Part 19 Flashcards
1
Q
General ED principles (5)
A
- Identify and stabilize life threatening condition***
- find an explanation for condition if possible as well as recognize coexistent pathology
- Determine why patient presented now rather than earlier/later
- Consider the necessity to determine the diagnosis before the patient leaves the ED***
- Document entire visit
2
Q
Digital blocks should be done with what anesthetic?
A
Lidocaine without epi
3
Q
Hematoma block in the ER
A
Done into hematoma immediately after a fracture to help limit pain before reduction, does not block entire nerve still resulting in pain during reduction but decreases it significantly
4
Q
Field block in the ER
A
Injection under the skin and around at different sites to numb a site
5
Q
Regional blocks in the ER
A
Can be done on toes, fingers, ankles, inject around the nerve deep and then superficial but put the entire digit/space to sleep that will last an hour or so but need to do vascular check and motor check beforehand
6
Q
Nail avulsion in the ER
A
Need to get nail tucked underneath in the matrix to prevent closure of the matrix to allow the nail to continue to grow
7
Q
Dental repair box
A
Located in every ER for handling emergency dental repairs when dentists not open or available
8
Q
FAST exam definition
A
Focused assessment with sonography for trauma exam, diagnostic exam for internal bleeding checking the heart (pericardial), liver/kidney (perihepatic), spleen (perisplenic), and bladder (pelvic) regions
9
Q
Glasgow coma scale
A
Tool utilized to establish level of consciousness and compare over course of treatment, 3 components including eye opening (spontaneous 4, to speech 3, to pain 2, none 1), verbal response (oreinted 5, confused, 4, inappropriate 3, incomprehensible 2, none 1), and motor response (obeys commands 6, localizes pain 5, withdraws from pain 4, flexion to pain, 3, extension to pain 2, none 1) for a max score of 15, correlates inversely with aspiration risk, GCS equal or less than 8 indicates ET intubation
10
Q
Empiric management of decreased mental status patient (4 things)
A
- maintain spO2
- rapid bedside glucose
- naloxone .4mg IV
- thiamine 100mg IV
11
Q
EM approach to acute MI/ACS (11)
A
- Goal under 10 min
- 12 lead ekg
- baby aspirin (325mg) chewed
- Sublingual nitro .4mg every 5 min x3 doses
- Establish IV access
- blood work including cardiac biomarkers
- initiate supplemental oxygen therapy
- continuous ECG monitoring
- B blocker
- anticoag therapies
- Call cath lab if acute ST elevation
12
Q
Benign causes of appearing melena or hematochezia (2)
A
- pepto bisthmol
- beets
13
Q
Recall the physical exam for the abdomen order
A
Inspection, auscultation, perussion, palpation (in all 4 quadrants)
14
Q
Perforated viscus (peptic ulcer often) common presentation (4)
A
- sudden onset severe abdominal pain
- worse with movement
- pain with breathing
- abdominal series x ray showing free air below the diaphragm
15
Q
Acute appendicitis imaging (2)
A
- Abdominal CT
- u/s second line
-
16
Q
Ectopic pregnancy definition
A
Pregnancy implanted out of the uterus, presents with positive hCG with ultrasound showing absence of intrauterine pregnancy, or presence of adnexal mass, surgical emergency for treatment
17
Q
Choledocholithiasis/ascending cholangitis charcot’s triad
A
- fever
- right upper quadrant pain
- jaundice
18
Q
IBD (UC/crohn’s) presentation symptoms (3)
A
Bloody diarrhea, abdominal pain, weight loss
19
Q
IV vancomycin for C diff is useless because…
A
….it is not absorbed that way into the gut and therefore must be taken orally
20
Q
Pelvic inflammatory disease diffrentiation from gastroenterological disease (2)
A
- cervical motion test
- abnormal vaginal discharge
21
Q
Ovarian torsion definition and how is it ruled out?
A
Twisting of the ovary around its axis along the fallopian tubes with lower abdominal pain being the only presenting symptom, may resolve spontaneously but if not can infarct, can only be ruled out with ultrasound
22
Q
What is intravenous access used for? (5)
A
- deliver fluid
- Deliver medication/IV contrast
- Give parental nutrition/electrolytes
- Deliver blood products/draw blood
- hemodialysis
23
Q
Reasons for an arterial line (3)
A
- measure constant blood pressure
- drawing ABGs
- measure central venous pressure
24
Q
Goal catheter size gauge for adequate flow rate upon catheterization
A
20 gauge, ideally 18 (easier for IV contrast)
25
Peripheral IV access protocol (2)
- Can be done by many different healthcare providers
- - should take 3 attempts, if cannot then second person tries, then if not IV team must be called
26
Advantages (3) and disadvantages (3) for peripheral IV access
```
+ease of insertion
+ low cost
+minimal complications
- short duration must be less than 3 days and cannot be used with certain medications
-easily occluded
-potential tissue injury
```
27
If labs are not drawn immediately upon a peripheral IV access being established, then...
....cannot draw blood labs later on as they are no longer accurate (need a different site)
28
Contraindications for peripheral IV establishment (7)
- If med can be given orally***
- cellulitis
- injury to extremity
- previous IV infiltration (IV not actually in vein)
- surgical procedures
- Burn
- AV fistula presence
29
Typical placement areas of a peripheral IV (4)
- Dorsal hand
- forearm/wrist (cephalic or basilic vein)
- leg/ankle/dorsum of vein (greater saphenous vein)
- scalp in neonate
30
Gauge size needed in resuscitation to get large amounts of fluid/medications fast
16 gauge
31
Infiltration
Leakage of fluid or medications that can be given peripheral IV into surrounding tissue from being slightly pulled out causing swelling, discomfort, and burning
32
Extravasation
Accidental administration of toxic medications that should not be given IV into tissue around the infusion site that can cause tissue necrosis, disfigurement, or loss of function
33
Examples of drugs that can cause extravasation if given peripheral IV (6)
- Chemotherapy
- K+
- vancomycin
- cefotaxime
- amiodarone
- calcium chloride
34
Indications for central venous catheter (6)
- Inadequate peripheral venous access
- administration of toxic medications (vasopressors, chemo, TPN)
- hemodynamic monitoring (measurement of CVP)
- extracorpeal (hemodialysis)
- rapid infusion of fluids/blood
- drawing frequent labs
35
Contraindications for a central venous catheter (4)
- all relative as these can be life saving
- anatomic distortion or trauma for specific sites
- hemodyalysis or pacemaker presence
- moderate to severe coagulopathy
36
PICC line
Central venous catheter inserted into cephalic, basilic, brachial vein into distal superior vena cava, less procedural risk than others as uses ultrasound guidance with an IV nurse with confirmation of placement via radiology, can be single or double lumen, used for temporary access infusion 15-30 days for things like IV antibiotics, chemo, or vasopressor medications, inserted in nondominant arm
37
Advantages (4) and disadvantages (2) of PICC line
```
+ease of insertion
+relatively safe and inexpensive
+good for drawing several labs
+easy to remove
-potential for occlusion
-can take over 1 hour to place, not stat
```
38
More lumens on a catheter increase higher rate of...
....venous thrombosis
39
Central venous catheter advantages (4) and disadvantages (2)
```
+long term access
+decreased infection rate in tunneled
+safe with most meds
+emergency access
-requires surgical insertion often under sedation
-increased cost
```
40
Implantable venous access port
Often used for same reasons as a tunneled central line, most often used for patient with chemotherapy, entirely under skin allowing for lowering risk of infection, can remain lifelong, much more cosmetic, medicines injected into skin thru catheter, after being filled reservoir slowly releases medicine into blood stream, except for flushing once a month no special care needed
41
Intraosseous access
Used in emergency situations, presence of vascular collapse (due to shock as blood shunts to core), in children/infants, or in trauma, bone marrow functions as a noncollapsible venous access allowing meds and fluids to enter central circulation in seconds, should only be done for an avg of 5.2 hours
42
Most common site of intraosseous access
Proximal tibia
43
Intraosseous access advantages (3) and disadvantages (2)
```
+rapid and easy to insert
+low complication rate
+safe with resuscitation meds
-short term only
-potential for osteomyelitis or fracture
```
44
Intracranial pressure (ICP)
Pressure exerted by fluids such as CSF and blood inside the skull (rigid nonexpandable box) on brain tissue, normal is 7-15 mmHg (average 10mmHg), for supine adult, >20 is abnormal, >40mmHg is severe, sustained increased ICP leads to decreased brain function and poor outcome
45
Compensated state of ICP
When an individual has a brain bleed (or enlarging mass), CSF and venous volume decrease to maintain normal ICP in a compensatory manner (brain mass and arterial volume unaffected) if overwhelmed see drop in arterial volume leading to ischemia of the brain or herniation of brain tissue
46
Cerebral perfusion pressure (CPP)
Difference between mean arterial pressure (avg between systolic and diastolic) and intracranial pressure, a net pressure gradient that drives oxygen delivery to brian tissue but not actually a measure of cereral blood flow, normal range 60-70 mmHg (CPP=MAP-ICP), if CPP too low can raise blood pressure or decrease ICP, requires ICP monitor placement first
47
Do intracranial bleeds cause hypotension?
No because of the rigidity of the cranium - if hypotensive might have some other type of shock going on
48
Cushings triad
Seen as result of and indicates increased ICP
- hypertension
- bradycardia
- irregular respiration
49
How to determine who with a mild TBI gets a head CT criteria? (10)
- retrograde amnesia >30min
- suspicion of skull fracture
- suspicion of basilar skull fracture
- 2 or more episodes of vomiting
- use of any anticoagulant
- age >60
- seizure since episode of injury
- neurologic deficits
- high impact mechanism
- intoxication or abnormal behavior
50
Diffuse axonal injury (DAI)
traumatic shearing of the axons that occur when head is rapidly accelerated/decelerated and by secondary biochemical cascades, occurs in white and grey matter and majority end up in post traumatic coma as result, may have relatively normal head CT but exam with severely diminished GCS, generally confirmed by MRI, death rare as has no effect on brainstem
51
Epidural hematoma
Collection of blood between dura and skull, 80% of skull fractures, an arterial bleed affecting middle meningeal arteries and can lead to herniation if untreated, see initial brief loss of consciousness then rapid neuro deterioration, fixed dilated pupil on unilateral side
52
Subdural hematoma
More common than epidural hematoma, occurs from shearing force on venous bridging veins between dura and arachnoid, commonly due to acceleration or deceleration injuries, space occupying lesion causing concave hematoma, can be acute or chronic and many relatively asymptomatic, causes midline shift of structures to one side due to the space occupying lesion
53
Traumatic subarrachnoid hemorrhage
Venous bleeding in subarachnoid space between arachnoid and pia mater, usually associated with other hemorrhage, not space occupying, may increase ICP and block outflow of CSF from ventricles, if isolated may be aneurysmal in origin
54
Cerebral contusion
Bruise of brain tissue that primarily occurs in cortical tissue when the brain collides with bony protuberances on inside surface of the skull, frontal/temporal lobes most commonly affected, frequently associated with edema which can be a cause of elevated ICP, sometimes mislabeled as an intraparenchymal/intracerebral hemorrhage
55
Coup vs contrecoup injury
Coup is at the site of impact with an object, contracoup is on the opposite side of the area the object was hit, can occur individually or together
56
3 types of skull fractures
- Linear (extends thru full thickness, most common, often without significance unless cross middle meningeal artery groove which then causes a lot of bleeding)
- Depressed (leaves impression on skull, often involves brain parenchymal injury)
- Basilar (fracture thru posterior or anterior skull base, most often petrous portion of temporal bone or occipital bone, can cause CSF leaks, increased risk of meningitis)
57
Nearly all nutrients (carb protein fat electrolytes vitamins and water) are absorbed/chemically digested in the ___ section of the GI tract
Small intestine
58
4 layers of the entire alimentary canal
- Mucosa (epithelium with mucus, lamina propria and muscularis mucosa)
- submucosa (connective tissue and meisner's plexus)
- muscularis externa (inner circular, outer longitudinal, aurbach's plexus)
- serosa/adventitia (Provide lubrication)
59
Intraperitoneal organs are surrounded by ___, the retroperitoneal are by ____
serosa, adventitia
60
Mesenteric adenitis
Inflammation of lymph nodes of the mesentery caused by infection, inflammatory conditions, and cancer, if a patient has abdominal pain out of proportion to physical exam findings***
61
Stomach muscular layers
2 layers of smooth muscle + a 3rd oblique layer for crushing, collapses on itself forming gastric folds called rugae when empty
62
Stomach absorbs nearly nothing except 3 things
- alcohol
- aspirin
- nsaids
63
4 cells and their secretions of the gastric glands
Mucus cells - maintain mucus layer
parietal cell - secrete HCL and intrinsic factor
Chief cells - secrete pepsinogen (activated by HCL)
enteroendocrine cells - gastrin (regulates gastric acid secretion and motility)
64
3 Phases of gastric secretion
1) Cephalic - triggered by aroma or sight get ready for digestion relayingfrom hypothalamus to stimulate secretory activity of gastrin
2) Gastric - stimulated by distension of the stomach presence of food as well as rise in pH causing release of gastrin which then stimulates HCL
3) intestinal - excitatory release when food enters the duodenum to stimulate release of gastrin and HCL, followed by inhibitory where as intestines distend with chyme the enterogastric reflex is activated inhibiting secretory activity to slow gastric emptying to prevent intestine from becoming too acidic
65
Veins of the esophagus and esophageal varicies
The lower 1/3rd of the esophagus is drained by gastric veins and drains into the portal system so in the case of portal hypertension from cirrhosis of the liver can see esophageal varicies that are at risk of rupture (hematemesis)
66
Caput medusae
A sign seen in patients with portal hypertension describing appearance of distended and engorged paraumbilical veins seen radiating from the umbilicus across abdomen
67
Ligament of treitz
A thickened part of the small intestine separating duodenum and jejunum
68
Carbohydrate/lipid/protein digestive enzymes
- Amylase
- lipase
- HCL and pepsin
69
Small intestine villi/microvilli and crypts of lieberkuhn
- finger like projections exclusive to the small intestine that increase nutrient absorption by 30 fold
- cells for immune defense, stem cells that replenish the epithelial cells
70
Brunner's glands
Submucosal glands found in duodenum, roduce alkaline bicarb to protect duodenum from acidic content
71
Peyer's patches
Lymphoid nodules locaed in the ileum that help with immune surveillance of the intestinal lumen
72
Peristalsis
Wave like movements that move chyme thru the intestines toward the rectum and anus
73
Tenae coli and haustra
Large bands of smooth muscle that contract forming haustra pouches giving the colon its trademark segmented appearance
74
Blood supply of the small intestine
- Gastroduodenal artery supplies upper duodenum and upper pancreas
- Superior mesenteric artery supplies the majority** including distal duodenum, jejunum, ileum, and cecum
75
Large intestine reabsorbs these 2 things
water
electrolytes
76
Internal anal sphincter vs external anal sphincter
- Internal works thru an intrinsic defacation reflex via the myenteric plexus that causes it to drop into the lower rectum/anus
- external works thru parasympathetic reflex involving the spinal cord where stretching of rectum sends sensory signals to spinal cord and splanchnic nerve returns signals intesnifying peristalsis and removal (must relax and override to allow this reflex to occur)
77
4 lobes of the liver
Right
Left
Caudate (most posterior
quadrate (inferior to left lobe)
78
Liver functional lobes
Liver has 8 completely independent segments that each have their own vascular in and outflow/biliary drainage allowing for easy resection if necessary without compromising function
79
Hepatic blood supply
```
Portal vein (75% of the blood supply, 50% of the oxygen) derived from the intestinal tract
Hepatic artery (25% of blood supply, 50% of oxygen) derived from the celiac complex
```
80
Biliary canuliculi
"space of disse" between stacks of hepatocytes that form a pseudoduct collecting bile excreted by hepatocytes
81
Gallbladder duct system
Gallbladder has the common cystic duct which merges from the common hepatic duct from the liver to form the common bile duct, then the pancreatic duct merges with it within the pancreas before emptying into the spincter of oddi into the duodenum
82
Portal triad
Revers to each lobule of the liver receiving a branch of the hepatic artery (oxygen) branch of hepatic portal vein (nutrients), and biliary duct (bile secretion)
83
Hepatocytes and its 9 big functions***
Most versatile and multifunctional cell in the body with thousands of enzymes assisting in
- glycogen storage
- decomposition of RBC
- plasma protein synthesis
- production of non essential amino acids
- gluconeogenesis
- hormone production
- detox
- bile production
- urea production
84
Kupffer cells
Liver macrophages that line the sinusoids that perform multiple immune based functions
85
Unconjugated (indirect) bilirubin vs conjugated (direct) bilirubin
- Indirect is bound to albumin, water insoluble/fat soluble and typically calculated from total - direct and reabsorbed in small bowel
- direct is measured result, water soluble, in the hepatocyte, not reabsorbed, direct + indirect = total
86
3 categories of jaundice
Prehepatic - excess hemolysis of RBC
Intrahepatic - disorders that affect ability of liver to remove bilirubin from blood or conjugate it so it can be eliminated in bile
Posthepatic - bile flow obstruction between liver and intestine
87
Bile production mech of action and excretion
- made up of bile acids, cholesterol, and bile pigments such as bilirubin
- bilirubin is from when the spleen breaks down hemoglobin into heme+ globin from RBC lysis
- globin is recycled
- heme is split into iron (used for storage as ferritin) and bilirubin
- Bile is secreted into duodenum
- most unconjugated is reabsorbed into small bowel, conjugated is not
- in large bowel, bacteria metabolize direct bilirubin into urobilinogen
- some is reabsorbed and excreted in urine (yellow color), most exit colon after conversion to urobilin and stereobilin (brown)
88
Rovsing's sign
Test for appendicitis with either pain in right lower quadrant from pressing deeply into the left lower quadrant or if RLQ pain occurs on quick withdrawal (rebound tenderness)
89
Murphy's sign
A test for acute cholecystitis if the patient is asked to inspire with a hand below the costal margin on the right side at mid clavicular line, positive if the patient stops breathing in and winces
90
What drug class is contraindicated in spinal trauma
Steroids
91
Motor pathway corticospinal tracts crosses at the ___, spinothalamic (pain, temp, crude touch) crosses at the ___, posterior column (position, vibration, fine touch) crosses at the ___
- medulla (travels down contralateral side)
- Spinal cord to then travel up the contralateral side
- medulla (travels up ipsalateral side where signal entered)
92
How to palpate a posterior C spine in suspected trauma patient without external assistance
How is T and L spine palpated?
- Place pressure pushing their forehead down into bed
- with other hand unvelcro cervical collar and palpate down the C spine
-log roll
93
Grading of motor exam scale
0 - paralysis
1 - insufficient to produce joint motion even with elimination of gravity
2 - muscle can move the joint it crosses thru full range without gravity
3 - can move against gravity but not with any resistance
4 - can move against gravity and moderate resistance
5 - can move against gravity and full resistance
94
Nexus criteria
Decision to determine if imaging necessary in cervical spine injury, includes
- younger than 60 years
- absence of posterior midline cervical tenderness
- normal level of alertness
- no evidence of intoxication
- no abnormal neurlogic findings
- no painful distracting injuries
95
Spinal cord ends at what level
L1
96
When a calcaneal fracture presents in trauma unit, get this imaging study
T/L spine (force can be transmitted up the spine
97
Central cord syndrome
Most common type of cord syndrome, due to injury of corticospinal tract causing loss of motor function, can occur with hyperextension injury with cervical stenosis, can see with falling forward onto face, typically caused by vascular compromise of the anterior spinal artery, lower extremity less effected than upper and tends to recover before upper but typically permanent hand disability at least
98
Anterior cord syndrome
Injury to ventral 2/3 of spinal cord psaring posterior column, see paraplegia (loss of motor) and sensory loss of pain/temp (spinothalamic), posterior column is still intact, due to infarction of cord in anterior spinal artery territory, has poor prognsis
99
Brown sequard syndrome
Hemidissection of spinal cord typical with penetrating trauma causing ipsalateral motor loss, ipsalateral loss of posterior column and contralateral loss of spinothalamic 1-2 levels below injury, some recovery seen
100
Cauda equina syndrome
Damage to the lumbar, sacral, and coccygeal nerve roots (distal to L2), peripheral nerve injury with lower motor neuron injury only, motor and sensory loss of lower extremity, sciatica, bowel and bladder dysfunciton, bladder anesthesia, prognosis is better than other incomplete injuries but requires good workup to prevent litigation
101
General story of hypoglycemia (5)
- Delay in eating after insulin dosing
- malnutrition or inadequate food intake
- acute N/V after insulin dose
- increased physiologic stress (infection, injury, emotion, etc)
- excessive endogenous insulin release with oral agents in a patient with renal insufficiency
102
Hypoglycemia treatment options (4)
- Glucose IV D50 (dextrose)
- Oral glucose gel/tabs
- food if conscious and capable of swallowing
- glucagon 1mg IM, IV, or SQ
103
Glucagon is released from the ___ cells of the pancreas, insulin from the ___, and somatostatin from the ___ cells
Alpha, Beta, delta
104
Clinical presentation of Diabetic ketoacidosis (DKA) (6)
- acute headache
- polyuria and polydipsia
- acute weakness/lethargy
- Kussmaul respiration
- dehydration
- acidosis (fruity breath)
105
Diabetic ketoacidosis Diagnosis (6)
- history and symptoms
- blood glucose >250mg/dL
- urine ketones
- ABG (serum bicarb <15)
- hyperkalemia
- chemistry panel (glucose electrolytes and renal function) and serum ketones
106
The Anion gap
Measure of the difference between serum Na+ and K+ minus (Cl- + HCO3- (bicarb)), Normal 8 + or - 4mmol/L, >12mmol/L is elevated and has its own subset of etiologics that are causing said metabolic acidosis (MUDPILERS acronym)
107
MUDPILERS acronym for the common cayses of metabolic acidosis with increased anion gap
- Methanol
- Uremia
- Diabetic/alcohol/starvation ketosis
- Paraldehyde
- Iron
- Lactic acidosis
- Ethylene glycol
- Rhabdo
- Salicylates
108
Diabetic ketoacidosis treatment options (5)
- IV fluids first (500 mL/hr)(once you start insulin, the glucose will go into the cells and water will follow resulting in dehydration)
- Insulin 10U bolus then 5U/hr 1 hour after IVF, follow blood sugar and lower gradually 100/hr
- K+ replacement, if urinating dose depending on T waves, if anuric and peaked T waves wait for labs to determine
- Start Dextrose once blood glucose is 200-250mg/dL
- Switch to SQ insulin at least 1/2 hour before stopping insulin drip
109
Too rapid of a drop in blood glucose in correcting diabetic ketoacidosis can result in....
....cerebral edema
110
Hyperosmolar hyperglycemic state (HHS) definition and average level of glucose elevation
Insidious onset (days to weeks) ketone free that sees adequate insulin activity but decreased cell response (type 2 DM in most cases) and hence an absence of lipolysis and ketogenesis (low or absent serum/urine ketones), can have precipitating infection or stressor, has severely elevated glucose levels often >600mg/dL (wayyy higher than DKA typically)
111
Hyperosmolar hyperglycmeic state (HHS) clinical presentation (4)
- typically >60
- chronic care facility
- change or addition of new med
- recent or current infection***
112
Hyperosmolar hyperglycemic state (HHS) signs and symptoms (4)
- significant dehydration
- depressed mental status
- focal neurologic abnormalities
- Kussmaul respiration and nausea/vomiting usually NOT present
113
Hyperosmolar hyperglycemic state (HHS) treatment options (3)
- Admit to ICU
- IV fluids judiciously (congestive heart failure patients often comorbid)
- IV insulin or DM meds to increase insulin sensitivity
114
Blood alcohol concentration (BAC) measurement
- 50mg/dL (.05%) loss of restraint, emotional
- 80mg/dL (.08%) legal limit for intoxication in PA
- 100mg/dL (.1%) slurring speech and confusion
- 200mg/dL (.2%) very slurred speech and staggering
- 400mg/dL (.4%) comatose and incontinent
- 500mg/dL (.5%) possibly lethal suppression of breathing
115
Alcohol intoxication/poisioning diagnosis
-Based on history and symptoms and clinical presentation -> NO specific BAC level
116
Lactic acidosis definition
Biproduct of anaerobic glucose metabolism characterized by elevated anion gap and serum lactate at least 4-5mmol/L and pH <7.35, seen in hypoxia or decreased tissue perfusion
117
Lactic acidosis diagnosis (4)
- hyperventilation to blow off CO2
- altered mental status
- high serum phosphate
- precipitating cause
118
Thyroid storm etiology (5)
- infection
- stopping antithyroid meds
- recent surgery
- trauma
- pregnancy
119
Thyroid storm treatment options (4)
- propylthiouracil or methimazole
- propranolol
- hydrocortisione
- radioactive idione or surgery definitive treatment but delayed until euthyroid
120
Adrenal insufficiency (addison's disease or addisonian crisis) definition
Often precipitated by surgery, trauma, infection, or sudden withdrawal of exogenous adrenocortical hormone, etc
121
The synthetic ACTH cosyntropin stimulation test
-Confirmatory diagnosis for adrenal insuficiency where serum cortisol level is checked at baseline then .25 synthetic ACTH cosyntropin is given parenterally, serum is then obtained at both 30 and 60 min after administered, should normally rise at elast 20mcg/dL and if not primary deficit exists in the adrenals
122
Hypocalcemia signs and symptoms (3)
- mild often asymptomatic
- severe sees tetany, weakness, fatigue cramps, dyspnea and stridor
- chvostek sign and trousseau sign
123
Chvostek sign
Tap over facial nerve 2cm anterior to tragus of ear, depending on ca2+ if low levels see twitching of angle of mouth, or in more severe then nose, eye, facial muscles
124
Trousseau sign
Inflation of blood pressure cuff above systolic pressure causes localized ulnar and median nerve ischemia resulting in carpal spasm (contraction)
125
Hypocalcemia diagnostic labs (3)
- low Ca2+ <2mg/dL
- ABGs
- EKG prolongation of QT interval
126
Hypercalcemia signs and symptoms (2)
- CNs depression, stupor, weakness, constipation, abdominal pain
- - often asymptomatic up to levels of 12mg/dL
127
Hypercalcemia treatment options (3)
- IV normal saline
- furosemide
- bisphosphonates
