CCT-Kendra's Notes

3.5-5.0

8.8-10.4

1.5-2.5

135-145

70-110

6-23

.6-1.4

60-400

285-295

15-45

40-80

less than 100

4.5-10.5

12-18

36-52

140-400

30-50

1-2 ml/kg/hr

Sodium greater than 155

Sodium less than 120

1-Blood in GI 2-Dehydration 3-Renal failure

Acute renal failure lab values

Lab Value for Rhabdomylosis

Serum Osmolarity >320

Ammonia >45

Ammonia (peds) >80

BNP >100

HCT >52

Platelets <140

100ml/hr

2-4ml/kg/hr

2-6

100-250

8-12

15-25

8-15

800-1200

2.5-4.3

Right side heart reload measured by

Right sided afterload measured by

Left sided pre-load measured by

Left sided afterload measured by

CVP and CO of right atrium and right atrial pressure

Opens to pumonary artery/ PAP / Wedge

PAWP / Wedge

Fluids

Blue port on PAC

yellow port on PAC

Red port on PAC

White port on

Nipple line/Midaxilary line 4th intercostal

Stock cock off to patient and opened to air

less than 2 oscillations

more than 2 oscillations, slow return, Long or stiff tubing, air in system, loose connections, Overestimates BP

no oscillations, slow return to baseline, tip of catheter against wall, low pressure bag, underestimates BP

closure of pulmonic valve

• Left ventriclar failure
• Increased pulmonary vascular resistance (cor pulmonae)
• mitral stenosis/regurgitation
• Left-right shunts
• Liver failure

after occluding ulnar and radial arteries, when radial released palm turns pink

Waveform jagged and sharp, high BP, length of tubing, moving catheter tip

• 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

• atrial contraction
• correlates with p wave

• closure of tricuspid/ventricular contraction
• correlates with QRS

• Descent atrial relaxation
• Depolarization of Right atrium
• Correlates after the QRS

• Atrial passive filling
• Tricuspid is open
• correlates tiwh T wave

• Atrial emptying
• correlates after t wave

• Cannon a waves
• sharks in the water
• a-fib
• severe hypovolemia

mitral regurgitation shows which type of CVP waveform

• locate z-point (end of QRS or c wave)
• C wave to c wave

• nonintubated--inspiratory is down and expiratory is up
• intubated--inspiration is up and expiration is down

• .08-.12 sec delay from CVP pressure wave
• measured at end of expiration

• 20=mild
• 25=moderate
• 30=severe

PAWP greater than 12 but less than 20

• 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

• If PAWP=PAD
• Pulsus Paradoxus
• Becks triad
• dresslers syndrome
• pericardial effusion

drop in pressure by 10-15 mmHg when pt takes a breath

• hypotension
• Kussmaul sign
• Muffled heart tones

Rise in jugular venous pressure (JVP, the filling of the jugular vein) on inspiration

• 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

• water bottle appearance
• electrical alternans (stops when effusion goes to tamponade)

• systolic volume / diastolic volume
• normal range 58%-75%

• diastolic BP-wedge
• 50-60mmHg

• stroke volume x heart rate
• 4-8 lpm

EDV-ESV

• MAP-ICP
• 70-90

• (diastolic x2 + systolic)/3
• 80-100

0-10

systolic BP-Diastolic BP

Na-(Cl+HCO3)

Protamin sulfate

sodium bicarb, physostigmine (sz)

• 150mg/kg
• tx with mucomyst (N-acetylcysteine)

forced diuresis with sodium bicarb to get alkaline urine to help excrete and not get reabsorbed

Atropine-->2Pam-->Praloxidime

dilated pupil

constricted pupil

droopy eyelid

unequal pupils

• irregular shaped pupil
• ?cataract

• red nonpainful areas on soles and palms
• ?Enocarditis

• Painful sores on palms and soles
• ?endocarditis

• retinal hemorrhage
• ?endocarditis

• Ipsilateral ptosis
• miosis
• anhydrosis
• ?lesion in sympathetic pathway in brain stem/upper spinal cord

Rash / skin sloughs off

• BP / carpal pedal spasms
• ?hypocalcemia

• Cheek tap=rapid jerky movements
• ?hypocalcemia

• bruising -flank / retroperitoneal
• ?pancreatitis/retroperitoneal and intraperitoneal hemorrhage

• marbled abdomen
• ?necrotic pancreatitis

• rebound tenderness on palpation to abdomen
• ?peritoneal irritation

• Halsted sign
• discoloration of breast
• ?ca

• palpate LLQ and pain in RLQ
• ?appendicitis

• McBurney's point pressed and pain in epigastrum
• Appendicitis

Middle between umbilicus and left iliac crest

• lying on side flex or extend leg back+pain RLQ
• Heel tap on right heel+pain in RLQ
• ?appendicitis

• referred shoulder pain while supine
• ?spleen injury
• ?ectopic pregnancy

• pain during deep palpation or RUQ
• ?Gallbladder/cholecystitis

• eccymosis in peritoneum / scrotum / labia
• ?pelvic Fx

• air is tented
• ?tension pneumocephalus

• Abnormal-toes go up and flare
• normal-flexor plantar toes go down
• Peds--opposite due to cortical pathways not fully mylinated
• ?upper motor dysfunction

• auscultation of anterior breath sounds as a crunching or crackling
• ?tracheal bronchial injury (fixed with intentional right mainstem intubation)

• axial loading
• ?c1 fracture

• pain
• Hot skin/ swelling
• deep muscle tenderness
• ?venous thrombosis

• head, abdominal and lower extremity injury
• caused by auto vs pediatric pedestrian

• SVR less than 800
• High CI

• SVR less than 800
• Low CI
• Low HR

• SVR less than 800
• CI low
• HR high

• SVR more than 1200
• low CVP

• SVR greater than 1200
• high CVP
• hich PWP

• high CVP
• low PWP

Keeps the diaphragm alive

shoulders clavicles

index finger and thumb / above t6 + hyperreflexia

middle finger

pinky

upper limbs (lateral)

upper limbs (medial)

nipple line

umbilicus

inguinal

knee

big toe

small toe

sacral

• uncal herniation
• ipsilateral pupil dilation

• severe HA
• vomiting
• brudzinski's sign
• confusion
• ALOC

constricted pupils

• embolic
• hemorrhagic
• thrombic

bilateral hemispheres

Midbrain / above pons

below pons

medulla

complete motor pain and temperature loss with proprioception vibrations and touch

ipsilateral loss of moto position and vibration. Central lateral loss of pain and temperature

greater motor weaknes in upper extremities than lower.

fluffy margins / Kerley B Lines / silhouette appearance / cardiomegaly

ground glass appearance / no pleural effusion

line extends to base of skull

central focal point with multiple fx outwards

separation of bones at suture line / bone fragments

indentation--don't cover

horizontal across maxilla

bridge of nose and down around mouth / jaw

transverse from ear to eyes to bridge of nose to ear

• epiglottitis
• lateral chest xray
• bacterial
• supraglottic
• over 4 years
• high fever

• croup
• anterior chest xray
• 6mo-4yrs

thymus gland

• Amiodarone
• 1. 150mg d5w over 10 minutes
• 2. 1mg/min over 6hrs
• 3. .5mg/min over 8hrs maintenance drip
• contraindication-verapamil, cardizem, adenosine, digitalis

• insulin
• d50
• alb SVN
• CaCl,
• NaHCO3
• Kayexalate

electrical alternans on ecg

• 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

hemoptysis (1-1 1/2 blood in alveolar tissue)

• decreased cardiac output
• dysrhythmias
• right ventrical is more commonly injured

• 4ml x kg x BSA% in first 24 hours
• half in eight hours
• rest over sixteen hours

• 1st degree
• redness

• 2nd degree
• Blisters

• 3rd degree
• through to the bone

• Virchows triad:
• pain
• hotskin / swelling
• deep muscle tenderness

• pain uncontrolled
• cool / pale skin

• combo of boyle's and charles' law
• bends
• gas in liquid =bubbles

• parts make up total pressure
• increase pressure=increase partial pressure
• soft tissue swelling

• volume and pressure
• expansion / contraction of gas at a constant temperature

• gas exchange at cellular level
• 20x CO2 then O2
• gas diffusion

• pressure and temperature
• O@ pressure gauge tanks
• increase temperature / increase pressure

• volume and temperature
• volume expands with increased temperature

1 atm every 33 feet of water

poisoning

anemia

altitude

decrease cardiac output / pooling og blood (CHF)

• 500' ceiling
• 1 mile

• 800' ceiling
• 2 miles

• 1000' ceiling
• 1 mile

• 1000' ceiling
• 3 miles

121.5

• flight crew on talks during take off and landing
• begin to lose night vicion
• 5000'

• sedation of patient with asthma.
• decreases mucous plugging
• reflexes intact
• analgesic and amnesthic properties

(age +16)/4

10+age

6+ kg

2xETT

4xETT

narrowest portion of airway for kids under 10

Narrowest opening after age 10

120-160 bpm

40-60 bpm

over 60 systolic

80-120 bpm

30-40 bpm

over 70 systolic

60-100 bpm

20-30 bpm

over 80 systolic

(age x2) + 70

2/3 systolic BP

finger in baby's mouth with breech delivery

Knees up to shoulders

seen with shoulder dystocia. Head comes out with contraction but goes back in

delivery within 2 hours of onset of contractions

cord problems (hr110-160)

• Head compression
• mirror image of mom's contractions

Uterine placental insufficiency

• metabolic hypoxia
• U shaped contractions

fetal anemia

abdominal contents protrude into base of the umbilical cord

doesn't involve umbilical cord

narrow blockage of nasal airway

can't pass OG tube

• small lower jaw with tongue that falls back
• high arched palate

no kidneys

• inotropic
• tx to keep BP above 80 systolic

• inotropic, chronotropic, dromotropic
• tx to keep BP above 80 systolic

Inotropic

• cardiac glycoside
• increase myocardial contraction and decrease HR in a-fib

angiotensin II blocker

• carvedilol
• betablocker
• contraindicated in dig toxicity
• contraindicated in meth / cocaine OD

• betablocker
• no alpha and can be given to meth / cocaine OD

vasodilator

vasodilator

vasodilator

loop diuretic

loop diuretic

loop diuretic

loop diuretic

synthetic BNP

• antiarrythmic
• afib with WPW history

• antiarrythmic
• max dose 17mg/kg
• cease if hypotension or QRS greater than 50% of original width

• electrolyte balance
• tx hypokalemia
• 10 meq/hr

TCA

TCA

TCA

TCA

Iron supplement

urine is pink

• reactivation of acetylcholinestrase
• tx organophosphate poisoning

PDA dependent patient

closes PDA after delivery

• vasoconstrictor
• given for postpartum hemorrhage after oxytocin

• vasoconstrictor
• esophageal varices / GI bleed

DOBUTAMINE

INOTROPIN

DIGOXIN

ATACAND

DIOVAN

APRESOLINE

ISORDIL

TRIDIL

FUROSEMIDE

BUMETANIDE

TORSEMIDE

NATRECOR

CARDONE

PRONESTYL

ELAVIL

TROFANIL

SINEQUAN

PAMELOR

DESFORAL

METHYLERGONOVINE

OCTREOTIDE