Treatments 2 Flashcards
(122 cards)
1
Q
Burns
A
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
Q
Drowning
A
Airway, supplemental O2, NG tube, maintain temp, admission for any symptoms of hypoxia
3
Q
Choking
A
Active coughing
Heimlich if unable to breathe
Emergency tracheotomy if continued obstruction
Bronchoscopy for visualization and removal (IV corticosteroids first may decrease inflammation)
4
Q
Heat exhaustion
A
Hyrdation, electrolyte replacement
5
Q
Heat stroke
A
Cool patient, benzos if seizures
6
Q
Hypothermia
A
Warm patient, treat arrhythmias/hypotension as needed
7
Q
Snake bite
A
Immobilize extremity
Clean wound
Antivenin
8
Q
Scorpion bite
A
Antivenin
Atropine / phenobarbital for symptoms
9
Q
Black widow bite
A
Local wound care
Antivenin
24 hr observation for systemic symptoms
Benzos if symptoms
10
Q
Brown recluse bite
A
Local wound care
Dapsone to prevent necrosis
Oral erythromycin if infx
11
Q
Dog/cat bite
A
Irrigation
Tetanus and rabies prophylaxis
Antibiotics if infx
Leave open on arm/hand, cat bite; close on face
12
Q
Human bite
A
Irrigation
Antibiotics (amoxicillin-clavulanate)
13
Q
PUD
A
+H pylori: amoxicillin + clarithromycin + PPI
-H pylori: PPI/H2 blocker
14
Q
BPH
A
Alpha 1 blockers (doxazosin, tamsulosin)
5-alpha reductase inhibitors (finasteride)
Possible surgery
15
Q
Atherosclerosis
A
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
Q
Lower LDL
A
Statins (best)
Ezetimibe
Bile acid resins
(Fibrates)
17
Q
Lower TG
A
Fibrates
Omega 3 FA
Statins (minor)
18
Q
Raise HDL
A
Niacin
Statins (minor)
19
Q
Stable angina
A
Sublingual nitro (peripheral venous vasodilator, reduces preload, reduces myocardial O2 demand) Also helps esophageal pain (GERD, spasm)
20
Q
Prinzmetal angina (arterial vasospasm)
A
CCB (either type)
also nitrates
21
Q
Unstable angina, acute
A
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
Q
Unstable angina, home
A
BB, ASA, nitroglycerin, statin, antiplatelet (1-12 months), ACE/ARB (DM, CHF, HTN)
23
Q
Unstable angina, nonresponsive to medications
A
PTCA (balloon catheter w/ or w/o stent)
NO fibrinolysis
24
Q
Indications for CABG
A
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
