Emergency Medicine

Question 1

What are the parts of a rapid primary survey?

Answer 1

Airway (assume cervical injury unless otherwise clear - jaw thrust/ OPA/ ETT)
Breathing (nasal prong/ simple face mask/NRB/ CPAP/ BiPAP
Circulation (start 2 large bore IV, 1-2L bolts NS warmed, type and cross)
Disability (neurological status - LOA to GCS, pupils)
Exposure and Environment (take off all clothes, DRE, log roll, warm IV fluids)

Always check pulses first, especially in the context of MI or trauma. Then secure the airway.

Question 2

What are the parts of a secondary survey?

Answer 2

SAMPLE (signs and sx, allergies, meds, past medical history, last meal, events)
Complete physical exam
Consider imaging

Question 3

Signs of a head injury?

Answer 3

GCS<15 (if less than 8 intubate), and if it is dropping
Unequal pupils
Lateralizing neurological signs
Amnesia
Seizure
N/V
Having lost consciousness at anytime post or during trauma

Question 4

Treatment for anaphylaxis?

Answer 4

IM Epi (1:1000, 0.01mg/kg) 
Rapid sequence intubation if airway not controlled 
Anti-histamines, corticosteroids

Question 5

Several weeks of cyclical, high fevers, elevated liver enzymes and anemia combined with a history of travel to equatorial areas?

Answer 5

Consider Malaria - ask for a blood smear and consult infectious disease for treatment based on strain

Question 6

Acute severe diarrhea several hours after eating at a pot luck?

Answer 6

S. Aureus toxin (remember quick sx of GI pathogen = toxins produced by bacteria)

Question 7

Watery diarrhea, several days, works with kids?

Answer 7

Rotavirus

Question 8

Ate some raw oysters, has diarrhea several days after?

Answer 8

Vibrio species

Question 9

Anticholinergic toxidrome

Answer 9

Hyperthermia, Dilated pupils, dry skin, constipation, urinary retention, flushed skin, agitation, tachycardia

Question 10

Cholinergic toxidrome

Answer 10

Bradycardia, respiratory distress (bronchospasm) , diarrhea, emesis, lacrimation, drooling, low BP, seizures

Question 11

Extrapyramidal symptoms include

Answer 11

Dystonia, dysphagia, rigidity and tremor, akinethesia, dyskinesia, tardative dyskinesia

Question 12

Signs of carbon monoxide poisoning?

Answer 12

Tachypnea, decreased LOC, unresponsive to O2, lactic acidosis

Question 13

Narcotic/ opioid toxidrome

Answer 13

Hypothermia, hypotension, respiratory depression, pinpoint pupils, CNS depression

Question 14

Sympathomimetics

Answer 14

Increased temperature, seizures, tachycardia, nausea, vomiting, diaphoresis, dilated pupils

Question 15

Serotonin syndrome

Answer 15

Hyperthermia, autonomic instability, rigidity, myoclonus, encephalopathy, diaphoresis

Comes on rapidly - NLMS comes on slowly

Question 16

Universal antidotes?

Answer 16

Dextrose, Oxygen, Naloxone, Thiamine

Question 17

Tx for mammalian bites

Answer 17

Initially - wound cleansing, debride, culture wound if signs of infection, start prophylactic abx, and consider tentanus immunization

Question 18

Tx for asthma exacerbation

Answer 18

Ventolin/ Atrovent nebulizers, can give IV magnesium. IV steroids if PO are not an option and O2

Question 19

Cellulitis most likely organism

Answer 19

Group A Strep or streptococcus pyogenes , followed by Staph. A.

Question 20

Tx Bell’s Palsy

Answer 20

Acyclovir and Prednisone

Look for full facial droop

Question 21

Trauma patient with ?splenic injury what determines if they get emergent lap?

Answer 21

Stable? If yes - peritonitis? If no then FAST can be done followed by a CT scan, or serial abdo exams in neg FAST. If peritonitis = lap.

Question 22

Type of spinal cord injury after hyperextension injury

Answer 22

Central cord syndrome - numbness/ weaknesss in upper limbs only