Shift Flashcards
Atropine dosing
1mg IV q5min
peds atropine dosing
.01-.03mg/kg
Diltiazem dosing
.25 mg/kg IV over 2 min
repeat q15 mins at .35mg/kg IV
Diltiazem infusion
5mg/hr -> 10 -> 15
ACAT MUDPILES
alc ketoacidosis, carbon monoxide, ASA, Toluene
Methanol, uremia, DKA
Paraldehyde, iron/INH, lactic acidosis, ethylene glycol, starvation/sepsis
When do you give insulin with K+ levels in HHS
> 5 = nothing
4-5 = 20-30 mEq in 1st liter then 20 mEq/hr
3-4 = 40 mEq
<3 = hold insulin & give 10-20 mEq until >3.3
Tx for hypoglycemia
1.D5W
2. Octreotide
3. glucagon
***if adrenal insuff then give hydrocortisone
glucagon dosing
0.5-2mg IV/IM/SC
peds glucagon dosing
.03-.1
Hydrocortisone dosing
100mg IV
Dx HHS
- pH > 7.3
- BG >600
- HCO3 >15
- Serum osm >320
purpura description
non-blanchable, palpable
Venous stasis MC s/sx
pruritus
MC location of venous stasis ulcers
proximal to medial malleolus
DX osteomyelitis
MRI
Dx venous air embolism
bubble study
churning sound on auscultation of heart
air embolism
position for arterial air embolism
supine
position for venous air embolism
left lateral decubitus or trendelenburg
Pancreatitis abx
fluoroquinolone + metronidazole
Abx covering gram neg
Aminoglycosides, Monobactams, Ciprofloxacin, Cephalosporins, Carbapenems, Fluoroquinolones, Polymyxins, and Fosfomycin
abx covering anaerobes
Augmentin, Unasyn, Zosyn, Cefoxitin, carbapenems, moxifloxacin, clindamycin
abx covering MRSA
doxycycline, vancomycin, daptomycin, TMP SMX, clindamycin, linezolid, 5th gen cephalosporin
abx covering pseudomonas
Zosyn, ceftazidime, Rocephin, carbapenems, quinolones, amnioglycoside
Ranson Criteria on admission
Age >55 yr
WBC count >16,000 mm3
Blood glucose >200 mg/dL
Serum lactate dehydrogenase >350 IU/L
AST >250 IU/L
triad of Salicylate toxicity
- respiratory alkalosis (earliest sign)
- AG metabolic acidosis
- metabolic (contraction) alkalosis
Tx of Salicylate toxicity
- airway - avoid intubation
2.decontamination - charcoal vs irrigation - D5W - impairs glucose metab
- Bicarb - NaHCO3 1-2mEq/kg IV bolus; then 3amp bicarb in 1L D5W at 2-3mL/kg/hr
- dialysis
pathophys of Salicylate tox
Uncouples oxidative phosphorylation → increased metabolic rate and hyperthermia
s/sx of salicylate tox
- N/V
- resp alkalosis
- AG metab acidosis
- hyperthermia
- AMS
6.pul edema - increased pul vascularity
anaphylaxis epi dosing
.3-.5mg IM
epi cardiac arrest
1mg
push dose epi
10mg syringe with NS –> remove 1cc -> add 1cc epi
management of transient global amnesia
- Rule out CVA (clinically or with further workup)
- Neurology referral
- Once diagnosed, no specific treatment needed
s/sx of transient global amnesia
Anterograde amnesia
Unaware of their memory loss
Normal attention and social skills
Struggle with delayed recall
Periods of time typically less than 24 hrs, but typically lasts 4-6 hrs
No localizing symptoms
isopropyl metabs to
acetone
isopropyl alcohol
- AG metab acidosis
+osmolar gap
+ketones - ca ox stones
+ reduced vision
Work up for toxic alcohols
Fingerstick glucose
Complete metabolic panel
Serum ketones
Serum Osmolality
Urinalysis
VBG
Aspirin/Tylenol levels
ECG
Serum alc level
Total CK
tx isopropyl toxicity
supportive
ethylene glycol
+AG metab
+osmolar gap
-ketones
+ca ox stones
- reduced vision
tx ethylene glycol toxicity
Fomepizole, thiamine, B6, dialysis
Methanol
+AG metab
-ketones
-ca ox
+ reduced vision
tx methanol toxicity
fomepizole, etoh, folinic acid
Clinical features of CRAO
sudden, painless, monocular vision loss
Work up for CRAO
ESR & CRP, carotid US, EKG, echocardiogram
Managment of CRAO
high ESR/CRP -> start steroids & ophthalmology consult
Ativan dose for seizures
2mg
CIWA score to start benzos
8-10
management of type I AC joint injury
rest, ice, sling
ROM and strengthening exercises
management of type II AC joint injury
rest, ice, sling 3-7 days
ROM and strengthening exercises
management of Type III AC injury
rest, ice, sling 2-3 weeks
ROM and strengthening exercises
return to sport/work 6-12 weeks after injury
ortho consult within one week
Type IV & V AC joint injury
surgery; ortho consult
RSI induction agents
Etomidate
Versed
Propofol
Ketamine
etomidate dosing
0.2-0.4mg/kg
etomidate onset and duration
onset: 1 min
duration 30-60 mins
Versed dosing
0.2-0.3mg/kg
Versed onset and duration
onset: 1-2 mins
duration: 30-60 mins
propofol dosing
1-3mg/kg
propofol duration
10-15 mins
Ketamine dosing
1-2 mg/kg
ketamine duration
30 mins
RSI paralytics
succinylcholine, rocuronium, vecuronium
succinylcholine dosing
1.5mg/kg
succinylcholine onset and duration
onset: 45 seconds
duration: 4-6 mins
Rocuronium dosing
1.2mg/kg
Rocuronium onset and duration
onset: 60 seconds
duration: 25-60 mins
Vecuronium dosing
0.1mg/kg
vecuronium onset and duration
onset 60-90 seconds
duration: 65 mins
COPD exacerbation tx
CPAP/BiPAP, Duonebs (albuterol/ipratropium), steroids, magnesium, +/- abx
Tx for outpatient CAP with no comorbidities
amoxicillin or doxycycline
Tx for outpatient CAP with comorbidities (chronic heart, liver, lung, and renal disease; DM, alcoholism, malignancy, or asplenia)
Augmentin or cephalosporin + macrolide or doxycycline
Tx for inpatient CAP (non-severe)
beta lactam + macrolide OR fluoroquinolone
TX for inpatient CAP (severe)
beta lactam + macrolide OR beta lactam + fluoroquinolone
Causes of proctitis
radiation, autoimmune, vasculitis, ischemia, infectious (STI)
causes of epididymitis
STI ; e.coli, pseudomonas, TB, syphillis
tx epididymitis
STI: rocephin and doxy
STi and enteric: rocpehin and levofloxacin
only enteric: Levofloxacin
Peds: Bactrim or augmentin
Bacteria that causes cellulitis
staph and strep
COVID 19 tx outpatient
Paxlovid, remdesivir,
COVID tx outpatient or inpatient requiring new or increased oxygen
Dexamethasone
Normal vent settings
TV: 8
RR: 10-12
PEEP: 5
lung protective vent settings
TV: 6
RR:12-20
PEEP: 2-15
obstructive vent settings
TV: 6
RR: 5-8
PEEP: 0-5
Hypovol vent settings
TV: 8
RR: 10-12
PEEP: 0-5
SCAPE (sympathetic crashing acute pul edema) s/sx
rales/crackles
SBP >180
Tachycardia
Tachypnea
Tx SCAPE
GOAL: vasodilate arterial side and maintain oxygenation
BiPAP
Nitroglycerin
if dehydrated: IVF
captopril
acute post infectious cerebellar ataxia
sudden ataxia after viral infection
can be seen on MRI
onset 5-10 days after
psychogenic non-epileptic seizures tx
if new: EEG
lorazepam 1-2mg or hydroxyzine 50-100mg
psychogenic non-epileptic seizures eval
same as seizure
transient synovitis s/sx
unilat hip pain; children <10 yo; recent URI
transient synovitis eval
XR, ESR, CBC, CRP
transient synovitis tx
NSAIDs
Retropharyngeal abscess s/sx
early: sore throat, fever, dysphagia, torticollis
Late: stridor, resp distress, chest pain, drooling, neck stiffness
Retropharyngeal abscess dx
CT with IV contrast or XR soft tissues
Retropharyngeal abscess tx
ENT for I&D
clindamycin or cefoxitin or zosyn
types of supracondylar fx that needs ortho and surgery
type II & III
splint for supracondylar
double sugar tong or long arm posterior
XR findings of supracondylar fracture
anterior fat pad, posterior fat pad, and anterior humeral line
tx refractory vfib
ap pad placement
refractory vfib definition
continues after three successful shocks from a defib
Miller fisher syndrome
(GBS variant) ophthalmoplegia, ataxia, areflexia
neutropenic enterocolitis s/sx
10-14days after toxic drug (chemo), fever, RLQ pain, N/V
neutropenic enterocolitis dx
neutropenia, thrombocytopenia
CT: cecal distention, wall thickening, pneumatosis, perf, fat stranding
neutropenic enterocolitis tx
NPO, NG to suction, IVF, TPN, flagyl + cefepime or zosyn or amphotericin B
chance fx
unstable; caused by flexion distraction forces (seatbelt from MVC)
MC location for chance fx
T12-L2
chance fx tx
if no neuro deficits: immobilize
neuro deficits: surgery
ITP s/sx
petechiae, epistaxis, gingival bleeding, menorrhagia, GI bleed, intracranial bleed
ITP tx
adults: high dose steroids
peds: IVIG and steroids
tx mesenteric adenitis
only if ill: ciporfloxacin or TMP/SMX to cover for yersinia
Tx HAPE
O2, hyperbarics, nifedipine (30mg ER)
Tx of hypercalcemia of malignancy
only if s/sx or >14; fluids, calcitonin, bisphosphonates; dialysis
when do you give dialysis for hypercalcemia
Anuric with renal failure
Failing all other therapy
Severe hypervolemia not amenable to diuresis
Serum Calcium level >18mg/dL
Neurologic symptoms
Heart failure with reduced ejection fraction (unable to provide fluids)
refeeding syndrome electrolyte abnormalities
hypophos, hypomag, metab acidosis, hypokal, prolonged QT
starting BiPAP settings
IPAP of 8-10 cm H2O and an EPAP of 2-4 cm H2O.
Traditional initial mechanical vent settings
FiO2: 100%, rate: 8-12, PEEP 0-5, TV: 5-8, I:E: 1:2
LVAD complications
pump thrombosis, batteries, suction event (cannula malposition, tamponade, or vascular resistance), arrhythmia, infection, bleeding
how to measure BP with LVAD
BP cyff with doppler
Elevated LDH >1150 for LVAD patients
pump thrombosis
when to start compressions on a LVAD patient
patient is unresponsive with MAP less than 50mmHg, end tidal carbon dioxide level less than 20mmHg, or LVAD cannot be restarted
NMS presentation
AMS, hyperthermia, lead pipe rigidity (MC), tachycardia, HTN, diaphoresis
Tx NMS
benzos, IVF, cooling; +/- dantrolene and bromocriptine
NMS cause
antipsychotics or DA anti nausea
How to tell difference between NMS and serotonin syndrome
NMS has elevated CK, LFTs, and WBCs and decreased iron
serotonin syndrome presentation
clonus (MC), more acute, hyperreflexia, AMS, tremor
tx serotonin sydrome
benzos, cyproheptadine, chlorpromazine
malignant hyperthermia causes
anesthesia
malignant hyperthermia tx
dantrolene, O2, bicarb
malignant hyperthermia presentation
fever, muscle contraction (Masseter), hypercarbia
tx of asthma exacerbation
O2, albuterol, ipratropium, steroids (dexamethasone or methylprednisone), magnesium, epi (0.5mg), terbutaline,
tx lymphadenitis
abx - cephalexin, augmentin
ethylene glycol produces what stones
ca oxalate
what toxic alcohols produce reduced vision
methanol an disopropyl
what toxic alcohols produce ketones
ethanol and isopropyl
lethal triad of trauma
coagulopathy, hypothermia, acidosis
what is the shock index
HR/SBP; closer to 1 is bad
anterior shoulder dislocation on XR
displaced medially and overalying glenoid
posterior shoulder dislocations on XR
light bulb sign, loss of half moon, trough sign
ABI formula
SBP ankle/SBP brachial
ABI values
<0.4 = severe occlusion
.4-.69 = moderate occlusion
0.7-0.9 = mild occlusion
0.91-1.30 = NORMAL
>1.30 = calcified vessels
why use delayed sequence intubation
to help pre-oxygenation; use ketamine 1-2mg/kg
PAC
abnormal early p wave; can precipitate Afib, Aflutter, or SVT
underlying conditions with PACs
chronic heart disease, chronic lung disease, and drugs: cocaine, amphetamines, caffeine, nicotine, and digoxin
PVCs
broad QRS
causes of PVCs
anxiety, sympathomimetics, beta agonists, caffeine, hypokalemia, hypomag, digoxin, MI
three or more PVCs with HR >100bpm
non sustained VT
premature junctional complex
narrow QRS without preceding p wave or retrograde p wave
constipation tx
docusate (emollient), senna/Bisacodyl (stimulant), mag citrate (saline laxative, lactulose (hypersom), enema (fleet vs soap sud)
constipation work up
CBC, CMP (hypokalemia and hypercalcemia), LFTS + lipase
TSh if hypothyroid
lactate if stercoral colitis concern
stercoral colitis
inflammatory colitis that causing increased intraluminal pressure from impacted feces; can cause ulceration/necrosis/perforation
stercoral colitis CT findings
free air
stercoral colitis tx
IVF, IV rocephin + Flagyl, surgical consult , can be non-surgical if no bowel perf or ischemia
Hard signs of neck trauma
airway compromise, air bubbling, expanding hematoma or pulsatile hematoma, active bleeding, shock , hematemesis, neuro deficits, or absent radial pulses
which neck zones will CNs be injured
zone 2&3
which neck zone will esophagus be injured
zone 1&2
which neck zone will the subclavian artery and vein be injured
zone 1
clinical features of PAD
shiny, hyperpigmented skin, hair loss, cap refill >3 seconds
PAD eval
ABI, CTA
PAD eval
manage outpatient
phlegmasia albs vs cerulea
alba: white leg, acute
cerulea: painful, blue, edema -> can progress to gangrene and high risk for PE
does hypothyroidism cause anemia
yes: decreased receptors on BM
hereditary spherocytosis labs
increased MCHC, spectrin def
why does renal failure cause anemia
decreased EPO production
lab findings of lead poisoning
basophilic stippling, increased free erythrocyte protoporphyrin
adams13 function
cut vWF into smaller units to prevent clotting
TTP
decreased adams13; hypercoag
vWF disease
increased adams13; destroy vWF
anagrelide moa
inhibits megakaryocytes from making platelets
bernard soulier disease
defective gp1B; floating large mass of platelets that cannot anchor
glanzmans disease
defective gp2B3A; platelets cannot bind together
ADP2 receptor inhibitors
clopidogrel; stops the creation of gp2B3A
ITP tx
STEROIDS, ig THERAPY
ITP presentation
two weeks after URI; increased BT
TTP pentad
purpura, fever, renal failure, neuro changes, hemolytic anemia
TTP smear
schistocytes
autoimmune thrombocytopenia tx (under 40k)
steroids
autoimmune thrombocytopenia tx (under 20k)
plasmapheresis or IVIG
intrinsic clotting system lab value
PTT
Extrinsic clotting system lab value
PT
thrombin inhibitors
agatroban, dabigatran, biluvaridin
direct xa inhibitors
apixaban
tx HIT
24-28 hrs: obs
>5 days: stop heparin, start thrombin inhibitor or xa inhibitor
LMWH
enoxaparin aka lovenox
heparin metabolism
hepatic
LMWH metabolism
renal
monitor heparin with
PTT
monitor warfarin with
PT/INR
vitamin k affects which factors
X,IX, VII, II, proteinC, protein S
vWF disease lab values
elevated PTT and BT
tx vWF disease
mild: DDAVP
mod: cyroprecipitate (8, 5, vWF, and fibrinogen)
severe: FFP
tx hemophilia A
mild: DDAVP
mod: cryoprecipitate
Severe: factor 8
tx hemophilia B
FFP
tpa reversal
aminocaproic acid
tx polycythemia rubra vera
NS+ASA+anegrelide
anterior mediastinum cancers
thymus, thyroid, t cell leukemia/lymphomas, teratomas
kidney transplant rejection s/sx
HTN + decreased UOP; increased creatinine
kidney transplant complications
renal artery stenosis, renal vein thrombosis, fistula, pseudoaneurysm, ureteral obstruction
liver transplant rejection s/sx
malaise + ab pain; jaundice + increased LFTs
complications of liver transplant
thrombosis of portal vein or hepatic artery, biliary obstruction, bile leak, biliary stricture, hemorrahge
lung transplant rejection s/sx
diff breathing +xr infiltrates
cardiac transplant rejection s/sx
dyspnea+ palpitations+ arrhythmia +/- syncope
does atropine work for heart transplants
no; no vagus nerve
corneal transplant rejection s/sx
pain + injection + decreased visual acuity
discriminatory zone of intrauterine sac on US
1500 to 2000 mIU/mL
causes of cardio syncope
WPW, long QT, brugada, catecholaminergic polymorphic ventricular tachycardia, sick sinus, arrhythmogenic right ventricular dysplasia
catecholaminergic polymorphic ventricular tachycardia
7-9 yo; intracell calcium dysregulation; polymorphic vtach -> syncope/presyncope, palpitations, death
what is catecholaminergic polymorphic ventricular tachycardia induced by
exercise, emotional stress, physio stress
tx catecholaminergic polymorphic ventricular tachycardia
IV beta blockers; at home nadalol, flecainide, verapamil
arrhythmogenic right ventricular dysplasia
fibro-fatty infiltrate of R vent
hemolytic anemia labs
low hgb, low hemocrit, reticulocytosis, elevated indirect bilirubin
intravascular hemolysis (cold -> IgM)
high LDH, low haptoglobin, hemoglobinuria
intravascular hemolysis causes
mycoplasma pneumo, MM, idiopathic
extravascular hemolysis (Warm -> IgG)
in spleen -> hemolysis -> unconjugated -> conjugated hyperbili
tx warm hemolytic anemia
plasmapheresis if severe
tx cold hemolytic anemia
prednisone, plasmapheresis, transfuse RBCs
meningitis tx for neonates
ampicillin, gentamicin, vanco
meningitis tx for 1 month - 50 yo
Rocephin, vanco, acyclovir
meningitis tx for >50 yo
rocephin, vanco, ampicillin
meningitis tx for post procedural or penetrating trauma
vanco, cefepime
ampicillin covers for
listeria
dic tx
tx underlying illness; fibrinogen, platelets, FFP, vit k, folate, heparin
vitamin k dosage for warfarin
100mcg
lovenox reversal
protamine
indication for surgery for acute sdh
hematoma >10mm thick
midline shift >5mm
GCS <9 or 2 point decrease from injury to admission
ICP >20
asym or fixed pupils
lethargy or mental status changes
neurogenic shock tx
IVF and NE; may add phenylephrine
lab values of tumor lysis syndrome
hyperuricemia, hyperkalemia, hyperphos, hypocal, ARF
dialysis criteria for tumor lysis syndrome
Potassium >6
Significant renal insufficiency (Creatinine >10)
Uric Acid >10
Symptomatic hypocalcemia
Serum phosphorus >10
Volume overload
CT imaging of typhlitis
cecal distention, wall thickening, pneumatosis intestinalis, intestinal perforation, fat stranding
tx typhlitis
bowel rest, NG, IVF, TPN, consider GCSF (for neutropenia)
abx: flagyl + cefepime or zosyn or amphotericin B
calcium gluconate dosage for hyperk
1g
insulin/dextrose dosage for hyperk
insulin : 10 units
dextrose: 50g
albuterol dosage for hyperk
15-20mg
furosemide dosage for hyperk
40-80mg
Lokelma dosage for hyperk
10mg TID
hypokalemic periodic paralysis
muscle weakness (can be painful)
strenuous exercise, high carb meal, high sodium meals, suden change in temp, emotional stress
hypokalemic periodic paralysis physical exam
decreased reflexes, shoulder/hips involved most often, no myoclonus or spasticity
hypokalemic periodic paralysis tx
replace k, propranolol
thyrotoxic periodic paralysis
mc in males and asians
painless weakness, lasts hours to days, proximal muscles > distals, hyporeflexia
hemolysis bilirubin levels
total: increased
direct: -
liver disease bilirubin levels
total: increased x2
direct: increased x2
obstruction bilirubin levels
total: increased x3
direct: increased x3
cirrhosis bilirubin levels
total: increased
direct: increased
tx crigler nijjar
phenobarbital
