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CEN prep 2021 > SCEN Medical Emergencies > Flashcards

SCEN Medical Emergencies Flashcards

1
Q

Medical and psychosocial

How many of these questions are on the test?

A

25

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2
Q

what are three main causes of hyperkalemia?

A

Cellular death such as rhabdo, crush or burns
Acidosis such as DKA or addisons
Renal failure because the kidneys push the potassium out

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3
Q

what are the early s/s of hyperkalemia?

A

muscle excitability, which causes irritability, nausea, vomiting, diarrhea

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4
Q

what are the late s/s of hyperkalemia?

what are some of the things that it causes? (6)

A

muscular weakness
which causes fatigue, generalized weakness, distal limb parethesias, tetany, respiratory depression, and ascending paralysis

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5
Q

when potassium reaches a level of 8-9, what happens?

A

there is the same amount of potassium on either side of the cell causing the late s/s

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6
Q

what is the progression in EKG abnormalities as the level of potassium rises? (6)

A 
normal 
peaked T wave - hurts to land on
elongated PR interval
Absent P wave
enlarged QRS complex
sine wave - after that asystole
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7
Q

what is the treatment for hyperkalemia for the short term, a few hours?
(3)

A

calcium chloride or calcium gluconate - will wear off though
Insulin as a carrier protien with dextrose to push the potassium back into the cells
albuterol to move potassium back into the cells

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8
Q

what are some methods of treating hyperkalemia for the long term?

A

hemodialysis
NSS with furosemide
kaexelate

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9
Q

why is calcium chloride and calcium gluconate used to treat hyperkalemia?

A

it produces a cardioprotective effect against arrhythmias

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10
Q

how does kayexelate work to decrease potasium?

A

it works as an ion exchange resin

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11
Q

how does a pH level affect potassium?

A

acidosis will cause potassium to go up and alkalosis will cause potassium levels to drop

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12
Q

what are some causes of hypokalemia?

A

losses through vomiting, diarrhea, intestinal obstruction
shifts from the uses of insulin, beta 2 antagonists, aldosterone, alkalosis
decreased intake from alcoholism and malnutrition

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13
Q

true or false

generally healthy people may not show symptoms of hypokalemia

A

true
most people who show symptoms have preexsisting conditions such as cardiac disease, but generally healthy people might not show symptoms until they’re down in the 2-3 range

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14
Q

what are the s/s of hypokalemia?

5

A

hyporeflexia
latent tetany
paralysis to the lower extremities or respiratory failure
paresthesias

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15
Q

what are the EKG wave s/s of hypokalemia?

2

A
  • more prominent U wave, making a biphasic T wave or a double “camel hump” T wave
  • depressed ST segment
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16
Q

what are the treatments for hypokalemia?

A

oral and IV potassium replacement

must be given gradually

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17
Q

what other condition tends to occur simultaneously with hypokalemia?

A

hypomagnesemia

the two should be corrected at the same time

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18
Q

high magnesium levels cause what?

A

decreased muscular activity and irritability, leading to weakness

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19
Q

low magnesium levels cause what?

A

increased muscular irritability and activity

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20
Q

Mild to moderate hypomagnesemia may cause what s/s?

A

may be asymptomatic

gotcha

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21
Q

severe hypomagnesemia may cause what s/s?

10

A 
muscle cramping
palpitations 
vertigo/ataxia 
depression
siezures 
hyperreflexia 
PR/QT prolongation 
Afib, torsades, Vfib
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22
Q

what are some things you would see in a persone with hypermagnesemia?
(7)

A 
decreased deep tendon reflexes
hypotension
QRS widening
QT/PR prolongation 
respiratory insufficiancy 
heart block 
cardiac arrest
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23
Q

what is the normal range for magnesium?

A

1.7 - 2.2 mg/dl
or
0.85 - 1.10 mmol/L

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24
Q

what would you expect to see in a person with a Magnesium level of 4-5?

A

decreased deep tendon reflexes

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25
Q

what would you expect to see in a person with a Magnesium level of 5-7?

A

hypotension, QRS widening, QT/PR prolongation

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26
Q

what would you expect to see in a person with a Magnesium level of 10?

A

respiratory insufficiency

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27
Q

what would you expect to see in a person with a Magnesium level of 10-15?

A

heart block

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28
Q

what would you expect to see in a person with a Magnesium level of 10-24?

A

cardiac arrest

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29
Q

what are two bedside tests tht you can do to test for hypomagnesemia?

A

Chvostek’s sign (show vos tec)

Trousseau’s sign (true-so’s)

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30
Q

how do you perform a Chvostek’s sign test?

A

tap on the patients facial nerve

lateral to the cheekbone

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31
Q

how do you perform Trousseau’s sign test?

A

place a blood pressure cuff on the patient and pump it up to 20mmHg higher than the known SBP and you will see the contracture

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32
Q

how can mild hypomagnesemia be treated through diet?

A 
legumes
bananas
avacado
green leafy vegetables
chocolate
seeds
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33
Q

what are some ways to treat hypermagnesemia?

A

fluid administration
loop diuretics
dialysis (may be given IV calcium while awaiting dialysis)

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34
Q

what are the two electrolytes that have a seesaw inverse relationship?

A

calcium and phosphate

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35
Q

what are some causes of hypocalcemia and hyperphosphatemia?

12

A 
hypoparathyoidism 
pancreatitis 
malabsorption 
chronic nephritic syndrome or nephritis 
cushings syndrome
overdose of calcium channel blockers 
multiple blood trnsfusions (more than 10, because of additives)
hydrofluoric acid exposure
hypoalbuminemia
hyperventilation
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36
Q

what are the s/s of hypocalcemia / hyperphosphatemia?

9

A 
muscular irritability 
muscle cramping 
perioral or finger paresthesias
SOB (bronchospasm) 
tetanic contractions 
positive Chvostek's or Trousseau's sign 
hypotension 
heart failure
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37
Q

what are some s/s of hypercalcemia / hypophosphatemia?

8

A

non focal abdominal pain that can mimic appendicitis
constipation
anorexia
nausea and vomiting
fatigue and body aches
bradycardia
neuropsychiatric (anxiety, depression, confusion, hallucinations)

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37
Q

what are some s/s of hypercalcemia / hypophosphatemia?

8

A

non focal abdominal pain that can mimic appendicitis
constipation
anorexia
nausea and vomiting
fatigue and body aches
bradycardia
neuropsychiatric (anxiety, depression, confusion, hallucinations)

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38
Q

what are some s/s of hypercalcemia / hypophosphatemia?

8

A

non focal abdominal pain that can mimic appendicitis
constipation
anorexia
nausea and vomiting
fatigue and body aches
bradycardia
neuropsychiatric (anxiety, depression, confusion, hallucinations)

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39
Q

what are the EKG s/s of hypocalcemia / hyperphosphatemia?

A

prolonged QT interval

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40
Q

what causes a hyper/hypo natremia imbalance?

A

when the intake of water and sodium don’t match to balance each other out

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41
Q

what are the s/s of hyponatremia?

7

A 
related to water retention
generalized swelling 
confusion (cerebral edema) 
apathy
sense of impending doom 
seizures 
muscle cramps
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42
Q

what are the s/s of hypernatremia?

A

indications of dehydration
altered mental status (fatigue, lethargy, confusion, coma)
weakness
diarrhea

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43
Q

how would mild and severe hyponatremia be corrected?

A

mild - fluid restriction

severe - slow, over 48 - 72 hours correction with 3-5% saline solution

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44
Q

what would be the result of rapid correction of hyponatremia?

A

central myelinolysis causing flacid paralysis, dysarthia, dysphagia, hypotension

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45
Q

what are some underlying causes that can cause hypernatremia?

A

fever
vomiting
diabetes insipidus

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46
Q

acute pre-renal failure can be caused due to conditions the ___ blood flow to the kidney such as

A 
decrease 
hypovolemia
decreased cardiac output 
decreased vascular resistance 
obstruction of the renal vascular system
47
Q

what is the difference between pre renal failure and intra renal failure

A

pre renal failure is related to causes that occur before the kidney, whereas intra renal failure occurs from reasons inside the kidney

48
Q

what are some causes of intra renal failure?

10

A 
damage to the tubules or nephrotoxic agents 
NSAIDS 
crush injury
rhabdomyolysis  
hypertension 
contrst dye 
diabetes
lupus and infectious processes
certain Abx such as aminoglycosides
49
Q

what is post renal failure?

A

renal failure that has a cause after the kidney

50
Q

what are some causes of post renal failure?

A 
calculi 
prostate hypertrophy 
tumors 
strictures 
neurogenic bladder
51
Q

what are some s/s of renal failure involving pH and electrolytes?
(5)

A 
hyperkalemia 
hypernatremia 
hyperphosphatemia 
hypocalcemia 
metabolic acidosis due to the kidneys not being able to regulate hydrogen ions
52
Q

what is the term for elevated BUN and creatinine?

A

Azotemia

53
Q

not all endocrine glands create emergent conditions, so we are going to only focus on three, what are they?

A

thyroid gland
pancreas
adrenal gland

54
Q

a diminished thyroid function causes what condition?

What is it called when the condition becomes life threatening?

A

hypothyroidism

Myxedema coma

55
Q

an elevated thyroid function is called what?

it’s not hyperthyroidism. well, it is but it isn’t

A

graves disease

56
Q

what is it called when the thyroid has a life threatening over-function?

A

thyroid storm

57
Q

what condition is caused by diminished pancreatic function?

what is it called when it becomes life threatening?

A

DKA

HHS, or hyperosmolar hyperglycemic syndrome

58
Q

what is the condition caused by a pancreas with an elevated function?

A

hypoglycemia

59
Q

an adrenal gland with a diminished function is called what?

what is it called when it becomes life threatening?

A

Addison’s disease

Addison’s crisis

60
Q

what is it called when the adrenal gland over functions?

A

cushings syndrome

61
Q

what are the treatments for thyroid storm?

A

beta blockers
iodine
glucocorticoids
antipyretics (acetaminophen)

62
Q

what is the treatment for myxedema coma?

A

mechanical ventilation for reduced respiratory rate
IV thyroid hormone replacement
levothyroxine
passive rewarming

63
Q

what are some of the s/s of hypoglycemia? and what causes them?

A

sweating, tachycardia, pallor, anxiety, restlessness, shaking, palpitations, hunger, tingling of the lips
the body responds by releasing epinephrine, which stimulate glucagon in the liver, so you see s/s of epinephrine

64
Q

name three conditions that may predispose you to hypoglycemic unawareness

A

long standing diabetes
patients on beta blockers
alcoholism

65
Q

hypoglycemia that gets to the point where the brain can’t extract oxygen is called what?

A

neuroglycemia

66
Q

what IV fluids are used to treat hypoglycemia?

why are the concentrations different for pediatrics?

A

Adults D50
child D25
infant D10-12.5
because of the size of the dextrose molecule, can have an osmotic effect and cause dehydration

67
Q

what medication do you give to treat hypoglycemia in someone without an IV?
what should you look out for after giving it?

A

IM glucagon

watch out for vomiting and position the patient to avoid aspiration

68
Q

why does DKA cause dehydration?

A

glucose is trapped in the bloodstream, is highly osmolar and causes fluid buildup in the bloodstream, which is then diuresed, causing dehydration

69
Q

how does DKA cause acidosis?

A

glucose cannot enter the cell, so the cell makes energy by breaking down fatty acids which releases a hydrogen ion and a ketone body, which results in acidosis, Kussmauls respirations, ketoneuria, and an acetone smell to the breath

70
Q

what are the s/s of DKA?
think fluids, respirations, HR, BP, ect.
(8)

A 
dehydration
Kussmauls respirations 
acetone breath 
tachycardia
hypotension
poor skin turgor
altered mental status
abdominal pain
71
Q

what type of diabetic is more likely to develop HHS and why?
what does it stand for?

A

type II
hyperosmolar hyperglycemic syndrome
T2 diabetics still make some insulin, so the cell doesn’t have to break down fatty acids that cause DKA, but glucose is still stuck in the bloodstream

72
Q

what is the big difference between DKA and HHS?

A

acidosis

DKA involves acidosis whereas HHS does not

73
Q

what are the mortality rates for DKA and HHS?

what are some reasons?

A

DKA 3-10%
HHS 20-60%, because of lack of s/s, obesity comorbidities, and pts are slow to seek care, and it takes days or weeks to develop

74
Q

why would the treatment of DKA and HHS involve IV insulin rather than sub Q?

A

due to dehydration fluid might not be absorbed through the sucutaneous route

75
Q

what is the typical dose of IV insulin for the treatment of DKA and HHS?

A

0.1 units regular insulin per kg of body weight bolus and then and then an infusion of 0.1 units per kg per hour

76
Q

what 2 hormones do the adrenal glands regulate?

A

cortisol and aldosterone

77
Q

what does cortisol do?

A

regulates blood sugar

78
Q

what does aldosterone do?

A

facilitates sodium and water reabsorption and indirectly affects potassium excretion, as it comes from the adrenal glands seated on top of the kidneys

79
Q

when the adrenal glands function too much, what condition does it cause?

A

cushings

80
Q

what condition is caused when the adrenal glands don’t function enough?

A

addisons disease

81
Q

what glucose and electrolyte imbalances are associated with cushings disease

A

high glucose levels
low potassium
high sodium

82
Q

what glucose and electrolyte imbalances are associated with Addisons disease

A

low glucose levels
high potassium
low sodium

83
Q

what is the main cause of cushings disease?

A

taking exogenous prednisone, because prednisone is an adrenal hormone

84
Q

if you have a patient who looks like a cushings patient, but presents as a Addisons crisis, what could be the cause?

A

cold turkey from prednisone, due to the adrenal glands shrinking from being on prednisone

85
Q 
A decrease in which of the following factors is associated with effective treatment of Addison's crisis
a sodium
b glucose
c potassium 
d blood pressure
A

c potassium, which runs high with Addison’s, so treatment would bring it down

86
Q

an elevated red blood cell count is called what?

A

polycythemia

87
Q

an decreased red blood cell count is called what?

A

anemia

88
Q

an elevated white blood cell count is called what?

A

infection or leukemia

89
Q

how many types of white blood cells are there?

and what is it called when they are ALL at a low level?

A

Leukopenia, or neutropenia/lymphopenia

or sometimes pancytopenia

90
Q

an elevated platelet count is called what?

A

thrombocytosis

91
Q

an decreased platelet count is called what?

A

thrombocytopenia

92
Q

what are the conditions that can bring on a sickle cell crisis?
(5)

A 
cold temperature
high altitude 
infection
acidosis
stress
93
Q

what is the treatment for sickle cell anemia?

A 
pain management
mild - NSAIDS,acetaminophen, Ultram
severe - opiods, toradol 
O2, rehydration, consider transfusion, Abx for infection
warm, moist heat to affected areas
94
Q

what does DIC stand for?

what type of condition is it considered to be?

A

disseminated intravascular coagulation

coagulopathy

95
Q

how does DIC result in both clotting and bleeding

A

overformation of clotting results in overproduction of fibrin degradation products that results in bleeding, and you can no longer clot because you used up all of your clotting factors

96
Q 
which of the following lab values are most consistent with DIC?
Elavated D-dimer
elevated fibrinogen level
decreased pt
decreased ptt
A

elevated D-dimer

because it is a fibrinogen degridation product

97
Q

what is the treatment for full blown DIC?

A

call the priest
not much hope here vigorously treat underlying cause
hard to treat with the paradoxal challenge of DIC

98
Q

85-90% of hemophillia patients have this type of hemophillia, which is a deficiancy of this factor.

A

Hemophillia A, or classic hemophillia, which is a deficiency of factor VIII (8)

99
Q

Hemophillia B is a deficiancy of this clotting factor, and otherwise known as ___ disease

A 
factor IX (9)
Christmas disease
100
Q

The third most common type of Hemophillia in the US, type C is also called what?
These patients can self treat at home, so why come to the ED?

A

Rosenthal’ syndrome

They may often need assistance with drainage from a muscle or joint, to avoid things like compartment syndrome.

101
Q

DDAVP can be used to treat this type of hemophillia.

A

type A, because it can stimulate the release of factor 8 to treat minor cuts

102
Q

what consideration should you take in performing venipuncture on a patient with hemophillia?

A

direct pressure for at least 5 minutes

103
Q

what consideration should you give for IM injections in hemophilliac patients?

A

don’t do it, for risk of compartment syndrome

104
Q

why is fever in an immunocompromised patient a medical emergency?

A

Immunocompromise is due to a deficiency of white blood cells of some kind. Pus, swelling, redness are all do to WBC, therefore, fever being the only sign of bacterial infection.

105
Q

an immunocompromised patient could have a rip-roaring bacterial infection and the only symptom you would see is this.
Why?

A

Fever

Due to deficiency of WBC, which would be the cause of all other s/s of infection

106
Q

A child under 28 days with a fever has an increased chance of having what?

A

bacterial infection

the older the child gets, the higher the chance of less serious viral infection

107
Q

what can be said about the metabolic demands caused by a fever that affect HR and RR?

A

an increase in HR of 10 beats per minute for each 0.5 degree Celsius and an increase in RR of 5 breaths per minute for each 1 degree celsius

108
Q

any fever above this degree celsius/F is known to denature the proteins of the brain and cause irreversible brain damage

A

41, or 105.8

109
Q

what is the cascade of sepsis?

5

A 
SIRS
sepsis
severe sepsis
septic shock
MODS
110
Q

what does SIRS and MODS stand for?

A

Systemic Inflammatry response system

Multiple Organ Dysfunction Syndrome

111
Q

what causes redness and swelling of a localized immune response?

A

vasodilatation and increased capillary permeability

112
Q

what is the difference between sepsis and severe sepsis?

A

severe sepsis includes the failure of one organ system

113
Q

sepsis bundles are to include what (5) and be completed within __ hours of triage

A 
serum lactate
blood cultures 
broad spectrum Abx
30 ml per kg bolus for map >65, if no response try pressors 
3
114
Q

Anaphylaxis is similar to this due to the release of mediators into the bloodstream

A

sepsis

115
Q

what are some of the treatments for anaphylaxis? (medications) (9)

A

inhaled beta-2 agonists for bronchodilation
Corticosteroids to prevent delayed reaction
antihistamines
H1 blockers (Benadryl)
H2 blockers (famotidine, ranitidine, cimetidine)
mild anaphx - 1:1000 IM epi
severe anaphx - 1:10,000 IV epi
repeat q 15-20 minutes if needed

116
Q

what type of epi should you never use via IV?

A

1:1000
because the patients HR will go to like, 500, you’ll probably kill the patient, and then get investigated by the joint commission

CEN prep 2021 (36 decks)

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