Criteria

Question 1

Q Sofa

Answer 1

2/3

GCS < 15
systolic BP < 100
RR 22 +

Question 2

Centor

Answer 2

no cough
+ fever
cervical lymphadenopathy
pharyngeal exudate

3+ - empiric strep tx
2 - rapid strep + cx

Question 3

A/C in A Fib?

Answer 3

CHADS2 (start if 2+)

C - CHF
H - HTN
A - age > 75
D - DM
S - stroke or TIA

Question 4

Bleeding Risk in A Fib

Answer 4

HAS BLED

H - HTN
A - abnormal liver or renal function
S - stroke
B - bleeding hx or predisposition
L - labile INR 
E - elderly (> 65)
D - drugs or alcohol use

(do not start A/C if&raquo_space; CHADS2 score)

Question 5

PERC

Answer 5

age > 50
HR >100
O2 sat < 95%
Unilat leg swelling
Hemoptysis
Recent surg or trauma in last 4 wks
Prior DVT or PE 
Hormone Use

Question 6

Well’s Criteria

Answer 6

Signs / sx DVT (3 pt)
PE is #1 diag (3 pt)
HR > 100 (1.5 pt)
3 d immobilization or surg in last 4 weeks (1.5 pt)
Prior DVT or PE (1.5 pt)
Hemoptysis (1 pt)
Cx treated w/in 6 mo or palliative (1 pt)

< 2 …consider D dimer or PERC
2-6 … high sensitivity d dimer or CT angio
6+ … right to CT angio

Question 7

Ottowa Knee Rules

Answer 7

age > 55
Isolated patella tenderness
Tenderness at head of fibula (lateral bone)
Cannot flex knee 90 deg
Cannot bear wt

X-ray if 1+

Question 8

Ottowa Ankle Rules

Answer 8

Pain at base of 5th metatarsal
Posterior medial or lateral malleolus tenderness
Unable to bear wt

X-ray if 1+

Question 9

Canadian Head CT Rules

Answer 9

GCS < 15 2 hrs post injury
Signs skull frax (CSF leak, blood in ears, raccoon eyes, battle sign) 
Head lac or skull hematoma
2+ epi vomiting
30+ min amnesia 
Age > 65
On A/C
Neuro deficit or sz activity
Dangerous mechanism 

CT if 1+ criteria

Question 10

Canadian Cervical Spine Rules

Answer 10

HIGH RISK (1+ then imaging)

• age > 65
• fall > 1 meter
• axial load injury
• High speed MVC or ejection
• paresthesias
• motorcycle or bike collision

LOW RISK (if any then safe for just assessment)

• simple rear end
• sitting in ED
• ambulatory at any time
• delayed onset of neck pain
• no midline cervical tenderness

Question 11

Nexus Criteria for Cervical Spine

Answer 11

• no midline tenderness
• no focal neuro def
• normal alertness
• no intoxication
• no painful distracting injury

** If meet all then no imaging needed

Question 12

Massive PE v. Submassive PE

Answer 12

MASSIVE

• systolic < 90 for 15+ min OR requires ionotropes
• pulseless
• HR < 40

SUBMASSIVE
No sustained hypotension but RV dysfunction OR myocardial necrosis 
- RV dilation 
- RV systolic function per ECHO
- BNP > 90
- ECG changes
- elevated trop

Question 13

Glasgow - Blatchford Score

Answer 13

Upper GI Bleed

• low HgB
• elevated BUN
• Initial systolic
• Sex (male)
• HR 100 +
• melena on exam
• syncope
• CHF hx
• cirrhosis hx

0-1 may send home w/o scope

Question 14

Berlin Criteria

Answer 14

ARDS

C - CXR (bilateral opacities)
O - overload (r/o cardiogenic etiology)
S - severity (PaO2 / FIO2 <300, <200, <100)
T - timing (insult within 1 wk)