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Critical Care > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

This distributive shock is an antigen induced non-IgE response

A

Anaphylactoid Reaction

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2
Q

This is a preferred mediation to control bleeding esophageal varices

A

Octreotide

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3
Q

These devices aid in the tamponade of esophageal varices

A

Sengstaken- Blakemore and Linton Tube

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4
Q

According to the Monro-Kellie doctrine, this is the percentage of brain, blood and cerebral spinal fluid

A

80:10:10

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5
Q

This is the target systolic blood pressure for a non-traumatic aortic dissection

A

100-120 mmHg

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6
Q

This device is ideal for patient with poor cardiac output, unrelieved chest pain, and failed drug therapy with poor perfusion related to cardiogenic shock

A

Intra-Aortic Balloon Pump (IABP)

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7
Q

A rapid decompression at this altitude could be life threatening for a patient with an esophageal obstruction

A

35000 ft

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8
Q

The adverse effects of this transfusion include new-onset or worsening hypoxemia, and pulmonary edema

A

TRALI

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9
Q

This is the cerebral arterial auto regulatory response to an increase in mean arterial pressure

A

Constriction to decrease cerebral blood flow

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10
Q

The vasomotor centers in the pons and medulla control the physiologic response when triggered by baroreceptors located here

A

Carotid Bodies and Aortic Arch

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11
Q

This is the term used to describe a fall in systolic blood pressure that occurs during inspiration

A

Pulsus Paradoxus

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12
Q

This IABP mode should be selected when performing CPR

A

Pressure Mode

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13
Q

Your first priority for a patient with bleeding esophageal varices

A

Establish an advanced airway

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14
Q

These are the three Vs of initial shock management

A

Volume control, ventilation, and vasopressors

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15
Q

This is the most common cause of cardiogenic shock

A

Myocardial infarction with greater than 40% of the left ventricle involved

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16
Q

Tissue Plasminogen Activator (tPA) should not be administered after this amount of time

A

3 hours from the onset of symptoms

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17
Q

This is released with renal detection of low circulating blood volume

A

Renin

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18
Q

AHA/ASA stroke care guidelines recommend a diastolic blood pressure less than this value

A

110 mmHg

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19
Q

This device will not respond to defibrillation

A

Total Artificial Hearts

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20
Q

Aggressive volume resuscitation should be used to treat abdominal aortic emergency

A

FALSE

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21
Q

The heartmate II is a short-term cardiac support device

A

FALSE

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22
Q

This is the most common cause of sudden cardiac death in the United States

A

Ventricular Arrhythmia

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23
Q

This is the intrinsic atrial rate for atrial flutter

A

220-350

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24
Q

This condition is most likely to cause a loss of cerebral auto-regulation and decreased cerebral blood flow

A

Traumatic Brain Injury

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25
Q

This is accomplished when the IABP loses power to prevent clot formation

A

60 cc syringe to inflate the balloon every 5 minutes

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26
Q

What is the most likely diagnosis for a 72 year old patient with acute change in level of consciousness, headache, nausea, vomiting, and a GCS of 14

A

Hemorrhagic Stroke

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27
Q

Insulin prevents this from entering the mitochondria

A

Fatty Acids

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28
Q

This gland regulates metabolism

A

Thyroid

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29
Q

Steroid hormones are produced here

A

Adrenal Cortex

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30
Q

These are the components of standard precautions

A

Mask, Gloves, Eye Protection

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31
Q

This is the “hub of thermoregulation”

A

Hypothalamus

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32
Q

Calcium is the antidote for this lethal toxin

A

Hydrofluric Acid

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33
Q

A patient with impaired consciousness and no longer shivering would be in this stage of hypothermia

A

Stage II/Moderate

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34
Q

This should be your initial action when preparing to transport an infectious patient

A

Ccquire basic screening information about the patient

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35
Q

When using non-invasive blood pressure monitoring, these are optimum parameters for the cuff

A

40% of the circumference or ⅔ the length of the extremity

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36
Q

This substance inhibits ADH

A

Ethanol

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37
Q

This is the best diagnostic hallmark of exertion all heatstroke

A

Elevated Creatine Phosphokinase (CPK)

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38
Q

This is the most common mode of transmission for severe cases of diarrhea

A

Person to person and hand to mouth

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39
Q

This is a group of signs and symptoms constituting the basis for a diagnosis of poisoning

A

Toxidrome

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40
Q

Mannitol can cause this adverse effect

A

Hypertonic Hyponatremia

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41
Q

This disease is the result of the adrenal glands failing to respond to ACTH

A

Addison’s disease

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42
Q

Unusual odors, smoke, vapors, multiple patients with similar symptoms, and unexpectedly ill or unconscious bystanders

A

Signs/cues of toxic exposure

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43
Q

This is the most important laboratory study for a patient with a mental status change

A

Glucose Assessment

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44
Q

Transduce from this port when your patient has a PAC

A

Distal Port

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45
Q

This heal-related illness commonly occurs in trained athletes and physically fit individuals

A

Heat Cramps

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46
Q

This is the most likely etiology for community-acquired pneumonia

A

Streptococcus pneumonia

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47
Q

This is the most common source of blood-borne pathogen infection in the healthcare setting

A

Needle Sticks

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48
Q

This catheter allows for direct monitoring for right atria pressure, pulmonary artery pressure, pulmonary artery wedge pressure, and cardiac output

A

Pulmonary Artery Catheter

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49
Q

This category of medications are most likely to affect thermoregulation

A

beta-blockers

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50
Q

This life-threatening condition occurs in patients with untreated hypothyroidism

A

Myxedema Coma

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51
Q

This is accomplished to determine an ART line’s ability to accurately reproduce a physiologic signal

A

Square wave test

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52
Q

This stage of acetaminophen poisoning is characterized by right upper quadrant pain and tenderness with elevated liver enzymes

A

Second Stage of Poisoning

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53
Q

This is the central venous oxygen saturation via the pulmonary artery catheter

A

Greater than 70%

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54
Q

This is the normal pulmonary capillary wedge pressure

A

8-12 mmHg

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55
Q

This type of school is characterized by low CVP, low CQI, low SVP, and low PCWP

A

Septic Shock

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56
Q

Spasms of the facial muscles elicited by tapping the facial nerves secondary to hypocalcemia

A

Chvostek’s sign

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57
Q

Referred left shoulder pain secondary to splenic injury

A

Kehr’s sign

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58
Q

This is the antidote for acetaminophen

A

Mucomust/Acyticystine

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59
Q

This is the antidote for benzodiazepines

A

flumazenil/romazicon

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60
Q

Inability to completely extend the leg when sitting or lying

A

Kernig’s Sign

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61
Q

The typical patient is elderly, with new or uncontrolled Type II diabetes, may be on TPN, or have Pancreatitis

A

HHS

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62
Q

This is the antidote for Coumadin

A

Vitamin K

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63
Q

This type of shock is characterized by high CVP, high SVR, high PCWP, and low CI

A

Obstructive Shock

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64
Q

This is the normal Central Venous Pressure (CVP)

A

2-6 mmHg

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65
Q

This type of shock is characterized by low CVP, low SVR, low PCWP, and normal CI

A

Neurogenic Shock

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66
Q

Caused by an increase in ADH secretion resulting in water retention with no edema, hyponatremia, and concentrated urine

A

SIADH

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67
Q

Symptoms include hyperpyrexia, diaphoresis, tachycardia/A-fib, N/V/D, and confusion

A

Thyroid Storm

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68
Q

This type of shock is characterized by high CVP, high SVP, high PCWP, and low CI

A

cardiogenic shock

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69
Q

This type of shock is characterized by a low CVP, low CI, low PCWP, and a high SVR

A

Hypovolemic

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70
Q

This is the antidote for Digitalis

A

Digifab/Digibind

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71
Q

Classic symptoms include polyuria, polydipsia, polyphagia, weight loss, blurred vision, lower extremity parenthesis, and yeast infections

A

Type II Diabetes

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72
Q

This is the normal systemic vascular resistance

A

800-1200 dynes/cm2

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73
Q

Bluish discoloration around the umbilicus associated with intraperitoneal hemorrhage

A

Cullen’s Sign

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74
Q

These are the antidote for tricyclics antidepressants

A

Sodium Bicarbonate, 3% Normal Saline

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75
Q

This is the normal mean arterial pressure

A

70-110 mmHg

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76
Q

Flexion of the neck usually causes flexion of the hip and knees

A

Brudzinski Sign

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77
Q

Classic symptoms include polyuria, polydipsia, polyphagia, and unexplained weight loss

A

Type I Diabetes

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78
Q

Your diagnose for a patient presenting with dyspnea and weakness with a BP of 90/40, RR of 30 with bilateral Rales and Wheezing, an SpO2 of 86% while on oxygen, and JVD. Labs include pH of 7.13, PaCO2 of 22, HCO3 of 16, PaO2 of 58.

A

CHF/ Cardiogenic Shock

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79
Q

What causes the release of renin?

A

A reduction in blood volume detected in the kidney’s

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80
Q

When is shock considered decompensated?

A

When the body can no longer maintain the Blood pressure (hypotension), maintain perfusion.

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81
Q

The 3 V’s of initial shock management

A

Volume Ventilation Vasopressor—- Pg: 204,205,

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82
Q

Define types of hypovolemic shock

A

Hemmoragic: Bleeding, loss of plasma and red blood cells

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83
Q

According to the AHA/ASA guidelines what is the SBP and DBP guideline?

A

SBP < 185 DBP <110, Post TPA: At or <185/105 for 24 hr

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84
Q

Acetaminophen antidote

A

N-acetylcysteine (Mucomyst, Acedote)

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85
Q

Acetylcholinesterase inhibitor antidote (CBRN agents, cholinergic agents)

A

Atropine and pralidoxime (2 PAM)

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86
Q

Acids causes

A

coagulation necrosis: limits the depth and extent of injury

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87
Q

Alkaline causes

A

Liquefactive necrosis, allows for extensive damage

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88
Q

Anticholinergic antidote (antihistamines, antispasmodic, some antiparkinsonsim, antipsychotic, some antidepressants, phenothiazines)

A

Physostigmine, rarely used

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89
Q

Art line Leveling

A

Leveling eliminates the effect of weight of the fluid filled catheter tubing and fluid column. This requires you to place the transducer at the phelbostatic axis. Should be laid flat or at 45% angle.

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90
Q

ART line Zeroing

A

Zeroing and leveling eliminates the effects of hydrostatic and atmospheric pressure

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91
Q

At what point of pregnancy does gestational diabetes usually present?

A

24th week

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92
Q

Benzodiazepines antidote

A

Flumazenil

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93
Q

Best active internal warming method for a hypothermic patient

A

Continuous arteriovenous rewarming, CAVR, rapid blood rewarming with the level one fluid warmer normally used for trauma resuscitation

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94
Q

Beta Block or Calcium channel blocker antidote

A

Glucagon, calcium, high dose insulin therapy, intravenous lipid emulsion therapy.

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95
Q

Brain cannot tolerate temps higher than

A

104.9F /40.5C

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96
Q

Carbon Monoxide antidote

A

High flow Oxygen

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97
Q

causes of cardiac tamponade

A

penetrating injuries, pericarditis, Acute pericarditis, post MI or cardiac surgery, infection, aortic dissection extending proximal into the pericardium, collagen vascular disease, chest trauma. Rapid accumulation of fluid.

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98
Q

Causes of cardiogenic shock

A

MI, ventricle wall rupture, papillary muscle rupture, valve failure, infections, structural cardiomyopathies, dysrhythmias

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99
Q

Causes of congestive heart failure

A

Most common. LV diastolic or systolic problems, Damage to Myocardium
Prolonged MI
Heart valve disorders
Conduction defects
Wall damage from Cardio myoptohys
Hypertension.

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100
Q

Common heat-related illness affecting trained athletes

A

Heat Cramps

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101
Q

Community acquired pneumonia most likely cause?

A

Streptococcus pneumonia

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102
Q

Components of standard precautions

A

Gloves, Surgical masks, eye protection

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103
Q

Concerns for transporting a patient with a PAC :

A

1: insertion depth (monitor for migration)2: Always transducing the distal port using a pressure monitoring waveform to confirm presence of a pulmonary artery waveform
3: Watching for migration of catheters. Can cause dysrhythmias
4: Verify the balloon is deflated
5: taking the 1.5 ml syringe
6: never flushing the catheter in wedge position
7: never using the distal port to admin fluids or meds other than saline flush at 1-3ml/h

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104
Q

Cues to a toxic exposure

A

Unusual odors, smoke vapors, placards, signs , markings, vehicles known to carry toxic substances, Walmart/Target delivery trucks, industrial, manufacturing, agricultural, or lab facilities, Bystanders who unexpectedly become ill or large groups of people showing similar symptoms.

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105
Q

CVP monitoring is for?

A

Allows for the assessment of the right heart hemodynamics and may aid in evaluating responses to therapy.

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106
Q

Define Anaphylaxis and how would you recognize it?

A

An Acute systemic allergic reaction causing the release of chemical mediators resulting in Vasodilation, Smooth muscle spasm, increased vascular permeability. A massive histamine response to not a real threat. Recognition: SOB, Coughing, Swelling, Hives, Hypotension Normally 2-4 organ systems are involved Ie. Cardiovascular, respiratory, gastro intestinal or skin.

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107
Q

Define Cardiac Tamponade

A

When Blood or effusion accumulates in the closed and relatively non-compliant pericardial sac. Heart unable to fill. Large chronic accumulation can usually be tolerated. Sudden acute changes are less manageable When Blood or effusion accumulates in the closed and relatively non-compliant pericardial sac. Heart unable to fill. Large chronic accumulation can usually be tolerated. Sudden acute changes are less manageable

108
Q

Define cardiac tamponade

A

When fluid accumulation results in pressure and subsequent compression of all chambers.

109
Q

Define cardiogenic shock? How would you recognize it

A

Hypotension caused by cardiac failures that causes a failure of perfusion of the vital organs. Recognition: Reduced CI <1.8 L/min/m2 without support or under 2.2L/min/m2 with support. and elevated ventricle filling pressures.

110
Q

Define congestive heart failure

A

Clinical condition of extreme pump failure leading to the inability of heart to perfuse the vital organs. Pump failure leads to inadequate tissue perfusion.

111
Q

Define congestive heart failure

A

Heart is unable to pump sufficient blood to meet metabolic needs of the body. Resulting in inadequate tissue perfusion.

112
Q

Define distributive shock

A

Distributive shock: Vasomotor dysfunction resulting in either high/normal arterial resistance with expanded venous capacitance, or low arterial resistance.

113
Q

Define nurogenic shock and how would you define it

A

Caused by acute spinal injury. Development of hypotension and variable heart rate response. Occurring secondary to sympathetic denervation, resulting in arterial dilation and pooling of blood in venous compartments.

114
Q

Define obstructive shock

A

Obstruction to cardiovascular flow resulting in impaired diastolic filling or significantly increase in after load.

115
Q

Define pericardial effusion:

A

Is present when there is accumulation of more than normal amounts of fluid in the sac.

116
Q

Define pericarditis

A

Inflammation of the pericardial sac. Most common disorders involving the paracardial sac.

117
Q

Define Septic shock and how would you recognize it

A

A systemic infection that leads to organ dysfunction. Recognition: 2 or more of the following
AMS
SBP less than or equal to 100mmHG—MAP greater than or equal to 65mmHg
RR greater than 22
Serum lactate greater than 2mmol/L

118
Q

Define tension pneumothorax.

A

Collapse of the lung due to air in the chest cavity.

119
Q

Define types of hypovolemic shock

A

Hemmoragic: Bleeding, loss of plasma and red blood cells
Non Hemorrhagic: Vomiting, Diarrhea, excessive sweating, Polyuria

120
Q

Describe the pituitary gland

A

Pea sized, located at base of brain produces hormones and causes other organs to produce and release hormones,

121
Q

Describe the thyroid gland

A

Butterfly shaped gland that sits in and anterior neck below the cricoid cartilage. Secretes Thyroxine (T4) and Triiodothyronine (T3). The parafollicular cells produce calcitonin which affect calcium metabolism.

122
Q

Devices used for acute short term refractory heart failure

A

ECMO

123
Q

Diabetic cataract causes:

A

fructose and sorbitol in the lens

124
Q

Digoxin antidote

A

Digibind, Digoxin fib antibodies

125
Q

Efects of Beta-blockers & Calcium channel blockers

A

Negative chronotropic, dromotropic and inotropic effects. CCB ALSO CAUSE VASODILATION. Can cause bradycardia, AV heart blocks, hypotension and impair glucose utilization. BB can cause respiratory distress by blocking B2 receptors.

126
Q

Effects of alcohols

A

Ethylene Glycol: inebriated patients with no odor of alcohol, reaches peek effects in 1-4 hours. CNS toxicity, hepatically motabilized into glycolic and oxalic acid. Calcium crystals deposited in heart and kidneys Menthaol (wood alcohol) initial presentation similar to acute ethonal ingestion, severe metabolic acidosis, blindness, and eventually death

127
Q

Effects of antihistamines

A

Have Anticholinergic effects, inhibits the actions of acetylcholine at central and peripheral muscarinic receptors (Dry as a bone, Mad as a hatter, hotter than hades….) S/S of OD: Hyperthermia, AMS, Tachycardia,

128
Q

Effects of Ecstasy (MDMA)

A

(MDMA) sympathomimetic: stimulant peripheral and CNS sympathetic nerves. A & B receptors, Euphoria, decreased fatigue, excitement, can progress to anxiety, paranoia, hostility, hyperthermia and seizures, tachycardia, arrhythmias, hypertension, and vasospasm leading to MI, Stoke and death. Pt may drink a lot of water and cause hyponatremia.

129
Q

Effects of ethanol

A

Psychomotor retardation, reflex slowing, lethargy, sleep, coma and death, Initially respirations increase but with increased concentrations alcohol respiratory depression can occur. Heat loss through vasodilation, increased gastric secretions lead to irritation of the gastric mucosa and diuresis leads to dehydration.

130
Q

effects of Opioids

A

Pinpoint pupils, hypoventilation, lethargy/sedation, non cardiac pulmonary edema.

131
Q

Electrical alternans

A

A beat to beat alteration in the QRS complex, which reflects movement of the heart in the pericardial fluid.

132
Q

Elipidae venom

A

Cobras, mambas, sea snakes, coral snakes • “Red on yellow kills a fellow” Coral snake: Neurotoxic course, drowsiness, euphoria, weakness, nausea, vomiting, fasciculations, dysphagia, salivation, extraocular muscle paresis, hypotension, and cardiopulmonary failure.

133
Q

Endocrine disorders often confused with these common problems

A

• Sepsis • Psychiatric disorders
• Toxicology disorders

134
Q

Forms of enhanced elimination:

A

Alkalization of the poisoned Pt’s urine which causes ion trapping diuresis. For alkalization of urine, sodium bicarb is added to IV fluids, which are administered to yield a urine pH of 7.5.

135
Q

Hallmark of heat stroke

A

• Elevated muscle enzymes; hallmark of heatstroke • Sever metablic acidosis,
• Significant rhabdomyolysis

136
Q

Heaprin antidote

A

Protamine

137
Q

Heavy metals antidote

A

Edetate calcium disodium (EDTA), dimercaprol (BAL), Succimer, or D-penicillamine

138
Q

How are patients intentionally exposed to poisons?

A

Intentional poison exposure usually results from suicide attempts, abuse and or intentional misuse of medication

139
Q

How can dysrhythmias be described?

A

Serious electrical abnormalities of the HR and rhythm

140
Q

How dose HHNS happen?

A

Usually in type 2 diabetics, and over the age of 50. Typically slower onset. The body beings to metabolize fat and muscle tissue increases, though little ketone creation happens. Existing hyperglycemia is made worse by gluconeogenesis

141
Q

How to treat HHNS?

A

Will require significant rehydration (average deficient of 9-10L) 1-2L over the first hour to restore BP and volume

Anticipate Hypokalemia
Should only lower serum glucose by 75-150mg/dl/hr

142
Q

How would you recognize Neurogenic shock

A

Loss of supraspinal control of sympathetic nervous system resulting in unopposed Vagal tone with relaxation of vascular smooth muscle below the level of the injury to the spinal cord.Decreased venous return,
Decreased cardiac output
Hypotension
Loss of diurnal function
Reflex bradycardia
Peripheral adrenoreceptor hyperresponsiveness.

143
Q

If a Pt is eligible for tPA but there BP is >185/110 what is used and at what dose

A

Labetalol 10 -20mg IV over 1 to 2 mins, OR nicardipine infusion at 5mg/h

144
Q

If Stroke Pts SBP is > 180-230 or DBP is >105-120 you should consider what med at what dose

A

Labetalol 10mg followed by continuous infusion at 2 to 8 mg of nicardipine.

145
Q

Indications for gastric decontamination

A

• Highly toxic ingestion likely to remain unabsorbed in stomach • Substances not absorbed well by activated charcoal
• No effective antidote or treatment therapy

146
Q

Interventions for an abdominal aortic emergencies?

A

Blood products coordinate effort to decrease time to surgery, be cautious with volume resuscitation, titrate to maintain cerebral and myocardial perfusion. Prep for Cardiac arrest.

147
Q

Intrinsic rate for a-fib and a-flutter

A

A flutter: 220-350, A FIB: 350-600

148
Q

Iron Antidote

A

Deferoxamine

149
Q

Methemoglobinemic agents (Nitrates, topical anesthetics) antidote

A

Methylene blue

150
Q

Monitor and trouble-shooting IABP: Diastolic hypertension
Rapid HR >200
Balloon rupture

A

1 Provide afterload reduction or decrease augmentation volume IABP if possible
2. Leave IABP in 1:1 counter pulsation
3. Stop pump immediately clamp the catheter
4. Position Pt in left lateral position
5. IABP needs to be removed ASAP

151
Q

Monitor and trouble-shooting IABP: Asystole/PEA:

A

ACLS guidelines/pump on pressure mode. IABP will continue to pump with CPR as pressure sensed

152
Q

Monitor and trouble-shooting IABP: Power failure

A

Attach 60ml syringe and refill balloon ever 3-5 min quickly then deflate

153
Q

Monitor and trouble-shooting IABP: Pulseless V-Tach/Vfib

A

ACLS guidelines, stomping the pump is unnecessary, can accommodate shocks

154
Q

Monro-Kellie doctrine percentages

A

80% Brain 10% Blood 10% CSF

155
Q

Most common cause of cardiogenic shock

A

MI with extreme with extensive ischemic damage involving over 40% of the ventricle.

156
Q

Most common mode of transmission for bacterial diarrhea?

A

Person to Person or hand to mouth. Contaminated food and water.

157
Q

Most common source of infection by blood-borne pathogens in a healthcare setting?

A

Needle stick

158
Q

Most effective preventative medical measure to combat the spread of infectious disease:

A

Vaccines and immunization programs.

159
Q

Most important test for patients with a mental status change

A

BGL, rapid blood glucose.

160
Q

Myxedema is usually caused by a?

A

precepting event…cold exposure, infection, drugs…

161
Q

Odor of arsenic

A

Garlic

162
Q

Odor of Cyanide

A

Bitter almonds

163
Q

Odor of isopropyl alcohol, ingested acetone

A

Fruity, sweet

164
Q

Odor of methyl salicylate

A

winter green

165
Q

Odor of phosgene gas

A

newly mown hay/grass

166
Q

Other causes of cardiogenic shock

A

Severe RV infarction, Acute exacerbation of severe HF, stunned myocardium as a result of CA, Hypotension, advanced septic shock, significant dysrhythmia, valvular disorders, ruptured ventricles aneurysm, cardiac tamponade, tension pnumo.

167
Q

PAC monitoring is for

A

Allows for direct measurement of RA pressure, pulmonary artery pressure, PAWP, CO, and circulation of systemic and pulmonary vascular resistance.

168
Q

Parameters for NIBP monitoring (i.e. cuff size/coverage, placement)

A

Covers 2/3s of extremity and cover 40% of surface area. On the correct axis

169
Q

Pit viper venom causes

A

1-2 puncture wounds: localized pain, swelling and edema and bitten area. Diaphoresis, chills, paresthesia, nausea, hypotension, faintness, weakness, muscle fasciculations, local ecchymosis, coagulopathies

170
Q

Primary risk factors for heart failure:

A

LV dysfunction from CAD and advanced age

171
Q

Pulsus paradoxus

A

Abnormal fall of BP during inspiration caused by differential filling of ventricals.

172
Q

ROCLAVAX means? and Antidote of choice

A

Reserpine Narcan,Opioids 0.4 mg titrate
Clonidine
Lomotil All others
Aldomet 10mg
Valproate
ACE inhibitor and Angiotensin receptor blocker
X: Zanaflex

173
Q

S/S of a Cardiac tamponade

A

Tachycardia, edema, elevated venous pressures, JVD, decreased BP, muffled heart sounds

174
Q

S/S of meningitis

A

fever, headache, irritability, altered LOC, nuchal rigidity, increased ICP

175
Q

S/S of pericarditis

A

Chest pain(improved with sitting forward), recent illness, plural friction rub sounds, substernal chest pain that radiates to the neck, back and shoulder. Fever, lukocytosis, dyspnea

176
Q

Serum sickness

A

May develop after antivenom admin. Incidents rates vary from 10-80% of all pts given Anti venom therapy. S/S occur up to three weeks after admin. Fever joint pain rash nausea, vomiting, neurologic symptoms. Tx is antihistamines and steroids.

177
Q

Signs and symptoms of aortic dissection related to the subclavian artery

A

Pain, differential BP and pulses

178
Q

Signs and symptoms of hemorrhagic stroke

A

Acute LOC, headache, N/V

179
Q

Signs, symptoms of Cyanide exposure

A

Smell of bitter almonds, inhibits oxygen transport, oxygen phosphorylation, and inhibits the production of ATP. Causes Hypoxia, anerobic metabolism, and sever anion gap. Will show signs of metabolic acidosis, hypoxia, to include AMS, headache, GI upset, tachypnea, tachycardia leading to bradycardia and hypotension. PA02 is not reliable.

180
Q

Signs, symptoms of organophosphate exposure

A

Reports of the smell of garlic, SLUDGEM Salivation, lacrimation, urination, defecation, GI, expectoration/emsis/ Misosis, This includes, brochorrhea, bradycardia, broncho spasam hypotension.

Note Nicotinic stimulation leads to tachycardia, hypertension, mydriasis, muscle facisculations, seizures, eventually paralysis, including the diaphragm

181
Q

Signs/symptoms for each stage of heatstroke

A

AMS is key, hot flushed skin, hyperventilation, tahycardia, elevated CVP atrial and ventricular arrythmias.

182
Q

Signs/symptoms for each stage of heatstroke: Heat Cramps

A

Heat Cramps: Painful, sustained muscular contractions, mostly in the lower extremities, after heavy exercise in hot environment.

183
Q

Signs/symptoms for each stage of heatstroke: Heat Exhaustion

A

Heat Exhaustion: CNS unimpaired, core temp lower than heat stroke Pt’s 100.4-102.2, still sweating, headache, euphoria, muscle cramp.

184
Q

Square wave test

A

Determine the hemodynamic systems ability to accurately reproduce the physiologic signal.

185
Q

SSRI antidote (serotonin syndrome)

A

Cyproheptadine, benzodiazepines

186
Q

Swiss Staging of Hypothermia

A

HT1: Conscious shivering 95-91F(35-32C) HT2: Impaired consciousness, not shivering 91-82F (32-28C)
HT3: Unconscious, not shivering, vital signs present 82-75.2F (28-24C)
HT4: No vital signs <75F (24C)

187
Q

Sympathomimetic antidote

A

Benzodiazepines

188
Q

Target systolic BP for non-traumatic aortic dissection

A

SBP 100-120 with a BP as low as safely possible while still maintaining vital organ perfusion

189
Q

Time parameters for the use of tPA in stroke patients

A

Door to drug <1hr or within 3 hours of onset

190
Q

Toxic Alcohol Antidote

A

Fomepizole (Antizol) or ethanol

191
Q

Toxic ingestion of Tylenol Stage 1

A

occurs within 24hrs post ingestion: anorexia, N/V malaise, pallor, and disphoresis

192
Q

Toxic ingestion of Tylenol Stage 2

A

24-72 hrs post ingestion. RUQ pain and tenderness due to liver enlargement. Level of liver enzyme serum bilirubin and prothrombin increase. 36 hrs post ingestion Oliguria from acute tubular necrosis

193
Q

Toxic ingestion of Tylenol Stage 3

A

72-96hrs after ingestion. Peak liver function abnormalities, anorexia, N/V return, jaundice becomes apparent, fatalities usually occur from fulminant hepatic necrosis.

194
Q

Toxic ingestion of Tylenol Stage 4

A

4 days -2 weeks post ingestions. Asymptomatic an liver functions return to base line.

195
Q

Toxic level for aspirin

A

> 150mg/kg

196
Q

Treatment for a hyperthermic, hypovolemic, comatose patient

A

Intubation, cooling, possibly need high rates of ventilation to prevent acidosis, Large amounts of fluids and inotropic agents are only needed if cooling fails to correct hypotension

197
Q

Treatment for asymptomatic bradycardia

A

None only observation

198
Q

Treatment for meningitis

A

Antibiotics, Dexamethasone

199
Q

Treatment of Cardiac tamponade

A

Pericardiocentesis. Fluid treatments can be provided while preparing for the procedure.

200
Q

Treatment of Pericarditis

A

Ibuprofen, ketorolac, proton pump inhibitors, Narcotic opioids, monitored for pericardial effusion

201
Q

Tricyclic antidepressant antidote

A

Bicarbonate infusion therapy

202
Q

Warfarin antidote

A

Vitamin K + Fresh frozen plasma or prothrombin complex

203
Q

Water-depletion heat exhaustion results from

A

• Inadequate fluid replacement (few hours) • Loss of salt (over several days)

204
Q

What altitude can affect esophageal obstructions if a rapid decompression should occur?

A

35,000 feet

205
Q

What are Acute Hemolytic Transfusion Reactions

A

Red blood cell destruction following transfusion. Symptoms within minuets.

206
Q

What are Allergic reactions in regards to blood transfusions?

A

Urticaria: mildest form of reaction Anaphylaxis: Life threatening reaction

207
Q

What are Disorders of Potassium

A

Rarely causes problems. Irradiated cells have greater K+ leakage. HypoK is more common, post transfusion.

208
Q

What are Febrile Non Hemolytic Transfusion Reactions

A

An otherwise unexplained raise in temperature of atleast 1 degree C during or after transfusion- More often after transfusion of platelets.

209
Q

What are hormones from the posterior pituitary gland

A

ADH and Oxytocin.

210
Q

What are Linton tubes used fore

A

Esophageal balloon tamponade devices traction dependent ( used for esophageal varices AND acute gastric occurrences)

211
Q

What are Sengstaken-Blakemore tubes & Linton tubes used for ?

A

Esophageal balloon tamponade device, traction dependent (used for esophageal varices)

212
Q

What are some causes of Obstructive shock?

A

PE, Cardiac Tamponade, Tension Pneumothorax

213
Q

What are some common toxidromes and causes?

A

Anticholinergic: low potency, antipsychotics, oxybutynin, ipratropium, Ach receptor antagonist Cholinergic: Ach receptor agonist, EX: AchEl i.e: Donepezil
Opioid: morphine, heroin, hydromorphone
Sympathomimetic: Epi, cocaine, amphetamine, methylphenidate
Sedative hypnotics: Benzos, barbiturates, Z drugs, antihistamines

214
Q

What are some risk factors for Cushing syndrome?

A

Poorly controlled type 2 diabetes, obesity, hypertension.

215
Q

What are some signs of Cushing’s syndrome

A

Thinning of the skin, mood swings, depression, weakness/fatigue, increased thirst/urination

216
Q

What are some Signs of PE?

A

Recent surgery, SOB, spinal cord injury, lower limb fracture, join replacements. Oral contraceptive use. Recent pregnancy. Chest pain (pleuritic), No improvement with O2 admin. S3Q3T3, D-Dimer

217
Q

What are some the hormones from the Anterior pituitary gland

A

Prolactin, growth hormone, thyroid stimulating hormone, luteinizing hormone, follicle stimulating hormones

218
Q

What are Storage lesions

A

A possible damage to RBC’s due to storage of Blood. Hinders ability of blood to be used effectively by the body. Current data is inconclusive.

219
Q

What are the mortality rates for Aortic dissection and a ruptured Aortic aneurism

A

Dissections 25-30% Ruptured aneurism-80%

220
Q

What are the sub atmospheric pressures in the esophagus normally?

A

-5 - 10mmHg

221
Q

What arrhythmias are major causes of sudden cardiac death in the United States?

A

Ventricular Arrythmias

222
Q

What can cause hyperthyroidism?

A

Graves disease an autoimmune disease.

223
Q

What can Mannitol cause

A

Hypertonic hyponatremia, osmotic diuresis.

224
Q

What causes osmotic diuresis

A

Severe hyperglycemia, HHNS, HHNK

225
Q

What condition is likely to cause loss of cerebral auto regulation and reduced cerebral blood flow?

A

Hypoventilation

226
Q

What devices may respond to defibrillation?What ones wont?

A

Will: impella, Centri Mag(without disconnect), HeartMate II, Jarvik, Heart Ware, Heart Mate3. Will not: TAH (Synthacardia,) ECMO

227
Q

What do people not produce in Type 1 diabetes

A

Insulin

228
Q

What drug is considered if DBP is >140

A

Sodium nitroprusside

229
Q

What happens to Cerebral artery when there is a decrease in MAP

A

Arteries dilate increasing cerebral blood flow

230
Q

What happens to the cerebral arteries when there is an increase of the mean arterial pressure?

A

• Causes cerebral arterial blood vessels to constrict • Preventing increase in Cerebral Blood Volume

231
Q

What is a Anaphylactoid reaction?

A

Anaphylactoid reactions are the same but do not require IgE mediation and do not require prior sensitization. Most often caused by drugs (Iodine contrast.)

232
Q

What is a myexedema coma

A

when you have decreased thyroid leading to an increase in fluid in face and around eyes. Severe and life threatening.

233
Q

What is a toxidrome?

A

• A group of signs and symptoms constituting the basis for a diagnosis of poisoning.

234
Q

What is accomplished BEFORE balloon tamponade of the esophagus?

A

Intubation

235
Q

What is Addison’s disease?

A

Under secretion of the adrenal cortex. due to autoimmune disorders, infections, tumors

236
Q

What is adrenal insufficiency?

A

inability of adrenal glands to generate enough glucocorticoids +/- mineralocorticoids for body’s needs

237
Q

What is Alloimmunization?

A

Antibodies generated post transfusion, organ transplant or fetal maternal hemorrhage. Can cause anemia due to death or destruction of RBC’s

238
Q

What is are PE’s sometimes referred to as?

A

THE GREAT MASQUERADER

239
Q

What is Citrate Toxicity?

A

Increased plasma citrate causes chelates in calcium, magnesium ions, resulting ins hypocalcemia and hypo magnesia. MUST BE HIGH TRANSFUSION RATE >6 units per hour (35ml/min) of blood must be transfused to cause reduction in ionized calcium.

240
Q

What is Cushing’s syndrome?

A

excessive cortisol production and exposure

241
Q

What is Meningitis?

A

Inflammation of CNS and the surrounding structures caused by virus, bacteria, parasite fungal

242
Q

What is ocreotide used for?

A

Decreases blood to portal system constricting splanchnic arterioles

243
Q

What is Olanzapine?

A

Antipsychotic used to treat schizophrenia

244
Q

What is omeprazole used for?

A

It a Proton pump inhibitor used for heart burn, GERD etc etc

245
Q

What is Primary adrenal insufficiency?

A

Addisons- Failure of the adrenals to respond to ACTH

246
Q

What is Secondary adrenal insufficiency

A

Failure of the pituitary to make ACTH

247
Q

What is the abdominal cavity pressures normally

A

P+5 - +10 mmHgl

248
Q

What is the cause of pericardial effusion.

A

Acute pericarditis, post MI or cardiac surgery, infection, aortic dissection extending proximal into the pericardium, collagen vascular disease, chest trauma.

249
Q

What is the hub of thermoregulation

A

Hypothalmus

250
Q

What is the most common cause of esophageal varices?

A

hepatic congestion

251
Q

What is the most common form of diabeties?

A

Type 2

252
Q

What is thyroid storm?

A

acute, life-threatening form of thyrotoxicosis that may present w/ Afib, fever, and delirium, N/V/D, hypertension, heart failure, AMS

253
Q

What is Transfusion- Associated Immunomodulation (TRIM)

A

Down Regulation of a recipients cellular immune response as a result of allogenic blood transfusions. Increases the risk of post operative infections, hospital acquired infection, cancers and Transfusion related multiple organ dysfunction.

254
Q

What is Transfusion-Associated Circulatory Overload (TACO)

A

Acute Pulmonary edema within 6 hours of transfusion. Same management as Pulmonary edema, fluid restrictions, diuresis, CPAP.

255
Q

What is Transfusion-Related Acute Lung Injury (TRALI)

A

New on set of worsening Hypoxia (PA02/FiO2 <300mmHg) with a chest X ray consistent with Pulmonary Edema. NOT CARDIOGENIC AND WILL NOT RESPOND TO DIURETICS THERAPY. Usually improves in 96 hours. Greatest risk from platelet transfusion.

256
Q

What medications a most likely to affect thermoregulation?

A

Sympathomimetics: cocaine, amphetamines and MDMA. K2/ Spice. AlcoholOTC medications with mild anticholinergic properties that inhibit sweat glands.
Drugs that cause hyperthermic syndromes, such as psychiatric drugs, lithium, tricyclic antidepressants, drug associated with serotonin syndrome.

257
Q

What rhythm is associated with congenital structural heart disease, endocardial cushion defects, ischemia, anoxia, and digitalis toxicity?

A

1st degree HB

258
Q

What substance/drug is Ketamine similar to?

A

PCP/phencycilidine

259
Q

What will a transducer above the axis cause?

A

FALSE LOW VALUES RESULT

260
Q

What will a transducer below the axis cause?

A

FALSE HIGH VALUES RESULT

261
Q

When getting PAWP for a Pt you should inflate the balloon no longer than?

A

2 to 4 respiratory cycles (8-15sec), Note: should be allowed to passively deflate

262
Q

When should all pressure measurements be obtained?

A

At the end of expiration

263
Q

When should you require contact precautions?

A

Should be used when caring for Pt’s with known or suspected infections spread by direct or indirect Pt contact.

264
Q

When to use TXA?

A

In uncompressible hemorrhage or in massive trauma. OB, Orthopedic within 3 hours of injury. —Pg 206

265
Q

Where are the baroreceptors located controlling the response to physiologic shock?

A

Carotid bodies and aortic arch

Critical Care (4 decks)

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