Internal Med - Critical Care Flashcards
Hyperthyroid state + acute event
Thyroid storm
Sx of thyroid storm
Heat intolerance, palpitations, weight loss tachycardia, anxiety, jaundice
Jaundice = hepatic tissue hypoxia due to increased peripheral consumption of oxygen
Clinical → tachycardia HR >140, heart failure, hypotension, dysrhythmia (afib), hyperpyrexia (104F-106F), agitation, psychosis, coma; hyperreflexia, goiter, exophthalmos, pretibial edema
Dx and tx of thyroid storm
Dx = free t4/t3, TSH → low TSH and high free T4
Tx =beta-blocker, thionamides, iodine, hydrocortisone, bile acid sequestrants
- Propylthiouracil – inhibits the conversion of thyroxine to triiodothyronine
- Methimazole or PTU (PTU if pregnant)
A single epileptic seizure lasting more than five minutes or two or more seizures within a five-minute period without the person returning to normal between them
Status Epilepticus
Tx of status epilepticus
- Place in left lateral decubitus position (suppressed gag reflex ⇒ prone to aspiration of gastric contents)
- Benzodiazepines (lorazepam) are the preferred initial treatment after which typically phenytoin is given
Difference in primary vs secondary pneumothorax
Can be spontaneous or traumatic
- Primary: occurs in absence of underlying disease (tall, thin males age 10-30 at greatest risk)
- Secondary: in presence of underlying disease (COPD, asthma, cystic fibrosis, interstitial lung disease)
Tx of pneumothorax
*Depends on size
<15% diameter → Resolves spontaneously without chest tube
Large >15% → Chest tube placement
*Serial CXR every 24hrs until resolved
Tension pneumo = Emergency, what is the tx
Large bore needles to allow air out of the chest; chest tube for decompression
Excess fluid between the heart and pericardium
Pericardial Effusion
How does a pericardial effusion happen?
- Abnormal accumulation of inflammatory fluid, immune cells → diffuse into interstitium → fluid pools in pericardial space → pericardial dilation → pressure on heart, vena cava → decreased cardiac filling → cardiac tamponade → decreased cardiac output
Common causes of pericardial effusion
Aortic dissection, heart failure, hypoalbuminemia, lymphatic obstruction, malignancy, radiation, renal failure, trauma, autoimmune disease, acute pericarditis (viral, bacterial, tuberculous, idiopathic in origin), myxedema, some drugs, iatrogenic, idiopathic
Sx of pericardial effusion
Same symptoms as acute pericarditis except patient will now have signs of fluid buildup around the heart which include low voltage QRS complexes, electrical alternans, distant heart sounds and an echocardiogram showing a collection of pericardial fluid
Dx findings of Pericardial effusion
- EKG showing low voltage QRS along with electrical alternans
- Echocardiogram with increased pericardial fluid
- Radiograph: Water bottle heart
Absolute contraindictions for fibrinolytic use in STEMI
- Prior intracranial hemorrhage (ICH)
- Known structural cerebral vascular lesion.
- Known malignant intracranial neoplasm.
- Ischemic stroke within 3 months.
- Suspected aortic dissection.
- Active bleeding or bleeding diathesis (excluding menses)
Tx of STEMI
Beta Blockers + NTG + aspirin and clopidogrel + heparin + ACEI + statins + reperfusion
- Aspirin and Clopidogrel are given at once
- Very time sensitive - Immediate (within 90 minutes) coronary angiography and primary PCI
- Thrombolytic therapy within the first 3 hours if PCI not available
