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ED/Surgery > Chest & Abd Pain > Flashcards

Chest & Abd Pain Flashcards

1
Q

Thoracic chest pain DDX

A

Cardiac: CAD (angina, MI), Pericarditis, Pulmonary HTN, PE, Aortic dissection, mitral valve prolapse, Myocarditis

Non-Cardiac: MSK, GERD, Esophageal disorder, Lung disease, Pleural disease, gall bladder disease, anxiety

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2
Q

How is pleuritic pain described?

A

Pain is increased by deep breathing, coughing, etc…

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3
Q

Pleuritic chest pain DDX

A

PE, Pneumothorax, Pneumonia, Pleurisy

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4
Q

Possible causes of chest wall (somatic) pain

A

Intercostal Strain, Costochondritis, Herpes Zoster

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5
Q

sudden, very intense tearing pain =

A

aortic dissection

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6
Q

Becks triad

A

for cardiac tamponade = hypotension, JVD, muffled heart sounds

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7
Q

Essential workup for chest pain

A

EKG
CXR
Troponin (does not r/o AMI if taken w/i 12 hrs)

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8
Q

Acute coronary syndrome and acute MI treatment

A

MONA (BB if tachycardic or hypertensive)

Goal is reperfusion (fibrinolysis less than 12 hrs)

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9
Q

Cardiac tamponade treatment

A

Pericardiocentesis (just below xyphoid aiming for left shoulder at 45 degrees)

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10
Q

Pulmonary embolism treatment

A

Stable: LMWH (Enoxaparin 1mg/kg subQ)
Unstable: Thrombolysis (Alteplase 100mg over 2hrs)

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11
Q

Aortic dissection treatment

A

Initial: Central Line, Morphine for pain, fluids for hypotension
Stable: Propranolol, Diltiazem, Enalapril (heart, vessels, BP)
Unstable: Surgery

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12
Q

Esophageal Spasm/Rupture treatment

A

Spasm: GI cocktail, nitro
Rupture: Airway, Fluids, Surgery

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13
Q

Pericarditis treatment

A

NSAIDs, Colchicine (70-90% self limited)

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14
Q

Pneumothorax (Tension) treatment

A

Severe/Unstable: needle decompression (14-guage 2nd intercostal MCL)
Definitive Tx: chest tube thoracotomy (36-French 4th intercostal AAL)

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15
Q

dyspnea vs respiratory distress

A

dyspnea is subjective

respiratory distress is objective (hypoxia, tachypnea, cyanosis, etc.)

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16
Q

Red flags of dyspnea

A
  • decreased mental status (anxiety-lethargy)
  • labored breathing (tachypnea/accessory muscle use)
  • speaking in fragmented sentences
  • Cyanosis
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17
Q

Life threatening dyspnea

A

Upper airway obstruction (FB, angioedema, hemorrhage)
Tension pneumothorax
PE

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18
Q

Essential workup for dyspnea?

A

chest XR!!!

pulse ox, ABG, EKG

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19
Q

s/s: moist crackles, JVD, pedal edema, S3 heart sound, pink/frothy sputum

A

CHF exacerbation or pulmonary edema

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20
Q

triggers: pulm infection, allergens

s/s: wheezing, poor air movement, coughing

A

asthma or COPD exacerbation

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21
Q

Triggers: foreign body, infection (epiglottitis), hypersensitive reaction (angioedema)
s/s: stridor, drooling, hoarseness, swelling

A

upper airway obstruction

22
Q

Triggers: viral URI, influenza, hx of respiratory problems

s/s: cough, fever, pleuritic chest pain

A

pneumonia

23
Q

Triggers: hx of PE/DVT, smoking, OCP use, cancer, immobilization, recent trauma
s/s: dyspnea, tachypnea, tachycardia, hemoptysis

A

pulmonary embolism

24
Q

Triggers: young, tall, male, smoker

s/s: pleuritic chest pain, uneven chest rise/breath sounds, tracheal shift

A

pneumothorax

25
Q

Goals for oxygen level in dyspnea patient

A

greater than 90%

26
Q

Initial treatment for all dyspnea patients

A

facemask with 100% oxygen

caution if COPD

27
Q

Labs for dyspnea workup

A

CBC, BMP, BNP, D-dimer, sputum/blood culture, tox screen

28
Q

How is a pneumothorax managed?

A

Observe if less than 15%

Tube thoracotomy if over 15-20% or enlarging on repeat CXR

29
Q

________ refers to a sudden, severe abdominal pain of unclear etiology that is less than 24 hrs in duration.

A

acute abdomen

30
Q

What type of abdominal pain tends to make patients want to move around? type to make lie still?

A

visceral - move

parietal - lie still

31
Q

Describe ischemic visceral abdominal pain

A

severe, diffuse, and disproportionate to exam

32
Q

Which organ visceral pain is referred to umbilicus?

A

midgut

33
Q

Which organ visceral pain is referred to superior of umbilicus?

A

foregut (liver, stomach)

34
Q

How to test Murphy’s sign? Seen with what?

A

Pain with inspiration when pressure applied under right costal margin

gall bladder inflammation

35
Q

McBurney’s Point pain indicates _________.

A

appendicitis

36
Q

positive psoas sign indicates _________.

A

retrocecal appendicitis

37
Q

________ sign indicates pelvic inflammation.

A

obturator

38
Q

When to do a rectal exam with abdominal pain?

A

possible GI bleed, prostatitis, hemorrhoids or fissures

39
Q

Why order lipase for abdominal pain?

A

evaluate pancreas

40
Q

What patients with abdominal pain need urgent surgery?

A

acute, severe pain
pulsatile mass
shock sx’s

41
Q

Common IV antiemetics

A

Zofran

Reglan

42
Q

Common IV antibiotics for abdominal pain

A

Ancef

Zosyn

43
Q

How to image renal stones?

A

CT without contrast

44
Q

Signs of small bowel obstruction on XR

A

air-fluid levels and dilation

45
Q

Signs of foreign bodies on XR

A

opacities

46
Q

Signs of perforation on abdominal XR

A

free air under diaphragm

47
Q

Admission criteria for abdominal pain

A 
surgical intervention needed
IV abx needed
peritoneal signs
unable to keep down fluids
lack of pain control
48
Q

Discharge criteria

A

No surgical or severe condition found
Able to keep down fluids
Good pain control
Able to follow discharge plan

49
Q

Admission criteria for dyspnea

A

Requires assisted ventilation
Ongoing hypoxia
Requires ongoing treatment

50
Q

colicky abdominal pain and spasm of smooth muscle comes from pathology where?

A

intestines, gall bladder

ED/Surgery (16 decks)

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