EM Experience Flashcards
(136 cards)
1
Q
what are the 5 W’s of fever?
A
- wind (PNA, PE)
- water (urine)
- wound
- walker (DVT)
- wonder drugs (abx, immuno drugs, etc)
2
Q
name the quinolones and what they cover
inhib DNA gyrase aka: topoisomerase I
A
- 2nd gen: ciprofloxacin -> gram - and atypicals
- 3rd gen: levofloxacin -> same as 2nd gen + S. pneumo
- 4th gen: Moxifloxican -> same as 3rd gen + anaerobes
3
Q
what side effect do you need to aware of with quinolones?
A
- tendon rupture
- QT prolongation with Moxi
4
Q
describe the side effects of antipsychotics
A
- both can cause Malignant Hyperthermia and Tardive Diskenesia
- some can cause QT prolongation
5
Q
what ABx is good against spore forming organisms and is a C. diff risk?
A
- clindamycin
6
Q
what is the antidote for Beta Blocker OD?
A
- glucagon
pt will likely have bradycardia and hypoglycemia
7
Q
what is the antidote for Tylenol OD?
A
- Mucomyst (n-acetylcysteine)
- is also used off label to kidney clearance of contrast after contrast use
8
Q
what are the 3 types of dizziness and describe them?
A
- vertigo: the illusion of movement (room spinning?. you are spinning?, etc) typically dt inner ear pathology
- pre-syncope: relative or true hypovolemia (feel like passing out?, feel same as when you stand up to fast?) typically dt cardiac, vascular, CNS -> cerebral ischemia
- disequilibrium: unsteady on your feet (happen when walking/standing) typically dt motor and/or sensory disturbances needed to stand upright. pt may have cerebellar dz or polyneuropathy
9
Q
describe the w/o for SOB if you suspect a PE
pleuritic pain, immobilization, Cancer, leg swelling pain
A
suspect PE? -> yes -> Wells Criteria w/high-mod risk -> get CTA or VQ scan if renal probs
Wells Criteria is low -> Perc Rule -> if + -> D-dimer -> if + -> get CTA or VQ scan
if Perc Rule is -, you are done
10
Q
what are some Bactim (Sulfamethoxazole / Trimethoprim) contraindications?
A
- renal probs
- w/ Warfarin (will increase INR)
- ACE or ARB use (will increase hyperkalemic effect)
11
Q
Lasix (furosemide) can cause what SE?
A
- ear probs/deathness
12
Q
what is the first you ask if you have a pt with a skin penetration/bleeding?
A
- when was your last tetanus shot
13
Q
if you have a pt with facial trauma and you order a CT don’t forget to check here for blood…
A
- the sinuses (mc-ly dt external causes)
14
Q
which anti-emetic can cause QT prolongation?
A
- Zofran (odansetron): at high doses ( chemo dose 32mg). 8mg for reg nausea does not
- reglan (metoclopramide): dose NOT
15
Q
what is the abx of choice for a complicated UTI?
A
- Rocephin (ceftriaxone)
16
Q
what can an oropharyngeal abscess lead to?
A
- trismus (typically not seen with just a tooth prob)
17
Q
what is a recrudescence stroke?
A
- re-appearance of resolved stroke ssx (all stroke deficits re-appear)
18
Q
when do you typically use contrast in imaging?
A
- when you suspect vascular pathology or infections
19
Q
when is a kidney stone a urological emergency?
A
- when the pt also has pyelonephritis
stone traps infecs in kidney
20
Q
if you suspect pylo or kidney stone, how do you order the CT?
A
- NO contrast
21
Q
what are likely causes of hemoptysis?
A
- PE, PNA, Malignancy
22
Q
what is one way you can tell if a pt passed out vs had a seizure?
A
seizure pt will mc-ly have a post-ictal state
23
Q
what is Ransons Criteria for?
A
- predicting mortality from Pancreatitis
24
Q
don’t forget to check these areas with Chest and/or Abd Ct scans…
A
- lung apexes and lung bases
25
what is the lateral spine sign?
- on a lateral chest x-ray, the spine should get darker as you move down the spine. If it is not, suspect PNA
26
if you have an abd CT and want to look for air leakage dt bowel perforation, what can you do?
- look at it using the "lung window"
27
if you have a pt with a seizure hx, what anti-depressant is contraindicated?
wellbutrin
28
what must you monitor in pts who use Depokote?
| how do you treat depokote OD?
- monitor ammonium levels
| - Treat with Lactulose (will remove ammonia from blood/liver via diarrhea)
29
how do you treat ETOH withdrawal?
- gabapentin
| - Librium (Chlordiazepoxide)
30
how do you treat COPD exacerbation?
- dual ned tx (albuterol/ipratropium)
- Salumederol (125)
- CPAP or BPAP is holding CO2 (check blood gases)
31
what is the pneumonic for the wrist bones?
```
Slowly - scaphoid
Lower - lunate
Tillys - triquetrium
Pants - pisiform (at pinky)
To - trapezoid
Touch - trapezium
crotch - capitate
hairs - hamate (at pinky)
```
32
what 1st gen anti-histamine is good for anxiety and as an anti-emetic?
- Vistaril (hydroxyzine)
oral for anxiety
IM for anti-emetic
33
what are the various scenarios/routes for giving antipyretics in febrile pts?
- if N/V, give IV
- if not N/V, give PO
etc. just think about stuff like this
34
what is the migraine cocktail (head and/or stomach)?
- 1 liter fluid
- 10 mg Reglan (can also use Compazine (prochlorperazine)
- 50 mg Benedryl (Reglan can cause skin crawling)
- 10 mg decadron (dexamethasone to prevent rebound)
- +/- toradol
35
what must you look for in a pt with eye pain?
- acute angle glaucoma
pt will have eye pain and a "steamy cornea"
- iridotomy is the Tx
36
what can you use as extra validation to admit/discharge a pt w/ chest pain?
HEART Score
37
what is ventricular bigeminy?
- when a premature ventricular complex follows every sinus beat
- trigeminy is when a premature ventricular complex follows 2 sinus beats (every 3rd beat is a ventricular beat)
38
what is phlegmasia alba dolens?
| what is phlegmasia cerulea dolens?
```
- spectrum of severe DVT
alba dolens (white leg, pain, edema) -> cerulea dolens (cyanosis, pain, edema) -> venous gangrene
```
39
how do you treat Superficial Thrombophlebitis?
- aspirin 325 1xday and abx if needed. and cold compresses
(common inflammatory-thrombotic disorder in which a thrombus develops in a vein located near the surface of the skin like after venous puncture)
40
what is a Jefferson Burst Frx?
C1 burst fracture (MC-ly seen after diving head first into a shallow pool)
41
what is Monsel's solution?
Ferric subsulfate solution is a hemostatic agent used after superficial skin biopsies (ex. gyn stuff)
42
what is Henoch-Schönlein purpura?
disorder that causes inflammation and bleeding in the small blood vessels in your skin, joints, intestines and kidneys -> purplish rash (lower legs and buttocks) if GI pain, think intussusception!!!!!!.
43
what must you mention in the chart of any FM with abd pain?
- that you ruled out Ovarian Torsion
44
what can you not do if taking Flagyl (metronidazole)?
drink ETOH!!!! (mixing the 2 can cause HA, flushing, GI pain and complaints, etc)
45
what are the Tx for Diverticulitis for inpt and outpt?
- in: cipro and flagyl
| - out: levo and flagyl
46
what is a pesary?
- rubber ring inserted in vagina for prolapse (CM-ly seen on imaging in older women)
47
if a pt has a seizure before or with stroke like ssx, what can you not give them?
- tPA
48
what is Typhlitis?
- neutropenic enterocolitis: life threatening transmural inflammation of the cecum
49
what is pathologic on an elbow x-ray?
- Posterior Sail sign (from blood/fluid collection dt frx)
| - anterior sail sign is normal
50
what reverses paralysis caused by rocuronuim?
- Bridion (Sugammadex): binds to paralytic
51
can a pt have a fever with a PE?
- Yes! PE shares SSX with PNA
52
what is lactic acid from?
- it screens for tissue damage and is made by muscle and RBCs when O2 is low
- is seen during infecs, Sepsis, heart failure, exercise, turniqet on too long during blood draw!!!, etc
53
what must a pts alcohol level be before Psych facilities will admit them?
- <80
- most pts blood ETOH drops 30 pts per hour so if they are 170, they will have to sit in ER for 3 hrs before psych will take them
54
what meds do you give pts who appear to be close to "shizzle hitting the fan"?
- Zyprexa (olanzapine) 5-10 mg... 10 will knock them out
| - and Ativan (lorazepam)
55
what do you check in pts with altered mental status who have a hx of seizures?
- check there serum anti-seizure meds levels for toxicity or low therapeutic levels (ex: Dilantin (phenytoin), phenobarbital, etc)
56
what is one thing you need to check in altered mental status and/or stroke pts?
- need to order coags to see where their levels are in case tPa is considered or other vascular procedures
57
what can you give a pt with vertigo?
- antivert (meclozine)
58
what lipase level is diagnostic for pancreatitits?
- >900 (nl is <100)
59
who do you MC-ly see pancreatitis in and how do you Tx it?
- in alcoholics
| - Tx with NPO (food will make it worse)
60
describe a Focal Seizure and how do you Tx it?
- this is when only a focal segment of the brain seizes resulting in a focal deficit
- this is sometimes dt a previous stroke and the focal deficit may be the area impacted by the stroke
- you may see stroke like ssx with weird muscle twitching or leg stuck in flexion, etc, think this
- Tx w/ Ativan and Keppra
61
what do you look for on NON-contrast CT of stroke pt with MCA occlusion signs?
dense MCA sign (MCA will appear bright) on NON-contrast CT
62
what do you look for on Contrast CT if you suspect dura venous thrombosis?
empty delta sign (no dye where the thrombos is... should be a solid bright triangle)
- pt may present with stroke like SSX, HA, visual changes, etc and they may be transient
63
what pro-coag can you give during a trauma?
-TXA (tranexamic Acid) give within 3 hrs of hitting the door. will help prevent heavy blood loss
64
what sedation do you use in trauma pts and why?
- ketamine (will raise BP a little which can be good in trauma)
- can cause hallucinations
65
what causes Bells Palsy (unilateral Facial Nerve deficit, ear pain)?
my Lovely Bell Has An STD
- Lyme Dz
- Herpes
- AIDS
- Sarcoidosis
- Tumors
- Diabetes
66
how do you treat viral Bells Palsy?
- Valtrex and steroids (no need to taper of <7 days)
67
What is the proper placement for an IO?
Two finger widths inferior of the tibial plateau on the flat part of the tibia
68
What should you suspect in a patient with transient unilateral peripheral vision loss?
dura venous sinus thrombus
69
What are some adverse effects of using succinylcholine?
malignant hyperthermia (treat with dantrolene) and increase K+ from muscle (so must be careful in burn patients)
70
When do we use RSI? (rapid sequence induction)
when a pt must be intubated or anesthetized without time for stomach emptying
71
What are some SSx of opioid OD?
- decreased consciousness
- pinpoint pupils
- decreased respiration
Tx: narcan (naloxone)
72
Describe the 4 classes of Mallampati scoring.
Class 1: Soft palate uvula and pillars are all visible
| Class 4: only the hard palate is visible
73
What is the Tx for pheochromocytoma?
phenoxybenzamine (this is an irreversible alpha blocker that will decrease blood pressure and sweating)
74
What is the ratio of crystalloid replacement for blood loss?
3:1 (3 liters of crystalloid for every liter of blood lost)
75
What kind of CT do you get in a Pt who you suspect a Chrons flare in?
CT with contrast because inflamed tissue will have increased blood supply so there will be increased contrast uptake where the tissue is inflamed
76
You see a Pt who is complaining of fatigue and sore throat and you palpate an enlarged spleen. What do they have?
Mono due to EBV
77
What do you use to convert A-fib?
- If no SSx of hypotension, chest pain, or crashing use diltiazem (CCB. can cause hypotension which is worse with verapimil)
- to cardiovert use Etomidate and sync cardoversion
78
A patient has elevated WBC. What drugs should you see if they're on?
- filgrastim (used to increase WBC after cancer Tx)
79
Explain SSx of epididymitis/orchitis, how it occurs, and Tx.
- nut pain, gradual onset, seen MC-ly in >18yo
- dt STD or urogenital reflux (dt difficulty urinating)
- Tx: abx
80
A patient has nut pain. What is the first thing you get?
- stat US (have 4-6 hours to fix if testicular torsion)
81
Describe testicular torsion and Tx.
- acute onset of nut pain with N/V, (no N/V if epiditimits), may see loss of cremaster reflex, and elevated nut
- MC-ly in teens
- Tx: surgery (if surgery is not an option within the 4-6 hour window, detorse by 2 outward turns)
82
What do you never do in a Pt with pelvic trauma if you suspect urethral damage?
Never put in a foley.
83
What is one rare finding on CT in Pt with abdominal pain?
twisting of the bowels as seen in midgut volulus
84
What does chronic weed use lead to?
worsening severe nonalcoholic steaotosis and severe fibrosis
85
How do you make your own epi drip if none available?
needle on crash cart epi and squirt into saline bag. turn all the way on until desired response, then titrate.
86
What must you suspect in a Pt who is coughing until they vomit or pass out?
Pertussis until proven otherwise.
87
How do you treat constipation dt opioid use?
relistor (methylnaltrexone - blocks mu recptors in the gut)
88
Pt has horrible withdrawal Sx such as nausea, confusion, seizures, etc. What do you suspect they are withdrawing from?
baclofen (muscle relaxer)
89
Describe a vasovagal response.
Pt will be sweating, pale, eyes rolled back. -> syncope (passing out. syncope can look like seizures)
90
What does an anaphylactic rash look like?
hives along with anaphylactic SSx.
91
What is used to monitor inflammation in inflammatory dz?
CRP and SED rate (inflammation causes red blood cells to clump and travel further faster, leading to increased SED rate)
92
What is a simple way to check for dehydration?
capillary refill time (should be < 3 sec.)
93
How can you tell the difference between strep and mono?
- mono: enlarged spleen and sore throat with more white/pus-sy patches and Pt will get rash with abx use.
- strep: throat is more red
94
What is the empty cup sign?
this is seen on lateral wrist x-ray in Pt with perilunate dislocation
95
What are some SSx of a retroperitoneal bleed or pancreatic necrosis?
- Cullens sign (abdomen)
| - Gray Turner sign (flank)
96
What can peripheral edema be dt?
- heart failure (RH failure)
- liver failure (loss of oncotic factors)
- kidney failure (loss of volume control)
97
What is one thing you always check for in sick, elderly, and/or diabetic Pts?
Fournier's Gangrene (nec fas of perineum perianal or genital regions)
98
When are the only times ovarian cysts hurt?
- when they leak/rupture
| - if torsion occurs
99
What are some good cough suppressants?
- tesilon pearls
| - ibuprofen (cough dt tickle which is a primitive pain response)
100
What is a good Tx for croup?
decadron (dexamethasone lasts up to 3 days)
101
What do you suspect in a Pt with wide QRS that turns into sign wave on EKG?
TCA OD (Pt will be acidotic. Tx with continuous bicarb until QRS narrows)
102
What is the difference between cannabis hyperemesis syndrome and cyclic vomiting syndrome?
- CHS Pts will vomit daily
| - CVS Pts will have periods of normal health between vomiting episodes
103
What are some concerns in Pts with Gestational Trophoblastic dz?
- choriocarcinoma to the lungs
| - molar pregnancy
104
if a pt has chest pain, what is one thing you ask them?
- to determine if the pain is pleuritic (pain associated with breathing) ask, " when you take a deep breath in, does the pain get better, worse, or the same?" If worse, think PE
105
what is paraphimosis?
a urological emergency seen in uncircumcised men when the foreskin is not put back in its normal place and it cuts off blood flow distal to constriction -> gangrene of glans penis
106
what is priapism sometimes dt?
- sickle cell dz/crisis
| - Tx: is MONA to tx crisis
107
if pt is pregnant, what can they not get?
- MMR or ACE-inhib
108
what are the x-ray findings of PNA dt?
- actually dt to edema (not pus) so you may not see PNA on x-ray if pt is dehydrated
109
how do you reduce a Posterior Hip dislocation?
- Captain Morgan Technique
110
beside Zofran, what do you also give pts with N/V to prevent stomach irritation that occurs the next day following N/V?
- IV 40mg of Pepcid
111
always take nut pain seriously. what are two things to not forget about nut pain?
- nut pain can refer to abd, so always check nuts in pts with abd pain
- dont forget mumps can cause nuts pain and swelling
112
what kind of CT do you get in pts with abd pain and Hx of gastric by pass Sx?
- CT with IV and Oral contrast to examine suture sites as they are prone to ulcers
113
what pain killer/cough suppresant should you NEVER give to kids?
- Codeine!! (is a prodrug that is metab into morphine and some kids are fast metabers -> morphine OD -> death)
114
what on a UA indicates dehydration?
- increase specific gravity (bc pee is very concentrated/heavy)
- ketones
115
what are the 3 complications any surgical or instrumentation procedure can have?
- trauma (ex: hit blood vessel -> hematoma)
- infection
- wrong location/migration (ex: inserts in wrong place or mesh that moves)
116
what is the best mental approach when seeing pts in the ED?
- think, "what is the worst this could be?"... think Worst First
117
what is the first thing that swells in the airway if pt is rxn to something?
- the Uvula
118
what are the 2 causes of syncope associated with diuretic use?
- volume loss
| - K+ loss -> arrthymias
119
in terms of imaging, what is different between a perforated stomach ulcer and a perforated bowel?
- a perf stomach ulcer will expel more air than a perf bowel so look for free air in the abd Under the diaphragm
120
what kind of imaging do you ALWAYS get for trauma pts?
CT with Contrast to look at solid organs and for aortic dissection at lig. arteriosis
121
what are some SSx of an epidural abscess and some risk factors?
- focal tenderness on spinous process, fever, and night sweats
- IV drug use and back surgery
122
if K+ is low, what must you also check?
- Mg+!! (you can't correct K+ if Mg+ is low bc Mg+ is needed for K+ absorption
123
how do you treat muscle spasms and what are some causes of them?
- IM Cogentin (benzatropine) or 100mg of Benedryl
| - some causes include Reglan, Compazine, and some anti-psychs
124
you Tx a pt with steroids and they get N/V, hyper-electrolytes, AKI, arryhthmias... what happened?
- Tumor Lysis Sx (some tumors respond to steroids and TLS can occur)
125
what will you see on a repeat head CT w/o contrast closely following a CT w/contrast (can't get back to back w/contrast)?
- you may see increased attenuation in the vasculature as the previously admin dye is uptaken... don't let this fool you into believe there was a change intracranially
126
how do you treat PVCs?
- 1 gram of Mg+
127
what do you never ever give for MRSA?
- Kefflex (cephalexin... it does not work)
128
what are some causes of leukocytosis (increased WBCs)?
- anything stressor really.... pregenancy, trauma, emotional stress, infecs, etc
129
you see a depressed pt. what should you NEVER send them home with?
- enough of any meds that they could use to harm themself with
130
what do young thin females have an increased risk for?
- spondylolysis (fracture of pars interarticularis) -> spondylolisthesis (ant. shift of vertebrae with frx pars)
- typically seen in lumbar
131
what is a adrenal crisis and how do you tx it?
- failure of adrenal glands leading to low cortisol, hypoglycemia, hypotension, etc
- Tx with steroids
132
what gel can you use to numb lacerations?
| what about if the skin is intact?
- LET cream (lidocaine, epi, and tertacaine) for cuts/lacerations as needed to numb b4 lidocaine injec/suturing
- EMLA cream (lidocaine and prilocaine) for unbroken skin or genital region b4 procedures
133
what other finding in a CHF exacerbation pt warrants direct admission?
- pulmonary edema (wet lung)
134
what is a pts risk for adverse cardiac events who presents with a "low risk" story (pinching pain in my left shoulder) and who has no change in serial trops?
- same risks as general population for ACE
| (note: a "high risk" story pt is diff and they report things like "it feels like an elephant is sitting on my chest"
135
what size needle do you use to numb an area with lidocaine?
- 27 gauge and bend the needle a little like Dr. Donvito showed me which makes injecting easier (must inject lateral to the laceration a few mm)
- note: if numbing b4 I&D of an abscess, let the lidocaine sit for 15 mins bc the acid produced by the bacteria in the abscess slows lidocaines impact)
136
will epi work in a pt who has been down for a while?
- no!! the acidotic environment produced bc of low O2 (lactic acid) prevents epi from working. You must Tx with BICARB first to buffer the environment (remember all enzymes like epi work best in their ideal environments)
