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Misc Flashcards

1
Q

What is the purpose of a wet-to-dry dressing?

A

non-selective debridement

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2
Q

What are the 3 superficial veins in the UE?

What are the 6 deep veins in the UE?

A
  • SUPERFICIAL*
  • cephalic
  • basilic
  • median cubital vein
  • DEEP*
  • subclavian
  • axillary
  • brachial
  • ulnar
  • radial
  • interosseous
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3
Q

What are the 2 superficial veins in the LE?

What are the 6 deep veins in the LE?

A
  • SUPERFICIAL*
  • greater saphenous
  • lesser saphenous
  • DEEP*
  • iliac
  • common femoral
  • deep femoral
  • femoral
  • popliteal
  • deep calf
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4
Q

General risk factors of VTE include Virchow’s triad which is:

A
  • stasis
  • endothelial trauma
  • hypercoagulable state
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5
Q

From most common to least what are the 5 cancers that cause VTE?

A
  1. lung
  2. pancreas
  3. colon
  4. kidney
  5. prostate
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6
Q

A younger patient with no other risk factors who presents with recurrent LEFT leg DVT should be worked up for this syndrome.

A

Mae-Thurner syndrome

important because this is one of the rare cases where you will need to stent a vein

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7
Q

Thrombophlebitis is often associated with what?

A

peripheral IV catheter placement

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8
Q

What are the 3 classic DVT symptoms?

A
  • pain
  • swelling (unilateral lower extremity edema)
  • erythema
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9
Q

A patient presents with sudden severe leg pain. On PE you notice he has unilateral swelling and edema that is extremely firm and non-palpable. What should this patient be worked up for?

NOT DVT but associated

A

Phlegmasia cerulea dolens

surgical emergency (thrombectomy) it is a limb threatening injury

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10
Q

What risk assessment tool is used for DVT?

A

Well’s Score

>3 = high probability (50-75%)
1-2 = mod probability (17%)
0 = low probability (5%)
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11
Q

What lab test is a good test to rule OUT DVT?

A

D-dimer

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12
Q

What is the gold standard diagnostic imaging test for DVT?

A

ultrasound

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13
Q

If a patient is at a LOW risk for VTE what initial test should you start off with? Depending on that test’s results what do you do?

A
  • start off with D-dimer

If negative = ruled out DVT
If positive = obtain U/S

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14
Q

If a patient is at a MOD risk for VTE what initial test should you start off with? Depending on that test’s results what do you do?

A
  • start of with U/S

If positive = DVT
if negative = no DVT

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15
Q

If a patient is at a HIGH risk for VTE what initial test should you start off with? Depending on that test’s results what do you do?

A
  • start off with U/S

If positive = DVT
If negative = consider venography

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16
Q

What is the treatment for superficial thrombophlebitis?

A
  • local heat (warm compresses)
  • NSAIDs
  • remove catheter
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17
Q

What is the treatment for a hemodynamically stable DVT?

A
  • outpatient treatment with anticoagulation
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18
Q

What are the 3 anticoagulation treatment options for DVT?

A
  • IV heparin bridge to Coumadin
  • LMWH bridge to Coumadin
  • Oral factor Xa inhibitors
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19
Q

What is the difference in management for a unprovoked vs. provoked DVT?

A
  • unprovoked = indefinite a/c

- provoked = 3-6 months a/c

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20
Q

If a patient has a very low risk of VTE based on the Caprini score what is the treatment?

A

early ambulation

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21
Q

If a patient has a low risk of VTE based on the Caprini score what is the treatment?

A

mechanical prophylaxis

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22
Q

If a patient has a moderate risk of VTE based on the Caprini score what is the treatment?

A
  • mechanical prophylaxis

- pharm prophylaxis (low-dose)

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23
Q

If a patient has a high risk of VTE based on the Caprini score what is the treatment?

A
  • mechanical prophylaxis

- pharm prophylaxis (low-dose)

24
Q

What is the treatment for thoracic outlet syndrome?

A
  • remove the anterior scalene and the first rib
25
Q

When examining for carotid artery disease which artery do we care about the most?

A

internal carotid artery

26
Q

What is the treatment for carotid dissection?

A

anticoagulation

27
Q

what is the mainstay diagnostic study for carotid artery disease?

A

carotid duplex ultrasound

28
Q

If you want to rule out a stroke what diagnostic imaging study should you order?

29
Q

What is the goal of treatment for carotid artery disease?

A

stroke prevention

30
Q

what is the first line surgical treatment for carotid stenosis?

A

carotid endarterectomy (CEA)

31
Q

Which of the following ASYMPTOMATIC patients with carotid stenosis get surgery?

a. <50% stenosis
b. 50-69% stenosis
c. >70% stenosis
d. 100% occluded

A

c. >70% stenosis

  • all others are medically managed*
  • if you have complete occlusion DO NOT reopen them because that will increase risk of clot*
32
Q

Which of the following SYMPTOMATIC patients with carotid stenosis get surgery?

a. <50% stenosis
b. >50% stenosis
c. 100% occluded

A

b. >50% stenosis

* think about Mr. Herring here*

33
Q

If a patient has carotid stenosis and presents with a TIA how soon should he have surgery?

A

ASAP

cut off is 2 weeks!!!

34
Q

What is Hering’s nerve?

A

branch of the glossopharyngeal nerve (CN IX) that innervates the baroreceptors of the carotid sinus and the chemoreceptors in the carotid body.

35
Q

If someone needs acute dialysis what type of catheter will they get?

A

temporary dialysis catheter

36
Q

When you are using an ash split catheter for hemodialysis what do you need to make sure to do first?

A
  • DO NOT FLUSH

- remove the pre-stored heparin first

37
Q

How do you manage an infection d/t hemodialysis?

A
  • remove catheter and replace in 1-2 days
  • antibiotics
  • protocol for catheter care
38
Q

How do you manage a fibrin sheath d/t hemodialysis?

A
  • catheter striping and exchange
39
Q

How do you manage a catheter thrombosis d/t hemodialysis?

A
  • cathflo (Alteplase) installation protocol

- catheter replacement

40
Q

How do you manage an exposed cuff d/t hemodialysis?

A
  • catheter exchange
41
Q

How do you manage a central venous stenosis d/t hemodialysis?

A

angioplasty

42
Q

What is the best first choice for dialysis access and why?

A
  • Arteriovenous fistula (AVF)
  • lower infection rates
  • higher flow rates
  • lower risk of thrombosis
  • better long-term patency
43
Q

Why is a fistula better than a graft for dialysis access?

A
  • if a graft gets infected it needs to come out
44
Q

What location do you want to start with for an AVF for dialysis?

A
  • radiocephalic

* move from distal to proximal*

45
Q

A normal fistula that is functioning properly will have this present daily.

A
  • thrill/bruit

* need to check everyday*

46
Q

What are the 8 points relating to dialysis access patient care/education?

A
  • check trill daily
  • avoid tight clothing
  • avoid sleeping on the site
  • no heavy lifting
  • begin maturation exercises after a few weeks
  • monitor for infection
  • no BP/blood draws from the arm
  • call if thrill is absent
47
Q

What is the Maturity Rule of 6’s for a dialysis fistula?

A
  • 6 weeks old
  • < 6mm deep
  • at least 6 mm in diameter
  • 600ml/min flow
  • if not mature by 6 weeks needs to re-evaluate
48
Q

What is the arm elevation test used for and what do the results mean?

A
  • assess for outflow stenosis in a dilated AVF

* if elevation of the arm DOES NOT cause vein collapse = outflow stenosis*

49
Q

A patient who recently underwent dialysis presents with facial edema, a hoarse voice, distended neck, chest and arm veins. What should he be worked up for?

A
  • superior vena cava (SVC) syndrome
50
Q

what is the gold standard diagnostic study for SVC syndrome?

51
Q

what are the 7 red flags for human trafficking

A
  • someone else is speaking for the patient
  • not aware of location, time, date
  • exhibits fear, anxiety, PTSD, tension
  • shows signs of abuse, torture
  • reluctant to explain injury
  • not able to provide home address
  • not in possession of personal ID
52
Q

communication errors are responsible for ____% of sentinel events

53
Q

what are the 4 standards of effective communication?

A
  • complete
  • clear
  • brief
  • timely
54
Q

what does the CUS work stand for?

A
  • I am Concerned
  • I am Uncomfortable
  • This is a Safety issue
55
Q

what does SBAR stand for?

A
  • situation
  • background
  • assessment
  • recommendation
56
Q

What is the goal INR with Coumadin?

Surgery (7 decks)

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