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

Emergency Medicine Flashcards by Bronwyn Delacruz

unilateral, non-reactive pupil? Think:

focal mass
epidural hematoma
subdural hematoma

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Explain fluid resus during a trauma

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

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Cushing’s sign of increased ICP

hypertension
bradycardia
irregular respirations

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signs of ICP

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

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best imaging modality for head trauma

non-contrast CT

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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

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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.

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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)

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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.

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becks triad of tamponade

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

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BP phenomenon seen in cardiac tamponade

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

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which organs are retroperitoneal

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

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Management of open fracutres

STAND:
Splint
Tetanus prophylaxis
antibiotics
neurovascular status
dressing.

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6 Ps of compartment syndrome

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

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nerves at risk on anterior shoulder dislocation

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

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scaphoid fracture management

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

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preferred imaging modality in assessment of acute pelvic pain

ultrasound

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AEIOU TIPS for COMA

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

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life threatening causes of chest pain

PE
esophageal rupture
tamponade
MI/angina
Aortic dissection
pneumothorac

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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

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

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