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PGY1 > Rosen > Flashcards

Rosen Flashcards

1
Q

“can’t intubate and can’t oxygenate” approach

A

topical anesthesia, IV sedation, no paralytic

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2
Q

(3) indications for intubation

A

failure to protect airways, failure to oxygenate or ventilate, predicted/anticipated outcome

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3
Q

(4) factors in assessing airways

A

difficult to BMV, difficult to intubate, extraglottic insertion, extraglottic ventilation

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4
Q

double set-up airway

A

RSI intubation equipment, cricothyrotomy

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5
Q

Difficult Laryngoscopy RFs

A

LEMON (Box 1.1)- look externally for signs (gestalt; if pt cannot bite upper li with lower teeth, difficult intubation), evaluate the 3-3-2 rule, mallampati score, obstruction/obesity, neck mobility (AnkSp, RA)

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6
Q

3-3-2 rule

A

3 of own fingers between open incisors, 3 own fingers along floor of mandible, 2 own fingers from laryngeal prominence to underside of chin; if receeding mandible and high riding larynx: impossible to intubate as operator cannot displace tongue to overcome acute angle for a direct view

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7
Q

Mallampati scale

A

requires awake patient for cooperation; assess oropharynx; class I (soft palate, uvula, fauces(back of throat) tonsillar pillars seen), II soft palate, uvula, fauces, class III (soft palate, base of uvula), IV: only hard palate

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8
Q

Definition of shock

A

failure to oxygenate and perfuse tissues adequately; hypoperfusion leading to organ failure

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9
Q

(5) Categories of Shock (as per Rosen’s)

A

Primary Infusion of volume (hemorrhage, hypovolemia), volume infusion and vasopressor support (septic, anaphylactic, central neurogenic, drug OD), Improvement of pump function/cardiac (MI, cardiomyopathy, dysrhythias), obsructive (PE, tamponade, valvular), toxins (CO, methemoglobinemia, hydrogen sulfide, cyanide)

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10
Q

Hemorrhagic Shock presentation (Vitals)

A

tachycardia (heart contraction increases), diastolic bp increases –> narrowing of pulse pressure –> decrease in ventricular filing –> decreased sBP; however it is VERY VARIABLE

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11
Q

Initial Bloodwork Abnormalities in Shock

A

worsening base deficit >-2; base deficit more negative first before pH (acidosis) occurs; lactate > 2.0

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12
Q

3 Major effects of septic shock

A

hypovolemia, cardiovascular depression, induction of systemic inflammation

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13
Q

Cardiogenic shock definition

A

> 40% of myocardium becomes dysfunctional (ischemia, inflammation, immune injury): LV dysfunction in ECHO

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14
Q

Neurogenic Shock definition

A

disruption between sympathetic and parasympathetic connections between SC and heart; peripheral vasodilation and bradycardia

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15
Q

Criteria for Circulatory Shock (4 must be met to meet criteria)

A

ill appearance/altered mental status, HR > 100, RR > 22 or paCo2 < 32, arterial base deficit of < -4 or lactate > 4, UO < 0.5, arterial hypotension > 30 mins duration, continuous

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16
Q

Types of hemorrhagic shock

A
  1. simple hemorrhage (normal vitals, normal base deficit); 2. hemorrhage with hypoperfusion (base deficit < -4 or persistent HR > 100; 3. hemorrhage shock (hypotension, tachypnea, tachycardia, altered LOC)
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17
Q

Types of cardiogenic shock

A
  1. cardiac failure

2. cardiogenic shock

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18
Q

Management of Hemorrhagic Shock

A
  1. ABCs - ventilation and oxygenation; 2. control hemorrhage (Traction, direct pressure), obtain urgent consultation if uncontrollable; 3. pRBC; 4. Treat dysrhythmias
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19
Q

Management of Cardiogenic Shock

A
  1. help with increased work of breathing using oxygen and PEEP if pulmonary edema; 2. vasopressors or inotropic support; 3. seek to reverse the insult; consider intraaortic balloon pump counterpulsation for refractory shock
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20
Q

Management of Septic Shock

A
  1. ABCs; 2. fluid resuscitation 20 ml/kg; begin antimicrobial treatment; vasopressors if necessary
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21
Q

Definition of 1:1:1

A

pRBC: FFP: platelets

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22
Q

Complications of IV vasopressors

A

potential for limb damage from extravasation from peripheral IV injection; use central line to prevent this

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23
Q

Purpose of IV vasopressors

A

increase cardiac output and oxygen delivery to vital organs when volume resus fails

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24
Q

Norepinephrine doses for septic shock

A

5 - 30 mcg/min; 0.05mcg/kg/min boluses, then titrated at 3 and 5 mins interval until MAP > 65; no maximum but less effective after > 30 mcg/min

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25
Q

Dobutamine uses

A

inotropic effects; used with norepi to increase CO and maintain adequate oxygen delivery in cardiogenic shock

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26
Q

Role of PPV/ventilation in shock

A

reduces work of breathing (thus preventing decreased cerebral blood flow, and oxygen consumption from accessory muscles), prevents suction effect (high neg thoracic pressure required if airway resistance) of LV thus preventing impedement of LVEF

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27
Q

True or False; Circulatory shock can occur with normal arterial blood pressure and not all pts with arterial hypotension have circulatory shock

A

true

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28
Q

True or False: urine output is a reliable index of vital organ perfusion with shock; normal is? what output indicates severe renal hypoperfusion?

A

0.5 is abnormal; 1.0 ml/kg/hr is normal; it is true

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29
Q

Massive Transfusion Protocol

A

pRBC, platelets (if < 50 and bleeding), FFP (if INR > 1.5), cryo (if fibrinogen < 1.0); level 1 transfuser (1L in 90 seconds), warm fluids

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30
Q

CRASH II Trial

A

published in Lancet 2010; TXA siginficantly reduced all-cause mortality in trauma patients with significant hemorrhage; no significant differences between TXA and none for vaso-occlusive events

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31
Q

Indication and dose of TXA in trauma/hemorrhagic shock

A

1g over 10 mins, then infuse 1 g over 8 hours

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32
Q

Definition of sepsis

A
  1. known infection, 2. causing organ dysfunction 3. and is life-threatening
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33
Q

Definition of septic shock

A
  1. sepsis; 2. shock (hypotension requiring pressors after volume resus) and 3. lactate > 2
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34
Q

MGMT of septic shock

A
  1. antibiotics within 1 hour and source control; 2. fluid resuscitation, norepi if MAP < 65
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35
Q

MGMT of anaphylactic shock

A
  1. epi 0.5 mg IM; 2. diphenhydramine 50 mg, 3. prednisone 50 mg; 4. ranitidine 150 mg
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36
Q

Difficult BVM Criteria

A

MOANS: mask seal (beard), obstructive/obesity, age > 55, no teeth, stiffness of chest (COPD, asthma, pregnancy)

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37
Q

Difficult extraglottic device Criteria

A

RODS: restricted mouth opening, obstruction/obesity, distorted anatomy, stiffness to ventilate

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38
Q

Difficult cricothyrotomy criteria

A

SMART: surgery, mass (abscess, hematoma), access/anatomy problems (edema, obesity), radiation, tumor

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39
Q

Cormack Lehane grading view (1-4) with DL

A

1 - 4; 4; not even the epiglottis; 2a: arytenoids and portion of vocal cords; 2b: arytenoids only

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40
Q

Pathophysiology of cocaine

A

release of dopamine, epinephrine, norepi and serotonin; most importantly involved in adrenergic stimulation by norepi and epi; Norepi causes vasoconstriction by stimulation of alpha adrenergic receptors on vascular smooth muscles; epinephrine causes increased myocardial contractility and heart rate through beta1 adrenergic receptors; reuptuake from synaptic clefts is inhibited; local anaesthetic (Na channel blockade)

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41
Q

Metabolite of cocaine in plasma detected by urine tox

A

benozyl ecgonine

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42
Q

ethanol + cocaine

A

can potentiate cocaine stimulatory effects

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43
Q

Signs and Symptoms of Cocaine Use

A

diaphoresis, tachycardic, mydriasis (dilated pupils), HTN –> agitated, combative and hyperthermic; rare: hypertensive emergency, delirium, seizures

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44
Q

Urgent things to evaluate in cocaine abuse

A

hyperthermia, hypertensive emergencies, cardiac dysrhythmias

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45
Q

Cocaine Route of Administration

A

inhalation (crack; onset seconds, duration 10 - 20 mins), intranasal (onset: 5 mins, duration: 30 mins); IV (onset seconds, duration 90 mins)

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46
Q

Sympathomimetic Toxidrome

A

CNS excitation, diaphoresis, HTN, hyperthermia, increased motor tone, tachycardia, mydriasis (dilated pupils)

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47
Q

RFs and Mechanism for hyperthermia in cocaine abuse

A

increased motor tone and generating excessive heat; vasoconstriction and salt and water depletion compromises cooling; risk of fatality when > 41.4

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48
Q

Normotemperature + cocaine; tests to order

A

CK and lytes (r/o rhabdomyolysis)

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49
Q

Cardiac Complications of Cocaine

A

AD, pulmonary edema, MI, intracranial hemorrhage, stroke, infarction of anterior spinal artery/bowel/renal/retina, placental insufficiency and infarction in gravid uterus, dysrhythmias

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50
Q

Dysrhythmias in cocaine abuse

A

sinus tachycardia, AFib, SVTs due to catecholamine surge;; TdP from K+ blockade or wide-complex tachycardia from fast Na channels on myocardium, transient conduction abnormalities consistent with Brugada type pattern, hyperkalemia from rhabdomyolysis

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51
Q

Chronic cocaine use

A

“Cocaine washout”: profoundly sleepy bur arousable and oriented; crackl dancing: transient choroathetoid movement disorder related to dopamine abnormalities, psychosis and paranoia,

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52
Q

Complications of inhaled crack cocaine

A

oropharyngeal burns, PTX, pneumopericardium, pneumomediastinum

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53
Q

Complications of intranasal cocaine

A

sinusitis, nasopalatine necrosis or perforation

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54
Q

DDx of stimulant abuse/sympathomimetic toxidrome

A

other sympathomimetics (amphetamine, PCP), thyrotoxicosis, lithium toxicity, CNS infections, benzo withdrawal, heat stroke, serotonin syndrome, NMS

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55
Q

Complications from designer amphetamines (i.e., ecstasy)

A

hypnatremia from SIADH or excessive free water

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56
Q

Signs of PCP abuse

A

multidirectional nystagmus, highly combative behaviour

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57
Q

Difference between sympathomimetic abuse vs. anticholinergic abuse

A

anticholinergic: dry skin, acute urinary retention

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58
Q

Serotonin Syndrome Signs and Symptoms

A

altered mental status, hyperthermia, agitation, hyperreflexia, clonus, diaphoresis

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59
Q

NMS Signs and Symptoms

A

“FARM” - fever, autonomic instability, rigidity, mental status change

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60
Q

Drawbacks of urine tox screen, in cocaine specifically

A

measures metabolite (benzoyl ecgonine) that persists for at least 3 days

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61
Q

Inv for cocaine abuse

A

ECG (dysrhythmias, ischemia, hyperK, QRS prolongation from Na blockade), CXR (PTX, pneumomediastinum, FB), BW (CBC, lytes, extended lytes, Cr, CK (serum +urine myoglobin), +/- CT Head (subarachnoid)

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62
Q

Rare Cocaine Adulerant: Levamisole - Complications

A

agranulocytosis, vasclopathy + thrombosis, dermal ulcer and purpura

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63
Q

Acute MGMT of Agitated Patient with Sympathetic Abuse

A

rapid assessment of vital signs + core temperature, r/o hypoxia/hypoglycemia/hyponatremia), sedation with benzodiazepines, ECG, urinalysis, CK

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64
Q

Benzos for Agitated Patient with suspected sympathomimetic abuse

A

diazepam 5 - 10 mg q5 mins, lorazepam (1 - 2 mg IV q5mins), midazolam 10 mg IM

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65
Q

Rx for Acute cocaine abuse

A

benzodiazepines (lorazepam 1 - 2 mg IV q5 mins; midazolam 10 mg IM), butyrophenone antipsychotics (haldol 2 - 5 mg IM q20-30mins)

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66
Q

MGMT of Stimulant-Induced Hyperthermia

A

Cooling: identify temperature, large bore IV rapid infusion of crystalloid, sedation and muscle relaxation with benzos, rapid cooling within 20 mins with ice water immersion, paralysis and intubation if necessary; monitoring: UO with foley, labs (liver function, PTT, bacterial cultures, UA, Cr, CK)

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67
Q

Minutes of hyperthermia (>41 degrees) until end organ failure

A

20 mins

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68
Q

Intubation Sedation for cocaine abuse

A

rocuronium (1mg/kg; succinylcholine may precipitate hyperkalemia if rhabdomyolysis is present

69
Q

Rx for acute hypertensive emergencies in cocaine

A

phentolamine: direct alpha adrenergic antagonist IV 1 mg q3mins with monitoring; other rx: NG, hydralazine; AVOID BETA BLOCKERS

70
Q

Anti-HTN medications to avid in cocaine abuse

A

beta blockers; due to beta-adrenergic antagonism causing paradoxical HTN from unopposed alpha-receptor activity –> coronary artery spasm and HTN

71
Q

Dysrhythmias in cocaine MGMT

A

if not responding to benzos, can consider CCB (diltiazem); r/o hyperkalemia, sodium channel blockade (cyclic antidepressants + cocaine), ischemia; can consider sodium bicarb for sodium channel reversal

72
Q

RF for cocaine cardiac CP

A

cocaine causes coronary artery vasoconstriction, enhances platelet aggregation

73
Q

Causes of CP in cocaine abuse

A

coronary thrombosis, endocarditis, ischemia/infarct, LV apical ballooning, pericarditis; AD, FBA, infection, pneumomediastinum, pneumopericardium, PTX, pulmonary infarction, intestinal ischemia or infarct

74
Q

Cocaine body packing MGMT

A

continuous monitoring; if retained packet, remove with whole bowel irrigation with PEG; can consider OR/surgery in event patient develops acute toxicity, bowel obstruction or leaking packet

75
Q

Cocaine body stuffers MGMT

A

usually much less doses and will not be lethal; do not require WBI but do monitor 8 - 12 hours

76
Q

Admission for cocaine abuse

A

cardiogenic shock, CHF, dysrhythmias, ECG changes, elevated cardiac enzymes, persistent CP/SOB or abnormal vital signs, pre-existing CAD or stent placement, requiring vasodilating pharmacotherapy, persistent symptoms

77
Q

Amphetamines complication

A

same as stimulants: hyperthermia, hypertensive emergencies, dysrhythmias, MI, hyperkalemia; however less sodium channel blockade; longer duration of action

78
Q

MDMA complications

A

same as stimulants, but higher risk of hyponatremia due to release of vasopressin

79
Q

methamphetamine (crystal meth) complications

A

same as stimulants but longer duration of action and ++paranoid delusions persisting for 15 hours

80
Q

ephedrine and ephedria complications

A

similar to amphetamine, used in chinese herbal products, higher risk of strokes

81
Q

khat and methcathinone complications

A

stimulant occuring in plant catha edulis; smoking khat is usually asx; can be associated with elevated manganese concentration

82
Q

bath salts complications

A

similar to sympathomimetics: agitation, hyperthermia, rhabdomyolysis

83
Q

T or F: rapid sedation with IV benzo is the key for most symptoms from cocaine and other stimulants

A

true

84
Q

T or F; hyperthermia is a high risk event for cocaine OD and body temperature must be reduced slowly

A

false - reduce temp quickly!

85
Q

T or F; short-acting antihypertensive agents(phentolamine, nitroglycerin) are recommended for cocaine-induced hypertension including CP

A

T

86
Q

what anti-hypertensive should be avoided in cocaine/stimulant OD?

A

beta-blockers for potential unopposed alpha adrenergic activity resulting in coronary vasoconstriction and HTN

87
Q

what IV Rx can be used for wide-complex cocaine indued arrhythmias?

A

sodium bicarb for sodium channel blockade reversal

88
Q

which groups of cocaine users may require emergent surgical intervention and WBI?

A

cocaine body packers

89
Q

T or F; amphetamine symptoms last shorter than cocaine

A

false; they last longer!

90
Q

what are MDMA patients specifically at high risk for?

A

hyponatremia secondary to vasopressin release, presents similar to SIADH in that high urine sodium levels

91
Q

what can bath salt ingestions cause?

A

sympathomimetic effects; rhabdomyolysis, hyperthermia, severe agitation

92
Q

MGMT of cocaine-induced HA

A

r/o SAH with CT head AND lumbar puncture

93
Q

Average time for fracture healing in healthy adults

A

2 months - 4 months (femur/large bones)

94
Q

T or F: oblique fractures heal quicker than transverse fractures

A

True

95
Q

Malunion

A

residual deformity exists after healing

96
Q

Nonuion

A

failure of fracture to unite

97
Q

(3) signs to return to normal activity/fully healed

A

pain free, weight bearing and Xray showing bridging bone at 3+ cortices

98
Q

Signs of compression fracture on XRay

A

increased density vs lucency (in typical fractures)

99
Q

Use of CTs in fracture

A

confirm possible fracture, CSpine trauma, vertebral fractures relativel to spinal canal, articular surfaces (Salter Harris type fractures)

100
Q

Salter-Harris Fracture Classifications

A

SALTR: Type I - Slipped, Type II - above or away from joint, Type III: Lower, Type IV: through or transverse or together, Type V: Ruined or rammed

101
Q

Osteomyleitis in fractures MGMT

A

IV antibiotics (cefazolin +/- gentamycin), emergent washout of debris, coverage with moist dressing

102
Q

MGMT of open fractures

A
  1. Control hemorrhage with sterile pressure, remove debris; 2. Splint with reduction unless vascular compromise; 3. Irrigate with saline, cover with saline soaked sponges after arrival; 4. Begin IV antibiotics prophylaxis 5. Administer tetanus, +/- tetanus IG for large crush wounds
103
Q

Crush/Open injuries of the fingers/toes MGMT

A

thorough irrigation, antibiotics PO (no evidence), outpt follow-up

104
Q

Estimated blood loss in fractures (forearm vs. pelvis)

A

100 mL in forearm, femur 1L, 3L in pelvis

105
Q

Fracture of femoral neck MGMT

A

emergent reduction and fixation, r/o compartment syndrome/vascular injury

106
Q

neurapraxia definition

A

contusion or traction injury of intact nerve; transiet paralysis and slight sensory loss; normal function usually returns in weeks - months

107
Q

axonotmesis definition

A

more severe injury of axons within intact epineurium; Schwann tubes remain in continuinty and spontaneous healing is possible but slow

108
Q

Neurotmesis definition

A

complete severing of nerve, requiring surgical repair

109
Q

Normal two-point discrimination value at the fingertip

A

4 mm

110
Q

Nerve injured in distal radius fracture

A

median nerve

111
Q

Nerve injured in elbow injury

A

median or ulnar

112
Q

Nerve injured in shoulder dislocation

A

axillary

113
Q

Nerve injured in sacral fracture

A

cauda equina nerve

114
Q

Nerve injured in acetabulum fracture

A

sciatic nerve

115
Q

Nerve injured in hip dislocation

A

femoral nerve

116
Q

Nerve injured in femoral shaft fracture

A

peroneal nerve

117
Q

Nerve injured in knee dislocation

A

tibial or peroneal nerve

118
Q

Nerve injured in lateral tibial plateau fracture

A

peroneal nerve

119
Q

Life or Limb threatening emergency in open fracture

A

ostemyelitis

120
Q

Life or Limb threatening emergency in fracture with vascular disruption

A

amputation, especially popliteal

121
Q

Life or Limb threatening emergency in major pelvic fracture

A

hemorrhagic shock

122
Q

Life or Limb threatening emergency in hip dislocation

A

AVN of femoral head

123
Q

Life or Limb threatening emergency in compartment syndrome

A

ischemic contracture, myoglobinuria, renal failure

124
Q

Associated life-threatening causes to r/o in the ED with AKI/azotemia

A

pulmonary edema, hyperkalemia

125
Q

Definition of acute anuria

A

< 100 cc of urine/day

126
Q

Approach to AKI/azotemia (elevated Cr)

A

r/o pre-renal and post-renal causes first, then investigate renal causes

127
Q

5 factors affecting electrical injuries

A

circuit type, current, resistance, voltage, current pathway, current duration

128
Q

resistance of body tissue from lowest to highest

A

lowest: nerve, blood vessels, highest: fat, bone

129
Q

4 types of skin burns from electrical injuries

A

entrance and exit burns, arc burns, flash burns, thermal burns

130
Q

skin spot diagnosis associated with lightening injuries

A

lichtenberg figure (ferning pattern)

131
Q

(2) medical conditions where CPAP or BIPAP is effective

A

copd, CHF

132
Q

proportion of BMV being impossible and difficult

A

impossible in 1/600, difficult in 1/50

133
Q

neck obstruction mechanism of making difficult intubation

A

i.e., epiglottitis, head and neck cancers, ludwig’s angina, neck hematoma, glottis swelling or polyps, compromise laryngoscopy, passage of ETT, BMV or all three

134
Q

“RODS” for difficult extraglottic placemenet

A

restricted mouth opening, obstruction/obesity, distorted anatomy, stiffness (ILD, asthma, COPD)

135
Q

“SMART” for difficult cricothyrotomy

A

surgery, mass, access/anatomy problems, radiation, tumor

136
Q

CL system for laryngoscopy view

A

grade1: all of glottic structures seen, grade 2: portion of glottis, arytenoid cartilatge+ VC, grade 3: only epiglottis, grade 4 none.

137
Q

Confirmation of tube placed in intubation

A

ETCO2 continuous, or colour if not available, U/S to see cricothyroid membrane or trachea to confirm, aspiration technique of air through ETT with ETT cuff deflated easy if in trachea, hard if in esophagus (collapsed), bougie inserted to see resistance (R mainstem)

138
Q

blood supply to pericardium

A

internal mammary artery

139
Q

pericardial chest pain

A

sharp, pleuritic pain that varies with position - relieved sitting up, worse with lying flat, deep inspiration or swallowing, can radiate to trapezius or isolated shoulder pain

140
Q

DDx of chest pain

A

costochondritis, pleuritis, infection, PE, ACS

141
Q

evolution of ECG in pericarditis

A

1st satge: first hours, diffuse ST segment elevation and ST segment depressions, concurrent PR segment depressions; 2nd stage: ST and PR normalize but T-waves flatten followed by symmetric deep T wave inversions

142
Q

percentage of patients with classic CP and ECG of pericarditis

A

2/3 only!

143
Q

key ECG changes with ST elevation in pericarditis and STEMI

A

ST elevation in pericarditis are concave (smile) rather than convex upwards (STEMI); in pericarditis, simultaneous T wave inversions are not seen, and are diffuse

144
Q

MGMT pericarditis

A

NSAIDS (ibuprofen) 1st line, if no relief within 1 week; colchicine can be added to reduce risk of recurrent pericarditis

145
Q

criteria to admit for pericarditis

A

significant pericardia effusion, ACS , hemodynamic instability

146
Q

uremic pericarditis is associated with ____

A

occult infections

147
Q

T or F: uremic pericarditis can have a normal ECG

A

true - it is often normal bc little epicardial inflammation

148
Q

Etiology of pericarditis - infectious

A

viral, bacterial, fungal, parasite, rickettsia

149
Q

Etiology of pericarditis - post-injury

A

penetrating trauma, blunt trauma, surgery, MI, radiation, medication

150
Q

Etiology of pericarditis systemic disease

A

uermia, mets cancer, RA, SLE, sarcoidosis, scleroderma, dermatomyositis, amloidosis

151
Q

MGMT o furemic pericarditis

A

NSAIDS are not helpful - consider dialysis (usually renal failure, dialysis pts), can consider steroids later on

152
Q

percentage of pts having MI-associated pericarditis

A

20% of pts with transmural MI experience post-MI pericarditis

153
Q

T or F: post-MI pericarditis and Dressler’s are the same

A

false - Dressler’s is delayed complication of MI vs. post-MI percarditis can happen 2-4 days after

154
Q

Dressler’s syndrome sx

A

fever, pleuritis, leukocytosis, friction rub, pericardial or plerual effusion in MI pts

155
Q

MGMT of Dressler’s syndrome

A

NSAIDS

156
Q

cancers associated with neoplastic pericardial disease

A

lung, breast, lymphoma, leukemia

157
Q

other infectious causes of pericarditis

A

rickettsia conorii (Mediterranean spotted fever, treated with doxy), mycoplasma pneumoniae, nocardia asteroides (pericardiectomy, long term antibiotics), chlamydia, EBV, CMV, H. actinomycetemcomitans (Rx: chloramphenicol), coccidioidomycosis, varicella, TB

158
Q

minimum amount of fluid needed to see cardiomegaly on CXR

A

200 - 250 cc

159
Q

complications of pericardiocentesis

A

dysrhythmias, PTX, myocardial perforation, coronary or internal mammary artery laceration, liver laceration

160
Q

3 stages for tamponade to develop

A

fluid filling recesses of parietal pericardium, fluid accumlating faster than rate of parietal pericardium to stretch, fluid accumulation exceeding body’s ability to increase blood volume to support RV filling pressure

161
Q

Beck’s triad

A

hypotension distended neck veins, muffled heart sounds

162
Q

ECG finding for cardiac tamponade

A

decreased voltage, electrical alternans

163
Q

US signs for cardiac tamponade

A

pericardial effusion AND chamber collapse

164
Q

MGMT of cardiac tamponade

A

++IVF to increase preload, pericardiocentsis

165
Q

definition of electrical alternans

A

alternating QRS amplitude

166
Q

Etiology for purulent pericarditis

A

steptococcus, staphlococcus, candida

167
Q

cause of spontaneous penumopericardium

A

increase in intra-alveolar pressure above atmospheric pressure –> rupture of alveoli

168
Q

clinical sx for pneumopericardium

A

Hamman’s sign, mediastinal crunch

PGY1 (12 decks)

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