Neurological and Medical Emergencies: A Comprehensive Guide, Exams of Nursing

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Right ventricular infarction (RVI) lead changes Correct Answer: II, III, AVF R ventricular infarction s/s Correct Answer: clear breath sounds, hypotension, JVD. R ventricular dilation and dec contractility>> dec preload and CO Reperfusion therapy standard Correct Answer: Within 60 min of ED arrival Common causes of PEA Correct Answer: Hypoxia, tension pneumo, cardiac tamponade BNP as a marker Correct Answer: of L ventricular dysfunction bc ventricles make BNP and an inc of over 100 pg/ml indicates symptomatic HF Transcutaneous pacing (TCP) Correct Answer: A beat after every pacer spike is electrical capture. Beats are wide complex bc ventricle is paced. Palpate central pulse, pt may still be hypotensive w/ diminished or absent peripheral pulses. Preferred tx with symptomatic brady esp in pts with acute MI Wolff Parkinson-White (WPW) syndrome Correct Answer: shortened PR interval and widened QRS complex with a delta wave. When there is an extra electrical conduction path to heart causing electrical signal to arrive too soon at ventricle (pt presents in tachy) Brugada syndrome Correct Answer: R bundle branch block with ST segment elevation in leads V1-V and inc risk of sudden cardiac death (SUDS), common in young men Wellen syndrome Correct Answer: T wave changes plus history of anginal chest pain w/o serum marker abnormalities, EKG lacks Q waves and significant ST segment elevation. Assoc with critical proximal L anterior descending (LAD) artery stenosis Hypothermia associations Correct Answer: With bradycardia, Osborne (J) waves and prolonged QT intervals Sick sinus syndrome Correct Answer: Sinoatrial node (SA) the primary heart pacemaker is not functioning properly resulting in bradydysrythmias and/or tachydysrhythmias with potential for hypotension and syncope Morphine and nitrates for tx pulmonary edema Correct Answer: Results in dec preload or dec venous return>> dec pulmonary congestion How to diagnose endocarditis Correct Answer: Echocardiogram Pericardiocentesis Correct Answer: For suspected pericardial effusion or tamponade Primary complication of bowel obstruction Correct Answer: Dehydration

Testicular referred pain is indicative of? Correct Answer: Duodenal injury S/s pancreatitis Correct Answer: Sharp, boring, epigastric pain, inc after eating and having alcohol Dx with abd CT scan Paracentesis Correct Answer: Procedure to remove fluid that has accumulated in the abd cavity After doing paracentesis Correct Answer: Check pt for s/s shock, EKG, dressing, VS q 15 min Auscultate bowel obstruction Correct Answer: Freq and high pitched Dec or absent bowel sounds caused by Correct Answer: Paralytic ileus, paralysis, dec in peristalsis One cause of HYPOkalemia Correct Answer: Excess fluid loss from GI (ex: diarrhea) One cause of Magnesium depletion Correct Answer: Intestinal malabsorption Bland diet is for Correct Answer: Peptic and gastric ulcers Chocolate enhances Correct Answer: S/s GERD Life threatening complications of acute pancreatitis Correct Answer: Atelectasis, pleural effusion, ARDS HELLP syndrome Correct Answer: Hemolysis, Elevated liver enzymes, Low platelets) Liver panel dx it S/s rhabdomyolysis Correct Answer: HYPERkalemia, brown urine, inc CPK, HYPERcalcemia Septal hematoma Correct Answer: Can occur with mid facial trauma; untreated can lead to abscess formation or avascular necrosis Ethmoid bone fx can cause Correct Answer: CSF leakage Preferred eye irrigation fluid Correct Answer: LR Pocket vision screener should be held ___ inches from nose? Correct Answer: 14 inches HHNC s/s Correct Answer: UA shows glycosuria without ketouria, polyuria, tachycardia, hypotension Acute renal failure (ARF) s/s Correct Answer: HYPERkalemia, HYPOnatremia, HYPOcalcemia, HYPERphosphatemia. K level is priority BUN / Cr ratio that would dx prerenal failure Correct Answer: > 20: S/s HYPOcalcemia Correct Answer: muscle cramping Latex allergy crossovers Correct Answer: Tomatoes, bananas, kiwis, white potatoes, avocados, bell peppers, peaches

Tx acute HYPERkalemia Correct Answer: Ca and albuterol, sodium bicarb, insulin and dextrose 50%, kayexalate Kayexalate Correct Answer: Sodium polystyrene sulfonate takes 1-2 hrs to kick in Herpes zoster (shingles) transmission Correct Answer: Direct contact via vesicular fluid Fibromyalgia Correct Answer: Chronic fatigue, multiple somatic s/s, widespread pain and hypersensitivity Thyrotoxic crisis/storm s/s Correct Answer: Hyperthermia, agitation, tachydysrythmias Scabies tx Correct Answer: Pyrethrin liquid (RID), do 2nd tx 7-10 days later if 1st is done to try hair. If hair is wet, reapply in 24 hrs. Put washable items in plastic bags for 1 - 2 weeks until mites die Anterior AND lateral corticospinal tract Correct Answer: Voluntary muscle movement Lateral spinothalamic tract Correct Answer: Sharp pain and temperature Posterior tracts Correct Answer: Proprioception, fine touch, 2 pt discrimination Anterior spinothalamic tract Correct Answer: Crude touch A fib Correct Answer: Risk factor for embolic stroke Bell's Palsy cause Correct Answer: Paralysis of CN VIII C5 > C7 Correct Answer: innervation for arm flexion and extension L2> L4 Correct Answer: Extension and flexion legs L4>L5 Correct Answer: Foot flexion and toe extension S3>S5 Correct Answer: Anal sphincter tone 9 - 15 GCS Correct Answer: mild to moderate head injury 3 - 8 GCS Correct Answer: severe head injury Noxious stimuli that trigger autonomic dysreflexia Correct Answer: Bladder/intestinal distension, pressure sores Extreme hip flexion can cause Correct Answer: Inc intra-abdominal pressure; causing inc ICP, flex no more than 90 degrees Fosphenytoin/Phosphenytoin (Cerebyx) dosing for status epilepticus Correct Answer: 15-18 mg/kg given 100-150 mgPE/min IV Lorazepam dosing for status epilepticus Correct Answer: 0.05-0.1 mg/kg IV slow push

Phenobarb dose for status epilepticus Correct Answer: 200-600 mg slow IV Phenytoin sodium (dilantin) dosing for seizure management Correct Answer: 10-15 mg/kg IV not exceeding 50 mg/min Pelvic fx complications Correct Answer: Vascular damage is WORST, can result in high blood volume loss 1st degree sprain Correct Answer: Mild. Mild pain and edema, no joint laxity, able to bear weight 2nd degree sprain Correct Answer: Moderate laxity, edema, point tenderness, swelling, inability to use limb, joint effusion, ecchymosis Tx humeral and scapula fx Correct Answer: Sling and swathe Anatomic snuffbox Correct Answer: Scaphoid carpal bone (outstretched hand falls). Fx here needs splinting even with negative xrays bc fx may not show for 2-4 weeks Lunate bone Correct Answer: on wrist dorsum Ulnar styloid Correct Answer: on side of hand/wrist below little finger Triquetrum Correct Answer: bone on dorsum of wrist Pseudomonas aeruginosa assoc with Correct Answer: Infections from plantar foot puncture wounds

cellulitis, chondritis, osteomyelitis Pasteurella multacida Correct Answer: Cat bite bacteria Strep. pyogenes is assoc with Correct Answer: Resp infections Radial nerve motor component Correct Answer: Extending wrist or thumb Irrigation of wound Correct Answer: with 35 ml syringe, 18 gauge angiocath for pressure of 5-8 psi Vancomycin red man syndrome Correct Answer: Stop infusion, given benadryl. Since not allergic rxn, may be able to start later Hot water heater temp Correct Answer: Set <120 (49 C) Dilantin 1 gram IV dosing Correct Answer: Given over 20 min at minimum (Rate 50 mg/min) Serotonin syndrome Correct Answer: Confusion, agitation, hyperreflexia, hyperthermia, diaphoresis SSRI withdrawal Correct Answer: Lethargy, flu s/s, vertigo, tinnitus Croup Correct Answer: Cough starts 24-72 hrs after URI starts

Pneumomediastinum Correct Answer: Air in mediastinum (space between lungs). Can occur in rapid ascent altitude changes, mech ventilation or trauma resulting in rupture of airways. Pneumothorax caused by inc intrathoracic pressure (asthma, smoking, drugs, etc.) Bronchiolitis infant can be discharged when Correct Answer: Able to tolerate bottle feeds Asthma that does not respond to bronchodilators and occurs at night is caused by Correct Answer: GERD Lowest possible palpable carotid pulse is if SBP is Correct Answer: 60 mm Hg An inc in serum lactate Correct Answer: Body is using anaerobic metabolism to inc energy in shock state Pulm emboli can cause obstructive shock by Correct Answer: Obstructing return of blood to head during systole Common rhythm after electrical shock Correct Answer: V fib Dilutional hyponatremia Correct Answer: Occurs in hot environments with prolonged activity and results in dec LOC and sweating Fomepizole/Antizole Correct Answer: Antidote for ethylene glycol and methanol poisoning Dimer caprol/ British anti lewisite Correct Answer: Antidote for heavy metal poisoning Prussian blue Correct Answer: Antidote for thallium poisoning Methylene blue Correct Answer: Antidote for tx methemoglobinemia Sodium bicarb used for treating what kind of poisoning Correct Answer: TCA Activated charcoal uses Correct Answer: Binding tylenol in overdose or other salicylates. It affects formation and elimination of bezoars Treating N/V in tylenol overdose Correct Answer: Metoclopramide/reglan Indomethacin / Indocin Correct Answer: NSAID, used for pericarditis D- dimer Correct Answer: Test used to evaluate for presence of clots in body (if neg=WNL), checks for PE for example Coarctation of aorta Correct Answer: Aorta narrows or becomes pinched which restricts amt of blood that can go to lower part of body (dec leg BP) Aspirin used for MI pts why Correct Answer: Antiplatelet medicine that reduces mortality risk Beck's Triad of cardiac tamponade Correct Answer: Hypotension, distended neck veins, muffled heart sounds

HF can activate what kind of response? Correct Answer: SNS Thoracic aortic aneurysm Correct Answer: Tearing chest pain, wide mediastinum, varying BPs in arms (difference 20 mm or more SBP higher in L than R) Synchronized cardioversion settings Correct Answer: SYNCH mode where R waves are differentiated Tension pneumo pressures Correct Answer: Air accumulates in pleural space with loss of negative intrapleural pressure>>>expanding positive pressures in thoracic cavity>> pressures inc and great vessels are pushed away from affected side which kinks off great vessels minimizing R atrial blood return>> decreases cardiac output T wave inversion in leads II, III, AVF is a result of? Correct Answer: Inferior ischemia Murphy's sign Correct Answer: Inability to take deep breaths during palpation beneath R costal arch below hepatic margin, assoc with cholecystitis Loperamide/Lomotil side effects Correct Answer: Sedation, dizziness, dry mouth, paralytic ileu, constipation Bismuth salicylate (pepto) can cause Correct Answer: Black leathery tongue When can fistula formation happen Correct Answer: with diverticulitis Common complaint with hiatal hernia and esophatitis Correct Answer: Heartburn Parotitis Correct Answer: Inflamed salivary glands Acute pancreatitis and glucose level Correct Answer: HYPERglycemia (bc of glucagon release) Priority for priaprism Correct Answer: Analgesia Adolescents and pelvic inflammatory disease risk (PID) Correct Answer: Immature immune system and thinner cervical mucus Inevitable abortion Correct Answer: No passage of products of conception but bleeding Methotrexate (trexall) Correct Answer: Taken for ectopic pregnancies, bleeding should not develop until pt has period. Pt should go in for serial HCG testing to make sure it dec or else another injection may be needed Retroperitoneal injuries cannot be diagnosed by Correct Answer: FAST exam Avulsed teeth replacement Correct Answer: within 30 min or less HYPERcalcemia s/s Correct Answer: Wt loss bc of anorexia, N/V, constipation, QT shortening, polydypsia and polyuria When does hypercalcemia occur commonly? Correct Answer: With thiazide diuretics or phosphorus and magnesium abnormalities

Reye's syndrome Correct Answer: Caused by inc ammonia level (>300) >> changes urea synthesis, gluconeogenesis and krebs cycle >> inc ammonia, hypoglycemia, lipid accumulation in cells and lactic acidosis. SGOT level 2-3x normal; SGPT level 2-3x normal CSF fluid normal values Correct Answer: Glucose 50- 75 RBC 0 WBC 0- 5 Fluid pressure 50- 200 Protein 15-45 mg/ Adrenal crisis cause Correct Answer: Primarily from cortisol deficiency Cortisol purpose Correct Answer: Blood volume, BP, hemostasis, glucose Adrenal crisis s/s Correct Answer: Hypotension, tachycardia, tachypnea, fever, abd pain, n/v, confusion, HYPOnatremia, HYPERkalemia Complication: shock Adrenal crisis tx Correct Answer: Fluids, decadron, hydrocortisone, glucose, vasopressors Aminocaproic acid / Amicar Correct Answer: Used for heparin-induced bleeding from peripheral IV and central line sites to dec bleeding from hyperfibrinolysis bc it inhibits activation of plasminogen activator substances Anaphylactic reaction tx Correct Answer: Epi first, 2nd given H2 blockers and benadryl (like ranitidine) to offset histamine release causing urticarial skin lesions Swimmer's itch cause Correct Answer: Allergic rxn to microscopic parasites released in salt or fresh water by infected snails. Should towel dry Hep A Correct Answer: 15-50 day incubation period, pt can be contagious, 4 weeks no work, 2 vax available, can donate blood after 1 year ITP s/s Correct Answer: Hematuria, dec platelet count <150k, positive hemoccult but NORMAL WBC count Thyroid storm tx Correct Answer: PTU (blocks thyroid syn=thesis), given 8 hrs by PO, NG, rectal. Can use glucocorticoids to also block T4>T3 conversion, Use tylenol NOT aspirin bc aspirin displaces thyroid hormone from binding sites. Give IV fluids (5% dextrose+ NS). Also BBs (inderol/propanolol, esmolol/brevibloc) to counter tachycardia Neurogenic shock Correct Answer: Loss of SNS function below SC injury (vagal/parasymp stimulus causes vasodilation, hypotension, bradycardia) Spinal shock Correct Answer: Loss of all neuro function below injury causing flaccid paralysis, loss of spinal reflexes, sensation loss, loss of autonomic function Perfect score on NIHSS stroke scale Correct Answer: 0 (max score is 42)

NIHSS stroke scale measures Correct Answer: LOC, language, neglect, visual field loss, extraocular movements, motor strength, ataxia, dysarthria, sensory loss Tensilon test Correct Answer: Atropine used in case of symptomatic bradycardia does occur if it is cholinergic crisis Guillane-Barre (GBS) Correct Answer: Neuropathy begins in lower, pain usu worse at night, may be urinary retention but not incontinence tPA dosing Correct Answer: 0.9 mg/kg (not to exceed 90 mg) given over 60 min with 10% in bolus over 1 min first Epidural hematoma Correct Answer: Between skull and dura Subdural hematoma Correct Answer: Between dura and subarachnoid layer Tx clavicle fx Correct Answer: Usually self healing, need sling for pain Wound botulism s/s Correct Answer: Weakness, blurred vision, difficulty speaking or swallowing, dry mucous membranes, dilated fixed pupils, progressive paralysis. S/s delayed 36 hrs at least, can occur up to 4 days later Rationale for knee immobilizer Correct Answer: Prevent further soft tissue damage from ligamentous tears Colles fx Correct Answer: of ulna and radius, forms a hump deformity bc of swelling (silver fork). Assoc w/ fx distal 1/3rd ulna where nerve radiates (check radial nerve) Herbals that affect platelet function Correct Answer: Ginger, garlic, ginseng, ginkgo biloba Goldenseal herb purpose Correct Answer: Immune system stimulant Gotu kola herb purpose Correct Answer: improves mental functioning St. Johns wort purpose Correct Answer: Depression, pts can experience transplant rejection with it though Hypokalemia possible causes Correct Answer: Malabsorption (excess K excretion in urine- diuresis, or feces- diarrhea), metabolic acidosis, insulin therapy, transient type if there are high epi levels Child vax schedules Correct Answer: Hib: 1st dose 2 mo Hep B: after birth, 4 wks, then 16 weeks later DTap: 2, 4, 6 mo MMR: 12 mo, then 4-6 years Mitigating circumstances Correct Answer: Brought up by defendent, not plaintiff (person filing suit) Early s/s alcohol withdrawal Correct Answer: Anxiety, insomnia Chest tube uncontrolled bleeding drainage Correct Answer: Output >1500 ml or hourly > 200

Ventilator stacking Correct Answer: When pts BP drops right after being hooked up bc of intrathoracic pressure caused by inability to completely exhale How to fix ventilator stacking? Correct Answer: Disconnect pt from vent, gently compress chest to evacuate lungs, then use small tidal volume and long expiratory times Biggest risk with vent Correct Answer: Pneumothorax caused by PEEP due to overextension of lungs Pt who should get nasotrach intubation Correct Answer: Pt on BiPAP bc this pt needs spontaneous respirations to get this type of intubation (do NOT use in pediatrics) Pleural rub noise Correct Answer: Low pitched grating sound heard more on inspiration than expiration Infant in shock state; glucose Correct Answer: Give 2-4 ml/kg at 25% when level goes below normal during treatment Infant's circulating blood volume Correct Answer: 90 ml/kg Adult's circulating blood volume Correct Answer: 70 ml/kg Urine output in shock needs to be Correct Answer: >0.5 ml/kg/hr Classes of shock Correct Answer: I= compensated, stable VS II= normal mentation, mildly anxious III= confusion, anxiety IV= pulse>140/min, dec BP, dec PP, confusion, lethargy Trauma pts fluid resus Correct Answer: After 5 units PRBCs, give FFP (has clotting factors and fibrinogen which prevent further bleeding) PRBCs can help bleeding related to thrombocytopenia Active internal warming used when pt is Correct Answer: <86 F or <30 C Acute R ventricular MI Correct Answer: Pump function is damage, need to maintain CO by inc preload and give IV crystalloids How to tell if fibrolytic therapy is effective for STEMI Correct Answer: Reperfusion dysrhythmias (ex: accelerated idioventricular) Q waves in EKG can indicate Correct Answer: MI or necrosis A fib first line treatment Correct Answer: Diltiazem in pts in asthma Inferior wall MI Correct Answer: Most likely dysrhythmia is bradycardia bc of ischemia of R coronary artery Torsades de pointes Correct Answer: Caused by prolonged QT, drug toxicity, hypokalemia

A fib s/s Correct Answer: Irregular heart rhythm, dizziness, fatigue and weakness in elderly usually STEMI in leads V1-V4 Correct Answer: Anterior septal MI Why are beta blockers given to STEMI pts Correct Answer: To reduce morbidity and mortality Early s/s hepatic encephalopathy (liver failure) Correct Answer: Asterixis (hand flapping), cognitive changes, irritability, muscle rigidity Acute pancreatitis s/s Correct Answer: Abd pain worse when pt is supine, released with sitting up, pain radiates to back Hemorrhagic pancreatitis Correct Answer: Bluish discoloration over lower abd flanks Cholecystitis Correct Answer: RUQ/epigastric pain after eating fatty food diet Bethanechol side effect and use Correct Answer: GERD. Urinary urgency, inc sphincter pressure and gastric emptying, cholinergic drug Lap belt injury usu causes Correct Answer: Rupture of small bowel or colon IBS instructions Correct Answer: Should not drink foods with meals (distension) Acute prostatitis instructions Correct Answer: Inc fluid intake to eliminate bacteria (can still have sex) Red urine can be caused by Correct Answer: Beets, rhubarb, blackberries Candidiasis Correct Answer: Thick cheesy white discharge Viable fetus if fundal height is Correct Answer: 26 cm or more above symphysis pubis (26 week old fetus) Normal fetal HR Correct Answer: 100- 160 Glucagon hydrochloride use Correct Answer: Relax smooth muscles to aid in food impaction passage Untreated lyme disease can cause Correct Answer: AV blocks, flu s/s, meningitis, hepatitis, arthralgia Adrenal crisis/insufficiency caused by Correct Answer: Not enough glucocorticoid and mineralcorticoid hormones Myxedema coma Correct Answer: Lots of swelling (check airway), hypoventilation, dec CO, profound fatigue, dec activity tolerance, SOB, prolonged QT, ST segment and T wave changes, bradycardia, low body temp. Undiagnosed or untreated hypothyroidism. Viral meningitis s/s Correct Answer: Protein <200, leuks <1000 cells/ml, INC glucose Bacterial meningitis s/s Correct Answer: Protein >200, Leuks >1000 cells/ml, DEC glucose Chronic ITP Correct Answer: Have dec platelet production <150k, tx is to give platelets

Normal body platelet level Correct Answer: 150k-450k Temporal arteritis Correct Answer: Swelling of branches of temporal artery (s/s weight loss, night sweats, aching joints, fever) Inhalation abuse from chlorofluorocarbon can result in what Correct Answer: Thermal burns Antidote for GHB overdose Correct Answer: NONE Phenytoin/Dilantin dosing Correct Answer: Max adult dose 50 mg/min. Elderly 25 mg/min (use LR or NS to dilute) High dose methyprednisolone Solumedrol for pts with injury at C7>T1 level Correct Answer: 30 mg/kg over 15 min, wait 45 min. then 5.4 mg/kg/hr over next 23 hrs. Should be started within 8 hrs of injury Central cord syndrome cause Correct Answer: Hyperextension usually elderly fall pts Central cord syndrome s/s Correct Answer: Loss upper extremities, intact lower extremities, functional bladder and nbowel Autonomic dysreflexia pt should receive what Correct Answer: Ganglionic blocker like hydralazine hydrochloride / Apresoline bc of inc in endogenous sympathetic catecholamines Human diploid cell vaccine (HDCV) Correct Answer: Never give in gluteal area, usu in deltoid Cane use Correct Answer: R leg injury, use cane on L side with elbow at 30 deg of flexion Radial nerve function check Correct Answer: Thumbs up hitchhikers sign Confirm shoulder dislocation by Correct Answer: AP films/XR joint Titrating NTG (Tridil) w/ acute inferior wall MI pt Correct Answer: Must dec drip rate when pt experiences a dec in chest pain level and BP of 86/56 (common side effect of NTG is headache and hypotension but SBP <90 should be avoided) Echinacea herb contraindicated for Correct Answer: Cancer pts and autoimmune disease pts bc it stimulates immune system EMTALA and hospital property Correct Answer: Within 250 yards of the building Fluticasone and salmeterol inhalation powder (Advair) contains corticosteroids that can Correct Answer: Cause depressive symptoms esp in elderly (also emotional lability, lack of motivation, difficulty sleeping, appetite loss) Anorexia nervosa Correct Answer: Amenorrhea, low body wt, hypotension, tachycardia, cardiac dysrythmias, dehydration, intolerance to cold Panic anxiety state s/s Correct Answer: Hyperventilating, rapid pulse, pale skin and mucosa, cognitive impairment

Respiratory system and elderly Correct Answer: Dec muscle strength, inc residual volume MDI use Correct Answer: Activate at beginning of inhalation phase Tracheal transection s/s Correct Answer: Resp distress, neck swelling, subcutaneous emphysema S/s inc intrathoracic pressure Correct Answer: Anxiety, dec breath sounds, tracheal deviation, hypotension Steps to confirm ET tube placement Correct Answer: 1. auscultate absent epigastric sounds with chest rise, if sounds heard could be in esophagus

2. bilateral breath sounds Laryngotracheobronchitis (croup family) Correct Answer: Barking cough, mild stridor, low grade fever. Cool humidified O2, racemic neb epi (tx starts in 30 min only lasts 2 hrs, can repeat but check pulse) Albuterol adverse effects Correct Answer: Tachycardia, PVCs, palpitations, HYPOkalemia Arterial blood gas of pregnant pt Correct Answer: DEC paCO2 (30-34), INC pH, INC bicarb Early s/s pneumonia in elderly Correct Answer: acute confusion, lethargy Hypovolemic shock early s/s Correct Answer: Gradual inc rate and depth of respirations Autotransfusion of blood more than 25-50% total volume what happens Correct Answer: Dilution of clotting factors which can result in coagulopathies Recombinant human activated protein C (Xigris) Correct Answer: Contraindicated for presence of bleeding risk Antivenom should be given Correct Answer: within 4 hrs of bite (does not work well after 12 hrs) Salicylate toxicity Correct Answer: Hyperthermia, confusion, hallucination, tachypnea, pulmonary edema, dehydration, renal failure Opioid ingestion s/s Correct Answer: Pinpoint fixed pupils Rule of Nines Correct Answer: Leg 18%, anterior leg 9% (superficial burns not calculated) Hydrofluoric acid (HF) exposure tx Correct Answer: Apply Ca gluconade bc HF penetrates skin and affects Ca in bone and tissue. Applying water will worsen burn Who does NOT need transfer to burn center Correct Answer: Pts with partial thickness <10% Nerve agent poisoning from organophosphates (fertilizers) Correct Answer: Inhibits enzyme acetylcholinestrase (AChE), allows excess acetylcholine at neuro junctions and causes overstimulation of organs S/s fertilizer poisoning Correct Answer: Lacrimation, salivation, n/v, bradycardia

Sting ray venom Correct Answer: Heat labile and will dissipate while soaking it in warm or hot water Lateral MI Correct Answer: I, V5, AVL, V Anterior MI Correct Answer: V1, V2, V3, V Posterior MI Correct Answer: Reciprocal changes in V1 and V Inferior MI Correct Answer: II, III, AVF Pacemaker Correct Answer: Has unique asynchronous rate for beginning of life, elective replacement indicator, and end of life. Use magnet to put pacemaker into fixed rate and determine if battery needs to be replaced Troponin Correct Answer: Measures myocardial tissue damage specifically CK Correct Answer: Measures all muscle tissue destruction Arterial pressure reading with dampened waveform cause Correct Answer: Air inside system, flush out closest port Arterial pressure transducer Correct Answer: Keep at phlebostatic axis (4th ICS and mid axillary line or at level of R atrium) Upper GI bleed Tx Correct Answer: Stabilize ABCs, give proton pump inhibitor (acid suppression therapy) to dec risk of recurrent bleeding (balloon tamponade is temporary). NO ICED lavage Tx ibs Correct Answer: High fiber diet Balloon tamponade precaution Correct Answer: Keep scissors at bedside in case of airway obstruction Umbilical cord protrusion tx Correct Answer: Place pt on left side Pregnancy induced HTN (PIH) s/s Correct Answer: Visual changes, headache, R upper abd pain, dec urination DIC Correct Answer: Accelerated activation of the coagulation cascade and assoc with elevated liver enzymes, HELLP syndrome, severe eclampsia, hemolysis Lefort I Correct Answer: Transverse fx of maxilla above upper teeth at level of nasal floor Lefort II Correct Answer: Pyramidal shaped fx that involves triangular segment of the midportion of the face and nasal bones Lefort III Correct Answer: Complete separation of the cranial attachments from the facial bones, results in craniofacial dysjunction

Fractured larynx s/s Correct Answer: Hoarseness, dysphagia, stridor, hemoptysis, SOB, cough, difficulty speaking Digoxin toxic in elderly Correct Answer: Renal blood flow, glomerular filtration rate and creatinine clearance dec in advanced age, reduced ability to clear toxins Sickle cell kids have greater chance for Correct Answer: Ischemic stroke Kussmaul breathing Correct Answer: More common with DKA Adrenal disease Correct Answer: Can't regulate the amt aldosterone to maintain sodium and water by kidneys>>>aldosterone dec and sodium and water are dec >> K is retained>>> HYPERkalemia TSH levels and hyperthyroidism Correct Answer: Decreased Rubeola Correct Answer: Red measles (assoc with Koplik spots) Donepezil (Aricept) Correct Answer: Overdose can lead to cholinergic crisis (N, inc salivation, diaphoresis, bradycardia, hypotension) Elderly are at greater risk for what kind of hematomas Correct Answer: Epidural Subarachnoid hematoma (SAH) Correct Answer: Usu caused by aneurysm rupture by inc ICP and not physical injury Boxer's fracture Correct Answer: Distal 5th metacarpal Gas gangrene Correct Answer: History of intestinal or gallbladder surgery or minor trauma to old scar containing spores (clostridium perfinges) Subluxations are caused by Correct Answer: Loose surrounding support structures ligaments and tendons How to test sensory aspect of radial nerve Correct Answer: Checking for feeling on dorsum of hand Face sutures Correct Answer: 3-5 days Most sutures Correct Answer: 7-10 days Lower legs and feet sutures Correct Answer: 10-14 days Normal INR range Correct Answer: 0.8-1. Pt with A fib INR range Correct Answer: 2.0-3. HIPAA and med errors in chart Correct Answer: Should be changed within 60 days but hospital can make changes up to 90 Descriptive research Correct Answer: Describes problem or clinical issue that has not been examined before where little research has been done

Threatening pt is Correct Answer: Assult Mental health holds are Correct Answer: Usually 72 hrs Benzo withdrawal s/s Correct Answer: Anxiety, disorientation, hand tremors, flu like s/s Pulm embolism causes Correct Answer: Immobilization, oral contraceptives, pelvic surgery (like hysterectomy) Pulsus paradoxus Correct Answer: Dec >10 mm Hg in SBP during inspiration in disorders that cause high negative intrathoracic pressure (COPD) or restrictive forces on heart (tamponade). Can be seen in severe asthma and pericardial effusion Child breathing Correct Answer: Diaphragm is usually used bc intercostal muscles are poorly developed Pt bleeding acutely on warfarin Correct Answer: Give FFP so that clotting factors can be normal The following must be ABO compatible Correct Answer: whole blood, PRBCs, cryoprecipitate, FFP Best indicator of shock in peds Correct Answer: Tachycardia (initially) Best sepsis survival Correct Answer: Prophylactic against DVTs and stress ulcers Primary blast injuries Correct Answer: Mostly affects air filled organs (cerebral air embolism, pneumothorax) Revised trauma score Correct Answer: SBP, RR, glasgow coma scale (4 pts for each) TCA antidepressant s/s side effects Correct Answer: Neurotoxic, cardiotoxic, anticholinergic Ethylene glycol toxicity Correct Answer: metabolism by alcohol dehydrogenase produces oxalic and formic acids. Ca oxalate crystals can be visualized in urine by UV light or Woods lamp Iron toxicity Correct Answer: use of deferoxamine/Desferal antidote, vin rose urine discoloration Vasopressin/pitressin Correct Answer: Adrenergic agent thatcan be swapped with epi for ACLS pulseless rhythm Pericarditis chest pain is relieved by Correct Answer: Rest and NTG (Tridil) Pathologic Q waves Correct Answer: Negative deflection after P wave deeper than 1/3 QRS height or longer than 0.04 seconds How to lower BP in pt with chronic HTN and altered autoregulation Correct Answer: Dec BP by 20- 30% over 2-3 hrs Renal impairment can be caused by Correct Answer: Higher serum levels digoxin and hyperkalemia

Amiodarone dose to tx wide complex tachycardia Correct Answer: 150 mg bolus IV q10 min then continuous infusion R atrial hypertrophy Correct Answer: in leads II and III by tall peaked P waves >2.5 mm height L atrial hypertrophy Correct Answer: broad notched P waves > 0.11sec and biphasic P waves in V with broad terminal negative deflections Peaked T waves V1-V5 Correct Answer: Hyperkalemia Prinzmetal's angina Correct Answer: aka variant angina, occurs at rest usually at same time each day, poor prognosis Ludwig's Angina Correct Answer: Expansion of existing dental infection untreated or cellulitis into submandibular, sublingual or submental types Pericarditis and EKGs Correct Answer: ST segment elevation in all leads; in stable pts tx is medical (NSAIDs) and can occur following viral infection Diagnose aortic aneurysm Correct Answer: Chest radiograph (widened mediastinum) Risk factor for infective endocarditis Correct Answer: IV drug abuse Risk factor for pericarditis Correct Answer: systemic lupus erythematous (SLE) Risk factor for myocarditis Correct Answer: Exposure to environmental toxins Pancreatitis stool Correct Answer: Foul smelling fatty Tarry stools are associated with Correct Answer: Peptic ulcers Nonoperative management of blunt splenic and hepatic injuries Correct Answer: Serial VA, abd physical exam for inc peritoneal signs, Hct and Hgb trends Acute pancreatitis labs Correct Answer: DEC bilirubin, INC amylase, DEC glucose, INC calcium Cholecystitis relief of colicky pain tx Correct Answer: gastric decompression with NG tube and low intermittent suction and NPO Licorice increases what Correct Answer: Digoxin activity Psyllium/Metamucil and antacids Correct Answer: Dec digoxin absorption Renal trauma Correct Answer: Microscopic or gross hematuria During miscarriage need to do what labs Correct Answer: A blood type and screen to check for Rh factor (if neg will need Rhogam injection) Prerenal failure example Correct Answer: Hypovolemia

Intrarenal failure Correct Answer: Rhabdomyolysis and glomerulonephritis Postrenal failure Correct Answer: Urethral obstruction Pain and ectopic pregnancy Correct Answer: Quality and nature is important to diagnose Hyperkalemia and HR Correct Answer: Can lead to bradycardia Detached retina Correct Answer: Shield both eyes to prevent movement Meniere's disease Correct Answer: Episodic, frequency of attacks ranges from several times a month duration 20 min - > 12 hrs Vestibular neuronitis Correct Answer: Vertigo s/s with hearing loss that are continuous N/V Normal eye pH Correct Answer: 7.0-7. Acetazolamide (Damox) Correct Answer: Inhibits hydrogen ion excretion in renal tubules, inc K excretion; can result in hypokalemia Malignant otitis externa (MOE) Correct Answer: Life threatening condition if infection spreads to deeper structures from recurring ear infection despite antibiotic tx Cholesteatoma Correct Answer: Complication of otitis media; erosion of bone in middle ear Lateral sinus thrombosis Correct Answer: Associated with otitis media, headache usually presenting s/s Mastoiditis Correct Answer: s/s postauricular redness, swelling Necrotizing fascitis Correct Answer: Common with elderly, tx surgery, present with severe pain from abrasion with a fever Meningeal irritation s/s Correct Answer: Pain after flexing and extending leg with or without fever (in thigh) Herpes zoster Correct Answer: Moves down sensory nerve, dermatonal pain, skin lesions may last up to 3 weeks Packed red blood cells can cause hypocalcemia bc Correct Answer: Citrate binds with free calcium (need IV Ca chloride or Ca gluconate) Pertussis Correct Answer: AB tx up to 3 weeks, neg nasopharyngeal culture, resolved cough and fever indicate infection is gone Thyroid storm Correct Answer: Low TSH, high thyroxin T4 levels in hyperthyroidism Initial fluid for tx HHNC pt Correct Answer: 0.9% saline, after glucose dec to 200-300, convert fluids to D5W with NS

SIADH Correct Answer: HIgh ADH > excess H2O retention > hyponatremia> cerebral edema > high seizure risk Fibromyalgia tx Correct Answer: Warm bath at night, massage, use of heat, exercise, get enough sleep, NSAIDs, antidepressants, pace activities Burr holes Correct Answer: Used to place intracranial monitoring device or remove epidural or subdural hematoma Meningeal irritation triad Correct Answer: Nuchal rigidity, fever, altered LOC Diabetes inspidus Correct Answer: HYPERnatremia bc of ADH deficit Complications of methylprednisolone (Solu Medrol) therapy Correct Answer: Impaired wound healing, GI bleeding, infection, hyperglycemia, HTN, hypokalemia, thrombocytopenia. Used for spinal cord injury to help with return of sensation. Penumbra Correct Answer: Ischemic area around area of infarction; in a stroke (need to reperfuse it) 1/2 trauma related deaths are a result of Correct Answer: head trauma What injuries are assoc with autonomic dysreflexia? Correct Answer: T6 and above lesions Generalized seizures Correct Answer: Brief lapse of awareness with or without LOC "staring into space, maybe with minor motor movements Atonic seizures Correct Answer: Sudden loss of muscle tone, assoc with myoclonic jerks (fall to the ground) Bursitis causes Correct Answer: Trauma, direct blow, prolonged repetitive use Clavicle fx s/s Correct Answer: Pt cannot raise arm above head Humeral head fx s/s Correct Answer: Cannot move arm Scapular fx Correct Answer: Pain with shoulder movement Shoulder dislocation Correct Answer: Limited range of motion of arm; have deformity to shoulder Costochondritis Correct Answer: Pts have reproducible pain with point tenderness to palpation of chest wall RSI Correct Answer: Premedicate with lidocaine and defasciculating nose of a nondepolarizing neuromuscular dose blocking agent (ex: vecuronium/Norcuron)....prevents the INC ICP Selleck maneuver/ Cricoid pressure Correct Answer: Used to visualize vocal cords during RSI and minimizes vomiting and aspiration Arterial line complication Correct Answer: Unrecognizable disconnection could result in severe blood loss

Arterial line waveform damping Correct Answer: Occurs when catheter lodges against arterial vessel wall Transport to tertiary center should occur if pt has Correct Answer: Altered LOC, status epilepticus, near drowing, blunt abd trauma and unstable Informed consent Correct Answer: Description of procedure, alternatives, risks, benefits, acknowledgment that pt or legal caregiver understands all of the components. Full understanding not under the influence with full legal capacity. Implied consent Correct Answer: Any appropriate tx in emergency if pt is unable to give consent (based on assumption that pt would have given consent) Expressed consent Correct Answer: Written or oral agreement for tx (consent for evaluation, meds, xrays, labs) Involuntary consent Correct Answer: Pt refuses to consent and doc and police ensure that pt gets tx Restraint use Correct Answer: Pt must have 1 hour of face to face observation at initiation; max of 4 hrs; after a new order is needed Paranoia Correct Answer: Delusional psychotic thought system, Ex: persecution or excessive religious sentiment Tartive dyskinesia Correct Answer: Late appearing side effect of anti psychotic drugs characterized by involuntary movements of mouth, tongue and jaw The most common etiologies for severe mental status changes are Correct Answer: Organic in nature (ex: meds, drug intoxication, withdrawal, general illness) Ruptured diaphragm causes Correct Answer: Blunt force trauma or penetrating injury; abd cavity contents herniate into thorax which creates pressure on lungs, resp compromise and forces mediastinal shift mimicking tension pneumo (breath sounds are heard only on upper lobes) Spontaneous pneumothorax Correct Answer: Males young 20-40, SOB, chest pain on side of pneumo, hypotension BiPAP and CPAP Correct Answer: Must be continuous in order to be effective; cannot take mask off Cromolyn (Intal) inhaler Correct Answer: Does not tx acute attacks of bronchosspasm, does not inc RR, has minimal side effects, caffeine has no effect on it. Mast cell inhibitor; blocks release of inflammatory mediators which can prevent late phase rx of asthma Caffeine can inc levels of what drug Correct Answer: Aminophylline/theophylline Elderly pt lung changes Correct Answer: Inc WOB, inc residual volume, INC functional residual capacity. Impaired ventilation while supine (keep semi to high Fowlers), dec elastic lung recoil How to dec diaphragmatic excursion Correct Answer: Change from supine to Fowlers position

Pneumomediastinum s/s Correct Answer: Vary, chest pain below sternum, progressive SOB Pneumomediastinum tx Correct Answer: Mediastinoscopy (scope), thoracostomy, percutaneous drainage (all to remove gas) Hyperbaric chamber Correct Answer: Tx for air or gas embolism, decompression sickness, carbon monoxide poisoning Cricothyrotomy complication Correct Answer: Subcutaneous emphysema (air leakage from interrupted airway), AIR COLLECTS UNDER DERMAL LAYERS How to assess severity of asthma attack Correct Answer: Peak expiratory flow rate before and after tx plus O2 sat levels Diaphragmatic hernia more likely to occur where Correct Answer: On L side bc liver provides protection PEFR Correct Answer: 50-70% of personal best (yellow zone) indicates moderate exacerbation and need for pt to take rescue inhaler and follow Rx tx plan. <50% (red zone) indicates need for med care. Acute epiglottitis Correct Answer: edema above level of vocal cords (severe sore throat, fever, mouth breathing, drooling, tripod or sniffing position); rapid onset Definitive dx test PE Correct Answer: High res multidetector CT angiography. V/Q scans determine likelihood of PE; D dimer test misses 10% pts with PE while 30% are false positives Foreign body aspiration tx Correct Answer: Give glucagon and benzo like diazepam to induce smooth muscle relaxation and pass object. Resolved when pt can drink a cup of water Capnography shark fine waveform Correct Answer: Bronchospasm by uneven emptying of alveoli (ex: asthma) Lap belt injuries Correct Answer: Risk for lumber spine fx as well as duodenal and pancreatic injuries Class II hemorrhage category (15-30% blood loss) Correct Answer: Pulse >100 beats/min, but less than 120. BP normal, mildly anxious Cardiogenic shock meds Correct Answer: NTG/Tridil>>dec preload Norepinephrine bitartrate (Levophed) Correct Answer: Inc afterload Dopamine and milrinone Correct Answer: Inc contractility and dec afterload Cardiogenic shock s/s Correct Answer: Heart has inadequacy to pump>> backs up into venous system and lungs>>distended neck veins, tachypnea, hypotension, tissue hypoxia Responses when pt loses 30% circulating blood volume Correct Answer: Inc preload from vasoconstriction and inc total peripheral resistance