Undifferentiated Patients

Question 1

approach to undifferentiated ed patient

Answer 1

• initial actions and primary survey
• initial differentials
• secondary survey
• refinement of differential diagnoses
• essential ed diagnostic evaluation
• patient reevaluation
• treatment and disposition

Question 2

assessment of abcde

Answer 2

airway
breathing
circulation
disability
exposure

Question 3

steps in airway assessment

Answer 3

• can the patient talk normally?
• yes = proceed to abcde
• no = can the patient talk at all?
• yes but not normally: look for fluid, foreign body, swelling, or altered mental status; swallowing
• no: check chest movement and air movement @ nose and mouth

Question 4

if a patient is unconscious without normal breathing you ___

Answer 4

open the airway using head tilt or chin lift maneuver

Question 5

if cervical spine trauma is suspected __

Answer 5

maintain cervical spine immobilization and use jaw-thrust maneuver for trauma patients

Question 6

life threatening breathing conditions (breathing)

Answer 6

• tension pneumothorax
• asthma
• copd and acute exacerbation
• pleural effusions
• hemothorax
• suspected opiate overdose

Question 7

breathing assessment

Answer 7

read

Question 8

breathing management

Answer 8

unconscious with abnormal breathing = bag-valve-mask ventilation + oxygen support

conscious but inadequate breathing = o2 support

hypoxia and tachypnea = o2 support or o2 therapy

large pleural effusion and pneumothorax = o2 support and chest tube thoracostomy

Question 9

emergent interventions for breathing management

Answer 9

• saba (salbutamol) for wheezing
• epi for anaphylaxis
• needle decompression for tension pneumothorax
• immediate transfer for chest tube thoracostomy

Question 10

life threatening conditions (circulation)

Answer 10

• external bleeding from trauma
• pericardial tamponade
• dehydration

Question 11

circulation assessment

Answer 11

• pulse
• bp
• capillary refill time
• skin changes

Question 12

circulation management

Answer 12

• no pulse and cardiac arrest: cpr
• weak pulse, hypotension, poor perfusion = iv crystalloids or fluids
• direct pressure on external bleeding
• pelvic biner or splint

Question 13

avpu scale

Answer 13

alert
verbal response
pain
unresponsive

Question 14

disability assessment

Answer 14

• level of consciousness
• blood sugar level/ capillary blood glucose
• pupillary size and reactivity
• movements and sensation in limbs
• seizures or convulsions

Question 15

life threatening conditions (disability)

Answer 15

hypoglycemia, increased icp, seizures

Question 16

non-trauma with inc icp

Answer 16

presentation: dec sensorium, anisocoria or unequal pupils
mgt: neutral position and head elevation 30 deg

Question 17

pts with suspected traumatic injuries or unknown cause mental status

Answer 17

place in supine and flat bed position with cervical immobilization

Question 18

mgt for active seizures

Answer 18

• benzodiazepine
• iv or im midazolam
• iv diazepam

Question 19

mgt for opioid overdose

Answer 19

pres: dec sensorium, pin-point pupils, bradypnea
mgt: naloxone

Question 20

life threatening conditions (exposure)

Answer 20

• external injuries
• rashes
• exposure to environmental elements

Question 21

sample history

Answer 21

symptoms
allergies
medical history
last meal
events
family/social history

Question 22

labs in the ed

Answer 22

• point of care testing (glucose, pregnancy, cardiac markers)
• uts (fast)
• ecg
• xray/ct

Question 23

two dispositions

Answer 23

admitted or discharged