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Prep Study > ED Rotation > Flashcards

ED Rotation Flashcards

1
Q

Fast Exam Locations

A 
Morrisons pouch (right side)
Renal splenic window (left side)
Bladder
Pericardial window
Anterior Chest

Fluid is black
Must be 200cc to be seen on US

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2
Q

Morrisons pouch

Fast Exam

A

Morrisons pouch = between liver and kidney
Sub diaphragmatic space (above morrisons pouch)
Inferior renal view

Mid Axillary line
Start at morrisons pouch, move superior in up and down (painting) fashion to sub diaphragmic space, then move inferior in painting fashion to inferior kidney

Depth 11-15cm

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3
Q

Renal Splenic window

Fast Exam

A

Look at spleen then kidney
Check splenic renal recess for fluid

Depth 11-15cm

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4
Q

Inferior cardiac window

Fast Exam

A

Pericardial space

Just under xiphoid, 45 degree angle

Adjust Depth to 20cm

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5
Q

Retro vesical pouch (bladder) (pouch of Douglass)

Fast Exam

A

Scan bladder just above pubis symphyses

Look for bladder rupture, free fluid

Adjust Depth to 12cm

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6
Q

7 lethal causes of chest pain

A 
ACS (STEMI, N-STEMI, Unstable angina)
Dissection
Pneumothorax
Pneumonia
Esophageal Rupture
PE
Tamponade
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7
Q

Lethal causes of SOB

A 
ACS (STEMI, N-STEMI, Unstable angina)
CHF
Pulmonary edema
PE
Pneumothorax
Pneumonia
COPD
Asthma
Anaphylaxis
Obstruction
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8
Q

Ketorolac (toradol)

A

Mod/severe pain

PO, IM, IV
IM = 15 or 30 mg/ml

No liver dosing,
Renal dosing = check

Peds= 6 months and up check dose

Adverse = GI, SJS, Etc

Preg Cat C

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9
Q

Fentanyl

A

Severe Pain

IM, IV, Topical patch

50-100 mcg per dose

5 min onset,
1-2 hour duration

Give zofran

Has renal dosing, no liver dosing

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10
Q

Morphine

A

ACS Dosing 2-5 mg - IV
Q 5-30 mins

Pain Dosing = 10-30mg Q4hr

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11
Q

Methocarbamol

A

500 or 750mg tablets
100mg/ml inj

Spasm = 1000mg QID PO / 1000mg IM/IV x1
Max 3000 QD

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12
Q

Naproxen

A

250- 500mg tabs

Dose 250-500mg Q12

Peds 2 and up

Adverse = GI, SJS, Etc

Preg Cat C

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13
Q

Heart Score

A

Hx= Slightly Moderate Highly suspicious

EKG= Normal Non specific changes Sig changes

Age = <45, 45-64, >65

Risk Factors= none 1-2 RF >3 risk factors

Trop= Normal limit 1-3x normal >3x normal

0-3 = D/c
4-6 = Obs
7-10 = intervention

6 week risk of major cardiac event
Points are 0, 1, 2

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14
Q

PERC

A 
>50
HR >100
O2 Sat <95
Trauma/surg requiring Anesthesia <4wks
Unilateral leg swelling
Hemoptysis
Hormone use (OCP/Estrogen/etc)
Vascular (prior clot/DVT/PE)

any one = positive PERC

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15
Q

WELLS

A

HR >100 (+1.5)
S/S of DVT (+3)
PE is most likely Dx (+3)
Immobile for last 3 days or surg in last 4 weeks (+1.5)
Previous PE/DVT (+1.5)
Hemoptysis (+1)
Malignancy w/ treatment in last 6 mo (+1)

score of 4 or under unlikely (only 3 % occurrence)

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16
Q

Anterior Chest

Fast Exam

A

Probe in sagittal (vertical position)

Mid clavicular line 3rd/4th intercostal space (right side)
Look for sliding (normal)

Repeat on other side

17
Q

Auscultation order post intubation

A

Gastric Left
Gastric Right
Left Lungs
Right Lungs

18
Q

Tonopen

A 
Anesthetize Eye (drops)
Turn on Pen
Calibrate
Cover
Use

Normal Pressure should be under 15mmhg

19
Q

Eye Exam

A 
Visualization (abnormalities, color, Foreign Bodies)
Cardinal Directions
PERRLA
Rosenbaum/Snellen
Tonopen
Fluorescein stain
Ophthalmoscope
Slit Lamp
20
Q

Fascia illiaca compartment block

A

Bupivacaine 0.25% or ropivacaine 1%
Not Sterile

Ultrasound

Visualize ASIS on US
Move down to visualize Femoral Nerve, artery, vein
Anesthetize skin
Insert long needle
Aspirate
Inject 3-4 ml to visualize location
Once location confirmed, aspirate again
Inject remainder of anesthetic

Worst adverse reaction is vessel injection (toxicity)

21
Q

Pelvic Exam

A

Always with Escort
Keep it short ~ 30 seconds
Explain everything as you go
Keep sheet pushed own so you can see their face

Have patient empty Bladder

Palpate Abdomen
Palpate inguinal lymph nodes
Position patient, end of table, stirrups, semi fowlers
Inspect and palpate external genitalia
Insert finger at bottom, have squeeze, relax

Insert speculum, vertically, rotate to correct position
Swab, Sweep cervix
Inspect Cervix

Bimanual exam
Insert finger
Palpate skin, bladder, adnexal regions

22
Q

Patient Presentation

A
  1. Summary (Demo, RF’s, CC)
  2. OPQRST
  3. 5 Pertinent (+) or (-)
  4. VS Summary (Abnormals)
  5. 3 Pertinent exam findings
  6. DDX (Note for or against and why)
  7. Workup (list labs /imaging etc.)
  8. Treatment plan (meds, tx, consults, admit, D/C, etc)
23
Q

ACS protocol

A

EKG within 10 minutes
Repeat EKG’s Q15-30 mins

Draw Trop Early
Redraw at hour 1
Redraw at hour 3

IV 18ga
ASA
O2
Monitor

24
Q

Number 1 AFIB Rate control with any comorbidity

A

Diltiazem
Diltiazem
then consider Diltiazem Drip
Then consider Metoprolol etc.

(Cardizem)
non-dihydropyridine CCB

25
Q

WPW Drug

A

Procainamide

26
Q

Wide complex SVT Med

A

Amiodarone
(unless Delta Wave)
(No Adenosine)

27
Q

Torsades

A

Give Mag

28
Q

EKG Presentation

A 
Rhythm
Rate
ST Deviations or none
Axis
Intervals
R wave progression
Previous EKG for comparison
Other abnormalities
29
Q

RSI Medications

A

Presentation

30
Q

H’s & T’s

A 
Hypovolemia
Hypoxia
Hydrogen ion loss
Hypothermia
Hypoglycemia
Hypokalemia
Hyperkalemia
Toxins
Tamponade
Tension Pneumothorax
Thrombosis
Trauma
31
Q

H’s & T’s

Hypovolemia

A

Look for bleeding
Fix it
Give Fluids (bolus)

Hypovolemia
Hypoxia
Hydrogen ion loss
Hypothermia
Hypoglycemia
Hypokalemia
Hyperkalemia
32
Q

H’s & T’s

Hypoxia

A

Confirm chest rise and fall
Confirm bilateral breath sounds
Check O2 source

Hypovolemia
Hypoxia
Hydrogen ion loss
Hypothermia
Hypoglycemia
Hypokalemia
Hyperkalemia
33
Q

H’s & T’s

Hydrogen ion loss

A 
Hypovolemia
Hypoxia
Hydrogen ion loss
Hypothermia
Hypoglycemia
Hypokalemia
Hyperkalemia
34
Q

H’s & T’s

Hypothermia

A 
Hypovolemia
Hypoxia
Hydrogen ion loss
Hypothermia
Hypoglycemia
Hypokalemia
Hyperkalemia
35
Q

H’s & T’s

Hypoglycemia

A 
Hypovolemia
Hypoxia
Hydrogen ion loss
Hypothermia
Hypoglycemia
Hypokalemia
Hyperkalemia
36
Q

H’s & T’s

Hypokalemia

A 
Hypovolemia
Hypoxia
Hydrogen ion loss
Hypothermia
Hypoglycemia
Hypokalemia
Hyperkalemia
37
Q

H’s & T’s

Hyperkalemia

A 
Hypovolemia
Hypoxia
Hydrogen ion loss
Hypothermia
Hypoglycemia
Hypokalemia
Hyperkalemia

Prep Study (10 decks)

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