Last Minute Flashcards
4 elements of negligence?
- Duty to treat
- Breach of duty (failed to conform to standard of care)
- Proximate cause (breach of duty must be the cause of the injury)
- Damages
EMTALA requirements for transfer?
Does not apply to the transfer of stable patients
If unstable, may NOT transfer unless:
- Physician certifies that medical benefits outweigh risks OR
- Patient makes request in writing after being informed of hospital’s obligations and risks of transfer
Also, transfer must be appropriate under the law:
- Ongoing care until transfer
- Copies of medical records
- Confirm the receiving facility has space/qualified personnel to treat, agreed to accept transfer
- Transfer with qualified personnel and appropriate equipment
Benzodiazepines for agitation (dose, route, onset, side effects)?
Lorazepam 2-4 mg IV/IM/PO (5-30 min)
Midazolam 5 mg IV/IM/PO (10-30 min)
Respiratory depression, excessive sedation
Typical antipsychotics for agitation (dose, route, onset, side effects)?
Haloperidol 2.5-10 mg PO/IM/IV (30-60 min)
EPS, NMS
Atypical antipsychotics for agitation (dose, route, onset, side effects)?
Ziprasidone 10 mg Q2hr or 20 mg Q4hr PO/IM (15-20 min)
Risperidone 2 mg Q1hr PO (<90 min)
Olanzapine 5-10 mg Q2-4hr PO/IM (15-45 min IM, 3-6 hr PO)
Orthostatic hypotension, QTc prolongation
SADPERSONS scoring for suicide risk
Sex (male) = +1 Age >45 or <19 = +1 Depression/hopelessness = +2 Prior attempts/psychiatric illness = +1 Excessive alcohol/drug use = +1 Rational thinking loss = +2 Separated/widowed/divorced = +1 Organized or serious attempt = +2 No social support = +1 Stated future intent = +2
> 9 high risk
6 moderate risk
<6 low risk
Animal bites at high risk for rabies?
Bats
Racoons
Skunks
Wound closure in cat and dog bites?
Dog bites - primary wound closure
Cat bites - secondary intention
PPx ABX?
Amox-clav for bite wounds
Routine PPx not recommended, but warranted in certain situations (first-gen cephalosporins addquate for most)
- Deep puncture wounds (cats)
- Moderate to severe wounds with associated crush
- Wound in areas of underlying venous and/or lymphatic compromise
- Wounds on hands, genitalia, face, close to bone or joint
- Wounds requiring closure
- Bite wounds in immunocompromise
Match laceration location with suture choice and duration until removal - SubQ
Facial - 6.0; within 5 days
Torso, arms, legs, hands, feet - 3.0 4.0 5.0; 7-10 days
Larger material for lacerations subject to high degrees of static or dynamic skin tension; 10-14 days
Tetanus immunization indications in setting of laceration?
Tetanus immunization - 0.5 mL IM; give if >5 years since last if tetanus prone wound, 10 years for non-tetanus prone wound (Give Tdap instead of Td if never received)
HTIG (250 IU IM) if primary immunization series not completed or unknown
Presentation and management of heat cramps?
Brief intermittent and involuntary muscle contraction (usually calves) from prolonged exercise in heat, occur at rest
Define heat stroke
Hyperthermia >40 C associated with severe CNS dysfunction and anhydrosis
Classic heat stroke?
Environmental heat waves, body fails to dissipate heat
Present with hyperthermia, AMS, anhydrosis, CNS symptoms
Exertional heat stroke?
Young healthy individuals unable to dispel heat due to endogenous heat production -> hyperthermia, diaphoresis, AMS during extreme physical exericse in hot environment
More likely to develop rhabdo, acute renal failure, etc.
Rx heat illness?
Active cooling - drop temp to 100-102, NO antipyretics
Degrees of hypothermia?
Mild - 32-35 C
Moderate - 28-32 C
Severe - <28 C
Rx hypothermia
Rewarming
Mild - passive external
Moderate - add active external
Severe - add active internal
Rx frostbite
Immerse affected area in warm water (37-39 C)
Remove constrictive clothing and jewelry
Consult surgery
Rx ibuprofen, tetanus toxoid, elevation of affected area, narcotics
Treat hypothermia first
Rx Lyme
Stage 1 - doxycycline or amox if <8 y/o
Stage 2 and 3 - ceftriaxone IV, cefotxaime IV, penciillin G IV
Define toxic dose of acetaminophen (acute and chronic). When should levels be checked?
Acute - 140-200 mg/kg or 7.5 g
Chronic - >4 g in 24 hours
4 hours after ingestion - within 8 hours, NAC is 100% hepatoprotective
DDx - otalgia
External otitis
OM
Mastoiditis
Auricular infections
Can be referred - TMJ, cancer, dental problems, tonsillitis, laryngitis, sinusitis, trauma
DDx - odynophagia
Tonsillitis, pharyngitis, adenoiditis, epiglottitis, cancer, caustic ingestion, pill esophagitis, GERD
Most common causative agents - OM?
S. pneumoniae
H. influenzae
RSV (most common viral cause)
Rx of choice - OMG
High dose ABX
Most common causative agents - mastoiditis?
Same as OM (spreads from OM)
Dx and Rx mastoiditis
CT
IV ABX
Admit (can progress to meningitis and abscess)
Most common causative agents - OE
Pseudomonoas, then S. aureus
Rx OE
Cipro + dexamethasone, consider ear wick
Most common causative agents - peritonsillar abscess
Complication of pharnygitis
Rx peritonsillar abscess
Drainage + ABX
Most common causative agents - retropharyngeal abscess
GAS/GBS, polymicrobial
Dx/Rx retropharyngeal abscess?
Lateral soft tissue XR, but CT w/contrast is gold standard
Emergent ENT consult, IV ABX, surgical drainage
Most common causative agents - epiglottisi
H. flu, strep, staph, viral/fungal
Rx epiglottitis
Emergent ENT consult
Sit up, humidified O2, IV fluids, IV ABX (2nd/3rd gen ceph), IV dexamethasone - admit to ICU
What is Ludwig’s angina? How does it present?
Cellulitis of submandibular and lingual space (spread of odontogenic infection of 2nd and 3rd molars) - dysphagia, trismus, edema of floor of mouth
Rx Ludwig’s
Early decadron, ABX (GP, anaerobes), early intubation for airway protection
Centor criteria?
Tonsillar exudate
Tender cervical LAD
NO cough
Hx of fever
4 - empiric ABX
2-3 - rapid strep
0-1 n test
Rx strep pharyngitis
IM benzathine PCN or pen VK PO
Manage epistaxis
If anterior - pinch x20 minutes, vasoconstrictor soaked Qtips x10 minutes, cauterize w/silver nitrate, pack, then cephalexin
If posterior - don’t lie flat, pack, O2, analgesics, ABX, admit for airway compromise monitoring
Cause of hypernatremia in dehydration?
Water depletion
Chronic vs. acute hypernatremia + management?
Present for > or < 48 hours
Chronic - lower serum Na by 10 meQ/L in first 24 hours
Acute - lower serum Na by 1-2 meq/L per hour, restore normal in <24 hours
Calculate water deficit?
Current TBW x (serum Na/140-1)
Estimate TBW by age
75% in newborn
65% in 1 y/o child
55-60% in infants and adults
