ER Shelf Flashcards
Most common cause of sudden cardiac death in adults is
Ventricular fibrillation
Medications that can be given through endotracheal tube
ALE
Atropine
Lidocaine
Epinephrine
(Also Naloxone)
Give with suspected torsades de pointes
Magnesium sulfate
Atrial fibrillation tx if stable
CCB (Diltiazem)
Then Beta blocker
Metoprolol
Esmolol
Atenolol
Afib/ A Flutter if unstable
Cardioversion
Paroxysmal supraventricular tachycardia (PSVT)
SVT
Vagal maneuvers
Adenosine
—> CCB
Suspected meningitis what test to get
CT scan of brain before lumbar puncture
Especially if papilledema
Seizure for 6 minutes what to give
Benzo (Lorazepam)
Status epilepticus
Hypotension without tachycardia
Neurogenic shock
Imaging for ACL tear
MRI for soft tissue
32 y.o with chest pain. Pain is sharp and left sided. Worse with inspiration and when laying down. SOB.
Tachycardic regular heart rhythm.
ST segment elevations
Troponin less than 0.01
What other history
Acute pericarditis
Preceding upper respiratory infection
What do you see preceding large pulmonary embolism
Hemoptysis
Pulmonary emboli EKG
Tachycardia
S1Q3T3 elevations
Hepatitis infection acute from fecal oral
Hepatitis A virus
What do you see with epididymitis
Increased epididymal blood flow
Simple anechoic fluid collection in testicle
Hydrocele
Symptomatic bradycardia Tx
Atropine
Substituted judgement
Surrogate decision maker should try to imagine what the patient would want if they were competent
Prolonged erection what imaging to get
Doppler ultrasound
Hypertensive emergency with blood pressure above 180 affects what
Elevates what lab
Kidneys
Heart
Arteries
Brain
Creatinine
D-dimer
Elevated with elevated fibrin degradation
Thrombosis
Localized temporal abnormalities on MRI
Confusion, HA, lethargic, speaking incomprehensibly
Fever
Tx
Herpes Simplex encephalitis
Acyclovir
Vaccination for meningitis
11 years to 18 years old
Child in garage
Breathing irregular
Hypotensive
Rapid breathing
Low Bicarb
Give what
Ethylene glycol poisoning (antifreeze)
Give membrane receptor blockade
Fomepizole
Concerned for what in chemo patients with fever
Neutropenic fever
Overdose of lithium causes
Nephropathy
- Elevated serum osmolality
Venom works how
Destructive enzymatic proteins
Antivenom is antibodies or antibody fragments that bind to venom protein and inactivate them
Colon cancer see what on blood smear
Microcytosis= Low MCV
Iron deficiency anemia
Bacterial thrombophlebitis of the internal jugular vein
Lemierre syndrome
Complication of peritonsillar abscess
Fusobacterium necrophorum= gram negative rod
Tx Vibrio vulnificus
Doxycycline and ceftrazidime
Clams
Curved gram negative pathogen
Vibrio vulnificus
Tx Doxycycline and ceftrazidine
TMP SMX good for
Cellulitis w/ MRSA
Tx hemolytic transfusion reaction
Stop transfusion
IV fluids in a large bolus
Wrist extension
Finger extension
Thumb abduction
What nerve
Radial nerve
Loss of abduction of the arm 15 to 90 degrees
Axillary nerve
Weakness in flexion of wrist, hand, thumb, and lateral fingers
Median nerve
Weakness of elbow flexion and forearm supination
Musculocutaneous nerve
Injury to medial epicondyle
Ulnar nerve
Weakness in flexion of the wrist, hand and medial fingers
Ulnar nerve
Supracondylar fractures
Median nerve
Associated with ulcerative colitis and Crohns
Erythema nodosum
Red or violaceous subcutaneous nodules on anterior surface of both legs.
Dermatitis herpetiformis
itchy and painful papulovesicular rash associated with celiac disease
Wound on hip with desquamation and black eschar
Pressure ulcer due to bony prominences
Ipsilateral ptosis associated with
Cluster headache
Malignant pleural effusions
Bloody
Total protein 4
LDH 120
Exudative
Exudative pleural effusion
Pleural fluid protein to serum protein is greater than 0.5
The ratio of pleural fluid LDH to serum LDH is greater than 0.6
Pleural fluid LDH is greater than 0.6 times the upper limit of normal for serum LDH
Initial step for HHS
Normal saline
Decreased breathe sounds on one side
Hyperresonance
Tension penumothorax
Inadequate venous return from increase in intrathoracic pressure increases and results in vena cava compression.
Salicylate poisoning
Aspirin
Respiratory alkalosis
Elevated pH
Decreased PaCo2
Anterior cord syndrome
Anterior spinal artery
Loss of motor function and sensation of pain and temp
Retention of touch, proprioception, and vibratory sensation
Brown Sequard syndrome
One half of the spinal cord
Penetrating injury
Loss of ipslateral motor function and touch, proprioception and vibratory sensation
CL loss of sensation of pain and temp
Central cord syndrome
Trauma to cervical spine
Decreased motor function and sensation in both upper extremities.
Hypothermia at risk for
Cardiac arrhythmias
HR 50
Tx
Bradycardia
Atropine
Risk factor for placental abruption
HTN
Trauma
Substance use (cigarettes, alcohol, cocaine)
Maternal age younger than 20 and older than 35
Low socioeconomic status
TX PEA
Has P, QRS and T waves
Epinephrine
Next step in patients who survive out of hospital sudden cardiac arrest
Therapeutic hypothermia
Improves neurologic outcomes
Alcohol withdrawal scoring evaluation system
Clinical institute withdrawal assessment for alcohol (CIWA)
CHA2DS2-VASc
Predict stroke in patients with atrial fibrillation
Ranson criteria
evaluate severity of pancreatitis
Suspected TCA overdose get what
EKG
Haemophilius influenza
Epiglottitis
Polysaccharide-protein conjugate vaccine
Watery diarrhea Now has fever and abdominal pain Meckels diverticulum TEmp Yellow drainage on rectal exam
Pneumaturia
Fistulas common w/ crohns disease
Enterovesical fistula between bowel and bladder. Pneumaturia is air in bladder
birefringent crystals
Calcium pyrophosphate crystals
Pseudogout
Rhomboid shaped
Dont give what antibiotic with acute intermittent porphyria
Sulfa drugs
TMP-SMX
Myasthenia gravis
Anti-acetylcholine receptor antibodies
What to initial do for incarcerated inguinal hernia
Trendelenburg position
Suspected appendicitis what test
Ultrasound abdomen
Scale used to traumatic brain injury
Glasgow Coma Scale (GCS)
ST elevations in Inferior leads
II, III, aVF
Right coronary artery
ST elevations in V2, V3, V4 and lateral V5, V6, I, aVL
Left anterior descending artery
LAD
Anterior
ST elevations RV4, RV5, RV6
Right anterior leads
Right marginal artery
Getting stitches
Patient becomes numb and dizzy and has seizure
Intravascular injection of local anesthetics
Causes central nervous system or cardiovascular toxicity
Numbness, metallic taste, lightheadedness, dizziness, disorientation before progressing to nconsciousness or seizure
Dont give TPA
if previous bleed
therapeutic anticoagulation
- heparin
- warfarin
- direct thrombin inhibitors
- Factor Xa inhibitors
Genital pain
Pain and erythema over left inguinal region
Fever
Perineal tenderness
Skin overlying scrotum, perineum, and left inguinal region is dusky with crepitance and a feculent odor
Fournier gangrene
Necrotizing soft tissue infection of the perineum, genitals and surrounding areas
Associated with compromised immunity from any cause
- Diabetes mellitus
Fever Fluid wave Abdominal pain Abdominal swelling Emesis nonbloddy Loose stool Elevated WBC
Testing to get
Spontaneous bacterial peritonitis (SBP)
Paracentesis
What lab to get for blunt chest injury with sternal fracture
Troponin
Concerned for myocardial contusion
IV drug use to bacteremia spreads by
Hematogenous seeding
Spinal epidural abscesses
Acute limb ischemia
Lack of blood flow and pulses
What medication to give
Heparin
Receives unit of packed red blood cells
During transfusion reports shortness of breath
Bilateral rales
Drop in blood pressure
Drop in oxygen saturation
Most likely cause?
Donor antibodies
Transfusion related acute lung injury (TRALI)
Febrile nonhemolytic transfusion reaction
Donor leukocytes attacked by the recipients preformed antibodies
Fever w/o hypotension
Acute hemolytic transfusion reaction
Recipient antibodies against donor RBC
Severe intravascular hemolysis with error in cross-matching
Incompatibility
Fever, chills, and severe intravascular hemolysis
Sickle cell with chest pain
What to do
Acute chest syndrome
IF doesnt improve with oxygen, morphine, albuterol, maintenance IV fluids, antibiotics
Next: Exchange transfusion
Tx Bell palsy
Oral steroids within first three days of paresis
Medication for chest pain with no atherosclerotic coronary artery disease
Prinzmetal angina
Coronary artery vasospasm
CCB
- Amlodipine
PCP MOA
NMDA receptor antagonist
Cocaine MOA
blocking of DA, NE, 5HT (serotonin) reuptake
Marijuana MOA
CB1/CB2 recptors
Benzo MOA
Increased firing of GABAa
MOA of opiates
Mu receptor agonist
Class III hemorrhage
30-40%
Hypovolemic shock manifesting with tachycardia (120-140 beats per min)
Hypotension
Decreased pulse pressure
Tachypnea
Mental status changes
Oliguria
Class I hemorrhage
up to 15%
DO not have hemodynamic changes
No altered mental status
Class II hemorrhage
15-30%
Tachycardia
Narrowed pulse pressure
Rhinosinusitis treatment
Intranasal fluticasone propionate for 15 days
15-21 day course of intranasal steroids
Emergency thoracotomy location
Left fifth intercostal space from the border of the sternum to the mid-axillary line
Rhabdomyolysis has a decrease in what lab
Calcium
Calcium deposition occurs in areas of necrotic muscle can result in hypocalcemia
HIV and headache
Meningeal enhancement
No mass lesion
CD4 97
Increased opening pressure on lumbar puncture
What test
Cryptococcal meningitis
Cryptococcus neoformans
India ink preparation
Abdominal pain
Diabetes, HTN, CKD
Began with carrying groceries
Diaphoresis
N/V
SOB
Acute coronary syndrome
Get EKG
Pain reproduced by leg straightened and passively flexed at the hip
Sciatica
intervertebral disc herniation
Medication to give if mass effect and edema with brain neoplasm
Increased intracranial pressure
Dexamethasone IV
Epilepsy controlled with antiepiletpci
Latent TB found and started on medications
Blurry vision now with nystagmus
Elevated phenytoin level
Due to decreased folate
Leads to megaloblastic anemia and gingival hyperplasia
Overuse of local anesthetic agents
Prilocaine
Benzocaine
Dapsone
Methemoglobinemia
Methemoglobin oxidized form of hemoglobin unable to bind oxygen
Hypoxia
Tx Methylene blue
Area colon most likely to perforate
Cecum
Heroin overdose given naloxone
Stats drop in 30 minutes
Naloxone pharmacodynamics
Duration of action 30 minutes
Haloperidol
Sweating
Fever
Elevated blood pressure
Tachycardia
Resting tremor
Pale
Rigidity
What would be elevated
Neuroleptic malignant syndrome
Creatine kinase due to muscle injury
Allopurinol
Can cause stevens-johnson syndrome/toxic epidermal necrolysis
Skin rash
Difficulty swallowing
Rubeola virus
Measles
Koplik spots
Conjunctivitis
Rhinitis
MOA of MRSA
Penicillin binding protein
Mutation of the pencillin binding protein which no longer bind the beta-lactam antibiotics
Widening and flattening of the femoral head
Legg-Calve Perthes disease is avascular necrosis
HIV lung infection
Silver staining crushed ping pong balls
Pneumocystis pneumonia (PCP)
TMP-SMX
Salter-Harris fracture
Involves epiphyseal plate
Can lead to limb length discrepancy
Angular deformity
TX Scabies
Ivermectin
Acetaminophen overdose scale
Rumack-Matthew nomogram
Likelihood of hepatotoxicity can be predicted based on a plot of the serum acetaminophen level against time starting four hours post ingestion
Acute Physiology and Chronic Health Evaluation (APACHE)
Validated severity of disease score that predicts mortality in patients upon admission to intensive care units
Milan criteria
Used to select patients with hepatocellular carcinoma associated with cirrhosis for liver transplantation
Model for End-Stage LIver disease (MELD) score
is used to objectively assess the severity of chronic liver disease
Bright red blood per rectom of 11 month old
Bleeding past ileocecal valve on colonoscopy
Meckel diverticulum
Get Nuclear imaging to confirm
Medication put you at risk for latent TB reactivation
TNF inhibitors for autoimmune conditions
Adalimumab
Etanercept
Infliximab
Tx Benzo withdrawal
Diazepam
Chlordiazepoxide
Taper off
Needle aspiration of peritonsillar abscesses at risk for
Hitting Carotid artery
Fall on outstretch hand and fracture
Distal radius
Wrist in dorsiflexion
Colles fracture
With posterior and radial displacement of wrist
Community acquired pneumonia that is drug resistant
Pseudomonas aeruginosa
Prolonged QT interval
Delayed cardiac repolarization
Increases risk fo torsades de pointes
Cause syncope
Avoid antibiotics, antidepressants, and antipsychotics
Malignant otitis externa
Left mastoid process tender
IV Ciprofloxacin
Tx Digoxin toxicity
Hydration
Correction of electrolyte abnormalities
Digoxin specific antibody fragments (Fab)
Diarrhea Urination Bradycardia Pinpoint pupils Drainage from eyes
Overdose
Organophosphate poisoning
MOA enzyme inhibition
What to do for boerhaave syndrome esophagus rupture
NPO status
IV proton pump inhibitor
IV broad-spectrum antibiotics
MI medication that causes hypotension
Nitroglycerin
Complete heart block/ Third degree heart block tx
Transcutaneous cardiac pacing
Abdominal pain
Fever
Scleral icterus
RUQ tenderness
Tx
Cholangitis
RUQ pain, jaundice, fevers
Tx: Piperacillin- tazobactam
Aspiration pneumonia bacteria
Polymicrobial
Gram positive
Gram negative
Anaerobic
MOA to Toxic shock syndrome
Tx
Immune activation
Toxin-producing staph aureus
Which allows non-specific binding of T cell receptor MHC II resulting in massive immune activation
Tx IV antibiotics
Risk factor for hemorrhagic stroke
Bright area of blood on CT
Hypertension
Causes leakage form intracerebral arteries
Elevated lab with necrotizing fasciitis
Elevated C-reactive protein
Elevated WBC
Elevated Creatinine
Elevated Glucose
Decreased hemoglobin
Decreased sodium
Temporal arteritis give what
Corticosteroids
What to do with a human bite
Wound debridement
You don’t need prophylactic antibiotics unless primary closure
Globe rupture due to projectile get what imaging
CT for foreign body
DM affects what to cause wounds
Microvascular circulation
[Not venous insufficiency]
Chest pain
Dyspnea
Congestive Heart failure
“Suffocating”
Mottled skin
Thready pulses
JVD
Distant heart sounds
Intra-aortic balloon pump placed to reduce afterload
What next
Dobutamine
[Beta-1 receptor agonist with some beta 2 activity]
Cardiogenic shock
Positive inotropic effect
Decreases afterload
Side effect Etomidate
Short acting IV anesthetic agent used for intubation
Acute adrenal insufficiency due to the suppression of the adrenal synthesis of cortisol
Candidiasis of the mouth caused by what medications
Inhaled corticosteriods
[Fluticasone]
Not albuterol
Wolff-parkinson white drug to give to prevent SVT tx
Propafenone
[Dont give CCB, beta blocker or adenosine]
Infections in immunosuppressed patients causing left sided facial swelling and vision loss
Mucormycosis
Mucor
Rhizopus
Absidia
Cunninghamella
First Treatment hyperthermia
Electric fan and tepid water from spray bottles
Spinal metastases can progress to
spine or cauda equina compression
Paraplegia
[Quadriplegia if metastasis in cervical spine]
Tx for hip fracture pain if pain not improved with morphine
Regional anesthesia
Femoral nerve block
How to catch preeclampsia early
Blood pressure checks
[Not urine dipstick protein]
Reduce mortality and morbidity in COPD
Continuous oxygen
13 y.o with left hip and groin pain. Past month No trauma Limping Obese No deformity or change in length Limited internal rotation
Physeal fracture
Slipped capital femoral epiphysis (SCFE)
Physeal fracture of the growth plate of the femur
Rash from drug reaction
Leukocytoclastic vasculitis
Small vessel inflammation with a neutrophilic infiltrate and necrosis with nuclear debris
Henoch- Schonlein purpura
IgA antibody deposition
Skin lesions
Lower extremity palpable purpura, abdominal pain, gastrointestinal bleeding
Joint pain
CML related to
Increased activity of tyrosine kinase (bcr-abl) which is encoded by the philoadelphia chromosome
Mutant tyrosine kinase causes inhibition of apoptosis and increased mitosis, leading to unregulated proliferation of granulocytes
Person might go into septic shock what to do
Urinary catheterization
Provides ongoing assessment of urine output, a surrogate for end organ (specifically kidney) perfusion
Chest compression rate
At least 100 per minute
Subdural bleed caused by
Age
[Not acetaminophen]
Lead poisoning cells
Basophilic stippling
Howell jolly bodies
Sickle cell disease
Macroovalocytes
enlarged oval shaped red blood cells
Megalblastic anemia
Folate or vitamin B12 deficiency
What to give to continuous nose bleed
Alpha receptor agonist
[Epinephrine, oxymetazoline, or phenylephrine]
Vasoconstricting agent
Traumatic injury in pregnancy get what test
Kleihauer Betke test
Maternal exposure to fetal blood
anti-rH antibodies to negative month
KB: blood test performed on pregnant woman to measure the amount of fetal hemoglobin transferred from the fetus to the mothers bloodstream
Serum Elisa negative for HIV
Get nucleic acid testing
HIV RNA
Second intercostal space at the midclavicular line
Decompressive needle thoracostomy
Subxiphoid space
Used to perform pericardiocentesis
Non bloody vomiting and diarrhea
Norovirus
Heart pain referred into epigastrium
Inferior wall myocardial infarction
Inferior leads: II, III, avF
Most common myocardial infarction location
Anterior wall MI
ST depression in V1, V2, V3 and V4
Posterior wall MI
ST segment elevation in leads I, II, III, aVF, aVL, V2, V3, V4, V5 and V6
Pericarditis
ST segment elevations in leads V2, V3, and V4
Left anterior wall infarct
St segment elevation in leads V4, V5, and V6
lateral wall MI
On warfarin and blood in stool. What lab to check
Prothrombin time (PT)
Convulsive epileptic seizures with open eyes
PNES Pseudoseizure
Botulism MOA
Neurotransmitter release inhibition
Wound botulism
Black tar heroin
