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Emergency Medicine > Rules,Criteria,Guidelines > Flashcards

Rules,Criteria,Guidelines Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Ottawa Ankle Rules

A

An ankle X-Ray is required ONLY if:

  1. Medial or lateral malleolus tenderness 6cm at the posterior portion.
    AND
  2. Unable to bear weight immediately at the time of injury and in the ER.

A foot X-Ray is required ONLY if:

  1. Medial tenderness at the navicular or lateral tenderness at the base of the 5th metatarsal.
    AND
  2. Unable to bear weight immediately at the time of injury and in the ER.
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2
Q

C-Spine Rules

A

*All alert patient with GCS of 15

High Risk for ANY ONE of the following:
ID]
Age > or = to 65

HPI]
Dangerous mechanism – fall from 3 feet or 5 stairs
MVC high speed (>100km/h), rollover, ejection
MVC recreation vehicle
Bicycle struck or collision
Axial load to heard ie. Diving
Paresthesia in extremities

O/E]
Cannot move neck 45 degrees left or right

If ANY low risk factor then NO scan:
HPI]
Simple rear end MVC
Ambulatory at any time
Delayed onset of pain

O/E]
Sitting position in the ER
No midline C-Spine tenderness

Exclusion criteria:
Age < 16
Glasgow Coma Scale score <15
Grossly abnormal vital signs
Injury > 48h old
Penetrating trauma
Acute paralysis
Known vertebral disease (ankylosing spondilitis, rheumatoid arthritis, spinal stenosis, previous spinal surgery)
Return visit for reassessment of same injury
Pregnant

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3
Q

SIRS

Systemic Inflammatory Response Syndrome

A

Any TWO of the following:

O/E] HR>90, RR>20, T>38 or <36 or PaCO2<32
PaCO2<35 means patient is hyperventilating.
PaCO2>45 means patient is hypoventilating.

INVESTIGATIO]
L(H)/Haim]
WBC>12,000 cells/mm3 <4,000 cells/mm3 >10% bands

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4
Q

Centor Criteria

A

HPI]
No cough, Fever >38 OR Subjective

O/E]
HEENT] Anterior cervical lymphadenopathy, tonsillar exudates

Score:
0-1 no need for Abx
2-3 rapid strep test or culture
4 Abx

Amoxicillin 50mg/kg x 10 days OR
Penicillin V 250mg PO BID x 10 days
If Pencillin hypersensitivity then: Clindamycin

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5
Q

A Fib

A

Is patient stable? Yes or No

  • *No**
  • *Signs of ischemia** – heart
  • *Hypotension, ALOC** – weak perfusion and pressure
  • *Pulmonary edema** – backup flow into lungs

RECIPERE]
NP/Pro]
Electrical Cardioversion
P/Haim]
Immediate OAC in ED for >or= 4 weeks

Yes
What is the immediate risk of stroke?

High
Onset >48hours or unknown
Stroke/TIA <6months
Mechanical/Rheumatic valve disease

RECIPERE]
P/Org(Cardios)]
Rate Control (or TEE Guided Cardioversion)
Metoprolol 2.5-5mg IV bolus over 3min, x3 if needed
Metoprolol 25-100mg PO BID
OR
Diltiazem 0.25mg/kg IV bolus over 2min, 5-15mg/h
Diltiazem 120-360mg PO OD
P/Haim]
Therapeutic OAC x 3 weeks before cardioversion.

Low
Clear onset <48hours
Therapeutic OAC >or= 3weeks

RECIPERE]
NP/Pro]
Electrical Cardioversion (150-200J)
OR
P/Org(Cardios)]
Flecainide 2mg/kg IV over 10 min
Flecainide 200-300mg PO
P/Haim]
No OAC needed before cardioversion. After cardiovesion, OAC by CHADS65.

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6
Q

National Emergency X-Radiography Utilization Study

(NEXUS)

A

Scan if ANY of the following present:

HPI]
Intoxication
Painful distracting injury

O/E]
Not oriented x3 (abnormal LOC)
Midline cervical spine tenderness
Focal neurological deficits

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7
Q

Salter Harris Classification

A

S - Type 1 - Strait across the physis

A - Type 2 - Above the physis toward the metaphysis

L - Type 3 - BeLow physis toward the epiphysis

T - Type 4 - Through the physis

ER - Type 5 - ERase the physis or cRushed the physis

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8
Q

PERC

Pulmonary Embolism “Rule Out” Criteria

PERC em out

A

ID]
Age <50

HPI]
No hemoptysis

PMHx]
No prior DVT or PE
No hospitalization or surgery within last 4 weeks

O/E] HR <100 (No tachycardia), SaO2 > 95% on RA
No unilateral leg swelling

MEDS]
No OCP or exogenous estrogen use

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9
Q

Oral Presentation

A

CC]

ONE LINER]
Age
Gender
Relevent PMHx
“CC”

HPI]
Location
Sensation
Radiation
Time
Exacerbation
Alleviation
Association

  1. Exhaust Deadly Diagnosis
    Pertinant positive and pertinant negatives on history.
  2. Why today?
  3. How long?
  4. Has this happened before?
    Who have you seen where (ie. clinic hospital), what tests, what treatments.

O/E] HR BP RR SpO2 T
Comment on abnormal findings.
Pertinant physical exam findings.

SUMMARY] 
One liner (setup) -- Clincher
\*\* Most important and abnormal findings

IMPRESSION]
I think this is…

INVESTIGATIO]

RECIPERE]

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10
Q

CHADS2-VASC

A

ID]

  • *S**ex M (0), F (1)
  • *A**ge<65 (0), 65-74 (0), >74 (2)

PMH]

  • *S**troke/TIA (2)
  • *C**HF (1)
  • *H**ypertension (1)
  • *D**iabetes (1)
  • *V**ascular disease (1) (MI, PAD, Aortic sclerosis)
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11
Q

CT Head Rules

A

High risk for ANY ONE of the following:

ID]
Age > or = 65

HPI]
Vomiting > or = 2 times

O/E] GCS <15 two hours after injury

  • *Open or depressed skull fracture.**
  • *Basal skull fracture**: hemotympanum, CSF otorrhea/rhinorrhea (blood in ear, brain fluid leaking out of ear or knose), “racoon” eyes, battle sign.

Medium risk if:
Dangerious mechanism – fall from >3 feet or 5 stairs
MVC occupant ejected from vehicle
Pedestrian stuck
Amnesia before impact >30min

Not applicable if:
GCS <13
Age <16
On anticoagulants or bleeding disorder
Obvious open skull fracture

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12
Q

Fever

A

Oral - 37.5 (37.8)

Axilla - 37.0 (37.2)

Rectal or Ear - 38.0

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13
Q

Wells Criteria for PE

A

HPI]
Hemoptysis (1)

PMH]
Prior DVT/PE (1.5)
Surgery/immobiliztion in previous 4 weeks (1.5)
Active malignancy (trt within 6 months) (1)

O/E] HR>100 (tachycardia) (1.5)
Clinical signs and symptoms of DVT (3)

DIAGNOSIS]
PE is the most likely diangosis (3)

PE unlikely 0-4, PE likely >4

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14
Q

CURB-65

A

Rule used to guide admission for pneumoniae.

ID]
Age >or= 65 (1)

HPI]
Confusion (1), defined by ATMS > 8

O/E] S < 90 (1), D < 60 (1), RR > 30

INVESTIGATIO]
L(H)/Org(Nephros)]
BUN > 19 (1)

RECIPERE]
Discharge if 0-1 points.
Admit if 2+ points.

Note: CRB65 can be used without the need for labs.

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15
Q

GCS

A

Eyes: 1 None, 2 To pain, 3 To voice, 4 Spontaneuos

Verbal: 1 None, 2 Sounds, 3 Words, 4 Disoriented conversation, 5 Normal conversation

Motor: 1 None, 2 Decerebrate, 3 Decorticate, 4 Withdrawal to pain, 5 Localized to pain, 6 Normal

Decorticate is arms flexed with hands on chest. Decerebrate is arms extended by the side.

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16
Q

qSOFA

Quick

Sepsis Organ-related Failure Assessment

A

qSOFA tool used to identify patients who are at risk for a poor outcome outside the intensive care unit (ICU).
** Contraversy is out on the validation of qSOFA.

O/E] SBP < 100 (1), RR > 22 (1)

General] ALOC (GCS<15) (1)

RECIPERE]
2 or more ADMIT

17
Q

**CHADS65

A

ID]
Age > 65 or > 75 – OAC

PMHx]
CHADS2 – OAC
CHF
HTN
DM
Stroke/TIA/DVT

Arterial disease = ASA
CAD
PAD
AAA/TAA

Emergency Medicine (10 decks)

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