Podiatry Boards Part 2

  1. What is anaphylaxis?
    • Hypersensitivty Type 1 reaction to already exposed sensitized person to a antigen that may cause respiratory arrest, vascular collapse, shock, accompanied with urticuria, angioedema, etc
    • IgE
  2. What is the main mediator in the bodyt hat causes anayphylaxis?
    Histamine
  3. What happens cardio in anaphylaxis?
    • Hypotensions
    • arrythmias
    • cardiac arrest
  4. What local anestheics is more likely to have a rxn?
    Esters
  5. What is the epi dose for anaphylaxis?
    0.3-0.5 ml of epi (1:1000 dilution)
  6. What are the signs of shock?
    • Increase venous pressure
    • Pulmonary Edema
  7. How do you tx shock?
    • Fluids
    • O2
    • EKG
  8. What do you do if the pt is in intense pain or dyspnea but no shock?
    • IV and infuse D5W
    • IV Morphine 2-5 mg every 10-20 min
    • Blood gases
  9. How do you know if you have a extopic pacemaker in the ventricle?
    QRS is wider and the p wave will be absent
  10. What causes torsades de pointes?
    Quinidine toxicity
  11. Comatose pt?
    • ABCs
    • STAT blood for toxins, electrolytes, ca, bun, creatinine, liver function
  12. What can you give a comatose pt that won't hurt them?
    • Glucose (D50)
    • Thiamin- but give with glucose
    • Corticosteriods- decrease cerebral edema
    • Mannitol- reduce intracranial pressure
    • Naloxone- 0.4-2.0 mg IV narcotic overdoes
    • Valium 5-10 mg IV- Stop seizures
    • Flumazenil IV- Reverse benzos overdose
  13. What is the most important element in treating shock?
    Organ perfusion with oxygenated blood
  14. What are the signs of shock?
    • Tachycardic: Earliest sign
    • RR increases b/c of tissue perfusion decreases less oxygen so more lactic acid build up causing metabolic acidosis
    • Capillary filling will decrease causing cold extremities
    • Pulse pressure (difference between systolic and diastolic) will decrease because of raise in diastolic pressure b/c of catecholamines released during shock state increases peripheral resistance
    • Change in metnal status: Early on
    • Fall in systolic pressure with blood loss of 1500-2000ml
    • Decrease in urinary output (20-30ml/hr in adult) shoudl return with fluids. Is sign that it is working 50ml/hr
    • Hematocrit normal is 45% in males- low is significant blood loss or anemia
  15. How much blood in the body?
    5 liters (7% of body weight)
  16. How much blood loss until you see mental stasus change?
    15-30%
  17. How much blood loss can your body replace?
    15%
  18. Greater than 40% or 2000 ml is life threatening?
    Yes. No urine output, intervention needed
  19. How much blood loss with a tibia fx?
    750 ml (15% of blood)
  20. How much in femoral blood loss?
    3 units or (1500 ml)
  21. What is the ratio of electrolyte replacement needed with blood loss?
    • 3:1 
    • 300ml electrolyte for each 100ml of blood
  22. What is initial management of hemorragic shock?
    • 1- Airway (wanted >95%)
    • 2- Hemorrhage control
    • 3- Gastric decompression: Danger of aspiration b/c GI stops working
    • 4- Vascular access: lare bore 16 gauge IV
    • 5- Initial fluid replacement: Crystalloid isotonic electrolyte solution are used for resuscitation only. Ringers lactate is first choice follow by normal saline.
    • 1-2 liters bolus in adults
    • 6- Blood replacement: must cross match. Type O rh negative is the universal donor.
    • 7-Peumatic antishock Garmet: device raises systolic pressure by increasing peripheral resistance and cardial afterload. 
  23. When is Bicarb indicated?
    Metabolic acidosis and pH drops below 7.2
Author
dhubbard
ID
190257
Card Set
Podiatry Boards Part 2
Description
Emergency Medicine
Updated