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LMCC > Emergency > Flashcards

Emergency Flashcards

1
Q

Hypothermia

A

<35C

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2
Q

Hypothermia rewarming rate

A

2.1C/h

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3
Q

Afterdrop phenomenon a/w rewarming after hypothermia

A

Warming of extremities causes vasodilation and movement of cool pooled blood from extremities to core –> drop in core temperature –> cardiac arrest

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4
Q

Frostbite tx

A 
Tx the hypothermia 
Remove wet clothing 
Immerse in 40-42C water for 10-30min (+analgesia) 
Clean, debride
Tetanus prophylaxis
Consider Pen G as high risk of infection
May need sx
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5
Q

Rule of 9s with burns

A

Each side of entire leg is 9% Each side of torso is 18%
Each side of arm is 4.5%
Groin is 1%
Each side of head is 4.5%

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6
Q

Superficial 1st degree burn

A

Epidermis only

Painful and tender to palpation

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7
Q

Superficial partial thickness (2nd degree) burn

A

Epidermis and superficial dermis
blister formation
Very painful

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8
Q

Deep partial thickness (2nd degree) burn

A

Involves hair follicles, sebaceous glands
Skin is blistered
Exposed dermis si white to yellow
Absent sensation

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9
Q

Full thickness (3rd degree) burn

A

Epidermis and all dermal layers

Skin is pale, insensate, charred

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10
Q

Deep (4th degree) burn

A

Involvement of fat, muscle, even bone

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11
Q

Parkland formula for burn

A

Ringer’s lactate 4cc/kg/%BSA burned
Give half in first 8h, half in next 16h
Maintenance fluids are required if pt can’t tolerate PO hydration

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12
Q

Classic triad of wernicke’s encephalopathy

A

Encephalopathy
Ataxic gait
Oculomotor dysfunction (nystagmus, bilat lateral rectus palsies, conjugate gaze palsies)

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13
Q

Initial mgmt of anaphylaxis

A 
Epinephrine 0.3-0.5cc q5min
Benadryl (H1 blocker)
PO or IV steroids (same bioavailability, only give IV if pt can't take PO) 
Ranitidine (H2 blocker) 
Keep pt in ED for 4-6 h (biphasic)
Consider epi nebs 
O2, ventolin, atrovent nebs 
Code blue if pt has stridor
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14
Q

Canadian C-Spine rules high risk category

A 
Age >/=65yo 
Paresthesias in extremities
Dangerous mechanism 
- Fall from >/= 1m or 5 stairs
- Axial loading 
- MVC with: high speed (>100km/h), rollover, ejection, bicycle, motorcycle

GET RADIOGRAPHY

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15
Q

Canadian C-spine rules low risk/safety factors

A 
Delayed onset of neck pain
Sitting upright in ED 
Walking at any point 
Simple rear-end MVC 
Absence of midline tenderness
If any of these are YES --> is pt able to turn head 45deg to L and R?
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16
Q

Maissonneuve fracture

A

Proximal fibular fracture with ankle injury

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17
Q

Emergency tracheotomy location

A

Above cricoid through cricothyroid membrane

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18
Q

Lisfranc fracture

A

Tarsometatarsal fracture

Pain at midfoot

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19
Q

Medications that can be delivered by ETT

A 
NAVEL 
Naloxone 
Atropine 
Ventolin
Epinephrine 
Lidocaine
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20
Q

3:1 rule of hemorrhagic shock

A

Give 3x estimated blood loss because only 30% of infused isotonic crystalloids remain in intravascular space

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21
Q

Neurogenic shock level

A

Occurs within 30min of SCI at level of T6 or above, lasting up to 6wk

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22
Q

Flail chest

A

Free floating segment of chest wall due to >2 rib fractures, each at 2 sites
Tx: O2, fluid therapy, pain control, PPV +/- intubation

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23
Q

Pulsus paradoxus

A

Seen in cardiac tamponade

Drop in BP >10mmHg with inspiration

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24
Q

Initial treatent of open fracture

A

STAND
Splint
Tetanus
Antibiotics
Neurovascular status
Dressings (debride, irrigate, cover with sterile dressing)
Definitive surgical management within 6h!

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25
Q

Anterior shoulder dislocation nerves at risk

A

Axillary nerve

Musculocutaneous nerve

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26
Q

Colles fracture characteristics

A

Dorsal tilt and displacement
Ulnar styloid fracture
Radial displacement and tilkt
Shortening

Colles fracture = distal radial fracture with dorsal displacement often from FOOSH

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27
Q

Scaphoid fracture mgmt

A

Xray negative: thumb spica splint, repeat xray in 1wk +/- CT scan
Xray positive: thumb spica split x 6-8wk, repeat xray in 2wks
Risk of AVN of scaphoid if not immobilized

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28
Q

Ottawa Knee Rules

A 
Get knee xray if 1 or more of: 
>/= 55yo 
Tenderness at head of fibula 
Isolated tenderness of patella 
Inability to flex to 90 deg 
Inability to weight bear both immediately and in ED (4 steps)
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29
Q

Ottawa ankle rules

A

Pain in malleolar zone and any one of:
bony tenderness at posterior edge or tip of lateral malleolus
Bony tenderness at posterior edge or tip of medial malleolus
Inability to weight bear both immediately and in ED

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30
Q

Ottawa foot rules

A

Pain in midfoot zone and any one of:
Bony tenderness at base of 5th metatarsal
Bony tenderness at navicular bone
Inability to weight bear both immediately and in ED

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31
Q

Clean, minor wounds and unknown or <3 tetanus doses

A

Tetanus vaccine

32
Q

Serious wounds (ie. penetrating) and unknown or <3 tetanus doses

A

Tetanus vaccine and immunoglobulin

33
Q

Clean, minor wounds or serious wounds with hx of >/=3 tetanus doses

A

No vaccine or immunoglobulin required

34
Q

When to NOT suture close a wound

A 
Delayed presentation >6-8h 
Puncture wound
Mammalian bite
Crush injury
Retained foreign body
35
Q

Delayed deficit after head trauma suggestive of…

A

Epidural hematoma

36
Q

Tracheal deviation and tension vs non-tension pneumo

A

Deviates AWAY from tension

Deviates TOWARDS from non-tension

37
Q

Acute pericarditis management

A

High dose NSAIDs +/- colchicine

38
Q

Hyperkalemia on ECG

A

Tall T waves

Severe: sine wave - p waves flatten and disappear, QRS widens

39
Q

Hypokalemia on ECG

A

ST depression
Prolonged QT
Flattened T waves
Prominent U waves (U> T)

40
Q

Digitalis toxicity on ECG

A

Gradual downward curve of ST
At risk for AV blocks and ventricular irritability
Salvidore dali sign

41
Q

Sexual assault reporting

A

Do NOT report unless victim requests or if <16yo

42
Q

Tx for AFib in WPW pt

A

Amiodarone or procainamide

AVOID AV NODAL BLOCKING AGENTS (adenosine, digoxin, diltiazem, verapamil, beta blockers)

43
Q

TdP tx

A

IV Mg
Temporary overdrive pacing
Isoproterenol

44
Q

DKA dx

A

Hyperglycemia
Metabolic acidosis
Hyperketonemia
Ketonuria

45
Q

Main form of tx of hyperosmolar hyperglycemic state

A

Rehydration
Insulin controversial
Treat the cause (ie. infection)

46
Q

Stroke thrombolysis requirements

A

<4.5h from onset to drug admin (+ confirmed no bleed with NCCT)

47
Q

1st line drug of choice for antiplt agent to prevent recurrent stroke or stroke after TIA

A

Aspirin

Clopidogrel is 2nd line

48
Q

Absolute C/I to thrombolysis for stroke

A 
Suspected SAH
Previous ICH 
Severe HI within past 3mo 
BP >185 systolic or >110 diastolic 
Bleeding diathesis 
Prolonged PT>15s or INR>1.7 
Plt <100 000
Heparin within last 48h 
Current use of thrombin inhibitors or direct factor Xa inhibitors
Blood glucose <2.8 
ICH on CT or large infarct
49
Q

1st line abx for animal or human bite wounds on hands

A

Amoxclav
Dog/cat bites: Pasteurella multocida, S. aureus, S. viridans
Human: Eikenella corrodens, S.. aureus, S. viridans, oral anaerobes

50
Q

Universal antidotes

A 
Tx that will not harm pts and may be essential!
DONT:
Dextrose
O2 
Naloxone
Thiamine
51
Q

Drugs that can be removed with urine alkalinization

A

ASA
MTX
Phenobarb
Chlorpropamide

52
Q

Tylenole antidote

53
Q

Benzo antidote

A

Flumazenil

54
Q

Methanol antidote (any toxic alcohols)

A

Fomepizole OR ethanol

55
Q

Heparin antidote

A

Protamine sulfate

56
Q

TCA antidote for wide QRS/seizures

57
Q

Common causes of anaphylaxis

A 
Peanuts 
bee stings
Wasp stings 
Other insect bites (ie. fire ants) 
IV abx 
Blood pdts
Antivenom
Radiological contrast materials 
Anesthetic agents
58
Q

Hypercalcemia ECG

A

Shortened QT

59
Q

Hypocalcemia ECG

A

Prolonged QT

60
Q

Osborne J wavs

A

Hump like waves at junction of J point and ST segment

Seen in hypothermic pt

61
Q

Medications that can be removed by dialysis

A 
STUMBLE 
Salicylates
Theophylline
Urea
Methanol 
Barbiturates
Lithium
Ethylene Glycol
62
Q

Carbon monoxide antidote

63
Q

Hypoglycemic agent antidote

64
Q

Drugs not amenable to charcoal

A

iron, Li, pesticides, alkalis, acids

65
Q

Overdose to think of with widened QRS

66
Q

One pill can kill

A 
Opioids
Iron
Toxic alcohols (e.g. ethylene glycol)
TCA
CCBs
Methylsalicylates
Antimalarials
67
Q

Most common upper extremity injury in infants

A

Radial head subluxation

68
Q

Radial head subluxation reduction

A

Supination-flexation
Pronated arm, elbow 90 deg flexed, pressure applied over radial head
Supinate wrist with pressure maintained on radial head, then flex elbow

69
Q

Organophosphate poisoning

A

AChE (degrades AChE)

Tx: Pralidoxime within a few hours of exposure (AChE reactivator) and Atropine (muscarinic receptor antagonist)

70
Q

Physostigmine

A

Treat atropine overdose

AChE inhibitor

71
Q

Malignant hyperthermia tx

A

Dantrolene (ryanodine receptor antagonist)

72
Q

Buckle fracture treatment

A

Removable splint x 3 wks

73
Q

Rotator cuff tear definitive tx

A

Early surgical repair

74
Q

4 muscles of rotator cuff

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

75
Q

Reversal of ethylene glycol OD

A

Ethanol or fomepizole

LMCC (22 decks)

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