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Emerg Mobile Flashcards

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USMLE® Step 1 flashcards
1
Q

CT Head Rules: High and Medium Risk

A 
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
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2
Q

Life threatening abdominal pain

A

CVS: MI, aortic dissection, ruptured AAA
GI: perf, hepatic/splenic injury, ISCHEMIC BOWEL (diffuse pain), strangulated hernia
GYN: ectopic pregnancy

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3
Q

Where NOT to use epinephrine when suturing

A 
Fingers
Toes
Nose
Ears
Penis
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4
Q

Max lidocaine doses

A

7mg/kg with epi

5mg/kg without epi

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5
Q

Indications for wound prophylaxis

A

Puncture wound to foot
Animal/human bites
Intraoral lesion

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6
Q

Bankart Deformity

A

Glenoid disruption, incidental finding on radiograph with dislocated shoulder.

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7
Q

Hill Sachs Deformity

A

Depression in posterior lateral humoral head, finding with anterior dislocation of shoulder

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8
Q

Five steps of Rapid Sequence Intubation (RSI)

A
  1. Preparation
  2. Preoxygenation (5min, minimum 3 vital capacity breaths)
  3. 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)
  4. Paralysis (with sedation) SuccinylCholine (8-10min) or Roc (30min)
  5. Placement (ETT)
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9
Q

Succinylcholine Contraindications

A 
Burn patients (after 24 hours)
Crush injuries (after 7 days)
Demarcation/neuromuscular disease (after 7 days)
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10
Q

RSI dose of SUCCINYLCHOLINE

A

1.5mg/kg
onset 45-60 seconds
Duration 8-10min

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11
Q

Rocuronium dose for RSI

A

0.6mg/kg
Onset 60-90 seconds
Duration 30 min

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12
Q

Vertebral level of tracheal opening

A

C4 - adults
C1- infancy
C3- age 7

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13
Q

Narrowest part of larynx

A

Cricoid ring in children

Chords in parents

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14
Q

Rescue ventilation rate

A

8-10 breaths per minute

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15
Q

ETT Tube Drugs

A 
LEAN
Lidocaine
Epinephrine
Atropine
Narcan
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16
Q

Response to Unresponsive patient in Vfib or Vtach

A

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

17
Q

Anticoagulants

A

Warfarin (coumarin)
Heparin (LMWH and UF)
Rivaroxaban/Apixaban/Edoxaban (Xa factor inhibitors)
Dabigatran (thrombin inhibitor)

18
Q

Which MI’s require caution in providing Nitro and Morphine?

A

Right sided MI, low blood pressure

19
Q

Normal urine output

A

Adults 50cc/hour

Children 1cc/kg/hour

20
Q

Difference between amiodarone and adenosine and atropine.

A

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.

21
Q

Tx for three types of Obstructive Shock

A

Cardiac tamponade - IV fluids, inotropes, pericardiocentesis
Massive PE - IV fluids, inotropes, thrombolytics
Tension pneumo - needle decompression, chest tube to follow

22
Q

Anaphylaxis treatment

A

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

23
Q

SIRS Criteria

A

RR > 20
HR > 90
Temp > 38 or 12 or 10% immature neutrophils)

24
Q

Lactate > 4 + hypovolemic

A

Sepsis. Check your sirs criteria

25
Q

Critical Chest Pain DDx

A 
TEAM PPP
Tamponade (cardiac)
Esophageal rupture
Aortic dissection
MI
Pneumothorax (tension)
PE
Pneumonia (severe)
26
Q

What is the pink lady?

A

Antacid + lidocaine

27
Q

How much discrepancy between blood pressure of two arms suggests aortic dissection?

A

> 20mmHg sBP

>10mmHg dBP

28
Q

What does pulses paradoxicus >10mmHg suggest?

A

Asthmaticus or cardiac tamponade

29
Q

Beck’s Triad

A
  1. Muffled heart sounds
  2. Hypotension
  3. Elevated JVP

CARDIAC TAMPEMADE

30
Q

CAP (community acquired pneumonia) causative agents

A

CMS
Chlamydophila pneumoniae
Mycoplasma pneumoniae
Streptococcus pneumoniae

31
Q

The three things worth investigating with ABD x3 (abdominal radiographs).

A
  1. Bowel obstruction
  2. Perforations
  3. Radio-opaque ingestion of foreign body
32
Q

Wide complex undetermined arrhythmia : what is it and how is it treated?

A

VTach

procainamide 20-50mg/min
amiodarone 150mg over 10 minutes
sotalol 1.5mg/kg over 5 minutes
lidocaine 1 to 1.5mg/kg IV every 5-10 minutes
magnesium 1-2g IV over 15 minutes (Torsades de pointes)

33
Q

Classes of Hemorrhagic Shock

A

Class 1 = 140 HR,

Medical School (12 decks)

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