Emerg Mobile Flashcards
CT Head Rules: High and Medium Risk
HIGH RISK GCS 1 vomits 65 or older Signs of basal skull fracture Suspected open or depressed skull fracture MEDIUM RISK > 30 min retrograde amnesia Dangerous mechanism
Life threatening abdominal pain
CVS: MI, aortic dissection, ruptured AAA
GI: perf, hepatic/splenic injury, ISCHEMIC BOWEL (diffuse pain), strangulated hernia
GYN: ectopic pregnancy
Where NOT to use epinephrine when suturing
Fingers Toes Nose Ears Penis
Max lidocaine doses
7mg/kg with epi
5mg/kg without epi
Indications for wound prophylaxis
Puncture wound to foot
Animal/human bites
Intraoral lesion
Bankart Deformity
Glenoid disruption, incidental finding on radiograph with dislocated shoulder.
Hill Sachs Deformity
Depression in posterior lateral humoral head, finding with anterior dislocation of shoulder
Five steps of Rapid Sequence Intubation (RSI)
- Preparation
- Preoxygenation (5min, minimum 3 vital capacity breaths)
- Pretreatment (atropine children under 10 (0.2mg/kg IV) lidocaine for asthmatics (1.5mg/kg IV) Fentanyl for CHF and Ischemia (3-6 micrograms/kg split) and
lidocaine + fentanyl + Roc for ICP) - Paralysis (with sedation) SuccinylCholine (8-10min) or Roc (30min)
- Placement (ETT)
Succinylcholine Contraindications
Burn patients (after 24 hours) Crush injuries (after 7 days) Demarcation/neuromuscular disease (after 7 days)
RSI dose of SUCCINYLCHOLINE
1.5mg/kg
onset 45-60 seconds
Duration 8-10min
Rocuronium dose for RSI
0.6mg/kg
Onset 60-90 seconds
Duration 30 min
Vertebral level of tracheal opening
C4 - adults
C1- infancy
C3- age 7
Narrowest part of larynx
Cricoid ring in children
Chords in parents
Rescue ventilation rate
8-10 breaths per minute
ETT Tube Drugs
LEAN Lidocaine Epinephrine Atropine Narcan
Response to Unresponsive patient in Vfib or Vtach
Chorus:
Start CPR
Defibrillate x 1
IV/IO access
Repeat chorus
Epinephrine (1mg IV q3min) or Vasopressin (40mg IV once)
Repeat chorus
Amiodarone (300mg IV) or Lidocaine (1.5mg/kg IV bonus)
Repeat chorus
Repeat previous agents possibly
Consider treatment of causes
Anticoagulants
Warfarin (coumarin)
Heparin (LMWH and UF)
Rivaroxaban/Apixaban/Edoxaban (Xa factor inhibitors)
Dabigatran (thrombin inhibitor)
Which MI’s require caution in providing Nitro and Morphine?
Right sided MI, low blood pressure
Normal urine output
Adults 50cc/hour
Children 1cc/kg/hour
Difference between amiodarone and adenosine and atropine.
Atropine is an anticholinergic….it’s going to dry things up and will increase HR….usually give with pre-op meds to dry secretions up and also during symptomatic bradycardia.
Amiodarone is a Class III antiarrhythmic which prolongs phase 3 of the cardiac action potential. It also has some beta-blocker and CCB like effects on the AV and SA node. Commonly used in afib, vfib, and vtach.
Adenosine causes a transient AV Block. Useful for pharmacological conversion of SVT.
Tx for three types of Obstructive Shock
Cardiac tamponade - IV fluids, inotropes, pericardiocentesis
Massive PE - IV fluids, inotropes, thrombolytics
Tension pneumo - needle decompression, chest tube to follow
Anaphylaxis treatment
3-5mL 1:1000 epinephrine IM (1.5 mL children)
Benadryl (H1) and Pantoprazole (H2)
Ventolin 5mg
Steroids IV
FLUIDS 1-2L IV NS Bolus
SIRS Criteria
RR > 20
HR > 90
Temp > 38 or 12 or 10% immature neutrophils)
Lactate > 4 + hypovolemic
Sepsis. Check your sirs criteria
