TEST 2 Flashcards
RBC transfusions
-<7 - transfuse
->10 - transfuse if actively bleeding
-7-10 - transfuse if MI, hemodynamic unstable, cardio & respiratory sx
-CAD and unstable non-cardiac surgery- 8
-GI and ICU- 7
-cardiac surgery- 7.5
-chemo-7-8
-palliative as needed
-1 unit = 500mL = 1 hmg
-leukoreduced to prevent worsening fever or CMV
-do not transfuse- Heparin induced thrombocytopenia and Thrombotic Thrombocytopenia Purpura
forward and reverse matching
FORWARD- detect ANTIGEN
-3 tubes of of recipients blood
-add antibody A, B, and Rh antigens
REVERSE- detect ANTIBODIES
-add serum to
platelet transfusion indications
-10,000 for adult
-50,000 for neonate
-30,000 for bleeding or minor procedure
-50,000 for intraoperative or postop bleeding
-100,000- cardiopulmonary bypass
-DO NOT TRANSFUSE- if platelets are low due to excessive bleeding -> purpura, heparin induced thrombocytopenia
FFP transfusion indications
-INR >= 2 - bleeding or bedside procedure
-INR > 10 - prophylaxis
-FFP NOT indicated < 1.5
-high INR in cases of coagulopathy, warfarin, liver failure
-indicated for massive bleeding
cryoprecipitate transfusion indications
-dysfibrinogenemia
-fibrinogen <100
-von willebrand disease
-disseminated intravascular coagulation
blood products that need to cross matched / ABO grouped
-ABO MUST: FFP, RBC, granulocytes
-ABO preferred: platelets, cryprecipitate, plasma
-cross match must: RBC, FFP, granulocytes
neutropenia
-can transfuse granulocytes to neonates not mounting a response to infection
-not really dont anymore bc we have injections
->1500 -no risk
-1500-1000- fever managed outpt
-500-1000- some risk, either or
-200-500- significant risk -> inpatient with antibiotics
-<200- inpatient parenteral antibiotics -> no signs of infection!
transfusion complications
-1st complaint- back pain
-rash, temperature, aches, chills
-tachycardia, HTN, tachypnea, oliguria
-blood in urine
-hot around entry point
-hemolytic transfusion- immune rxn
-2 wide bore IVs in separate arms
-stop transfusion in reaction arm -> start other arm
-other arm- benadryl, tylenol, lasix
-if reaction STOP and disconnect -> only put saline in suspected infection arm
-monitor vitals every 5 mins
-aggressive steroids therapy
-acute hemolytic rxn -> respiratory measures
-look for hemolysis -> urine, labs
-send tubing to lab to find out what happened
type 1 diabetes testing
-autoantibodies
-pancreatic autoantibodies
hyperthyroid: graves, toxic multinodular goiter, toxic adenoma, thyroiditis, painless thyroiditis
GRAVES DISEASE
-autoimmune -> TSH receptor antibodies
TOXIC MULTINODULAR GOITER
-Less severe
-Normal to high radioactive uptake
-Iodine localized to active nodules
-hot nodule -secreting T3 and T4
TOXIC ADENOMA
-Adenoma that secretes thyroid hormone
-Radioactive uptake local to adenoma
THYROIDITIS
-Viral infection
-Eventual return to normal
-NO radioactive uptake
-Can progress to hypothyroid after inflammation
PAINLESS THYROIDITIS
-Drug reaction
-Low TSH, elevated Free T4 & T3
-LOW radioactive uptake
hypothyroid: hashimoto, infants
-infant- cretinism
-hashimoto thyroiditis- high anti-TPO
ATCH
-aka corticotropin
-regulates glucocorticoids and mineralocorticoids
-stimulates- stress, infection, trauma, exercise, hypoglycemia
renin, aldosterone
-stimulates- low volume, low Na, low pressure
-aldosterone- sodium retention and water resorption, excretes potassium
-hyperaldosteronism- HTN, hypervolemia, low K
-hypoaldosteronism- low blood volume and Na
cushing syndrome, disease
-excess cortisol
-cushing disease- (pituitary adenoma)- high ATCH and cortisol
-cushing syndrome- (lung adenoma)- high ATCH and cortisol
-adrenal cushing syndrome- (adrenal tumor)- low ATCH and high cortisol
-low dose dexamethasone (cortisol-like) suppression test
-normally should suppress ATCH, but in cushings it does not
-cortisol testing- 24 hour urine
addisons
-adrenal insufficiency
-bolus of ACTH given -> no rise in cortisol
adrenal medulla
-2 min half life of catecholamines
-24 hour urine
-pheochromocytoma- chromaffin cell tumor
-measure plasma metanephrine or urinary
-then find tumor
primary and secondary parathyroid
-Excess PTH, high Calcium
-Kidney stones, HTn, polyuria, constipation, depression, neuromuscular dysfunction, recurrent pancreatitis, osteopenia
-Parathyroid adenoma
-Hyperplasia
-Carcinoma
-Work Up: Calcium, PTH & phosporus*
-bone (osteoporosis), groans (muscle ache), moans (GI upset), kidney stones, psychiatric undertone
-high vitamin D, Ca reabsorption, bone resorption
-secondary:
-chronic hypocalcemia
-high PTH and low Ca
-renal ds or vit D deficiency
hypoparathyroidism, pseudohypoparathyroidism
-MC with unintentional removal with thyroid surgery
-numbness, tingling, low serum calcium levels, muscle spasms, convulsions
-PTH low and Ca, phosphorus is high
-pseudohypoparathyroidism- resistance to PTH
-high PTH, low Ca
-no response in presence of PTH
GH stimualtion
-sleep, exercise
-hypoglycemia
-stress
ADH
-stimulation- increase in osmolarity
-ADH causes vasoconstriction, increase BP, volume, water retention
-neg feedback with atrial natriuretic peptide
lipid screening
-if high risk ASCVD present (multiple major events) -> max dose statin with ezetimibe or PCSK9-1
-If low risk ASCVD -> high-moderate dose statin
NO ASCVD (40-75yo)
-LDL > 190 - max dose statin with ezetimibe or PCSK9-1
-LDL < 70 - assess lifetime risk
-LDL 70-189:
-with DM - moderate statin IF MULTIPLE RISK FACTORS (50-75) high dose statin
-no DM:
->20% risk- high dose statin
-7.5-20% risk- moderate statin
-5-7.5%- lifestyle with possible moderate statin
-<5%- lifestyle and risk discussion
-@ threshold repeat 3 years
-WNL- repeat 5 years
-repeat lipids and LFTs at 6 weeks med mark
framingham score
-Gold standard for CV risk
-HDL is only protective factor
-total cholesterol
-age
-gender
-smoker
-HTN
-HDL
-DM
HDL
->60 HDL reduces risk
triglycerides
-elevated in
-hypothyroidism, nephrotic syndrome, metabolic disorder, pancreatitis, toxemia
metabolic syndrome criteria
-prediabetes
-HTN- 130/85
-triglycerides- >150
-HDL <40 in men or < 50 in women
-abdominal obesity- >102cm (40in) in men ; >88cm (35in) in women
vasculitis
-antineutrophil cytoplasmic antibody, ANCA
-CRP
-ESR
-vessel bx
-inflammation of blood vessel wall -> decrease flow -> necrosis
-livedo reticularis
-purpura
-joint pain
-BLOOD- bloody stool, nose bleed, bloody cough, glomerular nephritis
-decrease vision
-stroke!!!!!!!!!!!
-MI, HTN
-primary- no cause
-secondary- infection or autoimmune
MI flow chart
-1st troponin neg ->
-HEART score >= 1 -> do another troponin in 3 hours -> if still neg reevalute HEART -> >3 -> obtain noninvasive eval for ischemia
-if HEART score 0 and pts symptoms cant be explained by noncardiac event -> do another troponin
HEART score
-Hx- high, moderate, slightly
-ECG
-Age- >65, 45-65, <45
-Risk factors
-Troponin
->7- high risk
-4-6- intermediate
-0-3- low risk
troponin
-rise/fall with acute ischemia- acute MI -> CAD + thrombosis (plaque) OR O2 supply and demand mismatch (HTN, tachyarrhythmia)
-rise/fall without acute ischemia -> acute myocardial injury (acute HF, myocarditis)
-troponin stable- chronic myocardial injury (structural heart disease, chronic kidney disease)
BNP
->400- HF with dyspnea
-100-400- echo
-<100- neg for HF
PRO-BNP (better prognostic bc accounts for LF function)
-Age <50 @ 450
-Age 50-75 @ 900
-Age >75 @ 1800
respiratory alkalosis causes
-pain
-anxiety
-drug withdrawal
-intracranial pathology
-overdoses of catecholamines, nicotine
-hypoxemia
-pneumothorax
-pneumonia
-PE
-aspiration
-interstitial lung disease
-high altitude
-right to left shunt
-hyperthyroid
-sever anemia
-pregnancy
-chronic liver disease
-paralysis
-SALICYLATE OVERDOSE**
metabolic acidosis
-MUDPILES- methanol, uremia, DKA, propylene glycol, iron or INH, lactic acid, ethylene glycol, salicylates
-Na - (Cl+HCO3)
-<12 is normal
-diarrhea
-renal tubular acidosis
-spironolactone
-addison’s disease
-saline infusion
-acetazolamide
metabolic alkalosis
-vomit
-NG suction
-laxatives
-loop diuretics
-primary mineralocorticoid excess- cushings and primary hyperaldosteronism
lights criteria and examples of each
bronchalveolar lavage fluid analysis by color
-bloody- alveolar hemorrhage
-cloudy- pulmonary alveolar proteinosis
-microscopy/biomarkers
-culture
-WBC
-gram stain
Ventilator Infections strands
-Drug Resistant:
-K. pneumonia
-P. aeruginosa
-A. Baumanii
-MRSA
ARDS
-dx- hx, CXR, CT, ABG, echo, cardio, biomarkers
-tx- O2, IV fluids, tx underlying ds
-bilateral infiltrates
-no HF or pulmonary HTN
neonatal respiratory distress syndrome
-preterm
-alveolar collapse due to lack of surfactant
-no ventilation but perfusion is present
-steroids 48hrs before birth -> allow for development of lungs
-respiratory acidosis
-lamellar body count test- fetal lung maturity in amniotic fluid
sepsis
-left shift- neutrophils (banded), leukocytosis
-syndrome of inflammatory response syndrome (SIRS):
->100.4 or < 96.8
-tachypnea (>20), tachycardia (>90)
-WBC- >12 or <4
-10% bands
-CO2 <32
-sepsis:
-2 SIRS + confirmed or suspected infection
-severe sepsis:
-sepsis + end organ damage + hypotension (<90) + lactate > 4
-septic shock:
-sepsis with PERSISTANT: end organ damage, hypotension <90, lactate > 4
lung cancer marker
-cytokeratin 19 fragments
KOH → fungal infection
NAAT → viral
Rapid antigen test → flu
-acid fast- TB
