CCT-Kendra's Notes

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  1. Potassium Lab Value
    3.5-5.0
  2. Calcium Lab Value
    8.8-10.4
  3. Magnesium Lab Value
    1.5-2.5
  4. Sodium Lab Value
    135-145
  5. Glucose Lab Value
    70-110
  6. BUN Lab Value
    6-23
  7. Creatinine Lab Value
    .6-1.4
  8. CK/CPK Lab Value
    60-400
  9. Serum Osmolarity Lab Value
    285-295
  10. Ammonium (adult) Lab Value
    15-45
  11. Ammonium (kids) Lab Value
    40-80
  12. BNP Lab Value
    less than 100
  13. WBC Lab Value
    4.5-10.5
  14. HgB Lab Value
    12-18
  15. HCT Lab Value
    36-52
  16. Platelets Lab Value
    140-400
  17. Urinary Output (adult) Lab Value
    30-50
  18. Urinary (peds) Lab Value
    1-2 ml/kg/hr
  19. Sodium Lab Value for CHI
    Sodium greater than 155
  20. Sodium Lab Value for seizures
    Sodium less than 120
  21. High BUN indicates (3)
    1-Blood in GI 2-Dehydration 3-Renal failure
  22. High BUN (>23) and high Creatinine (>1.4)
    Acute renal failure lab values
  23. CK/CPK >2000
    Lab Value for Rhabdomylosis
  24. CHI Lab Value
    Serum Osmolarity >320
  25. Liver Failure Lab Value
    Ammonia >45
  26. Reyes syndrome with chicken pox Lab Value
    Ammonia (peds) >80
  27. CHF Lab Value
    BNP >100
  28. Dehydration Lab Value
    HCT >52
  29. Thrombocytopenia Lab Value
    Platelets <140
  30. Electrical injury urinary output (adult)
    100ml/hr
  31. Electrical injury urinary output (peds)
    2-4ml/kg/hr
  32. CVP Lab Value
    2-6
  33. PVR Lab Value
    100-250
  34. PWP Lab Value
    8-12
  35. PAS Lab Value
    15-25
  36. PAD Lab Value
    8-15
  37. SVR Lab Value
    800-1200
  38. CI
    2.5-4.3
  39. Central Venous Pressure measures
    Right side heart reload measured by
  40. Pulmonary Vascular Resistance measures
    Right sided afterload measured by
  41. Pulmonary Wedge Pressure measures
    Left sided pre-load measured by
  42. Systemic Vascular resistance measures
    Left sided afterload measured by
  43. PAC poximal port measures
    CVP and CO of right atrium and right atrial pressure
  44. PAC distal port measures
    Opens to pumonary artery/ PAP / Wedge
  45. PAC Balloon Port measures
    PAWP / Wedge
  46. Infusion Port
    Fluids
  47. PAC poximal port color
    Blue port on PAC
  48. PAC distal port color
    yellow port on PAC
  49. PAC Balloon Port color
    Red port on PAC
  50. Infusion Port color
    White port on
  51. Phlebostatic axis
    Nipple line/Midaxilary line 4th intercostal
  52. Zero Referencing
    Stock cock off to patient and opened to air
  53. Normal fast flush for PAC
    less than 2 oscillations
  54. Underdamening fast flush for PAC
    more than 2 oscillations, slow return, Long or stiff tubing, air in system, loose connections, Overestimates BP
  55. Overdampening
    no oscillations, slow return to baseline, tip of catheter against wall, low pressure bag, underestimates BP
  56. Pulmonary artery Dichrotic notch
    closure of pulmonic valve
  57. Causes of increased PA pressure (5)
    • Left ventriclar failure
    • Increased pulmonary vascular resistance (cor pulmonae)
    • mitral stenosis/regurgitation
    • Left-right shunts
    • Liver failure
  58. Positive Allens test
    after occluding ulnar and radial arteries, when radial released palm turns pink
  59. Catheter whip
    Waveform jagged and sharp, high BP, length of tubing, moving catheter tip
  60. Swan emergency ventricular waveform
    • PAC falls into right ventricle
    • Anacrotic notch correlates with QRS
    • Rise in pressure
    • Waveform loks like v-tach
    • Inflate balloon and float back into PA
    • If unable to float into PA pull back and switch meds to distal port
  61. a wave on CVP
    • atrial contraction
    • correlates with p wave
  62. c wave on CVP
    • closure of tricuspid/ventricular contraction
    • correlates with QRS
  63. x wave on CVP
    • Descent atrial relaxation
    • Depolarization of Right atrium
    • Correlates after the QRS
  64. v waveon CVP
    • Atrial passive filling
    • Tricuspid is open
    • correlates tiwh T wave
  65. y wave on CVP
    • Atrial emptying
    • correlates after t wave
  66. Absence of a waves
    • Cannon a waves
    • sharks in the water
    • a-fib
    • severe hypovolemia
  67. Large V waves
    mitral regurgitation shows which type of CVP waveform
  68. How to measure CVP
    • locate z-point (end of QRS or c wave)
    • C wave to c wave
  69. Measure CVP at end of expiration
    • nonintubated--inspiratory is down and expiratory is up
    • intubated--inspiration is up and expiration is down
  70. Left atrial waveform measured (2)
    • .08-.12 sec delay from CVP pressure wave
    • measured at end of expiration
  71. PAWP in pulmonary congestion
    • 20=mild
    • 25=moderate
    • 30=severe
  72. PAWP in ARDS
    PAWP greater than 12 but less than 20
  73. How to perform a wedge
    • inflate balloon with up to 1.5ml over 2-3 seconds
    • stop with change in waveform
    • keepp less than 8-15 seconds
    • if there's blood in balloon, stop and clamp off port
  74. Cardiac tamponade signs/symptoms (5)
    • If PAWP=PAD
    • Pulsus Paradoxus
    • Becks triad
    • dresslers syndrome
    • pericardial effusion
  75. Pulsus paradoxus
    drop in pressure by 10-15 mmHg when pt takes a breath
  76. Becks triad
    • hypotension
    • Kussmaul sign
    • Muffled heart tones
  77. Kussmaul sign
    Rise in jugular venous pressure (JVP, the filling of the jugular vein) on inspiration
  78. Dresslers syndrome (8)
    • pericarditis-->cardiac tamponade
    • 2-3 weeks after heart surgery
    • latent viral infection
    • low grade fever
    • chest pain
    • pericardial friction rub
    • pleural effusion
    • increased Sed Rate
  79. Pericardial effusion (2)
    • water bottle appearance
    • electrical alternans (stops when effusion goes to tamponade)
  80. Ejection fraction formula
    • systolic volume / diastolic volume
    • normal range 58%-75%
  81. Coronary Persusion Pressure formula
    • diastolic BP-wedge
    • 50-60mmHg
  82. Cardiac output formula
    • stroke volume x heart rate
    • 4-8 lpm
  83. stroke volume
    EDV-ESV
  84. Cerebral Perfusion PRessure
    • MAP-ICP
    • 70-90
  85. Mean aterial pressure
    • (diastolic x2 + systolic)/3
    • 80-100
  86. Intracranial pressure
    0-10
  87. Pulse pressure
    systolic BP-Diastolic BP
  88. Anion Gap
    Na-(Cl+HCO3)
  89. Heparin overdose treatment
    Protamin sulfate
  90. TCA OD Tx
    sodium bicarb, physostigmine (sz)
  91. Acetaminophen OD Tx
    • 150mg/kg
    • tx with mucomyst (N-acetylcysteine)
  92. Salicylate poisoning Tx
    forced diuresis with sodium bicarb to get alkaline urine to help excrete and not get reabsorbed
  93. Organophosphate poisoning
    Atropine-->2Pam-->Praloxidime
  94. myadriasis
    dilated pupil
  95. miosis
    constricted pupil
  96. ptosis
    droopy eyelid
  97. anisocoria
    unequal pupils
  98. corectopia
    • irregular shaped pupil
    • ?cataract
  99. Janeway lesions
    • red nonpainful areas on soles and palms
    • ?Enocarditis
  100. Oslers nodes
    • Painful sores on palms and soles
    • ?endocarditis
  101. Roths spots
    • retinal hemorrhage
    • ?endocarditis
  102. Horners
    • Ipsilateral ptosis
    • miosis
    • anhydrosis
    • ?lesion in sympathetic pathway in brain stem/upper spinal cord
  103. Stevens Johnson Syndrome
    Rash / skin sloughs off
  104. Trousseaus sign
    • BP / carpal pedal spasms
    • ?hypocalcemia
  105. Chirsteks Sign
    • Cheek tap=rapid jerky movements
    • ?hypocalcemia
  106. Grey Turners sign
    • bruising -flank / retroperitoneal
    • ?pancreatitis/retroperitoneal and intraperitoneal hemorrhage
  107. Halstead sign
    • marbled abdomen
    • ?necrotic pancreatitis
  108. Markles sign
    • rebound tenderness on palpation to abdomen
    • ?peritoneal irritation

    • Halsted sign
    • discoloration of breast
    • ?ca
  109. Rovsings sign
    • palpate LLQ and pain in RLQ
    • ?appendicitis
  110. Aarons sign
    • McBurney's point pressed and pain in epigastrum
    • Appendicitis
  111. McBurney point
    Middle between umbilicus and left iliac crest
  112. Psoas Sign
    • lying on side flex or extend leg back+pain RLQ
    • Heel tap on right heel+pain in RLQ
    • ?appendicitis
  113. Kehrs sign
    • referred shoulder pain while supine
    • ?spleen injury
    • ?ectopic pregnancy
  114. Murphys sign
    • pain during deep palpation or RUQ
    • ?Gallbladder/cholecystitis
  115. Coopernails sign
    • eccymosis in peritoneum / scrotum / labia
    • ?pelvic Fx
  116. Mount Fuji sign
    • air is tented
    • ?tension pneumocephalus
  117. Babinski reflex
    • Abnormal-toes go up and flare
    • normal-flexor plantar toes go down
    • Peds--opposite due to cortical pathways not fully mylinated
    • ?upper motor dysfunction
  118. Hammans sign
    • auscultation of anterior breath sounds as a crunching or crackling
    • ?tracheal bronchial injury (fixed with intentional right mainstem intubation)
  119. Jeffersons fracture
    • axial loading
    • ?c1 fracture
  120. Virchows triad
    • pain
    • Hot skin/ swelling
    • deep muscle tenderness
    • ?venous thrombosis
  121. Waddell's triad
    • head, abdominal and lower extremity injury
    • caused by auto vs pediatric pedestrian
  122. Septic shock
    • SVR less than 800
    • High CI
  123. Neurogenic schock
    • SVR less than 800
    • Low CI
    • Low HR
  124. Anaphylactic shock
    • SVR less than 800
    • CI low
    • HR high
  125. Hypovolemic schock
    • SVR more than 1200
    • low CVP
  126. Cardiogenic shock
    • SVR greater than 1200
    • high CVP
    • hich PWP
  127. R ventricular MI
    • high CVP
    • low PWP
  128. C3, C4, C5
    Keeps the diaphragm alive
  129. c5
    shoulders clavicles
  130. c6
    index finger and thumb / above t6 + hyperreflexia
  131. c7
    middle finger
  132. c8
    pinky
  133. c5, c6, c7
    upper limbs (lateral)
  134. c8-t1
    upper limbs (medial)
  135. t4
    nipple line
  136. t10
    umbilicus
  137. L1
    inguinal
  138. L4
    knee
  139. L5
    big toe
  140. s1
    small toe
  141. S3-4
    sacral
  142. epidural bleed presentation
    • uncal herniation
    • ipsilateral pupil dilation
  143. subarachnoid bleed presentation (5)
    • severe HA
    • vomiting
    • brudzinski's sign
    • confusion
    • ALOC
  144. ponteen bleed presentation
    constricted pupils
  145. intraparenchymal bleed (CVA)
    • embolic
    • hemorrhagic
    • thrombic
  146. Damaged area for Cheyne stokes resp pattern
    bilateral hemispheres
  147. Damaged area for central neurogenic resp pattern
    Midbrain / above pons
  148. Damaged area for apneustic resp pattern
    below pons
  149. Damaged area for ataxic resp pattern
    medulla
  150. s/s of anterior cord injury
    complete motor pain and temperature loss with proprioception vibrations and touch
  151. s/s of brown-sequard cord injury
    ipsilateral loss of moto position and vibration. Central lateral loss of pain and temperature
  152. s/s of central cord injury
    greater motor weaknes in upper extremities than lower.
  153. CHF on xray
    fluffy margins / Kerley B Lines / silhouette appearance / cardiomegaly
  154. ARDS on xray
    ground glass appearance / no pleural effusion
  155. Linear skull fx on xray
    line extends to base of skull
  156. linear stellate fx on xray
    central focal point with multiple fx outwards
  157. diastatic on xray
    separation of bones at suture line / bone fragments
  158. depressed on xray
    indentation--don't cover
  159. laforte 1 on xray
    horizontal across maxilla
  160. laforte2 on xray
    bridge of nose and down around mouth / jaw
  161. laforte3 on xray
    transverse from ear to eyes to bridge of nose to ear
  162. thumb print on xray
    • epiglottitis
    • lateral chest xray
    • bacterial
    • supraglottic
    • over 4 years
    • high fever
  163. steeple on xray
    • croup
    • anterior chest xray
    • 6mo-4yrs
  164. Angel wing on xray
    thymus gland
  165. afib with WPW tx
    • Amiodarone
    • 1. 150mg d5w over 10 minutes
    • 2. 1mg/min over 6hrs
    • 3. .5mg/min over 8hrs maintenance drip
    • contraindication-verapamil, cardizem, adenosine, digitalis
  166. hypercalemia tx
    • insulin
    • d50
    • alb SVN
    • CaCl,
    • NaHCO3
    • Kayexalate
  167. Pericardial effusion presentation
    electrical alternans on ecg
  168. pericardial tamponade presentation
    • becks triad
    • tx with periocentesis-
    • 3" needle with 3 way stop cock,angle 10-15 degrees to left shoulder just left of the subxiphoid process and aspirate unclotted blood
  169. pulmonary contusion presentation
    hemoptysis (1-1 1/2 blood in alveolar tissue)
  170. Myocardial Contusion presentation
    • decreased cardiac output
    • dysrhythmias
    • right ventrical is more commonly injured
  171. Parkland fluid replacement for burns
    • 4ml x kg x BSA% in first 24 hours
    • half in eight hours
    • rest over sixteen hours
  172. Hyperemia burn
    • 1st degree
    • redness
  173. Stasis burn
    • 2nd degree
    • Blisters
  174. Coagulation burn
    • 3rd degree
    • through to the bone
  175. Venous thrombosis
    • Virchows triad:
    • pain
    • hotskin / swelling
    • deep muscle tenderness
  176. Arterial thrombosis
    • pain uncontrolled
    • cool / pale skin
  177. Henry's gas law
    • combo of boyle's and charles' law
    • bends
    • gas in liquid =bubbles
  178. daltons gas law
    • parts make up total pressure
    • increase pressure=increase partial pressure
    • soft tissue swelling
  179. boyle's gas law
    • volume and pressure
    • expansion / contraction of gas at a constant temperature
  180. graham's gas law
    • gas exchange at cellular level
    • 20x CO2 then O2
    • gas diffusion
  181. Gay Lussac's gas law
    • pressure and temperature
    • O@ pressure gauge tanks
    • increase temperature / increase pressure
  182. Charle's gas law
    • volume and temperature
    • volume expands with increased temperature
  183. Atmospheric pressure
    1 atm every 33 feet of water
  184. histoxic hypoxia
    poisoning
  185. hypemic hypoxia
    anemia
  186. hypoxic hypoxia
    altitude
  187. stagnant hypoxia
    decrease cardiac output / pooling og blood (CHF)
  188. Local day flight restrictions
    • 500' ceiling
    • 1 mile
  189. local night flight restrictions
    • 800' ceiling
    • 2 miles
  190. Cross country day restrictions
    • 1000' ceiling
    • 1 mile
  191. cross country night restrictions
    • 1000' ceiling
    • 3 miles
  192. Emergency transmit frequency
    121.5
  193. sterile cockpit
    • flight crew on talks during take off and landing
    • begin to lose night vicion
    • 5000'
  194. Ketamine
    • sedation of patient with asthma.
    • decreases mucous plugging
    • reflexes intact
    • analgesic and amnesthic properties
  195. Peds ET size
    (age +16)/4
  196. peds ET depth
    10+age
  197. newborn ET depth
    6+ kg
  198. peds Foley, salem pump, and suction catheter sizes
    2xETT
  199. peds chest tube size
    4xETT
  200. Cricoid
    narrowest portion of airway for kids under 10
  201. glottic opening
    Narrowest opening after age 10
  202. neonate HR
    120-160 bpm
  203. neonate RR
    40-60 bpm
  204. neonate BP
    over 60 systolic
  205. infant HR
    80-120 bpm
  206. infant RR
    30-40 bpm
  207. infant BP
    over 70 systolic
  208. peds HR
    60-100 bpm
  209. peds RR
    20-30 bpm
  210. peds BP
    over 80 systolic
  211. peds systolic BP
    (age x2) + 70
  212. peds diastolic BP
    2/3 systolic BP
  213. Mauricearu's maneuver
    finger in baby's mouth with breech delivery
  214. McRoberts Position
    Knees up to shoulders
  215. Turtle sign
    seen with shoulder dystocia. Head comes out with contraction but goes back in
  216. Precipatate delivery
    delivery within 2 hours of onset of contractions
  217. variable deceleration contractions
    cord problems (hr110-160)
  218. early decelerations problem
    • Head compression
    • mirror image of mom's contractions
  219. late decelerations
    Uterine placental insufficiency
  220. preeclampsia
    • metabolic hypoxia
    • U shaped contractions
  221. Sinusoidal waveform
    fetal anemia
  222. omphalocele
    abdominal contents protrude into base of the umbilical cord
  223. gastroschisis
    doesn't involve umbilical cord
  224. chanal atresia
    narrow blockage of nasal airway
  225. esophageal atresia
    can't pass OG tube
  226. Pierre Robin syndrome
    • small lower jaw with tongue that falls back
    • high arched palate
  227. renal agenesis
    no kidneys
  228. dobutrex
    • inotropic
    • tx to keep BP above 80 systolic
  229. dopamine
    • inotropic, chronotropic, dromotropic
    • tx to keep BP above 80 systolic
  230. milrinone
    Inotropic
  231. lanoxin
    • cardiac glycoside
    • increase myocardial contraction and decrease HR in a-fib
  232. cardesartan
    angiotensin II blocker
  233. valsartanAngiotenson II blocker
    • carvedilol
    • betablocker
    • contraindicated in dig toxicity
    • contraindicated in meth / cocaine OD
  234. labetolol
    • betablocker
    • no alpha and can be given to meth / cocaine OD
  235. Hydralazine
    vasodilator
  236. isosorbide
    vasodilator
  237. nitroglycerin
    vasodilator
  238. lasix
    loop diuretic
  239. Bumex
    loop diuretic
  240. demadex
    loop diuretic
  241. edecrine
    loop diuretic
  242. neseritide
    synthetic BNP
  243. amiodare
    • antiarrythmic
    • afib with WPW history
  244. procainamide
    • antiarrythmic
    • max dose 17mg/kg
    • cease if hypotension or QRS greater than 50% of original width
  245. KCL
    • electrolyte balance
    • tx hypokalemia
    • 10 meq/hr
  246. amitriptaline
    TCA
  247. imipramine
    TCA
  248. doxepin
    TCA
  249. nortryptaline
    TCA
  250. deferoxamine
    Iron supplement
  251. Iron toxicity
    urine is pink
  252. praloxidime
    • reactivation of acetylcholinestrase
    • tx organophosphate poisoning
  253. prostagladin
    PDA dependent patient
  254. indomethacin and o2
    closes PDA after delivery
  255. methergine
    • vasoconstrictor
    • given for postpartum hemorrhage after oxytocin
  256. Sandostatin
    • vasoconstrictor
    • esophageal varices / GI bleed
  257. DOBUTREX
    DOBUTAMINE
  258. DOPAMINE
    INOTROPIN
  259. LANOXIN
    DIGOXIN
  260. CARDESARTAN
    ATACAND
  261. VALSARTAN
    DIOVAN
  262. HYDRALAZINE
    APRESOLINE
  263. ISOSORBIDE
    ISORDIL
  264. NITROGLYCERIN
    TRIDIL
  265. LASIX
    FUROSEMIDE
  266. BUMEX
    BUMETANIDE
  267. DEMADEX
    TORSEMIDE
  268. NESERITIDE
    NATRECOR
  269. AMIODARE
    CARDONE
  270. PROCAINAMIDE
    PRONESTYL
  271. AMITRIPTALINE
    ELAVIL
  272. IMIPRAMINE
    TROFANIL
  273. DOXEPIN
    SINEQUAN
  274. NORTRYPTALINE
    PAMELOR
  275. DEFEROXAMINE
    DESFORAL
  276. METHERGINE
    METHYLERGONOVINE
  277. SANDOSTATIN
    OCTREOTIDE

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Author:
Tmc9
ID:
129178
Filename:
CCT-Kendra's Notes
Updated:
2012-01-20 22:45:40
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Kendra's Notes
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