Emergency Med Flashcards
(146 cards)
1
Q
NS vs LR: high Cl
A
LR
2
Q
NS vs LR: non-anion gap metabolic acidosis
A
LR
3
Q
NS vs LR: lactic acidosis
A
NS
4
Q
NS vs LR: AKI
A
NS
5
Q
NS vs LR: hypovolemic hyponatremia
A
NS
6
Q
dropping the serum Na level >10-12 mEq/<24 hr can lead to ____
A
Osmotic demyelination syndrome
Central pontine myelinolysis (CPM) is a component of osmotic demyelination syndrome (ODS). It is characterized by damage to regions of the brain, most commonly pontine white matter tracts, after rapid correction of metabolic disturbances such as hyponatremia.
7
Q
to reduce intracerebral pressure, use ____ fluid
A
hypertonic, like mannitol
8
Q
resuscitation fluid bolus amount
A
30mL/kg
9
Q
avoid what mask in COPD pts
A
NRB
10
Q
which induction agent for intubation also provides analgesia?
A
ketamine
11
Q
which induction agent commonly causes hypotension?
A
propofol
12
Q
2 main risky SEs of succinylcholine
A
hyperK, malignant hyperthermia
13
Q
most reliable way to tell if intubation is working
A
Wave form capnography/end tidal capnography
14
Q
get CXR to confirm that ET tube is _____ above carina
A
5cm
15
Q
narrow vs wide complex PEA: which is d/t metabolic problems?
A
wide
16
Q
narrow vs wide complex PEA: which is d/t mechanical problems?
A
narrow
17
Q
for pt that will need blood transfusion, place __ ______ IVs
A
2 large bore
18
Q
reverse warfarin w/ ____
A
vitamin K
19
Q
reverse dabigatran w/ _____
A
idarucizumab (Praxbind)
20
Q
Tranexamic acid (TXA) can be given w/in first ___ hrs of presentation of hemorrhage
A
3
21
Q
High Risk Features Spinal Cord Injury:
High speed MVA (>___mph)
* ____ at scene of MVA
* Fall from height (>__ ft)
* Significant closed head injury or ___ on CT
* Neuro S&S
* _____ or multiple extremity fx
A
High speed MVA (>35mph)
* Death at scene of MVA
* Fall from height (>10 ft)
* Significant closed head injury or ICH on CT
* Neuro S&S
* Pelvic or multiple extremity fx
22
Q
initial test for all pts w/ blunt thoracic trauma
A
CXR
23
Q
sensitive finding for aortic injury on CXR
A
widened mediastinum
24
Q
pt w/ blunt thoracic trauma: if 1st test shows widened mediastinum, order ____ if stable, _____ if unstable
A
chest CTA
TEE
25
BP goal for management of aortic injury
100
26
for aortic injury, emergent consult w/ _____ or _____
trauma surgeon
vascular surgeon
27
definitive imaging for diaphragmatic rupture
CT
28
definitive dx for esophageal rupture
Endoscopy or esophagography w/ contrast
29
best loc for needle thoracostomy
5th intercostal space (nipple) in the midaxillary or midclavicular line
30
in abd trauma, be sure to ask about ______ pain
referred
31
initial imaging for unstable trauma pt
eFAST
32
initial imaging for stable trauma pt
eFAST
33
initial imaging for stable trauma pt is neg. now order ______ (3 options)
serial eFAST exams, CT, or observation
34
initial imaging for stable trauma pt is +. now order ______
CT scan
35
initial imaging for unstable trauma pt is +. next step?
OR
36
initial imaging for unstable trauma pt is neg. now order ______
CT
37
2 MC injured abd organs in abd trauma
spleen, liver
38
fx of sacrum. risk of bladder/GU injury level?
low
39
2 CI for placing foley catheter in presence of pelvic trauma
Sign of ureteral injury: blood at urethral meatus, hematuria.
or high risk pelvic fx
40
initial imaging for unstable pt w/ suspected pelvic fx
pelvic xray
41
main concern in pelvic fx
vascular injury / hemorrhage
42
pt w/ confirmed pelvic fx: immediate consultation w/ _____
ortho
43
dose of fentanyl to start w/ for trauma pt in pain per kg
0.5-1mcg/kg
44
are kids at higher or lower risk of hypoglycemia than adults?
higher
45
preg pt w/ minor abd trauma. do continuous fetal HR mohnitoring if >__________________
22-24 wks
46
ped abd injury. imaging?
CT w/ IV contrast
47
sexual assault pt: you have suspicion of neck/throat injury. order what imagint?
CTA of neck
48
pt in shock can have what acid/base problem?
metabolic acidosis (hyperlactinemia)
49
septic shock is infx + ______
organ dysfunction
50
5 labs to order for suspected sepsis pt w/in 45 min of presentation
CBC, CMP, PT/PTT/INR, Serum lactate, blood cultures x2
51
must start what 2 tx w/in 1st hour of septic pt?
IV fluids and abx
52
quantity and timeframe for IV fluids in initial septic shock pt
30mL/kg (start w/in 1 hr, complete w/in 3 hrs). give in 500mL boluses and recheck pt after each
53
empiric abx for sepsis
(zosyn/ carbapenem/ cefepime) + vanc
54
1st line tx if septic shock pt is still hypotensive despite fluid resus
NE
55
anaphylaxis epi dose for adult 25-50kg
0.3mg
56
anaphylaxis epi dose for adult >50kg
0.5mg
57
anaphylaxis epi dose for ped 10-25kg
0.15mg
58
anaphylaxis epi dose for infant <10kg
0.01mg/kg
59
IVF to give in anaphylactic shock
NS
60
what to do w/ anaphylactic pt who had good response to epinephrine in ED
observe 4-6 hr
61
what peptide induces angioedema from ACEi? will epi help?
bradykinin, no
62
suspect ________ if pt has mechanism of injury that likely would cause brain/spinal cord injury + bradycardia + hypotension
neurogenic shock
63
only tx to improve neuro outcomes in spinal cord injury pts
methylprednisolone
64
onset timing of TSS
rapid, w/in 48 hrs
65
does TSS rash involve palms/soles?
yes
66
empiric abx for TSS
Vanc + Clindamycin + Zosyn (pip-taz)/cefepime/meropenem
67
will cardiogenic shock have wide or narrow pulse pressure?
narrow
68
how many pts w/ orthostatic hypotension have systolic HTN when seated or supine?
half
69
test to differentiate between orthostatic hypotension and relfex syncope/vasovagal
table tilt
70
reverse eliquis, xarelto w/ _____
andexxa/ andexanet alfa
71
EKG finding specific for PE
S1Q3T3
72
PE anticoag for pregnant pt
LMWH
73
tx for unstable PE
tPA
74
compartment syndrome: more likely from closed or open fx?
open
75
abx prophylaxis for mild-moderate contamination open fx
cefazolin +/- vanc if indicated
76
abx prophylaxis for severe contamination open fx or periosteal stripping
gentamicin/ceftriaxone + vanc
77
abx prophylaxis to add if open fx has soil contamination
metronizole
78
abx prophylaxis to add if open fx has freshwater contamination
zosyn
79
how to determine whether pt w/ open fx needs tetanus booster
dirty wound: give if >5 yrs
clean wound: give if >0 yr
80
nursemaid's elbow happens in kids < ____
4 y/o
81
all ped head injuries should be observed for _____ hours
4-6
82
imaging for non-low risk ped head injury
head CT
83
2 concerning eye sx after concussion that would req further investigation
pupilary abnormality, visual field deficits
84
odontoid fx: stable or unstable?
unstable, high risk of nonunion
85
Hangman's fx (b/l fx of C2 pars interarticularis): stable or unstable?
unstable
86
Jeferson fx (C1 burst): stable or unstable?
extremely unstable
87
burst fx of vertebral body: stable or unstable?
typically stable, but risk of neuro deficits if burst fx involves posterior elements
88
vertebral compression fx: stable or unstable?
stable
89
initial imaging for facial trauma (except for isolated nasal bone injuries)
facial CT w/o contrast
90
in pt w/ nasal bone trauma, must r/o ____ in PE
septal hematoma
91
ideal mgmt of displaced nasal bone fx? ok mgmt if outside of that timeframe or not possible
reduce immediately or w/in 6 hrs.
refer to ENT for reduction w/in 3-7 days
92
pt w/ midface fx has clear rhinorrhea. suspect fx of _____ and do what to pt position?
cribriform plate fx and CSF leak.
elevate head of bed to 40-60 degrees and allow leak to seal
93
pt w/ Epiphora (excessive tearing), photophobia, reluctance to open eye. what part of eye was probably injured?
cornea
94
do superficial burns blanch w/ pressure?
yes
95
do superficial partial thickness burns blanch w/ pressure?
yes
96
do deep partial thickness burns blanch w/ pressure?
no
97
superficial burns heal in ___ to __ days
4-6
98
superficial partial thickness burns heal in _____
1-3 wks
99
deep partial thickness burns heal in _____
2-9 wks
100
deep partial thickness burns have pain w/ ______ only
pressure
101
adult pt's full hand is ____% TBSA. Just palm is ____%TBSA
1%, 0.5%
102
burns >___% TBSA need to go to burn center
10
103
fluid to use in electrical burns
NS
104
fluid to use in thermal burns
LR
105
parkland formula for burns and timeframe
4ml x TBSA (%) x body weight (kg)
* 50% in first 8 hrs
* 50% in next 16 hrs
106
lab test for suspected CO poisoning
carboxyhemoglobin
107
burn pt: you suspect inhalation injuries. order what additional 3 tests?
ABG, EKG, CXR
108
if planning to transfer pt to burn center, cover burns w/ ____ gauze
dry
109
how long does SJS/TEN last?
8-12 days
110
MC meds causing SJS/TEN (2 names, 2 classes)
ABOA: allopurinol, bactrim, oxicams, anticonvulsants
111
SJS starts on ___ and ____
face, thorax
112
rash suspicious for SJS, ask about/look at ____ and ____ (body areas)
eyes ( Most cases, severe conjunctivitis w/ purulent discharge), mouth
113
difference between Erythema multiforme major and minor
Erythema multiforme major = severe mucosal involvement
* Erythema multiforme minor = w/o/very mild mucosal involvement
114
expected acid base abnormalities in cyanide poisoning
Anion gap metabolic acidosis
o Lactic acidosis
115
tx for cyanide poisoning
Antidotal tx = Hydroxocobalamin (Cyanokit)
§ Often in combo w/ sodium thiosulfate
116
tx for a recently hospitalised pt w/ DM back w/ non-purulent cellulitis
IV vanc - prob 10-14days
117
tx for pt w/ cellulitis and multiple abscesses who is otherwise healthy
PO bactrim
118
tx for pt w/ non-purulent cellulitis near a prosthetic joint. no MRSA RF and otherwise healthy
IV cefazolin
119
onset of nec fasc
w/in hours
120
abx for nec fasciitis
(carbapenem OR zosyn) + vanc + clinda
121
superficial animal bite on hand. close or not? abx or not?
don't close
give augmentin bc on hand
122
small but deep puncture bite on forearm. close or not? abx or not?
don't close
give augmentin bc deep
123
small laceration from cat bite on L cheek that happened 2 hours ago. close or not? abx or not?
close loosely bc on face
augmentin bc on face and bc closing
124
superficial bite on middle posterior calf. close or not? abx or not?
don't close
no abx unless close to bone
125
otherwise healthy pt has abrasion on anterior thigh from kayaking in a lake. abx or not?
no
126
otherwise healthy pt is bleeding from ripped off toenail while playing in a river. abx?
yes bc on foot. keflex + levofloxacin
127
in addition to normal labs, order what 4 for suspected acute toxidrome?
acetaminophen, salicylate, and alcohol levels. glucose. UDS can be ordered but isn/t super helpful. preg test if F
128
chemical restraint med for pt intoxicated w/ CNS depressant
haldol
129
chemical restraint med for pt w/ known psychosis or psych d/o
Olanzapine or Ziprasidone (Haldol if
unavailable)
130
does cocaine cause myosis or mydriasis?
mydriasis
131
pt w/ severe acute alcohol intoxication has hypoglycemia. give ____ before giving glucose
thiamine
132
key PE finding in serotonin syndrome besides elevated everthing
clonus / hyperreflexia
133
dialysis pt w/ hyperK is in arhythmia. give ____ immediately
Ca gluconate
134
What classic chest radiograph finding is indicative of pulmonary edema due to CHF?
kerley B lines
135
most effective cooling measures for pt w/ heat stroke
evaporative (spray w/ cool water and place under fans)
136
should you give antipyretics in heat stroke?
no
137
tetrad of neuroleptic malignant syndrome
Tetrad: hyperthermia + rigidity + AMS + autonomic instability (tachy, labile BP etc)
138
2 meds for neuroleptic malignant syndrome
lorazepam, dantrolene
139
1st sign of malignant hyperthermia
1st sign: Hypercarbia
o ↑ end tidal CO2
140
hypothermia = temp of <___
35C
141
should you put ice on a snakebite?
no
142
should you elevate a snake bite?
yes
143
thyroid storm must have _____ for dx
AMS
144
adrenal crisis occurs d/t ______ deficiency
cortisol
145
what imaging can definitively clear C spine after trauma in pts of all ages?
MRI
146
reversal agent for BB toxicity
glucagon
