Third Year Saveables Flashcards
TRALI
More common in FFP and platelets
Mortality rate 5-8%!
Supportive and maybe Intubate
Hypoxia fever ARDS CXR
How do you decide inpatient vs outpatient CAP tx?
PSI score!
CAP outpatient therapy healthy and comorbids
Healthy Doxy
Co morbids: Augmentin + doxy OR Levo
Sudden onset
2 labs to order in a septic mimic?
VBg and sailicylate. ASA toxicity
Acidosis with CO2 lower than it should be (resp alk. + met acidosis) co2 should match pH levels
They can intislly be alkalemic with vomiting and resp. Alk
Always get what test in Preg VB
Type and screen for Rhogam
ASA tox treatment
Avoid HypoG Put oxygen on with good sats Replenish K Hydrate sodium bicarbonate in D5w 7.4-7.5 pH Dialysis
What kills is pulm edema and cerebral edema and renal failure
4 causes hypoxia
VQ mismatch (the common lung diseases): PNA, Asthma, COPD, Atalectasis, PE, pulmonary edema, ARDS. Corrects with supplemental O2. Shunt: deadspace (alveoli filled with pus, fluid, or blood); or cardiac defect with RL shunt. Will NOT improve with supplemental O2. Diffusion defect: interstitial lung disease or interstitial edema. Hypoventilation: resp depression, CNS injury, peripheral neuromuscular dz, chest wall rigidity Low Fi02: altitude, SCUBA system malfunction
Absolutely lymphocyte count less than 1600 should make you think about…
HIV
Saline load vs CT
CT is 100/100% ,vs 92/92% for knee saline load good p but lower power
ppx abx
rosh says ct scan is best vs saline load
40 cc is needed for elbow- not sure of CT here.
Codes things you actually shoudlnt do:
- Calcium (harmful, worse outocmes- JAMA 2021 articles)
- bicarb (harmful, worse outcomes)
- Intubate (really just need oxygenation)
- atropine
when do you shock asystole
US shows a quivering heart (asystole is dead heart) and it is fine v fib - shock it
tourniquet on finger which is too tight?
Digital block
use a cutting needle (look to see if conventional or reverse cutting)
Food impaction tx
Don’t use glucagon for vomiting against a closed tube
Nitro paste works!
Secretions a lot of them is a sign, if it stops then there is partial passage. Then GI scope maybe
CHF risk factors for poor prognosis
hyponatremia, poor renal function, hypoalbuminemia, and congestive hepatopathy or elevated liver enzymes.
why low plt in liver disease?
Portal hypertension leads to splenomegaly, which causes platelet sequestration and is the largest contributor to thrombocytopenia.
ptosis ddx
bells stroke MG brain aneyrusm horners
thyroid dz with eye pain
watch out for conreal ulcer
dacroadenitis is
inflammation of lacrimal gland above the eye- usually viral
2 month old with purpleish outpouching above eye
think a deep hemangioma (treat with BB)
BP necessary for pre-E PP
150-160 or 110 DBP
usually with headache
then get labs and urine and think mag and admit
What clinical tool should you use for liver stuff?
Meld for chronic
Kings college for transfer in acute liver failure for transplant eval
Headache, CTA neg within 6 hours, small aneurysm tho…
Have to do LP
Do do eacharatoty unless you have electrocautery
Unless on the chest and HD unstable - transfer for it or only do if loss Doppler pulses
Bowel Obstructions 3 6 9 rule (Small, larhe, cecal on CT)
SBO usually resolve on own, valvuale (stair step and pearls on a string)
LBO (diverticuli can cause it)- surgery usually, half way haustra on KUB
Cant miss volvulus, closed loop obstructions
Admit, hydtae (not all routine NG and abx, case by case for bad casses)
isolated elevated AST and abd pain, net CT…
Think cardiac, AST also released in cardiac damage
Lactate sensitivity in mesenteric ishcmeia
48% of Mes Ischemia normal - does not rule out
CT findings: thickened/edema bowel wall, new ascites
Think possible mesenteric ischemia, early findings (reg CT w/ contrast sensitivity is 70-90%)
Now htink Surgery consult or CTA
Smart trial/salted, LR vs NS
Basic balanced crystallioids nnt 94, 5 percent mortality ARR for 90 day mortality especially beneficial in sepsis, much better than NS
Remember: LR more hypotonic than plasmalyte- don’t give it in head injuries but otherwise pretty equal. No trial looking at the two of them
Valvular emergency
Don’t expect to hear a murmur, pressure between LV aorta the same - keep on ddx for SOB CP-
From dissection, endocarditis, trauma
Don’t use BB
Reduce aftelad nitropussy
Hypotensive= dobutamine
Surgery consult *
Avoid intubation, bipap (increased Intra thoracic pressure)
Avoid levo (up after road) avoid nitro (decrease preload)
More ways to screw it up than go right
Kids sedations adjuncts to decrease slaivation
atropine, glucorpyrralte
can sedate for an exam if needed
Refractory migraine/headache in Female <40 yo, some neck pain, partial hroner, HA
Cartoid artery dissection - repeat imaging if not imrpovong - it is more common than you think
Post T&A bleed
TXA, epi soaked gauze, sedate the kid if needed, once you stabilize, intubate (secondary hemorrhage adter herald dbleed), mcgill foreceps with gauze and hold pressure and leave tail outside the mouth. be prepared for needle cric
BRB in diaper for kid…
Think omnicef, looks like tomato sauce, if neg bedside test can go home
What do you do if you want a cath and cardiologist doesn’t?
Heparinize them, admit for serial ekgs/trop
5 deadly withdrawals
Alcohol Bacolfen Benzo Barb Clonidine
UAs
- look at Antibiogram
- In order E coli, Enterobacter, Proteus,
- MAcrobid good for E coli, bad for everything else, Keflex good, Augmentin good
- Cefdinir For outpatient pyelo
- Realize what rules in and rules out on UA (Nitrite IN, if no WBC helps rule out, 8 squames cut off (a urine culture still good)
evidence behind bicarp for renal dysfunction acidosis
No mrotlaity benefit but does help (ICU septic patient mostly) - Good to go for it
AKI + edema
Pulm inovlvement: 1 mg/kg lasix
if not, think albumin possibly vs Give fluids fo rkidneys
Who do you scan with AKI?
UA normal PVR normal AKI doesnt get better with fluids Hydronephrosis b/l =badness within belly
Do you need to wake up nephrologist voernight for AKI patient needing CRRT?
STARRT - AKI trial:
Ealry vs late CRRT no difference in outcomes (6 hours vs 18 or so hours)
*you can wait
AEIOU for dilausis
What is the dilayzable ingestion?
I STUMBLED INZD, iso alcohol salicyaltes theophylliine URea Methaniol BArbs lithium Ethylene glycil Depakote, dabitgratran
bleeding fistual steps
direct pressure 5-10 mins>
Surgicell, combat gause with it
Protamine 10-20 mg or DDAVP
Last line is figure of 8
If life threatening: toruiquet and vascular consult- graft is done tho
DASS or steal syndrome is poor flow and inschemic limb- vasc consult
Fisutla problems
thinks thrombosis or stneosis needs fisutlagram and vasc surgery consult
Type 4 rash DDX
usually days to weeks later
Morbilliform drug eruoptions (95%) (many diff presentations)
SJS
AGEP (single drug, 24 hours later, can have mucous membranes)
DRESS
Photosensitivity allergic reaction after a drug (PMLE is similar but unknown trigger after light exposure)
rash emergencies DDX
Morbilliform drug eruoptions SJS AGEP DRESS Photosensitivity allergic reaction HIV MONO RMSF 2nd syphilis SCAR Subacute cutaenous Lupus Erythema (upperchest/arms and up) acute cutaneous lupus (systmic lupus flares)
rash red flags
pain mcuousa hgih fever blisters ertyehderma immunosuppressed purpura
Infection, drugs, autoimmune stuff
AKA
Does not need ketones in urine (measures acetoen not beta hydoybtyrate)
order beta hyroxybutyrate to confirm if needed
if not gettign better think toxic alcohols
Think in an older person, hihg ethnaol [ ] , and HIGH anion
osmol gap and anion gap graph
know the graph, understand the time frame and that you may not see the osmol gap if they ave had tiem to metabolize and turn it into an anion gap ongoing acidosis (lactate will continue to rise too!) and you cant explain thin ktoxic alcohol SI attempt and call tox and think fomepizole
