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Emergency Lectures > May 30 > Flashcards

May 30 Flashcards

1
Q

What are the Big 6 for Chest Pain?

A

Squeeze: tamponade, tension pneumothorax
Starve: MI/UA, PE
Burst: esophageal rupture, aortic dissection

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2
Q

Chest Pain - other causes:

A 
Myocarditis, pericarditis
Chest wall pain syndromes
GERD, spasm, PUD
Pancreatitis, cholecystitis
Pneumothorax, pneumonia, pluritis
Psych: hyperventilation...
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3
Q

Most frequent critical chest pain dx?

A

MI

  • time is muscle
  • get EKG and CXR promptly
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4
Q

Why harsh HSM radiating to axilla in MI?

A

Papillary muscle ischemia

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5
Q

What 3 things does Dr. Sharpless want?

A

Story, risk factors, hard clinical findings

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6
Q

Aside from vitals, what tells me the pt is critically ill or hypo-refused?

A 
Diaphoresis - sweating pt makes me sweaty
Cool, clammy skin
Poor capillary refill
AMS
Poor urine output
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7
Q

What are 4 anginal equivalents?

A

Substernal pressure/pain rad to left arm = classic

  • dyspnea
  • weakness
  • syncope
  • confusion
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8
Q

What are the top 6 MI risk factors?

A
  1. DM
  2. Hypercholesterolemia
  3. HTN
  4. Smoking
  5. Family history early CAD
  6. Age (Men>45, women>55)
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9
Q

How can you tell if systolic ejection murmur rad to carotids is severe?

A

Aortic Stenosis

  • Parvus et tardus
  • late peak in intensity of the murmur = tight
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10
Q

What order for eval Chest Pain?

A

EKG, CXR, telemetry
IV, O2, Pox
Troponin, CBC, BMP, Mg, PT/PTT

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11
Q

What is classic EKG changes in MI?

A

ST elevation >1mm in 2 contiguous leads

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12
Q

Describe 4 shapes of ST elevations:

A

Smile: you have chance not MI
Concave upward: often MI but others

Convex: huge risk MI (frown or elevated but flat)

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13
Q

Inferior wall MI: leads? worry?

A

II, III, AvF

- may be assoc w/ RV MI = NO nitrates

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14
Q

What are reciprocal leads for inferior wall?

A

I, L

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15
Q

What is an anterior wall MI?

A

V1-V4 - knock on the anterior door

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16
Q

What are reciprocal leads to anterior wall?

A

II, III, AvF

17
Q

What is a lateral wall MI?

A

V5-6, I, L

18
Q

How see posterior wall MI on EKG?

A

ST depression in V1-V4

- but also could be sub-endocardial infarct

19
Q

What is Acute MI therapy?

A 
Aspirin - 4x 81mg chewable - MOST important
Nitroglycerin (sub-lingual + IV)
Morphine
Heparin (bolus + drip) 
Cardiology - ASAP
20
Q

Chest pain + back pain = ?

A

Aortic Dissection

- abrupt, excruciating, tearing pain

21
Q

What kind of murmur w/ aortic dissection?

A

Aortic regurg - proximal dissection

  • dilation of aortic valve ring
  • loss of commissural support of aortic valve
22
Q

Risk factors for aortic dissection?

A

HTN
Bicuspid aortic valve
Marfan / Ehlers-Danlos
Pregnancy

23
Q

What is common in proximal aortic dissections?

A

Aortic insufficiency (regurg)

24
Q

Tests/imaging for aortic dissection?

A

EKG - usually normal

CXR - abnormal 80% of the time

25
Q

What is the egg shell sign on CXR for aortic dissection?

A

Separation > 5mm of intimal calcium from outer aortic contour

26
Q

How treat aortic dissection?

A

Lower BP to reduce sheer forces
- give BB esmolol - short acting

  • can also give nitroprusside after the BB
27
Q

Classic triad for PE?

TEST TEST TEST

A

Dyspnea - labored breathing
Hemoptysis
Pleuritic chest pain

28
Q

What may suggest massive PE?

A

Vascular collapse

29
Q

Types of PE?

A

Thrombus - emboli
Amniotic fluid - usu during labor
Fat embolism - long bone fx
Air embolism - iatrogenic

30
Q

Rick factors for PE?

A 
Prior DVT/PE
Lupus anticoagulant
Protein C/S deficiency
Central lines, surgery, cast/immobilization
Cancers (ovarian/colon)
Pregnancy, high dose estrogens
IBD - Crohn's (often decreased C/S)
31
Q

What hear on auscultation with a PE?

A

Wide split S2

- pipe is obstructed, takes more time to get all blood through pulmonary valve so it closes after aortic

32
Q

What is Virchow’s triad?

A

Venous stasis
Hypercoagulability
Endothelial injury

33
Q

Low pulse ox + normal pulmonary exam…

A

PE

34
Q

CXR findings for PE

A

Westermark’s cut-off sign
- following a vessel and it just cuts off
Hamptom’s hump

35
Q

Two main scans for PE?

A

V/Q scan

CT scan w/ contrast - so need good kidneys

36
Q

How treat PE?

A

IV heparin bolus + drip (or lovenox)
Give tPA if:
- shock + PE
- PE + right heart failure

Emergency Lectures (3 decks)

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