General ICU/Emergency Flashcards
Name the major (6) and minor (4) criteria for PPI use in ICU
- the major are those that should always use PPI
- the minor are those that need 2+ criteria met
1) Coagulopathy: plt 1.5, PTT >2xcontrol
2) Mechanical Vent >48hrs
3) TBI
4) Traumatic Spinal cord injury
5) Burn >30% BSA
6) GI ulceration/bleeding in last year
minor criteria (need 2+)
1) sepsis
2) ICU stay >1 week
3) occult bleed >6days
4) hydrocortisone equivalent therapy >250mg
Dose of PPI for stress ulcer prophylaxis
Pantoprazole 40mg IV daily
Omeprazole 20-40mg po daily
Parkland Formula
Used for 2-3rd degree burns
24hr fluid req: 4x%BSA burnedxkg
Give 1/2 fluid in first 8 hrs
Olanzapine (Zyprexa)
2nd Gen antipsychotic
Primarily Anti dopamine/serotonin, some anticholinergic
USE: schizophrenia, bipolar I d/o, Delerium(off label)
SE: Risk metabolic syndrome, anticholinergic effects, orthostatic hypotension, increased risk of death (particularly in elderly dementia related psychosis populations), may lower seizure threshold
(Idiopathic Pulmonary Fibrosis) IPF
Pathology: Cyclical lung injury with fibrotic healing
Presentation: SOB, dry cough
Imaging: HRCT shows honeycombing > groundglass opacity. Honeycombing = 3-10mm D blebs subpleural
Exacerbations can be caused by: PE, Pneumothorax, PNA, HF
Flare: Few days-4weeks of progressive dyspnea, new ground glass opacities, no sign infection/sepsis/hf ect.
MORTALITY in flare is 3/4 patients. No acute tx
Tx: Lung transplant
DDx Intersitial Lung Disease
IPF
Hypersensitivity Pneumonitis: birds/pigeons/hot tubs. Eosinophilia on BAL. presents with fever, cough, dyspnea. resolves with removal of exposure
Pneumoconiosis: Occupational exposures; coal, silicosis, berylliosis, asbestosis
Sarcoidosis, scleroderma
Rheumatoid Arthritis, dermatomyositis, polymyositis
Other causes exist: think autoimmune, IPF, and extrinsic
Multiorgan Failure definition and usual circumstances
dysfunction/failure of 2+organs persisting >24hrs
-shock, sepsis, Severe inflammation (ie.pancreatitis), trauma
L1 radiculopathy s/s
Ddx herniated disc, lumbar spinal stenosis, cauda equina syndrome, diabetic amyotrophy, lumbosacral plexopathy, and mononeuropathies of the leg, such as femoral, sciatic, peroneal, and tibial nerve lesions.
L1 radiculopathy is rare. Symptoms involve pain, paresthesia, and sensory loss in the inguinal region.
L2-4 radiculopathy s/s
Ddx herniated disc, lumbar spinal stenosis, cauda equina syndrome, diabetic amyotrophy, lumbosacral plexopathy, and mononeuropathies of the leg, such as femoral, sciatic, peroneal, and tibial nerve lesions.
L2, L3, and L4 radiculopathies are most often seen in older patients with spinal stenosis. They are generally considered as a group because of marked overlap of innervation of the anterior thigh muscles. Acute back pain is the most common presenting complaint, often radiating around the anterior aspect of the leg down into the knee.
L5 radiculopathy
Ddx herniated disc, lumbar spinal stenosis, cauda equina syndrome, diabetic amyotrophy, lumbosacral plexopathy, and mononeuropathies of the leg, such as femoral, sciatic, peroneal, and tibial nerve lesions.
L5 radiculopathy is the most common radiculopathy affecting the lumbosacral spine. It often presents with back pain that radiates down the lateral aspect of the leg into the foot. On examination, strength can be reduced in foot dorsiflexion, toe extension, foot inversion, and foot eversion. Reflexes are generally normal. (
S1 radiculopathy
Ddx herniated disc, lumbar spinal stenosis, cauda equina syndrome, diabetic amyotrophy, lumbosacral plexopathy, and mononeuropathies of the leg, such as femoral, sciatic, peroneal, and tibial nerve lesions.
In S1 radiculopathy, pain radiates down the posterior aspect of the leg into the foot from the back. On examination, strength may be reduced in leg extension (gluteus maximus) and plantar flexion. Sensation is generally reduced on the posterior aspect of the leg and the lateral foot. Ankle reflex loss is typical.
S2-4 radiculopathy
Ddx herniated disc, lumbar spinal stenosis, cauda equina syndrome, diabetic amyotrophy, lumbosacral plexopathy, and mononeuropathies of the leg, such as femoral, sciatic, peroneal, and tibial nerve lesions.
S2, S3, and/or S4 radiculopathies due to structural etiologies are rare, but may be caused by a large central disc that compresses the nerve roots intrathecally at a higher level (eg, L5). Patients can present with sacral or buttock pain that radiates down the posterior aspect of the leg or into the perineum. Weakness may be minimal, with urinary and fecal incontinence as well as sexual dysfunction.
***ALSO think about cauda equina syndrome here
Diverticulitis s/s dx complicated vs uncomplicated tx
s/s: LLQ pain, fever?, N/V?
dx: CT w/contrast (oral and IV) {94/99%}, leukocytosis?
Inpatient: if complicated (perf, obstr, fistula) or (immunosuppressed, fever >39, sig leukocytosis, severe abd pain, adv age, cannot po, signif comorbid, poor compliance, failred op tx)
complicated vs uncomplicated
tx
abx: cipro + flagyl x7 days
Nexus Criteria
Must image (ct or xray) if:
1) AMS
2) intoxication
3) midline tenderness
4) focal neuro findings
5) distracting injuries: long bone, visceral injury, burn, large lac, crush injury
Once clear: require rotation neck 45 deg either side, if able to even with pain, no image necessary. If unable -> MRI for ligamentous injury
Tx of neuroleptic induced acute dystonia
IV benztropine or benadryl for 48-72hrs
