EM flashcards CSV
(190 cards)
1
Q
Abdominal pain associated with hypotension =
A
Vascular emergency!
2
Q
ED Safety net
A
2 large bore (14 or 16) IV lines, NS resuscitation, cardiac monitoring, supplemental O2
3
Q
True AAA
A
dilation of all 3 layers of arterial wall
4
Q
Definition of aorta diamter for aneurysm
A
3cm or greater
5
Q
Most AAAs involve
A
infrarenal aorta
6
Q
Major AAA risk factors
A
atherosclerosis, PVD, first deg relative w/ AAA (10x higher risk)
7
Q
Ruptured AAA triad
A
Abdominal pain, hypotension, syncope
8
Q
AAA rupture more likely w/ what diameter
A
> 5.5 cm
9
Q
AAA Diagnostic tools
A
US, CT ; No place for Angiography or MRI in emergency eval
10
Q
Surgical mortality of ruptured vs. elective AAA repair
A
50% if ruptured, 5% if elective
11
Q
Intestinal blood supply (4)
A
Cardiac plexus, SMA, IMA, internal iliac
12
Q
Most acute mesenteric ischemia due to occlusion of
A
SMA or IMA
13
Q
Embolic mesenteric ischemia most often etiology
A
just distal to origin of middle colic artery of SMA
14
Q
Thrombotic mesenteric ishcemia most common arterial and venous etiologies
A
arterial: origin of SMA; venous: venous arcades to SMV
15
Q
Typically see non-occlusive mesenteric ischemia in
A
elderly, debilitated, critically ill pts
16
Q
KUB “thumb printing” shows
A
thickened bowel wall
17
Q
Gold standard for dx of mesenteric ischemia
A
Angiography
18
Q
Tx of occlusive mesenteric ischemia
A
Heparin, Glucagon (if angiography not done), intraarterial papaverine, laparotomy usually necessary
19
Q
Tx of non-occlusive mesenteric ischemia
A
correct underlying conditions; vasodilation, anticoagulants, mesenteric regional blockade, intraarterial papverine (lap only necessary if dead bowel)
20
Q
Tx of mesenteric venous thrombosis
A
Heparain, IV thrombolytics, throbectomy occasionally
21
Q
Top cause of upper GI bleed
A
Peptic ulcer disease
22
Q
Most common presentation of PUD
A
melena
23
Q
For NG lavage, most people use what solution
A
tap water at room tempereature
24
Q
Relative contraindication to placing NG tube
A
Patients w/ prior gastric bypass surgery
25
Tx of Upper GI bleed
Octreotide or somatostatin to reduce splanchnic blood flow, PPI, Sengstaken-Blakemore tube for intractable hemorrhage (very rare); Endoscopy
26
Has endoscopy reduced mortality for upper GI bleeds?
No
27
If lower GI bleed, from where can you see melena?
right side colonic bleeds
28
Most common cause of lower GI bleeding
diverticulosis
29
Tx of lower GI bleed
embolization, intraarterial vasopressin, surgery
30
AVPU
Alert/Awake, Voice, Pain, Unresponsive
31
GCS points by category
Eye Opening (4), Verbal Response (5), Motor Response (6)
32
Tx for Hypoglycemia rule of 50
Infants: D5 x 10ml/kg; Toddlers D10 x5 ml/kg; Kids D10 or D25 2ml/kg; Adults 1-2 amps D50
33
Opioid antagonist (OD tx), dose
Naoloxone ; 0.4-2mg, double q2-3min till desired effect (IV onset l/t 1min, half life 30-60min)
34
Indication for administration of naloxone
Opioid OD, insufficient respiratory drive
35
Target for naloxone administration
Sufficient respiratory drive, NOT normalization of mental status
36
biggest problem w/ naloxone
it wears off before opiate agent does
37
Conjugated eye deviation in stroke vs. seizure
Stroke deviates towards lesion, seizure away from lesion
38
Drug therapy for agitated pts w/ unknown cause
benzodiazepines (Lorazepam 1-2mg IV, Midazolam 2.5-5mg IM)
39
Haloperidol used cautiously in which patients
prolonged QT
40
When to treat agitated delirium
Presence of excited delirium or continued max struggle despite attempts at maximal restraint
41
For sympathomimetic toxidorme tx, avoid
Beta blockers
42
Duration of CK-MB vs. Trop I vs. Trop T
2d vs 5-10d vs 5-14d
43
ACS Tx
Aspirin, Nitrates, Beta blockers, Fibrinolysis/PCI; consider heparin/enoxaprain, antiplatelet agents, GIIb/IIIa inhibitors
44
Aspirin mechanism
Inhibits thromboxane A2 (decreases platelet aggregation)
45
Nitrates mechanism
Dec preload and afterload, inc coronary perfusion in obstructed vessels
46
Indications for fibrinolysis
ST elev in 2 or more contiguous leads or new LBB, time to therapy l/t 12 hrs
47
Tx for Cocaine related CP
Benzodiazepines, avoid beta blockers
48
Aortic dissection pathophys
intimal tear --> dissection b/w intima and adventitia --> blood into media
49
#1 site for aortic dissection
ascending aorta at ligamentum arteriosum
50
Stanford Classification for aortic dissection
A: involves Ascending aorta (80%), B: descending aorta only
51
High risk pts for aortic dissections
>50 yo w/ HTN; younger pt w/ Marfan's, Ehler-Danos, pregnant
52
Mortality for Type A aortic dissection
untreated 75%, sugically treated 15-20%
53
CXR findings for aortic dissection
widened mediastinum, L pleural effusion, indistinct aortic knob, displaced calcified intima
54
Tx of aortic dissection
[nitroprusside + esmolol] OR labetalol; goal SBP 100-110 mmHg, HR 60-80; early CT surg involvement
55
PE mortality
2-10% if dx and tx; 30% if undiagnosed
56
Source of PE in 80-90% of cases
Lower extremity DVT
57
Virchow's triad
Venous stasis, hypercoagulability, Endothelial damage
58
#1 risk factor for PE
prior DVT/PE
59
Classic PE triad
Dyspnea, pleuritic CP, hemoptysis
60
Classic (thought unusual) PE ECG finding
S1Q3T3
61
Hamptom's Hump
Pleural based wedge shaped infiltrate
62
Tx if high pretest probability for PE
1) anticoagulate w/ heparin, 2) then order study; can consider thrombolytics if unstable
63
Heparin mechanism
activates antithrombin III --> inactivates thrombin and Xa
64
"Big 5" Life threatening causes of CP
ACS, Aortic dissection, PE, tension pneumothorax, esophageal rupture
65
EMS curriculum set by
Federal Dpt of Transportation
66
Order of Emergency Providers from Least to Most Training
EM dispatcher -> EM Responder (certified first responder) -> EMT-B -> EMT-I ->EMT-Paramedic -> EMS Physician
67
Most common pelvic infection
Chlamydia trachomatis
68
Recommended tx for chlamydia
Azithromycin 1g PO single dose OR doxycycline 100mg PO 2x/d for 7d
69
Whiff test
for bacterial vaginosis - "fishy" odor on wet mount w/ KOH
70
Tx for bacterial vaginosis
Metronidazole 500mg PO BID x 7d
71
strawberry cervix
trichomonas
72
PID CDC diagnostic guidelines
low abd pain w/o other cause + at least 1 of uterine, adnexal, or cervical motion tenderness
73
PID outpatient tx
Ceftraixone 250mg IM once PLUS doxy 100mg BID x 14d w/ or w/o metronidazole 500mg BID x 14d (ALTERNATE: cftx + azithro)
74
most common ultrasonographic finding in women w/ ovarian torsion
ovarian enlargement
75
strongest predictor of ectopic pregnancy
prior ectopic
76
most common risk factor for ectopic pregnancy
hx of PID
77
When can you see IUP on US?
transvaginal: B-HCG>1500; transabdominal: B-HCG>4000
78
Medical mgt of ectopic
methotrexate
79
Pre-eclampsia & Severe Pre-eclampsia criteria
BP >140/90 or inc in SBP>20 or DBP>10 over baseline AFTER 20wks gestation and 6hrs apart; severe: SBP 160 or higher, DBP 110 or higher 6hrs apart, proteinuria >5g/24hr
80
Pre-eclampsia mgt
definitive tx delivery, magnesium sulfate (titrate to reflexes) for seizure prophylaxis in severe cases, anti-hypertensives (hydralazine / labetalol), fluids
81
Antidote to mg toxicity
calcium gluconate
82
Eclampsia
pre-eclampsia + seizure (up to 4 wks postpartum)
83
HELLP syndrome
Severe pre-eclampsia variant: Hemolysis, Elevated Liver enzymes, Low Platelets + epigastric/RUQ pain
84
Tx of urosepsis
Abx, aggressive IVF (rivers protocol), admit
85
leading cause of long term disability in US
acute ischemic stroke
86
acute ischemic stroke most commonly caused by
embolus (usually from heart) or thombus (usually at site of atherosclerotic plaque)
87
Todd's paralysis
post-ictal transient paralysis
88
Menier'es Disease
Inner ear disorder (endolymphatic hydrops); vertigo + fluctuating sensorineural hearing loss + tinnitus
89
Classic presentation of middle cerebral artery (MCA) stroke
Aphasia (Broac's & Wernicke's usually on L), R hemiparesis & sensory loss, L hemianopsia (L visual field cut), gaze preference to L
90
Window for thrombolytics in acute ischemic stroke
4 hrs, longer for posterior circulation strokes
91
FDA-approved thrombolytic for ischemic stroke; dose
Tissue Plasminogen Activator (tPA); 0.9mg/kg (max 90mg), 10% IV bolus, 90% infusion over 60min; can give 6hrs post sx in some pts
92
Causative oganisms in g/t 80% of acute meningitis cases
Strep pneumoniae, Neisseria meningitidis
93
Causative organisms in 25% of meningitis cases in pt g/t 60yo
Listeria
94
Classic 4 sx of acute bacterial meningitis
headache, neck stiffness, fever, altered MS
95
CSF findings in bacterial meningitis
Elevated opening pressure (often g/t 40), WBC g/t 5, Elevated protein, Low glucose, Organism on gram stain
96
Tx of bacterial meningitis
Abx PRIOR to CT/LP (Vanc + 3rd gen cephalosporin pts l/t 50, +ampicillin pts g/t 50), IV Dexamethasone (esp Pneumococcal), stabilization/resuscitation
97
Indications for meningococcal meningitis and penumoccal meningitis prophylaxis
household member Rifampin or Cipro q12hrs x 4 doses; HC workers only if interacted w/ secretions; No ppx for pneumococcal
98
Risk factors for subarachnoid hemorrhage / intracranial aneurysm rupture
tobacco, alcohol, cocaine, HTN, family hx (polycystic kidney ds, ehlers-danlos, etc)
99
Pseudotumor cerebrii
Idiopathic intracranial HTN
100
Tx of SAH
SBP less than 140, analgesia, nimodipine (in aneurysmal SAH), seizure prophylaxis, correct hyperglyceima & hyperthermia
101
In SOB pt, breathing goal is:
paO2>60 or sO2>90%
102
Wells' Criteria
For PE; clinical signs/sx of DVT, PE #1 dx, HR g/t 100, Immobilization at least 3d or surg in previous 4 wks, previous PE/DVT, Hemoptysis, malignnacy w/ tx w/in 6mo or palliative
103
PERC rules
for PE; Age over 50, HR over 100, O2 on RA less than 95%, Prior VTE, Trauma/Surg w/in 4wks, hemoptysis, exogenous estrogen, unilateral leg swelling
104
TIMI Risk Score
for UA/NSTEMI mortality; Age>65, 3+ risk factors, known CAD (stenosis >50%), ASA use in past 7d, severe angina (2+ episodes in 24hrs), EKG ST changes>0.5mm, positive cardiac marker
105
What is Grace score for?
ACS risk
106
Approach to poisoning
ABCs, D (Dextrostick, details, decontaminate), E (EKG, evaluate toxidrome)
107
QRS/ST segment with hockey stick scoop?
Digitalis effect
108
EKG finding for cyclic antidepressants
RAD (look at R in AVR)
109
QRS>100msec suggests what poisoning agents (e.g. wide complex tachy)
TCA, quinidine, diphenhydramine, cocaine
110
QT prolongation suggests what type of poisoning agents
antipsychotics, hypocalcemia (risk for torsade de points)
111
Indications for whole bowel irrigation
SR drugs (CCBs, lithium), drug packets (body packers)
112
opioid (=narcotic, opiate) toxidrome
pinpoint pupils, respiratory depression, latheargy to coma, bradycardia, hypothermia, borderline hypotension
113
common opioids
morphine, heroin, codeine, meperidine, propoxyphene, fentanyl, hyrdocodone, methadone
114
"opioid like" agents
clonidine, imidazolidines, tramadol
115
anticholinergic toxidrome
tachy, elevated temp, AMS, delirium, mydriasis, dry mouth/skin, flushing, decreased bs, urinary retention
116
anticholinergic toxidrome rhyme
mad as a hatter, blnd as a bat, red as a beet ,hot as a hare, dry as a bone, full as a tick
117
common anticholinergics
diphenhydramine, antiparkinson/anticholinergic meds (benztropine), misidentified plant/herbal products
118
sympathomimetic toxidorme
tachy, elevated bp, hyperthermia, dilated pupils, hyperactive bowels, diaphoresis
119
sympathomimetics
cocaine, amphetamines, anorectics, otc stimulants, "herbal" stimulants
120
cholinergic toxidorme
AMS, excess secretions, fasciculations, weakness; DUMBBELS
121
DUMBBELS
cholinergic toxidorme: diarrhea/diaphoresis, urination, miosis, bradycardia, bronchorrhea, emesis, lacrimation, salivation/seizures
122
cholinergic agents
organophsophates/carbamate pesticides, carbamate medicinals (donepezil, physostigmine, pyridostigmine), nerve gas agents
123
Wadell Triad
(pediatric trauma - e.g. hit by car) closed head injury, intraabdominal injury, mid-shaft femur fracture
124
AMPLE History
Allergies, medicatins, PMHx, last meal, event
125
What is an independent predictor if ICI?
Seizures (not LOC when adjusted for mental status)
126
Leading cause of death in kids
Trauma; TBI leading cause of trauma death/disability
127
Clinically important TBI linked to what signs/sx (pt more than 2 yrs and less than 2yo)
more than 2: AMS, signs of basial skull fracture, less than 2: AMS, parietal/temporal scalp hematoma, palpable skull fracture
128
Salter-Harris Classification
Pediatric fractures: S (straight across), A (above), L (lower/Below), T (Two/through), ER (erasure of growth plate or crush)
129
most common pediatric elbow fx, often due to
supracondylar fracture, fall on outstretched hand
130
Most common avulsion fractures in pelvis in kids
Ischial tuberosity, anterior superior iliac spine
131
Toddler's Fracture
spiral or oblique fx through distal 3rd of tibia, non-displaced
132
Philadelphia Criteria
29-56d old, T g/t 38.2; low-risk criteria: PE no infxn, Labs (CSF wnl, neg gram stain), WBC l/t 15k, Band/neutrophil l/t 0.2, UA l/t 8 wbc/hpf, CXR no infiltrate), social good observer, car, phone
133
Workup/tx for FYI l/t 4 wks old
full sepsis w/u, hospitalized, empiric abx
134
Which protocol for FYI doesn't use CSF to define low-risk?
Rochester 1994 (applies to FYI l/t 60d)
135
role for coticosteroids in meningitis for 29-56do infants?
No proven role
136
Most common three bacterial pathogens for ?meningitis (in order)
E coli (56%), GBS, S aureus
137
Neonatal HSV distribution
1/3 SEM, 1/3 CNS, 1/3 disseminated
138
Indication for empiric HSV testing/tx w/ acyclovir
Any one criteria: hx (l/t 21d old, mom w/ active primary HSV at delivery), exam (vesicles, seizure), lab (CSF pleocytosis, inc liver enzymes)
139
FYI 29-56d old who meet all low risk criteria - mgt?
CBC w/ diff, blood culture, enhanced UA and urine cx (vs. full eval for sepsis + LP is fail to meet any criteria)
140
Heptavalent Pneumococcal Vaccine - how many serotypes and when to give?
7 serotypes (cause 85% of IPD in kids), give at 2,4,6, 12-15mo
141
Risk factors for pyelonephritis in infants
Screen if 2 or more: F:l/t 12mo, white, T g/t 39, F g/t 2d, no other source; M; l/t 6mo, uncircumcised
142
Is 1 dose of HPV7 effective?
Yes, esp if given after 12mo
143
Leading cause of inpatient hospitilization fo rinfants
bronchiolitis
144
most common chronic pediatrician-treated disease
asthma
145
Ipratropium bromide
synthetic derivative of atropine, reduces bronchospasm (atrovent, given w/ albuterol up front for asthma attack)
146
Terbutaline
systemic beta agonist (IV/SubQ then drip)
147
Magnesium mechanism for asthma
smooth muscle relaxer
148
Bronchiolitis
lower airway infection/inflamation - VIRAL (RSV most common)
149
PNA etiology in neonates
Group B strep, GN enterics
150
PNA tx for infants
amoxicillin, 3rd gen cephalosporins, macrolides (azithromycin), supportive care (antitussives NOT indicated)
151
Croup
upper airway inflammation due to viral infection, then stridor
152
Croup tx
airway first; decadron IM/PO, racemic epi neb +/- humidified air or heliox, possibly epi pen
153
Foreign body in infants triad
wheeze, cough, decreased breath sounds
154
CXR indicated for foreign body aspiration?
Yes
155
FAST scan suprapubic space
retrovescular/pouch of douglas
156
RUQ/LUQ spaces on FAST scan
pleural, subphrenic, hepatorenal/splenorenal, infrarenal
157
US findings for pneumothorax
absence of pleural sliding, leading edge sign
158
heat stroke definition
core temp g/t 40 w/ CNS dysfunction in setting of environment heat load
159
drugs that can cause heat stroke
cocaine, ecstasy, diphenhydramine/anticholinergics, phenothiazoines/dopamine blockers, ethanol, diuretics
160
most sensitive tissues to hyperthermia
vascular endothelium, hepatocytes, neural tissue
161
UA dip +blood but none on micro suggests
myoglobinuria
162
Hypothermia definition
core temp l/t 35 (severe l/t 28)
163
Osborne J waves
Seen in severe hypothermia; can be accompanied by afib, bradycardia, prolonged QT/QTc
164
Electrolyte abnormality to watch for in ED mgt of hypothermia
Hyperkalemia
165
TCA overdose tx to consider for hypotension, prolonged qrs, etc
sodium bicarb
166
cardinal features of shock
hypotension g/t 20min, oliguria, HR g/t 100, RR g/t 20 or PaCO2 l/t 32, ill appearing/AMS, metabolic acidosis
167
SIRS
2 or more of: T g/t 38 or l/t 36, HR g/t 90, RR g/t 20 or PaCO2 l/t 32, or wBC g/t 12k or l/t 4k or 10% bands
168
Sepsis
SIRS + hypotension or organ dysfunction
169
Septic shock
SIRS + hypotension despite fluid resuscitation
170
Most common organisms for 0-56d febrile infant
e. coli, GSB, Listeria (
171
occult UTI bugs in febrile young child 2-36mo old
E. coli or GN enterics, enterococcus
172
Tx for gram - enterics in febrile young child w/ UTI
cefixime, TMP-SMX
173
tx for meningitis: community acquired and brain abscess
CA: ceftriaxone IV +/- vanc/ampicillin; Brain: ceftriaxone IV +/- metronidazole
174
Sinusitis tx: acute vs chronic
3 wks tmp/smz
175
tx of acute bacterial pharyngitis
penicillin V PO, amoxicillin
176
acute bronchitis tx
no abx
177
copd/chronic bronchitis tx
doxy or tmp-smx or azithro
178
CAP tx
azithro + PCN/dox depending, if multiple lobes levofloxacin
179
tx for urethritis (c. trachomatis + n. gonorrhea) or cervicitis
Ceftriaxone 125mg IM x1 + Azithro 1g PO or 100mg BID x 7d
180
trichomoniasis tx
metronidazole
181
Scope of EMS practice set by
each state, no uniform regulation
182
Length of training minimums for EMS set by
DOT, overseen by states
183
Who verifies paramedic's authority to provide care?
In PA, physician medical director anually
184
migraine tx
reglan or compazine, serotonin agonists (triptans), narcotics
185
tx of cluster headache
100% o2, intranasal lidocaine, NSAIDs
186
for early goal directed therapy of shock, what is first line vasopressor to get MAP to 65-90?
norepinephrine
187
in evaluating delirium, what element of GCS does the prognosis lie most heavily on?
motor response
188
For pt with disequilibrium, what to avoid?
no medications! e.g. sedation can worsen sx
189
for aortic dissection, what tx to get to goal SBP of 90-100 and goal HR 60-80?
IV nitroprusside + esmolol or labetolol
190
tx for cocaine related chest pain
benzodiazepines, AVOID beta blockers
