Emergency Medicine Flashcards
unilateral, non-reactive pupil? Think:
focal mass
epidural hematoma
subdural hematoma
Explain fluid resus during a trauma
give bolus until heart rate comes down, urine output increases, and patient stabilizes. Then run maintenance.
Cushing’s sign of increased ICP
hypertension
bradycardia
irregular respirations
signs of ICP
- cushings triad: hypertension, bradycardia, irregular respirations
- deteriorating LOC
- lateralizing CNS symptoms (cranial nerve palsy)
- seizures
- papilledema
- nausea/vomiting/headache
best imaging modality for head trauma
non-contrast CT
In Vehicle vs Pedestrian Crash: look for Waddles Triad, which is:
- tib-fib or femur fracture
- truncal injury
- craniofacial injury
mimic the way a person would be hit by a car, legs first, then trunk, then hit head
canadian head rule
High risl:
GCS<15 at 2 hours after injury
suspect depressed or open skull fracture
signs of basal skull fracture
vomiting >2 episodes
age >65
medium risk: amnesia before impact >30 min
- dangerous mechanism
**does not apply to kids, GCS ,13, patients on blood thinner or bleeding disorder.
Can clear C-spine if:
- oriented to person, place, time and event
- no evidence of intoxication
- no posterior midline cervical tenderness
- no focal neurological deficits
- no painful distracting injuries (long bone fracture)
what do the 3 vies of Cspine tell us
- lateral: swimmers view, injury of the processes
- odontoid view: assess the dens
- AP view: alignment of spinous processes and spacing.
becks triad of tamponade
hypotension
muffled heart sounds
distended neck veins
(+tachycardia and tachypnea)
BP phenomenon seen in cardiac tamponade
pulsus paradoxus
kussmaul’s sign (increased JVP with inspiration)
which organs are retroperitoneal
adrenal glands, aorta, kidneys, esophagus, ureters, pancreas, rectum, and parts of the stomach and colon (ascending and descending)
Management of open fracutres
STAND:
Splint
Tetanus prophylaxis
antibiotics
neurovascular status
dressing.
6 Ps of compartment syndrome
pale
pulseless
paresthesia
paralysis
pain
pain with passive stretch
polar (col)
nerves at risk on anterior shoulder dislocation
axillary nerve (lateral aspect of shoulder)
musculocutaneous nerve (extensor aspect of forearm)
scaphoid fracture management
spica splint 6-8 weeks, repeat XR in 2 weeks. Outpatient orthopedics follow-up
preferred imaging modality in assessment of acute pelvic pain
ultrasound
AEIOU TIPS for COMA
acidosis
epilepsy
infection
oxygen/opiates
uremia
temperature/trauma
insulin
psychogenic
structural/space-occupying lesion
life threatening causes of chest pain
PE
esophageal rupture
tamponade
MI/angina
Aortic dissection
pneumothorac
score to apply when discharging stable patient /negative workup due to chest pain
HEART score to risk stratify them
immetriate treatment of acute MI
BEMOAN
beta blocker
enoxaparin
morphine
oxygen
ASA
nitro
therapeutic apprach to severe migraine
1L NS bolus
metaclopramide 10
diphenhydramine 25
ketorolac 30
dex 10
Ottawa Subarachnoid hemorrhage rule
for headaches of adult patients reaching maximum intensity within 1 hour, further investigate if:
- age >40
- neck pain or stiffness
-witnessed LOC
- onset during exertion
- thunderclap headache
- limited neck flexion.
treatment for meningitis
early empiric abx: ceftriaxone, vancomycin, ampicillin +/- acyclovir, +/- steroid therapy
DO NOT wait for LP
findings on CT of subarachnoid hemorrhage (worst heachache in life)
hyperattenuating signal around Circle of Willis
Symptoms of giant cell arteritis
fever, myalgia, temporal headache, scalp tenderness, middle-older age women, jaw claudication, malaise/weight loss, optic disc edema on fundoscopy.
positive ESR CRP
temporal artery biopsy is gold standadr
treat with high dose steroids immediately if suspected, no need to hold treatment until path results
what other autoimmune condition is temporal arteritis assocaited with
polymyalgia rheumatica
outline 1-2a/b-3 heart conduction block
- long PR interval. Not really a block
2i/Weinchebach: each PR drop gets longer until it drops
2ii/mobitz II: fixed drop every 3rd beat or something
3: atrial P waves are “going through”/independent of ventricular complexes
what is holiday heart
a fib in the context of heavy alcohol use.
what to do if anticoagulation is contraindicated in someone with a vte (ex/ they had a brain bleed)
IVC filture or surgical thrombectomy if anticoagulation is contraindicated.
signs of PE on CXR
westermark’s sign (abrupt tapering of a vessel on chest film)
hampton’s hump (wedge shaped infiltrate that abuts the pleura
management of DKA
- hydration
- potassium
- insulin
-d50 usually
-bicarb if at risk of shock (acidotic)
HHS vs DKA
HHS- person usually more dry, older, more comorbid illness that has been evolving over a few days to weeks. fever GI symptoms and more neurological deficits than DKA. Polyuria, N/V
whipples triad for hypoglycemia
low plasma glucose, symptoms suggestive of hypoglycemia, prompt resolution of symptoms when glucose administred
treating severe hypoglycemia
IV access and rapid glucose measurement (d50W 50ml IV push)
- if no IV, glucagon
- thiamine if etOH use disorder is suspected
- full meal as soon as mental status permits
- search for cause (usually too much insulin)
management of NSTEMI
stabilize (o2, IV access, monitors)
ASA + ANOTHER antiplatelet (clopidogrel, ticagreloor)
Anticoagulant (unfractionated hep or LMWH)
nitro
statin
beta blocker if no signs of CHF
initiate ACEi within 24 hours.
reperfusion therapy protocol for STEMI
PCI within 90 minutes, thrombolytics (alteplase) if percutaneous corontary intervention unavailable within time frame
sudden onset of severe unilateral eye pain or a headache associated with blurred vision, rainbow-colored halos around bright lights, nausea, and vomiting. The physical exam will reveal a fixed midpoint pupil and a hazy or cloudy cornea with marked conjunctival injection.
Dx and treatment
acute angle closer glaucoma. Must manage the high IOP
- timolol eye drops
alpha 2 agonists like apraclonidine or epi
this condition has sudden painless monocular vision loss, and a cherry red spot and retinal pallor on fundoscopy
retinal artery occlusion. Must restore blood flow. Decrease IOP via timolol
Parkland formula for burns
ringers lactate 4cc/kg/% BSA burned. Give half in the 8 hours, then the other half over the 16.
first line abx for cat and dog bites
amoxicillin and clavulanic acid
Which psych meds cause wide QT? Which ones wide QRS?
long QT= antipsychotics
wide QRS= TCAs
ASA toxicity treatment:
The earliest symptoms of acute aspirin poisoning may include ringing in the ears (tinnitus) and impaired hearing. More clinically significant signs and symptoms may include rapid breathing (hyperventilation), vomiting, dehydration, fever, double vision, and feeling faint.
- bicarb via urine alkalinization,
- fluid resus, then 3 amps of bicarb in 1L of D5W at 1.5 maintenance. add 20 KCL if patient is able to urinate.
- hemodialysis
anticholinergic toxidrome
mad as a hat –> agitation and halluciation
dry as a bone
red as a beet: vasodilation
blind as a bat: dilated pupils.
ileus
tachycardia
cholinergic toxidrome
dumbels
diaphoresis
urination
miosis
bronchospasm
emesis
lacrimation
salivaiton
*will see in organophosphate poisoning
reversal of heparin
protamine sulfate
reversal of benzo
flumazanil
treating agitation chemically
benzo: loraz 2
antipsychotic: halo 5, or olanzepine 5-10
b52: benadryl, 5halo, 2loraz
