Approach to scenarios 1 Flashcards
Abdominal pain in conjunction with hemodynamic instability should alert the physician to the possibility of what 4 things?
hemorrhage, sepsis, perforated viscus, or necrotic bowel
What is often the first sign of hemodynamic instability?
In patients with established hemodynamic instability, what 3 things need to be done immediately?
tachycardia
fluid resuscitation should begin by establishing 2 large bore IVs and rapidly infusing isotonic crystalloid. Supplemental oxygen should be administered, and patients should be placed on a monitor.
In the unstable patient with abdominal pain in whom hemorrhage is diagnosed or highly suspected, what must be done immediately?
typed and crossed blood should be immediately ordered. The transfusion of type O blood can be performed in critical situations where there is not enough time to wait for cross matched blood.
Women of childbearing age who present with abdominal pain require urgent?
pregnancy test to rule out ectopic pregnancy
Portable x-ray and ultrasound can serve as immediate diagnostic tools that can be performed at the bedside when there is concern for what two things?
air or blood in the abdominal cavity
What is the diagnostic modality of choice for suspected biliary pathology, ovarian and testicular torsions?
US
two imaging choices for kidney stones and which one can see super small stones?
CT and US
CT
Diffuse and upper abdominal pain should always warrant what 2 examinations?
heart and lungs
All emergency department patients require an initial assessment for immediate threats, what is the standard approach?
ABCDEF
airway, breathing, ciruclation, disability, exposure and finger stick glucose
What type of breathing status can lead to AMS and what am I thinking is the cause and treatment?
hypoventilation leading to respiratory acidosis
narcotic overdose, naloxone
What are three broad range classifications of AMS?
delirium, dementia and psychosis
onset, vital signs, hallucinations and level of consciousness for all 3?
onset: rapid for delirium
VS: abnormal for delirum
visual for del, none for dem, auditory for psychosis
altered for del
An important differentiating aspect of psychosis is that?
their orientation is often intact, which can help differentiate from delirium and dementia.
Decreased level of consciousness with cranial nerve findings is a what until proven otherwise.
brainstem lesion
Lets say you are looking at the QRS with a patient in cardiac arrest and it is wide. What are the two differentials an how to treat each?
hyperkalemia, calcium
sodium channel blocker, bicarb
same question but QRS is narrow, what 3?
tamponade, centesis
PE, tpa
tension, needle decompression
What is the most important prognostic factor for survival in cardiac arrest?
duration of cardiac arrest
how are we going to treat asystole or PEA?
transcutaenous pacing
What are my top 3 life threatening differentials for chest pain, and then 4 others not as common life threatening?
ACS, PE, and aortic dissection
tension, esophageal rupture, pericardits, and tamponade
Ligament of Trietz separates what two things?
duodenum from jejunum
What are the most common etiology in patients presenting with acute upper gastrointestinal bleeding>
Peptic ulcers
Hematemesis (red blood in emesis) or coffee ground emesis usually indicates?
upper GI bleed
Melena (dark or tarry stools) occurs in about 70% of patients with?
upper GI bleed
What is the diagnostic choice for headache if you are thinking bleed and how will it look on the image?
CT without contrast and bright
