I, uh, fell on it..?!?.... (Emergency Med) Flashcards
Name the H’s and T’s
Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/ Hyperkalemia, Hypothermia
Tension pneumo, Tamponade, Toxins, Thrombosis, pulmonary, Thrombosis, coronary
Head trauma or prior stroke in previous ________ is an exclusion criteria for treatment with tPA
3 months
Symptoms suggestive of ____________ is an exclusion criteria for treatment with tPA
subarachnoid hemorrhage
Arterial puncture at a noncompressible site in the previous _________ is an exclusion criteria for treatment with tPA
7 days
History of _________ is an exclusion criteria for treatment with tPA
previous intracranial hemorrhage
A blood pressure of ___________ is an exclusion criteria for treatment with tPA
SBP > 185; or DBP >110
Evidence of ________ on examination is an exclusion criteria for treatment with tPA
active bleeding
Acute bleeding diathesis, including but not limited to ____________ is an exclusion criteria for treatment with tPA
Platelets upper limit of normal; current use of anticoagulant with INR >1.7 or PT >15 sec
Blood glucose of _________ is an exclusion criteria for treatment with tPA
<50 mg/dL
A CT that demonstrates multilobar _______ (hypodensity >1/3 cerebral hemisphere) is an exclusion criteria for treatment with tPA
infarction
An 85 y.o. man comes in with a HR of 40. He is hypotensive and disoriented. What do you want to do?
Give atropine. First dose: 0.5 mg bolus; repeat q3-5 mins. Maximum: 3 mg.
A child comes in with an altered level of consciousness. What 4 things MUST you rule out right away?
Mass effects (Epidural bleed, subdural bleed, cerebral edema..)
Meningitis
Opioids
Hypoglycemia
A pt presS
“AEIOU TIPS”
A — Alcohol
E — Endocrine
Electrolytes
Encephalopathy
I — Insulin
O — Opiates
U — Uremia
T — Trauma
I — Intracranial
P — Poisoning
S — Seizure
What is the only known metabolic cause of focal neurological deficits?
Hypoglycemia
A pt comes in with the classic syndrome of “red as a beet, dry as a bone, blind as a bat, mad as a hatter” – what drugs should be suspected?
Antihistamines Antipsychotics Antispasmotics (lomotil) Muscle relaxants (Flexeril) Tricyclics
What is the antidote for anticholinergic syndrome?
Physostigmine (Antilirium) (Only indicated in pts with coma, delirium, unstable vitals. Most cases of anticholinergic syndrome are treated with supportive measures)
What is the therapy of choice for Beta-adrenergic antagonist (Beta blocker) and calcium channel blocker overdose?
Glucagon (and HIE… which is newer)
VS: HR 100, RR 28; pH 7.15
Given only the above information, what should be on your differential diagnosis?
Metabolic acidosis: Methanol Uremia DKA Propylene glycol Infection, Isoniazid, Iron, Inborn error of metabolism Lactic acidosis Ethylene glycol Salicylates
A pregnant female comes into the ED in severe cardiac distress. A shockable rhythm is detected. Do you shock this expectant mother who is obviously pregnant?
Yes. Absolutely. Fetus has a high fibrillation threshold. The amount of current reaching the uterus is small. Don’t forget to remove fetal and uterine monitors before shocks!
Agitation can suggest _________ while obtundation suggests __________
hypoxia; hypercarbia
Name the steps (in order) of a Rapid Sequence Intubation. (10 steps)
- Be prepared to perform surgical airway
- Ensure that suction, as well as ability to deliver positive pressure ventilation is ready
- Preoxygenate pt with 100% O2
- Apply cricoid pressure
- Administer induction agent (e.g., etomidate, 0.3 mg/kg, or 20 mg) or sedate, according to local protocol
- Administer 1-2 mg/kg succinylcholine IV (usual dose, 100 mg)
- After pt relaxes, intubate orotracheally
- Inflate cuff, confirm placement
- Release cricoid pressure
- Ventilate pt
