Mock Exam Part 1, #1-15 Reviewer Flashcards
primary indication for temporary transcutaneous pacing
bradycardia with hemodynamic compromise
until a more definitive pacing method can be established
indication for temporary transvenous pacemaker placement (not transcutaneous)
asystole
overdrive pacing in unresponsive VTach
Unresponsive recurrent sinus pauses (>3 s)
alternating bundle branch block
consider in RBBB with anterior or posterior hemiblock
when performing synchronized cardioversion, at which phase of the QRS complex should the shock be delivered?
on the R wave
“peak of the QRS complex”, “highest point of the R-wave”
synchronized cardioversion for atrial flutter
may require as little as 25-50 J
synchronized cardioversion for atrial fibrillation
150-200 J
(or 120-200 J)
A fib is narrow-complex, irregular.
But if narrow-complex, regular (SVT): 50-100 J
MOA of adenosine
inhibition of the conduction through the AV node, interrupting the reentry circuit responsible for SVT
6 mg - 12 mg - 12 mg
other drugs that block AV nodal conduction
verapamil, diltiazem
esmolol, metoprolol, propranolol
(table 18-2)
antiarrhythmic of choice for the stable wide-complex tachycardia
procainamide
if unstable –> electrical cardioversion, start at 100 J
preferred acute pain management for the patient with severe abdominal pain due to suspected kidney stones
ketorolac
“Agents such as NSAIDs should be considered for mild to moderate pain or when targeting severe pain originating from smooth muscle spasm such as renal or biliary colic
In specific instances such as renal and biliary colic, although parenteral NSAIDs may control severe pain, combination therapy with an opioid is usually superior.
before administering procedural sedation, what is the most important aspect to assess in the patient
allergies to medications
TRUE or FALSE
don’t give propofol in those with soy allergies
FALSE
“Propofol’s only TRUE immunologic contraindication is an allergy to the drug itself.”
A pediatric patient requires procedural sedation. What medicaiton is preferred for procedural sedation in children due to its safety profile and rapid onset
ketamine
- also the combination of anesthesia, analgesia, and amnesia is suitable for kids
almost universally preferred anxiolytic for minor procedures in children
midazolam, because of its rapid onset and short duration of action
sedative that can cause hallucinations and dissociation
ketamine
- derivative of the drug phencyclidine and is an NMDA glutamate receptor antagonist
critical dosing threshold of ketamine, above which characteristic dissociative state appears
1.0 to 1.5 mg/kg IV
or 3 to 4 mg/kg IM
no observable increased levels of depth beyond threshold, just increased duration of dissociative state
recommended immediate treatment for individuals exposed to a nerve agent in a chemica lwarfare incident
administer atropine and pralidoxime
nerve agents are organophosphates
never give succinylcholine
type of chemical warfare agent primarily affecting the skin and mucous membranes, causing blistering and tissue damage
vesicants
also known as blister agents
examples: sulfur mustard, phosgene oxime, lewisite
treatment for vesicant exposure
irrigate with water, supportive care
vesicant that can cause bone marrow supression
mustard agents
agents that interfere with O2 utilization in mitochondria
cyanide
hydrogen sulfide
phosphine
sodium azide
carbon monoxide
treatment: hydroxocobalamin
(table 8-4)
agents that interrupt delivery of oxygen to tissues
carbon monoxide
methylene chloride
nitrites
benzocaine
phenazopyridine
treatment: O2, methylene blue
(table 8-4)
examples of simple asphyxiants
carbon monoxide
hydrogen
nitrogen
butane
propane
asphyxiants displace O2 from the air
treatment: remove from source, give O2
(table 8-4)
what is sarin?
a nerve agent
= sarin is aka “GB”
= an organophosphate
may be seen in the recovery phase of trauma
trauma (also seen in acute phase)
communicable disease
soft tissue infections
vectorborne disease
infectious complications of trauma (also seen in immediate postevent phase)
exacerbation of chronic disease (also seen in immediate postevent phase)
PTSD
(table 6-1)
the only natural disaster where more injury and death occur during the recovery phase than in the acute phase
hurricanes
type of blast injury that results from the patient being propelled through the air and striking stationary objects
Tertiary blast injury
“Flying Tao”
blast injury due to collateral damage from flying objects
Secondary blast injury
“Flying Shrapnels”
most common fatal primary blast injury
pulmonary barotrauma
primary blast injuries most commonly affect gas-filled structures, such as lungs, stomach, middle-ear
most common serious complication of crush syndrome
renal failure
cause is multifactorial:
- systemic hypoperfusion
- renal vasoconstriction
- nephrotoxicity from myoglobin (via formation of ferriheximate, free hydroxyl radicals)
- uric acid and phosphate precipitation in the distal tubules
primary cause of delayed death in compartment syndrome
renal failure
fluid hydration in compartment syndrome
PNSS 1000 mL/hour for 2 hours,
then 500cc/hour thereafter
to maintain UO 200-300 mL/hour (5-7 L every 24 hours
