Emergency Medicine Flashcards
AAFP Board Review lecture: Emergency Medicine Parts 1 & 2
What are the two Nonshockable rhythms?
- Asystole
- Pulseless Electrial Activity (PEA)
Per ACLS protocol what are the steps of managment for nonshockable heart rhythms?
- Continue CPR for 2 minutes, establish an airway and provide oxygen
- Give Epinephrine 1 mg IV/IO every 3-5 minutes
- Evaluate heart rhythm
- If no VT or VF, evaluate and treat reversible causes (5Ts and 6Hs); still continue CPR and epinephrine
- If no return of circulation, repeat all steps
What are the 5 T’s and 6 H’s to consider with nonshockable rhythms?
- Toxins
- Tamponade
- Tension pneumothorax
- Thrombosis (cardiac)
- Thrombosis (PE)
- H+ (acidosis)
- Hypothermia
- Hypokalemia
- Hyperkalemia
- Hypovolemia
- Hypoxia
What are the Shockable Rhythms?
Ventricular fibrillation
Ventricular Tachycardia
Per ACLS, What are the mangement steps for a shockable rhythm?
- CPR for 2 minutes
- Epinephrine 1 mg IV/IO every 3-5 minutes
- Evaluate rhythm, If VT/VF, Defibrillate 200J x1
- CPR for 2 minutes, 5 times
- Evaluate rhythm, If VT/VF, Defibrillate again and give epinephrine 1mg
- CPR for 2 minutes, 5 times
- Evaluate rhythm, if VT/VF defibrillate agian and give amiodarone or lidocaine
- If no ROSC, repeat all steps
Which 3 unstable rhythms are treated with synchronized cardioversion?
SVT
Atrial flutter/fibrillation
Monomorphic VT
What are the general principles of the Good Samartian Law?
- No legal obligation to provide aid (outside of hospital/clinical setting)
- Immunity from malpractive suit*
*except if actions were willful negligence or lack of good faith
*Immunity removed if payment is accepted for aid provided
3.Recipient of aid must not object to aid rendered
Where does the Good Samaritan law apply?
In all 50 states and on airlines
What is the definition of SIRS?
2 or more of the following:
Temperature < 36 C (96.8 F) or >38 C (100.4 F)
Respiratory Rate >20
Pulse >90
WBC < 4,000 or >12,000 or >10% immature cells
Define sepsis, severe sepsis and 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
How is septic shock managed and within what time frame?
All steps should be completed within 3 hours of presentation
- Measure Lactate
- Obtain cultures
- Administer antibiotics (within 1 hour of presentation)
- Administer 30 mL/kg of cystalloid for hypotension or lactate >4
- If hypotensive (MAP <65) after fluids, start norepinephrine
What is the #1 and #2 causes of trauma deaths in adults?
- Firearms
- Motor vehicle accident
What is the #1 and #2 causes of trauma deaths in kids?
- Motor vehicle accident
- Firearms
At what age can children safely sit in the front seat of a car?
13 and older
12 and under always in the backseat
Are car seats based off of age or weight/height recommendations?
Weight and height
Which is associated with the poorest outcome in drowning cases?
A) Below freezing water
B) Saltwater aspiration
C) >6 minute submersion
C) >6 minute submersion
Water temperatue has no correlation with outcome
No difference in fresh water v. salt water aspiration
*4 sided fencing is the best prevention measure
What is the most common cause of unintentional death in infants and how can it be prevented?
Suffocation
- remove soft bedding and toys from sleeping area
- have newborns sleep on their back
Name 4 types of head trauma
Intracerebral hemorrhage
Epidural hematoma
Subdural hematoma
Concussion
What causes epidural hematomas?
Usually due to middle meningeal artery rupture
- associated with skull fracture
- can present during a “lucid interval” then deteriorate
- Convex bleed on CT
Which type of head trauma may not be seen on initial CT?
Intracerebral hemorrhage
What causes subdural hematomas?
Tearing of bridging veins between dura and arachnoid
- Common in elderly and alcoholics
- Concave, crescent shape bleed on CT
Name and Rank the order of INR reversal agents from longest to fastest
Vitamin K (12-24 hours)
FFP (13-48 hours)
Prothrombin Complex Concentrate (3-15 minutes)
What is the ideal treatment for life threatening bleeding in a patient on warfarin?
Vitamin K 10mg IV
and
prothrombin complex concentrate (dose based on INR)
Why is FFP used more but less ideal?
Cheaper, available in more hospitals
Requires ABO testing
Takes 30-45 minutes to thaw
Takes 12-48 hours to have effect
What is the treatment for corneal abrasion?
Topical NSAIDs
Topical antibiotics (Grade C)
If wearing contacts remove and add pseudomonas abx coverage
What treatments are not proven to be beneficial in corneal abrasion?
Topical cycloplegics and mydriatics (no pain relief or benefit)
Eye patch (may delay healing)
“I got punched in the eye” What are three eye injuries to look out for?
Orbital fracture, Traumatic iritis, Hyphema
What common physical exam findings can be found with orbital fractures?
Restricted upward gaze
numbness of lower eyelid, lateral side of nose, anterior cheek, upper lip (infraorbital nerve)
What is traumatic iritis and how to treat it?
Inflammation of iris and ciliary muscle
Analgesia: mydriatics (help with ciliary spasm and light sensitivity)
What is this? How to treat?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/344/752/331/q_image_thumb.jpeg?1620049093)
Hyphema-blood in anterior chamber
Elevate bed to 30 degrees, call ophtho
Avoid NSAIDs/ASA
[https://en.wikipedia.org/wiki/Hyphema]
What is the diagnosis and treatment?
![](https://s3.amazonaws.com/brainscape-prod/system/cm/344/752/500/q_image_thumb.jpg?1620049280)
Not an emergency, provide reassurance
Avoid straining
[https://en.wikipedia.org/wiki/Subconjunctival_bleeding]
Differential for Non-traumatic painful eye problem?
What intervention can help narrow your differential?
Relieved by proparacaine: conjunctivitis, keratitis, corneal ulcer
Not relieved by proparacaine: iritis, uveitis, acute glaucoma
Differential for Non-traumatic painless eye problem with vision changes?
Posterior vitreous detachment
Rretinal detachment
Retinal artery/vein occlusion
Ischemic optic neuropathy (temporal arteritis)
Differential for blunt chest trauma?
Rib fractures, flail chest
hemothorax, pneumothorax
pulmonary contusion
aortic tear
cardiac tamponade
What is commotio cordis?
Blunt chest trauma just as the T wave begins before the peak -> Causes Vfib
Classic example: kid hit in chest during baseball game
What is Kehr’s sign? In what common situation is it seen?
Left shoulder pain due to blood irritating the diaphragm.
Seen with spleen hemorrhage, abdominal trauma
What vaccines are needed post splenectomy?
Pneumococcal, HIB, meningococcal
What are some causes of Rhabdomylolysis?
Trauma, seizures, burns, drug overdose, exertion, toxins
What labs results are seen in rhabdomylolysis?
Urine dipstick (+) blood, UA RBCs 0-2
CPK (2-3x above upper limit of normal)
elevated Cr
What is the treatment of rhabdomyolysis?
Fluids- crystalloid 500 cc/hour
goal urine output 200-300 cc/hour
When does compartment syndrome occur?
When perfusion pressure falls below tissue pressure in any anatomic space
Pressure >30 mm Hg
What are the signs of Compartment Syndrome?
Pain (first sign)
parenthesia
poikilothermia (affected limb is colder)
Paralysis
Pallor
Pulselessness
When irrigating wounds should sterile or tap water be used?
Irrigation with tap water has been shown to have comparable (or lower) rates of infection compared to sterile water
When should tetanus prophylaxis be given in the setting of a new wound?
Give if clean wound and greater than 10 years since last dose
Give if dirty wound and greater than 5 years since last dose
Can non sterile gloves be used in wound care?
Yes, does not increase infection rate
Up to how many hours after the incident can non infected wounds caused by clean objects be closed up?
Up to 18 hours
If on face/scalp 24 hours
Can lidocaine with epinephrine be used on digits?
Yes if no concern for vascular compromise
What is the next step in management if you are concerned about glass in a wound?
X-ray
Can identify any glass 2mm or greater
Which wounds need prophylactic antibiotics?
High risk site- hand, foot
High risk mechanism- bites
High risk patient-immunocompromised, prosthetic valve
4 month old with diffuse cerebral injury with edema +/- intracerebral bleed and retinal hemorrhages, diagnosis?
Shaken baby syndrome
What are 3 principles to remember about child abuse?
- If they don’t cruise they don’t bruise
- 82% of rib fractures in kids less than 3 years old are abuse
- Undiagnosed abuse had a 25% mortality in 2 years
20 month old with spiral fracture of the distal tibia, diagnosis? Treatment?
Toddler’s fracture
Below knee walking cast for 3 weeks
What age range is toddler’s fracture seen most commonly?
9 months to 3 years