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Professional Development > Part 19 > Flashcards

Part 19 Flashcards

1
Q

General ED principles (5)

A
  • Identify and stabilize life threatening condition***
  • find an explanation for condition if possible as well as recognize coexistent pathology
  • Determine why patient presented now rather than earlier/later
  • Consider the necessity to determine the diagnosis before the patient leaves the ED***
  • Document entire visit
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2
Q

Digital blocks should be done with what anesthetic?

A

Lidocaine without epi

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3
Q

Hematoma block in the ER

A

Done into hematoma immediately after a fracture to help limit pain before reduction, does not block entire nerve still resulting in pain during reduction but decreases it significantly

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4
Q

Field block in the ER

A

Injection under the skin and around at different sites to numb a site

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5
Q

Regional blocks in the ER

A

Can be done on toes, fingers, ankles, inject around the nerve deep and then superficial but put the entire digit/space to sleep that will last an hour or so but need to do vascular check and motor check beforehand

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6
Q

Nail avulsion in the ER

A

Need to get nail tucked underneath in the matrix to prevent closure of the matrix to allow the nail to continue to grow

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7
Q

Dental repair box

A

Located in every ER for handling emergency dental repairs when dentists not open or available

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8
Q

FAST exam definition

A

Focused assessment with sonography for trauma exam, diagnostic exam for internal bleeding checking the heart (pericardial), liver/kidney (perihepatic), spleen (perisplenic), and bladder (pelvic) regions

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9
Q

Glasgow coma scale

A

Tool utilized to establish level of consciousness and compare over course of treatment, 3 components including eye opening (spontaneous 4, to speech 3, to pain 2, none 1), verbal response (oreinted 5, confused, 4, inappropriate 3, incomprehensible 2, none 1), and motor response (obeys commands 6, localizes pain 5, withdraws from pain 4, flexion to pain, 3, extension to pain 2, none 1) for a max score of 15, correlates inversely with aspiration risk, GCS equal or less than 8 indicates ET intubation

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10
Q

Empiric management of decreased mental status patient (4 things)

A
  • maintain spO2
  • rapid bedside glucose
  • naloxone .4mg IV
  • thiamine 100mg IV
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11
Q

EM approach to acute MI/ACS (11)

A
  • Goal under 10 min
  • 12 lead ekg
  • baby aspirin (325mg) chewed
  • Sublingual nitro .4mg every 5 min x3 doses
  • Establish IV access
  • blood work including cardiac biomarkers
  • initiate supplemental oxygen therapy
  • continuous ECG monitoring
  • B blocker
  • anticoag therapies
  • Call cath lab if acute ST elevation
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12
Q

Benign causes of appearing melena or hematochezia (2)

A
  • pepto bisthmol
  • beets
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13
Q

Recall the physical exam for the abdomen order

A

Inspection, auscultation, perussion, palpation (in all 4 quadrants)

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14
Q

Perforated viscus (peptic ulcer often) common presentation (4)

A
  • sudden onset severe abdominal pain
  • worse with movement
  • pain with breathing
  • abdominal series x ray showing free air below the diaphragm
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15
Q

Acute appendicitis imaging (2)

A
  • Abdominal CT
  • u/s second line

-

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16
Q

Ectopic pregnancy definition

A

Pregnancy implanted out of the uterus, presents with positive hCG with ultrasound showing absence of intrauterine pregnancy, or presence of adnexal mass, surgical emergency for treatment

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17
Q

Choledocholithiasis/ascending cholangitis charcot’s triad

A
  • fever
  • right upper quadrant pain
  • jaundice
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18
Q

IBD (UC/crohn’s) presentation symptoms (3)

A

Bloody diarrhea, abdominal pain, weight loss

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19
Q

IV vancomycin for C diff is useless because…

A

….it is not absorbed that way into the gut and therefore must be taken orally

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20
Q

Pelvic inflammatory disease diffrentiation from gastroenterological disease (2)

A
  • cervical motion test

- abnormal vaginal discharge

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21
Q

Ovarian torsion definition and how is it ruled out?

A

Twisting of the ovary around its axis along the fallopian tubes with lower abdominal pain being the only presenting symptom, may resolve spontaneously but if not can infarct, can only be ruled out with ultrasound

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22
Q

What is intravenous access used for? (5)

A
  • deliver fluid
  • Deliver medication/IV contrast
  • Give parental nutrition/electrolytes
  • Deliver blood products/draw blood
  • hemodialysis
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23
Q

Reasons for an arterial line (3)

A
  • measure constant blood pressure
  • drawing ABGs
  • measure central venous pressure
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24
Q

Goal catheter size gauge for adequate flow rate upon catheterization

A

20 gauge, ideally 18 (easier for IV contrast)

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25
Q

Peripheral IV access protocol (2)

A
  • Can be done by many different healthcare providers
    • should take 3 attempts, if cannot then second person tries, then if not IV team must be called
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26
Q

Advantages (3) and disadvantages (3) for peripheral IV access

A 
\+ease of insertion
\+ low cost
\+minimal complications
- short duration must be less than 3 days and cannot be used with certain medications
-easily occluded
-potential tissue injury
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27
Q

If labs are not drawn immediately upon a peripheral IV access being established, then…

A

….cannot draw blood labs later on as they are no longer accurate (need a different site)

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28
Q

Contraindications for peripheral IV establishment (7)

A
  • If med can be given orally***
  • cellulitis
  • injury to extremity
  • previous IV infiltration (IV not actually in vein)
  • surgical procedures
  • Burn
  • AV fistula presence
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29
Q

Typical placement areas of a peripheral IV (4)

A
  • Dorsal hand
  • forearm/wrist (cephalic or basilic vein)
  • leg/ankle/dorsum of vein (greater saphenous vein)
  • scalp in neonate
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30
Q

Gauge size needed in resuscitation to get large amounts of fluid/medications fast

A

16 gauge

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31
Q

Infiltration

A

Leakage of fluid or medications that can be given peripheral IV into surrounding tissue from being slightly pulled out causing swelling, discomfort, and burning

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32
Q

Extravasation

A

Accidental administration of toxic medications that should not be given IV into tissue around the infusion site that can cause tissue necrosis, disfigurement, or loss of function

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33
Q

Examples of drugs that can cause extravasation if given peripheral IV (6)

A
  • Chemotherapy
  • K+
  • vancomycin
  • cefotaxime
  • amiodarone
  • calcium chloride
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34
Q

Indications for central venous catheter (6)

A
  • Inadequate peripheral venous access
  • administration of toxic medications (vasopressors, chemo, TPN)
  • hemodynamic monitoring (measurement of CVP)
  • extracorpeal (hemodialysis)
  • rapid infusion of fluids/blood
  • drawing frequent labs
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35
Q

Contraindications for a central venous catheter (4)

A
  • all relative as these can be life saving
  • anatomic distortion or trauma for specific sites
  • hemodyalysis or pacemaker presence
  • moderate to severe coagulopathy
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36
Q

PICC line

A

Central venous catheter inserted into cephalic, basilic, brachial vein into distal superior vena cava, less procedural risk than others as uses ultrasound guidance with an IV nurse with confirmation of placement via radiology, can be single or double lumen, used for temporary access infusion 15-30 days for things like IV antibiotics, chemo, or vasopressor medications, inserted in nondominant arm

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37
Q

Advantages (4) and disadvantages (2) of PICC line

A 
\+ease of insertion
\+relatively safe and inexpensive
\+good for drawing several labs
\+easy to remove
-potential for occlusion
-can take over 1 hour to place, not stat
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38
Q

More lumens on a catheter increase higher rate of…

A

….venous thrombosis

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39
Q

Central venous catheter advantages (4) and disadvantages (2)

A 
\+long term access
\+decreased infection rate in tunneled
\+safe with most meds
\+emergency access
-requires surgical insertion often under sedation
-increased cost
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40
Q

Implantable venous access port

A

Often used for same reasons as a tunneled central line, most often used for patient with chemotherapy, entirely under skin allowing for lowering risk of infection, can remain lifelong, much more cosmetic, medicines injected into skin thru catheter, after being filled reservoir slowly releases medicine into blood stream, except for flushing once a month no special care needed

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41
Q

Intraosseous access

A

Used in emergency situations, presence of vascular collapse (due to shock as blood shunts to core), in children/infants, or in trauma, bone marrow functions as a noncollapsible venous access allowing meds and fluids to enter central circulation in seconds, should only be done for an avg of 5.2 hours

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42
Q

Most common site of intraosseous access

A

Proximal tibia

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43
Q

Intraosseous access advantages (3) and disadvantages (2)

A 
\+rapid and easy to insert
\+low complication rate
\+safe with resuscitation meds
-short term only
-potential for osteomyelitis or fracture
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44
Q

Intracranial pressure (ICP)

A

Pressure exerted by fluids such as CSF and blood inside the skull (rigid nonexpandable box) on brain tissue, normal is 7-15 mmHg (average 10mmHg), for supine adult, >20 is abnormal, >40mmHg is severe, sustained increased ICP leads to decreased brain function and poor outcome

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45
Q

Compensated state of ICP

A

When an individual has a brain bleed (or enlarging mass), CSF and venous volume decrease to maintain normal ICP in a compensatory manner (brain mass and arterial volume unaffected) if overwhelmed see drop in arterial volume leading to ischemia of the brain or herniation of brain tissue

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46
Q

Cerebral perfusion pressure (CPP)

A

Difference between mean arterial pressure (avg between systolic and diastolic) and intracranial pressure, a net pressure gradient that drives oxygen delivery to brian tissue but not actually a measure of cereral blood flow, normal range 60-70 mmHg (CPP=MAP-ICP), if CPP too low can raise blood pressure or decrease ICP, requires ICP monitor placement first

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47
Q

Do intracranial bleeds cause hypotension?

A

No because of the rigidity of the cranium - if hypotensive might have some other type of shock going on

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48
Q

Cushings triad

A

Seen as result of and indicates increased ICP

  • hypertension
  • bradycardia
  • irregular respiration
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49
Q

How to determine who with a mild TBI gets a head CT criteria? (10)

A
  • retrograde amnesia >30min
  • suspicion of skull fracture
  • suspicion of basilar skull fracture
  • 2 or more episodes of vomiting
  • use of any anticoagulant
  • age >60
  • seizure since episode of injury
  • neurologic deficits
  • high impact mechanism
  • intoxication or abnormal behavior
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50
Q

Diffuse axonal injury (DAI)

A

traumatic shearing of the axons that occur when head is rapidly accelerated/decelerated and by secondary biochemical cascades, occurs in white and grey matter and majority end up in post traumatic coma as result, may have relatively normal head CT but exam with severely diminished GCS, generally confirmed by MRI, death rare as has no effect on brainstem

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51
Q

Epidural hematoma

A

Collection of blood between dura and skull, 80% of skull fractures, an arterial bleed affecting middle meningeal arteries and can lead to herniation if untreated, see initial brief loss of consciousness then rapid neuro deterioration, fixed dilated pupil on unilateral side

52
Q

Subdural hematoma

A

More common than epidural hematoma, occurs from shearing force on venous bridging veins between dura and arachnoid, commonly due to acceleration or deceleration injuries, space occupying lesion causing concave hematoma, can be acute or chronic and many relatively asymptomatic, causes midline shift of structures to one side due to the space occupying lesion

53
Q

Traumatic subarrachnoid hemorrhage

A

Venous bleeding in subarachnoid space between arachnoid and pia mater, usually associated with other hemorrhage, not space occupying, may increase ICP and block outflow of CSF from ventricles, if isolated may be aneurysmal in origin

54
Q

Cerebral contusion

A

Bruise of brain tissue that primarily occurs in cortical tissue when the brain collides with bony protuberances on inside surface of the skull, frontal/temporal lobes most commonly affected, frequently associated with edema which can be a cause of elevated ICP, sometimes mislabeled as an intraparenchymal/intracerebral hemorrhage

55
Q

Coup vs contrecoup injury

A

Coup is at the site of impact with an object, contracoup is on the opposite side of the area the object was hit, can occur individually or together

56
Q

3 types of skull fractures

A
  • Linear (extends thru full thickness, most common, often without significance unless cross middle meningeal artery groove which then causes a lot of bleeding)
  • Depressed (leaves impression on skull, often involves brain parenchymal injury)
  • Basilar (fracture thru posterior or anterior skull base, most often petrous portion of temporal bone or occipital bone, can cause CSF leaks, increased risk of meningitis)
57
Q

Nearly all nutrients (carb protein fat electrolytes vitamins and water) are absorbed/chemically digested in the ___ section of the GI tract

A

Small intestine

58
Q

4 layers of the entire alimentary canal

A
  • Mucosa (epithelium with mucus, lamina propria and muscularis mucosa)
  • submucosa (connective tissue and meisner’s plexus)
  • muscularis externa (inner circular, outer longitudinal, aurbach’s plexus)
  • serosa/adventitia (Provide lubrication)
59
Q

Intraperitoneal organs are surrounded by ___, the retroperitoneal are by ____

A

serosa, adventitia

60
Q

Mesenteric adenitis

A

Inflammation of lymph nodes of the mesentery caused by infection, inflammatory conditions, and cancer, if a patient has abdominal pain out of proportion to physical exam findings***

61
Q

Stomach muscular layers

A

2 layers of smooth muscle + a 3rd oblique layer for crushing, collapses on itself forming gastric folds called rugae when empty

62
Q

Stomach absorbs nearly nothing except 3 things

A
  • alcohol
  • aspirin
  • nsaids
63
Q

4 cells and their secretions of the gastric glands

A

Mucus cells - maintain mucus layer
parietal cell - secrete HCL and intrinsic factor
Chief cells - secrete pepsinogen (activated by HCL)
enteroendocrine cells - gastrin (regulates gastric acid secretion and motility)

64
Q

3 Phases of gastric secretion

A

1) Cephalic - triggered by aroma or sight get ready for digestion relayingfrom hypothalamus to stimulate secretory activity of gastrin
2) Gastric - stimulated by distension of the stomach presence of food as well as rise in pH causing release of gastrin which then stimulates HCL
3) intestinal - excitatory release when food enters the duodenum to stimulate release of gastrin and HCL, followed by inhibitory where as intestines distend with chyme the enterogastric reflex is activated inhibiting secretory activity to slow gastric emptying to prevent intestine from becoming too acidic

65
Q

Veins of the esophagus and esophageal varicies

A

The lower 1/3rd of the esophagus is drained by gastric veins and drains into the portal system so in the case of portal hypertension from cirrhosis of the liver can see esophageal varicies that are at risk of rupture (hematemesis)

66
Q

Caput medusae

A

A sign seen in patients with portal hypertension describing appearance of distended and engorged paraumbilical veins seen radiating from the umbilicus across abdomen

67
Q

Ligament of treitz

A

A thickened part of the small intestine separating duodenum and jejunum

68
Q

Carbohydrate/lipid/protein digestive enzymes

A
  • Amylase
  • lipase
  • HCL and pepsin
69
Q

Small intestine villi/microvilli and crypts of lieberkuhn

A
  • finger like projections exclusive to the small intestine that increase nutrient absorption by 30 fold
  • cells for immune defense, stem cells that replenish the epithelial cells
70
Q

Brunner’s glands

A

Submucosal glands found in duodenum, roduce alkaline bicarb to protect duodenum from acidic content

71
Q

Peyer’s patches

A

Lymphoid nodules locaed in the ileum that help with immune surveillance of the intestinal lumen

72
Q

Peristalsis

A

Wave like movements that move chyme thru the intestines toward the rectum and anus

73
Q

Tenae coli and haustra

A

Large bands of smooth muscle that contract forming haustra pouches giving the colon its trademark segmented appearance

74
Q

Blood supply of the small intestine

A
  • Gastroduodenal artery supplies upper duodenum and upper pancreas
  • Superior mesenteric artery supplies the majority** including distal duodenum, jejunum, ileum, and cecum
75
Q

Large intestine reabsorbs these 2 things

A

water
electrolytes

76
Q

Internal anal sphincter vs external anal sphincter

A
  • Internal works thru an intrinsic defacation reflex via the myenteric plexus that causes it to drop into the lower rectum/anus
  • external works thru parasympathetic reflex involving the spinal cord where stretching of rectum sends sensory signals to spinal cord and splanchnic nerve returns signals intesnifying peristalsis and removal (must relax and override to allow this reflex to occur)
77
Q

4 lobes of the liver

A

Right
Left
Caudate (most posterior
quadrate (inferior to left lobe)

78
Q

Liver functional lobes

A

Liver has 8 completely independent segments that each have their own vascular in and outflow/biliary drainage allowing for easy resection if necessary without compromising function

79
Q

Hepatic blood supply

A 
Portal vein (75% of the blood supply, 50% of the oxygen) derived from the intestinal tract
Hepatic artery (25% of blood supply, 50% of oxygen) derived from the celiac complex
80
Q

Biliary canuliculi

A

“space of disse” between stacks of hepatocytes that form a pseudoduct collecting bile excreted by hepatocytes

81
Q

Gallbladder duct system

A

Gallbladder has the common cystic duct which merges from the common hepatic duct from the liver to form the common bile duct, then the pancreatic duct merges with it within the pancreas before emptying into the spincter of oddi into the duodenum

82
Q

Portal triad

A

Revers to each lobule of the liver receiving a branch of the hepatic artery (oxygen) branch of hepatic portal vein (nutrients), and biliary duct (bile secretion)

83
Q

Hepatocytes and its 9 big functions***

A

Most versatile and multifunctional cell in the body with thousands of enzymes assisting in

  • glycogen storage
  • decomposition of RBC
  • plasma protein synthesis
  • production of non essential amino acids
  • gluconeogenesis
  • hormone production
  • detox
  • bile production
  • urea production
84
Q

Kupffer cells

A

Liver macrophages that line the sinusoids that perform multiple immune based functions

85
Q

Unconjugated (indirect) bilirubin vs conjugated (direct) bilirubin

A
  • Indirect is bound to albumin, water insoluble/fat soluble and typically calculated from total - direct and reabsorbed in small bowel
  • direct is measured result, water soluble, in the hepatocyte, not reabsorbed, direct + indirect = total
86
Q

3 categories of jaundice

A

Prehepatic - excess hemolysis of RBC
Intrahepatic - disorders that affect ability of liver to remove bilirubin from blood or conjugate it so it can be eliminated in bile
Posthepatic - bile flow obstruction between liver and intestine

87
Q

Bile production mech of action and excretion

A
  • made up of bile acids, cholesterol, and bile pigments such as bilirubin
  • bilirubin is from when the spleen breaks down hemoglobin into heme+ globin from RBC lysis
  • globin is recycled
  • heme is split into iron (used for storage as ferritin) and bilirubin
  • Bile is secreted into duodenum
  • most unconjugated is reabsorbed into small bowel, conjugated is not
  • in large bowel, bacteria metabolize direct bilirubin into urobilinogen
  • some is reabsorbed and excreted in urine (yellow color), most exit colon after conversion to urobilin and stereobilin (brown)
88
Q

Rovsing’s sign

A

Test for appendicitis with either pain in right lower quadrant from pressing deeply into the left lower quadrant or if RLQ pain occurs on quick withdrawal (rebound tenderness)

89
Q

Murphy’s sign

A

A test for acute cholecystitis if the patient is asked to inspire with a hand below the costal margin on the right side at mid clavicular line, positive if the patient stops breathing in and winces

90
Q

What drug class is contraindicated in spinal trauma

A

Steroids

91
Q

Motor pathway corticospinal tracts crosses at the ___, spinothalamic (pain, temp, crude touch) crosses at the ___, posterior column (position, vibration, fine touch) crosses at the ___

A
  • medulla (travels down contralateral side)
  • Spinal cord to then travel up the contralateral side
  • medulla (travels up ipsalateral side where signal entered)
92
Q

How to palpate a posterior C spine in suspected trauma patient without external assistance

How is T and L spine palpated?

A
  • Place pressure pushing their forehead down into bed
  • with other hand unvelcro cervical collar and palpate down the C spine

-log roll

93
Q

Grading of motor exam scale

A

0 - paralysis
1 - insufficient to produce joint motion even with elimination of gravity
2 - muscle can move the joint it crosses thru full range without gravity
3 - can move against gravity but not with any resistance
4 - can move against gravity and moderate resistance
5 - can move against gravity and full resistance

94
Q

Nexus criteria

A

Decision to determine if imaging necessary in cervical spine injury, includes

  • younger than 60 years
  • absence of posterior midline cervical tenderness
  • normal level of alertness
  • no evidence of intoxication
  • no abnormal neurlogic findings
  • no painful distracting injuries
95
Q

Spinal cord ends at what level

A

L1

96
Q

When a calcaneal fracture presents in trauma unit, get this imaging study

A

T/L spine (force can be transmitted up the spine

97
Q

Central cord syndrome

A

Most common type of cord syndrome, due to injury of corticospinal tract causing loss of motor function, can occur with hyperextension injury with cervical stenosis, can see with falling forward onto face, typically caused by vascular compromise of the anterior spinal artery, lower extremity less effected than upper and tends to recover before upper but typically permanent hand disability at least

98
Q

Anterior cord syndrome

A

Injury to ventral 2/3 of spinal cord psaring posterior column, see paraplegia (loss of motor) and sensory loss of pain/temp (spinothalamic), posterior column is still intact, due to infarction of cord in anterior spinal artery territory, has poor prognsis

99
Q

Brown sequard syndrome

A

Hemidissection of spinal cord typical with penetrating trauma causing ipsalateral motor loss, ipsalateral loss of posterior column and contralateral loss of spinothalamic 1-2 levels below injury, some recovery seen

100
Q

Cauda equina syndrome

A

Damage to the lumbar, sacral, and coccygeal nerve roots (distal to L2), peripheral nerve injury with lower motor neuron injury only, motor and sensory loss of lower extremity, sciatica, bowel and bladder dysfunciton, bladder anesthesia, prognosis is better than other incomplete injuries but requires good workup to prevent litigation

101
Q

General story of hypoglycemia (5)

A
  • Delay in eating after insulin dosing
  • malnutrition or inadequate food intake
  • acute N/V after insulin dose
  • increased physiologic stress (infection, injury, emotion, etc)
  • excessive endogenous insulin release with oral agents in a patient with renal insufficiency
102
Q

Hypoglycemia treatment options (4)

A
  • Glucose IV D50 (dextrose)
  • Oral glucose gel/tabs
  • food if conscious and capable of swallowing
  • glucagon 1mg IM, IV, or SQ
103
Q

Glucagon is released from the ___ cells of the pancreas, insulin from the ___, and somatostatin from the ___ cells

A

Alpha, Beta, delta

104
Q

Clinical presentation of Diabetic ketoacidosis (DKA) (6)

A
  • acute headache
  • polyuria and polydipsia
  • acute weakness/lethargy
  • Kussmaul respiration
  • dehydration
  • acidosis (fruity breath)
105
Q

Diabetic ketoacidosis Diagnosis (6)

A
  • history and symptoms
  • blood glucose >250mg/dL
  • urine ketones
  • ABG (serum bicarb <15)
  • hyperkalemia
  • chemistry panel (glucose electrolytes and renal function) and serum ketones
106
Q

The Anion gap

A

Measure of the difference between serum Na+ and K+ minus (Cl- + HCO3- (bicarb)), Normal 8 + or - 4mmol/L, >12mmol/L is elevated and has its own subset of etiologics that are causing said metabolic acidosis (MUDPILERS acronym)

107
Q

MUDPILERS acronym for the common cayses of metabolic acidosis with increased anion gap

A
  • Methanol
  • Uremia
  • Diabetic/alcohol/starvation ketosis
  • Paraldehyde
  • Iron
  • Lactic acidosis
  • Ethylene glycol
  • Rhabdo
  • Salicylates
108
Q

Diabetic ketoacidosis treatment options (5)

A
  • IV fluids first (500 mL/hr)(once you start insulin, the glucose will go into the cells and water will follow resulting in dehydration)
  • Insulin 10U bolus then 5U/hr 1 hour after IVF, follow blood sugar and lower gradually 100/hr
  • K+ replacement, if urinating dose depending on T waves, if anuric and peaked T waves wait for labs to determine
  • Start Dextrose once blood glucose is 200-250mg/dL
  • Switch to SQ insulin at least 1/2 hour before stopping insulin drip
109
Q

Too rapid of a drop in blood glucose in correcting diabetic ketoacidosis can result in….

A

….cerebral edema

110
Q

Hyperosmolar hyperglycemic state (HHS) definition and average level of glucose elevation

A

Insidious onset (days to weeks) ketone free that sees adequate insulin activity but decreased cell response (type 2 DM in most cases) and hence an absence of lipolysis and ketogenesis (low or absent serum/urine ketones), can have precipitating infection or stressor, has severely elevated glucose levels often >600mg/dL (wayyy higher than DKA typically)

111
Q

Hyperosmolar hyperglycmeic state (HHS) clinical presentation (4)

A
  • typically >60
  • chronic care facility
  • change or addition of new med
  • recent or current infection***
112
Q

Hyperosmolar hyperglycemic state (HHS) signs and symptoms (4)

A
  • significant dehydration
  • depressed mental status
  • focal neurologic abnormalities
  • Kussmaul respiration and nausea/vomiting usually NOT present
113
Q

Hyperosmolar hyperglycemic state (HHS) treatment options (3)

A
  • Admit to ICU
  • IV fluids judiciously (congestive heart failure patients often comorbid)
  • IV insulin or DM meds to increase insulin sensitivity
114
Q

Blood alcohol concentration (BAC) measurement

A
  • 50mg/dL (.05%) loss of restraint, emotional
  • 80mg/dL (.08%) legal limit for intoxication in PA
  • 100mg/dL (.1%) slurring speech and confusion
  • 200mg/dL (.2%) very slurred speech and staggering
  • 400mg/dL (.4%) comatose and incontinent
  • 500mg/dL (.5%) possibly lethal suppression of breathing
115
Q

Alcohol intoxication/poisioning diagnosis

A

-Based on history and symptoms and clinical presentation -> NO specific BAC level

116
Q

Lactic acidosis definition

A

Biproduct of anaerobic glucose metabolism characterized by elevated anion gap and serum lactate at least 4-5mmol/L and pH <7.35, seen in hypoxia or decreased tissue perfusion

117
Q

Lactic acidosis diagnosis (4)

A
  • hyperventilation to blow off CO2
  • altered mental status
  • high serum phosphate
  • precipitating cause
118
Q

Thyroid storm etiology (5)

A
  • infection
  • stopping antithyroid meds
  • recent surgery
  • trauma
  • pregnancy
119
Q

Thyroid storm treatment options (4)

A
  • propylthiouracil or methimazole
  • propranolol
  • hydrocortisione
  • radioactive idione or surgery definitive treatment but delayed until euthyroid
120
Q

Adrenal insufficiency (addison’s disease or addisonian crisis) definition

A

Often precipitated by surgery, trauma, infection, or sudden withdrawal of exogenous adrenocortical hormone, etc

121
Q

The synthetic ACTH cosyntropin stimulation test

A

-Confirmatory diagnosis for adrenal insuficiency where serum cortisol level is checked at baseline then .25 synthetic ACTH cosyntropin is given parenterally, serum is then obtained at both 30 and 60 min after administered, should normally rise at elast 20mcg/dL and if not primary deficit exists in the adrenals

122
Q

Hypocalcemia signs and symptoms (3)

A
  • mild often asymptomatic
  • severe sees tetany, weakness, fatigue cramps, dyspnea and stridor
  • chvostek sign and trousseau sign
123
Q

Chvostek sign

A

Tap over facial nerve 2cm anterior to tragus of ear, depending on ca2+ if low levels see twitching of angle of mouth, or in more severe then nose, eye, facial muscles

124
Q

Trousseau sign

A

Inflation of blood pressure cuff above systolic pressure causes localized ulnar and median nerve ischemia resulting in carpal spasm (contraction)

125
Q

Hypocalcemia diagnostic labs (3)

A
  • low Ca2+ <2mg/dL
  • ABGs
  • EKG prolongation of QT interval
126
Q

Hypercalcemia signs and symptoms (2)

A
  • CNs depression, stupor, weakness, constipation, abdominal pain
    • often asymptomatic up to levels of 12mg/dL
127
Q

Hypercalcemia treatment options (3)

A
  • IV normal saline
  • furosemide
  • bisphosphonates

Professional Development (19 decks)

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