Trauma And Postop Care

Question 1

What is classic presentation of acute adrenal insufficiency

Answer 1

Hyponatriemia, hypoglycemia,hyperkalemia and hypotension refractory to fluid resuscitation and vasopressors and fever

Question 2

Ddx of postoperative hypotension and fever

Answer 2

Severe sepsis, PE, acute adrenal insufficiency

Question 3

Does all patients with septic patients have fever?

Answer 3

No, immunocompromised, very young, elderly and dialysis dependent renal failure population may not have fever

Question 4

Sepsis is defined as

Answer 4

Life threatening organ dysfunction caused by a dysregulated host response to infection

Question 5

qSOFA criteria

Answer 5

RR>=22
SBP<=100
Altered mental status

Question 6

SOFA criteria

Answer 6

Bilirubin
GCS
Platelet count
PaO2/FiO2
BUN
BP

Question 7

At what GCS score do you intubate

Answer 7

8 or less

Question 9

What are the Hs to consider if the patient becomes pulseless?

Answer 9

Hypovolemia, hypoxia, hydrogen ion (acidosis), hypokalemia, hyperkalemia, hypothermia

These are critical conditions that should be assessed during a pulseless state.

Question 10

What are the Ts to consider if the patient becomes pulseless?

Answer 10

Toxins, tamponade, tension pneumothorax, thrombosis (MI or PE)

These factors can contribute to a pulseless state and require immediate evaluation.

Question 11

Fill in the blank: The first H to consider in a pulseless patient is _______.

Answer 11

Hypovolemia

Question 12

True or False: Hypoxia is one of the Hs to consider in a pulseless patient.

Answer 12

True

Question 13

Fill in the blank: _______ is a toxin that should be considered in a pulseless patient.

Answer 13

Cocaine

Question 14

Name one of the Hs related to electrolyte imbalances in a pulseless patient.

Answer 14

Hypokalemia or hyperkalemia

Both conditions can lead to cardiac dysrhythmias and should be monitored.

Question 15

Which H condition is associated with low body temperature in a pulseless patient?

Answer 15

Hypothermia

Question 16

Name one of the Ts associated with cardiac issues in a pulseless patient.

Answer 16

Thrombosis (MI or PE)

Myocardial Infarction (MI) or Pulmonary Embolism (PE) can obstruct blood flow and lead to a pulseless state.

Question 17

Fill in the blank: Tension _______ is a potential cause of pulselessness.

Answer 17

Pneumothorax

Question 18

What Are the Initial Laboratory Studies
to Order for a Patient in Septic Shock?

Answer 18

CBC with differential, ABG, metabolic panel, urinalysis, serum lactate, coagulation studies , peripheral blood cultures and if there is indwelling venous catheter take a culture from there as well

Question 19

What can metabolic acidosis lead to in a patient with acute kidney injury?

Answer 19

Worsening hypotension

Question 20

What are indications for acute renal replacement therapy?

Answer 20

• Acidosis
• Hyperkalemia
• Uremia
• Fluid overload

Question 21

When should renal replacement therapy be considered in patients with acute kidney injury?

Answer 21

Early on in patients with septic shock and acute kidney injury

Question 22

The major difference between HD and CRRT is

Answer 22

CRRT avoids rapid shifts in fluid and electrolyte

Question 23

Continuous bacteremia causes

Answer 23

Persistent endovascular infection like endocarditis and infected central venous catheter

Answer 24

Persistent endovascular infection like endocarditis and infected central venous catheter

Question 25

What is synchronized shock?

Answer 25

Delivery of a low-energy shock synchronized to the QRS complex ## Footnote Also known as cardioversion, it avoids shocking during the T wave.

Question 26

What is the purpose of the delay after the shock button is pressed in synchronized shock?

Answer 26

To allow synchronization to the heart's natural electrical beat ## Footnote This helps avoid shocking during the T wave, which can initiate ventricular fibrillation.

Question 27

What conditions is synchronized shock used for?

Answer 27

* Unstable atrial fibrillation * Atrial flutter * Supraventricular tachycardias unresponsive to medication ## Footnote These are conditions where synchronized shock is clinically indicated.

Question 28

What is desynchronized shock?

Answer 28

Delivery of a random high-energy shock as soon as the shock button is pressed ## Footnote Also known as defibrillation, it does not consider the QRS complex.

Question 29

When is desynchronized shock used?

Answer 29

When there is uncoordinated intrinsic electrical activity in the heart ## Footnote Examples include pulseless ventricular tachycardia and ventricular fibrillation.

Question 30

True or False: Synchronized shock can be delivered during the T wave.

Answer 30

False ## Footnote Delivering a shock during the T wave can initiate ventricular fibrillation.

Question 31

Fill in the blank: Synchronized shock is used for unstable atrial fibrillation, atrial flutter, and _______.

Answer 31

supraventricular tachycardias unresponsive to medication

Question 32

What type of shock is delivered in desynchronized shock?

Answer 32

High-energy shock ## Footnote This shock is delivered irrespective of the heart's electrical activity.