Readings Flashcards
AMPLE mnemonic for quick history
AMPLE is a useful mnemonic:
A – Allergies: What is this patient allergic to?
M – Medications: What medications is this patient taking?
P – Past History: What are the pertinent medical/surgical conditions of this patient?
L – Last Meal: When did this patient eat or drink last?
E – Events: What are the brief events that led to this patient’s condition?
Primary survey components
ABC or CAB
Are they going to die without intervention soon?
Immediate actions like IV, O2, Monitor
Secondary survey components
A focused history and PE
Risk factors for fever caused by UTI in infants?
Girls White Uncircumcised boys Boys <6 mo Girls <12 mo Well appearing Tenderness on exam No urine symptoms
What is a good predictor for sepsis mortality?
Lactate is the primary method of risk stratification for patients presenting with sepsis. Lactate is believed to be a marker of anaerobic glycolysis during periods of insufficient oxygen delivery. Low lactate levels correlate with low mortality; conversely, elevated lactate levels correlate with high mortality.
Sigs of sepsis and organ dysfunction?
- elevated lactate ≥ 2 mmol/L.
- creatinine 2.0 mg/dl,
- urine output < 0.5 ml/kg/hour,
- bilirubin > 2,
- platelets < 100,000, INR > 1.5, PTT > 60 secs.
- Hypotension is typically defined as SBP ≤ 90 mm Hg, MAP ≤ 70 mm Hg, or a drop in SBP by 40 mm Hg from baseline
What is shock?
Shock is a broad term that describes a physiologic state where oxygen delivery to the tissues is inadequate to meet metabolic requirements, causing global hypoperfusion. It may also be thought of as an imbalance between tissue oxygen supply and demand.
Two ways to describe shock in terms of compensation
Shock may be described as compensated (normal blood pressure with inadequate perfusion) or uncompensated (hypotension and inability to maintain normal perfusion). Thus, a patient with normal vital signs may still be in shock.
4 types of shock and examples
Hypovolemic
(most common)
Decreased circulatory volume
Hemorrhage or fluid loss
Cardiogenic
Impaired heart pump function
Acute coronary syndrome, valve failure, dysrhythmias
Distributive
Pathologic peripheral blood vessel vasodilation
Sepsis, anaphylaxis, neurogenic
Obstructive
Non-cardiac obstruction to blood flow
Pulmonary embolus, tension pneumothorax, tamponade
What is the primary survey for trauma?
A: Airway Maintenance with CERVICAL SPINE protection
B: Breathing and Ventilation
C: Circulation with hemorrhage control / shock assessment
D: Disability: Neurological status (GCS)
E: Exposure/Environmental control
What GCS requires intubation?
9 or 8 (8 intubate)
What are two diagnoses you can’t miss on the primary survey in terms of airway and breathing?
Tension PTX and hemothorax
Mnemonic for AMS differential?
AMS = AEIOU TIPS A Alcohol E Epilepsy, Electrolytes, and Encephalopathy I Insulin O Opiates and Oxygen U Uremia T Trauma and Temperature I Infection P Poisons and Psychogenic S Shock, Stroke, Subarachnoid Hemorrhage and Space-Occupying Lesion
Contrast delirum, dementia, and psychosis in terms of
- Onset
- Course
- VS
- Hallucinations
- Consciousness
Delirium
- Rapid onset
- Fluctuating course
- Abnormal vital signs
- Can have visual hallucinations RES
- Fluctuating consciousness
Dementia
- Slow onset
- Progressive course
- Normal vital signs
- No hallucinations
- Normal consciousness
Psychosis
- Variable onset
- Variable course
- Normal vitals
- Visual and auditory hallucinations and RIS
- Variable consciousness
Anticholinergic toxicity toxidrome
This is the classic anticholinergic syndrome:
Mad as a hatter (Altered mental status) Blind as a bat (mydriasis) Hot as Hades/Hare Red as a beet Dry as a bone
3 most common anticholinergic drugs for toxicity
TCA’s Tricyclic antidepressants
Antihistamines
Overactive bladder medication
Cholinergic classic toxidrome
This is the classic mnemonic SLUDGE:
Salivation Lacrimation Urination Diaphoresis and defecation Gastrointestinal upset Excessive bradycardia or tachycardia (muscarinic or nicotinic)
Sympathomimetic toxidrome
This is the classic sympathomimetic syndrome with a fight or flight picture:
Tachycardia Hypertension Mydriasis Diaphoresis Hyperthermia Agitation
Opiate toxidrome
Classic signs:
Apnea
Hypoxia
Unresponsiveness
Flash pulmonary edema (rare)
3 sedatives used in emergent intubation
Propofol
Etomidate
Ketamine
2 Paralytics used in emergent intubation
Succinylcholine
Rocuronium
Impt exam elements for ingestion/poisoning
Vital signs
Level of consciousness
Pupils: miosis or mydriasis
Skin: color, presence of diaphoresis, dry skin or piloerection
Oral: moist/dry mucous membranes
Abdomen: hyper or hypoactive bowel sounds, bladder size (urinary retention)
Neurological: hypo or hyperreflexia, seizures
5 Steps in Poison Control?
- Resuscitation
- Risk Assessment
- Detoxification
- Testing
- Observation
What’s the most important part of the resuscitation ABC? What component specifically?
Breathing
Most specifically minute ventilation b/c of metabolic acidosis, need to have hyperventilation so they compensate
Components of Circulatory resuscitation (3)
Fluids and vasopressors (Epi, NE), then rhythms
Poisoning Risk assessment components (3)
Drug, dosage, patient
What’s a common poisoning test to do? (3)
Acetaminophen, EKG, ABG
Treatment of hypovolemic shock
Fluid repl only
Treatment of distributive shock
Fluid replacement attempt then vasopressors if inadequate response
Treatment of cardiogenic shock
Inotropes, probably not fluid
What is the dose dependent effect on target of dopamine?
Low to high
D-B1-A
3 Vasopressors used in tx of distributive shock?
NE, phenylephrine, Vasopressin
What are the 2 main differentiators between anticholinergic and sympathomimetic toxidromes?
Anticholinergic- DRY and CONFUSED
Sympathomimetic- WET (sweat) and AGITATED
What are the 2 differentiators for Opiate vs Sedative toxidromes?
Opiate- MIOSIS, decr RESPIRATION
How do you calculate shock index?
What value is concerning?
heart rate divided by systolic blood pressure
A normal index ranges from 0.5-0.7; repeated values >1.0 indicate decreased left ventricular function and are associated with higher mortality.
If the HR is higher than the BP that is generally a bad sign
CREDIT mnemonic for AMS
C- anything from a CT like bleeding or abscess R- respiratory E- electolyte abn D- drugs I- infection T- tonic clonic seizures/post ictal
