Lectures Flashcards

1
Q

Pain control of choice for appendicitis

A

Morphine (.1mg/kg) and repeat as needed
-usually start giving 4mg (that’s underdosing)

Don’t give NSAIDs b/c increase bleeding

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2
Q

To r/o ACS how often do we recycle trops

A

After first trop, recycle in 6 hours

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3
Q

How to medically optimize an ACS patient who doesn’t go to cath lab

A

Aspirin, statin, BP control

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4
Q

Management for NSTEMI

A

Depends on CP and stability of pt

Stable NSTEMI w/o continuing CP = contraindicated to emergent cath!!! (will probs find no vessel disease), so medically optimize

Stable NSTEMI w/ ongoing CP => emergent cath

Unstable NSTEMI => emergent cath

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5
Q

Aortic dissection

(a) physical exam findings
(b) CXR
(c) US

A

Aortic dissection- tearing CP radiating towards the back

(a) Disparate pulses, muffled heart sounds
(b) CXR: widened mediastinum (not in all, just classically)
(c) US findings: dilated aortic root (over 4cm), potentially pericardial effusion
- if dissection involves the ascending aorta, it can back track into the pericardium

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6
Q

What is a Q-wave on EKG?

(a) When is it pathologic?

A

Q-wave is a the first downward reflection in ventricular depolarization before the R-wave

(a) Pathologic (indicative of old infarct) if height is greater than 1/4 height of the R-wave

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7
Q

Describe normal direction of T-wave

A

Physiologic T-waves go in the same direction as the QRS complex

-exception is LBBB when T waves are physiologically inverted (don’t indicate ischemia)

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8
Q

Describe pneumonic for reciprocal changes

A

PAILS

In a posterior MI you’d expect ST depressions in anterior leads => V2/V4 depressions make you concerned for posterior MI

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9
Q

What may ST elevations in aVR indicate?

A

ST elevation sin aVR can indicate proximal LAD occlusion or really extensive (3 vessel) disease

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10
Q

EKG findings indicative of critical LAD stenosis

A

Critical LAD stenosis can show on EKG by Wellens syndrome = deep T-wave inversions in V2/V3 (T-wave inversions in anterior leads)

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11
Q

Where would expect to see reciprocal changes in an anterior MI

A

LAD occlusion (anterior MI)- expect reciprocal ST depressions in inferior leads

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12
Q

When in ACS do you not give nitro?

A

Don’t give nitro if you’re worried about inferior MI b/c 40% of cases of inferior MI have right heart involvement

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13
Q

What is Sgarbosa’s criteria used to determine?

A

Determine if there is ST elevations on top of a LBBB

-hard to tell if it’s just a LBBB or if theres elevations

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14
Q

EKG findings of PE

A

Tachycardia

E/o right heart strain

  • RBBB
  • S1Q3T3: S wave in I, Q wave in III, and T-wave inversion in III
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15
Q

What are delta waves on EKG?

A

Delta waves seen in WPW = upslope btwn P and QRS complex b/c of the aberrant pathway btwn atria and ventricles that starts ventricular contraction earlier

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16
Q

What EKG finding may contraindicate zofran?

A

Prolonged QT- don’t give reglan or zofran

-if pt puking and can’t give either, can give ativan

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17
Q

Describe EKG appearance of supraventricular tachycardia

A

Narrow complex (from the atrium) tachy w/o P-waves

18
Q

Management of supraventricular tachycardia

a) First line (before meds
(b) Pharma

A

SVT

(a) Start w/ vagal maneuvers: carotid massage, bear down
(b) If those don’t work (probs wont) start w/ 6mg of adenosine

19
Q

Mgmt of Torsades

(a) Medically
(b) Second line

A

Torsades

(a) Give Mg2+
(b) Shock

20
Q

What is MAT?

(a) EKG criteria
(b) First line tx

A

Multifocal atrial tachycardia- fast HR coming from the atria (P-waves present) but P-waves of dif morphology

(a) P-waves w/ 3 or more dif morphologies
(b) First line tx = treat the underlying pulm disease
- seen in COPD tx
- really refractory to cardiac tx, just have to try to treat the underlying pulm disease

21
Q

Splinting vs. casting

A

Splinting- hard part w/ open/free side to accommodate swelling
So splint put on first (for about a weekish) then get more permanent cast

22
Q

Clinical scenario that leads to

(a) scaphoid fracture
(b) fracture of 4th/5th metatarsal
(c) Distal radial fracture
(d) triquetrum fracture

A

Clinical scenario

(a,c) FOOSH (fall out outstretched hand) => scaphoid fracture and distal radial fracture

(b) Boxer’s fracture- punching something
(d) Triquetrum fracture from either hyperextension or hyperflexion of the wrist

23
Q

Splint for

(a) scaphoid fracture
(b) fracture of 4th/5th metatarsal
(c) Distal radial fracture
(d) triquetrum fracture

A

Splint for

(a) Scaphoid fracture =
(b) Boxer’s fracture = ulnar gutter
(c) Distal radial fracture = sugar-tong split
(d) Triquetrium/chip fracture = volar slab

24
Q

Step before splinting a fracture

A

Perform neurovascular exam!!!

-always before AND after reduction and immobilization

25
3 reasons to suture up a wound
- aid wound healing - decreased risk of infection - cosmesis
26
5 steps of suturing up a wound
1. anesthetize 2. irrigate 3. sterile prep 4. close wound 5. dress wound
27
Why give lidocaine w/ epi?
Adrenaline causes local vasoconstriction to decrease bleeding, and to decrease systemic absorption to keep more locally => increases duration of action on local target
28
Where to never put lidocaine?
Place w/ end arterial supply: hand, penis, nose, pinna, toes
29
Max dose of (a) 1% lidocaine w/o epi (b) 1% lidocaine w/ epi
Max dose | a) 1% lidocaine w/o epi = 35cc (5mg/kg (b) 1% lidcaine w/ epi = 50cc
30
Name the main absorbable vs. non-absorbable suture
Absorbable suture = Vicryl Nonabsorbable suture = Nylon, silk
31
When to give tetanus vaccine to clean wounds
Give tetanus vaccine if pt has had less than 3 doses, last dose given more than 10 yrs ago, or unknown doses
32
When to give tetanus immunoglobulin in addition to tetanus vaccine for wounds?
Give tetanus immune globulin ONLY for contaminated wounds where pt has had fewer than 3 or unknown doses of tetanous vaccine -never give immune globulin to clean/minor wound
33
Difference btwn dressing a wound closed by dermabond
Don't put bacitracin over dermabond b/c it will inactivate it
34
Pharmacologic difference btwn morphine and codeine
The two natural opioids (morphine and codeine) are similar: but step by which codeine is metabolized into morphine involved enzyme CYP2D6 -about 10% of ppl are CYP2D6 deficient (therefore wouldn't get any pain relief) and a lot of drugs (prozac, benadryl) can act as CYP2D6 inhibitors
35
When to use hydromorphine over morphine?
Morphine (natural opioid) releases causes bigger histamine release than hydromorphine (semisynthetic) => use hydromorphine when really large doses are required
36
Pain med for ppl w/ morphine allergy
1. Make sure it's a true allergy, don't be confused by normal histamine-release caused physiologically by morphine 2. fentanyl - has shorter duration
37
Name 3 NSAIDs
Ibuprophen (advil), ketoralac (toradol), naproxen
38
When to use tylenol over advil
Acetaminophen (tylenol) isn't an anti-inflammatory- use it as anti-pyretic and minimal pain Advil (ibuprophen) is the better one <3
39
Starting morphine dose for adults
.1mg/kg | -often give 4g which is often underdose
40
Downside of opioids (name 3)
- Respiratory depression - constipation - risk of addiction