Topics in EM

Question 1

Massive hemothorax: dx and tx

Answer 1

chest tube >1500cc immediate return

tx: volume resuscitation and chest decompression; operative management

Question 2

Open pneumothorax tx

Answer 2

occlusive dressing

secure 3 sides only, place thoracostomy tube

Question 3

JVD, hypotension, muffled heart sounds: dx and tx

Answer 3

cardiac tamponade

immediate pericardiocentesis

Question 4

Trauma fluidresuscitation

Answer 4

Isotonic (LR or NS) repletion in 3:1 ration (fluids to blood loss)
1-2L bolus, reassess
Consider PRBCs if continue to be unstable

Question 5

Immediate tx penetrating chest wound

Answer 5

1. intubate
2. empiric bilat chest tubes
3. open thoracotomy if cardiac arrest

Question 6

New diastolic murmur after chest trauma

Answer 6

aortic dissection

Question 7

Reasons for ex lap in abd trauma pts

Answer 7

below 4th intercostal

peritoneal signs, hemodynamically unstable

Question 8

trauma penetrating platysma

Answer 8

admit + surgical exploration

Question 9

upper extremit hypertension, hoarse voice

CXR: widented mediastinum, loss aortic knob: dx + workup

Answer 9

Aortic dissection (ligamentum arteriosum for rabid-decel injury)
CT/TEE
Aortography= gold standard

Question 10

Subdural vs epidural hematoma

Answer 10

Subdural: can cross suture lines, crescentic (bridging veins)
Epidural: biconvex, middle meningeal

Question 11

Fever, tachypnea, rash on upper extremities, conjunctival hemorrhage after trauma

Answer 11

fat embolism

Question 12

Retroperitoneal air in trauma pt

Answer 12

duodenum perf

confirm with CT

Question 13

bood urethral meatus, ballotable or nonpalpable prostate

Answer 13

suspect urethral injury

retrograde urethrogram before foley placement

Question 14

Tx: asystole or PEA

Answer 14

epinephrine or vasopressine

5Hs 5Ts

Question 15

Tx: Vfib, pulseless vtach

Answer 15

Defib 200J x2->epi->defib->ami->defib->epi

Question 16

Afib/aflutter tx

Answer 16

synchronized cardiversion (120-200J)
diltiazem or bblock

Question 17

SVT: tx

Answer 17

vagal maneuver
adenosine
AV-nodal blocker (bblock, cachblock)

Question 18

J wave

Answer 18

classic sign of hypothermia

Question 19

cranial nerve dysfunction, excessive motor acitivity, resp compromise after hiking: tx and dx

Answer 19

scorpion bite
benzodiazepine and analgiesic
atropine for hypersalivation and resp distress
IV scorpion-specific ab

Question 20

spider bite side effects

Answer 20

necrosis, hypocalcemia

Question 21

Angular stomatitis, cheliosis, corneal vascularization

Answer 21

B2 (riboflavin deficiencey)

Question 22

diarrhea, dementia, dermatitis

Answer 22

B2 (niacin)

Question 23

Convulsion, hyperirritability, INH

Answer 23

B6 (pyridoxine)

Question 24

Dermatitis, enteritis, alopecia, adrenal insufficiency

Answer 24

B5 (pantothenate)

Question 25

Dermatitis, enteritis, raw egg consumption/abx use

Answer 25

biotin def

Question 26

Keshan cardiomyopathy

Answer 26

selenium def

Question 27

weakness, muscle cramps, CNS hyperritiability, choreoathetoid mvmt

Answer 27

Mg def

Question 28

What avoid with cocaine/ amphetamine withdrawal

Answer 28

bblock- unopposed a activity, HTN