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Medicine > floor management 4 > Flashcards

floor management 4 Flashcards

1
Q

what to always check when starting new meds

A

allergies

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2
Q

first thing to change with low BP

A

urine output

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3
Q

management of acute hypotension

A

250 cc bolus, then pressor if no response

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4
Q

diabetes management when NPO

A

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

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5
Q

problem with oral mag

A

gives patients diarrhea commonly

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6
Q

soma

A

carisoprodol, muscle relaxer

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7
Q

1 amp =

A
  • not a standardized measurement of volume. refers to a single dose of medication prepackaged.
  • 1 amp D50 = 25 grams dextrose in 50 mL
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8
Q

centrally acting meds….

A

…

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9
Q

resource management

A

specialized nurses for getting blood draws

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10
Q

typical chest pain

A

substernal
relieved with exertion or nitro
worse with activity

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11
Q

electrolytes to order when considering arrhythmia

A

mag + K

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12
Q

who to call for pneumo

A

pulm fellow (or ICU resident if at night)

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13
Q

management of unstable angina

A

Treat as ACS

admission
dual anti platelet therapy
heparin

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14
Q

troponin leak

A

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

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15
Q

type 2 NSTEMI

A

demand ischemia

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16
Q

first step in hypernatremia

A

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

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17
Q

flash pulmonary edema

A

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.

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18
Q

managing run of Vtach

A

Check electrolytes, monitor

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19
Q

warfarin other caveat

A

tube feeds will change warfarin levels

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20
Q

caveat about TSH

A

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

21
Q

fluid to give to decrease risk of acidosis

A

LR

22
Q

other importance of BUN/CR ratio

A

sensitive for GI bleed

23
Q

indication for ICD with HFrEF

A

EF less than 35

24
Q

what to look out for with paralyzed/motionless patients

A

dependent edema

25
Q

QTc vs. QT

A

QTc = corrected for heart rate

26
Q

submassive PE

A

intermediate PE – RV dysfunction + borderline BP

27
Q

other NOAC contraindication

A

obese people

28
Q

submassive PE management

A

NO lytic

possible IVC filter

29
Q

fever threshold

A

38 for over an hour

38.4 at all

30
Q

when drains are generally pulled?

A

less than 100 ml

31
Q

what to think about when ordering FENa?

A

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

32
Q

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

A

re-expansion edema + dropping pressure

33
Q

what to give for bloating/abdominal upset from bowel gas

A

simethicone

Gas-X

34
Q

what to always consider with patient on betablocker

A

whether you’re masking tachycardia

35
Q

expected bump in hct with 1 unit of blood

A

3%

36
Q

seroma

A

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.

37
Q

what is a mould?

A

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

38
Q

expected bump in platelets with 1 unit of platelets

A

40-50

39
Q

be careful about FFP because

A

you can drop INR fast and pt can throw a clo

40
Q

GI bleeders management

A

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

41
Q

problem with FFP in GI bleeders

A

doesn’t affect bleeding

42
Q

how to taper steroids

A

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

43
Q

meds that improve survival in HF

A

betablockers
ACEi’s/ARBs
mineralocorticoid receptor antagonist

44
Q

when HFrEF patients are potentially eligible for an ICD

A

when optimal medical management fails + lower than 30% EF

45
Q

indications for imaging in HA

A
  • 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
46
Q

how to renally adjust meds for elderly pts

A

use cockcroft gault equation

47
Q

procalcitonin utility

A
  • determining abx therapy duration

* bad test characteristics so doesn’t rule out bacterial infection if clinical suspicion high

48
Q

d-dimer caveat when assessing

A

needs to be age-adjusted

49
Q

basic concepts of sepsis management

A
  • requires less fluid than previously thought

- pressors early

Medicine (71 decks)

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