Pimp Questions

[mycrofft]

^ could you be more specific? :blink:

I will take a stab...

The more alkaline the blood pH is there is a greater affinity for TCA to bind to protein therefore reducing serum levels. Also the increase in pH causes unbinding of TCA from Sodium Chanel Receptors (which is what is causing most of the problems). There may be a few other mechanisms I can't think remember.

Compare and contrast the mechanisms that cause hypotension in Septic, Neurgoenic, and Cardiogenic Shock.

Define the Universe. Give three examples.
Ready?
GO!

 

[abckidsmom]

Oh, one of my favorite pimp questions ever. I first heard it from a psychiatrist who probably studied with Freud: what's the best part about Xanax?

 

[mycrofft]

You can't spell it backwards. Easy Rx'ing

 

[abckidsmom]

You can't spell it backwards. Easy Rx'ing

Confirmed. You are definitely the old guy.

 

[CANDawg]

^ could you be more specific? :blink:

I will take a stab...

The more alkaline the blood pH is there is a greater affinity for TCA to bind to protein therefore reducing serum levels. Also the increase in pH causes unbinding of TCA from Sodium Chanel Receptors (which is what is causing most of the problems). There may be a few other mechanisms I can't think remember.

Compare and contrast the mechanisms that cause hypotension in Septic, Neurgoenic, and Cardiogenic Shock.

That's pretty much what I was looking for.

How much of lidocaine is metabolized prior to elimination?

Can any one guess that I'm studying pharmacology right now?

 

[mycrofft]

A dental patient is prepped for a root canal and the assistant hands the dentist the carpuject full of lidocaine. The pt is resting comfortably,receives the injection, then begins to grunt and say "Ah kah' beef, ah kah' beeve", then loses consciousness.

The dentist sees a medicalert tag, reads it and calls 911 while stripping off the dental dam which muffled the pt's voice.:blush:

The tag doesn't say "lidocaine" or any variant.

What happened?

 

[bigbaldguy]

A dental patient is prepped for a root canal and the assistant hands the dentist the carpuject full of lidocaine. The pt is resting comfortably,receives the injection, then begins to grunt and say "Ah kah' beef, ah kah' beeve", then loses consciousness.

The dentist sees a medicalert tag, reads it and calls 911 while stripping off the dental dam which muffled the pt's voice.:blush:

The tag doesn't say "lidocaine" or any variant.

What happened?

Well he can't breath so the dental dam blocked oral airway which left the nose so I'm assuming the lidocaine caused something that blocked that route as well. Maybe some kind of airway collapse from the numbness similar to what happens in sleep apnea.

Or maybe he's just allergic to the latex dental dam.

 

[Dwindlin]

Compare and contrast the mechanisms that cause hypotension in Septic, Neurgoenic, and Cardiogenic Shock.

Septic shock is due to massive vasodilitation secondary to inflammatory mediators. Neurogenic is also due to massive vasodilitation, though it is due to release of normal vasomotor tone generally because of severe spinal cord injury. Finally cardiogenic is due the heart physically not moving enough blood around to maintain a blood pressure.

 

[VFlutter]

Septic shock is due to massive vasodilitation secondary to inflammatory mediators. Neurogenic is also due to massive vasodilitation, though it is due to release of normal vasomotor tone generally because of severe spinal cord injury. Finally cardiogenic is due the heart physically not moving enough blood around to maintain a blood pressure.

correct.

Compare Diabetes Insipidus and SIADH

 

[JPINFV]

correct.

Compare Diabetes Insipidus and SIADH

Too little vasopressin (or kidneys don't respond like they're supposed to)... too much vasopressin.

 

[Clare]

Using Starlings Law of capillaries, explain the initial fluid shift that would occur if the if the patients blood volume was suddenly reduced under Starlings Law

 

[JPINFV]

Using Starlings Law of capillaries, explain the initial fluid shift that would occur if the if the patients blood volume was suddenly reduced under Starlings Law

Are we losing whole blood or just plasma/dehydration? Assuming blood concentrations remain the same, then a decrease in hydrostatic forces results in less interstitial fluid production. If it's dehydration and the plasma protein amount (concentration increases) remains the same, then both a decrease in hydrostatic pressure coupled with an increase in the oncotic pressure results in less interstitial fluid production.

 

[Clare]

Are we losing whole blood or just plasma/dehydration? Assuming blood concentrations remain the same, then a decrease in hydrostatic forces results in less interstitial fluid production. If it's dehydration and the plasma protein concentration remains the same, then both a decrease in hydrostatic pressure coupled with an increase in the oncotic pressure results in less interstitial fluid production.

Let's assume hypovolaemia.

A better way of writing the question would be "explain why fluid tends to shift from the interstitial to intravascular space in the early stages of shock".

This was a written test question on the Paramedic course and it confused the hell out of me and I wonder if other people feel the same?

 

[Brandon O]

A better way of writing the question would be "explain why fluid tends to shift from the interstitial to intravascular space in the early stages of shock".

Loss of intravascular hydrostatic pressure.

Followup: what is the main factor driving a subsequent shift from intravascular to interstitial?

Answer: annoying medics with bags of saline

 

[JPINFV]

Let's assume hypovolaemia.

A better way of writing the question would be "explain why fluid tends to shift from the interstitial to intravascular space in the early stages of shock".

This was a written test question on the Paramedic course and it confused the hell out of me and I wonder if other people feel the same?

Non-hemorrhagic hypovolemia? Increased oncotic, decreased hydrostatic pressure.

 

[lightsandsirens5]

Loss of intravascular hydrostatic pressure.

Followup: what is the main factor driving a subsequent shift from intravascular to interstitial?

Answer: annoying medics with bags of saline

Beat me to it.

I have totally jumped on the bandwagon with the folks in Baltimore. Permissive hypotension FTW!

 

[VFlutter]

I have totally jumped on the bandwagon with the folks in Baltimore. Permissive hypotension FTW!

I'm right there with you. I wish more places would adopt their approach to trauma care and hemorrhage management. Shock Trauma is on the top of my dream job list.

 

[mycrofft]

Does the treatment maintain enough perfusion pressure to vital organs and the brain (note I differentiated those ) versus need to abosultely keep pt volumed until they GET TO THE HOSPITAL ?

 

[mycrofft]

WHen this subthread is over: 'Stuttering CVA"?

There's an old thread about a pt with a "stuttering stroke" which sounds interesting.
http://www.emtlife.com/showthread.php?t=959
Maybe hijack it here?

 

[VFlutter]

It appears a stuterring stroke is a stroke with fluctuating symptoms as opposed to a steady progression. It sounds similar to a TIA except the stroke never completely resolves. Maybe vasospasm?

Here is one for you critical care guys. Name the various Swan wave forms...

Hint: Even if you have never seen any tracings think about the anatomy of the heart and how a swan (PA cath) is placed and you should be able to guess the answers.