Gold standard diagnostic test for abdominal trauma
CT
Chronic Liver Failure electrolyte imbalances, glucose levels, and labs
Low: Sodium, mag, K, Ca
Hypoglycemia, low albumin
Increased RBC, decreased platelets, fibrinogen (at risk for bleeding), decreased WBC (at risk for infection)
Increased aldosterone and ADH
What (2) infusions are used to achieve hemostasis post esophageal bleed
Octreotide and vasopressin. Both decrease venous portal pressure.
Folks with pancreatitis are at risk for breathing complications. What type and what would you see on imaging?
Inflammation from the pancreas near the left diaphragm can cause pleural effusions.
Or you can get pulmonary infiltrates- ARDS!
If pancreatitis is caused by a gallstone how is it treated?
ERCP
What labs would you see in a patient with pancreatitis?
Amylase elevates in 24 hours, lipase
Hypocalcemia, hypokalemia, hypomagnesemia
Low albumin
leukocytosis
Hyperglycemia
What is refeeding syndrome
In a starvation state cells use up phosphate for ATP production- patient is in hypophosphatemia. This causes a left shift on oxyhemoglobin curve- less oxygen available to vital organs and tissues. Leading to organ and respiratory failure (due to respiratory muscles not having enough O2)
Introduction of nutrition can cause the release of insulin pushing K into cells (K may be depleted) and pushing magnesium into cells causing cardiac arrhytmias
What is the main electrolyte to monitor for in refeeding syndrome?
Phosphate.
Your patient had a gastric sleeve surgery. What 2 big things do you monitor for?
Leak- sepsis
Bleed
Your patient had a Roux en Y what do you monitor for?
What should you teach?
Leak and bleed
Small pouch only holds 30 mL- start slow with diet (Dr. Now). Diet is protein based
The nurse knows that they need to monitor for these 4 acute things in the hospital after gastric bypass
Leak, bleed, DVT, hypoglycemia
What long term issues after gastric bypass?
Dumping syndrome, vitamin deficiences, lactose intolerance
Your patient is C. Diff positive. What kind of bug and what kind of tx?
Gram + anaerobe
1. Oral vanco only (no IV) or fidaxomicin
Your patient with a hx of Roux en Y gastric bypass comes in with a small bowel obstruction and needs urgent decompression. The nurse knows this procedure is contraindicated
NG tubes must only be inserted under fluroscopy due to potential for pouch rupture. Therefore blindly inserting an NG tube is contraindicated
Fibrinolytic considerations for stroke (times)
- Door to needle time 60 mins
- Time of last known normal to needle: 4.5 hours
- Age over 80, anticoag, hx stroke or DMII, baseline NIH greater than 25 the time to needle is 3 hours
Remember BP less than 185/110
Right sided stroke typically manifests (movement, language)
Left sided deficits, understands language, rambling speech
Left sided stroke
Right sided deficits, aphasia, acalcula, labile
Absolute contraindications to fibrinolytics
Aortic dissection, history of aneurysm, embolic stroke within one year, active internal bleeding, pericarditis, intracranial tumor
(Merck manual)
Relative contraindications to fibrinolytics
High blood pressure, trauma or surgery within 4 weeks, pregnancy, peptic ulcer, INR greater than 2, non compressible vascular access, coagulopathies
(Merck)
This disease manifests with a long PR interval, R BBB, structural R ventricle pathlogy, short QT. What is it and how is it treated?
Brugunda sydrome- sodium channelopathy. treated with ICD or quinidine
Hypertrophic cardiomyopathy clinical manifestations (3)
S4, murmur (mitral regurg), displaced PMI
Hypertrophic cardiomyopathy treatment
Beta blockers and/or calcium channel blockers
Avoid: Inotropes like dig or dobutamine
This murmur occurs during systole and manifests with pulmonary edema and rales
aortic stenosis
Apical diastolic murmur
mitral stenosis
