Medical Emergencies and Trauma Flashcards
Airway causes of obstruction
loss of muscle tone in obtunded patient FB epiglottitis angioedema oral facial trauma
Breathing conditions and causes
air movement/chest expansion (if none, need to artificial ventilations)
wheezes (asthma/COPD)
rales (pneumonia, pulm edema, atelectasis)
unequal breath sounds (pneumothorax)
Impaired circulation treatment options
IV voume replacement: crystalliod, blood
vasopressors, inotropes
if pulseless, do chest compressions
Classic hx of unstable angina/acute MI
L sided substernal CP
pressure, heavy, squeezing, tightness, pressure
radiation to neck, left or both arms
assoc sx: SOB, diaphoresis, nausea
Brought on by stress , relieved by rest/NG
EKG changes in reversible ischemia
ST depression
T wave flattening or inversion
changes resolve after episode is over
EKG changes in an acute MI
ST elevation
reciprocal changes
new LBBB
Q wave develops later
Cardiac enzymes
myocardial cell damage releases enzymes
Delay in rise> need to follow serial enzymes to r/o MI
Troponin is MC - sensitive and specific
Myoglobin rises sooner but is non-specific becuz it is also in skeletal muscle
How to manage acute MI
Oxygen Aspirin Heparin/enoxaprin Nitrates Beta blockers possibly emergent cardiac cath vs a tPA
Aortic dissection
Tear in intimas of aorta leads to dissection of blood within aortic media, seperating the walls
S/s: ripping or tearing pain in the chest, abdominal, or intrascapular
possible pulse deficits, hypotension
Dgx: CXR for widened mediastinum or Chest
Tx: emergent cardiovascular surgery consult, lower BP decrease shearing forces: propranolol, nitroprusside
Proximal dissections require surgery
Pulmonary embolus
originates in DVT, then blocks branch of pulm artery and that area of lung no longer perfused blood and decreases oxygenation
S/s: dyspnea, chest pain (pleuritis, sharp), hemoptysis
tachypnea, tachycardia, rales, rhonchi, wheezes, pleural rub, possible DVT findings in leg
Labs: CXR (r/o other causes), D-dimer (screening blood test that is sensitive), definitve dx with imaging: Chest CT or V/Q scan
Tx: hospital admission, anticoag, if unstable consider thrombolytics
Congestive Heart Failure
loss of cardiac contractile ability leads to abnormal fluid retention- pulm edema or peripheral edema
S/s: dyspnea, orthopnea, fatigue, altered mental status, reduced urine output
lungs: rales, rhonchi, wheezes
JVD, hepatomegaly, leg edema
Dgx: CXR-cardiomegaly, pulmonary, interstitial edema, pleural effusions
BNP- released in response to ventricular stretch
Tx: oxygen, nitroglycerin (vasodilator to reduce pre and after load) , diuretics
Pneumothorax
acute onset of SOB, pleuritic CP
S/s: dyspnea, tachypnea, tachycardia, decreased breath sounds on affected side
Tx: chest tube, if small may just observe
Pericarditis
inflamm of pericardium usually d/t viral or idiopathic
S/s: CP (sharp, worse when lying supine), possible low grade fever
Pericardial friction rub
Dgx: EKG: diffuse ST elevation, PR depression
Echo: assess for effusion
Tx: NSAIDs
Toxic/Metabolic causes of Coma/Altered LOC
Glucose
EtOH/Drugs-will slowly come to as drugs gets eliminated
Oxygen-cerebral anoxia from hypoperfusion
Infection
Endocrine/electrolyte disturbances
Liver-cirrhosis can lead to elevated ammonia level which decreases LOC
TIPS AEIOU for altered LOC
Trauma
Infection
Psychiatric
Space occupying lesion, stroke, sz
Alcohol, drugs/toxins Electrolytes, endocrine, exocrine (liver) Insulin Oxygen, opiates Uremia
