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Emergency Med Rotation Flashcards

1
Q

Morphine dosing for Peds

6 mo- 12 yo

A

0.1- 0.2 mg/kg/dose

every 2-4hr

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2
Q

Morphine dosing for Adults

SC/IM/IV

A

2-10 mg every 4 hours

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3
Q

Epi dosing for O-shit heart rhythms (MI)

Asystole
PEA
V-tachy
V-fib

A

1 mg IV/IO

q3-5 min

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4
Q

Epi dosing for Bradycardia

when Atropine doesn’t work

A

2-5 micrograms (mcg) / min

every minute

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5
Q

Epi strength for cardiac stuff

A

1: 10,000 solution

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6
Q

Epi strength for Anaphylaxis (allergic rxn) and Asthma exacerbation

A

1: 1000 solution

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7
Q

Epi dosing for Allergic rxn/ Anaphylaxis

A
  1. 15 mg every 5-15 min if you are <66 lbs

0. 30 mg every 5-15 min if you are >66 lbs

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8
Q

Epi dosing for Asthma exac

A

0.30- 0.50 mg every 20 min x 3 doses prn

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9
Q

Which dose is higher for Epinephrine, Asthma exac or Anaphylactic rxn?

A

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

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10
Q

Peds Morphine dosing

A

0.1-0.2 mg/kg/dose

max 15 mg/dose

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11
Q

Bupivacaine max per DOSE

A

175 mg/dose

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12
Q

Lidocaine max per DOSE

A

300 mg/dose

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13
Q

Bupivacaine max mg/kg/dose

A

2 mg/kg/dose is MAX for Bupivacaine

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14
Q

ABCDD risk of Stroke after TIA

A

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

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15
Q

NIHSS

How bad was the stroke?
Perform after STAT Head CT b4 and after tPA if pt is getting tPA

A

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

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16
Q

NEXUS spinal cord trauma (5 things)

if all 5 are negative, no need for Head CT

A 
Midline spiny tenderness
Focal neuro def
AMS
Intoxication
Distracting injury
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17
Q

PERC r/o criteria

only use for Low risk pts

A

“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
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18
Q

If pt is Low risk but doesn’t pass the PERC r/o criteria,

A

Order D-dimer

if negative, can prob go home
if positive, consider CT angio or V/Q

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19
Q

Revised Geneva Score for PE

A

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

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20
Q

Revised Geneva for PE

Score of 0-3: Low risk

A

<10% risk of PE

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21
Q

Revised Geneva for PE

Score of 4-10: Moderate risk

A

Depends on D-dimer

(-) D dimer, no further workup
(+) D dimer, consider CT and Ultrasound

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22
Q

Revised Geneva for PE

Score of 11+: High risk

A

CT and US automatically

if those don’t tell you anything, consider Angiography

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23
Q

Wells criteria for PE

A

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

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24
Q

Wells Criteria for PE

if score is 0-4 “PE unlikely”

A

Get D-dimer

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25
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
26
Wells for DVT score is 0-2
still get D dimer
27
Wells for DVT score is >3
get US | skip the D-dimer step
28
HEART score when does someone need to be admitted to hospital?
score of 4 or greater
29
HEART score 0-2 points for each category, max of 10 pts
``` History EKG Age Risk factors Trop (initial) ```
30
Risk factors for MI
``` HTN, HLP, DM Obesity, Smoking Family hx Atherosclerotic dz (previous MI, CABG, CVA, TIA) PAD ```
31
Based on HEART score, when can someone go home?
0-3: can be d/c home
32
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
33
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
34
SIRS criteria "T, HR, RR, W"
Temp HR RR WBC
35
SIRS
Temp >100.4 or <96.8 HR >90 bpm RR> 20 or CO2 >32 mmhg WBC >12k or <4k
36
What should you do next if pt has 2 or more + elements of SIRS?
Obtain a Lactate level
37
If infection is found and 2 or more of SIRS, what is this now called?
SEPSIS
38
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
39
If infection is found, 2 or more, AND pt is Hemodynamically Unstable... what is this?
Septic Shock
40
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 ```
41
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 ```
42
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 ```
43
If no High risk features in >16 YO head injury, what do you ask next?
Was there LOC or Post injury memory loss?
44
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
45
GCS scale
4, 5, 6 Eyes Talking Motor
46
GCS for Eyes
4: spontaneous 3: open to verbal command 2: open to pain 1: nuttin
47
GCS for Speech
5: oriented 4: confused speech 3: not appropriate 2: slurred, cant understand 1: nuttin
48
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
49
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
50
CURB 65 score interpretation
1: outpatient 2: Short inpatient stay, then supervised outpatient 3 or greater: Admitted for a few, possibly ICU
51
HiNTs is used to differentiate b/w what two things?
Vestibular Neuritis (peripheral) or CVA stroke (central)
52
What is used to confirm the suspicion of BPPV?
Dix Hallpike Maneuver pt will likely have vertical nystagmus with rotary component
53
4 Components of HiNTS+ exam
Nystagmus Skew Head impulse test Hearing loss
54
Seconds of vertigo brought on by movement
BPPV
55
Tx of BPPV
Epley Maneuver
56
Many hours/days of continuous vertigo that is WORSENED by movement
Vestibular Neuritis vs Stroke Perform HiNTS+ exam
57
Results that are CENTRAL for the HiNTS+ exam
Bidirectional nystagmus Vertical skew (when one eye is covered) Normal response to Head impulse Hearing loss
58
Results that are PERIPHERAL for HiNTS+ exam Note: all must be peripheral to overall have a Peripheral result and be able to d/c someone home with dx of "Vestibular Neuritis" without imaging for stroke
Unidirectional Nystagmus No skew with eye covering Abnormal head impulse test (eyes jump) No new hearing loss
59
Max dosing of Lidocaine with Epi 1% Lidocaine
50 mL or 500 mg
60
Max dosing of Lidocaine only
30 mL or 300 mg
61
Max dosing of Bupivacaine with Epi 0.5% Bupivacaine
45 mL or 225 mg
62
Max dosing of Bupivacaine only
35 mL or 175 mg
63
Moral of story, if you use EPI,
you can use a larger amount of substance
64
Tylenol dosing, do not exceed
4g per day 4000 mg in one day
65
SA node intrinsic rate
60-100 bpm our physiologic normal
66
AV node intrinsic rate
40-60 bpm
67
Purkinje fibers rate
20-40 bpm
68
Limb Leads | "Standard"
I, II, III
69
augmented leads "a___"
avR avL avF unipolar
70
Precordial aka Chest leads
V1-V6 also unipolar
71
Normal PRI
0.12-0.20 seconds
72
Normal QRS duration
0.06-0.12 seconds 60-120 ms
73
Normals in milliseconds (ms)
PRI: 120-200 QRS: 60-120
74
Anterior leads
V1-V4 Left Anterior Descending, LAD artery
75
Lateral leads
I, avL, V5-6
76
Inferior leads
II, III, avF Right Coronary Artery
77
Large Box Estimate of HR
300, 150, 100, 75, 60, 50
78
Tall p wave
>2.5 mm RAE- Right Atrial Enlargement "P pulmonale"
79
Wide p wave
> 100 ms LAE "P mitrale"
80
Where else can pacemaker signals come from? (normal: SA node)
``` Atria AV jx Bundle branches Purkinje fibers Ventricular myocardium ```
81
1 small square =
0.04 seconds 40 milliseconds
82
1 large box=
0.20 seconds 200 milliseconds
83
Atrial tachycardia
150-250 bpm
84
Atrial flutter
"Saw tooth P waves" often well tolerated enlarged atrial tissue, elevated atrial pressures i.e. post cardiac surgery, valve dz, pericarditis, CHF, acute infarction, COPD, etc
85
A-Fib irregularly irregular
Atrial rate is >350 bpm Ventricular rate may be slow, normal, or fast
86
Risk of A-fib
Atria are not contracting properly so they may develop clot as blood is stagnant in the atria pre-D to stroke
87
Junctional rhythms
P-wave usually INVERTED QRS is normal
88
Junctional Escape Rhythm
40-60 bpm
89
Accelerated Junctional Rhythm
60-100 bpm
90
Junctional Tachycardia
100-180 bpm
91
Ventricular rhyrhms
P waves ABSENT QRS are Wide and Bizarre
92
Idioventricular rhythm
20-40 bpm
93
Accelerated Idioventricular rhythm
40-100 bpm
94
Ventricular tachy
100-250 bpm
95
Torsades de Pointes is a unique subcategory of
Polymorphic V-tachy
96
Tx of Torsades
Magnesium Sulfate
97
2nd Degree Mobitz type 1 AV block "Wenckebach"
PRI progressively increase until a QRS is dropped
98
2nd deg type II
PRI is prolonged and constant
99
3rd deg AV block
P waves "march right through" QRS No association b/w the P waves and QRS complexes rhythms are regular but not at all related to each other
100
Where to look to find "Mean Axis"
Lead I and AVF
101
Normal Axis
Mean QRS deflection is positive in both Leads: I and avF
102
RAD
Mean QRS is negative in Lead I, positive in avF
103
LAD
Mean QRS is positive in Lead I, negative in avF
104
What does LAD mean?
LVH- Left ventricular hypertrophy* (most common) Chronic CAD Diffuse myocardial dz- cardiomyophaty, myocarditis
105
What does RAD mean?
Can be NORMAL in children and tall, thin adults
106
What lead do we look at for p waves?
Lead II and V1 RAE: taller than 2.5 mm LAE: wider than 0.10 (2.5 blocks)
107
RAE criteria
P wave >2.5 mm tall OR Initial component (first part of wave) is larger in V1
108
RAE is present in
Pulmonic stenosis | Tricuspid stenosis and regurgitation
109
LAE look at Lead II and V1
P wave >0.10 s Terminal (last portion) of wave in V1 is bigger, going to be the part that DIPS DOWN
110
LAE present in
MITRAL | stenosis and regurg
111
LVH is present in
HTN | Valve heart dz
112
LVH criteria
Deep in V1-2 TALL TALL in V5-6 R in avL is very deep, >11 mm
113
HTN | Valvular heart dz
LVH- Left ventricular hypertrophy
114
RVH often coencides with
RAD
115
RBBB seen with
CAD and PE | Coronary artery dz and Pulmonary embolism
116
What leads do I look at to assess for BBB?
Lead V1 | Lead I and V6
117
RBBB
M shaped in V1 Wide S wave (down part) in Lead I and V6
118
LBBB
wide R wave (up part) in Lead I and V6
119
Where to look for BBB
Lead I and V6 wide up part (LBBB) wide down part (RBBB)
120
Wellens Syndrome EKG changes
Deeply inverted or biphasic T waves in V2-V3 Highly specific for: Stenosis of LAD artery
121
Wellens syndrome | (LAD coronary artery) can leadd to
Anterior or Antero-lateral MI
122
Wolf Parkinson White syndrome
An extra electrical pathway in the heart causes a rapid heartbeat
123
Sx of Wolf Parkinson White
congenital (present at birth) but sx often develop later in life, age 11-50 Lightheaded, Dizzy
124
Tx of WPW
Meds Ablation Rarely: shock
125
Characteristic of Wolf Parkinson White
"Delta wave" the upsloping before the QRS
126
What is setting off the electrical impulse with Wolf Parkinson White?
The Bundle of Kent is overriding the AV node
127
Be thinking about this is a Diabetic comes in with abnormal EKG
Hyperkalemia and Acid-base disturbance
128
Mean axis
Lead I and avF
129
Inverted T waves in V2-V3
Wellens syndrome critical lesion in LAD (coronary artery)

Clinical Prep (41 decks)

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