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Flashcards in Treatments 2 Deck (122):
1

Burns

1st/minor 2nd degree - outpatient, antimicrobial agents (topical silver sulfadiazine or bacitracin)
2nd >10%, 3rd >2%, 2nd/3rd on hands, face, genitalia, major flexion areas - inpatient
2nd/3rd >25% or face - airway management

2

Drowning

Airway, supplemental O2, NG tube, maintain temp, admission for any symptoms of hypoxia

3

Choking

Active coughing
Heimlich if unable to breathe
Emergency tracheotomy if continued obstruction
Bronchoscopy for visualization and removal (IV corticosteroids first may decrease inflammation)

4

Heat exhaustion

Hyrdation, electrolyte replacement

5

Heat stroke

Cool patient, benzos if seizures

6

Hypothermia

Warm patient, treat arrhythmias/hypotension as needed

7

Snake bite

Immobilize extremity
Clean wound
Antivenin

8

Scorpion bite

Antivenin
Atropine / phenobarbital for symptoms

9

Black widow bite

Local wound care
Antivenin
24 hr observation for systemic symptoms
Benzos if symptoms

10

Brown recluse bite

Local wound care
Dapsone to prevent necrosis
Oral erythromycin if infx

11

Dog/cat bite

Irrigation
Tetanus and rabies prophylaxis
Antibiotics if infx
Leave open on arm/hand, cat bite; close on face

12

Human bite

Irrigation
Antibiotics (amoxicillin-clavulanate)

13

PUD

+H pylori: amoxicillin + clarithromycin + PPI
-H pylori: PPI/H2 blocker

14

BPH

Alpha 1 blockers (doxazosin, tamsulosin)
5-alpha reductase inhibitors (finasteride)
Possible surgery

15

Atherosclerosis

Prevention
Stop smoking
Control HTN
Control hyperglycemia
Control hypercholesteremia (statins, also have anti-inflammatory properties and stabilize plaques)
Diet low in fat and cholesterol

16

Lower LDL

Statins (best)
Ezetimibe
Bile acid resins
(Fibrates)

17

Lower TG

Fibrates
Omega 3 FA
Statins (minor)

18

Raise HDL

Niacin
Statins (minor)

19

Stable angina

Sublingual nitro (peripheral venous vasodilator, reduces preload, reduces myocardial O2 demand)
Also helps esophageal pain (GERD, spasm)

20

Prinzmetal angina (arterial vasospasm)

CCB (either type)
(also nitrates)

21

Unstable angina, acute

ABCs
MONA (O2 only in hypoxemic patients)
BB (if no heart failure; careful in COPD, asthma, DM)
Statin (preferably before PCI)
Antiplatelet therapy
Anticoagulant therapy
K>4, Mg>2

22

Unstable angina, home

BB, ASA, nitroglycerin, statin, antiplatelet (1-12 months), ACE/ARB (DM, CHF, HTN)

23

Unstable angina, nonresponsive to medications

PTCA (balloon catheter w/ or w/o stent)
NO fibrinolysis

24

Indications for CABG

Left main stenosis >50%
Three vessel disease
Hx CAD and DM

25

MI, acute

MONA
Anticoagulant (heparin/LMWH)
BB
Statin
Antiplatelet
K>4, Mg>2
PCI if possible (use LMWH, add Gp IIb/IIIa inhibitor to AP)
If no PCI available w/i 12 hrs, consider fibrinolysis w/ tPA (must be w/i 12 hrs, sooner is better)
Cath to see if PTCA/CABG needed

26

MI, home

ASA or clopidogrel
BB*
ACE*
Aldosterone antagonist
Statin*
*Improve mortality

27

Dressler syndrome

NSAIDs or ASA

28

1st degree heart block

None

29

2nd degree heart block, Mobitz type I (Wenckebach)

Adjust medication dose
None
Symptomatic bradycardia, maybe pacemaker

30

2nd degree heart block, Mobitz type II

Pacemaker (can progress to 3rd degree)

31

3rd degree heart block

Pacemaker

32

PSVT, AV nodal reentry

Carotid massage, Valsalva maneuver
DOC: IV adenosine (6 mg, 12 mg, 12 mg)
Cardioversion or CCB for hemodynamic instability
BB or CCB for long-term symptomatic patients

33

PSVT, Wolff-Parkinson-White syndrome

Carotid massage, Valsalva maneuver
DOC: IV adenosine (6 mg, 12 mg, 12 mg)
Cardioversion or CCB for hemodynamic instability
1A or 1C antiarrhythmic or catheter ablation for long-term symptomatic patients

34

MAT

CCB (NDP, verapamil/diltiazem) or BB
K >4, Mg >2
Catheter ablation or surgery if needed

35

Bradycardia

Stop precipitating medication
IV atropine
Pacemaker if severe

36

AFib

Anticoagulation
Rate control (BB/CCB, digoxin) or rhythm control (Class III)
Synched cardioversion if <48 hrs
Look for thrombus with TEE
If over 2 days or thrombus seen, anticoagulate and wait 3-4 wks before cardioversion
AV nodal ablation for recurrence

37

AFlutter

Rate control (BB/CCB)
Electrical or chemical cardioversion if can't control w/ medication
Catheter ablation may be possible

38

Chemical cardioversion

Class IA, IC, III antiarrhythmics

39

PVC

None if healthy
BB if patient w/ CAD

40

VTach (w/ pulse)

Rapid infusion amiodarone (first line)
Or procainamide/sotalol
Synched cardioversion if no drugs available
Internal defibrillator may be needed for recurrent

41

Torsades de pointes

Magnesium (large rapid IV bolus)

42

VFib, VTach (pulseless)

CPR, immediate electrical cardioversion (360J) Q2 min
Epinephrine 1 mg Q3-5 min [NO max dose]
Vasopressin 40 un in place of 1st/2nd dose epi
Consider amiodarone 300 mg IV then 150 mg IV
Consider Lidocaine 1-1.5 mg/kg up to 3 mg/kg total

43

Unresponsive patient w/ pulse

Resuce breathing (1 breath Q5-6 sec)

44

Unresponsive patient w/o pulse

CPR 30:2
Check rhythm

45

PEA/Asystole

CPR 30:2
Epinephrine 1 mg Q3-5 min [NO max dose]
Vasopressin 40 un in place of 1st/2nd dose epi
Evaluate and treat causes (H&Ts)

46

PEA/Asystole caused by Hypovolemia

Rapid volume resuscitation through multiple IVs or central line

47

PEA/Asystole caused by Hypoxia

Intubation, chest tube or oxygen

48

PEA/Asystole caused by H ions (acidosis)

IV push 1-2 amps bicarb
(Common in prolonged code)

49

PEA/Asystole caused by Hyperkalemia

CaCl2 IV push
Bicarb, Insulin/glucose to push K into cells
(Common in prolonged code from acidosis)

50

PEA/Asystole caused by Hypokalemia

KCl

51

PEA/Asystole caused by Hypoglycemia

(Always check finger stick)
1 amp D50 IV push

52

PEA/Asystole caused by Hypothermia

Warming

53

PEA/Asystole caused by Tamponade

Pericardiocentesis

54

PEA/Asystole caused by Tension pneumothorax

Needle decompression then chest tube

55

PEA/Asystole caused by Thrombosis (MI)

Cardiac cath or thrombolytic

56

PEA/Asystole caused by Thrombosis (PE)

Thrombolytic or thrombectomy

57

PEA/Asystole caused by Trauma

Follow ATLS protocols (ABC, etc)

58

CHF, acute exacerbation

NO LIP
Nitrates (dilate veins>arteries, work faster than diuretics)
Oxygen (if hypoxemic)
Loop diuretics
Inotropes (last resort)
Positioning (feet down to clear lungs)

59

CHF, chronic outpatient (mortality vs symptoms)

Improves mortality
- ACE, some ARB
- BB (bisoprolol, carvedilol, ER metoprolol)
- Spironolactone/eplerenone
Symptoms
- Loop diuretic
- Digoxin
- VD if also needed (isosorbide dinitrate reduces preload, hydralazine reduces afterload)

60

Progressive chronic CHF

May need biventricular pacing or cardiac resynch therapy (pacemaker at EF <35% for 3 months)
May need cardiac transplant

61

Acute pericarditis

Treat underlying cause
NSAIDs for pain, inflammation
Pericardiocentesis for large effusions

62

Chronic constrictive pericarditis

NSAIDs, colchicine, corticosteroids
Surgical excision of pericardium (high mortality)

63

Cardiac tamponade

(Dx w/ echo)
Immediate pericardiocentesis

64

Hypertrophic cardiomyopathy

BETA BLOCKERS
(CCB, pacemaker, partial septal excision)

65

Dilated cardiomyopathy

Treat like heart failure
Diuretics, ACE, BB, AC

66

Restrictive cardiomyopathy

Treat underlying cause
Palliative treatment for heart failure

67

Myocarditis

Treat infection / stop offending medications
Avoid exertional activity
Treat heart failure symptoms

68

Acute rheumatic fever

NSAIDs for joint inflammation
Corticosteroids if severe carditis
B-lactam if GAS infection still present

69

Endocarditis

Long term IV antibiotics (4-6 wks) (B-lactam plus aminoglycoside like ceftriaxone + gentamicin, maybe also vancomycin for MRSA)
Antibiotic prophylaxis before surgery or dental work
Valve replacement if severe valve damage

70

Antibiotic prophylaxis for endocarditis

2 gm amoxicillin 30-60 min before procedure (nothing after)

71

HTN emergency

Rapidly reduce diastolic BP to 100 mmHg (use IV anti-HTN, also start oral BB/ACE)
- Should not drop more than 25% in first 2 hrs (to avoid triggering ischemic event)
DIuretics to reduce pulmonary edema if needed

72

HTN, initial

Lifestyle (weightloss, exercise, salt restriction, alcohol reduction)
Thiazide diuretic unless comborbid C/I

73

HTN secondary to renal disease

ACEi (delays progression)
- C/I if acute renal failure (can accelerate)
- C/I if bilateral renal stenosis
- C/I if hyperkalemia (can worsen)

74

Renal artery stenosis

Angioplasty, stent placement, surgical repair
ACEi if one sided

75

Aortic coarctation

Surgical repair

76

HTN + DM
(C/I)

ACE
(+/- Thiazide diuretic, impaired glucose tolerance)
(+/- BB, can mask hypoglycemia symptoms)

77

HTN + CHF
(C/I)

ACE/ARB
Aldosterone antagonist
BB
(NDP CCB, can exacerbate by reducing rate/contractility)
(BB during acute exacerbation)

78

HTN + Post-MI

BB
ACE/ARB
Aldosterone antagonist

79

HTN + BPH

alpha-1-blocker (-zosins)

80

HTN + migraines

BB (or verapamil)

81

HTN + osteoporosis

Thiazide diuretic

82

HTN + Asthma/COPD (C/I)

Non-selective BB

83

HTN + Pregnancy

Hydralazine
Methyldopa
Labetalol
Nifedipine
(+/- Thiazide, esp starting; mild hypovolemia at start)
(ACE/ARB, teratogenic)

84

HTN + Gout (C/I)

(Diuretic, increase serum uric acid)

85

HTN + Depression (C/I)

(BB, can worsen symptoms)

86

HTN + LVH

ACE/ARB

87

HTN + Hyperthyroidism

Propranolol

88

HTN + benign essential tremor

BB

89

HTN + post-menopausal woman

Thiazide (increase calcium)

90

HTN + Prinzmetal angina

DHP CCB

91

HTN + AFib or SVT

NDP CCB

92

HTN + esophageal spasm

DHP CCB

93

Nonhemolytic febrile transfusion rxn

Acetaminiophen

94

Acute hemolytic transfusion rxn

Aggressive supportive care

95

Delayed hemolytic transfusion rxn

No acute therapy needed; determine responsible Ab type to prevent future rxns

96

Anaphylactic transfusion rxn

Epinephrine, volume maintenance, airway protection; use extra washed blood products next time

97

Minor allergic transfusion rxn

Diphenhydramine

98

Post-transfusion purpura

IVIG or plasmapheresis

99

DOC in septic shock

NE

100

DOC in anaphylactic shock

Epinephrine

101

DOC in cardiogenic shock

Dobutamine

102

AAA

Monitor w/ US q6 months if 0.5 cm in 6 months or symptomatic

103

Aortic dissection

BB (nitroprusside second choice) to stabilize BP
Stanford A - emergency surgery
Stanford B - medical management

104

PVD/PAD

Smoking cessation, glucose/BP control
Daily exercise to increase collateral flow
Cilostazol (arterial VD) or pentoxifylline (+RBC flexibility)
ASA/clopidogrel; Statin
[cardiac stress test prior to surgery]
PTA for failed medical management, significant disability from claudication
Bypass grafting if incapacitating claudication, resting foot pain, necrotic foot lesions
Limb amputation for prolonged ischemia

105

Varicose veins

Weight reduction, leg elevation
Compression stockings
Sclerotherapy
Thermal ablation
Surgery w/ venous ligation

106

AVM

Surgical removal or sclerosis if symptomatic or located in brain or bowel

107

DVT

Leg elevation
Heparin then warfarin
IVC if c/i to AC

108

Polyarteritis nodosa

Corticosteroids, immunosuppressants

109

Temporal (giant cell) arteritis

High dose prednisone 1-2 months then taper
Low dose ASA
Vitamin D, calcium supplementation

110

Takayasu arteritis

Corticosteroids, immunosuppressants
Bypass grafting if needed

111

Allergic granulomatosis w/ angiitis (Churg-Strauss)

Corticosteroids, immunosuppressants

112

Henoch-Schonlein purpura

Usu self-limiting
Corticosteroids for severe symptoms

113

Kawasaki disease

IVIG (ideally w/i first 10 days)
High dose ASA until 48 hrs after fever resolution
Low dose ASA until inflammatory markers (ESR, platelets) return to normal (about 6 wks)
Echo in acute phase and 6-8 wks later
NO steroids

114

Thromboangiitis obliterans (Buerger disease)

Smoking cessation

115

Tetralogy of Fallot

PGE, O2, propranolol, IVF
Morphine, Tet position during cyanotic episodes
Surgical correction

116

Endocardial cushion defect

Surgical correction

117

Persistent truncus arteriosus

Surgical correction

118

Transposition of the great vessels

PGE
Balloon atrial septostomy to widen ASD/VSD
Prompt surgical correction

119

Patent ductus arteriosus

Indomethacin (after a week or two)
Surgical closure if unresponsive

120

Atrial septal defect

Small - observation
Symptomatic/large - surgical closure

121

Ventricular septal defect

Small - observation
Large - diuretics, ACEi, surgical repair

122

Ebstein anomaly

PGE, digoxin, diuresis, propranolol