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EM case files > Deck 1 > Flashcards

Deck 1 Flashcards

1
Q

What other bacterial illnesses can mimic common bacterial pharyngitis?

A
  • Peritonsilar abcess
  • retropharyngeal abcess
  • ludwig angina
  • epiglottitis
  • vincent angina
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2
Q

What are the centor criteria for predicting strep pharyngitis?

A
  • Tonsillar exudates = 1 pt
  • tender anterior cervical LAD = 1 pt
  • Fever by history = 1 pt
  • Absence of cough = 1 pt
  • Age under 15 = add 1 pt
  • Age over 45 = subtract 1 pt
  • 4 points = tx w/ Abx, no further testing
  • 2-3 = RAT….+ = tx , - = throat culture
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3
Q

Tx for strep pharyngitis?

A

-Penicillin po x 10 days

Or…..IM Penicillin G 600k units once

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4
Q

Tx for retropharyngeal, peritonsillar abcesses, and ludwig angina?

Tx of epiglottitis?

A
  • PCN and Flagyl

- Cefuroxime

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5
Q

What are initial diagnostic steps in working up Acute MI?

A
  • EKG
  • Troponin
    * Other labs: BMP, PT, PTT, CBC
  • Cardiac monitor
  • Get IV access
  • CXR
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6
Q

What are immediate THERAPIES for Acute MI?

A
  • Aspirin 325
  • O2
  • Sublingual nitro
  • IV beta blocker
  • IV nitro
  • LMW Heparin
  • Plavix
  • Thrombolytics if no cath available
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7
Q

What are other life-threatening conditions that can mimmick MI? (present with cp)

A
  • Aortic dissection
  • PE
  • Pneumothorax
  • Boerhaave syndrome
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8
Q

What EKG findings are indications for immediate reperfusion therapy for ACS?

A
  • ST elev > 1 mV in 2 contiguous leads

- New LBBB

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9
Q

When should troponins be repeated after first draw?

A

4 to 12 hours after

*normal level at 8 to 12 hours after pain onset essentially excludes infarction

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10
Q

How do you decide on tx for UA or NSTEMI?

A
  • ASA and nitro are minimum of therapy
  • Beta-blockers (IV) added for persistent pain, tachycardia, or HTN
  • High risk = Heparin and Plavix

-Possible cath

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11
Q

Bradyarrythmias are common complication of _________ MI, and are an indication for _________.

A
  • Anterior
  • Transvenous Pacing

*Heart block in setting of MI usually due to irreversible damage of HIS-purkinje system

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12
Q

________ MI frequently causes AV node dysfunction and _________ degree block that is transient and responsive to what medication?

A
  • Inferior
  • 2nd degree block
  • may respond to Atropine
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13
Q

Viral etiologies of pharyngitis

A

-rhino
-corona
-coxackie
-HSV
-adeno
-influenza
-CMV and EBV
-HIV
etc

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14
Q

Pt with palpitations and dyspnea on exertion…..DDx?

A
  • A-fib
  • PE
  • MI
  • anemia
  • sepsis
  • pneumonia
  • Hyperthyroidism
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15
Q

In the acute setting, what is the most important gaol of A-fib therapy?
Why?

A

Rate control

-slowing ventricular response provides positive hemodynamic effects

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16
Q

For A-fib pts who need cardioversion, who needs anticoagulation?

A

> 48 hours duration A-fib

or….

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17
Q

What are the 2 anticoagulation options for pts with A-fib receiving cardioversion?

A
  • Coumadin (3 weeks)

- TEE + Heparin if no clot is seen ….then cardioversion can be done immediately

18
Q

What are some options for rate control of A-fib?

A
  • Verapamil
  • Beta blockers
  • Amiodarone
  • Cardioversion (unstable pt)
  • Diltiazem
  • Digoxin
19
Q

What is the tx for pts with A-fib after cardioversion?

A
  • AC with coumadin (from “atrial shock”)

- Antiarrhythmic therapy with Amiodarone or propafenone

20
Q

What are some things to have on your DDx for severe abd pain and ams?

A
  • Sepsis
  • Intra-abdominal infxn
  • ruptured appendicitis
  • toxic ingestion
  • illicit drug use
  • Pancreatitis
  • Severe metabolic process like DKA
21
Q

In an adult with shock should receive ____ Liters of normal saline?

A

2 liters

22
Q

What insulin is given in DKA patients? How is it given? For how long?

A
  • Regular insulin
  • Continuous IV infusion
  • Until the anion gap returns to normal
23
Q

What is given to DKA patients when their glucose gets to 200-300?

A

Dextrose to prevent hypoglycemia

24
Q

What is the proper dose of insulin for DKA patients?

A

-0.1 U/Kg/hr

25
Q

Name a rare, but devastating complication of DKA:

A

-Cerebral edema….especially in kids

26
Q

Diagnostic work-up in an elderly pt presenting with concern for sepsis:

A
  • IV access
  • EKG
  • Troponin
  • CBC
  • BMP
  • UA
  • CXR
  • ABG
  • LFTs
  • Glucose
27
Q

Most common pathogens for urosepsis in elderly?

A
  • E,Coli
  • Proteus

Other GNRs

28
Q

Initial empiric tx for urosepsis in elderly?

A
  • Aminoglycosides
  • Quinolones
  • Ampicillin sometimes added
29
Q

How can Sepsis be divided into phases?

A

Early = Hyperdynamic phase

  • incr capillary leakage and periph vasodilation
  • decr SVR
  • decr venous return
  • end result = HoTN
  • tachycardia, tachypnea, warm extremities clinically

Late = Hypodynamic phase

  • presents as shock
  • Cardiac output decreased
  • incr Lactate
  • Hyperglycemia
30
Q

What are the 4 classes of hemorrhagic shock?

A

1:

  • 120
  • BP decr

4:

  • > 2L loss
  • HR>140
  • BP significantly dropped
31
Q

Name some treatments used for Anaphylaxis with resp compromise?

A

-Epinephrine (IV or subQ…but IV better)
give 1 ampule in 1L NS….infuse at 1 to 4 cc/min
-Albuterol
-Racemic epi
-IV glucagon for pts on Beta blockers
-Systemic steroids to prevent 2nd anaphylaxis (continue for days)
-Histamine blockers

32
Q

DDx for a wheezing patient:

A
  • Asthma
  • COPD
  • CHF
  • Foreign body
  • Pneumonia
  • anaphylaxis
  • PE
  • toxic inhalation
  • tumor
33
Q

What dose of steroids is given to pts with asthma attack?

A
  • 40 to 60 of po prednisone

- IV for pts with severe sx who may not be able to swallow a pill

34
Q

What else (other than albuterol/ipratroprium, epi, etc) can you give for asthma attack?

A
  • IV Mg

- 2 to 4 g

35
Q

What criteria should an asthmatic meet in order to be discharged?

A

-Improvement of PEFR of FEV1 to 70% or greater of predicted or personal best

36
Q

What should asthmatics be given upon discharge?

A
  • Albuterol
  • MDI spacer device
  • 3-10 day course of oral steroids

Maybe…Leukotriene inhibs or inhaled steroids

37
Q

What should initial vent settings be in an intubated asthmatic patient?

A
  • Assist control mode
  • RR 8-10
  • TV 6-8 mL/Kg
  • no PEEP
  • flow rate of 80 - 100 L/min
38
Q

What should you use to close a scalp or forehead wound?

A

Scalp:
-4-0 monofilament suture
-remove 7-10 days later
Or…..staples

Forehead:

  • close in layers
  • approximate skin with 6-0 nonabsorbable continuous running or interrupted suture
  • remove after 5 days
39
Q

What should be avoided when repairing a wound of the nose?

A

-Epinephrine

40
Q

What suture do you use for a lip laceration?

A
  • 6-0 non-absorbable suture –> 5 days

* Vermillion border = call plastics

EM case files (1 decks)

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