Exam 1 Flashcards
1
Q
How is Metric BMI calculated?
A
BMI= kg / m2
[Weight (Kg) / Height (m2)]
2
Q
Familial history can detect which condition?
A
Malignant Hyperthermia
3
Q
How is BMI calculated in the inferior Imperial way?
A
703 x lbs / in2 [703 x weight / height (in2)]
4
Q
BMI Ranges:
Underweight
Normal
Overweight
Obese
A
Underweight: <18.5
Normal: 18.5-24.9
Overweight: 25-29.9
Obese >30
5
Q
2 Anesthesia Hard Stops
A
Unstable Chest Pain
Decompensated Heart Failure
6
Q
Q
2 Most Important Physical Examination Questions?
Emergent Physical Examination A.M.P.L.E. meaning ?
A
Allergies and Medications
Allergies, Medications, PMH, Last meal eaten, Event leading to surgery.
7
Q
Which court case established practice of informed consent?
A
Salgo v. Leland Stanford Jr. University Board of Trustees
8
Q
Common causes of anaphylaxis? (3)
A
Rocuronium (muscle relaxant), antibiotics, chlorhexidine
9
Q
Do not combine MAOIs with which 2 drugs?
A
Demerol / Meripedem
Ephedrine
10
Q
Which drug will not work on someone on meth? TEST
A
Ephedrine
11
Q
Glaucoma/stroke effect of vision? (2) TEST
A
Decreased peripheral vision loss
Glaucoma - tunnel vision
12
Q
Risks of:
Garlic
Ginger
Gingko
Ginseng
Green Tea
A
bleeding
13
Q
Risks of:
Ephedra
Kava
Saw Palmetto
St. Johns Wort
A
Ephedra: MI, dec catecholamines
Kava: dec sedation
Saw Palmetto: bleeding
SJW: CYP450
14
Q
BMI can be used to determine? (4)
A
- Fluid volume requirement,
- acceptable blood loss,
- drug dosage,
- adequate u/o
15
Q
What Pre-op intervention can be done for someone with sickle cell?
A
Admit day before to hydrate & possibly pre medicate as it is very hard to control their pain.
16
Q
What is G6PD deficiency?
What is Factor V Leiden?
A
Enzyme helps red blood cells work properly. A lack of this enzyme can cause hemolytic anemia.
F5: clotting disorder
17
Q
What should be avoided in Pts with neuromuscular disorders?
A
NMJB
18
Q
How does anesthesia affect seizure meds?
A
It will reduce half-life of the seizure meds
19
Q
Why is it important to monitor how long patient has been taking prednisone?
A
High exogenous glucocorticoids suppress cortisol secretion at HPA Axis. This may blunt normal cortisol hypersecretion during surgery.
20
Q
What should be watched in someone with Raynaud’s?
A
BP sensitive; monitor O2, comfort b/c cold
21
Q
Blood glucose swings is a sign of what?
A
Poor nutrition
22
Q
3 Examples of High risk procedures are?
A
Aortic
Major Vascular
Peripheral Vascular
23
Q
4 Examples of Intermediate risk procedures are?
A
Head/neck surgery
Carotid endarterectomy
Intrathoracic surgery
Intraabdominal surgery
24
Q
Briefly Describe ASA w/ disease examples:
I
II (4)
III (3)
A
I: healthy Patient
II: mild disease w/o limitations; smoker, pregnant, drinker, well-controlled DM & HTN
III: Moderate disease w/ limitations; COPD, hepatitis, pacemaker, ESRD w/ dialysis
25
Briefly Describe ASA w/ disease examples:
IV
V (4)
VI
IV: Recent (<3months) MI, CVA, TIA, CAD, ARDS, Sepsis, severe CHF
V: Massive Trauma, Intracranial bleed, ischemic bowel, aneurysm
VI: brain dead organ donor
26
What is scored 1 point in the Revised cardiac Index scale? (6)
- cerebrovascular disease
- High-risk Sx (intraperitoneal)
- ischemic heart disease
- CHF
- DM requiring insulin
- Creatinine >2.0mg/dL
27
Revised Cardiac Risk Index:
Score 0 correlates to?
Score of 3?
0 = 0.4%
3 = 5.4% risk of major cardiac events.
28
What does the MET scale evaluate?
How many are sufficient?
- Cardiopulmonary fitness & if further testing is necessary.
- Want >4 METs. Below = cancel Sx to run more tests
29
Which Labs should be ordered for:
ASA-PS 3 or 4 undergoing intermediate risk? (4)
ASA-PS 2, 3, 4 undergoing major procedures (2)
3 or 4: CBC/Hgb/Hct, Renal Function Test, Coagulation, ECG
2, 3, 4: Renal Functioning Test, ECG
30
How to asses cardiopulmonary function in a bedridden Pt?
With a chemical stress test.
31
When to get pre-op renal panel? (6)
ASA __ & ___ undergoing intermediate
ASA __ & ___ & ___ undergoing major Sx
- DM
- HTN
- Cardiac disease
- N/V/D
- Renal disease
- Fluid overload
- ASA III & IV undergoing intermediate Sx
- ASA II, III, IV undergoing major Sx
32
What is considered minimal sedation?
Drowsy, able to talk
33
What is the difference between regional & local anesthesia?
- Regional numbs large area (epidural, nerve block)
- Local numbs small area (biopsy)
34
What are the most common allergies? (6)
- Abx
- Adhesives
- CHG/Iodine
- Latex (spina bifida)
- Rocuronium
- Opioids
35
What can be done in someone with an Abx allergy?
Give a test dose (1/10th)
36
In what kind of allergy are PCN/cephalosporin Abx avoided?
True IgE-mediated allergy
37
Which cancer is __ higher in Caucasian A. than African A.?
Which cancer is higher in African Americans than Caucasian Americans?
Skin cancer is 20% higher in Caucasian
Americans than African Americans.
Prostate cancer is higher in African Americans than Caucasian Americans.
38
Burning plastic releases ______ _______.
Person can also have _____ poisoning.
Treatment for poisoning?
releases carbon monoxide.
cyanide poisoning
Cyanocobalamin to treat cyanide poisoning
39
3 Types of Palpation and uses
Light palpation - organs
Deep palpation - abd masses
Bimanual palpation - organs
40
Define:
Strabismus
Leukoplakia
S: crossed eyes
L: thick white patches because of smoking and alcohol
41
How can Mg⁺⁺ evaluations be done in OB patients?
Knee extension/flexion
42
Ectropion
Entropion
Ptosis
E: eversion, lid margin turn out
E: inversion, lid margin turns inwards
P: abnormal drooping of lid over pupil
43
What is a VAN exam?
What does being VAN positive indicate?
Palms up, checking for downward drift.
VAN (+) = ↑ risk for LVO (large vessel occlusion)
44
When would a gluteal reflex be performed?
Trauma patients in assessing pelvic injury
45
How can Amides & Esters be identified?
- Amides have 2 I’s in their name
- Esters have 1 I in their name.
46
What 2 anesthetic consideration should one have for a patient with significant lordosis?
↑ abdominal pressure could = worse GERD.
Difficult spinal/epidural
47
Is Lidocaine and amide or an ester?
How can you tell?
Lidocaine = Amide
Two “i’s” would indicate and amide (ex. bupivicaine)
48
What component of “ester” medications are people allergic to?
PABA (Para-aminobenzoic acid)
49
Which antihypertensive medications should be d/c’ed before Sx & why?
- ACEi & ARB’s
- May cause severe hypotension under anesthesia.
50
What medication should be d/c’ed 4 weeks prior to Sx & why?
- Oral contraceptives
- High risk for post-op venous thrombosis
51
What interaction is there between NMJB’s & anticonvulsants?
Anticonvulsants decrease the lifespan of NMJB’s
52
When should topical medications be discontinued prior to Sx?
24hrs
53
D/c which diuretic before Sx
When should it be d/c-ed?
Thiazides
24hrs
54
When is it not okay to d/c P2Y12 inhibitors?
Within the first 6 months of taking drug eluting stents.
55
When should Post-Menstrual HRT be d/c’ed prior to Sx?
4 weeks
56
What should a type 1 diabetic do with their insulin regimen prior to Sx?
- Take 1/3 of their usual dose the morning of Sx
- Continue basal rate if infusion pump present
57
What should a type 2 diabetic do with their insulin regimen prior to Sx?
Take none or up to half of a **long-acting** the day of Sx.
58
What & how much stress dose medication is given?
100mg hydrocortisone q8hr for up to 24-48hrs.
59
What are the NPO times for full meal, light meal, breast milk, & clear liquids?
8hrs, 6hrs, 4hrs, & 2hrs
60
Kahoot
Leoning Face associated with infectious disease?
Chipmunk face associated with which eating disorder?
Spider Angioma associated with which liver disease?
Pyloric Stenosis associated with mass shaped as?
Leoning Face associated with Leprosy.
Chipmunk face associated with Bulimia Nervosa
Spider Angioma associated with Cirrhosis.
Pyloric Stenosis associated with olive shaped mass.
61
Kahoot
Hyperthyroidism is associated with what ophthalmic change
Physical feature for Cushing’s disease
Rice water stool is commonly found in what illness?
Hyperthyroidism ; Exophthalmos.
Cushing’s disease ; Buffalo hump
Rice water stool ; Cholera
62
Stimulating the peroneal nerve causes? TEST
Foot drop; plantar reflex
63
When can tube feeds be continued?
With a Dobhoff unless it is a abdominal case.
64
What is Mendelson syndrome?
What two factors increase your risk for this?
Aspiration Pneumonitis is a chemical injury caused by inhaled gastric contents.
Increased risk of aspiration due to > 25mL of gastric contents and a gastric pH < 2.5.
65
What are some aspiration prophylactic measures?
- Decrease gastric volume
- Increase gastric pH (sodium citrate),
- H-2 receptor antagonist
- PPI’s
- Dopamine-2 antagonist.
66
H-2 receptor antagonists like Pepcid & PPI’s do what?
Increase gastric pH & decrease gastric acid secretion
67
Who is at risk for pulmonary aspiration?
- Pregnancy
- DM
- Significant opioid users
- BMI >40
- Emergent Sx
- Any esophagus or abdominal issue Pt
68
What is PONV?
What are risk factors for it? (4)
Premedication Nausea and Vomiting Prevention
Female, History of PONV, Nonsmoker, PostOp Opioids
69
For someone with an Apfel score of 3-4 should receive what considerations? (4)
- Avoid general anesthesia
- Propofol
- Minimize opioids
- Prevent 3 drugs from different classes.
70
For a Pre-op Pt currently on Vanc or fluoroquinolone should receive their Abx when?
2hrs before incision
71
What chance of cross-reactivity exists with cephalosporins and penicillin?
10%
72
What 2 anesthesia considerations are made in someone taking Echinacea?
-Reduces effectiveness of immunosuppressants.
-Can cause perioperative allergic reaction
73
What anesthesia considerations are made in someone taking Ephedra? (3)
D/c when?
- Risk of MI
- Arrhythmia
- Hemodynamic instability
- D/C 24hrs pre-op
74
What anesthesia considerations are made in someone taking garlic (ajo)?
D/c when
Inhibits plt aggregation. D/c 7 days prior to Sx
75
What anesthesia considerations are made in someone taking ginger?
Increased risk of bleeding
76
What anesthesia considerations are made in someone taking Ginko?
Increased risk of bleeding. D/C 36hrs before Sx.
77
What anesthesia considerations are made in someone taking Ginseng? (3)
- Hypoglycemia
- Inhibit Plt aggregation ->
- Decrease effect of Warfarin. D/c 7days prior to Sx.
78
What anesthesia considerations are made in someone taking Green tea?
Inhibit plt aggregation
79
What anesthesia considerations are made in someone taking Kava?
Increase sedative effects of anesthetics
80
What anesthesia considerations are made in someone taking Saw palmetto?
Increased risk of bleeding.
81
What anesthesia considerations are made in someone taking St John’s? (3)
- Induction of CYP450
- Affects benzos, CCB’s
- Delayed emergence.
82
What anesthesia considerations are made in someone taking Valerian?
- Increased sedation effects
- Increased anesthetic use with long-term use.
- Acute benzo withdrawal
83
Scopolamine patch should **NOT** be used in what kind of Pt? (2)
Confused because they can’t see?
Narrow-angle glaucoma, confused Pts
84
What N/V medication is given after induction & what can it cause?
Dexamethasone. Can cause increased blood glucose
85
When are Abx re-dosed in the OR?
When the Sx lasts >4hrs
86
RUQ pain with cholecystitis is called? TEST
Murphy's sign
87
Kahoot
Bluish discoloration associated w/ pancreatitis?
Rebound tenderness associated w/ appendicitis?
Icteric Sclera associated with _______.
Addison’s disease associated with this skin color?
Condition w/ inspiratory wheezes?
Blue & Pan: Cullen sign
Rebound: McBurney’s point
Icteric S: Hepatitis.
Addison’s D: Bronze
Wheeze: Asthma.
88
What is the name for chest-clutching that occurs during MI? TEST
Levine’s sign
89
#1 sign of hypoexmia in children? TEST
Bradycardia
90
Kahoot!
Myasthenia Gravis results in facial condition?
Two common findings in hyperthyroidism?
Which medication should be avoided in adrenal insufficiency & why?
Which two signs are common with Meningitis?
Which two are associated with hypocalcemia?
MG: Ptosis
HyperThy: Exophthalmos & Tachycardia
Adrenal: Etomidate causes adrenal suppression
Meningitis: Kernig and Brudzinski
Hypocalcemia: Chvostek and Trousseau
91
WEBER’S TEST
RINNES TEST
Purpose of test
Rinne’s test. + when air conduction is better than bone conduction.
Weber’s is heard in the midline is equal
Tests for hearing loss
92
Vibration travels faster through bone than air?
True, vibration travels fastest thru bone.
93
Rank the following from most to least reflective; bone, air, muscle, liver?
Air, bone, liver, muscle
94
In what leads will the P wave be positive?
P wave duration
Leads I, II, aVF, V4-V6
D: < 012s
95
Right MI causes death of?
Expected HR?
Lead Elevation?
pacemaker cells.
HR: 40-60
Lead: II & III
96
Bachman’s bundle
Conduction pathway traveling from SA node to L atrium
97
Baseline HR of Purkinje Fibers
What is an idioventricular rhythm?
20-40 bpm
ID: rate <50, absent P waves, wide QRS
98
AV node inherent HR
Junctional Rhythm conducted where? HR?
40-60bpm
JR from AV junction. HR still 40-60
99
A retrograde P-wave means what?
A junctional rhythm with the signal coming from the AV node
100
PR interval represents:
Length of PR Interval:
AV conduction
0.1-0.2
101
QRS Complex
Big QRS Complex =
0.08-0.12 seconds
Big QRS Complex = small heart size
102
ST elevation in all the leads
PERICARDITIS
103
The T-wave will positive in what leads?
Leads I, II, V3-V6
104
PVCs are problematic because
it's 75% of SV in ventricles
need to check if pt perfusing
105
Common cause of:
PVCs
Bifocal PVCs (2)
Hypoxia
Electrolyte imbalances, electrical injuries
106
What can induce A flutter (2)
Caffeine and cocaine
107
Which electrolyte imbalance do V fib patients usually have?
Hyperkalemia
108
First MEDICATION after NO PULSE is _____? Next try _____; how many units in bottle?
1 mg of Epi
Next try Vasopressin 20-unit dose
109
Halothane & enflurane can cause what?
Sensitive myocardium leading to arrhythmias
110
Sevoflurane can cause _____ in infants?
Bradycardia
111
Desflurane may cause ____ during induction?
Prolonged QT
112
Concentrated intravascular local anesthetic can cause ____ & is treated with____?
Asystole & lipid rescue
113
Lidocaine's effect on ventricles
Lidocaine: knocks out ventricular component
114
What is sometimes masked intra-op & presents post-op with HTN, tachycardia or both?
Catecholamine excess
115
Pt’s using cocaine are more likely to what intra-op?
Bleed
116
Pt’s using meth are likely to what intra-op?
Go hypotensive. They are chronically hypertensive.
117
What does a Pt’s temp have to be to go to PACU?
96 degrees
118
What is anthropometry?
Study of measurements & proportions of the human body
119
What is micrognathia?
Undersized lower jaw.
120
Compare axillary vs core temp.
Axillary will read 1 degree Fahrenheit less
121
Which NMJB should not be given to bedridden Pt’s?
Succinylcholine
122
When is mediated or indirect percussion used?
How is it performed?
To evaluate the abdomen or thorax. Strike fingers of one hand with other.
123
How to do Immediate Percussion?
What does it evaluate?
Striking the surface directly with the fingers of the hand.
Evaluate the sinus or an infant thorax.
124
When is fist percussion used?
To evaluate the back and kidneys for tenderness.
125
A high pitched, drum-like sound during percussion is indicative of?
Air containing space, enclosed area, gastric air bubble
126
A long, hollow, low pitched sound during percussion is indicative of?
Sound name?
Resonance
Normal lungs
127
Name of a very loud & low booming sound during percussion.
Indicative of?
TEST
Hyperresonance
Emphysematous lungs
128
A thud-like, high pitched percussion is indicative of which organ?
Liver
129
A short, high pitched, flat sound percussion is indicative of which organ?
Muscle
130
What is Gilbert’s syndrome?
Inherited condition that impairs the ability of enzymes to process the excretion of bile.
131
What is Cholestasis?
This interrupts the flow of bile from the liver. The bile containing conjugated bilirubin remains in the liver instead of being excreted.
132
What is Hemolytic anemia?
The production of bilirubin increases when large quantities of red blood cells are broken down.
133
What happens in inflammation of the bile duct?
This can prevent the secretion of bile and removal of bilirubin, causing jaundice.
134
What happens in acute inflammation of the liver?
Results in?
Impair liver’s ability to conjugate and secrete bilirubin
Resulting in a buildup.
135
What is Vitiligo?
An autoimmune disorder in which the systems in the body that fight off infection begin to fight off the healthy cells (melanocytes). Black & white skin)
136
Ecchymosis can be caused by what? (4)
- cocaine use
- Sinus infection
- spontaneous bleeding
- skull fx
137
Koilonychia can be a sign of
other name
Sign of hypochromic anemia, especially iron-deficiency anemia.
Spoon nails. Abnormally thin nails that lost their convexity.
138
What is Paronychia?
Caused by which bacteria or fungus?
- Inflammation of the skin around the nail
- due to the bacterium Staphylococcus aureus
- Gradually caused by the fungus Candida albicans.
139
Someone with a shampoo allergy might also be allergic to?
CHG, chloraprep, etc.
140
What is anisocoria?
A notable difference in pupil size between the two eyes.
141
What is Arcus Senilis?
Deposition of phospholipids/cholesterol in the peripheral cornea of older patients. (benign usually)
142
What is Horner’s syndrome? (TEST)
Cause (2)
- Constellation of clinical signs, the triad of **ptosis**, miosis, & anhidrosis.
-Interscalene blocks
- Results from a lesion to the sympathetic pathway that supply the head and neck region.
143
What is the treatment for a sty?
Warm moist towel, helps increase perfusion and unclog the duct.
144
How does Narcan affect the pupils?
Narcan can make pupils slow to react. Even unevenly.
145
PEA is also know as
EMD: Electromechanical Dissociation: Rhythm but no squeeze
146
Defibrillation Jules:
Biphasic
Monophasic
Biphasic: 120-200J
Monophasic: 360J
147
PEDI Defibrillation Joules
First shock:
Second Shock:
First: 2J/kg
Second: 4J/kg
148
What are the 6 H's of ACLS?
Hypoxia
Hypovolemia
Hyper-/hypokalemia
Hydrogen ion (acidosis)
Hypoglycemia
Hypothermia
149
What are the 5 T's of ACLS
Toxins
Tamponade(cardiac)
Tension pneumothorax
Thrombosis (coronary and pulmonary) Trauma.
150
What is the dose & interval for atropine in adult bradycardia?
1mg q3-5mins max 3mg
151
What is the treatment for beta blocker induced bradycardia?
Glucagon
152
What is the treatment for CCB induced bradycardia?
Calcium
153
At what ETCO2 reading does a cardiac arrest pt perfuse adequately?
>15 mmHg
154
What are the lidocaine doses for an adult cardiac arrest?
- First dose: 1 -1.5 mg/kg.
- 2nd dose: 0.5 – 0.75 mg/kg
155
3 Meds for **Stable Wide Complex Tachycardia**
-include dose
- Amio: bolus 150mg over 10mins then infusion.
- Procainamide: 20-15 mg/min (start w/ 20 mg/min & titrate until
arrhythmia is suppressed or hypotension occurs or QRS widens
>50%).
- Sotalol: 100 mg over 5mins (avoid in long QT).
156
What is the treatment for magnesium OD in PIH?
Calcium or gluconate
157
What are the causes for cardiac arrest in pregnancy?
ABCDEFGH
- (A)nesthetic
- (B)leeding (prone to DIC)
- (C)ardiovascular
- (D)rugs
- (E)mbolic
- (F)ever
- (G)eneral
- (H)TN
158
What is the Epi dose in pediatric cardiac arrest (IV & ETT)?
- IV: 0.01 mg/kg
- ETT: 0.1 mg/kg
159
Pediatric patients usually have VF or Asystole/PEA?
What causes Vf? (2)
Kid’s usually have H*T’s so Asystole/PEA.
Vf: electrocution and drowning
160
What is the Amio dose for pediatric cardiac arrest?
5mg/kg up to 3 doses
161
What is the lidocaine dose for pediatric cardiac arrest?
1mg/kg loading
162
What is the atropine dose & frequency in pediatric bradycardia?
0.02 mg/kg q3-5mins
163
What is the adenosine dose for pediatric tachycardia?
0.1 mg/kg
164
What are the neonatal target SpO2 1min & 5mins post birth?
- 1min= 60-65%
- 5mins= 80-85%
165
When should Epi be given in neonatal resuscitation?
If HR <60 persists.
166
When is neonatal resuscitation started?
If apneic or HR <100.
167
How are Celsius convert to Fahrenheit & vice versa?
- Take Celsius temp multiply it by 1.8 & add 32.
- Take Fahrenheit temp, subtract 32 and multiply by 5/9th.
168
EKG Changes:
Hyperkalemia
Hypokalemia (2)
HyperK: peaked T waves
Hypok: U wave & ST depression
169
EKG Changes:
Hypercalcemia (4)
Hypocalcemia
HyperC: P wave disappears, **WIDE QRS***, Peaked T & J wave
HypoC: Prominent U wave
170
What is a Delta wave?
Which patients get it?
What are problematic medications? (2)
D: Slurred upstroke of QRS
P: WPW
Avoid CCB and Adenosine in WPW pts
171
What position is recommended for EKG lead placement?
Supine
172
Precordial Lead Placement: V1-V6
V1 4th intercostal, right sternum
V2 4th intercostal, left sternum
V3 between V2 & V4
V4 5th intercostal, left mid clavicular
V5 5th inter; more left than V4
V6 5th inter; more left than V5
173
Briefly Describe:
Q Wave
R wave
S
J Point
Q: first negative deflection after P wave
R: first POSITIVE deflection after P wave
S: negative deflection after Q/R
J: Juncture point for QRS ends, ST begins
174
What is axis deviation used for?
- To diagnose hemiblocks
- Calling VT
- Identify possible complications
175
Physiologic Left Axis Degrees?
Lead I, II, III +/- ?
Degrees: 0 to -40
I: +, II: +/-, III: -
176
What axis would result from an anterior hemiblock?
Pathological Left axis (-40 to -90degrees)
177
What axis would result from a posterior hemiblock?
Right axis (90 to 180degrees)
178
What axis would result from a ventricular origin rhythm?
Extreme right axis (>180)
179
What will the QRS, in Leads I, II, III look like in an extreme right axis?
Negative like a V in all 3.
180
What Lead is used for BBB (Turn Signal) & what other criteria is important?
- V1 (MCL-1)
- QRS must be at least .12sec wide
-Down = left; Up = right
181
What will the QRS, in Leads I, II, III look like in a pathological left axis?
- Lead I= ^
- Lead II & III= negative V
182
What meds are not given to someone with a RBBB + anterior hemiblock (bifasicular)?
Why?
Lidocaine & procainamide
They'll lose all ventricle function
183
Which 2 block is at high risk for LAD occlusion?
RBBB + posterior hemiblock
184
RCA supplies blood to (5)
SA & AV node
Right Ventricle
LV Inferior & Posterior wall
Posterior Fascicle of LBB
185
What part of the heart is the best seen on a 3 lead EKG?
LV inferior wall
186
The LAD supplies which structures? (4)
Also called the?
- LV anterior wall
- septal wall
- Bundle of His
- BB
Called the Widow Maker
187
Someone with an occlusion in the LAD is at risk for?(3)
- Decreased systemic perfusion
- myocardial rupture
- hypotension
188
The Circumflex supplies which structures? (4)
- LV lateral & posterior walls
- SA (40%) & AV (10%) nodes
189
Chest Pain Relation to Occlusion:
CP on exertion
CP at rest
CP on nitro
Exertion: 70 – 85% occlusion
Rest: 90%
Nitro: 100%
190
What is ischemia & at what time does it start?
- Transient reduction in blood flow to the myocardium
- Begins to form in 30mins
191
Ischemia primary effect on T waves?
Inverted T waves in 2+ leads
192
Reciprocal changes of an **Inferior MI** causes ST depression in which leads?
- ST depression in Lead I & aVL
193
ST depression can indicate what else besides infarcts? (2)
- Subendocardial injury
- Drug or electrolyte problems
194
At what size is a Q wave pathological & what does it mean?
- >40 ms wide or 1/3 depth of R wave
- Means necrotic tissue is present
195
Leads I & aVL refer to what part of the heart?
High lateral
196
The circumflex correlates to which leads & where would reciprocal changes be?
- V5, V6, Lead I
- Reciprocal in aVL Leads II, III, aVF
197
The LAD correlates to which leads & where would reciprocal changes be?
- V1 – V4
- Reciprocal in II, III, aVF
198
The RCA correlates to which leads in a normal EKG
- Normal EKG= inferior II, III, aVF
199
What reciprocal changes would be seen with a posterior AMI?
ST depression in V1 – V4
200
Inferior MI’s may present with what kind of symptoms? (4)
- Nausea
- Abd referred pain
- Bradycardia
- Hypotension
201
An anterior wall MI can lead:
-3 heart rhythms
-heart conduction problem
-spread to create MIs in 2 places
- CHB, VT, or VF
- Hemiblocks
- Anterorseptal or anterolateral MI’s
202
Besides PCI, what is the treatment for anterior wall MI’s? (2)
- Nitrates IV
- No fluid bolus, use fluids cautiously
203
What reciprocal changes will be seen with LV hypertrophy?
None
204
What position will someone with pericarditis feel best in?
Leaning forward
205
What can inhaled nitrous lead to in nasal procedures?
Air trapping
206
Besides the eyes & skin what is a good site to check for jaundice?
Buccal mucosa
207
A bright red tongue is an indication for what? TEST
Vitamin B12 or niacin deficiency
208
What is an indication of cherry-colored lips?
Carbon-monoxide poisoning
209
What are spongy gums indicative of?
Vitamin C deficiency
210
What is Leukoplakia?
Thick white patches on gums due to smoking & EtOH
211
What does the Romberg’s test assess?
Perception
212
How do you assess arm flexion at the elbow?
- Identify biceps tendon by flexing against resistance
- Then place arm @ 90 degrees
- Place finger on tendon & strike it.
213
How do you assess extension at elbow?
1) Flex arm at elbow,
2) Hold arm across chest or hold upper arm horizontally
3) Strike tendon just above elbow
214
What herbs/supplements carry increased risks for bleeding?
Saw Palmetto & anything starts with a G.
215
Who population is 90% fast acetylators
Asians are ultra-rapid metabolizers
216
Temporal nature refers to the __________ of the pain.
Underlying etiology refers to the _______ of the experienced pain
Temporal: duration; acute vs chronic
Etiology: source; nociceptive vs inflammatory
217
What are the four ways to classify pain?
Underlying etiology
Anatomic location
Temporal nature
Intensity.
218
Pain Underlying Etiology:
Describe **Nociceptive Pain**
Result of direct tissue injury from a noxious stimulus.
219
Pain Anatomic Location:
Describe **Somatic vs Visceral Pain**
S: superficial like muscle, bone
V: internal organ pain like appendicitis
220
Which opioid does not show up on a UDS?
Fentanyl
221
OPQRST Pain History Mnemonic
Onset
Provocation of symptoms
Quality
Region
Severity
Timing
222
Pain Pharm Tx for Etiologies:
Nociceptive (2)
Inflammatory
Neuropathic (3)
Idiopathic
N: Both opiate & non-opiate
I: Anti-inflammatory
N: SNRI, Gabapentin, Antidepressant
I: difficult to address
223
Pain Pharm Tx for Anatomy:
Somatic (4)
Visceral
S: Topical & local anesthetics, opiates & non-opiates
V: Opiates
224
Pain Scale for Pediatrics:
Birth-6mo
Infant & older
3y and older
8y and older
B-6: Neonatal Infant Pain Scale (NIPS)
Infant: Faces, Legs, Activity, Cry, Console (FLACC)
3: Wong Baker FACES
8: Numeric Pain Scale (NPS)
225
PO Pediatric Dose of Acetaminophen:
PO (dose, frequency, max)
PO: 15mg/kg, q 4-6h
Max 90mg/kg/d
226
IV Pediatric Dose of Acetaminophen:
(2 dose & frequency; max)
Dose: 15mg/kg q6 or 12.5mg/kg q 4;
Max: 75mg/kg/d
227
Ketamine Procedural Dosing:
Adult
Pediatric
IM
A: 0.5-1.0 mg/kg
P: 1-2mg/kg
IM: 4-5mg/kg
228
Ketamine Sub-dissociative Dosing:
Adult IV
IM
IN
Adult IV: 0.1 - 0.3mg/kg
IM: 0.5-1.0 mg/kg
IN: 0.5-1.0 mg/kg
229
Ketamine **Delirium** Dosing:
Adult
IM
IV: 1mg/kg
IM: 4-5mg/kg
230
Intranasal Doses and Max:
Fentanyl
Midazolam
F: 1.5-2mcg/kg q1-2h; max 3mcg/kg
M: 0.3mg/kg; max: 10mg per nostril
231
Intranasal CONCENTRATIONS of:
Ketamine
Fentanyl
Midazolam
K: 50mg/ml
F: 50mcg/ml
M: 5mg/ml
232
Ketamine MOA
Block NMDA receptors, peripheral Na channels and μ-opioid receptors
233
Dermatomes:
Shoulder & Clavicle
Thumb & Index Finger
Forearm
Nipple
Xiphoid Process Tip
Shoulder & Clavicle C4-C5
Thumb & Index Finger C6-C7
Forearm T1-T2
Nipple T4
Xiphoid Process Tip T6
234
Dermatomes:
Umbilicus
Inguinal Ligament
Knee & Distal Thigh
Lateral Foot
Perineum
Umbilicus T10
Inguinal Ligament T12
Knee & Distal Thigh L3-L4
Lateral Foot S1
Perineum S2-S4
