EM No. 1 Flashcards
(64 cards)
what is the dx: pt has swollen red and tender right calf. dorsiflexion of the right foot induces pain in calf. venous ultrasonography reveals failure of venous compression with passive dilatation.
DVT
sign associated with passive dorsiflexion of the foot inducing pain in the calf - also, what is the dx once the sign is positive?
homan sign; dvt
once dvt is dx what is the immediate treatment regimen?
anticoagulant - heparin for the first 5-7 days followed by oral anticoagulants with interlacing in the 3 or 5th days
during pregnancy when treating a DVT, what is the preferred anticoagulant?
heparin b/c warfarin is associated with congenital anomalies
with pleural effusion, the trachea is displaced to the which side?
the side opposite the fluid
what is the dx - increasing dyspnea, mild temp elevation; dull percussion note of posterior chest, distant bronchovesicular breath sounds, increased whispered voice sounds, and diminished voice sounds below 6th ITS.
pleural effusion - dullness in area of effusion; distant sounds due to fluid presence; whispers increase in area of fluid, and spoken are diminished in areas of fluid.
what is the formula for the anion gap? what is the normal range?
sodium minus chloride plus bicarb; 3 to 12
in cardiac arrest involving ventricular fibrillation, what is the highest priority in terms of next step management?
DEFIBRILLATION - immediately - DO NOT do anything else before you DEFIB!
what is the first line treatment of management of asystole and PEA?
DO NOT DEFIB!! continue CPR and give epinephrine.
what are the 4 rhythms that can produce pulse cardiac arrest?
vfib, pea, rapid vtach, asystole
an increase in stroke volume leads to what type of pulse pressure and eventual systolic pressure?
increase in pulse pressure and increase in systolic pressure
what eventually happens to stroke volume with chronic aortic regurgitation?
increases
what is the definitive treatment of AR?
valve replacement
what is the MCC of CHF? and the 2nd MCC?
CAD; dilated cardiomyopathy
pts with protein c and s deficiencies are more prone to a hyper-coagulable state which predisposes them to what condition?
DVT and PE
what is known as enlargement of the right ventricle of the heart as a response to increased resistance or high blood pressure in the lungs (pulmonary hypertension).
cor pulmonale
which heart sound is associated with pulmonary embolism that has progressed to acute cor pulmonale?
s3 gallop
as the RV suffers from acute pressure overload it will increase RV wall tension , dilatation and failure. RV dilatation shifts the ITV septum towards the LV reducing its capacity and increasing resistance of LV - what is the phenomenon called?
ventricular interdependence
what are the two signs you are looking for on the echo to dx PE?
right ventricular dilatation and asynergy except in the apex (McConnell’s sign) *Remember that pts with RV abnormalities are at higher risk than those without
what are the two ways you can differentiate a right ventricular infarction from a PE?
on the EKG look for signs of inferior infarction and also look for ST elevations
what are the two ways you can differentiate PE from pneumonia?
in pneumonia the cough is typically productive and also the dyspnea is typically NOT of sudden onset
in terms of the primary treatment for PE what are your top 3?
oxygen, NSAID, and dobutamine (positive inotropic and pulmonary vasodilator)
why is it IV fluids is NOT advised in PE?
b/c ventricular interdependence may lead to left sided heart failure
what is the major cause for concern with thrombolytic therapy?
intracranial bleeding (1% risk)
