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Emergency Medicine > Quiz #4 > Flashcards

Quiz #4 Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What must be documented on eye exams?

A

Visual acuity (Snellen chart) and Fundoscopic Exam

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2
Q

What is the most common pathogen of bacterial conjunctivitis?

A

viral

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3
Q

Txt for conjunctivitis?

A

anti-histamines
lubricants
Abx (bacteria)

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4
Q

What are the 3 types pathogens can cause conjunctivitis?

A

viral, bacterial, or allergic

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5
Q

Corneal dendrite w/ fluorescein uptake, often involves trigeminal nerve?

A

Herpes Simplex Keratitis

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6
Q

Hutchinson Sign

A

Herpes Simplex Keratitis

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7
Q

Txt for Herpes Simplex Keratitis?

A

antivirals, optho consult

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8
Q

Often common w/ contact lens use, and visible opaque ulcer?

A

Corneal ulcer

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9
Q

Txt for corneal ulcer?

A

requires compounded drops, ophtho consult

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10
Q

Pupil dilates, tightens contact of lens and iris, stopping outflow of aqueous humor?

A

Acute angle closure glaucoma

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11
Q

Deep “boring” pain, rainbow colored rings or halos around bright lights

A

Acute angle closure glaucoma

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12
Q

What 3 things can cause acute angle closure glaucoma?

A

mydriatic (dilating) drops, emotional upset, sympathomimetic and anti-cholinergic drugs

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13
Q

Txt for acute angle closure glaucoma?

A

drops: timolol, pilocarpine
PO: acetazolamide, osmotic diuretics

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14
Q

Consensual photophobia?

A

iritis and uveitis

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15
Q

Txt for irits and uveitis?

A

ophtho consult

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16
Q

Sector of eye involved w/ pain and FB sensation?

A

Episcleritis

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17
Q

Txt for Episcleritis?

A

normally self limiting

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18
Q

Med txt for Episcleritis?

A

lubricating drops and optho consult (ocular NSAIDs after consult)

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19
Q

Very tender eye w/ pain during EOM use, vasculitis?

A

Scleritis

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20
Q

Txt for scleritis?

A

oral NSAIDS and optho f/u after discharge

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21
Q

Sudden monocular vision loss, “cherry red spot”

A

Central retinal artery occlusion

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22
Q

Txt for central retinal artery occlusion?

A

rebreathe CO2 for arterial dilation, gentle eyeball massage, IOP lowering drugs

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23
Q

Drug txt for central retinal artery occlusion

A

Timolol, acetazolamide

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24
Q

When should optho be consult in central retinal artery occlusion?

A

EMERGENTLY retina irreversibly damaged in 90 min

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25
Q

Rapid progressive vison loss, “ blood and thunder fundus”

A

Central retinal vein occulusion

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26
Q

Txt for central retinal vein occlusion?

A

CONSULT OPTHO EMERGENTLY!

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27
Q

Painless bright lights, decreased visual fields (curtain drops), visual floaters?

A

Retinal detachment

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28
Q

Txt for retinal detachment?

A

Emergent ophtho consult

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29
Q

What causes 60-90% of periorbital cellulitis?

A

sinusitis

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30
Q

No vision changes or pain w/ extraocular muscle use?

A

Periorbital cellulitis

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31
Q

Txt for Periorbital celluitis?

A

Abx and follow closely

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32
Q

Painful extraocular muscle use, diplopia, vision loss?

A

Orbital cellulitis

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33
Q

What imaging and labs are done for orbital celluitis?

A

CT scan, CBC, cultures, consider LP

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34
Q

Txt for orbital cellulitis?

A

IV abx and consult ophtho

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35
Q

Pain and foreign body sensation?

A

corneal abrasion

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36
Q

Can recall moment abrasion occurred?

A

corneal abrasion

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37
Q

Txt for corneal abrasion?

A

antibiotic drops, no contact use

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38
Q

What should not be done with a penetration of the globe?

A

DO NOT REMOVE impaled item!!

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39
Q

Seidel’s sign?

A

Penetration of the globe

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40
Q

What is the txt for globe penetration?

A

protect the globe and call ophtho

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41
Q

What muscle is entrapped in a blowout fracture?

A

inferior rectus

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42
Q

The eye can’t be moved which way in a blowout fracture?

A

inability to move eyes upwards

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43
Q

Txt for blowout fracture?

A

Ophtho consult (open fx)

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44
Q

Most eye complaints should receive follow up in ??

A

24hrs

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45
Q

Persistent otitis externa despite 2-3 wks of topical antimicrobial therapy should be suspected of having?

A

malignant otitis externa

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46
Q

What is the imaging for otitis externa?

A

CT or MRI

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47
Q

What is the txt for otitis externa?

A

IV abx

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48
Q

A otitis media infection that spreads to the mastoid air cells?

A

Acute mastoiditis

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49
Q

Protrusion of the auricle and obliteration of the postauricular crease?

A

acute mastoiditis

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50
Q

What is the imaging for acute mastoiditis?

A

CT or MRI

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51
Q

Txt for acute mastoiditis?

A

IV abx, myringotomy, and tympanocentesis

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52
Q

Caused by trauma to the ear sheering blood vessels from cartilage to skin

A

auricular hematoma

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53
Q

Cauliflower ear

A

auricular hematoma

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54
Q

Txt for auricular hematoma?

A

remove fluid and maintain pressure in the area for several days to prevent reaccumulating fluid

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55
Q

What kills insect in the ears?

A

lidocaine

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56
Q

Txt for insects in the ears?

A

attempt to remove w/ forceps or flush out

Abx drops to prevent infection from scratches

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57
Q

What are txts for anterior epistaxis?

A

Afrin
Lido w/ epi covered packing
Chemical cautery w/ silver nitrate
Rhino rocket

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58
Q

Blood that comes from both nostrils and mouth?

A

posterior bleeding

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59
Q

Txt for posterior epistaxis?

A

Rhino rocket or foley catheter to apply posterior pressure

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60
Q

When is the Rhino rocket removed for a posterior bleed?

A

at f/u with ENT

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61
Q

Txt for closed nasal fracture?

A

refer to ENT within 6-10days

po abx

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62
Q

Txt for grossly open fracture?

A

EMERGENT ENT consult!

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63
Q

What must be ruled out in all facial and nasal trauma?

A

nasal septal hematoma

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64
Q

Txt for nasal septal hematoma?

A

incise and drain the hematoma to avoid ischemic necrosis of the nasal septum

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65
Q

Txt for nasal foreign body?

A

forceps

parent blows into pt mouth

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66
Q

Med txt for nasal foreign body?

A

abx for infection post removal

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67
Q

What is the txt for bacterial sinusitis?

A

abx

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68
Q

How many days of purulent nasal secretions and “double worsening” is considered bacterial sinusitis?

A

> 7days

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69
Q

Txt for dental abscesses?

A

incision

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70
Q

Med txt for dental abscesses?

A

penicillin VK or amoxicillin

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71
Q

Dental pain followed by local swelling that spreads within facial plane?

A

dental abscesses

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72
Q

oral infection that spreads into bilateral submandibular spaces?

A

Ludwig angina

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73
Q

Txt for Ludwig angina?

A

IV ABX

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74
Q

Imaging for Ludwig?

A

CT face and neck w/ contrast

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75
Q

Emergent surgical consult

A

Ludwig angina

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76
Q

Sensitivity to hot and cold stimuli as well as air passing over the exposed surface during breathing?

A

Enamel Dentin Fracture

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77
Q

If the patient cannot follow up with dentist in 2 days what must be done?

A

dental sealant

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78
Q

Txt dental fractures?

A

abx prophylaxis

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79
Q

Txt for crown root fractures?

A

stablize the fracture

abx prophylaxis

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80
Q

What is the dental f/u period for a crown root fracture?

A

24-48hrs!

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81
Q

How long is splinting required for crown root fracture?

A

min 4 wks

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82
Q

Txt for luxation injuries?

A

splint in place and f/u w/ dentist

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83
Q

Txt for avulsions injuries?

A

DENTAL EMERGENCY!!!

Replace tooth and splint in place abx

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84
Q

What should be done with the tooth in avulsions?

A

rinse tooth less 10 sec w/ sterile saline or tap water

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85
Q

Collection of purulent material in tonsil?

A

peritonsillar abscess

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86
Q

Muffled “hot potato voice”

A

peritonsillar abscess

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87
Q

What is the biggest s/s seen in peritonsillar abscess?

A

inferior and medial displacement of the infected tonsils

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88
Q

Txt for peritonsillar abscess?

A

drainage (AVOID CAROTID!!)

89
Q

Med txt for peritonsillar abscess?

A

IV steroid x 1 dose, Abx x 10dys

90
Q

Post tonsillectomy bleeding is most significant when?

A

days 5 and 10

91
Q

Txt for Post tonsillectomy bleeding?

A

Direct pressure to the bleeding tonsillar bed. Moistened w/ either coagulant or lido w/ epinephrine

92
Q

Any respiratory problems gets a ?

A

Chest X ray

93
Q

Diagnostics for ingestion related esophagitis?

A

upper endoscopy

94
Q

Txt for battery removal?

A

endoscopy ASAP

95
Q

What 2 things shouldn’t be done in caustic liquid?

A

induce vomiting

Use neutrizling agents

96
Q

Treatment for overdose patient who “won’t get sick”

A

stable
benign ingestion
Do well

97
Q

Treatment for overdose patient who “may get sick”

A

Stable initially
Intervene early or observe
Most do well

98
Q

Treatment for overdose patient who “Sick on presentation”

A

Stablize
Intubate
Antidotes
Supportive care and ICU admit

99
Q

What are general approach steps?

A 
Look 
Listen
Touch 
Smell*
Dx studies
100
Q

What is the most important general approach?

A

Intervene anytime

101
Q

“DON’T” ?

A

Dextrose, Oxygen, Naloxone, Thiamine

102
Q

What should be considered for unclear toxidrome?

A

DON’T

103
Q

What is not always reliable?

A

History

104
Q

Constricted, pinpoint?

A

Miosis

105
Q

Dilated

A

Mydriasis

106
Q

What are two test that can be done immediately?

A

D-stick and ECG

107
Q

Inhibits the enzyme acetylcholinesterase

A

Cholinergic Syndrome

108
Q

What is the txt for cholingergic poisoning?

A

Atropine
Benzodiazepines
Pralidoxime

109
Q

What 4 things make up Sympathomimetic syndrome?

A

Cocaine
Amphetamine class agents
PCP
Catecholamines

110
Q

Central nervous system excitation

A

Sympathomimetic Syndrome

111
Q

Symptoms of cholinergic?

A 
agitation or seizures
Miosis
increase mouth, lungs, intestine, urine, paralysis
increase/decrease- HR
Fasciculation and paralysis
112
Q

Symptoms of sympatho?

A 
agitation, combative
Mydriasis (dilated)
decrease mouth, lung, intestine
Intestine urine
hyperthermia
113
Q

Sympathomimetic poisoning treatment?

A

Active cooling
Benzodiazepines
B-blocker
IV fluids

114
Q

Most common cause of antimuscarinic syndrome?

A 
Antihistamines
Antipsychotics
Tricyclic antidepressants
Belladonna alkaloids
Antiparkinsonain meds
115
Q

Competitively inhibits or antagonizes the binding of neurotransmitter acetylcholine to muscarinic acetylcholine receptors

A

Antimuscarinic syndrome

116
Q

“Red as a beet”

A

due to loss of sweat production, skin capillaries dilate

117
Q

“Hot as a hare”

A

anhydrotic hyperthermia

118
Q

“Bland as a bat”

A

nonreactive mydriasis

119
Q

“Mad as a hatter”

A

delirium; hallucinations

120
Q

“Full as a flask”

A

urinary sphincters constrict

121
Q

Treatment Antimuscarinic poisoning?

A

supportive
sedation if necessary
Physostigmine

122
Q

Treatment Antimuscarinic poisoning?

A

supportive
sedation if necessary
Physostigmine

123
Q

The most important general approach?

A

Smell

124
Q

First thing that should be done in a tox pt?

A

Call toxicologist

125
Q

Alpha/Beta blocker for sympathomimetic?

A

Labetolol

126
Q

Why isn’t beta blockers used?

A

Can affect alpha blockers which will cause blood rise through the roof

127
Q

Why isn’t beta blockers used?

A

Can affect alpha blockers which will cause blood rise through the roof

128
Q

Red as a beet, dry as a bone, hot as a hare, blind as a bat, mad as hatter, full as a flask

A

Antimuscarinic syndrome

129
Q

Antidote for antimuscarnic?

A

Physostigmine

130
Q

Txt for sedative/hypnotic poisoning tx?

A

Supportive care

Flumazenil

131
Q

Txt for Se/hyp withdrawal?

A

Benzodiazepine

Thiamine

132
Q

Txt for opioid poisoning?

A

Naloxone

Supportive care

133
Q

Supportive Txt for opioid withdrawal?

A

Clonidine

134
Q

Replacement txt for opioid withdrawal?

A

methadone

buprenorphine

135
Q

You should treat the ?? and not the ???

A

patient, NOT the poison

136
Q

Supportive care?

A

ABC
Safety net- IV, O2
Temperature control
Electrolyte replacement

137
Q

What is a GI decontamination based on?

A

Drug, Dose, Patient

138
Q

No longer used for gastric emptying?

A

Ipecac

139
Q

Why is Ipecac no longer used?

A

risk of aspiration usually outweighs benefits

140
Q

When is gastric lavage used?

A

cases w/ high morbidity

141
Q

The most common ED complaint?

A

Abdominal pain

142
Q

What does the safety Net for abdominal pain include?

A 
Vital signs w/ pulse oximetry
O2 supplementation
IV access
NPO status
\+/- IV fluid resuscitation, EKG, NG tube
143
Q

How does pain being in abdominal pain?

A

Begins visceral and progresses to somatic pain once the peritoneum is involved

144
Q

What is important in narrowing the ddx in abdominal pain?

A

Location and OLDCARTS

145
Q

Describe the Acute Abdomen?

A

sudden, spontaneous, non-traumatic 10/10 pain

146
Q

What does all abdominal pain pts require?

A

rectal exam w/ stool guaiac and

GU exam- pelvic or testicular exam

147
Q

What 4 types of imaging are done in abdominal pain?

A

acute abdominal series
Beside ultrasound
CT scan w/ contrast
MRI

148
Q

What does the FAST exam include?

A

Beside US

149
Q

What does a Beside US look for?

A

FREE FLUID in the abdomen or pelvic (blood)

150
Q

What are 4 areas that the beside US views?

A

Heart
RUQ
LUQ
Pelvic

151
Q

What 2 things does the eFast or extended FAST exam include?

A

Chest

Lung viscera

152
Q

How do you determine if a source is a upper or lower GI bleed?

A

NG tube

153
Q

Hematemesis or blood per NG tube?

A

UGIB

154
Q

Clear NG tube?

A

LGIB

155
Q

What two things are used to determine blood loss?

A

SBP <100 or HR > 100

156
Q

A drop in systolic bp indicates what present of blood loss?

A

30-40%

157
Q

What is the txt for UGIB/LGIB?

A

2 large bore IVs- blood products
Igm Ceftriaxone
PPI- IV

158
Q

What is the treatment for esophageal varices?

A

Octreotide IVP, followed by continuous infusion

159
Q

What is the diposition for UGIB/LGIB?

A

Consult GI, admit to ICU or floor

160
Q

What is solid organ rupture caused by?

A

trauma

161
Q

Massive bleeding is seen in?

A

solid organ rupture

162
Q

What causes hollow organ rupture?

A

variety of causes (excessive dilation, infection, acid/base erosion, trauma)

163
Q

Bleeding, infection, and sepsis is seen in?

A

hollow organ rupture

164
Q

What is the flow of hollow organ rupture?

A

progressive abdominal pain
Period of pain improvement
Worsening abdominal pain w/ fever
Sepsis

165
Q

Txt for hollow organ rupture?

A 
(ideally we avoid rupture)
IV fluids
IV abx
Vasoactive meds
Pain meds
Surgery
166
Q

Can follow acute embolus, vascular disease, decreased cardiac output?

A

ischemic bowel disease

167
Q

Disease where pain is out of portion to exam?

A

ischemic bowel disease

168
Q

Txt for ischemic bowel disease?

A

Surgery! (re-vascularization or necrotic debridement)

169
Q

What position should pregnant patients be placed in?

A

semi-left lateral decubitus

170
Q

Why the semi-left lateral decubitus?

A

to avoid vena cava compression

171
Q

How much volume increase is needed for a pregnant pt?

A

50%

172
Q

T/F withhold imaging needed for maternal trauma?

A

FALSE (DON’T WITH HOLD use shielding!)

173
Q

Vaginal bleeding < 20 weeks indicates?

A

spontaneous abortion

174
Q

Dx of vaginal bleeding?

A

FAST EXAM
Vaginal US
Quant hCG

175
Q

What med is given for vaginal bleeding in a preggo?

A

RhO D immunoglobulin (RhoGAM) (Rh - woman)

176
Q

Disposition for a <20wk old bleeding preggo?

A

d/c safely w/ close OB follow up

177
Q

What should be r/o in a preggo >20wks?

A

abruptio placentae
placenta previa
vasa previa

178
Q

What should be done before performing a digital or speculum pelvic exam?

A

Transvaginal US (to locate the placenta)

179
Q

What is done after a US in a traumatic preggo?

A

Sterile pelvic exam

180
Q

Used to identify injury, bleeding, or amniotic fluid leakage?

A

Sterile pelvic exam

181
Q

2 things used to determine leakage of amniotic fluid?

A

Nitrazine paper pH strips

Ferning

182
Q

Dispostion for trauma in preggo?

A

> 20 wks require observation or admission for fetal monitoring

183
Q

What is preeclampsia?

A 
Hypertension > 20 wks +
new proteinuria
sudden increase in proteinuria
OR
development of HELLP syndrome
184
Q

What is HELLP syndrome?

A

hemolysis, elevated liver enzymes, and low platelet count

185
Q

What is considered HTN in preeclampsia?

A

SBP> 140, DBP >80

186
Q

Mild Preeclampsia txt?

A

discharge w/ OB fu and after OB consult

187
Q

Severe Preeclampsia txt?

A

Antihypertensives- Labetalol, hydralazine, nifedipine

IV magnesium

188
Q

Definitive treatment for preeclampsia?

A

DELIVERY

189
Q

What is eclampsia?

A

new onset seizures + preeclampsia

190
Q

When can eclampsia occur?

A

> 20 wks to 4 wks postpartum

191
Q

Txt for eclampsia?

A

Antihypertensives- Labetalol, hydralazine, nifedipine

IV magnesium

192
Q

Definitive txt for eclampsia?

A

delivery

193
Q

What is imminent delivery?

A

complete cervical effacement and the fetus is at the vaginal introitus

194
Q

What should be done in a emergency delivery?

A 
Call OB to ED
Initiate monitor (if possible)
Obtain IV access and begin IV hydration
Prepare perineum by washing with soap/water and swabbing w/ povidone-iodine
ASSIST IN DELIVERY
195
Q

When is gastric lavage used?

A

high morbidity cases (<30min)

196
Q

When is activated charcoal used?

A

Sustained release (<1hr)

197
Q

PHAILS stand for?

A 
P- Potassium
H- Heavy metals, Hydrocarbon
A- Alcohol, Alkalis, Acid
I- Iron, Inorganic salts
L- Lithium
S- Solvents
198
Q

Used for body packers?

A

Whole bowel irrigation

199
Q

When is hemodialysis used?

A

lithium, valproic acid, aspirin

200
Q

Specific remedy that stops or controls the effects of a specific poison?

A

antidotes

201
Q

What is the antidote of Tylenol?

A

N-acetylcysteine

202
Q

What is used to determine txt for Tylenol?

A

Rumack-Matthew Treatment nomogram

203
Q

If ingestion is less than ??? plot on Rumack-Matthew

A

<8hr

204
Q

Antidote for tricyclic antidepressants?

A

Sodium Bicarbonate

205
Q

Antidote for Beta blocker?

A

Epi or norepi
Glucagon
High dose insulin w/ glucose

206
Q

Antidote for Calcium Channel blocker?

A 
Calcium chloride
(epi or norepi, glucagon, high dose insulin w/ glucose)
207
Q

Antidote for iron?

A

Deferoxamine

208
Q

Antidote for cyanide?

A

Hydroxocobalamin

209
Q

Antidote for Organophosphates?

A

Atropine and Pralidoxime

210
Q

Antidote for Sulfonylureas?

A

Dextrose and Octreotide

211
Q

Antidote for Hydrofluoric Acid?

A

Calcium

212
Q

Antidote for Anti-freeze?

A

Ethanol or Fomepizole

213
Q

Antidote for Opiates?

A

Naloxone

214
Q

Antidote for Benzo?

A

NOT FLUMAZENIL— JUST LET IT WEAR OFF- SUPPORT BREATHING!

215
Q

Antidote for Carbon Monoxide?

A

Oxygen and hyperbaric chamber

216
Q

Antidote for snake bite?

A

Crofab

217
Q

When should fluids be given?

A

before vasopressors

218
Q

Poison center number?

A

1-800-222-1222

Emergency Medicine (6 decks)

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