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Emergency Medicine > Clin Assess > Flashcards

Clin Assess Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is more common, LE or UE injuries?

A

LE

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2
Q

What are the 2 most commonly injured blood vessels?

A

femoral and popliteal

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3
Q

Which is more damaging, GSW or stabbing?

A

GSW

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4
Q

What are signs of vascular trauma (6)

A
  • absent/diminshed pulses
  • obvious arterial bleeding
  • large expanding hematoma
  • audible bruit
  • palpable thrill
  • distal ischemia
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5
Q

What should you do if there definitely is a vascular injury to an extremity?

A

Vascular consult ASAP!

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6
Q

What should you do if you are highly suspicious of a vascular injury?

A

CT angiography

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7
Q

What should you if there are no signs of a vascular injury but you want to r/o?

A

ABI

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8
Q

What are some additional tests you can order when concerned for vascular bleeding?

A
  • creatinine (before CT with contrast)
  • CBC (if significant blood loss)
  • xray (if concerned about fx)
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9
Q

What is a complete disruption of joint?

A

dislocation

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10
Q

What is a partial dislocation of a joint?

A

subluxation

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11
Q

What is a tearing injury of muscle fibers called?

A

strain

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12
Q

What is a tearing injury of ligament called?

A

sprain

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13
Q

Patient presents with unilateral swelling in leg, pain out of proportion, discoloration, decreased pulses and coolness?

A

compartment syndrome

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14
Q

What is the first step in an orthopedic PE?

A

Inspection!

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15
Q

What is the second step in an orthpedic PE?

A

Palpation (check for bony step-off, extend palpation area beyond location of pain– pain may be referred)

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16
Q

What nerve controls the pinky and half of ring finger?

A

ulnar nerve

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17
Q

what nerve controls half the ring finger to the thumb

A

median

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18
Q

What nerve controls the base of the thumb?

A

radial

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19
Q

What nerve controls most of the top of the foot?

A

superficial fibular

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20
Q

Which nerve has the lateral side of the foot?

A

dorsilateral cutaneous nerve

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21
Q

Which nerve only has half the big toe and half the next toe?

A

deep fibular

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22
Q

Which nerve has the medial malleolus and above?

A

saphenous

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23
Q

What are different ways of describing a fracture? (6)

A
  • open v closed
  • location (midshaft, distal, proximal, intra-auricular)
  • orientation of fracture line (transverse, oblique, spiral)
  • displacement and separation
  • shortening
  • angulation
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24
Q

What are steps you should take in the ER for someone with a fx?

A
  • control pain and swelling
  • withhold oral intake (if surgery)
  • reduce fx deformity
  • reduce dislocation
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25
Q

Why should you redice fx deformity?

A
  • alleviates pain
  • relieve tension on nerves/vessels
  • minimize possibility of inadvertently closed changing to open
  • restore circulation to pulseless distal extremity
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26
Q

What should you always do when reducing a joint?

A

get pre and post xrays

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27
Q

When should you use a shoulder immobilizer? (4)

A
  • clavicle fx
  • AC separation
  • shoulder dislocation
  • humeral head fx
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28
Q

When should you use an arm sling? (2)

A

-non-displaced radial head fx

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29
Q

When should you use a long-arm gutter? (2)

A
  • elbow fx

- elbow dislocation

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30
Q

When should you use a sugar tong? (1)

A

-wrist/forearm fx

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31
Q

When should you use a short-arm gutter? (1)

A

metacarpal/proximal phalanx fx

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32
Q

When should you use a thumb spica splint?

A

scaphoid, thumb, metacarpal

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33
Q

When should you use a knee immobilizer? (4)

A
  • patellor fx/subluxation
  • knee dislocation
  • tibial plateau fx
  • knee ligament/meniscus injury
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34
Q

When should you use a posterior ankle mold? (4)

A
  • ankle dislocation
  • unstable fx
  • widened medial mortise
  • metatarsal fx
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35
Q

When should you use an ankle stirrup? (2)

A
  • simple ankle sprain

- stable lateral malleolus fx

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36
Q

When should you use a hard-soled shoe? (1)

A

toe fx

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37
Q

When should you use a short-leg walking boot?

A

toe/foot fx with wt-bearing allowed

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38
Q

What are discharge instructions you should give someone with an orthopedic injury?

A
  • rest
  • elevate (above heart)
  • ICE (keep splint dry)
  • no weight-bearing until ortho
  • pain meds prn
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39
Q

when should a patient call/return immediately? (3)

A
  • pain severe/worsening
  • numbness is new/worsening
  • skin discoloration (dusky toes)
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40
Q

What are delayed complications of an orthopedic injury?

A
  • fat embolus
  • non-union/malunion
  • joint stiffness
  • traumatic arthritis
  • avasculuar necrosis
  • osteomyelitis
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41
Q

What does a BMP give you info on?

A
  • kidneys
  • electrolyte balance
  • acid/base balance
  • blood glucose
  • Ca levels
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42
Q

What does an elevated Ca concern you for?

A
  • Malignancy

- hyperparathyroid

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43
Q

What does a low CO2 concern you for?

A
  • Acidosis

- possible ketoacidosis (esp of low K and high glucose)

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44
Q

What does a low glucose concern you for?

A
  • insulin OD

- sepsis

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45
Q

What does an elevated BUN AND elevated creatinine concern you for?

A

renal failure

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46
Q

What does an elevated BUN and normal creatinine concern you for?

A

diureased

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47
Q

What does the CMP have?

A

Everything the BMP has PLUS:

  • Albumin
  • Alka phos (ALP)
  • total bilirubin
  • total protein
  • LFT’s
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48
Q

What are reasons to order CMP?

A
  • LFT’s (alcoholics)

- Nutritional status (albumin, total protein)

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49
Q

What does a low albumin worry you for?

A

malnutrition

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50
Q

What does an increase in alk phos worry you for?

A

gallstones

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51
Q

What does an increase in AST/ALT worry you for?

A

hepatitis

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52
Q

What does an increase in bilirubin concern you for?

A

cirrhosis, hepatitis

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53
Q

What does a low RBC, hemoglobin, hematocrit worry you for?

A
  • blood loss

- anemia

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54
Q

What does a high RBC, H/H concern you for?

A
  • hemoconcentration due to DEHYDRATION

- polycythemia

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55
Q

What does a CBC WITH DIFF show you?

A

breakdown of WBC’s into types

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56
Q

What is the most abundant type of WBC normally?

A

Neutrophils

57
Q

What does a low platelet count concern you for?

A
  • acute infection
  • BLEEDING
  • DIC
  • HELLP (preeclampsia in PG lady)
58
Q

What does an increase in neutrophils concern you for?

A

BACTERIAL infection

59
Q

What does a decrease in neutrophils concern you for?

A

Widespread infection (left shift)

60
Q

What does an increase in lymphocytes concern you for?

A

VIRAL infection (mono, mumps, measles)

61
Q

What does an increase in eosinophils concern you for?

A

acute allergic reaction

62
Q

What does a VERY elevated eosinophil level concern you for?

A

parasitic infection

63
Q

What urine glucose level concerns you for uncontrolled DM or possible DKA?

A

urine glucose over 130 with ketones

64
Q

What do positive nitrates and leukoesterase on UA concern you for?

A

UTI

65
Q

What if someone has UTI sxs but negative nitrates and leukoesterase on UA?

A

interstitial cystitis

66
Q

What does metabolic acidosis concern you for?

A

DKA

67
Q

What does metabolic alkalosis concern you for?

A

vomiting

68
Q

What does resp. acidosis concern you for?

A

hypoventilation (PE, pna, COPD, heroin)

69
Q

What does resp. alkalosis concern you for?

A

hyperventilation (PE, anxiety, pain, febrile illness)

70
Q

What is present with DKA?

A

serum and urine ketones

71
Q

What should you measure to monitor DKA tx response?

A

capillary blood ketones

72
Q

What does a d-dimer measure?

A

fibrin content

73
Q

What is d-dimer a good test for?

A

RULING OUT PE in pt w/low risk factors

74
Q

Why is BNP secreted?

A

In response to volume overload/myocardial stretch

75
Q

What is BNP used for?

A

CHF detection

76
Q

What are cardiac troponins?

A

They are essential proteins in cardiac muscle contraction

77
Q

What happens to troponins during myocardial injury?

A

extracellular leakage of troponins

78
Q

What is the biomarker of choice, troponins or CK-MB?

A

troponins

79
Q

What is considered an early presentation of someone with chest pain?

A

w/n 6hrs of sxs

80
Q

What test do you order to monitor warfarin effect?

A

PT/INR

81
Q

What pathway does PT/INR evaluate?

A

EXTRINSIC

82
Q

What is the extrinsic pathway responsible for?

A

Most pro-coag activity (TF, factor VII)

83
Q

What does coumadin do?

A

Inhibits Vit K (II, VII, IX, X)

84
Q

What do you order to monitor heparin?

A

PTT (partial thrombin time)

85
Q

What does PTT evaluate?

A

INTRINSIC pathway

86
Q

What is the role of the intrinsic pathway

A

Involved in procoag activity related to inflammation and innate immunity

87
Q

How soon will a monospot test become positive?

A

2-6 weeks after onset of sxs

88
Q

What can cause a false-pos monospot test?

A
  • toxoplasmosis
  • rubella
  • lymphoma
  • malignancies
89
Q

What can cause a false-neg monospot test?

A

testing too early

90
Q

Which pathogen does rapid strep test detect?

A

Group A streptococci

91
Q

What influenza strains do influnza swabs detect?

A

Both A and B

92
Q

When should influenza swabs be done?

A

ASAP to start of sxs

93
Q

What secretes amylase? and why?

A

salivary glands and pancreas to digest starch

94
Q

Shat secretes lipase? and why?

A

Pancreas to breakdown dietary fats

95
Q

What is the most specific pancreatic enzyme?

A

lipase

96
Q

What are the 2 most common ED complaints?

A
  • chest pain

- abd pain

97
Q

Where is the glottis located in normal adults?

A

level of FIFTH cervical vertebrae

98
Q

What are pre-op airway assessments (6)

A
  1. Mallampati classification
  2. Neck ROM
  3. TMD (3 finger lengths between hyoid bone and chin)
  4. mouth-opening
  5. Teeth
  6. Bones
99
Q

What is the usual cause of airway obstruction?

A

tongue

100
Q

How can you get that damn tongue out of the way?

A

Chin lift/jaw thrust

101
Q

How if chin lift/jaw thrust doesn’t work and that tongue is still obstructing the shit out of the airway?

A

oral/nasal airway is next step

102
Q

What, other than the tongue, can also cause airway obstruction?

A

dentures

103
Q

Who are ORAL airways NOT good for?

A

people with gag reflexes

104
Q

What can happen if an oral airway is poorly sized/improperly inserted?

A

can worsen obstruction

105
Q

What are 2 oral airway insertion techniques?

A
  • tongue depressor

- insert and rotate

106
Q

Why are nasal airways sometimes better than oral airways?

A

less stimulating, better tolerated

107
Q

What is the most common complication from nasal airways?

A

hemorrhage

108
Q

What are relative contraindications to using nasal airways?

A
  • coagulopathies

- head trauma

109
Q

Who should you def not use nasal airways in?

A

someone taking anticoag

110
Q

What are some advantages to using a laryngeal mask airway? (6)

A
  • allows one-handed ventilation
  • forms seal around larynx
  • less stimulating than ETT (asthma, CAD)
  • less S/T
  • less risk eye/facial nerve injury
  • helps w/difficult airway
111
Q

What are contraindications to using LMA? (7)

A
  • suspected gastric contents/acute abd
  • gross obesity
  • PG
  • thoracic injury
  • heavy opiate intox
  • hiatal hernia
  • low pulm compliance
112
Q

What are insertion techniques for LMA?

A
  • LMA held in DOMINANT HAND like pen

- confirm placement iwth BBS and ETCO2

113
Q

What should ventilatory pressure not exceed with LMA? and why?

A

20mm (risk aspiration)

114
Q

What are indications for ETT? (9)

A
  • controlled ventilation
  • compromised/inaccessible airway
  • failure of other methods
  • aspiration risk
  • PG
  • airway disease/distortion
  • lack gag reflex
  • surgical procedure
  • various positions
115
Q

What are contraindications to using ETT?

A

No contraindications

116
Q

What is monitoring equipment?

A
  • pulse ox
  • BP gauge
  • cardiac monitor
117
Q

What are some oxygenation equipment?

A
  • O2 source and tubing
  • face mask
  • anesthesia bag or self-inflating amby bag (HIGH FLOW)
  • suction catherter w/Yankauer tip
118
Q

What classifies as high flow?

A

10-15L

119
Q

What do you call a curved laryngscope blade?

A

Macintosh

120
Q

How does a Macintoch blade work?

A

top of blade rests of valecular and epiglottis and lifts INDIRECTY

121
Q

What do you call a straight laryngyscope blade?

A

Miller/Wisconsin

122
Q

How do straight blades work?

A

Tip instered below epiglottis and lifts DIRECTLY (long-floppy epiglottis)

123
Q

What cuff pressure should ETT tubes not exceed?

A

25 torrs

124
Q

What length should ETT tubes be for females?

A

7-7.5

125
Q

What length should ETT tubes be for males?

A

7.5-9

126
Q

What are some equipment for verifying tube position?

A
  • stethoscope
  • CO2 detector/end-tidal CO2 monitor
  • esophageal syringe
  • CXR to confirm placement (REQUIRED)
127
Q

How should you always hold a layngscope?

A

in LEFT hand

128
Q

Why are stylets helpful?

A

allow curvature of ETT to be customized

129
Q

What is a risk with stylets?

A

can cause trauma (LETHAL!)

130
Q

What position should a patient be in for tracheal intubation?

A

sniffing position

131
Q

What is sniffing position?

A
  • enables alignment of axes of patients mouth for direct visualization of larynx
  • moderate head elevation (7-10cm) and extension of A/O joint accomplishes flexion of lower CS and extension of upper CS
132
Q

How should you open a patients mouth?

A

scissor maneuver

133
Q

What are some common mistakes made when intubating? (3)

A
  • Inserting blade too far– into esophagus
  • Pulling the lever- Wrist NEVER breaks (pull up and away)
  • Inserting ETT too far– bronchial intubation
134
Q

What are subjective ways to verify correct placement of ETT (6)?

A
  • chest wall rise
  • EQUAL breath sounds
  • condensation in ETT
  • right “feel’
  • no gurgling noise/vomit
  • pink patient
135
Q

What are objective ways to verify correct placement? (2)

A
  • Continued presence ETCO2

- interpreted CXR

136
Q

What are Gllidescope applications (6)?

A
  • potentially difficult airway
  • trauma/emergency intubations
  • morbidly obese
  • C-spine immobilization
  • reintubation in ICU
  • awake intubations
137
Q

What are predictors of a difficult airway? (8)

A
  • protruding incisors
  • permanent dentures/caps
  • missing/mal-aligned teeth
  • ornementation/tongue jewelry/braces
  • macroglossia
  • obese (morbidly)
  • large breasts
  • hoarseness/stridor
138
Q

How far should normal adult be able to open their mouth?

A

4-5 cm (3 fingers)

Emergency Medicine (3 decks)

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