ER rotation booklet Flashcards
What are the two things that should be covered when signing out patients?
- Complete all pt-related duties
- Inform attending
What is the Hypothetico Deductive decision making?
Working dx is tested as new data is collected (clues in a detective case)
What is the algorithmic decision making model?
Series of steps followed via algorithm
What is pattern recognition decision making model?
Series of s/sx are clumped together into a known grouping
Which decision making model has a risk of premature closure?
Pattern recognition (mostly)
What is the exhaustive decision making model?
Shotgun and figure out later
What is the event-driven decision making model?
Clinician treats symptoms without seeking underlying diagnosis
For each degree F rise in temp, how much faster does the HR go?
10 beats per minute
What is the formula for calculating the normal BP in children?
BP = 80+ 2*(age in years)
What is the 5th vital sign?
Pulse ox
What is the downfall of pulse ox readings?
-Does not reflect ventilatory status
-
What happens to the pulse ox with carboxyhemoglobinemia?
False rise
What happens to the pulse ox with methemoglobinemia?
Will appear as 85% d/t wavelength of light emitted from methHb
What is the definition of an emergency medical condition?
A medical condition manifesting itself by acute symptoms of sufficient severity, such that
- the health of the pt is in serious jeopardy
- Impairment in bodily functions
- Serious dysfunction of any bodily organ or part
What is the grade level at which medical instructions should be written?
6th grade level
What do most pts rescued from fires die of?
Inhalation injuries
How hot should hot water heaters allow water to get?
120 F
What are the six core competencies?
- Pt care
- Medical knowledge
- Professionalism
- System-based practices
- Practice-based learning environment
- Interpersonal and communication skills
What are the two treatments and their dosages for acute dystonic rxn 2/2 neuroleptic use?
1-2 mg IV/IM or benztropine
25-50 mg IV/IM of diphenhydramine
What EKG finding may appear with Haldol use?
Prolonged QT
What life threatening complication can arise from restraint use?
Metabolic acidosis from struggling.
What sort of acidosis does isopropyl alcohol cause? Why?
Non-anion gap, since it is metabolized by alcohol dehydrogenase to ketones. So causes ketosis without anion gap
What electrolyte abnormality usually exist with alcoholics, and should be treated empirically?
Mg
What is the definition of delirium?
Global inability to relate to environment and process sensory input
What happens to psychomotor activity with delirium?
Increased
What the the most common metabolic abnormality that leads to confusion? Which metabolic abnormality, by itself, will not cause confusion?
Most common is hypernatremia
Hypokalemia will not, of itself, cause confusion
When is rapid lowering of BP indicated for eclamptic pts?
If diastolic remains above 110 after seizures are controlled
What are the indications for an ED thoracotomy? (6)
- Hemorrhage control
- Release of cardiac tamp
- prevent air embolism
- Cardiac massage
- Repair cardiac injury
- Expose the aorta for clamping
How will the leg appear with a femoral neck fracture?
Abducted and externally rotated
How will the leg appear with a posterior hip dislocation?
internally rotated thigh
What physical exam finding is found with high voltage injuries from electrical wiring vs lightning?
Deep burns will be present on high voltage wiring injury
Review rule of 9s.
Review
What is the major side effect of Etomidate?
Adrenal suppression
What sort of ingestions is gastric lavage contraindicated for? (2)
caustic ingestions, or hydrocarbons.
What ingestions are charcoal contraindicated? (2)
Caustic substances since interferes with visualizing with endoscopy
Heavy metals, as will do nothing
How well does Li levels correlate with prognosis in cases of an overdose?
Not well–use clinical appearance to guide decision making
What is the treatment for Li overdose?
Dialysis
What OTC drug commonly interacts with Li?
NSAIDs 2/2 renal vasculature effects
What is the toxic dose of acetaminophen (mg/kg)?
140
What is the nomogram used for acetaminophen overdose? What type of acetaminophen is this used for?
- Rumack-Matthew
- This is for the non-sustained release form of the drug
When are serum levels drawn for the Rumack-Matthew nomogram?
4 hours post ingestion
What is NAC given?
Orally
How does clonidine OD present? How does this med work?
Like opioids
Alpha-2 agonist
What are the EKG manifestations of TCA overdose?
Marked RAD
QRS prolongation
How is deferoxamine given, and what is the classic side effect?
IV/IM
Urine turns pink/red
What are the neurologic symptoms of Pb toxicity?
Paresthesias
Wrist drop
Memory issues
What is the antidote for methemoglobinemia?
Methylene blue
Chocolate brown blood = which toxidrome?
Methemoglobinemia (Fe3+)
What are the drugs that can cause methemoglobinemia? (4)
- Nitrates/nitrites
- Local anesthetics
- Dapsone
- Phenazopyridine
How fast does ASA toxicity present?
Within 30 minutes
What is the role of inhaled steroids in the treatment of an asthma exacerbation?
Give IV or PO, NOT inhaled
True or false: tapering is needed with all corticosteroid regimens
False
True or false: Heliox should only be used in the intubated pt
False
What type of medication is the MOST beneficial in the treatment of COPD exacerbations?
Beta- agonists
True or false: CMV does not usually cause pneumonia in immunocompetent adults
True
What is the most common infectious cause of death world-wide?
TB
What is the most common findings on CXR of food aspiration?
Hyperinflation of the left lung
True or false: 25% of patients who have a PE w/o identifiable risk factors will be diagnosed with CA in 2 years
True
Pneumonia + bullous myringitis = which bacteria?
mycoplasma
What is the #1 cause of drowning in children aged 1-4?
Unsupervised at the pool
What percent of fire deaths occur at home? What percent of these are the result of not having a smoke detector?
4/5
1/2
Which local anesthetic is known for average potency, low toxicity, and rapid onset of action?
Lidocaine
What is the classic presentation of a spinal epidural hematoma?
Acute lower back pain worse with coughing after and epidural
How does an anterior spinal artery thrombus present?
painless paraplegia
True or false: a posterior tibial nerve block will provide anesthesia to the entirety of the sole of the foot
False
Under what age is a surgical cricothyrotomy absolutely contraindicated? Why?
5 years
Anatomic differences, including a smaller cricothyroid membrane, and the rostral funnal shaped more compliant pediatric larynx
What is the only absolute contraindication to a cricothyroidotomy?
Age under 5 years
True or false: lidocaine with epi can be safely used in the eyebrow region
True
Is a large wound occurs with large amounts of fatty tissues protruding, what should be done to reduce post closure skin tension?
Undermining of SQ tissue
What is the first symptom of lidocaine toxicity? What general symptoms follow?
- Lightheadedness and dizziness
- CNS excitatory effects
What is the maximum acceptable dose of lidocaine with and without epi for local wound anesthesia?
7 mg/kg with epi
5 mg/kg without
What is the role of prophylactic abx in the treatment of clean wounds?
Unstudied
What is the preferred method of anesthesia for palmar lacerations?
Local nerve block (ulnar, medial)
Why is a vertical mattress not used to close lacerations to the palm?
Risks deep structures
What is the rare, but classic side effect of using high dose fentanyl rapidly? Treatment?
- Chest wall rigidity and glottic spasm
- RSI with paralytic if cannot bag properly
Does lying supine prevent the development of post LP headaches?
No
What is the role of needle size in the formation of a post LP headache?
Smaller size = less likely to develop
Where are LP HAs located?
Bitemporal worse with sitting up
What is the normal ratio between CSF and serum glucose in adults and children respectively? Pts with systemic hyperglycemia?
- 6:1 = adult
- 4:1 = kids
- 4:1 if hyperglycemia
What is the appropriate management for a paronychia that has spread significantly into the surrounding tissue?
Drainage, abx.
What is the difference between a hypopyon and hyphema?
Hypopyon is a collection of purulent material in the eye, as opposed to blood in hyphema
What is the treatment/workup for suspected hyperextension neck injury causing neurologic s/sx?
Steroids and MRI
How reliable is the physical exam with neck injuries?
Not very- get imaging and admit for obs
Can beside US image the retroperitoneum?
No
What psych disorder increases the chance of suicide the most?
Panic disorder
Why is phenytoin avoided in pts with seizures 2/2 hyperglycemic cerebral edema?
Impairs insulin release
At what temperature does shivering cease?
32 C
What is the most appropriate first step in treating frostbite?
Immerse in warm water
What is the drug of choice for suspected but not confirmed hypoadrenalism?
Dexamethasone
True or false: pregnancy is a contraindication to hyperbaric oxygen treatment
False
True or false: OM is a contraindication to hyperbaric oxygen treatment
True–relative contraindication
Why is a ptx a contraindication to hyperbaric oxygen?
May precipitate a tension ptx
True or false: necrotizing fasciitis is an indication for hyperbaric oxygen treatment
True
True or false: necrotizing enterocolitis is an indication for hyperbaric oxygen treatment
False
What is the treatment for most scorpion envenomations? How often is intubation needed?
supportive care for mild-moderate, antivenom for severe–intubation not usually needed despite apparently terrible s/sx
What is a complication with the use of anti-venom?
Serum sickness
What is the most common s/sx of scorpion stings?
Pain and paresthesias–more than local inflammation
How long may snake venom take to have an effect, and thus how long should you observe pts?
8 hours
What is the major differentiating factor between heat stroke and heat exhaustion?
AMS in heat stroke
What is a major differentiator on PE between electrical shocks from lightning vs wiring?
Burns go with wiring, not common with lightning
True or false: seizures that occur in kids immediately after trauma are unlikely to be associated with intraparenchymal insults
True
What is the appropriate treatment for supracondylar humeral fracture in children? Why?
- Ortho consult for possible ORIF
- Risk of injury to median and ulnar nerves
What are the salter-harris classification for fractures?
- Type I = fracture through the physeal plate (often not detected radiographically)
- Type II = fracture through the metaphysis and physis
- Type III = fracture through the epiphysis and physis
- Type IV = fracture through the metaphysis, physis and epiphysis
- Type V = crush injury involving part or all of the physis
True or false: there is no need for imaging for a radial head subluxation if pain resolves after injury
True
What injury to the shoulder is usually held in slight abduction and external rotation, with pain with attempts to reverse this?
Hill-sachs deformity
What is a Hill-Sachs deformity?
It is a cortical depression in the posterolateral head of the humerus. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly
What is the most common rhythm to see in a pediatric arrest?
Bradycardia
Which is associated with an increased risk of neonatal resuscitation: fetal acidosis or alkalosis?
Acidosis
Alkalosis is NOT
When should chest compression begin for an infant with bradycardia?
- at 60 bpm or lower AND
- Oxygen and adequate ventilation have not resolved
What is the rate of compressions for an infant for CPR?
90 cpm
What are the ACLS drugs that can be given via endotracheal tube?
Lidocaine
Epi
Atropine
Naloxone
(“LEAN”)
What is the most common rhythm in the setting of pediatric cardiopulmonary arrest?
Asystole
In the post-arrest setting, what is the presser of choice to treat hypotension?
Epi infusion
Low body temperatures in the neonate can cause hyper or hypoglycemia?
Hypoglycemia
True or false: long bone fracture is a contraindication to the use of an IO?
True
What is the equation for ET tube size in children?
16 + age /4
What is the appropriate order of maneuvers for a choking child?
- Back thrust then 4 chest thrust
- Jaw thrust to look for FBs
What is the role of the Heimlich maneuver in children?
Not performed due to risk of abdominal organ damage
What APGAR scores coincide with perinatal asphyxia?
0-3
The pediatric airway is more (posterior/anterior) than in an adult?
Anterior
What should be given prior to use of succinylcholine in the pediatric intubation, and why?
Atropine to prevent bradycardia
Why is lidocaine used in pretreating the pediatric patient for intubation?
Prevents further increases in intracranial pressure
What are the four ways of approximating ET tube size in kids over 1 year?
- Age +16 /4
- Approximation with nares
- Age in months /3
- approx with child’s 5th finger
What is the most likely CXR findings of a radiolucent FB aspiration?
Atelectasis of the affected lung
What sort of FBs carry the worst prognosis in kids that aspirated them?
Large objects in the proximal airway
What is the most common form of shock in kids?
hypovolemic
