PEARLS Flashcards
high heart rate, low BP
think bleed-dehydration
flat jugular veins when supine
think bleed-dehydration or HHNK
hot skin in a shock pt
think SEPTIC shock, look for source
- commonly will present with open wound
- can present in nursing home pts
- bacteria in bloodstream via lymph system to be septic
- temp down = late sign in septic shock
- cause is always bacterial
female pt on birth control and/or smoking w/ SOB
think PE
- NR classically uses 35 y/o female smoker
- predisposing factors: travel, long period of inactivity, recent surgery, cancer
- PE mimics RSF (blocks blood flow up through the lungs, blood backs up causing edema & JVD)
hives, laryngeal edema
think allergic or anaphylaxis
- stridor usually exists with anaphylaxis related throat swelling
- laryngeal edema also caused by trauma/localized infection (Ludwig’s angina)
- hive is a swollen capillary bed
- urticaria = hive related itching
- IgE = antibody responsible for anaphylaxis (histamine from mast cells, IgE attaches, causes them to burst)
cool, clammy skin
think shock (sympathetic response)
sudden onset of vomiting/diarrhea after eating
think allergic or anaphylactic shock
- food poisoning typically takes ~ 12 hours, allergy/anaphylaxis is quicker
cool, clammy skin above & warm, dry skin below w/ low BP & low HR, think…
neurogenic shock (does not have to be trauma)
- spinal shock is temporary (difference between spinal and neurogenic)
- neurogenic shock can come w/ any disruption in blood flow (not just trauma)
getting pt to the hospital is not enough…
treat the MI or shock
if hives present, think…
allergic or anaphylactic
person on ace inhibitor w/ laryngeal edema and stridor, think…
allergic response/anaphylactic shock
- ace inhibitors given for HTN
- most common (lisinopril), any “pril”
if it is wet, sticky, and not yours…
don’t touch it!
black tarry stools, think…
lower GI bleed
- black tarry stool is the same as melena
hematochezia
bright red bleeding, most commonly a hemorrhoid
dividing line of the upper and lower GI
ligament of treitz
coffee ground emesis
generally due to an ulcer, ulcer is normally caused by bacteria h-pylori
pt states “feels like my heart is beating out of my chest,” think…
SVT
- can/will result in LSF, backup blood to lungs
- CHAP = stable or unstable
- Tx stable = adenosine (6mg/12mg, save last 12 for hospital)
- Tx unstable = cardiovert @ 100 J
Wolff Parkinson White Syndrome presents with (on 12-lead)…
delta wave on ECG, slurred P wave line into QRS
crushing substernal chest pain, think…
MI
- classic sign = crushing substernal chest pain
- other signs = toothache, bellyache
- Tx = MONA (Morphine, Nitro, Oxygen, Aspirin)
sudden onset SOB, think…
PE
JVD, think…
RSF
- PE, tension pneumo, cardiac tamponade, COPD
COPD pts are…
hypercarbic
- can’t blow off CO2
- normal blood gas between 35 - 45, hypercarbic over 45
any female of childbearing age with belly pain has an…
ectopic pregnancy
- having tubal ligation increases the risk, but used to throw people off on test
- transport is position of comfort (not LLR)
tall, skinny males with SOB, think…
spontaneous pneumo
- closed pneumo, often presents with history of smoking
- can occur in pts with Hx of COPD
- monitor for signs of tension developing (JVD, absent breath sounds on ipsilateral side, narrowing pulse pressure)
if the pt has history of hypertension, think…
MI, stroke, aneurism
number one cause of pulmonary edema
LSF
number one cause of LSF
MI
number one cause of RSF
LSF
if you hear wet lungs, you must ask yourself this question…
“are they having an MI?”
what side failure is seen with COPD patients
RSF
what can refer pain to the shoulders?
belly insults - ruptured spleen, liver, ectopic pregnancy
- Kehr’s Sign (pain referred to L shoulder when palpating the abdomen when pt is lying down with legs elevated)
never trust a
diabetic
the only reason not to disrobe a trauma pt
environmental
vaginal bleeding with sharp, sudden, tearing pain, stiff abdomen, massive hemorrhage, third trimester
complete abruption (abruptio placentae)
painless, bright red bleeding from vagina during pregnancy
placenta previa
s/s of lightheadedness, breathlessness, weakness, headache, nausea, vomiting could indicate what condition
acute mountain sickness
- occurs at 6600 ft, least serious of the altitude related illnesses
- Tx includes remaining where you are and it will subside or go to lower elevation, fluid admin recommended, can be treated with diuretic (acetazolamide)
- high respirations lead to respiratory alkalosis
s/s of progressive weakness, fatigue, decreased appetite, weight loss, hyperpigmentation of skin, vomiting, diarrhea could indicate what condition
addison’s disease (hypoadrenalism)
- adrenal disease -> hypoadrenalism -> possibly autoimmune disease (can also be caused by an intense stressor on the system) -> cessation of adrenal gland function
- die from cardiopulmonary collapse
s/s of flushed skin, itching, hives, swelling of skin, cyanosis, respiratory difficulty, sneezing, coughing, wheezing, stridor, laryngeal edema, laryngospasm, bronchospasm, etc. could be indicative of what condition
allergies and anaphylaxis
- Tx for allergy run w/o airway compromise = Benadryl
- Tx for anaphylaxis = epi 1:1000 (antibody driver behind this reaction is IgE, which is attached to mast and mobile mast cells, anaphylaxis is type 1 allergic reaction)
s/s of problems with short term memory, shuffling gait, stiffness of body muscles, aphasia, psychiatric disturbances, and decorticate (severe) could indicate what condition
alzheimer’s disease
