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Emergency Medicine > EM Topics Final > Flashcards

EM Topics Final Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

oxygenation is a ____ process affected by ______ and _______

A

passive, V/Q mismatch, PEEP, percentage inhaled oxygen

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2
Q

what is a shunt

A

lack of gas diffusion in the presence of blood flow

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3
Q

what is dead space

A

lack of blood flow to a functioning alveolus

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4
Q

transudate example

A

pulmonary edema

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5
Q

dead space examples

A

PE, low cardiac output

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6
Q

what is PEEP

A

positive end expiratory pressure that keeps the alveoli open at the end of expiration to improve alveolar compliance

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7
Q

next step if nonrebreather isn’t improving oxygenation

A

add PEEP

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8
Q

oxygenation is NOT affected by

A

tidal volume

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9
Q

CO2 exchange is affected by

A

tidal volume, respiratory rate

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10
Q

minute ventilation

A

tidal volume x respiratory rate

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11
Q

ideal tidal volume

A

6-8 cc/kg of ideal body weight

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12
Q

CPAP influences ____

A

oxygenation

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13
Q

BiPAP influences _____

A

ventilation

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14
Q

infectious causes of airway compromise

A

epiglottitis, retropharyngeal abscess, Ludwig’s angina

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15
Q

retropharyngeal abscess presentation

A

difficulty moving neck, +/- muffled voice, febrile

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16
Q

what is Ludwig’s angina

A

deep space infection below tongue with woody induration (submandibular or sublingual space)

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17
Q

epiglottitis population affected

A

unvaccinated against strep pneumo/h flu

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18
Q

how to position airway in adults

A

bring external auditory meatus to the level of the sternal notch with jaw thrust/head-tilt chin lift

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19
Q

how to position pediatric airway

A

same as adults but will probably need to put towels under shoulders instead

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20
Q

basic airway adjuncts

A

nasopharyngeal airway, oropharyngeal airway

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21
Q

OPA contraindications

A

gag reflex

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22
Q

NPA contraindications

A

massive midface trauma

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23
Q

how to size an NPA

A

tip of nose to bottom of earlobe

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24
Q

how to size an OPA

A

corner of mouth to earlobe

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25
Q

size of BVM bag

A

approx 1 liter

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26
Q

how much to ventilate someone with BVM

A

approximately 450 cc

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27
Q

how to hold BVM mask to patient’s face

A

EC or thumbs down grip with 2 hands whenever possible

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28
Q

ventilation frequency with BVM

A

once every 5-6 seconds (10 times per minute)

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29
Q

consequences overventilation

A

overwhelm lower esophageal sphincter causing gastric insufflation

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30
Q

what is true of exhalation vs inhalation with BVM

A

give the patient at least twice as long to exhale

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31
Q

Airway continuum

A

positioning, supplemental O2, +/- suctioning/beta agonists, NIPPV, adjunctions, supraglottics, intubation, surgical

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32
Q

predictors of dangerous intubation

A

O2<93%, hypotension, acidosis (HOP killers)

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33
Q

why does intubation compromise hemodynamics

A

sedation/paralytics, PPV suppresses the negative intrathoracic pressure that draws blood into the right side of the heart (venous return), vagal nerve stimulation

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34
Q

how to mitigate negative hemodynamics of intubation

A

resuscitate before you intubate

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35
Q

difficult airway mnemonic

A

LEMONS

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36
Q

what does LEMONS stand for

A

look externally, evaluate 3-3-2, mallampati, obstruction, neck mobility, saturation

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37
Q

3-3-2 rule

A

3 fingers of mouth opening, 3 fingers worth of space between tip of chin and thyroid cartilage, 2 fingers between bottom of chin and thyroid cartilage

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38
Q

mallampati 1

A

can see entire uvula

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39
Q

mallampati 2

A

can see most of uvula

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40
Q

mallampati 3

A

cannot see uvula but can see upper part of back of throat

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41
Q

mallampati 4

A

cannot see uvula or back of throat

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42
Q

grade 4 airway

A

cannot see any epiglottis

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43
Q

Miller blade

A

straight blade, pins epiglottis up blindly

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44
Q

Macintosh blade

A

curved blade, lifts epiglottis by putting pressure on hyoepiglottic ligament

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45
Q

tube size adult male

A

8.0-8.5

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46
Q

tube size adult female

A

7.5-8.0

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47
Q

tube size peds

A

broselow tape or (age/4) + 4 for uncuffed tube or 3.5 if cuffed

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48
Q

ET tube depth

A

3 x size of ETT or 22 at the teeth

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49
Q

blade size for intubating adults

A

3-4

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50
Q

blade size for intubating peds

A

00-3

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51
Q

how to inflate ETT balloon

A

5-10 cc (no more than 25 cc)

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52
Q

induction agents aka

A

sedatives

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53
Q

what induction agent has the least hemodynamic effect

A

ketamine and etomidate

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54
Q

what paralytics are used the most

A

succinylcholine, rocuronium

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55
Q

succinylcholine MOA and cautions

A

depolarizing neuromuscular blocker (causes all myocytes to depolarize). Can cause hyperkalemia in people with predisposition (CKD, crush injury, myasthenia gravis)

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56
Q

succinylcholine duration

A

3-5 minutes

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57
Q

rocuronium/vecuronium MOA and cautions

A

nondepolarizing neuromuscular blocker, longer acting (1 hour) - must adequately sedate

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58
Q

how to lift laryngoscope

A

up and forward

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59
Q

what to do after intubation

A

secure tube, confirm placement (listen to breath sounds, end tidal CO2/capnography), set vent, get chest x-ray, post-intubation sedation/pain control

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60
Q

what happens if tube is too deep and how can you tell

A

will likely end up in right mainstem bronchus, will hear breath sounds on the right but not on the left

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61
Q

how deep should tube appear on chest x-ray

A

3-5 cm above carina (between carina and clavicles)

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62
Q

vent settings

A

10-20 breaths per minute, 6-8 cc/kg ideal body weight for tidal volume

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63
Q

what to do if airway is going bad

A

go back to last thing that worked

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64
Q

extraglottic airway examples

A

LMA, king, combitube, i-gel

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65
Q

extraglottic airway uses

A

cardiac arrest, primary device for difficult airway, backup device for intubation

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66
Q

extraglottic airway advantages

A

easy to place, 97% effective

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67
Q

extraglottic airway disadvantages

A

not good for distorted airways (anaphylaxis, expanding hematoma, etc), not good for preventing aspiration if there is massive bleeding/vomit, not good if high airway pressures are needed

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68
Q

how to troubleshoot a tube

A

DOPES

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69
Q

DOPES

A

displacement, obstruction, pneumothorax, equipment, stacked breaths

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70
Q

what is breath stacking

A

people with obstructive breaths don’t get enough time to exhale so air builds up in lungs which diminishes venous return

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71
Q

indications for surgical airway

A

can’t intubate and can’t oxygenate. It is not necessary to attempt intubation first if it is very unlikely to succeed

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72
Q

surgical airway in peds

A

needle cric (transtracheal jet ventilation) or tracheotomy

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73
Q

disadvantage to needle cric

A

ventilation is poor, can be a stopgap for 30-40 minutes

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74
Q

inner incision site for cric

A

cricothyroid membrane

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75
Q

vital signs of the eye

A

vision, pressure, pupil

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76
Q

how to measure eye pressure

A

tonometer

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77
Q

what does afferent pupillary defect indicate

A

optic nerve problem until proven otherwise

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78
Q

afferent pupillary defect aka

A

marcus gunn pupil

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79
Q

how afferent pupillary defect look on exam

A

neither pupil will constrict when light is shined in the affected eye, both pupils will constrict when light is shined in the unaffected eye

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80
Q

what intraocular pressure increases risk for disk ischemia and atrophy

A

> 20

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81
Q

steps for unanticipated intubation difficulty

A

stay calm, call for help, plan/communicate next steps, alternate airway techniques with each attempt

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82
Q

what is DART

A

difficult airway response team

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83
Q

when to activate DART

A

signs of extremely difficult airway, excessive hypoxia during intubation attempts, poor BVM compliance, failed attempt by experienced intubator, displaced tracheostomy, crisis situation with inadequate equipment

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84
Q

normal intraocular pressure

A

12-20 mmH20

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85
Q

causes of high IOP

A

glaucoma, increased ICP, trauma

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86
Q

causes of low IOP

A

globe rupture

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87
Q

what does teardrop pupil indicate

A

sign of ruptured globe until proven otherwise - points toward rupture location

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88
Q

eye exam steps

A

vision/pressure/pupil, EOM, visual field, lids/lacrimals, conjunctiva/sclera, cornea, lens, anterior chamber, fundus

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89
Q

biggest mistake in fluoroceine exam

A

not using enough

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90
Q

steps in fluoroceine exam

A

remove contacts, put fluorosceine and tetracaine onto a strip and place in tear reservoir, allow pt to blink

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91
Q

risk factor for lens dislocation

A

connective tissue disorder

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92
Q

common cause of exophthalmos

A

hyperthyroidism

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93
Q

complication of exophthalmos

A

chronic keratitis

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94
Q

ptosis causes

A

Horner’s syndrome, stroke, muscular weakness

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95
Q

preseptal cellulitis aka

A

periorbital cellulitis

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96
Q

septal cellulitis aka

A

orbital cellulitis

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97
Q

how to differentiate preseptal vs septal cellulitis

A

septal is more likely to have pain with eye movement and vision changes, definitive diagnosis is with CT

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98
Q

what to worry about with periorbital ecchymosis

A

retrobulbar hematoma that will damage optic nerve as it grows

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99
Q

retrobulbar hematoma treatment

A

lateral canthotomy

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100
Q

causes of disconjugate gaze

A

blowout fracture, muscle tear

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101
Q

what commonly accompanies disconjugate gaze

A

double vision

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102
Q

disconjugate gaze management

A

refer to ophthalmology

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103
Q

what is blepharitis

A

inflammation of eyelids, typically due to blockage of oil glands along base of eyelashes

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104
Q

blepharitis ssx

A

red eye, crust along eyelid

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105
Q

blepharitis tx

A

warm compresses, hygiene

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106
Q

what is chalazion

A

generally chronic bump on eyelid (not at the edge) due to blockage of oil gland

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107
Q

chalazion pathogen

A

polymicrobial

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108
Q

chalazion tx

A

refer to ophthalmology, warm compresses

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109
Q

what is pterygium

A

growth over the conjunctiva, often due to chronic sun exposure

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110
Q

pterygium tx

A

none unless vision loss is present

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111
Q

subconjunctival hemorrhage causes

A

trauma, sneezing, heavy lifting, vomiting

112
Q

subconjunctival hemorrhage tx

A

none, will reabsorb

113
Q

common cause of corneal ulcer and concerning pathogen

A

contact lenses, pseudomonas

114
Q

corneal ulcer tx

A

refer to ophthalmology

115
Q

corneal ulcer complications

A

scarring, vision loss

116
Q

dendritic lesion cause

A

herpes simplex or zoster (depending on who you ask)

117
Q

dendritic lesion complications

A

scarring, can block aqueous humor circulation leading to glaucoma

118
Q

dendritic lesion tx

A

refer to ophthalmology

119
Q

UV keratitis onset

A

sudden

120
Q

UV keratitis tx

A

toradol/lidocaine drops

121
Q

UV keratitis prognosis

A

usually heals quickly

122
Q

corneal scratch appearance on fluorosceine exam

A

ice rink sign: multiple scratches in linear pattern

123
Q

corneal scratch tx

A

evert lid and remove foreign body, maintain high suspicion for penetrating injury/rupture globe if associated with high velocity injury

124
Q

uveitis/iritis causes

A

RA, lupus, reiter’s syndrome

125
Q

what is uveitis/iritis

A

inflammation of anterior chamber

126
Q

uveitis/iritis diagnosis

A

white cells on slit lamp exam

127
Q

uveitis/iritis tx

A

steroids

128
Q

what is hyphema and what usually causes it

A

blood in anterior chamber, trauma

129
Q

hyphema concern

A

globe rupture until proven otherwise

130
Q

what is hypopyon

A

pus in anterior chamber

131
Q

hypopyon tx

A

abx injections into eye

132
Q

most common age-related lens opacity

A

cataracts

133
Q

cataracts presentation

A

otherwise asymptomatic progressive blurred vision

134
Q

common cause of lens dislocation

A

blunt trauma

135
Q

lens dislocation presentation

A

monocular diplopia, grossly blurred vision

136
Q

lens dislocation tx

A

surgery

137
Q

detached retina presentation

A

usually unilateral rapid vision loss, may or may not be in curtain pattern, +/- shower of floaters/flashes

138
Q

detached retina risk factors

A

age > 50, nearsightedness, cataract extraction, blunt trauma

139
Q

detached retina diagnosis

A

US

140
Q

detached retina tx

A

if vision is gone, nonemergent. If vision is not gone, emergent ophthalmology consult

141
Q

acute angle glaucoma ssx

A

severe pain in eye or forehead, red eye, decreased/blurred vision, rainbows, halos, severe HA, N/V

142
Q

acute angle glaucoma physical exam

A

fixed mid-sized pupil with cloudy cornea, injected sclera, decreased peripheral vision, IOP >40

143
Q

acute angle glaucoma tx

A

acetazolamide 500 mg IV then PO, topical timolol, pilocarpine (alpha agonist), refer to ophthalmology

144
Q

open angle glaucoma ssx

A

gradual vision loss, blind spots, halos, mild HA/eye pain

145
Q

steps of trauma triage

A
  1. Physiologic criteria 2. anatomic criteria 3. MOI criteria 4. Other
146
Q

trauma criteria physiologic

A

GCS<14 SBP<90, RR <10 or >29

147
Q

trauma criteria anatomic

A

proximal penetrating injuries, chest wall instability, crushed/degloved/pulseless extremity, amputation, pelvic fracture, open fracture, paralysis

148
Q

trauma criteria MOI

A

Falls (>20 ft adults, 3x child’s height/10 ft peds), high risk MVC

149
Q

high risk MVC definition

A

ejection, death of another passenger, high-speed based on vehicle telemetry, intrusion (>12 inches roof, 18 inches anywhere), auto vs pedestrian/motorcycle >20 mph

150
Q

trauma criteria other

A

Peds, anticoagulated, burns, time sensitive, ESRD, pregnancy>20 weeks, EMS provider judgment

151
Q

Goal of primary survey

A

identify and temporize life threats within 15-30 seconds

152
Q

major elements of primary survey

A

Airway, breathing, circulation, disability, exposure

153
Q

elements of airway in primary survey

A

protect c-spine, ask a question to determine airway patency, look for abnormal findings, provide temporizing or definitive management

154
Q

elements of breathing in primary survey

A

listen to lung sounds, observe work of breathing, palpate chest wall, assess SpO2. Supplemental oxygen, assisted ventilations, needle decompression or chest tube PRN

155
Q

elements of circulation in primary survey

A

look for signs of shock, control hemorrhage, IV/IO access, monitor BP/pulse, FAST exam

156
Q

elements of disability in primary survey

A

simplified neuro exam (pupils, gross movement/sensory), GCS, rectal (if suspicion of spinal or pelvic injury)

157
Q

elements of exposure in primary survey

A

undress, observe for wounds/deformities/odors, logroll to examine back

158
Q

elements of secondary survey

A

AMPLE, head-to-toe exam

159
Q

GCS major components

A

eye opening, verbal, motor

160
Q

elements of eye opening in GCS

A

4: Spontaneous 3: Opens to verbal stimuli 2: Opens to painful stimuli 1: Does not open

161
Q

elements of verbal in GCS

A

5: Appropriate speech 4: Confused 3: Inappropriate words 2: Random sounds 1: Silent

162
Q

elements of motor in GCS

A

6: Follows commands 5: Localizes to pain 4: Withdraws from pain 3: Decorticate posturing 2: Decerebrate posturing 1: No movement

163
Q

AMPLE stands for

A

allergies, medications, past medical history, last meal/menses/tetanus, Events leading up to injury

164
Q

when this the earliest splinting/wound exploration and repair can occur during trauma?

A

during secondary survey

165
Q

labs to order for trauma

A

point of care: pregnancy, hemoglobin, BGL. Others: CBC, CMP, coags, type and cross. +/- ETOH and tox only if it will impact care.

166
Q

trauma imaging

A

plain films (esp chest and pelvis), selective use of CT, repeat FAST exam

167
Q

at what GCS should you start thinking about intubation due to inability to manage own airway

A

8-9

168
Q

how do you calculate GCS in someone who is intubated

A

add up motor and eye opening scores and put T for verbal

169
Q

“the box” of penetrating chest injuries

A

greater risk of major organ damage: bordered by clavicle, intracostal cartilage, midclavicular line

170
Q

what to do if penetrating chest injury but stable with normal imaging?

A

observe for 6 hours and then repeat imaging

171
Q

when will CXR show pulmonary contusion

A

may not see it for several hours

172
Q

management of flail chest

A

pain management, pulmonary toilet, maintain normovolemia, +/- intubation

173
Q

flail chest is associated with what injury

A

pulmonary contusion

174
Q

management of pericardial tamponade

A

pericardiocentesis, thoracotomy, pericardial window

175
Q

what to consider when chest injuries are below the nipple line

A

may have injured diaphragm, intraabdominal injury

176
Q

ssx of ruptured diaphragm

A

bowel sounds heard in chest, respiratory distress

177
Q

imaging for ruptured diaphgragm

A

CXR, need CT if on right side

178
Q

ruptured diaphragm management

A

surgical

179
Q

pneumothorax with crepitus and subq air suggests what

A

ruptured tracheobronchial tree

180
Q

ruptured tracheobronchial tree management

A

balloon occlusion of affected bronchus, avoid high lung pressures, surgery

181
Q

ruptured aorta MOI

A

severe deceleration impact or lateral acceleration

182
Q

ruptured aorta CXR

A

loss of aortic contour, need CT for definitive diagnosis

183
Q

ruptured aorta management

A

most dead on arrival, avoid HTN using beta blocker w/vasodilator, call cardiothoracic surgery

184
Q

stepwise management for stable abdominal injury

A

FAST, then CT, the operate if free air, extravasation of oral contents, solid organ injury

185
Q

what is the trauma triage of death

A

acidosis, coagulation, hypothermia

186
Q

criteria for tx of APAP OD

A

if blood levels >150 after 4 hours, treat with 140 mg/kg N-acetylcysteine

187
Q

when is NAC tx most effective for APAP OD

A

within 8 hours

188
Q

what is true of NSAID overdoses

A

they are generally associated with low morbidity/mortality because they require a huge amount

189
Q

are stable transfers subject to EMTALA

A

no

190
Q

for how long is the sending hospital responsible for Pt they are transferring

A

until care is assumed by receiving hospital

191
Q

when must a receiving hospital accept transfer of specialty Pt

A

if they have the capability to treat Pt and sending hospital does not

192
Q

what counts as a medical screening exam for EMTALA purposes

A

whatever is required to rule out an emergency medical situation and can be performed by any trained/qualified hospital personnel

193
Q

EMTALA definition of emergency medical condition

A

acute ssx with sufficient severity such that absence of care could reasonably expect to result in placing health in serious jeopardy, serious impairment to body function, serious dysfunction of any body part/organ

194
Q

who is most likely to sue you?

A

patients who leave AMA

195
Q

requirements for someone to leave AMA

A

must understand the risks and be of sound mind

196
Q

what is best to obtain from children prior to caring for them>?

A

assent

197
Q

95% of malpractice suits are for what

A

negligence

198
Q

what is capacity and where is it determined

A

the ability to make a reasoned, legally binding decision by weighing risks/benefits and alternatives. Determined at bedside

199
Q

criteria for negligence

A

duty to act, breach of standard of care, damages occurred, and those damages were a direct result of the breach of standard of care

200
Q

definition of standard of care

A

what a reasonable PA would do

201
Q

which toxic spider bites are initially painless

A

brown recluse

202
Q

indication for antivenom in crotalid bites

A

progressing edema

203
Q

what test to get in women of childbearing age with abdominal pain

A

serum HCG

204
Q

ectopic pregnancy most common location

A

ampulla of fallopian tube

205
Q

ectopy pregnancy presentation

A

sudden abdominal pain (can be mild or severe, lateral or diffuse), kehr sign (shoulder pain), vaginal bleeding, amenorrhea, +/-syncope/shock,

206
Q

ectopic pregnancy diagnosis

A

TVU if serum HCG levels are high enough: empty uterus with adnexal mass/free fluid

207
Q

definition of spontaneous abortion

A

loss of pregnancy before 20 weeks, loss of fetus <500 g

208
Q

when do most spontaneous abortions occur

A

< 8weeks

209
Q

most common cause of spontaneous abortion

A

chromosomal abnormalities

210
Q

most common presenting complaint with spontaneous abortion

A

vaginal bleeding +/- abdominal pain

211
Q

spontaneous abortion diagnosis

A

pelvic exam

212
Q

what is a threatened abortion

A

pregnancy-related bloody vaginal discharge or frank bleeding during 1st half of pregnancy without cervical dilation

213
Q

what is an inevitable abortion

A

vaginal bleeding with open cervical os

214
Q

what is incomplete abortion

A

passage of only parts of products of conception

215
Q

when are incomplete abortions most likely to occur

A

6-14 weeks

216
Q

what is missed abortion

A

fetal death at <20 weeks without passage of fetal tissue within 4 weeks

217
Q

tx for missed/incomplete abortion

A

D&C

218
Q

what is septic abortion

A

evidence of infection during any stage of abortion

219
Q

what is molar pregnancy

A

genetically abnormal fetus that will never progress

220
Q

what is HELLP syndrome

A

clinical variant of preeclampsia consisting of hemolysis, elevated liver enzymes, low platelets, abdominal pain. +/-HTN

221
Q

what type of exam to avoid during 3rd trimester

A

sterile speculum exam, TVUS

222
Q

what HR is indicative of fetal distress

A

<110, >160

223
Q

cardiac views in FAST exam

A

subcostal (most common), parasternal

224
Q

what is preeclampsia

A

new onset HTN after 20 weeks

225
Q

preeclampsia risk factors

A

prior HTN, nulliparity, DM, <20 or >35

226
Q

preeclampsia ssx

A

generalized edema, proteinuria, new renal insufficiency, weight gain >5 lbs in 1 week, headache, vision changes, dyspnea

227
Q

preeclampsia when to deliver

A

37 weeks or 34 weeks if severe

228
Q

meds for preeclampsia

A

magnesium to prevent seizures, BP control: nifedipine, methyldopa, labetalol, hydralazine

229
Q

what is placental abruption

A

partial or premature separation of placenta from uterine wall

230
Q

placental abruption risk factors

A

maternal HTN, smoking, alcohol, cocaine, abd trauma (may be minor)

231
Q

placental abruption ssx

A

sudden onset, painful third trimester vaginal bleeding with contractions, fetal distress, tender/rigid uterus

232
Q

placental abruption diagnosis

A

transabdominal US

233
Q

what is placenta previa

A

abnormal placental placement over cervical os

234
Q

placenta previa ssx

A

painless bright vaginal bleeding, typically large volume

235
Q

placenta previa management

A

delivery via c-section if it hasn’t moved prior to delivery

236
Q

what is PROM

A

rupture of membranes before onset of labor

237
Q

PROM diagnosis

A

sterile speculum exam with pH>7 and ferning pattern on smear

238
Q

PROM management

A

may need to induce if labor does not occur within 18 hours, may lead to chorioamnionitis

239
Q

SAGE mnemonic for tox emergencies

A

supportive care, antidotes, gastric decontamination, enhanced elimination

240
Q

elements of coma cocktail

A

dextrose, O2, narcan, thiamine

241
Q

MUDPILES-CAT

A

methanol, uremia, DKA, paraldehyde, iron/INH, lactic acidosis, ethylene glycol, salicylates, CO/CN, alcohol, toluene

242
Q

what does a combined anion and osmolar gap suggest

A

poisoning by methanol or ethylene glycol

243
Q

phase I APAP OD timing and ssx

A

30 mins-24 hours, N/V

244
Q

phase II APAP OD timing and ssx

A

24-72 hours, RUQ pain, elevated PT and liver transaminases

245
Q

phase III APAP OD timing and ssx

A

72-96 hours, centrilobular necrosis

246
Q

phase IV APAP OD timing and ssx

A

4 days- 2 weeks, complete resolution

247
Q

sodium channel blocker examples

A

TCAs, benadryl, cocaine, propranolol

248
Q

sodium channel blocker ssx

A

shock, AMS, long QRS, terminal R in aVR

249
Q

ddx of abd pain in early pregnancy

A

all non-pregnancy causes plus corpus luteal cyst, ectopic pregnancy, nonviable intra-uterine pregnancy

250
Q

ectopic risk factors

A

PID, tubal ligation, previous ectopic, IUD, assisted repro

251
Q

classic ectopic triad

A

abdominal pain, vaginal bleeding, amenorrhea

252
Q

infectious tests in PROM

A

GC/chlamydia, BV, group B strep

253
Q

most common cause of postpartum hemorrhage

A

uterine atony

254
Q

most common otitis media pathogen

A

strep pneumo

255
Q

most common cause of pediatric hearing loss

A

serous otitis media

256
Q

what is serous otitis media

A

presence of fluid in middle ear space without evidence of infection

257
Q

most common cause of posterior epistaxis

A

HTN

258
Q

which type of sinusitis is more likely to cause intracranial complications and what ssx suggest this

A

acute frontal sinusitis, HA/confusion/eyelid pain

259
Q

most common intracranial complication from rhinosinusitis

A

meningitis

260
Q

what is Pott’s puffy tumor

A

osteomyelitis of the frontal bone, usually with overlying soft tissue “doughy” swelling of the forehead

261
Q

MAP =

A

COxSVR

262
Q

what is shock index and what does it mean

A

heart rate/SBP. A persistent value >1 indicates impaired left ventricular function and carries a high mortality rate

263
Q

normal lactate level

A

<2

264
Q

SIRS criteria

A

2 or more of: hyper or hypothermia, HR> 90, RR>20, WBV> 12 or <4

265
Q

hemodynamic changes in hypovolemic shock

A

decreased preload, increased SVR, decreased CO

266
Q

hemodynamic changes in cardiogenic shock

A

increased preload, increased afterload, increased SVR, decreased CO

267
Q

hemodynamic changes in obstructive shock

A

decreased preload, increased SVR, decreased CO

268
Q

hemodynamic changes in distributive shock

A

decreased preload, decreased SVR, mixed CO

269
Q

what is neurogenic shock

A

sudden loss of vascular tone and sympathetic response leading to poor perfusion. Cool/clammy above level of injury, warm/dry below

270
Q

which crystalloid allows for some buffering of acidemia

A

LR

271
Q

which crystalloid may caise hyperkalemia in renal insufficiency

A

LR

272
Q

risks of NS

A

can induce hyperchloremic metabolic acidosis when given in large amounts.

273
Q

for every 1 l of blood lost, you need ____ to replace it

A

3 L isotonic crystalloid

274
Q

in what class shock do you need to start blood products

A

class III (AMS, hypotension)

275
Q

when massive transfusion protocol used

A

greater than 10 units of PRBCs in first 24 hours

276
Q

massive transfusion protocol

A

1:1:1 ratio of PRBC:FFP:Platelets, with calcium

Emergency Medicine (3 decks)

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