em Flashcards
Sickle cell disease is associated with an increased risk of priapism due to altered blood viscosity and resulting venous obstruction. Initial management of priapism includes ???
aspiration of blood from the corpora cavernosa, often followed by intracavernous injection of phenylephrine.
Hemorrhagic shock is the most common type of shock in trauma patients. Areas where large amounts of blood can be lost (or hidden) are “the floor” (external bleeding) “and 4 more”: ???
chest, abdomen, pelvis/retroperitoneum, and thigh.
??? lines can be placed rapidly when emergency access is necessary and peripheral access cannot be obtained.
Intraosseous
Intraosseous access can be performed with less required skill and practice than central venous access.
In cases of traumatic amputation, the amputated part should be transported how??
by wrapping it in saline-moistened gauze, sealing it in a plastic bag, and placing the bag in a bath of ice water. Cooling of the amputated part prolongs the window for replantation.
All trauma patients should be triaged using the Glasgow coma scale (GCS), which can predict the severity and prognosis of coma, during the primary survey. The GCS assesses which 3 components ?
the patient’s ability to open his/her eyes, motor response, and verbal response.
patient with chronic lower abdominal pain and several normal evaluations requires screening for ?? particularly in women of childbearing age, with increased incidence during times of stress or social changes (eg, marriage, postpartum, moving in with partner).
intimate partner violence (IPV).
patient’s presentation—muscle weakness, dark urine, decreased urine output, elevated creatinine, and blood on urinalysis without a significant number of red blood cells (RBCs) on urine microscopy—is consistent with ???
rhabdomyolysis
which drugs can cause rhabdo?
primarily statins, colchicine, ethanol, cocaine

Patients with rhabdomyolysis are at risk of developing ??? due to both intravascular volume depletion and pigment-induced nephropathy
acute kidney injury
Treatment of rhabdomyolysis involves ???
aggressive volume resuscitation to replace intramuscular and intravascular fluid. Affected muscle groups must be monitored closely because the initial tissue damage and subsequent volume replacement create a risk for acute compartment syndrome.
Manifestations of ?? include flank pain, nausea, and vomiting; urinalysis demonstrates hematuria and proteinuria without casts. A wedge-shaped cortical infarction on CT scan is diagnostic.
renal infarction
Patients with hyperkalemia who develop arrhythmias or other significant ECG changes should be treated rapidly with
intravenous calcium to stabilize the cardiac myocyte
Temporary measures (eg, intravenous insulin plus glucose) and definitive treatment (eg, dialysis) to reduce serum potassium should follow calcium administration.
Patients with the syndrome of inappropriate antidiuretic hormone secretion who are asymptomatic or have mild symptoms usually respond to fluid restriction. Patients with severe symptoms require treatment with ???
hypertonic (3%) saline.
Ingestion of ??? is unique among the most common toxic alcohol ingestions because it presents with a normal anion gap (eg, 10 mEq/L in this patient) and the absence of acidosis (suggested by the normal serum bicarbonate in this patient).
*also no signs of ethanol in blood
isopropyl alcohol
*no treatment required
what are the three reasons for urology consult for kidney stone?
- urosepsis
- stone >10mm
- no stone passage in 4-6 weeks

what is the management of kidney stone <10mm, no sepsis?
can be discharged home,
hydration, pain control, alpha blockers (tamsulosin), and strain urine
Postictal lactic acidosis commonly occurs following a tonic-clonic seizure. If metabolic acidosis is found on labs what to do?
repeat labs in 2 hours
It is a transient anion gap metabolic acidosis that resolves without treatment within 90 minutes following resolution of seizure activity.
??? presents with flank pain, low-volume voids with or without occasional high-volume voids, and, if bilateral, renal dysfunction.
obstructive uropathy
Intermittent episodes of high-volume urination can occur when the obstruction is overcome by a large volume of retained urine (post-obstructive diuresis)
Magnesium toxicity can occur from increased intake of magnesium-containing compounds, especially in patients with impaired renal function. Toxicity classically causes ???
neuromuscular effects (eg, decreased deep tendon reflexes, weakness, respiratory depression) and cardiovascular effects (eg, bradycardia, hypotension).
Protracted vomiting can cause ??? Patients typically have severe chest/back pain and may have pneumomediastinum with crepitus or a precordial crunching sound on auscultation (Hamman sign).
esophageal rupture (Boerhaave syndrome).
Esophageal perforation is a surgical emergency.
what is this finding ?

perforated peptic ulcer
Peptic ulcer disease can be complicated by perforation, revealed as intraperitoneal free air. Emergent surgical exploration is indicated for patients with severe symptoms and a systemic inflammatory response.

Complete small-bowel obstruction usually presents with nausea, vomiting, abdominal bloating, and dilated loops of bowel on abdominal x-ray. what are the most common etiology ???
Adhesions, typically postoperative
Thrombosed external hemorrhoids usually appear as purple or blue anal bulges below the dentate line and may cause severe pain. Although conservative management (eg, fiber, stool softeners, topical anti-inflammatories and antispasmodics) is usually indicated, patients with severe pain should undergo ???
hemorrhoidectomy under local anesthesia.
Sigmoid volvulus occurs when a segment of sigmoid colon twists on its mesentery, forming a closed-loop obstruction that often appears on abdominal x-ray as a dilated, inverted, U-shaped loop (“coffee bean” sign). ??? are risk factors.
Chronic constipation and colonic dysmotility





