All Flashcards
(149 cards)
0
Q
RF abdominal pain: pain out of proportion to exam
A
Mesenteric ischemia
1
Q
RF abdominal pain: sudden onset
A
AAA, ectopic pregnancy, mesenteric ischemia, viscous perfoation
2
Q
RF abdominal pain: pain with hitting bumps in the road on car drive
A
Peritonitis, appendicitis
3
Q
RF Abdominal pain: in elderly
A
AAA, mesenteric ischemia, MI, perforated ulcer, bowel obstruction, appendicitis, cholecystitis
4
Q
RF abominal pain: syncope
A
AAA, ectopic pregnancy
5
Q
RF abdominal pain: CAD
A
MI, mesenteric ischemia
6
Q
RF abdominal pain: recent surgery
A
Bowel obstruction
7
Q
RF abdominal pain: hypotension
A
AAA, ectopic pregnancy
8
Q
RF abdominal pain: distention or bilious emesis
A
Bowel obstruction, volvulus, malrotation
9
Q
RF abdominal pain: fever, RUQ pain, jaundice
A
Cholangitis
10
Q
RF abdominal pain: ascites
A
Spontaneous bacterial peritonitis
11
Q
RF abdominal pain: blood in stool
A
Colitis, intussusception, inflammatory bowel disease, cancer
12
Q
RF abdominal pain: awoke from sleep
A
Perforation or ischemia
13
Q
RUQ pain differential
A
Acute cholecystitis, acute hepatitis, acute pancreatitis, appendicitis, hepatic abscess, hepatomagaly/CHF, herpes zoster, MI, perforated duodenal ulcer, right lower lobe pneumonia
14
Q
RLQ pain differential
A
Abdominal wall hematoma, appendicitis, cecal diverticulitis, endometeriosis, incarcerated or strangulated inguinal hernia, Meckel’s diverticulitis, mesenteric adenitis, Mittelschmerz, pelvic inflammatory disease, psoas abscess, regional enteritis, ruptured AAA, ruptured ectopic, seminal vesiculitis, chrohns, torsed ovarian cyst, ureteral calculi
15
Q
Diffuse abdominal pain differential
A
Acute pancreatitis, aortic dissection, ruptured AAA, bowel obstruction, early appendicitis, gastroenteritis, mesenteric ischemia, perforated bowel, peritonitis, sickle cell disease
16
Q
LUQ pain differential
A
Acute pancreatitis, gastric ulcer, gastritis, left lower lobe pneumonia, MI, splenic enlargment/rupture/infarction
17
Q
LLQ pain differential
A
Endometriosis, incarcerated or strangulated hernia, Mittelschmerz, pelvic inflammatory disease, psoas abscess, regional enteritis, ruptured AAA, ruptured ectopic, seminal vesiculitis, sigmoid diverticulitis, torsed ovarian cyst, ureteral calculi
18
Q
Abdominal pain ROS
A
GI - nausea, vomiting, anorexia, constipation, diarrhea, blood
GU - dysuria, frequency, urgency, hematuria
Gyn - pregnancy, fertility, menses, contraception, STIs, discharge, bleeding, dyspereunia
Cardiopulmonary - cough, dyspnea, chest pain
19
Q
Clue: Abdominal pain radiating to infra scapular region
A
Biliary colic
20
Q
Clue - abdominal pain radiating to midback
A
Pancreatitis
21
Q
Clue: pain radiating to flank or genitals
A
Kidney stone or AAA
22
Q
Appendicitis symptom chronology
A
Pain prior to vomiting
23
Q
Risk factors for spontaneous bacterial peritonitis
A
Cirrhosis and ascites
24
Systemic causes of abdominal pain
Diabetic ketoacidosis, alcoholic ketoacidosis, uremia, sickle cell disease, porphyria, lupus, vasculitis, glaucoma, hyperthyroidism
25
Toxic causes of abdominal pain
Methanol poisoning, heavy metal toxicity, scorpion bite, black widow spider bite
26
Thoracic causes of abdominal pain
MI, unstable angina, pneumonia, PE, herniated disk
27
Abdominal wall causes of abdominal pain
Muscle spasm, muscle hematoma, herpes zoster
28
Hypotension in patient with abdominal pain may indicate
Dehydration, sepsis, or internal hemorrhage
29
Tachycardia in abdominal pain patient may indicate
Occult blood loss, sepsis, volume contraction, or pain
30
Increased respiratory rate in abdominal pain may indicate
Severe pain, metabolic acidosis, or thoracic cause (PE, MI, pneumonia)
31
Cullen's sign
Bluish umbilicus indicating retro peritoneal hemorrhage
32
Grey Turners sign
Discoloration of the flank indicating retro peritoneal hemorrhage
33
Clue: Abdominal pain with high pitched squeaky bowel sounds
Small bowel obstruction
34
Appendicitis symptoms
Peri umbilical pain that migrates to RLQ, anorexia, nausea, vomiting, diarrhea, low grade fever
35
Appendicitis signs
Abdominal tenderness, fever, guarding, rebound tenderness, Rovsimg, psoas, obturator, cervical motion tenderness
36
Appendicitis workup
Clinical diagnosis, abdominal CT, ultrasound preferred in pregnant and children
37
Biliary colic, cholecystitis, cholangitis symptoms
Acute, cramps, colicky RUQ or epigastric pain. May radiate to subscapular area. Nausea, vomiting, fevers, chills
38
Biliary colic, cholecystitis, cholangitis signs
RUQ tenderness, Murphy's sign, fever
39
Biliary colicky cholecystitis, cholangitis workup
Ultrasound, radionuclide scan, LFTs, amylase, lipase
40
Bowel obstruction symptoms
Crampy diffuse abdominal pain, nausea, vomiting, no flatus or stool passage, bloating, history of prior surgery or bowel obstruction
41
Bowel obstruction signs
Abdominal distention, abdominal tenderness, fever, abnormal bowel sounds, peritoneal signs may indicate strangulation
42
Bowel obstruction workup
Abdominal plain films, abdominal CT
43
Diverticulitis symptoms
LLQ abdominal pain, nausea, vomiting, fever, change in stool pattern, constipation, diarrhea, rectal bleeding
44
Diverticulitis signs
LLQ tenderness, guarding, rebound, fever, heme positive stools
45
Diverticulitis workup
Clinical diagnosis, abdominal CT, ultrasound, barium contrast enema
46
Ectopic pregnancy symptoms
Abdominal or pelvic pain, vaginal bleeding, amenorrhea, nausea, vomiting, dizziness, may have referred shoulder pain
47
Ectopic pregnancy signs
Abdominal or pelvic tenderness, adnexal mass, adnexal tenderness
48
Ectopic pregnancy workup
Urine or serum pregnancy test, quantitative bHCG, endovaginal ultrasound, Rh type, hematocrit
49
Gastroenteritis symptoms
Intermittent, crampy abdominal pain, poorly localized pain, diarrhea, nausea, vomiting
50
Gastroenteritis signs
Nonspecific abdominal exam, fever
51
Gastroenteritis workup
Testing usually not necessary
52
Intussusception symptoms
Episodic colicky abdominal pain, nausea, vomiting, bloody stool, diarrhea, poor feeding, episodes of crying and drawing up legs
53
Intussusception signs
Palpable abdominal mass, abdominal tenderness, occult blood in stool, currant jelly stool, dehydration and lethargy
54
Intussusception workup
Abdominal plain films, barium or air contrast enema is gold standard, sometimes therapeutic, ultrasound, abdominal CT
55
Mesenteric ischemia symptoms
Gradual to acute onset, poorly localized, unrelenting pain, nausea, vomiting, diarrhea
56
Mesenteric ischemia signs
Pain out of proportion to examination, may develop hyopvolemoa and sepsis
57
Mesenteric ischemia workup
Serum lactate, abdominal plain films (may show pneumatosis intestinalis, portal vein gas, or thumb printing), abdominal CT, gadolinium enhanced MRA angiography
58
Ovarian torsion symptoms
Abrupt onset, severe unilateral abdominal or pelvic pain, nausea, vomiting
59
Ovarian torsion signs
Unilateral abdominal pain or pelvic tenderness, tender adnexal mass
60
Ovarian torsion workup
Transvaginal ultrasound with color Doppler, exclude pregnancy
61
Pancreatitis symptoms
Severe, dull, epigastric or LUQ pain, radiating to back, vomiting
62
Pancreatitis signs
Abdominal tenderness, abdominal, distention, volume depletion
63
Pancreatitis workup
Amylase, lipase, abdominal CT with contrast
64
Pelvic inflammatory disease symptoms
Lower abdominal pain - dull, constant, poorly localized
| Vaginal discharge, abnormal vaginal bleeding, urinary symptoms, dyspareunia
65
Pelvic inflammatory disease signs
Lower abdominal tenderness, adnexal mass or tenderness, cervical motion tenderness, mucopurulent endocervical or vaginal discharge, fever
66
Pelvic inflammatory disease workup
Cultures for gonorrhea chlamydia, pregnancy test, pelvic ultrasound to exclude tubo-ovarian abscess, consider syphilis and HIV testing
67
Perforated peptic ulcer symptoms
Sudden severe abdominal pain, may radiate to back with posterior ulcers, nausea, vomiting
68
Perforated peptic ulcer signs
Diffuse abdominal pain, acute peritonitis, rigid abdomen, volume depletion, hypotension, tachycardia, fever
69
Perforated peptic ulcer workup
Abdominal plain films - may show free air
| abdominal CT
70
Ruptured or leaking AAA symptoms
Severe abdominal pain, flank or back pain, radiation to groin, thigh, syncope
71
Ruptured or leaking AAA signs
Pulsatile abdominal mass, diffuse abdominal tenderness, abdominal bruit, decreased pulses, hypotension, hematuria
72
Ruptured or leaking AAA workup
Straight to OR, abdominal plain films, ED ultrasound, abdominal CT
73
Testicular torsion symptoms
Sudden onset severe pain in lower abdomen, scrotum, or inguinal area, nausea, vomiting, previous episodes spontaneously resolving
74
Testicular torsion signs
Swollen, tender, firm hemiscrotum, high riding testis with transverse lie, loss of cremasteric reflex
75
Testicular torsion workup
Straight to OR, color Doppler imaging, radionucleide technetium scan
76
Ureteral colic symptoms
Abrupt onset of severe flank pain, radiates to groin, nausea, vomiting
77
Ureteral colic symptoms
Cannot find comfortable position, CVA tenderness, benign abdominal exam, fever if infection, hematuria
78
Ureteral colic workup
Urinalysis, abdominal CT, IVP, ultrasound. KUB
79
Volvulus symptoms
Sudden severe colicky abdominal pain, abdominal distention, may have recurrent episodes, nausea, vomiting, constipation
80
Volvulus signs
Diffuse abdominal tenderness, abdominal distention, tympany, palpable mass if cecal volvulus, peritoneal signs of fever, shock with bowel infarction
81
Volvulus workup
Abdominal plain films, barium enema, sigmoidoscopy
82
RBCs in urine differential
Infection, trauma, rumors, stones
83
Signs of UTI on UA
Pyuria, positive leukocyte esterase, positive nitrites, presence of bacteria
84
Amylase vs. lipase for pancreatitis testing
Serum lipase is more sensitive and specific
85
HIV and acute abdominal pain special added differential
Eneterocolitis with profuse diarrhea and dehydration
Large bowel perforation assoiciated with CMC
Bowel obstruction from kaposi's sarcoma, lymphoma or atypical mycobacterium
Biliary tract disease from cryptosporidium or CMV
Drug induced pancreatitis
86
Chest pain anatomical categories
Heart, lungs, Esophagus, aorta, upper abdomen, chest wall
87
Heart chest pain differential
MI, cardiac angina, pericarditis, myocarditis, valvular diseases
88
Lung causes of chest pain
Pneumonia, pneumothorax, PE, COPD
89
Esophagus causes of chest pain
Esophagitis, GERD, spasm, foreign body, rupture
90
Aorta causes of chest pain
Dissection, aneurysm, aortitis
91
Upper abdomen causes of chest pain
Cholelithiasis, cholecystitis, pancreatitis, duodenal or peptic ulcer, hepatic disease
92
Chest wall causes of chest pain
Costochondritis, contusion, rib fracture, muscle strain or tear, herpes zoster
93
Abdominal pain red flags on history
Sudden onset, pain out of proportion to exam, pregnant, pain with hitting numbs in car, elderly, trauma, syncope, tearing pain, history of vascular disease, history of risk factors for CAD, history of abdominal surgery or bowel obstruction
94
Abdominal pain red flag exam findings
Hypotension, peritoneal signs or rigidity, abdominal distention or bilious emesis, pulsatilla mass, fever with RUQ and jaundice, ascites, blood in stool, benign exam
95
Chest pain red flags history
Elderly, diaphoresis, exertional, radiation to arm/shoulder/neck, post-vomiting, neurological deficit, sudden onset, radiation to back, pleuritic, dyspnea, history of trauma with dyspnea
96
Chest pain examination red flags
Hypotension, diaphoresis, asymmetric pulse or BP, systolic murmur, diastolic murmur, subcutaneous air, neurologic deficit, bilateral rales, focal rales, egophany
97
RF chest pain with neurologic deficit
Aortic dissection
98
RF chest pain with sudden onset
PE, MI, pneumothorax
99
RF chest pain with pleuritic pain
PE, pericarditis, pneumothorax
100
RF chest pain with dyspnea
PE, ACS, COPD exacerbation, pneumonia, pneumothorax
101
RF chest pain with history of trauma and chest pain
Pulmonary contusion, flail chest, cardiac contusion, hemothorax, pneumothorax
102
RF chest pain with hypotension
Tamponade, CHF, sepsis, aortic dissection, PE, tension pneumothorax,
103
RF chest pain with systolic murmur
Aortic stenosis
104
RF chest pain with diastolic murmur
Aortic dissection causing aortic insufficiency
105
RF chest pain with subcutaneous air
Pneumothorax, ruptured esophagus
106
RF chest pain with bilateral rales
Congestive heart failure
107
RF Chest pain with focal rales, egophany
Pneumonia
108
Levines sign
Demonstration of pain with clenched fist against chest associated with cardiac ischemia
109
Nasal cannula flow rate
1-6 liters per minute
110
Nasal cannula oxygen concentration
24-44%
111
Simple face mask flow rate
6-10 liters per minute
112
Smoke face mask oxygenation percent
35-60%
113
Factors in nasal cannula O2 concentration delivered
Depends on flow rate and patients tidal volume
114
Problem with simple face mask
May promote CO2 retention at lower levels
115
Venturi face mask flow rate
2-12 liters
116
Venturi mask oxygen concentration
24-60%
117
Venturi mask use
Accurately controls proportion of O2. Used with chronic hypercarbia (COPD)
118
Face mask with O2 reservoir percent oxygen concentration
65-75%
119
Face mask with O2 reservoir flow rate
12-15 liters per minute
120
Bag mask flow rate
15 liters per minute
121
Bag mask O2 concentration
90-97 percent
122
Blow-by flow rate
6-10 liters per minute
123
Blow-by purpose
For infant or young child who cannot tolerate face mask or nasal cannula
124
Rapid sequence intubation steps
1. Preoxygenation with 100% O2
2. Sequential administration of induction agent and rapidly acting neuromuscular blocking agent
3. Intubation
125
Anticipating difficult larynoscopy mnemonic
LEMON
126
LEMON - L
Look externally
-obesity, abnormal face shape, short bull- neck, face or neck trauma, large or abnormal teeth can make intubation difficult
127
LEMON - E
Evaluate 3-3-2 rule
- 3 patients fingers in mouth
- 3 patients fingers under chin
- 2 patients fingers at top of neck
128
LEMON - M
Mallampati class, 1 and 2 pretty good
1. Faucial pillars, soft palate, uvula visualized
2. Faucial pillars and soft palate visualized
3. Base of uvula visualized
4. Nothing visualized
129
LEMON - O
Obstruction
| e.g. Epiglottitis, peritonsilar abscess, prevertebral abscess, laryngeal mass
130
LEMON - N
Neck mobility
| -cervical spine immobilization and degenerative arthritis can make more difficult
131
Mask seal difficulty mnemonic
MOANS
mask seal problems - beard, crusted blood, face disruption
Obstruction or obesity
Age - >55 have loss of muscle tone in upper airway
No teeth - leave dentures in for bag mask, take out for intubation
Stiff lungs - high airway resistance from asthma, COPD, pulmonary edema, ARDS, restrictive lung disease, pneumonia
132
How much preoxygenation for RSI
5 minutes of 100%
133
What populations desat faster after preoxygenation?
Children, late term pregnant women, obese
134
How long post preoxygenation do patients desat
Healthy adults get 8 minutes till below 90%
| Healthy children get 4 mi uses till below 90%
135
Rapid preoxygenation technique when neccessary
Eight vital capacity breaths from 100% oxygen source
136
Indications for lidocaine in RSI pretreatment
Increased intracranial pressure, reactive airway disease but don't give in high grade heart block
137
Fentanyl indication for pretreatment in RSI
Increased intracranial pressure, ischemic heart disease, aortic dissection (not great in young children)
138
Atropine indication in RSI
Children less than 1 year, adults receiving a second dose of succinylcholine
139
RSI induction choices
Thiopental, methohexital, midazolam, etomidate, ketamine
140
Etomidate RSI profile
Nonbarbiturate, sedative-hypnotic, no analgesia
| Most commonly used
141
Etomidate dose adjustment
50% if hemodynamically unstable
142
Benefits of using etomidate for RSI
Lowers ICP, rarely lowers BP
143
Ketamine RSI profile
Dissociative anesthetic inducing cataplexy. Provides analgesia, amnesia, anesthesia.
144
Ketamine should be used for RSI in
Hypotensive (septic), hypovolemic (hemorrhage), and bronchospastic patients
145
Ketamine physiologic effects
Increased HR, BP, myocardial consumption
| Bronchodilation
146
Ketamine RSI dangers
People with heart disease, with increased ICP
147
Adjunct to prevent laryngospam with ketamine RSI
Atropine
148
Adjunct to reduce hallucinations post ketamine
Lorazepam after intubation
