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EM quiz readings > Lecture 14: AMS + Psych Emergencies > Flashcards

Lecture 14: AMS + Psych Emergencies Flashcards

1
Q

() is slow in onset and chronic in nature

A

Dementia

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2
Q

() is an acute change in attention and mental functioning

A

Delirium

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3
Q

If a patient presents with neuro deficits and AMS, the first thing you focus on is…

A

their LOC

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4
Q

If you have an AMS patient that is also hypoxic, you should probably order a ()

A

ABG

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5
Q

The main restriction to using a simple mask or NRB over NC is (time)

A

NRB and simple mask can only be used for a few hrs.

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6
Q

There are 3 things you can administer IV for an AMS patient that are pretty much 0 risk. They are:

A
  • Dextrose
  • Thiamine
  • Naloxone
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7
Q

You have treated the pt’s vitals and started 2 large bore IVs. They are currently stable. Your next step is to…

A

Obtain history

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8
Q

Very abrupt onset of AMS is most likely () or () or seizures.

A

Ischemia or SAH

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9
Q

Associated symptoms in a neuro history

A

Have fun

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10
Q

GCS scale (better know this)

A
  • EYES: spontaneous, verbal, pain, none
  • VERBAL: oriented, confused, weird responses, weird SOUNDS, none
  • Motor: Obeys, Goes towards pain, withdraws from pain, Decorticate, Decerebrate, None

Decorticate = protect the core

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11
Q

A neuro deficit usually suggests a () abnormality of the brain

A

Structural

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12
Q

What lab measure serum ketones?

A

Serum-beta-hydroxybutyrate

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13
Q

You suspect SAH but CT non-con was negative. Your next test is a ()

A

LP

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14
Q

Delirium generally occurs over ()

A

Hours-days

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15
Q

The two agents used for acutely agitated delirious patients are:

A
  • Haldol PO/IM (monitor for EPS and QT prolongation)
  • Ativan PO/IM/IV (monitor for resp depression)

Haldol is an antipsychotic. Ativan is a benzo

Same tx for dementia pts with dangerous behaviors

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16
Q

Prior to discharging someone you gave Narcan to, you should observe them for ()

A

1-1.5 hours!

Narcan has a shorter half-life than some opiates.

Also consult psych if it was accidental. Intentional OD = SI attempt

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17
Q

Hypoglycemia is < () in symptomatic children and < () in asymptomatic children

A
  • < 45 if symptomatic
  • < 35 if asymptomatic
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18
Q

Neonates with hypoglycemia get () over 3-5 minutes, whereas Infants and Older children get () over 3-5 minutes. Maintenance dosing is with ()

All dextrose %s

A
  • Neonates: D10W
  • Infants/older children = D25W
  • Maintenance = D10W

Glucagon if no IV access

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19
Q

In adults, hypoglycemia is treated with (dextrose %) over 3-5 minutes and with a continuous infusion of (dextrose %)

A
  • D50W for adults
  • D10W for maintenance to keep > 100

Glucagon for no IV

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20
Q

() is used for hypoglycemia that is refractory and related to (diabetic drug) use

A

Octreotide to counter sulfonylurea usage

SC injection

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21
Q

T/F: You should remove insulin pumps if a patient is becoming hypoglycemic

A

False. Consult endo to lower tha basal rate.

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22
Q

Generally, the only people that need to be admitted for hypoglycemia are those on (drugs)

A

Sulfonylureas, long acting glucose or meglitinides for serial glucose monitoring

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23
Q

Insulin has 5 main actions:

  • () into cells
  • () into cells
  • () environment
  • Inhibits the breakdown of ()
  • Inhibits the breakdown of ()
A
  • Glucose into cells
  • K+ into cells
  • Anabolic environment
  • Inhibits fat breakdown
  • Inhibits protein breakdown
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24
Q

DKA is more common in type (1/2) diabetics

A

Type 1!

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25
Q

The 6 Is of DKA are:

A
  • Infection
  • Infarction
  • Insult (to the body)
  • Infant (pregnancy)
  • Indiscretion (lack of care)
  • Insulin (absence
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26
Q

Of hyperglycemia, volume depletion, and acidosis, the first symptoms will be from…

A

Hyperglycemia

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27
Q

DKA

The diagnostic criteria:

  • BG > () mg/dL
  • Anion Gap > () to ()
  • Bicarb < ()
  • pH < () with moderate ketonuria or ketonemia
A
  • BG > 250
  • AG > 10-12
  • Bicarb < 15
  • pH < 7.3
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28
Q

You shoulder order an EKG in a DKA patient in in order to check if they are having a () or if they have ()

A
  • MI
  • Hyperkalemia
29
Q

RFs for DKA with initial BG of < 250

A
30
Q

The very first step of DKA management is…

A

Fluid resuscitation!!!!

31
Q

Potassium correction in DKA is divided into 3 sections:

  1. If K > 5.2, you use ()
  2. If K is 3.3-5.2, you use () with ()
  3. If K is < 3.3, you use ()
A
  • > 5.2 = only need insulin.
  • 3.3-5.2 = 20-30 mEq of K to each LITER of NS + insulin
  • < 3.3 = only need K
32
Q

Once volume status is corrected and potassium is being corrected, your next step in management of DKA is…

A

Insulin therapy

0.1 and 0.1 units per kg if you bolus, otherwise 0.14 units per kg

33
Q

The first infusion of insulin you give in DKA is primarily to treat what?

A

Potassium levels

34
Q

The goal glucose reduction rate per hour in DKA is… ()

A

75 mg/dl/hr

35
Q

Your patient in DKA needs glucose reduction. They started at 250, but after one hour, they’re at 240 even with an insulin drip. They weigh 70 kg. You should give (amt) of insulin via (bolus/drip)

A

9.8 units of insulin BOLUS

70 kg * 0.14 Units/kg

36
Q

Your patient in DKA needs glucose reduction. They started at 450, but after one hour, they’re at 350 with an insulin drip. They weigh 70 kg. You should do what next???

A

Halve their insulin drip

37
Q

Your patient in DKA is being glucose monitored. They started at 275, and after one hour, they’re now at 200 with an insulin drip. They weigh 70 kg. You should switch their fluids to () and decrease their insulin dose to ()

A
  • Switch fluids to D5NS
  • Decrease insulin to 1.4-3.5 Units/hr
38
Q

Electrolytes, AG, and ABG/VBG should be rechecked every () hours in DKA.

A

Every 2 hours

39
Q

In a pH of less than 6.9 in DKA, you can consider giving () in water with K+ until pH is at least 7.

A

Bicarb

But just consider.

40
Q

The MC type of CVA is a…

A

Ischemic CVA

41
Q

The most important thing to know in history for a CVA is…

A

Last known normal time

42
Q

The goal time for a NON-con head CT to be done for a CVA is… () minutes of arrival. It is most sensitive within () hours.

A
  • 25 minutes upon arrival
  • 6 hours is highest sens
43
Q

The normal position for a stroke patient is…

A

Supine

44
Q

Antipyretics are only indicated in CVA if temperature is greater than…

A

100.4F/38C

45
Q

In an ICH with an SBP of 150-220, you should lower their SBP to () within () hours

A

Goal of 140 SBP in 1 hour

46
Q

In an ICH with an SBP > 220, you want to get their SBP down to ()

A

140-160 SBP

47
Q

The 3 first-line antiHTNs for lowering BP in a CVA are…

A
  • Labetalol
  • Nicardipine
  • Clevidipine
48
Q

In order for tPA to be administered for an ischemic stroke, SBP must be below () and DBP must be below ()

A
  • SBP <= 185
  • DBP <= 110

Labetalol, nicardipine, clevidipine

49
Q

In an ischemic stroke that is not eligible for tPA, the goal SBP and DBP are

A

Only treat if > 220/120 or signs of end-organ damage.

Labetalol, nicardipine, clevidipine

50
Q

tPA can only be used in a () stroke, within () hours of symptom onset, and a patient older than () years

A
  • Ischemic stroke
  • 4.5 hours of onset
  • 18 years or older

Also get informed consent and do exclusion criteria

51
Q

tPA is administered to your ischemic CVA patient. You need to perform neuro checks every () minutes for 3 hours and then every () for 6 hours. You also need to make sure their BP is under ()/()

A
  • Q15 mins x 3 hours
  • Q30 mins x 6 hours
  • 185/105
52
Q

Thrombectomy can be done if tPA is contraindicated or if a patient has a NIHSS of (less than ). It is specifically for a () artery occlusion in the () circulation with a small infarct core and non-hemorrhagic. It must occur within () hours of onset.

A
  • NIHSS >= 6
  • Large artery occlusion in anterior circulation
  • Must be done within 24 hrs of symptom onset.
53
Q

T/F: You should workup a TIA like a stroke

A

True

54
Q

(Auditory/Visual) hallucinations are more suggestive of a medical etiology, whereas (Auditory/Visual) hallucinations are more suggestive of a psychiatric etiology.

A
  • Visual = medical
  • Auditory = psychiatric

Lewy Dementia = Visual hallucinations, which is a medical etiology.

55
Q

T/F: UDS and BAC are necessary for awake, alert, and cooperative patients.

A

FALSE

56
Q

You should be at least () arms lengths from a violent patient and () access to the door

A
  • 2 arms length distance
  • At least equal access to door
57
Q

SAFEST approach stands for…

A
  • Spacing
  • Appearance
  • Focus
  • Exchange
  • Stabilization (Ativan to sedate)
  • Treatment
58
Q

Sedation is achieved using (), whereas chemical restraint is achieved using ()

A
  • Sedation is via ativan
  • Chemical restraint is via Haldol Q30minutes
59
Q

You should only use physical restraints on a patient when they pose an () or () evaluation/treatment

A
  • IMMEDIATE threat
  • Obstruct eval/treatment

Also document why

60
Q

The two sets of symptoms you should monitor when administering Haldol are…

A
  • EPS (extrapyramidal symptoms)
  • QT Prolongation
61
Q

Overall, the best screening approach to a suicidal patient is asking () questions

A

General questions about emotional state

62
Q

A high risk of suicide via Assessment of Suicide risk is greater than () pts.

A
63
Q

T/F: Males are at higher risk for suicide.

A

True

we r on the assessment thing

64
Q

A high SI risk patient must be admitted. Involuntary admission consists of () performing an evaluation while the ED provider issues a temporary hold lasting () hours.

A
  • Mental hygiene commissioner writes longer holds
  • ED provider can write a 24-hour temporary hold.
65
Q

Generally, a moderate SI risk patient is treated outpatient if:

  • No () needed
  • Therapy is established ()
  • Development of a ()
A
  • No medical intervention needed
  • Therapy is established immediately with close follow-up
  • Development of a safety plan
66
Q

T/F: A “no harm/suicide prevention” contract is useful in preventing suicidal behavior

A

False.

67
Q

() describes an agreement to treatment and proper follow-up.

A

Joint safety plan

68
Q

T/F: Any adult can apply to have an individual involuntarily committed for homicidal ideation.

A

True.

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