Quiz #4 Flashcards Preview

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Flashcards in Quiz #4 Deck (45)
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1

____ - _____% of patients with sepsis die.

28-50%

2

Risk Factors for Sepsis (4)

- 65+ years old
- Pts with chronic medical conditions (DM, lung dz, CA, kidney dz)
- People with weakened immune systems
- Neonates

3

SIRS Criteria

1. Body Temperature (>38 or < 36)
2. Heart Rate (> 90 bpm)
3. Tachypnea (> 20 breaths)
4. WBC Count (> 12,000, < 4,000, or > 10% immature neutrophils)

4

Sepsis Steps

1. Sepsis: presumed source of infxn + 2 or more SIRS criteria
2. Severe sepsis: sepsis + organ dysfunction
3. Septic shock: sepsis refractory to IV fluid (refractory hypotension) OR lactate > 4

5

Severe Sepsis Bundle

Within 3 hrs of presentation:
1. measure serum lactate
2. obtain blood cx prior to abx
3. administer abx
4. start IV fluids (LR/NS) 2.5 L/hr
Within 6 hours of presentation:
1. repeat serum lactate if initial lactate > 2

6

IV fluid rate for peds in severe sepsis

40 ml/kg when septic

7

Septic Shock Bundle

Within 3 hours of presentation:
1. measure serum lactate
2. obtain blood cx prior to abx
3. administer abx
4. resuscitate with 30 ml/kg fluids
Within 6 hours of presentation:
1. repeat volume status and tissue perfusion assessment
2. give vasopressors (if hypotension persists)

8

Top sources of sepsis infections

Lungs
Urinary tract
Skin
GI tract

9

Types of Headaches

Tension (most common - 40%)
Migraine
Cluster

10

DDX for headache

1. Primary (tension, migraine, cluster)
2. Vascular (hemorrhage, hematoma, aneurysm)
3. Infectious (meningitis, abscess, encephalitis)
4. Cancer
5. Medical D/O (hypothyroidism, OCPs, fever, CO exposure)

11

Characteristics of Migraines (POUND)

Pulsatile
Onset/Duration 4-72 hours
Unilateral
Nausea
Disabling

12

Red Flags for Headaches

"Worst HA of my life"
Thunderclap HA
FND (atypical aura)
Fever, nuchal rigidity, kernig's, papilledema
> 50 y/o
New onset in pregnancy
Worsening pattern
HA triggered by cough or exertion
Recent trauma

13

Classifications for Migraines

At least 2 of the following:
1. Unilateral
2. Moderate to severe
3. Pulsatile
4. Aggravated by movement

1 of the following:
1. Nausea
2. Photo and phonophobia

At least 5 episodes

14

Auras of migraines

Visual - scintillating scotoma, photophobia
Sensory - paresthesia, numbness
Other - weakness, aphasia

15

Tx for migraines (acute)

NSAIDs
Tylenol
Triptans
OTC Excedrin
Fioricet
Cafergot
Goody's Powder
Opiates
Antiemetics

16

Tx for migraines (preventative)

Consider if 2+/month
CCB (Verapamil)
BB (Propranolol)
TCA (Amitriptyline)
Valproate Sodium
Botox

17

Tx for tension HA (acute)

Aspirin
Acetaminophen
Ibuprofen
Naproxen
Excedrin

18

Tx for tension HA (chronic)

Amitriptyline
Fluoxetine
Tizanidine
Stop smoking

19

Tx for cluster HA

O2, ergotamines at first signs of sx
Corticosteroids
Verapamil
Topiramate
Valproic Acid

20

Associated symptoms with migraines

Nausea
Vomiting
Photophobia
Phonophobia
Aura

21

Associated symptoms with cluster HA

Ipsilateral lacrimation
Ipsilateral redness of the eye
Stuff nose
Rhinorrhea
Pallor
Sweating
Restlessness or agitation

22

Presentation of CVA

Sudden speech difficulty
Weakness
Paralysis
Vision loss
Dizziness
Severe HA
FAST (face, arm, speech, time)

23

DDX of stroke

Seizures
Hypoglycemia
Migraine with aura
HTN encephalopathy
Drug toxicity
CNA abscess or tumor
Wernicke's encephalopathy

24

Time since "last known normal" timeframes

< 4.5 hrs for tPA
< 6 hrs for endovascular thrombectomy

25

Physical Exam for stroke

Skin: purpura, ecchymoses
Head: signs of trauma, papilledema, tongue laceration (seizure)
CV: pulses in neck, arms, legs, auscultate for murmurs, check for bruits
Extremities: cellulitis, DVT
Lungs: abnormal breath sounds, fluid overload, stridor, rales

26

Dx for CVA

Non contrast CT or MRI
Glucose
O2 sat
Electrolytes
BUN
sCr
CBC
Cardiac enzymes
PT/INR,PTT
EKG

27

Tx for CVA

tPA
Antipyretic
IV labetalol
PT, OT, mental health support
speech therapy

28

Exclusion criteria for tPA

evidence of hemorrhage
glucose < 50
current anticoagulant
active internal bleeding
systolic > 185 or diastolic > 110
significant head trauma
< 18 y/o

29

Relative exclusion criteria for tPA

Pregnancy
Seizure at onset
Major surgery w/n 14 days
Recent acute mI
Recent GI or urinary tract hemorrahge

30

Labs/tests for gout

CBC
Uric acid
Arthrocentesis
Xray