Floor management knowledge

Question 1

Concerning UOP…

Answer 1

Less than 0.5 ml/kg/hr

Question 2

How to replete phos

Answer 2

drug is phos-lo. Give orally.

Question 3

hemoperitoneum presentation

Answer 3

low-grade fever, abdominal pain, drop in crib, tachycardia

Question 4

How to manage a transfusion reaction…

Answer 4

If mild, stop transfusing, give tylenol and benadryl. Wait and restart.

Question 5

How much would you expect platelets to respond to transfusion?

Answer 5

Should go up by 10 units per pack.

Question 6

When would you use a dobhoff for feeding?

Answer 6

long term

Question 7

What is fioricet?

Answer 7

tylenol + caffeine + barbiturate

Question 8

name of permanent drain for pulmonary effusion?

Answer 8

pleurX

Question 9

decent alternative to vanc?

Answer 9

Doxy, but weak MRSA coverage.

Question 10

what is a vesicant?

Answer 10

agent that causes chemical burns and blisters

Question 11

threshold for a concerning UOP?

Answer 11

0.5 ml/kg/hr in any patient

Question 12

what will happen with extended resuscitation with NaCl?

Answer 12

Plasma sodium content will increase and you may get hypernatremic

Question 13

how to keep someone’s sodium constant?

Answer 13

half normal saline

Question 14

when to worry about 0 UOP after catheter being pulled

Answer 14

6 hours

Question 15

problems with insulin drips

Answer 15

1) takes a while to get off. discharge barrier.

2) requires constant hourly checks

Question 16

lovenox

Answer 16

enoxaparin

Question 17

DVT treatment

Answer 17

lovenox

Question 18

how to replace B12

Answer 18

IV cyanocobalamin

Question 19

how to replace calcium

Answer 19

• IV if severe/sympamtic

- oral if mild

Question 20

calculating maintenance fluids

Answer 20

4 ml/kg/h for first 10 kg
2 ml/kg/h for second 10 kg
1 ml/kg/h for every additional kg

Question 21

fluids to replace GI fluid losses

Answer 21

LR + NS

Question 22

hyperkalemia on EKG management

Answer 22

exogenous sources of potassium, administration of a source of calcium ions (which will immediately oppose the myocardial effects of potassium), and administration of sodium bicarbonate (which, by producing a mild alkalosis, will shift potassium into cells)

Question 23

normal bicarb

Answer 23

22-28

Question 24

what to always think about with GI fluid loss

Answer 24

GI loss of bicarbonate

Question 25

concern with large ileostomy output

Answer 25

at risk for dehydration with hyponatremia + hypokalemia + non gap metabolic acidosis

Question 26

treatment of metabolic acidosis from GI fluid losses

Answer 26

fluid replacement

Question 27

treatment of hemolytic transfusion reactions

Answer 27

need to correct hypotension and oliguria with fluids and mannitol (need to prevent glomerular damage from hemolyzed red cell membranes)

Question 28

lassitude

Answer 28

fatigue

Question 29

management of ongoing bleeding from trach

Answer 29

1) reintubate with ETT + pull tract and compress innominate artery

Question 30

predictors of successful extubation

Answer 30

1) rapid shallow breathing index between 60 and 105 2) patient should be weaned to 5 cm H2) PEEP 3) RR less than 20 4) minute ventilation less than 10 5) negative inspiratory force at least greater than -20

Question 31

gas that can worsen abdominal distention

Answer 31

NO (causes progressive distention of air-filled spaces during prolonged anesthesia because it is only anesthetic less dense than air)

Question 32

ARDS diagnosis

Answer 32

``` 1) bilateral pulmonary infiltrates on CXR OR PaO2/FiO2 less than 200 OR wedge pressure less than 18 mm Hg ```

Question 33

dopamine effects

Answer 33

1) increases coronary flow at all doses low dose -- dilation of renal and mesenteric vasculature, reducing blood flow to kidneys and bowel moderate dose -- B1 dominates + inotropic effect high dose -- alpha stimulation causes peripheral vasoconstriction

Question 34

respiratory distress following transufsion

Answer 34

TRALI

Question 35

TRALI presentation

Answer 35

respiratory distress + hypoxemia + bilateral pulmonary infiltrates

Question 36

treatment for TACO

Answer 36

diuretics

Question 37

treatment of TRALI

Answer 37

respiratory support, mechanical ventilation as needed

Question 38

treatment of cardiogenic shock secondary to MI?

Answer 38

positive isotropy with dobutamine (minimal chronotropic effect so only marginally increases myocardial O2 demand)

Question 39

acalculous cholecystitis pathophys

Answer 39

probably ischemia

Question 40

acalculous cholecystitis treatment

Answer 40

percutaneous drainage of the gallbladder

Question 41

pulsus paradoxus

Answer 41

decrease in SYSTOLIC BP by more than 10 mm Hg at the end of the INSPIRATORY phase of respiration

Question 42

major predictors of cardiac events

Answer 42

``` Unstable angina Recent MI decompensated CHF significant arrhythmias severe valvular disease ```

Question 43

initial treatment of neurogenic shock

Answer 43

- fluid resuscitation first | - vasoconstrictors (dopamine or phenylephrine)

Question 44

vitals with neurogenic shock

Answer 44

bradycardia (pts loss reflex increase in HR in response to hypotension)

Question 45

management of air embolism during central line placement

Answer 45

1) put patient in left lateral decubitus trendelenburg | 2) aspirate central venous catheter

Question 46

pseudocholinesterase deficiency presentation

Answer 46

FH of prolonged effects of succinylcholine. Also happens with mivacurium.

Question 47

pre albumin vs. albumin

Answer 47

- albumin has a long half-life so is a better indicator of long term nutritional depletion - pre albumin has a short half life so is a better indicator of short-term nutritional status

Question 48

respiratory quotient (RQ) tells you

Answer 48

- composition of nutritional support

Question 49

rare but deadly complication of tracheostomy

Answer 49

tracheoinnominate artery fistula (TIAF)

Question 50

ddx of tracheoinnominate artery fistula (TIAF)

Answer 50

- bronchoscopy in OR under anesthesia

Question 51

preop management of VW deficiency

Answer 51

give patient cryoprecipitate

Question 52

fioricet use

Answer 52

headaches (migraine and tension type)

Question 53

Xa inhibitors

Answer 53

Rivaroxaban | Fondaparinux