Emerency Medicine Flashcards
1
Q
MCC of shock
A
Hemorrhage and hypovolemia
2
Q
Trauma labs
A
- CBC
- PT
- PTT
- CMP
- Amylase
- Beta hcg
- Blood glucose and urine dipstick
3
Q
With what pathology is Beck’s triad associated?
A
Cardiac tamponade
4
Q
Triad of symptoms associated with cardiac tamponade (name of the triad and the symptoms)
A
Becks triad:
- Muffled heart sounds
- Neck vein distention
- Low blood pressure
5
Q
Perfect Glasgow coma scale score
A
15
6
Q
Lowest possible Glasgow come scale score
A
3
7
Q
Glasgow score for eyes opening spontaneously
A
4
8
Q
Glasgow score for eyes opening only when the patient is told to do so
A
3
9
Q
Glasgow score for eyes opening after painful stimuli
A
2
10
Q
Glasgow score for no eye-opening response
A
1
11
Q
Glasgow score for speaking and making sense (patient is oriented)
A
5
12
Q
Glasgow score for when the patient speaks, but is confused (disoriented)
A
4
13
Q
Glasgow score for when the patient does not speak, but makes sounds
A
2
14
Q
Glasgow score for when the patient speaks, but makes no sense
A
3
15
Q
Glasgow score for when the patient does not speak
A
1
16
Q
Glasgow score for when the patient obeys verbal commands to move
A
6
17
Q
Glasgow score for when the patient responds to painful stimuli and is able to localize the pain
A
5
18
Q
Glasgow score for when the patient responds to painful stimuli and flexes or withdrawals away from the pain
A
4
19
Q
Glasgow score for when the patient responds to painful stimuli and displays abnormal flexion (decorticate rigidity)
A
3
20
Q
Glasgow score for when the patient responds to painful stimuli and displays abnormal extension (decerebrate rigidity)
A
2
21
Q
Glasgow score for when the patient has no response to pain
A
1
22
Q
First places we’ll look for bleeding if the patient is becoming shocky from hypovolemia
A
Thorax and abdomen
23
Q
Stage of hemorrhagic shock:
- Agitated mental status
- Pulse > 100
A
II
24
Q
How much blood (volume) has a patient in stage II hemorrhagic shock lost?
A
0.75 - 1.5 L
25
What type of fluids should you give a patient in stage II hemorrhagic shock?
Lactated ringers
26
How much blood (volume) has a patient in stage I hemorrhagic shock lost?
0 - 0.75 L
27
How much blood (volume) has a patient in stage III hemorrhagic shock lost?
1.5 - 2.5L
28
How much blood (volume) has a patient in stage IV hemorrhagic shock lost?
> 2.5 L
29
What type of fluids should you give a patient in stage I hemorrhagic shock?
Lactated ringers
30
What type of fluids should you give a patient in stage III hemorrhagic shock?
Normal saline and blood
31
What type of fluids should you give a patient in stage IV hemorrhagic shock?
Normal saline and blood
32
Stage of hemorrhagic shock:
- Agitated mental status
- Pulse < 100
Stage I
33
Stage of hemorrhagic shock:
- Confused mental status
- Pulse > 120
Stage III
34
Stage of hemorrhagic shock:
- Lethargic mental status
- Pulse > 140
Stage IV
35
Second place we'll look for bleeding if the patient is becoming shocky from hypovolemia
Pelvis
36
Third place we'll look for bleeding if the patient is becoming shocky from hypovolemia
Long bones
37
Fluid resuscitation bolus for adults
1-2L
38
Fluid resuscitation bolus for peds
20mL/kg
39
If you're going to administer blood, what type of fluid must be used?
Normal saline
40
Imaging requirements to clear a C-spine
- AP, Lateral, and Odontoid views
- Visualization of 7 cervical vertebrae on AP/Lateral
- Visualization of C7-T1
41
What test do we need to perform on every female?
HCG
42
Most common type of impact in a MVA
Rotational impact
43
2nd most common type of MVA impact
Frontal impact
44
Glasgow coma scale scores that indicate "mild" brain injury
>= 14
45
Glasgow coma scale scores that indicate "moderate" brain injury
9-13
46
Glasgow coma scale scores that indicate "severe" brain injury
< 9
47
Contrecoup brain injury
Injury that occurs on the side of the brain opposite to the impact
48
Patient fell down stairs and hit her head. When EMS got there, she was lucid and talking. But in the ambulance she became lethargic and was unconscious by the time she made it to the hospital (30 miles away from her home). What type of head bleed do you suspect?
Epidural hematoma
49
Normal range of intracranial pressure
0-15mmHg
50
Triad of symptoms associated with increased ICP that results from a head injury (name of the triad and the symptoms)
Cushing's triad:
- Hypertension
- Bradycardia
- Agonal respirations
51
The head comprises what % of the total adult BSA?
4.5 front, 4.5 back, for 9% total
52
The front of the torso comprises what % of the total adult BSA?
18%
53
The back of the torso comprises what % of the total adult BSA?
18%
54
Each arm comprises what % of the total adult BSA?
4.5 front, 4.5 back, for 9% total
55
Each leg comprises what % of the total adult BSA?
9 front, 9 back, for 18% total
56
The perineum comprises what % of the total adult BSA?
1%
57
The head comprises what % of the total pediatric BSA?
7 front, 7 back, for 14% total
58
The front of the torso comprises what % of the total pediatric BSA?
18%
59
The back of the torso comprises what % of the total pediatric BSA?
18%
60
Each arm comprises what % of the total pediatric BSA?
4.5 front, 4.5 back, for 9% total
61
Each leg comprises what % of the total pediatric BSA?
8 front, 8 back, for 16% total
62
What type of fluids do we give when fluid resuscitating burn victims?
Ringer's lactate solution
63
Test best for patients in whom you suspect CO poisoning
Carboxyhemoglobin
64
Treatment for lower airway burn
Pulmonary lavage
65
Effects of hydrogen sulfide
- Paralyzes the olfactory nerve and the respiratory center
| - Forms acid in the lungs
66
Effects of methane
-Displaces oxygen
67
Patient comes into the ER with an asthma attack. What signs would you look for that would indicate respiratory failure?
- Absence of wheezing
- Lethargy, Confusion
- Suprasternal retractions
68
What early blood gas changes would you expect to find in a patient experiencing an asthma attack?
Decreased PaO2
| Decreased PaCO2
69
What mid-late blood gas changes would you expect to find in a patient experiencing an asthma attack?
Decreased PaO2
| Normal PaCO2
70
What late blood gas changes would you expect to find in a patient experiencing an asthma attack?
Decreased PaO2
| Increased PaCO2
71
Under what circumstances would you admit a patient who had an asthma attack rather than discharging them home?
- Significant hypoxia
- Initial PEFR was < 50%
- Their post-treatment PEFR is >50% but <70%
- They are drowsy or confused
72
What do mast cells release in response to antigen?
- Histamine
- SRSA
- Heparin
- ECF (Eosinophil Chemotactic Factor)
73
General effects of histamine
- Vasodilation
- Makes cells more permeable
- Increases capillary permeability
- Causes smooth muscle spasm
74
Gold standard imaging modality for pneumothorax
Upright PA CXR
75
Most common cause of an acute CHF exacerbation
Acute MI or ischemia
76
MCC of death from an acute CHF exacerbation
Vfib
77
What's a good lab to order if you want to see how long a patient has had CHF?
Beta natriuretic peptide (BNP)
78
What should we be mindful of in any patient complaining of SOB?
A pulmonary embolism!
79
Virchow's triad
- Hypercoagulability
- Venous stasis
- Endothelial injury
80
Most common sign of a PE
Tachypnea
81
Signs and symptoms of a PE
```
Tachypnea
Tachycardia
Hypoxemia
Hemoptysis
Diaphroesis
Dyspnea
```
82
Gold standard for diagnosing an acute PE
Pulmonary angiography
83
What type of syncope do we need to rule out first?
Cardiogenic
84
Important lab findings in a DKA patient
- Glucosuria
- Ketonuria
- Hyperglycemia > 300mg/dL
- Ketonemia
- Acidosis
85
First treatment response to DKA
Isotonic fluids
86
Insulin dose for DKA
Infusion of 0.1 units/kg/hour
87
After initial stabilization with isotonic saline, what type of fluid do we use to maintain supportive therapy for a DKA patient?
Hypotonic saline to provide for intracellular volume
88
3 characteristics of HHNC
- Hyperglycemia
- Hyperosmolarity
- Absence of significant ketosis
89
What's in the "coma cocktail"?
- Dextrose
- Oxygen
- Narcan
- Thiamine
90
What type of overdose is associated with SLUDGE syndrome?
Cholinergic
91
What type of overdose is associated with the Alice in Wonderland syndrome?
Anticholinergic
92
SLUDGE syndrome
- Salivation
- Lacrimation
- Urination
- Defecation
- GI cramps
- Emesis
93
Common "syndrome" of symptoms associated with anticholinergic overdose
- Altered mental status
- Flushing
- Dry mucus membranes
- Mydriasis
- Hyperthermia
94
Tx for cholinergic overdose
Atropine or Pralidoxime
95
Treatment for anticholinergic overdose
Physostigmine
| Cooling, supportive treatment
96
During what time frame is orogastric lavage is helpful in an overdose situation?
Within 1 hour of ingestion
97
What do we give with our first dose of activated charcoal?
A cathartic like sorbitol or mag citrate
98
What substance helps conjugate Tylenol metabolites in the liver to help with excretion?
Glutathione
99
Toxic dose of acetaminophen in adults
150mg/kg or >7.5g in 24 hours
100
What do we give if a toxic dose of acetaminophen has been ingested?
NAC (N-acetylcysteine)
101
Gold standard imaging study for an aortic dissection?
CT with angiography
102
Target systolic BP in patient with aortic dissection
120-130 max
103
Is the venom of pit vipers hemotoxic or neurotoxic?
Hemotoxic
104
Is the venom of coral snakes hemotoxic or neurotoxic?
Neurotoxic
105
Prophylactic abx tx for dog bites
Augmentin
106
MC pathogen in cat bites
pasteurella multocida
107
Abx good for cat bites
Penicillin-based abx
108
Absorbable suture material
- Vicryl
| - Cat gut
109
Non-Absorbable suture material
-Nylon, silk, prolene
