Emergency Med

Question 1

1 cause of death in US adults

Answer 1

Guns then MVA

Question 2

1 cause of death peds <18

Answer 2

MVA -> guns

<13yo should sit in back seat.

Question 3

1 cause of death age 1-4

Answer 3

drowning

Question 4

prevention of head injury

Answer 4

helmets dec ~60-70%

Question 5

epidural hematoma

Answer 5

-rupture of middle meningeal artery
-associated with skull fracture
-lucid interval: talk and deteriorate
- Convex on CT

Question 6

subdural hematoma

Answer 6

-tear of bridging veins between dura and arachnoid
-common in elderly and alcoholics
- concave on CT (under the dura)

Question 7

Reversing warfarin in acute ICH in elderly patient after a fall

Answer 7

Kcenta (4 factor PT complex concentrate)* + Vitamin K 10mg IV**

*stored as powder (not frozen) and doesn’t required ABO testing
**Vit K doesn’t reverse INR but gives you substrate for II,VII, IX, X to start making w/in 24 hours

Question 8

Corneal abrasion

Answer 8

• topical NSAIDs for pain
• DO NO PATCH, delays healing, doesn’t improve pain
• Toopical abx to prevent bacterial superinfection
  — topical abx req if contact lens wearer

Question 9

hyphema

Answer 9

• blood in anterior chamber of eye, can happen after trauma
• elevated HOB
• avoiod NSAIDs/blood thinners
• refer to ophtho

Question 10

testing etiology of painful eye by propericaine

Answer 10

PAINLESS: conjunctive, corneal ulcer, keratitis

PAINFUL: iritis, uveitis, acute angle glaucoma

Question 11

painless visino change

Answer 11

-vitreous detachment
- retinal artery/vein occlusion
-ischemic optic neuropathy

Question 12

post splenectomy vaccines

Answer 12

encapsulated organisms
-pneumococcal
-HIB
-meningococcal

Question 13

rhabdomyolsis urine findings

Answer 13

+blood on dipstick = myoglobinuria but negative RBC on microscopy

Question 14

tetanus ppx in wounds

Answer 14

clean wound >10 yrs
dirty wound >5 years

Question 15

who gets ppx abx for lacerations/wounds

Answer 15

hand/foot
bites
immunocompromised person
prosthetic valve

Question 16

wound care pearls

Answer 16

tap water/large volume > saline
non-infected wounds repair 18 hrs, face/scalp 24 houors

Question 17

toddler fracture

Answer 17

-not abuse
-most common fx 9mo-3yr
-spiral fracture of distal fibula
-tx= below knee walking cast x3 weeks

Question 18

NAT- rib fractures

Answer 18

rib fractures are extremely rare in peds <2 yo

Question 19

anaphylaxis vs anaphylactoid

Answer 19

anaphylaxis is IgE dependent –> need exposure once and then will have future reaction

anaphylactoid= NON IgE mediated, rxn is instant –> opioiods, NSAIDS, contrast

tx is the same w/ epi, H1 or H2, steroids (don’t do anything immediately but help with recurrence

Question 20

difference between heat exhaustion and heat stroke

Answer 20

heat stroke will have CNS dysfunction –tx with evaporative cooling

Question 21

APAP ingestion tx/management

Answer 21

Immediate= activated charcoal (dec absorption by 70% at 30 mins, 30% at 60 mins)
Draw APAP level at 4 hours –> treat with NAC according to nomogram level

Toxic dose= 150mg/kg

Question 22

serotonin syndrome dx/tx

Answer 22

-hyperthermia, diaphoresis, rigidity, HTN< tachy, anxiety, ataxia, ect
-etiology: SSRI, MAO + cocaine, dextromethorphan, SNRI, amphet, linezolid

tx= ciproheptadine