Emergency Medicine Flashcards
What are the 5Ts and 6Hs of ACLS?
5Ts: toxins, tamponade, tension pneumo, cardiac thromus, pulmonary thrombus
6Hs: H+, hypothermia, hypokalemia, hyperkalemia, hypovolemia, hypoxia
ACLS algorithm for Vfib/Vtach
- Defibrillate (200 J) –> CPR
- Defibrillate again, give vasopressor (Epi) –> CPR
- Defibrillate again, given antiarrhythmic (amiodarone)
Cardioversion dose in this scenario:
Narrow QRS, regular such as SVT or A flutter
50-100 J
Cardioversion dose in this scenario:
Narrow irregular such as a fib
120-200 J
Cardioversion dose in this scenario:
wide regular such as monomorphic VT
100 J
Cardioversion dose in this scenario:
wide irregular such as polymorphic VT
200 J not synchronized
Definition of SIRS
SIRS = 2 or more of following Temp < 36 or > 38 C RR > 20 P > 90 WBC < 4000 or > 12,000 or 10% immature cells
Definition of
- sepsis
- severe sepsis
- septic shock
- sepsis: SIRS + source of infection
- Severe sepsis: sepsis + lactate > 2 or organ dysfunction
- Septic shock: severe sepsis + lactate > 4 or hypotension despite fluid resuscitation
Septic Shock Management
- obtain lactate level
- obtain blood cultures before Antibiotics
- administer broad spectrum Abx before 1 hour
- administer 30 cc/kg crystalloid for hypotension or lactate > 4 * administer w/in 3 hours
- if hypotensive (MAP < 65) after fluid challenge, start norephinephrine
Most common cause of trauma related deaths in peds
motor vehicle crash
Most common cause of death in children ages 1-4 yo
Drowning
Most common cause of unintentional death in newborns
suffocation
At what age can children move into the front seat?
13
65 yo with a fib on warfarin presents with acute intracerebral hemorrhage. What should you start according to the ACCP and AHA/ASA recommendations?
Start a 4 factor prothrombin complex concentrate (K centra) + vitamin K 10 mg IV
Rapidly reverses INR in 2-15 minutes
ABO testing not required
low volume
If pt has life-threatening bleed on warfarin and has history of HIT, what should you use?
Profilnine
K centra has heparin in it
Management of Corneal abrasion
- no eye patch (SOR A)
- topical NSAIDs offer effective pain relief (SOR B)
- topical cycloplegics and mydriatics do not relieve pain and aren’t recommended (SOR B)
- topical antibiotics may be prescribed to prevent bacterial superinfection in corneal abrasions (SOR C)
- if associated with contact lense use antipseudomonal abx
Management of chemical burns of the eye
IRRIGATE!!!!! 2L
Management of hyphema
blood in anterior chamber
- elevated HOB 30 degrees during rest
- avoid aspirin or NSAIDS
- optho consult
How do you approach evaluation of painful eye trauma
does proparacaine relieve pain?
- if yes –> conjunctivitis, keratitis, corneal ulcer
- if no –> iritis/uveitis, acute glaucoma
How do you approach evaluation of painless eye trauma?
Is there a visual change?
if yes, consider posterior vitreous detachment, retinal detachment, retinal artery/vein occlusion, ischemic opthic neuropathy (including temporal arteritis)
What is kehr’s sign?
sign of splenic rupture: blood irritates the diaphragm and leads to referred pain to left shoulder
Diagnosis and management of rhabdo
urine dipstick positive 50% (myoglobinuria)
elevated CPK (> 2-3 times reference)
complcation: acute renal failure
Treatment: crystalloid 500 cc/hr => urine output 200-300 cc/hr
In diagnosis of compartment syndrome, what is the pressure at which it is diagnosed?
> 30 mm Hg
In the emergency room, when should you given tetanus booster?
Clean wound > 10 years since last dose
dirty wound > 5 years since last dose
