CR - Miscellaneous Flashcards
(23 cards)
What is the most frequent cause of malpractice claims against emergency physicians?
Failure to diagnose fractures and/or dislocations
The most costly cause of malpractice for emergency physicians is?
Failure to diagnose MI
What is the purpose of off line (indirect) medical control of EMS?
Development of prehospital protocols, training and credentialing of EMS providers, quality assurance and performance improvement, identification and implementation of best practices, disaster preparedness, representation of EMS care to political leaders, and research
In a disaster situation, a patient with uncontrolled major hemorrhage, but the ability to respond, no respiratory distress, and intact peripheral pulse would be categorized as ___ based on the SALT or START triage algorithm
Immediate / Red (first priority)
The SALT disaster criteria classifications are expectant, immediate, delayed minor, and deceased
Red, yellow, green, and black for START triage.
Uncontrolled major hemorrhage in a patient who is otherwise expected to survive would be immediate (SALT) or red (start)
In the hospital phase of disaster management, where should the hospital incident command center be located?
In close proximity to, but not in the emergency department
Incident command posts should be located close enough to allow the incident commander to observe operations but far enough away to provide safety and shelter form the noise and confusion that accompanies normal operations
What are the strategies / recommendations used in scheduling night shifts that will be least disruptive to the body’s natural circadian rhythm?
The “gold standard” is to not change shifts at all - work the same shift all the time and keep the same sleep pattern
Working only one or two night shifts in a row is the next best strategy because it minimizes circadian disruption
If rotating shifts cannot be avoided it is best to rotate all shifts in a clockwise direction with a minimum of one month per rotation
Scalded skin syndrome is usually caused by a ____ in children.
Toxic epidermal necrolysis on the other hand is most often caused by ____ in adults
Staphylococcal infection (children)
Drug/toxin reaction (adults)
The “herald patch” is most closely associated with what disease process?
Pityriasis rosea
Clinical presentation: a patient presents with a rash after recently starting a thiazide diuretic for hypertension. The rash is diffuse, markedly erythematous, mildly warm to the touch and with scaling and flaking
What is the most likely diagnosis?
Exfoliative erythoderma
Most commonly associated with psoriasis, also secondary to medication reactions (such as thiazides) or malignancy
Clinical presentation: an elderly man with a history of prostate disease with urinary tract infections presents with fever, a systolic BP < 100, and a rash. The lesions are necrotic ulcers with erythematous borders.
Which organism is the likely offender?
Ecthyma gangrenosum is most commonly caused by pseudomonas aeruginosa infection and associated bacteremia.
The rash beginas as pustules and evolves hemorrhagic centers which then become necrotic ulcers
Wood’s light examination is helpful in diagnosing which skin disorders?
Angioedema associated with ace-inhibitors has a predilection for which areas of the body?
Lips, tongue, and laryngeal soft tissues
This should be treated as an airway emergency with early intubation considered before the laryngeal tissues become too swollen
Which medication is the most common cause of a drug reaction?
Penicillin antibiotics (especially ampicillin)
What is the treatment for paronychia?
Without an abscess: warm water and antiseptic (chlorhexidine) soaks and topical triple antibiotic ointment
If not improving: add oral antibiotic therapy for staph and strep coverage such as cephalexin or TMP/Sulfa
With an abscess: incision and drainage along with the above mentioned soaks and oral antibiotic therapy. For ingrown nails consider partial nail plate removal
How does one treat a felon
Early felon without abscess: elevation, oral antibiotics with staph coverage (clindamycin, cephalexin, or TMP/sulfa), and warm water soaks
Felon with abscess: incision and drainage with lateral volar approach to break up fibrous septae, IV antibiotics (clindamycin)
Regarding puncture wounds of the foot:
name 5 major complications that can occur
If the puncture occurred through a shoe, what organism is classically associated with this injury and becomes much more likely to become the cause of subsequent infection?
- Cellulitis, abscess, septic arthritis, necrotizing deep tissue infection, and osteomyelitis
- pseudomonas aeruginosa as the causative organism is markedly increased when the puncture wound occurs through a shoe, however staph is still the most common causative agent
How is skin abscess best treated in the emergency department?
Incision and drainage
Antibiotics are only required for concomitant surrounding cellulitis
What are the limitations of pulse oximetry
Pulse oximetry provides information on oxygenation but only indirectly assesses ventilation and does not provide pH or pCO2 levels.
Waveform may be poor or reading inaccurate due to vasoconstriction, patient movement, interference with transfer through nail bed (nail polish), improper positioning, and alterations in hemoglobin (carboxyhemoglobin, methemoglobin, severe anemia)
In a haz-mat incident, decontamination is best performed in the ___ setting
Prehospital: decontamination operations should be set up in the “warm zone”, close enough to the incident source to allow timely decon but far enough away from the hazard that decon workers are not in immediate danger
However, hospitals should have their own decon areas given some patients may present to the hospital by private vehicle or before decon operations can be established at the scene
If a patient has a wound which require suturing, but the patient reports they are allergic to lidocaine, what are the alternative options for local anesthesia?
- use an ester such as benzocaine, procaine, or tetracaine
- use injectable diphenhydramine as a local anesthetic
- apply benzonatate topically to the wound
- consider conscious sedation for more extensive wounds
- If the allergy does not include diffuse hives or anaphylaxis, inject a small amount of lidocaine and observe the patient for 30 minutes prior to proceeding with the remained of the wound repair
True or false: there is no significant difference in infection rates when using clean nonsterile gloves rather than sterile gloves in repairing uncomplicated lacerations
True
What are the first 2 priorities to determine when encountering a patient in the wilderness setting?
Is the scene secure to you or are you in an immediate risk by approaching the patient
Does the patient need help
What intervention provides the most significant outcome difference in the mass casualty or wilderness setting?
Hemorrhage control
