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EM Final Study Guide > Pages 31-40 > Flashcards

Pages 31-40 Flashcards

1
Q

Abx for perforated viscous?

A
  1. Ciprofloxacin
  2. Metronidazole
  3. Piperacillin/tazobactam
  4. Imipenem
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2
Q

What to consider in female patients presenting to ED with syncope or unexplained hypotension?

A

Ectopic

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3
Q

Sign of IUP on US?

A

Double decidual sac sign occurring at ~ 4.5-5 weeks after LMP

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4
Q

Rate at which BhCG increases?

A

Produced by trophoblasts that doubles approximately every 48-72 hours in the first trimester

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5
Q

What what HCG should IUP be visualized?

A

1500-2000 mIU/mL

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6
Q

How is alloimmunization prevented in expected ectopic?

A

50 mg RhoGAM

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7
Q

Rx mgmt ectopic? MOA? Success rate?

A

Methotrexate

  • Interferes w/ syntheses of DNA and cell replication of fetal cells, resulting in involution of the pregnancy
  • Failure w/ single dose methotrexate occurs in up to 36% of patients necessitating second dose
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8
Q

Side effects methotrexate?

A
  • Abdominal pain 3-7 days after administration secondary to tubal abortion or expanding hematoma within the fallopian tube
  • Worsening pain need be evaluated for tubal rupture, and the need for immediate rescue laparoscopy
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9
Q

What is purulent cervical discharge indicative of?

A

PID

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10
Q

Rx PID Inpatient?

A
  1. Cefoxitin 2 g q6 IV + Doxycycline 100 mg PO
    OR
    2 Cefotetan 2 g q 12 IV + Doxycycline
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11
Q

O/P treatment PID?

A
  1. Ceftriaxone 250 mg IM
    OR
  2. Cefoxitin 2 grams IM + Probenecid 1 gram PO
    OR
    AND
    Doxycycline 100 mg BID for 14 days
    - Addition of Metronidazole 500 mg BID for 14 days should be considered
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12
Q

What is cremasteric reflex and what does it indicate?

A

Loss of cremasteric reflex is most accurate sign of testicular torsion
- Elicited by stroking ipsilateral thigh which leads to reflex elevation of ipsilateral testicle by greater than 0.5cm

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13
Q

In which type of shock does HR go down?

A

None

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14
Q

When does CVP go up in shock?

A
  1. Cardiogenic

2. Obstructive

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15
Q

When does CVP go down in shock?

A
  1. Hypovolemic

2. Distributive

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16
Q

Types of distributive shock?

A
  1. Septic
  2. Neurogenic
  3. Anaphylactic
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17
Q

When does contractility increase in shock?

A

Hypovolemic

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18
Q

When does contractility decrease in shock?

A

Cardiogenic

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19
Q

When does SVR increase in shock?

A
  1. Cardiogenic
  2. Tamponade
  3. PE
  4. Hypovolemic
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20
Q

When does SVR decrease in shock?

A
  1. Tension pneumothorax

2. Distributive

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21
Q

Define anaphylaxis?

A 
Acute onset illness w/ involvement of:
1. Skin: hives, pruritus
 or 
2. Mucosal tissue: swollen lips/tongue  
AND either
1. Respiratory compromise 
OR
2. Reduced BP (<90 Sys or > 30% dec) 
- or associated symptoms of end-organ dysfxn
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22
Q

Anaphylaxis rx and dosing?

A
  1. STOP EXPOSURE
  2. EPI in anterolateral thigh (1:1000=IM or 1:10000 IV).
    - Adults: .3-.5 mg every 5-10 minutes
    - Kids: .01mg/kg up to .3mg q 5-10 minutes.
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23
Q

Fluids in anaphylaxis?

A

1L NS bolus over 5-10 minutes, can need up to 5-7L in severe cases

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24
Q

Secondary Rx anaphylaxis?

A
  1. H1 blockers: Diphenhydramine 50mg IV
  2. Steroids: DEXAMETHASONE 10mg IV
    or
    2.a Methylprednisolone 125mg IV)
  3. O2
  4. Glucagon
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25
Q

What is the SIRS criteria?

A

2 of the following:

  1. Temperature less than 36or greater than 38
  2. HR greater than 90 BPM
  3. RR > 24 breaths per minute or PaCO2 < 32
  4. WBC less than 4,000 or greater than 12,000
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26
Q

Definition of sepsis?

A

SIRS plus presence of infection

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27
Q

What is severe sepsis?

A

Sepsis plus evidence of organ failure or lactate > 4

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28
Q

Examples of end organ failure?

A
  1. CNSL Delirium
  2. Pulmonary: ALI/ARD
  3. Thrombocytopenia
  4. Liver: Hyperbilirubinemia
  5. Acute renal failure
  6. Lactate more than 4
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29
Q

Definition septic shock?

A

Sepsis plus hypotension unresponsive to 2 fluid boluses of 20-30 cc/kg
- Hypotension defined as a systolic less than 90 or 40 below baseline BP

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30
Q

Tests for sepsis at Loyola?

A
  1. WBC
  2. Lactate
  3. Procalcitonin
  4. Cultures
  5. Radiographs
  6. ABG
  7. Platelets
  8. LFTs
  9. BUN/creatinine
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31
Q

What does lactate represent?

A

Global HYPOperfusion

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32
Q

When is procalcitonin elevated?

A

Systemic bacterial / fungal infections, NOT viral

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33
Q

Central venous O2 sat goal in sepsis?

A

ScvO2 greater than 70mm Hg

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34
Q

Afterload goal in sepsis?

A

Titrate vasopressors to achieve MPA 65 - 90

35
Q

CVP goal in sepsis

A

Rapid, early fluid boluses to achieve aCVP 8-12

36
Q

UO goal in sepsis?

A

0.5 cc/kg/hour in adults

37
Q

What to do if ScvO2 is less than 70% in sepsis?

A
  1. Hematocrit less than 30%: transfuse PRBC

2. Hematocrit is greater than 30%: dobutamine

38
Q

When do abx need to be given in sepsis?

A

Within 3 hours of arrival

39
Q

How to confirm proper ET tube placement?

A

End-tidal CO2 is most accurate technology

40
Q

Compression to ventilation ratio w/o secured airway?

A

30 Compression : 2 breaths

41
Q

Ventilation rate in a patient 2/ ongoing CPR and advanced airway?

A

1 Ventilation every 5-6 seconds (8-10/minute)

42
Q

Rhythms requiring defibrillation?

A

Vfib or Vtach WITHOUT PULSE

43
Q

Where to place need in tension pneumo?

A

14-16 gauge long angiocath in midclavicular line at 2nd intercostal, over rib to avoid NV bundle

44
Q

Ddx pulseless electrical activity?

A
  1. Tension Pneumo
  2. HYPERkalemia
  3. HYPOglycemia
45
Q

What to do if TACHY causes HYPOtension, AMS, signs of shock, ischemic chest pain, or acute HF?

A

Synchronized cardioversion!!!

  • 100J if regular Narrow or wide
  • 200J mono/biphasic if narrow irregular
46
Q

Management narrow QRS v-tach?

A
  1. Vagal maneuvers,
  2. Consider Adenosine IF REGULAR
  3. BB and CCBs
47
Q

Management Vtach with QRS greater than .12?

A
  1. Adenosine IF regular and monomorphic
    Otherwise
  2. Amiodarone 150mg over 10 minutes followed by 1mg/min for 1st 6 hours
48
Q

Meds used in cardiac arrest?

A
  1. 1mg EPI every 3-5 minutes IV/IO
  2. Vasopressin 40U IV/IO can replace 1st or 2nd dose of EPI
  3. Amiodarone 300mg bolus IV/IO ONLY for V-FIB/VTACH, second dose is 150mg bolus.
49
Q

Whats does palpable radial pulses suggest?

A

Systolic blood pressure of at least 80

50
Q

What does palpable femoral and carotid but no radial suggest?

A

Systolic of at least 60

51
Q

Most common cause preventable death in kids?

A

Failure to control airway

52
Q

What is Cardiopulmonary Failure?

A

When Resp Failure (AMS) + Shock Leads directly to Cardiopulmonary arrest

53
Q

Only type SHOCK IS ONLY TYPE OF SHOCK THAT WORSENS WITH FLUID BOLUSES?

A

CARDIOGENIC

54
Q

Difference between respiratory distress and failure?

A

DISTRESS:=increased WOB

FAILURE= AMS from inadequate oxygenation or ventilation

55
Q

In kids does BP assess volume well in early schok?

56
Q

Definition HYPOtension in kids based on age?

A
  1. 0-1mo: 60
  2. 1mo-1yr: 70
  3. 1yr-10yr (70 +(2*age)) >
  4. 10 yrs =90mmHg
57
Q

Verbal GCS scale in infants?

A
  1. Coos: 5
  2. Irritable cries: 4
  3. Cries to pain: 3
  4. Moans to pain:
  5. Nothing: 1
58
Q

Most common cause bradycardia in kids?

59
Q

Urine output consideration in young kids?

A

Less than 2 yrs cannot concentrate urine

- NORMAL=1-2cc/h

60
Q

What is special about catecholamines?

A

They are catecholamine deplete: don’t use Vasopressin or Dopamine
**Better EPI and NE, Dobutamine and Milrinone

61
Q

What does PGE1 do?

A

PGE1 MAINTAINS PATENCY OF DUCTUS: can cause resp depression so READY TO INTUBATE

62
Q

What to do in kids with anaphylaxis?

A

Use both H1 and H2 blockers

63
Q

How to give fluids in hypovolemic shock in kids?

A
  1. 20cc/Kg bolus: always NS/LR

2. After 3 Crystalloid GIVE 1 COLLOID

64
Q

FiO2 management in kids in schock?

A

Ttrate to Sats over 94% BUT under 100% to prevent hyperoxia

65
Q

First sign shock in kids?

A

Tachycardia

- Hypotension = decompensation in kids

66
Q

What is otalgia?

A

Pain in ear

67
Q

Ddx otalgia?

A
  1. External otitis
  2. Otitis media
  3. Mastoiditis,
  4. Auricular infections.
  5. TMJ
  6. Neoplasm
  7. Dental problems
  8. Tonsillitis
  9. Laryngitis
  10. Sinusitis
68
Q

What is odynophagia?

A

Painful swallowing

69
Q

Most common cause OM?

A
  1. S.pneumo
  2. Hflu
  3. RSV
70
Q

Presentation mastoiditis?

A

Purulent otorrhea and tenderness over mastoid

71
Q

Rx OM?

A

Cipro/Dexamethasone

72
Q

Diagnosis Peritonsillar abscess?

A

Needle aspiration, CT or US

73
Q

Most common cause Retropharyngeal abscess?

74
Q

When is thumbprint sign seen?

A

Eppiglotitis

75
Q

Rx epiglottitis?

A
  1. Humidified O2

2. Cephalosporins

76
Q

What is Ludwig’s Angina? Cellulitis of submandibular and lingual space→spread of odontogenic infection (2nd/3rd molars

A

Cellulitis of submandibular and lingual space from spread of odontogenic infection in 2nd/3rd molars with get dysphagia, trismus, edema of floor of mouth

77
Q

Rx Ludwig’s angina?

A

Early decadron and Abx

78
Q

What is CENTOR Criteria?

A 
Criteria for pharyngitis
CERVICAL LAD
NO cough
TONSILLAR EXUDATE
TENDER 
NO cough
Hx of FEVER
0-1: NO test no tx
2-3 rapid strep
4 empiric Abx
79
Q

Rx pharyngitis?

A

IM benzathine penicillin or Pen-VK po

80
Q

Rx epistaxis?

A
  1. Pinch x20 minutes
  2. Vasoconstrictor soaked Q-tips x 10 minutes
  3. Cauterize w/Silver nitrate
  4. Pack, then prophylactic CEPHALEXIN
81
Q

What is DKA?

A

State of absolute insulin deficiency, hyperglycemia, anion gap acidosis, and dehydration seen in Type 1 diabetics

82
Q

Causes DKA?

A
  1. Infections
  2. Disruption of insulin therapy
  3. Presentation of new onset diabetes
83
Q

What is HHS?

A

“Hyperosmolar Hyperglycemic State”

- Seen in type II diabetics

84
Q

What are Kussmaul respirations?

A

Fast and deep breaths seen in DKA

EM Final Study Guide (29 decks)

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