Emergency Med Rotation Flashcards
Morphine dosing for Peds
6 mo- 12 yo
0.1- 0.2 mg/kg/dose
every 2-4hr
Morphine dosing for Adults
SC/IM/IV
2-10 mg every 4 hours
Epi dosing for O-shit heart rhythms (MI)
Asystole
PEA
V-tachy
V-fib
1 mg IV/IO
q3-5 min
Epi dosing for Bradycardia
when Atropine doesn’t work
2-5 micrograms (mcg) / min
every minute
Epi strength for cardiac stuff
1: 10,000 solution
Epi strength for Anaphylaxis (allergic rxn) and Asthma exacerbation
1: 1000 solution
Epi dosing for Allergic rxn/ Anaphylaxis
- 15 mg every 5-15 min if you are <66 lbs
0. 30 mg every 5-15 min if you are >66 lbs
Epi dosing for Asthma exac
0.30- 0.50 mg every 20 min x 3 doses prn
Which dose is higher for Epinephrine, Asthma exac or Anaphylactic rxn?
Asthma exac
Asthma: 0.30- 0.50 mg
Anaphylactic: 0.15 or 0.30 depending how much you weigh
HOWEVER, dose more frequently (every 5 min) for anaphylaxis. Dosing for Asthma is q20 min
Peds Morphine dosing
0.1-0.2 mg/kg/dose
max 15 mg/dose
Bupivacaine max per DOSE
175 mg/dose
Lidocaine max per DOSE
300 mg/dose
Bupivacaine max mg/kg/dose
2 mg/kg/dose is MAX for Bupivacaine
ABCDD risk of Stroke after TIA
Age >60 yo
BP >140/90
Clinical sx (unilateral wkness: 2pts, facial asymm: 1 pt)
Duration sx (more than 1 hr: 2pts, between 10 min and 1 hr: 1 pt)
Diabetes hx
6-7 High risk: Consult neuro, consider MRI + Carotid US, probably admit pt
NIHSS
How bad was the stroke?
Perform after STAT Head CT b4 and after tPA if pt is getting tPA
LOC- casually assess, then Qs (month and age), commands
Best gaze- move 1 finger have pt follow
Visual field- cover one of pts eyes
Facial palsy- test CN 7, smile, eyes, puff cheeks
Arm motor- 10 seconds at 90 deg
Leg motor- 5 seconds at 30 deg
Ataxia- finger to nose, heel to shin
Sensory- pin prick face, trunk, arms, legs
Language- picture and words to read
Dysarthria- repeat words back to me
Exctinction/ Inattention- compare visual reception and sensory on bilateral sides
NEXUS spinal cord trauma (5 things)
if all 5 are negative, no need for Head CT
Midline spiny tenderness Focal neuro def AMS Intoxication Distracting injury
PERC r/o criteria
only use for Low risk pts
“AOU, HHH, PR”
Age >50 O2 sat <95% Unilat leg swelling Hemoptysis HR >100 bpm Hormone use Prior DVT/PE Recent trauma/injury within 1 mo
If pt is Low risk but doesn’t pass the PERC r/o criteria,
Order D-dimer
if negative, can prob go home
if positive, consider CT angio or V/Q
Revised Geneva Score for PE
5 pts: HR >95 bpm
4 pts: pain on palpation and unilat edema
3 pts: previous DVT/PE, unilat pain, HR >75
2 pts: Active CA, hemoptysis, surgery/fx in past mo
1 pt: age >65
Revised Geneva for PE
Score of 0-3: Low risk
<10% risk of PE
Revised Geneva for PE
Score of 4-10: Moderate risk
Depends on D-dimer
(-) D dimer, no further workup
(+) D dimer, consider CT and Ultrasound
Revised Geneva for PE
Score of 11+: High risk
CT and US automatically
if those don’t tell you anything, consider Angiography
Wells criteria for PE
3 pts: Clinical sx of DVT, Other dx is less likely
1.5 pts: previous DVT/PE, recent surgery or immobilization, HR >100 bpm
1 pt: CA, Hemoptysis
if >4, PE is likely and you should get a CTA
Wells Criteria for PE
if score is 0-4 “PE unlikely”
Get D-dimer
Wells Criteria for DVT
All pts are worth 1, besides the one that is -2
Active CA Bedridden >3d or surg past 12 wks Calf sw >3cm more than other Collateral superficial vein present Entire leg swollen Localized TTP along deep vein system Pitting edema on symptomatic leg Paralysis, Paresis, or recent cast Previous DVT
-2: other dx is as likely or more likely
Wells for DVT
score is 0-2
still get D dimer
Wells for DVT
score is >3
get US
skip the D-dimer step
HEART score
when does someone need to be admitted to hospital?
score of 4 or greater
HEART score
0-2 points for each category, max of 10 pts
History EKG Age Risk factors Trop (initial)
Risk factors for MI
HTN, HLP, DM Obesity, Smoking Family hx Atherosclerotic dz (previous MI, CABG, CVA, TIA) PAD
Based on HEART score, when can someone go home?
0-3: can be d/c home
Score of 4-6 and 7-10 mean what for HEART score?
4-6: Admit
7-10: Admit and pt is Candidate for early invasive measures
TIMI heart score, when can someone be d/c?
NEVER really
This risk stratification only tells us how much at risk pt is, but cannot r/o enough to send someone home
Low risk 0-1
High risk >4 points: pt likely needs aggressive mgmt and early invasive measures
SIRS criteria
“T, HR, RR, W”
Temp
HR
RR
WBC
SIRS
Temp >100.4 or <96.8
HR >90 bpm
RR> 20 or CO2 >32 mmhg
WBC >12k or <4k
What should you do next if pt has 2 or more + elements of SIRS?
Obtain a Lactate level
If infection is found and 2 or more of SIRS, what is this now called?
SEPSIS
If infection is found, 2 or more, AND Lactate is 4 or greater mmol/L, what is this considered?
Severe Sepsis
Tx: Broad Spectrum Abx, IVF, Vasopressors
If infection is found, 2 or more, AND pt is Hemodynamically Unstable… what is this?
Septic Shock
PECARN for <2 YO
if all of these are present, don’t need to get head imaging
Normal mental status and behavior No head bruise (other than frontal) LOC <5 seconds Nonsevere mechanism No palpable skull fx
PECARN for >2 YO
If all of these are present, don’t need to get Head imaging
Normal mental status No LOC No Vomiting No Severe HA Nonsevere mechanism No signs of basilar fx
High risk features of Head Injury for >16 yo
if any Yes, get Head CT
Vomiting Severe HA Focal neuro def Signs Basilar fx On Blood thinner Inherited blood disorder or Liver dz Thrombocytopenia Dangerous MOI- ejected from car, fall>3 ft, or fall >5 stairs
If no High risk features in >16 YO head injury, what do you ask next?
Was there LOC or Post injury memory loss?
If Yes to LOC or post injury memory los….
Are any of these?
Pt >60 YO Intoxicated Short term mem loss Visible trauma above clavicles Post trauma seizure
If yes, get CT
GCS scale
4, 5, 6
Eyes
Talking
Motor
GCS for Eyes
4: spontaneous
3: open to verbal command
2: open to pain
1: nuttin
GCS for Speech
5: oriented
4: confused speech
3: not appropriate
2: slurred, cant understand
1: nuttin
GSC for Motor
6: obeys commands
5: localizes pain, moves it away
4: generalizes pain
3: flexes to pain
2: extensor rxn to pain
1: nuttin
CURB 65 for PNA
Confusion Urea >7 mmol/L RR >30 Blood pressure <90, <60 65 years or older
THRESHOLD score: 3 or greater, admit
CURB 65 score interpretation
1: outpatient
2: Short inpatient stay, then supervised outpatient
3 or greater: Admitted for a few, possibly ICU
HiNTs is used to differentiate b/w what two things?
Vestibular Neuritis (peripheral) or CVA stroke (central)
