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LMCC > ER > Flashcards

ER Flashcards

0
Q

History for accidental ingestion

A
  1. Age, past medical problems, medications, allergies
  2. Ingestion: what was taken? How much? How long ago?
  3. Current condition of patient: consciousness? Vomiting?
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1
Q

CXR signs of PE

A
  1. Hampton’s hump (wedge shaped infiltrate- lung infarct)
  2. Oligemic area/ westermark sign (dec perfusion distal to embolus)
  3. Unilateral effusion
  4. Elevated hemidiaphragm
  5. Normal CXR
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2
Q

Management of accidental ingestion over the phone

A
  1. Have child drink 2-3 glasses of milk
  2. Do not induce vomiting, have child lie on side in case vomit
  3. If unknown amount for significant amount- needs to come in
  4. Come in by ambulance
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3
Q

Lab investigations for accidental Ingestions

A

CBC
Lytes, creat, urea, serum osmolarity, serum ketones
ABG
CXR
Toxicology screen
Consult with toxicology for advice for management

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4
Q

Investigations for chest pain

A 
CBC, lytes, glucose, INR/PTT
Serial troponin 
ABG
CXR
ECG
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5
Q

Management of chest pain

A

First steps: raise head of bed, oxygen, monitor SpO2
MONA

Morphine (1 mg IV)- if BP ok
Oxygen
Nitroglycerin- if BP ok, and no med interactions (0.3mg SL q5minx3)
ASA 325 mg PO chewable

Trops Q8H

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6
Q

History for fall from 6 feet from ladder

A
  1. Sequence of events
  2. Symptoms prior to fall from ladder: loss of consciousness, seizure, dizziness, faint
  3. Symptoms post event: post-itcal drowsiness? Pain?
  4. Patient history:similar episodes in past, PMHx, PMSx, meds, allergies, smoking, alcohol, drugs
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7
Q

History for laceration on arm

A
  1. ID: name, age, occupation, handedness
  2. History of laceration: sequence of events/context environment (metal?), any other injuries?
  3. Symptoms: pain, loss of power, loss of sensation?
  4. ROS
  5. PMHx, meds, allergies, smoking/alcohol/drugs, vaccination status for tetanus
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9
Q

Choice of suture material

  • face
  • extremities
A
  • face: 6.0 prolene (remove in 5 days)

- extremities: 3.0 prolene or ethylon (monofilament non-absorbable)- remove in 10 days

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10
Q

Suture technique

A
  1. Sterile technique
  2. Cleanse and irrigate the wound
  3. Drape
  4. anesthetize with lidcaine +/- epi
  5. start in middle of wound
  6. Counsel patient
    - suture removal in 5 days for face, 10 days or elsewhere
    - return to ER is fever, red/pain, pustular discharge from wound
    - tylenol for pain control
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11
Q 
Tetanus immunization after cut 
-usual tetanus immunization schedule
if last tetanus immunization was:
-0-5 years ago: 
-5-10 years ago:
->10 years ago:
-unknown:
A 
-usual tetanus immunization schedule: DTP 2,4,6,18 months, 4-6 years old, Td at 14-16 years old, then Q10 years 
if last tetanus immunization was:
-0-5 years ago: none
-5-10 years ago: Td booster
->10 years ago: booster + Ig
-unknown: booster + Ig
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12
Q

Differential for Alcoholic with hematemasis

A 
Esophagitis 
Mallory Weiss tear
Esophageal varices
Gastritis
Duodenal ulcer
Peptic ulcer 
Esophageal cancer
Gastric cancer 
Lung tumor
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12
Q

Differential for Alcoholic with hematemasis

A

Esophagitis

Mallory Weiss tear

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13
Q

History for syncope

A
  • events leading up to the event
  • cardiac: chest pain, palpitations, shortness of breath
  • neuro: tonic-clonic movements, post-itcal
  • orthostatic: associated with change in position, dehydration, medication
  • vasovagal: nausea, vomiting before

PMHx: cardiac disease, arrythmia, diabetes
Meds:
Habits: drug use, alcohol, smoking
Family history

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14
Q

Differential for syncope

A
  • medication induced: digoxin, between blockers
  • cardiac: arrythmia, valvular disease, subclavian steal,
  • metabolic: hypoglycemia
  • autonomic: orthostatic hypotension, vasovagal
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15
Q

Symptoms of digoxin poison

A

Anorexia, N/V, abdo pain, diarrhea, visual effects (yellow, green, white halo around objects)
ECG: junctional tachycardia, PVC, AV block

16
Q

Physical exam for digoxin poisoning

A 
Vitals 
Orthostatic BP
Signs of dehydration: HR, urine output, thirst, mucous membranes, skin turf or BP
cardio, resp 
Neuro exam
MMSE
18
Q

Labs for Digoxin poisoning

A 
Digoxin level 
CBC, lytes, BUN, creat, INR/PTT, glucose
ECG, Holter, echo 
EEG 
CT head
Carotid Doppler
19
Q

Physician in peripheral hospital, wishes to transfer unstable patient in MVC. CXR shows opacification of R lung.

  • Dx?
  • Management?
A

-physician’s name, name of centre, pt’s name, age
-injuries
-vitals, GCS
-investigations done, lab values
-is patient intubated
-can not transfer patient until: good BP, good sats, bleeding controlled, blood products given
-ETA
-physician accompanied?
-CXR: hemothorax
-need to put in chest tube in ER, connect to pleur-evac
(thoracic sx consult)

LMCC (8 decks)

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