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Geriatrics > ER > Flashcards

ER Flashcards

1
Q

ABCs of every ED visit

A

Airway-tells you fast track or not
B-breathing 92% or lower–> CXR
C-circulation (EOD)
D- neurologic disability glasgow coma scale <13

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2
Q

vitals that suggest PE

A

Tachy in the setting of O2 stat under 92%

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3
Q

DDX for SOB

A

requiring ED includes

MI
COPD
CHF
PNA
PE
Bronchitis
dysrhytmia

if you can not exclude life-threatening event–>emergent
<92% without nebulizer stabilization with COPD

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4
Q

what are you worry about with COPD exacerbations

A

need a intubation cart right there if can’t stabalize after nebulizer x2

corticosteroids are helpful and antibiotics can be given with concomitant infection suspected

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5
Q

COPD treatment in the ED when is NPPV suspected

A

indicated for moderate to severe exacerbations as determined by tachypnea >25 breats

dyspnea with accessory muscle use

mod to severe acidosis or
prevent hypercapnia PaCO2>45

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6
Q

why do we not want COPD on chronic oxygen

A

CO2 retention
and anatomy

(CO2 causes an inhalation and if you constantly push oxygen people forget out how to breath

we need to wean COPD off oxygen

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7
Q

what to do if someone is on chronic oxygen

A

check BNP
BNP helps the body compensate for congestive heart failure (CHF) and can be helping

take a CXR

especially if they overweight which can mask symptoms

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8
Q

how to tell if someone has vasovagal syncope

A

vagal maneuvers

if they were taking a shit or having an orgasim or swalloing it was probably vasovagal

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9
Q

how to tell if they have hypotension syncope

A

take bp sitting or standing

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10
Q

what are we worried about with syncope

A

ACS

get cardiac bundle
bmp
anemia
tropes

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11
Q

what are we worried about with head trauma

A

cerebral atrophy causing internal hemorrhage

ICH

just get a CT
vomiting indicated increased risk

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12
Q

if you have a pt on anticoagulation

A

that is the first thing out of your mouth always in a presentation of your pt

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13
Q

what are the concerns about bp

A

END ORGAN DAMAGE

LOW BLOOD PRESSURE EVEN BELOW 110 IS BAD

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14
Q

head trauma needs to go over with any person over

A

55

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15
Q

SBP of ____ might suggest shock

A

110

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16
Q

most common stroke

A

ischemic

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17
Q

what is the time window with stroke

A

4.5 hours from symptom onset
b/w stroke time and ER

often time does not show up on CT

you should be able to do a CN in <30 seconds

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18
Q

what if you pt is outside of stroke window

A

pt with equivocal symptoms where stoke is in the differential

WHEN DID THIS START

more than 4 hours and has not progressed and there are no signs of defecits

cover you ass by saying he is outside of the therapeutic window

unless the symptoms are progressing in which case it could be hemorrhagic

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19
Q

ddx for stroke (7)

A 
syncope
seizures
super low (HYPOGLYCEMIA)
some toxins
subdural hematomas
neoplasms

if you don’t get a finger stick you’re a fucking idiot

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20
Q

what should you do for a potential stroke assuming it does not delay the transfer process

A

oxygen
IV access
fluid if hypotensive

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21
Q

acute abdomen general categories for surgical ddx

A

peritonitis
perforated viscus
bowel obstruction
vascular

22
Q

peritonitis covers

A

appendicitis cholecysisits diverticulitis

23
Q

perforated viscus encompasses what dx

A

diverticulitis
duodenal or gastric ulcers
large bowel obstruction with perf

24
Q

bowel obstruction encompasses

A

incarcerated hernia
malignancy
volvulus
small bowel adhesions

25
Q

vascular ddx fo abd (5)

A 
aortic dissection
gastrointestinal hemorrhage
mesenteric ischemia
infarction
ruptured or symptomatic AAA
26
Q

medical ddx for acute abd

A

endocrine: dka
GU: adenexal mass, cystitis, pyelo, renal calculi
hepatobiliary (stones cholangitis pancreatitis )
Pulm: empyema, pna, pe, pulm infarction
other: MI

27
Q

Pulm ddx for acute abd

A

empyema, pna, pe, pulm infarction

28
Q

hepatobiliary med acute abd ddx

A

stones cholangitis pancreatitis )

29
Q

what are we especially worried about post surgery in a pt with acute abd complaint

A

BOWEL OBSTURCTION

listen to bowel sounds
have they passed gas and have they had a bowel movement

30
Q

septic shock

A

sepsis along with hypotension of systolic BP <90 despite appropriate fluid

check for UTI lungs bladder most common infection

31
Q

ancilliary testing

A

CXR UA C&S CBC CMP

blood gas

lactate

and ECG

CRP maybe be used as an earlier marker for infection but it is not specific

32
Q

sepsis refers to

A

organ dysfunction due to infection

severe sepsis is a term that is no longer used

septic shock refers to circulatory failure

33
Q

new sepsis criteria

A

SOFA

three measurements

altered mental status

RR>22
hypotension<100

each one point

2 or more is positive

designed to be faster

34
Q

treatment of sofa

A

one hour of triage

routine labs antibiotics started if hypotensive or lactate>4 crystalloid bollus

three hours of triage

6 hours
vasopressors for fluid unresponsive hypotension and subsewuent documentation of volume status

35
Q

preop cardiac risk assessment

A 
CAD
prior MI
CHF
Arrhythmias
pacemaker
orthostatic intolerance
36
Q

preoperative cardiac evaluation for non-cardiac surgery

A

clinic markers
functional capacity
surgery specific risk

37
Q

medications that increase risk

A 
anbx
theophylline
sedative hypnotics
analgesics
digoxin
anticholinergics
antiarrhythmics 
anti-seizure rx
anti-hypertensices
anticoagulants 
antihistamines
38
Q

when to stop meds preop

A 
ASA 7 days
NSAIDS 7 days
benzos slow taper
diuretics 48 hours before 
hypoglycemics night before
39
Q

preop nutritional assessment

A 
appetite change
weight loss
special diet
poor dentition
consider nutrition boost two weeks
40
Q

COPD preop complications

A

48 hours-8 weeks
use transdermal nicotine replacement

pre-op education
deep breathing
cough
incentive spirometery

41
Q

CHF preop complications

A

stabalize:

ACE inhibitors
ARBS
spironolactone
digoxin

beware:
dehydration
volume depletion
electrolyte disturbances

42
Q

pre-op complications HTN

A

leads to intraoperative bp

mild to moderate hypertension should not be delayed
in elective surgery control 2-4 weeks
emergency surgery

43
Q

pre-op complications DVT

A

risk increases with age

high risk procedures -

orthopedic procedures
total hip replacement

prevent with eleasctic stockings
LDUH
LMWH
Warfarin
ELIQUIS
44
Q

warfarin management - low risk

A

low risk d/c 5 days before surgery
allow INR to fall below 1.5
no preop heparin required
resume 12-24 hours post op

45
Q

warfarin management - medium risk

A

d/c warfarin 4 days before surgery
allow INR to fall below 1.5
use IV heparin if warfarin cannot be resumed within 48 hours

46
Q

warfarin management - high risk

A

require concomitant heparin tx
d/c warfarin 4 days before surgeyr
when the INR drops to less than 2.0 begin heparin
resume heparin 12-24 hours post op

47
Q

what is the half life of warfarin

A

1/2 life of warfarin is 5 days

48
Q

pre-op dm

A

goal glucose 100-200 through pre op period

postpone surgery if >300
utilize insulin post op at half the dose
restart oral hypoglycemics when full diet is resumed

49
Q

postoperative care consists of

A 
effective pain management 
encouraging mobilization
preventing uclers
removing catheters
bewaring of deliruium 
monitor for DVT
encouraging pts to perform ALDs
50
Q

post op delirium risk

A

surgery: cardiac hip thoracic AAA repair, opthalmologic emergency

intra-operative factors: pre-existing dementia parkinson’s low cardiac output hypotension anticholinergic medications

post-op: hypoxia visual/auditory impairments, polypharm, ETOH

51
Q

MDM pt must

A

be able to communicate choice
understand relevant information
appreciate the medical consequence of the situation
and the reasons for treatment choices

Geriatrics (12 decks)

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