EM Abdominal Emergencies Flashcards
What are risk factors for AAA
smoker
fhx
age
men
hx dissection/aneurysm
HTN
what is the presentation of AAA
abrupt onset
abdominal pain
pain radiating to the back
syncope
GI bleed
arteriovenous fistula
“ripping” pain
shock
ischemic limb
death
what imaging is ordered for abdominal pain
Fast Exam
CTA (thorax, abdomen, pelvis)
XR?
what labs are ordered for abdominal pain
CBC, CMP, troponin, type and screen, PT, PTT
what is the management of AAA
allow hypotension with goal SBP 90mmHg
if hypotensive, support with blood products
pain managmenet
if rupture: immediate endovascualr or open repair
non-rupture: permissive hypotension - NIcardipine drip and Esmolol for prevention of dysrhythmias
what is the presentation of massive GI bleed
tachy
orthostatic
vomit blood or melena or hematochezie
may be in shock
what are differential dx for massive GI bleed
PUD
Varices
Arteriovenous malformation
tumor
mallory-weiss tear
what labs are ordered for GI bleed
CBC, CMP, type and screen, PT/PTT, Hemoccult, gastrocult
what is initial mgmt of GI bleed
ABC, IV, 02, monitor
cystalloid vs colloid
correct coagulopathy
NGT
IV PPI
endoscopy
what is the presentation of mesenteric ischemia
depends on chronicity:
chronic: anginal symptoms with pain after eating. weigh tloss out of avoidance
Acute: POOP with exam
what are causes of mesenteric ischemia
aterial embolism
aterial thrombosis
venous throbosis
non-occulsive
what is mesenteric ischemia
occulsion of vessel affecting the small or large intestine.
what can cause arterial embolism
m/c d/t A fib, valvular disease or reduced EF.
typically sudden onset of pain
what imaging is prefered for mesenteric ischemia
CTA ideal - non-contrast CT still ok
what lab work is done for Mesenteric Ischemia
Leukocytosis
lactate
+/- d-dimer
EKG for a.fib
what is the presentation of pancreatitis
Epigastric pain, radiating to the back
N/V
fever
tachy
hypotensive
what are causes of pancreatitis
Gallstones
ETOH
elevated triglyceride
meds
trauma
infection
what lab work and imaging is used for pancreatitis
CBC, CMP, lipase, amylase?
US and/or CT
what is the treatment of pancreatitis
fluids, fluids, fluids (2-4L/24hr)
pain management
antiemetics
abx if indicated
when does a AAA need repair
> 5.0 cm
what is the size of dilated Aorta
> 3.0cm
what is the triad for AAA
hypotension
abdominal pain/ radiating to the back
pulsatile abdominal mass
how much does mortality increase by minute prior to arrival to ED with AAA
increase by 1% per minute
What is Boerhaaves syndrome
full perferation of the esophagus
what is gastricult
test pH of the vomit
