Critical Care Error List Flashcards

1
Q

What is Diabetic Ketoacidosis

A

When the body is unable to use glucose because all the glucose is being flushed out of your system
Hyperglycemia

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2
Q

What causes DKA

A

Hormonal changes cause excess glucose, leads to osmotic diuresis which leads to increased lipolysis and increased acetyl-CoA which churns out Ketones
There is a shift to anaerobic respiration: Ketones are made

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3
Q

What are the 2 main Ketones made, which one predominates

A

Acetone and Beta-Hydroxybutyrate

Mostly Beta

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4
Q

What is offending factor that starts up DKA

A

Infection, not taking insulin appropriately, first presentation of DM, MI

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5
Q

Dx of DKA

A

Glucose >250

Serum pH

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6
Q

Sx of DKA

A

Polyuria, Polydipsia, Weakness, Blurry Vision, “I ran out of insulin”
Dehydration, Acetone Smell, Abdominal Tenderness
Kussmaul Respiration

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7
Q

Tx of DKA

A

IV fluids is 1st (Isotonic then D5)
Regular Insulin is next
Potassium (always, even if potassium levels are fine now)
Bicarbonate only in severe cases

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8
Q

What is a Thyroid Storm

A

A complications of untreated Thyrotoxicosis (Hyperthyroidism)

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9
Q

What causes a thyroid storm

A

Surgery, trauma, infection

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10
Q

Sx of Thyroid Storm

A

Hypermetabolic State: Palpitations, A.Fib, Tachycardia, High Fevers, N/V, Psychosis, Delirium, Tremors

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11
Q

Dx of Thyroid Storm

A

Decreased TSH

Increased T3/T4

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12
Q

Tx of Thyroid Storm

A

Anti-Thyroid Meds: Methimazole, PTU
Beta Blockers for sx
Supportive IV
Glucocorticoids

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13
Q

What is a Pericardial Effusion

A

Increased fluid in the pericardial space

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14
Q

What causes a Pericardial Effusion

A

Pericarditis

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15
Q

Sx of Pericardial Effusion

A

Distant Heart Sounds
Pleuritic Chest Pain worse with laying down, relieved with leaning forward
May radiate to trapezius

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16
Q

Dx of Pericardial Effusion

A

EKG: Low voltage QRS Complex, Electric Alternans (QRS Alternates between big and small), Tachycardia

17
Q

Tx of Pericardia Effusion

A

Tx Pericarditis
ASA, NSAIDS, Colchicine
Pericardiocentesis if tamponade or large effusion

18
Q

What is Acute Respiratory Distress Syndrome

A

Non-Cardiogenic Pulmonary Edema
Life-Threatening acute hypoxemia respiratory failure, usually in critically ill patients
Usually due to sepsis

19
Q

What is a hallmark sign of Acute Respiratory Distress Syndrome

A

Not response to 100% oxygen

20
Q

Sx of ARDS

A

Acute Dyspnea, Hypoxemia with mulit-organ failure if severe

21
Q

Dx of ARDS

A

ABG
CXR: Diffuse, Bilateral pulmonary infiltrates, white out pattern
Resembles CHF but heart is normal
Cardiac Cath: PCWP

22
Q

Tx of ARDS

A

CPAP with full face mask

23
Q

What is a Hypertensive Urgency

A

Increased BP but without any acute end-organ damage

24
Q

What is considered increased BP in Hypertensive Urgency/Emergency

A

Systolic BP >220

Diastolic BP >120

25
Q

Tx for Hypertensive Urgency

A

Decrease BP by 25% in first 24-48 hours using ORAL agents

26
Q

What is a Hypertensive Crisis/Emergency

A

Increased BP (>220/110) WITH Acute end-organ damage

27
Q

Sx of end-organ damage in Hypertensive Crisis/Emergency

A

Neurologic damage: encephalopathy, hemorrhagic or ischemic stroke
Cardiac damage: ACS, HF, Aortic Dissection
Renal Damage: AKI, Proteinuria, Hematuria
Retinal Damage: Maliganant HTN

28
Q

Tx for Hypertensive Crisis/Emergency

A

Decrease BP by 10% in the first hour
Additional 15% decrease in the next 2-3 hours
Both with IV agents

29
Q

What is Acute Angle Closure Glaucoma

A

Increased Intraocular pressure that can lead to optic damage (decreased visual acuity)
This is an EMERGENCY

30
Q

What is Acute Narrow Angle Glaucoma related to

A

Decreased drainage of aqueous humor via trabecular meshwork and canal of Schlemm

31
Q

Sx of Acute Angle Closure Glaucoma

A

Halos around lights, Peripheral visual loss (tunnel vision)
Severe, unilateral ocular pain, N/V, Headache, intermittent blurry vision
Conjunctiva erythema, steamy cornea, nonreactive pupil, eye fells hard to palpation

32
Q

Dx of Acute Angle Closure Glaucoma

A

Tonometry shows Increased IOP

Cupping of optic nerve

33
Q

Tx of Acute Angle Closure Glaucoma

A
First lower the IOP, then open the angle
Acetazolamide IV is 1st line
Topical Beta Blockers reduced IOP
Miotics/Cholinergics (Pilocarpine, Carbachol)
Peripheral Iridotomy is DEFINITIVE
34
Q

What is Cardiac Tamponade

A

Pericardial effusion that causes significant pressure on the heart
It restricts ventricular filling which results in decreased CO

35
Q

Sx of Cardiac Tamponade

A

Beck’s Triad: Distant muffled heart sounds, increased JVD, Systemic Hypotension
Pulsus Parodoxus: More than 10mmHg decrease in systolic BP with inspiration
Dyspnea, fatigue, peripheral edema

36
Q

Dx of Cardiac Tamponade

A

Echo: Effusion + Diastolic Collapse of cardiac chamber

37
Q

Tx of Cardiac Tamponade

A

Pericardiocentesis