common problems in acute care Flashcards by Mary Ann Abrahamson

Name three individuals in your family who have loved and supported you throughout grad school

This should be easy.

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What type of pain last longer than 6 months, may be episodic?

chronic pain

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What type is on the skin?

cutaneous

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How do you describe soft tissue pain?

somatic

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What is the three step process associated with the treatment of cancer pain?

step 1: begin with non-opoid (NSAID, tylenol), +/- adjuvanct (antidepressants etc)

step 2: maintain step one + mild narcotid (codeine, oxycontin)

step 3: add hydromorphone, fentanyl

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Per Barkely, what type of medication can be used for round the clock breakthrough pain?

narcotic patch (fentanyl patch)

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What’s normal body temperature?

37 Celcius

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What are causes of fever they don’t require antibiotics?

SLE

thrombus

neurogenic fever

hyperthyroidism

seratonin syndrome

neuroleptic malignant syndrome

malignant hyperthermia

non-infectious post op fever

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What degree celcius defines fever?

38.3

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What woul you consider in the differential of a patient taking antipsychotics (aka neuroleptic drugs) who presents to the ER with fever, muscle cramps, muscle rigidity, and elevated creatinine phosphokinase?

neuroleptic malignant syndrome

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What are causes of non-infectious post-op fever?

atelectasis

dehydration

medications/drug reactions

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A shift to the left results in bandemia which means:

high young neutrophil count, implies infection

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If your WBC is extremely high, like >40, what should you consider in the differential?

leukemia

transplant patient

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In the abscence of source of infection, the first line treatment for post-op fever should be:

hydration (to treat dehyration)

lung expansion (to treat atelectasis)

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A post op patient has a fever for three days, WBC elevated, eosinophils 9%, and negative blood cultures. What is your most likely cause?

drug fever (high eosinophils imply allergic reaction)

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What is the medication treatment for malignant hyperthermia?

dantrolene

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Cluster headache are characterized by:

unilateral peri orbital pain

sinus congestion

awakens patient at night

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Vice like headache pain describes what type of common HA?

tension HA

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Are classic migraines with or without aura?

Classic migraines are with aura

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Are the most common migraines with or without aura?

The most common migraines are without aura

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What are some triggers for migraines?

emotional/physical stress

changes in weather

nitrate containing foods

too much/lack of sleep

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What are differentials for patient presenting with HA and focal neuro deficits?

neurosyphilis (test with VDRL venereal disease research lab)

tumor

migraine

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What medications can be given for migraine prophylaxis?

amitriptyline (antidepressant)

propranolol

topamax (topiramate)

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What medication can be given for treatment of acute migraine?

sumatriptan (causes vasoconstriction)

100% O2

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What are normal albumin levels?

3.5-5

What two labs gives an indication of malnutrition?

prealbumin (early indicator) albumin

Why are women's H and H values lower than mens?

because testosterone stimulates erythropoietin production

According to Society of Critical Care medicine, what it the H & H threshold for blood transfusion?

hgb 8/ hct 24

If you give a patient one unit PRBC, how much do you expect their H & H to change?

hgb increase by 1, hct increase by 3

You would consider a PEG tube in a patient who needs enteral nutrition support for longer than _____ weeks.

What percent dextrose content requires a central line?

\>10% dextrose content requires a central line

What are complications of enteral feedings?

aspiration dehydration

What are complications of parenteral nutrition?

catheter related complications (infection, pneumo)

What is the most common electrolyte abnormality?

hyponatremia

How do you determine if hyponatremia has a renal or non-renal cause?

look at the urine sodium if the urine sodium is \<10 the problem is outside the kidney if the urine sodium is \>20 the problem is with the kidney Normal urine sodium is 10-20

What are causes and treatments of a pseudohyponatremia AKA isotonic hyponatremia?

extreme hyperlipidemia hyperproteniemia treatment: cut down on the fat in the diet \*the patient is asymptomatic

What are some causes of hypoosmolar *hypovolemic* hyponatremia and what is the treatment?

diarrhea (c. dif) vomiting/prolonged NG tube suctioning diuretics ace inhibitors treatment: NS (replaces the Na+ and volume)

What are three causes of hypoosmolar *hypervolemic* hyponatremia and what is the treatment?

heart failure cirrhosis advanced renal failure treatment: fluid restriction, diuretics if needed

What is a common cause of *hyperosmolar* hyponatremia?

elevated BG HHNK

What are signs/symptoms of hypokalemia?

decreased amplitute, broad t-waves, multifocal PVCs, u-waves on EKG muscle weakness/muscle cramps \<2.5 tetany, hyporeflexia, rhabdo

What are two differentials for a patient with new multifocal PVCs?

hypokalemia MI

How does alkalosis influence serum potassium levels?

high pH --\>\>\> low K+

What are causes and signs of of hyperkalemia?

chronic NSAID use renal failure signs: peaked T waves

How do you treat hyperkalemia? (What do you do when you "C BIG K" on the labs?)

C BIG K calcium bicarb insulin dextrose ("glucose") kayexalate

Calcium levels need to be interpretted in relationship to albumin levels because calcium binds to albumin. Which calcium levels do not change with albumin levels, serum or ionized?

ionized calcium levels don't fluctuate with albumin levels and therefore should be treated in critically ill patients

What are causes of hypocalcemia?

pancreatitis hypoparathyroidism low magnesium renal failure severe trauma multiple blood transfusions

What are signs of hypocalcemia? \*(remember signs of hypocalcemia are "opposite/high")

INCREASED DTRs chvosteks (sustained cheek blink) trousseau's (carpal tunnel spasm) QTc *prolongation*

What are causes of hypercalcemia?

hyperthyroidism hyperparathryoidism vitamin D intoxication prolonged immobility the use of thiazide diuretics

What are symptoms of hypercalcemia? (remember it is opposite, everything is slow)

sluggish fatigue muscle weakness N/V constipation

What is the drug treatment for hypercalcemia?

calcitonin, it pushes calcium back into the bone consider NS and lasix

How do you calculate an anion gap and why is it useful?

Na - bicarb - chloride Normal 8-16ish Anion gap is helpful to identify the cause of a metabolic acidosis.

What are causes of non-anion gap metabolic acidosis? (HARDUP)

Hyperchloraemia, Acetazolamide, Addison’s disease Renal tubular acidosis Diarrhoea, ileostomies, fistulae Ureteroenterostomies, uretosigmoid fistula Pancreatoenterostomies, parenteral saline

What are causes of anion gap metabolic acidosis? (MUDPILES)

Methanol Uremia DKA Paraldehyde INH, iron Lactic acidosis Ethylene glyol Salycilates

The higher the anion gap the more ______ the patient.

acidotic and acutely ill

What are causes of metabolic alkalosis and what drug can be used to treat metabolic alkalosis?

vomiting prolonged NG suctioning Manegement: acetazolamide/diamox forces the kidneys to excrete bicarbonate, the conjugate base of carbonic acid. By increasing the amount of bicarbonate excreted in the urine, the blood becomes more acidic

What differentiates 1st and 2nd degree burns?

2nd degree has blistering and 1st degree doesn't

A burn that goes down to the muscle or bone is classified as what degree?

3rd degree

According to the rule of 9s in burn injury, each arm is worth what percent?

According to the rule of 9s in burn injury, each leg is worth what percent?

18%

According to the rule of 9s in burn injury, the front of the chest is worth what percent?

18%

According to the rule of 9s in burn injury, the back of the chest is worth what percent?

18%

According to the rule of 9s in burn injury, *any* burn to the head is worth what percent?

How do you calculate fluid requirements for a burn patient using the Parkland formula?

4ml/kg x TBSA burned = volume needed over 24 hours 1/2 given in the first 8 hours, the other 1/2 given in the next 16 hours. the time begins at the time of injury, not at the time of arrival to the hospital

If a 220 pound man had a 60% burn, how much fluid would he need in the first 24 hours?

4ml x 100kg x 60 = 24,000ml in the first 24 hours 12,000ml in the first 8 hours 12,000ml over the next 16 hours

In the first three days of the burn the potassium will be \_\_\_\_\_\_\_\_. Three days post burn the potassium will be \_\_\_\_.

In the first three days of the burn the potassium will be high. Three days post burn the potassium will be low.

What type of medication cream is used for the treatment of burns?

silvadene

What type of bites are the dirtiest? human dog or cat?

human

Generally speaking, how many hours do you have to close a wound?

less than 6 hours from the time of injury

What antibiotic covers staph and anaerobes very well and can be given PO for 3-7 days for the treatment of bites?

augmentin

What are the two major types of bacteria do we consider covering in outpatient cellulitis?

staph and strep

How would you manage community associated MRSA without systemic symptoms?

Without systemic signs: I&D and culture, return in three days if not feeling better

How would you manage community associated MRSA with systemic symptoms?

options: bactrim, doxyminocycline, clindamycin

Clindamycin is sensitive to BOTH staph and \_\_\_\_\_. So it is a good single agent treatment for cellulitis

strep.

What is the reversal agent for benzodiazapine overdose?

flumazenil

What drug is used in the overdose of tylenol?

N-acetylcycsteine/mucomyst

What type of overdose causes anion gap metabolic acidosis, tinnitus, hyperthiermia, elevated LFTs, and can be treated with dialysis?

ASA overdose

Severe acidosis defined by ACLS is less than\_\_\_.

7.1

Acidosis and fever cause the oxyhemoglobin dissociation curve to shift to the\_\_\_\_\_.

right

A shift to the right in the oxyhemaglobin dissociation curve can be caused by:

acidosis fever

MiOsis is seen in downers (heroin, synthetic opiates). Miosis is:

pupilary cOnstriction

MydriAsis is seen in patients using uppers. Mydriasis means:

pupillary dilAtion

Malignant hyperthermia and seratonin syndrome can both be treated with what drug?

dantrolene

What are signs of organ transplant rejection?

flu-like prodrome and immediate failure of the organ

What do you do if you suspect organ transplant rejection?

treat as transplant rejection until proven otherwise call transplant service biopsy the organ

Varicilla (chicken pox) is a live vaccine so patients with _____ *cannot* get a varicella vaccine.

HIV

Zostavax is a vaccine used for \_\_\_\_\_.

shingles prophylaxis

If a patient has shingles on the side of the face, it is an emergency because the patient can:

go blind

Two drugs used for the treatment of post herpatic neuralgia pain:

pregabalin (lyrica) gabapentin \*both cause sleepiness and weight gain

A typical presentation of herpes zoster looks like:

an erruption of vesicles with non-purulant exudate and errythema

This type of keratosis is typically found on sun exposed areas of the body, including inside the ear, on top of the head, rough raised areas, and they are premalignant to squamous cell cancer.

actinic keratosis

This type of carcinoma comes from actinic keratosis so they are usually in sun exposed places, they are firm, irregular papules or nodules, they bleed easily when scratched.

squamous cell cancer

This type of keratosis is NOT premalignant, found on sun exposed and not sunexposed areas of the body, the have a stuck on appearance, brown/black plaques. Require no treatment. You can freeze them off if you want.

suborrheic keratosis

The most common skin cancer. It is slow growing. It has a classic valcano lesion: spider veins, waxy shiny read, central depression.

basal cell carcinoma

highest mortality rate of all skin cancers, can spread anywhere, ABCDE mnemonic applies

malignant melanoma

What is the ABCDE(F) mnemonic for malignant melanoma?

Asymmetry Boarders, irregular boarders Color variation Diameter \>6mm Enlargement (F)riend (your friend points it out because it may be in a place you don't see)

Is EEG required for brain death diagnosis?

No, you do not need EEG for braindeath diagnosis

Clinical indicators of brain death:

abscent reflexes no cranial nerve involvement apnea "You aren't dead until you are warm and dead." Brain death means you are dead both functionally *and* legally.

In end of life care, scopolamine is indicated for\_\_\_\_.

management of secretions

In end of life care, morphine is indicated for \_\_\_\_\_\_\_\_\_.

tachypnea and respiratory distress

common problems in acute care Flashcards

(100 cards)