Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

St Charles ED > Fellowship > Flashcards

Fellowship Flashcards

1
Q

What documents are printed out for a transfer to a correctional facility?

A 
ED/inpatient summary
Current visit notes
Nursing documentation
AVS
Face sheet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q
  1. What are the sepsis/SIRS criteria? (Must meet 2)

2. What are the severe sepsis/septic shock criteria? (Must meet one in addition to 2 of above)

A
  • HR >90
  • RR >20
  • Temp >38.3 or <36.0
  • WBC’s >12,000 OR <4,000
  • AMS

Severe/sepsis:

  • lactic >2.0
  • creatinine >2 or double baseline
  • oliguria (<0.5/ml/kg/hr for >2hrs
  • Platelets <100k
  • SBP <90, MAP <65
  • Bilirubin >2mg/dl
  • INR >1.5 or PTT >60 sec
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

After the ABCDE primary assessment, what is involved in the secondary assessment?

A

F: full set of vitals
G: giving comfort
H: history and head to toe assessment
I: inspecting posterior surfaces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What effect does an increase or decrease in stroke volume have in pulse pressure?

A

Increase in stroke volume: widened pulse pressure

Decrease in stroke volume: narrowed pulse pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are pediatric contraindications for taking a rectal temp?

A

Less than 1 month
Recent rectal surgery
Diarrhea or rectal lesions
Taking chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the circulatory state of an obstetric patient?

A

Hyperdynamic, hypervolemic, hypercoagulable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Allodynia

A

Pain caused by a stimulus that does not normally cause pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Damaged tissue releases which powerful pain mediators?

A

bradykinins
leukotrienes
serotonin
histamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is “LET” and what is in it?

When should it not be used?

A

A topical mixture of lidocaine, epinephrine, and tetracaine. Often used for pediatric patients prior to venipuncture.

Do not use in areas with decreased circulation such as fingertips, toes, or penis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Normal bicarbonate (HCO3)
Venous
Arterial

A

Venous: 22-26
Arterial: 22-26

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Normal PaO2
Venous:
Arterial:

A

Venous: 38-42
Arterial: 80-100

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Normal base excess

A

No difference between arterial or venous

2.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Flow range for simple mask?

A

Less than 5lpm can cause CO2 retention.

Range is 5-10lpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hiflo NC fitment considerations

A

Prongs should occlude no more than 50% of each nare

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Max pressure for suctioning et tubes?

A

150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Standard RSI pre-oxygenation

A

15 LPM NRB
+
6 LPM NC
X 3 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When is etomidate contraindicated?

A

Sepsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Post RSI considerations/tasks

A

Pain control
Additional sedation
HOB at 30 degrees
X-ray tube placement confirmation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hemoccult test process

A
  • Apply sample and wait 3-5 minutes.
  • Apply developing drops on back side - 2 drops per side plus 1 drop for control
  • wait 60 seconds to read results - blue is positive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How do you pull RSI meds for a patient not in the Pyxis?

A

Flu vaccine, employee Redmond

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is normal anion gap?

A

8-16

High anion gap = acidosis such as DKA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 3 primary types of obstructive shock?

A

Tension Pneumothorax
Pericardial tamponade
Massive PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Dobutamine

A

Catecholamine (vasopressor) used in the treatment of shock.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Difference between epi and nor-epi?

A

Epi has less A1 effects and more B1 effects thereby having less effect on BP and more on HR.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is considered a prolonged QT?

A

0.44 seconds
or
Greater than 50% of the R to R interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What EKG change might be seen in hemorrhagic stroke?

A

T-wave inversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

I’m addition to troponin, what are 2 other cardiac markers that can indicate cardiac tissue damage?

A

CK - creatinine kinase
or
Myoglobin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Onset, peak, and return to baseline timeframes for cardiac bio markers:

  1. Troponin I
  2. Troponin T
A
  1. 4-6 hours, 14-18 hours, 5-7 days

2. 3-4 hours, 4-6 hours, 2-3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What type of drug is clopidigrel?

A

Plavix - P2Y12 receptor blocker

Anti-coagulant (reduces platelet aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is normal lactate?

A

0.5-2.2 (variable depending on facility)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q 
What does a base deficit indicate?
What are levels for:
Mild
Moderate
Severe
A

Indicates tissue ischemia (shock)
Mild: 2-5
Moderate: 6-14
Severe: >15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How recent must a blood glucose be to be used in Endo tool?

A

20 minutes

33
Q

What is the definitive diagnosis for temporal arteritis?

A

Biopsy.

Consider temporal arteritis for any patient over 50 who presents with new headache or vision changes.

34
Q

What’s the first and second steps (charting) in a massive transfusion?

A
  1. Order set -> massive transfusion

2. Release 4 RBC’s and 2 plasma

35
Q

What’s a consideration with pediatric DKA fluid administration?

A

Cerebral edema can occur if fluids are administered too quickly.

Recent studies recommend 20ml/kg over the first hour for initial fluid resuscitation

36
Q

Pediatric DKA

  1. After initial fluid resuscitation of 20ml/kg NS, what is the determining criteria for whether or not to start an insulin drip?
  2. If potassium is greater than 5.5 what maintenance fluid should be used?
  3. What maintenance fluid if potassium is 3.5-5.5?
  4. What maintenance fluid if potassium is less than 3.5
A
  1. Start insulin drip at 0.1 units/kg/hr only if potassium is greater than 3.5
  2. D5NS
  3. D5NS w/40k
  4. NS w40k

Never give insulin bolus

37
Q

What is the “last seen normal” or “onset of symptoms” inclusion criteria for ischemic stroke fibrinolytic therapy?

A

Less than 4.5 hours

38
Q

Stroke Fibrinolytic exclusion criteria?

A
  1. Significant head trauma or prior stroke within previous 3 months
  2. Arterial puncture at non-compressible site in previous 7 days
  3. Hx of previous intracranial hemorrhage.
  4. Intracranial neoplasm or aneurysm
  5. HTN >185/110
  6. Platelets less than 100k
  7. Heparin received in the last 48hrs resulting in a high aPTT
39
Q

rTPA dose and

How to administer

A

0.9 mg/kg
Max dose of 90mg
1. 10% of dose bolus over 1 minute
2. Remaining 90% over 1 hour

40
Q

What is endovascular coiling?

A

inserted through the groin and then inserted and coiled full of thin wires into the aneurysm around which clots form so that blood can no longer circulate into the weakened structure.

41
Q

What precautions for suspected bacterial meningitis?

A

Droplet for first 24hours of antibiotic therapy.

42
Q

What is myasthenia gravis?

A

Autoimmune disorder that damages nicotinic acetylcholine receptors.
Because these sites cannot be activated, muscle weakness occurs. May present with drooping eyelid(s)

43
Q

Nexus criteria

A
  1. No midline cervical tenderness
  2. No focal neuro deficits
  3. Normal alertness (no AMS)
  4. No intoxication
  5. No distracting injuries
44
Q

Atypical antipsychotics such as haldol and droperidol can cause what type of adverse reaction?

A

Dystonic reactions such as tardive dyskinesia or torticollis (painful neck rotation)

45
Q

Mechanism of barbiturates and 1 example of a barbiturate.

A

Enhances activity of GABA

Phenobarbital

46
Q

What class of drug is phenytoin?

A

Anti-seizure
Hydantoin class

Milk and antacids can reduce absorption

47
Q

What is the reversal agent for benzos

A

Flumazenil

48
Q

What type of drug is valproic acid?

A

Anti-seizure

49
Q

LEAPS neuro assessment

A 
L- LOC
E- eyes, pupils, gaze
A- Arm & leg strength
P- Pat’s other symptoms
S- Swallow screen
50
Q

Post TNK administration vitals/neuro assessment timeline

A

Q15 for 2 hours
Q30 for next 4 hours
Q hour after that until discharge

51
Q

When should a swallow screen occur?

A

Within 1 hour of ED arrival for all Ischemic, hemorrhagic, or TIA patients.

52
Q

Hemorrhagic stroke or subarachnoid bleed goal BP

A

140 SBP

53
Q

Goal BP for ischemic strokes who have received TNK?

A

180 SBP

54
Q

TNK qualification criteria

A

Symptom onset <4.5 hours
NIH > 4 or life altering deficit
No contraindications present

55
Q

Drug/alcohol and suicide screenings are mandatory for what age?

A

12 or older

56
Q

Fetal heart tones should be performed on what gestational age?

A

12 weeks or greater (if applicable to chief complaint)

57
Q

Blood cultures:

  1. Min/max volume for Adult tubes?
  2. Min/max volume for pediatric tubes?
  3. What color tubes for no abx?
  4. What color tubes if pt is on abx?
  5. What must be done before putting blood into culture tubes?
A
  1. 8ml/10ml
  2. 0.5ml/4ml
  3. Blue and Red
  4. Green and Red
  5. Wipe top with alcohol
58
Q

Cath lab door to balloon time goal?

A

<90 minutes

59
Q

ART lines:

  1. Pressure bag set to?
  2. Phlebostatic access point?
A
  1. 300

2. 4th intercostal, mid-axillary

60
Q

ART line contraindications?

A
  1. Failed Allen’s test (no ulnar circulation after holding pressure)
  2. Uncontrolled coagulopathies or DIC
61
Q

All sexual assault victims should be triaged at what level?

A

2

62
Q

Which physician does not like when nurses put any orders in?

A

Bouska

63
Q

Lab requirements to meet criteria for DKA?

A

Anion Gap >15

Bicarb <18

64
Q

What is anion gap?

A

Sodium - (Chloride + HCO3)

65
Q

What is the ideal hourly blood glucose decrease in a DKA or HHS patient?

A

30-100

66
Q

Facts about GHB

A

*Gamma-hydroxybutyrate
*Metabolite of GABA
*Depressant
*Used as a “date rape” drug
*Abrupt onset and rapid recovery
Not detected on routine drug screenings

67
Q

Bath Salts facts

A
  • chemically similar to methamphetamines
  • can be inhaled, injected, or taken orally
  • can cause paranoia, hallucinations, violent behavior, euphoria
68
Q

Ecstasy facts

A
  • increases activity of dopamine, norepinephrine, and serotonin
  • Usually lasts 3-6 hours
  • Complications can include hypertension, hyperthermia, and tachycardia
69
Q

What drug, that might be used to treat alcohol withdrawal behavior issues, should be used with caution as it can lower the seizure threshold?

A

Haldol

70
Q

What is the incubation period for chickenpox?

A

10-20 days after exposure

71
Q

What is the timeframe for reversing testicular torsion?

A

If detorsion is performed within 12 hours, the testicular salvage rate is 80%

72
Q

What does HELLP stand for in regards to a pregnancy complication?

A

HELLP syndrome is a life threatening form of preeclampsia which presents with N/V, RUQ pain, and jaundice
Hemolysis
Elevated liver function tests
Low platelet count

73
Q

How to fit crutches

A

2-3 inches below axilla. Advise pt not to rest body weight on axillary padding as it could cause nerve compression.

74
Q

Is a cane used on the injured side or non-injured side?

A

Non-injured

75
Q

How long should LET be left on?

A

At least 20 minutes

76
Q

Procedural Sedation Equipment checklist:

SOAPME

A 
Suction
Oxygen
Airway - airway adjuncts and  bvm, intubation supplies if needed
Pharmacy - meds
Monitors 
Equipment - code cart
77
Q

Sedation Meds that must be pushed by MD

A

Ketamine (ok for RN to push for RSI)
Propofol
Methohexital
Etomidate

78
Q

Vitals frequency for moderate sedation?

Vitals frequency for deep sedation?

A

Moderate: Q15
Deep: Q5

Also Within 5 minutes of any medication administration

79
Q

How long must a patient be monitored after procedural sedation?

A

At least 60 minutes from last med administration
AND
At least 30 minutes from end of procedure

If reversal agents are used - 120 minutes of monitoring is required.

St Charles ED (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions