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393 Cards in this Set
- Front
- Back
What is the most common cause of sudden cardiac death in adults? |
V-Fib |
|
Survival rates are highest when BLS is initiated within ____ minutes and ACLS is initiated within ___ minutes |
4, 8 |
|
What is the most common cause of airway obstruction in an unconscious victim? |
The tongue |
|
When an advanced airway is in place, during 2 person CPR, give 1 breath every ___ to ____ seconds without attempting to synchronize with chest compressions. |
6 to 8 seconds |
|
How much tidal volume normally causes visible chest rise during resuscitation breathing? |
500-600 mL |
|
What is the most common cause of foreign body airway obstruction in adults? |
Poorly chewed meat |
|
If a patient with a foreign body airway obstruction is able to cough and speak, what is the next best step? |
- DO NOT interfere
- Coughing is the most effective way to clear the obstruction
- Speaking indicates adequate ventilation is still occuring |
|
Which cardiac medications can be administered through an ET tube? |
"ALE"
Atropine Lidocaine Epinepherine
(Also, naloxone) |
|
What is the fluid of choice in a resuscitation setting? |
Normal Saline |
|
Return to Spontaneous Circulation is characterized by a PCO2 > ___? |
40mm Hg |
|
Markers of compromised quality CPR:
PETCO2 < _____
Diastolic Pressure < ______ |
PETCO2 < 10mm Hg
Diastolic BP < 20 mm Hg |
|
What drug can be used in the V-fib/Pulseless V-tach algorithm if Amiodarone is not available? |
Lidocaine 1-1.5mg/kg |
|
DOC for Torsades de pointes? |
Magnesium Sulfate |
|
DOC for hypomagnesemia? |
Magnesium sulfate |
|
What are the 10 causes of PEA? |
"HOT MATCH MD"
Hypovolemia (normal saline infusion)
HypOxemia (O2, intubation, ventilation)
HypoThermia (warmed normal saline infusion)
Massive Pulmonary Embolism (thrombolytics)
Acidosis (sodium bicarbonate)
Tension pneumothorax (needle decompression)
Myocardial Infarction
Drug Overdose with TCAs, digoxin, beta-blockers, calcium channel blockers |
|
What is the most common cause of a "flatline" tracing on ECG? |
Detached lead or equipment malfunction |
|
Why is atropine not preferred in Type II second-degree heart block? |
Atropine may convert Type II second-degree heart block into complete heart block.
Transcutaneous Pacing is indicated |
|
Contraindications to carotid massage and ice baths in an attempt to convert stable Paroxysmal Supraventricular Tachycardia? |
Carotid Massage --> bruits present
Ice Bath --> previous MI |
|
ECG strip shows a narrow, regular QRS and a rate greater than 160bpm |
PSVT |
|
What is the biggest mistake when using adenosine to try to convert PSVT? |
Not pushed rapidly enough ------------------------------------------------------------
Adenosine 6mg rapid IV push (Important: Wait 1-2 minutes) ↓ Adenosine 12mg rapid IV push |
|
This drug feels like a "mule kick to the chest"
Warn patients before giving it... |
Adenosine |
|
Adenosine is contraindicated in patients with what airway disease? |
Asthma |
|
Before giving adenosine to patients with heart transplants, or patients taking dipyramidole or carbamazapine, you should _____ the dose |
Decrease the dose |
|
Patients with tachyarrhythmias that are unstable should receive ___________________ |
Synchronized cardioversion |
|
Ventricular Tachycardia may readily convert to _________ |
V-fib |
|
Shock is defined as inadequate _______ perfusion |
inadequate tissue perfusion |
|
Ventricular Tachycardia = wide QRS + rate > ____ |
> 100msec |
|
Rapid Sequence Intubation:
Children should be pretreated with _____ |
Atropine |
|
Rapid Sequence Intubation:
Patients with head injuries should be pretreated with ______________ |
Lidocaine (to ↓ Intracranial Pressure) |
|
Rapid Sequence Intubation:
Agent used for sedation in children? |
Ketamine |
|
Rapid Sequence Intubation:
Succinylcholine should not be used in patients with _____________ (3 things) |
Crush Injuries
Hyperkalemia
History of Neuromuscular Dz |
|
Rapid Sequence Intubation:
Name 4 agents used for sedation |
Etomidate (doesn't cause hypotension)
Ketamine (doesn't cause hypotension)
Midazolam
Propofol (can cause hypotension) |
|
Rapid Sequence Intubation:
Which agent used for paralysis has the shortest onset? |
Succinylcholine |
|
Rapid Sequence Intubation:
Name the 3 agents used for paralysis |
Succinylcholine
Rocuronium
Vecuronium |
|
Rapid Sequence Intubation:
Steps to take before, during and after RSI? |
Prepare = equipment
Pretreat = drugs
Position = sniffing position
Preoxygenate = pulse oximetry of 100%
Paralyze = drugs
Placement of tube
Position of tube = confirm by 2 methods |
|
Needle vs. Surgical Cricothyroidotomy
Which one allows for both oxygen delivery and ventilation for elimination of CO2? |
Surgical Cricothyroidotomy |
|
Equation to calculate a patient's accurate calcium level? |
4 - serum albumin (g/dL) x 0.8 + serum Calcium |
|
Rough correction for total body calcium in hypoalbuminemia:
Add 1 mg/dL to serum Calcium for every 1 mg/dL in albumin below _____ mg/dL |
Add 1 mg/dL to serum Calcium for every 1 mg/dL in albumin below 4 mg/dL |
|
How are calcium levels affected by acidosis? |
Acidosis ↑ Calcium levels ----------------------------------------------------
Alkalosis ↓ Calcium levels |
|
What changes will hypercalcemia cause on ECG? |
Shortened QT interval
(Hypercalcemia also potentiates digoxin toxicity) |
|
A patient's bloodwork reveals hypercalcemia.
Bloodwork also shows ↑ serum Cl and low bicarbonate in a ratio > 33:1
This is suggestive of _____________ |
Primary Hypothyroidism |
|
A patient's bloodwork reveals hypercalcemia.
Bloodwork also shows a high serum protein with a reversed albumin-to-globulin (A/G) ratio.
This is suggestive of _____________ |
Multiple Myeloma |
|
How does hypocalcemia affect ECG? |
Prolonged QT Intervals |
|
Type of diuretic used to help correct Hypercalcemia? |
Loop Diuretic
(Loops LOOSE Calcium) |
|
Giving _____ in the setting of digitalis toxicity mya cause tetany and "stone heart" |
calcium
---------------------------------------------------------
(Consider this when using Calcium Gluconate to treat patients with hyperkalemia) |
|
A woman presents because her home blood sugar monitor readings at home have been "high"
Bloodwork reveals a serum glucose of 900 mg/dL, and a sodium level of 124 mg/dL.
In addition to correcting her blood glucose, should you also correct her hyponatremia? |
No. This is pseudohyponatremia, caused by increased blood glucose.
Sodium "falls" by approximately 1.6 mEq/L for every 100 mg/dL of glucose over 200.
Her actual sodium level is 124 + (7x1.6) = 135 |
|
What is the most common cause of hypernatremia? |
dehydration |
|
Hypothalamus does not make ADH |
Central Diabetes Insipidus |
|
Kidneys do not respond to SIADH |
Nephrogenic Diabetes Insipidus |
|
Most common cardiac axis seen in asthma and COPD? |
Right axis |
|
A new LBBB is considered an ________ until proven otherwise |
Acute MI |
|
A normal PR interval is _______ms |
200 ms |
|
Risk of torsades de pointes is increased in patients with a prolonged ___________ |
QT Interval
------------------------------------------------------------ Seen with hypokalemia, hypomagnesemia, hypocalcemia and certain medications (TCAs) |
|
Normal QRS duration is _____ ms |
120 ms |
|
Diffuse ST elevations and PR depression are seen in ____________ |
pericarditis |
|
U waves may indicate _____ or _____ |
hypokalemia or hypocalcemia |
|
A loss of costophrenic angle on a CXR indicates approximately _____ cc of fluid accumulation |
250cc |
|
What is the most sensitive film to order to check for intrabdominal free-air? |
Upright Chest X-ray |
|
Views obtained in an Abdominal X-ray series? |
Upright chest, Supine and lateral decubitus abdominal |
|
Cervical Spine X-ray series consists of which views? |
Lateral, AP and Open mouth |
|
One abdomen/Pelvis CT exposes a patient to as much radiation as _____ X-rays |
250 x-rays! |
|
Acute ischemic strokes may initially present with a _____ CT scan |
negative CT scan |
|
What study should be done before a lumbar puncture to r/o increased ICP? |
Head CT w/o contrast |
|
Best study to order for an HIV positive patient with a suspected intracranial infection? |
CT with contrast |
|
Intrauterine pregnancy on ______ ultrasound is seen at beta-HCG 1000-1500 IU/L |
Transvaginal US --------------------------------------------------------------------
Intrauterine pregnancy on transabdominal US may not be seen until beta-HCG is around 6000 IU/L |
|
The HIDA scan loses sensitivity when _____ levels rise above 5 mg |
bilirubin |
|
You suspect a PE in a pregnant patient. Which test is preferred, A V/Q scan, or CT scan? |
CT scan with abdominal shielding.
-------------------------------------------------------------------- V/Q scan exposes the mother to less radiation, but radioisotope collects in the bladder near the fetus which exposes the fetus to more radiation. |
|
"Low probability V/Q scans" miss ___% of pulmonary emboli |
16% ------------------------------------------------------------------- PIOPED study |
|
In the trauma room, life-threatening hemorrhage should be controlled with __________ __________ |
Direct pressure |
|
How much of body water is intravascular? How much is extravascular? |
1/4 Intravascular
3/4 Extravacular |
|
How much of body water is intracellular? How much is extracellular? |
2/3 Intracellular
1/3 Extracellular |
|
What is the most common cxause of shock in an injured patient? |
Hemorrhage ------------------------------------------------------------------ Pressors will not help! |
|
Adequate urinary output for an adult in trauma situation? |
0.5 cc/kg per hour
--------------------------------------------------------------- Child less than 1 = 2.0 cc/kg/hr
Child over 1 = 1.0 cc/kg/hr |
|
What is the AVPU scale used in trauma assessment? |
Alert Verbal Unresponsive |
|
What studies are included in a Trauma Series of x-rays? |
C-spine, chest and pelvis |
|
The normal adult blood volume is ____ % of body weight |
7%
--------------------------------------------------------------- So, a 70kg adult has 4.9L of blood
(70x.07 = 4.9) |
|
The scalp consists of 5 layers... Name them |
"SCALP"
Skin Connective Tissue Aponeurosis (galea) Loose areolar tissue Pericranium |
|
Occular deformity caused by uncal herniation? |
"Blown pupil" --> CN III compression
CN III runs along the edge of the tentorium cerebelli, which is the most common site of herniation |
|
________ reflex: Hypertension, bradycardia and respiratory depression in the setting of ↑ ICP |
Cushing reflex
------------------------------------------------------------------- This is the brain's attempt to maintain Cerebral perfusion pressure (CPP)
CPP= MAP - ICP |
|
Racoon eyes, Battle sign (mastoid bruising), blood in auricular canal, Blood/CSF in nares and hemotympanum all suggest _________________ |
Basilar Skull Fracture |
|
A severe head injury has a GCS less than or equal to ______ |
8
------------------------------------------------------------
Moderate Head injury = GCS 9-13 Mild Head injury = GCS 14-15
|
|
|
|
|
Name 2 noxious stimuli used to assess Glascow Coma Scale |
Nail bed pressure
Sternal rub |
|
What has the highest sensitivity and specificity for identifying a fluid as CSF in a patient with a head injury? |
𝞫 2- transferrin |
|
Describe how the ring test identifies CSF rhinorrhea in the presence of epistaxis in a patient with a head injury |
Sample of blood from the nose is placed on filter paper to test for presence of CSF.
If CSF is present, a large transparent ring will surround a blood clot on the paper |
|
This type of skull fracture carries a much greater risk of underlying brain injury and complications such as meningitis and post-traumatic seizures |
Depressed Skull Fracture |
|
How does a head CT look in a patient with a concussion? |
With concussions, head CTs are most often unremarkable |
|
Biconcave/Lenticular shape seen on head CT |
Epidural Hematoma |
|
Mortality rate range for subdural hematomas? |
1/3-2/3
(33-66%) |
|
Vessel damaged in a patient with an Epidural Hematoma? |
Middle Meningeal Artery |
|
Vessels damaged in a patient with a subdural hematoma? |
Bridging Veins |
|
Crescent shape seen on head CT that may cross suture lines |
Subdural Hematoma
-------------------------------------------------------------------- Alcoholics and Elderly have ↑ brain atrophy and have a higher risk for subdurals |
|
Name 5 measures that can be used to ↓ ICP in patients with head trauma. |
"HIVED"
Hyperventilation Intubation Ventriculostomy (burr hole) Elevate the head of bed Diuretics (Mannitol, Furosemide) |
|
Where do the majority of vital structures lie in the neck? |
The anterior triangle |
|
What types of neck injuries are most likely to produce C-spine fractures? |
Blunt neck injury |
|
Injury to which neck zone buys the patient a trip to the OR for surgical exploration? |
ZONE II
|
|
Patients on a backboard for long periods of time are at risk for formation of ____________ |
Pressure Ulcers |
|
Cardiac Arrest unresponsive to fluid resuscitation in penetrating neck trauma may be ___________________
Keep the patient in head down, left lateral decubitus position |
Venous Air Embolism |
|
What is the first sign of resolution of spinal shock in a patient with a spine injury? |
Return of the bulbocavernous reflex |
|
A 70 yo male presents to the ED after a whiplash injury. He ambulates well but has an extremely weak handshake. |
Central Cord Syndrome |
|
What are the NEXUS criteria for ordering C-spine films? |
C-spine films should be ordered in patients with:
-Posterior midline cervical tenderness -Intoxication -Altered Mental Status - Distracting Injuries |
|
The most common level of cervical vertebral fracture is at ___________ |
C5 |
|
Most common level of cervical subluxation is between ____ and ______ |
C5 and C6 |
|
You have ordered a C-spine x-ray series and noticed that C7-T1 are not visualized on the films.
What additional view should you order |
Swimmer's view
-------------------------------------------------------------------- C-spine Series:
Oblique Views are optional |
|
Basion Axis Interval (BAI) > 12mm or ↓ < 4mm
Basion Dental Axis Interval (BDI) >12mm |
Atlanto-Occipital Dislocation |
|
What do you call a C1 (atlas) burst fracture? |
Jefferson Fracture
--------------------------------------------------------------------- Most common C1 fracture
Occurs when patient lands directly on head or heavy object is dropped on head |
|
Beck's triad seen in cardiac tamponade? |
---------------------------------------------------------------------- ECG Findings = Electrical Alternans |
|
Procedure of choice for a patient with laryngotracheal separation? |
Tracheostomy |
|
What percentage of hemothoraxes have an associated pneumothorax? |
25% (1/4) |
|
What percentage of hemothoraxes are associated with extrathoracic injuries? |
75% (3/4) |
|
- CVP line or chest tube placement
- Intra-aortic balloon pump placement
- Use of non-vascular clamp during ED thoracotomy
-Over-inflation of Swan- Ganz balloon
**These are all Iatrogenic causes of what?** |
Great Vessel Injury |
|
The most frequently injured solid organ associated with penetrating trauma is ______ followed by ____________ |
the liver, followed by small bowel |
|
The most frequently injured solid organ associated with blunt trauma is _________ followed by ____________ |
the spleen, followed by the liver |
|
In a stable patient with suspected abdominal trauma and a negative FAST exam, _______ is the next best step |
CT scan |
|
Next best step for a patient with a positive FAST scan? |
Send to the OR
------------------------------------------------------------------- Negative FAST: look for other sites of bleeding |
|
What do you fall a FAST exam that also checks for a pneumothorax? |
eFAST |
|
What is the most sensitive test for retroperitoneal injury? |
CT scan |
|
Name some past medical history that can make passage of a foley catheter difficult in a trauma patient and can be confused for urethral disruption. |
- Enlarged prostate
- Prostate cancer
-Urethral Stricture
- Self catheterization
- Previous urological surgery |
|
________ relase during rhabdomyolysis can cause renal failure |
Myoglobin
------------------------------------------------------------------ In order to reduce precipitation of myoglobin in the kidney:
1) Maintain a high urine output 2) Alkalize the urine |
|
ET tube size is based on the size of the ______ rather than the glottic opening because the narrowest part of a child's airway is beyond the glotic opening |
cricoid ring |
|
What are the 3 symptoms that are assessed during the Pre-Hospital Cinicinnati Stroke Scale? |
|
|
Why is identification of strokes involving the cerebellum important? |
Increased risk of edema and ↑ pressure to brainstem |
|
Steps for optimization of a patient experiencing an ischemic stroke:
- Supplemental O2
- BP: MAP should be greater than _____, SBP should be greater than or equal to _______
-Serum Glucose < _______
-Normal temperature
- Screen for thrombolytics
- For HTN, do not treat until MAP < 130 |
- Supplemental O2
- BP: MAP should be greater than 60, SBP should be greater than or equal to 90 -Serum Glucose < 150
-Normal temperature
- Screen for thrombolytics
- For HTN, do not treat until MAP < 130 |
|
Which diagnosis should be considered in a young patient with stroke and in patients with headaches and neck pain with acute stroke? |
Carotid or Vertebral Artery Dissection |
|
Up to ____% of patients with hemorrhagic stroke will seize within 72 hours. |
25%
--------------------------------------------------------------------- Control seizures with lorazepam acutely, followed by phenytoin.
Seizure prophylaxis is achieved with phenytoin |
|
Use the PAC3T mnemonic to recall conditions where a headache is not a benign symptom. |
Pseudotumor Cerebri
Acute Angle Closure Glaucoma
Cervical Artery dissection
Cerebral Venous Thrombosis
Carbon Monoxide poisoning
Temporal areritis
Sub-arachnoid hemorrhage |
|
A patient presents during a cold winter month with headache, nausea and vomiting. Several other family members have the same complaint. |
Consider Carbon Monoxide Poisoning |
|
You suspect a patient has a sub-arachnoid hemorrhage. However, the CT is negative. What next step is required? |
Lumbar puncture |
|
Tests to order for a patient with "the worst headache of my life" |
Suspect SAH:
CT w/o contrast Lumbar Puncture |
|
Hunt and Hess classification for SAH:
Which grade begins to show confusion or mild focal neurological deficit? |
Grade III
----------------------------------------------------------------- Grade I: Asymptomatic, mild headache, mild nuchal rigidity
Grade II: Moderate to severe headache, nuchal rigidity, cranial nerve palsy may be present
Grade III: Drowsiness, confusion, or mild focal neurological deficit
Grade IV: Stupor, hemiparesis, early decerebration or vegetative state
Grade V: Coma, decerebrate, moribund |
|
ECG findings possibly seen in a patient with SAH? |
Deep, inverted T-waves |
|
Clinical Diagnosis:
-New headache
-Temporal artery deformity/abnormality
- Jaw claudication |
Temporal Arteritis
-------------------------------------------------------------- These clinical findings have 94% specificity and 100% sensitivity for temporal arteritis |
|
This neurological condition has a triad of:
(DVT mnemonic) |
Meniere's Disease
|
|
Meningitis:
The _____ sign is considered positive with pain or resistance with passive extension of the knee with the hip flexed 90 degrees |
Kernig Sign |
|
Meningitis:
The _______ sign is considered positive when passive flexion of the neck causes flexion of the hips |
Brudzinski Sign |
|
The causes of encephalitis are usually viral in origin. What are the most common causes (4)? |
"HEAR"
Herpes Epstein- Barr Arboviruses Rabies |
|
You suspect meningitis in a patient with fever, nuchal rigidity, photophobia and altered mental status.
What is the next immediate step? |
Begin antibiotic therapy!
Do not delay antibiotics for LP or CT |
|
Posterior shoulder dislocations are common with what 2 conditions? |
Seizure
Electrical Shock |
|
This is a focal neurological deficit persisting from seizure which usually resolves within 48 hours |
Todd's Paralysis |
|
Continuous Seizures can cause _______ injury |
CNS Injury |
|
Eclampsia usually occurs in patients > _____ weeks of gestation |
20 weeks |
|
Approximately 70% of patients with HIV will develop _______ caused by opportunistic bacteria, viruses, or fungi |
sinusitis |
|
Most patients with sinusitis can be treated __________ |
Symptomatically |
|
Anterior epistaxis commonly origninates from which confluence of arteries on the posterior nasal septum? |
Keisselbach's Plexus (located in the "picking zone")
|
|
In this type of epistaxis, the bleeding is unilateral and the patient denies the sensation of blood in the back of the throat. |
Anterior Epistaxis |
|
What percentage of properly placed nasal-packs fail to control bleeding? |
25%
-ENT consult is indicated |
|
Approximately ___% of patients with posterior epistaxis have a systolic BP >/= 180mm Hg or a diastolic BP > 110mm Hg |
50% |
|
A 16 yo swim-team captain presents with a greenish discharge from his ear and complains that his ear feels "full".
He withdraws as you tug on his ear to examine it.
Most likely diagnosis? |
Otitis Externa ("Swimmer's Ear") |
|
How long should patients diagnosed with otitis externa ovoid getting into water after treatment? |
2-3 weeks |
|
Treating Group-A, 𝞫 -hemolytic strep pharyngitis prevents Rheumatic fever, but does not prevent ________________ |
Post-streptococcal Glomerulonephritis |
|
Does epiglottitis occur more in adults or children? |
Adults |
|
A "thumbprint sign" is seen on lateral neck radiograph. |
Epiglottitis |
|
A 29 year-year old female who had been treated for strep throat the previous week presents with progressive difficulty swallowing. Physical exam reveals a fluctuant mass on the right side of the soft palate and deviation of the uvula to the right
Diagnosis? |
Peritonsilar abscess |
|
How does a patient with epiglottitis prefer to sit?
How does a patient with retropharyngeal abscess prefer sit? |
Epiglottitis: leaning forward with neck flexed
RPA: recumbency with hyperextension of neck |
|
You see currant jelly sputum on physical exam and bulging fissure on chest x-ray.
diagnosis? |
Klebsiella pneumonia |
|
Name 5 pulmonary pathogens found in the oropharynx that commonly cause penumonia |
S. pneumoniae
M. pneumoniae
H. influenzae
Strep. pyogenes
M. catarrhalis |
|
Which area of the lungs is aspiration pneumonia most commonly seen? |
Lower Right Lobe |
|
Acute Pulmonary Edema may be a presentation of ______ |
acute MI |
|
Treatment for Acute Pulmonary Edema?
"NOt BAD" |
Nitroglycerin Oxygen t
BiPAP (or CPAP) Aspirin Diuretics
|
|
What are the criteria for the PERC score to determine the need for diagnostic testing for a low risk of PE? |
PERC Score:
- Age >/= 50 - HR >/= 100 - O2 Sat on room air < 95% - Prior DVT or PE - Recent trauma or surgery - Hemoptysis - Exogenous estrogen use - Unilateral leg swelling |
|
Name the 3 most common causes of pleaural effusion |
|
|
Why are steroids given in asthma? |
to decrease the late inflammatory response |
|
What 2 drugs are commonly associated with acute asthma exacerbations? |
Beta-blockers
Aspirin |
|
Early asthmatic response may last for a few hours. A late asthmatic response hyperresponsiveness can persist for _______ |
days to months
---------------------------------------------------------------------- This is why we give steroids |
|
How do we treat Asthma in the ED?
(BIOMES mnemonic) |
Beta agonists (albuterol) Ipratroprium (anti-muscarinic) Oxygen Magnesium Sulfate Epinepherine Steroids |
|
Patients with __________ are sometimes referred to as "blue bloaters" |
Chronic bronchitis |
|
Patients with ______ are sometimes referred to as "pink puffers" |
Emphysema |
|
What is the most important treatment in patients with COPD? |
Smoking Cessation |
|
Tuberculosis adenitis is known as _________ |
scrofula |
|
A _____ complex is a calcified lesion of primary pulmonary TB |
Gohn Complex |
|
This form of tuberculosis results from hematogenous spread |
Miliary TB |
|
Tuberculosis of the spine is known as _______ |
Pott's Disease |
|
What is the cause of death in patients with massive hemoptysis:
Asphyxiation or Exanguination? |
Asphyxiation |
|
___________ is persistent and progressive dilation of the bronchi or bronchioles.
It as seen as a consequence of chronic infections, tumor or cystic fibrosis.
Hallmark findings are coughing, fetid breath, and expectoration of mucopurulent matter |
Bronchiectasis |
|
What ventilatory rate is usually set for patients on mechanical ventilation? |
14-16 bpm |
|
What is the tidal volume set for in patients on mechanical ventilation?
What if there is concern for development of ARDS? |
Tidal volume is initially set to 6-10mL/kg
If ARDS is a concern, set tidal volume to 6mL/kg |
|
__________ improves oxygenation by keeping alveoli open during inspiration |
PEEP |
|
What ventilator setting is useful for patients with no spontaneous respiration, heavily sedated patients, or paralyzed patients? |
Controlled Mechanical Ventilation (CMV)
------------------------------------------------------------------- The patient is ventilated at a preset rate; the patient cannot breathe between the delivered breaths |
|
What is the Levine Sign? |
Patient puts a clenched fist to his chest to describe pain of a myocardial infarction |
|
What are 2 contraindications for the administration of NTG in patients with acute chest pain? |
2. Patients with an inferior wall MI
SEVERE hypotension may result in these cases |
|
Name some contraindications to the administration of beta-blockers in a patient experiencing Acute Coronary Syndrome. |
Heart Rate < 60 bpm
Systolic BP < 100 mm Hg
2nd or 3rd degree Heart Block
Moderate to severe LV dysfunction
Signs of peripheral hypoperfusion
PR interval > 0.24 ms
Acute MI due to Cocaine |
|
What are the Sgarbossa Criteria for impending MI in Left Bundle Branch Block? |
1. ST Elevation > 1mm in leads with dominant R waves (concordant with QRS complex)
2. ST Elevation > 5 mm in leads with dominant S waves (discordant with QRS complex)
3. ST Depression > 1mm in V1, V2, or V3 |
|
What are the absolute contraindications for thrombolytic therapy? (8) |
- History of intracranial hemorrhage
- History of ischemic stroke > 3 hours but < 3 months
- Cerebral Vascular Malformation
- Intracranial malignancy
- Symptoms or signs of an aortic dissection
- Bleeding diathesis
- Active bleeding
- Significant closed-head or facial trauma < 3 months |
|
What are some relative contraindications to thrombolytic therapy? (7) |
- History of chronic, severe, poorly controlled hypertension
- Severe, uncontrolled hypertension on presentation > 180/110 mm Hg
- Recent (within 2-4 weeks) internal bleeding
- Traumatic or prolonged (>10min) CPR
- Major Surgery within 3 weeks
-Current use of anticoagulant (warfarin) with INR 1.7
- Pregnancy |
|
Which has a worse prognosis:
Type I or Type II heart block? |
Type II |
|
Name some causes of AV Heart Blocks |
Age Ischemia Cardiomyopathies Myocarditis Congenital Surgery Valvular Disease Drugs |
|
Name 2 causes of sudden cardiac death in young people |
HCOM
Prolonged QT |
|
What is the heart rate commonly seen in patients who have experienced an inferior wall MI? |
Sinus Bradycardia (resolves in 1-2 days) |
|
Atrial fibrillation increases the risk of acute ischemic stroke ___-fold. It is responsible for 15-20% of all acute ischemic stroke. |
five-fold |
|
What is the most common pediatric dysrhythmia? |
SVT |
|
This heart condition has the following ECG findings:
-Short PR interval
-Widened QRS
-Delta-wave slurring QRS upswing
|
Wolff-Parkinson White |
|
Why are adenosine, beta blockers, calcium channel blockers and digoxin contraindicated in patients with WPW? |
They preferentially block at the AV node, allowing unopposed conduction down the accessory bypass tract. |
|
What is considered the most significant risk factor for sudden death for patients with hypertrophic cardiomyopathy? |
Symptoms prior to age 30
(Severity of symptoms does not do not increase risk) |
|
A young patient has a systolic murmur that decreases with valsalva |
HCM |
|
Name 3 causes of paradoxical splitting of S2 |
1. HCM
2. Aortic stenosis
3. LBBB |
|
List , in order, the valves affected by acute bacterial endocarditis |
1. Aortic
2. Mitral
3. Tricuspid |
|
Which is most sensitive for the diagnosis of acute bacterial endocarditis:
Transesophageal or transthoracic echocardiography? |
Transesophageal = 90-100% sensitive
Transthoracic = 28-63% sensitive |
|
A 29 yo male presents with fever and retrosternal chest pain. He had the "flu" two weeks ago.
Most Likely diagnosis? |
Myocarditis |
|
In new diagnosis of refractory asthma in a young adult, consider this diagnosis: |
Myocarditis |
|
ECG shows diffuse PR depression and ST elevations |
Pericarditis
------------------------------------------------------------ Always rule out ACS in a patient presenting with the classical signs of pericarditis |
|
What is the mean survival for patients with Aortic stenosis and:
- Angina = _______ years
- Syncope = _______ years
- Heart failure = _________ years |
- Angina = 5 years
- Syncope = 2-3 years
- Heart failure = 1-2 years |
|
Mechanisms:
Abdominal aortic aneurysms __________, thoracic aneurysms ___________________ |
Abdominal aortic aneurysms rupture
Thoracic aortic aneurysms dissect |
|
AAA is most commonly misdiagnosed as _______ |
renal colic |
|
What is the mortality rate for patients with a ruptured AAA that get to the OR? |
50% mortality |
|
Aortic dissections are most commonly misdiagnosed as _________ |
Acute MI's |
|
You should always get a Chest film in patients that you suspect are having an MI. Some patients will have __________ and thrombolytics will kill them |
aortic dissection |
|
How do you calculate MAP? |
(2DBP x SBP)/3 |
|
Nitroprusside, given for hypertensive emergencies, can cause _______ toxicity |
cyanide toxicity |
|
This region of the GI system has a higher rate of morbidity and mortality than any other source of upper GI bleed |
Esophagus |
|
How should you treat ingestion of a button battery that has:
A) Passed into the stomach
B) Is lodged in the esophagus |
A) Expectant management
B) Immediate removal --> alkaline ingestion is highly corrosive and can lead to liquefactive necrosis |
|
A majority of patients with asthma have associated ________ |
GERD |
|
Barrett's esophagus carries a ___ to ____ risk of development of esophageal adenocarcinoma, which carries a <5% chance of 5-year survival |
2-5% risk |
|
____________ is a transmural perforation of the esophagus.
___________ is a non-transmural tear of the esophagus associated with vomiting |
Boerhaave syndrome = transmural tear
Mallory-Weiss Syndrome = non-transmural |
|
What is the most common cause of gastritis? |
Chronic NSAID use |
|
Crossmatching blood takes 40-60 mins. Use _________ blood if type-specific blood is not readily available and the patient is unstable |
O negative blood |
|
_______ is associated with ____% of gastric ulcers and ________% of Duodenal ulcers |
80% of GUs
95% of DUs |
|
What is triple therapy for H. pylori? |
PPI + Amoxicillin + Clarithromycin |
|
Name 4 adverse affects of cimetidine when used to treat Peptic Ulcer Disease |
1) P450 system inhibitor (inhibits clearance of warfarin, phenytoin, diazepam, propanolol, lidocaine, theophylline, TCAs)
2) CNS dysfunction in the elderly
3) Thrombocytopenia
4) Painful gynecomastia
|
|
This form of inflammatory bowel disease has:
-lower incidence
-lower risk of cancer
-more common in women |
Crohn's Disease |
|
When used to treat inflammatory bowel disease, which component of sulfasalazine is active |
sulfapyridine
------------------------------------------------------------------ The 5-ASA component is not effective in treating IBD. It is effective in rheumatoid arthritis, however. |
|
Drugs that only have a ________ component are not effective in treating Inflammatory bowel disease |
5-ASA |
|
What is the definition of pneumatosis intestinalis as described on an abdominal x-ray? |
Gas in the bowel wall |
|
What is the most common cause of small bowel obstruction? |
Adhesions |
|
What is the second most common cause of small bowel obstruction behind adhesions? |
Incarcerated hernias |
|
What is the most common cause of bowel obstruction in children ages 2 months to 5 years? |
Intussusception |
|
What is the most common blood-borne cause of viral hepatitis in the U.S.? |
Hepatitis C |
|
In alcoholic hepatitis, the ____ is greater than ______ by a factor of 2 |
SGOT (AST) > SGPT (ALT) |
|
___________ : acute hepatic encephalopathy associated with ASA use in children |
Reye Syndrome |
|
What is the mortality rate for hepatorenal syndrome? |
Almost 100% |
|
__________ is an obstruction of the biliary tract leading to stasis → bacterial overgrowth and infection.
This is a surgical emergency |
Cholangitis |
|
What is the most common cause of hepatic abscess? |
Ascending cholangitis |
|
_________'s sign: The arrest of inspiration while palpating the RUQ. This testis more than 95% sensitive for acute cholecytsitis, less sensitive in the elderly. |
Murphy's Sign |
|
What is the sonographic Murphy's sign? |
Arrest of inspiration when the U/S probe is placed in the RUQ |
|
Most gallstones are composed of _____ and are radiolucent. |
Cholesterol (70%)
------------------------------------------------------------------- Pigment (20%) → Radiodense
Mixed (10%) |
|
What metabolic derrangement can be caused pancreatitis? |
Hypercalcemia
---------------------------------------------------------------------
Hypercalcemia can also cause pancreatitis |
|
This abdominal diagnosis has the following abdominal X-ray findings:
Sentinel Loop
Colon cutt-off sign (distended colon to midtransverse colon with no air distally) |
Pancreatitis |
|
Suspect a ______ when patients with pacreatitis fail to resolve |
pancreatic pseudocyst |
|
Criteria used to assess prognosis in pancreatitis |
Ranson's Criteria |
|
What is the most common surgical emergency? |
Appendicitis |
|
_________ in late pregnancy presents with RUQ pain due to displacement by gravid uterus |
appendicitis |
|
What is the most common cause of pancreatitis? |
Fecalith |
|
Due to its small radius, the ______ is normally the site of highest pressure in the GI tract |
cecum |
|
What is the most common cause of painless lower GI bleeding in older adults? |
Diverticulosis |
|
__________ is a common cause of large bowel obstruction |
Diverticulitis |
|
What 2 modalities should be avoided in cases of acute diverticulitis due to risk of perforation? |
Barium enema
Colonoscopy |
|
What is the most common cause of GI bleeding in younder patients?
Older patients? |
Younger = Angiodysplasia
Older = diverticulosis |
|
What is usually the most common cause of an apparent lower GI bleed? |
An upper GI bleed |
|
What is the most common cause of anorectal pain (especially in children)? |
Anal fissure |
|
________ is the production of less than 400mL of urine in 24 hours |
oliguria |
|
What is the most common cause of community-acquired Acute renal failure (40-80% of cases) |
Pre-renal Acute Renal Failure
---------------------------------------------------------------------- BUN:Cr ratio > 20:1
Urine sodium excretion is < 10
Fractional excretion of sodium < 1% |
|
What is the most common cause of postrenal failure? |
BPH |
|
What is the most common reason to initiate dialysis in a patient with end stage renal disease? |
Pulmonary Edema |
|
List the most common causes of non-traumatic hematuria in order of frequency (6) |
1. Nephrolithiasis
2. Carcinoma of GU tract
3. Urethritis
4. UTI
5. BPH
5. Glomerulonephritis |
|
Granular casts in urine are seen in __________ |
acute tubular necrosis |
|
WBC casts in urine are seen in _____________ |
pyelonephritis/interstitial nephritis |
|
RBC casts in urine are seen in _____ and ______ |
Glomerulonephritis and Malignant HTN |
|
Renal stones formed from ______ may appear as coffin-lid crystals in urine |
Struvite |
|
Many OTC medications contain ________, which can cause prostatic obstruction |
pseudoephederine |
|
Buzzwords for stages of this disease include:
Phase 1 : Painless chancre
Phase 2: condyloma lata
Phase 3: Gummas, Argyll Robertson pupil, tabes dorsales |
Syphilis |
|
______________ is an acute reaction that occurs ~24 hours after treatment of early syphilis.
It presents with headache, and severe myalgias. It can cause early labor and fetal distress during pregnancy. |
Jarisch-Herxheimer reaction |
|
Drug of choice for syphilis infection? |
Penicillin G |
|
Both _____ and ______ have a positive Whiff test after KOH is mixed with discharge and heated on a slide. |
Trichomonas and Bacterial Vaginosis |
|
The effectiveness of the intrinsic clotting pathway can be measured with ______________ |
PTT |
|
The effectiveness of the extrinsic clotting pathway can be measured with ___________ |
PT |
|
Heparin is associated with the intrinsic or extrinsic clotting pathway? |
Intrinsic |
|
Warfarin primarily affects the PT or PTT? |
PT |
|
Ingestion of what can cause subtherapeutic INR levels in patients taking warfarin? |
Green Leafy Vegetables --> ↑ Vit. K |
|
What is the most common inherited bleeding disorder? |
Von-willebrand disease |
|
Bleeding time in Von-willebrand disease Vs. Hemophilia A? |
vWD = ↑ Bleeding time
Hemophilia A: No change in BT (platelets are not affected) |
|
What is the lifespan of RBCs in patients with sickle cell anemia? |
17 days as compared to 120 in patients without sickle cell |
|
Most cases of spinal cord compression are in which area of the spine? |
Thoracic (68%)
---------------------------------------------------------------- Lumbar (19%)
Cervical (15%) |
|
Which gynecologic disorder presents with the triad of:
1. Hirsutism 2. Obesity 3. Oligomenorrhea |
Polycystic Ovarian Syndrome |
|
What is the most common ovarian tumor? |
Benign Cystic teratoma (dermoid cyst) |
|
Yoplait contains which type of bacteria which are shown to be decreased in patients with bacterial vaginosis? |
Lactobacilli |
|
Bacterial vaginosis during pregnancy can cause ______________, so it should always be treated even if the patient is asymptomatic |
preterm labor |
|
A woman presents with recurrent vaginal candidiasis. What is the next best test to order? |
Blood glucose ---> Diabetes |
|
There is a high rate of recurrence of Bartholin's abscess due to ___________ formation |
fistulous tract formation |
|
What is the leading cause of female infertility? |
PID |
|
______ is a risk factor for infertility, chronic pelvic pain, and ectopic pregnancy |
PID |
|
__________ is uncommon during pregnancy due to the plug formed by the fusion of the chorion and decidua providing an extra natural barrier to infection |
PID |
|
What is the most common organism to cause a tubo-ovarian abscess? |
Bacteroides |
|
Should you treat asymptomatic bacteriuria in pregnant women? |
Yes... use nitrofurantoin |
|
𝞫 -hCG levels double every _____to_____ days in normal early pregnancy |
2-3 days |
|
What test can be used to determine the amount of fetal-maternal blood mixing in Rh (-) patients? |
Kleihauer-Betke tets |
|
First-trimester bleeding occurs in approximately ____% of all pregnancies, one-half of patients will eventually experience a miscarriage |
25% |
|
What is the most common risk factor for abruptio placentae? |
Hypertension |
|
Eclampsia and Seizures:
____% of seizures are before labor
___% are during labor
____% are up to 10 days postpartum |
25% of seizures are before labor
50% are during labor
25% are up to 10 days postpartum |
|
_______ syndrome complicates about 10% of preeclampsia:
Hemolysis, Elevated liver enzympes, Low platelets |
HELLP Syndrome |
|
Why should rapid BP reduction be cautioned against during eclampsia/preeclampsia? |
Decrease in uterine blood flow --> fetal distress |
|
Drug of choice for a patient with Eclampsia? |
Magnesium Sulfate
--------------------------------------------------------------------- -Terminates seizure -Prevents recurrence of seizure - ↓ risk of placental absorption - Associated with ↓ NICU admissions - Better than phenytoin or placebo |
|
Patients with PROM are at higher risk for what complication? |
chorioamnionitis |
|
What is the leading cause of neonatal death? |
Preterm labor |
|
What is the most common organism to cause septic arthritis in all age groups? |
Staph. aureus |
|
Most common joints involved in septic arthritis? |
The knee, followed by the hip, shoulder and wrist |
|
Most common cause of osteomyelitis? |
Staph. aureus |
|
Most common cause of osteomyelitis in patients with asplenia or sickle-cell disease? |
Salmonella |
|
What is the most common entrapment neuropathy? |
Carpal Tunnel Syndrome |
|
What percentage of the population normally has a positive Phalen or Tinel's sign? |
20-50% |
|
Most common malignancies causing spinal cord compression? |
Prostate, breast, lung |
|
Which has longer morning stiffness, OA or Rheumatoid arthritis? |
Rheumatoid arthritis |
|
OA vs RA:
Which affects the Distal Interphalangeal joints (DIPs)? |
OA |
|
This disorder affects small joints and aspiration shows needles with negative biferingence |
Gout ---> Uric acid crystals
---------------------------------------------------------------------
Pseudogout --> large joints (shoulder,knee,wrist), positive biferingence --> calcium pyrophosphate crystals |
|
What is the most common and frequent manifestation of gout? |
Podagra |
|
Polymyositis and dermatomyositis are both more common in men or women? |
women |
|
Patients with dermatomyositis or polymyositis are often given azathioprine or methotrexate.
Both can cause what side effect? |
Bone marrow suppression
---------------------------------------------------------------- Azathioprine may also cause hepatotoxicity |
|
Posterior shoulder dislocations account for only __% of all dislocations |
2% |
|
Posterior shoulder dislocations are frequently missed. Surgical fixation is necessary when diagnosis is delayed more than ____ weeks |
2 weeks |
|
A fracture of the humerous at this location is associated with radial nerve injury and wrist drop |
Mid-shaft humerus |
|
This is a distal radius fracture with dorsal angulation.
-FOOSH - "Dinner fork deformity" is classic |
Colle's Fracture |
|
Anterior shoulder dislocations may damage which nerve? |
Axillary Nerve |
|
________ is commonly associated with ski-pole injury |
Gamekeeper's thumb
--------------------------------------------------------- -Avulsion of ulnar collateral ligament of first MCP joint |
|
A patient complains or arm pain after a fall on outstretched hand. X-ray shows a posterior fat pad. |
Radial head/neck fracture |
|
If left untreated, a mallet finger may result in a permanent ________ deformity. |
Boutonniere deformity
---------------------------------------------------------------- -Mallet finger --> rupture of extensor tendon at insertion of distal phalanx |
|
Fracture/dislocation at the base of the thumb |
Bennett fracture |
|
Fracture at neck of 5th metacarpal following a closed-fist injury |
Boxer's Fracture |
|
Fracture of the ulnar shaft |
Nightstick fracture |
|
What is the percentage of patients that die within 1 year of hip fracture? |
30% |
|
What is the most frequently injured foot bone? |
Calcaneous |
|
Describe an antalgic gait |
Pain on weight bearing in which the stance phase of the gait is shortened on the affected side |
|
Is compartment syndrome most common in the upper or lower extremity? |
Lower extremity |
|
What is the most common cause of adrenal crisis? |
Abrupt withdrawal of steroid therapy |
|
Patients with CHF and DKA will require ________ |
agressive fluid resuscitation
------------------------------------------------- This also holds true for patients with CHF and HHS |
|
Which anti-thyroid drug does NOT block conversion of T3 to T4 |
Methimazole |
|
What antiparasitic drug can cause seizure if overused? |
Lindane |
|
More potent steroids are needed for rashes/diseases involving ______ skin |
thicker |
|
_______ agents are first-line for the treament of acne |
Topical Agents -benzoyl peroxide -Clindamycin -Trenitoin -Erythromycin |
|
Exposure to sun while on ________ or ________ can cause a rash in patients being treated for acne |
tetracycline or doxycycline |
|
Lyme disease can cause which nerve palsy? |
Bell's palsy (CN VII) |
|
Many patients with Rocky Mountain Spotted Fever have exquisite tenderness of the ________ muscle |
gastrocnemius |
|
Varicella-zoster infection of CN VIII is called _______________ syndrome.
-Hearing loss -Vertigo -Tinnitus |
Ramsay Hunt Syndrome |
|
Bullous Pemphigoid vs. Pemphigus Vulgaris:
Which is Nikolsky (+) ? |
Pemphigus Vulgaris |
|
Bullous Pemphigoid vs. Pemphigus Vulgaris:
intraepidermal involvement |
Pemphigus Vulgaris |
|
Bullous Pemphigoid vs. Pemphigus Vulgaris:
subepidermal involvement |
Bullous Pemphigoid |
|
Psoriasis is worse during which season? |
Winter |
|
What accounts for most recurrent cases of erythema multiforme? |
HSV |
|
Describe the stages of decubitus ulcers (I-IV) |
I - nonblanching erythema of intact skin
II - partial-thickness skin loss involving epidermis and/or dermis
III- full thickness skin loss involving epidermis and dermis. May involve damage to subcutaneous tissues, extending down to fascia
IV- full thickness skin loss with extensive damage to muscle, bone or supporting structures |
|
Early Kaposi's sarcoma is often mistaken for ____________ |
Bruising |
|
What is the emergent treatment of choice if a chest tube can't be immediately placed for a patient with a tension pneumothorax? |
Needle decompression with a 14g needle at the 2nd intercostal space, mid-clavicular line |
|
Neurovascular bundles run along the ______ rib margin |
inferior |
|
An emergence reaction is the occurrence of hallucinations and nightmares during the wearing off of ________ after procedural sedation |
Ketamine
---------------------------------------------------------------- Not common in children, occurs in 10-20% of adults. Allow emergence in a dark, calm room to decrease this phenomenon |
|
DOC for procedural sedation in children? |
Ketamine |
|
Which drugs are preferred in hypotensive patients needing procedural sedation? |
Ketamine or Etomidate
-------------------------------------------------------------------- These do not decrease BP |
|
How should the patient be positioned for a central venous cannulation? |
Trendelenburg position ----------------------------------------------------------------- Thought to prevent air embolism |
|
Is central venous cannulation preferred on the right or left side? Why? |
Right side!
Avoids thoracic duct (on left) and dome of right lung is lower leaving a decreased chance of pulmonary injury |
|
Antibiotic of choice for an abscess in an otherwise healthy individual? |
None.. Incision and drainage is the treatment of choice...
--------------------------------------------------------------------- Antibiotics should be considered in immunocompromised patients or those with valvular disease. |
|
A farmer presents after spraying insecticide on crops all day. He has increased salivation, lacrimation, anxiety and bradycardia.
Treatment of choice? |
This is Cholinergic toxicity from organophosphate poisoning. Treat with atropine +/- pralidoxine |
|
A patient presents mad as a hatter, blind as a bat, hot as a hare, and dry as a bone.
What's going on? |
Anticholinergic Toxicity
Treat with Benzos +/- Physostigmine (↑s ACh)
----------------------------------------------------------------- Mad as a Hatter: AMS Blind as a bat: Mydriasis Hot as a Hare: Hyperthermia (can't sweat) Dry as a bone: Dry mucous membranes |
|
Toxidrome:
Decreased level of consciousness, respiratory depression, pinpoint pupils |
Opioid Toxicity
Treat with Naloxone |
|
Toxidrome:
Treatment for benzodiazepine overdose? |
Supportive +/- flumazenil |
|
What's in the "coma cocktail"? |
(DON'T)
Dextrose Oxygen Naloxone Thiamine
[Give thiamine before dextrose] |
|
name a classic example for a "spot" test for a toxidrome |
Ferric Chloride ---> Salicylate Poisoning |
|
What are two factors that accelerate acetameniphen toxicity |
1) Prior induction of P450 (smokers, EtOH, drugs)
2) Malnutrition (↓ glutathione stores) |
|
What is the potential toxic dose of acetameniphen? |
140 mg/kg |
|
What is the initial dose for NAC in acetameniphen toxicity? |
140 mg/kg |
|
At what 4-hour level of acetameniphen will hepatic toxicity become induced? |
140 ug/kg
------------------------ micrograms |
|
A 67 yo female presents with 6 days of headache and 2 days of "ringing in ears" and fever. She is breathing deeply at a rate of 22/min.
Diagnosis? |
Aspirin toxicity |
|
What ECG finding is pathognomic for digoxin toxicity? |
Bidirectional ventricular tachycardia |
|
Without digibind therapy, Digoxin toxicity mortality is:
___% for K+ levels > 5.5
____% for K+ levels 5.0-5.5
____% for K+ levels < 5.0 |
100% for K+ levels > 5.5
50% for K+ levels 5.0-5.5
0% for K+ levels < 5.0 |
|
First-line drug for treatment of dysrhythmias in patients with a TCA overdose? |
Sodium Bicarbonate
----------------------------------------------------------------- Sodium in sodium bicarb alters the interaction between the drug and sodium channels in the heart. |
|
Does lithium bind to charcoal? |
No... Activated charcoal is useless in the presence of lithium overdose |
|
Toxicity from antipsychotic medications can occur with ______ or _______ |
therapeutic dose or overdose
------------------------------------------------------------------- -Extra Pyramidal Symptoms --> Tx = Benadryl -Sedation -Orthostatic hypotension |
|
A patient with newly diagnosed schizophrenia presents with hyperthermia, AMS, autonomic instability and muscular rigidity...
Diagnosis? |
Neuroleptic Malignant Syndrome
--------------------------------------------------- Treat with supportive care, benzo's and dantrolene |
|
In alcoholic ketoacidosis, most ketones are ______ and are poorly detected by the lab |
𝞫 -hydroxybutyrate |
|
In patients who ingest Methanol, toxicity is contributed to formation of ___________ |
formic acid |
|
Which opiod causes dilated pupils (mydriasis)? |
Meperidine ---------------------------------------------------------------- Can also precipitate Serotonin syndrome in patients using MAOIs |
|
Although flumazenil is the DOC for benzodiazepine reversal by IV drug sedation, why should it not be used in an overdose setting? |
It may precipitate seizures
Also, which drug is first line for seizures --> Lorazepam... Wouldn't make sense to give a competitive inhibitor of benzodiazepines if seizure is a risk! |
|
What is the most common household caustic exposure? |
Bleach |
|
Type of necrosis caused by acid exposure? |
Coagulation necrosis |
|
Type of necrosis caused by alkali exposure |
Liquefactive necrosis |
|
Dermal exposure to hydrofluoric acid, found in rust removers, may result in systemic absorption causing hypocalcemia, hypomagnesemia and death.
How would you treat? |
Calcium gluconate paste for dermal burn
IV/IA Calcium |
|
How do organophosphates cause cholinergic crisis? |
Deactivation of acetylcholinesterase |
|
3 unique symptoms associated with high-altitude sickness? |
-Snow blindness (ultraviolet keratitis)
-Pharyngitis
-Retinopathy |
|
The definitive treatment for high-altitude syndromes is ____________ |
descent
-------------------------------------------------------------- When not possible, descent may be simulated by a Gamow bag (portable hyperbaric O2 chamber) |
|
According to Boyle's Law, as Pressure increases, Volume _______ |
decreases |
|
What is a risk factor for "reverse ear squeeze" (ascent barotrauma)? |
Respiratory tract infection/congestion |
|
Decompression Sickness occurs at a dive/depth of at least ______ feet |
30 ft |
|
Treatment of choice for Decompression Sickness ("The bends")? |
Immediate hyperbaric O2 |
|
What is "secondary drowning"? |
Death after initial stabilization |
|
Name 3 risk factors for near drowning: |
-Hypoglycemia
-Seizures
-Head trauma |
|
Name 4 subsets of patients at high risk for drowning: |
- Children < age 4
- Teens (poor judgment)
- Elderly (tubs)
-Alcohol and Drug Users |
|
A 24 yo male diver syncopizes upon ascent tot he surface.
Diagnosis? |
Dysbaric Air Embolism |
|
When do you NOT close wounds caused by human bites? |
Closed fist injuries ("Fight Bite") |
|
What is the Parkland formula for burn victims? |
4 x weight(kg) x %BSA = mL fluid resuscitation
Give 1/2 over first 8 hours
Give remaining half over a 16 hr period
|
|
Fluid of choice for burn victims? |
Ringer's Lactate |
|
Rule of 9's for burn victims |
|
|
Name some criteria for patient transfer to a burn unit |
-Electrical or chemical burns
-Inhalation injury
-Children
- >10% TBSA in ages < 10 or >50
- >20% TBSA in ages 10-50
- >5% TBSA Third degree burn
- Significant burns to face, eyes, ears, hands, feet, genitalia, perineum or major joints |
|
Name some products that contain Hydroflouric acid and can cause burns/toxicity |
Glass etching dyes High-octane gas Germicides |
|
Name some products containing Phenol, which can cause a chemical burn after exposure to skin |
Dyes Deodorants Agriculture Disinfectants
|
|
When should ocular pH be tested when irrigating an eye exposed to a chemical? |
Before AND After irrigation! |
|
What is Frostnip? |
Mild, reversible, superficial frost bite |
|
Best way to get a core temperature in a patient with hypothermia? |
Rectal or bladder temperature |
|
ECG finding in hypothermia? |
Osborn ( J ) wave |
|
"Duty to warn" was established by the _________ case |
Tarasoff Case |