Week 4--even more Flashcards
when is ipratropium useful for an asthma attack
first hour of an asthma attack –no evidence for use beyond this time
what is a blast
a malignant cell
what is CREST
variant of scleroderma
features include:
Calcinosis–calcium deposits in skin
Raynauds–spasm of blood vessels in response to cold or stress
Esophageal dysfunction–acid reflux and decrease in motility of esophagus
Sclerodactyly–thickening and tightening of the skin on the fingers and hands
Telangiectasias–dilation of the capillaries, causing red marks on the surface of the skin
what does the following antibody pattern suggest:
anti-sm AB
lupus (specific)
what does the following antibody pattern suggest:
RNP
ribonucleotide protein lupus/mixed connective tissue disease
what does the following antibody pattern suggest:
SSA (Ro)
sjogrens
lupus
risk for congenital heart block or neonatal lupus
what does the following antibody pattern suggest:
SSB (La)
same as Ro
what does the following antibody pattern suggest:
SCI-70/topoisimerase
diffuse scleroderma
systemic sclerosis
what does the following antibody pattern suggest:
DNA Ab
specific for lupus
what does the following antibody pattern suggest:
anti phospholipid ab
often + in lupus
assoc with fetal loss in lupus
what % of people returning of afghanistan have PTSD
8%
*trauma is common, PTSD is not
how do you manage ventricular tachycardia
SHOCK
then continue CPR for 2 minutes
causes of potentially reversible cardiac arrest (mnemonic)
Hs and Ts
what are the Hs of reversible cardiac arrest
hyperkalemia hypokalemia hypovolemia hypoxia H+ excess (acidosis) hypothermia hypoglycemia
what are the Ts of reversible cardiac arrest
Toxins Tamponade Thrombus (PE or MI) trauma tension pneumo
what are the non-shockable rhythms
asystole/PEA
what do you do in the event of cardiac arrest with asystole/PEA
CPR for 2 min
IV/IO access
EPINEPHRINE every 3-5 min
consider advanced airway
if rhythm becomes shockable, then shock. if not…
another 2 min CPR and treat reversible causes of cardiac arrest
if signs of return of spontaneous circulation, then go to post cardiac arrest care. if not, continue CPR as above
what do you do in the event of cardiac arrest with VF/VT
SHOCK
then CPR + IV/IO access established
if rhythm shockable again, SHOCK…if not, see if return of spontaneous circulation, otherwise do CPR and treat reversible causes
after second shock, continue CPR and give EPINEPHRINE every 3-5 min
rhythm shockable? if yes, shock again. then give amoidarone and continue to treat reversible causes.
continue as above
what is the epinephrine dose for ACLS
1 mg every 3-5 min IV
what is the amoidarone dose for ACLS
first dose 300 mg bolus
second dose 150 mg
how do you initially manage a tachyarrhythmia in a stable patient
maintain patent airway, assist breathing as necessary
oxygen if hypoxemic
cardiac monitor to ID rhythm
monitor BP and oximetry
if patient continues stable and the complex is not wide, you can: establish IV access and 12 lead ECG vagal maneuvers adenosine if regular complex Beta blocker or CCB consider expert consult
how do you manage a persistent tachyarrhythmia (usually above 150) causing hypotension, acutely altered mental status, signs of shock, ischemic chest discomfort, or acute heart failure?
synchronized cardioversion
- if regular narrow complex tachy, consider adenosine
- if wide irregular tachy, use defibrillation dose
what is the dose of adenosine used to treat narrow complex tachyarrhythmias
first dose–6 mg rapid IV push followed with NS flush
second dose–12 mg if required
how do you manage a persistent tachyarrhythmia (usually above 150) in a stable patient, but that has a wide QRS?
IV access and 12 lead ECG
consider adenosine only if regular and monomorphic
consider an antiarrhythmic infusion
consider expert consult
