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Step 2 DIT 😱 > Treatments 2 > Flashcards

Treatments 2 Flashcards

1
Q

Burns

A

1st/minor 2nd degree - outpatient, antimicrobial agents (topical silver sulfadiazine or bacitracin)
2nd >10%, 3rd >2%, 2nd/3rd on hands, face, genitalia, major flexion areas - inpatient
2nd/3rd >25% or face - airway management

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2
Q

Drowning

A

Airway, supplemental O2, NG tube, maintain temp, admission for any symptoms of hypoxia

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3
Q

Choking

A

Active coughing
Heimlich if unable to breathe
Emergency tracheotomy if continued obstruction
Bronchoscopy for visualization and removal (IV corticosteroids first may decrease inflammation)

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4
Q

Heat exhaustion

A

Hyrdation, electrolyte replacement

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5
Q

Heat stroke

A

Cool patient, benzos if seizures

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6
Q

Hypothermia

A

Warm patient, treat arrhythmias/hypotension as needed

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7
Q

Snake bite

A

Immobilize extremity
Clean wound
Antivenin

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8
Q

Scorpion bite

A

Antivenin

Atropine / phenobarbital for symptoms

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9
Q

Black widow bite

A

Local wound care
Antivenin
24 hr observation for systemic symptoms
Benzos if symptoms

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10
Q

Brown recluse bite

A

Local wound care
Dapsone to prevent necrosis
Oral erythromycin if infx

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11
Q

Dog/cat bite

A

Irrigation
Tetanus and rabies prophylaxis
Antibiotics if infx
Leave open on arm/hand, cat bite; close on face

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12
Q

Human bite

A

Irrigation

Antibiotics (amoxicillin-clavulanate)

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13
Q

PUD

A

+H pylori: amoxicillin + clarithromycin + PPI

-H pylori: PPI/H2 blocker

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14
Q

BPH

A

Alpha 1 blockers (doxazosin, tamsulosin)
5-alpha reductase inhibitors (finasteride)
Possible surgery

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15
Q

Atherosclerosis

A 
Prevention
Stop smoking
Control HTN
Control hyperglycemia
Control hypercholesteremia (statins, also have anti-inflammatory properties and stabilize plaques)
Diet low in fat and cholesterol
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16
Q

Lower LDL

A

Statins (best)
Ezetimibe
Bile acid resins
(Fibrates)

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17
Q

Lower TG

A

Fibrates
Omega 3 FA
Statins (minor)

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18
Q

Raise HDL

A

Niacin

Statins (minor)

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19
Q

Stable angina

A 
Sublingual nitro (peripheral venous vasodilator, reduces preload, reduces myocardial O2 demand)
Also helps esophageal pain (GERD, spasm)
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20
Q

Prinzmetal angina (arterial vasospasm)

A

CCB (either type)

also nitrates

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21
Q

Unstable angina, acute

A 
ABCs
MONA (O2 only in hypoxemic patients)
BB (if no heart failure; careful in COPD, asthma, DM)
Statin (preferably before PCI)
Antiplatelet therapy
Anticoagulant therapy
K>4, Mg>2
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22
Q

Unstable angina, home

A

BB, ASA, nitroglycerin, statin, antiplatelet (1-12 months), ACE/ARB (DM, CHF, HTN)

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23
Q

Unstable angina, nonresponsive to medications

A

PTCA (balloon catheter w/ or w/o stent)

NO fibrinolysis

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24
Q

Indications for CABG

A

Left main stenosis >50%
Three vessel disease
Hx CAD and DM

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25
Q

MI, acute

A 
MONA
Anticoagulant (heparin/LMWH)
BB
Statin
Antiplatelet
K>4, Mg>2
PCI if possible (use LMWH, add Gp IIb/IIIa inhibitor to AP)
If no PCI available w/i 12 hrs, consider fibrinolysis w/ tPA (must be w/i 12 hrs, sooner is better)
Cath to see if PTCA/CABG needed
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26
Q

MI, home

A 
ASA or clopidogrel
BB*
ACE*
Aldosterone antagonist
Statin*
*Improve mortality
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27
Q

Dressler syndrome

A

NSAIDs or ASA

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28
Q

1st degree heart block

A

None

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29
Q

2nd degree heart block, Mobitz type I (Wenckebach)

A

Adjust medication dose
None
Symptomatic bradycardia, maybe pacemaker

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30
Q

2nd degree heart block, Mobitz type II

A

Pacemaker (can progress to 3rd degree)

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31
Q

3rd degree heart block

A

Pacemaker

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32
Q

PSVT, AV nodal reentry

A

Carotid massage, Valsalva maneuver
DOC: IV adenosine (6 mg, 12 mg, 12 mg)
Cardioversion or CCB for hemodynamic instability
BB or CCB for long-term symptomatic patients

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33
Q

PSVT, Wolff-Parkinson-White syndrome

A

Carotid massage, Valsalva maneuver
DOC: IV adenosine (6 mg, 12 mg, 12 mg)
Cardioversion or CCB for hemodynamic instability
1A or 1C antiarrhythmic or catheter ablation for long-term symptomatic patients

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34
Q

MAT

A

CCB (NDP, verapamil/diltiazem) or BB
K >4, Mg >2
Catheter ablation or surgery if needed

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35
Q

Bradycardia

A

Stop precipitating medication
IV atropine
Pacemaker if severe

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36
Q

AFib

A

Anticoagulation
Rate control (BB/CCB, digoxin) or rhythm control (Class III)
Synched cardioversion if <48 hrs
Look for thrombus with TEE
If over 2 days or thrombus seen, anticoagulate and wait 3-4 wks before cardioversion
AV nodal ablation for recurrence

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37
Q

AFlutter

A

Rate control (BB/CCB)
Electrical or chemical cardioversion if can’t control w/ medication
Catheter ablation may be possible

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38
Q

Chemical cardioversion

A

Class IA, IC, III antiarrhythmics

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39
Q

PVC

A

None if healthy

BB if patient w/ CAD

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40
Q

VTach (w/ pulse)

A

Rapid infusion amiodarone (first line)
Or procainamide/sotalol
Synched cardioversion if no drugs available
Internal defibrillator may be needed for recurrent

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41
Q

Torsades de pointes

A

Magnesium (large rapid IV bolus)

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42
Q

VFib, VTach (pulseless)

A

CPR, immediate electrical cardioversion (360J) Q2 min
Epinephrine 1 mg Q3-5 min [NO max dose]
Vasopressin 40 un in place of 1st/2nd dose epi
Consider amiodarone 300 mg IV then 150 mg IV
Consider Lidocaine 1-1.5 mg/kg up to 3 mg/kg total

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43
Q

Unresponsive patient w/ pulse

A

Resuce breathing (1 breath Q5-6 sec)

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44
Q

Unresponsive patient w/o pulse

A

CPR 30:2

Check rhythm

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45
Q

PEA/Asystole

A

CPR 30:2
Epinephrine 1 mg Q3-5 min [NO max dose]
Vasopressin 40 un in place of 1st/2nd dose epi
Evaluate and treat causes (H&Ts)

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46
Q

PEA/Asystole caused by Hypovolemia

A

Rapid volume resuscitation through multiple IVs or central line

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47
Q

PEA/Asystole caused by Hypoxia

A

Intubation, chest tube or oxygen

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48
Q

PEA/Asystole caused by H ions (acidosis)

A

IV push 1-2 amps bicarb

Common in prolonged code

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49
Q

PEA/Asystole caused by Hyperkalemia

A

CaCl2 IV push
Bicarb, Insulin/glucose to push K into cells
(Common in prolonged code from acidosis)

50
Q

PEA/Asystole caused by Hypokalemia

51
Q

PEA/Asystole caused by Hypoglycemia

A

(Always check finger stick)

1 amp D50 IV push

52
Q

PEA/Asystole caused by Hypothermia

53
Q

PEA/Asystole caused by Tamponade

A

Pericardiocentesis

54
Q

PEA/Asystole caused by Tension pneumothorax

A

Needle decompression then chest tube

55
Q

PEA/Asystole caused by Thrombosis (MI)

A

Cardiac cath or thrombolytic

56
Q

PEA/Asystole caused by Thrombosis (PE)

A

Thrombolytic or thrombectomy

57
Q

PEA/Asystole caused by Trauma

A

Follow ATLS protocols (ABC, etc)

58
Q

CHF, acute exacerbation

A 
NO LIP
Nitrates (dilate veins>arteries, work faster than diuretics)
Oxygen (if hypoxemic)
Loop diuretics
Inotropes (last resort)
Positioning (feet down to clear lungs)
59
Q

CHF, chronic outpatient (mortality vs symptoms)

A 
Improves mortality
- ACE, some ARB
- BB (bisoprolol, carvedilol, ER metoprolol)
- Spironolactone/eplerenone
Symptoms
- Loop diuretic
- Digoxin
- VD if also needed (isosorbide dinitrate reduces preload, hydralazine reduces afterload)
60
Q

Progressive chronic CHF

A

May need biventricular pacing or cardiac resynch therapy (pacemaker at EF <35% for 3 months)
May need cardiac transplant

61
Q

Acute pericarditis

A

Treat underlying cause
NSAIDs for pain, inflammation
Pericardiocentesis for large effusions

62
Q

Chronic constrictive pericarditis

A

NSAIDs, colchicine, corticosteroids

Surgical excision of pericardium (high mortality)

63
Q

Cardiac tamponade

A

(Dx w/ echo)

Immediate pericardiocentesis

64
Q

Hypertrophic cardiomyopathy

A

BETA BLOCKERS

CCB, pacemaker, partial septal excision

65
Q

Dilated cardiomyopathy

A

Treat like heart failure

Diuretics, ACE, BB, AC

66
Q

Restrictive cardiomyopathy

A

Treat underlying cause

Palliative treatment for heart failure

67
Q

Myocarditis

A

Treat infection / stop offending medications
Avoid exertional activity
Treat heart failure symptoms

68
Q

Acute rheumatic fever

A

NSAIDs for joint inflammation
Corticosteroids if severe carditis
B-lactam if GAS infection still present

69
Q

Endocarditis

A

Long term IV antibiotics (4-6 wks) (B-lactam plus aminoglycoside like ceftriaxone + gentamicin, maybe also vancomycin for MRSA)
Antibiotic prophylaxis before surgery or dental work
Valve replacement if severe valve damage

70
Q

Antibiotic prophylaxis for endocarditis

A

2 gm amoxicillin 30-60 min before procedure (nothing after)

71
Q

HTN emergency

A

Rapidly reduce diastolic BP to 100 mmHg (use IV anti-HTN, also start oral BB/ACE)
- Should not drop more than 25% in first 2 hrs (to avoid triggering ischemic event)
DIuretics to reduce pulmonary edema if needed

72
Q

HTN, initial

A

Lifestyle (weightloss, exercise, salt restriction, alcohol reduction)
Thiazide diuretic unless comborbid C/I

73
Q

HTN secondary to renal disease

A

ACEi (delays progression)

  • C/I if acute renal failure (can accelerate)
  • C/I if bilateral renal stenosis
  • C/I if hyperkalemia (can worsen)
74
Q

Renal artery stenosis

A

Angioplasty, stent placement, surgical repair

ACEi if one sided

75
Q

Aortic coarctation

A

Surgical repair

76
Q

HTN + DM

C/I

A

ACE
(+/- Thiazide diuretic, impaired glucose tolerance)
(+/- BB, can mask hypoglycemia symptoms)

77
Q

HTN + CHF

C/I

A 
ACE/ARB
Aldosterone antagonist
BB
(NDP CCB, can exacerbate by reducing rate/contractility)
(BB during acute exacerbation)
78
Q

HTN + Post-MI

A

BB
ACE/ARB
Aldosterone antagonist

79
Q

HTN + BPH

A

alpha-1-blocker (-zosins)

80
Q

HTN + migraines

A

BB (or verapamil)

81
Q

HTN + osteoporosis

A

Thiazide diuretic

82
Q

HTN + Asthma/COPD (C/I)

A

Non-selective BB

83
Q

HTN + Pregnancy

A 
Hydralazine
Methyldopa
Labetalol
Nifedipine
(+/- Thiazide, esp starting; mild hypovolemia at start)
(ACE/ARB, teratogenic)
84
Q

HTN + Gout (C/I)

A

(Diuretic, increase serum uric acid)

85
Q

HTN + Depression (C/I)

A

(BB, can worsen symptoms)

86
Q

HTN + LVH

87
Q

HTN + Hyperthyroidism

A

Propranolol

88
Q

HTN + benign essential tremor

89
Q

HTN + post-menopausal woman

A

Thiazide (increase calcium)

90
Q

HTN + Prinzmetal angina

91
Q

HTN + AFib or SVT

92
Q

HTN + esophageal spasm

93
Q

Nonhemolytic febrile transfusion rxn

A

Acetaminiophen

94
Q

Acute hemolytic transfusion rxn

A

Aggressive supportive care

95
Q

Delayed hemolytic transfusion rxn

A

No acute therapy needed; determine responsible Ab type to prevent future rxns

96
Q

Anaphylactic transfusion rxn

A

Epinephrine, volume maintenance, airway protection; use extra washed blood products next time

97
Q

Minor allergic transfusion rxn

A

Diphenhydramine

98
Q

Post-transfusion purpura

A

IVIG or plasmapheresis

99
Q

DOC in septic shock

100
Q

DOC in anaphylactic shock

A

Epinephrine

101
Q

DOC in cardiogenic shock

A

Dobutamine

102
Q

AAA

A

Monitor w/ US q6 months if 0.5 cm in 6 months or symptomatic

103
Q

Aortic dissection

A

BB (nitroprusside second choice) to stabilize BP
Stanford A - emergency surgery
Stanford B - medical management

104
Q

PVD/PAD

A

Smoking cessation, glucose/BP control
Daily exercise to increase collateral flow
Cilostazol (arterial VD) or pentoxifylline (+RBC flexibility)
ASA/clopidogrel; Statin
[cardiac stress test prior to surgery]
PTA for failed medical management, significant disability from claudication
Bypass grafting if incapacitating claudication, resting foot pain, necrotic foot lesions
Limb amputation for prolonged ischemia

105
Q

Varicose veins

A 
Weight reduction, leg elevation
Compression stockings
Sclerotherapy
Thermal ablation
Surgery w/ venous ligation
106
Q

AVM

A

Surgical removal or sclerosis if symptomatic or located in brain or bowel

107
Q

DVT

A

Leg elevation
Heparin then warfarin
IVC if c/i to AC

108
Q

Polyarteritis nodosa

A

Corticosteroids, immunosuppressants

109
Q

Temporal (giant cell) arteritis

A

High dose prednisone 1-2 months then taper
Low dose ASA
Vitamin D, calcium supplementation

110
Q

Takayasu arteritis

A

Corticosteroids, immunosuppressants

Bypass grafting if needed

111
Q

Allergic granulomatosis w/ angiitis (Churg-Strauss)

A

Corticosteroids, immunosuppressants

112
Q

Henoch-Schonlein purpura

A

Usu self-limiting

Corticosteroids for severe symptoms

113
Q

Kawasaki disease

A

IVIG (ideally w/i first 10 days)
High dose ASA until 48 hrs after fever resolution
Low dose ASA until inflammatory markers (ESR, platelets) return to normal (about 6 wks)
Echo in acute phase and 6-8 wks later
NO steroids

114
Q

Thromboangiitis obliterans (Buerger disease)

A

Smoking cessation

115
Q

Tetralogy of Fallot

A

PGE, O2, propranolol, IVF
Morphine, Tet position during cyanotic episodes
Surgical correction

116
Q

Endocardial cushion defect

A

Surgical correction

117
Q

Persistent truncus arteriosus

A

Surgical correction

118
Q

Transposition of the great vessels

A

PGE
Balloon atrial septostomy to widen ASD/VSD
Prompt surgical correction

119
Q

Patent ductus arteriosus

A

Indomethacin (after a week or two)

Surgical closure if unresponsive

120
Q

Atrial septal defect

A

Small - observation

Symptomatic/large - surgical closure

121
Q

Ventricular septal defect

A

Small - observation

Large - diuretics, ACEi, surgical repair

122
Q

Ebstein anomaly

A

PGE, digoxin, diuresis, propranolol

Step 2 DIT 😱 (23 decks)

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