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
vascular ddx fo abd (5)
``` aortic dissection gastrointestinal hemorrhage mesenteric ischemia infarction ruptured or symptomatic AAA ```
26
medical ddx for acute abd
endocrine: dka GU: adenexal mass, cystitis, pyelo, renal calculi hepatobiliary (stones cholangitis pancreatitis ) Pulm: empyema, pna, pe, pulm infarction other: MI
27
Pulm ddx for acute abd
empyema, pna, pe, pulm infarction
28
hepatobiliary med acute abd ddx
stones cholangitis pancreatitis )
29
what are we especially worried about post surgery in a pt with acute abd complaint
BOWEL OBSTURCTION listen to bowel sounds have they passed gas and have they had a bowel movement
30
septic shock
sepsis along with hypotension of systolic BP <90 despite appropriate fluid check for UTI lungs bladder most common infection
31
ancilliary testing
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
sepsis refers to
organ dysfunction due to infection severe sepsis is a term that is no longer used septic shock refers to circulatory failure
33
new sepsis criteria
SOFA three measurements altered mental status RR>22 hypotension<100 each one point 2 or more is positive designed to be faster
34
treatment of sofa
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
preop cardiac risk assessment
``` CAD prior MI CHF Arrhythmias pacemaker orthostatic intolerance ```
36
preoperative cardiac evaluation for non-cardiac surgery
clinic markers functional capacity surgery specific risk
37
medications that increase risk
``` anbx theophylline sedative hypnotics analgesics digoxin anticholinergics antiarrhythmics anti-seizure rx anti-hypertensices anticoagulants antihistamines ```
38
when to stop meds preop
``` ASA 7 days NSAIDS 7 days benzos slow taper diuretics 48 hours before hypoglycemics night before ```
39
preop nutritional assessment
``` appetite change weight loss special diet poor dentition consider nutrition boost two weeks ```
40
COPD preop complications
48 hours-8 weeks use transdermal nicotine replacement pre-op education deep breathing cough incentive spirometery
41
CHF preop complications
stabalize: ACE inhibitors ARBS spironolactone digoxin beware: dehydration volume depletion electrolyte disturbances
42
pre-op complications HTN
leads to intraoperative bp mild to moderate hypertension should not be delayed in elective surgery control 2-4 weeks emergency surgery
43
pre-op complications DVT
risk increases with age high risk procedures - orthopedic procedures total hip replacement ``` prevent with eleasctic stockings LDUH LMWH Warfarin ELIQUIS ```
44
warfarin management - low risk
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
warfarin management - medium risk
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
warfarin management - high risk
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
what is the half life of warfarin
1/2 life of warfarin is 5 days
48
pre-op dm
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
postoperative care consists of
``` effective pain management encouraging mobilization preventing uclers removing catheters bewaring of deliruium monitor for DVT encouraging pts to perform ALDs ```
50
post op delirium risk
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
MDM pt must
be able to communicate choice understand relevant information appreciate the medical consequence of the situation and the reasons for treatment choices