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ED Flashcards

1
Q

GCS scoring & intubation criteria

A

Eyes: 4 points possibleVerbal: 5 points possibleMotor: 6 points possible GCS < 8 = intubate (…it rhymes)

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2
Q

Tension pneumo presentation, dx, tx*

A

Absent breath sounds
hypotension
JVD
hypoxia

Clinical dx!
CXR: hyperlucent, midline shift (away), flattened diaphragm

Tx: STAT needle decompression* w/ 14 gauge @ midclavicular line 2nd intercostal space ==> thoracostomy (chest) tube

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3
Q

Systolic BP estimation

A

Carotid pulse = 60
Femoral = 70
Radial = 80

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4
Q

ED thoracotomy indications

A

Chest trauma w/ cardiac arrest in hospital or just before arriving

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5
Q

Warning signs for not placing foley in trauma patient, management, sequelae:

A 
High riding prostate
Non palpable prostate
Ballotable prostate
Pelvic fx
Urethral blood
Perineal echymoses
Blood in scrotum

Dx: retrograde urethrogram BEFORE foley ==> *always do one before surgical penile intervention

Foley could cause abscess and/or worsen tear

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6
Q

ICP elevation signs, tx

A 
Cushing: 
Bradycardia + hypertension + respiratory depression
Fixed, dilated pupil
Respiratory depression
Vomiting
Papilledema
Oculomotor nerve is first compressed

*Tx: mannitol, hyperventilation, surgery

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7
Q

Epidural hematoma path, hx, PE, dx

A

Arterial bleed

Loss of consciousness ==> lucid interval
Ipsilateral pupil dilation, contralateral hemiparesis

CT: biconvex, lens shaped bleed

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8
Q

Diffuse axonal injury hx, dx*

A

Rapid deceleration injury

CT: blurring & punctate hemorrhage at grey-white junction

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9
Q

Subdural hematoma path, dx

A

Vein bleed

Crescent shaped bleed that CAN cross suture lines

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10
Q

Aortic dissection/disruption presentation, dx, tx

A

Rapid deceleration injury
Hoarse or quiet voice 2/2 laryngeal nerve injury
HYPERtension 2/2 vasoconstriction in non-damaged upper extremities

CXR: >8cm mediastinum, loss of aortic knob, deviated trachea
Angiography +/- TEE

Surgery

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11
Q

Flail chest definition, PE, tx

A

3+ adjacent ribs fractured in 2+ places==> inward motion with inspiration

Hyperventilation 2/2 shallow breathing
Progresses to respiratory failure

Pain control
O2
Intubation with PEEP if severe

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12
Q

Pulseless electrical activity (pea) ddx

A 
5H5T
Hypotension
Hyper/hypo K+
Hydrogen (acidosis)
Hypothermia
Hypoxia
Tablets (drugs)
Tension pneumo
Tamponade 
Thrombosis: cardiac
Thrombosis: pulmonary
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13
Q

Kehr’s sign*

A

Referred shoulder pain 2/2 diaphragm injury

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14
Q

Pelvic fx presentation, tx

A

Hypotension with negative FASTX-ray

FLUIDS!
External binder
Embolization and/or surgery

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15
Q

Fat embolism hx, PE

A 
Trauma w/ fracture
Fever
Tachypnea
Tachycardia
Petechia
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16
Q

Positive beta-HCG plus abdominal pain =

A

Ruptured ectopic until proven otherwise

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17
Q

Female abdominal pain diagnostic not to miss

A

Pelvic exam and beta-HCG

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18
Q

Burn BSA estimation

A 
Arm: 9%
Head: 9%
Leg: 18%
Back: 18%
Chest: 18%
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19
Q

Burn degrees w/ associated PE findings, workup, tx

A

1- epidermis only: red, +capillary refill, no blisters
2- partial dermis: blistered
3- full dermis and into fat: white, painless(!)

BSA assessment
Carboxyhemoglobin levels
Cyanide levels

Parkland formula for 24 hr fluids: 4x Kg x%BSA ==> 50% given in first 8 hours
Tetanus ppx
Stress ulcer ppx

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20
Q

Appendicitis presentation, dx (normal vs abscess)*, tx (normal & abscess)

A

Mcburneys: RLQ pain 1/3 toward ASIS
Rosving: LLQ palpation creates RLQ pain
Psoas: RLQ pain with passive hip extension
Obturator: RLQ pain with hip internal rotation when flexed Hamburger: anorexia
Usually rebound or guarding

Dx: clinical but CT (PO and IV contrast) if equivocal or u/s if child or pregnant
Abscess: delayed presentation, inconclusive McBurney’s point, +Psoas sign (aggravates posteriorly)

ALWAYS: broad spectrum abx
Surgery unless abscess (wait 6 weeks)

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21
Q

When to transfer burn patient to critical burn unit

A

> 10% BSA if child or old

>20% BSA if healthy

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22
Q

Vital sign changes in shock

A

HR increases first

BP doesn’t fall until 30% volume loss

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23
Q

Post-op fever ddx w/ timing*

A

Transfusion rxn (immediately post-op)NMS/malignant (immediately post-op)>24hrs post-op: 6WsWind: [1-2 days] atalectasis, pneumonia, PE Water: [3-5] UTIWalking: [4-6] DVTWound: [5-7] infection (clostridium, beta hemolytic strep)Wonder drugs: [7+] many drugs, especially TMP/SMX, anticonvulsant*Womb: endometritis

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24
Q

Types of shock w/ CO & when to use pressors

A 
Hypovolemic:  CO decreases ==> no pressors! 
Cardiogenic:  CO decreases ==> pressors
Obstructive:  CO decreases
Septic:  CO increases ==> pressors
Anaphylactic:  CO increases ==> epi!
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25
Hypothermia dx, tx*
T < 95 ECG: bradycardia + AF + J-wave [hump after QRS] Systemic: rapid infusion of warm liquid Frostbite: RAPID rewarming with warm water
26
Hyperthermia dx, tx
T > 104 Dantrolene: NMS or malignant hyperthermia 2/2 halothane Benzo: to prevent shivering Anything cool!
27
Rabies animals, tx
Bats, dogs, cats, ferrets, skunks, raccoons Monitor domestic animal for 10 days; immediately kill rodents for testing If unvaccinated: 1 dose Rabies Ig and 4 doses rabies vaccine If vaccinated: 2 doses vaccine
28
CO poisoning presentation, dx, tx
Smoke exposure... Headache, confusion, myalgia Cherry red skin (rare) NORMAL pO2 (O2 just isn't unloading) ABG: serum carboxyhemoglobin >5 (or >10 if smoker) O2, hyperbaric if severe Intubate: low threshold
29
Abdominal trauma laparotomy indications**
If penetrating trauma: > 5th intercostal, unstable or peritonitis ``` If blunt trauma: Unstable ==> FAST or DPL ==> OR if positive ==> CT if negative If stable, CT for anatomical help ```
30
Pulmonary contusion* vs ARDS*
CXR: patchy alveolar infiltrate in both Contusion: hypoxic respiratory alkalosis within 24 hours post-trauma; chest pain & SOB; worsens with fluids! ARDS: 24-48 hours post-trauma; necessarily bilateral
31
Burn intubation criteria*
Very liberal: anything from singed eyebrows to stridor...be more careful than not
32
AAA presentation*, dx, tx*
Abdominal and/or back pain Syncope Hematuria* Hypotension If suspicious ==> OR CT if not unstable
33
Rib fx presentation, dx, tx*
Localized tenderness 2/2 trauma CXR: MAY NOT show fracture Pain meds ==> nerve block to PREVENT ATALECTASIS & PNEUMONIA 2/2 hypoventilation
34
Acute mediastinitis presentation, dx, tx, complication*
Recent sternotomy Chest pain Septic-looking Leukocytosis CXR: MEDIASTINAL WIDENING* Tx: immediate debridement & abx *A-fib can occur, but don't anticoagulate/cardiovert until after surgery
35
Myocardial contusion presentation, dx*
[Cardiogenic shock] Hypotension Tachycardia ``` Elevated PCWP (>14) increasing w/ fluid +Cardiac markers EKG changes ```
36
Trauma fluid resuscitation challenge dx, tx
If IVF doesn't increase >100 systolic ==> exlap without need for FAST CXR etc.
37
Leriche syndrome path, presentation*
Thrombosis @ iliac branch point Triad: bilateral hip/thigh/butt claudication + LE atrophy + impotence
38
Often overlooked management of spinal cord trauma*
Bladder catheterization ==> assess for retention to prevent distention damage
39
Parotitis path, presentation*
Post-op parotid infection, often S. aureus 2/2 poor oral hygiene & fluids Jaw pain, swelling, purulence
40
Post-op atalectasis path, dx**, tx
Impaired cough & shallow breathing NO FEVER Hypoxic (pO2 < 35; pH > 7.4) Spirometry
41
Mechanisms to lower ICP (with path*)
Hyperventilation: decrease CO2 ==> cerebral vasoconstriction (dilation increases ICP...opposite of BP) Sedation: reduce metabolic demand ==> vasoconstriction Head elevation: increase venous outflow Mannitol
42
INR reversal values & options*
INR > 1.5-ish Immediate: FFP Longer-term: vitamin K
43
pRBC transfusion threshold*
Hgb <7
44
Malignancy arising from non-healing wound*
SCC
45
Anterior, posterior, and central cord syndrome findings**
Anterior: bilateral motor paresis pain/temperature loss Posterior: ["P"roprioception] bilateral proprioception/vibration loss Central: UE weakness with preserved LE function
46
Brown sequard syndrome path, presentation*
Cord hemisection Ipsilateral motor loss Contralateral pain/temperature loss
47
Respiratory quotient (RQ) meaning & associated values
CO2 produced / O2 consumed normally = 0.8 Carb > 0.8 Protein or fat < 0.8
48
Escharotomy vs fasciotomy
Fasciotomy goes deeper and should be performed only if escharotomy does not relieve symptoms
49
Imaging/discharge rules for TBI*
1. No CT "minor" trauma [GCS 15, no neuro abnormalities, no skull fracture evidence] "mild" TBI [GCS 13-15] without headache, vomiting, LOC 2. CT & discharge if normal "mild-moderate" TBI [GCS 9-15] or headache, vomiting, LOC 3. CT & admit: "severe" TBI [GCS <8] or prolonged LOC, skull fx, focal neurologic deficit, seizure
50
Clavical fx presentation, dx*, tx
Holding arm with opposite hand XR ==> if broken ==> REQUIRES bruit exam, angiography & neuro exam to r/o subclavian and brachial plexus injury middle third fx: closed reduction distal third fx: ORIF
51
Ludwig angina path*, presentation, tx
Infected molar ==> bilateral submandibular/sublingual gland infection 2/2 strep or anaerobe Pain, induration, swelling, fever, drooling Abx Remove tooth Intubate if necessary ==> asphyxiation risk!
52
Commonly injured organs in blunt abdominal trauma w/ presentation*, dx
1. Spleen Abdominal pain / nausea Kehr sign: L shoulder pain 2/2 diaphragmatic irritation Ultrasound ==> if inconclusive & stable ==> CT 2. Pancreas Abdominal pain / nausea Retroperitoneal abscess: chills, fever May be missed on initial CT
53
AAA screening*
Men 65+ who ever smoked
54
Ankle brachial index (ABI) use & values*
Use if: symptomatic claudication of extremities cramping with activity or at rest 0.9-1.3 = normal ankle to brachial ratio
55
Fat necrosis of breast presentation, dx*, tx
Trauma or surgery Mimics breast cancer presentation U/S, mammography mimic breast cancer calcification *Core biopsy differentiates: foamy macrophages and fat globules No intervention
56
Splenic dysfunction prophylaxis*
Vaccinate against: N. meningitidis H. influenzae S. pneumo (q5)
57
Sringomyelia path, presentation*
Impaired CSF drainage @ cervical cord 2/2 trauma or arnold-chiari UE weakness Loss of pain/temperature sensation in UE and/or cape-like Preserved vibration/proprioception
58
Acute vs chronic pericardial tamponade*
Acute (2/2 trauma) requires little fluid to cause tamponade, thus CXR will not show enlarged mediastinum Both show hypotension, tachycardia, JVP
59
Pilonidal cyst presentation*, tx
Painful purulent swelling over coccyx, midline in gluteal cleft I&D
60
Post-op oliguria tx*
FIRST: change catheter to r/o obstruction SECOND: fluid challenge if suspecting pre-renal AKI
61
Intraductal carcinoma path, presentation*
Benign breast tumor Unilateral bloody nipple discharge No appreciable mass
62
Bladder rupture anatomical site and presentation*
Bladder dome Abdominal pain with Kehr sign (referring to shoulder)
63
DVT treatment*
Heparin ==> warfarin ==> goal INR 2-3
64
Nasopharyngeal carcinoma risk factors*
EBV infection Smoking Eastern & Mediterranean descent
65
Hemothorax presentation*
Hypovolemia ==> flat neck veins Dullness to percussion on affected side Decreased breath sounds on affected side Tracheal shift away from affected side (if massive)
66
Diaphragmatic hernia presentation*, dx*
2/2 blunt trauma Respiratory distress...though sometimes asymptomatic XR: hemidiaphragm elevation (usually L-sided bc liver protects right), mediastinal/tracheal deviation NG tube goes into thorax CT: required for definitive diagnosis
67
Inflammatory breast carcinoma presentation, dx*
Unilateral inflammatory nodule "Peau d' orange" appearance Palpable axillary LN Nipple discharge Biopsy for histology
68
Torus palatinus path, presentation*, tx
Congenital bony growth Hard, non-tender bony growth @ midline mouth palate No surgery unless symptomatic
69
How to preserve amputated tissue in the field*
Wrap in saline moistened gauze ==> put on ice
70
Central line procedure*, complications*
Insert into SVC ==> CXR to confirm placement ==> heparin flush Aortic perf Pneumothorax Hemothorax Myocardial perf ==> tamponade
71
Anaphylaxis dx*, tx*
Symptoms in MORE THAN ONE organ system: Skin: hives GI: lip swelling, vomiting Respiratory: wheezing Cardio: hypotension IM epinephrine

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