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EM II Flashcards

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1
Q

Airway Interventions flow chart:

  • […]
  • reposition the airway- jaw thrust
  • BVM ventilation- 2 person
  • intubation with RSI

A

Airway Interventions flow chart:

  • verbal/tactile stimulation- sternal rub
  • reposition the airway- jaw thrust
  • BVM ventilation- 2 person
  • intubation with RSI

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2
Q

Airway Interventions flow chart:

  • verbal/tactile stimulation- sternal rub
  • […]
  • BVM ventilation- 2 person
  • intubation with RSI

A

Airway Interventions flow chart:

  • verbal/tactile stimulation- sternal rub
  • reposition the airway- jaw thrust
  • BVM ventilation- 2 person
  • intubation with RSI

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3
Q

Airway Interventions flow chart:

  • verbal/tactile stimulation- sternal rub
  • reposition the airway- jaw thrust
  • […]
  • intubation with RSI

A

Airway Interventions flow chart:

  • verbal/tactile stimulation- sternal rub
  • reposition the airway- jaw thrust
  • BVM ventilation- 2 person
  • intubation with RSI

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4
Q

Airway Interventions flow chart:

  • verbal/tactile stimulation- sternal rub
  • reposition the airway- jaw thrust
  • BVM ventilation- 2 person
  • […]

A

Airway Interventions flow chart:

  • verbal/tactile stimulation- sternal rub
  • reposition the airway- jaw thrust
  • BVM ventilation- 2 person
  • intubation with RSI - Rapid Sequence Intubation

https://emedicine.medscape.com/article/80222-overview

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5
Q

All AMS pts are […] until proven otherwise!

A

All AMS pts are hypoglycemic until proven otherwise!

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6
Q

Always check a […] level before acting on Hyperkalemia.

A

Always check a hemolysis level before acting on Hyperkalemia.

K 5.5 and 2+ hemolysis = ok

K 8 and 1+ hemolysis = bad

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7
Q

Always determine onset in […] prior to cardioverting.

A

Always determine onset in AFib (<48hrs) prior to cardioverting.

if >48hrs need anticoagulation

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8
Q

Always get […] prior to performing Procedural Sedation.

A

Always get consent prior to performing Procedural Sedation.

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9
Q

Always label syringes and IV bags if you mix […].

A

Always label syringes and IV bags if you mix push dose/epi drip.

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10
Q

Always perform […] on all Psych pts.

A

Always perform full physical exam on all Psych pts.

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11
Q

Always treat […] in pregnancy.

A

Always treat UTI’s in pregnancy.

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12
Q

AMS ddx: (AEIOUTIPS)

  • A[…]
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

A

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

“TINE”

Trauma/tox

Infection/ischemia

Neuro

Electrolytes/endocrine

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13
Q

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • E[…]
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

A

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

“TINE”

Trauma/tox

Infection/ischemia

Neuro

Electrolytes/endocrine

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14
Q

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • I[…]
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

A

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

“TINE”

Trauma/tox

Infection/ischemia

Neuro

Electrolytes/endocrine

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15
Q

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • O[…]
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

A

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

“TINE”

Trauma/tox

Infection/ischemia

Neuro

Electrolytes/endocrine

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16
Q

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • U[…]
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

A

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

“TINE”

Trauma/tox

Infection/ischemia

Neuro

Electrolytes/endocrine

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17
Q

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • T[…]
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

A

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

“TINE”

Trauma/tox

Infection/ischemia

Neuro

Electrolytes/endocrine

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18
Q

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • I[…]
  • Psych/polypharmacy
  • Stroke/SAH

A

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

“TINE”

Trauma/tox

Infection/ischemia

Neuro

Electrolytes/endocrine

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19
Q

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • P[…]
  • Stroke/SAH

A

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

“TINE”

Trauma/tox

Infection/ischemia

Neuro

Electrolytes/endocrine

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20
Q

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • S[…]

A

AMS ddx: (AEIOUTIPS)

  • Alcohol/acidosis
  • Electrolytes
  • Infection/ischemia
  • Oxygen (hypoxia)
  • Uremia
  • Toxidrome/trauma
  • Insulin
  • Psych/polypharmacy
  • Stroke/SAH

“TINE”

Trauma/tox

Infection/ischemia

Neuro

Electrolytes/endocrine

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21
Q

AMS exam: (6)

  • […]
  • pupils - size + nystagmus
  • axilla- dry?
  • lungs- pna?
  • abd- tenderness/pain
  • skin- decubitus ulcers, rash, petechiae

A

AMS exam: (6)

  • basic “ED Neuro Exam”
  • pupils - size + nystagmus
  • axilla- dry?
  • lungs- pna?
  • abd- tenderness/pain
  • skin- decubitus ulcers, rash, petechiae

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22
Q

AMS exam: (6)

  • basic “ED Neuro Exam”
  • […]
  • axilla- dry?
  • lungs- pna?
  • abd- tenderness/pain
  • skin- decubitus ulcers, rash, petechiae

A

AMS exam: (6)

  • basic “ED Neuro Exam”
  • pupils - size + nystagmus
  • axilla- dry?
  • lungs- pna?
  • abd- tenderness/pain
  • skin- decubitus ulcers, rash, petechiae
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23
Q

AMS exam: (6)

  • basic “ED Neuro Exam”
  • pupils - size + nystagmus
  • […]
  • lungs- pna?
  • abd- tenderness/pain
  • skin- decubitus ulcers, rash, petechiae

A

AMS exam: (6)

  • basic “ED Neuro Exam”
  • pupils - size + nystagmus
  • axilla- dry?
  • lungs- pna?
  • abd- tenderness/pain
  • skin- decubitus ulcers, rash, petechiae

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24
Q

AMS exam: (6)

  • basic “ED Neuro Exam”
  • pupils - size + nystagmus
  • axilla- dry?
  • […]
  • abd- tenderness/pain
  • skin- decubitus ulcers, rash, petechiae

A

AMS exam: (6)

  • basic “ED Neuro Exam”
  • pupils - size + nystagmus
  • axilla- dry?
  • lungs- pna?
  • abd- tenderness/pain
  • skin- decubitus ulcers, rash, petechiae
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25
AMS exam: (6) ## Footnote * basic "ED Neuro Exam" * pupils - size + nystagmus * axilla- dry? * lungs- pna? * [...] * skin- decubitus ulcers, rash, petechiae
AMS exam: (6) ## Footnote * basic "ED Neuro Exam" * pupils - size + nystagmus * axilla- dry? * lungs- pna? * **abd- tenderness/pain** * skin- decubitus ulcers, rash, petechiae
26
AMS exam: (6) ## Footnote * basic "ED Neuro Exam" * pupils - size + nystagmus * axilla- dry? * lungs- pna? * abd- tenderness/pain * [...]
AMS exam: (6) * basic "ED Neuro Exam" * pupils - size + nystagmus * axilla- dry? * lungs- pna? * abd- tenderness/pain * **skin- decubitus ulcers, rash, petechiae**
27
AMS Stroke with no intacranial bleed and within [...] hrs onset can give [...].
AMS Stroke with no intacranial bleed and within 4 hrs onset can give TPA. read through TPA contraindications!
28
Anaerobic abx coverage: ## Footnote * [...] * clindamycin * augmentin (amox/clav) * unasyn (amp/sulb) * zosyn (pip/tazo) * moxifloxacin * carbipenem * tigecycline
Anaerobic abx coverage: ## Footnote * **flagyl (metro)** * clindamycin * augmentin (amox/clav) * unasyn (amp/sulb) * zosyn (pip/tazo) * moxifloxacin * carbipenem * tigecycline
29
Anaerobic abx coverage: ## Footnote * flagyl (metro) * [...] * augmentin (amox/clav) * unasyn (amp/sulb) * zosyn (pip/tazo) * moxifloxacin * carbipenem * tigecycline
Anaerobic abx coverage: ## Footnote * flagyl (metro) * **clindamycin** * augmentin (amox/clav) * unasyn (amp/sulb) * zosyn (pip/tazo) * moxifloxacin * carbipenem * tigecycline
30
Anaerobic abx coverage: ## Footnote * flagyl (metro) * clindamycin * [...] * unasyn (amp/sulb) * zosyn (pip/tazo) * moxifloxacin * carbipenem * tigecycline
Anaerobic abx coverage: ## Footnote * flagyl (metro) * clindamycin * **augmentin (amox/clav)** * unasyn (amp/sulb) * zosyn (pip/tazo) * moxifloxacin * carbipenem * tigecycline
31
Anaerobic abx coverage: ## Footnote * flagyl (metro) * clindamycin * augmentin (amox/clav) * [...] * zosyn (pip/tazo) * moxifloxacin * carbipenem * tigecycline
Anaerobic abx coverage: ## Footnote * flagyl (metro) * clindamycin * augmentin (amox/clav) * **unasyn (amp/sulb)** * zosyn (pip/tazo) * moxifloxacin * carbipenem * tigecycline
32
Anaerobic abx coverage: ## Footnote * flagyl (metro) * clindamycin * augmentin (amox/clav) * unasyn (amp/sulb) * [...] * moxifloxacin * carbipenem * tigecycline
Anaerobic abx coverage: ## Footnote * flagyl (metro) * clindamycin * augmentin (amox/clav) * unasyn (amp/sulb) * **zosyn (pip/tazo)** * moxifloxacin * carbipenem * tigecycline
33
Anaerobic abx coverage: ## Footnote * flagyl (metro) * clindamycin * augmentin (amox/clav) * unasyn (amp/sulb) * zosyn (pip/tazo) * moxifloxacin * [...] * tigecycline
Anaerobic abx coverage: ## Footnote * flagyl (metro) * clindamycin * augmentin (amox/clav) * unasyn (amp/sulb) * zosyn (pip/tazo) * moxifloxacin * **carbipenem** * tigecycline
34
Anaerobic abx coverage: ## Footnote * flagyl (metro) * clindamycin * augmentin (amox/clav) * unasyn (amp/sulb) * zosyn (pip/tazo) * [...] * carbipenem * tigecycline
Anaerobic abx coverage: * flagyl (metro) * clindamycin * augmentin (amox/clav) * unasyn (amp/sulb) * zosyn (pip/tazo) * **moxifloxacin** * carbipenem * tigecycline
35
Anaerobic abx coverage: ## Footnote * flagyl (metro) * clindamycin * augmentin (amox/clav) * unasyn (amp/sulb) * zosyn (pip/tazo) * moxifloxacin * carbipenem * [...]
Anaerobic abx coverage: ## Footnote * flagyl (metro) * clindamycin * augmentin (amox/clav) * unasyn (amp/sulb) * zosyn (pip/tazo) * moxifloxacin * carbipenem * **tigecycline**
36
Anaphlyaxis pt on beta blockers needs: * [...] * glucagon 1-5mg IV slowly * zofran 4mg
Anaphlyaxis pt on beta blockers needs: * **epi- IM/epi pen/push dose** * glucagon 1-5mg IV slowly * zofran 4mg glucagon to counteract BB
37
Anaphlyaxis pt on beta blockers needs: * epi- IM/epi pen/push dose * [...] * zofran 4mg
Anaphlyaxis pt on beta blockers needs: * epi- IM/epi pen/push dose * **glucagon 1-5mg IV slowly** * zofran 4mg glucagon to counteract BB
38
Anaphlyaxis pt on beta blockers needs: * epi- IM/epi pen/push dose * glucagon 1-5mg IV slowly * [...]
Anaphlyaxis pt on beta blockers needs: * epi- IM/epi pen/push dose * glucagon 1-5mg IV slowly * **zofran 4mg** glucagon to counteract BB
39
Anaphylaxis first step is [...].
Anaphylaxis first step is rapid **ABC's.**
40
Anaphylaxis pts who don't improve with IM epi can receive [...].
Anaphylaxis pts who don't improve with IM epi can receive **IV epi.**
41
Anatomical EKG locations are: ## Footnote * inferior = [...] * anterior/septal = V1 - V3 * lateral = I and AVL + V4-V6 * isolation = AVR
Anatomical EKG locations are: ## Footnote * inferior = **II, III, AVF** * anterior/septal = V1 - V3 * lateral = I and AVL + V4-V6 * isolation = AVR
42
Anatomical EKG locations are: ## Footnote * inferior = II, III, AVF * anterior/septal = [...] * lateral = I and AVL + V4-V6 * isolation = AVR
Anatomical EKG locations are: ## Footnote * inferior = II, III, AVF * anterior/septal = **V1 - V3** * lateral = I and AVL + V4-V6 * isolation = AVR
43
Anatomical EKG locations are: ## Footnote * inferior = II, III, AVF * anterior/septal = V1 - V3 * lateral = [...] + V4-V6 * isolation = AVR
Anatomical EKG locations are: ## Footnote * inferior = II, III, AVF * anterior/septal = V1 - V3 * lateral = **I and AVL + V4-V6** * isolation = AVR
44
Anatomical EKG locations are: ## Footnote * inferior = II, III, AVF * anterior/septal = V1 - V3 * lateral = I and AVL + [...] * isolation = AVR
Anatomical EKG locations are: ## Footnote * inferior = II, III, AVF * anterior/septal = V1 - V3 * lateral = I and AVL + **V4-V6** * isolation = AVR
45
Anatomical EKG locations are: ## Footnote * inferior = II, III, AVF * anterior/septal = V1 - V3 * lateral = I and AVL + V4-V6 * isolation = [...]
Anatomical EKG locations are: ## Footnote * inferior = II, III, AVF * anterior/septal = V1 - V3 * lateral = I and AVL + V4-V6 * isolation = **AVR**
46
Anion Gap = [...]
Anion Gap = [Na - (Cl +HCO3)]
47
Anti-Hypertensives quick doses: ## Footnote * labetalol: 10-40mg IV q10min =\> 0.5-2 mg/min IV * hydralazine: [...] * nicardipine: 5mg/h =\> +2.5mg/hr (max15mg/hr) * nitroglycerin: 5-20mcg/min IV
Anti-Hypertensives quick doses: ## Footnote * labetalol: 10-40mg IV q10min =\> 0.5-2 mg/min IV * hydralazine: **10mg slow IV Q6 (up to max 40mg)** * nicardipine: 5mg/h =\> +2.5mg/hr (max15mg/hr) * nitroglycerin: 5-20mcg/min IV
48
Anti-Hypertensives quick doses: ## Footnote * labetalol: 10-40mg IV q10min =\> 0.5-2 mg/min IV * hydralazine: 10mg slow IV Q6 (up to max 40mg) * nicardipine: [...] * nitroglycerin: 5-20mcg/min IV
Anti-Hypertensives quick doses: ## Footnote * labetalol: 10-40mg IV q10min =\> 0.5-2 mg/min IV * hydralazine: 10mg slow IV Q6 (up to max 40mg) * nicardipine: **5mg/h =\> +2.5mg/hr (max15mg/hr)** * nitroglycerin
49
Anti-Hypertensives quick doses: ## Footnote * labetalol: [...] * hydralazine: 10mg slow IV Q6 (up to max 40mg) * nicardipine: 5mg/h =\> +2.5mg/hr (max15mg/hr) * nitroglycerin: 5-20mcg/min IV
Anti-Hypertensives quick doses: * labetalol: **10-40mg IV q10min =\> 0.5-2 mg/min IV** * hydralazine: 10mg slow IV Q6 (up to max 40mg) * nicardipine: 5mg/h =\> +2.5mg/hr (max15mg/hr) * nitroglycerin: 5-20mcg/min IV
50
Anti-Hypertensives quick doses: ## Footnote * labetalol: 10-40mg IV q10min =\> 0.5-2 mg/min IV * hydralazine: 10mg slow IV Q6 (up to max 40mg) * nicardipine: 5mg/h =\> +2.5mg/hr (max15mg/hr) * nitroglycerin: [...]
Anti-Hypertensives quick doses: ## Footnote * labetalol: 10-40mg IV q10min =\> 0.5-2 mg/min IV * hydralazine: 10mg slow IV Q6 (up to max 40mg) * nicardipine: 5mg/h =\> +2.5mg/hr (max15mg/hr) * nitroglycerin: **5-20mcg/min IV**
51
Anyphylaxis assesment triangle: ## Footnote * [...] * work of breathing * color- skin color
Anyphylaxis assesment triangle: ## Footnote * **appearance- overall** * work of breathing * color- skin color
52
Anyphylaxis assesment triangle: ## Footnote * appearance- overall * [...] * color- skin color
Anyphylaxis assesment triangle: ## Footnote * appearance- overall * **work of breathing** * color- skin color
53
Anyphylaxis assesment triangle: ## Footnote * appearance- overall * work of breathing * [...]
Anyphylaxis assesment triangle: ## Footnote * appearance- overall * work of breathing * **color- skin color**
54
Anything that irritates the tympanic membrane can cause [...].
Anything that irritates the tympanic membrane can cause **dizziness.**
55
Aortic Dissection CXR shows [...] (60-70% sn).
Aortic Dissection CXR shows **widened mediastinum** (60-70% sn). \>6cm (some say 8cm)
56
Aortic Dissection presents with [...] radiating to back/shoulder.
Aortic Dissection presents with **ripping chest pain** radiating to back/shoulder.
57
Aortic Dissection presents with ripping chest pain radiating to [...].
Aortic Dissection presents with ripping chest pain radiating to **back/shoulder.**
58
Aortic Dissection prx: ## Footnote * [...] * hx of htn * pulse and motor deficits
Aortic Dissection prx: ## Footnote * **ripping/tearing chest/back pain** * hx of htn * pulse and motor deficits
59
Aortic Dissection prx: ## Footnote * ripping/tearing chest/back pain * [...] * pulse and motor deficits
Aortic Dissection prx: ## Footnote * ripping/tearing chest/back pain * **hx of htn** * pulse and motor deficits
60
Aortic Dissection prx: ## Footnote * ripping/tearing chest/back pain * hx of htn * [...]
Aortic Dissection prx: ## Footnote * ripping/tearing chest/back pain * hx of htn * **pulse and motor deficits**
61
Aortic Dissection risk factors: ## Footnote * [...] * smoking * age 60+ * pregnancy * connective tissue dz (marfans/ED)
Aortic Dissection risk factors: * **HTN #1** * smoking * age 60+ * pregnancy * connective tissue dz (marfans/ED)
62
Aortic Dissection risk factors: ## Footnote * HTN #1 * [...] * age 60+ * pregnancy * connective tissue dz (marfans/ED)
Aortic Dissection risk factors: * HTN #1 * **smoking** * age 60+ * pregnancy * connective tissue dz (marfans/ED)
63
Aortic Dissection risk factors: ## Footnote * HTN #1 * smoking * [...] * pregnancy * connective tissue dz (marfans/ED)
Aortic Dissection risk factors: ## Footnote * HTN #1 * smoking * **age 60+** * pregnancy * connective tissue dz (marfans/ED)
64
Aortic Dissection risk factors: ## Footnote * HTN #1 * smoking * age 60+ * [...] * connective tissue dz (marfans/ED)
Aortic Dissection risk factors: ## Footnote * HTN #1 * smoking * age 60+ * **pregnancy** * connective tissue dz (marfans/ED)
65
Aortic Dissection risk factors: ## Footnote * HTN #1 * smoking * age 60+ * pregnancy * [...]
Aortic Dissection risk factors: * HTN #1 * smoking * age 60+ * pregnancy * **connective tissue dz (marfans/ED)**
66
Aortic Dissection tx: ## Footnote * [...] * nicardipine 2mg IV =\> 5mg/hr (titrate up by 2.5mg/hr) * fentanyl 1mcg/kg IV * surgery cs
Aortic Dissection tx: ## Footnote * **esmolol 500mcg/kg over 1 min =\> 50mcg/kg/min** * nicardipine 2mg IV =\> 5mg/hr (titrate up by 2.5mg/hr) * fentanyl 1mcg/kg IV * surgery cs start with esmolol for BB effects
67
Aortic Dissection tx: ## Footnote * esmolol 500mcg/kg over 1 min =\> 50mcg/kg/min * [...] * fentanyl 1mcg/kg IV * surgery cs
Aortic Dissection tx: ## Footnote * esmolol 500mcg/kg over 1 min =\> 50mcg/kg/min * **nicardipine 2mg IV =\> 5mg/hr (titrate up by 2.5mg/hr)** * fentanyl 1mcg/kg IV * surgery cs start with esmolol for BB effects
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Aortic Dissection tx: ## Footnote * esmolol 500mcg/kg over 1 min =\> 50mcg/kg/min * nicardipine 2mg IV =\> 5mg/hr (titrate up by 2.5mg/hr) * [...] * surgery cs
Aortic Dissection tx: ## Footnote * esmolol 500mcg/kg over 1 min =\> 50mcg/kg/min * nicardipine 2mg IV =\> 5mg/hr (titrate up by 2.5mg/hr) * **fentanyl 1mcg/kg IV** * surgery cs start with esmolol for BB effects
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Aortic Dissection tx: ## Footnote * esmolol 500mcg/kg over 1 min =\> 50mcg/kg/min * nicardipine 2mg IV =\> 5mg/hr (titrate up by 2.5mg/hr) * fentanyl 1mcg/kg IV * [...]
Aortic Dissection tx: ## Footnote * esmolol 500mcg/kg over 1 min =\> 50mcg/kg/min * nicardipine 2mg IV =\> 5mg/hr (titrate up by 2.5mg/hr) * fentanyl 1mcg/kg IV * **surgery cs** start with esmolol for BB effects
70
Aortic Dissection w/u: ## Footnote • [...]
Aortic Dissection w/u: ## Footnote • **CTA** TEE if dye allergy or bad kidneys
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APAP liver metabolism: ## Footnote * 90% = [...] * 10% = P450 into NAPQI =\> glutathione
APAP (acetaminophen) liver metabolism: * 90% = **sulfation + glucuronidation** * 10% = P450 into NAPQI =\> glutathione
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APAP (acetaminophen) liver metabolism: ## Footnote * 90% = sulfation + glucuronidation * 10% = [...]
APAP liver metabolism: * 90% = sulfation + glucuronidation * 10% = **P450 into NAPQI =\> glutathione**
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APAP OD can be [...] and lethal.
APAP OD can be **asymptomatic** and lethal.
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APAP OD can be asymptomatic and [...].
APAP OD can be asymptomatic and **lethal.**
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APAP OD dispo: (3) ## Footnote * pt asx/mild sxs =\> [...] * pt tx with NAC =\> admitted * pt with sxs hepatotoxicity =\> ICU
APAP OD dispo: (3) ## Footnote * pt asx/mild sxs =\> **admit to obs** * pt tx with NAC =\> admitted * pt with sxs hepatotoxicity =\> ICU
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APAP OD dispo: (3) ## Footnote * pt asx/mild sxs =\> admit to obs * pt tx with NAC =\> [...] * pt with sxs hepatotoxicity =\> ICU
APAP OD dispo: (3) ## Footnote * pt asx/mild sxs =\> admit to obs * pt tx with NAC =\> **admitted** * pt with sxs hepatotoxicity =\> ICU
77
APAP OD dispo: (3) ## Footnote * pt asx/mild sxs =\> admit to obs * pt tx with NAC =\> admitted * pt with sxs hepatotoxicity =\> [...]
APAP OD dispo: (3) ## Footnote * pt asx/mild sxs =\> admit to obs * pt tx with NAC =\> admitted * pt with sxs hepatotoxicity =\> **ICU**
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APAP OD doesn't cause liver damage immediately so you have [...].
APAP OD doesn't cause liver damage immediately so you have **time ~4hrs to wait on serum lvl.**
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APAP OD meds that worsen outcome: ## Footnote * [...] * anti-TB drugs * TMP-SMX * zidovudine * herbal supplements
APAP OD meds that worsen outcome: ## Footnote * **anticonvulsants** * anti-TB drugs * TMP-SMX * zidovudine * herbal supplements
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APAP OD meds that worsen outcome: ## Footnote * anticonvulsants * [...] * TMP-SMX * zidovudine * herbal supplements
APAP OD meds that worsen outcome: * anticonvulsants * **anti-TB drugs** * TMP-SMX * zidovudine * herbal supplements
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APAP OD meds that worsen outcome: ## Footnote * anticonvulsants * anti-TB drugs * [...] * zidovudine * herbal supplements
APAP OD meds that worsen outcome: * anticonvulsants * anti-TB drugs * **TMP-SMX** * zidovudine * herbal supplements
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APAP OD meds that worsen outcome: ## Footnote * anticonvulsants * anti-TB drugs * TMP-SMX * [...] * herbal supplements
APAP OD meds that worsen outcome: ## Footnote * anticonvulsants * anti-TB drugs * TMP-SMX * **zidovudine** * herbal supplements
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APAP OD meds that worsen outcome: ## Footnote * anticonvulsants * anti-TB drugs * TMP-SMX * zidovudine * [...]
APAP OD meds that worsen outcome: ## Footnote * anticonvulsants * anti-TB drugs * TMP-SMX * zidovudine * **herbal supplements**
84
APAP OD occurs due to increased [...] and decreased glutathione.
APAP OD occurs due to increased **NAPQI** and decreased glutathione.
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APAP OD occurs due to increased NAPQI and decreased [...].
APAP OD occurs due to increased NAPQI and decreased **glutathione.**
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APAP OD pts who qualify for NAC: ## Footnote * [...] * single APAP ingestion \>150mg who can't get APAP level in under 8 hrs * pt with uknown time of ingestion and APAP \>10mcg/ml * pt with \>24hrs post ingestion evidence of liver injury
APAP OD pts who qualify for NAC: * **pt above line on Rumack-Mathew nomogram** * single APAP ingestion \>150mg who can't get APAP level in under 8 hrs * pt with uknown time of ingestion and APAP \>10mcg/ml * pt with \>24hrs post ingestion evidence of liver injury
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APAP OD pts who qualify for NAC: ## Footnote * pt above line on Rumack-Mathew nomogram * [...] * pt with uknown time of ingestion and APAP \>10mcg/ml * pt with \>24hrs post ingestion evidence of liver injury
APAP OD pts who qualify for NAC: * pt above line on Rumack-Mathew nomogram * **single APAP ingestion \>150mg who can't get APAP level in under 8 hrs** * pt with uknown time of ingestion and APAP \>10mcg/ml * pt with \>24hrs post ingestion evidence of liver injury
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APAP OD pts who qualify for NAC: ## Footnote * pt above line on Rumack-Mathew nomogram * single APAP ingestion \>150mg who can't get APAP level in under 8 hrs * [...] * pt with \>24hrs post ingestion evidence of liver injury
APAP OD pts who qualify for NAC: * pt above line on Rumack-Mathew nomogram * single APAP ingestion \>150mg who can't get APAP level in under 8 hrs * **pt with uknown time of ingestion and APAP \>10mcg/ml** * pt with \>24hrs post ingestion evidence of liver injury
89
APAP OD pts who qualify for NAC: ## Footnote * pt above line on Rumack-Mathew nomogram * single APAP ingestion \>150mg who can't get APAP level in under 8 hrs * pt with uknown time of ingestion and APAP \>10mcg/ml * [...]
APAP OD pts who qualify for NAC: * pt above line on Rumack-Mathew nomogram * single APAP ingestion \>150mg who can't get APAP level in under 8 hrs * pt with uknown time of ingestion and APAP \>10mcg/ml * **pt with \>24hrs post ingestion evidence of liver injury**
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APAP OD stages: ## Footnote * I = [...] * II = 24-72hr * III = 72-96hr * IV = 4d-2wk
APAP OD stages: ## Footnote * I = **30min-24hr** * II = 24-72hr * III = 72-96hr * IV = 4d-2wk
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APAP OD stages: ## Footnote * I = 30min-24hr * II = [...] * III = 72-96hr * IV = 4d-2wk
APAP OD stages: ## Footnote * I = 30min-24hr * II = **24-72hr** * III = 72-96hr * IV = 4d-2wk
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APAP OD stages: ## Footnote * I = 30min-24hr * II = 24-72hr * III = [...] * IV = 4d-2wk
APAP OD stages: ## Footnote * I = 30min-24hr * II = 24-72hr * III = **72-96hr** * IV = 4d-2wk
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APAP OD stages: ## Footnote * I = 30min-24hr * II = 24-72hr * III = 72-96hr * IV = [...]
APAP OD stages: ## Footnote * I = 30min-24hr * II = 24-72hr * III = 72-96hr * IV = **4d-2wk**
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APAP OD tx: (+ doses) ## Footnote * [...] * NAC 150 mg/kg IV in 100ml D5W =\> 50 mg/kg in 250ml D5W • +/- activated charcoal 1g/kg PO within 4 hrs of ingestion (max 50g)
APAP OD tx: (+ doses) ## Footnote * **ABCs: O2, IVFs, EKG** * NAC 150 mg/kg IV in 100ml D5W =\> 50 mg/kg in 250ml D5W • +/- activated charcoal 1g/kg PO within 4 hrs of ingestion (max 50g)
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APAP OD tx: (+ doses) ## Footnote * ABCs: O2, IVFs, EKG * NAC 150 mg/kg IV in 100ml D5W =\> 50 mg/kg in 250ml D5W • +/- [...]
APAP OD tx: (+ doses) ## Footnote * ABCs: O2, IVFs, EKG * NAC 150 mg/kg IV in 100ml D5W =\> 50 mg/kg in 250ml D5W • +/- **activated charcoal 1g/kg PO within 4 hrs of ingestion (max 50g)**
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APAP OD tx: (+ doses) ## Footnote * ABCs: O2, IVFs, EKG * [...] • +/- activated charcoal 1g/kg PO within 4 hrs of ingestion (max 50g)
APAP OD tx: (+ doses) ## Footnote * ABCs: O2, IVFs, EKG * **NAC 150 mg/kg IV in 100ml D5W =\> 50 mg/kg in 250ml D5W** • +/- activated charcoal 1g/kg PO within 4 hrs of ingestion (max 50g)
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APAP OD w/u: ## Footnote • [...] * CBC/CMP * ABG/VBG (acidosis) * coags • LFTs * ammonia * urine hCG * EKG * EtOH * ASA
APAP OD w/u: ## Footnote • **serum APAP** * CBC/CMP * ABG/VBG (acidosis) * coags • LFTs * ammonia * urine hCG * EKG * EtOH * ASA
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APAP OD w/u: ## Footnote • serum APAP * [...] * ABG/VBG (acidosis) * coags • LFTs * ammonia * urine hCG * EKG * EtOH * ASA
APAP OD w/u: ## Footnote • serum APAP * **CBC/CMP** * ABG/VBG (acidosis) * coags • LFTs * ammonia * urine hCG * EKG * EtOH * ASA
99
APAP OD w/u: ## Footnote • serum APAP * CBC/CMP * [...] * coags • LFTs * ammonia * urine hCG * EKG * EtOH * ASA
APAP OD w/u: ## Footnote • serum APAP * CBC/CMP * **ABG/VBG (acidosis)** * coags • LFTs * ammonia * urine hCG * EKG * EtOH * ASA
100
APAP OD w/u: ## Footnote • serum APAP * CBC/CMP * ABG/VBG (acidosis) * [...] • LFTs * ammonia * urine hCG * EKG * EtOH * ASA
APAP OD w/u: ## Footnote • serum APAP * CBC/CMP * ABG/VBG (acidosis) * **coags** • LFTs * ammonia * urine hCG * EKG * EtOH * ASA
101
APAP OD w/u: ## Footnote • serum APAP * CBC/CMP * ABG/VBG (acidosis) * coags • [...] * ammonia * urine hCG * EKG * EtOH * ASA
APAP OD w/u: ## Footnote • serum APAP * CBC/CMP * ABG/VBG (acidosis) * coags • **LFTs** * ammonia * urine hCG * EKG * EtOH * ASA
102
APAP OD w/u: ## Footnote • serum APAP * CBC/CMP * ABG/VBG (acidosis) * coags • LFTs * [...] * urine hCG * EKG * EtOH * ASA
APAP OD w/u: ## Footnote • serum APAP * CBC/CMP * ABG/VBG (acidosis) * coags • LFTs * **ammonia** * urine hCG * EKG * EtOH * ASA
103
APAP OD w/u: ## Footnote • serum APAP * CBC/CMP * ABG/VBG (acidosis) * coags • LFTs * ammonia * [...] * EKG * EtOH * ASA
APAP OD w/u: ## Footnote • serum APAP * CBC/CMP * ABG/VBG (acidosis) * coags • LFTs * ammonia * **urine hCG** * EKG * EtOH * ASA
104
APAP OD w/u: ## Footnote • serum APAP * CBC/CMP * ABG/VBG (acidosis) * coags • LFTs * ammonia * urine hCG * [...] * EtOH * ASA
APAP OD w/u: • serum APAP * CBC/CMP * ABG/VBG (acidosis) * coags • LFTs * ammonia * urine hCG * **EKG** * EtOH * ASA
105
APAP OD w/u: ## Footnote • serum APAP * CBC/CMP * ABG/VBG (acidosis) * coags • LFTs * ammonia * urine hCG * EKG * [...] * ASA
APAP OD w/u: • serum APAP * CBC/CMP * ABG/VBG (acidosis) * coags • LFTs * ammonia * urine hCG * EKG * **EtOH** * ASA
106
APAP OD w/u: ## Footnote • serum APAP * CBC/CMP * ABG/VBG (acidosis) * coags • LFTs * ammonia * urine hCG * EKG * EtOH * [...]
APAP OD w/u: ## Footnote • serum APAP * CBC/CMP * ABG/VBG (acidosis) * coags • LFTs * ammonia * urine hCG * EKG * EtOH * **ASA**
107
ASA alternate preparations: ## Footnote * [...] * bismuth subsalicylate (pepto) * methyl salicylate (oil of wintergreen
ASA alternate preparations: ## Footnote * **salicylic acid (acne)** * bismuth subsalicylate (pepto) * methyl salic
108
ASA alternate preparations: ## Footnote * salicylic acid (acne) * [...] * methyl salicylate (oil of wintergreen)
ASA alternate preparations: * salicylic acid (acne) * **bismuth subsalicylate (pepto)** * methyl salicylate (oil of wintergreen)
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ASA alternate preparations: ## Footnote * salicylic acid (acne) * bismuth subsalicylate (pepto) * [...]
ASA alternate preparations: ## Footnote * salicylic acid (acne) * bismuth subsalicylate (pepto) * **methyl salicylate (oil of wintergreen)**
110
ASA is [...] to salicylate within intestinal wall/liver/RBCs.
ASA is **hydrolyzed** to salicylate within intestinal wall/liver/RBCs.
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ASA is hydrolyzed to salicylate within [...].
ASA is hydrolyzed to salicylate within **intestinal wall/liver/RBCs.**
112
ASA OD dispo is [...].
ASA OD dispo is **admission**.
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ASA OD exam: ## Footnote * [...] * vital signs- tachypnea, hyperthermia, hypotension, or tachycardia * lungs- hyperpnea, crackles, signs of pulmonary edema * GU- oliguria
ASA OD exam: ## Footnote * **general- AOx3, confused, agitated, restless** * vital signs- tachypnea, hyperthermia, hypotension, or tachycardia * lungs- hyperpnea, crackles, signs of pulmonary edema * GU- oliguria
114
ASA OD exam: ## Footnote * general- AOx3, confused, agitated, restless * [...] * lungs- hyperpnea, crackles, signs of pulmonary edema * GU- oliguria
ASA OD exam: ## Footnote * general- AOx3, confused, agitated, restless * **vital signs- tachypnea, hyperthermia, hypotension, or tachycardia** * lungs- hyperpnea, crackles, signs of pulmonary edema * GU- oliguria
115
ASA OD exam: ## Footnote * general- AOx3, confused, agitated, restless * vital signs- tachypnea, hyperthermia, hypotension, or tachycardia * [...] * GU- oliguria
ASA OD exam: * general- AOx3, confused, agitated, restless * vital signs- tachypnea, hyperthermia, hypotension, or tachycardia * **lungs- hyperpnea, crackles, signs of pulmonary edema** * GU- oliguria
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ASA OD exam: ## Footnote * general- AOx3, confused, agitated, restless * vital signs- tachypnea, hyperthermia, hypotension, or tachycardia * lungs- hyperpnea, crackles, signs of pulmonary edema * [...]
ASA OD exam: ## Footnote * general- AOx3, confused, agitated, restless * vital signs- tachypnea, hyperthermia, hypotension, or tachycardia * lungs- hyperpnea, crackles, signs of pulmonary edema * **GU- oliguria**
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ASA OD floor monitoring: ## Footnote * [...] * serial ASA lvl Q2 * serial BMP/ABG/pH Q2
ASA OD floor monitoring: * **continuous respiratory/cardiac monitoring** * serial ASA lvl Q2 * serial BMP/ABG/pH Q2
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ASA OD floor monitoring: ## Footnote * continuous respiratory/cardiac monitoring * [...] * serial BMP/ABG/pH Q2
ASA OD floor monitoring: ## Footnote * continuous respiratory/cardiac monitoring * **serial ASA lvl Q2** * serial BMP/ABG/pH Q2
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ASA OD floor monitoring: ## Footnote * continuous respiratory/cardiac monitoring * serial ASA lvl Q2 * [...]
ASA OD floor monitoring: ## Footnote * continuous respiratory/cardiac monitoring * serial ASA lvl Q2 * **serial BMP/ABG/pH Q2**
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ASA OD hemodialysis indications: (6) ## Footnote * [...] * intubated * oliguric renal failure * pulmonary/cerebral edema * AMS * clinical deterioration
ASA OD hemodialysis indications: (6) ## Footnote * **ASA \>100mg/dL (\>50 if chronic)** * intubated * oliguric renal failure * pulmonary/cerebral edema * AMS * clinical deterioration
Emergency Medicine
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