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ED > Norries > Flashcards

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
Q

isiniazid

A

pyridoxine

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26
Q

anticholinesterases

A

atropine

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27
Q

calcium channel blockers

A

calcium

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28
Q

digoxin

A

digoxin antibodies

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29
Q

methanol

A

ethanol

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30
Q

TCA’s antidote

A

sodium bicarb

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31
Q

trx for sympathomimetic toxic (cocaine, amphetamines) ?

A 
Stimulation; mydriasis (dilated);
diaphoresis; hyperthermia;
HTN; seizures; MI
tx:
benzos, hydration, cooling
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32
Q

cholinergics ( insecticides) tooxidrome?

A

Salivation; tearing; diaphoresis;
N/V; urination; defecation;
fasciculation; paralysis:

protect airway, atropine

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33
Q

anticholinergics ( scopolamine, atropine) antedote?

A

AMS; mydriasis; dry skin;
urinary retention; decr. bowel;
hyperthermia
tx:

benzos, cooling, physostigmine

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34
Q

ASA antedote

A

AMS; resp alkalosis; met
acidosis; tachycardia; N/V;
diaphoresis

tx :
charcoal, dialysis, hydration

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35
Q

Seretonin Syndome Sx and antedote trx

A

AMS; incr muscle tone;
hyperreflexia; hyperthermia;
whole body tremor
Cooling; benzos; supportive

36
Q

Opoid ( heroin, morphine) overdose sx and trx

A

CNS/pulm/cardiac depression,
miosis (pinpoint), hypothermia
Ventilation/Narcan

37
Q

wound care primary intention

A

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
Q

secondary intention

A

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
Q

tertiary intention

A

delayed primary intension; 4-5 days after injury; old/contaminated/bites/
gunshots/exploratory wounds

40
Q

when do you give abms for wound healing

A

bone/cartilage/tendon/join injuries; bite wounds; valve disease

41
Q

when do you remove sutures from the face?

A

2-5 days

42
Q

when do you remove sutures from the body

A

5-8 days

43
Q

packing wounds

how often do you repack? and how much does the depth change?

A

daily and 1-2 inches daily

44
Q

Tx of hymenoptera stings

A

Aka(bees, wasps and mosquitoes) Remove stinger, wash, ice, Antihistamines, NSAIDS

45
Q

Patient was camping in the Yukon, says he got bit by a brown recluse. Tx? Actual vector?

A

Tetanus, Hobo Spider Nigga!!!

46
Q

Black widow bite Tx?

A

Tetanus, AntiVenom

47
Q

frostbite mostly superficial, Tx?

A

1st Degree, Warm immediately

48
Q

frostbite Entire EpiDermis w/ blisters, Tx?

A

2nd Degree, immediate warming

49
Q

3rd degree frostbite symptoms

A

tissue loss, blue grey discoloration, loss of sensation, hemorrhagic bullae at 12-35hrs

50
Q

3rd degree frostbite tx

A

immediate rewarming

51
Q

Necrosis, loss of sensation, cold injury, Tx?

A

4th degree frostbite, Amputation

52
Q

Flu like symptoms, HA, N/V, dizziness, visual disturbances, CP palpitations, Coma, Seizures, Respiratory failure at high levels.

A

CO poisoning

53
Q

how do you treat a paronychia

A

nail infx:18 gauge needle or 11 blade into infection; Keflex if cellulitis

54
Q

how do you treat a sublingual hematoma

A

18G needle twisted down or 11 blade if under distal nail

55
Q

how to perform toenail removal?

A

digital block; abx after w/ dressing

56
Q

Auricular Hematoma

A

auricular block; 15 blade to incise then curved hemostats to separate; manual pressure
for 5-10minutes

57
Q

Fish Hook Removal

A

string pull technique; needle-cover technique; advance and cut technique

58
Q

Abscess I&D –

A

incise; deloculate; manually express; pack; dressing; abx if cellulitis

59
Q

1st, 2nd , 3rd , 4th degree burns

A

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
Q

Joint Aspiration

A

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
Q

Lumbar Puncture – indications =

A

meningitis or subarachnoid hemorrhage; L3-L4 interspace; pt remains supine
for 20-30minutes

62
Q

Central Line – indications =

A

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
Q

abx for ears

A

amox

64
Q

abx for lungs

A

azith

65
Q

abx for urinary

A

macrobid, bactirim, cipro

66
Q

abx for sinus

A

augmentin

67
Q

lung big gun abx

A

levaquin

68
Q

abx for skin

A

keflex

69
Q

abx for throat

A

pen VK

70
Q

abx for gi

A

Cipro & flagyl

71
Q

Abx for everything else

A

Doxy

72
Q

drug seeking rules for norris

A

must be recent, sever, visible

73
Q

Neutropenic Fever

A

neutrophils

74
Q

DIC

A

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
Q

Chemical Ocular Injury

A

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
Q

Central Retinal Artery Occlusion

A

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
Q

Erythema Multiforme

A

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
Q

Anemia

A

transfusion if Hgb

79
Q

Thrombocytopenia

A

transfusion if

80
Q

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

A

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
Q

Cat Bite Pathogen

A

Pasteurella

82
Q

Pasteurella Tx

A

augmentin

83
Q

bartonella tx

A

azithromycin

84
Q

Bat bite Tx?

A

Rabies MF!

85
Q

Chemical Ocular Injury Tx

A

Topical Proparicaine, irrigation, ABX, cycloplegic agent

ED (3 decks)

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