Emergency Flashcards
(50 cards)
Indication for definitive airway
GCS < 8 cannot protect airway inadequate O2 shock need for intubate in future
Class I shock
<15% loss
no change
Class II shock
750-1500 (15-30%) loss tachycardic tachypnea reduced cap refill 20 ml/hr urine
Class III shock
1500-2000 (30-40%) loss tachycardia tachypnea hypotension decreased cap refill 10 ml/hr urine
Class IV shock
>2000 (40%) loss tachycardia tachypnea hypotension decreased cap refill no urine
GCS eye
4 spontaneous
3 voice
2 pain
1 none
GCS verbal
5 answers 4 confused 3 words 2 sounds 1 none
GCS motor
6 commands 5 localizes 4 withdraws 3 decorticate flexion 2 decerebrate extension 1 none
Canadian CT head = minor injury +
GCS 2
Age > 65
Amnesia > 30 min
Dangerous mechanism
Basal skull fractures
hemotympanum
raccoon eyes
otorrhea/rhinorrhea
Battle’s sign
Dangerous mechanism injury
person hit by car
eject from car
fall > 3ft/5 stairs
Minor head injury
witnessed LOC
amnesia
witnessed disorientation
GCS 13-15
Clear C-spine
no posterior midline cervical tenderness no intoxication oriented x 3 + event no focal neuro deficit no painful distractions can rotate neck
Compartment syndrome 6P’s
pain out of proportion, pain with passive stretch, pallor, paresthesia, paralysis, polar
Ottawa ankle rule
Ankle
Ankle X ray only if tenderness in lateral malleolus, medial malleolus and inability to weight bear
Ottawa ankle rule
Foot
Foot x-ray if tender at base of 5th metatarsal, navicular (medial) and inability to weight bear
Ottawa knee rule
Acute injury plus one of
1) >55 yr
2) tender at head of fibula
3) isolated tender of patella
4) cannot flex to 90 degrees
5) cannot bear weight (4 steps)
Altered LOC metabolic/toxic causes
Major organ fail Electrolytes/Endocrine Toxin/temperature Acid Base Oxygen decrease Lactate Insulin/Infection Cardiac/Calcium high
Universal antidote
thiamine (100 mg iv/im)
D50W (1-2 ml)
naloxone (2-10 mg)
oxygen
Wells DVT
2+ pt likely active cancer paralysis/paresis/recent immobilize bedridden > 3 d, major surg in 4 wk Localized tender Leg swollen Calf swell > 3cm compared to other pitting edema collateral veins alternative dx unlikely (2 pt)
Wells PE
4+ pt likely Clinical finding DVT 3 Alternative Dx unlikely 3 Recent bed rest >3d, surgery in 4wk 1.5 HR > 100 1.5 Previous DVT/PE 1.5 Malignancy 1 Hemoptysis 1
PERC score PE
1+ need Wells > 50yr HR > 100 O2 RA < 94 Prior DVT/PE recent trauma/sx hemoptysis exogenous E clinical sign DVT
D-dimer cutoff
500 ng/ml
Status epilepticus management
O2, monitor, iv –> glucose –> benzo –> phenytoin –> phenobarbital –> pentobarbital
