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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
Q

When do you do PFTs for asthma

A

PFTs are normal between attacks, monitor with PEF in attacks or with reversible bronchoconstriction by metcholine challenge and 12% reversal

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26
Q

What are some key s/s of ashtma

A

Increased expiration, pulsus paradoxus (severe obstrucitons) hypersensitivity to metacholine and 12% reversibility of PFTs (rescuable)

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27
Q

What is DLCO in asthma?

A

In asthma DLCO is WNL

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28
Q

what do you look at for whats reversed in obstruction for asthma diagnosis?

A

FEV1 reversible by 12%

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29
Q

FEV1 reverses (increase) by 12% with metacholine recused with albuterol and DLCO normal in 65 year old, Dx?

A

Asthma

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30
Q

What is a comorbid disease in 75% of asthmatics

A

Airway hyper reactivity = 75% have GERD

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31
Q

Treatment of asthma algorithm

A

B2, ICS, LABA, ICS high dose, PO prednisone

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32
Q

What are names of LABAs

A

LABAs are form and salmeterol

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33
Q

what are ICS names?

A

Prednisone, beclamethasone

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34
Q

what drugs are beclamethasone and pregnisone

A

ICS

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35
Q

what drugs are -eterols?

A

formo and slameterol are LABAs

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36
Q

what are AE of b-agonists?

A

K+ decreases causing tremor and arrhythmia in acute attacks when overused

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37
Q

MC AE of ICS?

A

Thrush.

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38
Q

What are is the FEV1/FVC ratio in asthma

A

Normal or decreased (obstructive) and FEV1 is 12% reversible and DLCO is WNL

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39
Q

What are the common causes of chronic cough?

A

Asthma, GERD, post-nasal drip, ACEi

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40
Q

in someone with a cough worse at night and GERD with normal CXR, next test?

A

Asthma and GERD coexist together 75% of asthma patients, do PFTs as it is likely lung hyperreactivity and not heart issues

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41
Q

What is DLCO in asthma

A

DLCO in asthma is WNL

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42
Q

what is DLCO in COPD

A

In COPD (Bronchitis) DLCO is WNL, in emphysema, DLCO is DECREASED in idiopathic restrictive interstitial lung disease it is decreased

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43
Q

What is a common complication of bronchiectasis?

A

A common complication of bronchiectasis is hemoptysis

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44
Q

Key sign of bronchiectasis?

A

Hemoptysis

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45
Q

What does DLCO indicate?

A

DLCO indicates intact pulmonary alveolar structure

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46
Q

what tells you if pulmonary alveolar structure is intact?

A

DLCO

47
Q

When is home O2 issued in COPD

A

Home O2 is issued in COPD when PaO2

48
Q

How is NSAID allergy treated and why

A

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
Q

How is COPD exas treated?

A

Steroids, O2, antibiotics (fluoro, macro) + NPPV (nonivnasive positive pressure ventilation) and intuation if it doesn’t work after 2 hours

50
Q

What are the AE of theophylline

A

headahce, CNS changes, seizure, GI disturbance and heart arrhythmia

51
Q

What causes theophylline AE

A

narrow TI and CYP metabolized, adding new drugs often precipitates toxicity of HA, CNS changes/seizure and heart arrhytmia along with GI disturabance

52
Q

What type of lung disease is chest wall restriction

A

chest wall restriction is restrictive lund disease

53
Q

how is chest wall restrictive lung PFTs distinguished from others?

A

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
Q

What is the Aa gradient like in restrictive lung disease

A

The Aa gradient in restrictive lung disease is INCREASED due to fibrosis and DLCO is decreased!

55
Q

What lesion prompts someone to get a CXR in an AA patient with cough?

A

erythema nodosum in an AA patient with or without cough = get CXR

56
Q

Silicosis looks like what on XR

A

silicosis has eggshell calcification

57
Q

what does silicosis increase risk of?

A

silicosis increases the risk of TB reactivation

58
Q

How is aspiration pneumonia treated

A

Clindaymycin or blactam for aspiration pneumonia

59
Q

how is chemical pneumonitis from gatric acid treated

A

supportive, happens within hours after aspiration event

60
Q

What does NPPV do

A

it is non invasive positive pressure ventilation and it increases aslovela ventilation, gives o2 and reduces CO2 retention

61
Q

When is Aa gradient increased?

A

VQ mismatch, alveolar destruction

62
Q

When is Aa gradient normal

A

Hypoventilation, high altitude

63
Q

Key sign of ARDS

A

ARDS does NOT respond to oxygen and needs PEEP

64
Q

what does ARDS NOT respond to?

A

ARDS does NOT respond to O2

65
Q

What are two associations (disease and treatment) ARDS is associated with?

A

ARDS is associated with pancreatitis and refractory to O2 treatment as it needs PEEP

66
Q

What is the goal of FIO2 and why

A

the goal of FiO2 is to keep it below 40% because high O2 is toxic to the lung

67
Q

burn victim, airway charred/edematous, next?

A

intubate

68
Q

What is goal of urine output

A

1ml/kg/hour in burns

69
Q

1ml/kg/hr is goal of what

A

parkland formula

70
Q

What two things are you worried about in burn victims unconscious

A

CO and CN poisoning

71
Q

how is CN poisoning treated in fires

A

empirically with thiosulfate or hydrocobalamin

72
Q

what 2 ways is fire CN prophylaxis treated

A

hydroxbocalamin and thio sulfate nitrites to make methemglobin and excrete it

73
Q

What type of bug do you suspect in a burn victim?

A

Pseudomonas is common in burn victims

74
Q

First vital sign to change in hemorrhagic shock

A

Heart rate increases

75
Q

when does BP change in shock?

A

heart rate is first VS to change, BP only changes afer 30-40% loss of volume

76
Q

What shock shows you decreased Venous O2 return?

A

Cardiogenic because tissue extract more

77
Q

what shock hsa increased venous O2 return?

A

Septic shock, tissue is damaged and dying and cannot extract it

78
Q

What is cutoff for hypothermia

A

95T

79
Q

what is treatment for hypothermia of 90-95

A

esternal passive warming

80
Q

how is hypothermia 82-90 treated

A

active external warming

81
Q

how is hypothermia below 82 treated

A

internal active warming

82
Q

when is internal active warming treated?

A

internal active warming is treated at 82

83
Q

when is active external active warming

A

82-90

84
Q

when is passive external warming

A

90-5

85
Q

what hapens as T drops below 90T

A

you stop to see active shiver, BP drops and arrhytmia occurs

86
Q

When someone has body temp over 104, how do you treat?

A

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
Q

How is heat stroke (non-exertional) treated in the ederly

A

They don’t need ice water immersion, this increases mortality, they need a spray fan with lukewarm H2O

88
Q

YOung person and T104 with altered mental status, tx?

A

Active ice water immersion, it is not a hypothalamus issue it inability to evaporate off heat

89
Q

old person T104 how treat?

A

Warm spray fan, cold water immersion increases mortality

90
Q

what are some s/s of CO poisoning

A

increased hematocrit and RBC mass labs

91
Q

can CO cause increased hematocrit or RBC mass

A

yes

92
Q

what are s/s of CO poisoning other than working indoor with cars/exhaust/fire grills and high hct or RBC mass?

A

headache, fatigue, nasuea dizziness adn cherry red skin with n/v

93
Q

s/s of CO poison

A

cherry red skin, n/v, ultiple people, seizure, confusion, headache, mylagia, nausea

94
Q

can pulse ox tell you CO poisoining

A

no, you need to get CO blood level directl

95
Q

How is CO treated?

A

CO is treated with 100% O2 until no syx and CO is normal

96
Q

A patient is treated with standard 100% O2 and CO does not go to normal, next?

A

Hyperbaric O2

97
Q

in acid/alkali ingestion what is always done?

A

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
Q

Situation which EGD is always done regardless of presentation

A

Alkali/acid ingestion

99
Q

What is a first step in acetaminophen poisoning

A

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
Q

how does acetaminophen poison present

A

commonly normal, liver dysfunction takes 24 hours, give charcoal if within 24 hours and treat with naectylectysein

101
Q

how is organophosphage/cholinergic poison treated

A

treat cholinergic poison with pramlidoxime or atropine

102
Q

what is atropine and pramlidoxine both used for

A

cholinergic poisoin

103
Q

how is salicyclate piosoin treated

A

urine aklanlinization

104
Q

EKG sign TCAs

A

Long WRS

105
Q

presentation of TCA OD?

A

Seizre is common, look for long WRS, get EKG, QRS is prognostic

106
Q

what is prognostic in TCA OD?

A

EKG QRS prolongation is prognostic TCA OD

107
Q

what are less subtle signs of TCA overdose?

A

Anticholinergic AE: flushed skin, ileus, dilated pupils

108
Q

what is most distinguishing feature of bath salts?

A

prolonged duration

109
Q

Amiodarone AE

A

pulmonary fribosis, glue skin ,thyroid, coreneal deposition, LFTs

110
Q

what needs to be consdiered for amiodarone?

A

it causes pulmonary fibrosis, thyroid issues, blue skin and hepatotoxicity

111
Q

Carbamazepine causes?

A

agranulocytosis

112
Q

What are the AE of antihistamines an ddiphenhdryamine?

A

Anticholinergic in antihistamine and diphenhydra

113
Q

what are are AE of antihist and diphenhydramine treated wiht?

A

Pyridostigmine (cholinesterase inhibitor)

114
Q

what is not given in BB OD?

A

IN BB OD DO NOT GIVE BB IT CAUSES UNOPPOSED Alpha blockade

Final review for Step 2 Ck (12 decks)

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