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LMCC > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

unilateral, non-reactive pupil? Think:

A

focal mass
epidural hematoma
subdural hematoma

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2
Q

Explain fluid resus during a trauma

A

give bolus until heart rate comes down, urine output increases, and patient stabilizes. Then run maintenance.

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3
Q

Cushing’s sign of increased ICP

A

hypertension
bradycardia
irregular respirations

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4
Q

signs of ICP

A
  • cushings triad: hypertension, bradycardia, irregular respirations
  • deteriorating LOC
  • lateralizing CNS symptoms (cranial nerve palsy)
  • seizures
  • papilledema
  • nausea/vomiting/headache
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5
Q

best imaging modality for head trauma

A

non-contrast CT

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6
Q

In Vehicle vs Pedestrian Crash: look for Waddles Triad, which is:

A
  • 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

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7
Q

canadian head rule

A

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.

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8
Q

Can clear C-spine if:

A
  • 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)
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9
Q

what do the 3 vies of Cspine tell us

A
  1. lateral: swimmers view, injury of the processes
  2. odontoid view: assess the dens
  3. AP view: alignment of spinous processes and spacing.
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10
Q

becks triad of tamponade

A

hypotension
muffled heart sounds
distended neck veins
(+tachycardia and tachypnea)

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11
Q

BP phenomenon seen in cardiac tamponade

A

pulsus paradoxus
kussmaul’s sign (increased JVP with inspiration)

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12
Q

which organs are retroperitoneal

A

adrenal glands, aorta, kidneys, esophagus, ureters, pancreas, rectum, and parts of the stomach and colon (ascending and descending)

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13
Q

Management of open fracutres

A

STAND:
Splint
Tetanus prophylaxis
antibiotics
neurovascular status
dressing.

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14
Q

6 Ps of compartment syndrome

A

pale
pulseless
paresthesia
paralysis
pain
pain with passive stretch
polar (col)

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15
Q

nerves at risk on anterior shoulder dislocation

A

axillary nerve (lateral aspect of shoulder)
musculocutaneous nerve (extensor aspect of forearm)

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16
Q

scaphoid fracture management

A

spica splint 6-8 weeks, repeat XR in 2 weeks. Outpatient orthopedics follow-up

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17
Q

preferred imaging modality in assessment of acute pelvic pain

A

ultrasound

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18
Q

AEIOU TIPS for COMA

A

acidosis
epilepsy
infection
oxygen/opiates
uremia
temperature/trauma
insulin
psychogenic
structural/space-occupying lesion

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19
Q

life threatening causes of chest pain

A

PE
esophageal rupture
tamponade
MI/angina
Aortic dissection
pneumothorac

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20
Q

score to apply when discharging stable patient /negative workup due to chest pain

A

HEART score to risk stratify them

21
Q

immetriate treatment of acute MI

A

BEMOAN
beta blocker
enoxaparin
morphine
oxygen
ASA
nitro

22
Q

therapeutic apprach to severe migraine

A

1L NS bolus
metaclopramide 10
diphenhydramine 25
ketorolac 30
dex 10

23
Q

Ottawa Subarachnoid hemorrhage rule

A

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.

24
Q

treatment for meningitis

A

early empiric abx: ceftriaxone, vancomycin, ampicillin +/- acyclovir, +/- steroid therapy
DO NOT wait for LP

25
Q

findings on CT of subarachnoid hemorrhage (worst heachache in life)

A

hyperattenuating signal around Circle of Willis

26
Q

Symptoms of giant cell arteritis

A

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

27
Q

what other autoimmune condition is temporal arteritis assocaited with

A

polymyalgia rheumatica

28
Q

outline 1-2a/b-3 heart conduction block

A
  1. 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
29
Q

what is holiday heart

A

a fib in the context of heavy alcohol use.

30
Q

what to do if anticoagulation is contraindicated in someone with a vte (ex/ they had a brain bleed)

A

IVC filture or surgical thrombectomy if anticoagulation is contraindicated.

31
Q

signs of PE on CXR

A

westermark’s sign (abrupt tapering of a vessel on chest film)
hampton’s hump (wedge shaped infiltrate that abuts the pleura

32
Q

management of DKA

A
  • hydration
  • potassium
  • insulin
    -d50 usually
    -bicarb if at risk of shock (acidotic)
33
Q

HHS vs DKA

A

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

34
Q

whipples triad for hypoglycemia

A

low plasma glucose, symptoms suggestive of hypoglycemia, prompt resolution of symptoms when glucose administred

35
Q

treating severe hypoglycemia

A

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)

36
Q

management of NSTEMI

A

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.

37
Q

reperfusion therapy protocol for STEMI

A

PCI within 90 minutes, thrombolytics (alteplase) if percutaneous corontary intervention unavailable within time frame

38
Q

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

A

acute angle closer glaucoma. Must manage the high IOP
- timolol eye drops
alpha 2 agonists like apraclonidine or epi

39
Q

this condition has sudden painless monocular vision loss, and a cherry red spot and retinal pallor on fundoscopy

A

retinal artery occlusion. Must restore blood flow. Decrease IOP via timolol

40
Q

Parkland formula for burns

A

ringers lactate 4cc/kg/% BSA burned. Give half in the 8 hours, then the other half over the 16.

41
Q

first line abx for cat and dog bites

A

amoxicillin and clavulanic acid

42
Q

Which psych meds cause wide QT? Which ones wide QRS?

A

long QT= antipsychotics
wide QRS= TCAs

43
Q

ASA toxicity treatment:

A

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
44
Q

anticholinergic toxidrome

A

mad as a hat –> agitation and halluciation
dry as a bone
red as a beet: vasodilation
blind as a bat: dilated pupils.
ileus
tachycardia

45
Q

cholinergic toxidrome

A

dumbels
diaphoresis
urination
miosis
bronchospasm
emesis
lacrimation
salivaiton
*will see in organophosphate poisoning

46
Q

reversal of heparin

A

protamine sulfate

47
Q

reversal of benzo

A

flumazanil

48
Q

treating agitation chemically

A

benzo: loraz 2
antipsychotic: halo 5, or olanzepine 5-10

b52: benadryl, 5halo, 2loraz

LMCC (19 decks)

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