ICU/ER/meds

Question 1

Treatment for malignant hyperthermia

Answer 1

Hyperventilation, oxygen, dantrolene

Question 2

What predicts risk for future deterioration in near drowning events

Answer 2

Hx of apnea and cpr in the field

Neurological signs (seizure or disorientation) or respiratory failure from aspiration

Arterial desaturation and or tachypnea

Question 3

What is the key to prognosis in a near drown event

Answer 3

Duration of asphyxia

If a pt requires less than 10 mins of cpr there is a good chance they will survive with no neurological impairment

Question 4

Factors that worsen prognosis in near drowning

Answer 4

Submersion > 25 mins
Apnea or coma at admission
Initial arterial pH of < 7

Question 5

Initial tx for caediogenic shock

Answer 5

Dobutamine

Question 6

Tx with presented with acute heart failure

Answer 6

Furosemide

Question 7

What findings are consistent with brain death

Answer 7

Absense of vertebral and carotid artery blood flow

Must make sure there are no other disorders which obscure neurological functioning

Question 8

Formula for calculating ET tube size

Answer 8

Age divided by 4 plus 4

Question 9

If an intubation pt experiences deterioration what should you consider

Answer 9

Displacement of ET tube
Obstruction
Pneumothorax
Equipment failure

Question 10

What medications can be given by ET tube

Answer 10

Lidocaine
Atropine
Narcan
Epi

Question 11

What medication can you give for bradycardia

Answer 11

Atropine

Question 12

When are antibiotics for bites indicated

Answer 12

When dogs, cats, humans
When on hands, feet, face
Dirty wound
Crush injuries 
Cartilage involvement 
Immunocompromised

Question 13

Antibiotic for bite wounds

Answer 13

Augmentin

If penicillin allergic clinda plus Bactrim

Question 14

How does brown recluse spider bite present

Answer 14

Target lesion consisting of a red circle surrounding a white ring that appears within hours

Bite becomes necrotic

Question 15

Tx of brown recluse spider bite

Answer 15

Self limited

Question 16

How does black widow spider bite present

Answer 16

Puncture wound barely noticed

Systemic symptoms within 8 hrs - muscle aches and HTN

Question 17

Tx of black widow bite

Answer 17

Local wound care and pain control

Benzodiazepine in severe muscle spasms

In severe cases may use anti venom

Verify tetanus

Question 18

Initial management of venamous snake bite

Answer 18

ABCs and then immobilize the limb and let it hang at the patients side

Question 19

When is a head CT indicated

Answer 19

Prolongues LOC
Protracted vomiting 
Progressing headache 
Retrograde amnesia 
Lethargy

Question 20

Poor prognostic signs for a pt in coma

Answer 20

Cerebral bleeding
Brain edema
Coma lasting longer than 6 hrs
Low Glasgow score (less than 8 severe)

Question 21

Fractures due to abuse

Answer 21

Bucket handle fractures
Corner fractures 
Spiral fractures in infants 
Rib fractures
Multiple skull fractures 
Spinous process fractures 
Scapular fractures
Sternum fractures

Question 22

What could Peri-orbital ecchymoses be a sign of

Answer 22

Neuroblastoma

Question 23

Female athlete triad

Answer 23

Menstrual irregularity
Eating disorder
Low bone mass

Question 24

What is the half life for 5 cycles

Answer 24

After 1 - 50% of the drug remains
After 2 - 25% of the drug remains 
After 3- 12.5% of the drug remains
After 4 - 6.25% of the drug remains
After 5- 3.125% of the drug remains 

After 5 half lives 97% of the drug would have been cleared from the body

Question 25

What is steady state

Answer 25

When the drug is administered at a steady interval and the Amt in equals the amt out

A drug will reach 97% of steady state after 5 half lives

Question 26

Which medications should you not have with dairy

Answer 26

Tetracycline, doxycycline, ciprofloxacin

Question 27

What happens when an antacid is administered with iron

Answer 27

Antacid binds iron and prevents its absorption

Question 28

Which medications should be taken with fatty foods

Answer 28

Isotretinoin and griseofulvin

Question 29

Erythromycin, ciprofloxacin, cimetidine and omeprazole have inhibitory effects on hepatic enzymatic systems how does this impact other drugs

Answer 29

Reduces theophylline, codeine, beta blocker, antidepressants, corticosteroids, warfarin and metronidazole metabolism resulting in increased bioavailability and toxicity

Question 30

Which drugs inhibit renal metabolism of digoxin resulting in elevated levels

Answer 30

Quinidine and amiodarone

Question 31

What are dose related side effects of furosemide

Answer 31

Ototoxicity and renal toxicity

Question 32

Mechanism of action of furosemide

Answer 32

Blocks absorption of Na and Cl results in wasting of calcium, potassium and hydrogen chloride

Question 33

Mechanism of action of acetazolamide

Answer 33

Carbonic anhydrase inhibitor

In proximal tubule presents reuptake of bicarb and causes metabolic acidosis with alkaline urine

Question 34

What happens with potassium with spironolactone

Answer 34

Potassium sparring

Question 35

What is required for monitoring during conscious sedation

Answer 35

Pals certified member to monitor
Pulse ox, Bp and vitals q5min
Bag mask and oxygen should be immediately available
Reversal agents like naloxone (opiates) and flumazenil (benzos) should be available

Question 36

Define moderate sedation

Answer 36

Pt retains ability to respond normally to verbal commands and cardio respiratory function are unaffected

Question 37

Define deep sedation

Answer 37

Responds to repeated or painful stimuli. Partial or complete loss of protective airway reflexes

Question 38

Define minimal sedation

Answer 38

Relief of apprehension with minimal effect on perception and sensorium

Question 39

Parkland formula for first 24 hr fluid replacement

Answer 39

4 x wt (kg) x %TBSA