Critical Care Error List Flashcards Preview

Internal Medicine > Critical Care Error List > Flashcards

Flashcards in Critical Care Error List Deck (37):
1

What is Diabetic Ketoacidosis

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

2

What causes DKA

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

3

What are the 2 main Ketones made, which one predominates

Acetone and Beta-Hydroxybutyrate
Mostly Beta

4

What is offending factor that starts up DKA

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

5

Dx of DKA

Glucose >250
Serum pH

6

Sx of DKA

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

7

Tx of DKA

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

8

What is a Thyroid Storm

A complications of untreated Thyrotoxicosis (Hyperthyroidism)

9

What causes a thyroid storm

Surgery, trauma, infection

10

Sx of Thyroid Storm

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

11

Dx of Thyroid Storm

Decreased TSH
Increased T3/T4

12

Tx of Thyroid Storm

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

13

What is a Pericardial Effusion

Increased fluid in the pericardial space

14

What causes a Pericardial Effusion

Pericarditis

15

Sx of Pericardial Effusion

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

16

Dx of Pericardial Effusion

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

17

Tx of Pericardia Effusion

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

18

What is Acute Respiratory Distress Syndrome

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

19

What is a hallmark sign of Acute Respiratory Distress Syndrome

Not response to 100% oxygen

20

Sx of ARDS

Acute Dyspnea, Hypoxemia with mulit-organ failure if severe

21

Dx of ARDS

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

22

Tx of ARDS

CPAP with full face mask

23

What is a Hypertensive Urgency

Increased BP but without any acute end-organ damage

24

What is considered increased BP in Hypertensive Urgency/Emergency

Systolic BP >220
Diastolic BP >120

25

Tx for Hypertensive Urgency

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

26

What is a Hypertensive Crisis/Emergency

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

27

Sx of end-organ damage in Hypertensive Crisis/Emergency

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

28

Tx for Hypertensive Crisis/Emergency

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

29

What is Acute Angle Closure Glaucoma

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

30

What is Acute Narrow Angle Glaucoma related to

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

31

Sx of Acute Angle Closure Glaucoma

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

Dx of Acute Angle Closure Glaucoma

Tonometry shows Increased IOP
Cupping of optic nerve

33

Tx of Acute Angle Closure Glaucoma

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

What is Cardiac Tamponade

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

35

Sx of Cardiac Tamponade

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

Dx of Cardiac Tamponade

Echo: Effusion + Diastolic Collapse of cardiac chamber

37

Tx of Cardiac Tamponade

Pericardiocentesis