ER/ICU/Critical Care Flashcards
(101 cards)
1
Q
antidote for arsenic
A
dimercaprol, succimer, or penicillamine
2
Q
antidote for methanol, ethylene glycol (antifreeze)
A
fomepizole, ethanol
3
Q
vasopressors
A
phenylephrine NE EPI Dobutamine Dopamine Isoproterenol
4
Q
Phenylephrine
A
alpha 1 agonist
use in septic shock
5
Q
Epinephrine
A
A1, A2, B1, B2 agonist that vasoconstricts at high doses
use:anaphylaxis, septic shock
6
Q
dopamine
A
b1 agonist at low doses, a1 agonist at high doses
use: cardiogenic shock, not renal -protective
7
Q
dobutamine
A
beta-1 agonist
use in cardiogenic shock
8
Q
isoproterenol
A
beta 1 agonist, beta 2 agonist
use in cardiac arrest
9
Q
Packed RBCs
A
RBCs that have been separated from other blood components
this is suitable for a patient who has lost a lot of blood (trauma, surgery, etc)
10
Q
vasopressin
A
ADH analog with weak pressor effect
uses: resistant septic shock
ACLS: VF, PEA
11
Q
Platelets
A
active bleeding due to thrombocytopenia
12
Q
Fresh frozen plasma
A
plasma from which cellular components have been removed
Use in warfarin overdose, clotting factor deficiency, DIC, TTP
13
Q
Cryoprecipitate
A
precipitate rich in clotting factors and von Willebrand factor, collected while FFP is thawing
smaller volume than FFP
14
Q
Specific clotting factors
A
pooled from multiple donors
15
Q
Albumin
A
given after large- volume paracentesis (>5L of ascites from abd)
to prevent hypotension and maximize colloid pressure
given in cases of hypoalbuminemia
16
Q
Transfusion reactions
A
nonhemolytic febrile reaction caused by cytokines generated by cells in the blood while in the blood is in storage
onset 1-6 hours after transfusion
fever, chills, malaise
no hemolysis
treat with acetaminophen
17
Q
acute hemolytic reaction
A
1/250,000 transfusions
Due to ABO incompatibility
main reason is clerical error
onset during transfusion
antibody- mediated hemolysis
fever, chills, nausea, flushing, tachycardia, tachypnea, hypotension
18
Q
AB+
A
universal recipients
19
Q
O-
A
universal donors, but can only receive blood from other O-
20
Q
delayed hemolytic reaction
A
caused by antibodies to Kidd of Rh (D) antigens
Occurs 2-10 days after transfusion
slight fever, less- severe hemolysis, mild increase in unconjugated bilirubin
21
Q
anaphylactic reaction
A
1/150,000 transfusions shock hypotension angioedema respiratory distress
maybe 2/2 anti IgA IgG as that IgA- deficient patients have but maybe don’t know about
Treatment iV fluids, airway maintenance
for these patients, provide extra-washed RBCs when possible
22
Q
Minor allergic reactions
A
caused by plasma present in donor blood, leads to urticaria
treat with diphenhydramine
23
Q
Post- transfusion purpura
A
thrombocytopenia developing 5-10 days after transfusion, primarily in women who are sensitized by pregnancy
24
Q
how to treat severe anemia due to autoimmune hemolytic anemia
A
pRBC
25
treat hemophilia
give specific clotting factor (8 or 9)
26
treat DIC
FFP, platelets
27
treat shock due to trauma or postpartum hemorrhage
pRBCs, IV fluids
28
to maintain blood pressure during large volume paracentesis
albumin
29
for hemorrhage due to warfarin overdose
FFP
30
need for vWF-rich blood product
cryoprecipitate
31
give for thrombocytopenia
platelets
32
high doses optimize the alpha-1 vasoconstriction
epinephrine
33
ADH analog
vasopressin
34
best choice for anaphylactic shock
epinephrine
35
best choice for septic shock
NE
36
best choice for cardiogenic shock
dobutamine
37
causes vasoconstriction but with bradycardia
phenylephrine
38
What physiologic pressure does PCWP approximate
LAP
39
What are the preferred vessels to target in the placement of a Swan- Ganz catheter
R. IJ
| L. subclavian
40
what 2 cardiovascular diseases are the biggest risk factors for CHF
hypertension and ischemic heart disease
41
Polyarteritis nodosa
necrotizing inflammation of small or medium arteries, leading to ischemia of the affected tissue
PAN can affect any tissue, but it often affects the kidneys, heart, GI tract, muscles, nerves, and joints
SPARES THE LUNGS
Risk factors: Hepatitis B, hepatitis C
Labs: increased WBC, increase ESR
proteinuria, hematuria if there is kidney disease
negative for ANCA
Renal angiography may show aneurysms
42
Temporal (giant cell) arteritis
subacute granulomatous inflammation of external carotid and vertebral arteries
granulomas where macrophages cluster around
more common in older women
associated with polymyalgia rheumatica
unilateral or bilateral headache,
scalp pain, temple tenderness, jaw claudication, and transient or permanent blindness in one eye
Labs: ESR, if elevated get a temporal artery biopsy
multinucleated biopsy
Start treatment- prednisone, continue until biopsy results are available,
If positive, keep going on high-dose prednisone, then taper off
Aspirin
calcium, vitamin D to prevent osteoporosis 2/2 steroids (this goes for anyone on steroids for more than 3 months)
43
Takayasu arteritis
arteritis in one of the 3 main branches of the aorta
inflammation of the arch of the aorta
Cerebrovascular ischemia
Myocardial ischemia
Asian heritage, women ages 10-40 (young)
Can cause vertigo, syncope, fever, decreased pulses in the limbs ("pulseless disease:)
If you find poor pulses in the upper extremities think about takayasu arteritis
CTA to look for stenosis and defects in vascular walls
Treat with steroids, immunosuppressive agents,
or surgically bypass obstructed
44
Eosinophilic granulomatosis with polyangiitis (Churg- Strauss)
inflammation of small and medium arteries
associated with asthma, nasal polyps, sinusoidal obstruction
H and P: fatigue, malaise, mono or polyneuropathy, tender skin nodules, palpable purpura, papular rash
labs: eosinophilia, p-ANCA
45
Eosinophilia DDx (CANADA-P)
Collagen vascular disease (PAN, dermatomyositis)
Atopic diseases (allergies, asthma, Churg-Strauss, allergic bronchopulmonary aspergillosis)
Neoplasm
Adrenal insufficiency (Addison disease)
Drugs (NSAIDs, penicillins, cephalosporins)
Acute interstitial nephritis
Parasites (strongyloides, ascaris > Loffler eosinophilic pneumonitis)
Other causes: HIV, hyper-IgE syndrome, coccidiomycosis, etc).
Tx: steroids and immunosuppressive agents
46
Henoch- Schonlein Purpura
IgA immune complex- mediated vasculitis, affecting arterioles, venules, and capillaries
CHildren> adults
```
recent URI
LE palpable purpura
arthritis
arthralgias
abdominal pain
renal disease from IgA deposition in the kidney
```
often self- limited but we can use steroids in patients who have GI symptoms
47
Granulomatosis with polyangiitis (Wegener's)
focal necrotizing vasculitis
granulomas in the lung and upper airway
glomerulonephritis
c-ANCA positive
48
Thromboangiitis obliterans (Buerger disease)
vasculitis of small and medium- sized peripheral arteries and veins
affects young male smokers (30s-40s)
```
Clinical presentation:
intermittent claudication
superficial nodular phlebitis
Raynaud phenomenon
Gangrene, auto-amputation of the digits
```
Treatment: stop smoking and it will go away
49
Kawasaki disease
necrotizing vasculitis
infants and young children
Asian descent
```
diagnostic criteria (mucocutaneous lymph node syndrome)"
Fever (>40 C or 104F), lasting at least five days in addition to 4 of the following 5 symptoms (CRASH)
```
Conjunctivitis (bilateral, non-exudative, painless)
Rash on the trunk
Adenopathy of the cervical lymph nodes
Strawberry tongue and diffuse erythema of mucous membranes
Hands and feet have edema with induration, erythema, or desquamation
Coronary artery aneurysms can occur within weeks of the illness but are not included in the diagnostic criteria (these can rupture and extend within the aneurysm leading to MI). Since they don't show up for weeks, you don't need to them to make the diagnosis
Treatment: IVIG (ideally within the first 10 days of illness)
High- dose aspirin, continued until 49 hours after fever resolution, followed by low- dose aspirin until inflammatory markers (platelets, ESR) return to normal (usually 6 weeks)
Steroids are not indicated and are of no proven benefit
Echocardiogram in the acute phase and 6-8 weeks later
50
20 year-old Asian female
Takayasu arteritis
51
2 year-old Asian female
Kawasaki disease
52
Associated with asthma
Eosinophilic granulomatosis with polyangiitis
53
young male smoker
Thromboangiitis obliterans
54
associated with PMR
Temporal arteritis
55
Associated with IgA nephropathy
Henoch Schonlein purpura
56
Associated with hepatitis B
polyarteritis nodosa
57
elderly woman with jaw claudication and vision loss
temporal arteritis
58
strawberry tongue
Kawasaki disease
59
desquamation on hands/feet
Kawasaki disease
60
Poor pulses in the arms
Takayasu
61
Palpable purpura on the legs
HSP
62
vasculitis of the kidney and GI tract, spares the lungs
PAN
63
Vasculitis of the kidney, upper airway, and lungs
GPA
64
necrotizing immune complex inflammation of visceral and renal vessels
PAN
65
infants and young children: involves coronary arteries
Kawasaki disease
66
most common vasculitis
temporal arteritis
67
Cushing's triad and other signs of increased intracranial pressure
hypertension
bradycardia
bradypnea
papilledema
altered mental status
pupil asymmetry
68
classic findings in a basilar skull fracture
bruising around the eyes (raccon eyes)
bruising over the mastoid process (Battle sign)
Blood behind the tympanic membrane
CSF rhinorrhea or otorrhea
69
Next step: possible fracture and +DPL
emergent laparotomy
70
pelvis fracture + DPL shows urine in the pelvis
urgent, non-emergent laparotomy
71
pelvis fracture + nothing on DPL + pelvic instability
angiography with possible embolization (you suspect a retroperitoneal hemorrhage)
72
Blunt abdominal trauma + unstable vital signs + FAST positive
exploratory laparotomy, emergent
73
blunt abdominal trauma + unstable vital signs + FAST shows no fluid in pelvis
angiography with possible embolization
74
blunt abdominal trauma +unstable vital signs + FAST inconclusive
DPL
75
Blunt abdominal trauma + stable vital signs
CT abd/pelvis
76
abdominal stab wound + hypotensive or signs of peritonitis
emergent laparotomy
77
Antibiotic prophylaxis for a rape victim:
Gonorrhea
Chlamydia
Trichomoniasis
HepB if not yet vaccinated or if perpetrator is known carrier
HIV
Pregnancy
Ceftriaxone 125 mg IM (gonorrhea)
Azithromycin 1g PO or doxycycline 100mg PO BID for 7 days (chlamydia)
Metronidazole 2g PO (trichomoniasis)
Hepatitis B !1 of 3 if not yet vaccinated +/- hepatitis B immune globulin (not standard of care)
HIV prophylaxis for 3-7 days with follow-up for further counseling
Other prophylaxis:
Antiemetic (promethazine) for nausea caused by HIV meds and pregnancy prophylaxis
Levanorgestrel (Plan B) 0.75 mg PO- repeat dose in 12 hours (alternatively, both doses can be taken at once for improved compliance). Other options exist
78
How do we evaluate for extremity trauma?
sensory, motor, vascular exam in addition to `imaging
79
What antidepressants are associated with hypertensive crisis?
MAOIs, exacerbated by tyramine
80
When is post-op MI most likely
within the first 48 hours after surgery
| Telemetry in the postop period helps check for this
81
What are signs of hepatic disease in a pre-operative workup
increased PT/PTT
low platelets
increased bilirubin
decreased albumin
82
what interventions help optimize lung function in a patient with pre-existing pulmonary disease
```
incentive spirometry
pain control
deep breathing
physical therapy
bronchodilators
inhaled steroids
```
83
What do you order in your evaluation of post-op fever?
```
CXR
urinalysis with urine culture
blood culture
sputum culture
examine surgical wound
wound culture
```
84
What are 2 indicators of how severe hypotension is in a shock patient?
urine output
| mental status
85
Hyperacute transplant rejection
Seen within initial 24 hours after transplantation
Cause: anti-donor antibodies in recipient
Treatment: untreatable, avoided by proper crossmatching
86
Acute rejection
seen 6 days to 1 year later
Cause- anti-donor T-cell proliferation in recipient
Treatment: immunosuppressive agents (reversible)
87
chronic rejection
seen >1 year after transplant
| Treatment- untreatable, but immunosuppressants can delay onset
88
which cytokine is most important for T cell differentiation
IL2
89
Adverse effects of cyclosporine
nephrotoxic, mannitol can help prevent nephrotoxicity
90
Azathioprine adverse effects
bone marrow suppression, leukopenia
metabolized by xanthine oxidase (don't combine with allopurinol)
91
Tacrolimus adverse effects
nephrotoxicity
92
corticosteroids adverse effects
Cushingoid features
osteoporosis
diabetes
93
Muromonab side effects
leukopenia
94
Rapamycin side effects
thrombocytopenia, hyperlipidemia
95
Mycophenolate adverse effects
This drug is often used to treat lupus
leukopenia
lymphoma
teratogenic
96
Anti-thymocyte glubulin side effecs
depletes T cells
97
Hydroxychloroquine adverse effects
lupus, transplant, RA
visual disturbances
98
Thalidomide adverse effects
phocomelia
99
Graft versus host disease
grafted bone marrow is now attacking the patient's entire body
H&P: maculopapular rash, abdominal pain, n/v, diarrhea, recurrent bleeding, easy bleeding
Labs: elevated LFT, decreased immunoglobulin levels, decreased platelets
Biopsy of the skin and liver will detect inflammatory reaction with significant cell death
Treatment: steroids, tacrolimus, mycophenolate
100
AXR findings consistent with ruptured viscus
free aid under the diaphragm
101
Labs to get in a patient presenting with generalized abdominal pain
CBC with differential, basic metabolic profile, LFTs, beta hCG, stool guaiac, amylase and lipase, EKG and cardiac enzymes if >45yo especially if women, diabetics, elderly
