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Flashcards in ICU/ER Deck (68)
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0

What should you suspect and how would you treat a patient with unilateral pupil dilation?

Uncal hernia room/oculomotor nerve compression
Osmotic agents

1

What are 3 features of Cushings triad and what diagnosis does this point to?

Bradycardia
HTN
Irregular respirations
*increased intracranial pressure

2

What is the goal for blood pressure reduction in a patient with acute hypertensive crisis?

Reduce by 25% during the first 8 hrs and then slowly over the next 48 hours

3

What is the hypermetabolic state that leads to metabolic acidosis, hyperthermia and cardiac arrhythmia after administration of general anesthesia ?

Malignant hyperthermia

4

What symptoms would lead you to expect malignant hyperthermia (7 answers)?

Tachypnea
Fever
Muscle rigidity
Increased CO2 production
Cardiac arrhythmia
Elevated CK
Myoglobinuria

5

What is the treatment for malignant hyperthermia ? (3 answers)

Hyperventilation
Oxygen
Dantrolene

6

What diagnosis should you consider in a patient with fine reticular infiltrate on CXR after near drowning who presents with difficulty breathing a few hours later? What is the ultimate cause of mortality ?

Acute respiratory distress syndrome - multi organ failure

7

What are 7 common causes of ARDS ?

Drowning
Pneumonia
Aspiration
Lung contusion
Smoke inhalation
Transfusion
Sepsis

8

What diagnosis should you consider in a patient who presents with vomiting, muscle aches and labs showing low glucose, low sodium and high potassium?

Adrenal insufficiency

9

What diagnosis presents with electrolyte disturbances associated with adrenal insufficiency as well as candidiasis?

Autoimmune polyendocrinopathy

10

What diagnosis should you consider in a patient with hyponatremia, hyperkalemia and hypoglycemia who also had an elevated ADH level ?

Adrenal insufficiency (can have elevated ADH levels )

11

What diagnosis should you consider in a patient who presents with new onset afebrile seizure after recently being at a water park ? What 6 other conditions could be associated with this diagnosis?

Water intoxication / electrolyte abnormalities - feeding with dilute formula, malnutrition, excessive water intake, hypotonic IVF, glucocorticoid deficiency or hypothyroidism

12

What is the most appropriate first step in a patient with flail chest and respiratory distress?

Place chest tube

13

What is the key element of respiratory support in a patient with ARDS ?

PEEP

14

What is the correct imaging to order when presented with blunt abdominal trauma?

Abdominal CT with contrast

15

What is the best initial IV therapy for an infant in heart failure ?

Furosemide

16

A child is presented after sudden collapse and syncope. There is a family hx of sudden death and epilepsy. What is the most likely test to confirm the diagnosis?

EKG - prolonged QT

17

What medication should be given to an infant in heart failure with aortic stenosis ? Why?

Prostaglandin E1 (maintain open ductus arteriosis)

18

What is the most appropriate initial treatment for SVT?

Adenosine

19

What is the definition of pulsus paradoxus?

Decreased systolic BP during inspiration

20

What tests can be done to document the absence of vertebral and carotid artery blood flow in a patient with brain death?

Radio nucleotide scan
Angiography

21

What is the most important lab finding in a patient with impending liver failure ?

Elevated serum ammonia

22

What is the difference in urine osmolality when trying to diagnose pre-renal vs renal azotemia?

Pre-renal : increased urine osmolality (>350)
Renal : low urine osmolality (<350)

23

What is the fractional excretion of sodium in a patient with pre-renal azotemia? And in renal azotemia?

Prerenal: <1%
Renal: >1%

24

What is the ratio of compressions to breaths when performing CPR on an infant?

With 2 rescuers - 15:2
With 1 rescuer - 30:2

25

What is the rate of compressions per minute when performing CPR on an infant?

100 compressions per minute

26

What is the appropriate ventilation rate after establishment of an airway during CPR in an infant ?

8-10 breaths per minute

27

When should chest compressions be discontinued during infant CPR ?

HR > 60 and good perfusion

28

How do you determine the size of the ET tube when establishing an airway?

Childs age + 16 divided by 4

29

What is the first thing you should do when presented with a child who has ingested an unknown substance and is unresponsive ?

Establish an airway