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Flashcards in EM, ICU, and surgery 2 Deck (21):
1

How is Vfib/Pulseless Vtach managed?

Monophasic shock (360J) and CPR (30:2) --> then recheck...and repeat if still no pulse --> Epi 1mg q3-5m (can give vasopressin 40U in place of 1st or 2nd epi) --> recheck --> Shock/CPR --> consider Amiodarone or lidocaine

Magnesium for torsades

2

How is PEA/Asystole managed?

CPR at 30:2 --> epi 1mg q3-5m (consider vasopressin 40U for 1st or 2nd dose)

Evaluate and treat causes

3

What causes PEA?

H's and T's

Hypoxia, hyperkalemia, hypokalemia, hypothermia, hydrogein ions (acidosis)

Tamponade, Tension pneumo, Thrombosis, Tablets/Toxins

4

How is a suspected acute stroke initially managed?

ABCs [Airway (assess), Breathing (give O2), Cardiac (ECG, IV access, blood glucose)]
Determine time of onset
Neurological exam
CT

5

What do you do with a suspected acute stroke that shows a hemorrhage on CT?

Stop anticoagulant drugs
Neurosurgery

6

A patient comes in with an expected stroke. A CT does not show a hemorrhage, but an LP is positive. What is the likely diagnosis? What should be done?

Subarachnoid hemorrhage

Stop anticoagulants
Neurosurgery

7

A patient comes in with an expected stroke. A CT does not show a hemorrhage, but a subarachnoid hemorrhage is expected so an LP is gotten. The LP is found to be negative. What should be done?

Anticoagulation
Supportive cares

8

A patient comes in with an expected stroke. A CT does not show a hemorrhage. The symptoms started less than 3hrs ago, the patient has not had intracranial surgery in the last 3 months, has not had an LP in the past 7 days, and has no history of brain aneurysm. What should be done?

Make inpatient
Fibrinolytic therapy (tPA, urokinase, or streptokinase)
No anticoagulation

REMEMBER the requirements...basically make sure no risk of a brain bleed

9

How can high intracranial pressure be decreased?

Mannitol
Hypertonic saline
Hyperventilation

10

A patient comes in with blood at the urethral meatus and a high-riding prostate. What shouldn't be done?

Don't cath this patient...unless under cystoscopic guidance

11

Why can BP drop more in pregnant women after trauma? With this in mind, in what position should mother be in during exam?

Uterus compresses IVC --> decreased venous return --> poor cardiac output

Left lateral decubitus position...minimizes compression of IVC

12

What needs to be seen in pregnancy women before they can be discharged after trauma?

Contractions less frequent than q10m
No vaginal bleeding
No abdominal pain
Normal fetal heart tracing

13

What is the most common form of child abuse?

Neglect

14

What kinds of abuse are physicians REQUIRED to report?

Child abuse
Elder abuse

15

Where are Swan-Ganz catheters often inserted? What do the measure?

Left subclavian or right internal jugular

Right atrial pressure
Pulmonary artery pressure
Wedge pressure (equals left atrial pressure)
Also, CO, mixed venous O2 saturation, and systemic vascular resistance

16

A patient had a transfusion 1-6 hours ago and now has fever, chills, rigors and malaise. What is going on? What caused it? What should be done?

Nonhemolytic febrile transfusion reaction (most common; 3% of transfusions)

Caused by antibodies to human leukocyte antigens

Treat with tylenol

17

While a patient is being transfused, she develops fever, chills, nausea, flushing, tachycardia, tachypnea, and hypotension. What is going on? What caused it? What should be done?

Acute hemolytic transfusion reaction (1:250,000 transfusions)

Caused by ABO incompatibility

Aggressive supportive cares

18

2-10 days after a transfusion, a patient develops a slight fever, falling hgb/hct, and mild increase in indirect bilirubin. What is going on? What caused it? What should be done?

Delayed hemolytic transfusion reaction

Caused by antibodies to Kidd or D (Rh) antigens

No acute therapy, but determine antibody type to prevent recurrence

19

While a patient is being transfused, he develops rapid onset of shock and hypotension. What is going on? What caused it? What should be done?

Anaphylactic transfusion reaction

Caused by anti-IgA antibodies (in patient with IgA deficiency)

Give epi, volume maintenance, and airway maintenance

20

A pregnant woman develops purport 5-10 days after a transfusion. What should be done?

IVIG or plasmapharesis

21

Which inotrope can be used for CHF? Besides inotropic effects, what else does it do?

Dobutamine

It also causes mild reflex vasodilation