FINAL Flashcards

Question

ejection fraction

Answer 1

Normal EF: 55-70% Borderline EF: 50-55% Reduced EF: <50% Severely Reduced EF: <35% -<35- defib -preserve- diastolic HF -low- systolic HF

Answer 2

-increase A wave in PS, pHTN, tricuspid stenosis -C and V combine in tricuspid regurgitation -increase V in TR -X and Y gets deeper with constrictive pericarditis -Y gets shallow with pericardial tamponade

Answer 3

-12-25 /kg first 7-10 days -less calories is better (used to be 30) -refeeding syndrome- arrythmia from increase electrolytes -high carbs -> high CO2 -> acidosis -80% of wt for obese -CC of tube feed = CC of water -1.2-2 /kg = protein -> higher for burns, obesity, trauma and lower for renal -EN = PN -mixed-oil lipid injectable emulsions (olive oil, triglycerides, oils) or 100% soybean oil lipid injectable emulsions in first week (PN) -fish oil- or non-fish oil-containing lipid injectable emulsions be provided to pts who are candidates for PN within first week

Answer 4

-first line -initial- 50ml/hr -increase by 25 ml/hr q 4-8hr until target -complication: -aspiration -perforation -resp failure

Answer 5

-LEFT SHIFT -increase affinity for O2 -decrease CO2 -decrease H+ -decrease 2,3DPG -decrease temp -HbF RIGHT SHIFT -decrease affinity for O2 -increase CO2 -increase H+ -increase 2,3 DPG -increase temp -EX. exercise

Answer 6

-Na - (Cl + HCO3) -<12 is normal -anion gap acidosis- MUDPILES- methanol, uremia, DKA, propylene glycol, INH, lactic acidosis, ethylene glycol, salicylates -GOLD MARK- ethylene/propylene Glycol, Oxoproline, L/D lactate, Methanol, ASA, renal failure, Ketoacidosis

Answer 7

-10a causes prothrombin -> thrombin -thrombin causes fibrinogen -> fibrin -heparin + enoxaparin inhibit thrombin -you need Ca for all of this to work -> supplement -FFP- coagulation factors -cryo- fibrinogen -> clots -platelets, FFP, desmopressin -> increase strength of clots (MA) -lysis in 30 -> tranexamic acid (TXA) or aminocalproic acid to increase clot stability

Answer 8

-1 PRBC, 1 FFP, platelet, Ca, blood warmer -thrombosis if too much cryo, FFP, platelets

Answer 9

-MC with UFH (5%) >LMWH (1%) -heparin > enoxaparin TYPE 1 -non immune response -mild drop in platelets >100,000 -1-2 days after start of heparin- returns to normal when you stop it -usually no clinical consequence TYPE 2 -immune mediated -antibody against heparin platelet factor 4 complex -> bind to Fc receptor -> activates platelet -> white clots -life/limb threatening condition -leads to thrombocytopenia, arterial, and venous thromboses -thrombotic sequelae: -venous:arterial thrombosis -> 4:1 -DVT (50%), PE (25%), acute limb ischemia (10-20%), warfarin assoc venous limb gangrene (5-10%), acute thrombotic stroke or MI (3-5%) -50% risk of thrombosis over 30 days if no tx -thrombotic tendency exist for at least 40 days after stopping -overall risk - 38-76% -4-14 days after starting heparin (take into consideration of other recent hospitalizations) -as soon as 10 hrs after re-exposure to heparin -has occurred 3-4 days after cessation of heparin -platelets count decrease to >50% of what it was on admission after 4 days -> particularly if they got unfractionated and LMWH

Answer 10

-consider in anyone with unexplained drop in platelets -<150,000 or 50% decrease while on heparin -dx is CLINICAL -do not wait for lab test results to start tx -tx: -d/c ALL HEPARIN (LMWH and flushes, catheters) -treat immediately -do NOT wait for lab results -begin direct thrombin inhibitor -> lepirudin (refludan) or argatroban (acova) -DTI- dont prolong PT and PTT -do NOT use warfarin as substitute -> may actually worsen -continue direct thrombin inhibitor until platelets are normal and need for IV anticoagulation has resolved -overlap DTI with warfarin for at least 3-5 days -warfarin start when pt is stable and platelets >100,000 and the DTI is therapeutic -MONITOR- aPTT or factor 10a -check every 2-4 hrs until its 1.5-2.5x normal -check at least daily thereafter

Answer 11

-thrombin generation, fibrinolytic activation, inhibitor consumption AND -end organ damage -clot and lyse -> bleed everywhere -cause- neuro trauma, burns, infection/sepsis (gram neg), amniotic fluid embolism, cancer -dx- schistocytes and low platelets -high PT/PTT -low fibrinogen -high d-dimer, thrombin time -high Cr, LDH (organs) -tx- underlying cause -replace factors -coagulation inhibitors -platelets transfusions

Answer 12

-class 1- clean - hernia -class 2- clean contaminated - elective chole, GI -class 2- clean contaminated- colorectal surgery -class 3- contaminated- penetrating trauma, enterotomy -class 4- dirty- perf diverticulitis, nec fascitis

Answer 13

-135-145 -HYPERNATREMIA -dehydration -tx- hypotonic solution - D5W or hypotonic saline -acute- decrease by 1-2/hr -chronic- decrease by .5/hr -max 10/day -HYPONATREMIA -pontine myelinosis if >25 for 24-48hrs -limit to 10/day -cerebral edema -hypertonic saline -> NOT sodium bicarb

Answer 14

-HYPERKALEMIA -peak t wave -high LDH -cause- high WBC, high platelets, cell death (rhabdo, burns, tumor lysis), hypoaldosterone -CaCl2 10% - 1amp -Sodium bicarb - 1amp -D50 and insulin 10u -beta 2 agonist nebulizer -kayexalate -sodium zirconium cyclosilicate -dialysis -HYPOKALEMIA -(K you want - K you have / Cr) x 100 = K you need to replete -10/hr via IV -NEED MG TO GIVE K

Answer 15

-HYPERCALEMIA -nephrolithiasis -constipation -GI effects -arrythmia -tx- calcitonin, bisphosphonates, denosumab -diuretics -HYPOCALEMIA -prolonged QTC interval -tetany -paresthesias -seizure -chvostek sign -trousseau sign- carpal -tx- -IV calcium gluconate (severe) -oral for mild - ca citrate/carbonate -CHECK MG

Answer 16

HYPOMAGNESEMIA -energy, muscle, protein low -cause- diet, diuretics, massive diarrhea, resus, burns, pancreatitis, SIADH, hyperaldosteronism -arrythmia -> POST OP AFIB GIVE MG!!!!!!!! -4.2-4.5 POST OP -hyperreflexia, seizure -torsades -tx- -magnesium sulfate IV -rate of 2g/hr -emergency 2g/5mins HYPERMAGNESEMIA -hypothyroid, adrenal insuff, antacid abuse, renal insuff, iatrogenic -weak, hyporeflexia, paralysis of muscles -EKG- AV block and prolonged QT and PR -HYPOTENSION- give in eclampsia -tx- -normal saline -IV calcium gluconate for acute -loop diuretic -DIALYSIS

Answer 17

HYPOPHOSPHATEMIA -hyperalimentation (after starving), DKA, malabsorption, phosphate binding antacids, alkalosis, hemodialysis, hyperparathyroid -refeeding syndrome -HEAD TRAUMA -myocardial depression bc low ATP -> cardiac arrest -oxyhemo curve shift to left -anorexia -bone pain -hemolysis -diaphragm stops working bc no ATP -> cant take off vent -tx: -PO replacement (neutrophos) or -IV KPhos or NaPhos -keep phosphorous x calcium ration <60 -GIVE MG AT SAME TIME HYPOPHOSPHATEMIA -renal insuff, hypoaparathyroid -metastatic calcification -tx: -restriction of phosphate binding antacid (amphogel)