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CDM II Fall Block > Hospital Med II > Flashcards

Hospital Med II Flashcards

1
Q

key to inpt is?

A

ACLs
Primary and secondary assessment

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2
Q

What is definition and rationale of MET/RRT

A

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

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3
Q

What does MET stand for?

A

Medical emergency team

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4
Q

What does RRT stand for?

A

Rapid response team

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5
Q

IS MET and RRT the same thing?

A

Yes

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6
Q

Rationale?

A

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

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7
Q

What’s activation criteria? (10)

A

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

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8
Q

What are common activation?

A

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

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9
Q

What is the primary assessment of ACLS?

A

Airway
Breathing
Circulation
Disability
Exposure

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10
Q

What is in AB

A

+/- O2, +/- NIPPV or intubation

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11
Q

What is in C

A

IV, monitor, vitals

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12
Q

What is in D

A

Glucose; neuro assessment

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13
Q

What is E

A

Look at the patient; surgical sites, etc.

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14
Q

What is part of the secondary assessment in ACLS

A

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

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15
Q

AMS start with?

A

BLS
Is she breathing, pulse?

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16
Q

Whats the next step for AMS after BLS?

A

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

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17
Q

Whats next after AMS?

A

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

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18
Q

Whats the acronym for ddx AMS

A

AEIOU-TIPS

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19
Q

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

A

Immediate Interventions
- Start abx, administer naloxone?

20
Q

Whats the acronym for stroke?

A

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

21
Q

whats the most important with stroke?

A
  • Last known normal
  • Glucose
  • Start NIHSS
  • Brief initial neuro exam
22
Q

What is first line imaging for stroke?

A

CT non contrast

23
Q

Whats the treatment within 10min of stroke?

A

“Door to doctor”

24
Q

Whats the treatment within 15min of stroke?

A

Neurologist

25
Q

Whats the treatment within 25min of stroke?

A

CT scan completion

26
Q

Whats the treatment within 45min of stroke?

A

CT interpretation

27
Q

Whats the treatment within 60min of stroke?

A

treatment

28
Q

Whats the treatment within 3 hrs of stroke?

A

Admission to ICU

29
Q

When can tPA be given?

A

less than 4.5 hours

30
Q

When can ALL get mechanical embolectomy?

A

6 hrs

31
Q

When can they get embolectomy for SOME?

A

6-24hrs

32
Q

What is status epilepticus?

A

Seizures lasting more than 5 minutes, or

Recurrent seizures without return to baseline mental status

33
Q

What are the causes of seizures

A
  • 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)
34
Q

What do you typically order for seizure?

A
  • CBC, CMP, Mg, Phos, Lactate
  • Antiepileptic drug levels
  • +/- head CT, lumbar puncture
  • Urine drug screen
  • EEG
35
Q

What is 1st line for seizures?

A
  • position to lateral decubitus
  • Airway/breathing: nasopharyngeal aiway
  • Benzo’s (Lorazepam 4mg IV)
    or midazolam IM
36
Q

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

A

Thiamine 100mg IV then D50.

37
Q

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

A

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

38
Q

If seizure goes on for 30min

A

Intubate
Midazolam or propofol gtt

39
Q

Review slide 51 CHADs & CHADSVASC

A
40
Q

What are most common chest pain emergencies (5)

A

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

41
Q

Most common for SOB

A

Infection, volume and clot

42
Q

whats the work up for SOB?

A

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

43
Q

What are some different ways to deliver O2?

A

NIPPV
NPPV

44
Q

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

A

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

45
Q

What is absolute contraindication for NIPPV?

A

cardiac or respiratory arrest

46
Q

What is heated high flow O2?

A

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

47
Q

Classic indications for NIPPV?

A

Cardiogenic pulmonary edema
COPD

CDM II Fall Block (9 decks)

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