Medical Emergencies Flashcards

Question

What are the three major problems with hyperosmolar hyperglycemic syndrome?

Answer 1

Hyperglycemia Dehydration Hyperosmolality

Answer 2

There is enough circulating insulin in order to avoid ketones.

Answer 3

Glucose – usually > 600, often > 1000 UA – Positive for glucose; negative for ketones pH - normal (may be slightly acidotic) PO2 - normal unless underlying respiratory problem. WBC - increased if underlying problem infection. Na - Normal or increased depending on dehydration. K - normal or increased depending on dehydration. Osmolality - increased.

Answer 4

``` Vague abdominal pain Polyuria Headache Seizures Shallow respirations Elevated T waves Anorexia Polydipsia Blurred vision Coma Tachycardia Dysrhythmias Confusion Nausea/vomiting ```

Answer 5

Rehydrate Oxygen Foley Potassium supplements to prevent hypokalemia from hemodilution and insulin therapy. Cardiac monitor Insulin drip not as important but is often used. Heparin or Lovenox for blood viscosity.

Answer 6

``` Lack of intake. Increased physical stress. Liver disease Changes in medication. Pregnancy Alcohol ingestion Drugs - NSAIDs, phenytoin, thyroid, propanolol. Increased insulin intake Certain drugs – Salicylates / sulfonamides influence the metabolism of oral hypoglycemics ```

Answer 7

When a decrease in glucose is sensed, the body releases glucagon and epinephrine. The glucagon releases stored glucose, but it cannot be utilized fast enough. The epinephrine decreases the utilization of existing glucose and may be the cause of the symptomatology that occurs.

Answer 8

``` Confusion Seizures Slurred speech Cool & clammy Palpitations Shakiness Hunger Pale Competitiveness Coma Staggering gate Tachycardia Diaphoresis Dilated pupils Death ```

Answer 9

``` Glucose Oral - 10 to 15 g of carbohydrate followed by a meal. 4 to 6 ounces of orange juice 5 to 6 Lifesavers 1/2 to 3/4 cup of nondiet soda 6 ounces of milk 2 to 3 glucose tablets D50 Glucagon - IM (this will not work for a cirrhosis patient) Insulin Pump — turn off ```

Answer 10

NovoLog, Apidra, Numalog = 30 to 90 minutes. Humulin R, Novolin R = 2 to 4 hours. Humulin N, Novolin N = eight hours. Levimir, Lantus = no peak.

Answer 11

Thyroid storm occurs in hyper thyroid patients who may either be undiagnosed or stop taking their medication. Mortality rate is 20 to 60%

Answer 12

Overactive thyroid – Grave’s disease. Thyrotoxicosis - increased hormone release. Drug induced - Iodine containing agents (amiodarone/lithium).

Answer 13

``` Hyperthermia Tachycardia Tremors Exophthalmus Cardiac failure Hyperglycemia Hypertension Agitation Diaphoresis Mental status changes Pulmonary edema Hypercalcemia Metabolic acidosis Flushed skin ```

Answer 14

General treatment: Treat fever - no salicylates (causes more thyroid hormone to be released from binding sites). Fluid replacement (hyperthermia/vomiting/diarrhea). Anti-emetics Antidiarrheals Oxygen Monitor/treat dysrhythmias Do not allow shivering. Treatment to slow release of hormone: Propanolol (large doses needed for tachycardia. Blocks conversion of T4 to T3). Guanethidine/ Reserpine - depletes stores/blocks release. Iodine (Give one hour after use of meds to block synthesis.) Treatment to Block Synthesis of Hormone: Propylthiouracil Methimazole Glucocorticosteroids/Diuretics

Answer 15

Myxedema coma is a complication of hypothyroidism with a mortality rate of 50% (stated to be as high as 80%). It is a progressive disease process with respiratory failure as the usual cause of death.

Answer 16

Autoimmune thyroiditis Ablation therapy Iodine deficiency Tumor Drugs (lithium, amiodarone, anticonvulsants) Secondary hypothyroidism - pituitary dysfunction. Tertiary hypothyroidism - hypothalamic dysfunction.

Answer 17

``` Infections General anesthesia Sedatives Antidepressants Trauma CHF Surgery Narcotics Cold temperatures Stress ```

Answer 18

``` Hyperthyroid = low TSH Hypothyroid = increased TSH ```

Answer 19

``` Hypothermia Decreased activity tolerance Weight gain Confusion Altered mental status Hypo ventilation Hyponatremia Decreased cardiac output Depressed T waves Myxedema madness Pronounced fatigue Dyspnea Tongue swelling Slow answers Coma Hypercarbia Decreased renal blood flow Peripheral vasoconstriction prolonged QT interval Dry, pale, cold skin ```

Answer 20

ABC’s Hormone replacement – T4 or T3 Glucocorticoids to prevent adrenal crisis in patients with compromised adrenal systems. Passive warming.

Answer 21

Disease state | Discontinuation of steroids

Answer 22

Hyponatremia Hypoglycemia Hyperkalemia

Answer 23

``` N/P Amenorrhea Fever Irritability Abdominal cramps Hypovolemic shock Weakness Fatigue headache Tachycardia ```

Answer 24

Hyper pigmentation Moon face Truncal obesity

Answer 25

Fluids – used D5NS (Patient is hyponatremic and hypoglycemic). Hydrocortisone Mineralocorticoids (dexamethasone) Treat for hyperkalemia - D50 and insulin but may resolve with fluids and glucocorticoids. Cardiac monitoring

Answer 26

``` Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E ```

Answer 27

Fecal – oral

Answer 28

Percutaneous, sexual, Bile, perinatal

Answer 29

Percutaneous, sexual, perinatal

Answer 30

*Occurs in combination with hep-B | Percutaneous, sexual, bile, perinatal

Answer 31

Fecal - oral. | *occurs in Underdeveloped countries

Answer 32

``` Fever Anorexia Dark urine Jaundice Malaise N/V Abdominal pain Rash occurs with type B ```

Answer 33

Cirrhosis or carcinoma

Answer 34

Hepatitis A and hepatitis B

Answer 35

Immune globulin

Answer 36

A pulmonary disease caused by Mycobacterium tuberculosis. Usually pulmonary in nature but can also affect other organs. Incubation period is 4 to 12 weeks. A TB test is positive is 10 mm induration (5mm if HIV +).

Answer 37

``` Night sweats Coffee Anorexia Weight loss Bloody sputum ```

Answer 38

``` INH Rifampin Myambutal Streptomycin Pyrazinamycin Need baseline liver studies Isolation Controlled airflow rooms Identify at triage if possible Treat symptoms ```

Answer 39

``` Fever Headache Macular rash (head to toe is typical; extremities to central is atypical). Koplick’s sign (mucosal lesions) Photophobia Arthralgia ```

Answer 40

Droplet (nasopharyngeal)

Answer 41

Pneumonia Encephalitis Otitis media

Answer 42

Treatment of symptoms. | Exposed family members should be vaccinated within 72 hours.

Answer 43

10 to 14 days

Answer 44

``` Rash Low-grade fever Malaise Conjunctivitis Sore throat ```

Answer 45

Pink, popular rash (face/neck to extremities)

Answer 46

Droplets (nasopharyngeal)

Answer 47

Arthralgia Arthritis Fetal injuries (deafness, mental retardation, cataracts, heart defects)

Answer 48

Treat the symptoms

Answer 49

14 to 21 days

Answer 50

Low-grade fever | Lesions in stages (macules - papules - vesicles - crusted)

Answer 51

Direct contact with the vesicular discharge or mucus membranes

Answer 52

Encephalitis | Pneumonia

Answer 53

Anti-histamines Varicella immunoglobulin within 96 hours of exposure. May use acyclovir Symptomatic treatment

Answer 54

10 to 21 days

Answer 55

Epididymitis Orchitis Testicular atrophy Meningitis

Answer 56

``` Low-grade fever Headache Vomiting sore throat Unilateral/bilateral parotid swelling ```

Answer 57

Droplet oral contact with saliva or contaminated articles

Answer 58

Sterility | Meningitis

Answer 59

Symptomatic treatment Bedrest for adult males Analgesics

Answer 60

14 to 21 days

Answer 61

``` History of injury Malaise Muscle rigidity Fever Headache Trismus (lockjaw) Dysphasia Distorted facial muscles Sardonic grin (risus sardonicus) Opisthotonos Respiratory arrest Seizures ```

Answer 62

Contact of open wound with spores.

Answer 63

Respiratory failure | Death

Answer 64

``` Tetanus immunoglobulin. Benzodiazepines (spasms) Neuromuscular blocking agents Supportive care Dark room with low stimulation Fluid/electrolyte balance Anabiotic‘s Wound excision/debridement Horse serum antitoxin Nitroprusside (hypertension) Propranolol (dysrhythmias) ```

Answer 65

Two hours to seven days.

Answer 66

Persistent cough (greater than seven days) “Whoop” sound to cough Paroxysmal cough

Answer 67

Respiratory secretions

Answer 68

Pneumonia Seizures Cranial nerve abnormalities

Answer 69

Erythromycin Supportive Possible intubation

Answer 70

7 to 13 days

Answer 71

``` Fatigue Fever Sore throat Lymphadenopathy Splenomegaly Hepatomegaly ```

Answer 72

droplet cross infection

Answer 73

Splenic rupture (avoid sports and aspirin products for up to eight weeks)

Answer 74

Supportive

Answer 75

``` N/V Headache Fever Nuchal rigidity Decrease LOC Petechiae Purpuric rash Hypertension Seizures Sepsis ```

Answer 76

Droplet (nasopharyngeal)

Answer 77

``` Meningococcemia DIC Death Loss of Limbs Increased ICP ```

Answer 78

``` Anabiotic‘s Volume replacement Strict isolation Anticonvulsants Airway management ```

Answer 79

``` Sore throat Dysphasia Headache Fever (really > 103) Nausea Malaise Respiratory distress Tachycardia Tachypnea Decreased mental status Cervical lymphadenopathy Dirty, gray white rubbery membrane covering structures of the pharynx (removal causes bleeding) Paralysis of soft palate and posterior pharynx Aspiration ```

Answer 80

Respiratory droplets | Direct contact with secretions or skin lesion exudates

Answer 81

``` Widespread organ damage Myocarditis Thrombocytopenia Vocal cord paralysis Acute tubular necrosis Ascending paralysis Death from asphyxia or cardiac complications ```

Answer 82

``` Airway management Diphtheria antitoxin (horse serum) ```

Answer 83

2 to 5 days

Answer 84

``` Call for three weeks or longer Hemoptysis Weakness or fatigue Weight loss Anorexia Chills and fever Night sweats ```

Answer 85

Airborne and droplet. | Negative pressure room needed.

Answer 86

Can affect other organs (extra pulmonary) | Can have multiple drug resistant TB

Answer 87

INH Rifampin Hospitalization for severe disease.

Answer 88

2 to 10 weeks

Answer 89

Hemorrhage Fever Vomiting/diarrhea

Answer 90

Droplet/contact | Negative pressure room

Answer 91

Supportive care

Answer 92

2 to 21 days

Answer 93

Rarely seen now because of education of the general public. Etiology is unknown, but it is seen with use of salicylates in viral illnesses in children. Find encephalopathy with fatty liver and fatty infiltrates in the heart.

Answer 94

``` Vomiting Hepatomegaly Altered mental status G.I. bleeding Lethargy Coma ```

Answer 95

``` Increased ammonia Decreased glucose Acidosis Increased liver enzymes Increased PT/PTT Increased skeletal and cardiac enzymes ```

Answer 96

Supportive | May need mechanical ventilation

Answer 97

Pre-renal Intra-renal Post-renal

Answer 98

Hypokalemia Decreased cardiac output Decreased peripheral resistance Renal vascular obstruction

Answer 99

``` Drugs X-ray contrast Transfusion reactions Chemicals Pyelonephritis Toxemia Lupus ```

Answer 100

``` Calculi Prostatic hyperplasia Prostate cancer Bladder cancer Trauma Strictures Spinal cord disease ```

Answer 101

``` Hypertension CHF Pericarditis Cardiomyopathy Pericardial effusion ```

Answer 102

Anemia | Infections

Answer 103

``` Pallor Pigmentation Pruritis Ecchymosis Excoriations Uremic frost ```

Answer 104

``` Nausea/vomiting Uremic Fetor (urine odor to breath) Bleeding Ulcers Stomatitis Gastritis ```

Answer 105

Amenorrhea Infertility Sexual dysfunction Azoospermia

Answer 106

Retinopathy

Answer 107

Thyroid abnormalities

Answer 108

``` Fatigue Headaches Sleep disturbances Muscle irritability Seizures Confusion Coma Peripheral paresthesias ```

Answer 109

``` Pulmonary edema Pleuritis Dyspnea Pneumonia Depressed cough reflex ```

Answer 110

Dialysis Peritoneal Vascular (hemo)

Answer 111

``` Hyperkalemia Hyponatremia Hypocalcemia Hyperphosphatemia Volume overload ```

Answer 112

``` Cardiac dysrhythmias N/V/D Twitching Seizures Paresthesias Paralysis Peaked T-waves Prolonged P-R intervals Widened QRS ```

Answer 113

IV calcium chloride or calcium gluconate (reduce cardiotoxicity) IV Glucose and IV insulin (to take potassium back in the cells) Loop/osmotic diuretics Renal dialysis Kayexalate Continuous cardiac monitoring Albuterol treatment

Answer 114

``` Arrhythmias Depressed T-wave Postural hypotension Anorexia N/V Paralytic ileus Constipation Hyporeflexia Muscle weakness Paresthesias ```

Answer 115

IV potassium chloride (must use infusion pump) Cardiac monitoring Oral potassium chloride

Answer 116

``` Irritability Apprehension Confusion Hypotension Tachycardia N/V Dry mucous membranes Tremors seizures Appears dehydrated Hyperthermia ```

Answer 117

``` Fluid replacement (dilute sodium – if pure water loss - treat with hypotonic solutions - no D5W - causes increased ICP) Slow correction to avoid cerebral edema. ```

Answer 118

``` Lethargy Postural hypotension Tremors Headache Edema Confusion Seizures Coma ```

Answer 119

``` If severe (< 110) give hypertonic saline solutions *be cautious!) Only give until symptoms go away, don’t wait for numbers to go down ```