ER

Question 1

Pts are triaged based on the Emergency Severity Index. What are the categories (5)

Answer 1

1. Red - Critical
2. Orange - emergent
3. Yellow - urgent
4. Green - Minor
5. Blue - very minor

Question 2

Undifferentiated Pt LO 1:

List the steps in the approach to the undifferentiated pt in the ED

Answer 2

1. Triage notes prompt a initial Ddx of life threatening possibilities
2. Is pt stable or unstable? (ie. ABCs)
3. Hx (AMPLE; Allergies, meds, PMH, Last meal, events)
4. Immediate interventions (IV hydration, oxygen, naloxone, etc)
5. Sick or not sick?

Question 3

Undifferentiated Pt LO 2:

Describe the importance of the life threatening Ddx in the ED

Answer 3

Allows you to create a complete list of etiologies that will threaten life or limb. Non emergent things can be done outside the ER
Looks for dangerous dz that may present in an atypical way (think worst first)

Question 4

Undifferentiated Pt LO 3:

Classify the components of the primary and secondary ED survey

Answer 4

Primary survey -assessing if pt is stable (ABC’s)

Secondary survey - focused Hx, PE

Question 5

Undifferentiated Pt LO 4:

Utilize the concepts of pre-test probabilities and diagnostic testing in the ED

Answer 5

IE criteria to confirm or r/o a dz (Wells criteria and PE)
These criteria can be helpful in guiding the workup for a ED pt, but every scoring system has limitations so ok to listen to your instinct

Question 6

What is spectrum bias?

Answer 6

Test becomes more reliable as dz progresses. IE EKG won’t show ST elevations immediately, but after a few hours it will

Question 7

What is shock?

Answer 7

Physiologic state where oxygen delivery to the tissues is inadequate
Global hypoperfusion, imbalance between tissue oxygen supply and demand

Question 8

What is compensated vs. uncompensated shock?

Answer 8

Compensated - NL bp but inadequate perfusion

Uncompensated - hypotension and inability to maintain perfusion

Question 9

What is hypovolemic shock?

Answer 9

Decreased circulatory volume (hemorrhage, fluid loss)

Question 10

What is cardiogenic shock?

Answer 10

Impaired heart pump fxn (ACS, valve failure, dysrhythmia)

Question 11

What is distributive shock?

Answer 11

Pathologic peripheral blood vessel vasodilation (sepsis, anaphylaxis, neurogenic)

Question 12

What is obstructive shock?

Answer 12

Non-cardiac obstruction to blood flow (PE, tension pneumo, tamponade)

Question 13

What is the shock index?

Answer 13

hr/SBP
NL = 0.5-0.7
>1 suggests LV function and is associated w/ higher mortality

Question 14

Why is lactate helpful in shock?

Answer 14

Measures the degree of hypoperfusion

Question 15

If you suspect septic shock you should order?

Answer 15

BC, wounds, CT, LP

Question 16

If you suspect cardiogenic shock order?

Answer 16

Trops, echo

Question 17

If you suspect obstructive shock, order?

Answer 17

CT, V/Q scan, echo

Question 18

Intubate when GCS is less than?

Answer 18

9

Question 19

Where do you put the needle to decompress a Tension PTX

Answer 19

Midclavicular line, 2nd intercostal space

Question 20

If radial pulse is palpable then the SBP must be at least?

Answer 20

80mmHg

Question 21

IF the femoral or carotid pulses are palpable then the SBP is roughly?

Answer 21

60 mmHg

Question 22

How do you assess disability?

Answer 22

AVPU
Alert - fully awake
Voice - patient responds when addressed
Pain - pt withdrawls from pain
unresponsive - nada

Question 23

Blown pupil represents?

Answer 23

Uncal herniation

Question 24

GCS is based on 3 categories?

Answer 24

Eyes
Verbal
Motor
15-3 pts

Question 25

How do you score Eyes on GCS?

Answer 25

4- spontaneous 3 - loud voice 2 - Pain 1 - None

Question 26

How do you score for Verval on GCS?

Answer 26

``` 5 - oriented 4 - confused 3 - inapprop words 2 - incomprehensible sounds 1 - none ```

Question 27

How do you score Motor on GCS?

Answer 27

``` 6 - obeys 5 - localizes to pain 4 - withdraws from pain 3 - abn flexion posturing 2 - abn extension posturing 1 - none ```

Question 28

What is flail chest?

Answer 28

Two or more fractures in 2+ contiguous ribs causing a free floating segment of the chest wall

Question 29

Three most common causes of AMS?

Answer 29

Dementia Delirium Psychosis

Question 30

CNS causes of AMS

Answer 30

``` Tumor Hemorrhage Edema Seizure Dementia ```

Question 31

Metabolic causes of AMS

Answer 31

``` Hypo/hyper: glycemia natremia calcemia thyroid thermia Hypercarbia Hypoxemia ```

Question 32

Pharmacologic/Toxic causes of AMS

Answer 32

Medications: HTN, Steroids, sedatives, analgesics, sleep aids, anticholinergics, polypharm Alcohols: EtOH, Methanol/ethylene glycol Illicit drugs Withdrawal: Alcohol, benzo, narcotic

Question 33

Infectious cause of AMS

Answer 33

Primary CNS: Meningitis, Encephalitis, Abscesses | Other sites of infection: UTI, PNA, skin/decub ulcer, intra-abdominal, viral

Question 34

What are other causes of AMS?

Answer 34

Shock: cardiogenic, hypovolemic, hemorrhagic, distributive Complicated migraine Psychiatric disorder Sundown/ICU psychosis

Question 35

Mnemonic for AMS ddx

Answer 35

``` AEIOU TIPS Alcohol Epilepsy, electrolytes, encephalopathy Insulin Opiates, Oxygen Uremia Trauma, temperature Infection Poisons, Psychogenic Shock, stroke, subarachnoid hemorrhage, space occupying lesion ```

Question 36

AMS with Rapid onset, fluctuating course, abn VS, altered level of consciousness, visual hallucinations, PE abn, Poor prognosis of underlying cause not tx

Answer 36

Delerium

Question 37

AMS with slow onset, progressive, NL VS, NL consciousness, rare hallucinations, PE NL, Prognosis is progressive

Answer 37

Dementia

Question 38

AMS with variable onset and course, NL VS, Variable level of consciousness, Auditory hallucinations, PE NL, Prognosis variable, Underlying cause

Answer 38

Psychosis