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
