Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EM > EM Test > Flashcards

EM Test Flashcards

1
Q

ekg big box time

A

5 mm

200 msec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

suture for superficial face

A

6-0 non absorbable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what cardiac marker peaks first?

A

myoglobin - peak sin 1-4, baseline in 18-24

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

treatment for distal radius fracture

A

reduction and sugar tong splint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes of second degree heart block mobitz I

A

Drugs: beta-blockers, calcium channel blockers, digoxin, amiodarone

Increased vagal tone (e.g. athletes)

Inferior MI

Myocarditis

Following cardiac surgery (mitral valve repair, Tetralogy of Fallot repair

Rarely require pacemakers, usually benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

memory of sutures

A

high memory = stiff, hard to handle, come untied

low memory =

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

lower frequency ultrasound

A

greater penetration –> deeper imaging but lower resolution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

thumb spica splint

A

for scaphoid fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what size should bites be in suturing?

A
  • Bite size: ¼-in bites at 90 degrees create wound eversion
    • Needle driver placement: 1/2-2/3 back from tip
      *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

when do inflammatory reactions to suture peak?

A

first 2-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

scaphoid fracture mechanism

A

FOOSH

snuffbox tenderness

risk for avascular necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Sgarbossa Criteria

A

MI diagnosis in LBBB

  • Concordant ST elevation > 1mm in leads with a positive QRS complex (score 5)
  • Concordant ST depression > 1 mm in V1-V3 (score 3)
  • Excessively discordant ST elevation > 5 mm in leads with a negative QRS complex (score 2).
  • A total score of ≥ 3 has a specificity of 90% for diagnosing myocardial infarction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

which sutures have the best strength?

A

polydiaxone/polygyconate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

when to use horizontal mattress stitches?

A
  • Horizontal mattress is good for use on fragile skin and also for areas of high tension; risk is that it holds so well that it can cause necrosis of the skin involved – best to only use when absolutely necessary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

traquetrum fracture mechanism

A

hyperextension or hyperflexion injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

palms/soles suture removal time

A

10-12 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

FAST indications

A
  1. hypotensive truma pt
  2. tachy trauma pt
  3. dyspneic trauma pt
  4. suspect pneumothorax or hemothorax
  5. suspect abd injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

higher frequency ultrasound

A

lesser penetration –> superficial imaging at higher resolution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what type of ACS requires hospital admission

A

unstable angina, NSTEMI, STEMI

asx CAD and SA can be outpaitnet wrokup

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

smiths fracture

A

volar displacement of distal wrist fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

suture elasticity

A

degree to which suture stretches and returns to original length

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

vessel for inferior MI

A

RCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

abdominal probe

A

low frequency curivlinear

  • 2-5 MHz
  • Greater depth, broader field
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q
A

anteroseptal MI

ST elevation is maximal in the anteroseptal leads (V1-4).

Q waves are present in the septal leads (V1-2).

There is also some subtle STE in I, aVL and V5, with reciprocal ST depression in lead III.

There are hyperacute (peaked ) T waves in V2-4.

These features indicate a hyperacute anteroseptal STEMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

where does the indicator go in ultrasound

A

facing the head or to the right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

hyperechoic

A

ultrasound

: reflect higher amplitude waves (brighter)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

wgat abx for tendon, joint, nerve injuries

A

1st gen cephalosporin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

FAST exam in non-trauma

A

ruptured AAA

ectopic pregnancy

ruptured hemorrhagic cyst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what to do if ST elevations?

A

go to cath emergently

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

fundamentals of splinting

A
  1. reduce first if needed
  2. isolate and immobilize the joint above and below the injury
  3. padding to prevent tissue necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Right Bundle Branch Block

A

activation of the RV is delayed as depolarization has to spread across the septum from the LV.

LV is activated normally, meaning that the early part of the QRS complex is unchanged

delayed RV activation produces a secondary R wave (R’) in the right precordial leads (V1-3).

RBBB Criteria:

Broad QRS > 120 ms

RSR’ pattern in V1-3 (‘M-shaped’ QRS complex)

Wide, slurred S wave in the lateral leads (I, aVL, V5-6)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

QRS interval

A

60-120 ms

1.5-3 small boxes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what does the R wave do along the precordials

A

limb leads - should be positive (except aVR)

should be more dominant portion of the complex going from V1 to V6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

tensile strength

A

amount of force required to break a suture divided by it’s cross sectional area

related to size

12-0 (smallest/weakest) –> 3 (largest/strongest)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

how to calculate QTc?

A

QT/sqrootRR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

unstable angina

A

CP at rest

nothing relieves the pain

no heart damage (no ST change or trop)

90% occlusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q
A

vertical mattress stitch

The vertical mattress suture is recommended for wounds under tension and for those with edges that tend to invert (fall or fold into the wound). It acts as a deep and superficial closure all in one suture. The first portion of the suture loop (far-far) approximates the dermal structures. The second portion (near-near) closes the wound and everts the edges.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

RVH

A
  • R axis deviation
  • Dominant R wave in V1 (>7mm tall)
  • Dominant S wave in V5, V6 (>7mm deep)
  • QRS <120 ms (bc changes not due to RBBB)
    • RV strain pattern: ST dep/t wave inversion in precordial (V1-V4) and inferior (II, III, aVF)
      *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

EKG Lead Diagram

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Wellen’s syndrome

A
  • Wellens’ syndrome is a pattern of deeply inverted or biphasic T waves in V2-3, which is highly specific for a critical stenosis of the left anterior descending artery (LAD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What to do if ECG and trops are negative

A

stress test (outpatient or obs stay) to see if CP is coronary

if stress is pos - elective cath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

when to use morphine

A

all purpose “go to drug”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

vessel for anterior MI

A

LAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

vessel for lateral MI

A

branches of LAD and L circ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

cross tolerance

A
  • Cross-tolerance is a phenomenon that occurs when tolerance to the effects of a certain drug produces tolerance to another drug. It often happens between two drugs with similar functions or effects – for example, acting on the same cell receptor or affecting the transmission of certain neurotransmitters.
  • Even among opioids, cross tolerance is imperfect
    • Most experts recommend a 25-50% reduction in first dose when using equivalency charts
      *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

First Degree AV Block

A

PR interval > 200ms (five small squares)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what does QRS represent

A

begins at AV node

conducts into bundle branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

first view on FASt

A

subxyphoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

NSTEMI ECG findings

A

ST depression

dynamic T wave inversion

(NSTEMI or high-risk unstbale angina)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what does lung sliding look like on M Mode?

A

seashore sign is normal!

bar code sign or stratosphere sign is suggestive of pneuomothorax - no lung sliding! (obstructive shock)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

causes of second degree av block mobitz II

A
  • Intermittently dropped QRS complexes without PR prolongation
  • More likely to be due to structural damage of the conduction system, such as infarction, fibrosis, necrosis
  • More likely to have HD instability, severe bradycardia, progression to third degree heart block
  • ~35% risk of asystole per year à mandates immediate admission for cardiac monitoring, backup temporary pacing, and ultimately pacemaker insertion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

LVH

A
  • Pressure 2/2 aortic stenosis or HTN
  • Increased R wave on L leads (I, aVL, V4-V6)
  • Increased S depth on R leads (III, aVR, V1-V3)
  • Lateral leads – ST depression + T wave inversion in L sided leads
  • R wave in V5, V6 + S wave in V1 > 35 mm
    • Largest R + largest S in precordial > 45 mm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

when to use vertical mattress stitches?

A

Vertical mattress is recommended for wounds under tension and those with edges that tend to invert; acts as a deep and superficial closure all in one – the far-far loop approximates the dermal structures and the near-near loop closes the wound/everts the edges

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Inferior EKG Leads

A

II, III, aVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

suture for superficial foot/sole

A

3-0 non-absorbable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

4 views on LUQ fast

A
  1. L costophrenic rescess
  2. subdiaphragmatic space
  3. splenorenal rescess
  4. inferior pole of L kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

max dose of lidocaine 1%

A

5 mg/kg OR 35 cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

ekg small box time

A

1 mm = 40msec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

volar splint

A

for triquetrum chip fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

adequate pressure for irrigating wounds?

A

5-8 PSI

can use higher (25) for really dirty wounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

cardiac probe

A
  • 3.5-5 MHz
    • Greater depth, smaller field
      *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

max dose of lido with epi

A

7 mg/kg

OR

500 mg

about 50 ml for 70 kg person

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

scaphoid fracture treatment

A

thumb spica splint

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

how to treat anaphylaxis

A
  • ABCs, be ready to intubate
  • Epi 1:1000 0.3-0.5mg IM
    • Can keep giving q5-15 minutes
  • IVF boluses (1-2L NS)
  • Benadryl (diphenhydramine) 50mg IV
  • Ranitidine 50 mg IV
  • Salumedrol 125mg
  • Albuterol and Mg for bronchodilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

antibiotics if tendon, jouint, nerve infection

A

first gen cephalosporin - cefazolin or cefalexin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

max volume of lido WITH epi - .5%, 1%, 2%

A

100 cc

50 cc

25 cc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

where should p wave be negative?

A

aVR, V1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q
A

boxers fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

QTc length

A

<440 ms in men

<460 ms in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

when to give tetanus vaccine for wound

A

if <3 or never received

if last dose >10 years prior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Causes of LBBB

A

aortic stenosis, ischemia, htn, dilated cardiomyopathy, dig tox, hyperkalemia, degenerative disease of conduction system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what does ST segment represent

A

slow ventricular repolarization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

fentanyl standard dose

A
  • Loading dose of 1mcg/kg to 1.5mcg/K
  • Additional doses 0.25-0.5mcg/kg q15 min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

what does T wave represent

A

rapid phase of ventricular repolarization

should be in same direction as QRS (normally upright but inverted in V1 and aVR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

hypoechoic

A

: reflect lower amplitude waves (less bright)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

RBBB pattern

A
  • Broad QRS >120 msec
  • RSR’ pattern in V1-V3
  • Wide, slurred S wave in lateral leads (I, aVL, V5-6)
    *
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

QT interval

A

<400 ms

2 large boxes

inversely proportional to heart rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

what does the Q wave represent?

A

septal depolarization

first downward deflection not preceeded by upward deflection

often absent, but can be seen in lateral leads

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

benefit to monofilament suture?

A

less risk of infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Piezoelectric effect

A
  • when an electrical pulse is applied, crystals vibrate, causing US waves to travel into the tissue and then be reflected back at various times and intensity depending on the tissue they encounter. The returning sound waves hit the crystals, mechanically distort them, create an electric current that is captured by the computer to form the image
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

What does a wide P wave mean?

A

left atrial enlargement

P mitrale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

P wave size

A

<120 ms

<2.5 mm high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

causes of first degree AV block

A
  • First degree: prolonged PR (>5 small boxes/200 msec)
  • increased vagal tone, athletic training, inferior MI, mitral valve surgery, myocarditis, hypokalemia, AV nodal-blocking drugs (BBs, Ca channel blockers, Digoxin, amiodarone), normal variant
  • Does not cause HD instability, generally benign
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

extremities suture removal time - under tension vs not

A

not - 8-10 days

tension - 10-14 days

85
Q

hand bones

A
86
Q

vascular probe

A

high frequency linear probe

  • 7.5-10 MHz
  • Higher resolution for superficial structures
  • ~6cm depth
87
Q

preferred needle curvature

A

3/8 curved needle

88
Q

Causes of third degree AV block

A

Causes of complete heart block: MI, AV-nodal blocking drugs (CCB, BB, dig), Idiopathic degeneration of conduction system

89
Q

max volume of lido WITHOUT epi - .5%, 1%, 2%

A

70 cc

35 cc

18 cc

90
Q

Second Degree AV Block Mobitz II Causes

A

While Mobitz I is usually due to a functional suppression of AV conduction (e.g. due to drugs, reversible ischaemia), Mobitz II is more likely to be due to structural damage to the conducting system (e.g. infarction, fibrosis, necrosis).

91
Q

Pelvic view on FAST

A
92
Q

causes of second degree Mobitz I AV block

A
  • progressive PR prolongation à dropped QRS
  • Usually benign, rarely require pacemakers; typically due to a functional suppression of AV conduction
  • Causes: drugs (BBs, Ca channel blockers, digoxin, amiodarone), increased vagal tone, inferior MI, myocarditis, s/p cardiac surgery (mitral valve repair, tetralogy of Fallot repair)
93
Q

when to use hydromorphone

A

when large doses are required! morphine releases more histamine

94
Q

suture for deep face

A

5-0 absorbable

95
Q

mechanism of distal radius fracture

A

: FOOSH (extended wrist) or fall onto flexed wrist. Direct blow to the wrist

96
Q

T wave

A

represents normal ventricular repolarization

should be same direction as QRS

normally upright, but inverted in aVR, V1

97
Q

what if contaminated wound and tetanus vaccine was completed >5 years ago

A
  • If 3+ doses, do not give Ig and only give vaccine if last dose >5 years ago
98
Q

suture for securing g tube

A

2-0 non absorbable

99
Q

2015 joint commission on opioids

A
  • tx strategies may consider both pharmacologic and nonpharmacologic approaches as well as risks (including dependency, addiction, and abuse) and benefits to pts when considering the use of medications to treat pain
100
Q

parenteral agents opioid equivalency

A

morphine - 10 mg

hydromorphone - 1.5 mg

fentanyl - 125 micrograms

101
Q

left axis deviation

A

I pos

aVF neg

102
Q

antibiotics if wound contamination by saliva, vaginal, or feces

A

saliva - PCN

vag/feces - metronidazole + amox or cipro(vag)

103
Q

normal heart conduction

A

SA node -> intermodal tracts -> AV node -> R and L bundles -> ventricular conduction pathways

104
Q

treatment for NSTEMI

A

if high-risk or elevated trop with NSTEMI ECG findings:

  • invasive if HDS, VTach,
  • add nitro, heparin (+ plavix, + beta block)
105
Q
A

running stitch - simple and locked

106
Q
A

lateral MI

107
Q

STEMI ECG findings

A

STE

New LBBB

108
Q

Third degree AV Block

A

In complete heart block, there is complete absence of AV conduction – none of the supraventricular impulses are conducted to the ventricles.

Perfusing rhythm is maintained by a junctional or ventricular escape rhythm. Alternatively, the patient may suffer ventricular standstill leading to syncope (if self-terminating) or sudden cardiac death (if prolonged).

Typically the patient will have severe bradycardia with independent atrial and ventricular rates, i.e. AV dissociation.

109
Q

what does a tall P wave mean?

A

Right Atrial Enlargement (P pulmonale)

110
Q

who to avoid routine antihistamine?

A

(requests for diphenhydramine are associated with drug-seeking behavior

111
Q

steps of wound closure

A
  • Sterile prep and drape
  • Debride tissue as needed
  • Ensure approximation of skin margins
    • Perform appropriate suture repair technique
112
Q

steps in suturing

A
  1. anethetize
  2. irrigate
  3. sterile prep
  4. close
  5. dress
113
Q

Second Degree AV Block Mobitz II

A

Intermittent non-conducted P waves without progressive prolongation of the PR interval (compare this to Mobitz I).

The PR interval in the conducted beats remains constant.

The P waves ‘march through’ at a constant rate.

The RR interval surrounding the dropped beat(s) is an exact multiple of the preceding RR interval (e.g. double the preceding RR interval for a single dropped beat, treble for two dropped beats, etc).

Mobitz II is much more likely than Mobitz I to be associated with haemodynamic compromise, severe bradycardia and progression to 3rd degree heart block.

Onset of haemodynamic instability may be sudden and unexpected, causing syncope (Stokes-Adams attacks) or sudden cardiac death.

The risk of asystole is around 35% per year.

Mobitz II mandates immediate admission for cardiac monitoring, backup temporary pacing and ultimately insertion of a permanent pacemaker.

114
Q

hydromorphone standard dose

A
  • Single dose 0.015mg/kg; can repeat this dose or half this dose q5min
115
Q

morphine standard dose

A

8 mg to start, subsequently increase by 4 mg

acute pain:.1 mg/kg

Can give 0.025-0.05mg/kg q5min as a loading dose initially to get pain under contro

116
Q

where should QRS be positive?

A

limb leads EXCEPT aVR

precordial - R should become more dominant going from V1 to V6

117
Q
A

half buried stitch

Version of horizontal mattress stitch that is used to suture wounds that have a dog-ear to keep flap under less tension.

118
Q

right axis deviaton

A

I neg

aVF pos

119
Q

PR interval

A

120-200 ms

(3-5 small boxes)

120
Q

ACS meds

A

Morphine IV (if nitro doesn’t help)

Oxygen

Nitro (sublingual or spray)

Aspirin (160-325)

121
Q

first steps if think someone has ACS

A
  • ABCs, vitals
  • ECG
  • IV access
  • Trop, lyte, XR
122
Q

Lateral EKG Leads

A

I, aVL, V5, V6

123
Q

face suture removal time

A

3-5 days

124
Q

benefits of suturing

A

aid wound healing

decrease infection risk

cosmesis

125
Q

when give tetanus Ig with the vaccine

A
  • Contaminated wounds (dirt, feces, soil, saliva, puncture wounds, avulsions, and wounds from missiles, crush injuries, burns, and frostbite)
    • If <3 or unknown previous doses, give vaccine and Ig
126
Q
A

railroad tracks

Mattress sutures are notorious for causing railroad track scars, so best to never use on the face or if cosmesis is concerned.

127
Q

unstable VS + pos FAST

A
  • OR (hemoperitoneum), chest tube (PTX, HTX), pericardial window
128
Q

triquetrum fracture treatment

A

volar splint

129
Q
A

Inferior MI

Right ventricular infarction is suggested by:

  • ST elevation in V1
  • ST elevation in lead III > lead II

Right ventricular infarction complicates up to 40% of inferior STEMIs. Isolated RV infarction is extremely uncommon. Patients with RV infarction are very preload sensitive (due to poor RV contractility) and can develop severe hypotension in response to nitrates or other preload-reducing agents.

130
Q

How to risk stratify NSTEMI

A
  • TIMI score can help with risk stratification in the setting of non-dx ECG/normal trops
  • Tx also includes oxygen, anti-plt, antithrombotic, nitrates, morphine, and potential later PCI or CABG
131
Q
A

running subcuticular

Often not used in the ed, takes longer time, harder to be precise

132
Q

most common thing to anesthetize?

A

Lidocaine

rapid onset

133
Q

volume of water for irrigating wounds?

A

1 cm = 100 cc

134
Q

p wave size

A

<3 small boxes (<120 msec)

<2.5 mm high

135
Q

where put prbe for lung exam in eFAST?

A
  • Linear probe in mid-clavicular line between 2nd-3rd intercostal space
  • Assess for lung sliding on M-mode (+seashore sign)
    • No lung sliding (bar-code sign/stratosphere sign) suggests PTX
136
Q

what is morrison’s pouch

A

the space between the liver and the kidney

137
Q

where to NOT use epi + antedote

A
  • Do not use epinephrine at the following sites: feet, hands, genitals, ears, nose
    • Risk of tissue necrosis
      • If you mistakenly do this, use phentolamine as an antidote (alpha blocker, causes vasodilation)
        *
138
Q

ulnar gutter splint

A

for boxers fracture

139
Q
A

simple interrupted stitch

140
Q

reciprocal ischemic changes

A

PAILS

LS stands for P-posterior A-anterior I-inferior L-lateral S-septal. ST elevations in these leads most commonly create reciprocal ST depressions in the corresponding leads of the next letter in the mnemonic. That is to say, posterior ST elevation will usually cause anterior lead ST depressions and anterior lead ST elevations will usually be seen with inferior lead depressions.

141
Q

NSTEMI

A

some ecg changes (st depressions, t wave inversions) - NO elevations

+ troponin!

142
Q

Boxer’s Fracture

A

from improper punch

4th, 5th metacarpal

143
Q

acetaminophen with codeine

A

pros: low abuse potential, low resale value, good of cough involved
cons: some people get no effect (2D6 poor metabolizers)

144
Q

Causes of RBBB

A

-Causes of RBBB: RVH/cor pulmonale, PE, MI, myocarditis, degeneration of conduction system

145
Q

Opioid “allergy”

A

all opioids release histamine to some degree - not a true allergy

  • For unclear allergy (red arm, N/V): probably can give anything but switch chemical class if possible
  • For anaphylaxis: switch chemical class and proceed with close monitoring

Classes: phenanthrenes, phenylpiperidine, phenylheptane

146
Q

NSTEMi

A

heart is damaged –> increased biomarkers

90% occlusion

DEMAND ISCHEMIA - if decrase workload, dcrease oxygen needs

147
Q

Stokes Adams attack

A

sudden onset HD instability due to mobitz type II av block

148
Q

abx if cat, human, dog bites

A

augmentin, PCN, first gen cefalosporin (cefazolin, cefalexin)

149
Q

most common preferred needle for suturing? for vascular cases?

A

most = reverse cutting needle

vascular = tapered

150
Q

Pericarditis on EKG

A
  • Stage 1: widespread ST elevation and PR depression with reciprocal changes in aVR (first 2 weeks)
  • Stage 2: normalization of ST changes, generalized T wave flattening (1-3 weeks)
  • Stage 3: flattened T waves become inverted (3-several weeks)
    • Stage 4: EKG returns to normal
      *
151
Q

wound dressing

A

bacitracin - fewer infections (NOT on dermabond - it will inactivate)

sterile gauze and kerlex

152
Q

sizes of sutures

A

number + 0 = progressively smaller

number alone = progressively bigger

153
Q

ACS Tx when someone hits the door

A

Morphine

O2

Nitrates - if continually have angina, NOT if inferior (II, III, aVL)

ASA

Beta block (decrease arrhythmias and demand)

ACE

Statin

Heparin (therapeutic) - if think STEMI !

Clopidogrel - if get a stent

tPA –> if no access to PCI or in rural setting (door to balloon = 90 min) give if transport time > 60 min

154
Q

complications of splinting

A

burns - from exothermic reaction of plaster

compartment syndrome - always perform neurovascular exam after reduction and immobilization (cap refill and sensation)

155
Q

colles fracture

A

dorsal displacement of distal radius fracture

156
Q

complications of splinting

A

burns from exothermic reactions of plaster

compartment syndrome (perform vascular exam!)

157
Q

4 views in RUQ on FAST

A
  1. R costophrenic rescess
  2. subdiaphragmatic space
  3. hepatorenal rescess
  4. inferior pole of R kidney
158
Q

stable VS + positive FAST

A

CT to refine mgmt

159
Q

benefit to braided suture?

A

easier to handle and tie

160
Q

oral agents opioid equivalency

A

morphine - 30 mg

hydromorphone - 7 mg

hydrocodone - 20 mg

oxycodone - 20 mg

tramadol - 50-100 mg

161
Q

diffrent biomarkers for ACS

A

troponins - go up first and stay up! better for immediate test

CKMB - reinfarction !

162
Q

when to give fentanyl

A

shorter duration or true morphine allergy

163
Q

CYP2D6 polymorphism

A

mutation of the enzyme that metabolizes codeine –>morphine

many drugs are inhibitors of metabolism (antidepressants, antihistamines, antipsychotics) as well as inducers

coadministration of one of these drugs with codeine can lead to lethal overdose

  • if poor 2D6 metabolizers - don’t get much effect from drug!
164
Q

Anterior EKG Leads

A

V3, V4

165
Q

Wrist bones

A

So Long To Pinky, Here Comes The Thumb

Scaphoid, Lunate, Traquitrum, Pisiform

Hamate, Capitate, Trapizoid, Trapezium

166
Q

knot strength

A

force required for a knot to slip

167
Q

wound care counseling

A
  • Keep wound dry for 24-48 hours
  • Keep area elevated if possible
  • Do not soak (baths, swimming) – can decrease tensile strength
  • Do not swim in fresh bodies of water – increases infection risk
  • Return for suture removal if appropriate
  • Seek immediate care if site is erythematous, swelling, draining pus, or increasingly painful especially with fevers and chills
168
Q

STEMI

A

100% occlusion

increase markers

ST changes

SUPPLY ISCHEMIA

169
Q

stable VS + neg FAST

A

clinical correlation

170
Q

which type of suture has the most tissue reactivity?

A

surgical or chromic gut

171
Q

confirmed STEMI tx

A

< 12 h - PCI (balloon), fibrinolysis

>12h - nitro, LMWH + ACE/ARB, statin, beta block, plavix

172
Q

timeline of healing

A

50% original strength at 40 days

70-90% at 1 year

173
Q
A

traquitrum chip fracture

174
Q

Left Bundle Branch Block

A
  • In LBBB, the normal direction of septal depolarization is reversed (becomes right to left), as the impulse spreads first to the RV via the right bundle branch and then to the LV via the septum.
  • This sequence of activation extends the QRS duration to > 120 ms and eliminates the normal septal Q waves in the lateral leads.
  • The overall direction of depolarization (from right to left) produces tall R waves in the lateral leads (I, V5-6) and deep S waves in the right precordial leads (V1-3), and usually leads to left axis deviation. As the ventricles are activated sequentially (right, then left) rather than simultaneously, this produces a broad or notched (‘M’-shaped) R wave in the lateral leads.

LBBB CRITERIA

Dominant S wave in V1

Broad monophasic R wave in lateral leads (I, aVL, V5-V6)

Absence of Q waves in lateral leads (I, V5-V6; small Q waves are still allowed in aVL)

Prolonged R wave peak time > 60ms in left precordial leads (V5-6)

175
Q

Chest view on FAST - what are you looking for?

A

B mode - looking for lung sliding

176
Q

Septal EKG Leads

A

V1, V2

177
Q
A

scaphoid fracture

178
Q

why lidocaine with epi for anesthesia?

A
  • Vasoconstriction
  • Decreased bleeding
  • Prolongs duration of action by decreasing systemic absorption
179
Q
A

horizontal mattress stitch

A horizontal mattress suture can also be used to achieve wound eversion in areas of high skin tension. The needle is introduced into the skin in the usual manner and brought out on the opposite side of the wound. A second bite is taken along the opposite side, approximately 0.5 cm from the first exit site, and is brought back to the original starting side, also 0.5 cm from the initial entry point.

Good for use on fragile skin.

However holds so well that it can cause necrosis of the skin that is involved. SO best only to use when absolutely necessary, and if possible, use simple stitch where feasible in same laceration.

180
Q

abx if through and through oral wound

A

PCN

181
Q

sugar tong splint

A

for distal radius fracture

182
Q

LBBB pattern

A
  • Tall R waves w/ RSR’ in lateral leads (I, V5-6)
  • Deep S waves in right precordial leads (V1-3)

Typically leads to L axis deviation

183
Q

Second Degree AV Block Mobitz I

A

Progressive prolongation of the PR interval culminating in a non-conducted P wave

The PR interval is longest immediately before the dropped beat

The PR interval is shortest immediately after the dropped beat

Rarely require pacemakers, usually benign

184
Q

Causes of first degree AV block

A

Increased vagal tone

Athletic training

Inferior MI

Mitral valve surgery

Myocarditis (e.g. Lyme disease)

Hypokalaemia

AV nodal blocking drugs (beta-blockers, calcium channel blockers, digoxin, amiodarone)

May be a normal variant

185
Q

inferior MI

A
  • RV infarction suggested by ST elevation in V1, III>II
    • Preload sensitive à no nitrates or other preload-reducing agents
      *
186
Q

Boxer’ Fracture tratment

A

reduction and ulnar gutter splint

187
Q
A

distal radius fracture

188
Q
A
189
Q
A
190
Q
A
191
Q

managment of PEA

A

CPR, epi 1 mg q 3-5 min

cardiac arrest where you see a HR but no pulse

not shockable

hypovolemia, hypoxia

192
Q

Hs and Ts

A

hypovol, hypoxia, H+, hypo/er kalemia, hypothermia

ptx, tamponade, toxins, thrombosis

193
Q

A fib managment

A

cardiovert if unstable

if stable - AV nodal blocker (adenosine)

194
Q

V fib management

A

defibrilate (not synchronized)

195
Q

V tach management

A

cardiovert if unstable

otherwise - lido, procainimide, amiodirone

196
Q

torsades management

A

defibrillate

197
Q
A
198
Q
A
199
Q
A
200
Q
A
201
Q
A
202
Q
A
203
Q
A
204
Q
A
205
Q
A
206
Q
A
207
Q
A
208
Q
A
209
Q
A

EM (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions