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ER Flashcards

1
Q

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

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

Undifferentiated Pt LO 1:

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

A
  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?
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3
Q

Undifferentiated Pt LO 2:

Describe the importance of the life threatening Ddx in the ED

A

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)

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4
Q

Undifferentiated Pt LO 3:

Classify the components of the primary and secondary ED survey

A

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

Secondary survey - focused Hx, PE

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5
Q

Undifferentiated Pt LO 4:

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

A

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

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6
Q

What is spectrum bias?

A

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

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7
Q

What is shock?

A

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

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8
Q

What is compensated vs. uncompensated shock?

A

Compensated - NL bp but inadequate perfusion

Uncompensated - hypotension and inability to maintain perfusion

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9
Q

What is hypovolemic shock?

A

Decreased circulatory volume (hemorrhage, fluid loss)

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10
Q

What is cardiogenic shock?

A

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

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11
Q

What is distributive shock?

A

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

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12
Q

What is obstructive shock?

A

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

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13
Q

What is the shock index?

A

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

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14
Q

Why is lactate helpful in shock?

A

Measures the degree of hypoperfusion

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15
Q

If you suspect septic shock you should order?

A

BC, wounds, CT, LP

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16
Q

If you suspect cardiogenic shock order?

A

Trops, echo

17
Q

If you suspect obstructive shock, order?

A

CT, V/Q scan, echo

18
Q

Intubate when GCS is less than?

A

9

19
Q

Where do you put the needle to decompress a Tension PTX

A

Midclavicular line, 2nd intercostal space

20
Q

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

A

80mmHg

21
Q

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

A

60 mmHg

22
Q

How do you assess disability?

A 
AVPU
Alert - fully awake
Voice - patient responds when addressed
Pain - pt withdrawls from pain
unresponsive - nada
23
Q

Blown pupil represents?

A

Uncal herniation

24
Q

GCS is based on 3 categories?

A

Eyes
Verbal
Motor
15-3 pts

25
Q

How do you score Eyes on GCS?

A

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

26
Q

How do you score for Verval on GCS?

A 
5 - oriented
4 - confused
3 - inapprop words
2 - incomprehensible sounds
1 - none
27
Q

How do you score Motor on GCS?

A 
6 - obeys
5 - localizes to pain
4 - withdraws from pain
3 - abn flexion posturing
2 - abn extension posturing
1 - none
28
Q

What is flail chest?

A

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

29
Q

Three most common causes of AMS?

A

Dementia
Delirium
Psychosis

30
Q

CNS causes of AMS

A 
Tumor
Hemorrhage
Edema
Seizure
Dementia
31
Q

Metabolic causes of AMS

A 
Hypo/hyper:
glycemia
natremia
calcemia 
thyroid
thermia
Hypercarbia
Hypoxemia
32
Q

Pharmacologic/Toxic causes of AMS

A

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

33
Q

Infectious cause of AMS

A

Primary CNS: Meningitis, Encephalitis, Abscesses

Other sites of infection: UTI, PNA, skin/decub ulcer, intra-abdominal, viral

34
Q

What are other causes of AMS?

A

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

35
Q

Mnemonic for AMS ddx

A 
AEIOU TIPS
Alcohol
Epilepsy, electrolytes, encephalopathy
Insulin
Opiates, Oxygen
Uremia
Trauma, temperature
Infection
Poisons, Psychogenic
Shock, stroke, subarachnoid hemorrhage, space occupying lesion
36
Q

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

A

Delerium

37
Q

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

A

Dementia

38
Q

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

A

Psychosis

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