Emergency Medicine Exam Flashcards
TIMI Risk Score
- for UA/NSTEMI
- 1 pt for each of the following:
Hx:
- Age > or = to 65
- > or = to 3 CAD risk factors (FHx, htn, high chol, DM, active smoker)
- Known stenosis (> or = to 50%)
- ASA use in past 7 days
Presentation:
- Recent severe angina (in last 24 hrs)
- increased cardiac markers
- ST deviation > or = to 0.5mm
WELLS Score
- evaluates for PE
Criteria: - clinical signs and sxs compatible with DVT= 3
- PE judged to be the most likely diagnosis= 3
- surgery or bedridden for more than 3 days during past 4 weeks= 1.5
- previous DVT or PE= 1.5
- heart rate > 100min= 1.5
- hemoptysis= 1
- active cancer (treatment ongoing or within previous 6 months, or palliative treatment)= 1
Score:
- 4 or below= LOW risk
- 4.5-6= MODERATE risk
- > 6= HIGH risk
PERC
= Pulmonary Embolism Rule-Out Criteria
Age >/= 50 Pulse < 100bpm SaO2 >/= 95% on RA no hemoptysis no exogenous estrogen use no prior venous thromboembolism no surgery or trauma requiring hospitalization within the past 4 weeks no unilateral leg swelling
SVT
- regular tachycardic rate (really tachy, 160s or higher)
- narrow QRS complex
Multifocal Atria Tachycardia
- irregularly irregular
- P waves different morphologies
Wellen’s Syndrome
- pattern of inverted or biphasic T waves in V2-4 in pts w/ ischemic chest pain that is highly specific for critical stenosis of the LAD
- pts can be pain free by the time of EKG, however they are at extremely high risk for extensive anterior wall MI within the next 2-3 weeks
Brugada Syndrome
- more common cause of sudden death than previously recognized
- think of this with young person and syncope
- = genetic disease characterised by abnormal EKG findings and increased risk of sudden cardiac death
- congenital Na-channelopathy
- AICDs decrease mortality by 50%
- EKG findings in leads V1-V3
- IRBBB/RBBB
- ST elevation- “coved”»“saddle” type
- findings can vary with time d/o autonomic balance/drugs/body temp
CURB65
- determines pt’s disposition with pneumonia
1 point for each of the following:
- confusion
- urea >7mmol/L (19mg/dL)
- respiratory rate >30
- SBP< 90mmHg, DBP< 60mmHg
- Age >/= 65
0-1: treat as an outpatient
2-3: consider a short stay in hospital or watch very closely as an outpatient
4-5: requires hospitalization with consideration as to whether they need to be in the intensive care unit
NEXUS Criteria
- identifies which patients require cervical spine imaging in setting of blunt trauma
No imaging if:
- no tenderness at posterior midline
- no focal neurological deficit
- normal level of alertness
- no intoxication
- no distracting injury
Ottawa Knee & Ankle Rules
- identify which patients require x-rays in setting of blunt trauma
Knee:
- age >55
- pain at patella or head of fibula
- inability to take 4 steps
- inability to flex to 90 degrees
Ankle:
- pain at posterior edge of med/lat malleoli
- pain at base of 5th metatarsal
- pain at medial aspect of navicular
- inability to bear weight for 4 steps
Compartment Syndrome
pain paresthesias pallor poikylothermia pulselessness
- can occur anywhere that swelling can occlude the blood supply
Causes of Altered Mental Status
AEIOU
Alcohol Epilepsy/Electrolytes/Encephalopathy Insulin Opiates/Oxygen (lack there of) Uremia Trauma/Temperature Infections Poisons/Psychogenic Shock/Stroke/SAH, Space-Occupying Lesions
Anaphylaxis
Acute onset of illness with involvement of skin or mucosal tissue AND
respiratory compromise OR reduced BP (30% decrease) OR end-organ dysfunction (hypoxia, collapse, syncope, incontinence)
SIRS Criteria
Presence of two of the four factors:
- temperatrue less than 36.0 or greater than 38.0C
- heart rate greater than 90 BPM
- respiratory rate >24 breaths per minute or PaCO210%
Sepsis
SIRS Criteria + the presence of infection
SIRS Criteria:
Presence of two of the four factors:
- temperatrue less than 36.0 or greater than 38.0C
- heart rate greater than 90 BPM
- respiratory rate >24 breaths per minute or PaCO210%
