ER

Question 1

ABCs of every ED visit

Answer 1

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

Question 2

vitals that suggest PE

Answer 2

Tachy in the setting of O2 stat under 92%

Question 3

DDX for SOB

Answer 3

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

Question 4

what are you worry about with COPD exacerbations

Answer 4

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

Question 5

COPD treatment in the ED when is NPPV suspected

Answer 5

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

Question 6

why do we not want COPD on chronic oxygen

Answer 6

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

Question 7

what to do if someone is on chronic oxygen

Answer 7

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

Question 8

how to tell if someone has vasovagal syncope

Answer 8

vagal maneuvers

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

Question 9

how to tell if they have hypotension syncope

Answer 9

take bp sitting or standing

Question 10

what are we worried about with syncope

Answer 10

ACS

get cardiac bundle
bmp
anemia
tropes

Question 11

what are we worried about with head trauma

Answer 11

cerebral atrophy causing internal hemorrhage

ICH

just get a CT
vomiting indicated increased risk

Question 12

if you have a pt on anticoagulation

Answer 12

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

Question 13

what are the concerns about bp

Answer 13

END ORGAN DAMAGE

LOW BLOOD PRESSURE EVEN BELOW 110 IS BAD

Question 14

head trauma needs to go over with any person over

Answer 14

55

Question 15

SBP of ____ might suggest shock

Answer 15

110

Question 16

most common stroke

Answer 16

ischemic

Question 17

what is the time window with stroke

Answer 17

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

Question 18

what if you pt is outside of stroke window

Answer 18

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

Question 19

ddx for stroke (7)

Answer 19

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

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

Question 20

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

Answer 20

oxygen
IV access
fluid if hypotensive

Question 21

acute abdomen general categories for surgical ddx

Answer 21

peritonitis
perforated viscus
bowel obstruction
vascular

Question 22

peritonitis covers

Answer 22

appendicitis cholecysisits diverticulitis

Question 23

perforated viscus encompasses what dx

Answer 23

diverticulitis
duodenal or gastric ulcers
large bowel obstruction with perf

Question 24

bowel obstruction encompasses

Answer 24

incarcerated hernia
malignancy
volvulus
small bowel adhesions

Question 25

vascular ddx fo abd (5)

Answer 25

``` aortic dissection gastrointestinal hemorrhage mesenteric ischemia infarction ruptured or symptomatic AAA ```

Question 26

medical ddx for acute abd

Answer 26

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

Question 27

Pulm ddx for acute abd

Answer 27

empyema, pna, pe, pulm infarction

Question 28

hepatobiliary med acute abd ddx

Answer 28

stones cholangitis pancreatitis )

Question 29

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

Answer 29

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

Question 30

septic shock

Answer 30

sepsis along with hypotension of systolic BP <90 despite appropriate fluid check for UTI lungs bladder most common infection

Question 31

ancilliary testing

Answer 31

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

Question 32

sepsis refers to

Answer 32

organ dysfunction due to infection severe sepsis is a term that is no longer used septic shock refers to circulatory failure

Question 33

new sepsis criteria

Answer 33

SOFA three measurements altered mental status RR>22 hypotension<100 each one point 2 or more is positive designed to be faster

Question 34

treatment of sofa

Answer 34

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

Question 35

preop cardiac risk assessment

Answer 35

``` CAD prior MI CHF Arrhythmias pacemaker orthostatic intolerance ```

Question 36

preoperative cardiac evaluation for non-cardiac surgery

Answer 36

clinic markers functional capacity surgery specific risk

Question 37

medications that increase risk

Answer 37

``` anbx theophylline sedative hypnotics analgesics digoxin anticholinergics antiarrhythmics anti-seizure rx anti-hypertensices anticoagulants antihistamines ```

Question 38

when to stop meds preop

Answer 38

``` ASA 7 days NSAIDS 7 days benzos slow taper diuretics 48 hours before hypoglycemics night before ```

Question 39

preop nutritional assessment

Answer 39

``` appetite change weight loss special diet poor dentition consider nutrition boost two weeks ```

Question 40

COPD preop complications

Answer 40

48 hours-8 weeks use transdermal nicotine replacement pre-op education deep breathing cough incentive spirometery

Question 41

CHF preop complications

Answer 41

stabalize: ACE inhibitors ARBS spironolactone digoxin beware: dehydration volume depletion electrolyte disturbances

Question 42

pre-op complications HTN

Answer 42

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

Question 43

pre-op complications DVT

Answer 43

risk increases with age high risk procedures - orthopedic procedures total hip replacement ``` prevent with eleasctic stockings LDUH LMWH Warfarin ELIQUIS ```

Question 44

warfarin management - low risk

Answer 44

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

Question 45

warfarin management - medium risk

Answer 45

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

Question 46

warfarin management - high risk

Answer 46

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

Question 47

what is the half life of warfarin

Answer 47

1/2 life of warfarin is 5 days

Question 48

pre-op dm

Answer 48

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

Question 49

postoperative care consists of

Answer 49

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

Question 50

post op delirium risk

Answer 50

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

Question 51

MDM pt must

Answer 51

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