Hospital Med II

Question 1

key to inpt is?

Answer 1

ACLs
Primary and secondary assessment

Question 2

What is definition and rationale of MET/RRT

Answer 2

Team Makeup
Activation Criteria
Common Activations
Outcomes Evidence
Approach to emergency assessment
Different Diagnosis
Cases

Question 3

What does MET stand for?

Answer 3

Medical emergency team

Question 4

What does RRT stand for?

Answer 4

Rapid response team

Question 5

IS MET and RRT the same thing?

Answer 5

Yes

Question 6

Rationale?

Answer 6

Identify deterioration and intervene early (prior to “code blue”)
Often signs of decompensation for several hours before cardiac arrest
Goals or RRT: Prevent cardiac arrest and ensure goals of care have been addressed

Question 7

What’s activation criteria? (10)

Answer 7

Threatened airway
RR < 6 or > 30
HR < 40 or > 140
SBP < 90
Symptomatic hypertension
Decrease in level of consciousness
- Unexplained agitation
- Seizure
- Significant fall in urine output
- Subjective concern about the patient

Question 8

What are common activation?

Answer 8

AMS, tachycardia, tachypnea, hypotension, hypoxia, staff worried, chest pain, brady, hypopnea

Question 9

What is the primary assessment of ACLS?

Answer 9

Airway
Breathing
Circulation
Disability
Exposure

Question 10

What is in AB

Answer 10

+/- O2, +/- NIPPV or intubation

Question 11

What is in C

Answer 11

IV, monitor, vitals

Question 12

What is in D

Answer 12

Glucose; neuro assessment

Question 13

What is E

Answer 13

Look at the patient; surgical sites, etc.

Question 14

What is part of the secondary assessment in ACLS

Answer 14

Signs and symptoms
Allergies
Medications
Past medical history
Last oral intake
Events leading up to

Question 15

AMS start with?

Answer 15

BLS
Is she breathing, pulse?

Question 16

Whats the next step for AMS after BLS?

Answer 16

A: patent
B: mild tachypnea, speaking in full sentences
C: sinus tachycardia, warm extremities
D: moves all extremities, glucose 83
E: surgical incision without erythema or discharge

Question 17

Whats next after AMS?

Answer 17

Secondary assessment
Signs and symptoms
Allergies
Medications
Past medical history
Last oral intake
Events leading up to

Question 18

Whats the acronym for ddx AMS

Answer 18

AEIOU-TIPS

Question 19

While you are waiting for results for AMS, what your next step?

Answer 19

Immediate Interventions
- Start abx, administer naloxone?

Question 20

Whats the acronym for stroke?

Answer 20

FAST
F = uneven smile
A = arm is weak
S = slurred speech
T = Time

Question 21

whats the most important with stroke?

Answer 21

• Last known normal
• Glucose
• Start NIHSS
• Brief initial neuro exam

Question 22

What is first line imaging for stroke?

Answer 22

CT non contrast

Question 23

Whats the treatment within 10min of stroke?

Answer 23

“Door to doctor”

Question 24

Whats the treatment within 15min of stroke?

Answer 24

Neurologist

Question 25

Whats the treatment within 25min of stroke?

Answer 25

CT scan completion

Question 26

Whats the treatment within 45min of stroke?

Answer 26

CT interpretation

Question 27

Whats the treatment within 60min of stroke?

Answer 27

treatment

Question 28

Whats the treatment within 3 hrs of stroke?

Answer 28

Admission to ICU

Question 29

When can tPA be given?

Answer 29

less than 4.5 hours

Question 30

When can ALL get mechanical embolectomy?

Answer 30

6 hrs

Question 31

When can they get embolectomy for SOME?

Answer 31

6-24hrs

Question 32

What is status epilepticus?

Answer 32

Seizures lasting more than 5 minutes, or Recurrent seizures without return to baseline mental status

Question 33

What are the causes of seizures

Answer 33

- Metabolic (hypoglycemia, hyponatremia, etc.) - Infection (CNS abscess, meningitis, encephalitis) - Withdrawal (alcohol, antiepileptics, benzodiazepines) - CNS lesion (cancer, CVA, trauma) - Intoxication (numerous prescription medications; MDMA; synthetic cannabinoids)

Question 34

What do you typically order for seizure?

Answer 34

- CBC, CMP, Mg, Phos, Lactate - Antiepileptic drug levels - +/- head CT, lumbar puncture - Urine drug screen - EEG

Question 35

What is 1st line for seizures?

Answer 35

- position to lateral decubitus - Airway/breathing: nasopharyngeal aiway - Benzo's (Lorazepam 4mg IV) or midazolam IM

Question 36

If glucose is low/can't get for seizure, what meds can you give?

Answer 36

Thiamine 100mg IV then D50.

Question 37

If seizure go on for 10min what is second line?

Answer 37

Valproic acid, levetiracetam, phenobarbital, fosphenytoin, or phenytoin (choose a favorite)

Question 38

If seizure goes on for 30min

Answer 38

Intubate Midazolam or propofol gtt

Question 39

Review slide 51 CHADs & CHADSVASC

Question 40

What are most common chest pain emergencies (5)

Answer 40

Acute coronary syndrome Acute aortic dissection Pulmonary embolism Tension pneumothorax Pericardial tamponade

Question 41

Most common for SOB

Answer 41

Infection, volume and clot

Question 42

whats the work up for SOB?

Answer 42

ABG  CXR EKG Stat bedside echo CBC, NT-proBNP, troponin, dimer, CMP Pending the above further imaging CT-PE

Question 43

What are some different ways to deliver O2?

Answer 43

NIPPV NPPV

Question 44

What are good canidates for Nasal intermittent positive pressure ventilation (NIPPV) (4)

Answer 44

Able to protect airway Able to clear respiratory secretions Cooperative Low risk of aspiration

Question 45

What is absolute contraindication for NIPPV?

Answer 45

cardiac or respiratory arrest

Question 46

What is heated high flow O2?

Answer 46

Heats and humidifies air and can deliver up to 100% FIO2 at flow rates up to 60 LPM

Question 47

Classic indications for NIPPV?

Answer 47

Cardiogenic pulmonary edema COPD