Approach to the Emergent Patient Lecture Powerpoint

Question 1

One of the first things to consider on an unresponsive patient is to check their…

Answer 1

…rapid bedside glucose level

Question 2

Approach to altered mental status acronym (ABCDEFG)

Answer 2

Airway
Breathing
Circulation
Decontamination
Enhanced elimination
Focused therapy
Get toxicology help

Question 3

Glasgow coma scale

Answer 3

Tool utilized to establish level of consciousness and compare over course of treatment, 3 components including eye opening (spontaneous 4, to speech 3, to pain 2, none 1), verbal response (oreinted 5, confused, 4, inappropriate 3, incomprehensible 2, none 1), and motor response (obeys commands 6, localizes pain 5, withdraws from pain 4, flexion to pain, 3, extension to pain 2, none 1) for a max score of 15, correlates inversely with aspiration risk, GCS equal or less than 8 indicates ET intubation

Question 4

What type of temp is preferred to take in an ER setting?

Answer 4

-rectal temp preferred***

Question 5

Excess dose acetaminophen (>4g a day) is very toxic to what organ?

Answer 5

Liver

Question 6

Empiric management of decreased mental status patient (4 things)

Answer 6

• maintain spO2
• rapid bedside glucose
• naloxone .4mg IV
• thiamine 100mg IV

Question 7

EM approach to acute MI/ACS (11)

Answer 7

• Goal under 10 min
• 12 lead ekg
• baby aspirin (325mg) chewed
• Sublingual nitro .4mg every 5 min x3 doses
• Establish IV access
• blood work including cardiac biomarkers
• initiate supplemental oxygen therapy
• continuous ECG monitoring
• B blocker
• anticoag therapies
• Call cath lab if acute ST elevation

Question 8

EM approach to acute stroke (4)

Answer 8

• ABC’s
• quickly reverse contributing conditions
• determining if patients with ischemic stroke are candidates for thrombolytic therapy or endovascular thrombectomy (non-contrast CT, vital signs, H&P, O2 sat)
• NIH stroke scale eval

Question 9

EM approach to the agitated/violent patient (3)

Answer 9

• actively violent patient exhibiting signs of impending violence require immediate restraint, assume all violent patients are armed until proven otherwise
• remain 2 arms lengths away from patient
• take all threats seriously

Question 10

Physical vs chemical restraints

Answer 10

Physical are leather cuffs to attempt to calm a combative patient are unsuccessful vs chemical are for severely violent patients that require immediate sedation such as droperidol, midazolam, haloperidol, or lorazepam