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Final review for Step 2 Ck > Emergency med > Flashcards

Emergency med Flashcards

1
Q

Do drug addicts still can best control in acute pain management?

A

Yes, treat everyone for acute pain regardless of drug history

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2
Q

What does GCS assess?

A

Verbal response, motor response, eye

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3
Q

What assess verbal response, motor response and eye opening?

A

GCS measures eye opening, verbal response and motor response

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4
Q

When do you intubate in GCS?

A

GCS

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5
Q

How is tension pneumo handled

A

Place needle decompression without other assessment immediately

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6
Q

General rule when to do open lap in GSW of abdomen?

A

T4 (nipple) and below is abd, in penetrating wounds (GSW) exp lap is indicated in these

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7
Q

Does stab wounds below T4 need exp lap too?

A

Stab wounds below T4 in unstable patient or one with periotneal s/s need exp lap

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8
Q

When is peritoneal lavage used?

A

peritoneal lavage is used in stable patient whos FAST was equivocal.

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9
Q

Something improtant to remember in gunshot and stab wounds with infection?

A

Tetanus prophyalxs

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10
Q

How is high ICP treated?

A

Hyperventilation (lose Co2) –> vasoconstriction; and head elevation +/- mannitol

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11
Q

What type of injruy is it when there is rapid decl with blurring and hemorrhage at gray white matter junction

A

diffuse axonal injury is when ther is blurring and hemorrhage at gray white matter junction

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12
Q

how is secondary injury is diffuse axonal injury which is edema/hemorrhage at gray-white matter reduce?

A

reduce secondary injury by limiting cerebral edema and increase in ICP by low CO2 (hypervent) mannitol and bed elevation

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13
Q

Cardiac / myocardial contusion is treated how

A

rarely intervention is needed

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14
Q

how does myocardial contusion present

A

new BBB, ectopy/dysrythmia and hypotension with slight cardiac biomarker elevation

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15
Q

what is a key sign of pulmonary contusion

A

there is brusing over the lung which causes capillary injury and some fluid in the lungs. there is hypoxia with this which worsens with IVF as more fluid is pushed into the lung with damaged capillaries and increased volume of vasculature

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16
Q

how is pulmonary contusion treate

A

control pain and good ventilation

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17
Q

Is myocardial contusion treated

A

no, rarely

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18
Q

what are associated breaks that are seen with aortic injury

A

scapular, sternal and ribs 1 and 2 fracture assocaited with aortic injury

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19
Q

what nerve is assocaited with aortic injury

A

recurrent laryngeal and hoarseness

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20
Q

most common organ injured in blunt abdominal trauma?

A

The most common organ injured in blunt abdominal trauma is the spleen

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21
Q

how is pelvic fracture treated?

A

treat pelvic fracture with stabilization of the pelvis

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22
Q

pelvic fracture with s/s of peritonitis?

A

exp lap, if only pelvic fractured and unstable, stabilize the hips and observe and give PRBCs when needed, no surgery

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23
Q

How does fat emoblism present?

A

Tachypnea, tachycardia, petechiae, mental status changes, and long bone fractures

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24
Q

HOw does a fixed obstruction airflow loop look

A

There is same volume, but increased exp and insp time due to decreased airflow, think of laryngeal edema and tx with IM Epi

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25
When do you do PFTs for asthma
PFTs are normal between attacks, monitor with PEF in attacks or with reversible bronchoconstriction by metcholine challenge and 12% reversal
26
What are some key s/s of ashtma
Increased expiration, pulsus paradoxus (severe obstrucitons) hypersensitivity to metacholine and 12% reversibility of PFTs (rescuable)
27
What is DLCO in asthma?
In asthma DLCO is WNL
28
what do you look at for whats reversed in obstruction for asthma diagnosis?
FEV1 reversible by 12%
29
FEV1 reverses (increase) by 12% with metacholine recused with albuterol and DLCO normal in 65 year old, Dx?
Asthma
30
What is a comorbid disease in 75% of asthmatics
Airway hyper reactivity = 75% have GERD
31
Treatment of asthma algorithm
B2, ICS, LABA, ICS high dose, PO prednisone
32
What are names of LABAs
LABAs are form and salmeterol
33
what are ICS names?
Prednisone, beclamethasone
34
what drugs are beclamethasone and pregnisone
ICS
35
what drugs are -eterols?
formo and slameterol are LABAs
36
what are AE of b-agonists?
K+ decreases causing tremor and arrhythmia in acute attacks when overused
37
MC AE of ICS?
Thrush.
38
What are is the FEV1/FVC ratio in asthma
Normal or decreased (obstructive) and FEV1 is 12% reversible and DLCO is WNL
39
What are the common causes of chronic cough?
Asthma, GERD, post-nasal drip, ACEi
40
in someone with a cough worse at night and GERD with normal CXR, next test?
Asthma and GERD coexist together 75% of asthma patients, do PFTs as it is likely lung hyperreactivity and not heart issues
41
What is DLCO in asthma
DLCO in asthma is WNL
42
what is DLCO in COPD
In COPD (Bronchitis) DLCO is WNL, in emphysema, DLCO is DECREASED in idiopathic restrictive interstitial lung disease it is decreased
43
What is a common complication of bronchiectasis?
A common complication of bronchiectasis is hemoptysis
44
Key sign of bronchiectasis?
Hemoptysis
45
What does DLCO indicate?
DLCO indicates intact pulmonary alveolar structure
46
what tells you if pulmonary alveolar structure is intact?
DLCO
47
When is home O2 issued in COPD
Home O2 is issued in COPD when PaO2
48
How is NSAID allergy treated and why
NSAID allergy is due to over production of leukotrienes in the arachidonic acid pathway, it is NOT IgE mediated; tx is with montekulast/leukotriene block
49
How is COPD exas treated?
Steroids, O2, antibiotics (fluoro, macro) + NPPV (nonivnasive positive pressure ventilation) and intuation if it doesn't work after 2 hours
50
What are the AE of theophylline
headahce, CNS changes, seizure, GI disturbance and heart arrhythmia
51
What causes theophylline AE
narrow TI and CYP metabolized, adding new drugs often precipitates toxicity of HA, CNS changes/seizure and heart arrhytmia along with GI disturabance
52
What type of lung disease is chest wall restriction
chest wall restriction is restrictive lund disease
53
how is chest wall restrictive lung PFTs distinguished from others?
The FEV1/FVC will still be normal or slightly increased like all other lung disease, but if DLCO is normal (should be decreased) it means the diffusion barrier isn't bad it is just restricted lung from chest wall
54
What is the Aa gradient like in restrictive lung disease
The Aa gradient in restrictive lung disease is INCREASED due to fibrosis and DLCO is decreased!
55
What lesion prompts someone to get a CXR in an AA patient with cough?
erythema nodosum in an AA patient with or without cough = get CXR
56
Silicosis looks like what on XR
silicosis has eggshell calcification
57
what does silicosis increase risk of?
silicosis increases the risk of TB reactivation
58
How is aspiration pneumonia treated
Clindaymycin or blactam for aspiration pneumonia
59
how is chemical pneumonitis from gatric acid treated
supportive, happens within hours after aspiration event
60
What does NPPV do
it is non invasive positive pressure ventilation and it increases aslovela ventilation, gives o2 and reduces CO2 retention
61
When is Aa gradient increased?
VQ mismatch, alveolar destruction
62
When is Aa gradient normal
Hypoventilation, high altitude
63
Key sign of ARDS
ARDS does NOT respond to oxygen and needs PEEP
64
what does ARDS NOT respond to?
ARDS does NOT respond to O2
65
What are two associations (disease and treatment) ARDS is associated with?
ARDS is associated with pancreatitis and refractory to O2 treatment as it needs PEEP
66
What is the goal of FIO2 and why
the goal of FiO2 is to keep it below 40% because high O2 is toxic to the lung
67
burn victim, airway charred/edematous, next?
intubate
68
What is goal of urine output
1ml/kg/hour in burns
69
1ml/kg/hr is goal of what
parkland formula
70
What two things are you worried about in burn victims unconscious
CO and CN poisoning
71
how is CN poisoning treated in fires
empirically with thiosulfate or hydrocobalamin
72
what 2 ways is fire CN prophylaxis treated
hydroxbocalamin and thio sulfate nitrites to make methemglobin and excrete it
73
What type of bug do you suspect in a burn victim?
Pseudomonas is common in burn victims
74
First vital sign to change in hemorrhagic shock
Heart rate increases
75
when does BP change in shock?
heart rate is first VS to change, BP only changes afer 30-40% loss of volume
76
What shock shows you decreased Venous O2 return?
Cardiogenic because tissue extract more
77
what shock hsa increased venous O2 return?
Septic shock, tissue is damaged and dying and cannot extract it
78
What is cutoff for hypothermia
95T
79
what is treatment for hypothermia of 90-95
esternal passive warming
80
how is hypothermia 82-90 treated
active external warming
81
how is hypothermia below 82 treated
internal active warming
82
when is internal active warming treated?
internal active warming is treated at 82
83
when is active external active warming
82-90
84
when is passive external warming
90-5
85
what hapens as T drops below 90T
you stop to see active shiver, BP drops and arrhytmia occurs
86
When someone has body temp over 104, how do you treat?
Active cooling, it is not due to temperature set piont, they cannot evaporate off the heat, no need for anitpyretics not a hypothaalmus issue
87
How is heat stroke (non-exertional) treated in the ederly
They don't need ice water immersion, this increases mortality, they need a spray fan with lukewarm H2O
88
YOung person and T104 with altered mental status, tx?
Active ice water immersion, it is not a hypothalamus issue it inability to evaporate off heat
89
old person T104 how treat?
Warm spray fan, cold water immersion increases mortality
90
what are some s/s of CO poisoning
increased hematocrit and RBC mass labs
91
can CO cause increased hematocrit or RBC mass
yes
92
what are s/s of CO poisoning other than working indoor with cars/exhaust/fire grills and high hct or RBC mass?
headache, fatigue, nasuea dizziness adn cherry red skin with n/v
93
s/s of CO poison
cherry red skin, n/v, ultiple people, seizure, confusion, headache, mylagia, nausea
94
can pulse ox tell you CO poisoining
no, you need to get CO blood level directl
95
How is CO treated?
CO is treated with 100% O2 until no syx and CO is normal
96
A patient is treated with standard 100% O2 and CO does not go to normal, next?
Hyperbaric O2
97
in acid/alkali ingestion what is always done?
always do a EGD to evaluate for stricture even if the mouth is ok, as injury is likely. If doing contrast esophogram, must be water soluble
98
Situation which EGD is always done regardless of presentation
Alkali/acid ingestion
99
What is a first step in acetaminophen poisoning
must be >7.5g to damge, but liver damge takes 24 hours, give charcoal if whtin 4 horus of ingestion, normal PE/presenation is common, you still need to treat
100
how does acetaminophen poison present
commonly normal, liver dysfunction takes 24 hours, give charcoal if within 24 hours and treat with naectylectysein
101
how is organophosphage/cholinergic poison treated
treat cholinergic poison with pramlidoxime or atropine
102
what is atropine and pramlidoxine both used for
cholinergic poisoin
103
how is salicyclate piosoin treated
urine aklanlinization
104
EKG sign TCAs
Long WRS
105
presentation of TCA OD?
Seizre is common, look for long WRS, get EKG, QRS is prognostic
106
what is prognostic in TCA OD?
EKG QRS prolongation is prognostic TCA OD
107
what are less subtle signs of TCA overdose?
Anticholinergic AE: flushed skin, ileus, dilated pupils
108
what is most distinguishing feature of bath salts?
prolonged duration
109
Amiodarone AE
pulmonary fribosis, glue skin ,thyroid, coreneal deposition, LFTs
110
what needs to be consdiered for amiodarone?
it causes pulmonary fibrosis, thyroid issues, blue skin and hepatotoxicity
111
Carbamazepine causes?
agranulocytosis
112
What are the AE of antihistamines an ddiphenhdryamine?
Anticholinergic in antihistamine and diphenhydra
113
what are are AE of antihist and diphenhydramine treated wiht?
Pyridostigmine (cholinesterase inhibitor)
114
what is not given in BB OD?
IN BB OD DO NOT GIVE BB IT CAUSES UNOPPOSED Alpha blockade

Final review for Step 2 Ck (12 decks)

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