EMERGENCY MEDICINE Flashcards
I HAVE BLOOD IN MY STOOLS
DZ X
HEMORRHOIDS ANGYODISPLASIA COLONIC POLYPS ULCERATIVE COLITIS CHRON DISEASE DIVERTICULITIS SOLITARY RECTAL ULCER
IWU:
CBC BUN CREATNINE NGT PLACEMENT AND LAVAGE PT/PTT ELECTROCARDIOGRAM
FM:
COLONOSCOPY
RADIONULCIDE SCINTYGRAPY IF BLEEDING IS TO RAPID TO MAKE COLONOSCOPY EFFECTIVE
*CLASSIC SPIDER ANGIOMA LIKE LESIONS IN THE COLON RIGHT
SURGERY CONSULT
ENDOSCOPIC ELECTROCOAGULATION
LASER ETC
RIGHT HEMICOLECTOMY IF FAILS
I’VE BEEN COUGHING AND WALKING FOR 2 WEEKS
PMH: EPISODE OF INTOXICATION
DZ X
FOREIGN BODY ASPIRATION
ASPIRATION PNEUMONIA CLINDAMICIN METRO PCN ABSCENSE GAG REFLEX EX: STROKE
ASTHMATIC BRONCHITIS
FBA
IM: CXR FM: BRONCHOSCOPY AND TOOTH FRAGMENT REMOVAL FROM THE BRONCHUS BRONCHIAL SECRETIONS ARE PURULENT ABX OBSTRUCTIVE PNA BRONCHIAL WASH CULTURES
I’VE BEEN COUGHING AND WALKING FOR 2 WEEKS
PMH: EPISODE OF INTOXICATION OF ALTERED MENTAL STATUS UNCONSCIOUS
DZ X
FOREIGN BODY ASPIRATION
ASPIRATION PNEUMONIA CLINDAMICIN METRO PCN ABSCENSE GAG REFLEX EX: STROKE
ASTHMATIC BRONCHITIS
FBA
IM: CXR FM: BRONCHOSCOPY AND TOOTH FRAGMENT REMOVAL FROM THE BRONCHUS BRONCHIAL SECRETIONS ARE PURULENT ABX OBSTRUCTIVE PNA BRONCHIAL WASH CULTURES
LEAVE ME ALONE!
DXZ
BACTERIAL MENINGITIS
SCHIZOPHRENIA
ALCOHOLIC HALLUCINOSIS
SUBDURAL HEMATOMA
IWU:
LYTES ALCOHOL LEVEL MAGNESIUM LEVEL ABG CT SCAN OF THE HEAD LUMBAR PUNCTURE CSF
FURTHER DIAGNOSTIC PLAN: CHLORODIAZEPOXIDO IVF D5NS MAGNESIUM SULFATE REPLACEMENT THIAMINE FOLIC ACID CLONIDINE TO SUPPRESS CARDIAC HYPER EXCITABILITY ATENOLOL
I CAN’T WALK RIGHT
SUBDURAL
CONTUSION COULD FND CT SCAN+ LOC
CONCUSSION LOC NO FND CT NEG
EPIDURAL
SUBARACHNOID
CT SCAN OF THE HEAD WITHOUT CONTRAST INTUBATION AND HYPERVENTILATION TO P CO2 25-30 mmHg IV MANITOL USE NEUROSURGICAL EVALUATION AND EVACUATION SBP > 100 STRESS ULCER PROPHYLAXIS PPI INHIBITOR
CONFUSION AND IRRITABILITY
BROAD SPECTRUM CASE
DO NOT WANDER!
DZ X
HYPOGLYCEMIA DELIRIUM DRUG OVERDOSE CEREBROVASCULAR ACCIDENT MENINGITIS HYPER HYPO THYROID SEPSIS SYNDROME
DZX HYPOGLYCEMIA
ISULINOMA SEVERE LIVER DZ ADRENAL INSUFFICIENCY ALCOHOL INTOXICATION MIXEDEMA MALNUTRITION REACTIVE HYPOGLYCEMIA* FACTITIOUS DISORDER
BLOOD GLUCOSE BY FINGERTICK
SERUM LYTES
IM:
50 ml OF D50%
FURTHER STUDIES:
BLOOD CULTURES URINE CULTURES CONSIDER THYROID FUNCTION TEST VIT B12 LEVEL LP CSF STUDIES URINE TOXICOLOGY HEAD CT SCAN
INSULIN LEVEL* IN REACTIVE POSTPRANDIAL OR POSGASTRECTOMY HYPOGLYCEMIA
ORGANOPHOSPHATE POISONING
ES UN ARDS*
DXZ
CHOLINERGIC CRISIS
AT TIMES MECHANICAL VENTILATION MAY B REQUIRED
REMOVE PT CLOTHES BEFORE PE ASSESSMENT AN IWU DO NOT LOSE POINTS IN CCS*
IWU:
RED BLOOD CELL CHOLINESTERASE LEVEL ADMIT ALL PTS OXYGEN *OXYMETRY* EKG BP CARDIAC MONITORING
IM: REMOVE FROM SIT EXPOSURE ATROPINA* PRALIDOXIMA = PAM 2 AIRWAY PROTECTION FU: HENNT: PUPILS DIAMETER FREQ CHECKS TO RESPONSE
SUDDEN SOB
PE PNA BRONCHITIS PNEUMOTHORAX PULMONARY HYPERTENSION ENLARGING PLEURAL EFFUSION MYOCARDIUM CARDIOMYOPATHY
S3Q3 R HEART STRAIN ON 2D ECHO SINUS TKC (MCF) ST-T UNSPECIFIC ABG A-a GRADIENT> 40 V/Q MISMATCH ABG: RESP ALKALOSIS PCO2 20 CXR: SHOULD B NORMAL
THINK ALWAYS IN THROMBOPHILIAS IN YOUNG PTS*
PROTHAMINE
IWU:
CXR CBC SMA 20 ABG EKG
SO:
SPIRAL CT SCAN* ENOUGH LESS INVASIVE
VENTILATION PERFUSION SCAN
PULMONARY ANGIOGRAM* GOLD STANDARD
D DIMER BUT IT RAISES IN ANY CLOT SO SPECIFICITY IS ALMOST ZERO SO IN LOW PROBABILITY SCENARIOS TO RULE OUT NOT TO RULE IN.
FM:
UNFRACTIONED HEPARIN* OR LMWH FONDOPARINAUX ENOXIPARINA
PTT 2XX NORMAL PT 1.5-2.5 NORMAL
THROMBOLYTIC IF SHOCK SBP <90 OR PE WHILE ON HEPARIN
IVC FILTER: C/I HEPARIN OR PE WHILE ON HEPARIN
BRIDGE TO WARFARIN DABIGATRAN ……
FU: INR 6MOS 2X-3XXX NORMAL
I HAVE BEEN NAUSEOUS AND VOMITING ALL DAY
ACETAMINOPHEN OVERDOSE
DZ X
APPY
CHOLE
PANCREATITIS
IWU:
CBC
LFT
LIPASE/AMYLASE
PT
FWU:
SERUM ACETAMINOPHEN LEVEL
ASPIRIN LEVEL
FM:
NGT: ASPIRATION LAVAGE
INDUCE VOMITING IPECAC < 1HR BEST
ACETYL CISTEINA < 24 HRS OF INGESTION
CHARCOAL ADMINISTRATION BETWEEN DOSES OF ACETYLCYSTEINA
I’M VOMITING AND MY LIPS ARE SWOLLEN
ACUTE ANAPHYLAXIA
ASTHMA
PE
FOREIGN BODY ASPIRATION
ALARM SIGNS:
HYPOTENSION
WHEEZING
STRIDOR
IWU:
PULSE OXYMETRY 92* OXYGEN IV ACCESS NORMAL SALINE EPINEPHRINE 1: 1000 SC EVERY 15 MIN TO IMPROVEMENT DIPHENHIDRAMINA e / 4 -6 HRS CORTICOSTEROIDS ENDOTRACHEAL INTUBATION ALBUTEROL INHALERS
CEREBRAL CONCUSSION
DZ X
CONTUSION BLOOD MIXED W BRAIN IN CT NO SURGERY
CONCUSSION CT NEG
EPIDURAL AND SUBDURAL HEMATOMA: BOTH SURGERY IF LARGE
OBSERVATION FOR 24 HRS AND NEURO CHECKS EVERY 3 HOURS
EXTENSIVE BODY BURNS
SKIN BURNS
CARBON MONOXIDE BURNS
AIRWAY BURN
HEAD 9 ARMS 9 CHEST 18 LEGS 18 BACK 18 PERINEUM 1
IWU:
CBC
SMA
CARBOXIHEMOGLOBIN LEVEL
CHEST X RAY
IMMEDIATE BRONCHOSCOPY
FLUID RESUSCITATION
PREVENTION OF INFECTION
ENDOTRACHEAL INTUBATION IF THERE IS EVIDENCE OF SIGNIFICANT RESPIRATORY INJURY
SULFADIZINE TOPICALLY TO ALL BURNED AREAS
ESCAROTOMY IF COMPARTMENT
BP HAS DROPPED DRAMATICALLY
PMH: RECENT MI
PE: CANNON a WAVES
DZ X
HYPOVOLEMIA CARDIOGENIC SHOCK VALVULAR OR CORDAE TENDINOSA RUPTURED PAPILLARY MUSCLE JARISCH BEZOLD COMPLETE HEART BLOCK VENTRICULAR TACHYCARDIA SINUS BRADYCARDIA VENTRICULAR RUPTURE VENTRICULAR SEPTAL DEFECT
ISOPROTEREENOL ES B INESPEC AGO PERO WRONG ANSWER IN BRADI + HYPO»_space; MIO O2 CONSUMPTION
RIGHT VENT SAME VASC OF INFERIOR WALL
IWU:
EKG
COMPLETE AV BLOCK
FM: ATROPINE DOPAMINE IVF BRIDGE TO
PACEMAKER*
END OF THE CASE
RIGHT VENTRICLE TREATED WITH FLUIDS
SIMPLE HYPO TENSION TREATED W FLUIDS AND DOPAMINE
VENTRICULAR TACHYCARDIA AND HYPOTENSION SYNCHRONIZED CARDIOVERSION
WALL AND VALVE RUPTURE IMMEDIATE OPERATIVE REPAIR
