TEST 1 Flashcards
5 ws
preop
-if taking steroids -> give vitamin A
-AMPLE
-if someones on aspirin -> give platelets
-glucose > 100 prior to surgery
-CXR if >40 or if cardiopulmonary ds
-EKG if >40
-spirometry for smoker or dyspnea
-NPO for 6 hours no liquids for 2 hrs
postop
-HTN + tachy is DVT PE unless proven otherwise
MAP
-70-100 is WNL
-60-65 for sick pts
-if too high can cause more bleeding
-use norepinephrine or phenylephrine to increase BP
-CPP= MAP - ICP
-CCP should be > 60 -> goal is 60-70
wallenberg (lateral medullary) syndrome
-vertebral artery or PICA occlusion
-stroke of the brain stem
-lateral medulla ischemia
-ipsilateral palate weakness
-impaired coordination
-contralateral sensory disturbances of trunk and extremities -> impaired gait and falls.
-Horner syndrome- decreased pupil size, drooping eyelid, decreased sweating on one side
-dizziness, double vision, pain or loss of pain on one side of the face, loss of taste on one side of the tongue, difficulty swallowing, slurred speech, and hoarseness
head injury
-SUBDURAL
-tx- airway stablization
-if midline shift >5mm, chronic, or hematoma >10mm -> surgery
-chronic subdural- MMAE
-EPIDURAL
-tx- surgery if >30ml volume, or GCS <=8 with pupillary changes
-SAH
-CT -> LP 6 hrs after if CT neg
-coil or clip
-antifibronolytic tx- transexamic acid, aminoceporic acid
-vasospasm- nimodipine
-hydrocephalus- CSF drain
craniopharyngiomas
-benign tumor
-headache, nausea, vomiting, visual deficits, endocrine disturbance
-stick to surfaces around it and reoccur often
-bimodal
-sellar/suprasellar region -> pituitary
-CT /MRI
-tx- replace hormones, transsphenoidal or transcranial surgery, radiotherapy
-adamantinomatous craniopharnygioma- kids
-papillary craniopharyngioma- adults
blood flow in brain
-internal carotids -> MCA, ACA, PCoA
-vertebral artery (PiCA branch to cerebellum) -> basilar artery -> PCA
brain injury management
-requires significant nutrition to heal
-Levetiracetam (Keppra) for 7 days -> prevents seizures
-NO anticoagulation for 48 hrs -> if stable then start DVT prophylaxis??- from high yield
-prophylactic hypothermia -> prevent secondary brain injury
-glucose- 140-160
-cefazolin- for pts with drains to prevent infection
-apixaban- Andexanet alfa (Andexxa)
-warfarin- Vitamin K and prothrombin complex concentrate (PCCs)
-heparin- Protamine sulfate
glioblastoma multiforme (GBM) on imaging & tx
-MRI
-Large mass with necrosis
-Prominent edema
-Mass effect
-Strong heterogeneous contrast enhancement
-butterfly appearance- can cross midline
-tx-
-Surgery: De bulking
-Radiation: 10 – 30 external radiation beam treatments. 1x/day; 5 days/week.
-Chemotherapy: Temozolamide (Temodal); every day during radiation therapy and then for six cycles after radiation during the maintenance phase. Each cycle lasts for 28 days, with temozolomide given the first five days of each cycle, followed by 23 days of rest.
CSF and ICP
-monitor ICP for GCS 3-8 and abnormal CT
-if CT is normal -> monitor if have 2 of following: >40yo, motor posturing, hypotension (<90)
-ICP > 22 -> TREAT
-draining CSF- continuous (not intermittent) -> drain for first 12 hrs from pts with GCS <6
-high ICP -> propofol, barbiturate, diuretics, hyperventilate them, pain management, to lower BP
-elevate the head to decrease ICP with cervical collar
-mannitol- osmotherapy for herniating pts
Bethesda scaling
-B1- non diganostic -> repeat in 4-6 weeks
-B2- benign
-B3-4- case by case basis
-B5- surgery
-B6- cancer -> surgery
toxic multinodular goiter
-plummer’s disease
-T3 toxicosis
-can cause afib, CHF
-hyperthyroidism
-can be precipitated by iodide containing drugs (contrast media and antiarrhythmic agent amiodarone -> Jod-Basedow hyperthyroidism)
-tx- RAI, subtotal/total thyroidectomy
-PTU short term if urgent
-if young- surgery
primary hyperparathyoid
-MEN1
-stones, bones, groans (PUD), psychiatric undertones
-can cause pancreatitis
-osteitis fibrosa cystica salt and pepper skull, brown tumors of long bones
-renal failure can happen
-24-hour urine calcium excretion -> used to rule out familial hypocalciuric hypercalcemia -> does NOT need resection
-Weakness, Fatigue, Polydipsia/Polyuria, Nocturia, Bone and Joint Pain, Constipation, Decreased Appetite, Nausea, Heartburn, Pruritus, Depression, Memory Loss
-DX:
-high vitamin D
-24 hours urine- calcium will be high
-dual energy x-ray absorptiometry (DEXA)
-bone scans, imaging for kidneys
-parathyroidectomy for everyone unless risks are prohibitive
thyroid storm
-a fib/shock
-hyperpyrexia
-CNS findings
-psychomotor agitation
-depression
-cardiovascular collapse
-GI dysfunction
-hepatic failure
-tx-
-PTU, methimazole
-cooling blanket
-antipyretic- (4g/day, 1g every 6 hrs)
-lugols solution- decrease iodine uptake
-O2
-beta blockers
-glucocorticoids
