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91 Cards in this Set
- Front
- Back
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What are the three stages of ARDS?
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Exudative, proliferative, fibrotic
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What is the exudative stage
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vasoconstriction, microthrombi, bs are clear
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What is the proliferative stage?
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agitation, fine crackles, hypoemia, ground glass look in xray
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What is the fibrotic stage?
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either get better or die if it gets worse it's MODS
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How do we treat ARDS
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treat underlying cause, promote gas exchange, circulatory support with fluids and nutritional support
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What are the meds for ARDS?
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corticosteroids, vasodialators, inotropic agents and bronchodialtors, mucolytics pain meds
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What is a pneumothorax?
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when part of the lung collapes
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how do you treat a pneumo?
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stab them with a needle which is a temp fix, chest tube or it can resolve itself
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A tension pnuemo is different from a regular pneumo how?
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a tension pneumo gets worse
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What are crackles?
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fluid in the lungs
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What is the disassociative curve?
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it's always better for the patient to shift right, if it shifts right it doesn't bind as much and you lease easier into the tissue
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what does the shift to the left mean?
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it is easier to bind at the lung but harder to release at the tissue level
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What is ventilation?
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neurochemical,mechanics of breathing, elasticity and compliance
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What is perfusion?
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gas exchange, oxygen transport, and CO2 transport and pulmonary circulation
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What is the key to oxygenation?
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cardiac output
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what is the V/Q ratio?
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the rate of ventilation to the rate of perfusion should be 1 to 1
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What if you have a high V/Q ratio?p
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it is probably a PE, pulmonary infarct, cardiogenic shock, mechanical vent
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What if there is a low V/Q ratio?
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it is probably pneumonia, actalactisis, tumors or mucos plug
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what is the most important step in setting up an intubation?
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preparation
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What are the seven p's?
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prepare, pre-oxgyenate, pre-treat, paralyze, protect and position, placement post intubation management
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what is the most important step in the 7 p's?
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pre-oxygenate
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What's sellicks' manuever
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hold cricoid pressure
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What is BURP?
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helps visualize cords go to the right
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What happens if someone loses their o2 sats while intubated?
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Remember DOPE
D- dislodged, O-obstruction, p-neumo, E-equipment failure |
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What is FIO2?
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the amount of oxygen delivered to the patient, if you have 50% or greater for longer than 24 hours you can have o2 toxicity
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What is the disassociative curve?
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it's always better for the patient to shift right, if it shifts right it doesn't bind as much and you lease easier into the tissue
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what does the shift to the left mean?
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it is easier to bind at the lung but harder to release at the tissue level
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What is ventilation?
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neurochemical,mechanics of breathing, elasticity and compliance
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What is perfusion?
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gas exchange, oxygen transport, and CO2 transport and pulmonary circulation
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What is the key to oxygenation?
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cardiac output
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What is FI02?
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amount of o2 delivered to patient
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What causes O2 toxicity?
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if the fi02 is greater than 50% for longer than 24 hours then you can get o2 toxicity
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What is PEEP?
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keeps alveoli open
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What is PIP?
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How much pressure is reached in the lung at the peak of inspiration
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What happens if PEEP increases on vent?
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air trapping, copd'ers to do this its common
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What happens if you have high PEEP and PIP?
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you have increased risk for volutrauma, pneumothorax, hypotension
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What is MODS?
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multi organ dysfunction syndrome
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How does MODS progress?
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first there is a primary cause temporary shock syndrome for the body, then becomes systemic global problem, organs all fail
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What are the levels of survival?
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1 or more organs fail = 40 %
2 or more = 60% 4 or more is DEAD |
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What is the major cause?
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chemical mediators, cells swich from aerobic to anaerobic, acidosis starts immediately
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what are the 4 phases of MODS?
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1. general increases capillary permeability, 2. hypermetabolic state, 3. organ malfx, 4. organs return to normal or death
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How do you treat MODS?
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treat underlying causes, adequate fluids, vasopressors, inotropics, support ventilation, adequate nutrition prevents sepsis
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What's normal Hct?
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3 x hgb
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What is hemolytic anemia?
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premature acceleration of red blood cells
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What is HIT?
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Heparin Induced Thrombocytopenia
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What is FI02?
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amount of o2 delivered to patient
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What causes O2 toxicity?
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if the fi02 is greater than 50% for longer than 24 hours then you can get o2 toxicity
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What is PEEP?
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keeps alveoli open
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What is PIP?
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How much pressure is reached in the lung at the peak of inspiration
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What happens if PEEP increases on vent?
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air trapping, copd'ers to do this its common
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what are the classic s/sx of an epidural hematoma?
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initial period of unconsciousness, BRIEF period fo consciousness, decrease of LOC, HA, N
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what are classic s/sx of a subdural hematoma?
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venous bleed very slow, very DANGEROUS patient appears drowsy, confused, episalateral pupil dilation, dilates on side of bleed. HIGH MORTALITY
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What about chronic subdural?
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older people who fall, may not show signs, easily confused with dementia, happens in 6-7 decade of life
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what is an indicator of brain stem injury?
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abnormal doll's eye movement
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what is required for brain death?
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blood flow study if there is blood flow wait 24 hrs, if not go ahead
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what is the qualifier for organ donation?
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no brain stem reflexes
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what is ICP
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intracranial pressure is 0-10, 15 is the absolute limit
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what are the three types of cerebral edema?
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vasogenic(white mater), cytotoxic(grey mater) and interstitial
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what are the clinical manifestations of ICP
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continous HA worse in AM, projectile vomiting not preceeded by nausea
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what is the treatment?
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keep airway patent and monitor VS
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what is spinal shock?
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temporary neurologic syndrome
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what are s/sx spinal shock
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decreased reflexes, loss of sensation and flaccid paralysis
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what is good about spinal shock?
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resolves in 7-20 days
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what are the s/sx of neurogenic shock?
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hypotensive and bradycardic
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what is the brown-sequard syndrome?
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damage on one side of cord, but sensation on the opposite side of injury
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what is autonomic dysreflexia?
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massive uncompensated cardiovasular reaction mediated by sympathetic nervous system
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what is the most common factor?
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distended bladder or rectum
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what is the rule of 9's?
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whole body surface is divided into 9%
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how fluid is given to a burn victim in 24 hours?
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% of burns x 4 x kg
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what are the basics for a burn victim?
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ventilate, fluid resusciate, control pain and transfer to burn center
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what is the most important part of the resume?
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projects...whatever
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what should you never put on a resume?
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every job you've had since you were 16
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how do you treat s-t elevation?
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STEMI - treat with MONA,
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how do you treat s -t depression?
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non-stemi treat with MONA
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how do treat a-flutter?
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aminoderone, cardioversion
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how do you treat a-fib?
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chemical cardioversion or shock
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how do you treat v-fib?
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ca+,lidocaine, cardiovert
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how do you treat v-tach
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02,lidocaine, ca cl 1 gm, shock
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what leads do you look at on a 12 lead ekg?
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lead I and AVR are lateral, left side is more important
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on a pacemaker, how do you tell what the 5 letters mean?
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first letter is the chamber being paced, second is the chamber being sensed, 3rd is the response to a heartbeat
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what is inhibited?
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it won't fire when heartbeat is sensed
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what is triggered?
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it is when an atrial beat is sensed an atrial is sensed
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what is dual?
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inhibited and triggered responses
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if your patient is hiccuping after pacemaker?
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turn them on left side and call dr. it means the pacewire has been dislodged or perforated the myocardium
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what teaching do you send with pacemaker patient?
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don't lift arm for two weeks
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what is your PMI?
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location of where heart contractions can be palpated, right under nipple
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what is ape to man?
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aortic,tricuspid, pulmonic, mitral,
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what is diaphragm for?
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higher heart sounds, bell is for lower
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what is lub caused by?
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closure of mitral and tricuspid valves, heard best in apex
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what dub?
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aortic and pulmonic closing 2 intercostals at base of heart
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when is troponin elevated?
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stays elevated for 1-3 weeks, detects in 3-4 hours specific to cardiac muscle
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