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Emergency Medicine > Cardiothoracic Emergency > Flashcards

Cardiothoracic Emergency Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Chest Pain Evaluation - three categories

A

Chest wall pain

Pleuritic/respiratory chest pain

Visceral chest pain

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2
Q

Identifying a High Lateral AMI

A

Look in leads 1 and AVL for ST elevation

May be very subtle

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3
Q

SVT Treatment

A

Vagal maneuvers (only if stable)

Adenosine (6 mg, then 12 mg IV w/ 20 ml NS bolus)

Cardioversion (50-100 J)

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4
Q

Aortic Dissection Presentation

A

HTN is MC predisposing factor

  • But they may be normotensive
  • Also atherosclerosis, vasculopathy, Marfan’s, congenital defect

Commonly present w/ abrupt and severe pain in anterior chest or between scapula - ripping/tearing pain

May cause acute aortic regurgitation

-never use a balloon pump with aortic regurgitation

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5
Q

Aortic Dissection Treatment

A

Control HTN - negative inotropic medications

IV BB: Labetalol, Metoprolol, Esmolol

Vasodilation: Nitroprusside IV

Stabilize and rapid referral to surgeon

Always assess all extremity pulses

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6
Q

Abdominal Injuries to Solid and Hollow Organs

A

Solid organs: may result in bleeding into abdominal cavity or dumping their contents into the cavity

  • liver, spleen, pancreas

Hollow organs: may discharge chemical and bacterial contents

  • stomach, duodenum, intestine
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7
Q

Peritonitis

A

Emergent

Infection, or rarely inflammation of the peritoneum

Peritoneum is the membrane that covers the surface of the organs within the abdominal cavity

Silent abdomen with rebound tenderness

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8
Q

Acute Abdomen

A

Generally intra-abdominal process causing severe pain which requires specialized investigation and intervention

An emergency

Treatment depends on cause

Determine whether patient is stable or unstable - belly pathology may manifest w/ systemic signs (renal failure or shock)

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9
Q

Morphine Effect with Angina

A

Pain control

Decreases BP and heart workload by dilating splenic vessels and decreasing peripheral vascular disease

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10
Q

Common Abdominal Pathologies in Children

A

Gastroenteritis

Meckel’s diverticulitis

Intussusception

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11
Q

Common Abdominal Pathologies in Adults and in Adult Women

A

Adults:

Regional enteritis

Kidney stone

Perforated ulcer

Testicular/Ovarian torsion

Pancreatitis

Women: PID, Pyelonephritis, Ectopic pregnancy

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12
Q

Common Abdominal Pathologies in Elderly

A

Diverticulitis

Intestinal Obstruction

Colon carcinoma

Mesentric infarction

Aortiv aneurysm

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13
Q

Pain Symptoms and Indications

Onset - slow or sudden

Severity

Character - burning, stabbing, gripping/intermittent/crampy

A

Slow insidious onset: inflammation of visceral peritoneum

Sudden onset: perforation of bowel, smooth muscle colic

Severity: Kidney stones is one of the worst pains

Burning: Peptic ulcer symptoms

Stabbing: kidney stone

Gripping, intermittent, crampy: intestinal obstruction that gets worse w/ movement

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14
Q

Pain Symptoms and Indications

Progression - constant, colicky, character change

Radiation - back, scapula, sacroiliac, groin

A

Constant pain: peptic ulcer

Colicky pain: bowel in seconds, kidney stone in minutes, gallbladder is tens of minutes

Character change: dull poorly localized pain to sharp pain indicates parietal peritoneum involvement (appendicitis)

Radiation to back: duodenal ulcer, pancreatitis, aortic aneurysm

Radiation to scapula: gall bladder

Radiation to sacroiliac region: ovary

Radiation to groin: testicular torsion

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15
Q

McBurney’s point

A

1/3 the distance between the anterosuperior iliac spine and umbilicus

Acute appendicitis

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16
Q

Four Cardinal Features of Intestinal Obstruction

A

Abdominal pain with intermittent cramping

Vomiting

Distension

Constipation

17
Q

Colon Obstruction - MC part affected and size measurements

A

Cecum is the most distensible part

Cecum = 9cm - cause for concern about perforation

Cecum = 11 cm - impending perforation

18
Q

Mesenteric Infarction/Ischemia

A

Older patients with history of arrhythmias or previous emboli

Pain out of proportion to exam

Visceral complaints without peritonitis

Systemic complications with acidosis - they look sick

19
Q

Acute Mesenteric Ischemia

A

Usually acute occlusion of SMA from thrombus or embolism

May need to do embolectomy

20
Q

Chronic Mesenteric Ischemia

A

Typically smoker, vasculopath with severe atherosclerotic vessels disease

Weight loss is most consistent sign

Severe post-prandial pain

21
Q

Reasons to call the surgeon

A

Peritonitis - rebound tenderness w/ involuntary guarding

Severe/unrelenting pain

Unstable - hemodynamically or septic

Intestinal ischemia

Pneumoperitoneum

Complete or high-grade obstruction

22
Q

Common Blunt Injury Patterns for Duodenum and Small Bowel

A

Duodenum: frontal-impact MVC with unrestrained driver, direct blow to abdomen

-Get bloody gastric aspirate, retroperitoneal air

Small Bowel Injury: Sudden Deceleration with subsequent tearing near fixed points of attachment

23
Q

Common Blunt Injury Patterns for Pancreas, Diaphragm, and Genitourinary

A

Pancreas: Direct epigastric blow compressing pancreas against vertebral column

Diaphragm: MC rupture on posterolateral hemidiaphragm noted on CXR

Genitourinary: Patients with multisystem injuries and pelvis fractures

24
Q

Common Blunt Injury Patterns for Solid Organ Injury or Pelvic Fracture

A

Solid Organ Injury: laceration to liver, spleen, or kidney

Pelvic Fractures: usually auto-pedestrian, MVC, or motorcycle

-significant association with intraperitoneal and retroperitoneal organs and vascular structures

25
Q

FAST

A

Focused Assessment with Sonography for Trauma

Used to identify hemoperitoneum in blunt abdominal trauma

Larger the hemoperitoneum, the higher the sensitivity

-Sensitivity increases clinically significant hemoperitoneum

26
Q

Gold Standard for characterizing intraparenchymal injury

A

CT is gold-standard

FAST is useful for a resuscitation

27
Q

Kidney Trauma

A

MC bruised

Shattered kidneys become rapidly unstable

Renal vascular injuries may result in thrombosed vessels

28
Q

Bladder Rupture

Extraperitoneal

Intraperitoneal

A

Extraperitoneal rupture presents with pain, hematuria, and inability to void - MC

  • May be managed by catheterization alone

Intraperitoneal ruptures always require surgical exploration and repair

29
Q

Urethral Injuries

Posterior

Anterior

A

Posterior: located in the membranous and prostatic urethra

  • related to massive blunt trauma with massive deceleration
  • often have pelvic fractures to anterior pelvis with shearing injuries

Anterior: anterior to membranous urethra and result of blunt trauma to perineum

  • delayed presentation, stricture like
30
Q

GI Bleed

A

UGI bleeds MC than LGI bleed

UGI proximal to Ligament of Treitz (LT), LGI distal to LT

  • UGI esophagus to 2nd/3rd duodenum

Usually presents w/o belly pain

Presents w/ hematemesis, hematochezia, melena

Never use barium in acute GI bleed

31
Q

Diverticulosis and GI Bleed

A

Acute, painless bleeding presenting with bright red blood/maroon stool

Right colon 20% recurrent/persistent episode sites

Colonoscopy after bowel prep

Tagged rbc scans/angiography

32
Q

Anorectal/Perianal Disease and GI Bleeds

A

Common cause of hemorrhoids

Minor, intermittent bleeding with defecation

Dx of exclusion - r/o more serious lesions of GI tract like CRC/polyps/colitis first

33
Q

GI Bleed and Hospitalization

A

UGI bleeds usually admitted even before endoscopy

Mandatory admission w/ proven or suspected variceal hemorrhage/hemodynamic instability/co-morbidity/mental impairment

Emergency Medicine (10 decks)

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