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Emergency Medicine > MTB 2 > Flashcards

MTB 2 Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Presentation of Heat cramps/exhaustion

A

Hx: exertion, high temp
Body temp: Nomral
CPK/K+ = Normal
Tx: oral fluids, electrolytes

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2
Q

Heatstroke

A

Hx: exertion, high temp
Body temp: High
CPK/K+ = High
Tx: IVF, evaporation, ice water immersion if no CNS involvement

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3
Q

NMS

A

Hx: APs
Body temp: High
CPK/K+ = High
Tx: Dantrolene or Dopamine Agonists, Bromocriptine, Cabergoline

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4
Q

Malignant Hyperthermia

A

Hx: Anesthetics
Body temp: High
CPK/K+ = High
Tx: Dantrolene

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5
Q

MOA of Dantrolene

A

Muscle relaxant

Works on Ryanodine receptors - Prevents calcium release from SR in skeletal muscle

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6
Q

Presentation of Hypothermia

A

Intoxicated person

Low body temp

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7
Q

MCC death hypothermia

A

Cardiac Arrhythmia

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8
Q

Best initial step in hypothermia

A

EKG

- J Waves - where QRS hits ST segment

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9
Q

TX for Frost bite

A

Rapid rewarming with warm water
Immerse in warm water
If systemic hypothermia - infuse warm fluids

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10
Q

Presentation of Salt water Drowning

A

Acts like CHF

Wet, heavy lungs, pulmonary edema

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11
Q

Presentation of Fresh water Drowning

A

Hemolysis from absorption of hypotonic fluid into vasculature

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12
Q

Role of steroids and Abx in drowning

A

None. They are not useful

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13
Q

Management in cardiac arrest

A
  1. Make sure pt is unresponsive
  2. Call for help
  3. Open airway
  4. Give rescue breaths if not breathing
  5. Check pulse, start compressions
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14
Q

When do we do precordial thump

A

Very recent onset of arrest
Less than 10 mins
No defibrillator available

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15
Q

Causes of pulselessness

A

Asystole
V Fib
V tach
PEA

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16
Q

Best initial management puleslessless

A

CPR

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17
Q

TX for Asystole

A
  1. Epinephrine + Atropine

- Vasopression = alternative for Epi

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18
Q

MOA Of epinephrine and vasopressin

A

Constrict BVs to shunt blood into critical central areas - heart and brain

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19
Q

When do we do Unsynchronized Cardioversion

A

V Fib
Pulseless V tach
Torsades des Pointes

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20
Q

Best initial Tx for V fib

A
  1. Immediate Unsynchronized Cardioversion
  2. If ineffective -> Resume CPR
  3. Shock again
  4. Epinephrine/Vasopressin
  5. Shock
  6. Amiodarone/Lidocaine
21
Q

When is Bretyllium the correct answer

A

Never

22
Q

Management for Pulseless V tach

A
  1. Immediate Unsynchronized Cardioversion
  2. If ineffective -> Resume CPR
  3. Shock again
  4. Epinephrine/Vasopressin
  5. Shock
  6. Amiodarone/Lidocaine
23
Q

Management for hemodynamically stable V tach

A
  1. Amiodarone
  2. Lidocaine
  3. Procainamide
  4. Cardiovert
24
Q

Management for hemodynamically unstable V tach

A

Electrical cardioversion several times

Amiodarone or Lidocaine

25
Q

What makes up hemodynamic instability

A

Chest Pain
SOB
HypoTN
Confusion

26
Q

What is PEA?

Patient presentation?

A

Heart is electrically normal
No motor contraction
Pt with No pulse and normal EKG

27
Q

Causes PEA

A 
T's and H's
Tamponade
Tension Pneumothorax
Hypovolemia
Hypoglycemia
Hypo/Hyper kalemia 
Hypoxia
Hypothermia
PE - massive
Metabolic Acidosis
28
Q

Difference bt A flutter and Fib

A 
Flutter = Regular rhythm
Fib = Irregular rhythm
29
Q

What is A flutter

A

Reentrant circuit that rotates around Tricuspid Annulus

30
Q

EKG of A fib

A

Absent P waves

Narrow QRS complexes

31
Q

What is most frequent origin for ectopic foci of A fib

A

Pulmonary veins

32
Q

When do we do synchronized cardioversion in A fib

A

Hemodynamically Unstable pts

33
Q

What does synchronization do

A

Prevents electricity from being delivered during refractory period
Helps prevent deterioration into VT or VF

34
Q

Best initial TX for Chronic A fib

A
  1. Rate control
    - Beta blockers
    - CCBs
    - Digoxin
  2. Anticoagulate
    - Warfarin
35
Q

Time length for chronic A fib

A

2 days

36
Q

Which CCBs used for A fib

MOA

A

Diltiazem
Verapamil
Block AV node

37
Q

With A Fib, when is it necessary to use heparin before warfarin

A

When there is current clot in atrium

38
Q

Benefits of Dabigatran

A

Does not need monitoring

Prevents stroke

39
Q

What problem can occur in an atrial rhythm problem + Cardiomyopathy

A

Pulmonary Edema

- loss of atrial contribution

40
Q

How much of atrium contributes to CO

A

10-15%

41
Q

Criteria for low risk stroke from A fib

A 
No Cardiomyopathy/CHF/Atherosclerosis
No HTN
75 or younger
No DM 
No past stroke
42
Q

Lone A fib - Criteria

Management

A

No Risk factors

ASA

43
Q

Presentation of SVT

A

Palpitations

Hemodynamically stable

44
Q

Best initial steps in managing SVT

A
  1. Vagal maneuvers
    - Carotid massage
    - Valsalva
    - Dive reflex
    - Ice immersion
  2. Adenosine
  3. Beta blockers, CCBs, Digoxin
45
Q

When is Adenosine used in SVT

A

Vagal maneuvers are ineffective

Only therapeutically

46
Q

EKG of SVT

A

Narrow complex Tachycardia
No P waves
No fibrillatory waves
Rate 160-180

47
Q

TX for SVT with unstable Vital signs

A

DC Cardioversion

48
Q

Presentation of Paroxysmal SVT

A

Benign and Abrupt attacks
HR 160-220
Reentry AV Node

49
Q

Management of Paroxysmal SVT

A

Increased vagal tone by Valsalva, Carotid massage, cold water immersion to Decrease AV conduction

Emergency Medicine (4 decks)

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