Rapids Flashcards
When do you/not remove a rust ring from an eye?
If overlying viusal field withvisual field defects (risk of scarring it, rust ring will soften over time)
if not, do it yourself and refer next day
Goodpasture vs Wegeners
GP (glomerular + Pulm), + antiglom Basement membrane Ab
Gran. polyangitis - Renal + pulm , ANCA
Churg strauss is eos. + asthma
acute headahce, bitemproal hemionspia, sellar hyperdensity
pituitary apoplexy (hemorrhage)>steroids and NSGY
Sudden headache, diplopia add to ddx
Pituitary apoplexy - microademona bleed into sella
bird/pet owner pna, sepsis
Psticcio - Doxycycline
Cardiac risk facotrs with vision loss
CRAO_ complete loss
CRVO- blurred and worse vision more vague
4 options cocaine induce chest pain
Phentolamine
Nitro
Benzos (and colling only affect mortality!)
CCB
on a mountain with progressive ataxia and AMS… DX and tx
HACE
Steroids, descent, oxygen, hyerbarics
HAPE - CCB
HUS triad and treatment
Renal, schitocytes, anemia, thrombocytopenia
Supportive
kid, red urine, edema, HTN…
PSGN (impetigo amd throat)
ABX, diruectis/antihypertenisves if needed, diaysis if needed
dress
Stop drug and high dose sterois
Rash, LFTs, eos,
Myocarditis- what is seen on US
diffuse hypokinesis, wall motion abnormlaities
clinically looks like tamponade and CHF in young person
supportive
Painful red spots on legs in vascular distbituion … think
pancreatic cancer - superficial thrombophlebitis
old person, pallor, ataxia, weakness, sore tongue-
pernicious anemia - or vit b12 deficinecy bc of autoimmune anema
Cullen sign
grey turner sign
Periumblivcal ecchymosis (from duodenum)
Flank ecchymosis
Think RP bleed
CO why do you treat
What time intervals do you need to remember?
To delay post neuro deficits down road
Time 90 minutes to oxygen it was out
30 mins hyperbarics
CN tx and co poison to think
Not sodium nitrite anymore!
Sodium thiosulfate
B12 or HYDPXYCPBALAMIN OR IV B12
CO
19% Carboxy, GCS 13, Stable vitals- Tx of CO poison?
NRB + HYPERBARICS
EKG changes, AMS, >25 (15) %, , ph 7.1, organ damage, LOC hx
Recent MI, New Pulseless leg- why
Poor cardiac motion leading to mural thrombus in LV
Hypercalcemia over 14
Polyuria polydipsia ams
Hypok hypo mg with it
I’ve fluids and bisphos
MC cause of HuperCa is hospitalized patients is cancer- lung breast and MM
Hypervigilance, irritable, angry
PTSD
Even if for secondary gain
Asthma patient, altered, oxygen 90 at NRB and duonebs- bipap or intubate
Boards is intubate
Bipap by definition cannot have AMS
Reasons to intubate asthmatic:
Altered
Cardiac arrest
Bradypnea
Physical exhaustion
MAP calculation
SBP + 2* DBP /3
Painful, Nikolsky rash, middle aged,
Tx and MC association?
Steroids
Myasthenia graves
Pemphogus vulgaris
Reversal agents for
Dabugatran
Xabans
Warfarin
Heparin
Idracuimab- backup PCC, back up hemodialysis
Andexant alpha- backup PCC
Vitamin K and PCC!
Protamine
Black widow spider bite tx for severe contractions
Benzos
Gono and chalmydia are difficult to culture
So uti that won’t go away or STD stuff think of that
ethylene glycol keys
Hypocalcemiq, long QT
Foemizole
Hemodialysis if there is acidosis or 50+ level
Gap Gap
Thiamine and b6!
Methanol keys
Seeing a snow storm vision
Foneizole or hemodialysis if gap or 50+
Gap gap
Bicarb
Folate
Isopropyl
Only osmol gap!!
Supportive care only!
infant, cough, eosinophils, patchy infiltrates, quick/interrupted cough, no fever
Chalmydia PNA - Azithro
PACEMAKERS
Failure to capture
Failure to Pace or Oversensing
Failure to Sense
Capture:appropriate spike, not strong enough to cause QRS
Pace: too much signa from body
Sense: Spike too close behind QRS (+/- depolarization)
Bat found in room of 6 yr old kid, no bite marks, DC or treat?
Treat
Ig and then Vaccine series
barky cough but toxic appearing kid
bacterial trach
headcahe, maialse, other ppl with same sympromsin house- test for CO or give oxygen if not hypoxic
give oxygen
PID pearls
Previous STD biggest risk factor (not recent birth or iud)
IUD doesn’t need to come out immediately
Open fractures
1
2
3
All get cefazolin- stage 3 gets gentamicin
<1 cm
1-10 moderately contaminated
>10 cm
SCC MC of Acute chest
Is leading cause mortality Acute chest
Mycoplasma and atypicals
Remember they do have risk for encapsulated organisms tho (used to be strep pneumonia)
Encapsulated organisms
Some nasty killers contain caps PS
Strep pneumonia
Neiserria
Klebsiella
Pseumonas
Capnocytophahia (dog bite)
Cryptoscoccus
Salmonella typhus
Dka hhs pearls
Remember to half you insulin and add Dexteose when bellow 300 ish
4.5 ish cut off for potassium
Hypoglycemia biggest risk bc of management
NMS and SS
NMS is benzos and dantrolene and bromide. Antipsychotics over days
SS is cyprohep. Over hours, opioids, ssri, lithium, maoi, linesolid
Meningitis ppx
Neisseri not streptococcus!
Health care workers if no Ppe or intubation
Rifmapin 600 bid two days
Cftx for preggos
Household, daycare, travel partners for 8 hours
Close contacts
LVAD
MC pump failure/ no hum- thrombosis- high flow alarm
MC complication: bleeding and GI bleed
Doppler BP 60-90 MAP, too high is bad for pump too
If asystplic- CPR still!
MC hypotension and LVAD failure= Suction event: preload dependent and give fluids
Infection MC in drive line
Dysthymia’s and battery failure
Do you go grab a razor blade past the pylorus?
No
Swallowed FB pearls and urgent endoscopy
Proximal to the pylorus (not if not tender, looking fine, eating)
Sharp
2x6
Button batteries
Adults is LES
Kids C6
Shingles
Ramsay hunt= needs steroids
Eye needs IV meds and admission
MC complication- post hepretocnneurlagia
No IC, preggos or kids near
Them but no airborne precautions
Treat if <72 hours or if past that and new lesions
AUB Tx
Stable:
1. Oral TXA 1 g Q8
2. OCPs
3. Progestin only if hx or high risk for clots
Unstable:
1. PRBCs
2. 25 mg q4 IV estrogen
MC for AAA expansion and rupture
- Smoking
- Size
Stable no symptoms and low is US outpatient
Stable and symptoms is CT
Unstable and symptoms is surgeon and stabilize
Anything over 5 and symptoms is admit
2 indications in ED to start a DOAC -bans
PE or Dvt
New onset non valvular A fib
When to give crofab? and earls
same dose in kids as in adults
only give in severe cases - systemic symptoms or symptoms more than 50 cm form the site
onyl facial fx reuqiring abx?
maxillary sinus fx
the rest if closed dont need them
Rember MCA is weakness and dysahgia
ACA is…
Sensory and motor
Whooping cough Complications
Ppx for hosuehold members
apnea in infants
Pneumothroax, neumomediastinum, too much coughing
when to give immunefab or antivenin in black widow spider bite?
Preggos, elderly, kids
give supportive care and fluids, benxos, nto calcium glcuonate
what to give in borwn recule bites if serious?
dapsone
MC fever from travlling pearls
tylenol and supportive
NOT NSAIDS (for their antcogaltuion) they can go into hemorrhagic shock
dont fluid overload them from vasvular leaks
Primary blast injuries MC sites
TM
Lung
Abd
2:shrapnel
3: being thrown
4:burns
First spot to go in FAST
Subxiphoid
FAST is higher spec then sensitivity
Pericarditis someone to admit
FEVER
older age, ummunsuppressed, elevated trop too
hypothyrid lab abnormality
Hypercholesterolemia!
hypoNA
hypercapnia
HUS tx
renal, plts, anemia
SOB several weeks after illness
supportive
HypoNa
HypoCa
MC acute kidney ijnury requiring trnaplant!
Occult trauma in preggo - they look fine
Stable- Tocomonitoring
Unstable- CT scan
Most concern for placental abruption
Travelers diarrhea Tx
Supportive
If severe: bloody, fever, or dehyrdation = 750 ciprofloxicin, 2nd line is Azithro (kids) (or India/thailand)
TCA OD tx
Sodium bicarb
(lidocaine and oehnyotin can be used)
drowning
Time in water is the worst, nto time to CPR
under 5, AA, males
no Abx ppx
Recue breaths first
Hypehmas
Sicklers: Avoid Nsaids and acetazolamide - needs optho(for sickerls)
give timolol
Hep B exposure
If unvaccinated and source is + its Ig and vaccine then
if vaccinated or patient is Hep B S ag is = do nothing
Pediatric PNA
5-16 yrs = Azithro
recent influenza= staph
under 5 is Amoxicillin
Mountain sickness
Mild:Desecend acetazmide and dex
Severe: add hyperbarics
HAPE= add CCB (prevent and treat) and oxygen
HOCM EKG
Deep Q waves
or
GIant TWI (but Deeo TWI can be wellens)
MOtrin OD
CO ingestion awlays test for it
100 mg/kg is mild
300 is severe
supportive
IO labs you cant trust
IO pearls
WBC, Plts, Na, K, Ca, LFTs, blood oxygen level
Peds= tibia and femur
You can infuse ANY drug thru them
Contraindications: fx, prox fx, overlying cellulitis, prev failed attempt at that site
HIV diarrhea tx
HARRT therpay and fluids
Factory fire, seizures> Tx
Hydorxycobalmine
then Sodium thosulfate for SN toxicity
PID
MC is chlamydia
prev PID, contraception use, young
dont need to remove IUD if infected (they dont inrease risk)
dont need diagnotsics to confirm
perihepatitis- Fitx Hugh is capsule not stormal so no LFTs elevated
Meckels
2 tyes of tissues + gastric
2x2 cm
painless and resloves spontabeous
MC complication is intuss and obstruction
t-99 scan
2 ft rpoixmal to IC valve
50% by age of 2
HIV PNA
Unheard of in USA but MC is bllod transfuion then Anal intercourse
Dehydration, AMSolyruia, polydipsia still gotta think
Hypercalcemia!
MC in malginancy (breast, non small Lung, MM)
14 is severe= IV bisphosphs and fluids
Loops are not main stay therpay
HypoK and HypoMg with it!
Fludis or insulin in HHS?
Flduis
insulin is more for ketoacids
Pelvic Fxs
Unstable and neg FAST= angiography
Unstable and + FAST= OR - its not chase plevic fx then
Venous bleeding is more MC
Ectopics MC and MOst trongly associated risk factor
MC is PID
Stronger= recent hx of ectopics
90% is fallopian tube
pregnancy + IUD= more likely ectopic
PPH pearls
MC is uterine atony
1: Manual + oxytocin
If unstable 1st step is MTP
Tears are second, then PLacental retention
White Phosphorus treatment?
GEt a woods lamp to see whats left
TONS of water
It ignites with AIR - slow an dinsidious burn
Transfer to burn center
electrolyte abnromality
from fireworks
HTN 230s, sounds like a Dissection- next step- CTA or BP meds
BP meds - CP could be from HTN
20-25% down in 1 hour if encephaolpathc
Pancreatitis
needs 3x upper limit liapse
If lipase and N/V = no CT needed (evidence based)
lots of fluids, NPO, no Abx
Dont give EKtamine to…
Schizophrenics
Skin + GI =
epi
Kawasaki pearls
MC in kids in Under 5
Mucocutaneous LN syndrome
Fever, Mouth, LN, Rash, Edema to hands of feet, desquamation
Fastest way to redcue temp in hyperthemia
Is Submersion!
but then Convection cooling with water and air
Thoractomomy
Never: found dead in field, conconmint terrible head injnury, down for longer than 15 mins - NO surgeon is not availble within 30 mins (abd diminshes chances
Indications: Blunt truama that loses ulses in fornt of you- penetrating throacic, pulses less than 15 mines
GSW to abd, stable vitals, + FAST- next step
CT
Unstable is OR
Osteomyelitis in kids MC bugs and neonateal bug
Heme spreading
Kids is staph (get x ray)
Neonates is GBS
Painful, dark vaginal bleeding in Preggos- what lab test and what next
Fibrinogen <200
Monitoring toco
Dystonia:
Akasthesia:
Tardive:
Acute facial, tongue trunk spasm
Restless
Later onset of lip smacking and facial/trunk stuff
Reducing hernia perlas
Trend.
Proximal pressure first! Not distal
Pain meds is the biggest!
BB overdose tx
Glucagon and High Dose insulin
Hypercalcemia ekg finding
Shortened QT
Bradycardia
Osborn!
Flattened wide t waves
Mc meningitis
Strep pneumonia for everyone except kids GBS 1-3 months
Listeria and Neisseria still not as common
Tension Pneumo
Late is trachea and BP
MC bug in kids and adults
GBS
Step penumo (even older adults is more than listeria and Nesiseria for young adults)
HIV infections pearls
PCP: MC infection in HIV, Bactrim (+dex if hypoxic)
Interstial edema is CMV pneumo
Mult pulm nodules is cryptococcus
HF acid
Hypocalcemia, Hypo Mg, QTc torsaded
Topical calcium gel
decon
HyperKalemia EKG
remeber ST segment can be altered!
and PR interval is elongated. PR is PRolonged
QT shortened
Hypercalcemia EKG
Osborns
Bradycardia
Short QT!
Traumatic Aortic Injury
Treat as if a regular Traumatic injury, if high BP then lower it.
they have upper extremity HTN usually
Descending aorta just distal to subclavian artery is the MC site
Transfusions
febrile non hemolytic reaction is MC reaction, cytokines
TRALI= ARDS, supportive
TACO= SCAPE, NIPV, diuretics etc - fluird overlodad
High mortlaity for the both of them
Hyphema managament , IOP 27> Tx
Timolol!! first, eye shield and head of bed
>50% or sicklers are admit or re-bleeds
cycloplegics only if no open globe
Avoid -zloamides and NSAIDS in sicklers
Sick kid with concern fo rintuss- next step?
KUB
GBS pearls
MC flccid paralysis in kids
sensation lost is NOT hallmark
up to 30% need a tube,
Compartment syndrome MC compartment
Anterior - Deep peroneal nerve, toe web space
Deep posterior is MC missed, post tibial nerve
Pain out of prortion and pain with passive stretch first!
sural- sup post
laterl- sup peroneal
Lightning strikes
AC - worst, outlets, V fib
DC- less ocmplications, aystole, BEtter outcomes!
Path of least of resistance, Nerve then most is fat and bone
paralysis and conservative treatment
fern - nothing to do
Cocaine
HTN
Arrythmia
HTN or CP= Benzos
VT or arrythmia= Sodium Bicarb (narrows the QRS) NOT procainamide!
They are high risk for MI (31X), need a trop! dont discharge without it even if young patient
crack lung is pulm edema, hypoxia induced cocaine
excited delirum
Cant leave AMA, try verbal de-escalation
Benzos first, ketamine second
Haldol would LOWER seizure threshold and slower acting!
SO HIGH
Silly, OD, HyperTSH, Infection, GLucose, HEad trauma!!!!
NMS vs SS
NMS haldol, rgidity, CK/LFTs, hyPO reflexia
SS clonus, hyeprfelxia, some rigdity
Ectopic Pregnancy
Biggest risk: prev ectopic
Previous STDs and scarring is MC risk
smoking and age also increases risk
IUD doesnt increase risk, but if they are pregnant with it in there is more of a chance to be ectopic
Vaginal bleeding MC sypmtom
Priapsim Tx cascase
Aspirate
Cold saline
then phenylephine \
Risk factors for SAH
- Smoking greatest risk facorts for rupture
- HTN
- Family Hx
CCB OD
Fluids, Levo and high dose Insulin (1 unit/kg, 1 unit per kg hour after) to support myocardium with energy
NOT glucagon, not calcium (you can give it a shot if you want)
Lipid Emulsoin on th test
WBI is correct if Sustained release!
Glucose is not the tell- all, BB is hypO and CCB is Hyper
Head ache and neck pain add to DDx
Intracranial dissection or vert dissection
bigger risk of thromboembolism
Horner syndorm ein a qurter of them, pulsatile tinnitus or storke stuff
GCA pearls
Cant diagnose it in ED (biopsy) so treat if suspected with high dose steroids
Vision loss is not reversibel and it can occur in the other eye
Lymes Tx
1. PPx
2. Dosing
3. Preggos
4. general
- 24 hrs or engorement of tick
- 1x dose of 200 Doxy
- Amox TID for 14 days
- if erythema migrans is 200 mg QD 14 days
- meningits for CFTX
Trach bleeding steps
- apply rpesure posterily at stenral notch
- overilnate cuff with up to 50 ml air
- secure airway
- digital comrpession
Kidney stones
heamturia present ealry on
Cnt rely on CVA tendernss
Fluids dont help, clacium restriction doesnt help
Recent sinusitis in a kid with new ataxia, FND, no signs of meningitis…
Brain empyema
CT head
If puncture wound with water add what ABx?
If puncture wound with salt water add what?
Fluro
Doxy
what is shcok index
HR/SBP
> 0.7
