Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Professional Development > Part 21 > Flashcards

Part 21 Flashcards

1
Q

Most common type of distributive shock

A

-Sepsis (sepsis is the next step of SIRS -systemic inflammatory response phenomenon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Nonhemorrhagic hypovolemic shock is most often due to ___ losses

A

Gastrointestinal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Third space losses

A

A type of nonhemorrhagic hypovolemic shock where fluid in a potential space sees filling due to capillary leakage (think peritoneum or pleura) and this depletes intravascular volume overall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Massive transfusion protocol

A

1:1:1 of packed RBC (first choice O neg, Op pos and type specific are alternatives), plasma, and platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Neurogenic shock pathophysiology

A

Dilation of the arterial and some degree of the venous side of the systemic circulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Examples of obstructive shock (5)

A

(this is the least common type)

  • PE
  • tension pneumothorax
  • pericardial tamponade
  • constrictive pericarditis
  • abdominal compartment syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Swan ganz catheterization of the right heart to obtain pulmonary capillary wedge pressure gives a measure of ___

A

left atrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cardiogenic shock diagnosis (2)

A
  • pumonary artery catheterization
  • echocardiogram of left ventricle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

SIRS criteria (4)

A
  • temp >38 or <36C
  • HR >90bpm
  • RR >20 or PaCO2 <32 (respiratory alkalosis)
  • WBC count >12000 or <4000 or >10% immature bands
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

qSOFA criteria for sepsis (3)

A
  • RR >22
  • SBP <100
  • altered mental status (due to suspected infection)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Sepsis treatment options (3)

A
  • administer broad spectrum antibiotics piperacillin, ampicillin
  • steroids that mute the immune response (leukotriene storm)
  • initiate pressors as needed (norepi)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Goal directed therapy for sepsis (4)

A

Meet the following criteria:

  • Central venous o2 sat of > or =70
  • central venous pressure > or =8-12
  • mean arterial pressure > or = 65
  • urine output > or = .5cc/kg/hr
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Neurogenic shock etiologies (4)

A
  • spinal anesthesia
  • vagal stimulation
  • cord transection
  • NOT head trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why don’t you use antihistamines for anaphylaxis?

A

Because most mast cells have already degranulated at the point of anaphylaxis presence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Conduction requires ___ while convection is dependent on ___

A

physical contact, wind velocity air and water vapor molecules moving around the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Thermoregulation mechanism of action

A
  • increased body temp
  • thermostat in hypothalamus activated by temp receptors
  • skin blood vessels dilate so warm blood allows heat to radiate from the skin surface
  • sweat glands activated increasing evaporative cooling
  • when body temp decreases
  • thermostat in hypothalamus activated by temp receptors
  • skeletal muscle activated to begin shivering to generate heat
  • skin blood vessels constrict diverting blood from skin to deeper tissues reducing heat loss from skin surface
  • body temp increases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Heat rash (prickly heat) definition and treatment

A

Skin irritation due to blocked sweat ducts trapping sweat beneath the skin, typically found on the neck, chest, groin, in skin folds, might be papular, pustular, or vesicular, may sting or be pruritic but typically self limiting and not a problem, can be prevented by wearing loose fitting clothing, avoiding extreme heat, etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Heat edema definition and treatment

A

Dependent edema from vasodilatory pooling, too much sodium can aggravate fluid retention, greater risk in rapid transiton from cold to warm climate, treatment is NOT diuretics but rather just elevate extremities and put in a cool environment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Heat exhaustion signs and symptoms (4)

A
  • early identification critical to prevent progression to heat stroke
  • fatigue/malaise/weakness
  • N/V/D
  • in tact mental status
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Heat exhaustion treatment options (3)

A
  • move to cool area, ice packs, remove excess clothing, spray with lukewarm water, trendelenberg, etc
  • gradual rehydration oral and or IV
  • monitor for progression to heat stroke (patients should respond if all they have is indeed heat exhaustion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Heat stroke signs and symptoms (4)

A
  • Elevated core temp >40.5C
  • Hot dry skin
  • CNS symptoms and lack of intact mental status
  • NVD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Heat stroke complications (2)

A
  • high core body temp leads to multisystem damage (DIC, hepatocellular necrosis, acute kidney injury)
  • cerebral hypoperfusion leads to mental status changes and can cause cereberal ischemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Heat stroke diagnostic studies (5)

A
  • CT of head to rule out edema
  • CXR
  • CBC, CMP, PT/PTT
  • EKG
  • urinalysis (rhabdo concerns)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Heat stroke treatment options (5)

A
  • Rapid cooling measures within 30 min
  • ice water immersion most effective
  • antipyretics ineffective and may be harmful
  • IV hydration
  • admit to hospital
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

2 types of cold injuries

A
  • Freezing (frostbite)
  • nonfreezing (chilbain or trench foot)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Frostnip definition and treatment

A

Mildest form of peripheral cold injury, superficial nonfreezing cold injury secondary to vasoconstriction, sees pale skin with associated numbness and paresthesias but skin is still pliable***, occurs in the apical structures (ears, nose, hands, feet), treated by simple warming techniques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Chilblains (pernio) definition and treatment

A

More severe than frostnip caused by exposure to nonfreezing temps and damp air, onset 1-5 hours of cold exposures but can be longer, develops over hours and subsides slowly over weeks, develop red to violet raised lesions (papules and nodules) most often on unprotected extremities such as fingers and toes, seen most often in middle aged women or those with chronic conditions such as raynauds, treated with local heat, gentle massage, nifedipine, corticosteroids, minimize cold exposure to prevent recurrent lesions or secondary infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Immersion (trench) foot definition and treatment

A

Occurs when feet are wet but not freezing for prolonged periods of time, most common in homeless and military starting with numbness and tingling pain with pruritis progressing to leg cramps and complete numbness, managed with gentle rewarming, careful washing and air drying, slight limb elevation, possible bed rest, prevented by keeping feet dry at least 8 hours a day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Frostbite definition and its 4 degrees of severity

A

Skin and deeper structure freeze resulting in tissue injuries, water crystals disrupt cell membranes and tissue structures resulting in ischemia and death of cells, has 4 degrees of severity (hyperemia and edema, accompanied by blisters, has hemorrhagic fluid in the blisters, and comprete necrosis with gangrene)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Frostbite management (4)

A
  • do NOT start if still risk of re-freezing as this has worse outcomes
  • restore core body temp first
  • RAPID rewarming in a water bath until extremity has flushed appearance, once rewarming started, avoid weight bearing, very painful process
  • tetanus prophylaxis
31
Q

Frostbite complications (4)

A
  • compartment syndrome
  • limb/digits amputaitons
  • digital shortening if growth plate injured in children
  • susceptible to reinjury
32
Q

Hypothermia definition

A

Body’s mech for temp regulation is overwhelmed in face of cold stressor, core temp <95 F or 35C, classified as accidental (unanticipated exposure in unprepared person), intentional (therapeutic post cardiac arrest), primary (environmental exposure) or secodnary (underlying medical issue)

33
Q

Hunter’s response

A

Paradoxical and cyclical vasodilation following initial vasoconstriction that occurs in response to cold often the fingers, toes, and face

34
Q

Hypothermia signs and symptoms (7)

A
  • altered mental status, mood changes
  • shivering
  • flushing
  • tachycardia then bradycardia
  • facial edema
  • hypotension
  • paradoxical undressing
35
Q

“They’re not dead till they’re warm and dead” meaning

A

Refers to how it is required to warm body before declaring death as hypothermia can often present with v-fib, dilated pupils, lack of responsiveness, etc

36
Q

Hypothermia management (4)

A
  • passive external rewarming
  • minimally invasive active rewarming (IV fluids warmed)
  • invasive active rewarming (bladder lavage, thoracic lavage)
  • ECMO
37
Q

If a patient is stable and can stand, what type of CXR do they get? What if they cannot get out of bed?

A
  • PA and lateral chest
  • AP x ray portable
38
Q

FAST exam

A

Focused assessment with sonography for trauma, looking for air or fluid in the body usually due to trauma to chest or abdomen, no specific contraindications but should not interfere with resuscitation, looks at pericardium for cardiac tamponade, peritoneal spaces including perihepatic (morrisons pouch), perisplenic, and pelvic, also form called eFAST which includes the looking for pneumothoraces or hemothoraces

39
Q

Most common pathogens involved in human bites from the oral flora (2) and the patient’s skin (2)

A
  • Eikenlla
  • Group A strep
  • staph
  • strep
40
Q

Clenched fist bites

A

Injuries that most often occur as lacerations in the 3rd or 4th MCPs or PIPs of dominant hand and highly prone to infection because often ignored, occur most often when clenched fist of person strikes teeth of another

41
Q

Occlusal bites

A

Semicircular or oval, skin may or may not be intact, more common on fingers, hands, or arms

42
Q

Infections are more common with what type of animal bite?

A

Cat bites

43
Q

Treatment for bite wound (4)

A
  • cleansing, irrigation, dressing, daily eval for infection, foreign body removal
  • most bites should be left to heal by secondary intention (left open) due to high risk of infection
  • augmentin prophylaxis (almost everyone)
  • IV if signs of systemic illness
44
Q

Rabies post exposure prophylaxis

A

If high risk wild animal then need it, if stray dog will need it, if low risk animal or vaccination status of animal is known then do not, can monitor animal status to see if they die within 10-14 days, if patient never had exposure before need immunoglobin and vaccine (0, 3, 7, 14, and 28 if immunocompromised), if patient has then need vaccine only on day 0 and 3

45
Q

Toxidromes

A

Signs and symptoms associated with a specific class of poisoning in a patient (anticholinergic, cholinergic, sympathomimeetic, sedative, serotonergic)

46
Q

Coma coctail (3 parts)

A

Used for patient with altered consciousness and includes

  • dextrose (hypoglycemia)
  • thiamine
  • naloxone
47
Q

Toxidrome approach (7)

A
  • pupil size
  • temp
  • bowel sounds
  • heart rate
  • blood pressure
  • respiratory rate
  • skin findings
48
Q

Common anticholinergic toxidromes (5)

A
  • antihistamines (diphenyhdramine, hydroxyzine)
  • antispasmotics (dicyclomine, oxybutynin)
  • atropine
  • TCAs (amitriptyline)
  • Jimson weed
49
Q

Anticholinergic toxidrome findings

A
  • hyperthermic, tachycardia, hypertensive
  • CNS agitation and delirium
  • mydriasis**
  • skin dry, warm flushed**
  • diminished bowel sounds, urinary retention
50
Q

Common cholinergic toxidromes (3)

A
  • organophosphates and insectisides
  • cholinesterase inhibitors
  • nerve agents
51
Q

Cholinergic toxidrome findings

A
  • bradycardia, high or low BP, high or low breathing
  • CNS agitation and confusion
  • pinpoint pupils, lacrimation
  • diaphoresis***
  • salivation, vomiting, diarrhea, incontinence***
52
Q

Common sympathomimetic toxidromes (5)

A
  • cocaine
  • PCP
  • amphetamines
  • LSD
  • bath salts
53
Q

Sympathomimetic toxidrome findings

A
  • Hyperthermia, tachycardia, hypertension
  • CNS enhanced alertness, delirium, seizure, coma
  • Mydriatic pupils
  • diaphoretic, hot skin
  • normal or active bowel sounds
54
Q

Common opioid toxidromes (6)

A
  • opium
  • morphine
  • heroin
  • hydrocodone (vicodin)
  • oxycodone
  • fentanyl
55
Q

Opioid toxidrome findings

A
  • hypothermia, bradycardia, normal or low BP, bradypnea
  • CNS lethargy and coma
  • pupil miosis
  • skin cool, pale, moist, evidence of needle injections
  • hypoactive bowel sounds, constipation***
  • hyporeflexia on neurologic exam
56
Q

Common sedative hypnotic toxidromes (4)

A
  • alcohol
  • benzos
  • barbituates
  • sleeping aids
57
Q

Sedative hypnotic toxidromes findings

A
  • hypothermia, normal or bradycardia
  • CNS drowsy, lethargy, coma
  • pupils miotic
  • decreased or no bowel sounds
  • dry
58
Q

Sympatholytic toxidrome findings

A
  • bradycardia, hypotension, bradypnea
  • CNS normal to lethargic
  • pupils mid size
59
Q

Common serotonin syndrome toxidromes (3)

A
  • MAOIs
  • SSRIs
  • NSRIs
60
Q

Serotonin syndrome toxidrome findings

A
  • hyperthermia, tachycardia, hypertension
  • CNS confusion, agitation, lethargy
  • pupils mydriatic
  • diaphoretic flushed skin
  • hyperreflexia, tremors, clonus
61
Q

Common sympatholytic toxidromes (3)

A
  • B blockers
  • a blockers
  • a2 adrenergic agonists
62
Q

Acetaminophen toxicity antidote

A

N acetylcysteine

63
Q

Anticholinergic agents toxicity antidote

A

Physostigmine

64
Q

Benzodiazepine toxicity antidote

A

Flumazenil

65
Q

Carbon monoxide toxicity antidote

A

Oxygen

66
Q

B or Ca2+ channel blockers toxicity antidote

A

IV fluids, calcium, glucagon, insulin

67
Q

Cocaine or other sympathomimetics toxicity antidotes

A

Benzodiazepines

68
Q

Acetone in ethanol, alcohol, chloroform, and salicyates have a characteristic ___ odor.
Cyanide has a characteristics ___ odor.
Arsenic, organophosphates, phosophorus have a ___ odor.
Organophoshates have a ___ odor.
Hydrogen sulfide has a ___ odor.
Methyl salicylate has a ___ odor.
Phosgene has a ___ odor

A 
Fruity
Bitter almonds
Garlic
kerosene
Rotten eggs
Wintergreen
Freshly mown hay
69
Q

Opioid toxicity antidote

A

Naloxone

70
Q

Salicylates toxicity antidote

A

Alkalinization, hemodialysis

71
Q

Warfarin toxiticy antidote

A

Fresh plasma, vit K

72
Q

Max dose of acetaminophen in adults and children, when do peak serum levels occur?

A
  • 4g/day or 3g/day if daily alcohol
  • 80mg/kg/day

-4 hours after overdose (get a 4 hour acetaminophen level!)

73
Q

Carbon monoxide poisoning symptoms (4)

A
  • nonspecific
  • vague, flu like symptoms without fever or lymphadenopathy, cherry red coloration
  • multiple patients from the same household
  • source presence such as smoke, car exhaust, malfunctioning in heating symptoms

Professional Development (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions