Emergency Flashcards
Indication for definitive airway
GCS < 8 cannot protect airway inadequate O2 shock need for intubate in future
Class I shock
<15% loss
no change
Class II shock
750-1500 (15-30%) loss tachycardic tachypnea reduced cap refill 20 ml/hr urine
Class III shock
1500-2000 (30-40%) loss tachycardia tachypnea hypotension decreased cap refill 10 ml/hr urine
Class IV shock
>2000 (40%) loss tachycardia tachypnea hypotension decreased cap refill no urine
GCS eye
4 spontaneous
3 voice
2 pain
1 none
GCS verbal
5 answers 4 confused 3 words 2 sounds 1 none
GCS motor
6 commands 5 localizes 4 withdraws 3 decorticate flexion 2 decerebrate extension 1 none
Canadian CT head = minor injury +
GCS 2
Age > 65
Amnesia > 30 min
Dangerous mechanism
Basal skull fractures
hemotympanum
raccoon eyes
otorrhea/rhinorrhea
Battle’s sign
Dangerous mechanism injury
person hit by car
eject from car
fall > 3ft/5 stairs
Minor head injury
witnessed LOC
amnesia
witnessed disorientation
GCS 13-15
Clear C-spine
no posterior midline cervical tenderness no intoxication oriented x 3 + event no focal neuro deficit no painful distractions can rotate neck
Compartment syndrome 6P’s
pain out of proportion, pain with passive stretch, pallor, paresthesia, paralysis, polar
Ottawa ankle rule
Ankle
Ankle X ray only if tenderness in lateral malleolus, medial malleolus and inability to weight bear
Ottawa ankle rule
Foot
Foot x-ray if tender at base of 5th metatarsal, navicular (medial) and inability to weight bear
Ottawa knee rule
Acute injury plus one of
1) >55 yr
2) tender at head of fibula
3) isolated tender of patella
4) cannot flex to 90 degrees
5) cannot bear weight (4 steps)
Altered LOC metabolic/toxic causes
Major organ fail Electrolytes/Endocrine Toxin/temperature Acid Base Oxygen decrease Lactate Insulin/Infection Cardiac/Calcium high
Universal antidote
thiamine (100 mg iv/im)
D50W (1-2 ml)
naloxone (2-10 mg)
oxygen
Wells DVT
2+ pt likely active cancer paralysis/paresis/recent immobilize bedridden > 3 d, major surg in 4 wk Localized tender Leg swollen Calf swell > 3cm compared to other pitting edema collateral veins alternative dx unlikely (2 pt)
Wells PE
4+ pt likely Clinical finding DVT 3 Alternative Dx unlikely 3 Recent bed rest >3d, surgery in 4wk 1.5 HR > 100 1.5 Previous DVT/PE 1.5 Malignancy 1 Hemoptysis 1
PERC score PE
1+ need Wells > 50yr HR > 100 O2 RA < 94 Prior DVT/PE recent trauma/sx hemoptysis exogenous E clinical sign DVT
D-dimer cutoff
500 ng/ml
Status epilepticus management
O2, monitor, iv –> glucose –> benzo –> phenytoin –> phenobarbital –> pentobarbital
Lorazepam dose
0.1 mg/kg at 2 mg/min
Diazepam dose
0.2 mg/kg at 5 mg/min
Phenytoin dose
15-20 mg/kg at 50 mg/min
max 30 mg/kg
Phenobarbital
20 mg/kg at 100 mg/min
Croup
Steeple sign
parainfluenza
barky cough with drool
Bacterial tracheitis
exudate in trachea
Staph aureus/GAS
Barchy cough, appear toxic
Epiglottitis
Thumb sign
H flu type B
Drool, appear toxic
Asthma Tx
Increasing severity
B-agonist, anticholinergic, steroid (pred 40-60 po), O2, intubate
COPDe Tx
Keep O2 88-92
Ipratriopium + salbutamol
Steroid pred 40 mg po taper 3 wk
Abx = TMP-SMX, cephalosporin, resp quinolone (sx of infect)
Anion gap acidosis
methanol uremia DKA phenformin/paraldehyde isoniazide/iron/ibuprofen lactate ethylene glycol salicylates cyanide/CO alcoholic ketoacidosis toluene/theophylline
Osmolar gap acidosis
Methanol acetone ethanol diuretic (osmolar) isopropanol ethylene glycol
Decreased anion gap
error
high Na/K/Mg/Li/Br
hypoalbuminemia (50%)
Paraprotein (MM)
Increased O2 sat
carboxyhemoglobin
methemoglobin
sulmethemoglobin
Normal anion gap acidosis
high K = pyelonephritis, obstructive nephropathy, renal tubular acidosis, IV, TPN
low K = small bowel loss, acetazolamide, RTA
Drugs cause hypoventilation
opioid, sedative, hypnotic, phenothiazines, EtOH
Drugs cause hyperventilation
ASA, CO
Drugs cause hyperkalemia
digitalis, fluoride, potassium
Drugs cause hypokalemia
theophylline, caffeine, beta-adrenergic, barium salt, diuretic, insulin
Drugs case Wide QRS
TCA, quinidine, Class 1a, 1c antiarrhythmic
Drugs cause long QT
quinidine, terfenadine, astemizole
Drugs cause AV block
Ca+2 antagonist, digitalis, phenylpropanolamine
Anticholinergic toxidrome
hot, blind, dry, red, mad, full
TCA, carbamazepine, antihistamine, anti-parkinson, anti-psychotic, anti-spasmotic
Cholinergic toxidrome
Diaphoresis/diarrhea/decreased BP urination miosis BBB (killer B) emesis/excitation lacrimation salivation/seizures nerve gas (carbamate), physostigmine, organophosphate
Narcotic/sedative/hypnotic/etoh
hypothermia, hypotension, resp depress, CNS depression
EtOH, benzo, opiate, barbiturate, GHB
Sympathomimetics
hyperthermia, CNS excite, tachy, HTN, n/v, diaphoresis, dilate pupil
caffeine, amphetamine, cocaine, LSD, PCP, decongestant, thyroid, ETOH withdrawal
Serotonin syndrome
HARMED
hyperhermia, autonomic instable, rigidity, myoclonus, encephalopathy, diaphoresis
MAOI, TCA, SSRI, opiate analgesic, cough med, weight reduce
