Hospital Med II Flashcards
key to inpt is?
ACLs
Primary and secondary assessment
What is definition and rationale of MET/RRT
Team Makeup
Activation Criteria
Common Activations
Outcomes Evidence
Approach to emergency assessment
Different Diagnosis
Cases
What does MET stand for?
Medical emergency team
What does RRT stand for?
Rapid response team
IS MET and RRT the same thing?
Yes
Rationale?
Identify deterioration and intervene early (prior to “code blue”)
Often signs of decompensation for several hours before cardiac arrest
Goals or RRT: Prevent cardiac arrest and ensure goals of care have been addressed
What’s activation criteria? (10)
Threatened airway
RR < 6 or > 30
HR < 40 or > 140
SBP < 90
Symptomatic hypertension
Decrease in level of consciousness
- Unexplained agitation
- Seizure
- Significant fall in urine output
- Subjective concern about the patient
What are common activation?
AMS, tachycardia, tachypnea, hypotension, hypoxia, staff worried, chest pain, brady, hypopnea
What is the primary assessment of ACLS?
Airway
Breathing
Circulation
Disability
Exposure
What is in AB
+/- O2, +/- NIPPV or intubation
What is in C
IV, monitor, vitals
What is in D
Glucose; neuro assessment
What is E
Look at the patient; surgical sites, etc.
What is part of the secondary assessment in ACLS
Signs and symptoms
Allergies
Medications
Past medical history
Last oral intake
Events leading up to
AMS start with?
BLS
Is she breathing, pulse?
Whats the next step for AMS after BLS?
A: patent
B: mild tachypnea, speaking in full sentences
C: sinus tachycardia, warm extremities
D: moves all extremities, glucose 83
E: surgical incision without erythema or discharge
Whats next after AMS?
Secondary assessment
Signs and symptoms
Allergies
Medications
Past medical history
Last oral intake
Events leading up to
Whats the acronym for ddx AMS
AEIOU-TIPS
While you are waiting for results for AMS, what your next step?
Immediate Interventions
- Start abx, administer naloxone?
Whats the acronym for stroke?
FAST
F = uneven smile
A = arm is weak
S = slurred speech
T = Time
whats the most important with stroke?
- Last known normal
- Glucose
- Start NIHSS
- Brief initial neuro exam
What is first line imaging for stroke?
CT non contrast
Whats the treatment within 10min of stroke?
“Door to doctor”
Whats the treatment within 15min of stroke?
Neurologist
Whats the treatment within 25min of stroke?
CT scan completion
Whats the treatment within 45min of stroke?
CT interpretation
Whats the treatment within 60min of stroke?
treatment
Whats the treatment within 3 hrs of stroke?
Admission to ICU
When can tPA be given?
less than 4.5 hours
When can ALL get mechanical embolectomy?
6 hrs
When can they get embolectomy for SOME?
6-24hrs
What is status epilepticus?
Seizures lasting more than 5 minutes, or
Recurrent seizures without return to baseline mental status
What are the causes of seizures
- Metabolic (hypoglycemia, hyponatremia, etc.)
- Infection (CNS abscess, meningitis, encephalitis)
- Withdrawal (alcohol, antiepileptics, benzodiazepines)
- CNS lesion (cancer, CVA, trauma)
- Intoxication (numerous prescription medications; MDMA; synthetic cannabinoids)
What do you typically order for seizure?
- CBC, CMP, Mg, Phos, Lactate
- Antiepileptic drug levels
- +/- head CT, lumbar puncture
- Urine drug screen
- EEG
What is 1st line for seizures?
- position to lateral decubitus
- Airway/breathing: nasopharyngeal aiway
- Benzo’s (Lorazepam 4mg IV)
or midazolam IM
If glucose is low/can’t get for seizure, what meds can you give?
Thiamine 100mg IV then D50.
If seizure go on for 10min what is second line?
Valproic acid, levetiracetam, phenobarbital, fosphenytoin, or phenytoin (choose a favorite)
If seizure goes on for 30min
Intubate
Midazolam or propofol gtt
Review slide 51 CHADs & CHADSVASC
What are most common chest pain emergencies (5)
Acute coronary syndrome
Acute aortic dissection
Pulmonary embolism
Tension pneumothorax
Pericardial tamponade
Most common for SOB
Infection, volume and clot
whats the work up for SOB?
ABG
CXR
EKG
Stat bedside echo
CBC, NT-proBNP, troponin, dimer, CMP
Pending the above further imaging CT-PE
What are some different ways to deliver O2?
NIPPV
NPPV
What are good canidates for Nasal intermittent positive pressure ventilation (NIPPV) (4)
Able to protect airway
Able to clear respiratory secretions
Cooperative
Low risk of aspiration
What is absolute contraindication for NIPPV?
cardiac or respiratory arrest
What is heated high flow O2?
Heats and humidifies air and can deliver up to 100% FIO2 at flow rates up to 60 LPM
Classic indications for NIPPV?
Cardiogenic pulmonary edema
COPD
