Quattttt Flashcards
What is Oversensing? SENSEOr Failure to PACE?
Undersensing? SENSE failure
Failure to capture? PACING Failure
failure to output? PACING Failure
- mistakes a fib, tremor, physical actvitiy for cardiac activity and doesn’t fire when it should. syncope. dropped beats
- spikes in the middle of QRS or after (some spikes with QRS some without). doesn’t sense native cardiac activity=asynchromnous pacing
Capture- pacer stimulus doesnt lead to myocardial contractions - from MI maybe
output failure- not generated when it should
kid, recent infection, puffy eyes, pericardial effusion- Tx?
PSGN - HD for uremia (effusion) or hyperK, get lytes, and urine
serotonin syndrome tx
crypoheptadine
benzos
What is paraphimosis?
Para- one extra step, one extra word- is retracted foreskin
What is the keht blokmore test for preggos
it determines how much fetal hemobling is in theri blood ot see how much rohgam to give
any mom over 25 weeks need to get rohgam after blunt trauma
Eye is down and out, what nerve is out, + headache- why?
CN 3- Post comm artery anyeusm SAH
you give benzos, keppra, barbs, propfol nad not stopping… what next
B6, isoniazid- time to think outside the box
why repair the galea?
anchor point for frontalis muscle! trauma and then facial droop is from galea injury
it also stops hematom and infection
repair with 3-4.0 absorbable if greater than 1/2cm
Distention, looks like SBO in an old person, CT neg for SBO=
Ogilive syndrome- neostigmine (if HDS) if >12 cm
What does wellens look like, what is the story, what artery, tx/
Slight BAM to inverted T»_space;> Deep invverted T in V2/3
CP w/ no EKG changes and then EKG chanegs with no CP symtoms
LAD
Heparin, urgent cath
peds 3 yo CAP tx?
amp
what do you poor onto a jelly fish sting?
vinegar - acid stops toxin spread. or hot water
What benzo do you give in AWS in cirrhtoic patients?
lorazepam! not acitve metbolites, still has ~10 hr half life
diazepam has active metabolties
Wide gap, AKI, AMS think about
ehtlyene glycol- get osmol gap to se eif high
Where do you do escahrotimies on burn chest compartment syndrome/
Bilateral ant axillary lines amd one across to connect - no blood, no pain!
What do you also need to give in hyperK that you dont right now/?????
Lasix!
AMS, miosis, Hypotension, Bradycardia, shallow breathing….
Clonidine
stope NE release in brain and stops symp outflow from brain
chronic pain, fibromyalgia, on opiates at home, breaktrhu pain- what next?
Pain dose ketamine - outpatient pain specialist
bullous pemphigoid tx/
steroids, dapsone
Three mainidications for lateral canthotomy
Iop40
Proptosis
Decreased visual acuity
APD
Lidocaine, clamp, incision 2 cm, scissors the ligament
Old, cheek swelling gotta think …
Supportive parotitis
Augmenting or unasyn
Toeralte secretions and PO
3 yo LOC , everything else normal- CT or nah?
0.8% risk, moderate risk catgeory- sahred decison making with parents
Recent Uri with anemia, kid, why?
Autoimmune hemolytic anemi- steroid- molecular mimicry
Swallowed bleach household- asymptomatic- what next?
Observe and discharge. Unlikely to damage the esophagus. Look out for aspiration.
Industrial bleach is more dangerous
Cryotococcus treatment
Flucytoclsine
CN toxicity
Anaerobic resp. Lactic acid
Hydrox- converts it to excretion 5 g IV
Nitrites makes metHgb to excrete
Sodium thisulfate makes it excretable
irst things you need to for lvads?
listen for hum
doppler pulse/art line- pulse may be absent
interrogate lvad device
hemolytic anemia common
36 wks rom- what next
abx gent amp
check for prolapsed cord/fetus
admit for induction of labor
bronchilitis
ids <2 yrs old look for dehydartion resp compromise apnea risk factors
nasal suction, hydration, 1-5 days, gets worse before better, humidified air
Drug intoxication with AMS, waes and wabnes, profound, sitmnualte them and they wake up…
GHB
recent infeciot nin kid now with joint pain and knee effusion?
reactive arthritis- HLA b 27
Cant see, cant pee , cant climb a tree
dermatitis, diarrhea, dementia- vitamin?
NIacine- B3
most cmmon gastoreneteritis?
NVD sick contacts- norovirus
Goal time for testicalu torision to urology?
6 hours high salvage rate
What is pathophys for HUS? PLEX or Fluids?
Shiga toxin endothelial damage- thrombcytopenia micornagiopathic hemolytic anemia
PLatels, Hematuria, AKI, N/V/D
FLUIDS! no plex, just supportive
ITP management
IVIG steroids - even if there is some bleeding
Add platelet tranfusion for: <10k (spontaneous intracranial hemorrhage) or major bleeding
Difference in Scleritis and episcleritis
Episcleritis- slef limtied, phenylephrine
Scleritis- very painful, ciclary flush, systmiec disease-NSAIDs steroids, optho-dilation of slera vessels
Modified sgarbossa
- 1mm concordant in any lead
- 1 mm discordant V1-V3
- 5mm discordance anywhere or 25% discordance of the S wave
Specific but not sensitive. + score= act fast. No score = doesn’t rule It out
2 additonal SE from etomidate/
mycolonus
N/V
amputation keys
irrigate wrap in guaze slaine on guaze. put in bag put bag on ice digits up to 8 hours limbs 4-6 hours
difference in priapisms/
High flow- spinal cord/AVM arrterial flow. not painful. soft tip. observe
Low flow- ischemic, emergency (need blood gas), painful, hard tip. no venous outflow. sicklers, Drugs
be careful when putting lidocaine into kids! 12 kg only allows you 4.8-6.0 ml!
cool
How to exclude signifcant cardiac injruy after blunt chest trauma
Trop negative
EKG with no abnromalities (sinus tac, a fib, svt common)
5 causes of brady cardia
- VS !!!hypoxia, hypoglcyemia
- Hypothryoid
- Hypthermia
- MI
- BB
5 causes of low K
Big cell shifts form insuoin Renail- diruetics, RTA GI, puke or poop hypomag Starvation give mag!
Vent settings for lung protective
obsturcitve
- 8 cc/kg, 16 RR, 60 IFV, 40% FIO2, 5 PEEP - use table
Isn hold: if platelau pressure is > 30= 7cc/kg - 8 cc/kg, 10 RR- full expirationr, 60-80, 40%, PEEP 0-5
What is NMS and how od you treat/
D2 antogonism - therpeuic dosages!
AMS, Hypthermic, lead pipe rigidity, Autonomic instability
benzos, cooling and supportive care
MAT regular or irrgauler/
tx?
irregular
tx undelrying cause
WHich tow acolols do you give ehtnaol or fomepizole to? why?
ethylene and mehtanol
all use alchol dehyrgaonse (inhbited by fomepizole) but acetone and isopropyl is equally as toxic
PUlsatile tinniuts, headache, Horner syndrome, neck pain
Carotid artery dissection stroke- MRA or CTA
recent hromone based tx to get preggo- what odyou need ot hin of
ovarian hyperstimualatin tx- DONT do a bimanual- can ruptue the ovary
abdominal, SOB, fatigue to hemoconcentration, liver failure, electrolyte derangements, coagulopathies, and renal failure, resulting in multiorgan system failure so the emergency physician should have a high index of suspicion in even a stable-appearing patient
volume- lytes- etc
first step anal fissure tx in child?
miralax - if stoool witholding
What s DRESS Or drug hypersentiivity syndrome? causes? tx
Basically flu like with GI, muscles after AEDs, Or Abx with a large mrobillofrm rash, eos
get a smear
fever, facial edema, skin tenderness, blistering, erythroderma, or mucositis - 2 weeks after Rx
Observe and supportive
Three contraidictions to anticogaulaiton someone
neurosurgery 10 days ago
20 K plateles
bleeding
Why do you not givr Wha tin R MI?
Nitro- dorps pre load even less getting to LV now
5 causes of hypoxia?
VQ mismiatch: corrects with supplemnts O2- PNA, PE, COPD, Asthma
Shunt- Puss or blood in avolei-no O2 helps- shunts blood to diff part of lung
low FIO2 altitude
hypoventlation
Iterstitial lung dz
eat fish, wheezing, ithcing, flushing 3o minutes later- what ifsh- Peppery taste
toothlessnes- ataxia- CNS- GI- Hypotension
scormboid or hsitmaine reaction
tuna, mackeral, mahi mahi
red snapper is ciguatera- BRADYCARDIA- HEat/Cold stuff. FLudis and atropine, maybe mannitol
treatment for symptomaitc MVP
BB
dispo phimosis
outpatient
no sugar- just topical steorids and follow up
how to evlauate for wood foriegn body/
US
TTP VS DIC
TTP- platelts problem. Vwf WITHOUT inhibtiory DAMST13. platelte plugs with end organ damage. thrombocytopenia, LDH, end organ damage, schisotcytes. GIve 2 units plasma. put in a line, bleeding is rare! go femoral.
DIC: secondary. too much thrombin. consumes factors to make bleeding, but in prothombotic state bc of thrombin, finbrinlysis also in play. D imer up, fibrinogen down, plates down, coags ups. No specific transfusion threshold, you CAN transfuse if bleeding or need procedure. give cryo 10 units if fibrinogen <150, transfuse if getting worse.
d Dimer is product of to fibrin vlots arc welded by factr 13 and fibrninlysis.
thrombin ceanes to make fibrin clot!
What can you treat PEs like?
Pulm HTN! inhaled nitric oxide. dont intubate. no fluids.
catheter, vs surgercal, vs medicine clot removal.
go epi and then vasopressin
remember the RV is very suspeiclpte to hypotension and ishcemia- poor RV is a poor LV and CO- look for Interventricular flattening
elecytlees that are off in sarcoid/
hypercalcemic, look at kidneys
ACE up
Hemophilia A or B with superificallac and continuous ooze Tx?
Topical thrombin! or Txa
which infectionis < 4.5 vag?
candida
Tamiflu stuff
give to ppl <2 (high risk!) or >65. <5 is actually considered high risk too.
immunocompromised, pregnant
COPD, CHF, sicklers, Renal/liver disease
obese, DM2
best if under 48 hours, up to 5 days, maybe. N/V/D/headache SE. shortens duration by 17 hours
knee dislocation
- warm foot still may be possible and a palpable DP pulse still may be possible. X ray. Check 1/2 interspace never for common peroneal. consider CTA vs surgery
NRP flow
gasping or <100 HR is MR SOPA, think Psitive pressure early (21% full term, 21-30% preemies)
HR 60-100 focus on airway and breathing stuff - think about PTX and hypovolemia. RR 40-60
if <60 CPR< intubate and epi
lunate is…
spilled teacup!
periluante is captiate displacemet
unstable thoracic aorta imaging…
TEE
trauamtic iritis- homatroptoine or timolol?
homatrtopine, parlayes cilairy body
timolol stops aquesous flow
Septic bursitis
needs OR I&D, IV abx, still needs arthrocentesis
Bronchitis Dx and tx
cough, mucous, inflammation for 5 days-4 weeks usually after URI. fever none usually
symptomatic relief with expectorants, antihistamines, mucolytics, and antitussives such as dextromethorphan
prednisone if underying COPD
Prolonged QT 5`
- Women @ 480 is high, 500 is severe
- Look for hypoK or HypoMg
- Think MI, drugs, lytes, congenital K channels
- BB tx
- risk for tachydysrhtimas
formula for HypoG in kids
2Xage + 8= Kg
<1 yr is = 2-5 ml/kg D10
1-8= 2 ml/kg D25
8= 1 ml/kg D50
Jefferson bit off a hangmans thimb
Jefferson, axial load- ant/post
Bilateral facets- jumped facets
odontoid- tip stable, base of tip and down unstable
Atlantoaxial dissocaiton - TP is very anterior on C spine X ray (flexion from Downs or RA)
hangman extension, posteroi
Thumb- tear drop with anteroir fx and retropulsion
what is segund fx?
Lateral avulasion fx for ACL injury
what is toddler fracture?
wont walk or put weight on it. Negative on X ray. immoblizie it (or a boot) and it will develpo over thenext several weeks. occult fracture from playing running around
Open joint, CT or saline load?
CT is 100% sensistve on one study! you can do a lad if that is negative.
pull the fluid out after!
wash it out yourslelf before OR wash out
vanc and levaquine- but really doesn tneed ot be a big gun deal- ancef or gent if bad lac
How to drain a paroncynia?
Felon?
Felon- volar- lateal and higher! or else insensate!
Dorsal is the same thign but dorsal! just poke it and reliev the rpessure
Flash pulmonary edema
Sublingual nitro in the mean time!
1.25 mg of IV enalapril - or captoril cn abe helpful
becareful for Aoritc stenosis with high doses of NItor to drop thier afterload!
Nitro in the hsort term, high doses is notgoing ot hurt them! we underdose this, ust like high doses bezosare nto goign to hurt AWS.
Get lasix on baord quickly!
Dissection earls
dont need ot be super HTN!
Sudden, severe, maximal, thoracic!! pain. or above an ebloew diaphragm.
pulse deficits/arotic murmur only 15%
Think about stemi and cath lab stuff and anticoagulant?
Stat CXR (20% normal), D Dimer + clinical tool = decent study and usabel to see if CTA needed US: suprasternal with flap in your vessel
If there is anaphylaxis to contrast - intubate them and then CTA and then OR
Tx: consultant coagulaopthy based reversal, 50/50!
Check for tamponade.
control pain.
Hyperammonia stuff
Ammonia in gut, metoblized in liver, excreted in kidney. If bad liver, Or TIPS, them excess glutamate.
give lactulose. no amount of ammonia is too high, use AMS as guide
avulsed tooth care
<60 minutes = wash and remip,ant
>60 minutes= oral surgeon
narrowst portion of peds ariway is…below the cords
ya
Psudojones dx and tx vs jones
Jones is 1.5 cm distal, splint nad crusthces
pseduo- proximal, hard sole and wieght beraing as tolerated
what is chillbains
cold exposire, red toes, burning toes, maybe from autoimmune stuff too. supprotive
recent conolsocopy three weeks ago with bleeding
sloughing of the skin or coagluated eschar. can last weeks. just observe for nto dropping crit. be careful its not arterial
What is Pals brady algorpthim
AMS, Hypotension, Shocky + HR <60 = all of the things
- 01 epi (or 0.1 mg/kg epi)
- 02 mg/kg atoprine
when to treat for SBP
250 PMNs or
pH of < 7.34 (A) or a pH gradient between arterial blood and ascitic fluid > 0.10
cocoaine and meth tachyc dysrhtymias tx
Benzos and cooling
then sodium bicarb! cocaine cna be sodium channel blocker
how to detorse and blue dot
blue dot is torsion of apepndi
medial to lateral 360
pre septal cellulilitis vs post septal dx tx and disp
peds usually pre septal. NO pain wth EOM! or eye involvement.
CT if bad exam. abx and 24 hour optho follow up.
How can you kill someone with adneosine?
central access (use 3 mg)
little old lady with sinus tach
wide and irregular
DKA pearl
if they arent getting better with tx, you are missing osmeh9itng! infection, OD, dissection.
If you give bicarb, you are going to wrosen both hypoK and osmlarlity
tylenol and iburpofen dosing?
15 mg/kg 4-6 hrs
10 mg kg 6-8 hrs
fever ddx peds to rule out if they look good?
pneumonia, urinary tract infection, Kawasaki disease, measles, respiratory syncytial virus, meningitis, bacteremia, cellulitis, and appendicitis +
what is the wernicke encpealphythy?
ataxia
opethlamoplegia
enceplapthy
DDx in sicklers- think head down
Stroke acute chest sepsis splenic sequestration cholecystitis aplastic crisis-anemia acute pain crisis osteonecoriss Clot-Anywhere! renal infarct
CXR can be normal- get CT. Abx. exchange transfusion.
cracked windpipe appraoch
fiberoptic scope to guid eyour intubation if necessary. Esopgus and other neck structures likely damaged. very deadly.
Angio pelvis when? binder when?
negative fast and unstable! ex lap wotn find it
binder on in vertical not compression fx
what are your mrsa risk factors? cellutlitis
dilaysis, recent hpsitlaiztion, hiv, puruluence, in a home.
if not, then think simpler with amociliin, augmentin or keflex
what is alveolar ostetisi? complication of periapical apbscess/
Dry socket, post removal. pack it with iodoform gauze. inflammation of local ostemotlytietis
erdoesinto max sinus
blepahrtiis tx
warm comrpess, possible eeyrhtmycin ointment
how do you repair a bleeding fisutla site?
hand above and beloew it to tamponade
use a NON cutting needle, 5-0 prolene, the needle will make a smaller hole than the string to clog it up (taper needle and figure -8 it
What is right heart train in EKG?
TWI in V1-V3
look for RAD too
anytime you see a abbay iwth consitpation and drooling and poor feeding…
gotta think botulsim
fecal toxin
baby big
blocks acetlycholine at pre synapase
how do you set up epi drip
1 bag NS to flushed in
1 bag NA w/ 1 mg epi is 1ug/1ml
start 1 ug per min and titrate up to effect
get either epi- if IM it can be hooked up to the bag. if not draw it up and needle it in
poor feeding, lethargic, AMS in newborn…
think hypoglycemia!
Pleurisy rule out DDx
PE, pericarditis, MI, PNA, pleural effusion, PTX///Rheum lupus- post infectious pleusiy
rule out bad and then NSAIDs Indomethicin to PCP
Sicklers at risk for which infections
Encapsulated, asplenic Shine Skis Pasteruella Strep strep H flu Neisseriea E coli Klebsiess salmonella
PEA think like this
Brady- wide= Sodium channel blocker OD or HyerpK
Sodimun bicarb or calcium
Narrow- PE, PTX, Tamponase
superficial thrombophlebitis
Uncomplicated: venous segment involvement < 5 cm, being remote from the saphenofemoral or saphenopopliteal junctions, and lack of medical risk factors for hypercoagulability.
treatment for uncomplicated superficial thrombophlebitis includes NSAIDs, extremity elevation, and compression therapy
