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EM - Exam 3 > Misc EM Topics > Flashcards

Misc EM Topics Flashcards

1
Q

Define TIA

A

Transient episode of neuro dysfunction WITHOUT evidence of infarct (return to baseline in less than 24 hrs)

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2
Q

Define stroke

A

Neuro dysfunction 2/2 cerebral infarct (as evidenced by neuroimaging or signs of permanent injury)

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3
Q

Define penumbra stroke

A

Ischemic but not infarcted tissue (potentially viable if circulation restored promptly)

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4
Q

Etiology of ischemic stroke

A

Cerebral artery blockage

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5
Q

Types of ischemic stroke

A
  • Thrombotic (clot forms in brain)

- Embolic (clot forms away from brain and swept through to brain)

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6
Q

Etiology of hemorrhagic stroke

A

Arterial leakage or rupture 2/2 HTN, AVM, anticoagulants, aneurysm

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7
Q

Types of hemorrhagic stroke

A
  • Intracerebral hemorrhage (vessel within the brain)

- Subarachnoid hemorrhage (vessel on brain surface)

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8
Q

How should onset of stroke be described if unable to determine specifically?

A

“Last known well”

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9
Q

Diagnostics of stroke

A
  • NIH stroke scale calculation

- HINTS testing (Head Impulse, Nystagmus, Test of Skew)

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10
Q

What is HINTS testing?

A

To determine if vertigo is peripheral or central (cerebellar)

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11
Q

Which patients will present with abnormal (positive) head impulse testing?

A

Peripheral vertigo

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12
Q

Which patients will present with unidirectional, horizontal nystagmus?

A

Peripheral vertigo

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13
Q

Which patients may reveal skew deviation with alternate eye cover testing?

A

Central vertigo

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14
Q

How will peripheral vertigo patients perform on HINTS testing?

A
  • Head impulse: abnormal (positive)
  • Nystagmus: unidirectional, horizontal
  • Skew: absent
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15
Q

How will central vertigo patients perform on HINTS testing?

A
  • Head impulse: normal (negative)
  • Nystagmus: rotatory, vertical, or direction changing horizontal
  • Skew: deviation with alternate eye cover testing
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16
Q

Most ischemic strokes will be evident on head CT within:

A

6 hours

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17
Q

When is head/neck CTA obtained in stroke evaluation?

A

If onset was less than 3 hours ago

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18
Q

When is MRI ordered for stroke evaluation?

A

Confirming diagnosis in TIAs OR if not giving tPA

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19
Q

Treatment of stroke

A
  • If less than 3 hrs onset, give tPA unless contraindicated
  • Intra-arterial fibrinolysis
  • Mechanical thrombectomy
  • Aspirin if out of tPA window
  • BP reduction (labetalol, nicardipine)
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20
Q

BP reduction in stroke treatment

A
  • Ischemic: reduce BP if SBP is over 185

- Hemorrhagic: reduce BP if SBP is over 140

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21
Q

How to treat hemorrhagic stroke?

A
  • Reverse anticoagulants
  • Hematoma evacuation
  • Aneurysm clipping or embolization
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22
Q

What is EMTALA?

A
  • Protects medically indigent pt from being refused care

- Mandates a minimum of “medical screening exam” and treatment if emergent

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23
Q

Why are pediatric patients more susceptible to CT radiation than adults?

A

Children’s cells proliferate more rapidly

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24
Q

Define priapism

A

Pathologic erection involving corpora cavernosa but NOT glans or corpus spongiosum

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25
Q

Treatment of priapism

A
  • Urology consult but don’t wait to treat
  • Terbutaline SC deltoid, repeat in 30 min prn
  • Pseudoephedrine
  • Corporal aspiration of blood then injection of phenylephrine (local pressure then compression dressing)
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26
Q

Define phimosis

A
  • Inability to retract foreskin (rarely emergent)
  • Generally from poor hygiene leading to infection or scarring
  • Treat w/topical steroids, dilation or circumcision
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27
Q

Define paraphimosis

A
  • Inability to reduce retracted foreskin back over glans
  • Venous engorgement can lead to gangrene
  • Emergency reduction necessary! Manual compression or wrapping distal penis w/phlebotomy tourniquet
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28
Q

Define Fournier gangrene

A
  • Polymicrobial necrotizing fasciitis of perineal, perianal or genital areas
  • Infection tracks along fascial planes and may spare deep muscular structures or even overlying skin
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29
Q

Pathophys of Fournier gangrene

A
  • Microorganisms produce enzymes which cause coagulation of local nutrient vessels
  • Allows for proliferation of anaerobes which release enzymes responsible for degradation of fascial barriers
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30
Q

Risk factors for Fournier gangrene

A
  • DM
  • PVD
  • Immunocompromise
  • Obesity
  • Alcoholism
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31
Q

Treatment of Fournier gangrene

A
  • Management of shock if present
  • Emergent surgical consult
  • Abx (cipro and clindamycin)
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32
Q

Methods of ring removal

A
  • Ring cutter: can be painful, ring must be bent open
  • String technique: painful, may be difficult to pass string under ring
  • Tourniquet
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33
Q

Describe tourniquet method of ring removal

A
  • Elevate above heart
  • Apply tightly distal to proximal
  • Quickly remove after a few min and apply lubrication
  • Retract skin proximally with one hand while pulling ring distally
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34
Q

Options for fish hook removal

A
  • Push through (push it)
  • String technique (yank it)
  • Needle over barb (cover it)
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35
Q

Treatment of plantar puncture wound

A
  • Core out, irrigate, pack x 24 hrs
  • Ensure tetanus is UTD
  • Consider abx proph (but limited evidence)
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36
Q

Plantar puncture wound infections

A
  • Within first 72 hrs is MC staph/strep (use Keflex)

- After 72 hrs is MC pseudomonas (use Cipro)

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37
Q

Treatment of AV fistula bleeding

A
  • Apply direct, localized pressure
  • BP cuff above and below fistula may help
  • Very superficial suture followed by pressure bandage (temporary measure, best to consult vascular surgery first)
  • Address BP, correct any coagulopathies
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38
Q

Treatment of fistula aneurysm

A

Emergent vascular consult to avoid rupture

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39
Q

Describe Ottawa knee rules

A

If 1 or more, x-ray indicated:

  • Patella tenderness
  • Fibula head tenderness
  • Inability to flex 90 degrees
  • Inability to bear weight
  • Age over 55
40
Q

Describe Ottawa ankle/foot rules

A

If 1 or more, x-ray indicated:

  • Malleolar, navicular OR base 5th MT pain on palpation
  • Inability to bear weight
41
Q

Describe Salter-Harris

A

Classification of pediatric fractures

1: through growth plate
2: through growth plate and metaphysis
3: through growth plate and epiphysis
4: through all 3 elements
5: crush injury of growth plate

42
Q

Prescription writing guidelines

A
  • Use leading zeros (0.1 mg) but not ending zeros (1.0 mg)
  • Use correct formulations
  • Adjust for renal or hepatic dysfunction
  • Verify correct drug when using EMR
43
Q

Every prescription requires:

A
  • Name and DOB
  • Drug name, dosage, frequency
  • Duration, quantity, refills
  • How to administer
44
Q

Every order requires:

A
  • Date and time
  • Initials or ID stamp
  • Drug name
  • Dosage
  • Route
  • Frequency (if more than 1 dose)
45
Q

Examples of bio-equivalent IV and oral meds?

A
  • Fluoroquinolones
  • Azithro, clarithromycin
  • Bactrim
  • Metronidazole
  • Cephalosporins
46
Q

Amoxicillin and Augmentin uses

A
  • OM
  • Sinusitis
  • Pneumonia
  • Tonsillitis (Pen Vee K 1st line)
  • UTI
47
Q

Adult dosing of amoxicillin

A

500 mg PO TID OR 875 mg PO BID

48
Q

Peds dosing of amoxicillin/augmentin

A

45 mg/kg/day PO (divide into 2-3 doses)

90 mg/kg/day PO (divide into 2-3 doses) for otitis media

49
Q

Duration of amoxicillin use

A

7-10 days

5-7 days for high dose otitis media

50
Q

Uses of cephalexin (keflex)

A
  • Skin infections
  • OM
  • Tonsillitis
  • UTI
  • Bronchitis
51
Q

Adult dosing of cephalexin (keflex)

A

250-500 mg PO QID

52
Q

Duration of cephalexin (keflex)

A

7-10 days

53
Q

Describe PCN allergy cross-reactivity rate

A

Approximately 1%

Lower for 3rd-4th generation cephalosporins

54
Q

Uses of ceftriaxone (rocephin)

A
  • PNA
  • Cellulitis
  • Meningitis
  • Pyelonephritis
  • Chlamydia
55
Q

Adult dosing of ceftriaxone

A

1 gm QD (IM or IV)

56
Q

Duration of ceftriaxone

A

Generally transitioned to PO alternative after few days; single dose for chlamydia

57
Q

Bactrim uses

A
  • UTI/pyelonephritis
  • PCP PNA
  • Bronchitis
  • MRSA skin
58
Q

Adult dosing of Bactrim

A
  • 1 DS (double strength) BID

- PCP rx is weight based

59
Q

Duration of Bactrim

A

7-10 days

3 days for uncomplicated UTI

60
Q

Bactrim drug interations

A

Known to inhibit warfarin clearance (results in high INR)

61
Q

Uses of Ciprofloxacin

A
  • UTI/pyelonephritis
  • Diverticulitis
  • Infectious diarrhea
62
Q

Adult dosing of Ciprofloxacin

A

250-500 mg BID OR 400 mg IV q12h

63
Q

Duration of Cipro

A
  • 3 days for UTI
  • 5-7 days for diarrhea
  • 10-14 days for diverticulitis
64
Q

Cipro drug interactions

A

Known to inhibit warfarin clearance

65
Q

Azithromycin uses

A
  • Bronchitis/PNA
  • Sinusitis
  • Tonsillitis
  • Chancroid/chlamydia
66
Q

Adult dosing of Azithromycin

A
  • “Z pack” (500 mg day 1, then 250 QD x 4d) for respiratory
  • 1 gm PO single dose for chancroid/chlamydia
  • IV usually 500 mg QD x 2d then PO transition
67
Q

Doxycycline uses

A
  • Lyme/Anaplasmosis/RMSF
  • PNA/bronchitis
  • Cellulitis including MRSA
68
Q

Adult dosing of Doxy

A

100 mg PO BID

69
Q

Duration of Doxy

A
  • 7-10 days

- 21 days for Lyme/tick

70
Q

Side effect of Doxy?

A

Photosensitivity

71
Q

Uses of acetaminophen (tylenol)

A

Pain, fever

72
Q

Adult dosing of acetaminophen (tylenol)

A

325-1000 mg q4-6h prn (325 or 500 mg tablets)

73
Q

Peds dosing of acetaminophen (tylenol)

A

15 mg/kg q4h

160 mg/5 mL elixir, 120 mg or 325 mg suppository

74
Q

Uses of ibuprofen (motrin/advil)

A

Pain, fever

75
Q

Adult dosing of ibuprofen (motrin/advil)

A

400-800 mg q6-8h prn (200 mg tablets)

76
Q

Peds dosing of ibuprofen (motrin/advil)

A

10 mg/kg q6h prn

100 mg/5mL elixir

77
Q

Adult dosing of hydrocodone/tylenol (Vicodin)

A

1-2 tab q4h prn

5, 7.5, or 10 mg/300 mg; Norco Tylenol is 325 mg

78
Q

Adult dosing of oxycodone/tylenol (Percocet)

A

1-2 tab q4h prn

5, 7.5, or 10 mg/325 mg

79
Q

Adult dosing of morphine sulfate

A

2-6 mg IV/IM/SQ q 15mins - 4hrs

shorter intervals for IV routes

80
Q

Adult dosing of hydromorphone (Dilaudid)

A

0.5 - 2 mg IV/IM/SQ q 30 mins - 4 hrs

81
Q

Adult dosing of Fentanyl

A

25-100 mcg IV/IM q 30-60 mins

82
Q

Describe Fentanyl

A

Shorter duration than morphine/dilaudid
Less hypotension
Consider Duragesic patch for home pain management

83
Q

Adult dosing of Ketorolac (Toradol)

A

30 mg IV or 60 mg IM q6h prn

84
Q

Describe Ketorolac

A
  • NSAID side effects/contraindications

- Good for renal/gallbladder pains

85
Q

Describe Tramadol (Ultram)

A

Non-narcotic, non-NSAID pain med

86
Q

What is a non-narcotic and non-NSAID pain med?

A

Tramadol (Ultram)

87
Q

What is Ultracet?

A

Tramadol with 325 mg Tylenol

88
Q

Adult dosing of Tramadol

A

25-100 mg PO q6h prn

89
Q

What does “mindful medicine” utilize?

A

Thorough DDX and bias elimination

90
Q

Types of bias

A
  • Availability
  • Anchoring
  • Framing
  • Confirmation
  • Premature closure
91
Q

Define availability bias

A
  • Favors the common diagnosis w/o proving its validity

- Providers tend to be influenced by recent events or info

92
Q

Define anchoring bias

A
  • Prior diagnosis/opinion is favored and misleads provider from correct current diagnosis
  • Provider relies on established diagnosis/opinion which impacts subsequent judgments
93
Q

Define framing bias

A
  • Failure to recognize that the data available does not fit diagnostic presumptions
  • Provider connects data in a manner that suggests a diagnosis but all relevant data has not been gathered
94
Q

Define confirmation bias

A
  • Info is selectively interpreted to confirm a belief
  • Provider has a preferential diagnosis and a finding, or lack of specific finding, during the hx/PE/workup used to support that diagnosis
95
Q

Define premature closure bias

A
  • Rushed diagnostic conclusion

- Provider jumps to a conclusion but fails to see additional relevant info

EM - Exam 3 (6 decks)

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