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Emergency high-yield packet 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
How is frostbite treated?
Prehospital: protect affected part and transport, no thawing or rubbing! Hospital: prompt rewarming, analgesia, aloe vera
26
What does severe hypothermia look like?
Core temp <28C | Pulmonary edema, oliguria, loss of reflexes
27
How is hypothermia treated?
``` 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 ```
28
What is the physiological process of wound healing?
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
29
When are vaccinations given in wound care?
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
What are anesthetic considerations in wound care?
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
What are three types of wound repair? (based on timing)
Primary closure Delayed primary closure Secondary intention
32
Random wound closure facts:
Bandages are okay for hand wounds <2cm | Sometimes antibiotics and delayed closure is okay
33
What are the five classic toxidromes?
``` Opiod Sympathomimetic Anticholinergic Cholinergic Sedative-hypnotic ```
34
Opioid toxidrome
Pinpoint pupils Respiratory depression Lethargy to coma Bradycardia, hypothermia, borderline hypertension
35
Anticholinergic toxidrome | diphenyhydramine, antiparkinson
MNEMONIC: bat, hatter, beet, hare, tick, bone, etc. | Mydriasis, AMS, flushing, hyperthermia, urinary retention, dry eyes/skin, decreased bowel sounds, tachycardia
36
Sympathomimetic toxidrome | cocaine, amphetamines, anorectics, otc stimulants, herbals
Tachycardia, hyperthermia, mydriasis Hypertension, Hyperactive bowels, Diaphoresis Tx: rapid cooling, sedation
37
Cholinergic toxidrome | organophosphates, pesticides, stigmines
DUMBBELLS | Diarrhea, urination, miosis, bradycardia, bronchorrhea, emesis, lacrimation, salivation
38
Sedative-hypnotics | anticonvulsants, barbituates, benzos, GHB
Deterioration of CNS function
39
The most common ultrasound finding in ovarian torsion is:
Ovarian enlargement due to venous and lymphatic engorgement ULTRASOUND IS DIAGNOSTIC Doppler is unreliable
40
Why does the R ovary torse more than the L ovary?
L is prevented by the descending and sigmoid colon.
41
What are the tests/imaging for a suspected ectopic pregnancy?
Urine hCG, serum hCG, pelvic ultrasound, pelvic exam, CBC
42
What are the two management modalities for ectopic pregnancy?
Surgical: laparoscopic salpingectomy only if patient is unstable or ruptured Medical: methotrexate
43
What is the battery of treatments given for pre-eclampsia?
Delivery is definitive Magnesium sulfate for seizure prophylaxis Hydralazine/labetolol IV fluids
44
What antibiotic is given for PID?
Ceftriaxone 250mg IM + Doxycycline 100mg BID x 14 days + Metronidazole 500mg BID x 14 days
45
What are the three main causes of fever (elevation of body set point)?
Host defense Increase in endogenous pyrogens Exogenous chemicals
46
What are SBIs for the febrile infant?
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
How are the Philadelphia criteria applied?
Used for infants 4-8 wks. | Said that outpatient therapy is safe and cost-effective for low-risk patients (no ABx necessary!)
48
What are the low risk criteria?
4-8 wks Normal past history, reliable caregiver, 24 hr f/u Well-appearing Mostly normal WBC, I/T, UA, CSF, CXR
49
What are two sources of fever in a well-appearing young child?
Bacteremia (HiB --> Strep pneumo --> decreasing, therefore no Abx needed) UTI (always check a suprapubic/catheter urine!! + = nitrite and/or LE)
50
What's the work-up for ill-appearing and toxic-appearing febrile young children?
Ill-appearing: CBC, urine dip, WBC>15000, urine (+) | Toxic-appearing: sepsis work-up, immediate abx, admission
51
What are three risk factors associated with AAA?
``` Atherosclerosis Peripheral Vascular Disease First-degree relative with AAA Rupture if AAA >5.5 --> 50% mortality Most common in infrarenal aorta ```
52
What two vessels are most commonly occluded in acute mesenteric ischemia?
SMA or IMA | Dx: Angiography
53
How does AMI from embolic/thrombotic etiology differ from occlusive disease?
Embolic: acute, severe, periumbilical Occlusive: intestinal angina after eating, frequent and small meals
54
How is AMI treated?
Heparin Glucagon Intraarterial papaverine Laparatomy to remove embolus, bypass occlusion, remove dead bowel
55
What fluid is used in NG lavage?
Tap water | Don't place in esophageal varices, active PUD, M-W tear, gastric bypass
56
What are the treatments for UGIB and LBIG?
UGIB: octerotride, somatostatin, PPIs, *endoscopy* LGIB: embolization, vasopressin, surgery
57
Epidemiology of Pediatric Injuries
0-14: Falls | Fatal: 0-14 = MVAs/drowning, 15-19 = firearms
58
What is the Wadell triad?
Closed head injury, intraabdominal injury, mid-shaft femur fracture (hit by auto)
59
What is the pediatric primary and secondary survey?
Recognize: airway compromise and unrecognized hemorrhage. AMPLE (avoid hyperventilation, fluid bolus: 20 cc/kg)
60
What should be considered for intracranial injury in peds patients?
LOC is not predictor; seizures are! | Consider abuse as mechanism (intentional injury --> retinal hemorrhages)
61
When should CT be ordered?
Risks: malignancy Child >2: AMS, LOC, vomiting, HA Child <2: AMS, scalp hematoma, LOC, mechanism
62
What are the five etiologies of croup?
RIPAM: RSV, influenza, parainfluenza, adenovirus, mycoplasma Tx: steroids + racemic epi
63
What can be seen on CXR during an asthma attack?
Hyperinflation, peribronchial thickening, atelactasis.
64
What are the etiologies of pneumonia in children?
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
How is PNA treated in children?
Amoxicillin + supportive care (3rd gen cephs if pen-allergic)
66
What is the ED management of acute stroke?
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
What are four life-threatening neurological injuries highlighted in lecture?
Sepsis Acute ischemic stroke Acute bacterial meningitis Subarachnoid hemorrhage
68
What is the treatment of acute meningitis?
Abx immediately: vancomycin + 3rd gen ceph +/- ampicillin (>/<50 yo) Dexamethasone Treat household! Rifampin/Cipro
69
What are the ten spaces evaluated in the FAST exam? (4 RUQ, 4 LUQ, 1 subxiphoid, 1 suprapubic)
RUQ: pleural, subphrenic, hepatorenal (Morrison's), infrarenal LUQ: pleural, subphrenic, plenorenal, inferior pole Subxiphoid: pericardial Suprapubic: retrovesical/rectouterine (Douglas)
70
When diagnosing PTX, what false positives and false negatives may occur?
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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