Emergency Medicine Flashcards
Major risk factor for coronary artery disease or MI in teenage population.
Cocaine use
-leads to myocardial oxygen deprivation thru coronary vasoconstriction
When a patient presents to the ER with chest discomfort when should an EKG be performed?
Hopefully within ten minutes of arrival.
What type of test checks for a right ventricle MI?
Right sided EKG
-look specifically at lead rV4 for ST elevation
In the ER, which symptoms should NEVER exclude acute MI?
Reproducible chest pain
most of the time it indicates MSK etiology but in rare cases it can be indicative of MI
What is MONA therapy.
Therapy used in patients suspected of any acute coronary syndrome.
Morphine, Oxygen, Nitrates, ASA
What are contraindications for nitrate therapy?
Hypotension (<90 mmHg sbp)
-possible caused by ED meds, the nitrates dilate coronary vasculature and further drop bp
When is the ideal time for fibrinolytic therapy?
For acute STEMI within a 30 minute time frame of admission to the ER
(if a cath lab is available, that should be the first choice)
What is the ideal time frame for PCI (like balloon therapy) in patients presenting with ACS?
Within 90 minutes of admission
What is the use of cardiac markers in the ER?
Used to “rule in” MI, however, the absence of a positive marker test does NOT “rule out” MI.
What is the population distribution that most commonly develops abdominal aortic aneurysms (AAA)?
Elderly Males
Which layer of the blood vessel is weakened in AAA?
Media Layer
What diameter measurement of the aorta classifies it as an AAA?
> 3cm
What does Laplace’s Law state?
The size of the aneurysm directly correlates to the speed of its progression. Basically as they get larger, the rate of growth also increases.
What is the classic presentation of AAA?
Syncope without warning followed by abdominal and lower back pain. PE will show hypotension and pulsatile abdominal mass.
What are Cullen and Grey Turner signs?
Cullen: periumbilical ecchymoses
GT: flank ecchymoses
-both indicate retroperitoneal hematoma
What is a GI complication of AAA?
Aortoenteric fistula causing GI bleeding.
What diameter measurement puts an AAA at highest risk of rupture?
> 5cm
Test to confirm diagnosis of AAA in stable patients vs. unstable.
Stable: CT
Unstable: US
(imaging is not required to begin treatment for suspected AAA)
What is treatment for AAA in the ER.
Early blood transfusion but care not to overtransfuse (can lead to excessive bleeding).
-patient should then be taken to surgery for endovascular repair
Population distribution for aortic dissection (AD).
Bimodal
- young usually with congenital vascular pathology
- elderly with lifestyle risk factors
Other than congenital conditions like Marfanism, what can illicit AD in a younger population?
Cocaine or Amphetamine use
Which layer of the blood vessel is torn in AD?
Intima layer
What is a Type A vs. Type B AD?
Type A: involves ascending aorta
Type B: does not
Other classification:
Type I: involves ascending and descending
Type II: just ascending
Type III: just descending
What is the presentation of AD?
Sudden sharp chest pain that may radiate between the shoulder blades.
