I, uh, fell on it..?!?.... (Emergency Med)

Question 1

Name the H’s and T’s

Answer 1

Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo-/ Hyperkalemia, Hypothermia

Tension pneumo, Tamponade, Toxins, Thrombosis, pulmonary, Thrombosis, coronary

Question 2

Head trauma or prior stroke in previous ________ is an exclusion criteria for treatment with tPA

Answer 2

3 months

Question 3

Symptoms suggestive of ____________ is an exclusion criteria for treatment with tPA

Answer 3

subarachnoid hemorrhage

Question 4

Arterial puncture at a noncompressible site in the previous _________ is an exclusion criteria for treatment with tPA

Answer 4

7 days

Question 5

History of _________ is an exclusion criteria for treatment with tPA

Answer 5

previous intracranial hemorrhage

Question 6

A blood pressure of ___________ is an exclusion criteria for treatment with tPA

Answer 6

SBP > 185; or DBP >110

Question 7

Evidence of ________ on examination is an exclusion criteria for treatment with tPA

Answer 7

active bleeding

Question 8

Acute bleeding diathesis, including but not limited to ____________ is an exclusion criteria for treatment with tPA

Answer 8

Platelets upper limit of normal; current use of anticoagulant with INR >1.7 or PT >15 sec

Question 9

Blood glucose of _________ is an exclusion criteria for treatment with tPA

Answer 9

<50 mg/dL

Question 10

A CT that demonstrates multilobar _______ (hypodensity >1/3 cerebral hemisphere) is an exclusion criteria for treatment with tPA

Answer 10

infarction

Question 11

An 85 y.o. man comes in with a HR of 40. He is hypotensive and disoriented. What do you want to do?

Answer 11

Give atropine. First dose: 0.5 mg bolus; repeat q3-5 mins. Maximum: 3 mg.

Question 12

A child comes in with an altered level of consciousness. What 4 things MUST you rule out right away?

Answer 12

Mass effects (Epidural bleed, subdural bleed, cerebral edema..)
Meningitis
Opioids
Hypoglycemia

Question 13

A pt presS

Answer 13

“AEIOU TIPS”

A — Alcohol
E — Endocrine

    Electrolytes
    Encephalopathy

    I — Insulin
    O — Opiates
    U — Uremia
    T — Trauma
    I — Intracranial
    P — Poisoning
    S — Seizure

Question 14

What is the only known metabolic cause of focal neurological deficits?

Answer 14

Hypoglycemia

Question 15

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?

Answer 15

Antihistamines
Antipsychotics
Antispasmotics (lomotil)
Muscle relaxants (Flexeril)
Tricyclics

Question 16

What is the antidote for anticholinergic syndrome?

Answer 16

Physostigmine (Antilirium) (Only indicated in pts with coma, delirium, unstable vitals. Most cases of anticholinergic syndrome are treated with supportive measures)

Question 17

What is the therapy of choice for Beta-adrenergic antagonist (Beta blocker) and calcium channel blocker overdose?

Answer 17

Glucagon (and HIE… which is newer)

Question 18

VS: HR 100, RR 28; pH 7.15

Given only the above information, what should be on your differential diagnosis?

Answer 18

Metabolic acidosis:
Methanol
Uremia
DKA 
Propylene glycol
Infection, Isoniazid, Iron, Inborn error of metabolism
Lactic acidosis
Ethylene glycol
Salicylates

Question 19

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?

Answer 19

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!

Question 20

Agitation can suggest _________ while obtundation suggests __________

Answer 20

hypoxia; hypercarbia

Question 21

Name the steps (in order) of a Rapid Sequence Intubation. (10 steps)

Answer 21

1. Be prepared to perform surgical airway
2. Ensure that suction, as well as ability to deliver positive pressure ventilation is ready
3. Preoxygenate pt with 100% O2
4. Apply cricoid pressure
5. Administer induction agent (e.g., etomidate, 0.3 mg/kg, or 20 mg) or sedate, according to local protocol
6. Administer 1-2 mg/kg succinylcholine IV (usual dose, 100 mg)
7. After pt relaxes, intubate orotracheally
8. Inflate cuff, confirm placement
9. Release cricoid pressure
10. Ventilate pt