Emergency Medicine Flashcards
If a pt is 12+ weeks pregnant, what type of bedside US should be performed?
If a pt is 10-12 weeks pregnant, what type of bedside US should be performed?
12+ weeks: Transabdominal
10-12 weeks: Transvaginal
A pt reports to the ED w/ obvious ascites. When performing a paracentesis with a 60 cc syringe, you notice the fluid is very yellow. What medical condition could the patient have that would cause his ascites to be this color?
Liver cirrhosis
When performing a paracentesis, you should pull down on the pt’s abd, approximately __-__ cm. After drawing fluid, you should analyze it for what?
1-2 cm; infection
You have expertly repaired a child’s laceration on their face with beautiful suture technique. When giving the patient discharge instructions, you inform them that they will need to return to have the sutures removed in __-__ days.
3-5
If the patient’s sutures were placed on the lips, mouth, or tongue, you should send the patient home with what?
A Rx for oral abx
A pt presents to the ED with a swollen knee. You are concerned that she may have a septic joint. What are your next steps?
Perform arthrocentesis: remove fluid and send for analysis as a septic joint could lead to loss of the joint or limb. Rx abx.
A pt presents to the ED with a swollen knee. You are concerned that she may be experiencing an inflammatory process like gout. What are your next steps?
Arthrocentesis: remove fluid, send fluid for analysis looking for crystals etc, refer to a rheumatologist
Where can abscesses occur?
Anywhere!
You have just drained an abscess in a pt’s mouth. Do you pack it with sterile gauze? Should you send the pt home with anything?
No, you do not use packing in the mouth
Yes, abx Rx
With orbital or preseptal cellulitis is there a concern for vision loss?
Orbital cellulitis presents a concern for losing vision
Before performing an I&D of a pt’s paronychia, you need to numb the site. How is this performed? How long will you need to wait before the site is numb?
Digital block; 20-30 minutes for numbness to reach tip of finger
Pt presents to the ED with an abscess. She has never had one before. You perform an I&D following proper technique. The pt has no known Hx of MRSA infection. Does this pt require abx?
No; would Rx abx if pt had Hx of multiple abscesses or MRSA
A pt presents to the ED and mentions that she has a pilonidal cyst. Being a smart PA, you know that a pilonidal cyst is located ____ and is a cyst that has become infected. She has no Hx of MRSA infection. After performing an I&D of the pilonidal cyst, do you Rx abx?
Gluteal region
Yes, you would Rx abx after performing an I&D of a pilonidal cyst.
What imaging study can be utilized to assess an abscess for fluctuance, or relative “ripeness”?
US
Where is a Bartholin gland cyst usually located?
Usually at 3/4 o’clock or 7/8 o’clock posterior/lateral to the vaginal opening, anterior to the rectum
Do you drain a Bartholin gland cyst?
No
After incision, what do you insert in a Bartholin gland cyst in order to help it drain?
Word catheter
then have pt f/u w/ GYN
What are the two sizes of sterile gauze typically associated with I&D kits?
1/4 inch and 1/2 inch
What is CroFab used for?
Snake bites or other envenomation
Level 1-5?
High risk of deterioration, or signs of a time-critical problem
i.e. cardiac related CP, asthma attack
2 (Emergent)
Level 1-5?
Immediate, life-saving intervention required without delay, i.e. cardiac arrest, massive bleeding
1 (Resuscitation)
Level 1-5?
Stable, with only one type of resource anticipated (such as only an X-ray, or only sutures)
i.e. simple laceration, pain on urination
4 (Less Urgent)
Level 1-5?
Stable, with multiple types of resources needed to investigate or treat (such as lab tests plus X-ray imaging)
i.e. abd pain, high fever with cough
3 (Urgent)
Stable, with no resources anticipated except oral or topical medications, or prescriptions
i.e. rash, Rx refill
5 (Nonurgent)
What does the primary survey consist of?
ABCDE
What does ABCDE stand for?
Airway patency and c-spine protection Breathing and ventilation Circulation and hemorrhage control Disability and neurological status Exposure/Environmental control
What is an AMPLE history?
Allergies Medications PMHx Last meal Events leading up to ED visit
What does the secondary survey consist of?
A head to toe physical examination
Examples of life-threatening abd pain include…
Abdominal aortic aneurysm Bowel obstruction Ruptured ectopic pregnancy or ectopic pregnancy Splenic rupture Myocardial infarction Mesenteric ischemia GI perforation Testicular torsion Ovarian torsion
The following conditions may present as pain in what abd quadrant? Retrocecal appendicitis Empyema Gallbladder and biliary tract Hepatitis Hepatomegaly Peptic ulcer Pancreatitis Renal pain Herpes zoster MI PNA
RUQ
The following conditions may present as pain in what abd quadrant? Appendicitis Diverticulitis Intestinal obstruction Leaking aneurysm Abdominal wall hematoma Ectopic pregnancy Ureteral calculi Renal pain Psoas abscess Seminal vasculitis
LLQ
The following conditions may present as pain in what abd quadrant? Appendicitis Intestinal obstruction Regional enteritis Diverticulitis Perforated ulcer Ectopic pregnancy Ovarian cyst or torsion Endometriosis
RLQ
The following conditions may present as pain in what abd quadrant? Gastritis Empyema Pancreatitis Splenic (enlargement, rupture, aneurysm, infraction) MI Renal pain Herpes zoster PNA
LUQ
Reportable events include examples of complaints like …
Animal bites, STDs, child abuse, sexual abuse
