy risk factors
Prior ectopic, h/o PID, h/o tubal surgery, presence of IUD, assisted reproductive therapy
Causes of neonatal jaundice
Non-serious: physiologic, breast milk (substances in milk inhibit glucuronyl transferase), breast feeding (inadequate feeding)
Serious: sepsis, biliary atresia (elevated direct bilirubin), metabolic dysfunction, blood disorder –> check CBC, bilirubin, Coombs, T & S
ABCD2 score in TIA (likelihood of stroke in 2 days
Age > 60 = 1 pt
BP: SBP >140 or DBP > 90 = 1 pt
Clinical feature: unilateral weakness = 2 pts, speech disturbance without weakness = 1 pt
Duration: 10-59 minutes = 1 pt, >60 minutes = 2 pts
History of DM = 1 pt
Low risk = 0-3 –> discharge
4-5 moderate risk, 6-7 high risk
Mechanical complications after MI
Rupture of LV free wall –> cardiac tamponade, check echo, pericardiocentesis, fluids, inotropes, surgical repair
Septal rupture –> holosystolic murmur best at left sternal border, check echo, afterload reduction, inotropes, intraaortic balloon pump, surgical repair
MV regurgitation –> early/mid/holosystolic murmur best at apex, check echo, afterload reduction promotes forward flow, surgical repair
Murmurs
mitral stenosis - loud S1, opening snap, diastolic murmur heard best at apex
mitral prolapse - early/mid click, high-pitched late systolic murmur heard best at left lateral border
Aortic stenosis - crecendo-decrecendo murmur radiating to neck
Aortic regurgitation - high-pitched diastolic murmur heard best at left sternal border
Well’s score
Low < 2, moderate 2-6, high > 6 Clinical S/s DVT = 3 pts Heart rate > 100 = 1.5 pts Immobilization >=3 days or surgery in last 4 weeks = 1.5 pts Previous DVT/PE = 1.5 pts Hemoptysis = 1 pt Malignancy = 1 pt Likely PE = 3 pts
Causes of late decelerations
Uteroplacental insufficiency: abruption, excessive uterine contractions/hyperstimulation, materal hypotension
NOT cord compression (variable decels)
Indications for HBO
Neuro deficits, AMS, cardiovascular compromise, MI, syncope, dysrhythmia, COHb level > 25%, pregnant with COHb level > 15%
Encapsulated orangisms
“Some Nasty Killers Have Some Capsule Protection”
Strep pneumo, Neiserria meningitidis, Klebsiella, H flu, Salmonella, Cryptococcus, Pseudomonas
Fluid analysis in SBP
PMN > 250
Total leukocyte count > 500-1000
Tx: 3rd generation cephalosporin
