CCT-Kendra's Notes

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Tmc9
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CCT-Kendra's Notes
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2012-01-20 17:45:40
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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
  109. Halsted sign
    • discoloration of breast
    • ?ca
  110. Rovsings sign
    • palpate LLQ and pain in RLQ
    • ?appendicitis
  111. Aarons sign
    • McBurney's point pressed and pain in epigastrum
    • Appendicitis
  112. McBurney point
    Middle between umbilicus and left iliac crest
  113. Psoas Sign
    • lying on side flex or extend leg back+pain RLQ
    • Heel tap on right heel+pain in RLQ
    • ?appendicitis
  114. Kehrs sign
    • referred shoulder pain while supine
    • ?spleen injury
    • ?ectopic pregnancy
  115. Murphys sign
    • pain during deep palpation or RUQ
    • ?Gallbladder/cholecystitis
  116. Coopernails sign
    • eccymosis in peritoneum / scrotum / labia
    • ?pelvic Fx
  117. Mount Fuji sign
    • air is tented
    • ?tension pneumocephalus
  118. 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
  119. Hammans sign
    • auscultation of anterior breath sounds as a crunching or crackling
    • ?tracheal bronchial injury (fixed with intentional right mainstem intubation)
  120. Jeffersons fracture
    • axial loading
    • ?c1 fracture
  121. Virchows triad
    • pain
    • Hot skin/ swelling
    • deep muscle tenderness
    • ?venous thrombosis
  122. Waddell's triad
    • head, abdominal and lower extremity injury
    • caused by auto vs pediatric pedestrian
  123. Septic shock
    • SVR less than 800
    • High CI
  124. Neurogenic schock
    • SVR less than 800
    • Low CI
    • Low HR
  125. Anaphylactic shock
    • SVR less than 800
    • CI low
    • HR high
  126. Hypovolemic schock
    • SVR more than 1200
    • low CVP
  127. Cardiogenic shock
    • SVR greater than 1200
    • high CVP
    • hich PWP
  128. R ventricular MI
    • high CVP
    • low PWP
  129. C3, C4, C5
    Keeps the diaphragm alive
  130. c5
    shoulders clavicles
  131. c6
    index finger and thumb / above t6 + hyperreflexia
  132. c7
    middle finger
  133. c8
    pinky
  134. c5, c6, c7
    upper limbs (lateral)
  135. c8-t1
    upper limbs (medial)
  136. t4
    nipple line
  137. t10
    umbilicus
  138. L1
    inguinal
  139. L4
    knee
  140. L5
    big toe
  141. s1
    small toe
  142. S3-4
    sacral
  143. epidural bleed presentation
    • uncal herniation
    • ipsilateral pupil dilation
  144. subarachnoid bleed presentation (5)
    • severe HA
    • vomiting
    • brudzinski's sign
    • confusion
    • ALOC
  145. ponteen bleed presentation
    constricted pupils
  146. intraparenchymal bleed (CVA)
    • embolic
    • hemorrhagic
    • thrombic
  147. Damaged area for Cheyne stokes resp pattern
    bilateral hemispheres
  148. Damaged area for central neurogenic resp pattern
    Midbrain / above pons
  149. Damaged area for apneustic resp pattern
    below pons
  150. Damaged area for ataxic resp pattern
    medulla
  151. s/s of anterior cord injury
    complete motor pain and temperature loss with proprioception vibrations and touch
  152. s/s of brown-sequard cord injury
    ipsilateral loss of moto position and vibration. Central lateral loss of pain and temperature
  153. s/s of central cord injury
    greater motor weaknes in upper extremities than lower.
  154. CHF on xray
    fluffy margins / Kerley B Lines / silhouette appearance / cardiomegaly
  155. ARDS on xray
    ground glass appearance / no pleural effusion
  156. Linear skull fx on xray
    line extends to base of skull
  157. linear stellate fx on xray
    central focal point with multiple fx outwards
  158. diastatic on xray
    separation of bones at suture line / bone fragments
  159. depressed on xray
    indentation--don't cover
  160. laforte 1 on xray
    horizontal across maxilla
  161. laforte2 on xray
    bridge of nose and down around mouth / jaw
  162. laforte3 on xray
    transverse from ear to eyes to bridge of nose to ear
  163. thumb print on xray
    • epiglottitis
    • lateral chest xray
    • bacterial
    • supraglottic
    • over 4 years
    • high fever
  164. steeple on xray
    • croup
    • anterior chest xray
    • 6mo-4yrs
  165. Angel wing on xray
    thymus gland
  166. 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
  167. hypercalemia tx
    • insulin
    • d50
    • alb SVN
    • CaCl,
    • NaHCO3
    • Kayexalate
  168. Pericardial effusion presentation
    electrical alternans on ecg
  169. 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
  170. pulmonary contusion presentation
    hemoptysis (1-1 1/2 blood in alveolar tissue)
  171. Myocardial Contusion presentation
    • decreased cardiac output
    • dysrhythmias
    • right ventrical is more commonly injured
  172. Parkland fluid replacement for burns
    • 4ml x kg x BSA% in first 24 hours
    • half in eight hours
    • rest over sixteen hours
  173. Hyperemia burn
    • 1st degree
    • redness
  174. Stasis burn
    • 2nd degree
    • Blisters
  175. Coagulation burn
    • 3rd degree
    • through to the bone
  176. Venous thrombosis
    • Virchows triad:
    • pain
    • hotskin / swelling
    • deep muscle tenderness
  177. Arterial thrombosis
    • pain uncontrolled
    • cool / pale skin
  178. Henry's gas law
    • combo of boyle's and charles' law
    • bends
    • gas in liquid =bubbles
  179. daltons gas law
    • parts make up total pressure
    • increase pressure=increase partial pressure
    • soft tissue swelling
  180. boyle's gas law
    • volume and pressure
    • expansion / contraction of gas at a constant temperature
  181. graham's gas law
    • gas exchange at cellular level
    • 20x CO2 then O2
    • gas diffusion
  182. Gay Lussac's gas law
    • pressure and temperature
    • O@ pressure gauge tanks
    • increase temperature / increase pressure
  183. Charle's gas law
    • volume and temperature
    • volume expands with increased temperature
  184. Atmospheric pressure
    1 atm every 33 feet of water
  185. histoxic hypoxia
    poisoning
  186. hypemic hypoxia
    anemia
  187. hypoxic hypoxia
    altitude
  188. stagnant hypoxia
    decrease cardiac output / pooling og blood (CHF)
  189. Local day flight restrictions
    • 500' ceiling
    • 1 mile
  190. local night flight restrictions
    • 800' ceiling
    • 2 miles
  191. Cross country day restrictions
    • 1000' ceiling
    • 1 mile
  192. cross country night restrictions
    • 1000' ceiling
    • 3 miles
  193. Emergency transmit frequency
    121.5
  194. sterile cockpit
    • flight crew on talks during take off and landing
    • begin to lose night vicion
    • 5000'
  195. Ketamine
    • sedation of patient with asthma.
    • decreases mucous plugging
    • reflexes intact
    • analgesic and amnesthic properties
  196. Peds ET size
    (age +16)/4
  197. peds ET depth
    10+age
  198. newborn ET depth
    6+ kg
  199. peds Foley, salem pump, and suction catheter sizes
    2xETT
  200. peds chest tube size
    4xETT
  201. Cricoid
    narrowest portion of airway for kids under 10
  202. glottic opening
    Narrowest opening after age 10
  203. neonate HR
    120-160 bpm
  204. neonate RR
    40-60 bpm
  205. neonate BP
    over 60 systolic
  206. infant HR
    80-120 bpm
  207. infant RR
    30-40 bpm
  208. infant BP
    over 70 systolic
  209. peds HR
    60-100 bpm
  210. peds RR
    20-30 bpm
  211. peds BP
    over 80 systolic
  212. peds systolic BP
    (age x2) + 70
  213. peds diastolic BP
    2/3 systolic BP
  214. Mauricearu's maneuver
    finger in baby's mouth with breech delivery
  215. McRoberts Position
    Knees up to shoulders
  216. Turtle sign
    seen with shoulder dystocia. Head comes out with contraction but goes back in
  217. Precipatate delivery
    delivery within 2 hours of onset of contractions
  218. variable deceleration contractions
    cord problems (hr110-160)
  219. early decelerations problem
    • Head compression
    • mirror image of mom's contractions
  220. late decelerations
    Uterine placental insufficiency
  221. preeclampsia
    • metabolic hypoxia
    • U shaped contractions
  222. Sinusoidal waveform
    fetal anemia
  223. omphalocele
    abdominal contents protrude into base of the umbilical cord
  224. gastroschisis
    doesn't involve umbilical cord
  225. chanal atresia
    narrow blockage of nasal airway
  226. esophageal atresia
    can't pass OG tube
  227. Pierre Robin syndrome
    • small lower jaw with tongue that falls back
    • high arched palate
  228. renal agenesis
    no kidneys
  229. dobutrex
    • inotropic
    • tx to keep BP above 80 systolic
  230. dopamine
    • inotropic, chronotropic, dromotropic
    • tx to keep BP above 80 systolic
  231. milrinone
    Inotropic
  232. lanoxin
    • cardiac glycoside
    • increase myocardial contraction and decrease HR in a-fib
  233. cardesartan
    angiotensin II blocker
  234. valsartanAngiotenson II blocker
    • carvedilol
    • betablocker
    • contraindicated in dig toxicity
    • contraindicated in meth / cocaine OD
  235. labetolol
    • betablocker
    • no alpha and can be given to meth / cocaine OD
  236. Hydralazine
    vasodilator
  237. isosorbide
    vasodilator
  238. nitroglycerin
    vasodilator
  239. lasix
    loop diuretic
  240. Bumex
    loop diuretic
  241. demadex
    loop diuretic
  242. edecrine
    loop diuretic
  243. neseritide
    synthetic BNP
  244. amiodare
    • antiarrythmic
    • afib with WPW history
  245. procainamide
    • antiarrythmic
    • max dose 17mg/kg
    • cease if hypotension or QRS greater than 50% of original width
  246. KCL
    • electrolyte balance
    • tx hypokalemia
    • 10 meq/hr
  247. amitriptaline
    TCA
  248. imipramine
    TCA
  249. doxepin
    TCA
  250. nortryptaline
    TCA
  251. deferoxamine
    Iron supplement
  252. Iron toxicity
    urine is pink
  253. praloxidime
    • reactivation of acetylcholinestrase
    • tx organophosphate poisoning
  254. prostagladin
    PDA dependent patient
  255. indomethacin and o2
    closes PDA after delivery
  256. methergine
    • vasoconstrictor
    • given for postpartum hemorrhage after oxytocin
  257. Sandostatin
    • vasoconstrictor
    • esophageal varices / GI bleed
  258. DOBUTREX
    DOBUTAMINE
  259. DOPAMINE
    INOTROPIN
  260. LANOXIN
    DIGOXIN
  261. CARDESARTAN
    ATACAND
  262. VALSARTAN
    DIOVAN
  263. HYDRALAZINE
    APRESOLINE
  264. ISOSORBIDE
    ISORDIL
  265. NITROGLYCERIN
    TRIDIL
  266. LASIX
    FUROSEMIDE
  267. BUMEX
    BUMETANIDE
  268. DEMADEX
    TORSEMIDE
  269. NESERITIDE
    NATRECOR
  270. AMIODARE
    CARDONE
  271. PROCAINAMIDE
    PRONESTYL
  272. AMITRIPTALINE
    ELAVIL
  273. IMIPRAMINE
    TROFANIL
  274. DOXEPIN
    SINEQUAN
  275. NORTRYPTALINE
    PAMELOR
  276. DEFEROXAMINE
    DESFORAL
  277. METHERGINE
    METHYLERGONOVINE
  278. SANDOSTATIN
    OCTREOTIDE

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