EM Flashcards
(215 cards)
1
Q
What are the ABCDs of acute management of patients?
A
Airway Breathing Circulation Disability Exposure
2
Q
Under what GCS score is intubation indicated?
A
GSC under 8, intubate!
3
Q
What is the treatment for hemoperitoneum?
A
Surgery
4
Q
What is the role of placing a foley catheter in the hemodynamically unstable patient?
A
Monitor urine output in those receiving fluids
5
Q
When is a CT neck/ spine indicated in a trauma patient?
A
Neck pain / TTP
Neurological findings
Depressed mental status
6
Q
What are the three main components of the GCS coma scale? How many points are in each category?
A
Eye opening 4 (EYES)
Verbal response 5 (VOICE)
Motor response 6 (ARM+ LEG)
7
Q
What are scores for 1-4 for the eye opening portion of the GSC scale?
A
4 = spontaneous 3 = opens to command 2 = opens to pain 1 = none
8
Q
What are scores for 1-5 for the verbal response portion of the GSC scale?
A
5= Oriented 4 = confused speech 3 = inappropriate words 2 = incomprehensible 1 = None
9
Q
What are scores for 1-6 for the motor response portion of the GSC scale?
A
6 = follows commands 5 = localized pain 4 = Withdraws to pain 3 = Flexion 2 = extension 1 = none
10
Q
What is the classic triad for cardiac tamponade?
A
Muffled heart sounds
JVD
Hypotension
11
Q
What are the components of circulation management in the trauma / unstable patient?
A
Assess pulses
Control bleeding
IVFs PRN
12
Q
What are the components of the disability part of the primary assessment?
A
GCS score
13
Q
What are the components of the exposure part of the primary assessment?
A
Disrobe pt and inspect
Cover pt
14
Q
A rough estimate of systolic BP (SBP) can be made on the basis of palpated pulses; Carotids correspond roughly to an SBP of what?
A
60 mmHg
15
Q
A rough estimate of systolic BP (SBP) can be made on the basis of palpated pulses;Femorals correspond to a rough SBP of what?
A
70 mmHg
16
Q
A rough estimate of systolic BP (SBP) can be made on the basis of palpated pulses; Radial correspond to a SBP of what?
A
80 mmHg
17
Q
All wounds that penetrate what anatomical structure are considered true penetrating neck trauma?
A
Platysma
18
Q
What is indicated in the ABCDEs of patients with penetrating neck traumas?
A
Intubation before airway is compromised
19
Q
Immediate surgical exploration of neck wounds is indicated if what?
A
If shock and active hemorrhage are present
20
Q
What testing is indicated in the treatment of penetrating neck trauma?
A
Angiography of the neck
Doppler US
Contrast esophagram
21
Q
True or false: intubation is indicated in all cases of thoracic trauma with penetrating injuries
A
True
22
Q
When is an open thoracotomy indicated to rule out pericardial effusion with penetrating chest trauma?
A
If patient goes into cardiac arrest in ED or shortly before arrival
23
Q
If a patient with a chest trauma suddenly becomes hemodynamically unstable, what should be at the top of the differential?
A
Air embolism
24
Q
A new diastolic murmur after chest trauma suggests what?
A
Aortic dissection
25
Penetrating trauma to areas lower than what anatomic landmark warrants abdominal investigation?
Nipple line
26
What are the indications for surgical exploration in penetrating stab wounds to the abdomen?
Hemodynamic instability or evisceration
27
What is the next step in diagnostic evaluation of an abdominal stab wound in the stable patient?
CT a close f/u
28
What are the first steps in MS injures?
Early wound irrigation
Wound debridement
Tetanus prophylaxis
29
Vascular injuries usually require what diagnostic evaluation and management?
Arteriography
30
Nerve injuries usually require what sort of management?
Surgical
31
What should always be assessed for with blunt head trauma, besides bleeding, fractures, and neuro?
Increased ICP
32
What is the stabilizing treatment for increased ICP? (3)
Head elevation
Hyperventilation
IV mannitol
33
What are the CT characteristics of diffuse axonal injuries?
Blurring and punctate hemorrhaging along the gray-white matter junction
34
Blurring and punctate hemorrhaging along the gray-white matter junction on a head CT indicates what sort of trauma?
Rapid-deceleration injuries leading to diffuse axonal injury
35
What are the shape of epidural hematomas? Can they cross suture lines?
Lenticular
| Cannot cross suture lines
36
What artery is classically indicated in epidural hematomas?
Middle meningeal artery
37
What type of hematoma is characterized by a lucid interval"?
Epidural
38
What is the shape of subdural hematomas? Can these cross suture lines?
Follow the curve of the skull (crescentic)
| Cross suture lines
39
What is/are the artery/arteries that are implicated in subdural hematomas?
Briding veins
40
Tracheobronchial disruption is most often caused by what sort of trauma?
Deceleration shearing forces
41
What are the PE findings of tracheobronchial disruptions?
Respiratory distress
Hemoptysis
Sternal TTP
Subcutaneous emphysema
42
Blunt cardiac injury may manifest how on an EKG?
New BBB
Ectopy
Dysrhythmia
43
True or false: blunt cardiac injury rarely requires intervention
True
44
What is the pathophysiology of pulmonary contusion?
Damage to capillaries and leakage of intra and extravascular fluid, causing hypoxic
45
What is the mainstay of treatment for pulmonary contusion?
Diuretics and fluid restriction, and airway support
46
What will a CXR show with pulmonary contusion?
Patchy alveolar opacities
47
What is the classic cause of aortic disruption?
Rapid-deceleration injury
48
Aortic disruption is often associated with what bony fractures? (4)
- 1st rib
- Second rib
- Scapular
- Sternal
49
What causes the hoarse voice that may appear with an aortic disruption?
Pressure on the recurrent laryngeal nerve
50
What causes a flail chest (physically)?
Three or more adjacent ribs, fractured at two points
51
What is the treatment for a flail chest?
O2, narcotic analgesia
52
What is the major complication of a flail chest?
Respiratory compromise
53
What is the most common solid organ to be traumatized in the abdomen? Second most common?
Spleen
| Liver
54
What is Kehr's sign?
Referred pain to the shoulder from peritoneal irritation
55
What is the duodenum susceptible to traumatic injury?
Sits right in front of the spine
56
What are the radiographic findings of a diaphragmatic rupture?
Elevated hemidiaphragm
57
What is the most commonly injured GU organ?
Kidneys
58
True or false: hemodynamically unstable patients with blunt abdominal trauma should undergo immediate exploratory lap
True
59
What is the immediate treatment for a pelvic fracture?
External binder
60
What is the treatment for a pelvic fracture?
Early resuscitation
| Angiography with embolization of bleeding vessels
61
Why do pelvic fractures tend to occur in multiple places?
Ring-like structure
62
What are the exam findings of a urethral injury?
High riding prostate
Blood at the urethral meatus/scrotum
Non-palpable prostate
63
What test is needed to r/o a urethral injury prior to catheter placement?
Retrograde urethrogram
64
What are the 5 H's of PEA?
```
Hypothermia
Hypovolemia
Hypoxia
H+
Hyper/hyp K
```
65
What are the 5 T's of PEA?
```
Tablets: drug overdose, ingestion
Tamponade: cardiac
Tension pneumothorax
Thrombosis: coronary
Thrombosis: pulmonary embolism
```
66
What Joules is used when shocking v-fib/pulseless v-tach?
120-200 J (biphasic)
67
What is the treatment for unstable SVT?
Shock
68
What is the treatment for stable SVT?
Adenosine, then beta blockers/CCBs
69
How many hours in a-fib is a contraindication to cardioversion?
48 hours
70
What is the treatment for symptomatic bradycardia?
Atropine
Dopamine
Epi
Transcutaneous pacing
71
Sudden onset abdominal pain with rigidity = ?
Perforated bowel
72
How can pneumonia cause upper abdominal pain?
Diaphragmatic irritation
73
A ⊕ β-human chorionic gonadotropin (β-hCG) in the setting of shock is what until proven otherwise.
Ruptured ectopic pregnancy
74
True or false: peritoneal signs warrant surgical exploration
True
75
What are the two exam that are needed with abdominal pain?
Rectal
| Pelvic
76
What is the classic presentation of a fat embolism?
fever, tachypnea, tachycardia, conjunctival hemorrhage, and upper extremity petechiae after a patient suffers longbone fractures.
77
When is an NG tube needed for decompression of the stomach?
In the setting of bowel obstruction
78
What is the diagnostic work-up for appendicitis?
CT with PO and IV contrast or US
79
What is the treatment for a rupture appendix?
Abx until afebrile
80
What is the treatment for a psoas abscess?
Broad spectrum abx and percutaneous drainage
81
What are the rule of 9's relating to burns and surface areas?
Head and each arm = 9%, each
Back and chest each = 18%
Each leg = 18%
Perineum = 1%
*Patient’s palm (including fingers) represents about 1% of total BSA in adults and children.
82
What is the parkland formula for calculating IVFs needed in burn patients?
Fluids for the first 24 hours = 4 × patient’s weight in kg × % BSA.
Give 50% of fluids over the first 8 hours and the remaining 50% over the following 16 hours.
83
What are first degree burns?
BUrns that only involve the epidermis
84
What are second degree burns?
Burns that involve epidermis and dermis
85
What are third degree burns?
Burns that involve dermis, epidermis, and SQ tissue
86
What type of burns have blisters?
2nd degree
87
What is the appearance of third degree burns?
Painless, white, and charred
88
If there is evidence of airway involvement with burn patients, what needs to be done?
Intubate
89
What are the 6 w's of post operative fever?
```
Wind: pneumonia
Water: UTI
Wounds:
Walking: DVT
Wonder drugs: rxn
Womb: Endometritis
```
90
What topical antimicrobial can be used to treat burns?
Silver sulfadiazine
91
What cause compartment syndrome from burns?
Circumferential burns causing stricture
92
What is the implicated organism in shock from burns?
Pseudomonas
93
What is the first sign of shock?
Tachycardia
94
What should be given first: pressors or IVFs
IVFs
95
What is the treatment for neuroleptic malignant syndrome? Malignant hyperthermia?
IV dantrolene
96
What usually causes immediate shock?
Drugs, malignant hyperthemia
97
What is the definition of acute shock, and what usually causes it?
Within 1st week post op
| Infections
98
What is the definition of subacute shock, and what usually causes it?
Onset 1-4 weeks post op
Wounds, DVT
99
What is the definition of delayed shock, and what usually causes it?
Onset more than 1 month
Viral infection
indolent bacterial infx
100
How long should domestic animals be kept after biting a human to r/o rabies?
10 days
101
What happens to the following in hypovolemic shock:
- Cardiac output
- PCWP
- PVR
- Cardiac output = decreased
- PCWP = decreased
- PVR = increased
102
What happens to the following in cardiogenic shock:
- Cardiac output
- PCWP
- PVR
- Cardiac output = Decreased
- PCWP = Increased
- PVR = increased
103
What happens to the following in obstructive shock:
- Cardiac output
- PCWP
- PVR
- Cardiac output = Decreased
- PCWP = increased
- PVR = Increased
104
What happens to the following in distributive shock:
- Cardiac output
- PCWP
- PVR
- Cardiac output = Increased
- PCWP = Decreased
- PVR = Decreased
105
What is the treatment for neurogenic shock?
Pressors and IVFs
106
What is the treatment for hypovolemic shock
fluids:blood in a 3:1 ratio
107
What is the definition of hypothermia?
Temp less than 35 C or 95 F
108
What are the three major endocrine abnormalities that can cause hypothermia?
Hypothyroidism
Hypoadrenalism
Hypoglycemia
109
What is the classic EKG finding associated with hypothermia?
J (osborne) wave
110
True or false: never stop resuscitation efforts on a hypothermic patient until they have been rewarmed
True
111
What is the treatment for unstable, hypothermic patients?
Core rewarming:
- NG or bladder lavage
- Cardiac bypass
112
What is the definition of hyperthermia?
More than 40 C or 104 F
113
Should deep bites be sutured closed?
No
114
What is the treatment for hyperthermia?
Cold water, wet blankets, ice
Benzo to prevent shivering
115
What are the s/sx of *chronic* CO poisoning?
ILI
116
What is the classic electrolyte abnormality with spider bites?
Hypocalcemia
117
What are the s/sx of scorpion bites?
Cranial nerve dysfunction
| Respiratory compromise
118
What is the treatment for scorpion bites?
Benzos and analgesics
| Atropine for hypersalivation and respiratory distress
119
What is the treatment for snake bites? (3)
- Antivenom
- Keep affected limb below the heart
- Compression bands, but NOT tourniquets
120
Do rodents carry rabies? Treatment?
Not known to
| Just local wound care
121
When is ipecac syrup indicated?
Never--makes matters worse with emesis
122
What is the treatment for rabies infx?
1 dose of human rabies immunoglobin
| 4 doses of rabies vaccine / 14 days
123
When should tetanus immunoglobulin be given?
If patient has had less than 3 lifetime toxoid vaccines and wound is major/dirty
124
When is orogastric lavage ("pumping stomach") indicated?
Life-threatening intoxications less than 1 hours after ingestion
125
What are the p450 inducing agents?
```
Barbs
St. John's wort
Phenytoin
Rifampin
Griseofulvin
Carbamazepine
```
“Barbara Steals Phen-phen and Refuses Greasy Carbs.”
126
What are the p450 inhibitors?
```
Acute alcohol abuse
Ritonavir
Amiodarone
Cimetidine/cipro
Ketoconazole
Sulfonamides
INH
Grapefruit juice
Quinidine
Macrolides
```
"AAA RACKS IN GQ Magazine"
127
What are the four major substrates of the p450 enzymes?
Anti-epileptics
Theophylline
Warfarin
OCPs
128
What are the drugs that can cause pulmonary fibrosis? ("My Nose Cannot BReathe BAd Air)
```
Methotrexate
Nitrofurantoin
Carmustine
Bleomycin
Busulfan
Amiodarone
```
129
What are the sulfa drugs? ("scary sulfa Pharm FACTS"
```
Sulfonamide
Sulfasalazine
Probenecid
Furosemide
Acetazolamide
Celecoxib
Thiazides
Sulfonylureas
```
130
What drugs cause photosensitivity ("SAT For Photo")
Sulfonamides
Amiodarone
Tetracyclines
5-FU
131
What are the drugs that can cause gynecomastia ("Some Drugs Create Awesome Knockers")?
```
Spironolactone
Digitalis
Cimetidine
Alcohol
Ketoconazole
```
132
What is the treatment for acetaminophen poisoning?
N-acetylcysteine
133
What is the treatment for acid/alkali poisoning?
Upper endoscopy to evaluate for stricutes
134
What is the treatment for anticholinesterase /organophosphates poisoning?
Atropine
| Pralidoxime
135
What is the treatment for anticholinergic poisoning?
Physostigmine
136
What is the treatment for Arsenic poisoning?
Succimer
| Dimercaprol
137
What is the treatment for Hg poisoning?
Succimer
| Dimercaprol
138
What is the treatment for Au poisoning?
Succimer
| Dimercaprol
139
What is the treatment for beta-blocker poisoning?
Glucagon
140
What is the treatment for Barbiturate poisoning?
Urine alkalinization
| Dialysis
141
What is the treatment for benzo poisoning?
Flumazenil
142
What is the treatment for black widow spider bite?
Ca-gluconate
143
What is the treatment for Cu poisoning?
Penicillamine
144
What is the treatment for Pb poisoning?
Penicillamine
| Dimercaperol
145
What is the treatment for cyanide poisoning?
Hydroxocobalamin
| Sodium nitrate
146
What is the treatment for digitalis poisoning?
Normalize K+
| Digibind
147
What is the treatment for heparin poisoning?
Protamine sulfate
148
What is the treatment for INH poisoning?
Pyridoxine
149
What is the treatment for Fe poisoning?
Deferoxamine
150
What is the treatment for Methanol poisoning?
EtOH
| Fomepizole
151
What is the treatment for methemoglobinemia?
Methylene blue
152
What is the treatment for opioid poisoning?
Naloxone
153
What is the treatment for salicylate poisoning?
Urine alkalinization
154
What is the treatment for TCA poisoning?
Na2CO3
155
What is the treatment for theophylline poisoning?
Activated charcoal
156
What is the treatment for tPA poisoning?
Aminocaproic acid
157
What is the classic side effect of amantadine?
Livedo reticularis
158
What is the classic side effect of aminoglycosides?
Ototoxicity
159
What is the classic side effect of amphotericin?
Nephrotoxicity
| Myelosuppression
160
What is the classic side effect of azoles?
p450 inhibition
161
What is the classic side effect of AZT
Thrombocytopenia
| Megaloblastic anemia
162
What is the classic side effect of beta blockers
Asthma exacerbation
| Masking hypoglycemic symptoms
163
What is the classic side effect of Bile acid resins
GI upset
164
What is the classic side effect of carbamazepine
Agranulocytosis
165
What is the classic side effect of CCBs
Peripheral edema
166
What is the classic side effect of Chloramphenicol
Gray baby syndrome
167
What is the classic side effect of cisplatin
Nephrotoxicity
| Acoustic nerve damage
168
What is the classic side effect of clonidine
Severe rebound HA and HTN
| alpha 2 agonist
169
What is the classic side effect of Clozapine
Agranulocytosis
170
What is the classic side effect of cyclophisphamide
Hemorrhagic cystitis
171
What is the classic side effect of Digoxin
Yellow visual changes and arrhythmias
172
What is the classic side effect of doxorubicin
Dilated cardiomyopathy
173
What is the classic side effect of furosemide
Ototoxic
174
What is the classic side effect of gemfibrozil?
Myositis, increased LFTs
175
What is the classic side effect of Halothans
Malignant hyperthermia
| Hepatotoxic
176
What is the classic side effect of HCTZ
Hypokalemia
Hyponatremia
Hyper everything else
177
What is the classic side effect of hydralazine
Drug induced SLE
178
What is the classic side effect of hydroxychloroquine
Retinopathy
179
What is the classic side effect of INH
Peripheral neuropathy 2/2 loss of B6
180
What is the classic side effect of MAOIs
Hypertensive tyramine rxn
| Serotonin syndrome
181
What is the classic side effect of methanol
Blindness
| Anion gap metabolic acidosis
182
What is the classic side effect of Methotrexate
hepatic fibrosis
| Pneumonitis
183
What is the classic side effect of methyldopa
+coombs test
| Drug induced SLE
184
What is the classic side effect of metronidazole
Disulfiram
| Metallic taste
185
What is the classic side effect of penicillamine
SLE
186
What is the classic side effect of phenytoin
Gingival hyperplasia
187
What is the classic side effect of prazosin
First dose hypotension
188
What is the classic side effect of procainamide
SLE
189
What is the classic side effect of PTU
Agranulocytosis
190
What is the classic side effect of Quinidine
Cinchonism
| Tdp
191
What is the classic side effect of resperpine
Depression
192
What is the classic side effect of rifampin
Orange-red body secretions
193
What is the classic side effect of salicylates
Respiratory alkalosis and metabolic acidosis
194
What is the classic side effect of SSRIs
Sexual dysfunction
195
What is the classic side effect of Succinylcholine
Malignant hyperthermia
196
What is the classic side effect of TCAs
QRS prolongation
197
What is the classic side effect of tetracyclines
Tooth discoloration
198
What is the classic side effect of trimethoprim
megaloblastic anemia
199
What is the classic side effect of valproic acid
NTDs
200
What is the classic side effect of vancomycine
Red man syndrome
201
What is the classic side effect of vinblastine
Severe myelosuppression
202
What is the classic side effect of vincristine
Peripheral neuropathy
203
What is the treatment for benzo or barb withdrawal
Benzo taper
204
What are the s/sx of deficiency in vitamin A
Night blindness
205
What are the s/sx of deficiency in Vitamin B1
BeriBeri (polyneuritis, dilated cardiomyopathy)
206
What are the s/sx of deficiency in B2 (riboflavin)
Angular stomatitis
| Corneal vascularization
207
What are the s/sx of deficiency in B3 (niacin)
Pellagra (diarrhea, dermatitis, dementia, death)
208
What are the s/sx of deficiency in B5 (pantothenate)
Dermatitis
Enteritis
Alopecia
209
What are the s/sx of deficiency in B6 pyridoxine
Convulsions
| Hyperirritability
210
What are the s/sx of deficiency in Vit E
Fragile RBCs
211
What are the s/sx of deficiency in biotin
Dermatitis and enteritis
212
What is the vitamin deficiency that is seen with the consumption of raw eggs?
Biotin
213
What is the most common vitamin deficiency in the US?
Folate
214
What are the s/sx of deficiency in Mg?
Weakness
| Muscle cramps
215
What are the s/sx of deficiency in selenium
Keshan disease (cardiomyopathy)
