Diabetic ketoacidosis
The only ketone body produced in diabetic ketoacidosis that does not react with the nitroprusside reagent urine strips
What is B-hydroxybutyrate ?
Note: Ketones reagent strips depend on the development of a purple color after acetoacetate reacts with nitroprusside. Some strips can also detect acetone, but none react with B-hydroxybutyrate.
The two 'shockable' rhythms when a cardiac arrest has occurred
What is Ventricular fibrillation and pulseless ventricular tachycardia ?
Target blood glucose levels in the critically ill patient
What is 140 - 180 mg/dL ?
Note: Hyperglycemia in critically ill ICU patients is associated with poor outcomes. Glucose levels of 140 – 180 mg/dL are currently recommended to avoid extremes of hyperglycemia or hypoglycemia and are only achievable with insulin infusions and frequent glucose checks.
What is N - acetylcysteine ?
Drug of choice for anaphylactic shock
What is intramuscular epinephrine ?
Note: anaphylactic shock is best treated with intramuscular epinephrine. Epinephrine is a very effective treatment for anaphylactic shock as it is a bronchodilator and vascoconstrictor
pH at which bicarbonate administration is indicated in the management of diabetic ketoacidosis
What is pH < 6.9 ?
Recent studies suggest that this parameter, which can be measured in real time, can be utilized to help determine prognosis during cardiac arrest
What is end - tital CO 2 ?
Also accept: capnography
Note: Recent studies have indicated that EtCO2 can help determine prognosis during cardiac arrest. Patients with an EtCO2 of < 10 mmHg after 20 minutes of CPR are highly unlikely to achieve ROSC.
Clinical parameters used in the calculation of the rapid shallow breathing index
What is respiratory rate and tidal volume (in liters) ?
Note: The rapid shallow breathing index (RSBI) has been shown to predict successful extubation. The RSBI is calculated using the respiratory rate divided by the tidal volume in liters. A RSBI < 105 is a predictor of successful extubation.
First line treatment in both ethylene glycol and methanol toxicity
What is Fomepizole ?
Note: Fomepizole is a competitive inhibitor of alcohol dehydrogenase and has replaced ethanol as the treatment of choice in ethylene glycol / methanol toxicity
SIRS criteria
What is fever/hypothermia, tachypnea > 24 BPM, HR > 90 BPM, and WBC > 12,000 ?
Also accept: Leukopenia < 4000, > 10% bands
In DKA management, IV insulin infusion may be tapered and transitioned to subcutaneous insulin when these laboratory parameters are met (comment on blood glucose, serum anion gap, serum bicarbonate, and venous pH)
What is blood glucose < 200 mg/dL, serum anion gap < 12 mEq/L, serum bicarbonate > 15 mEq/L, and venous pH 7.3 ?
The 5 T's that are common reversible etiologies/precipitants of cardiac arrest
What is thrombosis (MI, PE), Toxins, cardiac tamponade, tension pneumothorax ?
Note: The 5 H's that are reversible causes of cardiac arrest include: hypoxia, hypovolemia, hyper/hypokalemia, hypothermia, hydrogen ion (Acidosis)
Ventilation goals in ARDS (comment on tidal volume, inspiratory plateau pressure)
What is tidal volume < 6 ml / kg IBW & inspiratory plateau pressure < 30 Cm H20 ?
Tetrad of findings that characterize neuroleptic malignant syndrome
What is mental status change, muscular rigidity, hyperthermia, and autonomic instability ?
The most common cause of cardiogenic shock
What is acute myocardial infarction ?
The two most common precipitants of diabetic ketoacidosis
What is infection and discontinuation/inadequate insulin intake ?
Note: Other common precipitants of DKA include: acute medical illness (MI, CVA, sepsis, pancreatitis), drugs (thiazides, steroids, dobutamine, atypical antipsychotics, drugs of abuse (cocaine, amphetamine)
The most important predictor of survival after cardiac arrest
What is the quality of chest compressions ?
Note: Current ACLS guidelines have changed the order from ABC to CAB; the focus is on chest compressions first. The timing and quality of chest conmpressions are the most important predictor of survival after cardiac arrest.
What is captopril ?
Note: Captopril is preferred treatment of scleroderma renal crisis due to its rapid onset of action and extensive reported use in scleroderma renal crisis. The treatment should be continued even if renal function initially worsens and some patients may need hemodialysis following long-term control of blood pressure with angiotensin converting enzyme inhibitors
Antidote for tricycle antidepressant intoxication
What is sodium bicarbonate infusion (drip) ?
Note: the standard of care in TCA toxicity is bicarbonate administration
What is phenylephrine ?
What is serum K < 3.3 mEq/L ?
The two most common underlying and potentially reversible causes of pulseless electrical activity
What is hypoxia and hypovolemia ?
The four T's score used to assess the probability of heparin induced thrombocytopenia takes these four parameters into account
What is thrombocytopenia, thrombosis, timing, and oTher causes ?
Note: The diagnosis of immune mediated (Type 2 or delayed-onset) HIT is often suspected based on the 4 Ts score and is confirmed with HIT antibody testing. Empiric treatment with a nonheparin anticoagulant (argatroban) and the avoidance of all heparin-containing products should be initiated while awaiting confirmation. Transition to warfarin can occur once the thrombocyotepnia has resolved on alternate anticoagulation. Total treatment duration is unclear but those with an active thrombus are usually treated for at least 6 months.
Antidote for parathion intoxication
What is pralidoxime ?
Also accept: Atropine
Note: parathion and malathion are organophosphate poisons. They inhibit acetylcholinesterase in the synaptic junction by covalently binding to the enzyme. By inhibiting acetylcholinesterase, acetylcholine levels remain elevated int he synaptic junction, thereby resulting in increase stimulation of both nicotinic and muscarinic receptors. Pralidoxime is used as an antidote for acetylcholinesterase inhibitors as it acts to reactivate inhibited acetylcholinesterase. Atropine can also be used to treat the muscarinic symptoms associated with nerve gas poisoning.
Drug used in epinephrine refractory anaphylaxis in patients taking beta blockers
What is glucagon ?