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Emergency Medicine > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

Pt comes in with neck trauma, how do you open their airway?

A

Jaw thrust

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2
Q

What type of airway do you use in an obtunded Pt?

A

Oropharyngeal

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3
Q

How do you determine size of orotracheal tube in a kid?

A

(Age + 16)/4

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4
Q

What is rapid sequence intubation?

A

Uses paralysis + sedation to intubate pt

DON’T use if difficult/distorted airway

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5
Q

You need to RSI, & Pt is an asthatic, which sedation should you use?

A

Ketamine - relaxes bronchial smooth muscle

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6
Q

Sedation meds

A
  1. Fentanyl
  2. Midazolam
  3. Etomidate
  4. Propofol
  5. Ketamine - good for asthma
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7
Q

Paralysis meds

A
  1. Succinylcholine

2. Vecuronium

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8
Q

Causes of failure to oxygenate/ventilate?

A
  1. Mechanical failure
  2. Tension pneumo
  3. ARDS
  4. CHF
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9
Q

If you can palpate a radial pulse, what must SBP at least be?

A

> 80

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10
Q

If you can palpate a femoral pulse, what must SBP at least be?

A

> 70

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11
Q

If you can palpate a carotid pulse, what must SBP at least be?

A

> 60

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12
Q

How much cardiac output does chest compressions provide?

A

25-30%

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13
Q

What is the only intervention consistently proven to improve outcome in cardiac arrest?

A

Defibrillation

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14
Q

When do you use electrical pacing?

A
  1. Refractory tachycardia
  2. Torsades
  3. Unstable bradycardia
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15
Q

MCC sudden cardiac death?

A

CAD - MI

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16
Q

When does sudden cardiac death usually occur?

A

Morning

MC in winter, home, males 50-75

Beta-blockers protective

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17
Q

Which arrhythmias usually cause sudden cardiac death?

A

Pulseless VT or VF

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18
Q

What factors inc. your chance of survival if you go into VF?

A
  1. Witnessed collapse
  2. Prompt CPR
  3. Early defibrillation
  4. Younger
  5. Arrest occurring away from home
  6. Initial rhythm was VF/VT
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19
Q

What is bradyasystole?

A

Vent rate <60 &/or periods of asystole

Rarely survives

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20
Q

The SA node experienced ischemia/infarction…what rhythm would you typically see?

A

Bradycardia or asystole

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21
Q

The AV node experienced ischemia/infarction…what rhythm would you typically see?

A

AV block

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22
Q

Risk factors for sudden cardiac death in adults >35y/o

A
  1. Age
  2. Male
  3. CAD
  4. Cardiomegaly w/ LVH
  5. Impaired LV function, EF<30%, CHF
  6. Long QT
  7. Vent. arrhythmias
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23
Q

Is coarse or fine VF better?

A

Coarse

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24
Q

What is shock?

A

Circulatory insufficiency that creates imbalance btwn tissue Ox supply & demand
Causes anaerobic metabolism which creates lactic acid

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25
Q

Causes of lactic acidosis

A
  1. Inc. oxygen demand - Status epilepticus

2. Impaired tissue Ox use - septic shock, postresuscitation phase of cardiac arrest

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26
Q

Dx SIRS

A

Systemic Infammatory Response Syndrome - from shock
Need 2 or more
1. Temp >100.4 or 90bpm
3. RR >20
4. WBC >12 or <4 or 10% immature forms or bands

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27
Q

Classification of shock

A
  1. Hypovolemic
  2. Cardiogenic
  3. Obstructive
  4. Distributive
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28
Q

Tx shock

A 
Airway
Breathing
Circulation
Delivery of Ox
End points of resuscitation
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29
Q

When do you use vasopressors & name them

A

When volume resuscitation not adequate or contraindicated (cardiogenic shock)

  1. Dopamine
  2. NE
  3. Phenylephrine
  4. Vasopressin
  5. Epi
  6. Dobutamine
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30
Q

Risk factors for maternal death

A
  1. Maternal age
  2. Inc. live birth order
  3. Lack of prenatal care
  4. Unwed mother
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31
Q

What are the leading causes of maternal death?

A
  1. PE
  2. Hemorrhage
  3. Pregnancy-induced HTN
  4. Infection
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32
Q

When shouldn’t you use a femoral vein for IV access in a pregnant woman?

A

> 20 wks

Uterus compresses IVC

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33
Q

What position should a pregnant lady be in if you’re intubating?

A

Supine but elevate R hip to prevent vascular compression

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34
Q

When is the fetus viable?

A

22-26 wks

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35
Q

If a pregnant lady goes into cardiac arrest, what should you do?

A

Tilt Pt
C-section if baby >20wks after 5 min
Open chest CPR after 15 min

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36
Q

Pregnant lady gets PE, what tests should you do?

A

CT b/c D-dimer inc. w/ pregnancy

Tx w/ Heparin

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37
Q

What is the MCC of global brain ischemia in adults?

A

VF/VT

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38
Q

What is the MCC of global brain ischemia in kids?

A

Asphyxia

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39
Q

When should you induce therapeutic hypothermia?

A

Pts who remain in coma after resuscitation from arrest

  1. Reduces neuronal cell death
  2. Beneficial to heart, lungs, kidneys & intestines

ROSC 34 C

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40
Q

Contraindications of therapeutic hypothermia

A
  1. Trauma
  2. Sepsis
  3. Advanced dementia
  4. Active bleeding
  5. CA w/ brain mets
  6. DNR
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41
Q

What temp do you cool Pt to in therapeutic hypothermia?

A

33 C

Cool for 24h then rewarm over 24h

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42
Q

Name some opiates

A
  1. Morphine
  2. Hydromorphone
  3. Fentanyl
  4. Meperidine
  5. Oxycodone
  6. Hydrocodone
  7. Codeine
  8. Tramadol
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43
Q

Name some opiate agonists-antagonists

A
  1. Buprenorphine
  2. Butorphanol
  3. Nalbuphine
  4. Pentazocine
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44
Q

Contraindications to propofol

A

Egg or soy protein allergy

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45
Q

Which sedative has a risk of myoclonic jerking?

A

Etomidate - amnestic not analgesic

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46
Q

Visceral pain fibers

A

Sensation from heart, blood vessels, pericardium, lungs & esophagus

Pain poorly localized, dull, heavy or achy

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47
Q

Somatic pain fibers

A

Sensation from pleura, peritoneum, muscle, skeleton & skin

Pain well localized & sharp

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48
Q

Referred pain

A

Visceral pain signals perceived in somatic structures - arms, neck & jaw

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49
Q

Factors that inc. likelihood of acute MI

A
  1. Radiation to R arm/shoulder***
  2. Radiation to both arms/shoulders
  3. Worse w/ exertion
  4. Radiation to L arm
  5. Diaphoresis
  6. N&V
  7. Worse than previous angina/similar to previous MI
  8. Pressure
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50
Q

Factors that dec. likelihood of acute MI

A
  1. Pleuritic
  2. Positional
  3. Sharp
  4. Reproducible w/ palpation
  5. Inframammary location
  6. Not exertional
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51
Q

What is costochondritis & S/S?

A

Inflammation of costal cartilage

Sharp, dull &/or worse w/ breathing

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52
Q

What is xiphodynia?

A

Sharp pain at xyphoid

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53
Q

Troponin is elevated, but no MI, what could it be?

A
  1. Tachyarrhythmias
  2. LVH
  3. Myocarditis
  4. Pericarditis
  5. Cardiac contusion
  6. HF
  7. PE
  8. Sepsis
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54
Q

What influences coronary artery blood flow?

A

Duration of diastolic relaxation of the heart, coronary vascular resistance

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55
Q

Tx STEMI

A

PCI w/in 90mins or Fibrinolysis w/in 30 min

Antiplatelets, antithrombins, beta-agonists, nitrates

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56
Q

Absolute contraindications to fibrinolytics

A
  1. Prior intracranial hemorrhage
  2. Known structural cerebral vascular lesion (ex. AV malformation)
  3. Known intracranial CA
  4. Ischemic stroke w/in 3 mo
  5. Active internal bleeding
  6. Suspected aortic dissection/pericarditis
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57
Q

When would you use a glycoprotein IIb/IIIa inhibitor with an MI?

A

with PCI

  1. Abciximab
  2. Eptifibatide
  3. Tirofiban
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58
Q

When should you use caution with nitrates?

A

Inferior MI - nitrates dec. preload & may cause HOTN due to RV involvement

Do not use w/in 24h of Viagra or 48h of tadalafil use

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59
Q

You should start oral beta-blockers in MI Pts unless…

A
  1. Signs of HF
  2. Low cardiac output
  3. Inc. risk for cardiogenic shock
  4. Prolonged PR, 2/3rd degree heart block, active asthma, reactive airway disease
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60
Q

STEMI from crack…what is the Tx?

A

Get EKG, Troponin

  1. Aspirin
  2. Nitrates
  3. Benzos
  4. PCI

DO NOT use beta-blockers - will inc. BP

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61
Q

Define cardiogenic shock

A

Dec. cardiac output leading to inadequate tissue perfusion despite adequate or excessive circulating volume (pump problem)

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62
Q

Risk factors for cardiogenic shock

A
  1. Old
  2. Female
  3. Acute/prior ischemic event
  4. PMH
  5. CHF
  6. Diabetes
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63
Q

MCC of cardiogenic shock?

A

Large MI

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64
Q

S/S Cardiogenic shock

A

Hypoperfusion

  1. AMS
  2. Dec. urine output
  3. Ashen/cyanotic, cool skin, mottled extremities, weak pulses
  4. Weak pulses due to sympathetic nervous system
  5. HOTN
  6. Sinus tachycardia
  7. Tachypnea
  8. JVD
  9. Rales
  10. Loud/new systolic murmur
  11. Cardiac PMI moved
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65
Q

Tx cardiogenic shock

A
  1. PCI usually
  2. Correct hypoxia, hypovolemia, rhythm disturbances, electrolyte abnormalities, acid base abnormalities
  3. Foley-cath to monitor output
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66
Q

Tx cardiogenic shock + MI

A

Tx same way as w/o shock except

  1. No NTG if SBP <90
  2. No beta-blockers for Pts in shock or at risk for shock
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67
Q

MCC HF & Pulmonary edema

A
  1. Myocardial ischemia
  2. Cardiomyopathy
  3. HTN
  4. Cardiac dysrhythmias
  5. Noncompliance
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68
Q

What is normal ejection fraction?

A

60%

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69
Q

Describe systolic dysfunction

A
  1. EF <40%
  2. Impaired contractility - difficulty ejecting blood
  3. Leads to inc. intracardiac volumes & pressures, pulm. congestion & edema
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70
Q

Describe diastolic dysfunction

A
  1. EF normal/higher
  2. Impaired vent relaxation - difficulty receiving blood
  3. Atrial pressures inc.

inc. w/ age, women
Often due to chronic HTN & LVH, sometimes CAD

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71
Q

CXR - L-sided CHF

A
  1. Cardiomegaly
  2. Interstitial edema
  3. Effusions
  4. Kerley B lines
  5. Cephalization
  6. Bat wing pattern
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72
Q

BNP in chronic HF?

A

always inc. - but change of 40% from baseline = acute exacerbation

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73
Q

MC precipitants of acute HF syndrome

A
  1. Noncompliance - excess salt, meds
  2. Raid AFib
  3. Acute MI
  4. Renal failure
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74
Q

Tx HTN HF

A
  1. O2, SL NTG
  2. BP >150/100 - add IV NTG/nitroprusside
  3. IV diuretic - furosemide
  4. If severe dyspnea - begin BiPAP

Admit PRN

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75
Q

When should you avoid nitrates w/ HF?

A
  1. RV infarction
  2. Aortic stenosis
  3. Volume depletion
  4. Hypertrophic cardiomyopathy
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76
Q

Tx HOTN HF

A

SBP<90
1. Inotrope - dobutamine/dopamine until SBP 90-100

Admit - may need vasodilator

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77
Q

Drugs to avoid in HF

A
  1. CCB
  2. NSAIDs
  3. Antiarrythmics - quinidine, procainamide
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78
Q

Tx bradyarrhythmias

A

Only Tx if hypoperfusion or risk of AV block
1. TransQ pacing at 100

May need sedation w/ narcotics/benzos

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79
Q

Tx regular stable narrow tachyarrhythmias

A
  1. Vagal maneuvers
  2. Adenosine

Tx underlying cause

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80
Q

Tx irregular stable narrow tachyarrhythmias

A
  1. Control rate - diltiazem or beta-blockers

Tx underlying cause

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81
Q

Tx regular stable wide tachyarrhythmias

A

If VT - amiodarone
Consider synch. cardioversion

SVT - adenosine

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82
Q

Tx irregular stable wide tachyarrythmias

A

If WPW w/ AF - amiodarone/procainamide

If Torsades - Mg

If VT - synch. cardioversion

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83
Q

If defibrillator Pt is in cardiac arrest, how many shocks have they already had?

A

4

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84
Q

When a Pt presents to the ED, at what time are their BP measurements most representative?

A

60-80 mins

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85
Q

MCC hypertensive urgencies?

A

Noncompliance w/ meds

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86
Q

Tx hypertensive urgency

A

Reduce BP w/in 24-48h

Commonly use Clonidine

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87
Q

What is malignant HTN?

A

Elevated BP w/ papilledema

88
Q

S/S hypertensive emergency

A
  1. HA
  2. N/V
  3. Visual complaints
  4. AMS - encephalopathy - cardiac Sx, confusion, lethargy, coma
  5. Eyes - hemorrhages, exudates, papilledema
  6. Acute CHF
89
Q

S/S hypertensive urgency

A

Nonspecific

Usually HA

90
Q

Tx hypertensive emergency

A

Lower MAP ASAP by 20-25%

Use Labetalol/Metoprolol/Esmolol
Nicardipine/NTG/sodium nitroprusside
Benzos

91
Q

If a Pt has asthma & presents w/ hypertensive emergency, what should you use to lower BP?

A

Esmolol - short acting

92
Q

Tx aortic dissection w/ HTN emergency?

A

goal SBP <140-110

Morphine
Labetalol

93
Q

Tx pulm edema w/ HTN emergency

A

NTG then diuretics

94
Q

Tx acute MI w/ HTN emergency

A

NTG

beta-blockers

95
Q

Tx cocaine intox. w/ HTN emergency

A

Benzos

DO NOT use beta-blockers

96
Q

Tx eclampsia w/ HTN emergency

A

Labetalol

Nicardipine

97
Q

Tx HTN encephalopathy w/ HTN emergency

A

Nicardipine/Labetalol

98
Q

Tx SAH w/ HTN emergency

A

Labetalol/Nicardipine

Oral nimodipine

99
Q

Tx intracranial hemorrhage w/ HTN emergency

A

Labetalol

Nicardipine

100
Q

Tx acute ischemic stroke w/ HTN emergency

A

Labetalol

101
Q

Tx acute postop HTN

A

Tx pain & anxiety first

Nicardipine/Labetalol

102
Q

When in doubt w/ HTN emergency on test, use what??

A

Labetaol & Nicardipine

103
Q

Do you treat ED identified HTN?

A

If significantly elevated but no S/S - start meds & arrange follow up
HCTZ or Lisinopril

104
Q

MCC syncope

A

Unknown - have inc. risk of death

105
Q

What is the most dangerous type of syncope?

A

Cardiac
1. Structural
Old people? Aortic stenosis
2. Dysrhythmias - usually no prodrome

106
Q

Why are seizures usually confused with syncope?

A

Brief tonic clonic mvmts may occur w/ syncope

107
Q

What is a good predictor of syncope in old people?

A

CV risk

108
Q

Which types of syncope need admitted?

A

Cardiac & neuro

109
Q

S/S pericarditis & pericardial effusion

A
  1. Sharp, stabbing, severe retrosternal CP
  2. Sudden/gradual onset
  3. Worse w/ inspiration or mvmt
  4. Referred to back/trapezius
  5. Worst when supine, better when leaning forward
  6. Fever, malaise, dyspnea, dysphagia
  7. Pericardial friction rub
110
Q

EKG changes w/ pericarditis & CXR

A
  1. Diffuse ST elevation
  2. PR depression (II, aVF, V4-V6)
  3. Later see T wave inversion & ST normalization
  4. ST to T amplitude >0.25

CXR usually normal

111
Q

EKG changes w/ pericardial effusion & CXR

A

Low QRS - pulsus alternans

CXR - enlarged heart w/ water bottle appearance

112
Q

How do you diagnose pericardial effusion & Tx?

A

Echo

Tx - pericardiocentesis
Treat underlying cause

113
Q

MCC tamponade in ED?

A

Trauma

Metastatic effusion MC non-traumatic cause

114
Q

S/S tamponade

A
  1. Dyspnea at rest
  2. Fatigue
  3. Beck’s triad - neck vein distention, HOTN, muffled heart sounds
  4. Tachycardia
  5. Pulsus paradoxus
115
Q

Dx tamponade

A

Echo -Dx
RA compression, RV diastolic collapse, hyperdynamic heart

EKG - low voltage, electrical alternans
CXR - may be normal

116
Q

What is Beck’s triad & when is it seen?

A
  1. Neck vein distention
  2. HOTN
  3. Muffled heart sounds

seen w/ tamponade

117
Q

Tx tamponade

A
  1. IV fluids
  2. Dobutamine
  3. Pericardiocentesis

Traumatic - surgery

118
Q

What is constrictive pericarditis & when is it seen?

A

Pericardium becomes thickened & scarred preventing diastolic filling

  1. Trauma w/ intrapericardial hemorrhage
  2. Pericardiotomy
  3. Chronic renal failure
  4. Fungal/TB pericarditis
  5. Idiopathic
119
Q

S/S constrictive pericarditis

A
  1. DOE, orthopnea
  2. Fatigue, weakness
  3. JVD
  4. Inspiratory neck vein distension - Kussmaul sign
  5. Paradoxical pulse
  6. Pericardial knock
  7. Hepatomegaly
  8. Ascites
120
Q

What is a pericardial knock & when is it seen?

A

Constrictive pericarditis

Early diastolic sound just after S2

121
Q

Dx constrictive pericarditis

A

EKG - low voltage QRS, inverted T waves
CXR - pericardial calcification on lateral

**Doppler echo, CT or MRI preferred

122
Q

Tx constrictive pericarditis

A
  1. Fluid restriction & diuretics

2. Pericardiectomy

123
Q

S/S myocarditis

A
  1. Fever
  2. Fatigue
  3. Myalgias
  4. HA
  5. CP
  6. Palpitations
  7. Dyspnea
124
Q

Dx myocarditis

A

Labs - inc. WBC, ESR & troponin

May need nuclear imaging/Bx

125
Q

Tx myocarditis

A

Supportive

126
Q

Types of cardiomyopathies

A
  1. Dilated - Most common
  2. Hypertrophic
  3. Restrictive
127
Q

What is the main indication for heart transplantation?

A

Dilated cardiomyopathy

death w/in 2 years w/o transplant

128
Q

S/S dilated cardiomyopathy

A
  1. DOE
  2. Orthopnea
  3. PND
  4. Bibasilar rales
  5. Dependent edema
  6. CP
129
Q

Dx dilated cardiomyopathy

A

CXR - CMG, pulm congestion
EKG - LVH, LAE, Afib, AV conduction abnormalities, vent. arrhythmias
Echo - Chamber enlargement, dec. vent. function

130
Q

Tx dilated cardiomyopathy

A
  1. Nitrates, diuretics
  2. Anticoagulation
  3. Antiarrhythmics PRN
131
Q

Which cardiomyopathy shows systolic & diastolic dysfunction?

A

& diminished vent. contractile force - low CO & HF

Dilated

132
Q

Which cardiomyopathy shows diastolic dysfunction?

A

Hypertrophic

Muscular hypertrophy of nondilated LV - muscle becomes stiff
Restricted vent. filling

133
Q

Dx hypertrophic cardiomyopathy

A

EKG - LVH, LAE, deep septal Q waves

Echo*** - disproportionate septal hypertrophy

134
Q

Tx hypertrophic cardiomyopathy

A

Emergent? Beta-blockers for CP

Arrhythmias? Amiodarone

DO NOT give digoxin, nitrates, diuretics or beta-agonists

135
Q

Which cardiomyopathy shows elevated venous pressures?

A

Restrictive

May be from amyloidosis, sarcoidosis, hemochromatosis, scleroderma

136
Q

Which valve is most often infected w/ endocarditis?

A

Mitral

Then aortic, tricuspid then pulmonic

137
Q

MCC endocarditis acute & subacute

A

a - S. aureus
High fever, systemic toxicity

s - Strep. Viridans
Gradual onset

138
Q

When are Osler nodes & Janesway lesions seen?

A

Endocarditis
O - painful nodules on pads of digits

J - nontender hemorrhagic plaques on palms/soles

Bacteria seeds & heart spits out little clots

139
Q

Dx endocarditis

A
  1. Cultures - 3 diff sites
  2. Inc. ESR, CRP
  3. UA - hematuria, proteinura, pyuria
  4. EKG - conduction abnormalities
  5. Echo
  6. TEE better - can rule in but not out Dx
  7. Duke criteria
140
Q

Tx endocarditis

A
  1. ABCs
  2. Abx
    Sick - Nafcillin + Gentamicin
    Subacute - PCN + Gentamicin
    Prosthetic valve - Vanco + Gentamicin + Rifampin
141
Q

Should you anticoagulate an endocarditis Pt?

A

NO mammary glands

142
Q

During aortic dissection, what happens if the blood dissects through the adventitia?

A

you die

143
Q

MCC thoracic aortic dissection?

A

HTN

Prego MCC women <40

144
Q

Type A vs. B aortic dissections

A

A - ascending, surgery

B - below, medical mgmt

145
Q

S/S aortic dissection

A
  1. Abrupt severe onset CP that radiates to back/abdomen
  2. Ripping/tearing
  3. Diaphoresis, N/V
  4. FH
  5. Migratory findings
  6. SBP diff. >15mm btwn each arm
  7. Unilat pulse deficit/absent
  8. Diastolic murmur
  9. Neuro deficits
  10. Neuro deficits/dysphagia, Horner syndrome
146
Q

Dx aortic dissection

A

CXR - mediastinal widening, obliteration of aortic knob, tracheal displacement to the R, Pleural effusion to L

CT

147
Q

Tx aortic dissection

A

Tx HTN
Beta-blockers - Labetalol, Esmolol
Nitroprusside

148
Q

MCC acute limb ischemia?

A

Thrombotic occlusion

149
Q

Where do most emboli from arterial occlusion come from?

A

Heart

150
Q

MC locations for arterial occlusion

A

Lower extremities at the bifurcation of the common femoral artery
Then popliteal

Arm - brachial artery

151
Q

S/S arterial occlusion

A
  1. Pain
  2. Pallor
  3. Paralysis
  4. Pulselessness
  5. Paresthesias
  6. Poikilothermia
152
Q

Dx acute arterial occlusion

A

ABI 30mm = obstruction

US - most accurate above knee

CT angio

153
Q

Tx arterial occlusion

A

Supportive

  1. Aspirin
  2. Heparin
  3. Analgesia
  4. Fluids

Revascularization

  1. Thrombolytics
  2. Embolectomy
  3. PTCA
  4. Bypass graft
  5. Amputation
154
Q

What does dysfunction of venous valves cause?

A

Stasis & endothelial injury

155
Q

Are distal DVTs bad?

A

Not really

156
Q

Define phlegmasia alba dolens

A

Iliofemoral thrombosis causing edema of extremity

Pale, cool, possible limb loss

157
Q

Define phlegmasia cerulea dolens

A

Iliofemoral thrombosis that inclues all collateral veins of extermity

Arterial ischemia & cyanosis, possible limb loss

158
Q

Dx DVT

A
  1. Pain, tenderness, swelling
  2. Upper extremity - hand swelling
  3. Swelling, edema, tenderness in calves & thighs
  4. Arm - distended superficial veins that don’t collapse when arm is raised
  5. Measure - diff. >2 cm
  6. Homan’s sign
  7. US - better above knee
159
Q

Tx DVT

A
  1. Heparin/Lovenox then switch to PO
    Contraindicated? IVC filter/umbrella
  2. Thrombolytic therapy

Superficial thrombophlebitis - NSAID, warm compresses
Calf vein? Watch

160
Q

What murmurs do you usually hear with prosthetic aortic valves?

A

Systolic

Diastolic not good

161
Q

What murmurs should you worry about with prosthetic mitral valves?

A

Loud holosystolic murmur

162
Q

MC organism for prosthetic valve endocarditis?

A

S. epidermidis

163
Q

Who commits more suicides, men or women?

A

Men commit 4x more but women attempt 4x more

164
Q

Screening for suicide

A 
Sex
Age
Depression
Previous attempt
Ethanol use
Rational thinking loss
Social supports lacking
Organized plan
No spouse
Sickness

> 5 = high risk

165
Q

What medical conditions can cause mental status changes?

A
  1. Diabetes
  2. Thyroid disorders
  3. Intoxications
  4. Withdrawal
  5. AIDS
  6. Head injury
166
Q

Screening for depression

A 
Sleep disturbance
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor slowing
Suicidal thoughts
Mood

5or+ = major depression

167
Q

When are there more psych emergencies for kids?

A

school year

168
Q

MCC CHF

A

Afib

169
Q

What is the best Tx for COPD to extend life?

A

Oxygen

170
Q

What is your drive for breathing?

A

CO2

Ox in COPD Pts

171
Q

Tx hiccups

A

Thorazine

172
Q

Exudate - protein & LDH levels

A

p >0.5

L >0.6

173
Q

What drug commonly causes pleural effusions?

A

Exudative - amiodarone

174
Q

Dx pleural effusion

A
  1. +/- dyspnea
  2. Dullness to percussion & dec. breath sounds
  3. CXR
  4. Thoracentesis
175
Q

Tx pleural effusion

A
  1. Diuretics

2. Thoracentesis if <1-1.5L

176
Q

MCC hemoptysis?

A

Bronchitis

177
Q

Dx hemoptysis

A
  1. CXR
  2. Bronchoscopy if >600mL
  3. CT
178
Q

When is asthma worse during the day?

A

Late evenings & early mornings

179
Q

MCC COPD

A

Smokingggggggggg

next is asthma

180
Q

3 diseases of COPD

A
  1. Asthma
  2. Emphysema
  3. Bronchitis
181
Q

How is staging of COPD determined?

A

FEV1

182
Q

S/S COPD

A
  1. Exertional dyspnea***
  2. Chronic productive cough***
  3. Minor hemoptysis
  4. Tachypnea, accessory muscle use
  5. Pursed lip breathing
  6. Wheezing
  7. Prolonged expiratory time
  8. Crackles/rhonchi
  9. Barrel chest/reduced diagphragmatic motion
  10. Displacement of PMI - R HF & R axis dev.
  11. Dec. breath sounds
183
Q

S/S pulm. HTN/Cor Pulmonale

A
  1. Distended neck veins
  2. Passive hepatic congestion
  3. Peripheral edema
184
Q

S/S hypercarbia

A
  1. Confusion
  2. Tremor
  3. Plethora
  4. Stupor
  5. Hypopnea/apnea
185
Q

S/S PE

A
  1. Dyspnea
  2. Pleuritic CP worsened w/ cough/breathing
  3. Referred pain
  4. Neuro Sx
  5. Tachypnea
  6. Hypoxia
  7. LCTA usually
  8. R vent. S3 or split S2
186
Q

EKG PE

A
  1. S1Q3T3 - McGinn White sign

2. Sinus tachycardia MC** w/ R axis dev.

187
Q

Dx PE

A
  1. Ox<93%
  2. Dec. end tidal CO2
  3. CXR - westermark, CMG, Hampton, Fleischner
  4. Sinus tach, S1Q3T3
  5. CT angio
  6. V/Q scan
  7. Pulm. angiography***gold std
188
Q

When is Hampton’s hump sign seen?

A

PE

Peripheral dome shaped dense opacification on CXR

189
Q

When is Fleischner’s sign seen?

A

PE

local widening of artery at site of occlusion on CXR

190
Q

When is Westermark sign seen?

A

PE

Wedge shaped oligemia on CXR

191
Q

Gold Std for Dx PE?

A

Pulm angio

But you’ll prob get CT angio

192
Q

Tx PE

A
  1. UFH/LMWH
  2. Coumadin
  3. +/- fibrinolytics
193
Q

3 categories of PE

A
  1. Massive - BP t give fibrinolytics
194
Q

MCC PNA

A

Pneumococcus

195
Q

S/S PNA

A
  1. Cough
  2. Fatigue
  3. Fever
  4. Dyspnea
  5. Sputum
  6. Pleuritic CP
196
Q

Classic S/S Pneumococcus PNA

A
  1. Sudden onset w/ fever
  2. Rigor
  3. Dyspnea
  4. Hemoptysis
  5. CP
  6. Tachycardia
  7. Tachypnea
  8. Abnormal lung sounds
197
Q

Currant jelly sputum?

A

Klebsiella

Pulm. abscess common

CXR - necrotizing lobar PNA

198
Q

PNA w/ ear problems?

A

Bullous myringits from Mycoplasm

Tx - Azithromycin
(Macrolide)

common in young adults
confirm w/ cold agglutinin

199
Q

S/S consolidation

A
  1. Bronchial breath sounds
  2. Egophony
  3. Inc. tactile & vocal fremitus
  4. Pleuritic friction rubs
  5. Cyanosis & jaundice
  6. Abdominal distention
200
Q

Who gets H. flu PNA?

A

Immunocompromised & unvaccinated

CXR - patchy infiltrates

201
Q

Who should you consider pseudomonas PNA in?

A
  1. CF
  2. Hospitalized
  3. Central venous catheters
  4. Burn wounds
  5. Bronchiectasis
  6. HIV
202
Q

Who usually gets Staph PNA?

A

After viral illness

IVDU, hospitalized Pts, debilitated

203
Q

PNA & contact w/ pigeons?

A

Chlamydia psittaci

204
Q

Old person w/ PNA, GI Sx & bradycardia?

A

Legionella

205
Q

Tx PNA in healthy PT

A

Azithromycin

206
Q

Tx PNA w/ comorbidites

A

Levaquin

207
Q

If Pt aspirates - should you give abx?

A

No - wait 24-48h

208
Q

MCC empyema

A

S. aureus

209
Q

Dx empyema

A
  1. Thoracentesis
  2. Fluid w/ +GS/culture
  3. Glucose 1000
210
Q

MCC lung abscess

A

Aspiration

211
Q

S/S lung abscess

A

Several weeks of

  1. Cough
  2. Fever
  3. Pleuritic CP
  4. Wt loss
  5. Night sweats
212
Q

Dx lung abscess

A

CXR - dense consolidation w/ air-fluid level inside thick walled cavitary lesion

213
Q

Tx lung abscess

A

Clindamycin + Flagyl

Might need bronchoscopic drainage/surgery

214
Q

Primary TB S/S

A 
Asymptomatic
Active
1. Fever
2. Malaise
3. Wt loss
4. CP

Reactivation has same Sx w/ extrapulm - Lymph MC

215
Q

Gold Std for Dx TB?

A

Culture

216
Q

What is the first acid-base abnormality with shock?

A

Resp. alkalosis

Then Met. acidosis

Emergency Medicine (5 decks)

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