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Norries Flashcards

1
Q

What is EMTALA

A

anti-dumping law; emergency services must provide medical screening exam and address any
emergency medical conditions; anywhere on the campus or 250 yards off campus; CC/vitals/general
appearance/mental status/ability to walk/focused PE all must be done; can transfer pt when stable if unstable

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2
Q

What is the try for Massive PE?

A 
Stable = heparin
Unstable = Tpa
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3
Q

What is ssx and try for Aortic Dissection

A

ripping/tearing mid sternal pain and tx is :
Initial -> morphine/fluids
stable->ACE/Beta/CCB
unstable ->Surgery

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4
Q

Esophageal Rupture

A

substernal; sudden/sharp; after vomiting; back radiation; dyspnea; diaphoresis; sepsis
signs; spasm = GI cocktail/nitro; rupture = airway/fluids/surgery

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5
Q

pericarditis

A

substernal; sharp/pleuritic pain; fever; pericardial friction rub; NSAIDs/Colchicine

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6
Q

Pneumonia

A

sharp/pleuritic chest pain; fever; Abx

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7
Q

Perforated peptic ulcer

A

epigastric/severe/sharp pain; acute distress; diaphoresis

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8
Q

CHF/Pulmonary Edema

A

BiPAP; Lasix; Nitro; Morphine

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9
Q

Croup

A

racemic epi; decadron

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10
Q

Angioedema

A

epi + H1/H2 blocker + steroid

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11
Q

What is the SITS acronym and what is it used for?

A

AMS: this is a very concise lecture. Study the whole thing
Nutrients to consider – Oxygen, Glucose, Heart (BP, rhythm, cap refill)
Neurons – SITS
S tructural – head/neck exam, gross neuro changes (FAST = face, arm/leg
weakness, speech, timing)
I nfection – 5 body cavities can hide infx; core body temp, meningitis,
pneumonia, abd, urosepsis, skin
T oxic – You, me and endy
- You gave it to me – ADR or drug interaction
- I gave it to myself – alcohol, drugs, toxidrome
- Endocrine – hyperthyroid, steroid withdrawal, hyponatremic (most
common; too much water, too little water, pneumonia)
S eizures/Psych

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12
Q

sudden; arterial bleed; lucid interval; round on CT

A

Epidural bleed

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13
Q

sudden; aneurysm; thunderclap; exertional HA

A

Sub-arachnoid bleed

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14
Q

gradual; venous bleed; Coumadin; crescent on CT

A

Subdural bleed

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15
Q

global; gradual; positional; N/V; wake up w/; head CT w/ contrast

A

Intracerebral Mass

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16
Q

gradual; global; HTN; seizures; AMS; slowly lower BP by 25%

A

HTN Encephalopathy

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17
Q

How do you treat acute angle glaucoma?

A

i forget just look up sorry

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18
Q

What is methadone?

A

original structure + EDDP metabolite must be found to confirm (+)

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19
Q

Tylenol antedote

A

acetylcysteine

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20
Q

carbon monoxide antidote?

A

oxygen

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21
Q

heavy metal cantedote

A

chelating

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22
Q

anticholinergics antidote?

A

physostigmine

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23
Q

beta-blockers

A

glucagon

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24
Q

cyanide

A

sodium nitrite

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25
isiniazid
pyridoxine
26
anticholinesterases
atropine
27
calcium channel blockers
calcium
28
digoxin
digoxin antibodies
29
methanol
ethanol
30
TCA's antidote
sodium bicarb
31
trx for sympathomimetic toxic (cocaine, amphetamines) ?
``` Stimulation; mydriasis (dilated); diaphoresis; hyperthermia; HTN; seizures; MI tx: benzos, hydration, cooling ```
32
cholinergics ( insecticides) tooxidrome?
Salivation; tearing; diaphoresis; N/V; urination; defecation; fasciculation; paralysis: protect airway, atropine
33
anticholinergics ( scopolamine, atropine) antedote?
AMS; mydriasis; dry skin; urinary retention; decr. bowel; hyperthermia tx: benzos, cooling, physostigmine
34
ASA antedote
AMS; resp alkalosis; met acidosis; tachycardia; N/V; diaphoresis tx : charcoal, dialysis, hydration
35
Seretonin Syndome Sx and antedote trx
AMS; incr muscle tone; hyperreflexia; hyperthermia; whole body tremor Cooling; benzos; supportive
36
Opoid ( heroin, morphine) overdose sx and trx
CNS/pulm/cardiac depression, miosis (pinpoint), hypothermia Ventilation/Narcan
37
wound care primary intention
primary closure of the wound; w/in 8hrs; not grossly contaminated; scalp/face/neck can be w/in 24hrs; always check for function/sensation before starting
38
secondary intention
left open to heal on its own; longer healing period; incr risk for infx; unattractive scar; >8hrs from injury; heavily contaminated; large tissue defect; abrasion or penetration wounds
39
tertiary intention
delayed primary intension; 4-5 days after injury; old/contaminated/bites/ gunshots/exploratory wounds
40
when do you give abms for wound healing
bone/cartilage/tendon/join injuries; bite wounds; valve disease
41
when do you remove sutures from the face?
2-5 days
42
when do you remove sutures from the body
5-8 days
43
packing wounds | how often do you repack? and how much does the depth change?
daily and 1-2 inches daily
44
Tx of hymenoptera stings
Aka(bees, wasps and mosquitoes) Remove stinger, wash, ice, Antihistamines, NSAIDS
45
Patient was camping in the Yukon, says he got bit by a brown recluse. Tx? Actual vector?
Tetanus, Hobo Spider Nigga!!!
46
Black widow bite Tx?
Tetanus, AntiVenom
47
frostbite mostly superficial, Tx?
1st Degree, Warm immediately
48
frostbite Entire EpiDermis w/ blisters, Tx?
2nd Degree, immediate warming
49
3rd degree frostbite symptoms
tissue loss, blue grey discoloration, loss of sensation, hemorrhagic bullae at 12-35hrs
50
3rd degree frostbite tx
immediate rewarming
51
Necrosis, loss of sensation, cold injury, Tx?
4th degree frostbite, Amputation
52
Flu like symptoms, HA, N/V, dizziness, visual disturbances, CP palpitations, Coma, Seizures, Respiratory failure at high levels.
CO poisoning
53
how do you treat a paronychia
nail infx:18 gauge needle or 11 blade into infection; Keflex if cellulitis
54
how do you treat a sublingual hematoma
18G needle twisted down or 11 blade if under distal nail
55
how to perform toenail removal?
digital block; abx after w/ dressing
56
Auricular Hematoma
auricular block; 15 blade to incise then curved hemostats to separate; manual pressure for 5-10minutes
57
Fish Hook Removal
string pull technique; needle-cover technique; advance and cut technique
58
Abscess I&D –
incise; deloculate; manually express; pack; dressing; abx if cellulitis
59
1st, 2nd , 3rd , 4th degree burns
1 st Degree Burn – only epidermis; no blister; blanches; hurts 2 nd Degree Burn – into dermis; blisters; hurts; blanches 3 rd Degree Burn – through subcutaneous; dead area; no pain; no blanch; feels hard 4 th Degree Burn – below fat; electrical
60
Joint Aspiration
indications septic arthritis or joint effusion Landmarks: Shoulder = soft spot 1-2cm inferior/medial to acromion tip Elbow = flex 90degrees + soft spot between radial head and lateral epicondyle Wrist = dororadial just on ulna side of EPL Knee = lateral side under patella; ankle = 2.5cm proximal + 1.5cm medial to tip of lateral malleolus
61
Lumbar Puncture – indications =
meningitis or subarachnoid hemorrhage; L3-L4 interspace; pt remains supine for 20-30minutes
62
Central Line – indications =
rapid fluid/blood/vasopressors/nutrients or CV pressure/O2 monitoring; internal jugular site = between heads of SCM; subclavian = cangle of clavicle to suprasternal notch; femoral = medial to femoral artery pulsing
63
abx for ears
amox
64
abx for lungs
azith
65
abx for urinary
macrobid, bactirim, cipro
66
abx for sinus
augmentin
67
lung big gun abx
levaquin
68
abx for skin
keflex
69
abx for throat
pen VK
70
abx for gi
Cipro & flagyl
71
Abx for everything else
Doxy
72
drug seeking rules for norris
must be recent, sever, visible
73
Neutropenic Fever
neutrophils
74
DIC
systemic activation of coag + fibrinolysis; bruising/bleeding; epistaxis; bleeding gums; hematuria; petechiae; purpurpa; ischemia; low platelets; D-Dimer; ABCS/IV NS/FFP/Tx underlying
75
Chemical Ocular Injury
acid vs alkalai; alkalai lipophilic and worse; pain/tear/twitch/decr visual acuity; Proparicaine for pain; irrigation (Morgan Lens); Erythromycin ointment; Atropine eye drops
76
Central Retinal Artery Occlusion
sudden painless complete monocular vision loss; amaurosis fugax; pallor of disc (vein occlusion shows flame hemorrhages); cherry-red fovea; ocular massage; Acetazolamide or Timolol; r/o temporal arteritis
77
Erythema Multiforme
hypersensitivity Minor = HSV; round well demarcated target lesions w/ central clearing that spreads from extremities to trunk; topical steroids/oral antihistamine Severe = PCN/Sulfa/Phenytoin; red macules/bullae (bullae sloughs w/ lateral pressure); IV fluids/Abx/analgesics/antihistamin/IVIG/steroid
78
Anemia
transfusion if Hgb
79
Thrombocytopenia
transfusion if
80
BP too high/low = hydralazine/norepi HR too high/low = Cardizem/dopamine BG too high/low = insulin/D5W Agitated/Somnolent = B52/Naloxone Inflammation = Decadron Fever in baby/adult = Tylenol PR/Tordol Vomiting = Zofran Sedation baby/adult = Versed/Propofol
BP too high/low = hydralazine/norepi HR too high/low = Cardizem/dopamine BG too high/low = insulin/D5W Agitated/Somnolent = B52/Naloxone Inflammation = Decadron Fever in baby/adult = Tylenol PR/Tordol Vomiting = Zofran Sedation baby/adult = Versed/Propofol
81
Cat Bite Pathogen
Pasteurella
82
Pasteurella Tx
augmentin
83
bartonella tx
azithromycin
84
Bat bite Tx?
Rabies MF!
85
Chemical Ocular Injury Tx
Topical Proparicaine, irrigation, ABX, cycloplegic agent

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