Emergency Medicine Flashcards
Chest pain with neurologic symptoms is what until proven otherwise?
aortic dissection
What is the main purpose of CT head with suspected stroke?
rule out hemorrhagic stroke
Headache red flags?
meningismus, fever, n/v - meningitis
thundercap onset - SAH
… many
Elderly
Fever or immunocompromised (HIV/AIDS, Cancer)
Trauma
New onset, sudden onset, worst at onset
Neurological findings
Progressive headache
Jaw claudication, muscle aches, temporal artery pain (PMR/GCA)
Multiple patients with headache (CO toxicity)
Eye pain (acute angle closure glaucoma)
Pregnancy or post pregnancy (eclampsia)
Clotting disorder (primary or acquired)
Acute onset severe headache is what until proven otherwise?
Timeline: do what imaging or what test depending on time from headache onset…
- subarachnoid hemorrhage
- head CT if <6h from headache onset
- if greater than 6h, do LP
- or if CT head negative and you are still suspicious, do LP
Young person with syncope is what until proven otherwise?
Other thing you should always think about? hint.. young female
Cardiac cause - HCM, arrythmia..
- Always ask about history of sudden cardiac death in the family
Pulmonary embolism, ruptured ectopic (they’d probably have abdo pain though)
Every female between age 8-80 is _____ until proven otherwise
pregnant
Every pregnancy is _______ until proven otherwise
ectopic
A new LBBB is what until proven otherwise
Acute MI
What is the FiO2 delivered with non-rebreather mask?
near 100%
Good seal and running 10-15L
Threshold for transfusion in the absence of acute bleeding?
70 g/L
Important info you get with ABG/VBG - gases just counts for one, name 4 others
pH
lactate
hgb
lytes
What physical exam do you do for all patients with headache?
bonus: run through the exam
Full neuro
CN strength and sensation x4 gait and coordination tone and reflexes rhomberg and pronator drift
Typical treatment for a headache in ER?
Rule out dangerous causes, red flags
Consider fluid bolus
Analgesic - tylenol, NSAIDs (maybe toradol IM/IV)
Dopamine antagonists
- prochlorperazine (Compazine), metoclopramide, haloperidol (Haldol)
- maybe diphenhydramine or benztropine for EPS
Steroids to prevent rebound headache
- dexamethasome
Advise GP for abortive strategies or possible neuro consult for ++ frequency migraines
What is the purpose of the Wells and PERC scores?
When you suspect PE
Use Wells PE criteria to estimate pretest probability
- if low PTP, use PERC to “rule out” VTE in patients with low pretest probability
- if moderate PTP, get D-dimer, if pos, CTPE
- if high PTP, straight to CTPE b/c just a negative d-dimer would no be sensitive enough to rule OUT
ECG findings of PE
Hint: think through approach - rate, rhythm, axis, intervals, ischemia/infarct…
- Sinus tachycardia – the most common abnormality (seen in 44% of patients with PE)
Right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF). - This pattern is associated with high pulmonary artery pressures (34%)… so pretty massive PE
SI QIII TIII pattern – deep S wave in lead I, Q wave in III, inverted T wave in III (20%)
Non-specific ST segment and T wave changes, including ST elevation and depression (50%)
Right axis deviation (16%) - look at I, II, aVF
RBBB (18%) - bunny ears in V1/2
Dominant R wave in V1 – a manifestation of acute right ventricular dilatation
Peaked P wave in lead II > 2.5 mm in height (9%) - sign of right atrial enlargement (P pulmonale)
60 yo male with history of renal colic with right flank pain. He thinks he passed a stone. Pain has resolved. What ddx should you think about before letting him go?
AAA +/- rupture
- mortality about 50%
Consult vascular surgery for OR or an ICU
What tendon attaches to the base of the 5th metatarsal?
peronius brevis
You want to give morphine to your patient. Nurse asks if there is any dose adjustment for IM vs SC vs IV?
Nope, same same
Patient has abdo pain and fever, what test should you think of? You’ll probably start abx.
blood cultures
Patient has air under the diaphragm. You’re going to start abx. Thinking pip-tazo.
?normal and renal dosing for pip-tazo
- 5 g
3. 375 g renal dose
Person with lots of vascular risk factors with acute onset diffuse abdo pain. Benign abdo on palpation. What dx must be on your ddx?
mesenteric ischemia
Patient with lots of vascular risk factors (DLD, HTN, DM, afib) with acute onset 8/10 but diffuse abdo pain. Benign abdo on palpation.
What dx must be on your ddx?
RF?
Gold standard test?
Mesenteric ischemia
RF: afib, recent MI (for the most common mes. art. embolism 50% of cases)
Bloody diarrhea is a late finding after bowel has infarcted
CTA abdo/pelvis (Labs consider lactate and d-dimer but generally labs not sens or spec.; late findings on AXR - pneumatosis)
What are the four causes of mesenteric ischemia
bonus: common pathophys for each
- mesenteric artery embolism (commonly due to atrial fibrillation)
- mesenteric artery thrombosis (commonly due to atherosclerosis)
- mesenteric vein thrombosis (commonly due to hypercoagulability)
- non-occlusive mesenteric ischemia, aka abdominal angina, (commonly due to low flow states, eg low CO, sepsis)
Two genetic hypercoagulable states?
Factor V Leiden, Protein C deficiency
