CCPFPCflashcards.txt

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CCPFPCflashcards.txt
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Flash cards designed from CCP-C and FP-C preparatory texts
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  1. What does SVR measure?
    After-load of the left side of the heart
  2. What are the normal values for monitoring PAP pressures?
    15-25/8-15 mmHg
  3. How does Angiotensin II impact the cardiovascular system?
    Increasing both preload and afterload by vasoconstriction (afterload) and increasing urinary retention (preload)
  4. Your patient is experiencing left ventricular diastolic dysfunction. What should therapy be focused on?
    Increasing preload; impaired filling of the ventricles equals inadequate filling pressures; increasing preload increases filling pressures
  5. Your patient is experiencing right ventricular diastolic dysfunction. What should therapy be focused on?
    Increasing force of contraction; ventricle is having a problem pumping forcefully; positive inotropic agents i.e. Dopamine
  6. The patient's peripheral A-line is showing a very sharp waveform with readings that appear jagged and exaggerated. This may be due to:
    Catheter whip
  7. Overdampened waveforms can do what to blood pressure readings?
    Underestimate them
  8. Your patient's PA waveform has suddenly changed to resemble a low amplitude rolling waveform. This is most likely due to:
    An inadvertent advance to wedge
  9. When assessing CVP or PAWP pressures on a mechanically ventilated patient, the pressures should be assessed at:
    The end of exhalation
  10. The dicrotic notch on the PA waveform indicates:
    Closure of the pulmonic valve
  11. The patient's PA catheter is exhibiting a large, well defined waveform with an obvious "notch" on the left side of the waveform. The distal tip is most likely in the:
    Right ventricle
  12. A patient in early shock most probably has which acid-base imbalance?
    Respiratory alkalosis
  13. Treatment of pancreatitis would NOT include...
    Morphine for pain- it can increase spasms at sphincter of Oddi
  14. The clotting cascade can be triggered through an extrinsic pathway. The triggering mechanism is the release of?
    Tissue thromboplastin
  15. Your patient presents with the following: CVP 2, CI 6.4, PA S/D 34/16, wedge 7 and SVR 400. What is your diagnosis?
    Septic shock
  16. What would the blood test BNP evaluate a patient for?
    Congestive heart failure
  17. What are your primary medications for a patient presenting with a suspected AAA?
    Nipride and Beta Blockers
  18. The balloon has dislodged when treating your IABP patient. Which is the most common site that will be affected?
    Left radial
  19. During transport you notice rust colored "flakes" in the IABP tubing. This indicates...
    Balloon rupture
  20. During transport you experience a complete IABP failure. You should...
    Cycle the balloon manually every 30 minutes regardless of timing to prevent formation of clots
  21. Acute respiratory failure is defined as:
    pO2 <60 mmHg and pCO2 >50 mmHg
  22. A sign that can indicate hyperventilation and/or hypocalcemia is:
    Trousseau's (
  23. What measurements are indicators of right-side preload?
    • Right atrial pressure (RAP)
    • Central venous pressure (CVP)
    • Pulmonary vascular resistance (PVR)
  24. What measurements are indicators of left-side preload?
    • Left atrial pressure (LAP)
    • Pulmonary artery "wedge" pressure (PAWP)
    • Pulmonary wedge pressure (PWP)
    • Pulmonary capillary wedge pressure (PCWP)
    • Pulmonary artery occlusive pressure (PAOP)
    • Systemic vascular resistance (SVR)
  25. What measurements are indicators of pressure in the pulmonary artery?
    • Pulmonary artery pressure (PAP)
    • Pulmonary artery systolic (PAS)
    • Pulmonary artery diastolic (PAD)
  26. What measurements are indicators of afterload?
    • Cardiac Index (CI)
    • Cardiac Output (CO)
    • Stroke Volume (SV)
    • Left ventricular end-diastolic pressure (LVEDP)
    • Left ventricular end-diastolic volume (LVEDV)
  27. How do you calculate Cardiac Output?
    SV x HR
  28. How do you calculate SV?
    EDV-ESV
  29. How do you calculate ejection fraction?
    SV divided by EDV
  30. What is normal ejection fraction?
    • 55-75%
    • Most important predictor of prognosis
  31. How do you calculate CPP (coronary perfusion pressure)?
    • DBP - PAWP
    • Normal value 50-60
    • Can substitute PAD if no wedge
  32. What is normal wedge?
    8-12 mmHg
  33. What is normal CVP?
    2-6 mmHg
  34. What is normal PVR?
    100-250
  35. What is normal PAS?
    15-25 mmHg
  36. What is normal PAD?
    8-15 mmHg
  37. What is normal cardiac index?
    2.5 - 4.3 L/min
  38. What is normal SVR?
    800-1200
  39. What types of shock should you consider if your SVR is low (<800)?
    Vasodilatory or distributive
  40. If your SVR is low and your CI is high, what type of shock do you have?
    Septic
  41. If your SVR is low and your CI is low, what is the next thing to look for?
    • HR
    • If tachycardic, you have anaphylactic shock. If normal or low HR, you have neurogenic shock.
  42. What types of shock should you consider if your SVR is high (>1200)?
    Hypovolemic, Cardiogenic, or RV AMI
  43. If your SVR is high and your CVP is <2, what kind of shock do you have?
    Hypovolemic
  44. If your SVR is high and your CVP is normal or low, what condition do you have?
    RV AMI
  45. If your SVR is high and your CVP and wedge are high, what kind of shock do you have?
    Cardiogenic
  46. What is the mechanism of action of ACE inhibitor drugs?
    Vasodilation, thus decreasing afterload
  47. What is the mechanism of action of Angiotenson II Receptor Blockers (ARBs)?
    Decrease systemic afterload, decreasing the workload of the LV
  48. What is the most common insertion site for a PAC?
    Right internal jugular
  49. What does PAC stand for?
    Pulmonary artery catheter, aka Swan-Ganz catheter
  50. On CXR, where should tip of PAC be seen if placed properly?
    2nd or 3rd intercostal space
  51. What is the maximum amount of air that can be placed in balloon port (red port) for a wedge?
    1.5 cc
  52. If you can only monitor one port on a PAC, which port should you monitor?
    Distal (PA) Yellow port
  53. What does transducer leveling do?
    Eliminates the influence of hydrostatic pressure on the transducer
  54. When should transducer leveling be performed?
    After every change in patient position
  55. What axis should transducer leveling be performed at?
    Phlebostatic axis, where the nipple line and mid-axillary line meet at approximately fourth intercostal space
  56. What can cause catheter whip?
    High blood pressures, length of tubing, or movement of the catheter tip
  57. What does an overdampened waveform present like on the monitor?
    • Slow return to baseline
    • Waveform appears "squeezed down" from too much pressure
  58. What can cause overdampened waveforms?
    • Overly compliant tubing
    • Air bubbles
    • Clots
    • Catheter kinks
    • Low flush bag pressure (need minimum 300 cc)
  59. What does an underdampened waveform present like on the monitor?
    • More than two oscillations after fast flush test
    • Exaggerated waveform
  60. What can cause underdampened waveforms?
    • Non-compliant tubing
    • Increased vascular resistance
    • High systolic and low diastolic pressures
    • Loose connections
    • Air in the system
    • Altitude changes
  61. In a dampened waveform, what should you always do first to try to correct?
    Aspirate, do not flush in case of clots
  62. What waveform group has a dicrotic notch?
    Arterial waveforms
  63. What waveform group has a, c, v waves and x and y descent?
    Atrial waveforms
  64. What unique notch do ventricular waveforms have?
    Anacrotic notch that correlates with QRS
  65. What measurements do Atrial waveforms read?
    • Preload measurements
    • CVP/RAP
    • PAWP/LAP
  66. What measurements do Arterial waveforms read?
    • BP
    • A-line
    • PA
  67. In an atrial waveform, what does the a-wave indicate?
    Atrial contraction (prior to onset of QRS)
  68. In an atrial waveform, what does the c-wave indicate?
    Ventricular contraction and closure of tricuspid valve (occurs within the QRS)
  69. In an atrial waveform, what does the x descent indicate?
    Atrial relaXation (occurs after the QRS)
  70. In an atrial waveform, what does the v-wave indicate?
    PassiVe atrial filling (occurs just after T-wave)
  71. In an atrial waveform, what does the y descent indicate?
    Atrial emptYing and opening of the tricuspid valve
  72. How do you manage an inadvertent wedge position?
    • Check balloon, make sure it is deflated
    • Have patient cough forcefully
    • Change position of patient (elevate head slightly)
    • RAPID TRANSPORT - DO NOT PULL CATHETER BACK
  73. What does it mean if you have a wedge reading of 15-18?
    Ideal wedge in CHF patient
  74. What does it mean if you have a wedge reading of 18 or less than 12?
    ARDS
  75. What does it mean if you have a wedge reading of 20?
    Mild pulmonary congestion
  76. What does it mean if you have a wedge reading of 25?
    Moderate pulmonary congestion
  77. What does it mean if you have a wedge reading of 30?
    Severe pulmonary congestion
  78. What could large v-waves indicate on wedge tracing?
    Mitral valve regurgitation
  79. What does the dicrotic notch on the PA waveform indicate?
    Closure of the pulmonic valve
  80. What are some causes of elevated PAP?
    • Increased PVR
    • Left to right shunts (patent ductus arteriosus)
    • Left ventricular failure
    • Mitral regurgitation and stenosis
  81. What does the dicrotic notch on the A-line waveform indicate?
    Closure of the aortic valve
  82. What does the highest point of the A-line waveform correlate with?
    Systolic pressure; T-wave on EKG
  83. What does the lowest point of the A-line waveform correlate with?
    Diastolic pressure; end of QRS on EKG
  84. What is Cullen's sign and what does it indicate?
    • Bruising around umbilicus
    • Can indicate pancreatitis, peritoneal or retroperitoneal hemorrhage
  85. What is Grey-Turner's sign and what does it indicate?
    • Bruising to the flank area
    • Can indicate pancreatitis and retroperitoneal hemorrhage
  86. What is HalsteAd's sign and what does it indicate?
    • Marbled abdomen
    • Can indicate necrotic pancreas
  87. What is Halsted's sign and what does it indicate?
    • Breast discoloration
    • Can indicate breast cancer
  88. What is the primary treatment for hepatic encephalopathy?
    Evacuate any blood present in the gut via OG/NG tube to decrease ammonia levels
  89. What is the treatment for esophageal variceal hemorrhage?
    Vasopressin and S-Blakemore tube
  90. What structure defines lower versus upper GI?
    The Ligament of Treitz - suspensory ligament of the duodenum
  91. What is Markel's sign and what does it indicate?
    • Rebound tenderness on palpation
    • Can indicate peritoneal irritation or appendicitis
  92. What is Rovsing's sign and what does it indicate?
    • Referred pain to RLQ when LLQ is palpated
    • Can indicate appendicitis
  93. What is Aaron's sign and what does it indicate?
    • Referred pain felt in epigastric region upon continuous firm pressure over McBurney's point (iliac to umbilicus, form a v)
    • Diagnostic for appendicitis
  94. What is Psoas sign and what does it indicate?
    • Patient lying on side hyperextension or flexion of hip elicits RLQ pain
    • Can indicate appendicitis
  95. What is Kehr's sign and what does it indicate?
    • Referred shoulder pain while supine
    • Spleen injury/rupture (left shoulder)
    • Ectopic pregnancy (either shoulder)
  96. What is Balance sign and what does it indicate?
    • Dullness to percussion of LUQ with a shifting dullness to RUQ, both due to blood
    • Can indicate spleen injury or rupture
  97. What is Murphy's sign and what does it indicate?
    • Pain on inhalation or coughing when RUQ is palpated
    • Inflammation of gallbladder; diagnostic of cholecystitis
  98. What is Linea Nigra and what does it indicate?
    • Darkening "line" of skin from umbilicus to pubic symphysis
    • Indicates pregnancy
  99. One unit of PRBC's equals approximately ___ 330 mL and increases H/H by ____%.
    330 mL and 1/3 or 33%
  100. What is the pediatric dose for PRBC's?
    10 cc/kg
  101. What is the universal blood donor type?
    O
  102. What is the universal recipient blood type?
    AB
  103. What is FFP and what is it useful in correcting?
    • Fresh Frozen Plasma
    • Volume expander or to increase clotting factors
    • Corrects Warfarin induced hemorrhage or toxicity, along with Vit K
  104. What is cryoprecipitate and what types of conditions is it used for?
    • Corrects low fibrinogen levels
    • Used in DIC, Hemophilia A and Von Willebrand's disease (Factor VIII)
  105. What are the four types of blood transfusion reactions?
    • Hemolytic - short onset
    • Anaphylactic - 30 min onset, treat with epi
    • Febrile - 30-90 min onset
    • Circulatory overload - can occur anytime, treat with Lasix
  106. What is the problem in Hemophilia A patients?
    Cannot form a stable fibrin clot
  107. What is the problem in Hemophilia B patients?
    • AKA Christmas disease
    • Prolonged partial thromboplastin (PT) times
  108. What is the problem in Von Willebrand's patients?
    Defective platelet adherence; cannot form platelet plugs
  109. What is the drug of choice for treatment of vasodilatory shocks?
    • Levophed (Norepinephrine)
    • Increases vascular tone through alpha-adrenergic receptors
  110. What are the 7 P's of Spinal Cord injury?
    • Pain
    • Position
    • Ptosis, Pinpoint pupils
    • Parasthesias
    • Paralysis
    • Priapism
    • Poikilothermia
  111. What is the problem in a patient with Graves disease?
    • Increased levels of thyroid hormones
    • Avoid ASA - releases T3 and T4 hormones
    • Treatment is steroids (Dexamethasone)
    • Can present with tremors, weight loss, AFib, expothalmus, goiter
  112. What is the problem in a patient with myxedema coma?
    • Hypothyroidism
    • Treatment is Levothyroxine
    • Can present with coarse hair, fatigue weight gain
  113. What is the main problem in a patient with hypoparathyroidism?
    Hypocalcemia - PTH regulates calcium levels
  114. In a patient with a head injury, you note extreme urinary output with very low specific gravity. What is your initial treatment of this patient?
    • Aggressive fluid replacement and vasopressin
    • Diabetes Insipidus is often caused by head injury, due to a deficiency of ADH from posterior pituitary gland
    • Can result in hypernatremia (possible SZ) and hypokalemia if untreated
  115. What is the main problem in SIADH?
    • Overproduction of ADH which can be caused by anything that interferes with renal excretion of water
    • Can result in dilutional hyponatremia and hypokalemia
    • Treatment is to restrict fluids and correct electrolytes - hypertonic 3% NS
  116. What is Cushing's Disease?
    • Increased levels of cortisol, usually caused by an anterior pituitary tumor
    • Presents with moon face, buffalo hump, upper body obesity with thin extremities, hypertension
    • Treated with steroids
  117. What is Addison's Disease?
    • Acute Adrenal Insufficiency - Adrenal glands not producing enough cortisol
    • Presents with asthenia, severe fatigue, weight loss, darkening of skin, hypotension
  118. What drug is to be used with extreme caution in Addison's disease patients?
    Etomidate - refractory hypotension 8-10 hours later
  119. What is Conn's Syndrome?
    • AKA Hyperaldosteronism
    • Usually caused by adrenal tumor known as pheochromocytoma
    • Can lead to hypokalemia, hypernatremia, hypertension, alkalosis
    • Treated with Spironolactone (works as aldasterone antagonist)
  120. What is the treatment for HHNK?
    • Aggressive fluids
    • Short acting/regular insulin
  121. What lab value needs to be closely monitored in DKA patients being treated with insulin?
    Potassium - If falls below 3.3, insulin needs to be stopped and K+ administered to correct hypokalemia
  122. What EKG finding should force you to automatically consider RVMI?
    ST elevation of 1 mm or greater in aVR
  123. If a Q wave greater than 25% of the height of the QRS with ST elevation, you should...
    Suspect acute infarct
  124. If a Q wave is present with ST depression...
    It is indeterminate
  125. If a Q wave is present with no ST changes...
    There is an old infarct
  126. If you suspect an inferior infarct, what coronary artery do you expect to be affected?
    RCA
  127. If you suspect a lateral infarct, what coronary artery do you expect to be affected?
    Circumflex
  128. If you suspect a septal or anterior infarct, what coronary artery do you expect to be affected?
    LAD
  129. If you suspect a posterior infarct, what coronary artery(s) do you expect to be affected?
    RCA and Circumflex
  130. What are three things you should look for if you suspect a Posterior infarct?
    • Progressive, tall R waves
    • Slight ST elevation in V6
    • Reciprocal changes in V1-V3
  131. What can U waves indicate on EKG?
    Hypokalemia
  132. What is a common complaint from patients suffering from digitalis toxicity?
    yellow halos
  133. In a patient who has undergone a heart transplant, what drug would be useless in treatment of symptomatic bradycardia?
    Atropine - Vagus nerve is not re-transplanted with heart
  134. What does FAEDE stand for?
    • Fluids
    • Atropine
    • External Pacer
    • Dopamine/Dobutrex drip
    • Epinephrine drip
  135. What drugs are contraindicated in the patient with WPW?
    • Adenosine
    • Diltiazem
    • Digoxin
    • Verapamil
    • Drug of choice: Amiodarone
  136. What is BNP?
    • Brain Natriuretic Peptide
    • Assists in diagnosis of CHF
    • >100 positive, >500 severe
  137. What position should a CHF or ICP patient be loaded in a fixed-wing aircraft?
    Head forward - diminishes increased pressures on takeoff
  138. What are some hallmarks of pulmonary edema on CXR?
    • Fluffy margins
    • Kerley B lines
    • Pleural effusions
    • Cardiomegaly
  139. What presentation does ARDS have on CXR?
    • Ground glass
    • No Kerley B lines
  140. What presentation does pericardial effusion have on CXR?
    Enlargement of cardiac silhouette with characteristic water bottle appearance
  141. What does pericardial effusion present with on 12-lead EKG?
    Electrical alternans - increase and decrease in amplitude of R waves
  142. If PAWP = PAD, what should you suspect?
    Cardiac tamponade
  143. What is Dressler's syndrome?
    • Secondary form of pericarditis two to three weeks after injury to the heart or pericardium
    • Presents with fever, pleuritic pain, and pericardial effusion
  144. What are Janeway lesions?
    • Raised red lesions seen on fingers, palms, and soles of feet - painless
    • Indicate Endocarditis
  145. What are Osler's Nodes?
    • Painful raised reed lesions seen on fingers, palms, and soles of feet
    • Indicate Endocarditis
  146. What is the most common cardiac cause of clubbed fingers?
    Congenital cyanotic heart disease
  147. What is a cause of clubbed fingers aside from congenital heart disease and chronic hypoxia?
    Subacute bacterial endocarditis
  148. What does an aortic dissection present with on CXR?
    • Mediastinal and/or aortic widening
    • Left pleural effusion
  149. What is Hill's Sign?
    • Difference in SBP greater than or equal to 20 mmHg between brachial and popliteal BP
    • Indicates acute aortic insufficiency
  150. Where does the tear occur in a AAA?
    The tunica intima
  151. What is Marfan's syndrome?
    • A connective tissue disorder characterized by joint laxity, scoliosis, long upper extremities
    • Associated with dilation of the ascending aorta
  152. What is Turner's syndrome?
    • Missing X chromosome (only occurs in females)
    • Webbed necks is most identifiable physical characteristic
  153. How do we manage an aortic dissection?
    • 2 large bore IVs, restrict fluids unless patient is hypotensive
    • Nitroprusside to lower BP to 100-110 mmHg systolic
    • Beta blockers
    • Pain analgesics
    • Definitive treatment is surgery
  154. What is Virchow's Triad?
    • Pain
    • Flushed skin
    • Swelling
    • Indicates DVT
  155. What is the treatment for DVT?
    • Elevate extremity
    • Heat
    • Analgesia
    • Anticoagulants
  156. How much can IABP augment cardiac output?
    10-20%
  157. When does the IABP balloon inflate?
    During diastole, with the closure of the aortic valve
  158. What is the main benefit to placing an IABP?
    Decrease afterload
  159. What does the dicrotic notch on a balloon pump timing strip indicate?
    Closure of the aortic valve
  160. What is the primary indication for IABP placement?
    Cardiogenic shock
  161. What is the primary contraindication for IABP placement?
    Severe aortic insufficiency
  162. When using the ECG to trigger an IAB, what is the synchronization point for balloon inflation?
    With the T-wave
  163. When using an A-line to trigger an IAB, what is the synchronization point for balloon inflation?
    With the dicrotic notch on the A-line waveform
  164. Where should the distal tip of the IAB be seen on CXR?
    At the level of the 2nd or 3rd intercostal space
  165. Where should the proximal end of the IAB be?
    Above the renal artery
  166. Where should the distal end of the IAB be?
    In the descending aorta, just distal to the left subclavian artery
  167. If your patient experiences a distal dislodgement (most common) of the IAB, which site will be affected?
    Left radial artery
  168. If your patient experiences a proximal dislodgement of the IAB, which site will be affected?
    • Renal arteries, resulting in decrease in urine output
    • Possibly also the femoral arteries
  169. Acute respiratory failure is defined as:
    pO2 <60 mmHg and pCO2 >50 mmHg
  170. What are some causes of respiratory acidosis?
    • Airway obstruction
    • CNS depressant medications (hypoventilation)
    • Myasthenia gravis
    • Guillain-Barre
    • COPD
    • Pickwickian syndrome
  171. What are some causes of respiratory alkalosis?
    • Excessive mechanical ventilation
    • Fever
    • Anxiety
    • Pain
    • Third trimester pregnancy
    • Drugs
    • CNS
    • Hyperventilation
  172. What are some causes of metabolic alkalosis?
    • Vomiting, NG suction
    • Hypokalemia
    • Thiazide or loop diuretics
  173. How do you calculate Anion Gap?
    • Na - (Cl +HCO3) = AG
    • Normal is 12 (+ or - 4)
  174. What is the mnemonic for differential diagnoses of metabolic acidosis?
    MUDPILERS
  175. What does MUDPILERS stand for?
    • Methanol
    • Uremia
    • DKA
    • Propolene glycol
    • INH/Iron
    • Lactic acidosis
    • Ethylene glycol
    • Renal failure/Rhabdomylosis
    • Salicylates/Starvation ketoacidosis
  176. What is the normal value for K+?
    3.5 to 5.0
  177. What is the normal value for Ca?
    8.8 - 10.4
  178. What is the normal value for Mg?
    1.5-2.5
  179. What is the normal value for Na?
    135-145
  180. What is the normal value for glucose?
    70-110
  181. What is the normal value for BUN?
    6-23
  182. What is the normal value for Creatinine?
    0.6-1.4
  183. What does creatinine measure?
    Kidney function
  184. What is the normal value for CK/CPK?
    60-400
  185. What does CK/CPK measure?
    Muscle enzymes (rhabdo)
  186. What is the normal value for ammonia in an adult?
    15-45
  187. What is the normal value for ammonia in a pediatric?
    40-80
  188. What is the normal value for BNP?
    <100
  189. What is the normal value for WBC?
    4.5-10.5 (peds slightly higher)
  190. What is the normal value for Hgb?
    12-18
  191. What is the normal value for Hct?
    36-52
  192. What is the normal value for platelets?
    140-400
  193. If your pCO2 is <35 mmHg in a ventilated patient, what should you do?
    • Decrease tidal volume
    • Decrease RR
    • Consider sedation/analgesia
  194. If your pCO2 is >45 mmHg in a ventilated patient, what should you do?
    • Increase ventilation first by increasing tidal volume
    • Then increase respiratory rate
  195. What is typical tidal volume for an adult patient?
    5-8 cc/kg
  196. What is the oxygen formula?
    PSI x cylinder divided by liter flow = time of O2 remaining
  197. What is the formula for the oxygen required at altitude?
    FiO2% x barometric pressure prior to ascent divided by barometric pressure at altitude = % of O2
  198. How does asthma present on CXR?
    • SQ air upper lobes
    • Hyperinflated lungs
    • Elongated heart
    • Pneumomediastinal air "leaks"
  199. How does emphysema present on CXR?
    • Large, hyperinflated lungs
    • Low set diaphragm
    • Increased AP diameter
    • Vertical heart
    • Increased retrosternal air
    • BLEBS
  200. How does Chronic Bronchitis present on CXR?
    Bronchovascular structures have irregular contours - only finding
  201. Which toxicity presents with a profound anion gap?
    Ethylene glycol
  202. What is basic treatment of a snakebite?
    • Immobilize affected limb below level of heart
    • NO ICE
    • Obtain fibrinogen levels and CMP
  203. What is basic treatment of a spider bite, scorpion sting, or hymenoptera sting?
    • Ice, analgesia
    • Immobilize affected area
    • Watch for anaphylaxis
  204. What is the first line treatment for Rocky Mountain Spotted Fever?
    Doxycycline (Tetracycline)

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