Deck 1 Flashcards
(40 cards)
What other bacterial illnesses can mimic common bacterial pharyngitis?
- Peritonsilar abcess
- retropharyngeal abcess
- ludwig angina
- epiglottitis
- vincent angina
What are the centor criteria for predicting strep pharyngitis?
- Tonsillar exudates = 1 pt
- tender anterior cervical LAD = 1 pt
- Fever by history = 1 pt
- Absence of cough = 1 pt
- Age under 15 = add 1 pt
- Age over 45 = subtract 1 pt
- 4 points = tx w/ Abx, no further testing
- 2-3 = RAT….+ = tx , - = throat culture
Tx for strep pharyngitis?
-Penicillin po x 10 days
Or…..IM Penicillin G 600k units once
Tx for retropharyngeal, peritonsillar abcesses, and ludwig angina?
Tx of epiglottitis?
- PCN and Flagyl
- Cefuroxime
What are initial diagnostic steps in working up Acute MI?
- EKG
- Troponin
* Other labs: BMP, PT, PTT, CBC - Cardiac monitor
- Get IV access
- CXR
What are immediate THERAPIES for Acute MI?
- Aspirin 325
- O2
- Sublingual nitro
- IV beta blocker
- IV nitro
- LMW Heparin
- Plavix
- Thrombolytics if no cath available
What are other life-threatening conditions that can mimmick MI? (present with cp)
- Aortic dissection
- PE
- Pneumothorax
- Boerhaave syndrome
What EKG findings are indications for immediate reperfusion therapy for ACS?
- ST elev > 1 mV in 2 contiguous leads
- New LBBB
When should troponins be repeated after first draw?
4 to 12 hours after
*normal level at 8 to 12 hours after pain onset essentially excludes infarction
How do you decide on tx for UA or NSTEMI?
- ASA and nitro are minimum of therapy
- Beta-blockers (IV) added for persistent pain, tachycardia, or HTN
- High risk = Heparin and Plavix
-Possible cath
Bradyarrythmias are common complication of _________ MI, and are an indication for _________.
- Anterior
- Transvenous Pacing
*Heart block in setting of MI usually due to irreversible damage of HIS-purkinje system
________ MI frequently causes AV node dysfunction and _________ degree block that is transient and responsive to what medication?
- Inferior
- 2nd degree block
- may respond to Atropine
Viral etiologies of pharyngitis
-rhino
-corona
-coxackie
-HSV
-adeno
-influenza
-CMV and EBV
-HIV
etc
Pt with palpitations and dyspnea on exertion…..DDx?
- A-fib
- PE
- MI
- anemia
- sepsis
- pneumonia
- Hyperthyroidism
In the acute setting, what is the most important gaol of A-fib therapy?
Why?
Rate control
-slowing ventricular response provides positive hemodynamic effects
For A-fib pts who need cardioversion, who needs anticoagulation?
> 48 hours duration A-fib
or….
What are the 2 anticoagulation options for pts with A-fib receiving cardioversion?
- Coumadin (3 weeks)
- TEE + Heparin if no clot is seen ….then cardioversion can be done immediately
What are some options for rate control of A-fib?
- Verapamil
- Beta blockers
- Amiodarone
- Cardioversion (unstable pt)
- Diltiazem
- Digoxin
What is the tx for pts with A-fib after cardioversion?
- AC with coumadin (from “atrial shock”)
- Antiarrhythmic therapy with Amiodarone or propafenone
What are some things to have on your DDx for severe abd pain and ams?
- Sepsis
- Intra-abdominal infxn
- ruptured appendicitis
- toxic ingestion
- illicit drug use
- Pancreatitis
- Severe metabolic process like DKA
In an adult with shock should receive ____ Liters of normal saline?
2 liters
What insulin is given in DKA patients? How is it given? For how long?
- Regular insulin
- Continuous IV infusion
- Until the anion gap returns to normal
What is given to DKA patients when their glucose gets to 200-300?
Dextrose to prevent hypoglycemia
What is the proper dose of insulin for DKA patients?
-0.1 U/Kg/hr
