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Clinical Medicine > Emergency Medicine > Flashcards

Emergency Medicine Flashcards

1
Q

circulation: give what kind of fluids first?

A

2-3 L of crystalloids (normal saline or lactated ringers) then after then add blood

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2
Q

primary survey

A 
A-airway with c-spine stabilization
B-breathing
C-circulation with hemorrhage control
D-disability
E-exposure
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3
Q

which injuries do you treat first?

A

the most lethal ones

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4
Q

how do you assess patience of airway?

A

c-spine injury? Stridor, signs of obstruction
Blood, loose tissue, avulsed teeth,
Fx’s: facial, mandibular, tracheal

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5
Q

when to intubate?

A

Altered mental status

Unable to maintain airway

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6
Q

when to do cricothyroidotomy?

A

If inability to intubate due to airway edema, hemorrhage, laryngeal fx.

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7
Q

airway interventions

A 
Chin lift/jaw thrust
Suctioning
Oral or nasal airway
Intubation
Altered mental status
Unable to maintain airway
Cricothyroidotomy
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8
Q

what do you assess for circulation?

A 
Vital signs: hypotension, tachycardia
Pulse: strong vs. rapid/thready
Level of consciousness:
Impaired cerebral perfusion?
Skin color: pink vs. pale/ashen
Bleeding
External: identify and control
Internal: intra-abdominal, intra-thoracic, femur/pelvis fx.
Need for emergent surgery?
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9
Q

how do you assess disability?

A

brief neuro exam: mental status ,pupil size, see if can move all 4 extremities

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10
Q

what doees AVPU stand for?

A

Alert
Responds to Verbal StimulI
Responds to Painful Stimuli
Unresponsive

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11
Q

3 std initial trauma x rays

A

lateral c-spine, CXR, pelvis

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12
Q

initial labs in trauma

A 
Type and crossmatch in severely injured pt
CBC, chem-7, amylase
UA
UPT in females
ETOH, drug screen
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13
Q

secondary survey of head

A 
Head
Scalp bleeding
Control with direct pressure
Skull
Signs of fx: creptius or stepoff
Pupils
Ears
Hemotympanum? (basilar skull fx)
Facial fractures
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14
Q

secondary survey of neck

A

C-spine tenderness
Laryngeal injury, tracheal deviation (tension pneumo)
Keep immobilized until injury definitely ruled out

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15
Q

secondary survey of cheset

A 
Bruising, deformity, tenderness, crepitus
Review CXR
Injuries
Sternal fx, rib fx
Flail chest
Tension pneumothorax
Hemothorax
Sucking chest wound
Cardiac tamponade
Aortic rupture
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16
Q

secondary survey of abdomen/pelvis

A

Distention (internal bleeding)
Ecchymosis
Penetrating wound
Tenderness
Pelvic instability (press on anterior superior iliac spine)
Place nasogastric or orogastric tube
Frequent reassessment to look for change

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17
Q

“High-riding” prostate suggests ?

A

pelvic fracture/urethral disruption

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18
Q

secondary survey of genitourinary

A 
External inspection
Bruises, hematomas, lacerations
Rectal exam
Blood?
“High-riding” prostate suggests pelvic fracture/urethral disruption
Bimanual vaginal exam
Lacerations, blood
Pregnancy test on females
Place Foley catheter
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19
Q

secondary survey of m/S system

A 
Musculoskeletal
Back
Log-roll patient while stabilizing C-spine
Inspection
Percussion for tenderness of thoracic or lumbar spine
CVA tenderness
Extremities
Soft tissue injury
Lacerations
Fractures
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20
Q

secondary survey of neuro

A 
Neuro
More thorough neuro exam
Level of consciousness
Glascow Coma Score is the standard
Re-eval of LOC and pupils
Look for signs of deterioration
Motor/Sensory of extremities
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21
Q

3 components of glasgow coma scale

A

eye opening, verbal response, motor response

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22
Q

lowest and highest scores of glasgow coma scale

A

3, 15

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23
Q

T or F: always assume hypotension is due to brain injury

A

F: always look for other source of hemorrhage head injuries usu cause hypertension

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24
Q

assessment of head trauma

A

Neurologic Exam
Level of consciousness
Glascow Coma Score
Pupil size/reactivity/equality
Motor exam
Unilateral deficit suggests intracranial mass lesion
If flaccidity, suspect spinal cord injury
Brainstem function
Corneal, gag reflexes
Repeated exams essential to detect deterioration

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25
Q

standard imaging for suspected head trauma

A

CT: head X-rays are worthless b/c don’t give you info on brain

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26
Q

tx of linear non depresses skull fx

A

none! if no depression, no problem with brain no tx needed

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27
Q

tx of depressed skull fx

A

feel for crepitus, surgery to elevate fragment, abx (if open)

28
Q

basilar skull fx signs

A

Hemotypanum
Raccoon’s Eyes
Battle’s sign: mastoid ecchymosis
CSF rhinorrhea/otorrhea

29
Q

tx of basilar skull fx

A

none! close observation

30
Q

causes of airway obstruction

A
  • Loss of muscle tone in obtunded pt: tongue obstructs oropharynx
  • Foreign body aspiration
  • Epiglottitis • Angioedema
  • Oral-facial trauma
  • Signs: stridor, inability to speak, breathe, cough
31
Q

opening maneuvers of airway

A
  • Head tilt/chin lift, jaw thrust (lift tongue away)
  • If foreign body: finger sweep, back blows, Heimlich, direct visualization/removal with forceps
  • If complete obstruction, consider cricothyroidotomy
32
Q

life threatening causes of chest pain

A
  • Unstable angina/acute MI
  • Aortic dissection
  • Pulmonary embolus • CHF
  • Pneumothorax
  • Pneumonia
33
Q

generally benign causes of chest pain

A
  • Costochondritis
  • Pleurisy • Pericarditis
  • GERD/esophageal spasm
34
Q

who can have atypical presentations of chest pain/MI

A

women, elderly, diabetic pts

35
Q

what does reversible ischemia look like on EKG?

A
  • ST depression, T-wave flattening or inversion

* Changes resolve after episode is over

36
Q

what does acute mI look like on EKG?

A
  • ST elevation
  • Reciprocal changes
  • New LBBB
  • Q-wave develops later
37
Q

which cardiac enzyme is best to look for MI? how long do you follow?

A

troponin about 3-6 hours is detectable, follow for one day?

38
Q

management of mI: mONAH

A
  • Oxygen
  • Aspirin (+/- clopidogrel) • Heparin/enoxaparin
  • Nitrates • Beta-blockers
  • If acute MI: emergent cardiac cath (vs. t-PA)
39
Q

RFs for aortic dissection

A

age, HTN, atherosclerosis, Marfan’s syndrome

40
Q

what is the typical and atypical presentation of aortic dissection?

A

typical: ripping or tearing pain in chest or BACK
atypical: if Dissection may occludes major vessels
− Carotids: stroke symptoms
− Coronaries: acute MI
− Brachial, iliac: arm/leg ischemia- common presentation

41
Q

tx of aortic dissection

A
  • Emergent cardiovascular surgery consult
  • Lower BP, decrease shearing forces: propranolol, nitroprusside
  • Proximal dissections require surgery- type II may not
42
Q

what do contusions look like on brain?

A

white blood, surrounded by dark edema

43
Q

Tearing/shearing of nerve fibers at time of impact
CT may be normal despite profound neurological deficit
Results in prolonged, possibly permanent coma
Mortality 33%, usually due to cerebral edema

A

diffuse axonal injury

44
Q

Focal hemorrhagic area on brain, often surrounded by edema

A

cerebral contusion

45
Q

how is intracerebral hemorrhage different from cerebral contusion/

A

more blood, possibility of expanding more d/t torn blood vesels

46
Q

artery torn in epidural hematoma

A

middle meningeal

47
Q

signs of impending brain herniation

A

ipsilateral dilated pupil and contralateral weakness

48
Q

Bleeding between dura and arachnoid/brain
Appears “sickle-shaped” on CT
Due to tears of bridging veins between cerebral cortex and dura
Often with severe underlying brain injury

A

subdural hematoma

49
Q

Bleeding between inner skull table and dura
Appears “lenticular” on CT
Usually due to skull fx. which tears middle meningeal artery
Often, little or no injury to underlying brain
May rapidly expand, causing herniation/death
If rapid surgical intervention, prognosis is often excellent

A

epidural hematoma

50
Q

assume ___ in all pts with significant trauma

A

spinal injury

51
Q

neuro assessment of spine

A 
Entire spine: cervical, thoracic, lumbar
Tenderness, deformity
Log-roll pt to examine back
One person maintains inline neck immobilization
Neuro assessment
Motor: corticospinal tract
Pain: spinothalamic tract
Position/vibration: posterior columns
Rectal tone/perianal sensation
52
Q

assessment of chest trauma

A 
ABC’s,Vital signs
Tachycardic? Hypotensive?
Neck veins
Distended?
Expose chest completely
Equal respiratory movement?
Chest wall trauma? Crepitus? Bruising? Deformity?
Quality of respiration
Shallow? Rapid?
Breath sounds
Equal? Diminished?
53
Q

signs of a tension pneumo

A 
Resp distress
Tachycardia
Hypotension
Tracheal deviation
JVD
Unilateral absent breath sounds
A clinical diagnosis
54
Q

these things make you think of which condition? what is the triad called?
Hypotension
Distended neck veins
Muffled heart tones

A

becks triad of pericardial tamponade

55
Q

EKG pattern of electrical alternans signifies what?

A

of cardiac tamponade

56
Q

tx of pericardial tamponade

A

IV fluids to

57
Q

internal organs most commonly injured in trauma

A

spleen and liver

58
Q

what sign will alert you to the fact that stomach or intestines have been punctured?

A

peritonitis and pertioneal findings; guarding, rebound tenderness, etc

59
Q

organs in retroperitoneum

A

Duodenum, pancreas, kidneys, ureters

60
Q

advantages and disadvantages of FAST exam (focused abdominal sonography for trauma)

A

Accurate, fast, noninvasive, portable (done at bedside)
Looks for free intraperitoneal fluid suggesting organ injury/bleed
Disadvantage: doesn’t show etiology of fluid

61
Q

advantages and disadvtanges of abdominal CT for trauma

A

advantages: shows precise lesion, sensitive and specific
disadvatanges: takes extra time

62
Q

signs of positive diagnostic peritoneal lavage (DPL)

A

> 100,000 RBC
>500 WBC
presence of bile or vegetable matter

63
Q

signs or sx of compartment syndrome

A

Pain, paresthesia, pallor, pulselessness, paralysis of involved muscles
Measure compartment pressures
> 35-45

64
Q

tests for near drowning

A

CXR, ABG, CBC, lytes

65
Q

treatment of near drownign

A 
Airway, ventilation, oxygenation
C-spine stabilization and eval
Cardiac monitor, O2 sat monitor, IV
If persisten hypoxia: ntubation and mechanical ventilation
Warming measures
No role for steroids or antibx

Clinical Medicine (19 decks)

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