Internal Med Critical Care Flashcards
etiology of acute adrenal crisis
stressor with insufficient cortisol
presentation of adrenal crisis
- high fever
- severe abd pain
- n/v
- confusion
- hypotensive shock
diagnosis of adrenal crisis
order serum cortisol and ACTH but do not wait on results to start treatment
treatment of adrenal crisis
- IV hydrocortisone
- fix electrolytes
- broad spectrum antibiotics
defining location of upper GI bleed vs lower GI bleed
ligament of treitz
presentation of upper GI bleed
- hematemesis
- coffee ground emesis
- melena
- hyperactive bowel sounds
presentation of lower GI bleed
hematochezia
diagnosis of upper GI bleed
NG tube with lavage
diagnosis of lower GI bleed
- rectal exam
- colonoscopy
management of GI bleed
- hemodynamically stable: consult GI or surgery for endoscopy
- hemodynamically unstable: NPO, fluids, blood transfusion
indications for transfusion of GI bleed
- failure of perfusion after 2L of fluids
- hbg <7
- hbg<9 and comorbidities
etiology of acute glaucoma
sudden increase of IOP causing damage to optic nerve
s/s of acute glaucoma
- halos around lights
- dilated pupils
- headache
- severe eye pain
- steamy, red cornea
diagnosis of acute glaucoma
gonioscopy
treatment of acute glaucoma
- acetazolamide
- pilocarpine
- recheck IOP every 30-60 minutes
- definite: laser iridotomy
ARDS
acute respiratory failure following a systemic or pulmonary insult without evidence of heart failure
etiologies of ARDS
- sepsis
- aspiration pneumonia
pathophys of ARDS
lung injury causes excess fluid to accumulate in both the interstitium and alveoli which causes impaired gas exchange
diagnosis of ARDS
- acute onset within 1 weeks of clinical insult
- bilateral pulmonary infiltrates
- PaO2/FIO2 <300mg
s/s of ARDS
- SOB
- tachypnea
- intercostal retractions
- crackles
- multiple organ failure
- does not respond to supplemental O2
treatment of ARDS
- treat underlying cause
- PEEP
- low tidal volume ventilation
s/s of cardiac tamponade
- distant heart sounds
- JVD
- hypotension
- kussmauls sign
- pulsus paradoxus
- electrical alternans
- water bottle heart
diagnosis of cardiac tamponade
echo
Management of cardiac tamponade
pericardiocentesis
coma
state of unresponsiveness, even to stimuli, and may lack a gag reflex or pupillary response that lasts for >1hour
confirmatory test for coma
cold caloric testing with normal response
cold caloric testing normal response
eyes moving to irrigated side followed by brisk horizontal nystagmus back to contralateral ear
locked in syndrome
patients are awake and alert but are mute and quadriplegic
brain death
irreversible cessation of all brain function with a known cause
diagnosis of brain death
- 6 hours of flat EEG
- 12 hours without EEG
- 24 hours for anoxic brain injury without EEG
etiology of DKA
insulin deficiency triggered by stress
presentation of DKA
- n/v
- fruity breath
- hypotension and tachycardia
- kussmaul respirations
diagnosis of DKA
- elevated glucose
- b-hydroxybutyrate
management of DKA
fluids then insulin
hypertensive urgency
BP 220/125 with no sx
hypertensive emergency
BP 220/130 with end organ damage
treatment of hypertensive urgency
- clonidine
- captopril
- nifedipine
treatment of hypertensive emergency
- BB and CCB used first
- lower 25% in the first 2 hours, then 160/100 the next 2-6 hours
s/s of pneumothorax
- pleuritic CP
- tachypnea
- SOB
- diminished breath sounds
- tension: tracheal deviation and lateral PMI
diagnosis of pneumothroax
CXR
treatment of pneumothorax
- small primary: supplemental o2 and observe
- large primary: aspiration and possible chest tube
- secondary: tube and admit
- tension: needle decompression
s/s of PE
- pleuritic CP
- dyspnea
- tachypnea
diagnosis of PE
- first do PERC rules, then Wells score
- low risk and no perc: observation
- low risk with positive perc or moderate risk: D-dimer
- high risk: CTA
wells score interpretation
- high risk: >6
- moderate risk: 2-6
- low risk: <2
gold standard for diagnosis of PE
pulmonary angiography
treatment of PE
- supplemental O2
- anticoagulation
- TPA for high risk pts
- embolectomy for high risk patients that cant have TPA
Choice of anticoagulation for PE
- unstable and renal insufficiency: heparin
- cannot take oral anticoags: lovenox
- anyone else: DOAC
seizure disorder (epilepsy)
2 or more unprovoked seizures
pre-ictal phase of seizure
- sx that occur before the seizure
- numbness/tingling
- hallucinations
- HA
- nausea
post-ictal phase of seizure
weakness and fatigue that occurs after the seizure
focal seizure
- abnormal activity that affects only one area of the brain
- can have retained or impaired awareness
absence seizure
staring off into space with impaired consciousness
myoclonic seizure
sudden, irregular, brief jerks or twitches
atonic seizures
- drop attacks
- usually associated with intellectual impairment
tonic seizures
muscle stiffening and rigidity
clonic seizures
- convulsive movements
- rhythmic jerking
tonic-clonic seizures
- LOC
- violent shaking
- body stiffening
- loss of bowel and bladder incontinence
treatment of seizures
- focal: lamictal
- generalized: valproate
- pregnanct: keppra
Etiology of cardiogenic shock
Acute MI
S/S of cardiogenic shock
- hypoperfusion
- tachycardia
treatment of cardiogenic shock
- if due to ischemia, PCI
- NE or dopamine
s/s septic shock
- hypotensive
- hypo or hyper thermia
- tachycardia
- no response to at least 3L of fluids
treatment of septic shock
- vanc+zosyn
- fluids
- high flow o2
neurogenic shock
caused by lesion or injury to the cervical spine that causes loss of vascular tone
s/s of neurogenic shock
- warm skin
- hypotension
- no reflex tachy
treatment of neurogenic shock
- fluids
- vasopressors
etiology of obstructive shock
- pneumothorax
- pericardial tamponade
- massive PE
status epilepticus
seizure activity lasting longer than 5-10 minutes or several seizures occurring during a 30 minute time frame
treatment of status epilepticus
IV benzo
thyroid storm
severe, life treatening thyrotoxicosis triggered by stress
s/s of thyroid storm
- delirium
- tachycardia
- vomiting
- diarrhea
- dehydration
treatment of thyroid storm
- methimazole
- PTU
- beta blocker
