Emergency

Question 1

If a previously stable chest trauma suddenly dies?

Answer 1

Suspect air embolism

Question 2

What is the gold standard for evaluation of an aortic disruption?

Answer 2

Aortogram

This injury is often related to 1st/2nd rib, scapular, and sternal fractures

Question 3

MVA pt presnts with multiple fractures. Hours later he gets a fever, respiratory distress, and a rash of small red/purple macules on his arms and chest.

Dx?

Answer 3

Fat embolism (long bone fractures!)

Question 4

GCS

Answer 4

INtubate

Question 5

Tx for the following arrhythmias:
P.E.A.
V fib or pulseless v.tach
SVT
AF/flutter
bradycardia

Answer 5

P.E.A. = CPR and epi/vasopressin
V fib or pulseless v.tach = CPR and defibrillate, followed by epi
SVT = unstable, then cardiovert. stable, then positioning and then adenosine
AF/flutter = unstable, then cardiovert. If stable, control rate and anticoagulate if duration is >48h
bradycardia = atropine if symptomatic

Question 6

Think ischemic colitis if…

Answer 6

pt recently got treated for AF or AAA who presents with bloody stool and abdominal pain out or proportion to the exam

Question 7

Differentiate 1st
2nd
3rd degree burns

Answer 7

1st - only the epidermis. no blisters - basically a sunburn
2nd - epidermis and partial thickness dermis are involved. blisters
3rd - epidermis and full thickness dermis and potentially more. White, painless, charred looking

Question 8

BSA estimation in adults

Answer 8

Rule of 9's:
Head and each arm = 9%
back and chest each = 18%
each leg = 18%
perinuem = 1%

Question 9

What bugs cause infection in burn patients?

Answer 9

pseudomonas or gram + cocci

Question 10

What is one drug class you avoid in hypovolemic shock?

Answer 10

Pressors

Question 11

Halothane exposure and fever?

Answer 11

Malignant Hyperthermia!

Tx w/ dantrolene (note - same tx for NMS)

Question 12

After a bite, watch domesticated animals for 10 days

Answer 12

Kill skunks, raccoons, foxes, bats and test them for rabies

Question 13

When to use hyperbaric O2 in smoke inhalation?

Answer 13

If pregnant, CNS/cardiac ischemia signs

Everyone else can get 100% O2 until they are asymptomatic and their levels of COHb fall

Question 14

Wierd complications in bites/stings:
spider:
scorpions:

Answer 14

spiders = hypocalcemia
scorpion = CNS nerve dysfunction

Question 15

Rabies tx?

Answer 15

If never vaccinated - you get IVIG and 4 doses of vaccine

If vaccinated previously - you get 2 doses of vaccine

Question 16

Tetanus tx?

Answer 16

If not up to date on vaccines -tetanus toxoid if wound is clean. IVIG only if dirty wound

Question 17

What ingestions do you NOT use charcoal for?

Answer 17

Lithium, iron, lead, hydrocarbons, or alcohol

Everything else must be given

Question 18

What drugs will increase the risk of digoxin tox?

Answer 18

Cimetidine
Quinidine
Amiodarone
CCBs

Question 19

What drugs cause gynecomastia?

Answer 19

Spironolactone
Estrogens
Digitalis
Cimetidine
Alcohol
Ketoconazole

Question 20

Tx for withdrawal:
ETOH
Barbiturates
Benzodiazepines
Cocaine
Opioids

Answer 20

ETOH - benzos and thiamine
Barbiturates - benzos
Benzodiazepines - taper the benzo
Cocaine - supportive, no BB's
Opioids - antiemetics