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OME > ER > Flashcards

ER Flashcards

1
Q

headache

-HPI

A 
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
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2
Q

Headache - Exam

A

Fever, supple neck, photophobia
Pupils
Full neuro

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3
Q

Headache - DDX - non emergent w/ TX

A

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

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4
Q

Headache - DDX - emergent

A

acute glaucoma
corotid artery dissect

Encephalitis
Encephalopathy (HTN)
Meningitis
Temporal arteritis

Preeclampsia
Psuedotumor

SAH
Traumatic ICH

CO poisoning

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5
Q

Acute Glaucoma

A

Unilateral, blurry, fixed pupil

Topical + systemic dec IOP meds

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6
Q

Corotid Art dissec

A

Unilateral neck pain, trauma

CTA, MRA, US

Antigoagulation, CS NRSRG?

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7
Q

CO poisoning

A

Weakenss , N/v , exposure

CO - oximetry, VBG

100% 02

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8
Q

Encephalitis

A

Fever, AMS seizures

CT, LP

IV ABX, / antiviral / isolation

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9
Q

Hypertensive encephalopathy

A

dBP >120, AMS, vision changes

Check end organs ( CMP, …?)

Dec MAP 25%

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10
Q

Meningitis

A

Fever, stiff neck, photophobia, rash

LP —> CT

Steroids–> ABX, LP, isolation

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11
Q

Preeclampsia

A

> 20 weeks up to 6 weeks postpartum, inc BP, HA

LFTs, CBC, UA

Mag, BP controll, Cs OB/ GYN

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12
Q

Pseudotumor

A

overweight, young, visual sx

CT, LP

LP, acetazolamide

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13
Q

SAH

A

Sudden, worst, SYNCOPE

CT, LP

BP controll, cs nrsrg

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14
Q

Temporal arteritis

A

Unilateral, above 55, tender, jaw pain

ESR

Steroids, , FU with optho / reum

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15
Q

Traumatic ICH

A

Trauma, ETOH, elderly

CT

Neurosurg

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16
Q

acute HA and Syncope

A

Think SAH first!

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17
Q

Head Injury - HPI

A

Mechanism
LOC, N/V, seizure, whitnessed, intoxication, neuro deficit,
Blood thinners

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18
Q

Head Injury - Exam

A

GCS
Full Neuro
Pupils
Skull FX - raccon eyes, battle sign, nasal CSF leak, hemotympanum

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19
Q

Head injury - when to do CT

Brain

C Spine

A

Brain - Canadian Head CT rule

C Spine - Canadian C spine rule

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20
Q

Head Injury - acute general management of SAH, subdural hematoma, epidural, ICH, skull fx

A

COnsult neurosurgery

Close obs of neuro status

Consider - antiseizure med,s dec ICP, ICU

21
Q

GCS

A

out of 15

Eyes: 0-4

Verbal: 0-5

Motor : 0-6

Considered comatose if under 8

22
Q

SVT

A

No p waves, rate over 150

Give adenosine - blocks AV conduction for a bit - 6-12-12

23
Q

Vtach

A

give Amiodarone

24
Q

Afib

A

Rate vs rythem

Cardiovert to rythem only if youngish or new onset

Rate: Propranolol or CCB (dilt / verap )

25
Q

CHADS 2 score

A

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

26
Q

Sinus Brady

A

Atropine

If hemodynamically unstable, pace

27
Q

Types of heart block

A

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

28
Q

Idioventricular Rythem

A

Just Vents beating

Atropine wont work, just pace

29
Q

ACLS for:

VT/VF

PEA/ ASYSTOLE

A

Shock if: VT / VF

VT/VF
Epi -// 2min CPR // Atropine // 2min CPR // epi

PEA/ ASYSTOLE
Epi -// 2min CPR // (pulse, rythem, shock?) // 2min CPR // epi

30
Q

When is someone considered hemodynamically unstable? (FOR ACLS)

A

CP
SOB
AMS
SBP < 90

31
Q

GENERAL: Someone comes in with an arrythmia, what do you think through?

A

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)

32
Q

Tachy Rythms

A

Narrow:

Sinus
SVT

Afib
Aflut

MFAT

Wide:

VT
VFIB
Torsods

33
Q

Brady Ryhthms

A

Sinus brady
1,2,3 degree Hblocks

Junctional ( wut? )

Idioventricular (Vents on their own)

34
Q

Pt with hypotension - how to solve in 30 seconds

A

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

35
Q

Cough meds on tox screen can:

A

Come back positive for alcohol and opiates

36
Q

Antivert

A

Meclizine

37
Q

Options for complex uti

A

3rd gen cephalosporins

  • rocephin (iv only)
  • cephpodoxime
  • cephdinir
  • cefuroxime
  • cephtazidime

Doxy- SA: achilis rupture, c-diff

Don’t take nitrofurantoin or ffosphomyosin

38
Q

Indications for Dialysis

A 
Acidosis
Electrolyte imbalance (K)
Ingestion
Overload
Uremia
39
Q

Headache cocktail

A

Benadryl
Chlorpromazine
Ketoralac (toradol)

40
Q

Tx for asthma exacerbation

Info about asthma tx

A

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

41
Q

Cause Equina

A

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

42
Q

Most common causes of pancreatitis

A 
Stones
Alcohol
Medications
Infections
High triglycerides
43
Q

Ransoms criteria for pancreatitis

A 
WBC
Age
Glucose
AST
LDH
44
Q

Hints exam

A

Nystagmus -unidirectional is peripheral

Skew (cover uncover) - none in peripheral

Head Impulse- look for savage after quickly turning head- + means it is peripheral

45
Q

Types of fracture

A

Displaced
Spiral
Comminuted
Greenstick

Transverse
Linear
Oblique

46
Q

Components of heart score

A 
Hx
Age
Ekg 
Risk factors
Initial triponin

Helps decide if you need to admit

47
Q

Risk factors for heart attack

A

HTN
HLD
Dm

Obesity
Smoking

Prior MI/PCI
CVA/ TIA

PAD

48
Q

Wells criteria

A 
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

OME (11 decks)

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