Urgent Care Flashcards
Systemic or Pulmonary insult that leads to pulmonary edema, alveolar collapse, and hypoxemia is known as _____.
ARDS
Sepsis, severe trauma, and aspiration of gastric contents are leading causes of ______ (hypoxemia refractory to O2 + organ failure).
ARDS
_____ (Prone/Supine) position helps to improve oxygenation in patients with ARDS.
Prone
The MC cause of cardiac failure is _____ (chronic condition).
CAD
Chronic causes of cardiac failure include:
- Dilated cardiomyopathy
2. Valvular dz
The most common rhythms seen in cardiac arrest are:
- V tach
- V fib
(also PEA and asystole)
Reversible causes of cardiac arrest include:
*Hint- H’s & T’s
- Hypovolemia
- Hypoxia
- Hydrogen ion (acidosis)
- Hypo-/hyperkalemia
- Hypothermia
- Tension PTX
- Tamponade, cardiac
- Toxins
- Thrombosis, pulmonary
- Thrombosis, coronary
____ is a normal GCS and ____ indicates severe TBI and the need for intubation.
- 15–> normal
- < 8–> INTUBATE!
Give _____ then glucose when a patient is hypoglycemic with hx of EtOH abuse or malnutrition.
Thiamine
If you suspect an elevated ICP then elevate the head of bed 30 degrees and give _____ (drug).
Mannitol
Treatment of a local allergic reaction involves:
Ice, elevation, remove stinger, tylenol, ibuprofen
Treatment of urticaria involves:
Antihistamines, PO steroids (prednisone, medrol), consider EPI
Treatment of bronchospasm involves:
- Mild–> Moderate: Albuterol, parenteral steroids (methylprednisolone/solumedrol)
- Moderate–> Severe: Parenteral beta agonist (epinephrine), consider intubation
Treatment of Hypotension involves:
- Etiology: histamine, PGE, and leukotrienes vasodilate peripheral vessels, inc capillary endothelial permeability and 3rd spacing
- Treatment: IV NS or LR bolus, EPI or NE infusion; consider vasopressors (DA) for refractory hypotension
Treatment of Anaphylaxis involves:
-Etiology: IgE mediated
Treatment:
1. RSI, 2 large-bore IVs, continuous pulse ox, cardiac monitor
- Parenteral beta agonist (EPI), antihistamines, and glucocorticoids, IVF
- Obstructive Angioedema: Cricothyrotomy
- Contraindicated if < 8 y/o
How is free air on CXR under the diaphragm and free fluid that is not ascites treated?
Urgent surgical referral!
What ABX are used for acute abdomen?
- Levaquin-Flagyl combo
- Zosyn
- Also give aggressive IVF (1 L NS or LR per hr)
____ burns are the MC type.
Scald
_____ (treatment) is recommended for circumferential burns to prevent compartment syndrome.
Escharotomy
____ is used to treat superficial burns while _____ is used to treat 2nd-3rd degree burns (not including pregnant, <2mo, and face).
- Superficial- aloe vera and bacitracin
2. 2nd-3rd degree- Silvadene
What is the Parkland Formula?
Use to calculate IV Fluids for burns > 10%.
LR 4cc x Wt. (kg) x %BSA= amount given in 24hrs
-Half over first 8 hrs, half over subsequent 16 hrs
The treatment for chemical burns entails:
Continuous irrigation with H2O until pH= 7
*Ocular burns- Irrigate ASAP with NS or LR w/ morgan lens for at least 30 min. ABX- moxifloxacin and cycloplegics
Small surface injuries that may be associated with devastating internal injuries are related to which type of burn?
Electrical
Lichtenberg (fern like dendritic pattern on skin) is associated with what type of injury?
Lightning strike
____ is the MC cause of death in smoke inhalation pts
PNA
Injury ABOVE the glottis is MC caused by ____.
Heat
Injury BELOW the glottis is MC caused by _____.
Chemical injury
*Dx- fiberoptic bronchoscopy
How are inhalation injuries managed?
Mostly supportive: humidified O2, pulm physiotherapy, mucolytics, and bronchodilators
Consider intubation IF- copious secretions, laryngeal edema
Cherry red skin color, agitation, and AMS with a potentially normal PaO2 and SaO2 are signs of _____.
Carbon monoxide poisoning
How do you treat CO poisoning?
100% O2
What are common OB causes of 3rd trimester bleeding (after 28 weeks)?
- Abruptio placentae (MC)- premature separation of placenta–> abdominal pain and dark red blood
- Placenta previa- placenta covers opening of cervix–> profuse, painless, bright red bleeding
- Vasa previa- fetal blood vessels near opening of uterus–> painless vaginal bleeding w/ fetal distress
- Uterine rupture
- Premature labor
What are non-OB causes of 3rd trimester bleeding?
Genital tract lesions, infections, intercourse, friable cervix, cervical carcinoma
Rules for suturing areas of bites…
- YES if: clinically NOT infected, <12 hrs old (<24 hrs on face), NOT on hand or foot
- NO if: high risk for infection (crush injury, puncture wound, human/cat bite (unless on face), immunocompromised patient)
What is the treatment of choice for foreign body aspiration?
Bronchoscopy- used for object removal
What’s the study of choice for an occult hip fx?
MRI
What’s the study of choice for a pelvic, facial, or intraarticular fx?
CT
What IV abx are used for open fractures?
1st-2nd gen cephs and aminoglycosides
*Don’t forget tetanus shot!!
Common sites of dislocations?
Anterior shoulder, posterior hip, posterior elbow
Key features of Stable Angina are:
- Substernal CP (pressure, burning, tightness)
- Brought on by exertion
- Nonpleuritic
- Usually < 30 min, typically 1-5 min
How is stable angina managed?
Rest or NTG
Unstable angina, NSTEMI, and STEMI all fall under the umbrella of ______.
ACS- Acute Coronary Syndrome
UA and NSTEMI can be distinguished from STEMI by:
- UA and NSTEMI- subtotal occlusion; STEMI- TOTAL OCCLUSION
- UA and NSTEMI- ST depressions and/or T wave inversions; STEMI- ST elevations
Cardiac enzymes are _____ (positive/negative) in cases of UA and are ______ (positive/negative) in cases of NSTEMI.
UA= negative cardiac enzymes
NSTEMI= positive cardiac enzymes
The MC cause of MI is:
Atherosclerosis- acute plaque rupture causing coronary thrombosis
The S/s of ACS include:
- Retrosternal “pressure” usually > 30 min!
- NOT RELIEVED WITH REST/NITRO
Silent MIs….
About 25% of MIs
- More common in women, elderly, DM, and obese
- S/s= abdominal, jaw pain, or dyspnea w/o CP
Natural STEMI progression on EKG=
Peaked T waves–> ST elevations–> Q waves–> T wave inversions
The most sensitive and specific cardiac marker for NSTEMI/STEMI is _____.
Troponin
*Can also be elevated in cases of renal failure, advanced HF, acute PE, and CVA
How are cases of UA and NSTEMI managed?
- Antithrombotic Therapy
- Antiplatelet Meds
a. ASA
b. ADP Inhibitors (Clopidogrel)
c. GP II/IIIa Inhibitors (Eptifibatide) - Anticoags
a. Unfractioned Heparin
b. LMWH (ADR: thrombocytopenia; renal dose)
- Adjunctive Therapy and Assess RFs (TIMI)a. BBs (see p. 10 for CIs)
b. Nitrates
c. Morphine
d. CCBs (DOC for vasospastic disorders)
How are STEMIs managed?
- Reperfusion treatment
- Do w/in 12 hours; either with PCI or thrombolytics
- PCI best within 3 hours of symptom onset- ideally 90 min.
- Door to thrombolytics- 30 min. - Antithrombotics
- ASA- chew, dec. mortality by 20%
- Heparin - Adjunctive therapy
- BBs
- ACEI
- Morphine
- K+ and Mg+ repletion, Statin therapy, Monitor BP, glucose, reduce RFs
What are the indications for CABG v. PCI?
CABG:
- > 3 vessel dz.
- L main coronary artery
- Decreased LV EF
____ is DOC in cocaine-induced MI and _____ (drug) should be avoided.
CCB= DOC
-AVOID BB b/c of vasospasm
You want to avoid IV ____ and _____ in cases of R Ventricular (Inferior) MI because these drugs may drop preload.
Nitrates and Morphine
If CP began 12+ hours ago you want to proceed with conservative management which entails:
ASA +/- Clopidogrel x 9 months, statin, BB, ACEI, Nitro PRN
What is a TIMI score and what is considered a high risk?
Risk score to assess risk of death and ischemic events in pts with UA/NSTEMI to determine benefit of invasive angiography to reduce mortality
Score ≥ 3 = high risk!
Absolute CIs for use of Thrombolytics in ACS are:
- Intracranial hemorrhage
- Non-hemorrhagic stroke w/in 6 months
- Head/face trauma w/in 3 months
- Intracranial neoplasm
- Aneurysm
- AVM
-p. 11 for relative CIs
Transient ST segment elevations often seen in females > 50y/o and smokers and are associated with hyperventilation, emotional stress, and cold weather are known as ______.
Variant Angina
Management of Variant Angina and Cocaine-induced MI include:
CCBs or Nitro
-ASA, heparin, and benzos (for cocaine-induced MI) may be given until atherosclerotic dz is ruled out
Increased BP with NO acute end organ damage is known as a ______.
Hypertensive Urgency
HTN Urgency is treated with:
Clonidine or Captopril to decrease BP by 25% over 24-48 hours
Goal= < 160/100mmHg
Increased BP WITH acute end organ damage and BP > 180/120 is known as a ______.
HTN Emergency!
HTN Emergency managed by:
Decreased BP by 25% w/in the 1st hours and additional 5-15% over next 23 hours with IV meds
What medications do you want to use for an acute aortic dissection?
Esmolol, Labetalol
What medications do you want to use for HTN encephalopathy?
Nicardipine, Clevidipine, Labetalol
Classic triad for PE includes:
Dyspnea, Pleuritic CP, and Hemoptysis
MC predisposing condition for PE is _____.
Factor V Leiden
BREATHS acronym for suspected PE
Blood in sputum Room air sat < 95% Estrogen or OCP use Age > 50 y/o Thrombotic event in past- PE or DVT, Trauma HR > 100bpm Surgery in last 4 weeks
*PERC Criteria- if all the above are negative you effectively r/o PE
Workup for PE:
PE likely–> CT scan!
*If CT scan is indeterminate then Pulmonary Angiography is the GOLD STANDARD (can also do LE US–> 70% of patients will also have DVT)
PE UNlikely–> D-dimer
-If negative then VTE/PE excluded
EKG findings associated with PE:
- Sinus tach and nonspecific ST/T changes MC
- S1Q3T3 most specific–> wide deep S in lead I; isolated Q and T wave inversion in lead III
Management of Stable PE:
IV UFH or SQ LMWH–> PO Warfarin or NOAC at least 3 months
*No PTT monitoring with LMWH (protamine sulfate is antidote to UFH and LMWH)
**If anticoag CI–> IVC filter
Management of UNstable PE:
Thrombolytic treatment: tPA (CI if CVA or internal bleed within 2 months)
If Thrombolytics CI–> embolectomy
When is PE prophylaxis warranted?
Preop patients w/ prolonged immobilization, pregnant, hx of prior DVT/PE
*LMWH: used if undergoing ortho, neuro sx, trauma
What are the 3 types of PTX?
- Spontaneous- Due to bleb rupture
a. Primary- NO underlying lung dz; tall and thin men
that are 20-40, smokers, FHx of PTX
b. Secondary- underlying lung disease w/o trauma
(COPD, asthma) - Traumatic- iatrogenic: CPR, thoracentesis, PEEP,
subclavian line placement, trauma - Tension- increased JVP, pulsus paradoxus, HYPOtension
Management of PTX involves:
- Observe at least 6 hours w/ repeat CXR to affirm no progression +24-48 hr f/u
- If primary, spontaneous, and small then observation is okay. Usually resolves w/in 10 days.
*Chest tube placement if large or severe symptoms
**NEEDLE ASPIRATION for Tension PTX–> chest tube
Ingesting harmful substances
p. 14-15!
Orbital cellulitis…
- Usually secondary to sinus infxn (ethmoid 90%)–> S. aureus, S. pneumo, GABHS, H. flu
- May be caused by dental/facial infxns
- MC in kids 7-12
- S/s: decreased vision, pain with eye movement, proptosis, eyelid erythema, and edema
How is orbital cellulitis diagnosed?
CT scan or MRI
How is orbital cellulitis treated?
IV ABX- Vancomycin, clindamycin, cefotaxime
What is preseptal cellulitis?
Infection of eyelid and periocular tissue. May have ocular pain and swelling but NO visual changes and NO pain with eye movement
How is preseptal cellulitis treated?
Amoxicillin
