Approach to the Undifferentiated Patient Flashcards

1
Q

Most common triage coding system

A

Emergency Severity Index (ESI)

Red-Critical
Orange- Emergent
Yellow- Urgent
Green- Minor
 Blue- Very minor
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2
Q

Does the patient appear to be unstable or in any distress? Determine this with a basic assessment of

A

the ‘ABCs’ (airway, breathing, circulation).

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3
Q

For unresponsive adults w/ cardiovascular emergency, approach the patient using

A

“CAB” (circulation, airway, breathing

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4
Q

If patient is “sick”, the following events should always occur in parallel

A

Vital signs asap
vascular access
cardiac monitor
O2 prn

think “IV-O2-Monitor”.

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5
Q

Spectrum bias is

A

test characteristic wherein the test becomes increasingly reliable as the disease progresses

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6
Q

Well’s Criteria is for

A

pulmonary embolism

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7
Q

Well’s Criteria

A
  • s/s of DVT
  • PE is #1 diagnosis
  • HR > 100 bmp
  • Immobilization 3+ days
  • Surgery in last 4 weeks
  • Hx of PE of DVT
  • Hemoptysis
  • Malignancy within 6 months -palliative care
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8
Q

Indications for emergency airway management may include

A
  • hypoxia
  • hypercarbia
  • AMS
  • failure to tolerate oral secretions
  • anticipation of a worsening clinical condition.
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9
Q

Pain-related complaints are the most common reason for emergency department visits, with _____ & ____ being the two most frequent cc

A

abdominal pain and chest pain

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10
Q

“premature closure

A

potential pitfall of honing in on a particular diagnosis before all of the information is available

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11
Q

At a minimum, all AMS patients deserve:

A
ABCDE
Cardiac monitoring 
pulse oximetry
glucose testing
IV access
Eval for  trauma 
Consider naloxone
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12
Q

AMS = AEIOU TIPS

A
Alcohol 
Electrolytes
Insulin
Opiates/ Oxygen 
Uremia
Trauma/ Temp 
Infection 
Poison/ Psych 
Shock/ Stroke
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13
Q

Three common broad classifications of AMS include

A

delirium- emergency
dementia
psychosis.

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14
Q

Arousal is mediated primarily by ________

A

brainstem nuclei- reticular activating system

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15
Q

Many medical conditions manifest as AMS when decompensated. Look for a history of:

A
Meds
DKA/ HHNK
HTN
endocrine disease 
renal failure
cancer
dementia
CVD
seizure
psychiatric issues
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16
Q

Glasgow Coma Scale compantants

A

Eyes, Verbal, Motor

17
Q

Glasgow Coma Scale

Eyes

A

4 – Spont
3 – Loud voice
2 – To Pain
1- None

18
Q

Glasgow Coma Scale

Verbal

A
5 – Oriented
4 – Confused
3 – Inapprop words
2 – Incomprehensible
sounds
1 – No Sounds
19
Q

Glasgow Coma Scale

Motor

A
6 – Obeys
5 – Localizes to pain
4 – Withdraws to pain
3 – Abnormal flexion
posturing
2 – Abnormal extension
posturing
1 – None
20
Q

Glasgow Coma Scale and airway

A

less that eight, intubate!

21
Q

Metabolic or Endocrine AMS labs

A
Rapid glucose
Serum electrolytes 
ABG or VBG 
BUN/Creatinine
Thyroid function
Ammonia 
Serum cortisol level
Toxic or medication causes
22
Q

Levels of medications AMS labs

A
  • Drug screen- Benzo, opioids, barbiturates
  • Alcohol level
  • Serum osmolality (toxic alcohols)
23
Q

Hemodynamic instability causes of AMS labs

A

ECG
Cardiac enzymes
Echo
Carotid/vertebral artery ultrasound

24
Q

AMS diagnosis is never assured until ?

A

abnormalities recognized and remedied

patient has returned to their normal mental status.

25
Q

AMS rx

________ for agitated withdrawal states

A

Supportive care and sedation

26
Q

AMS rx

Intravenous fluids for __________

A
  • dehydration
  • hypovolemia
  • hypotension
  • hyperosmolar states (HHNS or hypernatremia)
27
Q

AMS rx

Empiric antibiotics for _____

A

suspected meningitis
urosepsis
pneumonia, etc.

28
Q

AMS rx

_________ for temperature extremes

A

Rewarming or aggressive cooling

29
Q

AMS rx

__________ for specific toxins

A

Fomepazole
pyridoxine
digoxin-fab fragments other antidotes

30
Q

AMS rx

_______ for opioid toxicity

A

Naloxone

31
Q

AMS rx

____________ for hypertensive encephalopathy

A

Controlled reduction of BP with

  • nitroprusside
  • labetolol
  • fenoldepam
32
Q

AMS rx

_________ for hypoglycemia

A

Dextrose

33
Q

AMS rx

_______ for profound hyponatremia with seizures or AMS

A

Hypertonic saline

34
Q

AMS rx

_______ for metastatic CNS lesions with vasogenic edema

A

Glucocorticoids

35
Q

AMS rx

_______ for suspected Wernicke’s encephalopathy

A

thiamine

36
Q

AMS pts who can discharge home

A

sz
hypoglycemia from DM
Narcotic OD

37
Q

AMS pt asking to leave can if?

A

patient can demonstrate they understand both the risk of leaving against advice vs benefit of staying