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TrueLearn Flashcards

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1
Q

What is the motor scoring system for GCS?

A 
Normal 6
Localizes 5
Withdraws 4
Flexion 3 
Extension 2
None 1
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2
Q

What is the Verbal scoring system for GCS?

A 
5 Oriented (AAO)
4 Confused (responds coherently but some confusion)
3 Verbalizes (no conversational exchange)
2 Vocalizes (sounds not words)
1 None
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3
Q

What is the eye opening scoring system for GCS

A

Spontaneous 4
To command 3
To pain 2
None 1

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4
Q

Severity of TBI based on GCS

A

Mild (13-15)
Moderate (9-12)
Severe (8 or less)

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5
Q

What type of retroperitoneal hematomas must be be explored?

A

All penetrating hematomas
Pulsatile/Expanding hematomas
All Zone 1 hematomas

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6
Q

What type of retroperitoneal hematomas can be safely observed?

A

Non-expanding, non-pulsatile hematomas in blunt trauma in zones II (lateral) and III (pelvic)

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7
Q

For burn patients equal to or greater than 30 kg, to what should UOP be titrated to ensure adequate fluid resuscitation?

A

0.5 to 1 ml/kg/hr

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8
Q

What is most common arrhythmia seen in blunt cardiac injury?

A

Sinus tachycardia

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9
Q

Degree of burn: blanching erythema, painful, no blisters

A

First degree

involve outer layer of epidermis; will slough and be replaced by keratinocytes within 3-4 days of injury

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10
Q

Burn: moist, redness with clear blisters, blanches with pressure

A

Superficial Partial thickness (Second degree)

Papillary Dermis

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11
Q

Burn: dry, yellow or white, less blanching, reduced sensation or insensate

A

Deep Partial Thickness (Second degree)

Reticular Dermis

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12
Q

Burn: leathery, stiff white/brown, no blanching, insensate

A 
Full Thickness (Third Degree)
Full Dermis
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13
Q

Burn: dry, black, charred with eschar

A

Fourth Degree

Extends through entire skin into underlying fat, muscle, bone

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14
Q

Recommended for full thickness burns < 40% BSA due to good penetration through eschar

A

Mafenide

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15
Q

Borders of posterior triangle of neck

A

SCM, trapezius, clavicle

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16
Q

Anterior triangle of neck Zone 1

A

Clavicle to Cricoid

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17
Q

Anterior triangle of neck Zone 2

A

Cricoid to angle of mandible

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18
Q

Anterior triangle of neck Zone 3

A

angle of mandible to skull base

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19
Q

Hard signs requiring exploration in neck trauma

A

crepitus, stridor, hoarseness, tracheal deviation, odynophagia, pulsatile bleeding, expanding hematoma, bruit, thrill

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20
Q

Hard signs of vascular injury

A
  1. Rapidly expanding hematoma
  2. Pulsatile bleeding
  3. Distal Ischemia
  4. Absent Pulse
  5. Bruit or palpable thrill
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21
Q

Soft signs of vascular injury

A
  1. Moderate sized hematoma
  2. Minor bleeding
  3. Associated nerve injury
  4. Decreased pulse
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22
Q

Berlin Criteria (Timing)- ARDS

A

respiratory compromise within 1 week of known insult

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23
Q

Berlin Criteria (Imaging)- ARDS

A

CXR or CT showing bilateral opacities that are not considered effusions, lung collapse, nodules

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24
Q

Berlin Criteria (PaO2/FiO2)- ARDS

A

201-300 Mild
101-200 Moderate
< 100 Severe

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25
Historical Berlin Criteria (PCWP)- ARDS
PCWP <18
26
What tidal volume is recommended in treatment of ARDS patients?
Low tidal volume | 6 ml/kg
27
3 Stages of pleural infection
1) exudative stage- fluid thin, sterile, low WBC and LDH, glucose > 40 mg/dL 2) fibrin purulent stage- fluid becomes infected and fibrin deposits on pleura, LDH and WBC increase, glucose and pH decrease; fluid thick purulent and lung unable to expand 3) organizing stage- thick pleural peel created by migrating fibroblasts
28
Common empyema causing organisms
Anaerobic organisms much more common than S. pneumo
29
Tx of pleural infection in organizing stage
decortication
30
When is Eloesser flap or Clagett procedure indicated?
post-pneumonectomy empyema, allows creation of open wound that permits tissue granulation of empyema cavity
31
Most common cause of exudative effusions?
Malignancy
32
Most common cause of transudative effusions?
CHF
33
Dobutamine MOA
B1 agonist- increase cardiac contractility | B2 agonist- vasodilatory (at higher doses)
34
Post-Op delirium mortality rate is as high as ___
40%
35
The duration of post-op delirium affects 6 month mortality by ___% for each day of post-operative delirium
17%
36
Cognitive impairment from post-op delirium can last as long as ____ year post-op and up to ____ years in those with dementia
1 | 5
37
How long must you continue CPR in a hypothermic patient?
Until core body temperature is rewarmed to at least 30C because vital signs may return with rewarming
38
What causes left shift in oxygen-hemoglobin dissociation curve?
increased pH decreased 2,3 DPG decreased PCO2 decreased temperature
39
What causes right shift in oxygen-hemoglobin dissociation curve?
decreased pH Increased 2,3 DPG Increased PCO2 Increased temperature
40
Class I hypovolemic shock
``` blood loss: up to 750 mL, 15% pulse rate: < 100 BP: normal PP: normal UOP: >0.5 mL/kg/hr ```
41
Class II hypovolemic shock
``` blood loss: up to 1500 mL, 30% pulse rate: >100 BP: minimal decrease PP: narrow UOP: >0.5 mL/kg/hr ```
42
Class III hypovolemic shock
``` blood loss: up to 2000 mL, 40% pulse rate: >120 BP: hypotensive PP: narrow UOP: <0.5 mL/kg/hr ```
43
Class IV hypovolemic shock
``` blood loss; >2000 mL pulse rate: >140 BP: significantly decreased PP: unobtainable/very narrow UOP: minimal ```
44
Tx for post-op Afib in patient without hemodynamic instability
IV beta-blockers
45
Tx for post-op Afib in patient with EF < 35%
IV amiodarone
46
Two biggest risk factors for gastric stress ulcers
prolonged mechanical ventilation >48 hr | coagulopathy (plt < 50K, INR > 1.5, PTT > 2x nL)
47
What is in renal feeding formulas?
low intracellular electrolyte concentration essential amino acids high calorie to nitrogen ratio
48
Most common presenting symptoms of anaphylaxis
urticaria and angioedema
49
According to guidelines, patients without cardiac history who can perform >4 METs require what type of work-up prior to surgery
No further work-up
50
What activities are >4 METs
climbing flight of stairs walking up a hills moderate intensity work-out
51
What is the definition of acute hyponatremia?
developed over last 48 hours; treat with hypertonic NaCl bolus (correcting by 4-6 mEq over several hours)
52
Why does chronic hyponatremia have to be corrected slowly?
to prevent central pontine myelinolysis
53
How is Atracurium metabolized?
non-depolarizing muscle relaxer Hoffman degradation (temp, pH dependent) increase in pH favors process; decrease in temp slows process can be used in patients with liver or kidney failure
54
Sepsis
source + 2 SIRS criteria
55
Severe Sepsis
Sepsis + organ dysfunction (25-40% mortality)
56
Septic Shock
Sepsis with refractory hypotension despite adequate fluid resuscitation (vasoplegia) (40-80% mortality)
57
Treatment for malignant hyperthermia
``` Dantrolene (act on ryanodine receptor to block Ca release) Sodium Bicarb (tx acidosis) ```
58
Normal Cardiac Index
2.5 to 4 L/min/m2
59
Normal PCWP
4-12 mmHg
60
Normal SVR
700 -1600 dynes/sec/cm-5
61
Normal PVR
20-130 dynes/sec/cm-5
62
Tx of C. albicans
fluconazole
63
Tx of C. krusei
Voriconazole
64
Tx of C. glabrata
Micafungin
65
Tx of invasive aspergillosis
Voriconazole
66
Where in the normal GI tract is the absorption of Calcium the highest?
Duodenum and proximal jejunum- highest number of Vitamin D dependent calcium binding proteins
67
Respiratory quotient < 0.7 indicates
starvation
68
Respiratory quotient 0.7 indicates
pure fat utilization
69
Respiratory quotient 0.8 indicates
pure protein utilization
70
Respiratory quotient 0.8-0.9 indicates
mixed substrate utilization (desirable)
71
Respiratory quotient 1.0 indicates
pure carbohydrate utilization
72
Respiratory quotient > 1.0 indicates
overfeeding

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