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USMLE® Step 1 flashcards
1
Q

sympathomimetic

A
  • Cocaine, methamphetamine/amphetamines, ecstasy (MDMA), ADHD meds like Ritalin, Adderall, ephedrine, caffeine
  • sympathetic stimulation involving epinephrine, norepinephrine, and dopamine
  • excessive stimulation of alpha and beta adrenergic system
  • tachycardia
  • arrhythmias
  • Hypertension
  • ICH (intracerebral hemorrhage)
  • confusion with agitation
  • seizures
  • rhabdomyolysis- renal failure can result
  • CNS excitation -> behavioral agitation -> cardiac excitation ->
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2
Q

opioids

A
  • morphine, codeine, heroin, methadone, hydrocodone, oxycodone, fentanyl
  • Deadly
  • respiratory, cardiac arrest
  • coma
  • miosis
  • respiratory depression
  • peripheral vasodilation
  • orthostatic hypotension
  • flushing (histamine)
  • bronchospasm
  • pulmonary edema
  • Seizures
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3
Q

anticholinergic

A
  • Blockage of ACh receptors -> mostly just muscarinic
  • confusion
  • agitation
  • myoclonus
  • tremor
  • picking movements
  • abnormal speech
  • hallucinations
  • coma
  • peripheral muscarinic effects:
  • mydriasis
  • anhidrosis
  • tachycardia
  • urinary retention
  • Ileus
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4
Q

cholinergic

A 
D- diarrhea, diaphoresis
U- urination
M- miosis
BBB- bradycardia, bronchorrhea, bronchospasm
E- emesis
L- lacrimation
S- salivation, seizure
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5
Q

sed-hypnotics

A
  • CNS depression
  • lethargy
  • can induce respiratory depression
  • can produce bradycardia or hypotension
  • Mess with GABA system
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6
Q

sympathomimetic treatment

A

benzodiazepine

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7
Q

opioid treatment

A
  • naloxone
  • Ventilation
  • Redose: opioids may last longer than antidote
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8
Q

anticholinergics treatment

A
  • benzos to stop agitation
  • physostigmine:
  • induces cholinergic effects
  • short acting
  • may help with uncontrollable delirium
  • do not use if ingestion not known -> danger with TCAs
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9
Q

cholinergic treatment

A
  • antagonize muscarinic symptoms- atropine
  • stop aging of enzyme blockage- 2-PAM
  • prevent and terminate seizures- diazepam
  • supportive care
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10
Q

sed-hypnotic treatment

A
  • supportive care
  • be wary of the benzo “antidote” flumazenil
  • an antagonist at the benzo receptor -> RARELY INDICATED
  • if seizures develop either because of benzo withdrawal, a co-ingestant or metabolic derangements, have to use 2nd line agents, barbiturates, for seizure control
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11
Q

acetaminophen (APAP) antidote

A

N-acetylcysteine (NAC)

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12
Q

organophosphate antidote

A

atropine

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13
Q

benzodiazepine antidote

A

flumazenil

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14
Q

beta-blockers antidote

A

glucagon

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15
Q

calcium channels antidote

A

calcium

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16
Q

carboxyhemoglobin antidote

A

100% O2

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17
Q

salicylate (ASA) antidote

A

alkalization

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18
Q

tricyclic antidepressant (TCAs) antidote

A

sodium bicarbonate

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19
Q

warfarin antidote

A

vitamin K, FFP (fresh frozen plasma)

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20
Q

acetaminophen toxicity

A
  • max dose- 4g/day for adults
  • 90 mg/kg day kids
  • peak serum levels- 4 hours after overdose
  • toxicity- 140mg/kg acute ingestion**
  • direct hepatocellular toxicity (liver)*
  • renal damage and pancreatitis
  • lab evidence of hepatic damage
  • 150ug/ml at 4 hours
  • NAC 140mg/kg** then 70mg/kg every 4 hours for 17 doses
  • labs- LFTs (liver function-> bilirubin), coags, lytes, aspirin, ETOH, tox screen
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21
Q

stages of acetaminophen toxicity

A
    1. (0-24 hours): n / v, but most asymptomatic
    1. latent stage (24-48 hours): subclinical increase in ast/alt/bilirubin
    1. hepatic stage (3-4days): liver failure, RUQ pain, vomiting, jaundice, coagulopathy, hypoglycemia, renal failure, metabolic acidosis
    1. IV recovery stage (4days-2weeks): resolution of hepatic dysfunction
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22
Q

salicylate (ASA)

A
  • aspirin
  • weak acid, rapidly absorbed
  • messes up acid base balance
  • enteric coated has delayed absorption
  • toxic dose- 160 mg/kg
  • lethal dose 480 mg/kg
  • mixed respiratory alkalosis (hyperventilation) - metabolic acidosis (limited ATP production)
  • tachypnea, tachycardia, hyperthermia
  • altered serum glucose
  • dehydration (vomiting, tachypnea, sweating)
  • Abdominal pain
  • n/v
  • tinnitus, hearing loss
  • lethargy, seizures, altered mental status
  • noncardiogenic pulmonary edema
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23
Q

salicylate overdose treatment

A
  • activated charcoal
  • urinary alkalinization (start if serum level is greater than 35mg/dl)
  • 3 amps bicarbonate in 1 L D5W at 150 ml/hr
  • neutralize acid base imbalance
  • by increasing urinary pH to greater than 8, ASA gets trapped in tubes and cannot be reabsorbed
  • dialysis for severe acidemia, volume overload, pulmonary edema, cardiac or renal failure, seizures, coma levels > 100 mg/dl in acute ingestion, or > 60-80 mg/dl in chronic ingestion
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24
Q

TCA overdose

A
  • blocks sodium channels
  • respiratory depression
  • death by cardiovascular dysrhythmias and cardiovascular collapse
  • most TCAs have anticholinergic effects- dry skin, blurry vision, hot
  • severe OD- hypotension, seizures, respiratory depression
  • in severe cases- ARDS, rhabdomyolysis, DIC
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25
Q

TCA overdose treatment

A
  • Get an ECG to diagnose.
  • The antidote is sodium bicarbonate
  • Give initial bolus of 2 amps, drip 3 amps in 1 L D5W at 150 ml/hr
  • Titrate for a serum pH of 7.45-7.5
  • Give lidocaine for persistent arrhythmias
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26
Q

hypothalamus

A

-

  • part of diencephalon
  • responsible for:
  • temperature regulation
  • preoptic region of hypothalamus
  • water balance
  • set point for thermoregulation
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27
Q

mechanisms of heat loss

A
  • radiation- 60%: between body and environment lost in the form of infrared radiation
  • convection- 15%: air flowing over body
  • conduction 3%: physical contact
  • involuntary heat loss:
  • activation of sweat glands, production of sweat
  • capillary dilation
  • inhibition of mechanisms that produce heat
  • shivering, chemical thermogenesis
  • voluntary heat loss:
  • limit activity
  • move- move to cool environment
  • clothing- remove clothing -> cause return to hypothalamic “set point”
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28
Q

involuntary heat gain

A
  • constriction of peripheral blood vessels- shunt blood away from areas that are not as important -> goes towards core
  • piloerection- goose bumps
  • release of thyroxine from thyroid gland- metabolism
  • increased production and release of epinephrine
  • shivering, increased BMR
  • unopposed increase of BMR can raise body temperature 1.1 C/hr
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29
Q

hyperthermia categories

A
  • Heat tetany- Respiratory alkalosis (hyperventilation) –> carpopedal spasms possible- paresthesia (pins and needles) due to low CO2
  • Heat cramps: Electrolyte imbalance -> hydrate
  • Heat exhaustion-Tachycardia, hyperventilation, hypotension
  • Heat syncope- Vasodilation, hypotension, dehydration
  • Heat stroke:
  • Higher than 40.5C
  • Anhidrosis, low LOC, seizures, pulmonary edema
  • Can be fatal
  • hypovolemic shock
  • Exertional vs. nonexertional
  • Rectal thermometer
  • administer lorazepam, chlorpromazine -> to control shivering*
  • rhabdomyolysis- increased GFR, give mannitol, sodium bicarbonate, Alkalize urine
  • Heat stroke at 43C (critical thermal maximum):
  • cellular respiration impaired
  • increased cellular membrane permeability
  • protein denaturing
  • tissue necrosis
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30
Q

hypothermia

A
  • at first heart rate, BP, CO rise, shivering, red

- then as it becomes severe….bradycardic, hypotensive, decreased LOC, undetectable pulse, organ failure, cyanotic

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31
Q

frost bite classifications

A
  • first degree- superficial, red, waxy, edema
  • second degree- fluid blisters start forming *
  • third degree- blood-filled blisters *
  • fourth degree- tissue necrosis, full thickness, muscles, tendons, bone
  • know the difference between 2nd and 3rd degree
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32
Q

role of kidneys

A
  • in retroperitoneal space at level of costovertebral angle (T12-L3)
  • 25% of CO
  • fluid and electrolyte balance
  • blood pressure regulation
  • red blood cell synthesis
  • metabolic waste removal
  • medication metabolism
  • acid base balance
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33
Q

renal failure

A
  • prerenal- decreased perfusion -> decrease GFR -> decrease urine -> hypovolemia, edema, waste products in blood, heart failure -> increased BUN and creatinine
  • intrarenal- trauma, infection, disease of kidney
  • postrenal- obstruction of urine flow (renal calculi, prostatic hypertrophy, neoplasms)
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34
Q

complications of dialysis

A
  • hypotension- when you take the blood out you arnt getting the same amount of blood flow
  • muscle cramps
  • nausea and vomiting
  • headache
  • chest and back pain- electrolyte abnormalities
  • febrile reactions
  • first use syndromes
  • pruritis
  • uncommon but serious complications:
  • disequilibrium syndrome
  • dialyzer reactions
  • arrhythmias
  • cardiac tamponade
  • intracranial bleeding
  • seizures
  • hemolysis
  • air embolism
  • dialysis associated neutropenia and complement activation
  • hypoxemia
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35
Q

BUN

A
  • urea formed by liver, excreted by kidneys
  • urea accumulates in blood if renal dysfunction occurs
  • normal range is 5-20 mg/dl
  • can be affected by hydration status `
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36
Q

creatinine

A
  • waste product of creatine phosphate, a high energy molecule found in skeletal muscle tissue, released into blood
  • normal value: .5-1.2 mg/dl
  • best indicator of renal function*
  • increases with renal failure
  • creatinine of 3-4 mg/dl indicates decreased of GFR by 50%
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37
Q

other lab values for chronic renal failure detection

A
  • urinalysis
  • *proteinuria indicates intrarenal or postrenal renal failure
  • *ketonuria, glycosuria, elevated specific gravity (hydration status) indicates prerenal origin of renal failure
  • serum protein
  • serum albumin
  • CBC
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38
Q

chronic renal failure

A
  • permanent loss of renal function
  • 80% of nephrons in the kidneys destroyed
  • S/S include changes in urinary habits, nausea, vomiting, dyspnea, or acute coronary syndrome
  • treatment:
  • fluid administration
  • administration of diuretics (long-term solution)
  • pain medication
  • dialysis - 2-3 times a week
  • kidney transplant
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39
Q

hyperkalemia: renal failure

A
  • cardiac abnormalities- tented T waves, abnormal EKGs**
  • 3.5-5 is normal
  • serum potassium greater than 5.5 mEg/L
  • electrolyte disorder caused ingestion of potassium supplements, acute or chronic renal failure, blood transfusions, sepsis, addisons disease, acidosis, and crush syndrome
  • S/S include weakness, muscle cramps, tetany, paralysis, palpitations, or arrhythmias
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40
Q

missing a dialysis appointment

A
  • difficulty breathing
  • pitting edema- push in on skin and indentation stays*
  • dry flakey skin
  • fluid build up
  • weakness/fatigue
  • increased BP- due to high build up fluid (u cant urinate)
  • cardiovascular and pulmonary signs *
  • make sure fistula isnt infected
  • high BP can cause CRF
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41
Q

renal buffering system

A
  • metabolic acidosis -> respiratory compensation -> increase respiratory rate to balance pH imbalance
  • respiratory acidosis -> renal compensation
  • metabolic alkalosis -> respiratory compensation
  • respiratory alkalosis -> renal compensation
42
Q

metabolic alkalosis

A
  • pH > 7.45
  • HCO3 is higher than 26
  • can occur secondary to:
  • excessive bicarbonate ingestion
  • blood transfusion
  • vomiting nasogastric suctioning
  • drug therapy/ abuse
43
Q

metabolic acidosis

A
  • pH < 7.35
  • HCO2 is less then 22
  • can occur secondary to:
  • hypermetabolic state- hyperthyroidism
  • anaerobic metabolism
  • ketoacidosis
  • acute or chronic renal, hepatic, and pancreatic failure
  • diarrhea
  • diabetes
44
Q

kidney stones

A
  • calcium oxalate and uric acid
  • risk factors:
  • certain diets: high in protein, sodium and sugar
  • digestive diseases and surgery; gastric bypass surgery, inflammatory bowel disease or chronic diarrhea
  • other medical conditions: renal tubular acidosis, cystinuria, hyperparathyroidism, certain medications and some urinary tract infections
  • testing:
  • blood testing: too much calcium or uric acid in your blood
  • urine testing: the 24-hour urine collection test may show that your excreting too many stone forming minerals or too few stone preventing substances
  • imaging: imaging tests may show kidney stones in your urinary tract (x-rays or CT)**
  • analysis of passed stones: urinate through a strainer to catch stones and lab analysis will reveal the makeup of stones
  • treatment:
  • drinking water- 2-3 quarts/day
  • pain relievers: ibuprofen, acetaminophen
  • medical therapy: alpha blockers to relax muscles in ureter*
  • lithotripsy- sound waves to break up stones
  • surgery
  • scope through urethra, bladder, ureters
  • parathyroid gland removal*
45
Q

pyelonephritis

A
  • fever
  • suprapubic pain that radiates through the back to the lower back
  • back pain on percussion**
  • can be life threatening if sepsis or complications develop
  • may present with few symptoms to severe symptoms
  • may or may not have associated dysuria
  • may have no fever to a fever greater than 103
  • costovertebral tenderness is common presentation over the affected kidney
  • management:
  • IV access- NS bolus 250 ml
  • cardiac monitoring
  • antipyretics
  • pain medications as needed
  • antibiotics- readily respond to antibiotic therapy
  • sepsis protocol if needed
46
Q

appendix

A
  • umbilical pain
  • McBurney’s point
  • lower right quad
47
Q

spleen

A
  • upper right quad
  • pain refers to right shoulder
  • uncommon injury
  • likely to be injured in a trauma incident -> large hemorrhage
48
Q

acute cholecystitis

A
  • biliary stasis bile levels arnt being secreted properly
  • leads to wall thickening
  • common in pregnant females, older patients, women
  • stones
  • epigastric -> URQ -> right scapula
  • pain may be crampy initially and then becomes constant
  • peritoneum may become irritates causing peritoneal signs and symptoms
  • positive murphy sign is present* -> while palpating the right subcostal region patient stops inhaling or complains of pain during the breath
49
Q

acute cholecystitis treatment

A
  • support airway- have suction available, vomiting is common
  • oxygen
  • IV fluid
  • position of comfort
  • antiemetics
  • analgesics
  • sonogram at the facility
  • CT scan for gal stones
50
Q

pancreatitis

A

-epigastric -> ULQ
-may come on suddenly or gradually
-pain is described as going through the body to the back, not around the body
-abdomen is usually distended with rigidity and guarding
-higher frequency in african american, white, and native american males, in that order
-history of alcoholism is the number one risk -> 30%
-onset after binge consumption is common
-40% of people with gallstones can have pancreatitis
-grey turner sign (flanks) and cullen sign (belly button) may be present due to hemorrhagic pancreatitis
-life threatening
TREATMENT*:
-support airway- have suction available as vomiting may occur
-NPO- sometimes
-oxygen
-IV fluid- crystalloids or blood if hemorrhage present
-pain medication (fentanyl or dilaudid)

51
Q

sigmoid diverticulitis

A
  • inflammation of the diverticula (pouches that have developed in the bowel)
  • usually localized to the lower left quad
  • often severe
  • change in bowel habits
  • bleeding may be present
  • urinary symptoms (may also be present ex. pain with urination)
  • fever is common due to inflammation
  • peritonitis may be present
  • a mass may be palpated if an abscess develops
  • CT may be used to confirm disease and severity
  • IV fluid- crystalloids or blood is hemorrhage is present
  • pain medication
  • antibiotics*
  • Support airway – have suction available as vomiting may occur-> oxygen
  • risk factors:
  • NSAID use
  • lower fiber use
  • chronic constipation
  • elderly
52
Q

hepatitis C

A
  • leading cause of chronic liver disease and the #1 indication for liver transplants
  • slow (2 week-6 month onset), progressive disease that causes severe liver damage over time
  • needle sharing
  • 85% of cases become chronic
  • NO VACCINE
  • spread PARENTERAL
  • most common chronic blood borne infection
  • sexual contact
  • organ transplantation
  • treatment is primarily supportive
  • 24 weeks course of interferon A are moderately effective with a combination of antiviral drugs
  • avoid agents known to cause liver damage, such as ETOH and NSAIDs
  • if liver failure develops, transplant is only real option
53
Q

meningococcal meningitis

A
  • caused by Neisseria meningitis, a gram-negative diplococcus bacterium
  • only causes disease in humans
  • active infection is almost always due to spread from colonization of nasopharynx
  • progresses rapidly over 24 hours
  • classic triad: fever, nuchal rigidity, and altered mental status (AMS), but headache is also common
  • petechiae and palpable purpura (not always)
  • stiffness and tiredness
  • very contagious
  • is it bacterial or viral?
  • rapid antibiotic therapy is key to outcome
  • do not delay for CT and/or difficult lumbar punctures (LP)
  • corticosteroids
  • supportive care as indicated
  • antibiotic prophylaxis for close contacts and health care providers (this is the ONLY cause of meningitis that needs prophylaxis)
54
Q

Kernig’s sign

A
  • place patient supine
  • flex the hip and knee 90 degrees
  • keep the hip immobile while extending the knee
  • positive sign:
  • it suggests irritation of meninges
  • the patient resists extending the knee -> may be +
  • patient has pain in the hamstrings
55
Q

Brudzinski’s sign

A
  • place patient supine
  • keep the trunk against the stretcher
  • touch the chin to the chest (flex neck)
  • positive:
  • it suggests irritation of meninges
  • the patient involuntary flexes hip
56
Q

mumps

A
  • caused by RNA-type virus
  • covered by standard childhood immunizations but some sporadic outbreaks in recent years
  • fever, malaise, myalgias, headache, then parotitis (swelling of parotid glands)
  • complications include meningitis, encephalitis, orchitis/oophoritis, hearing loss
  • all other body systems may be involved
  • contagious - droplet, direct contact with saliva
  • highly infectious and spreads rapidly
  • incubation period of 14-18 days
  • supportive care
  • analgesics and antipyretics
  • fluids as needed
  • cold packs to inflamed areas
  • Acute, communicable and systemic disease
  • signs and symptoms include a fever, swelling and tenderness of the parotid salivary glands affecting one or both sides of the neck
  • Prevention as part of MMR vaccine
57
Q

H1N1 influenza

A
  • Influenza A type virus with components of two swine, one human, and one avian strain
  • Higher attack rate, morbidity, and mortality than typical for seasonal flu among younger persons and pregnant women
  • Majority of deaths still in those with co-morbidities
  • Spread via airborne and surface droplets
  • Incubation period is about 2 days
  • Contagious period is from 1 day before symptom onset until fever resolves; longer in immunocompromised patients
  • standard precautions with droplet precautions
  • airway management as indicated
  • supportive care
  • IV fluids
  • analgesics/antipyretics
  • anti-viral therapy per current CDC guidelines:
  • severe or complicated disease
  • pregnant women
  • age <5 or >65 years
58
Q

sepsis from MRSA: MRSA

A
  • Methicillin-resistant Staphylococcus aureus
  • Gram positive bacterium resistant to certain antibiotics
  • Hospital-acquired strains more virulent than community acquired
  • Recent admission and IV are risk factors
  • Cellulitis (infection of the skin or the fat and tissues that lie immediately beneath the skin, usually starting as small red bumps in the skin).
  • Boils (pus-filled infections of hair follicles)
  • Abscesses (collections of pus in under the skin).
  • Sty (infection of eyelid gland).
  • Carbuncles (infections larger than an abscess, usually with several openings to the skin), and impetigo (a skin infection with pus-filled blisters).
  • spread to almost any other organ in the body -> severe symptoms develop
  • MRSA that spreads to internal organs can become life-threatening.
  • Fever, chills, low blood pressure, joint pains, severe headaches, shortness of breath, and “rash over most of the body
  • airway management
  • resuscitate with aggressive, large volume IVF
  • check glucose
  • consider vasopressor agents -> to raise BP
  • in hospital, will require specific antibiotic therapy and continued resuscitation and supportive care
59
Q

hepatitis A

A
  • Most common type of hepatitis in the US
  • Commonly transmitted through fecal-oral route
  • signs and symptoms include vomiting, diarrhea, fever, or abdominal discomfort
  • Recommended vaccine
  • Treated with IV fluids
  • Hand-Washing is key
  • spread FECAL, ORAL, PARENTERAL, SEXUAL
  • VACCINE -> YES
  • acute
60
Q

hepatitis B

A
  • Transmitted through exposure to blood and blood products, sexual contact, or perinatal exposure (mom to fetus)
  • Common causes include IV drug use from needle sharing, shared razors, and acupuncture
  • signs and symptoms include flu like symptoms and jaundice of the skin and eyes
  • Required vaccine in US within 12 hours of birth
  • jaundice*
  • spread PARENTERAL and SEXUAL
  • VACCINE -> YES
61
Q

rubeola (measles)

A
  • resides in the mucus of the nose and throat of the infected person
  • airborne illness requiring droplet precautions and hand washing
  • signs and symptoms include high fever*, blotch red rash and presence of Koplik spots
  • treatment is supportive with hydration
  • prevention as part of MMR vaccine
62
Q

rubella (german measles)

A
  • found in respiratory secretions
  • transmission by direct contact with nasopharyngeal secretions of infected persons
  • signs and symptoms include low grade fever*, rash, and swollen lymph glands behind the ears and at the base of the skull
  • treatment is supportive
  • prevention as part of MMR vaccine
63
Q

multidrug-resistant organisms: methicillin-resistant staphylococcus aureus (MRSA)

A
  • community acquired (prevalent in nursing homes)
  • signs and symptoms include deep abscesses to bones, joints, heart valves, and bloodstream
  • handwashing
64
Q

multidrug-resistant organisms: vancomycin-resistant enterococci (VRE)

A
  • resistant to antibiotics
  • found in patients with UTI or bloodstream infections
  • signs and symptoms unusual urine color or odor, fever, chills, or wound infections
  • handwashing
65
Q

multidrug-resistant organisms: clostridium difficile (C-diff)

A
  • caused by antibiotic therapy and unwashed hands by healthcare providers
  • infection usually is the stool
  • signs and symptoms include diarrhea that has a foul odor and abdominal pain
  • handwashing
66
Q

hepatitis D

A
  • spread FECAL, ORAL, SEXUAL, (parenteral?)

- VACCINE -> YES (same as hep b vaccine)

67
Q

MMR vaccine

A
  • measles
  • mumps
  • rubella
68
Q

becks triad

A
  1. JVD
  2. Distant heart tones
  3. Hypotension or narrowing pulse pressure* (numbers getting closer together)
    - cardiac tamponade
69
Q

viruses

A
  • H1N1
  • mumps
  • treated with antipyretics/analgesic
70
Q

compensated shock

A
  • normal blood pressure
  • normal to slightly increased heart rate
  • tachypnea
  • delayed capillary refill
  • cool hands and feet
  • pale mucous membranes
  • restlessness, anxiety
  • oliguria
  • vasoconstriction maintains blood flow to essential organs, but tissue ischemia occurs in less essential areas
71
Q

decompensated shock

A
  • blood pressure decreasing
  • tachycardic >120
  • tachypneic > 30-40
  • waxy, cool, clammy, skin
  • pale or cyanotic mucus membranes
  • profound weakness
  • metabolic (lactic) acidosis
  • anxiety
  • absent or decreased peripheral pulses
  • blood pressure decreases as the vascular tone decreases
  • dysfunction to all organs is imminent
  • anaerobic metabolism ensures, causing lactic acidosis
72
Q

irreversible shock

A
  • profound hypotension
  • lactate > 8 mEq/L
  • metabolic acidosis causes post capillary sphincters to open and release stagnant and coagulated blood
  • excessive potassium and acid causes dysrhythmias
  • cellular damage is irreversible
73
Q

distributive shock: sepsis

A
  • hyperthermia or hypothermia
  • decreased BP
  • altered LOC
  • infection
  • administer oxygen
  • give IV fluids bolus
  • administer antibiotics
  • high WBC
  • cultures
74
Q

distributive shock: anaphylactic

A
  • pruritus, erythema, urticaria, angioedema
  • increased heart rate, decreased BP
  • respiratory distress, wheezing
  • antibody-antigen release
  • give epinephrine 1:1000 .3-.5 mg subQ or IM for mild reaction
  • give epinephrine 1:10,000 .3-.5 IV for severe reaction over 3-10 mins as needed
  • give IV fluid bolus
  • give diphenhydramine 1-2 mg/kg IV (max 50mg)
  • consider corticosteroids
  • consider vasopressors
75
Q

distributive shock: neurogenic

A
  • warm, dry, pink, skin*
  • decreased BP
  • alert*
  • normal capillary refill time
  • spinal cord injury
  • administer oxygen
  • give IV fluid bolus
  • consider dopamine
  • surgery
76
Q

cardiogenic shock

A
  • cool, clammy, skin, pale, cyanotic skin
  • tachypnea, decrease BP, altered LOC
  • distended neck veins
  • decreased capillary refill time
  • pump failure: AMI, cardio-myopathy, myocarditis, ruptured chordae tendinea, papillary muscle dysfunction, toxins, myocardial contusion, acute aortic insufficiency, ruptured ventricular septum
  • dysrhythmia
  • administer oxygen
  • give IV fluid bolus (minimal)
  • rate correction (medication or pacing/cardioversion)
  • inotropes
  • vasopressors
  • intraaortic balloon pump
  • associated with cardiac pump failure
  • vasopressors&raquo_space;»> over fluids **
  • fluids can overload the system and cause death
77
Q

obstructive shock

A
  • decreased BP
  • difficulty breathing, tachycardia, tachypnea
  • JVD, unilateral decreased breath sounds, muffled heart tones
  • acute pericardial tamponade*
  • massive pulmonary embolus*
  • tension pneumothorax**
  • administer oxygen, perform needle decompression for tension pneumothorax
  • consider surgery
  • muffled heart sounds
  • pulmonary embolus -> blood thinners*
78
Q

hyperglycemia

A
  • elevated blood sugar
  • hypotension
  • dehydrated
  • syncope
  • can present same as hypoglycemia
79
Q

normal range for glucose

A

-60-120

80
Q

diabetic ketoacidosis (DKA)

A
  • build up of ketones in the blood
  • commonly seen in kids
  • high blood sugar -> 500
  • Thrombosis
  • hypotensive
  • sometimes shock
  • dehydrated
  • fluid resuscitation
  • occurs in absence or near absence of insulin
  • NIDDM (type 2) at risk during catabolic stress or when insulin dependent
  • common causes include medication non-compliance, infection
  • mortality- 9-14% -> increases with age > 65 -> 24-40%
  • anorexia, nausea, emesis
  • polyuria
  • kussmaul respirations- deep, fast labored breathing
  • fruity breath
  • deterioration mental status
  • progressive acidosis
  • chest and/or abdominal pain
  • children can decompensate very fast!
  • electrolyte imbalances
  • affects the heart and arrhythmias -> can cause death
  • sodium
  • chloride
  • potassium
81
Q

hyperglycemia hyperosmolar syndrome

A
  • very high blood sugar
  • unconscious or unresponsive
  • aggressive management
  • treat with fluids, insulin
  • Present with severe dehydration without ketosis and acidosis
  • Glucose > 1000
  • Coma, seizures, tremors, hemiplegia
  • Causes:
  • infection
  • MI
  • hemorrhage and trauma
  • burns
  • Similar to DKA treatment, but even more fluid depleted
82
Q

pancreas

A
  • metabolism of cells
  • alpha- stimulate release of glucagon and glycogen stores -> promote gluconeogenesis
  • beta -stores and release insulin
  • delta-inhibit glucagon and insulin via somatostatin
  • gamma-secrete pancreatic polypeptide
83
Q

diabetes type 1

A
  • also called juvenile or insulin-dependent diabetes mellitus (IDDM)
  • hyperglycemia
  • characterized by low production of insulin
  • closely related to heredity
  • polydipsia (drinking a lot), polyuria (urinating a lot), polyphagia (eating a lot), weight loss, and weakness (TRIAD*)**
  • high ketones in urine
  • untreated or noncompliant patients may progress to ketosis and diabetic ketoacidosis
  • altered mental status and dehydration may progress if left untreated
  • do they have dry mouth, skin turgor, blood flow
  • give 500-100CC of fluid for adults
  • 20CC per kilo for children (weight based
84
Q

diabetes type 2

A
  • not insulin dependent
  • also called adult-onset or non-insulin-dependent diabetes mellitus (NIDDM)
  • results from decreased binding of insulin to cells
  • related to heredity and obesity
  • most common form of diabetes
  • less risk of fat-based metabolism
  • results in less-pronounced hyperglycemia
  • hyperglycemic hyperosmolar nonketonic acidosis
  • managed with dietary changes and oral drugs to stimulate insulin production and increased receptor effectiveness
  • give them oral medications like metformin
85
Q

type 1 vs. type 2 diabetes

A
  • type 1:
  • sudden
  • any age (mostly young)
  • thin of normal body
  • ketoacidosis is common
  • autoantibodies are present
  • endogenous insulin is low or absent
  • less prevalent
  • type 2:
  • gradual onset
  • mostly in adults
  • often obese
  • ketoacidosis is rare
  • autoantibodies are absent
  • endogenous insulin is normal, decreased or increased
  • more prevalent -> 90%-95%
86
Q

sodium: DKA

A
  • variable
  • fall by 1.6 for every 100 increasing glucose (pseudohyponatremia)
  • falsely low with hypertriglyceridemia
87
Q

chloride: DKA

A
  • hyper in ketoacidosis
  • can be elevated due to choice of resuscitation fluid
  • hypo associated with severe emesis
88
Q

potassium: DKA

A
  • total body hypokalemia
  • intravascular K+ high with acidosis
  • at high risk for severe hypokalemia
  • treatment:
  • aggressive KCl replenishment and maintenace
  • do not start insulin until K > 3.5-5
89
Q

DKA: sodium bicarbonate

A
  • never give sodium bicarbonate
  • NaHCO3 + H+ -> H2CO3 -> CO2 + H2O
  • worsens intracellular acidosis as already man respiratory compensation
  • treat underlying cause
90
Q

hypoglycemia

A
  • shaky, hast heartbeat, sweating, dizzy, anxious, hungry, irritable, blurry vision, weakness or fatigue, headache
  • glucose
  • glucagon
  • dextrose (IV)
91
Q

diabetic ketoacidosis vs hyperglycemic hyperosmolar syndrome

A
  • diabetic ketoacidosis:
  • 250-600 mg/dL
  • young*
  • acute
  • severe dehydration
  • insulin is low
  • hyperglycemic hyperosmolar syndrome:
  • minimal or none ketoacidosis
  • > 900 mg/dL
  • elderly*
  • chronic
  • profound dehydration
  • insulin may be normal
92
Q

hypothyroidism

A
  • low BP
  • bradycardia
  • fatigued
  • iodine deficiency
  • thyroidectomy can cause
  • hair loss
  • dry skin
  • intolerance to cold
  • weight gain
93
Q

hyperthyroidism

A
  • hypertensive
  • tachycardia
  • everything is elevated
  • weight loss
  • fine, straight hair
  • bulging eyes
  • facial flushing
  • tachycardia
  • increased diarrhea
  • menstrual changes
  • localized edema
  • atrial arrhythmias
  • stroke age dependent not atrial fib dependent
  • clots can form!
  • CHF
  • malnutrition/dehydration
  • metabolic failure
  • drug metabolism
  • Caused by:
  • graves disease
  • toxic multinodular goiter (toxic nodular struma)
  • independent or solitary toxic adenoma
  • thyroiditis or inflammation of the thyroid gland
94
Q

hypothyroid treatment

A
  • synthroid
  • age dependent
  • young- 50-100 ug/d
  • old 12.5-25 ug/d
  • check TSH at 4-6 weeks
  • change doses 12.5 to 25 ug increments
  • get blood checked by endocrinologist often
  • look for underlying infections
  • correct hypothermia
  • blood volume restoration
  • monitor electrolytes
  • glucose replacement
  • check for drug toxicity (digoxin etc)
95
Q

thyrotoxicosis

A
  • high mortality rate -> 10-20% mortality
  • thyroid crisis “storm”
  • hyperthyroidism unregulated
  • precipitation factors:
  • infection
  • thyroid manipulation (operation, palpation)
  • metabolic disorders (DKA)
  • trauma
  • MI
  • PE
  • pregnancy
96
Q

thyroid storm treatment

A
  • pharmacologic control:
  • Inhibit conversion of T4 to T3
  • consider steroids or PTU
  • ipodate sodium (Oragrafin) highly effective
  • caution long-term use (“escape”)
  • Reduction of hyperadrenergic state
  • propranolol (historical)
  • cautious of B-blockers in CHF
  • Removal of T4
  • plasmaphresis or hemoperfusion
  • emergent thyroidectomy
97
Q

acid base values

A
  • pH- 7.35-7.45
  • PCO3- 35-45
  • HCO3- 22-26
98
Q

respiratory acidosis

A
  • pH < 7.35
  • PaCO2 is higher than 45
  • HCO3 is normal (22-26)
  • shallow breathing
  • CO2 is being retained
  • not breathing fast
  • treat with supplemental oxygen
99
Q

respiratory alkalosis

A
  • pH is greater than 7.45
  • PaCO2 is less then 35
  • HCO3 is normal (22-26)
  • hyperventilating
  • anxiety attack
  • give paper bag, or put on the o2 mask but not actually turn it on
100
Q

buffering mechanisms

A
  • four types of buffering systems in human body:
  • protein buffering
  • hemoglobin buffering
  • carbonic acid-bicarbonate buffering
  • phosphate buffering -> phosphate the most common intracellular buffer!
101
Q

rhabdomyolysis

A
  • a breakdown of muscle tissue that causes myoglobin to be released into the bloodstream, causing kidney damage and renal failure
  • S/S dark colored urine, weakness, and muscle pain
  • urine is dark bc kidney is filtering
  • causes:
  • prolonged periods of immobilization
  • trauma
  • crush injuries
  • drug abuse
  • electrolyte abnormalities
  • SIGNS:
  • myoglobin/protein in the urine
  • elevated creatine levels
  • TREATMENT:
  • fluid hydration
  • osmotic diuretics
  • bicarbonate infusion
102
Q

chain of infection

A
  • reservoir/host
  • portal of exit
  • transmission
  • portal of entry
  • host susceptibility

Medical Emergencies (16 decks)

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