Inpatient Medical Management

Question 1

When giving fluids your trying to fix the problem in what space?

Answer 1

Intravascular Space

Question 2

What do intravascularly dry patients look like?

Answer 2

• Decreased urine output
• CVP
• IVC - by ultrasound
• Hypotension
• Tachycardia
• Decreased weight

Question 3

What is the best way to evaluate hydration status?

By what imaging modality?

Answer 3

IVC

Ultrasound, cross section of IVC

Question 4

In a hypotensive patient, we are trying to increase their ________ to improve the Frank-Starling Curve.

Answer 4

Preload

Question 5

Rarely patients need greater than 3L per day, what disease states will require more than this?

Answer 5

• Burn
• DKA
• Septic Shock

But again, treating patient not the number

Question 6

Who may be malnourished?

Tea and toast patients are at risk for what electrolyte abnormalities?

Answer 6

• Eating disorders
• Elderly (tea and toast patients)
• Alcoholics

Hyponatremia

Question 7

Tonicity defines the shape of what?

Answer 7

Cells

Question 8

What are isotonic fluids?

What are example of isotonic fluids?

Answer 8

Denoting or relating to a solution having the same osmotic pressur as some other solution, especially one in a cell or body fluid

NS, LR, D5W, plasmalyte

Question 9

What are colloids?

What are examples of colloid fluids?

Answer 9

High molecular weight, will stay in intravascular space longer
*Higher protiens

Albumin, hetastartch (not used much anymore)

Question 10

What are hypertonic fluids?

What are examples?

Answer 10

Tonicity is higher than that of blood, for TBI, fluid shifts, hyponatremia

3% NACL, 7% NACL, D10W and higher concentration

Question 11

In what disease states do you use HYPERtonic solution?

When using hypertonic solutions what are they at risk for?

Answer 11

• Hyponatremia
• Increased ICP

Osmotic demyelination syndrome

Question 12

Can osmotic demyelination syndrome be lethal?

Answer 12

Yes, especially in kids

Question 13

What is the pH of lactated ringers?

What electrolytes are included in LR?

Answer 13

pH = 6.5

Ca, sodium lactate, K+, Cl-, Na+

Question 14

Acidosis can cause worsening hyperkalemia, pH is more balanced with what type of fluid?

Answer 14

LR

Question 15

What medication classes are typically not compatible with LR?

Why?

Answer 15

Antibiotics
Antipsychotics

Calcium crystals will form

Question 16

What population is a HARD STOP for using antibiotics and LR?

Answer 16

Neonates

Question 17

When is D5W used?

Answer 17

• Hypoglycemia
• Hyperkalemic patients will recieve insulin and D5W to maintain glucose

Question 18

Where is albumin made?

What is its role?

Answer 18

Liver

Needed to transport hormones/fats/nutreints and meds

Helps maintain intravascular volume and osmotic pressure

Question 19

Blood is a colloid, therefore it can be used to correct what?

Answer 19

Will improve BP and increase intravascular volume

Question 20

Are people more likely to third space when they are sick or healthy?

Answer 20

Sick

Septic patients have increased capilary permeability

Question 21

What is the treatment for VTE?

How long do you treat?

Answer 21

Anticoagulation
* Start with LMWH (Lovenox)
* Transition to oral (DOACs or Coumadin)

Minimum 3 months

Question 22

What are the W’s of Postop Fever?

Answer 22

• Wind (atelectasis)
• Water (catheter associated UTI)
• Walk (DVT)
• Wound (surgical wound infection)
• Wonder about drugs (drugs that arn’t compatible)

Question 23

What is the most common cause of postop fever within 24 hours?

Answer 23

Atelectasis

Wind

Question 24

What is the management for hospital-acquired infections?

Answer 24

• Removal/replacement of offending agent if possible
• Site +/- blood cultures
• Lab work-up for sepsis
• Emperic antibiotics –> de-escalation
• Fluid resuscitation if needed
• Monitor for deterioration

Question 25

What is the #1 hospital acquired infection?

Answer 25

Catheter-associated UTI (CAUTI)

Question 26

What are the two most common etiologies of CAUTI? | What are other possible etiologies?

Answer 26

* E. Coli * Pseudomonas | Kelbsiella, Proteus, Enterococcus, Staph

Question 27

What is the presentation of CAUTI?

Answer 27

* Often fever without urinary symptoms * Hematuria, suprabuic pain, flank pain, CVA tenderness, etc. * Bacteremia + positive urine culture AND no other source * Pyuria

Question 28

What is the treatment for CAUTI? | What are the antibiotic regimens?

Answer 28

* Change foley (biofilm) * Debatable when abx should be started | Pipercillin-Tazobactam, Ceftazidime, Aztreonam

Question 29

What are contraindications to IO placement?

Answer 29

* Osteoporosis * Osteogensis imperfecta * Bone fracture * Recent placement of IO * Cellulitis, infection, burn over insertion site

Question 30

What are risks of IO placement?

Answer 30

* Infection * Skin necorsis * Compartment syndrome * Epiphyseal injury * Fat embolism * Pain

Question 31

How can you prevent compartment syndrome with an IO placement?

Answer 31

Don't go out the other side of the bone, will fill up the posterior compartment

Question 32

What is the most common procedure to place a central line?

Answer 32

Seldinger technique

Question 33

What is a thoracentesis for? | What are the potential causes?

Answer 33

Pleural Effusion | CHF, pneumonia, cancer, PE, cirrhosis

Question 33

Should a patient inhale or exhale when removing a needle after a thorocentesis?

Answer 33

Exhale, you don't want any air to get into the pleural space

Question 34

What are some complications of a thoracentesis?

Answer 34

* Pneumo * Bleeding * Hemothorax * Puncture of spleen or liver