BCEN Flashcards
(274 cards)
1
Q
Requiring bag-mask ventilation / intubation / mechanical ventilation | SCI
A
C5 and above
C4 diaphragm
2
Q
Cause loss of intercostal muscle function with hypoventilation - may require O2
A
Above T11
3
Q
Cause loss of abdominal muscles with hypoventilation and inability to cough
A
T7
4
Q
- Hypotension (widening pulse pressure)
- Bradycardia
- Abnormal respiratory pattern
A
Cushing’s Triad found in late ICP
5
Q
Bulging fontanelles
Sunset eyes
Vomiting, anorexia, poor feeding
High pitched cry
Biot’s respiration
A
S/s of pediatric ICP
6
Q
Deep rapid respirations interrupted with long, apneic pauses
A
Biot’s respirations found in increased ICP (pediatrics)
7
Q
MAP - ICP
A
CCP | >70 GOOD
8
Q
Diuretic used to decrease ICP
A
Mannitol | Risk to kidney damage & electrolyte imbalance
9
Q
Pulse oximetry >95%
PaO2 >100 mm Hg
Sys BP >100
ICP <15
CCP >60
Temp 36-38
Glucose 80-100
Serum sodium 135-145
Hemoglobin >7
A
Goals of care for ICP
Avoid crystalloids | blood products and colloids preferred.
Colloid solutions contain large insoluble molecules
Proteins
Complex polysaccharides
Albumin, starches, dextrans
10
Q
80% of basilar fractures
A
Anterior Fossa Fracture
11
Q
Bleeding or CSF leak will cause epistaxis, rhinorrhea, subconjunctival hemorrhage, hemorrhage in the periorbital spaces
A
Anterior Fossa Fracture
12
Q
Bleeding or CSF leak will cause otorrhea, hemotympanum, nerve injury leading to deafness and vertigo
A
Middle Fossa Fracture
13
Q
Ecchymosis behind the ear (Battle signs)
Bleeding around medulla causes bradypnea, respiratory irregularities, hypertension, bradycardia.
Gag reflex impaired
A
Posterior Fossa Fracture | Rare | More severe, no where for bloodto go
14
Q
Ecchymosis behind the ear (Battle signs)
Bleeding around medulla causes bradypnea, respiratory irregularities, hypertension, bradycardia.
Gag reflex impaired
A
Posterior Fossa Fracture | Rare | More severe, no where for bloodto go
15
Q
Bleeding is ARTERIAL (middle meningeal artery) caused by a blow to temporal region with RAPID decline in LOC (often over 6 hours or less)
A
Epidural Bleed
16
Q
Unconscious immediately after incident followed by lucid period with onset of severe headache then rapid decline in LOC with signs of increased ICP
A
S/s of Epidural Bleed
17
Q
Evacuation of blood with burr holes or surgical evacuation
A
Tx of Epidural Bleed
18
Q
Bleeding is VENOUS with SLOWER onset of symptoms of ICP
A
Subdural Bleed
19
Q
Symptoms within 48 hours
A
Acute Subdural Bleed
20
Q
Symptoms within 48 hours - 2 weeks
A
Subacute Subdural Bleed
21
Q
Symptoms more than 2 weeks after injury
A
Chronic Subdural Bleed
22
Q
May be rupture of aneurysm or traumatic
A
Subarachnoid Bleed
23
Q
Meningeal irritation causing “worst headache of my life”, nuchal rigidity and photophobia. Decrease LOC, Motor deficits (hemiparesis) | Pupil abnormalities
A
S/s of Subarachnoid Bleed
24
Q
Preventing complications:
1. Rebleeding (keep SBP <160 mmHg with labetalol or nicardipine
2. Reducal local vasospasms by administrating IV calcium channel blockers
A
Tx of Subarachnoid Bleed`
25
Unconscious | GCS 3 | Posturing | Elevated ICP | SBP 140-160 | Hyperthermia | Excessive Sweating
Severe TBI (Diffuse Axonal Injury DAI)
26
Unconscious | GCS 3 | Posturing | Elevated ICP | SBP 140-160 | Hyperthermia | Excessive Sweating
Severe TBI (Diffuse Axonal Injury DAI)
27
Hypovolemic Shock = ____ pathetic
Sympathetic
28
Neurogenic Shock = _____pathetic
Parasympathetic
29
SCI above the level of ___ disrupt the sympathetic fibers that transmit through the spinal cord yet leave the parasympathetic pathways intact
Above T6
30
1-2L Bolus
Vasopressors
Atropine
Aggressive warming measures
Tx Neurogenic Shock
31
Vasodilation
Bradycardia
Skin warm/dry
Priapism
Neurogenic shock / Parasympathetic stimulation
32
Descending Motor nerves
ANTERIOR Cord
33
Ascending Sensory nerves
POSTERIOR Cord
34
Proprioception, fine touch, fine pressure, and vibration
POSTERIOR Cord (ASCENDING sensory nerves)
35
Ascending Sensory nerves - pain / temp /crude touch
LATERAL CORD (Ascending sensory nerves)
36
Loss of motor function, loss of pain, temperature, crude touch, and crude pressure
ANTERIOR cord injury
37
Loss of proprioception, vibration, fine touch, and finre pressure
POSTERIOR cord injury
38
Loss of motor function, proprioception, and vibration sense on side of injury but loss of pain and temperature on opposide side of injury
Brown-Sequard (lateral injury to the cord usually from penetrating trauma)
39
Greater loss of motor function in upper extremities than lower extremities with variable sensory sparing
Central Cord Syndrome
40
Difference between lateral cord and anterior/posterior cord nerve crossings
Anterior / posterior cords cross at the base of the brain while lateral cords cross at the point of insertion in the spine.
41
Difference between lateral cord and anterior/posterior cord nerve crossings
Anterior / posterior cords cross at the base of the brain while lateral cords cross at the point of insertion in the spine.
42
Stuttering start
Thrombolytic Stroke
43
Sudden onset of stroke s/s. 50% have a-fib | Can be caused by ENDOCARDITIS
EMBOLIC Stroke
44
Triggers include food, dieting, emotion, menses, medications, weather changes, sleep disturbances, bright lights, aggravated by activity
Migraines
45
Unilateral headache with pulsating quality | 4-72 hours | Nausea, photophobia, phonophobia, LIE STILL
Migraine S/s
46
Metoclopramid, prochlorperazine, Ketorolac, valproate | Prevention: Dexamethasone, BB, Triptans, Anti-epileptic | Anti-depressants
Migraine Tx and Prevention
47
Precipitated by alcohol, antihistamine or nitroglycerin
Cluster HA
48
Unilateral, excruciating, burning PERIORBITAL or temporal pain often waking the patient from sleep
Cluster HA s/s
49
15-180 minutes, 1-8/day, spring / fall, pain-free for periods of months/years
Cluster HA
50
100% oxygen NR for 15 minutes or until pain subsides
Cluster HA Tx
51
Rapid onset of symptoms causing death in 15% of cases and long term disability. ______ Meningitis
Bacterial Meningitis
52
Tightening of meninges spinal cord
Opisthontonos - bacterial meningitis
53
Petechial rash on trunk and thighs unique to _____
Bacterial Meningitis
54
Paradoxical crying in infants - cries when held but not when laid down
Bacterial Meningitis
55
_____ Meningitis associated with immunocompromise
Fungal Meningitis
56
Impairment of cognition (may remain responsive) with amnesia of the event. Demonstrates automatism - performs actions without thought
Focal Complex partial seizures
57
Tonic-clonic movements
Generalized convulsive seizures
58
Absence seizure, myoclonic seizures, tonic seizure atonic seizure \ FREEZE IN TIME
Generalized non-convulsive seizures
59
Post-ictal state which may include Todd's paralysis and neurogenic pulmonary edema
Focal complex partial / generalized tonic-clonic seizure
60
Focal activity in one hemisphere ( focal clonic movements, sensory disturbances, deja vu, etc.) WITHOUT LOC
Focal simple partial seizures
61
Affecting one limb or side of the body which can last for 24 hours
Todd's paralysis
62
IV Fosphenytoin (Cerebryx)
IV Phenytoin
IV Levetiracetam
Tx Status Epilepticus
63
Progressive nervous system disease that affects nerve cells in the brain and spinal cord causing loss of muscle control.
Amyotrophic Lateral Sclerosis (ALS / Lou Gehrig's disease)
64
Distal muscles more affected than proximal muscles
Upper extremities more affected than lower extremities
Results in muscular spasticity, hyperreflexia and muscle paralysis. CNS ofen unaffected. 15% develop Dementia
ALS
65
Sporadic attacks brought by triggers such as changes in body temperature, (fever, taking hot bath, hot weather, exercise). Blurred vision, double vision, red-green color distortion, blindness in one eye, weakness, difficulty with coordination and balance. Paresthesia, pain, speech impairment, tremors, dizziness.
MS
66
Interferon Beta (Rebrif) / immunosuppressants minimize symptoms
MS
67
Weakness more pronounced in proximal muscles compaired to distal muscles and to muscles of upper body than lower body
Myasthenia Gravis
68
Acute autoimmune polyneuropathy that primarily affects the motor component of the peripheral nerves. Often follows viral illness / immunization.
Guillain Barre Syndrome
69
Oh once one takes the anatomy final a good vacation seems heavenly
Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Acoustic
Glossopharyngeal
Vagus
Spinal Hypoglossal
70
Some say marry money but my brother says big boobs matter more
Sensory vs Motor Vs Both
71
AKA tic douloureux, sudden usually unilateral severe brief, stabbing recurrent pain in the distribution of one or more branches of 5th cranial nerve. May cause facial spasms.
Trigeminal Neuralgia | Neuropathic pain
72
Adjuvant analgesics for what kind of pain?
For neuropathic pain - antileptics, anti-depressants, antiarrhythmics
73
Carbamazepine, Phenytoin, Oxcarbazepine, Clonazepam, Lamotrigine, Valproic acid, gabapentin
Adjuvant analgesics - antileptics, anti-depressants, anti-arrhythmias
74
Paralysis to one side of the face is often caused by HSV
Bell's Palsy
75
Unable to blink in one eye resulting in cornea ulceration and unable to purse lips
Bell's Palsy
76
No airway sounds, inspiratory stridor, EXPIRATORY wheezing with prolong\ation of the expiratory phase, medium to coarse Ronchi, tachypnea, nasal flaring / retraction
Partial obstruction ABOVE vocal cords
77
Weak airway sounds, , inspiratory stridor, EXPIRATORY wheezing wtih prolong\ation of the expiratory phase, medium to corase ronchi, tachypnea, nasal flaring / retractions, HEAD BOBBING
Partial obstruction BELOW vocal cords
78
Wheezing auscultated on one side, unilateral retractions, new-onset asthma, bronchitis or pneumonia that doesn't respond to appropriate treatment
Obstruction in the BRONCHUS
79
Absent breath sounds on ONE side, Unilateral retractions
Complete obstruction in BRONCHUS
80
Viral inflammation of the UPPER airways often associated with an upper resiratory tract infection
Bronchitis
81
Viral infection of the LOWER airways that affects children under 24 months of age, most often caused by RSV
Bronchiolitis
82
Infection of the lung parenchyma (bacterial, fungal, viral, aspirate
PNeumonia
83
Copious nasal secretsions, atelectasis causing respiratory distress, high-risk infants can have apneic spells
Difference between bronchitis & bronchiolitis
84
S/s of this condition tend to occur within hours (6) of aspiration and resolve within 48 hours
Aspiration PNA
85
Changes including diffuse pulmonary edema seen on CXR
Respiratory Distress Syndrome
86
Visualization of neck veins is assessing the effectiveness of treatment of ____
Pulmonary Hypertension
87
Risk factors: immboility, pregnancy, and increasing age
Blood Emboli
88
S/s unique to ____ caused by a blood clot: Elevated D-Dimer
PE
89
S/s unique to ___ emboli: petechial rash to the chest anda axilla (transient)
FAT
90
S/s unique to ___ emboli: signs of R sided HF and continuous drum-like mill-wheel murmur
AIR
91
LEFT lateral decubitis positioning & Aspiration of the R ventricle
Tx Air Embolism
92
Prevention: early splinting and reduction of fractures & supportive therapy up to mechanical ventilation
Tx: FAT emboli
93
TX:
Positive inotropes (Dobutamine / Milrinone)
Vassopressors (Improve LEFT ventricular function by increasing left ventricular afterload | Norepinephrine preferred)
Inhaled nitric oxide
Diuretics
Tx: Pulmonary Hypertension
94
Emphysema
PE
L sided HF
High Altitude
Connective tissue disease
Liver Disease
Causes of pulmonary HTN
95
Accumulation of of more than 1000 mL of blood initially, OR more than 200 mL/hour over 2-4 hours
Arterial bleeding causing hemothorax
96
Treatment for simple pneumothorax
<20% - 100% O2 | >20%, needle aspiration, pigtail catheter, chest tube
97
Occlusive dressing placed over wound, taped on 3 sides | Monitor for tension pneumothorax and remove dressed as needed to relieve pressure
Open Pneumothorax
98
What makes tension pneumothorax unique?
Decreasing CO, tachycardia, hypotension, poor peripheral perfusion, JVD, Deviated trachea (away from the tension pneumothorax)
99
2nd intercostal space / mid clavicular line or 5th interconstal space / mid axillary line | Chest tube ASAP
Tx for tension pneumothorax
100
Absent over fluid & Decreased over air
Fremitus
101
Hyporesonance over fluid & Hyperesonance over air
Percussion
102
Decreased over fluid & Decreased over air
Breath Sounds
103
Near top of fluid line & not present over air
Air accumulation
104
Have patient say "99" while holding hands against the chest, Vibrations will transmit through air but not fluid
Fremitus
105
Have patient say "e" while holding a stethoscope ne=ar the top of the fluid line. The "e" will wound like an "a" through fluid line
Egophony
106
One adverse effect of _____ is transient hypertension, therefore blood pressure should be carefully monitored.
Hydroxocobalamin
107
An arterial dilator with little venous dilation. Arterial dilation causes reductions in afterload whereas venous dilation causes reductions in preload.
Hydralazine
108
An angiotensin converting enzyme (ACE) inhibitor and causes reductions in both preload and afterload.
Enalapril
Also nitroprusside
109
Venous dilator causing reductions in preload but very little reductions in afterload (except in high doses)
Nitroglycerin
110
_____ is used in treatment of HF. It is unlikely to have any therapeutic effects in the treatment of hematuria, narrow complex tachycardia or elevations in core body temperature.
Nesiritide (Natrecor)
111
_____ is known to be a venous dilator decreasing preload and reducing workload on the heart. Also a pain medication.
Morphine
112
_____ causes a systemic inflammatory reaction, Respiratory distress syndrome is a manifestation of an inflammatory reaction in the lungs causing severe pulmonary edema and other changes in the lung.
Pancreatitis
113
Testicular pain may be associated with which diagnosis?
Renal colic. The pain associated with renal colic sometimes referred to the external genitalia. In men, this can result in testicular pain, in women, this can result in pain the labial folds.
114
____ Causes a painless sore on the genitals as opposed to testicular pain.
Syphyllis
115
____ is associated with lower abdominal or rectal pain rather than testicular pain.
Prostatitis
116
_____ trauma is more likely to cause suprapubic pain with voiding difficulties as opposed to testicular pain.
Bladder
117
EKG changes including ST segment elevation in multiple leads, PR depression in multiple leads and tall peaked T waves in multiple leads is indicative of?
Pericarditis
118
What condition is known to cause nystagmus?
Labyrinthitis - disorder of the inner ear.
119
_____ is frequently used to treat stable wide complex tachycardias.
Procainamide
120
____ is treated with synchronized cardioversion or defibrillator (if pulseless)
Unstable wide complex tachycardia
121
The pain associated with an _____ is often exacerbated by reduced blood flow. Elevating an extremity with an ____ reduces blood flow to the area causing increased pain. Elevation of the limb will cause the extremity to become cooler rather than warmer, decrease pulse strength and cause the extremity to become pale when elevated.
Arterial Occlusion arterial occlusion
122
The emergency nurse knows that which of the following conditions may be a precursor to iritis?
Rheumatoid Arthritis.
Systemic inflammatory conditions such as inflammatory bowel syndrome, lupus and rheumatoid arthritis have all been linked to iritis.
123
What contributes to Ludwig's agina?
Dental abscesses
124
Hepatitis ___ is more likely to cause RUQ pain.
E
125
Which type of infarction is most associated with heart block?
Inferior Myocardial Infarction which is caused by occlusion of the R marginal artery. In many patients, this artery provides blood flow to the atrioventricular node. Hypoxia to this node can lead to heart blocks.
126
Elevations in the peak end expiratory pressure (PEEP) increase intrathoracic pressure which will decrease _____?
Return of blood to the left ventricle AKA BP. CO2 levels are relatively unaffected by changes in PEEP.
127
Which position is ideal for a patient in neurogenic shock?
Supine. Pt's with neurogenic shock usually have a spinal cord injury and spinal motion restriction should be maintained. Patients with neurogenic shock tend to be hypotensive, so supine is also ideal.
128
The goal of treatment for someone with costochondritis is?
Decrease in pain, there is no fever associated with this condition.
129
Patient with manic-bipolar disorder is most likely to also have?
STIs
130
Infected facial structures provide a source for bacteria to cause _____?
Meningitis
131
Respiratory failure secondary to an inhalation injury tends to take as long as ____ hours to develop.
24
132
Atrovent (Ipratopium Bromide) is a broad classification of _____ drugs and therefore the symptoms most closely aligned with this drug would be _____ & _____.
Anticholinergic - dry mouth and blurred vision.
133
Abduction and external rotation
ANTERIOR hip dislocation
134
Adduction and internal rotation
Posterior hip dislocation
135
Reversal agent for the effects of dabigatran (anticoagulant)
Idarucizumab
136
Findings associated with ____ include decreased vertical ocular rotary movements, pain on upward gaze and the inability to look above the midline.
Ocular Entrapment
137
Effective treatment for carbon monoxide poisoning is _____.
Hypotension. Monitor BP and ensure increase in BP to assess effective treatment. O2 are often normal with CO poisoning.
138
Renal failure will result in what electrolyte imbalances?
Hyperkalemia, Hyponatremia, Hyperphosphatemia, therefore hypocalcemia.
139
Epigastric pain that radiates to the back, severe nausea and vomiting as well as a history of alcoholism are all associated with ______.
Pancreatitis which can cause retroperitoneal bleeding that can lead to bruising in the flanks (and sometimes around the belly button).
140
Costovertebral angle tenderness is associated with ____?
Kidney infections.
141
Decrease in the amplitude of the QRS complex can be seen in?
Pericardial Tamponade. The presence of fluid around the heart may decrease the amount of electricity that is transmitted to the leads and this can decrease the amplitude of the QRS complex.
142
Do you encourage movement in DVTs or chronic arterial vein occlusions?
Pt's with chronic arterial occlusion (Buerger's disease) may benefit from movement of the extremity by increasing O2 delivery to the limb though the collateral circulation. A patient with DVT may dislodge the thrombosis and cause a PE.
143
Associated with spinal cord injury that can increase BP, bradycardia, leading to stroke, seizure, and cardiac arrest.
Autonomic Dysreflexia. It is also a sympathetic response to pain limited to patients who have had spinal cord injuries.
144
Administered to women who are likely to have preterm birth as the steroids speed fetal lung maturity and reduce the incidence of intraventricular hemorrhage and necrotizing enterocolitis.
Corticosteroids
145
Use of anti-coagulants and oral contraceptives increase the risk for?
Dysfunctional uterine bleeding
146
Ketonemia and Ketonuria can be associated with?
Hyperemesis gravidarum due to severe dehydration and starvation
147
Hematospermia, urinary retention, rectal pressure is associated with _____.
Prostatitis.
148
Test used to determine the presence of fetal blood in maternal circulation.
Kleihauer-Betke test
149
Liver enzyme useful in detecting liver illness or injury.
GGT Gamma-glutamyl-transpeptidase
150
Which finding is consistent with effective treatment of PTSD?
Re-establishment of strained personal relationships and the desire to connect with others.
151
Heart medications known to cause heart blocks and bradycardia.
Calcium channel blockers such as Verapamil.
152
Claritin and Doxepin
Anticholinergics associated with tachycardia.
153
Is there narrow or wide pulse pressures in pericardial tamponades?
Narrow pulse pressure
154
Represented by pressures in the pulmonary circulation (e.g., pulmonary artery wedge pressure)
RIGHT ventricular afterload
155
Represented by the patient's mean arterial pressure (MAP)
LEFT ventricular afterload
156
How to measure RIGHT ventricular preload?
Invasive (Central Venous Pressure) | Non-invasive - JVD
157
How to measure LEFT ventricular preload?
Invasive - Pulmonary wedge pressure (PWP) | Non-invasive - Lung sounds
158
Drugs which influence the HR
Chronotropic drugs
159
Drugs which increase the automaticity of the heart. Automaticity - the speed at which electricity moves through the heart
Dromotropic drugs
160
Drugs that influence the contractility of the heart
Inotropic drugs
161
HR between 40 and 60 beats per minute with either inverted P waves before or after the QRS complex or absent P waves
Junctional Rhythm
162
Elongating distance between the P wave and QRS complex
Wenckebach heart block AKA Mobitz Type I
163
Presence of P waves without corresponding QRS complexes after each one
Mobitz Type II heart block
164
Regular P waves and regular QRS complexes that are not coordinated (heart rate usually less than 40 bets per minute)
Third Degree Heart Block
165
Is patient stable? Is QRS complex narrow or wide?
2 questions to ask when pt has tachyarrhythmias.
Narrow (<0.12 seconds, and likely arising from the AV node or above)
Wide (>0.12 seconds, and likely arising from below the AV node).
166
Treatment for stable narrow complex tachycardias
- Regular Rhythm
- Irregular rhythm (usually a-fib / a-flutter)
Regular Rhythm
- Vagal Maneuvers
- Adenosine 6 mg - 12 mg ( Rapid IV push followed by a 20-mL bolus, may cause transient heart block or asystole)
Irregular Rhythm
- Calcium channel blockers (drugs that end in depine)
- Beta-blockers (drugs end in -lol)
Consider anticoagulation if artiral fibrillation is the cause and has been present for a period of time before presentation to the ED
167
Treatment for UNSTABLE narrow complex tachycardias
CARDIOVERSION
Narrow QRS with regular rhythm: start with 50J (monophasic and 100 J biphasic)
Narrow QRS with irregular rhythm: 120 (mono) vs 200 (biphasic) - consider anticoagulant or low molecular weight heparain (LMWH) as part of treatment
Pediatric: 0.5-1 j/kg increased to 2 j/kg
Deliver shock, increase energy if unsuccessful
168
Treatment for STABLE WIDE complex tachycardia
Procainamide preferred but must be administered slowly to prevent hypotension, If rapid conversion is needed, consider AMIODARONE
- Lidocaine
- Magnesium (mainly for TORSADES DE POINTE) - polymorphic
- Cardioversion
- QRS complexes are regular, start 100 J
- QRS complexes are irregular 200 j bi . 360 monophasic
169
Treatment for pulseless with a wide complex tachycardia
No defibrillator - consider precordial thump
Defibrillator - TURN OFF SYNC
Do not interrupt CPR when defibrillator charging
170
Drugs that increase PRELOAD
Volume
Vasoconstrictors:
norepinephrine, phenylephrine, vasopressin, epinephrine, dopamine
171
Drugs that decrease PRELOAD
Diuretics
Venous Dilators:
nitroglycerin, ACE inhibitors, angiotensin receptor blockers, morphine
172
Drugs that increase AFTERLOAD
Arterial vasoconstrictors:
Vasopressin / phenylephrine
173
Drugs that decrease AFTERLOAD
Arterial vasodilators:
Nitroprusside, milrinone, ACE inhibitors, hydralazine
174
Venous / arterial dilation and diuresis
ACE inhibitors (-pril)
175
Venous / arterial dilation
Angiotensin receptor blockers (-sartan)
176
Alpha-adrenergic blocker (different drugs have varying reffects of beta blockade as well)
Beta-blockers
177
Relax vascular smooth muscle, reduce pacemaker activity and decrease cardiac contractility
Calcium channel blockers
178
Potent venodilator (arterial dilator in higher doses), coronary artery dilator
Nitroglycerin
179
Potent venous AND arterial dilator with onset of action in seconds
Nitroprusside (Nipride)
180
Arterial vasodilator with little venous dilation
Hydralazine
181
Difference between hypertension, hypertensive urgency, and hypertensive emergency?
Hypertension <180/ 120
Hypertensive urgency >180/120
Hypertensive emergency >180/120 with end organ dysfunction
- Hematuria / decrease UO
- Altered LOC, HA, stroke, seizures
- CP, EKG changes, S3/S4 heart sounds
- Retinal hemorrhage
- Papilledema
- Epistaxis
182
Which is more common and deadly? Ascending or descending acute aortic dissection / aneurysm?
Ascending - accounts for 2/3 of cases
183
S/s of ascending aortic dissection?
Altered LOC
Stroke symptoms
Cardiac tamponade
Acute MI
Acute aortic insufficient (dyspnea, left ventricular failure, systolic murmur)
184
S/s of descending aortic dissection?
Anuria / renal failure
Paraplegia
Loss of distal pulses
185
Acute onset of severe tearing or ripping chest pain that may radiate to the back, flank, or shoulders, not relieved by analgesia. Difference of more than 20 mm Hg when comparing BP in both arm and legs
S/s of both ascending and descending aortic dissection or aneurysm
186
Positive inotrope, dromotrope, chronotrope as well as vasoconstrictor. Reserved for cardiac arrest and anaphylaxis
Epinephrine
CO ++, SVR either neutral or +
187
Use for refractory shock despite adequate fluid resuscitation. May cause splanchnic vasoconstriction and decreased CO
Vasopressin (Pitressin)
CO neutral or -, SVR ++
188
Increase alpha / beta one & two stimulation
5-10 mcg/kg/minute to increase CO
>10 mcg/kg /minute incraese BP
Dopamine
Low dose: CO + SVR +
Higher dose: SVR ++
189
Peripheral venous and arterial vasoconstrictor and cardiac stimulant considered in the treatment of hypotension or shock
Norepinephrine bitartrate (Levophed)
CO neutral or +
SVR ++
190
Pure alpha-agonist
Phenylepinephrine
CO neutral or +, SVR ++
191
Leave IV in place
Administer Regitine (Phentolamine) into IV so it infiltrates locally,
Treatment of infiltration of vasoconstrictors
192
Dopamine
Dobutamine
Epinephrine
Norepinephrine
Milrinon
Positive Inotropes
193
Calcium channel blocks
Beta-blockers
(Antidysrhythmic, Anesthetics, Propofol, Chemotherapy)
Negative Inotropes
194
Neurogenic shock
Sepsis
Anaphylaxis
3 types of distributive shock
195
V1, V2, V3, V4 (Septal infarction causes changes in V1, V2)
LEFT anterior artery descending / ANTERIOR WALL MI
Complications: LEFT ventricular failure
196
I, aVL, V5, V6
Circumflex artery (part of L coronary artery), LATERAL WALL MI
Complications: Cardiogenic Shock
197
II, III, aVF
RIGHT marginal artery (inferior wall MI) - varying degrees of heart block.
198
Tall R waves in VI and V2
Posterior descending artery, Posterior wall MI. R ventricular failure. Normal R wave progressions go from V1 - V6, but in posterior MI, R waves tallest in V1 / V2
199
S/s of R sided MI
Nausea / vomiting / JVD / bradycardia / Hypotension
200
S/s of L sided MI
Diaphoresis, dyspnea / orthopnea / Tachycardia / Hypertension
201
Tender subcutaneous nodules, often in the pulp of the digits
Osler's nodes - Endocarditis
202
non-tender erythematous, hemorrhagic, or pustular lesions often on the palms or soles
Janeway Lesions - Endocarditis
203
Widespread ST elevations
Tall, peaked T waves in all leads except a VR and V1
PR depression (especially in lead II)
Lack of reciprocal changes
S/s of pericarditis
204
Hypotension, distended neck veins, muffled/distant heart sounds
Beck's Triad - sign of pericardial tamponade
205
Electrical Alternans
Alternating amplitude of QRS complexes as seen in pericardial tamponade. EKG changes alsow show low voltage QRS, PEA.
Pulsus paradoxus also seen in pericardial tamponade
206
Infusion of IV fluids as needed to increase cardiac pressures
Needle pericardiocentesis
Sub-xyphoid window (trauma)
Tx pericardial tamponade
207
Homan's sign?
Affected leg is dorsiflexed and if there is pain, it is indicative of venous occlusions.
208
Inhibition of Gestational Diabetes
Inhibition of insulin is designed to ensure adequate glucose to the growing fetus, but this insulin resistance means taht pregnant women must produce more insulin for homeostasis and some women's pancreatic function cannot ramp up enough leading to gestational diabetes.
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Known as hyperresonance, noted when percussing over air. The center of the abdomen contains the large and small bowel, both of which are filled with air.
Tympany
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Inhibition of Gestational Diabetes
Inhibition of insulin is designed to ensure adequate glucose to the growing fetus, but this insulin resistance means taht pregnant women must produce more insulin for homeostasis and some women's pancreatic function cannot ramp up enough leading to gestational diabetes.
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Reversal agent for Heparin
Protamine Sulfate, given slowly and cannot be used in those allergic to fish.
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Reversal agent for Coumadin (Warfarin)
Vitamin K (Aqua Mephyton)
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Reversal for magnesium toxicities
Calcium gluconate
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Cyanide poisoning Tx
Hydroxocobalamin
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A test done to make sure the ulnar artery is functioning well. Done prior to carrying out ABG collection from the radial artery.
Allen's Test. The rational is that the ulnar artery must be functioning properly in case collection of blood from the radial artery causes damage or obstruction to that artery leaving the ulnar artery as the only option to deliver oxygen to the hand.
216
Normal intraocular pressure?
10-20 mm Hg. <10 increases the risk of retinal detachment
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A test done to make sure the ulnar artery is functioning well. Done prior to carrying out ABG collection from the radial artery.
Allen's Test. The rational is that the ulnar artery must be functioning properly in case collection of blood from the radial artery causes damage or obstruction to that artery leaving the ulnar artery as the only option to deliver oxygen to the hand.
218
_____________ is used as a competitive inhibitor that works on the enzyme alcohol dehydrogenase. This enzyme metabolizes toxic alcohols such as ethylene glycol and methanol to their toxic end products. When this medication is utilized for toxicities related to these forms of alcohol, they will preferentially metabolize these products instead of the alcohol, decreasing resulting toxicities.
Fomepizole
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Situational crisis can lead to?
Drug abuse, excessive alcohol intake, suicidal ideation and criminal activities. This patient may present with law enforcement.
220
Posterior Lead Placement
V4 --> V7 posterior axillary line
V5 --> V8 tip of the LEFT scapula
V6 --> V9 next to mid thoracic spine
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Mixing of anti-depressant medication such as paroxetine (Paxil) and fluoxetine (Prozac) with dextromethorphan (cough suppresant).
Serotonin Syndrome
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S/s of intussusception
Abdominal pain, draw up knees towards the abdomen, hypoxia to bowel wall causing mucosal lining to shed which may result in stools that appear like currant or grape jelly
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Tx Prolapsed Cord
When caring for a patient with a prolapsed cord, it is important to place the hand between the baby’s head and the cord and lift upward. The feeling of pulsations underneath the nurse’s hand would indicate that blood flow is continuing. If the nurse manipulates the cord and causes it to spasm, blood flow would cease. An emergent cesarean section is the definitive treatment.
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S/s of intussusception
Abdominal pain, draw up knees towards the abdomen, hypoxia to bowel wall causing mucosal lining to shed which may result in stools that appear like currant or grape jelly
225
Tx Prolapsed Cord
When caring for a patient with a prolapsed cord, it is important to place the hand between the baby’s head and the cord and lift upward. The feeling of pulsations underneath the nurse’s hand would indicate that blood flow is continuing. If the nurse manipulates the cord and causes it to spasm, blood flow would cease. An emergent cesarean section is the definitive treatment.
226
When do withdrawal seizures occur?
36 to 72 hours after their last drink, prior to delirium tremens which often occurs 72-96 hours after the last drink of alcohol.
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Colle's fx
Distal radius fracture often associated with falling on an outstretched hand
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Smith's Fx
Fall involves a flexed hand
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Buckle Fx
Torus Fx
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Fx occuring in children under the age of 10 in which there is a fracture on one side of the bone, but the other side of the bone. remains intact
Greenstick
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Curtain or veil obscuring the upper visual field
Retinal detachment
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Blurry vision or seeing haloes around lights
Glaucoma
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Children should be kept home for 5 days after antibiotics is started. This disease may cause pneumonia and therefore death in children. A petechial rash on the upper body above the nipple line can occur due to paroxysmal coughing associated with this illness.
Pertussis
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Blurry vision or seeing haloes around lights
Glaucoma
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Children should be kept home for 5 days after antibiotics is started. This disease may cause pneumonia and therefore death in children. A petechial rash on the upper body above the nipple line can occur due to paroxysmal coughing associated with this illness.
Pertussis
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A patient is brought in by family members delirious and confused. The patient has flushed skin, dry, cracked oral mucosa, hyperthermia, hypotension, and dilated pupils. The cardiac monitor displays prolongation of the QRS and PR intervals and tachycardia at 140 beats per minute. This scenario is most closely associated with an overdose of:
Tricyclic antidepressants
Tricyclic antidepressants cause cardiotoxic, neurotoxic, and anticholinergic symptoms. Cardiotoxic symptoms range from sinus tachycardia and A-V blocks to ventricular tachycardia and fibrillation as well as ECG changes such as QRS, QT, and PR interval prolongations. Neurotoxic symptoms include lethargy and confusion with delirium and possible hallucinations. Anti-cholinergic symptoms include mydriasis (dilated pupils), flushed skin, anxiousness, hyperthermia, and dry mucosal membranes
237
Pt presents with IV illicit drug use presenting with dental pain, loss of peripheral vision, fever, clubbing, and splinter hemorrhages of the nailbeds. Which disease and what diagnostic test?
Endocarditis / EKG
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A patient is brought in by family members delirious and confused. The patient has flushed skin, dry, cracked oral mucosa, hyperthermia, hypotension, and dilated pupils. The cardiac monitor displays prolongation of the QRS and PR intervals and tachycardia at 140 beats per minute. This scenario is most closely associated with an overdose of:
Tricyclic antidepressants
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Classic signs of opiate overdose?
Pinpoint pupils (miosis), coma, decreased respirations
240
Organophosphate poisoning causes?
Cholinergic stimulation leading to increased secretions - lacrimation, salivation, urination, and diarrhea, and bradycardic rhythms
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Ethylene Glycol s/s
Seizure activity, nystagmus, coma, dysrhythmias
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Which nerves control EOM - extra-ocular eye movements?
Oculomotor (III) which controls 5 of the 7 muscles that move the eye
Trochlear (IV)
Abducens (VI)
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Bleeding into the posterior chamber of the eye
Vitreous hemorrhage
vs Hyphema which is bleeding into the ANTERIO Chamber of the EYE
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Which nerves control EOM - extra-ocular eye movements?
Oculomotor (III) which controls 5 of the 7 muscles that move the eye
Trochlear (IV)
Abducens (VI)
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A “Salter-Harris Type III” classification is an indication of which of the following fractures?
Epiphyseal fracture
The Salter-Harris classification is a specific system of identifying varying degrees of epiphyseal fractures found in children.
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Which of the following groups of medications would most likely be prescribed for a non-penetrating hyphema to the eye?
Beta Blockers
Beta blockers such as timoptic or betoptic may be administered in the eye to help to control intraocular pressure. A mydriatic medication might be ordered to help with patient comfort once increased IOP has been ruled out – rather than a miotic agent. Anti-fibrinolytic agents would be utilized instead of fibrinolytics to discourage the potential of rebleeding. Antibiotics would have no therapeutic effect for this condition
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Cushing's Triad vs Beck's Triad
Associated with increased ICP
1. Hypertension / widening pulse pressure
2. Bradycardia
3. Decreased respiratory rate
Beck's Triade - Cardiac Tamponade
1. JVD
2. Muffled Heart Sounds
3. Hypotension
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Tactile hallucinations are most associated with?
Alcohol withdrawal may cause tactile, auditory or visual hallucinations. Most hallucinations associated with schizophrenia are auditory. Patients experiencing delirium are more likely to have auditory and visual hallucinations. Hallucinations are uncommon with acute mania.
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Cushing's Triad vs Beck's Triad
Associated with increased ICP
1. Hypertension / widening pulse pressure
2. Bradycardia
3. Decreased respiratory rate
Beck's Triade - Cardiac Tamponade
1. JVD
2. Muffled Heart Sounds
3. Hypotension
250
MRSA risk factors?
MRSA has several risk factors associated with it including incarceration and intravenous drug use as well as dialysis, diabetes mellitus, recent surgery, living in a long-term care facility, and recent (within past 12 months) hospitalization.
251
Reversal agent for diltiazem?
Calcium gluconate
252
Reversal agent for tylenol?
N-acetylcysteine (Mucomyst)
253
What blood test can be associated with cocaine use?
Cocaine abuse can release myoglobin into the blood stream, (potentially leading to rhabdomyolysis). Rhabdomyolysis causes high CK (creatinine kinase) levels. The risk of this increases if the patient is physically restrained as they will become more agitated with greater muscular activity. Liver enzymes, D-Dimer, and hemoglobin levels will not uncover complications associated with cocaine abuse.
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TPA rulse
If a patient’s blood pressure exceeds 185/110 mm Hg, it should be reduced pharmacologically before the administration of TPA. Labetalol or nicardipine are frequently used to facilitate this. TPA may be given to patients of any age and if the patient is less than 80 years of age, it may safely be given if the onset of symptoms is less than 4.5 hours. The fact that the patient had a myocardial infarction seven years previously does not influence the decision to give TPA for stroke symptoms
255
Sinusitis in the frontal sinuses causes pain where?
Cheeks
256
Sinusitis in the ethmoid region causes pain where?
Behind the eyes
257
Sinusitis in the frontal sinuses causes pain where?
Cheeks
258
Geodon can cause?
Geodon (Ziprasodone) can cause a prolonged QT interval which can then cause Torsades de Pointes. A past cardiac history should be of concern for patients receiving this medication
259
What is Vincent's angina?
Vincent’s angina is a bacterial infection of the lining of the mouth and is caused by a bacterial infection but does not have a genetic component.
260
Which of the following medications would be used to prophylactically treat a child for respiratory syncytial virus (RSV)?
Synagis (Palivizumab) is the vaccine for RSV (respiratory syncytial virus) and would be used as a preventive measure for this virus. RSV is a virus and therefore an antibiotic would not be used unless a secondary bacterial infection was suspected. Supportive therapy such as acetaminophen (Tylenol) for fever could be used as part of the treatment for RSV. Ribavirin (Rebetol) is an antiviral that might be used for extremely ill infants with RSV (respiratory syncytial virus) or those who are immunocompromised.
261
What is Vincent's angina?
Vincent’s angina is a bacterial infection of the lining of the mouth and is caused by a bacterial infection but does not have a genetic component.
262
Which of the following medications would be used to prophylactically treat a child for respiratory syncytial virus (RSV)?
Synagis (Palivizumab) is the vaccine for RSV (respiratory syncytial virus) and would be used as a preventive measure for this virus. RSV is a virus and therefore an antibiotic would not be used unless a secondary bacterial infection was suspected. Supportive therapy such as acetaminophen (Tylenol) for fever could be used as part of the treatment for RSV. Ribavirin (Rebetol) is an antiviral that might be used for extremely ill infants with RSV (respiratory syncytial virus) or those who are immunocompromised.
263
Hyperactivity, enuresis, and regressive behavior
Signs of depression in children
264
Atypical HA are associated with?
Subarachnoid hemorrhages, 1-2 weeks prior to rupture of aneurysm, pt will experience atypical HA (sentinel HA). These are sudden, severe headaches that are unusual for the patient. Subarachnoid hemorrhages are sudden in onset.
265
Brown recluse spider bites can cause complications such as?
Hemolytic anemia, DIC, hematuria, kidney failure
266
Which of the following findings would indicate myocardial reperfusion after administration of TNK (Tenecteplase)?
Accelerated idioventricular rhythm
267
Once the initial crisis is resolved, which of the following oxygen delivery products would be most appropriate to utilize in the patient with an acute exacerbation of chronic bronchitis?
Venturi mask.
The venturi mask is the best delivery option for patients with chronic obstructive pulmonary disease with chronic bronchitis as it can deliver specified, precise doses of oxygen and reduce the negative impact of high doses of oxygen for this diagnosis.
268
A patient complains of chest pain exacerbated in the supine position yet the pain improves when the patient is upright. Which ECG changes are most consistent with this complaint?
ST segment elevation in all leads except AVR and V1
Pericarditis will present with either sharp or dull pain that is worse with lying flat, swallowing, coughing or activity. Sitting upright will help the pain to dissipate. 90% of all patients with pericarditis will present with ECG changes that includes ST segment elevation in all leads except aVR and V1 in the first phase of this disease. T wave inversion in II, III, and aVF is indicative of inferior ischemia. Pathologic Q waves in I, aVL, V5, and V6 would indicate a lateral infarct. A J wave (Osborn wave) is present with hypothermia
269
Five days after a healthy vaginal delivery, the mother presents with increased respiratory rate and objective dyspnea. Which of the following diagnoses is the highest probability?
Pulmonary embolus due to high fibrinogen levels during pregnancy
270
A patient complains of chest pain exacerbated in the supine position yet the pain improves when the patient is upright. Which ECG changes are most consistent with this complaint?
ST segment elevation in all leads except AVR and V1
271
Which of the following assessment parameters is a part of the classic triad for a ruptured abdominal aneurysm?
Hypotension.
Abdominal pain with or without back pain, hypotension, and a pulsatile abdominal mass encompass the classic triad of symptoms for a ruptured abdominal aneurysm. Vomiting, diaphoresis, and tachycardia can be present, but are not part of the classic triad
272
Meningeal signs such as nuchal rigidity are caused by bleeding between which of the following two structures?
Subarachnoid bleeding occurs between the arachnoid and the pia mater. The accumulation of blood in this space creates a chemical irritant which then cause the meningeal signs.
273
Spinal shock vs neurogenic shock
Spinal shock occurs when there is an interruption in the impulses to and from the spinal cord. This causes loss of motor function including loss of bowel and bladder function and reflexes and flaccidity below the level of the lesion involved. It will usually last hours to days and can complicate the full diagnosis. Hypotension, bradycardia, and anhidrosis (loss of sweating) are manifestations of neurogenic shock which occurs due to loss of the sympathetic nervous system innervation following a spinal cord injury.
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Sarin gas
Toxicity with sarin gas, a nerve agent, causes a cholinergic crisis (which can also occur with insecticides). Symptoms include an increase in all body fluids including urination, defecation, sweating, tearing, salivation as well as pinpoint pupils (miosis). Drying of secretions would therefore indicate improvement as well as a reduction in urine output (rather than an increase). Bradycardia occurs in a cholinergic crisis and a decrease in pulse rate is not associated with effective treatment
