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common problems in acute care Flashcards

1
Q

acute vs chronic pain

A

plus or minus 6 months

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2
Q

cutaneous pain

A

skin

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3
Q

visceral

A

poorly localized in the organs

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4
Q

somatic

A

in muscle or soft tissue

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5
Q

neuropathic

A

nerve pain

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6
Q

step one pain control

A

asa, tylenol, nsaids, + adjuvants

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7
Q

step two pain control

A

insitial nsaid plus codeine, oxy or hydro, tramadol (not with asa or tylenol)

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8
Q

step three pain control,

A

nsaid plus morphene, dilaudid, methadone, fent

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9
Q

break through cancer pain

A

fent patches

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10
Q

causes of fever non bacterial

A

autoimmune disease, cns, neoplasm, blood disease, mi, gi disease, endocrine, nms

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11
Q

38.3 =

A

101.5

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12
Q

nms

A

antipsychotics, high fever, treat with fluids

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13
Q

treatment of fever

A

abx when microbe is present, tylenol, treat underlying cause

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14
Q

sux

A

not used with hyperkalemia

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15
Q

post op fever (non infecitous) leading cause

A

post op atelectesis, increased metabolic rate, dehydration, drug reactions,

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16
Q

infectious causes of post op fever

A
  1. leftshift, band formation lots of immature bands

2. wbc over 30K usually not infection

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17
Q

treatment of post op fever

A

in abcence of infection, expand lungs and hydrate

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18
Q

headache

A

chronology is most important history item

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19
Q

tension

A

most comon, vice like, tx withtylenol, no focal neuro symptoms

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20
Q

migrane

A

classic with aura- common without aura, related to diation and pulsation of external carotid, female > male, family history often present,

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21
Q

migrane symptoms

A

unilateral pain, dull or throbbing, lasts for hours, + focal neuro disturbances,

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22
Q

migrane tx

A

asa + sumatryptan iv or po- 6mg sq and up to three per day vs 25 po

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23
Q

albumin <3.5

A

malnutrition

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24
Q

albumin <2.7

A

edema

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25
Q

hgb repletion levels

A

8/24

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26
Q

need nutritional support for > 6 weeks <6weeks

A

peg tube ND nasoduedeanl tube if at risk of aspiration

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27
Q

need nutrition but cant use gi tract,

A

2 weeks or more or dex >10% central line, 2 weeks or less picc

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28
Q

Hyponatremia most common e abnormality determine and treat the cause eval includes

A

Urine NA- normal is 10-20
serum osmo 2xNA
Clinical status

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29
Q

hyponatremia urine

A

> 20 renal salt wasting ie a kidney problem

< 10 outside kidney

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30
Q

isotonic or psuedo hyponatremia

A

284-295 hiigh lipids, no symptoms, cut fat

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31
Q

fluid volume ranges

A

<280 is dry, 280-294 normal >290 is overloaded

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32
Q

hypernatremia cause and management
low volume
euvolemic
wet

A

145+ excess water loss,
dry- nss and 1/2 nss
nromal - free water
wet - free water and loop diuretics, may need HD

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33
Q

low K

cause

A

> 3.5 chronic use of diuretics, alkalosis , gi or renal loss

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34
Q

Low K sx

A

muscle weakness, constipation or illeus,

flacid paralysis if <2.5 tetany hyperrelfexia and rhabdo

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35
Q

Low K on diagnostics

A

broad T, low amplitude EKG, prominent U waves, PVC, vtach or fib

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36
Q

Low K treatment

A

oral if >2.5
IV at 10meq/hr if cant do po
if <2.5 or with sx give 40 IV, check q3, fix the mag. (1.7-2.2)

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37
Q

High K >5 causes

A

renal failure, nsaids, excess intake, low aldosterone, cell death, acidosis

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38
Q

High K acidosis

A

ph drops .1 K increase 0.7

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39
Q

High K S and S

A

weak, facid paralysis
ab distention
diarrhea

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40
Q

labs K>5

A

peaked T but not all

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41
Q

K>5 management

A

kayexalate

insulin 10uiv and and 1amp dex if >6.5

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42
Q

normal total ca

A

2.2-2.6mmol/L or 8.5-10.5mg/dl

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43
Q

normal ionized CA

A

1.1-1.4mmol/L or 4.5-5.5 mg/dl

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44
Q

if albumin is jacked up

A

use i calc cause it does not vary with serum albumin 3.4-5.4

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45
Q

50% of ca is bound to albumin so normal ca (2.2-2.6mmol/L or 8.5-10.5mg/dl) with low albumin <3.4

A

means that ca is high

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46
Q

ca <2.2 or 8.5 causes

A

hypoparathyroidism low mag >1.7, kidney failure, severe trauma, blood transfusion

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47
Q

management of ca .2.2 or <8.5

A

check ph looking for alkalosis
if acute IV calcium gluconate
if chronic - vitamin D, oral supplements, aluminum hydroxide,

48
Q

CA >2.6 or 10.5 causes

A

hyper thyroid, vitamin D intox, prolonged immobilizaiton, rare with thiazide diuretics.

49
Q

CA >2.6 or 10.5 S and S

A

fatigue, muscle weak, depression, aorxia, nausea, and emisis, sever >12 can lead to death. and is a medical emergency

50
Q

CA >2.6 or 10.5 tx

A

calcitonin if poor cardiac or renal funciton
HD
if >12 loop diuretics and ns infusion

51
Q

ca is opposite ie

A

low ca is up symptoms trusods - sustained carpal pedal spasm, cvostics wink or cheek, hi ca and ur sleepy

52
Q

Resp acidosis

A

PH <7.35 and Pco2 >45

53
Q

ph <7.35 and Pc02 >45 symptoms

A

sleepy, asteriskis myoclonus, increased csf pressure

54
Q

Ph <7.35 and Pco2 >45 tx

A

narcan for pts with no obvious cause, 0.04 to 2mg, intubate or improve ventilation, up vent rate.

55
Q

Resp alkalosis PH, >7.45 and pco2 <35

A

anxious, tingling, tetany if severe parastesia

56
Q

resp alkalosis ph >7.45 and pco2 <35

A

serum bicarb is low if chronic, renal system wont kick in for a while

57
Q

tx resp alkalosis,

A

retain more co2

58
Q

metabolic acidosis hallmark sign is Bicarb below 22

A

yup

59
Q

AG vs NAGM

A

NA + K - (bicarb+CL)

60
Q

AG metabolic acidosis

A

DKA, alcoholic keto, lactic acidosis, drug or chemical reaction

61
Q

Non anion gap acidosis

A

diarrhea, illy, renal tubular acidosis, dka recovery

62
Q

AG metabolic acidosis treatment

A

fluid restriction, no bicarb repletion for hypoxia or dka, yes bicarb if significant hyperkalemia is present

63
Q

non gap acidosis tx

A

common with chronic conditions like renal failure, treat with bicitral 10-30 with meals and hs

64
Q

metabolic acidosis, high plasma hco3 >26 and Pc02 rarely above 55 (compensatinng) causes

A

post hypercapnea alkalosis,
ng suction
vomiting and diuretics

65
Q

metabolic acidosis tx if salene responsive

A

correct volume deficit with nacl and kcl, discontinue diureticis, h2 blockers for nausea,

66
Q

metabolic acodisis if cant replete with fluidis

A

acetazolamide 250-500mg IV every 4-6h

67
Q

burns categories

A

1 dry no blisters epidermis only
2 moist blisters beyond epidermis
3 dry, black, down to fat or bone.

68
Q 
measuring extent of burn
arm
leg
thorax front
thorax back
head
perineum genitals
A 
arm 9 
leg each  18 
thorax front 18 
thorax back 18 
head 9 
perineum genitals 1
69
Q

lund and broward chart for burns

A

most common, takes into account total body surface area according to age and area burned.

70
Q

burns fluid recussitation calc

A

4ml/kg x tbsa during first 24 hours

71
Q

burn fluid recussitation general rule

A

1/2 of all the fluid req during the first 24 hours, should go in within the first 8 hours, then 1/4 and 1/4 over the next 16

72
Q

burns metabolic acidosis

A

seen early

73
Q

burns and potasium

A

early is high, late is low and can happen up to three days out

74
Q

burns and when to tube

A

face burns, singed eyes, dark soot in nares or mouth - indication is laryngeal edema

75
Q

emergent burn managemnt,

A

submerge in water, no ice or lotion, wrap in clean dry towel, maintain normal temp 37-37.5 c, pain managemnt, fent and morphen, silvadine is used for abx

76
Q

refer to burn center if

A

partial thickness over >10%of surface area, electrical or chemical burns, inhalation injury , third degree in any group.

77
Q

cellulitus most commmon cause outpatient

A

group a strep strep pyogenes most common

staph a
other strepg group

78
Q

abx for bite

A

augmentin ammox and clavulanate po 3-7days

79
Q

cellulitis most comon inpatent

A

gram negs- ecoli, klebs, psudomonas, enterobacter
staph(mrsa)
strep

80
Q

community associated mrsa

A

no fever - staph on foot, I&D culture and come backin 3

boil + fever bactrim, doxy or clinda

81
Q

group a strep

A

bactrim + beta lactam (pcn, ammox, or keflex)

or doxy/minocycline + ocn, ammox, keflex

clinda works alone,

82
Q

solid ingestions

A

syrup of ipacac

83
Q

gastric lavage in poisoing

A

lavge to clear then bind with charcole and sorbital to poop it out

84
Q

ipicac never use

A

corrosivs, or detergents, emisis will erode esophogaus or lead to

85
Q

benzo od

A

use flamozolil

86
Q

aceytlcystine or acetaminophin or anacin-3 or panadol tox

A

asymptomatic early
RUQ pain
24hrs in nausea and emisis
hepatotoxiity

87
Q

acetaminophen intox- tx

A

emisis for recent vs lavag and charcole

N-acetylcystine or mucomyst with a loading dose po prn

88
Q

asa tox s and s

A

nausea, tinnitis, dehydration, hyperthermia, apnea, met acodosis, elevated LFT

89
Q

asa tox tx

A

emiss for recent vs levage and activated charcoe

sodium bicarb to correct severe acodosis

90
Q

insecticide tox (malathion, parathion

A

blurred vision and miosis
bradycardia

nausea emisis, cramps
diarrhea
salivation
headache 
confusion
91
Q

management of insecticide tox (ions)

A

wash skin charcole, atropine for organophosphate tox

92
Q

antidepressant tox s and s

A

confusion, hallicunation, blurred vision, urinary retention,
hypotension, brady, dysrythmias, hypothermia, seizures

93
Q

antidepressant tox managemtn

A

admit to ICU is cns or cardiac sx
gastric lavage and activated charcole
sodium bicarb to tx dysrythmias and hold ph
benzo for seizures

94
Q

serotonin syndrome treatment

A

dantrium (dantrolene sodium) clonopin to treat rigor, cooling blankets for hyperthermia.

95
Q

cocain pupils

A

big

96
Q

heroin pupils

A

small

97
Q

opiate od

A

narcan, emetics are contirindicated, lavage and charcole,, butorphanol

98
Q

benzo od s and s

A

hyporeflexia and sleepy

99
Q

benzo tx

A

Flumazenil (romazicon) IV breathing and bp support, gastric levage and activated charcole

100
Q

BB od s and s

A

bronchospasm, hypo and brady delerium

101
Q

BB od

A

charcole, glucagon, atropine, airway watch

102
Q

transplant acute rejection

A

flu like prodrome plus immediate failure of the organ

103
Q

transplant rejection first priority

A

call in expert for immediate biopsy of the organ

104
Q

transplant meds classes

A

calcineurin inhibitor -tacrolimus or cyclosporine
antimetabolite- azathioprine Imuran or mycohenolate
steroids- prednisone

105
Q

shingles

A

erythema and exudate alonge the dermatomal path grouped vesicles,

106
Q

shingles tx

A

the ovirs, if eyes involved consult opthomolagist,

107
Q

post herpetic neuralgia:

A

gaba, lyrica or neurontin,

108
Q

actinic keratoses

A

small patches on sun exposed skin
premalignant- can progress to squamus cell
rough, flesh colored, hyperpigmented
freeze offf

109
Q

squamous celll

A

arise out of AK, firm irregular pap or nodule, develop oer a few months
keratotic, scaly bleeeding

tx biopsy and mohs

110
Q

seborrhec keratoses

A

benign
not painful
stuck on beigh brown or black
3-20mm in diameter

teatment maye none or liq nitrogen

111
Q

basal cell ca

A 
most common skin cancer
slow growing 1-2cm after years
waxy pearly or shiny red
centrel depression or rolled edge
may have telangietatic vessels

shave punch and surgical excision

112
Q

malignant melanoma

A

highest mortality rate
median age at diagnosis is 40
may metastize to any organ

113
Q 
A
B
C
D
E
A 
Asymmetyr
Border irregulairty
Color variation
Diameter >6mm
Elevation or enlargement
114
Q

NMS cause, sypmtoms, priority treatment

A

antipsytotics, crazy high fever, fluids

115
Q

best earlist lab sign of mal nutrition

A

pre- albumin 15 to 36 milligrams per deciliter (mg/dL) or 150 to 360 milligrams per liter (mg/L)

116
Q

prolonged QT electrolyte imbalance

A

HYPO calcemia

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