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Emergency high-yield packet Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What are the four etiologies of acute coronary syndromes?

A

Ischemia
Fixed atherosclerotic lesion
Evolving plaque
Spasm

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2
Q

What is the time frame for obtaining troponin levels?

A

Initial elevation at 3-12 hours, peak at 18-24 hours, duration of 5-10 days

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3
Q

How is MI generally treated?

A 
Oxygen
Heparin (thrombin/Xa inhibitor)
Beta-blockers (reduce myocardial demand/afterload)
Aspirin (TxA2 inhibitor, decrease plt aggregation)
Thrombolytics (now just PCI)
Morphine
Anti-platelets (clopidogrel)
Nitrates (avoid in R-sided MI!)
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4
Q

How is cocaine-induced chest pain treated?

A

Benzodiazepines

Avoid beta-blockers!

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5
Q

What are associated symptoms of aortic dissection?

A 
Carotid arteries (stroke)
Spinal arteries (paraplegia)
Abdominal circulation (ab pain)
Coronary arteries (aortic insufficiency)
Laryngeal nerve compression (hoarseness)
Tracheal compression (dyspnea/stridor)
Esophageal compression (dysphagia)
NOTE: dissection occurs at ligamentum arteriosum (ascending)
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6
Q

How is aortic dissection treated emergently?

A

2 large bore IVs, oxygen, ECG/monitors
Drop BP with IV nitroprusside/esmolol or labetolol
Early CT surgery

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7
Q

How do PE patients present?

A

Dyspnea, hemoptysis, pleuritic chest pain

Also: tachypnea/bradycardia

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8
Q

How is PE treated?

A

2 large bore IVs, oxygen, ECG/monitors
Anticoagulation with heparin
Consider thrombolytics if unstable
Imaging: V/Q scan (note, requires CXR first), CT

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9
Q

How do spontaneous pneumothorax patients present?

A

Acute pleuritic chest pain
Dyspnea
Decreased breath sounds

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10
Q

What are the “Big Five” life-threatening causes of chest pain?

A 
MI
PE
Aortic dissection
Pneumothorax
Esophageal rupture
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11
Q

What are the etiologies for chest pain caused by cocaine?

A

Spasm
Increased myocardial oxygen demand
Clot formation
Accelerated atherosclerosis and LVH

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12
Q

What is the definition of a coma?

A

Complete failure of the arousal system with no spontaneous eye opening
Includes brainstem dysfunction and/or bilateral cortical disease

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13
Q

What is the difference between stupor and obtundation?

A 
Stupor = patients awaken with stimuli by little motor/verbal activity when aroused
Obtundation = awake but not alert, psychomotor retardation
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14
Q

What is the difference between delirium and dementia?

A

Delirum always has an organic cause
Delirum: fluctuating course, acute onset, reversible, depressed consciousness
Dementia: stable course, chronic onset, irreversible, no consciousness impairment

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15
Q

What are the primary and secondary exams for AMS?

A

Primary: vital signs + FSG, ABCDE + c-immobilization, GCS
Secondary: neurological exam, complete physical exam

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16
Q

What is the broad differential for delirium?

A 
Alcohol
Endocrinopathy, Encephalopathy, Electrolytes
Insulin, Infection, Increased ICP
Opiates, Oxygen
Uremia
Trauma, Toxins, Tumor, Temperature
IEMs
Psychiatric
Seizure, Stroke, Shock
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17
Q

What is the ED approach to AMS?

A

History from patient and all sources

Airway, Breathing, Circulation, Disability, Exposures

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18
Q

What is the definition of shock?

A

A physiologic state characterized by decreased tissue perfusion and inadequate oxygen delivery

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19
Q

What are the compensatory mechanisms at work in warm shock?

A

Baroreceptors in aortic arch
Chemoreceptors in aortic arch
RAAS system in kidney
Sympathetic nervous system

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20
Q

What are signs of cold/uncompensated shock?

A 
Hypotension (SBP 4, drop of 40)
Decreased urine output
Restlessness --> agitation --> obtundation --> coma
Respiratory failure
Myocardial ischemia
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21
Q

What are the definitions associated with shock?

A

SIRS: temp >100.4, HR >90, RR>20, WBC 12
Sepsis: SIRS + known infection
Severe sepsis: SIRS + known infection + organ dysfunction

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22
Q

What is Early Goal-Directed Therapy based on?

A

CVP 8-12 before vasopressors (estimates preload)
MAP goal = 65-90
ScVO2 goal = 70% (central venous O2 sats)
Lactate = 2-4 is the cryptic range
Short time to ABx! (7.6% increase per hour)

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23
Q

How is heat stroke defined?

A

Core temp >104.5 with CNS dysfunction in the setting of environmental heat load

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24
Q

What are key aspects of heat regulation?

A

Regulated by hypothalamus, which signals ANS to induce sweating, vasodilate skin blood vessels, prevent organ failure (above 42 C)

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25
Q

How is frostbite treated?

A

Prehospital: protect affected part and transport, no thawing or rubbing!
Hospital: prompt rewarming, analgesia, aloe vera

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26
Q

What does severe hypothermia look like?

A

Core temp <28C

Pulmonary edema, oliguria, loss of reflexes

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27
Q

How is hypothermia treated?

A 
Lay person flat, give IVF
Give glucose (avoid caffeine)
Watch for hyperkalemia
Rewarming at 1-2 degrees per hour
NO ONE IS DEAD UNTIL WARM AND DEAD
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28
Q

What is the physiological process of wound healing?

A

Initially edges retract and tissue contracts
Plt agg and clotting cascade activated
Initial epithelialization @ 24-48 hrs
Peak collagen synthesis @ 5-7 days
Wound strength: 5% at 2wks, 35% at 1mo, 60% 4mos

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29
Q

When are vaccinations given in wound care?

A

Tetanus
Incomplete course: toxoid + immunoglobulin
Complete: toxoid for >5 yrs after course completion
Pertussis
Give Tdap to update pertussis regardless of last booster
Okay in pregnancy!

30
Q

What are anesthetic considerations in wound care?

A

Give lidocaine (allergies treated with Benadryl)
No epi in fingers/toes, penis, nose, etc.
Do regional blocks for large areas or where infiltration is painful
Bupivicaine for longer acting, procaine for very short

31
Q

What are three types of wound repair? (based on timing)

A

Primary closure
Delayed primary closure
Secondary intention

32
Q

Random wound closure facts:

A

Bandages are okay for hand wounds <2cm

Sometimes antibiotics and delayed closure is okay

33
Q

What are the five classic toxidromes?

A 
Opiod
Sympathomimetic
Anticholinergic
Cholinergic
Sedative-hypnotic
34
Q

Opioid toxidrome

A

Pinpoint pupils
Respiratory depression
Lethargy to coma
Bradycardia, hypothermia, borderline hypertension

35
Q

Anticholinergic toxidrome

diphenyhydramine, antiparkinson

A

MNEMONIC: bat, hatter, beet, hare, tick, bone, etc.

Mydriasis, AMS, flushing, hyperthermia, urinary retention, dry eyes/skin, decreased bowel sounds, tachycardia

36
Q

Sympathomimetic toxidrome

cocaine, amphetamines, anorectics, otc stimulants, herbals

A

Tachycardia, hyperthermia, mydriasis
Hypertension, Hyperactive bowels, Diaphoresis

Tx: rapid cooling, sedation

37
Q

Cholinergic toxidrome

organophosphates, pesticides, stigmines

A

DUMBBELLS

Diarrhea, urination, miosis, bradycardia, bronchorrhea, emesis, lacrimation, salivation

38
Q

Sedative-hypnotics

anticonvulsants, barbituates, benzos, GHB

A

Deterioration of CNS function

39
Q

The most common ultrasound finding in ovarian torsion is:

A

Ovarian enlargement due to venous and lymphatic engorgement
ULTRASOUND IS DIAGNOSTIC
Doppler is unreliable

40
Q

Why does the R ovary torse more than the L ovary?

A

L is prevented by the descending and sigmoid colon.

41
Q

What are the tests/imaging for a suspected ectopic pregnancy?

A

Urine hCG, serum hCG, pelvic ultrasound, pelvic exam, CBC

42
Q

What are the two management modalities for ectopic pregnancy?

A

Surgical: laparoscopic salpingectomy only if patient is unstable or ruptured
Medical: methotrexate

43
Q

What is the battery of treatments given for pre-eclampsia?

A

Delivery is definitive
Magnesium sulfate for seizure prophylaxis
Hydralazine/labetolol
IV fluids

44
Q

What antibiotic is given for PID?

A

Ceftriaxone 250mg IM + Doxycycline 100mg BID x 14 days + Metronidazole 500mg BID x 14 days

45
Q

What are the three main causes of fever (elevation of body set point)?

A

Host defense
Increase in endogenous pyrogens
Exogenous chemicals

46
Q

What are SBIs for the febrile infant?

A

Organisms: E. coli, GBS, Listeria
Bacteremia, meningitis, urinary tract infection (do CBC, LP, UA, CXR)
Less important: bacterial enteritis, skin and soft tissue infections, bone and joint infections

47
Q

How are the Philadelphia criteria applied?

A

Used for infants 4-8 wks.

Said that outpatient therapy is safe and cost-effective for low-risk patients (no ABx necessary!)

48
Q

What are the low risk criteria?

A

4-8 wks
Normal past history, reliable caregiver, 24 hr f/u
Well-appearing
Mostly normal WBC, I/T, UA, CSF, CXR

49
Q

What are two sources of fever in a well-appearing young child?

A

Bacteremia (HiB –> Strep pneumo –> decreasing, therefore no Abx needed)
UTI (always check a suprapubic/catheter urine!! + = nitrite and/or LE)

50
Q

What’s the work-up for ill-appearing and toxic-appearing febrile young children?

A

Ill-appearing: CBC, urine dip, WBC>15000, urine (+)

Toxic-appearing: sepsis work-up, immediate abx, admission

51
Q

What are three risk factors associated with AAA?

A 
Atherosclerosis
Peripheral Vascular Disease
First-degree relative with AAA
Rupture if AAA >5.5 --> 50% mortality
Most common in infrarenal aorta
52
Q

What two vessels are most commonly occluded in acute mesenteric ischemia?

A

SMA or IMA

Dx: Angiography

53
Q

How does AMI from embolic/thrombotic etiology differ from occlusive disease?

A

Embolic: acute, severe, periumbilical
Occlusive: intestinal angina after eating, frequent and small meals

54
Q

How is AMI treated?

A

Heparin
Glucagon
Intraarterial papaverine
Laparatomy to remove embolus, bypass occlusion, remove dead bowel

55
Q

What fluid is used in NG lavage?

A

Tap water

Don’t place in esophageal varices, active PUD, M-W tear, gastric bypass

56
Q

What are the treatments for UGIB and LBIG?

A

UGIB: octerotride, somatostatin, PPIs, endoscopy
LGIB: embolization, vasopressin, surgery

57
Q

Epidemiology of Pediatric Injuries

A

0-14: Falls

Fatal: 0-14 = MVAs/drowning, 15-19 = firearms

58
Q

What is the Wadell triad?

A

Closed head injury, intraabdominal injury, mid-shaft femur fracture (hit by auto)

59
Q

What is the pediatric primary and secondary survey?

A

Recognize: airway compromise and unrecognized hemorrhage.
AMPLE
(avoid hyperventilation, fluid bolus: 20 cc/kg)

60
Q

What should be considered for intracranial injury in peds patients?

A

LOC is not predictor; seizures are!

Consider abuse as mechanism (intentional injury –> retinal hemorrhages)

61
Q

When should CT be ordered?

A

Risks: malignancy
Child >2: AMS, LOC, vomiting, HA
Child <2: AMS, scalp hematoma, LOC, mechanism

62
Q

What are the five etiologies of croup?

A

RIPAM: RSV, influenza, parainfluenza, adenovirus, mycoplasma
Tx: steroids + racemic epi

63
Q

What can be seen on CXR during an asthma attack?

A

Hyperinflation, peribronchial thickening, atelactasis.

64
Q

What are the etiologies of pneumonia in children?

A

Neonates – GBS, GN enterics
2 wks - 2 mos – Chlamydia, viruses, S. pneumo, S. aureus, H. flu
2 mos to 3 yrs – viruses, S. pneumo, S. aureus, H. flu
3 years to 19 years – viruses, S. pneumo, mycoplasma pneumoniae

65
Q

How is PNA treated in children?

A

Amoxicillin + supportive care (3rd gen cephs if pen-allergic)

66
Q

What is the ED management of acute stroke?

A

Dx: CT, MRI, neuro consult
Finger stick blood glucose, standard labs, EKG, UA, CXR
Tx: tPA (up to 6hr post-sx onset), but lots of contraindications

67
Q

What are four life-threatening neurological injuries highlighted in lecture?

A

Sepsis
Acute ischemic stroke
Acute bacterial meningitis
Subarachnoid hemorrhage

68
Q

What is the treatment of acute meningitis?

A

Abx immediately: vancomycin + 3rd gen ceph +/- ampicillin (>/<50 yo)
Dexamethasone
Treat household! Rifampin/Cipro

69
Q

What are the ten spaces evaluated in the FAST exam? (4 RUQ, 4 LUQ, 1 subxiphoid, 1 suprapubic)

A

RUQ: pleural, subphrenic, hepatorenal (Morrison’s), infrarenal
LUQ: pleural, subphrenic, plenorenal, inferior pole
Subxiphoid: pericardial
Suprapubic: retrovesical/rectouterine (Douglas)

70
Q

When diagnosing PTX, what false positives and false negatives may occur?

A

Negative: cardiac motion for pleural sliding, small/localized PTX, bilateral PTX
Positive: cardiac motion for leading edge, pleural adhesions, poor respiratory effort

Emergency (2 decks)

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