SCEN Medical Emergencies Flashcards
1
Q
Medical and psychosocial
How many of these questions are on the test?
A
25
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
3
Q
what are the early s/s of hyperkalemia?
A
muscle excitability, which causes irritability, nausea, vomiting, diarrhea
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
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
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
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
8
Q
what are some methods of treating hyperkalemia for the long term?
A
hemodialysis
NSS with furosemide
kaexelate
9
Q
why is calcium chloride and calcium gluconate used to treat hyperkalemia?
A
it produces a cardioprotective effect against arrhythmias
10
Q
how does kayexelate work to decrease potasium?
A
it works as an ion exchange resin
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
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
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
14
Q
what are the s/s of hypokalemia?
5
A
hyporeflexia
latent tetany
paralysis to the lower extremities or respiratory failure
paresthesias
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
16
Q
what are the treatments for hypokalemia?
A
oral and IV potassium replacement
must be given gradually
17
Q
what other condition tends to occur simultaneously with hypokalemia?
A
hypomagnesemia
the two should be corrected at the same time
18
Q
high magnesium levels cause what?
A
decreased muscular activity and irritability, leading to weakness
19
Q
low magnesium levels cause what?
A
increased muscular irritability and activity
20
Q
Mild to moderate hypomagnesemia may cause what s/s?
A
may be asymptomatic
gotcha
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
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
23
Q
what is the normal range for magnesium?
A
1.7 - 2.2 mg/dl
or
0.85 - 1.10 mmol/L
24
Q
what would you expect to see in a person with a Magnesium level of 4-5?
A
decreased deep tendon reflexes
25
what would you expect to see in a person with a Magnesium level of 5-7?
hypotension, QRS widening, QT/PR prolongation
26
what would you expect to see in a person with a Magnesium level of 10?
respiratory insufficiency
27
what would you expect to see in a person with a Magnesium level of 10-15?
heart block
28
what would you expect to see in a person with a Magnesium level of 10-24?
cardiac arrest
29
what are two bedside tests tht you can do to test for hypomagnesemia?
Chvostek's sign (show vos tec)
| Trousseau's sign (true-so's)
30
how do you perform a Chvostek's sign test?
tap on the patients facial nerve
| lateral to the cheekbone
31
how do you perform Trousseau's sign test?
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
32
how can mild hypomagnesemia be treated through diet?
```
legumes
bananas
avacado
green leafy vegetables
chocolate
seeds
```
33
what are some ways to treat hypermagnesemia?
fluid administration
loop diuretics
dialysis (may be given IV calcium while awaiting dialysis)
34
what are the two electrolytes that have a seesaw inverse relationship?
calcium and phosphate
35
what are some causes of hypocalcemia and hyperphosphatemia?
| 12
```
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
```
36
what are the s/s of hypocalcemia / hyperphosphatemia?
| 9
```
muscular irritability
muscle cramping
perioral or finger paresthesias
SOB (bronchospasm)
tetanic contractions
positive Chvostek's or Trousseau's sign
hypotension
heart failure
```
37
what are some s/s of hypercalcemia / hypophosphatemia?
| 8
non focal abdominal pain that can mimic appendicitis
constipation
anorexia
nausea and vomiting
fatigue and body aches
bradycardia
neuropsychiatric (anxiety, depression, confusion, hallucinations)
37
what are some s/s of hypercalcemia / hypophosphatemia?
| 8
non focal abdominal pain that can mimic appendicitis
constipation
anorexia
nausea and vomiting
fatigue and body aches
bradycardia
neuropsychiatric (anxiety, depression, confusion, hallucinations)
38
what are some s/s of hypercalcemia / hypophosphatemia?
| 8
non focal abdominal pain that can mimic appendicitis
constipation
anorexia
nausea and vomiting
fatigue and body aches
bradycardia
neuropsychiatric (anxiety, depression, confusion, hallucinations)
39
what are the EKG s/s of hypocalcemia / hyperphosphatemia?
prolonged QT interval
40
what causes a hyper/hypo natremia imbalance?
when the intake of water and sodium don't match to balance each other out
41
what are the s/s of hyponatremia?
| 7
```
related to water retention
generalized swelling
confusion (cerebral edema)
apathy
sense of impending doom
seizures
muscle cramps
```
42
what are the s/s of hypernatremia?
indications of dehydration
altered mental status (fatigue, lethargy, confusion, coma)
weakness
diarrhea
43
how would mild and severe hyponatremia be corrected?
mild - fluid restriction
| severe - slow, over 48 - 72 hours correction with 3-5% saline solution
44
what would be the result of rapid correction of hyponatremia?
central myelinolysis causing flacid paralysis, dysarthia, dysphagia, hypotension
45
what are some underlying causes that can cause hypernatremia?
fever
vomiting
diabetes insipidus
46
acute pre-renal failure can be caused due to conditions the ___ blood flow to the kidney such as
```
decrease
hypovolemia
decreased cardiac output
decreased vascular resistance
obstruction of the renal vascular system
```
47
what is the difference between pre renal failure and intra renal failure
pre renal failure is related to causes that occur before the kidney, whereas intra renal failure occurs from reasons inside the kidney
48
what are some causes of intra renal failure?
| 10
```
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
what is post renal failure?
renal failure that has a cause after the kidney
50
what are some causes of post renal failure?
```
calculi
prostate hypertrophy
tumors
strictures
neurogenic bladder
```
51
what are some s/s of renal failure involving pH and electrolytes?
(5)
```
hyperkalemia
hypernatremia
hyperphosphatemia
hypocalcemia
metabolic acidosis due to the kidneys not being able to regulate hydrogen ions
```
52
what is the term for elevated BUN and creatinine?
Azotemia
53
not all endocrine glands create emergent conditions, so we are going to only focus on three, what are they?
thyroid gland
pancreas
adrenal gland
54
a diminished thyroid function causes what condition?
| What is it called when the condition becomes life threatening?
hypothyroidism
| Myxedema coma
55
an elevated thyroid function is called what?
| it's not hyperthyroidism. well, it is but it isn't
graves disease
56
what is it called when the thyroid has a life threatening over-function?
thyroid storm
57
what condition is caused by diminished pancreatic function?
| what is it called when it becomes life threatening?
DKA
| HHS, or hyperosmolar hyperglycemic syndrome
58
what is the condition caused by a pancreas with an elevated function?
hypoglycemia
59
an adrenal gland with a diminished function is called what?
| what is it called when it becomes life threatening?
Addison's disease
| Addison's crisis
60
what is it called when the adrenal gland over functions?
cushings syndrome
61
what are the treatments for thyroid storm?
beta blockers
iodine
glucocorticoids
antipyretics (acetaminophen)
62
what is the treatment for myxedema coma?
mechanical ventilation for reduced respiratory rate
IV thyroid hormone replacement
levothyroxine
passive rewarming
63
what are some of the s/s of hypoglycemia? and what causes them?
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
name three conditions that may predispose you to hypoglycemic unawareness
long standing diabetes
patients on beta blockers
alcoholism
65
hypoglycemia that gets to the point where the brain can't extract oxygen is called what?
neuroglycemia
66
what IV fluids are used to treat hypoglycemia?
| why are the concentrations different for pediatrics?
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
what medication do you give to treat hypoglycemia in someone without an IV?
what should you look out for after giving it?
IM glucagon
| watch out for vomiting and position the patient to avoid aspiration
68
why does DKA cause dehydration?
glucose is trapped in the bloodstream, is highly osmolar and causes fluid buildup in the bloodstream, which is then diuresed, causing dehydration
69
how does DKA cause acidosis?
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
what are the s/s of DKA?
think fluids, respirations, HR, BP, ect.
(8)
```
dehydration
Kussmauls respirations
acetone breath
tachycardia
hypotension
poor skin turgor
altered mental status
abdominal pain
```
71
what type of diabetic is more likely to develop HHS and why?
what does it stand for?
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
what is the big difference between DKA and HHS?
acidosis
| DKA involves acidosis whereas HHS does not
73
what are the mortality rates for DKA and HHS?
| what are some reasons?
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
why would the treatment of DKA and HHS involve IV insulin rather than sub Q?
due to dehydration fluid might not be absorbed through the sucutaneous route
75
what is the typical dose of IV insulin for the treatment of DKA and HHS?
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
what 2 hormones do the adrenal glands regulate?
cortisol and aldosterone
77
what does cortisol do?
regulates blood sugar
78
what does aldosterone do?
facilitates sodium and water reabsorption and indirectly affects potassium excretion, as it comes from the adrenal glands seated on top of the kidneys
79
when the adrenal glands function too much, what condition does it cause?
cushings
80
what condition is caused when the adrenal glands don't function enough?
addisons disease
81
what glucose and electrolyte imbalances are associated with cushings disease
high glucose levels
low potassium
high sodium
82
what glucose and electrolyte imbalances are associated with Addisons disease
low glucose levels
high potassium
low sodium
83
what is the main cause of cushings disease?
taking exogenous prednisone, because prednisone is an adrenal hormone
84
if you have a patient who looks like a cushings patient, but presents as a Addisons crisis, what could be the cause?
cold turkey from prednisone, due to the adrenal glands shrinking from being on prednisone
85
```
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
```
c potassium, which runs high with Addison's, so treatment would bring it down
86
an elevated red blood cell count is called what?
polycythemia
87
an decreased red blood cell count is called what?
anemia
88
an elevated white blood cell count is called what?
infection or leukemia
89
how many types of white blood cells are there?
| and what is it called when they are ALL at a low level?
Leukopenia, or neutropenia/lymphopenia
| or sometimes pancytopenia
90
an elevated platelet count is called what?
thrombocytosis
91
an decreased platelet count is called what?
thrombocytopenia
92
what are the conditions that can bring on a sickle cell crisis?
(5)
```
cold temperature
high altitude
infection
acidosis
stress
```
93
what is the treatment for sickle cell anemia?
```
pain management
mild - NSAIDS,acetaminophen, Ultram
severe - opiods, toradol
O2, rehydration, consider transfusion, Abx for infection
warm, moist heat to affected areas
```
94
what does DIC stand for?
| what type of condition is it considered to be?
disseminated intravascular coagulation
| coagulopathy
95
how does DIC result in both clotting and bleeding
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
```
which of the following lab values are most consistent with DIC?
Elavated D-dimer
elevated fibrinogen level
decreased pt
decreased ptt
```
elevated D-dimer
| because it is a fibrinogen degridation product
97
what is the treatment for full blown DIC?
call the priest
not much hope here vigorously treat underlying cause
hard to treat with the paradoxal challenge of DIC
98
85-90% of hemophillia patients have this type of hemophillia, which is a deficiancy of this factor.
Hemophillia A, or classic hemophillia, which is a deficiency of factor VIII (8)
99
Hemophillia B is a deficiancy of this clotting factor, and otherwise known as ___ disease
```
factor IX (9)
Christmas disease
```
100
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?
Rosenthal' syndrome
| They may often need assistance with drainage from a muscle or joint, to avoid things like compartment syndrome.
101
DDAVP can be used to treat this type of hemophillia.
type A, because it can stimulate the release of factor 8 to treat minor cuts
102
what consideration should you take in performing venipuncture on a patient with hemophillia?
direct pressure for at least 5 minutes
103
what consideration should you give for IM injections in hemophilliac patients?
don't do it, for risk of compartment syndrome
104
why is fever in an immunocompromised patient a medical emergency?
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
an immunocompromised patient could have a rip-roaring bacterial infection and the only symptom you would see is this.
Why?
Fever
| Due to deficiency of WBC, which would be the cause of all other s/s of infection
106
A child under 28 days with a fever has an increased chance of having what?
bacterial infection
| the older the child gets, the higher the chance of less serious viral infection
107
what can be said about the metabolic demands caused by a fever that affect HR and RR?
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
any fever above this degree celsius/F is known to denature the proteins of the brain and cause irreversible brain damage
41, or 105.8
109
what is the cascade of sepsis?
| 5
```
SIRS
sepsis
severe sepsis
septic shock
MODS
```
110
what does SIRS and MODS stand for?
Systemic Inflammatry response system
| Multiple Organ Dysfunction Syndrome
111
what causes redness and swelling of a localized immune response?
vasodilatation and increased capillary permeability
112
what is the difference between sepsis and severe sepsis?
severe sepsis includes the failure of one organ system
113
sepsis bundles are to include what (5) and be completed within __ hours of triage
```
serum lactate
blood cultures
broad spectrum Abx
30 ml per kg bolus for map >65, if no response try pressors
3
```
114
Anaphylaxis is similar to this due to the release of mediators into the bloodstream
sepsis
115
what are some of the treatments for anaphylaxis? (medications) (9)
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
what type of epi should you never use via IV?
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
