Cards
What is the best initial therapy for an unstable patient in afib?
Synchronized cardioversion
What are contraindications to thinners for a DVT?
-Active bleeding
-Platelets <20K (call Heme)
-Neurosurgery, ocular surgery, head bleed within 20 days (I'd call if it's within a month)
-Brain mets (Call Neurosurg)
-Recent major abd surgery or GI bleed (call specialist)
-objective weakness/paralysis
-hyporeflexia
What is the most common congenital bleeding disorder?
Von Willebrand's Disease
What are the symptoms of compartment syndrome?
PAIN OUT OF PROPORTION
pallor
cold
pulse deficit
paresthesia
paralysis
What are the symptoms of hypertrophic cardiomyopathy?
What is the initial treatment?
1. angina, dyspnea, syncope, lightheadedness
2. beta blockers
-> myomectomy or ICD
Avoid inotropic drugs
Which drugs are the most effective for CHRONIC mgmt of CHF w/ dilated cardiomyopathies?
ACE inhibitors
What is the most common cause of euvolemic hyponatremia?
SIADH
Syndrome of Inappropriate AntiDiuretic Hormone
(I think of meds, infection, brain injury, cancer)
What is the condition that causes severe tissue hypoxia with normal O2 sats/ no peripheral cyanosis?
carbon monoxide poisoning
What is the most common cause of death in patients with pelvic fractures?
hemorrhagic shock
What do you do when you find an incidental AAA?
What is the most important characteristic about the AAA?
[Incidental means no symptoms]
Diameter dictates:
<4cm won't rupture
3-4cm is monitored annually w/ US
4-4.5cm is monitored q6 months w/ US
>4.5cm is a referral to Vascular Surgery
What is the earliest & most common rhythm disturbance with digitalis toxicity?
PVC's
How long after someone stops drinking can withdrawal begin?
Mild symptoms within 2 hours!
Seizures between 6-48h
Psychosis 12-48h
massive blood transfusions, exchange transfusions, or ECMO can cause bleeding by this mechanism
dilutional thrombocytopenia
How can you distinguish a pulmonary contusion from ARDS on chest x-ray?
pulm contusion- minutes to hours after injury, looks like a consolidation or infiltrate, localized to a lobe or segment
ARDS- delayed onset 12-72h, diffuse patchy infiltrates
Which patients should get prophylaxis for infective endocarditis and when?
Who:
-prosthetic valves
-hx of endocarditis
-any prosthesis in the heart for a congenital defect
-status post heart transplant w/ abnormal valve
When:
-dental cleaning
-bronch
-ERCP
-cystoscopy
When are ACE inhibitors contraindicated?
1. PMH angioedema
2. hyperkalemia
3. bilateral renal artery stenosis or unilateral renal artery stenosis if you have 1 kidney
4. PREGNANCY HARD NO
5. severe aortic stenosis
What Endocrine pathology is assoc with afib & CHF?
thyrotoxicosis
Why do we use O neg PACKED cells instead of O neg WHOLE BLOOD prior to cross match?
packed cells have less anti-A & anti-B antibodies
(we use O positive RBC's in men & post menopausal women)
What are reversible mimics of brain death?
hypothermia
barbiturate coma
baclofen OD
benzo OD
What is the most common complication from ICD's and what causes them?
(Implantable cardioverter/defibrillators)
Inappropriate shocks
Caused by SVT, afib, other atrial arrhythmias, NSVT
In a heart transplant patient, what do you give for symptomatic bradydysrhythmias?
isopreterenol
Atropine won't work because they don't have parasympathetic innervation.
What are the lab findings in Addison's disease?
Hyponatremia
Hypokalemia
Hypercalcemia
What is the most common life-threatening viral infection in transplant patients?
CMV
...but bacterial infections are more deadly
When do we use steroids for head injury?
we don't