floor management 4

Question 1

what to always check when starting new meds

Answer 1

allergies

Question 2

first thing to change with low BP

Answer 2

urine output

Question 3

management of acute hypotension

Answer 3

250 cc bolus, then pressor if no response

Question 4

diabetes management when NPO

Answer 4

never don’t give basal insulin (can’t put patient into DKA)

Question 5

problem with oral mag

Answer 5

gives patients diarrhea commonly

Question 6

soma

Answer 6

carisoprodol, muscle relaxer

Question 7

1 amp =

Answer 7

• not a standardized measurement of volume. refers to a single dose of medication prepackaged.
• 1 amp D50 = 25 grams dextrose in 50 mL

Question 8

centrally acting meds….

Answer 8

…

Question 9

resource management

Answer 9

specialized nurses for getting blood draws

Question 10

typical chest pain

Answer 10

substernal
relieved with exertion or nitro
worse with activity

Question 11

electrolytes to order when considering arrhythmia

Answer 11

mag + K

Question 12

who to call for pneumo

Answer 12

pulm fellow (or ICU resident if at night)

Question 13

management of unstable angina

Answer 13

Treat as ACS

admission
dual anti platelet therapy
heparin

Question 14

troponin leak

Answer 14

happens in patients with high blood pressure (heart working harder against high pressure)

Question 15

type 2 NSTEMI

Answer 15

demand ischemia

Question 16

first step in hypernatremia

Answer 16

calculate free water deficit
D51/2NS with slow correction
Repeat BMP

Question 17

flash pulmonary edema

Answer 17

rapid onset pulmonary edema. It is most often precipitated by acute myocardial infarction or mitral regurgitation, but can be caused by aortic regurgitation, heart failure, or almost any cause of elevated left ventricular filling pressures. Treatment of FPE should be directed at the underlying cause, but the mainstays are ensuring adequate oxygenation, diuresis, and decrease of pulmonary circulation pressures.

Recurrence of FPE is thought to be associated with hypertension[15] and may signify renal artery stenosis.[16] Prevention of recurrence is based on managing hypertension, coronary artery disease, renovascular hypertension, and heart failure.

Question 18

managing run of Vtach

Answer 18

Check electrolytes, monitor

Question 19

warfarin other caveat

Answer 19

tube feeds will change warfarin levels

Question 20

caveat about TSH

Answer 20

takes months to correct so no utility in ordering it after altering levothyroxine dosing

Question 21

fluid to give to decrease risk of acidosis

Answer 21

LR

Question 22

other importance of BUN/CR ratio

Answer 22

sensitive for GI bleed

Question 23

indication for ICD with HFrEF

Answer 23

EF less than 35

Question 24

what to look out for with paralyzed/motionless patients

Answer 24

dependent edema

Question 25

QTc vs. QT

Answer 25

QTc = corrected for heart rate

Question 26

submassive PE

Answer 26

intermediate PE -- RV dysfunction + borderline BP

Question 27

other NOAC contraindication

Answer 27

obese people

Question 28

submassive PE management

Answer 28

NO lytic | possible IVC filter

Question 29

fever threshold

Answer 29

38 for over an hour | 38.4 at all

Question 30

when drains are generally pulled?

Answer 30

less than 100 ml

Question 31

what to think about when ordering FENa?

Answer 31

whether patient received diuretic (then have to wait 3 days)

Question 32

problem with chest tube or drain draining too much fluid or too fast

Answer 32

re-expansion edema + dropping pressure

Question 33

what to give for bloating/abdominal upset from bowel gas

Answer 33

simethicone | Gas-X

Question 34

what to always consider with patient on betablocker

Answer 34

whether you're masking tachycardia

Question 35

expected bump in hct with 1 unit of blood

Answer 35

3%

Question 36

seroma

Answer 36

pocket of clear serous fluid that sometimes develops in the body after surgery. This fluid is composed of blood plasma that has seeped out of ruptured small blood vessels and inflammatory fluid produced by the injured and dying cells.

Question 37

what is a mould?

Answer 37

alternative to yeast (single cell) so multicellular (includes aspergillus, trichophyton, rhizomes)

Question 38

expected bump in platelets with 1 unit of platelets

Answer 38

40-50

Question 39

be careful about FFP because

Answer 39

you can drop INR fast and pt can throw a clo

Question 40

GI bleeders management

Answer 40

1) don't give fluids or you will increase portal pressure

Question 41

problem with FFP in GI bleeders

Answer 41

doesn't affect bleeding

Question 42

how to taper steroids

Answer 42

1) depends on how long (low risk of HPA axis suppression with short term steroids) 2) base on patients symptoms. so adjust the taper depending on their symptoms after dose reduction

Question 43

meds that improve survival in HF

Answer 43

betablockers ACEi's/ARBs mineralocorticoid receptor antagonist

Question 44

when HFrEF patients are potentially eligible for an ICD

Answer 44

when optimal medical management fails + lower than 30% EF

Question 45

indications for imaging in HA

Answer 45

- First or worst severe headache - Change in the pattern of previous migraine - Abnormal neurologic examination - Onset of migraine after age 50 years - New onset of headache in an immunocompromised patient (eg, one with cancer or HIV infection) - Headache with fever - Migraine and epilepsy - New daily, persistent headache - Escalation of headache frequency/intensity in the absence of medication overuse headache - Posteriorly located headaches (especially in children, but also in adults) * don't image if history of migraines + normal neuro exam

Question 46

how to renally adjust meds for elderly pts

Answer 46

use cockcroft gault equation

Question 47

procalcitonin utility

Answer 47

* determining abx therapy duration | * bad test characteristics so doesn’t rule out bacterial infection if clinical suspicion high

Question 48

d-dimer caveat when assessing

Answer 48

needs to be age-adjusted

Question 49

basic concepts of sepsis management

Answer 49

- requires less fluid than previously thought | - pressors early