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EM Flashcards

1
Q

What are the ABCDs of acute management of patients?

A 
Airway
Breathing
Circulation
Disability
Exposure
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2
Q

Under what GCS score is intubation indicated?

A

GSC under 8, intubate!

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3
Q

What is the treatment for hemoperitoneum?

A

Surgery

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4
Q

What is the role of placing a foley catheter in the hemodynamically unstable patient?

A

Monitor urine output in those receiving fluids

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5
Q

When is a CT neck/ spine indicated in a trauma patient?

A

Neck pain / TTP
Neurological findings
Depressed mental status

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6
Q

What are the three main components of the GCS coma scale? How many points are in each category?

A

Eye opening 4 (EYES)
Verbal response 5 (VOICE)
Motor response 6 (ARM+ LEG)

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7
Q

What are scores for 1-4 for the eye opening portion of the GSC scale?

A 
4 = spontaneous
3 = opens to command
2 = opens to pain
1 = none
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8
Q

What are scores for 1-5 for the verbal response portion of the GSC scale?

A 
5= Oriented
4 = confused speech
3 = inappropriate words
2 = incomprehensible
1 = None
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9
Q

What are scores for 1-6 for the motor response portion of the GSC scale?

A 
6 = follows commands
5 = localized pain
4 = Withdraws to pain
3 = Flexion
2 = extension
1 = none
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10
Q

What is the classic triad for cardiac tamponade?

A

Muffled heart sounds
JVD
Hypotension

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11
Q

What are the components of circulation management in the trauma / unstable patient?

A

Assess pulses
Control bleeding
IVFs PRN

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12
Q

What are the components of the disability part of the primary assessment?

A

GCS score

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13
Q

What are the components of the exposure part of the primary assessment?

A

Disrobe pt and inspect

Cover pt

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14
Q

A rough estimate of systolic BP (SBP) can be made on the basis of palpated pulses; Carotids correspond roughly to an SBP of what?

A

60 mmHg

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15
Q

A rough estimate of systolic BP (SBP) can be made on the basis of palpated pulses;Femorals correspond to a rough SBP of what?

A

70 mmHg

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16
Q

A rough estimate of systolic BP (SBP) can be made on the basis of palpated pulses; Radial correspond to a SBP of what?

A

80 mmHg

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17
Q

All wounds that penetrate what anatomical structure are considered true penetrating neck trauma?

A

Platysma

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18
Q

What is indicated in the ABCDEs of patients with penetrating neck traumas?

A

Intubation before airway is compromised

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19
Q

Immediate surgical exploration of neck wounds is indicated if what?

A

If shock and active hemorrhage are present

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20
Q

What testing is indicated in the treatment of penetrating neck trauma?

A

Angiography of the neck
Doppler US
Contrast esophagram

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21
Q

True or false: intubation is indicated in all cases of thoracic trauma with penetrating injuries

A

True

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22
Q

When is an open thoracotomy indicated to rule out pericardial effusion with penetrating chest trauma?

A

If patient goes into cardiac arrest in ED or shortly before arrival

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23
Q

If a patient with a chest trauma suddenly becomes hemodynamically unstable, what should be at the top of the differential?

A

Air embolism

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24
Q

A new diastolic murmur after chest trauma suggests what?

A

Aortic dissection

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25
Q

Penetrating trauma to areas lower than what anatomic landmark warrants abdominal investigation?

A

Nipple line

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26
Q

What are the indications for surgical exploration in penetrating stab wounds to the abdomen?

A

Hemodynamic instability or evisceration

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27
Q

What is the next step in diagnostic evaluation of an abdominal stab wound in the stable patient?

A

CT a close f/u

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28
Q

What are the first steps in MS injures?

A

Early wound irrigation
Wound debridement
Tetanus prophylaxis

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29
Q

Vascular injuries usually require what diagnostic evaluation and management?

A

Arteriography

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30
Q

Nerve injuries usually require what sort of management?

A

Surgical

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31
Q

What should always be assessed for with blunt head trauma, besides bleeding, fractures, and neuro?

A

Increased ICP

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32
Q

What is the stabilizing treatment for increased ICP? (3)

A

Head elevation
Hyperventilation
IV mannitol

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33
Q

What are the CT characteristics of diffuse axonal injuries?

A

Blurring and punctate hemorrhaging along the gray-white matter junction

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34
Q

Blurring and punctate hemorrhaging along the gray-white matter junction on a head CT indicates what sort of trauma?

A

Rapid-deceleration injuries leading to diffuse axonal injury

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35
Q

What are the shape of epidural hematomas? Can they cross suture lines?

A

Lenticular

Cannot cross suture lines

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36
Q

What artery is classically indicated in epidural hematomas?

A

Middle meningeal artery

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37
Q

What type of hematoma is characterized by a lucid interval”?

A

Epidural

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38
Q

What is the shape of subdural hematomas? Can these cross suture lines?

A

Follow the curve of the skull (crescentic)

Cross suture lines

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39
Q

What is/are the artery/arteries that are implicated in subdural hematomas?

A

Briding veins

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40
Q

Tracheobronchial disruption is most often caused by what sort of trauma?

A

Deceleration shearing forces

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41
Q

What are the PE findings of tracheobronchial disruptions?

A

Respiratory distress
Hemoptysis
Sternal TTP
Subcutaneous emphysema

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42
Q

Blunt cardiac injury may manifest how on an EKG?

A

New BBB
Ectopy
Dysrhythmia

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43
Q

True or false: blunt cardiac injury rarely requires intervention

A

True

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44
Q

What is the pathophysiology of pulmonary contusion?

A

Damage to capillaries and leakage of intra and extravascular fluid, causing hypoxic

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45
Q

What is the mainstay of treatment for pulmonary contusion?

A

Diuretics and fluid restriction, and airway support

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46
Q

What will a CXR show with pulmonary contusion?

A

Patchy alveolar opacities

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47
Q

What is the classic cause of aortic disruption?

A

Rapid-deceleration injury

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48
Q

Aortic disruption is often associated with what bony fractures? (4)

A
  • 1st rib
  • Second rib
  • Scapular
  • Sternal
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49
Q

What causes the hoarse voice that may appear with an aortic disruption?

A

Pressure on the recurrent laryngeal nerve

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50
Q

What causes a flail chest (physically)?

A

Three or more adjacent ribs, fractured at two points

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51
Q

What is the treatment for a flail chest?

A

O2, narcotic analgesia

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52
Q

What is the major complication of a flail chest?

A

Respiratory compromise

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53
Q

What is the most common solid organ to be traumatized in the abdomen? Second most common?

A

Spleen

Liver

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54
Q

What is Kehr’s sign?

A

Referred pain to the shoulder from peritoneal irritation

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55
Q

What is the duodenum susceptible to traumatic injury?

A

Sits right in front of the spine

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56
Q

What are the radiographic findings of a diaphragmatic rupture?

A

Elevated hemidiaphragm

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57
Q

What is the most commonly injured GU organ?

A

Kidneys

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58
Q

True or false: hemodynamically unstable patients with blunt abdominal trauma should undergo immediate exploratory lap

A

True

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59
Q

What is the immediate treatment for a pelvic fracture?

A

External binder

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60
Q

What is the treatment for a pelvic fracture?

A

Early resuscitation

Angiography with embolization of bleeding vessels

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61
Q

Why do pelvic fractures tend to occur in multiple places?

A

Ring-like structure

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62
Q

What are the exam findings of a urethral injury?

A

High riding prostate
Blood at the urethral meatus/scrotum
Non-palpable prostate

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63
Q

What test is needed to r/o a urethral injury prior to catheter placement?

A

Retrograde urethrogram

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64
Q

What are the 5 H’s of PEA?

A 
Hypothermia
Hypovolemia
Hypoxia
H+
Hyper/hyp K
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65
Q

What are the 5 T’s of PEA?

A 
Tablets: drug overdose, ingestion 
Tamponade: cardiac 
Tension pneumothorax 
Thrombosis: coronary 
Thrombosis: pulmonary embolism
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66
Q

What Joules is used when shocking v-fib/pulseless v-tach?

A

120-200 J (biphasic)

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67
Q

What is the treatment for unstable SVT?

A

Shock

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68
Q

What is the treatment for stable SVT?

A

Adenosine, then beta blockers/CCBs

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69
Q

How many hours in a-fib is a contraindication to cardioversion?

A

48 hours

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70
Q

What is the treatment for symptomatic bradycardia?

A

Atropine
Dopamine
Epi
Transcutaneous pacing

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71
Q

Sudden onset abdominal pain with rigidity = ?

A

Perforated bowel

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72
Q

How can pneumonia cause upper abdominal pain?

A

Diaphragmatic irritation

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73
Q

A ⊕ β-human chorionic gonadotropin (β-hCG) in the setting of shock is what until proven otherwise.

A

Ruptured ectopic pregnancy

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74
Q

True or false: peritoneal signs warrant surgical exploration

A

True

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75
Q

What are the two exam that are needed with abdominal pain?

A

Rectal

Pelvic

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76
Q

What is the classic presentation of a fat embolism?

A

fever, tachypnea, tachycardia, conjunctival hemorrhage, and upper extremity petechiae after a patient suffers longbone fractures.

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77
Q

When is an NG tube needed for decompression of the stomach?

A

In the setting of bowel obstruction

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78
Q

What is the diagnostic work-up for appendicitis?

A

CT with PO and IV contrast or US

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79
Q

What is the treatment for a rupture appendix?

A

Abx until afebrile

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80
Q

What is the treatment for a psoas abscess?

A

Broad spectrum abx and percutaneous drainage

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81
Q

What are the rule of 9’s relating to burns and surface areas?

A

Head and each arm = 9%, each
Back and chest each = 18%
Each leg = 18%
Perineum = 1%

*Patient’s palm (including fingers) represents about 1% of total BSA in adults and children.

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82
Q

What is the parkland formula for calculating IVFs needed in burn patients?

A

Fluids for the first 24 hours = 4 × patient’s weight in kg × % BSA.

Give 50% of fluids over the first 8 hours and the remaining 50% over the following 16 hours.

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83
Q

What are first degree burns?

A

BUrns that only involve the epidermis

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84
Q

What are second degree burns?

A

Burns that involve epidermis and dermis

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85
Q

What are third degree burns?

A

Burns that involve dermis, epidermis, and SQ tissue

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86
Q

What type of burns have blisters?

A

2nd degree

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87
Q

What is the appearance of third degree burns?

A

Painless, white, and charred

88
Q

If there is evidence of airway involvement with burn patients, what needs to be done?

A

Intubate

89
Q

What are the 6 w’s of post operative fever?

A 
Wind: pneumonia 
Water: UTI
Wounds:
Walking: DVT
Wonder drugs: rxn
Womb: Endometritis
90
Q

What topical antimicrobial can be used to treat burns?

A

Silver sulfadiazine

91
Q

What cause compartment syndrome from burns?

A

Circumferential burns causing stricture

92
Q

What is the implicated organism in shock from burns?

A

Pseudomonas

93
Q

What is the first sign of shock?

A

Tachycardia

94
Q

What should be given first: pressors or IVFs

A

IVFs

95
Q

What is the treatment for neuroleptic malignant syndrome? Malignant hyperthermia?

A

IV dantrolene

96
Q

What usually causes immediate shock?

A

Drugs, malignant hyperthemia

97
Q

What is the definition of acute shock, and what usually causes it?

A

Within 1st week post op

Infections

98
Q

What is the definition of subacute shock, and what usually causes it?

A

Onset 1-4 weeks post op

Wounds, DVT

99
Q

What is the definition of delayed shock, and what usually causes it?

A

Onset more than 1 month

Viral infection
indolent bacterial infx

100
Q

How long should domestic animals be kept after biting a human to r/o rabies?

A

10 days

101
Q

What happens to the following in hypovolemic shock:

  • Cardiac output
  • PCWP
  • PVR
A
  • Cardiac output = decreased
  • PCWP = decreased
  • PVR = increased
102
Q

What happens to the following in cardiogenic shock:

  • Cardiac output
  • PCWP
  • PVR
A
  • Cardiac output = Decreased
  • PCWP = Increased
  • PVR = increased
103
Q

What happens to the following in obstructive shock:

  • Cardiac output
  • PCWP
  • PVR
A
  • Cardiac output = Decreased
  • PCWP = increased
  • PVR = Increased
104
Q

What happens to the following in distributive shock:

  • Cardiac output
  • PCWP
  • PVR
A
  • Cardiac output = Increased
  • PCWP = Decreased
  • PVR = Decreased
105
Q

What is the treatment for neurogenic shock?

A

Pressors and IVFs

106
Q

What is the treatment for hypovolemic shock

A

fluids:blood in a 3:1 ratio

107
Q

What is the definition of hypothermia?

A

Temp less than 35 C or 95 F

108
Q

What are the three major endocrine abnormalities that can cause hypothermia?

A

Hypothyroidism
Hypoadrenalism
Hypoglycemia

109
Q

What is the classic EKG finding associated with hypothermia?

A

J (osborne) wave

110
Q

True or false: never stop resuscitation efforts on a hypothermic patient until they have been rewarmed

A

True

111
Q

What is the treatment for unstable, hypothermic patients?

A

Core rewarming:

  • NG or bladder lavage
  • Cardiac bypass
112
Q

What is the definition of hyperthermia?

A

More than 40 C or 104 F

113
Q

Should deep bites be sutured closed?

A

No

114
Q

What is the treatment for hyperthermia?

A

Cold water, wet blankets, ice

Benzo to prevent shivering

115
Q

What are the s/sx of chronic CO poisoning?

A

ILI

116
Q

What is the classic electrolyte abnormality with spider bites?

A

Hypocalcemia

117
Q

What are the s/sx of scorpion bites?

A

Cranial nerve dysfunction

Respiratory compromise

118
Q

What is the treatment for scorpion bites?

A

Benzos and analgesics

Atropine for hypersalivation and respiratory distress

119
Q

What is the treatment for snake bites? (3)

A
  • Antivenom
  • Keep affected limb below the heart
  • Compression bands, but NOT tourniquets
120
Q

Do rodents carry rabies? Treatment?

A

Not known to

Just local wound care

121
Q

When is ipecac syrup indicated?

A

Never–makes matters worse with emesis

122
Q

What is the treatment for rabies infx?

A

1 dose of human rabies immunoglobin

4 doses of rabies vaccine / 14 days

123
Q

When should tetanus immunoglobulin be given?

A

If patient has had less than 3 lifetime toxoid vaccines and wound is major/dirty

124
Q

When is orogastric lavage (“pumping stomach”) indicated?

A

Life-threatening intoxications less than 1 hours after ingestion

125
Q

What are the p450 inducing agents?

A 
Barbs
St. John's wort
Phenytoin
Rifampin
Griseofulvin
Carbamazepine

“Barbara Steals Phen-phen and Refuses Greasy Carbs.”

126
Q

What are the p450 inhibitors?

A 
Acute alcohol abuse
Ritonavir
Amiodarone
Cimetidine/cipro
Ketoconazole
Sulfonamides
INH
Grapefruit juice
Quinidine
Macrolides

“AAA RACKS IN GQ Magazine”

127
Q

What are the four major substrates of the p450 enzymes?

A

Anti-epileptics
Theophylline
Warfarin
OCPs

128
Q

What are the drugs that can cause pulmonary fibrosis? (“My Nose Cannot BReathe BAd Air)

A 
Methotrexate
Nitrofurantoin
Carmustine
Bleomycin
Busulfan
Amiodarone
129
Q

What are the sulfa drugs? (“scary sulfa Pharm FACTS”

A 
Sulfonamide
Sulfasalazine
Probenecid
Furosemide
Acetazolamide
Celecoxib
Thiazides
Sulfonylureas
130
Q

What drugs cause photosensitivity (“SAT For Photo”)

A

Sulfonamides
Amiodarone
Tetracyclines
5-FU

131
Q

What are the drugs that can cause gynecomastia (“Some Drugs Create Awesome Knockers”)?

A 
Spironolactone
Digitalis
Cimetidine
Alcohol
Ketoconazole
132
Q

What is the treatment for acetaminophen poisoning?

A

N-acetylcysteine

133
Q

What is the treatment for acid/alkali poisoning?

A

Upper endoscopy to evaluate for stricutes

134
Q

What is the treatment for anticholinesterase /organophosphates poisoning?

A

Atropine

Pralidoxime

135
Q

What is the treatment for anticholinergic poisoning?

A

Physostigmine

136
Q

What is the treatment for Arsenic poisoning?

A

Succimer

Dimercaprol

137
Q

What is the treatment for Hg poisoning?

A

Succimer

Dimercaprol

138
Q

What is the treatment for Au poisoning?

A

Succimer

Dimercaprol

139
Q

What is the treatment for beta-blocker poisoning?

A

Glucagon

140
Q

What is the treatment for Barbiturate poisoning?

A

Urine alkalinization

Dialysis

141
Q

What is the treatment for benzo poisoning?

A

Flumazenil

142
Q

What is the treatment for black widow spider bite?

A

Ca-gluconate

143
Q

What is the treatment for Cu poisoning?

A

Penicillamine

144
Q

What is the treatment for Pb poisoning?

A

Penicillamine

Dimercaperol

145
Q

What is the treatment for cyanide poisoning?

A

Hydroxocobalamin

Sodium nitrate

146
Q

What is the treatment for digitalis poisoning?

A

Normalize K+

Digibind

147
Q

What is the treatment for heparin poisoning?

A

Protamine sulfate

148
Q

What is the treatment for INH poisoning?

A

Pyridoxine

149
Q

What is the treatment for Fe poisoning?

A

Deferoxamine

150
Q

What is the treatment for Methanol poisoning?

A

EtOH

Fomepizole

151
Q

What is the treatment for methemoglobinemia?

A

Methylene blue

152
Q

What is the treatment for opioid poisoning?

A

Naloxone

153
Q

What is the treatment for salicylate poisoning?

A

Urine alkalinization

154
Q

What is the treatment for TCA poisoning?

A

Na2CO3

155
Q

What is the treatment for theophylline poisoning?

A

Activated charcoal

156
Q

What is the treatment for tPA poisoning?

A

Aminocaproic acid

157
Q

What is the classic side effect of amantadine?

A

Livedo reticularis

158
Q

What is the classic side effect of aminoglycosides?

A

Ototoxicity

159
Q

What is the classic side effect of amphotericin?

A

Nephrotoxicity

Myelosuppression

160
Q

What is the classic side effect of azoles?

A

p450 inhibition

161
Q

What is the classic side effect of AZT

A

Thrombocytopenia

Megaloblastic anemia

162
Q

What is the classic side effect of beta blockers

A

Asthma exacerbation

Masking hypoglycemic symptoms

163
Q

What is the classic side effect of Bile acid resins

A

GI upset

164
Q

What is the classic side effect of carbamazepine

A

Agranulocytosis

165
Q

What is the classic side effect of CCBs

A

Peripheral edema

166
Q

What is the classic side effect of Chloramphenicol

A

Gray baby syndrome

167
Q

What is the classic side effect of cisplatin

A

Nephrotoxicity

Acoustic nerve damage

168
Q

What is the classic side effect of clonidine

A

Severe rebound HA and HTN

alpha 2 agonist

169
Q

What is the classic side effect of Clozapine

A

Agranulocytosis

170
Q

What is the classic side effect of cyclophisphamide

A

Hemorrhagic cystitis

171
Q

What is the classic side effect of Digoxin

A

Yellow visual changes and arrhythmias

172
Q

What is the classic side effect of doxorubicin

A

Dilated cardiomyopathy

173
Q

What is the classic side effect of furosemide

A

Ototoxic

174
Q

What is the classic side effect of gemfibrozil?

A

Myositis, increased LFTs

175
Q

What is the classic side effect of Halothans

A

Malignant hyperthermia

Hepatotoxic

176
Q

What is the classic side effect of HCTZ

A

Hypokalemia
Hyponatremia
Hyper everything else

177
Q

What is the classic side effect of hydralazine

A

Drug induced SLE

178
Q

What is the classic side effect of hydroxychloroquine

A

Retinopathy

179
Q

What is the classic side effect of INH

A

Peripheral neuropathy 2/2 loss of B6

180
Q

What is the classic side effect of MAOIs

A

Hypertensive tyramine rxn

Serotonin syndrome

181
Q

What is the classic side effect of methanol

A

Blindness

Anion gap metabolic acidosis

182
Q

What is the classic side effect of Methotrexate

A

hepatic fibrosis

Pneumonitis

183
Q

What is the classic side effect of methyldopa

A

+coombs test

Drug induced SLE

184
Q

What is the classic side effect of metronidazole

A

Disulfiram

Metallic taste

185
Q

What is the classic side effect of penicillamine

A

SLE

186
Q

What is the classic side effect of phenytoin

A

Gingival hyperplasia

187
Q

What is the classic side effect of prazosin

A

First dose hypotension

188
Q

What is the classic side effect of procainamide

A

SLE

189
Q

What is the classic side effect of PTU

A

Agranulocytosis

190
Q

What is the classic side effect of Quinidine

A

Cinchonism

Tdp

191
Q

What is the classic side effect of resperpine

A

Depression

192
Q

What is the classic side effect of rifampin

A

Orange-red body secretions

193
Q

What is the classic side effect of salicylates

A

Respiratory alkalosis and metabolic acidosis

194
Q

What is the classic side effect of SSRIs

A

Sexual dysfunction

195
Q

What is the classic side effect of Succinylcholine

A

Malignant hyperthermia

196
Q

What is the classic side effect of TCAs

A

QRS prolongation

197
Q

What is the classic side effect of tetracyclines

A

Tooth discoloration

198
Q

What is the classic side effect of trimethoprim

A

megaloblastic anemia

199
Q

What is the classic side effect of valproic acid

A

NTDs

200
Q

What is the classic side effect of vancomycine

A

Red man syndrome

201
Q

What is the classic side effect of vinblastine

A

Severe myelosuppression

202
Q

What is the classic side effect of vincristine

A

Peripheral neuropathy

203
Q

What is the treatment for benzo or barb withdrawal

A

Benzo taper

204
Q

What are the s/sx of deficiency in vitamin A

A

Night blindness

205
Q

What are the s/sx of deficiency in Vitamin B1

A

BeriBeri (polyneuritis, dilated cardiomyopathy)

206
Q

What are the s/sx of deficiency in B2 (riboflavin)

A

Angular stomatitis

Corneal vascularization

207
Q

What are the s/sx of deficiency in B3 (niacin)

A

Pellagra (diarrhea, dermatitis, dementia, death)

208
Q

What are the s/sx of deficiency in B5 (pantothenate)

A

Dermatitis
Enteritis
Alopecia

209
Q

What are the s/sx of deficiency in B6 pyridoxine

A

Convulsions

Hyperirritability

210
Q

What are the s/sx of deficiency in Vit E

A

Fragile RBCs

211
Q

What are the s/sx of deficiency in biotin

A

Dermatitis and enteritis

212
Q

What is the vitamin deficiency that is seen with the consumption of raw eggs?

A

Biotin

213
Q

What is the most common vitamin deficiency in the US?

A

Folate

214
Q

What are the s/sx of deficiency in Mg?

A

Weakness

Muscle cramps

215
Q

What are the s/sx of deficiency in selenium

A

Keshan disease (cardiomyopathy)

A1 (32 decks)

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