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ER New Grad > Common diagnosis > Flashcards

Common diagnosis Flashcards

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Royal College: Emergency Medicine flashcards
1
Q
  1. why would someone have AMS (8)?
  2. What to do (9):
A

1.stroke, sepsis, hypoglycemia, drugs/etoh, hepatic encephalopathy, seizure, hypoxia

  1. Airway, Vitals, EKG, blood cultures, pupils, accu check, NIH, ammonia levels, patient hx
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2
Q
  1. What do we prioritize in an allergic reaction?
  2. What are the treatments (7)?
A
  1. airway (intubate if necessary)
  2. Start IV, Epi 1:1000, benedryl, solumedrol, pepcid, fluids, O2
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3
Q
  1. What do we do for a patient with A-fib with RVR (3)?
  2. What are the treatments(5)?
A
  1. EKG, cardiac monitoring, start IV
  2. Diltiazem, digoxin, amiodarone drip, cardioversion (unstable), cardio consult
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4
Q
  1. What is an aortic dissection, type A and type B?
  2. S/S:
  3. What to do:
  4. TX (4):
A
  1. Tear in aorta, type A = ascending, type B = thoracic or abdominal
  2. sudden severe chest, back, or abdo pain. Different BP in arms
  3. continuous cardiac monitoring, 2 IVs, frequent vitals, I&O
  4. Control BP between 100-120 w/ beta blockers, esmilol drip, blood transfusion, surgery
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5
Q
  1. What is Arthrocentesis?
  2. what must you get?
  3. What supplies to gather (7)?
A
  1. Draining a joint
  2. consent
  3. Lidocaine (w or w/o epi), 10 & 20 mL syringes, 18 & 22G needles, CHG povidone iodine, sterile gloves, bandaid, tubes for labs.
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6
Q
  1. What does bipap do?
  2. When do we use it?
  3. When do we not use it?
  4. Who manages it?
  5. What do we get at start and 1 hour after start of Bipap?
A
  1. respiratory support, keeps airway open, expels CO2
  2. Retaining CO2, respiratory depression, low O2 sats, respiratory failure
  3. With very altered patients.
  4. RT
  5. ABGs
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7
Q
  1. What do we do with bradycardia?
  2. Continue to monitor if:
  3. TX:
  4. Potential causes:
A
  1. cardiac monitoring, EKG, defibrillator pads on, IV, vitals
  2. No hypotension, no AMS, no chest pain, no heart failure
  3. Atropine 1mg up to 3mg (avoid if hypothermia is the cause), transcutaneous pacing, epi or dopamine infusion.
  4. MI, heart block, drugs/meds, electrolytes?
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8
Q
  1. What to do with burns
  2. What fluids are given?
  3. If clothing is adhered to skin?
A
  1. ABC’s, possible intubation, remove clothing and jewelry, get weight, pain management, cardiac monitoring, perfusion, I&O, Foley, sterile non-adherent dressing
  2. for >20% TBSA, 2-4mL/kg/%burn of LR first 1/2 over first 8 hours, 2nd 1/2 over following 16 hours
  3. don’t remove. Rather, pour cool water on it. No ice cold water. Avoid IMs
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9
Q
  1. What to do in cardiac arrest?
  2. what to do with Vfib and Vtach?
  3. are PEA and asystole shockable?
  4. What meds to give?
A
  1. Pulse check, CPR, crash cart, defib pads, backboard, IV, labs, fluids, intubate, rhythm and pulse check q2min.
  2. shock w 120-200 joules biphasic, continue CPR
  3. no
  4. epi 1mg q3-5 min, amiodarone 1st dose 300 mg bolus, 2nd dose 150 mg, lidocaine 1st dose is 1-1.5mg/kg
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10
Q
  1. What are the S/S of cardiac tamponade?
  2. What causes it?
  3. What is the TX?
A
  1. tachycardia, chest pain, faintness, resp. distress, Beck’s Triad (hypotension, muffled heart JVD)
  2. trauma or aortic dissection
  3. pericardiocentesis
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11
Q
  1. What are the reasons for synchronized cardioversion?
  2. What to do?
A
  1. rapid A-fib/flutter, SVT
  2. Get consent, call RT, crash cart, pads, nasal cannula or non-rebreather cranked up. call EKG. IV, sedation, set to sync mode, make sure R wave is sensed, elect energy level, charge, don’t touch patient, shock, record rhythm
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12
Q
  1. What is the hallmark of a complete heart block?
  2. What to do?
A
  1. no association between p wave and QRS complex
  2. get pads and IV access, transcutaneous or transvenous pacing, pacemaker
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13
Q
  1. what to do for conscious sedation:
  2. What are the meds?
  3. do nurses push propofol?
  4. what do we do post?
A
  1. Consent, RT, fluids, suction, end tidal CO2, q2 vitals, aldrete, timeout.
  2. Physician’s choice between ketamine, propofol
  3. no
  4. aldrete, stay with patient till baseline, x-ray should be performed post reduction to confirm
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14
Q
  1. what are the S/S of DKA (8)?
  2. TX?
A
  1. hyperglycemia, metabolic acidosis, polyuria, polydipsia, dehydration, fruity breath, ketones in urine, n/v
  2. fluid bolus x’s 2, Start with NS then swith to D5W+0.45NS when glucose is less than or equal to 200, regular insulin drip (titrate per glucose), K+ must be > 3.3. Q 1hr accu check. monitor K+ closely and replace if needed.
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15
Q
  1. what to do or assess for in opioid overdose?
  2. meds?
A
  1. ABC’s, pads, intubate if unable to protect airway, RT to bedside, O2, pupil check, monitor GCS if <8, intubate, frequent vitals, IV, labs, accucheck, SI screening, poss call poison control.
  2. Narcan 0.4mg IV, narcan drip 0.2mg/hr (narcan can cause agitation and n/v)
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16
Q
  1. Questions to ask fall patient:
  2. Assessment should be ………. ………..
  3. DX would require
A
  1. loss of consciousness?, hit head?, anti coags? dizzy?
  2. neuro focused
  3. CT of head
17
Q
  1. What to assess in fracture?
  2. DX would need?
  3. Tx:
A
  1. Perfusion, circulation
  2. X-ray or CT
  3. immobilize, pain meds, possible reduction, surgery/ortho consult
18
Q
  1. what are the S/S of a GI bleed?
  2. Tx:
A
  1. blood in emesis or stool, abd pain cramps, SOB, fatigue
  2. NPO, NG tube, protonix, octreotide, fluids, blood transfusion for low hgb
19
Q
  1. What are the H’s and T’s in cardiac arrest?
A
  1. Hypovolemia, Hypoxia, Hydrogen ions (acidosis), Hypo/Hyperkalemia, Hypothermia.

Tension Pneumo, Tamponade, Toxins, Thrombosis (pulmonary or coronary)

20
Q
  1. What are the tx for hyperkalemia?
  2. What is the complication related to hyperkalemia?
  3. What EKG changes are present in hyperkalemia?
A
  1. cardiac monitoring, diuretics, kayexalate, D50+insulin, albuterol, calcium gluconate
  2. dysrhythmias (put pads on)
  3. peaked T waves & widened QRS complexes
21
Q
  1. What to do first in hypotension?
  2. What are the tx or actions?
  3. What must be checked for titration
A
  1. recheck BP
  2. lay flat (if no resp issues), fluids (check for CHF), norepi (levophed) 4mg/250mL & 8mg/250 mL (central line rec.)
  3. That vitals support the titration
22
Q
  1. Where do we place IOs?
  2. What not to do:
  3. What can be administered if there is pain with infusion
A
  1. Head of humerus, proximal tibia, medial maleolus, or distal femur in peds
  2. Not in injured limb, don’t try in same bone twice, don’t move limb with IO in it b/c may displace
  3. lidocaine 2% prior
23
Q
  1. When do we intubate?
  2. What do we need to prepare for intubation?
  3. What drugs do we give? Do we need to record the time given
A
  1. GCS <8, airway not protected, no gag reflex, or respiratory failure
  2. Call RT, suction, glidescope, end CO2 monitor, IV, fluids
  3. sedative + paralytic (sedative first). Sedatives: ketamine, etomidate. Paralytics: Rocuronium, succinylcholine. Can give propofol drip after to keep sedated if BP is stable
24
Q
  1. What to gather for laceration
  2. Should we use lidocaine with or without epi?
A
  1. Laceration kit, sterile water for irrigation, lidocaine, 10-20mL syringe, 22g needles x2, sterile gloves, sutures (ask dr what type)
  2. Both are fine, but no epi in small areas like fingers, toes, ears, and tip of nose b/c vasoconstriction
25
Q
  1. What to do post mortem
A
  1. notify organ procurement organization and coroner, clean up body, don’t remove lines if it’s a coroner case, Once family is done: body bag, name band, tag with patient label on patient and bag. Patient’s PCP signs death certificate.
26
Q
  1. What do we do with SI?
  2. What must be done before transfer to psyche facility
A
  1. 1:1 sitter right away. Can’t be left alone. Suicide screening, remove dangerous objects from room, inspect belongings, finger foods, paper plates only, no utensiles, possible transfer to psych facility.
  2. Must be medically cleared
27
Q
  1. What is the priority in seizures?
  2. To do:
  3. Don’t:
  4. What do we record?
  5. What classifies as status epilepticus?
A
  1. airway
  2. turn to side, protect head, pad side rails, suction @ bedside, remove restrictive clothing
  3. Restrain or put anything in mouth
  4. How long it lasted and patinet behavior right before and during.
  5. seizure lasting >5min
28
Q
  1. What triggers a sepsis alert?
  2. What are SIRS?
  3. What labs are drawn? When is lactic redrawn?
  4. What to do:
  5. When are vasopressors given?
A
  1. 2 or more SIRS + suspected infection
  2. T: >30 or <36, HR >90, RR > 20, WBC >12 or < 4
  3. Blood cultures and lactic. Redraw lactic if it is higher than 2
  4. NS 30mL/kg + broad spectrum antibiotics
  5. if after fluids, SBP is <90 or MAP is <65
29
Q
  1. What to do with a STEMI?
  2. What meds?
  3. What is the goal?
A
  1. If coming on ambulance, have them transmit EKG to ER. Do an EKG, call cath lab, vitals Q3, translucent pads for cath lab, 2 IVs, troponin/labs, consent
  2. aspirin, heparin, nitro (if BP is stable), morphine, statin, O2 (only if sat is low)
  3. restore blood flow, PCI vs fibrinolysis
30
Q
  1. What are the questions to ask in stroke?
  2. What actions to take:
  3. What are the TNK criteria?
  4. What to do is it’s a hemorrhagic stroke?
  5. How do we manage BP?
A
  1. last known normal, when did symptoms start? Taking anticoagulants?
  2. GCS, poss intubation, NIH, pupil check, accucheck, weight, IV, labs, CT scan (priority. doc time)
  3. Last known normal was <4 hours ago, no anticoagulants, BP <185/110 before TNK and < 180/105 after
  4. BP goal of <140, keep head elevated, frequent BP checks
  5. labetolol 10mg first line, then nicardipine drip
31
Q

What are the reasons for transcutaneous pacing?

A
  1. symptomatic bradycardia (hypotension, AMS, chest pain, shock, HF, electrolyte imbalance
  2. crash cart, place pads, continue to monitor cardiac status, sedation, turn monitor to pacing mode, set pace rate per doctor (60-70bpm), set output per Doctor, confirm capture on EKG, and pulse check
32
Q
  1. What to try first in SVT?
  2. What to do next?
  3. Meds?
  4. Where should IV be placed?
A
  1. valsalva (blow in syring or bear down)
  2. crash cart, pads, fluids, consent, continuous EKG recording
  3. Adenosine 6 or 12mg slam it + 20 ml NS
  4. Closer to heart the better. Avoid hands and lower forearm.
33
Q

What is shock index?
How to calculate?

A
  1. Indicator for mortality rates > 0.8 is indicative of need for resuscitation.
  2. HR/systolic

ER New Grad (4 decks)

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