Emergencies

Question 1

Hospital Admission Criteria for CHF

Answer 1

Respiratory Distress (RR >40 bpm) OR pulmonary edema
Hypoxia (O2 sat <90%)
Anasarca OR significant edema (>2+)
Syncope/Hypotension (sys <80)
CHF of recent onset (no PMHx)
Ischemia (CP Sx)
Inadequate social support for outpatient management
Failure of outpatient management
Concomitant acute medical illness

Question 2

Hospital Admission Criteria for Respiratory Distress

Answer 2

Pulse ox at rest <85% OR pulse ox at rest <90% w/sig. co-morbidities (not improved w/o2)
Rapid extremem, desat on slight exertion in pt not on o2 replacement therapy
Stridor
Resp acidosis w/COPD & compensatory drop in pH

Question 3

Co-morbid conditions w/respiratory distress

Answer 3

CHF
Worsening angina/ischemia
MI
Pneumonia
Acute bronchitis lingering (need xray)
Lung ca (new onset or exacer)
Unstable poorly controlled dm
Progressive/worsening/severe anemia
Worsening/uncontrolled sleep apnea
Oxygen concentrator or other home O2 requirement failure when dependent

Question 4

When to send a person with chest pain to the ER vs. cardiologist?

Answer 4

Chest Pain Hx:
On exertion? cardiologist
Pre-existing CP now unstable at rest? ER

No CP w/risk factors for stress test? cardiologist
Hemodynamic compromise in office? ER

Question 5

What constitutes hemodynamic compromise?

Answer 5

Sudden drop in BP
Weak/rapid irregular pulse, arrhythmia w/CAD risk factors
SOB, irregular breathing, rapid, shallow
CP (worse on exertion, prior Hx, no unstable at rest)
CHF on exam, pump failure, rhonchi, edema
SSx of Shock!!

Question 6

What are the SSx of Shock?

Answer 6

Sudden BP drop
Cold, clammy, pallor, cyanosis, sweaty skin
Weak/rapid pulse
SOB
Weakness
Dilated pupils
Anxiety, confusion, lethargy
DEC urination
Syncope/LOC

Question 7

What murmur do you NEED to refer to the hospital STAT!? When can you hold off for a day?

Answer 7

Acute Mitral Regurgitation!
When it is recent, rapid onset & pt is hemodynamically unstable

If pt is stable (no hemodynamic compromise) then you may have pt check in for elective surgery within 24 hrs

Question 8

SSx of Acute Mitral Regurgitation?

Answer 8

Abrupt onset of pulmonary edema, perfusion failure, hemodynamic compromise, tachypnea, dyspnea, need to sit upright, S4 gallop, and mitral regurgitation murmur (of course!)

Question 9

What acute condition that can occur after an MI (or from other causes) do you need instant referral to ER?

Answer 9

Pericardial (cardiac) tamponade from pericarditis!!

Question 10

SSx of cardiac tamponade? Complications?

Answer 10

Beck’s Triad! Distant/muffed heart sounds, JVD, DEC BP
Also… narrow pulse pressure, pulsus paradoxus

Complications: low cardiac output, shock, death

Question 11

Tx of cardiac tamponade?

Answer 11

Pericardiocentesis (Get fluid out)

Question 12

Tx for acute asthma attack!

Answer 12

*EPI 1:1000 2-5 mL IM then 2-5 SC (children)
*Terbutaline 1 mg/mL vial, 0.25 mg SC (adults)
Arsenicum or better homeopathic
Local moist heat over chest
*Nebulized albuterol sulphate
*MDI (metro dosed inhaler) of above
*Prednisone taper (60-50-40-30-20-10)
Hemlick maneuver (idk why)
B12 injection 2 mL (infraspinatus trigger)
Cupping with plum blossom?
O2 canula/mask if O2 sat low
Mg sulphate IV (questionable)