Comprehensive Review for Clinical Medicine Exam #1

ventrolateral wrist and groove between trachea and SCM

what are the two locations to check your heart rate

radial

what artery is checked at the ventrolateral wrist

carotid

what artery is being checked at the groove between the trachea and SCM

> 100 bpm

tachycardia = ___ bpm

< 60 bpm

bradycardia = ____ bpm

60-100 bpm

normal HR = ____ bpm

sphygomanometer

what is a noninvasive device used to measure blood pressure

20-50%

the blood pressure cuff should be how much larger than the arm diameter in %

falsely high

if the bp cuff is too small =

falsely low

if he bp cuff is too large =

< 120 & < 80

normal blood pressure =

120-129 and < 80

elevated bp =

130-139 or 80-89

HTN stage 1 bp =

140+ or 90+

HTN stage 2 =

180+ and/or 120+

hypertensive crisis bp =

37 +/- 0.6 C (98.6 F)

normal body temp =

> 41.4 C (105.9 F)

life threatening body temp =

12-18 /min

adult normal respiratory rate =

20-30 /min

child normal respiratory rate =

drug overdose

what is something that can cause bradypnea

pain, anxiety, and stress

what are some things that can cause tachypnea

indicated tests

which type of preoperative testing

- further info required as identified by med history review

high

do indicated tests produce low or high yields

indicated tests

these are examples of what type of preoperative testing

- blood glucose, HbA1c, INR, and urine pregnancy test

routine tests

which type of preoperative test

- info required due to increase risk only

low

do routine tests produce low or high yields

routine tests

these are examples of what type of preoperative test

- chest xray, stress test, lung function tests, complete blood count

preparation, organization, and practice

what are the 3 keys to effective response

> 80 mmHg

what is the normal PO2

60 mmHg

what is the PO2 for mild hypoxia

40 mmHg

what is the PO2 is severe hypoxemia

reversible

is mild hypoxemia going to cause reversible or irreversible damage

irreversible

is severe hypoxemia going to cause reversible or irreversible cell damage

21%

FiO2 room air =

25-45%

oxygen via nasal cannula can help increase the oxygen by what %

40-90%

oxygen via face mask can help increase the oxygen by what %

1 mg via IV every 3-5 min

what is the dead mans dose for epi for an adult in ACLS

0.3 mg

adult epipen mg =

0.15 mg

jr epipen mg =

increase

will nitroglycerin increase or decrease venous return

decrease

SVR

decrease

will nitroglycerin increase or decrease myocardial O2 demand

nitroglycerin

what vital emergency drug have these indications

- chest pain and MI

albuteral

what vital emergency drug has this MOA

- direct acting adrenergic agonist, catecholamine receptor, and selecitve beta 2

dilation

does albuterol cause constriction or dilation

epineprhine

if albuterol is not working what can be used

glucose

what vital emergency drug has this MOA

- hypoglycemia

3 mg/mL

1 g of glucose IV will increase the blood glucose by what

50% dextrose soln via IV

if a person is unconscious how should they be given glucose

atropine

which vital drug crosses the blood brain barrier

atropine

what vital emergency drug has this MOA

- muscarinic antagonist

vasovagal syncope

what is atropine used for

aspirin

what vital emergency drug has this MOA

- antithrombotic effect

MONA

what is used to treat a suspected MI

morphine

which part of MONA

- decreases pain and cause vasodilation

oxygen

which part of MONA

- helps with myocardial oxygen supply

nitroglycerin

which part of MONA

- causes vasodilation to decrease myocardial oxygen demand

aspirin

which part of MONA

- inhibits clot from getting worse and TxA2 medaited vasoconstriction

325 mg by chewing

if suspect MI all should one be given aspirin and how much

glucagon

which supplemental emergency drug has this MOA

- increase blood glucose, stimulates hepatic glyconeolysis, and hepatic gluconeogenesis

glucagon

which supplemental emergency drug has these special concerns

- adrenal release of catecholamines

- stimulates insulin release

- lil bit of tachycardia

diphenhydramine

which supplemental emergency drug has this MOA

- antihistamine

25-50 mg via PO, IM, or IV

what is the dosing of diphenhydramine that should be used

0.5-1 mg

what is the dosing of glucagon

corticosteroids

which supplemental emergency drug has this MOA

- mimics endogenous hormones

corticosteroids

which supplemental emergency drug has these indications

- acute allergic rxn

- acute adrenal insufficiency

benzodiapzepine

which supplemental emergency drug has this MOA

- positive allosteric modulator of GABA

benzodiazepine

which supplemental emergency drug is indicated for seizures

midazolam and diazepam

what are some type of benzodiazepine

IV and IM

which routes of administration are most commonly used in emergencies

IV

which route of administration has the most rapid onset

anteromedial aspect of tibial tuberosity and sternum

what are the sites for an IO administration

deltoid, gluteus medius, and vastus lateralis

3 common sites for intramuscular injections

enteral (oral and rectal)

which type of drug administration route goes through the liver

parenteral (IV, IO, IM, and SQ_

which type of drug administration route bypasses the liver and goes straight to the blood

vasovagal rxn, orthostatic hypotension, and hyperventilation

what are the most common etiologies of syncope that are seen in a dental office

anxious, jittery, tachycardia, and tachypnea

what are the initial S&S of vasovagal syncope

bradycardia, hypotension, pallor, diaphoretic, lightheadedness, and n/v

what are the S&S that are seen immediately prior to vasovagal syncope

release epi --> activaes beta 2 --> decrease filling pressure --> increase rate and contractility --> decrease filling time --> betzold jarisch reflex (decrease HR)

what is the series of effects leading up to vasovagal syncope

trendelenburgh position and atropine

how is vasovagal syncope managed

atropine

what drug should be used for vasovagal syncope is the HR = < 60 bpm

ephedrine

what drug should be used for vasovagal syncope is the HR = > 60 bpm

orthostatic hypotension

sudden change in body position

elderly and pts on beta blockers

who is more prone to orthostatic hypotension

alkalosis

will excessive exhalation of CO2 cause respiratory acidosis or alkalosis

seizure

uncoordinated massive discharge of electrical activity in the brain

generalized and partial

what are the two types of seizures

tonic/clonic and absence

what are the types of generalized seizures

simple and complex

what are the types of partial seizures

partial

which type of seizure

- electrical activity confined to specific regions of the brain

simple

which type of partial seizure

- specific motor or sensory symptoms or both

complex

which type of partial seizure

- hallucinations, illusions, or deja vu

generalized

which type of seizure

- electrical activity affects entire brain

absence (petit mal)

which type of generalized seizure

- less than 30 secs

- abrupt onset, staring off into space, no prodrome, and no responsiveness

tonic clonic

Description of a Grand-Mal or generalized seizure with stupor and transient LOC

90%

what % of epileptic pts experience tonic clonic seizures

tonic

tonic or clonic

- muscular contraction (rigidity)

- 10-20 secs

clonic

tonic or clonic

- intermittent rhythmic muscular contractions

- pattern of relaxation and contraction

status epilepticus

continuous or repetitive recurrence of any type of seizure without recovery between attacks

prodromal

which phase of seizures

- clues that hint seizure is about to start

- sensory changes