CCRN > Barron Multisystems > Flashcards

Barron Multisystems Flashcards

(54 cards)

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1
Q

How does SNS and RAAS maintain BP?

A

SNS detects decreased CO and stimulates SNS which vasoconstricts. RAAS secretes renin, which converts angiotensin 1 to 2, which vasoconstricts. Also secretes aldosterone which retains water and sodium

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2
Q

S/s of compensatory stages of shock

A

Tachycardia, respiratory alkalosis, increased work of breathing, normal PaO2, blood pressure maintained, anxiety, pale, cool skin, oliguria

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3
Q

Progressive Shock

A

Hypotension, worsening tachycardia, worsening tachypnea, worsening oliguria, metabolic acidosis, decrease PaO2, clammy mottled skin, further changes in level of consciousness

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4
Q

Refractory Shock

A

Not responsive to interventions, MODS

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5
Q

Hypovolemic Shock and its Treatment

A

Reduction in intravascular volume leading to low tissue perfusion. Caused by third spacing or outside cause like burns, or bleed. Causes Narrow BP!!
SVR IS THE ONLY THING INCREASED FOR THIS SHOCK

-2 LARGE IV
-REPLACE VOLUME
-AVOID PRESSORS IF YOU CAN
-IDENTIFY CAUSE
-USE ISOTONIC FLUIDS
-USE FLUID WARMER IF OVER 2L OF FLUIDS BEING GIVEN IN 1 HR

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6
Q

NS vs LR

A

NS: LARGE VOLUMES MAY LEAD TO HYPERCHLOREMIC ACIDOSIS
DONT GIVE TO THOSE WITH HYPERNATREMIA AND RENAL FAILURE

LR: MIMICS ECF, MAY CAUSE LACTIC ACIDOSIS

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7
Q

Hemorrhagic Shock and its treatment. Risks of blood product

A

CLASSES 1- UP TO 750 ML/15%-CRYSTALLOIDS
2-UP TO 750-1500/15-30%-CRYSTALLOIDS
3 UP TO 1500-2000, 30-40%-CRYSTALLOID AND BLOOD
4 OVER 2000/OVER 40%-CRYSTALLOID AND BLOOD

STOP THE BLEEDING
RBC DON’T HAVE COAGULATION FACTORS SO CRYO (FIBRINOGEN), PLTS, AND FFP (INR)

-Trali, hypothermia, hypocalcemia, hypomagnesemia

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8
Q

Triad of death

A

HYPOTHERMIA, ACIDOSIS, COAGULOPATHY

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9
Q

MTP

A

10 units in 24 hrs or 5 units in less than 3 hours

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10
Q

SIRS

A

FEVER OR HYPOTHERMIA
HR OVER 90
RR OVER. 20 AND. UNDER 10
WBC HIGH OR LOW OR NORMAL
NO INFECTIOUS SOURCE

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11
Q

WHAT IS qSOFA score?

A

Bedside evaluation score to identify patients with suspected organ dysfunction:
1. Systolic 100 or lower?
2. RR equal or over 22
3. GCS under 15

2 or 3 score means high probability

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12
Q

Severe Sepsis

A

Sepsis and markers of organ dysfunction

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13
Q

Septic shock

A

Hypotension d/t infection
-pressors required despite adequate fluid resuscitation
-serum lactate over 2 despite fluid resuscitation

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14
Q

S/s of early septic shock and s/s of late septic shock

A

Early: tachy, hypo, but responds to pressors, lactate over 2, confusion, oliguria, fever

Late:hypotension, but not as responsive to pressors, lactate over 4, tachy, lethargy/coma, anuria, hypothermia

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15
Q

True or False: pt with sepsis or septic shock always has positive bc

A

FALSE

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16
Q

Treatment for septic shock/sepsis

A

-30ml/kg of CRYSTALLOID,
-if fluid not fixing bp, then start pressors-LEVO is first line, epi second
Add on vasopressin if already on large amount of pressors
-obtain bc as early as possible
-Abx after bc if possible within 1 to 3 hrs
-obtain lactate
-If MAP below 65 OR lactate is below 4, reassess the fluid status: ask provider or measure the cvp/assess fluid responsiveness with leg raise/bedside echo/measure scvo2
-Add on inotropic gut-dopamine

If oxygenation goals not met: consider more fluids, dobutamine get max 20, maybe PRBC if hub less than 7

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17
Q

End Goal of Septic Shock

A

-map adove 65
-decreased lactate
-normal hr
Normal uo
Warm extremities
Mentation is back
Source control
Oxygen goals met

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18
Q

Anaphylactic shock and its treatment

A

IgE mediated hypersensitivity reaction to protein substances such as penicillin, contrast media, bee sting, food, latex
Causes histamine release
Causes hypotension, decreased co, dilates, increases capillary permeability, and cause bronchospams, and laryngeal edema

Treatment include oxygen, remove offensive agent, and IM .3-.5 mg of epi, aggressive fluid, Benadryl, steroids give asap, inhaled beta adrenegric agent

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19
Q

Sequential Organ Failure Assessment (SOFA)

A

SCORE 0-4
HYPOTENSION
GCS
PAO2/FIO2
CREATININE OR UO
BILIRUBIN
PLATELET

HIGHEST 24, HIGHER WORSE

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20
Q

TRAUMA

A

ABCDEFG

AIRWAY
BREATHING
CIRCULATION
DISABILITY
FULL SET OF VITAL

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21
Q

SEDATION LEVELS

A

MINIMAL-REPSONDS TO VERBAL COMMANDS
MODERATE-REPSONDS TO VERBAL/TACTILE CAN MAINTAIN AIRWAY
DEEP-NOT EASILY AROUSABLE
GENERAL ANESTHESIA- LOSS OF CONSCIOUSNESS

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22
Q

AGITATION AND SEDATION WHAT TO RULE OUT

Study These Flashcards
A

RULE OUT HYPOXEMIA, HEMODYNAMIC INSTABILITY, AND PAIN
-DELIRIUM, WITHDRAWAL, SLEEP DEPRIVATION, IMMOBILITY, ANESTHETICS, SEDATIVES, STEROIDS, PRE EXISTING CONDITIONS, DEMENTIA, ENVIRONMENTAL

23
Q

PRECEDEX

Study These Flashcards
A

-DO NOT PARALYZE SOMEONE ON DEX
-NO LOADING DOSE

24
Q

KETAMINE

Study These Flashcards
A

IV BOLUS AND GTT
MAY CAUSE HYPERSALIVATION/INCREASE IN BP/HR
-CAN CAUSE PSYCHOSIS/PRETREAT WITH A BENZO

25
LOREZAPAM
GTT OR LOADING DOSE -USE A FILTER FOR GTT -TURN OFF GTT EVERYDAY -20 MAX IF ON OVER 10 CONTACT PHYSCIAN
26
VERSED
LOADING DOSE, GTT TURN OFF EVERYDAY CONTACT IF OVER 10
27
PROPOFOL
CONT INFUSION CAN BE USED FOR STATUS EPILEPTICUS- CAN GO UP TO 150 DONT PARALYZE CHNAGE TUBING Q SHIFT COUNT AS CALORIES PROPOFOL INFUSION SYNDROME- LONG TERM USE BASICALLY CAUSES BODY CELLS TO NOT PRODUCE ENERGY EFFECTIVELY LEADING TO SEVERE ACIDOSIS, HEART/MUSCLE PROBLEMS/KIDNEY FAILURE NO PAIN PROPERITIES ONLY FOR VENTED TURN OFF EVERYDAY
28
BENZO REVERSAL WITH FLUMAZENIL (ROMAZICON)
.2 MG IV OVER 15 SECONDS FOR MODERATE SEDATION AND 30 SECONDS FOR OVERDOSAGE REPEAT DOSE AT 1 MINUTE INTERVALS -3 MG TOTAL IN 1 HOUR ONSET 1-2 MINUTES RESEDATION OCCURS AFTER AN HOUR MONITOR FOR RESP DEPRESSION FOR AT LEAST 2 HOURS
29
SAT SCREENING REQUIREMENTS
NO MI NO ACTIVE SEIZURE NO ALCOHOL WITHDRAWL NO PARALYSIS GTT STABLE ICP NO RECENT INCREASE IN SEDATION TO MAINTAIN RASS SCORE
30
SAT FAILURE
DANGEROUS AGITATION SUSTAINED TACHYPNEA/INCREASED WOB ACUTE ARRYTHMIA, HYPOXEMIA HYPOTENSION
31
NARCAN DOSAGE
.4 MG TO 2MG IV EVERY 2 MINUTES-MAX OF 10 DURATION IS 1 TO 2 HRS
32
TTM INCLUSION CRITERIA
-CA WITH ROSC UNRESPONSIVE OR NOT FOLLOWING COMMANDS AFTER ARREST WITNESSED ARREST WTIH DOWNTIME OF 1 HR
33
TTM EXCLUSION CRITERIA
PREGNANCY CORE TEMPERATURE OF LESS THAN 35 UNDER 18 OR OVER 65 DNR OR TERMINAL DISEASE CHRONIC RENAL FAILURE DRUG INTOXICATION HEMODYNAMIC INSTABILITY SHOCK ACTIVE BLEEDING SUSTAINED ARRHYTHMIA CHRONIC RENAL FAILURE
34
3 PHASES OF TTM
INDUCTION: LOWER THE PT TEMP TO 32-36 ASAP MAINTENANCE:KEEP AT 32-36 FOR 24 HR REWARMING:SLOWLY INCREASE TEMP TO 36.5-37
35
INDUCTION PHASE
GET EKG DEEP SEDATION MANAGE SHIVERING BY COVERING HEAD/HAND/FEET USING DEMEROL: USE NEUROMUSCULAR AGENT IF SHIVERING IS NOT CONTROLLED WITH DEMEROL BLOOD GLUCOSE OBTAIN BASELINE LABS SYS GOAL 90 AND MAP ABOVE 70
36
SYSTEMIC EFFECTS OF HYPOTHERMIA
INSULIN RESISTANCE WHICH CAUSE HYPERGLYCEMIA ELECTROLYTE/FLUID SHIFT SHIVERING SKIN BREAKDOWN PUPIL/CORNEAL REFELX ABSENT DUE TO HYPOTHERMIA DECREASED CARDIAC OUTPUT PLATELET DYSFUNCTION INCREASED RISK OF INFECTION
37
MAINTENANCE PHASE
OBTAIN BS AND INITIATE INSULIN GTT AS NEEDED TOF IF PARALYTIC 1-2
38
REWARMING PHASE
-STOP ALL POTASSIUM ADMINISTRATION 8 HR PRIOR TO REWARMING SINCE IT CAN CAUSE REBOUND HYPERKALEMIA, D/C PARALYTIC PUPIL AND CORNEAL REFLEX MAY CONTINUE TO BE ABSENT FOR SOME TIME
39
IF A PATEINT IS CAMATOSE BE PREPARED TO…
50DEXTROSE, THIAMINE 50-100, NARCAN 2MG GIVE CHARCOAL FOR GASTRIC LAVAGE MONITOR URINE OUTPUT/ANTIDOTE REMOVAL OF DRUG
40
TYLENOL OVERDOSE-SIGN AND SYMPTOM/TREATMENT
N/V/LATER RUQ PAIN/LIVER RESULTS ABNORMAL/CONFUSION NAC 8HRS AFTER INGESTION 140MG LOADING THEN 70 EVERY 4 GI LAVAGE WITHIN 4 HR AFTER INGESTION
41
BENZO S/S/TREATMENT
DORWSY, CONFUSION, SLURRED SPEECH, RESP DISTRESS,HYPOTENSION, ASPIRATION SUPPORT AIRWAY ROMAZICON .2MG IV PUSH THEN .3 THEN .5 TOTAL 3 MG SHORT HALF LIFE WATCH FOR REOCCURENCE LAVAGE WITH CHARCOAL FLUID RESUSCITATION
42
BETA BLOCKER OVERDOSE S/S/TREATMENT
BRADYCARDIA/HYPOTENSION/CV COLLAPSE GIVE GLUCAGON, EPI, INSULIN PLUS DEXTROSE, SODIUM BICARBONATE
43
CCB OVERDOSE S/S / TREATMENT
BRADY,HYPOTENSIVE, CV COLLAPSE TREATMENT INCLUDES CALCIUM GLUCONATE, EPI, INSULIN PLUS DEXTROSE, SODIUM BICARBONATE
44
COCAINE OVERDOSE S/S / TREATMENT
SEIZURE ACTIVITY, AGITATION, HYPERTHERMIA, RHABDO ACTIVATED CHARCOAL, COOLING, FLUIDS, GLUCOSE, THIAMINE IV, VASOPRESSIN PREFERED OVER EPI IN FULL ARREST VASODILATOR FOR HTN, CCB/NITRATES FOR ISCHEMIA ABSOLUTELY NO BETA BLOCKER
45
ETHYLENE GLYCOL (STUFF IN ANTIFREEZE) OVERDOSE S/S/ TREATMENT
VOMITTING, INTOXICATED BEHAVIOR, RENAL FAILURE, METABOLIC ACIDOSIS, ANION GAP GASTRIC LAVAGE, SODIUM BICARBONATE,ETHANOL OR FOMEPIZOLE DIALYSIS
46
ETHANOL ETOH OVERDOSE/S/S/TREATMENT
STUPOR, RESPIRATORY DEPRESSION, ASPIRATION RISK, INTERMITTENT AGITATION PROTECT AIRWAY, FLUID RESUSCITATION, MV AND THIAMINE 100MG IV ,electrolyte replacement, ciwa protocol for int agitation-benzo
47
Methamphetmaine overdose/s/s/treatment
Fever, tachycardia, htn, seizure, agitation, renal failure Fluids, cooling, benzo, haldol, physical restraints
48
Opioid overdose s/s treatment
Drowsiness,hypoventilation, hypotension, hypothermia, deep sedation, pinpoint pupils Support the airway, NARCAN .4-2 mg if every 2 minutes 10 max Gastric LAVAGE with activated charcoal
49
PCP (PHENCYCLIDINE)
BLANKSTARE, RAPID INVOLUNTARY EYE MOVEMENT, HALLUCINATION, SEVERE MMOOD DISORDER, FLUSHING , SWEATING, COMA, SEIURE, HYPERTENSION, TACHY, SUPPORT AIRWAY, PROVIDE CALM ENVIRONMENT, BENZOS, FLUID, COOLING, MONITOR RENAL
50
SALICYLATES OVERDOSE S/S TREATMENT
VOMITTING, TINNITUS, CONFUSION, HYPERTHERMIA, RESPIRATORY ALKALOSIS, METABOLIC ACIDOSIS, MULTIPLE ORGAN FAILURE ACTIVATED CHARCOAL, URINE ALKALIZATION , DIALYSIS REGARDLESS OF ADMISSION FUNCTION TO PREVENT INJURY
51
TRICYCLIC ANTIDEPRESSANT S/S/TREATMENT
SHCOK, ARRYTHMIA, DROSWY,DELIRIUM,COMA,SEIZURE, ANTICHOLINERGIC SIGNS: BLURRED VISION, FEVER,, TWITCHING SODIUM BICARBONATE, ACTIVATED CHARCOAL, CARDIAC MONITORING, FLUIDS
52
CLABSI PREVENTION/MAINTENANCE/MONITORING
ASEPTIC DURING INSERTION, HAND HYGEIEN, CHG BATH, DISINFECT CATHTER HUBS,ASEPTIC TECHNIQUE FOR DRESSING CHANGE, DONT CHANGE THE LINE UNLESS IT WAS PLACED EMERGENTLY PERFORM ROOT CAUSE ANALYSIS DEVELOP PROCESS FOR MEASURING COMPLAINCE WItH POLICY AN STAFF SHARE RESULTS WITH STAFF ASSESS COMPETENCY FOR STAFF REQUIRE EVERYONE TO BE EDUCATED ON CLABSI
53
CAUTI PREVENTION/MAINTENANCE
FOR2 CONSECUTIVE DAYS REMOVE WHEN NO LONGER NEEDED ASEPTIC TECHNIQUE FOR INSERTION/2 PERSON ASSESS STAFF COMPETENCY ROOT CAUSE ANALYSIS
54
MDRO
SOAP AND WATER FOR C DIFF FOCUS ON RAPID IDNEITFICATION OF MDRO ROOT CAUSE ANALYSIS
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