ER Flashcards
headache
-HPI
OLDCARTS First one? Different from previous? Worst? Neck Stiffness? / Menengeal signs (kernig =knee bend, +in SAH too! , brudzinski = kids, flex neck look for hips) Neruo Deficite
Headache - Exam
Fever, supple neck, photophobia
Pupils
Full neuro
Headache - DDX - non emergent w/ TX
Cluster - unilateral, sudden, orbital, tears, male, tobacco, 40’s - GIVE O2
Migrane - Unilateral, n/v, photophobia - Give NSAIDS / metoclopramide / IVF
Sinusitis - URI, sinus tenderness - nasal spray, pseudophedrine, abx?
Tension - b/l and tight - pain controll
Headache - DDX - emergent
acute glaucoma
corotid artery dissect
Encephalitis
Encephalopathy (HTN)
Meningitis
Temporal arteritis
Preeclampsia
Psuedotumor
SAH
Traumatic ICH
CO poisoning
Acute Glaucoma
Unilateral, blurry, fixed pupil
Topical + systemic dec IOP meds
Corotid Art dissec
Unilateral neck pain, trauma
CTA, MRA, US
Antigoagulation, CS NRSRG?
CO poisoning
Weakenss , N/v , exposure
CO - oximetry, VBG
100% 02
Encephalitis
Fever, AMS seizures
CT, LP
IV ABX, / antiviral / isolation
Hypertensive encephalopathy
dBP >120, AMS, vision changes
Check end organs ( CMP, …?)
Dec MAP 25%
Meningitis
Fever, stiff neck, photophobia, rash
LP —> CT
Steroids–> ABX, LP, isolation
Preeclampsia
> 20 weeks up to 6 weeks postpartum, inc BP, HA
LFTs, CBC, UA
Mag, BP controll, Cs OB/ GYN
Pseudotumor
overweight, young, visual sx
CT, LP
LP, acetazolamide
SAH
Sudden, worst, SYNCOPE
CT, LP
BP controll, cs nrsrg
Temporal arteritis
Unilateral, above 55, tender, jaw pain
ESR
Steroids, , FU with optho / reum
Traumatic ICH
Trauma, ETOH, elderly
CT
Neurosurg
acute HA and Syncope
Think SAH first!
Head Injury - HPI
Mechanism
LOC, N/V, seizure, whitnessed, intoxication, neuro deficit,
Blood thinners
Head Injury - Exam
GCS
Full Neuro
Pupils
Skull FX - raccon eyes, battle sign, nasal CSF leak, hemotympanum
Head injury - when to do CT
Brain
C Spine
Brain - Canadian Head CT rule
C Spine - Canadian C spine rule
Head Injury - acute general management of SAH, subdural hematoma, epidural, ICH, skull fx
COnsult neurosurgery
Close obs of neuro status
Consider - antiseizure med,s dec ICP, ICU
GCS
out of 15
Eyes: 0-4
Verbal: 0-5
Motor : 0-6
Considered comatose if under 8
SVT
No p waves, rate over 150
Give adenosine - blocks AV conduction for a bit - 6-12-12
Vtach
give Amiodarone
Afib
Rate vs rythem
Cardiovert to rythem only if youngish or new onset
Rate: Propranolol or CCB (dilt / verap )
CHADS 2 score
To decide if someone with Afib needs anti coag
CHF HTN AGE > 75 DM Stroke / TIA (2)
0 - none
1 - maybe
2 - yes
Anticoag: Warfarin or NOAC
Sinus Brady
Atropine
If hemodynamically unstable, pace
Types of heart block
1 - long PR interval (1 box, 0.04sec OR 400msec)
give atropine - then pace
2a - wenkibach - give atropne then pace
2b - regular drop - pace
3 - dissasoc - pace
Idioventricular Rythem
Just Vents beating
Atropine wont work, just pace
ACLS for:
VT/VF
PEA/ ASYSTOLE
Shock if: VT / VF
VT/VF
Epi -// 2min CPR // Atropine // 2min CPR // epi
PEA/ ASYSTOLE
Epi -// 2min CPR // (pulse, rythem, shock?) // 2min CPR // epi
When is someone considered hemodynamically unstable? (FOR ACLS)
CP
SOB
AMS
SBP < 90
GENERAL: Someone comes in with an arrythmia, what do you think through?
Do the have symptoms?
No - IVF, 02, monitor
Yes: Are the stable?
No (CP, SOB, AMS, SBP<90) - Brady: Pace Tachy: shock
Yes - but have other symptoms:
Fast+ wide - Amiodarone
Fast + Narrow - Adenosine
Slow: Atropine (unlass 2b or 3 HB)
Tachy Rythms
Narrow:
Sinus
SVT
Afib
Aflut
MFAT
Wide:
VT
VFIB
Torsods
Brady Ryhthms
Sinus brady
1,2,3 degree Hblocks
Junctional ( wut? )
Idioventricular (Vents on their own)
Pt with hypotension - how to solve in 30 seconds
PT HAS LOW BP
Asses airway patency- visualize breaths - make sure air is getting to lungs
HR - check HR - poor tone to brachial artery - could be the result of brady or non sinus tachy - check HR
Venous Volume - check the IVC, see if its easily compressible via US. Could be trauma, sepsis, or loss over longer periods. If still full, check heart: US.
Continuity of vascular circuit- is it a Tension Pneumo (auscultate) ? Is it a Tamponod (US)? Something obstructing lungs: Consider Massive PE, pulmonary arteriolar constriction, RV failure.
NEXT you check LV function. Listen for MR or ventricular rupture
Pause, see if it is just the brachial artery that is low
CHECK the peripheral arteries - Bounding pulses and warmpth = too much dilation. Sepsis, histamine release, vasodilation OD, Neurogenic schock
Cough meds on tox screen can:
Come back positive for alcohol and opiates
Antivert
Meclizine
Options for complex uti
3rd gen cephalosporins
- rocephin (iv only)
- cephpodoxime
- cephdinir
- cefuroxime
- cephtazidime
Doxy- SA: achilis rupture, c-diff
Don’t take nitrofurantoin or ffosphomyosin
Indications for Dialysis
Acidosis Electrolyte imbalance (K) Ingestion Overload Uremia
Headache cocktail
Benadryl
Chlorpromazine
Ketoralac (toradol)
Tx for asthma exacerbation
Info about asthma tx
Duoneb-albuterol and ipratropium
If chronic, will take time, if acute will clear up quick. Give three doses or write for one hour.
Steroids
02, Mg
Intimate if hypoxic, exhaustion, AMS
Cause Equina
Most likely in thoracic, not so much in lumbar. It is pinching of spinal cord
Presenting most likely: urinary retention
Saddle anesthesia, incontinance, b/l sciatica
Most common causes of pancreatitis
Stones Alcohol Medications Infections High triglycerides
Ransoms criteria for pancreatitis
WBC Age Glucose AST LDH
Hints exam
Nystagmus -unidirectional is peripheral
Skew (cover uncover) - none in peripheral
Head Impulse- look for savage after quickly turning head- + means it is peripheral
Types of fracture
Displaced
Spiral
Comminuted
Greenstick
Transverse
Linear
Oblique
Components of heart score
Hx Age Ekg Risk factors Initial triponin
Helps decide if you need to admit
Risk factors for heart attack
HTN
HLD
Dm
Obesity
Smoking
Prior MI/PCI
CVA/ TIA
PAD
Wells criteria
Fits clinical picture 3 PE is 1 or equal likelihood 3 HR is over 100. 1.5 Immob/ surgery 4wks. 1.5 Hemoptysis 1 Malignancy 1
If 2 or less, PERC
IF 3 - dimer
If 4 or more- CTA
