Term
| presentation of bronchiolitis: |
|
Definition
- clear profuse rhinorrhea and congestion
- wheezing
- cough
- low grade fever
- tachypnea |
|
|
Term
| Bronchiolitis is acute inflammatin of the bronchioles usually from a ___. It usually affects children from __ to age __ years and is most common in the __ months. |
|
Definition
- virus
- birth to age 2 years
- winter months (november-march) |
|
|
Term
| 60-90% of Bronchiolitis is caused by ___. Other causes include: |
|
Definition
- 60-90%= RSV
- parainfluenza
- rhinovirus
- adenovirus
- influenza
- human Bocavirus |
|
|
Term
| what you may hear on lung exam of pt with bronchiolitis: |
|
Definition
| inspiratory wheezes and crackles |
|
|
Term
| standard for dx of bronchiolitis: |
|
Definition
nasopharyngeal aspirate for rapid dx of RSV and influenza
these patients should also get a chest xray |
|
|
Term
| standard CXR findings of bronchiolitis: |
|
Definition
- hyperinflation
- atelectasis
- peribronchial thickening
- diffuse interstitial infiltrates |
|
|
Term
|
Definition
- oxygen
- trial of bronchodilators
- Ribavirin- synthetic nucleoside analoge that has virostatic activity against RSV |
|
|
Term
| What patients with bronchiolitis should Ribavirin be given to? |
|
Definition
- hx of congenital heart disease
- hx of chronic lung disease
- preterm infants
- infants younger than 6 weeks
- infants ventilated for RSV infection |
|
|
Term
| Criteria suggestive of severe bronchilitis: |
|
Definition
- toxic appearing
- O2 saturation less than 95%
- gestational age less than 34 weeks
- respiratory rate > 70 bpm
- atelectasis on CXR
- age less than 3 months |
|
|
Term
| Single best objective measure of severe bronchiolitis: |
|
Definition
| infants o2 saturation while feeding |
|
|
Term
|
Definition
supportive, unless severe RSV> Ribavirin
- hydration
- antitussives
- bronchodilators |
|
|
Term
|
Definition
- Ampicillin OR Nafcillin _+ Gentamycin
OR
Vancomycin + Cefotaxime |
|
|
Term
| 1-3 month old pneumonia tmt; |
|
Definition
| Erythromycin OR Amoxicillin OR Cefuroxime |
|
|
Term
| 2 options to treat chlamydia pneumonia: |
|
Definition
| Erythromycin or Cefuroxime or Ceftriaxone |
|
|
Term
| 2 tmt options for S. pneumoniae: |
|
Definition
| Amoxicillin or Cefuroxime |
|
|
Term
| STD with ulcer and firm rubbery non-tender lymph nodes: |
|
Definition
|
|
Term
| STD with ulcers and bilateral, firm, tender lymph nodes: |
|
Definition
|
|
Term
| STD with ulcer and unilateral, firm, erythematous, tender suppurative lymph nodes: |
|
Definition
|
|
Term
| STD with ulcer and unilater firm tender matted and fixed lymph nodes: |
|
Definition
|
|
Term
| name 3 stds with ulcers but no lymphadenopathy: |
|
Definition
- Genital warts
- Pediculosis
- Scabies |
|
|
Term
| define massive hemoptysis: |
|
Definition
| > 200 ml blood in 24 hours |
|
|
Term
| hemoptysis, weight loss, fever, night sweats: |
|
Definition
|
|
Term
| Good test to measure response to treatment with asthma and COPD: |
|
Definition
| - peak expiratory flow rate |
|
|
Term
| Drugs that may exacerbate asthma: |
|
Definition
- ASA
- NSAIDs
- Beta blockeres
- Food coloring |
|
|
Term
|
Definition
- Oxygen
- Beta-adrenergic agonists
- Anticholinergics
- Corticosteroids |
|
|
Term
| Specifics about beta adrenergic agonists for asthma COPD treatments: |
|
Definition
- Nebulized Albuterol: 0.05-0.15mg/kg, up to 1.25 mg per treatment
- 20-30 min apart
- up to 3 treatments |
|
|
Term
| Specifics about anticholinergics used to treat asthma/COPD: |
|
Definition
| Nebulized Ipatroprium Bromide 0.5 mg per neb, up to 3 doses |
|
|
Term
| Specifics about corticosteroids used to treat asthma/COPD: |
|
Definition
- Methylprednisone 125 mg IV
OR
- Prednisone 60 mg po
OR
- oral dose pack of choice |
|
|
Term
| Treatment for life threatening bronchospasm refractory to other tmts of asthma and COPD: |
|
Definition
- Magnesium Sulfate 2-3 grams IV infused at 1 gm/min
- monitor for hypotension, respiratory depression, and decreased DTRs |
|
|
Term
| What should you monitor for if you give Magnesium Sulfate to an asthma or COPD patient with bronchrospasm resistant to other treatments? |
|
Definition
- hypotension
- respiratory depression
- decreased DTRs |
|
|
Term
| Examples of Methylxanthines: |
|
Definition
Theophylline
Aminophylline |
|
|
Term
| What should be used to help intubate patients with status asthmasticus |
|
Definition
| Ketamine 1-2 gm/kg IV or 4 mg/kg IM |
|
|
Term
| Asthmatics with greater than __% PEF can be sent home. |
|
Definition
|
|
Term
| 3rd most common cardiovascular disease: |
|
Definition
|
|
Term
| most common symptom of PE: |
|
Definition
|
|
Term
| Signs of RV failure with PE: |
|
Definition
|
|
Term
| __ and __ in general suggest a massive PE. |
|
Definition
| hypotension and symptoms in general |
|
|
Term
| early on in PE, would you see respiratory alkalosis or acidosis? |
|
Definition
| alkalosis b/c hyperventiliating so blowing off lots of CO2 |
|
|
Term
|
Definition
- atelectasis
- infiltrates
- effusions
- Westermark's sign: dilated proximal to embolus, oligemia distal
- Hamptom's hump: pleural based density with a rounded border facing the hilum |
|
|
Term
| When is a VQ scan most helpufl? |
|
Definition
| - when the CXR was normal and the patient does not have chronic lung disease |
|
|
Term
| High probability VQ scan: |
|
Definition
| 2 or more areas with perfusion defects with normal ventilation |
|
|
Term
| current Gold standard for PE dx: |
|
Definition
| Pulmonary Artery Arteriogram |
|
|
Term
| what 3 tests will confirm or exclude acute PE in most cases: |
|
Definition
- D-dimer
- Doppler ultrasound
- VQ scan |
|
|
Term
| A normal chest x-ray with hypoxia with no other cuase is highly suggestive of a __ __. |
|
Definition
|
|
Term
| anticoagulatns are a form of __ prevention for recurrent PEs. |
|
Definition
|
|
Term
|
Definition
- Heaparin or low molecular weight heparin initially (Enoxaparin or Dalteparin)
- Heparin 80 u/kg bolus> then 18/u/kg/hr drip, PTT goal 1.5-2.5of norm
- Warfarin (coumadin)- add orally after starting heparin product
- initial dose of 2.5-10 mg
- overlap with heparinoid for at least 5 days
- INR: 2.5
- check monthly once therapeutic |
|
|
Term
| Acute aspiration of gastric contents: |
|
Definition
|
|
Term
| CXR findings with pulmonary aspiration syndrome: |
|
Definition
- initially normal
- later RLL consoliation |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| when is BNP most helpful? |
|
Definition
| when its low, best used to rule out. If its low> no fluid exacerbation. If its high> could be due to fliud, PE, or other causes. |
|
|
Term
|
Definition
4 x kg x % burn
- give half of this fluid over first 8 hours
- give the rest over the next 16 hours |
|
|
Term
| Urine output goal for adults and children who have suffered from burns: |
|
Definition
- adults: 0.5ml/kg/hr
- children: 1ml/kg/hr |
|
|
Term
| Review all notes from Environmental disasters ppt up to urine output for burn victims |
|
Definition
|
|
Term
| Hypothermia is a core temperature less than: |
|
Definition
| 35 degrees Celsius or 95 degrees Farenheit |
|
|
Term
|
Definition
| freezing without blistering, peeling occasionally present |
|
|
Term
| second degree frost bite: |
|
Definition
| freezing with clear blistering |
|
|
Term
|
Definition
| freezing with death of skin, hemorrhagic blisteres, and subcutaneous involvement |
|
|
Term
| fourth degree frost bite: |
|
Definition
| freezing with full thickness involvement, including bone, ultimate loss or deformity of body part |
|
|
Term
| full thickness frostbite manaagement: |
|
Definition
| Rapid rewarming is the most important aspect of management. It should not be attempted, however, if the potential for refreezing exists. Rewarming should be performed with a water bath or whirlpool containing an antimicrobial agent such as iodine or chlorhexidine. Water temperature of 40–42°C (104–107.6°F) is necessary. However, The State of Alaska Cold-injury Guidelines recommend a lower temperature of 37–39°C (98.6–102.2°F). This temperature causes less pain for the patient and only slightly prolongs rewarming. Rewarming should continue until a red-purple color appears and the skin becomes pliable. Recommended rewarming time is anywhere from 15 inutes up to 1 hour. |
|
|
Term
| Severe cases of frostbite have led to subsequent rhabdomyolysis with renal failure, which then requires aggressive hydration. Intravenous narcotics are almost always necessary secondary to the severe pain associated with rewarming. |
|
Definition
|
|
Term
| frostbite once in the hospital: |
|
Definition
| Debride clear blisters because prostaglandins and thromboxane are present in the exudate. Leave hemorrhagic blisters intact. Administer antitetanus prophylaxis. Apply aloe vera cream every 6 hours. Administer ibuprofen, 400–600 mg every 8–12 hours for 72 hours. |
|
|
Term
| with frost bite tmt what abx should be given prophylactically? |
|
Definition
|
|
Term
| mcc of death with lighting injuries: |
|
Definition
|
|
Term
| triage of lightning struck is diff in that dead appearing are attended to first |
|
Definition
|
|
Term
| Linear lightning strike burns: |
|
Definition
| Linear burns are first- and second-degree burns that begin at the head and neck and course in a branching pattern down the chest and legs. They tend to follow areas with a heavy concentration of sweat. |
|
|
Term
| Punctate lightning burns: |
|
Definition
| clusters of discrete circular partial or full thickness burns in star burst shape |
|
|
Term
| Feathering burns are not true burns but rather cutaneous imprints from electron showers that track through the skin. They create a fernlike pattern with delicate branching. These patterns are also called ferning, keraunographic markings, and Lichtenberg flowers or figures |
|
Definition
|
|
Term
Thermal burns
Thermal burns from clothing or heated metal are typical second- and third-degree burns. Cranial burns (direct or indirect head strike) and leg burns (ground current) are associated with increased death rates. |
|
Definition
|
|
Term
| Electric shock and burns essentials of dx: |
|
Definition
Direct current is less dangerous than alternating current (AC)
AC (most house current) can cause ventricular fibrillation and respiratory arrest
Burns can result from the electrical current and, although they may look mild, can indicate significant internal damage
Treatment includes CPR, wound care, and possibly fasciotomy |
|
|
Term
| poisoning that would cause miosis: |
|
Definition
Narcotics
Organophosphates |
|
|
Term
| poisoning that would cause mydriasis: |
|
Definition
- anticholinergics
- stimulants |
|
|
Term
| substances that could cause nystagmus: |
|
Definition
|
|
Term
| Anticholinergic toxidrome: |
|
Definition
- eyes dilated
- delirium
- mumbling speech
- tachycardia
- dry flushed skin
- myoclonus
- urinary retention
- decreased bowel sounds
- seizures
- dysrhythmias |
|
|
Term
| Opiod/sedative/ethanol toxidrome: |
|
Definition
- coma
- respiratory depression
- miosis
- hypotension
- bradycardia
- hypothermia
- pulmonary edema
- decrease bowel sounds
- hyporeflexia
- needle marks |
|
|
Term
|
Definition
- confusion
- CNS depression
- weakness
- salivation
- lacrimation
- urinary/fecal incontinence
- GI cramping
- emesis
- diaphoresis
- muscle fasiculations
- miosis
- brady/tachycardia
- seizures
causes: Organophosphates, carbamate, insecticeides, nicotine, pliocarpine, some mushrooms |
|
|
Term
| tmt of acetaminophen poisoning: |
|
Definition
|
|
Term
| Anticholinergic overdose tmt: |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Organophosphate and other cholinesterase inhibitors overdose tmt: |
|
Definition
|
|
Term
| Treatment of beta blocker overdose; |
|
Definition
|
|
Term
| Tmt of calcium channel blocker overdose: |
|
Definition
|
|
Term
| Tmt of cyanide poisoning: |
|
Definition
- Sodium nitrite
- Sodium thiosulfate |
|
|
Term
| Tmt of Isoniazid overdose: |
|
Definition
|
|
Term
| Tmt of methanol/ethylene glycol ingestion: |
|
Definition
|
|
Term
| Tmt of Narcotics overdose: |
|
Definition
|
|
Term
|
Definition
SAD-LIFE
- Sepsis
- Addison's
- Drugs
- Liver
- Insulin
- Fasting
- ETOH |
|
|
Term
|
Definition
| IV dextrose as a 50% solution- 1g/kg; continuous 10% dextrose solution to keep blood sugar above 100 |
|
|
Term
| Hypoglycemia treatment if there is NO IV access or if pt is critical: |
|
Definition
|
|
Term
| Refractory Hypoglycemia tmt: |
|
Definition
- glucagon IV or hydrocortisone 100 mg IV
- D-stick every hour
Admit: oral agent, recurrent dips, associated disease
Home: insulin error and ok post 6 hours |
|
|
Term
| Whipple's Triad is a collection of 3 criteria that suggest that a patient's symptoms are due to ___. |
|
Definition
|
|
Term
| Whipple's Triad is 3 criteria that suggest that their symptoms are due to hypoglycemia: |
|
Definition
1. Symptoms known or likely to be caused by hypoglycemia
2. A low plasma glucose measured at the time of symptoms
3. Relief of symptoms when the glucose is raised to normal |
|
|
Term
| Ketoacidosis is a type of metabolic acidosis caused by high concentrations of __ bodies formed from the breakdown of __ __ and __ of __ __. |
|
Definition
- ketone bodies
- fatty
- amino acids |
|
|
Term
| In Ketoacidosis the body fails to regulate ketone production b/c the body is not making enough ___ to decrease production, thus the pH of blood ___. |
|
Definition
|
|
Term
| Ketoacidosis is most commonly seen in __ __ _ ___ b/c the liver breaks down __ and __ in perceived need for respiratory substrate. This is also seen in ___. |
|
Definition
- untreated Type 1 Diabetics
- fat and protein
- alcoholics |
|
|
Term
| 3 main characteristics of Diabetic Ketoacidosis (DKA): |
|
Definition
- insulin deficiency
- hyperglycemia
- dehydration
(starvation in the face of plenty) |
|
|
Term
| DDx of Diabetic Ketoacidosis: |
|
Definition
MUDPILES:
- Methanol
- Uremia
- DKA
- Paraldehyde
- INH
- Iron inhalants
- Lactate
- ETOH
- Salicylate
also consider hypoglycemia and HHS |
|
|
Term
|
Definition
1. Decrease synthesis with propylthiouracil or methimazole
2. Prevent release with Iodine or Lithium carbonate
3. Beta blocker (propanolol or esmolol) |
|
|
Term
|
Definition
- Renal failure
- ACE-I
- Acidosis |
|
|
Term
|
Definition
|
|
Term
|
Definition
- Calcium gluconate- decrease K effects on heart
- Sodium Bicarbonate
- Glucose and Insulin may be used to drive K back into cells
- Kayexelate PO- removes K from body |
|
|
Term
| clinical features of hyperkalemia: |
|
Definition
- arrhythmia
- cardiac arrest
- numbness
- weakness
- flaccid paralysis |
|
|
Term
|
Definition
- diuretic use
- renal-tubular acidosis
- GI loss |
|
|
Term
| EKG findings of hyperkalemia: |
|
Definition
|
|
Term
| Clinical features of Hypokalemia: |
|
Definition
- ventricular arrhythmias
- hypotension
- cardiac arrest
- musce weakness/cramps
- hyperglycemia |
|
|
Term
|
Definition
|
|
Term
| EKG findings of hypokalemia: |
|
Definition
- flat or inverted T- waves
- U waves |
|
|
Term
|
Definition
PO K if not emergent
IV K if K< 2.5 |
|
|
Term
|
Definition
|
|
Term
| clinical features of hypernatremia: |
|
Definition
- thirst
- restlessness
- irritability
- delirium
- convulsions
- dry mouth
- anuria |
|
|
Term
|
Definition
- free water PO OR
- IV 5% dextrose solution
- Dialysis if sodium > 200
CAUTION- TOO RAPID> CEREBRAL/PULMONARY EDEMA |
|
|
Term
| MC electrolyte disorder in the hospital: |
|
Definition
| hyponatremia, sodium less than 135 |
|
|
Term
|
Definition
- urine sodium
- if SIADH suspected get GT of head and CXR to r/o lung mass and CNS disorder |
|
|
Term
|
Definition
- usually fluid restriction
- IV hypertonic solution possibly
check sodium hourly and closley monitor neuro |
|
|
Term
| Hypercalcemia clinical features: |
|
Definition
- nausea, anorexia, AMS, tachycardia
Bones, Mones, Stones, Groans, Psychiatric overtones |
|
|
Term
| Labs to order with hypercalcemia: |
|
Definition
- phosphorous
- CXR
- UA
- ESR
- Vitamin D |
|
|
Term
|
Definition
| normal saline and manage cause |
|
|
Term
|
Definition
| Cipro + Metronidazole/Clindamycin |
|
|
Term
| Appendicitis abx before sx: |
|
Definition
CAS:
- Cefoxitine
- Ampicllin/Sulbactam |
|
|
Term
|
Definition
- Ampicillin/sulbactam
- Clindamycin
- Levaquin
- Metronidazole
- Zosyn |
|
|
Term
|
Definition
| acute and chronic viral hepatitis |
|
|
Term
|
Definition
| ETOH induced hepatitis b/c ETOH stimulates AST |
|
|
Term
| If alkaline phosphate is 4 times normal suspect: |
|
Definition
|
|
Term
| what test do you run to LOCATE intestinal perforation: |
|
Definition
|
|
Term
|
Definition
- pain
- hypotension
- pulsatile mass |
|
|
