Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Medicine > Exam 3 > Flashcards

Exam 3 Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

vaginal bleeding

A

MUST do a pregnancy test

Check hematocrit (determine significance of bleeding - stable v. unstable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

vaginal bleeding and abdominal pain - history ?’s in ED

A

Pain: OPQRST

When did bleeding start, quantity, clots, tissue, color, trauma

Gyn hx: LMP, G’s, P’s, Abortions, chance of pregnancy, last sexual encounter, protection used, dyspareunia (pain w/ sex), STD hx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

dyspareunia

A

pain with sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

vaginal bleeding and abdominal pain - physical exam in ED

A

vitals, sick appearing (sweating, pale), tachycardia

abdominal exam: masses, inguinal nodes

pelvic exam: speculum, bimanual, external genitalia, cervical os

note: pain with abd palpation (appendix) v. pain with bimanual (adnexal - PID)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

pelvic exam

A

Exam Set Up: cotton swabs, chux, speculum, wet prep, GC/Chlam

Inspect perineum, vulva, urethra, and peri-anal region

Cervix must be visualized to R/O polyps, ulcers, STD, mass

May require use of swabs and/or suction to visualize structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

vaginal bleeding - lab studies

A

pregnancy test
CBC, chem-7 for renal function

pregnant: type and screen, quantitative BhCG (how far along) and Rh (neg get Rhogam)

pregnant trauma: Kleihauer-Betke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

standard pregnancy test (hCG) accuracy

A

Urine
95% sensitive/specific
+ 2 weeks after ovulation
May get false negative if dilute urine

Serum
+ 7-10 days after ovulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Quantitative Beta-hCG -“beta quant”

A

normal pregnancy, BhCG doubles approximately 48 hours

Low HCG levels: suggest ectopic pregnency or “blighted ovum” (anembryonic pregnancy)

High BhCG suggest GTD (molar pregnancy or choriocarcinoma), multiple pregnancy

Always, miscalculation of dates may be considered

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ultrasound in pregnancy - confirming IUP

A

determines if an IUP (intra-uterine pregnancy) is present; may miss heterotopic pregnancy

A living IUP may be definitively diagnosed when cardiac activity is seen in the uterine cavity (usually seen at 6-7 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Rh prophylaxis

A

Administer RhoGAM to the gravid patient who is Rh (-) and is vaginally bleeding

Exception: when father is known Rh–

When in doubt treat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

types of spontaneous miscarriage

A 
threatened
inevitable
incomplete
complete
septic

Note: 80% occur prior to 12 weeks.
Cardiac activity on US reduces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

threatened miscarriage

A

vaginal bleeding with a closed cervical os and benign PEX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

inevitable miscarriage

A

vaginal bleeding with cervical dilation; cervical os is open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

incomplete miscarriage

A

passage of only parts of products of conception (POC), usually occurs at 6-14 weeks; cervical os is open

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

complete miscarriage

A

passage of all products of conception (POC) and fetal tissue prior to 20 weeks; Os is closed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

septic miscarriage

A

evidence of infection during any stage of abortion - induced or spontaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

yankower suction

A

used to visualize cervix if very bloody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

septic miscarriage - treatment

A

OB consult for urgent D and C

Blood and cervical cultures and gram stains

Broad spectrum antibiotics: Unasyn or Clindamycin PLUS gentamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pregnant trauma patient - causes

A

MVAs
domestic violence
minor blunt trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Pregnant trauma patient - injuries

A

Placental Abruption
Uterine rupture
Maternal fetal hemorrhage
Preterm labor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pregnant trauma patient - evaluation

A 
Keep pt in left lateral decubitus position (avoid compression of IVC - supine hypotension)
OB and trauma consult
Two large bore IV’s, supplemental O2
Rhogam
Fetal heart tones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Kleihauer-Betke Assay Test

A

blood test performed on maternal blood to quantify fetal maternal blood mixing (if abdominal trauma)

Perform on all Rh negative women (followed by Rhogam)

But, if you suspect abdominal trauma, just give 300mcg Rhogam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

pregnant trauma patient - treatment goals

A

Pelvic exam: look for trauma, vaginal bleeding, PROM (do not perform if blood on external inspection)

FHTs: minimum of 4-6 hrs of fetal monitoring on labor deck

If high acuity: pt transferred or trauma takes over

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

perimortem c-section

A

Perform within 5 minutes of maternal cardiac arrest

Continue ongoing maternal resuscitation

Viable gestational age approx 24 weeks (+) FHT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

trauma stats

A 
#1 cause of death ages 1-46
#3 cause of death overall 
Injury causes: 
#1 MVC (blunt trauma)
#2 Suicide 
#3 Falls (blunt trauma)

35% ED visits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

distribution of trauma-related deaths

A

immediate deaths (seconds to minute): usually untreatable/nonsurvivable (severe CNS injury, hemorrhage)

early deaths (minutes to hours): the "golden hour"; potentially preventable (hemorrhage, severe TBI)
 - FOCUS IN TRAUMA

late deaths (days to weeks): ICU deaths (sepsis, multi organ failure - MOF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

the golden hour

A

the period of time (within the first hour or two after injury) that most potentially preventable deaths from trauma occur (early deaths - hemorrhage or severe TBI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

NEXUS Criteria for determining c-spine immobilization

A 
No midline tenderness
No focal neurological deficit
Normal alertness
No intoxication
No painful distracting injury

Note: also used to determine imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

shock - definition

A

2 leading cause of death in trauma

state of severe systemic reduction in tissue perfusion characterized by decreased cellular oxygen delivery and utilization, as well as decreased removal of waste byproducts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

most common shock in trauma

A

ALWAYS hemorrhagic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

lethal triad

A

coagulopathy, hypothermia, acidosis

occurs with hemorrhage (leads to distributive shock)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

shock: initial management

A

IV access

  • 2 peripheral large-bore IV’s
  • Central line

Fluid resuscitation

  • 2L IVF warmed LR (lactate ringers) or NS (nasal saline)
  • Blood products
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

acute mountain sickness - prophylaxis

A

gradual acent: 1st night at 1500m prior to ascending additional 1000m (sleeping elevation key)

Acetazolamide (Diamox) 125 mg BID: start one day prior to travel and continued for 2 days after reaching max altitude
- makes you a bit acidic

Avoid alcohol or dehydration

Eat high carb diet (40 min prior to arrival) and use of NSAIDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

concentration of O2 in air vs. PO2

A

Concentration of oxygen present in air is 21% both at sea level and high altitude

Inspired PO2 drops as barometric pressure decreases (both with higher altitude and farther from equator)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

CO poisoning - challenges to diagnosis

A

Normal pulse ox reading.

Half- life is 4-6 hrs in room air and 40-60 minutes with 100% O2

Mismatch of C0Hb levels to presenting SXS

Identifying low-level chronic CO exposure in smokers/COPD pts

Identifying pt who SXS are intermittent/resolve when leave environ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Rule of Nines

A

used to estimate percentage of body burned when reporting to burn center / trauma unit

  • arms and head are 9%
  • front, back, each leg is 18%
  • palm of hand is 1%
  • only applicable for 2nd and 3rd degree burns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

burns - when to refer to burn center

A

Second degree partial-thickness burn > 10 % TBSA (total body SA)
Burn to face, hands, feet , perineum, major joints
Full-thickness
Electrical, inhalation or chemical burn
Pediatric burn in hospital w/o meds burn staff
Associated trauma or major pre-existing medical conditions
Associated emotional or mental health condition
Cognitive impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

rhabdomyolysis

A

serious syndrome due to a direct or indirect muscle injury; results from death of muscle fibers and release of their contents into the bloodstream
- must monitor in electrical injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Lichtenberg ferning pattern

A

characteristic marking on skin following a lighting strike (looks like a red/streaky fern)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

life threatening conditions that may present as behavioral change

A 
CNS infection
CNS trauma
Intoxication		Etoh/drug withdrawal
Hypoglycemia	Hypoxia
ICH (intra-cranial hemorrhage)
Poisoning
Seizure disorder	Acute organ system 				failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

barriers to a complete psych evaluation in the ED

A 
Provider discomfort or bias
Other patients are sicker
Patient takes too much time
Patients may mistrust the medical staff
Patients may have a cognitive impairment/hallucinations interfering with evaluation
42
Q

delirium

A

global impairment in cognitive functioning that is sudden in onset and presents with diminished level of consciousness, inattention, visual hallucinations
- usually reversible

43
Q

dementia

A

pervasive disturbance primarily in memory, generally gradual in onset

44
Q

psychosis

A

“impaired contact with reality”, characterized by symptoms, such as:
- hallucinations, delusions, impulsive, a range of emotions from apathy to fear and rage (pos. or neg. sxs)

45
Q

indications for definitive airway

A

Need for airway protection:

  • maxillofacial fx
  • risk of abstraction (hematoma, URT injury)
  • risk for aspiration (bleeding, vomit)
  • unconscious, GCS<8, combative

Need for ventilation or oxygenation:

  • inadequate resp effort
  • massive blood loss (need for vol resuscitation)
  • severe closed head injury
  • apnea, unconscious

Note: chemical paralysis before insertion (do neuro exam first)

46
Q

Jefferson fracture (burst fx)

A

occurs to C1: anterior and posterior arches break

- transverse ligg interrupted

47
Q

Odontoid fracture

A

occurs to C2 (w/ dens): occurs w/ flexion, extension and rotational injuries

  • types 1 and 2 involve Dens only (surgery needed)
  • type 3 lower on vertebrae and heals better
48
Q

Hangman fracture

A

occurs to C2: bilateral pedicle fx

  • most common c-spine fx
  • hyperextension and axial load
49
Q

c-spine fracture above C4 - what am I worried about

A

paralysis of muscles of respiration (C3-5 innervates diaphragm)

50
Q

criteria for 72 hour mental health hold (M-1 hold)

  • who can initiate
  • who can lift / discontinue
A

gravely disabled
imminently dangerous to self
imminently dangerous to others

who can initiate:

  • physician
  • officer
  • licensed mental health therapist, social workers, nurse (NOT a PA)

who can discontinue:

  • physician
  • psychologist
51
Q

components of medical clearance exam

A

First: scene safety and stabilization

exclude organic/medical causes of a psychiatric problem

ABCs

Treat any acute medical problems (hypoglycemia? hypoxia?)

Laboratory testing (CBC, BMP, TSH), toxicology screens (urine drug screen, breathalyzer)

Determine the disposition (M1 hold requiring psych eval or not)

52
Q

medical (organic) disease characteristics for altered mental status

A 
Age <12 years >40 years old
 - elderly or multiple meds
Sudden onset / fluctuating course
Disoriented
Visual hallucinations
Emotional liability
Abnormal PE
Hx of substance abuse or toxins (this includes EtOH and drugs)
No previous psychiatric history
53
Q

psychiatric (functional) disease characteristics for altered mental status

A 
Age 13 to 40 years
Gradual onset / continuous course
Scattered thoughts
Awake and alert
Auditory hallucinations
Flat affect
Psychiatric history
Normal PE
54
Q

psych eval in ED: history questions

A

Gather hx from friends, family, EMS
Always ask, “why now”? Why today? Acute or choleric situation?
What are the pt’s current and historical stressors?
Resources (i.e. therapist)
Previous psychiatric illness
3 questions to ask:
- Auditory / visual hallucinations
- Drug / alcohol abuse and patterns
- Suicidal/ homicidal intentions
Any deterioration in physical, mental or emotional functioning

55
Q

psych eval in ED: physical exam

A 
Vital signs
Appearance: dress, groomed, etc.
Speech pattern: slurred, rapid pressured
HEENT: pupils, EOM’s (extra-ocular mov’t), nystagmus (uncontrolled mov’t), proptosis (pop out), goiter?
Skin: diaphoretic, flushed, dehydrated?  
Neurological exam:
 - focal neuro deficits (NOT psych)
 - cranial nerves
 - mental status exam (MMSE)
56
Q

psych eval in ED: labs

A

No routine tests: urine tox, breathalyzer is often minimum

  • Serum tox: OTC drugs
  • Urine tox: drug of abuse

Check current medication levels: lithium, Valproic Acid, etc.

Check glucose (esp. w/ DM, drug overdoses, elderly)

Explore relevant medical considerations (thyroid, DM)

57
Q

what blood test should you always get with altered mental status

A

finger stick glucose!!

58
Q

B-52

A

medication regime for chemical restraint in violent pts - pt sleeps for 10 hrs
- Benadryl (50mg IM), Haldol (5mg IM), Ativan (2mg IM)

59
Q

violent patient: chemical restraint options

A

Benzodiazepines: Ativan 1-2mg PO/IV/IM (short-term); Valium 5-10mg PO/IV/IM (lasts a bit longer)

Traditional Antipsychotics: Haldol 5-10mg PO/IM/IV (also great for puking)

Atypical Antipsychotics: Zyprexa (olanzapine) 5-10mg po/IM (less sedating than traditional antipsychotics)

B-52: Benadryl (50mg IM), Haldol (5mg IM), Ativan (2mg IM) → sleep for 10 hrs

60
Q

major depression - criteria for dx

A

Sxs at least daily for two wks

Depressed Mood OR
Loss of interest or pleasure in activities (anhedonia) PLUS
Five or more SIGECAPS:
•	S sleep 	
•	I Interest		
•	G Guilt			
•	E Energy
•	C concentration	
•	A appetite
•	P psychomotor changes	
•	S suicidal feelings
61
Q

bipolar - criterial for dx

A 
Depression with a manic component
Manic episode: at least 1 week marked by abnormally elevated or irritable mood PLUS 3+ of following sxs:
o	D: distractibility
o	I: indiscretion/Impulsivity: 
o	G: grandiosity 
o	F: flight of ideas 
o	A: activity – high energy
o	S: sleep – decreased need
o	T: talkativeness

Note: people DO kill themselves (suicide 25-50% attempt)

62
Q

borderline personality disorder

A

mood instability, aggression (intense anger), impulsivity, frequent self-injury, needy

Fourth greatest risk factor for suicide (after depression, schizophrenia, and addiction)
- more likely to attempt than complete suicide

63
Q

panic attack

A

episode of intense fear or discomfort in which 4 of the following symptoms develop abruptly and peak with in 10 minutes; resolution of sxs in 30 min; may be unexpected or situational / explained or unexplained
• Sxs: SOB, palpitations, sweating, nausea, hot flashes, fear of going crazy, dizziness, trembling, choking, chest pain, paresthesias (burning or prickling), fear of dying

Dx of exclusion: R/O MI, PE, pneumothorax, dehydration, hypoxia

Tx: relaxation, pysch eval, benzos

64
Q

suicide

A

Common

Most common methods: firearms, hanging (men), poisoning (women)

Assess lethality: specific plan, previous attempt, impulsive / poor tolerance of frustration

Tx: treat anxiety, agitation, psychosis or pain, offer to contact support (family, therapist); consult psychiatric services; ADMIT if concerned for pt safety / safety of others (1:1 security watch if any doubts about pt safety)

65
Q

medications with behavioral manifestations

A 
Steroids
TCAs (tricyclic anti-depressants)
Anticonvulsants
Benzodiazepines
Amphetamines/related drugs (CNS stimulant; used to tx ADHD)
Narcotics
Street drugs (alcohol, cocaine, meth)
66
Q

pitfalls in assessing psych / AMS patient in the ED

A

Inadequate evaluation

Failure to recognize acute worsening of a chronic condition that may be organic

Failure to treat the treatable

Failure to look at the medication list

67
Q

alcohol metabolism and rate of elimination

A

metabolized by alcohol dehydrogenase in liver

Steady state of elimination 15-40 mg/hour
- Improved elimination in practiced consumers (alcoholics metabolize faster)

68
Q

acute intoxication (low levels): signs and sxs

A

clouded judgment, ataxia, nystagmus, altered personality, slurred speech, hypotension, tachycardia

69
Q

acute intoxication (high levels; severe): signs and sxs

A

obtundation (low alertness), hypoventilation, hyporeflexia, hypothermia, severe hypotension

70
Q

severe EtOH intoxication - treatment

A

May need physical restraints
Screen for life threatening problems (don’t believe the history)
Observe until clinically sober
No practical therapies to reverse alcohol (alcohol IS dialyzable)
- tx dehydration with IV fluids
- hypoglycemia is common; screen for electrolyte abnormalities (esp. Mg)
- “Banana bag” for chronic alcoholics (key if person is not eating)

71
Q

banana bag

A 
given to chronic alcoholics who are not eating (in ED):
•	D5 NS or D5 1/2NS
•	2 gm Mag sulfate
•	multi-vitamin with folate
•	100mg thiamine
  • *rMg/Folate/Thiamine: can be done PO
72
Q

severe alcohol consumption: two syndromes / complication

A

Wernicke’s encephalopathy: acute and reversible
- Sxs: nystagmus, ataxia, confusion

Korsakoff’s encephalopathy: persistent and irreversible
- Sxs: persistent learning and memory deficits

Note: both caused by SEVERE thiamine deficiency

73
Q

Alcohol intoxication: discharge from ED

A

Chronic alcoholics: EtOH blood level doesn’t dictate discharge, may be “clinically sober”

Road test: watch pt walk

Minors only get released to parents / guardians

Adults get discharged to a sober adult or go to detox

74
Q

Alcohol withdrawal: characteristics

A

caused when a patient who is chronically habituated stops drinking
- onset 6-96 hrs after last drink

hyperadrenergic state: HTN, tachycardia, diaphoresis, agitation, tremor, mild fever, hallucinations (visual), seizures

75
Q

Alcohol withdrawal: 4 categories and tx

A

Minor withdrawal: withdrawal tremulousness (give Ativan)

  • onset 6-24 hours after drinking; duration < 48 hours
  • anxiety, N/V, tremor, clear sensorium
  • tx: Benzo (Ativan)

Major withdrawal: alcohol hallucinosis

  • onset 10-72 hours after drinking; up to 5 days
  • whole body tremor, vomiting, HTN, hallucinations, diaphoresis, fever
  • tx: ADMIT (can die)

Withdrawal seizures

  • occur 6-48 hr after last drink; generalized and brief; 30-40% go on to DTs
  • tx: ADMIT (can die)
Delirium tremens (DTs) most severe form of ethanol withdrawal 
 - tx: ADMIT (can die)
76
Q

delirium tremors (DTs): characteristics and treatment

A

most severe form of ethanol withdrawal

AMS (global confusion) and sympathetic overdrive (autonomic hyperactivity) –> can progress to cardiovascular collapse

life threatening (15% mortality); occurs >3 days after last drink

Profound global confusion (hallmark of dx), tremor, fever, incontinence, autonomic hyperactivity, hallucinations

Treatment:

  • R/O infection or other neurological abnormalities (head CT, LP, CXR)
  • Hemodynamic support
  • Thiamine/glucose/electrolytes; possible benzos, beta-blockers, haldol
77
Q

Alcohol withdrawal: general treatment

A

Evaluate for co-morbidities

Correct fluid and electrolyte imbalances
Meds: BENZODIAZEPINES (may require large doses)
- Ativan 1-4 mg IV q hour to effect
- Tranxene 15-30 mg PO Q 6-8 hours for discharge
- May require Beta-blockers or Clonidine to blunt adrenergic effects
- Haldol to help with hallucinations, prn (and nausea/puking)

78
Q

alcoholic ketoacidosis (AKA): sxs, how different from DKA, and treatment

A

sxs: binge drinking followed by days of starvation, vomiting, SOB/ Kussmaul respirations, N/V/abdominal pain, gastritis, pancreatitis

PE: tachycardia, tachypnea, abdominal tenderness

Labs:

  • ABG/VBG: acidotic (inc anion gap)
  • glucose: normal of low (unlike DKA)
  • EtOH: zero or low
  • urine dipstick: may or may NOT show ketones

Tx: corrects in 12-16 hrs

  • IV fluids w/ glucose to clear the ketones
  • No insulin; bicarbonate rarely needed
  • Antiemetics to control vomiting; benzos for withdrawal
79
Q

isopropyl alcohol: sxs, lab findings, tx

A

rubbing EtOH, mouthwash
- pt is drunk, but EtOH is zero

sxs: similar to EtOH, but longer duration and CNS effects profound (“twice as intoxicating”)
- fruity odor of ketones

lab findings: EtOh zero, anion gap normal, larger osmolal gap

tx: supportive (fluids and observe)

80
Q

methanol: sxs, lab findings, tx

A

windshield wiper fluid, antifreeze

  • pt is drunk, but EtOH is zero
  • metabolized to formaldehyde (toxic!)

sxs: 12-24 hrs after ingestion (delayed), accumulates in retina (“visual snowstorm”), CNS changes, GI irritant

Labs: high anion gap metabolic acidosis, elevated osmolal gap

tx: 4-MOP fomepizole; dialysis if late

81
Q

ethylene glycol: sxs, lab findings, tx

A

antifreeze, detergents
- pt is drunk, but EtOH is zero

sxs: 12-24 hrs after ingestion (delayed), renal failure

labs: high anion gap metabolic acidosis, elevated osmolal gap
- calcium oxalate crystals in urine

tx: 4-MOP fomepizole; dialysis if late

82
Q

seizures: two classifications

A

generalized: diffuse brain involvement
- always with LOC
- tonic-clonic / grand mal

Focal: occurs w/ or w/o LOC
- may be sign of more complications

83
Q

tonic-clonic / grand mal seizure: 3 stages

A

Tonic (rigid) phase: LOC, resp. arrest, fall, lasts < 1min

Clonic phase: rhythmic jerking of extremities (1-3 min), +/- incontinence, tongue biting, aspiration

Post-ictal phase: fatigue, H/A, N/V, myalgias (5-60min), confusion for several hours

84
Q

seizures: common secondary causes

A

Trauma, intracranial (mass, aneurysm, bleed), ecclampsia, HTN encephalopathy, infection (meningitis, abscess), drugs (cocaine, MJ, EtOH, w/drawal, etc.), metabolic (hyponatremia, hypoglycemia, hypocalcemia), uremia, hepatic failure

85
Q

seizure work-up: first time seizure

A

first time: more detailed W/U
• Head CT
• EKG
• Labs: CBC, chem 7 (Na and Glucose specifically), Ca/Mg, pregnancy (HCG); Urine tox
• Lumbar puncture: if febrile (R/O meningitis), immune-compromised, or possible SAH (sub-arachnoid hemorrhage)

Tx:

  • Send home if normal W/U and return to baseline
  • Outpatient neurology F/U: EEG
  • no driving X 3 months (or until cleared by neurology)
86
Q

seizure work-up: history of seizures

A

if known seizure disorder and normal pattern

  • check glucose and anticonvulsant levels
  • ask about: triggers, pattern (same, different), recent med changes, illnesses, etc.
87
Q

seizure work-up: status epilepticus treatment

A

epileptic seizure of greater than five minutes or more than one seizure within a five-minute period without return to normal in between

ABC’s, IV, O2, monitor, labs, Utox, temp

Benzo: Ativan (Lorazepam) 2- 4 mg IV repeat in 10 min

88
Q

pediatric febrile seizures: simple v. complex

A

simple:
- generalized tonic-clonic
- lasts <15 min
- temp >38C/100.4F
- 6mo-5yrs
- only 1 seizure in 24 hrs

complex (further W/U):

  • w/ focality
  • lasts >15min
  • post-ictal period
  • outside 6mo-5yr
  • multiple seizures
89
Q

pediatric simple febrile seizures: management

A

Look for infection (identify and tx source)

Antipyretics (rectal Tylenol 15mg/kg, Advil 10 mg/kg),

Lorazepam/Ativan (benzo) (0.05-0.1 mg/kg) if seizing during visit

Make sure return to baseline

90
Q

pediatric simple febrile seizures: general info for family

A

Usually occur on first day of illness
May be related to rate of rise of fever
Reassure family: very good prognosis, 1% risk of developing epilepsy (almost general public risk
Recurrence – between 15-70% likely

91
Q

most common cause of electrolyte disturbance

A

lab error

92
Q

anion gap: equation and normal range

A

sum of cations minus anions

anion gap = (Na+ + K+) - (Cl- + HCO3-)

normal: 8-16
- worry about high value (not low)
- calculated as part of CMP

93
Q

arterial blood gases (ABG): what are they + normal range

A

pH: 7.35-7.45
PCO2: 35-45 (respiratory)
HCO3: 22-26 (metabolic)

ISBM: key values

  • pH: 7.40
  • HCO3: 24 mEq/L
  • PCO2: 40 mmHg
94
Q

metabolic acidosis: general causes

A

pH is < 7.4, HCO3 < 24 mEq/L

Loss of Bicarbonate: diarrhea, ileus, fistula, high-output ileostomy

Increase in acids: lactic acidosis, ketoacidosis, renal failure, necrotic tissue

95
Q

metabolic acidosis (elevated anion gap): causes

A

MUDPILERS
• M: methanol
• U: uremia
• D: diabetic ketoacidosis
• P: paracetamol / acetaminophen, phenformin, paraldehyde
• I: iron, isoniazid (due to seizures), inborn errors of metabolism
• L: lactic acid
• E: ethanol (due to lactic acidosis), ethylene glycol
• R: rhabdomyolysis
• S: salicylates/ASA/Aspirin

96
Q

metabolic acidosis (normal anion gap): causes

A 
HARDUPS
•	H: hyperalimentation (TPN)
•	A: acetazolamide
•	R: Renal Tubular Acidosis
•	D: diarrhea
•	U: uretero-enteric fistula
•	P: pancreatoduodenal fistula
•	S: spironolactone
97
Q

metabolic alkalosis: general causes

A

pH is > 7.4, HCO3 > 24 mEq/L

Volume loss with chloride depletion: vomiting, diarrhea, NG suctioning (getting rids of acid)

98
Q

respiratory acidosis: general causes

A

pH < 7.4, PCO2 > 40 mmHg

Drug intoxication, cardiac arrest, COPD, hypoventilation, pneumothorax, pleural effusion
- retaining too much acid (CO2)

99
Q

respiratory alkalosis: general causes

A

pH > 7.4, PCO2 < 40 mmHg

Hyperventilation (anxiety, pain, fever, wrong ventilator settings), acute asthma exacerbation, PE, high altitude, Aspirin OD
- breathing off acid (CO2)

100
Q

complication that can occur if correct hypernatremia too quickely

A

seizures

101
Q

complication that can occur if correct hyponatremia too quickly

A

central pontine myelinolysis

Emergency Medicine (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions