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Emergency Medicine > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is the considered temperature for mild hypothermia?

A
  • 34 C -36 C

- 93.2 F - 93.2 F

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2
Q

What is the considered temperature for moderate hypothermia?

A

30 C - 34 C

86 F - 93.2 F

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3
Q

What is the considered temp for sever hyperthermia?

A

less than 30 C

less than 86 F

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4
Q

What are the symptoms for mild hypothermia?

A
  • tachycardia
  • tachypnea
  • shivering
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5
Q

What are the Sx of moderate hypothermia?

A
  • loss of shivering reflex
  • alterations of conciseness
  • bradycardia
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6
Q

What are the Sx of Severe hypothermia?

A
  • fixed dilated pupils

- ventricular fibrilation

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7
Q

What is the Tx for hypothermia?

A
  • take off wet clothing
  • warm IV fluids
  • warm blankets
  • heated O2
  • extracorporeal blood warming*, Gold Standard of Tx
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8
Q

What is the Gold Standard of Tx for hypothermia?

A

extracorporeal blood warming

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9
Q

What is the Tx for frostbite?

A
  • rewarming
  • hyperbaric oxygen
  • or surgical debridement
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10
Q

What are the findings with 1st degree frostbite?

A

-freezing without blistering

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11
Q

What are the findings with 2nd degree frostbite?

A

-freezing with clear blistering

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12
Q

What are the findings with 3rd degree frostbite?

A

-freezing with death of skin

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13
Q

What are the findings with 4rth degree frostbite?

A

-freezing with full thickness involvement, tissue and bone

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14
Q

What are the S/Sx of frostbite?

A

-initial white or blue/white cold skin

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15
Q

What are the S/Sx of Heat Stroke?

A
  • altered mental status
  • multiorgan dysfunction
  • core temp over 41C (105.8 F)
  • Head ache
  • siezures
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16
Q

What is the Tx for heatstroke?

A

-rapid body temp reduction

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17
Q

What is the most common cause of death in electrical injuries?

A

-respiratory arrest

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18
Q

What are the other common problems with electrical injuries?

A
  • ventricular fibrillation

- asystole

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19
Q

What are the S/Sx of High-Altitude sickness?

A
  • Headache
  • Nausea
  • fatigue
  • weakness
  • insomnia
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20
Q

What is the treatment for High-Altitude sickness?

A
  • decent
  • oxygen
  • antiemetics
  • if decent is not possible, tx with dexamethasone or acetazolamide
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21
Q

What are the two types of poisonous snakes?

A
  • pit vipors

- Elapids

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22
Q

What snakes are pit vipers?

A
  • rattle snakes
  • water moccasins
  • copperheads
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23
Q

What are the Elapid snakes?

A
  • coral snakes

- cobras

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24
Q

What is the Tx for poisonous snakes?

A

-antivenom (Crotalide Polyvalent)

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25
Q

What are the S/Sx of a Black Widow Spider bite?

A
  • sever pain
  • muscle spasms of the abdomen and trunk
  • severe hypertension
  • tachycardia
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26
Q

What is the Tx for a Black Widow Spider bite?

A
  • narcotic analgesics
  • local ice
  • antivenom only for seriously ill
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27
Q

Describe a Brown Recluse spider?

A

-Dark, violin-shaped area on its back

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28
Q

A Brown Recluse Spider causes these tissue changes?

A
  • it’s cytotoxic venom tissue necrosis

- it also causes hemolysis

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29
Q

What is the Tx for a Brown Recluse Spider?

A

+/- dapsone (sulfonamide antibiotic)

-antivenom (not in the US)

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30
Q

What is the cause of hypovolemic shock?

A

-bleeding

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31
Q

What are the S/Sx of hypovolemic shock?

A
  • initially tachycardia
  • advances to hypotension
  • cool skin
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32
Q

What is the Tx for hypovolemic shock?

A

-fluids, 20cc/kg
-blood transfusion
+/- surgery

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33
Q

What is the cause of cardiogenic shock?

A

pump problem / heart pumping problem

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34
Q

What are the etiology of cardiogenic shock (pumping problems) ?

A
  • MI
  • tachydysrythmias
  • bradycardia
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35
Q

What are the S/Sx of cardiogenic shock?

A
  • hypotension (low EF)

- cool skin

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36
Q

What is the Tx for cardiogenic shock?

A
  • MI treatments
  • vasopressors
  • IAPB
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37
Q

What is the etiology of Anaphylactic Shock or Bronchospasm?

A
  • could be any agent

- usually food

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38
Q

What are the S/Sx of Anaphylactic Shock?

A
  • difficulty breathing

- hypotension

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39
Q

What is the Tx for anaphylactic shock?

A
  • epinephrine 0.3 - 0.5 sub q
  • albuteral
  • steroids
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40
Q

What is the usual cause of septic shock?

A

-often gram negative rods

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41
Q

What are the S/Sx of septic shock?

A
  • fever
  • tachypnea
  • hypotension with decreased SVR (systemic vascular resistance)
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42
Q

What is the Tx for septic shock?

A

-IV antibiotics

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43
Q

What is neurogenic shock?

A

-spinal cord injury

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44
Q

What are the S/Sx of neurogenic shock?

A

-hypotension due to loss of vascular tone which causes warm flushed skin

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45
Q

What is the Tx for neurogenic shock?

A
  • vasopressors
  • volume
  • surgery
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46
Q

What are the causes of Obstructive Shock?

A
  • -tension pneumothorax
  • pericardial tamponade
  • PE
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47
Q

Describe the Rule of 9 for Adult burns?

A
  • head/neck 9
  • R arm 9
  • L arm 9
  • Torso, front 9
  • Torso, back 9
  • R leg 9
  • L leg 9
  • Genitalia 1Total 100
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48
Q

What is Hyponatremia?

A

< 136 mEq/L

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49
Q

What is the etiology for hyponatremia?

A

-hypotonic (water) > hypertonic (glucose and mannitol)

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50
Q

What are the S/Sx of hyponatremia?

A
  • HA
  • HV
  • seizures
  • cerebral edema
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51
Q

What is the Tx for hyponatremia?

A

-fluid restriction

+/- hypertonic 3% saline solution

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52
Q

What is hypernatremia?

A

> 146 mEq/L

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53
Q

What are the causes of hypernatremia?

A
  • Net water loss

- Sodium gain (Cushings Syndrome)

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54
Q

What are the S/Sx of hypernatremia?

A
  • thirst
  • weakness
  • seizures
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55
Q

What is the Tx for hypernatremia?

A

-hypotonic solutions (DW5)

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56
Q

What is hyperkalemia?

A

> 5.0 mEq/L

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57
Q

Is hyperkalemia an urgent situation?

A

-yes, it is a True emergency

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58
Q

What are the causes of hyperkalemia?

A
  • renal failure
  • ACE-inhibiors
  • spironolactone
  • digoxin
  • Addison’s disease
  • oral potassium excess
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59
Q

What are the S/Sx of hyperkalemia?

A
  • fatigue
  • muscular weakness
  • paresthesias
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60
Q

What does an EKG of hyperkalemia look like?

A
  • peaked T wave
  • QRS widening
  • ventricular fibrillation
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61
Q

What is the Tx for hyperkalemia?

A
  • IV calcium
  • IV lasix
  • glucose and insulin
  • dayexalte
  • albuterol
  • dialysis
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62
Q

What is hypokalemia?

A

3.5 mEq/L

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63
Q

What is the etiology for hypkalemia?

A
  • diuretics
  • vomiting
  • diarrhea
  • Cushing’s syndrome
  • magnesium depletion
  • poor intake
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64
Q

What are the S/Sx of hypokalemia?

A
  • weakness
  • paralytic ileus
  • atrial or ventricular tachycardia
  • ventricular fibrillation
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65
Q

What are the EKG findings for hypokalemia?

A
  • decreased T wave amplitude
  • T wave inversion
  • ST depression
  • U wave
  • prolonged QT
  • ventricular tachycardia
  • Torsades de points
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66
Q

What is the tx for hypokalemia?

A

-IV or PO potassium

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67
Q

What is the Tx for hypokalemia?

A

-IV or PO potassium

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68
Q

What is Hypercalcemia?

A

> 11 mg/dl

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69
Q

What are the causes of hypercalcemia?

A

-Primary hyperparathyroidism (#1 cause)
-Malignancies (#2)
(bone, lymphoma, leukemia, multiple myeloma)

  • Lithium therapy
  • Sarcoidosis
  • Endocrine (thyroxicosis, pheocromocytoma, adrenal insuff)
  • Drugs: tamoxifen, Vit A, Vit D
  • Renal failure
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70
Q

What is the #1 cause of hypercalciemia?

A

-primary hyperparathyroidism

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71
Q

What is the #2 cause of hypercalciemia?

A
  • Malignancies
    • bone
    • lymphoma
    • multiple myeloma
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72
Q

What are the Clinical features of hypercalcemia?

A
  • CNS
  • Neuromuscular
  • Cardiac
  • Renal
  • GI
  • Eye
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73
Q

What are the CNS features of hypercalemia?

A
  • lethargy
  • depression
  • psychosis
  • ataxia
  • stupor
  • coma
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74
Q

What are the neuromuscular features of hypercalcemia?

A
  • weakness

- proximal myopathy

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75
Q

What are the cardiac features of hypercalcemia?

A
  • hypertension
  • bradycardia
  • shortened QT interval
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76
Q

What are the Renal features of hypercalcemia?

A
  • stones
  • decreased glomerular filtration rate
  • polyuria
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77
Q

What are the GI features of hypercalcemia?

A
  • N/V
  • constipation
  • anorexia
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78
Q

What are the eye features of hypercalcemia?

A

-band keratopathy

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79
Q

What is the Tx for hypercalcemia?

A
  • Hydration
    • saline diuresis
  • UV biphosponates (first choice)*
    • inhibit osteoclastic bone resorption
    • Transient fever and myalgia can occur

Calcitonin

Glucocorticoid admin is 1st line of Tx in patients with
Multiple myeloma, lymphoma, sarcoidosis, intoxication
with Vit D or Vit A

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80
Q

What is Hypocalcemia?

A

-Serum Calcium < 8 mg/dl

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81
Q

What is the etiology of hypocalcemia?

A
  • chronic kidney disease (most common)*
  • hypoalbuminemia
  • hypoparathyroidism
    • hypocalcemia and hyperphosphatemia
  • Vitamin D deficiency
  • Magnesium depletion
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82
Q

What are the S/Sx of hypocalcemia?

A
  • Tetany: state of spontaneous tonic muscular contraction
  • Tingling paresthesias in the fingers and around the mouth
  • Carpopedal spasm - painful contraction with abduction of the thumb, followed by flexion of the MCP joints, extension of the IP joints, and flexion of the wrists
    • also seen with low magnesium
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83
Q

What are other S/Sx of hypocalcemia?

A

+ Chvostek’s sign: contraction of the facial muscle in response to tapping on the the facial nerve

+ Trousseau’s sign: carpal spasm occurring with BP cuff
inflation

  • Neuro: focal or generalized seizures, layngospasm
  • cardiac: prolongation of the QT interval
  • skin: dry, flaky, and brittle nails
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84
Q

What is the Tx for hypocalcemia?

A
  • calcium cloride

- calcium gluconate

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85
Q

What is the a positive Chvostek’s sign?

A

-contraction of the facial muscle in response to tapping on the facial nerve

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86
Q

When is the Chvostek’s sign seen?

A

-hypocalcemia

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87
Q

What is the Trousseau’s sign?

A

-carpal spasm occurring with BP cuff inflation

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88
Q

What is the etiology of an Acute Asthma Attack?

A
  • history of disease
  • aggravating factors
  • illness
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89
Q

What is classification of a mild exacerbation asthma attack?

A
  • DOE
  • PEF > 70%
  • Refief with inhaled SABA
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90
Q

What is a Moderate severity asthma attack?

A
  • Dyspnea at rest
  • PEF < 40 - 69
  • Sx 1 - 2 days after oral steroids
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91
Q

What is a Severe asthma attack?

A
  • Dyspnea at rest
  • PEF < 40 40%
  • S > days after oral steroids
92
Q

What is a Life Threatening Asthma Attack?

A
  • difficulty speaking
  • PEF < 25 %
  • no relief from SABA
93
Q

What are the S/Sx of an asthma attack?

A
  • shortness of breath
  • wheezing
  • cough
94
Q

Why get ABG testing with an asthma attack?

A

-rule out respiratory acidosis

95
Q

What is the Treatment for an asthma attack?

A

-oxygen
-B-agonists (repeated)
-IV magnesium
+/-BiPAP
-intubation
-systemic steroids

96
Q

What are the Risk Factors for and Acute Pulmonary Ebolism?

A
  • age > 50
  • obestity (BMI >35)
  • pregnancy
  • cancer
  • inherited thrombophilia
  • immobility
  • best rest ( 72 hrs )
  • travel
  • smoking
  • CHF
  • stroke ( 1st month)
  • estrogen
  • inflam conditions
97
Q

What are the S/Sx of an Acute Pulmonary Emobolim?

A
  • acute dyspnea
  • pleuritic chest pain
  • tachypnea
  • hypoxia
98
Q

How is an Acute Pulmonary Emobism Dx?

A

-pulmonary angiogram

99
Q

What is the Tx for an Acute Pulmonayr Embolism?

A
  • Oxygen
  • anticoagulation
  • thrombolytick therapy
100
Q

What is Respiratory Acidosis?

A

-pH < 7.35 with pCO2 > 45

101
Q

What is the etiology for Respiratory Acidosis?

A
  • Narcotics
  • cardiac arrest
  • airway obstruction
  • pneumonia
  • COPD*
  • kyphoscoliosis
  • OSA
  • paralysis of respiratory muscles (guillain-barre, myasthenia gravis, tetanus, poliomyelitis)
  • hypoventilation
102
Q

What are the S/Sx of Respiratory Acidosis?

A
  • fatigue
  • irritability
  • HA
  • confusion
  • stupor
103
Q

What is the Tx for Respiratory Acidosis?

A
  • reverse underlying process
  • BiPAP
  • intubation
104
Q

What is Respiratory Alkalosis?

A

-pH > 7.45 with pCO2 < 35

105
Q

What is the etiology for Respiratory Alkalosis?

A
  • hyperventilation
  • early shock
  • early sepsis
  • trauma
  • anxiety
  • pregnancy
  • CVA
  • hyperthyroidism
  • pulmonary disease (asthma, pneumonia, PE)
106
Q

What are the S/Sx for Respiratory Alkalosis?

A
  • circumoral and digital paresthesias
  • carpopedal spasm
  • dizziness
  • confusion
107
Q

What is the Tx for Respiratory Alkalosis?

A
  • Tx underlying cause

- brown paper bag breathing

108
Q

What is Metabolic Acidosis?

A

-pH < 7.35 with Bicarb < 22

109
Q

What is the etiology for Metabolic Acidosis?

A

“MUD PILES” increased Anion Gab due to :

 - methanol
 - uremia
 - diabetic ketoacidosis
 - paraldehyde
 - ibuprofen/INH/Iron
 - lactic acidosis
 - ethyline glycol
 - salicylates (aspirin)

Normal Anion Gap :

 - diarrhea
 - renal tubular acidosis
110
Q

What are the S/Sx for Metabolic Acidosis?

A
  • dyspnea
  • decreased cardiac function
  • hyperkalemia
  • obundation
111
Q

What is the Tx for Metabolic Acidosis?

A
  • Tx underlying disease

- IV bicarbonate

112
Q

What is Metabolic Acidosis?

A

-pH > 7.46 with Bicarb > 26

113
Q

What is the etiology for Metabolic Acidosis?

A
  • vomiting
  • volume depletion (diuretics)
  • if hypertensive think primary aldosteronism
114
Q

What are the S/Sx of Metabolic Acidosis?

A
  • lethargy & confusion
  • hypokalemia
  • hypocalcemia
  • hypomagnesaemia
115
Q

What is the Tx for Metabolic Acidosis?

A

-acetazolamide

116
Q

What are the 3 types of Acute Coronary Syndrome?

A
  • insufficient blood flow to the heart muscle
  • Plaque rupture and thrombin or emboli
  • Stable angina > Unstable angina > NSTEMI > STEMI
117
Q

What are the S/Sx of Acute Coronary Syndrome?

A
  • chest pain
  • DOE
  • heartburn
  • L arm pain
  • anxiety
  • diaphoresis
  • nausea/vomitting
118
Q

What are the EKG findings in Acute Coronary Syndrome?

A
  • ST depression or elevation

- EKG may be normal

119
Q

What are the Lab findings with Acute Coronary Syndrome?

A

-elevated enzymes if infarction (troponin, CK)

120
Q

What is the Tx for Acute Coronary Syndrome?

A

-MONA
-beta blockers
+/- thrombolytic therapy
-percutaneous coronary intervention
-CABG

121
Q

Describe an Aortic Dissection>

A

-a rare but deadly disease due to tearing of there aortic intima

122
Q

What is a Type A aortic dissection?

A

-involves the ascending aorta

123
Q

What is a Type B aortic dissection?

A

-involves other than the ascending aorta

124
Q

What are the Risk Factors for an aortic dissection?

A
  • hypertension
  • cystic medial necrosis
  • trauma
125
Q

What are the S/Sx of an Aortic Dissection?

A

-abrupt chest pain often radiating to the back
-pulse differential
+/- aortic regurgitation murmur

126
Q

How is an aortic dissection Dx?

A
  • aortography
  • CT scan with contrast
  • Echo (TEE)
127
Q

How are Aortic Dissection Tx?

A
  • Type A, Tx by surgery

- Type B, Tx with medication

128
Q

How are Hypertensive Urgency/Emergency Tx?

A
  • may be treated Without or With Symptoms

- Tx is Nitroprusside, IV Labetalol

129
Q

What are the causes/etiology of Pericarditis?

A
  • infections
  • neoplasms
  • MI
  • uremia
130
Q

What are the S/Sx of Pericarditis?

A
  • fever
  • chest pain, worse with leaning forward
  • pericardial friction rub
  • effusion
131
Q

What are the EKG findings for Pericarditis?

A

-diffuse ST elevation

132
Q

What is the Tx for Pericarditis?

A
  • morphine
  • pericariocentesis
  • or pericardial window
133
Q

ACLS now changed to C-A-B, what is this?

A

-Airway, Breathing, Circulation

134
Q

What is the ACLS pharmacology for Epinephrine?

A

-1 mg, any pulseless rhythm

135
Q

What is the ACLS pharmacology for Vasopressin?

A

-40 units, VF/pulseless VT

136
Q

What is the ACLS pharmacology for Amiodarone?

A
  • 300 or 150 mg bolus then gtt for VT/VF/SVT
137
Q

What is the ACLS pharmacology for Magnesium?

A
  • 1-2 g, Torsade de pints
138
Q

What is the ACLS for Atropine?

A
  • 0.5 -1 mg for bradycardia
139
Q

What is the ACLS for Adenosine?

A
  • 6-6-12 mg doses for SVT
140
Q

What are the conditions considered in the Acute Abdomen?

A
  • appendicitis
  • obstruction
  • mesenteric
  • ischemia
  • GI bleed
  • ectopic pregnancy
  • pacreatitis
  • cholecystitis
  • pyelonephritis
  • PID
  • intussusception
141
Q

What are the S/Sx of the acute abdomen?

A
  • pertioneal inflammation (+/- rebound tenderness)
  • pain that precedes the vomiting or diarrhea
  • pain out of proportion of the physical exam
142
Q

What is the Tx for at the Acute Abdomen?

A

-treat the underlying cause

143
Q

What is another name for Esophageal rupture?

A

-Boehaave’s Syndrome

144
Q

Describe the clinical picture of an esophageal rupture (Boerhaave’s Syndrome)?

A

-Triad of vomiting, lower chest pain and subcutaneous emphysema

145
Q

What is the etiology of an Esophageal rupture?

A
  • forceful voming
  • instrumentation
  • trauma
146
Q

What are the S/Sx of an Espopageal rupture?

A

-hypotension
-tachycardia
-dyspnea
-fever
+/- sepsis

147
Q

How is an Esophageal rupture Dx?

A
  • contrast-enhanced CT

- water soluble esophageal fluoroscopy or barium esophagram

148
Q

What is the Tx for an Esophageal rupture?

A
  • NPO
  • IV antibiotics
  • surgery
149
Q

What are the Neurologic emergencies by percentage?

A
  • Ischemic stroke (80%)

- Hemorrhagic stroke (20%)

150
Q

What are the causes (etiology) for a ischemic stroke?

A
  • thrombotic
  • embolic
  • lucunar occlusions
151
Q

What are the risk factors for an ischemic stroke?

A
  • A fib
  • valve disease
  • bleeding dyscrasias
  • atherosclerosis (HTN, TIA’s, hyperlipidemia, smoking, +family hx use of oral contraceptives)
152
Q

What are the S/Sx for an ischemic stoke?

A
  • they very

- neurological defects in sensory motor or speech function

153
Q

How is an ischemic stroke Dx?

A

-Emergent non-contrast head CT scan

154
Q

How is an ischemic stroke Tx?

A

-Thombolitic therapy as per AHA?ASA guidelines

155
Q

What are the two types of hemorrhagic stroke?

A
  • Subarachnoid Hemorrhage

- Intracerebral Hemorrhage

156
Q

What is the etiology of a Hemorrhagic stroke?

A

-80% due to saccular or berry aneurysms

157
Q

What are the risk factors for a hemorrhagic stroke?

A

+family hx

  • NTN
  • smoking
  • heavy ETOH
  • connctive tissue diseases
  • polycystic kidney disease
158
Q

What are the Sx of a hemorrhagic stroke?

A
  • “worse headache of my life”
  • N/V
  • neck stiffness
  • photophobia
  • visual changes
  • loss of consciousness
159
Q

How is a Hemorrhagic stroke Dx?

A
  • head CT
  • if neg then lumbar puncture
  • angiography
160
Q

What is the Tx for intracerebral hemorrhage?

A

-Neurosurgery

161
Q

What is Wernicke Encephalopathy?

A

-it is also known as Acute Thiamine Decficiency

162
Q

What is the Cause of Wernicke Encephalopathy?

A
  • Alcoholism

- malnutrition (thiamine decficiency)

163
Q

What are the S/Sx of Wernicke Encephalopathy?

A
  • opthalmoplegia
  • ataxia
  • mental status changes
164
Q

What are the Opthalmoplegia S/Sx seen in Wernicke Encephalopathy?

A

-nystagmus (horizontal or horizontal and vertical)
+/- 6th nerve palsey (eye turns inward toward the nose)
(often causes double vision)

165
Q

What are the ataxia S/Sx seen with Wernicke Encephalopathy?

A
  • the ataxia is a wide-based, and unsteady gait
166
Q

What are the mental status changes seen with Wernicke Encepalopathy?

A
  • drowsiness
  • inattention
  • decreased spontaneous speech
  • Korsakoff’s psychosis (marked impairment of recent memory and inability to retain new information)
167
Q

What is the Tx for Wernicke Encephalopathy?

A
  • Thiamine 100 mg IV

- replace magnesium if needed

168
Q

What is the Flail Chest?

A

-painful paradoxical motion of the rib cage or sternum due to trauma

169
Q

What are the common associated injuries with the Flail Chest?

A
  • rib fractures

- pneumothorax

170
Q

What is the Tx for Flail Chest?

A

-Surgery

171
Q

What is the amount of measured pressure in a Compartment syndrome?

A

-increased pressure > 30 mmHG

172
Q

What are the 4 common compartments of the leg?

A
  • anterior
  • lateral
  • posterior
  • deep posterior
173
Q

What are the S/Sx of a compartment syndrome?

A
  • pallor (pale, shiny skin)
  • pulselessness
  • pain
  • paresthesias
  • poikilothermia (increased skin temp on the affected side)
  • paralysis
174
Q

What is the Tx for a leg compartment syndrome?

A

-fasciotomy

175
Q

What are the two orthopeadic emergencies?

A
  • Flail chest

- leg compartment syndrome

176
Q

What are the two eye emergencies?

A
  • Acute angle-closure (IOP > 30)

- Central Retinal-Closure glaucoma

177
Q

What constitutes Acute-closure glaucoma?

A

-IOP > 30

178
Q

What are the S/Sx of Acute-angle closure glaucoma?

A
  • Severe unilateral eye pain
  • N/V
  • Blurry vision
  • mid dilated unreactive irregular pupil
  • halos around lights
179
Q

What is the Tx for Acute-angle closure glaucoma?

A
  • Acetazolamide
  • Timolol
  • pilocarpine
  • IV mannitol
180
Q

What are the S/Sx of a Central Retinal Artery Occlusion?

A
  • sudden, painless complete loss of vision in one eye

- cherry-red fovea

181
Q

What is the Tx for a Central Retinal Artery Occlusion?

A
  • ocular massage
  • IV actazolamide
  • thrombolytics
182
Q

What is Diabetic Ketoacidosis?

A

-A life threatening condition that develops when cells are unable to get glucose for energy. When cells do not receive sugar the body begins to break down fat and muscle for energy. When this occurs, ketones, or fatty acids, are produced and enter the bloodstream, causing imbalance (metabolic acidosis) called diabetic ketoacidosis.

183
Q

What causes Ketoacidosis?

A
  • not taking insulin
  • severe infection or other illness
  • severe dehydration
  • or a combination of the above
184
Q

What are the RF for diabetic ketoacidosis?

A
  • diabetic or recent infection
  • trauma
  • MI
  • CVA
  • Ethanol
  • pancreatitis
  • gastroenteritis
185
Q

What are the S/Sx of Diabetic Ketoacidosis?

A
  • fatigue
  • tachypnea (Kussmaul’s respirations)
  • tachycardia
  • altered mental status
  • abdominal pain
  • vomiting
  • polyuria
  • polydipsia
186
Q

What are the lab findings for diabetic ketoacidosis?

A

-hyperglycemia
-metabolic acidosis with bicarb less than 15
+ketones in serum or urin
-hyperkalemia
+/-hyponatremia

187
Q

What is the Tx for diabetic ketoacidosis?

A
  • fluid therapy
  • insulin
  • bicarb
188
Q

Describe the Hyperosmolar Hyperglycemic state?

A

-a condition seen in diabetics due to severe dehydration

189
Q

What is not seen the hyperosmolar hyperglycemic state?

A
  • acidosis
  • ketones
  • kussmaul’s respirations
  • abdominal pain
190
Q

What are the risk factors for the hyperosmolar hyperglycemic state seen in diabetics?

A

-age
-infection
-MI
-CVA
-trauma
-Medications
steriods
thiazides
anticonvulsants

191
Q

What are the S/Sx of the hyperosmolar hyperglycemic state seen in diabetics?

A
  • polydipsia
  • polyuria
  • polyphagia
  • weakness
192
Q

What are the lab findings hyperosmolar hyperglycemic state?

A
  • Glucose > 600

- Bicarb > 15

193
Q

What is the Tx for the hyperosmolar hyperglycemic state?

A
  • fluid therapy

- insulin therapy

194
Q

What is hypoglycemia>

A

-Glucose < 50 mg/dl

195
Q

What are the causes of hypoglycemia?

A
  • infection
  • endocrine disorders
  • drugs or ETOH
  • liver failure
  • intentional overdose insulin
  • insulin secreting tumor
  • beta blocker overdose
  • pregnancy
  • salicylate toxicity
196
Q

What are the S/Sx of hypoglycemia?

A
  • irritability
  • diaphoresis
  • tachycardia
  • diplopia
  • paresthesias
  • coma
197
Q

What is the Tx for hypoglycemia?

A
  • IV glucose
  • IM glucagon
  • thiamine to ETOH patients to prevent Wernicke’s encephalopathy
198
Q

Descibe Thyroid Storm?

A

-Life threatening disorder

1-2 % of thyrotoxicosis

199
Q

What are the RF for Thyroid Storm?

A
  • thyroxic patient with illness
  • infection
  • surgery
  • pregnancy
  • CVA
  • DKA
  • stimulants
  • ETOH
200
Q

What are the S/Sx for Thyroid Storm?

A
  • fever*
  • tachycardia
  • atrial arrhythmias
  • mental status from confusion to coma
201
Q

What does a EKG in Thyroid Storm look like?

A
  • tachycardia
  • increased QRS interval
  • often atrial fibrillation for flutter
202
Q

What is the Tx for Thyroid Storm?

A
  • volume replacement
  • B-blockers
  • prophylthiouracil (PTU) > methimazol
  • steroids
203
Q

What are the S/Sx of testicular torsion?

A
  • high riding testicle with “bell clapper” deformity
  • absent cremaster reflex
  • N/V
  • abd pain
204
Q

What is the Tx for testicular torsion?

A

-surgery– must be performed within 6 hours

205
Q

What is Priapism?

A

-a constant involuntary erection

206
Q

What is the etiology for priapism?

A
  • sickle cell
  • leukemia
  • carcinoma
  • ETOH
  • ecstasy
207
Q

What is the Tx for Priapism?

A
  • Hydration
  • terbutaline
  • corporal injection
208
Q

What is angioedema?

A

-Angioedema is the rapid swelling (edema) that is similar to hives, but the swelling is under the skin instead of on the surface. It involves the dermis, subcutaneous tissue, mucosa and submucosa tissues.

209
Q

What is the S/Sx for angioedema?

A

-swelling of the face, lips, tongue

210
Q

What is the Tx for angioedema?

A
  • epinephrine
  • oxygen
  • antihistamines
  • steroids
211
Q

What is Toxic Epidermal Necrolysis?

A
  • TEN is also known as Lell’s syndrome
  • is a sever life threatening condition of the skin, that is usually a reaction to drugs. The top layer of the skin (epidermis) detaches from the lower layers of skin (dermis) all over there body.
212
Q

How of the body surface does TEN involve?

A

-30 % of body surface

213
Q

What is the mortality for TEN?

A

-30 %

214
Q

What is cause of TEN?

A

-post viral

215
Q

What is Stephen’s Johnson Syndrome?

A

-separation of the epidermis from the dermis

216
Q

What is the mortality rate for Stephens-Johnson Syndrome?

A

-5 %

217
Q

What is the etiology of Stephens-Johnson Syndrome?

A

-drug induced or viral

218
Q

What are the S/Sx of TEN or Sephens-Johnson Syndrome?

A
  • painful bullae
  • fever
  • rash
  • skin sloughing
  • mucosal involvement
219
Q

What is the Tx for Stephens-Johnson Syndrome and TEN?

A
  • stop offending agent
  • antibiotics
  • do not give steroids*
220
Q

What is Staphylococcal scalded skin syndrome?

A

-toxin-induced blistering dermatosis

221
Q

What are the S/Sx of Stapylococcal Scalded Skin Syndrome?

A
  • fluid filled bullae

- mucous membranes are spared

222
Q

What is the Tx for Staphylococcal Scalded Skin Syndrome?

A

-IV Nafacillin or Oxacillin

223
Q

What is Penphigus Vulagris?

A

-Autoimmune disease

224
Q

What are the S/Sx for Pemphigus Vulgaris?

A
  • blistering often, often oral lesions 1st

- may be toxic

225
Q

What is the Tx for Pemphigus Vulgaris?

A

-fluids
-steroids
+/- antibiotics

Emergency Medicine (1 decks)

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