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LMCC > Emergency > Flashcards

Emergency Flashcards

(75 cards)

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1
Q

Hypothermia

A

<35C

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2
Q

Hypothermia rewarming rate

A

2.1C/h

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3
Q

Afterdrop phenomenon a/w rewarming after hypothermia

A

Warming of extremities causes vasodilation and movement of cool pooled blood from extremities to core –> drop in core temperature –> cardiac arrest

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4
Q

Frostbite tx

A 
Tx the hypothermia 
Remove wet clothing 
Immerse in 40-42C water for 10-30min (+analgesia) 
Clean, debride
Tetanus prophylaxis
Consider Pen G as high risk of infection
May need sx
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5
Q

Rule of 9s with burns

A

Each side of entire leg is 9% Each side of torso is 18%
Each side of arm is 4.5%
Groin is 1%
Each side of head is 4.5%

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6
Q

Superficial 1st degree burn

A

Epidermis only

Painful and tender to palpation

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7
Q

Superficial partial thickness (2nd degree) burn

A

Epidermis and superficial dermis
blister formation
Very painful

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8
Q

Deep partial thickness (2nd degree) burn

A

Involves hair follicles, sebaceous glands
Skin is blistered
Exposed dermis si white to yellow
Absent sensation

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9
Q

Full thickness (3rd degree) burn

A

Epidermis and all dermal layers

Skin is pale, insensate, charred

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10
Q

Deep (4th degree) burn

A

Involvement of fat, muscle, even bone

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11
Q

Parkland formula for burn

A

Ringer’s lactate 4cc/kg/%BSA burned
Give half in first 8h, half in next 16h
Maintenance fluids are required if pt can’t tolerate PO hydration

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12
Q

Classic triad of wernicke’s encephalopathy

A

Encephalopathy
Ataxic gait
Oculomotor dysfunction (nystagmus, bilat lateral rectus palsies, conjugate gaze palsies)

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13
Q

Initial mgmt of anaphylaxis

A 
Epinephrine 0.3-0.5cc q5min
Benadryl (H1 blocker)
PO or IV steroids (same bioavailability, only give IV if pt can't take PO) 
Ranitidine (H2 blocker) 
Keep pt in ED for 4-6 h (biphasic)
Consider epi nebs 
O2, ventolin, atrovent nebs 
Code blue if pt has stridor
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14
Q

Canadian C-Spine rules high risk category

A 
Age >/=65yo 
Paresthesias in extremities
Dangerous mechanism 
- Fall from >/= 1m or 5 stairs
- Axial loading 
- MVC with: high speed (>100km/h), rollover, ejection, bicycle, motorcycle

GET RADIOGRAPHY

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15
Q

Canadian C-spine rules low risk/safety factors

A 
Delayed onset of neck pain
Sitting upright in ED 
Walking at any point 
Simple rear-end MVC 
Absence of midline tenderness
If any of these are YES --> is pt able to turn head 45deg to L and R?
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16
Q

Maissonneuve fracture

A

Proximal fibular fracture with ankle injury

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17
Q

Emergency tracheotomy location

A

Above cricoid through cricothyroid membrane

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18
Q

Lisfranc fracture

A

Tarsometatarsal fracture

Pain at midfoot

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19
Q

Medications that can be delivered by ETT

A 
NAVEL 
Naloxone 
Atropine 
Ventolin
Epinephrine 
Lidocaine
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20
Q

3:1 rule of hemorrhagic shock

A

Give 3x estimated blood loss because only 30% of infused isotonic crystalloids remain in intravascular space

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21
Q

Neurogenic shock level

A

Occurs within 30min of SCI at level of T6 or above, lasting up to 6wk

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22
Q

Flail chest

A

Free floating segment of chest wall due to >2 rib fractures, each at 2 sites
Tx: O2, fluid therapy, pain control, PPV +/- intubation

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23
Q

Pulsus paradoxus

A

Seen in cardiac tamponade

Drop in BP >10mmHg with inspiration

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24
Q

Initial treatent of open fracture

A

STAND
Splint
Tetanus
Antibiotics
Neurovascular status
Dressings (debride, irrigate, cover with sterile dressing)
Definitive surgical management within 6h!

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25
Anterior shoulder dislocation nerves at risk
Axillary nerve | Musculocutaneous nerve
26
Colles fracture characteristics
Dorsal tilt and displacement Ulnar styloid fracture Radial displacement and tilkt Shortening Colles fracture = distal radial fracture with dorsal displacement often from FOOSH
27
Scaphoid fracture mgmt
Xray negative: thumb spica splint, repeat xray in 1wk +/- CT scan Xray positive: thumb spica split x 6-8wk, repeat xray in 2wks Risk of AVN of scaphoid if not immobilized
28
Ottawa Knee Rules
``` Get knee xray if 1 or more of: >/= 55yo Tenderness at head of fibula Isolated tenderness of patella Inability to flex to 90 deg Inability to weight bear both immediately and in ED (4 steps) ```
29
Ottawa ankle rules
Pain in malleolar zone and any one of: bony tenderness at posterior edge or tip of lateral malleolus Bony tenderness at posterior edge or tip of medial malleolus Inability to weight bear both immediately and in ED
30
Ottawa foot rules
Pain in midfoot zone and any one of: Bony tenderness at base of 5th metatarsal Bony tenderness at navicular bone Inability to weight bear both immediately and in ED
31
Clean, minor wounds and unknown or <3 tetanus doses
Tetanus vaccine
32
Serious wounds (ie. penetrating) and unknown or <3 tetanus doses
Tetanus vaccine and immunoglobulin
33
Clean, minor wounds or serious wounds with hx of >/=3 tetanus doses
No vaccine or immunoglobulin required
34
When to NOT suture close a wound
``` Delayed presentation >6-8h Puncture wound Mammalian bite Crush injury Retained foreign body ```
35
Delayed deficit after head trauma suggestive of...
Epidural hematoma
36
Tracheal deviation and tension vs non-tension pneumo
Deviates AWAY from tension | Deviates TOWARDS from non-tension
37
Acute pericarditis management
High dose NSAIDs +/- colchicine
38
Hyperkalemia on ECG
Tall T waves | Severe: sine wave - p waves flatten and disappear, QRS widens
39
Hypokalemia on ECG
ST depression Prolonged QT Flattened T waves Prominent U waves (U> T)
40
Digitalis toxicity on ECG
Gradual downward curve of ST At risk for AV blocks and ventricular irritability Salvidore dali sign
41
Sexual assault reporting
Do NOT report unless victim requests or if <16yo
42
Tx for AFib in WPW pt
Amiodarone or procainamide | AVOID AV NODAL BLOCKING AGENTS (adenosine, digoxin, diltiazem, verapamil, beta blockers)
43
TdP tx
IV Mg Temporary overdrive pacing Isoproterenol
44
DKA dx
Hyperglycemia Metabolic acidosis Hyperketonemia Ketonuria
45
Main form of tx of hyperosmolar hyperglycemic state
Rehydration Insulin controversial Treat the cause (ie. infection)
46
Stroke thrombolysis requirements
<4.5h from onset to drug admin (+ confirmed no bleed with NCCT)
47
1st line drug of choice for antiplt agent to prevent recurrent stroke or stroke after TIA
Aspirin | Clopidogrel is 2nd line
48
Absolute C/I to thrombolysis for stroke
``` Suspected SAH Previous ICH Severe HI within past 3mo BP >185 systolic or >110 diastolic Bleeding diathesis Prolonged PT>15s or INR>1.7 Plt <100 000 Heparin within last 48h Current use of thrombin inhibitors or direct factor Xa inhibitors Blood glucose <2.8 ICH on CT or large infarct ```
49
1st line abx for animal or human bite wounds on hands
Amoxclav Dog/cat bites: Pasteurella multocida, S. aureus, S. viridans Human: Eikenella corrodens, S.. aureus, S. viridans, oral anaerobes
50
Universal antidotes
``` Tx that will not harm pts and may be essential! DONT: Dextrose O2 Naloxone Thiamine ```
51
Drugs that can be removed with urine alkalinization
ASA MTX Phenobarb Chlorpropamide
52
Tylenole antidote
NAC
53
Benzo antidote
Flumazenil
54
Methanol antidote (any toxic alcohols)
Fomepizole OR ethanol
55
Heparin antidote
Protamine sulfate
56
TCA antidote for wide QRS/seizures
NAHCO3
57
Common causes of anaphylaxis
``` Peanuts bee stings Wasp stings Other insect bites (ie. fire ants) IV abx Blood pdts Antivenom Radiological contrast materials Anesthetic agents ```
58
Hypercalcemia ECG
Shortened QT
59
Hypocalcemia ECG
Prolonged QT
60
Osborne J wavs
Hump like waves at junction of J point and ST segment | Seen in hypothermic pt
61
Medications that can be removed by dialysis
``` STUMBLE Salicylates Theophylline Urea Methanol Barbiturates Lithium Ethylene Glycol ```
62
Carbon monoxide antidote
O2
63
Hypoglycemic agent antidote
Dextrose
64
Drugs not amenable to charcoal
iron, Li, pesticides, alkalis, acids
65
Overdose to think of with widened QRS
TCA
66
One pill can kill
``` Opioids Iron Toxic alcohols (e.g. ethylene glycol) TCA CCBs Methylsalicylates Antimalarials ```
67
Most common upper extremity injury in infants
Radial head subluxation
68
Radial head subluxation reduction
Supination-flexation Pronated arm, elbow 90 deg flexed, pressure applied over radial head Supinate wrist with pressure maintained on radial head, then flex elbow
69
Organophosphate poisoning
AChE (degrades AChE) | Tx: Pralidoxime within a few hours of exposure (AChE reactivator) and Atropine (muscarinic receptor antagonist)
70
Physostigmine
Treat atropine overdose | AChE inhibitor
71
Malignant hyperthermia tx
Dantrolene (ryanodine receptor antagonist)
72
Buckle fracture treatment
Removable splint x 3 wks
73
Rotator cuff tear definitive tx
Early surgical repair
74
4 muscles of rotator cuff
Supraspinatus Infraspinatus Teres minor Subscapularis
75
Reversal of ethylene glycol OD
Ethanol or fomepizole

LMCC (22 decks)

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