Inpatient Medical Management Flashcards
When giving fluids your trying to fix the problem in what space?
Intravascular Space
What do intravascularly dry patients look like?
- Decreased urine output
- CVP
- IVC - by ultrasound
- Hypotension
- Tachycardia
- Decreased weight
What is the best way to evaluate hydration status?
By what imaging modality?
IVC
Ultrasound, cross section of IVC
In a hypotensive patient, we are trying to increase their ________ to improve the Frank-Starling Curve.
Preload
Rarely patients need greater than 3L per day, what disease states will require more than this?
- Burn
- DKA
- Septic Shock
But again, treating patient not the number
Who may be malnourished?
Tea and toast patients are at risk for what electrolyte abnormalities?
- Eating disorders
- Elderly (tea and toast patients)
- Alcoholics
Hyponatremia
Tonicity defines the shape of what?
Cells
What are isotonic fluids?
What are example of isotonic fluids?
Denoting or relating to a solution having the same osmotic pressur as some other solution, especially one in a cell or body fluid
NS, LR, D5W, plasmalyte
What are colloids?
What are examples of colloid fluids?
High molecular weight, will stay in intravascular space longer
*Higher protiens
Albumin, hetastartch (not used much anymore)
What are hypertonic fluids?
What are examples?
Tonicity is higher than that of blood, for TBI, fluid shifts, hyponatremia
3% NACL, 7% NACL, D10W and higher concentration
In what disease states do you use HYPERtonic solution?
When using hypertonic solutions what are they at risk for?
- Hyponatremia
- Increased ICP
Osmotic demyelination syndrome
Can osmotic demyelination syndrome be lethal?
Yes, especially in kids
What is the pH of lactated ringers?
What electrolytes are included in LR?
pH = 6.5
Ca, sodium lactate, K+, Cl-, Na+
Acidosis can cause worsening hyperkalemia, pH is more balanced with what type of fluid?
LR
What medication classes are typically not compatible with LR?
Why?
Antibiotics
Antipsychotics
Calcium crystals will form
What population is a HARD STOP for using antibiotics and LR?
Neonates
When is D5W used?
- Hypoglycemia
- Hyperkalemic patients will recieve insulin and D5W to maintain glucose
Where is albumin made?
What is its role?
Liver
Needed to transport hormones/fats/nutreints and meds
Helps maintain intravascular volume and osmotic pressure
Blood is a colloid, therefore it can be used to correct what?
Will improve BP and increase intravascular volume
Are people more likely to third space when they are sick or healthy?
Sick
Septic patients have increased capilary permeability
What is the treatment for VTE?
How long do you treat?
Anticoagulation
* Start with LMWH (Lovenox)
* Transition to oral (DOACs or Coumadin)
Minimum 3 months
What are the W’s of Postop Fever?
- Wind (atelectasis)
- Water (catheter associated UTI)
- Walk (DVT)
- Wound (surgical wound infection)
- Wonder about drugs (drugs that arn’t compatible)
What is the most common cause of postop fever within 24 hours?
Atelectasis
Wind
What is the management for hospital-acquired infections?
- Removal/replacement of offending agent if possible
- Site +/- blood cultures
- Lab work-up for sepsis
- Emperic antibiotics –> de-escalation
- Fluid resuscitation if needed
- Monitor for deterioration
What is the #1 hospital acquired infection?
Catheter-associated UTI (CAUTI)
What are the two most common etiologies of CAUTI?
What are other possible etiologies?
- E. Coli
- Pseudomonas
Kelbsiella, Proteus, Enterococcus, Staph
What is the presentation of CAUTI?
- Often fever without urinary symptoms
- Hematuria, suprabuic pain, flank pain, CVA tenderness, etc.
- Bacteremia + positive urine culture AND no other source
- Pyuria
What is the treatment for CAUTI?
What are the antibiotic regimens?
- Change foley (biofilm)
- Debatable when abx should be started
Pipercillin-Tazobactam, Ceftazidime, Aztreonam
What are contraindications to IO placement?
- Osteoporosis
- Osteogensis imperfecta
- Bone fracture
- Recent placement of IO
- Cellulitis, infection, burn over insertion site
What are risks of IO placement?
- Infection
- Skin necorsis
- Compartment syndrome
- Epiphyseal injury
- Fat embolism
- Pain
How can you prevent compartment syndrome with an IO placement?
Don’t go out the other side of the bone, will fill up the posterior compartment
What is the most common procedure to place a central line?
Seldinger technique
What is a thoracentesis for?
What are the potential causes?
Pleural Effusion
CHF, pneumonia, cancer, PE, cirrhosis
Should a patient inhale or exhale when removing a needle after a thorocentesis?
Exhale, you don’t want any air to get into the pleural space
What are some complications of a thoracentesis?
- Pneumo
- Bleeding
- Hemothorax
- Puncture of spleen or liver
