FISDAP Missed Practice Questions Flashcards
Emphysema Medications and goals of treatment (these are also the same for chronic bronchitis)
The goal of treating emphysema or chronic bronchitis is to relieve hypoxia and reverse any bronchoconstriction.
Remember that these pts may be dependent on a hypoxic respiratory drive (their decreased levels of O2 stimulate respiration actions instead of a high CO2).
First treat with establishing an airway and then positioning them in a seated or semi-seated position to help the accessory muscle use.
Low flow O2 with a NC or CPAP with a peep of 10cm/H2O should be used and if medication is needed you may use:
- Bronchodilator (albuterol, levalbuterol, or metaproterenol)
- Ipratropium Bromide (Atrovent) to dry secretions (this is an anticholinergic drug)
- Corticosteroids for longer lasting relief
Physiological effects of Hyperventilation
Hyperventilation rapidly produces respiratory alkalosis which may lead to cerebral vasoconstriction, a wide range of neurological symptoms such as syncope, dizziness, tingling in the extremities and numerous other complaints, such as shortness of breath, tremors, weakness, subjective fear and chest pain.
Pushing too much air too fast can also cause barotrauma to the lungs in which alveoli can loose elasticity from being stretched too much and being damaged.
How to treat a pediatric pt with an upper airway obstruction?
Upper Airway Obstruction:
Mild obstruction is when the child can make sounds or forcefully cough, Severe is when there is POOR or no air exchange and makes high pitched noise while inhaling or no noise at all. If mild is when you should let them try to cough it up themselves but if severe then you can: (if infant = younger than 1) you can give 5 back thrusts and 5 chest thrusts alternating. or if over 1 to adolescent you give abdominal thrusts. If the pt becomes unresponsive no matter the age then start CPR and check if obstruction is visible after every 2 minutes, if it is visible then remove it!
How to treat a pt with pneumonia
Infectious pneumonia results from viral, bacterial, or fungal inflammation of the alveoli.
Pts typically present with fever/chills, weakness/malaise, deep, productive cough, yellow/brown sputum often streaked with blood, pleuritic chest pain, fever, tachycardia, tachypnea, crackles (rales), wheezing and or rhonchi.
Treat with O2, IV, fluids if needed for dehydration but be careful to not increase lung secretions, treat wheezing with a bronchodilator and the pts will benefit from CPAP. Intubate as needed. Acetaminophen can reduce fever.
Signs and Symptoms of Occlusive, Embolic, Thrombotic, and Hemorrhagic Strokes.
Occlusive Strokes: This is when there is an occlusion (Either thrombotic or embolic) in a cerebral artery that shuts off blood supply to distal tissues. Those tissues will eventually die and dead tissue will swell, making the stroke worse.
Embolic Strokes: An embolus is a solid, liquid, or gas mass carried to a blood vessel from a remote site. The most common emboli are clots (thromboemboli) that usually arise from diseased blood vessels in the neck or abnormal contraction in heart chambers (Big one is A-Fib). These strokes are very ACUTE and may be characterized as a sudden onset of a severe headache.
Thrombotic Strokes: A cerebral thrombus is a clot that gradually develops in and obstructs a cerebral artery. This is increased in risk as a person ages and atherosclerosis develops. ( remember that that plaque build up can break off and become an emboli causing an embolic stroke and the tissue it breaks off from can begin to bleed and cause a thrombotic stroke). These strokes are typically SLOW DEVELOPING in signs and symptoms and often occur at night with the pt waking up altered and with a speech, motor, or sensory function deficit.
Hemorrhagic Strokes: Bleeding within the brain is Intracerebral and if bleeding is in the space around the brain it is Subarachnoid. Onset is often sudden and marked by a severe headache. Most intracranial hemorrhages develop in the hypertensive pt when a small deep vessel in the brain ruptures. Subarachnoid hemorrhages most often result form congenital blood vessel abnormalities (such as aneurysms, aka weak blood vessels, or arteriovenous malformations) or they come from head trauma.
Pathophysiology of Type 2 AV blocks
A 2nd Degree Type 1 AV block is an intermittent block at the level of the AV node. Ischemia is the most common cause of 1st degree and 2nd degree type 1 (both are low grade) AV blocks, but can also occur in a healthy person. They can also be caused by parasympathetic tone and drugs.
A 2nd Degree Type 2 is associated with acute MI and septal necrosis.
Burst of V-tach vs a Run of PVCs
The ECG book says that 3 or more PVCs consecutively is considered a “run of PVCs” but everything online says that it should be considered a “run or burst of V-Tach”. FISDAP says in what I should study “identify rhythm with burst of V-Tach”, so just put that if there are 3 or more consecutive PVCs AT A RATE OF 100 OR MORE
What drug to use for dystonic reactions
DIPHENHYDRAMINE
Benzos also help but when chosen it was not the right answer so Benadryl must be a better choice
Vol.3 Ch. 5 has really good chart of pathophysiology of anaphylaxis and a good chart for treatment based on whether it is acute or mild Look it UP when this card comes up
For treatment the gist is if it is mild (itching, rash, urticaria) then:
- O2
- Epi 1:1k 0.3-0.5mg IM every 15-20min
- Consider antihistamine (Diphenhydramine 25mg IM)
- Oral Corticosteroids
If severe (serious airway edema, GI S&Ss, Cardiovascular collapse):
- O2
- IV access
- Epi 1:10k 0.1mg over 5 minutes
- Aggressive fluids
- Antihistamine
- Beta-Agonists
- Corticosteroids
Look at Pediatric Vital Signs on the AHA cards when this card comes up
Look at Pediatric Vital Signs on the AHA cards when this card comes up
Early Signs of Dehydration in an infant Pt
(I put loss of appetite for early sign and it still showed up as wrong)
On the test where I didn’t have this as a missed section i put the dry mouth one as an early sign
Tactile stimulation of newborn
On last test I put rubbing with towel on the back which is not technically wrong but I got it wrong so I believe it is flicking the soles of the feet
Treating a hypotensive pediatric pt
Normal fluid dosage for peds is 20mL/kg but hypovolemic kids may need 40-60ml/kg while septic kids may even need 60-80ml/kg.
Treating an apneic newborn
Begin with tactile stimulation such as flicking the soles of the feet or gently rubbing the babies back. If needed use a BVM to ventilate with the pop-off valve disabled (remember that ventilating a new born may require higher pressures that the pressure valve will stop early). If the baby still does not breath or the heart rate is less than 60 then begin compressions and intubation.
On the question about which IV will give the most/fastest amount of fluids
I put 14g 4inch but it must be 14g 1/2 in
