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Hospital Medicine > Inpatient Medical Management > Flashcards

Inpatient Medical Management Flashcards

1
Q

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

A

Intravascular Space

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2
Q

What do intravascularly dry patients look like?

A
  • Decreased urine output
  • CVP
  • IVC - by ultrasound
  • Hypotension
  • Tachycardia
  • Decreased weight
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3
Q

What is the best way to evaluate hydration status?

By what imaging modality?

A

IVC

Ultrasound, cross section of IVC

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4
Q

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

A

Preload

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5
Q

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

A
  • Burn
  • DKA
  • Septic Shock

But again, treating patient not the number

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6
Q

Who may be malnourished?

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

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

Hyponatremia

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7
Q

Tonicity defines the shape of what?

A

Cells

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8
Q

What are isotonic fluids?

What are example of isotonic fluids?

A

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

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9
Q

What are colloids?

What are examples of colloid fluids?

A

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

Albumin, hetastartch (not used much anymore)

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10
Q

What are hypertonic fluids?

What are examples?

A

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

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

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11
Q

In what disease states do you use HYPERtonic solution?

When using hypertonic solutions what are they at risk for?

A
  • Hyponatremia
  • Increased ICP

Osmotic demyelination syndrome

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12
Q

Can osmotic demyelination syndrome be lethal?

A

Yes, especially in kids

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13
Q

What is the pH of lactated ringers?

What electrolytes are included in LR?

A

pH = 6.5

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

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14
Q

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

A

LR

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15
Q

What medication classes are typically not compatible with LR?

Why?

A

Antibiotics
Antipsychotics

Calcium crystals will form

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16
Q

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

A

Neonates

17
Q

When is D5W used?

A
  • Hypoglycemia
  • Hyperkalemic patients will recieve insulin and D5W to maintain glucose
18
Q

Where is albumin made?

What is its role?

A

Liver

Needed to transport hormones/fats/nutreints and meds

Helps maintain intravascular volume and osmotic pressure

19
Q

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

A

Will improve BP and increase intravascular volume

20
Q

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

A

Sick

Septic patients have increased capilary permeability

21
Q

What is the treatment for VTE?

How long do you treat?

A

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

Minimum 3 months

22
Q

What are the W’s of Postop Fever?

A
  • Wind (atelectasis)
  • Water (catheter associated UTI)
  • Walk (DVT)
  • Wound (surgical wound infection)
  • Wonder about drugs (drugs that arn’t compatible)
23
Q

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

A

Atelectasis

Wind

24
Q

What is the management for hospital-acquired infections?

A
  • 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
25
Q

What is the #1 hospital acquired infection?

A

Catheter-associated UTI (CAUTI)

26
Q

What are the two most common etiologies of CAUTI?

What are other possible etiologies?

A
  • E. Coli
  • Pseudomonas

Kelbsiella, Proteus, Enterococcus, Staph

27
Q

What is the presentation of CAUTI?

A
  • Often fever without urinary symptoms
  • Hematuria, suprabuic pain, flank pain, CVA tenderness, etc.
  • Bacteremia + positive urine culture AND no other source
  • Pyuria
28
Q

What is the treatment for CAUTI?

What are the antibiotic regimens?

A
  • Change foley (biofilm)
  • Debatable when abx should be started

Pipercillin-Tazobactam, Ceftazidime, Aztreonam

29
Q

What are contraindications to IO placement?

A
  • Osteoporosis
  • Osteogensis imperfecta
  • Bone fracture
  • Recent placement of IO
  • Cellulitis, infection, burn over insertion site
30
Q

What are risks of IO placement?

A
  • Infection
  • Skin necorsis
  • Compartment syndrome
  • Epiphyseal injury
  • Fat embolism
  • Pain
31
Q

How can you prevent compartment syndrome with an IO placement?

A

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

32
Q

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

A

Seldinger technique

33
Q

What is a thoracentesis for?

What are the potential causes?

A

Pleural Effusion

CHF, pneumonia, cancer, PE, cirrhosis

33
Q

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

A

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

34
Q

What are some complications of a thoracentesis?

A
  • Pneumo
  • Bleeding
  • Hemothorax
  • Puncture of spleen or liver
35
Q
A

Hospital Medicine (5 decks)

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