Emergency Medicine Flashcards

Question

Indications/criteria for hemodialysis

Answer 1

Toxins that have high water solubility, low protein binding, low molecular weight, adequate concentration gradient, small volume of distribution, or rapid plasma equilibration

Answer 2

- Hyperthermia “Hot as a hare” - Dilated pupils “Blind as a bat” - Dry skin “Dry as a bone” - Vasodilation “Red as a beet” - Agitation/hallucinations “Mad as a hatter” - Ileus “The bowel and bladder “ - Urinary retention, Tachycardia

Answer 3

“DUMBELS” - Diaphoresis, Diarrhea, Decreased BP - Urination - Miosis - Bronchospasm, Bronchorrhea, Bradycardia - Emesis, Excitation of skeletal muscle - Lacrimation - Salivation, Seizures

Answer 4

- Dysphonia, dysphagia - Rigidity and tremor - Motor restlessness, crawling sensation (akathisia) - Constant movements (dyskinesia) - Dystonia (muscle spasms, laryngospasm, trismus, oculogyric crisis, torticollis)

Answer 5

- Increased temperature - CNS excitation (including seizures) - Tachycardia, HTN - N/V - Diaphoresis - Dilated pupils

Answer 6

Mental status changes, autonomic hyperactivity, neuromuscular abnormalities, hyperthermia, diarrhea, HTN

Answer 7

- Hypothermia - Hypotension - Respiratory depression - Dilated or constricted pupils (pinpoint in opioid) - CNS depression

Answer 8

- Vital signs (including temperature), skin (needle tracks, colour), mucous membranes, pupils, odours, and CNS - Head-to-toe survey including ▪ C-spine ▪ Signs of trauma, seizures (incontinence, “tongue biting”, etc.), infection (meningismus), or chronic alcohol/drug misuse (track marks, nasal septum erosion) ▪ Feel the patient’s axillae; in the average patient, should be somewhat moist (if dry, may indicate anticholinergic toxicity) - Mental status

Answer 9

- Decontaminate (activated charcoal) | - N-acetylcysteine - NAC protocol

Answer 10

Flumazenil

Answer 11

- Consider decontamination (activated charcoal, consider whole bowel irrigation for extended-release ingestion) - IV glucagon, IV calcium chloride, IV high-dose insulin (with dextrose), IV intralipid

Answer 12

- Glucose IV/PO/NG tube | - Glucagon: 1-2 mg IM (if no access to glucose)

Answer 13

- Aortic disruption - Blunt cardiac injury - Cardiac tamponade - Flail chest - Hemothorax - Pneumothorax (traumatic pneumothorax, open pneumothorax, and tension pneumothorax) - Pulmonary contusion

Answer 14

Clinical diagnosis; One-way valve causing accumulation of air in pleural space

Answer 15

Respiratory distress, tachycardia, distended neck veins, cyanosis, asymmetry of chest wall motion, Tracheal deviation away from pneumothorax, Percussion hyperresonance Unilateral absence of breath sounds

Answer 16

Needle thoracostomy – large bore needle, 2nd ICS mid clavicular line, followed by chest tube in 5th ICS, anterior axillary line

Answer 17

Open connection from pleural space to the atmosphere; air preferentially enters through the chest would rather than through the airway

Answer 18

Gunshot or other wound (hole >2/3 tracheal diameter) ± exit wound, Unequal breath sounds, subcutaneous emphysema

Answer 19

Air-tight dressing sealed on 3 sides, Chest tube, Surgery

Answer 20

>1500 cc blood loss in chest cavity

Answer 21

Pallor, flat neck veins, shock Unilateral dullness, Absent breath sounds, Hypotension

Answer 22

Usually only able to do supine CXR – entire lung appears radioopaque as blood spreads out over posterior thoracic cavity

Answer 23

- Restore blood volume, Chest tube | - Thoracotomy if: >1500 cc total blood loss ≥200 cc/h continued drainage

Answer 24

Free-floating segment of chest wall due to >2 rib fractures, each at 2 sites Underlying lung contusion (cause of morbidity and mortality)

Answer 25

Paradoxical movement of flail segment, Palpable crepitus of ribs Decreased air entry on affected side

Answer 26

- ABG: decreased pO2, increased pCO2 | - CXR: rib fractures, lung contusion

Answer 27

- O2 + fluid therapy + pain control - Judicious fluid therapy in absence of systemic hypotension - Positive pressure ventilation ± intubation and ventilation

Answer 28

Clinical diagnosis; Pericardial fluid accumulation impairing ventricular function

Answer 29

- Penetrating wound (usually), Tachycardia, tachypnea, Pulsus paradoxus, Kussmaul’s sign (increased JVP with inspiration) - Beck’s triad

Answer 30

Echocardiogram, FAST

Answer 31

IV fluids, Pericardiocentesis, Open thoracotomy

Answer 32

Blunt trauma to chest Interstitial edema impairs compliance and gas exchange

Answer 33

Hypotension, distended neck veins, muffled heart sounds

Answer 34

CXR: areas of opacification of lung within 6 h of trauma

Answer 35

Maintain adequate ventilation Monitor with ABG, pulse oximeter, and ECG, Chest physiotherapy, Positive pressure ventilation if severe

Answer 36

Blunt trauma to chest or abdomen (e.g. high lap belt in MVC)

Answer 37

CXR: abnormality of diaphragm/lower lung fields/ NG tube placement. CT scan and endoscopy: sometimes helpful for diagnosis

Answer 38

Laparotomy for diaphragm repair and associated intra- abdominal injuries

Answer 39

Usually penetrating trauma (pain out of proportion to degree of injury)

Answer 40

CXR: mediastinal air (not always), Esophagram (Gastrograffin®), Flexible esophagoscopy

Answer 41

Early repair (within 24 h) improves outcome but all require repair

Answer 42

90% tear at subclavian (near ligamentum arteriosum), most die at scene. Salvageable if diagnosis made rapidly

Answer 43

Sudden high speed deceleration (e.g. MVC, fall, airplane crash), complaints of chest pain, dyspnea, hoarseness (frequently absent). Decreased femoral pulses, differential arm BP (arch tear)

Answer 44

CXR, CT scan, transesophageal echo, aortography (gold standard)

Answer 45

ABC WHITE - Depressed left mainstem Bronchus - pleural Cap - Wide mediastinum (most consistent) Hemothorax - Indistinct aortic knuckle - Tracheal deviation to right side - Esophagus (NG tube) deviated to right

Answer 46

Thoracotomy (may treat other severe injuries first)

Answer 47

- Resuscitative thoracotomy is a temporizing measure that allows direct control of hemorrhage from exsanguinating thoracic injures or decompression of cardiac tamponade and allows control of the aorta to limit bleeding from infradiaphragmatic injuries to facilitate resuscitation. - Hemodynamically unstable from chest injury - Hemothorax with >1500cc output from chest tube - Hemothorax with ongoing blood loss from chest tube (200cc/hr for 2-4 hours) - Resuscitative thoracotomy (aka ED thoracotomy) – rarely indicated – almost always on penetrating traumas

Answer 48

- Pneumothorax - Hemothorax - Open sucking chest wound - Trauma Code

Answer 49

- Mechanism of injury, previous deficits, SAMPLE | - Neck pain, paralysis/weakness, paresthesia

Answer 50

- ABCs - Abdominal: ecchymosis, tenderness - Neurological: complete exam, including mental status , reflexes - Spine: maintain neutral position, palpate C-spine; log roll, then palpate T-spine and L-spine, assess rectal tone (voluntary anal sphincter contraction) - When palpating, assess for tenderness, muscle spasm, bony deformities, step-off, and spinous process malalignment - Extremities: check capillary refill, suspect thoracolumbar injury with calcaneal fractures

Answer 51

- Bloodwork: CBC, electrolytes, Cr, glucose, coagulation profile, cross and type, toxicology screen - Imaging: - Full C-spine x-ray series for trauma (AP, lateral, odontoid) - Thoracolumbar x-rays: AP and lateral views

Answer 52

- C-spine injury - Unconscious patients (with appropriate mechanism of injury) - Neurological symptoms or findings - Deformities that are palpable when patient is log rolled - Back pain - Bilateral calcaneal fractures (due to fall from height) – concurrent burst fractures of the lumbar or thoracic spine in 10% (T11-L2) - Consider CT (for subtle bony injuries), MRI (for soft tissue injuries) if appropriate

Answer 53

- Age ≥ 65 yr - Dangerous mechanism - Paresthesias in extremities

Answer 54

- Fall from ≥1 meter / 5 stairs - Axial load to head (e.g. diving) - MVC high speed (>100 km/h), rollover, ejection - Motorized recreational vehicles - Bicycle collision

Answer 55

- Oriented to person, place, time, and event - No evidence of intoxication - No posterior midline cervical tenderness - No focal neurological deficits - No painful distracting injuries (e.g. long bone fracture)

Answer 56

``` - Simple rear-end MVC excluding: • Pushed into on coming traffic • Hit by bus/large truck • Rollover • Hit by high-speed vehicle - Sitting position in ED - Ambulatory at any time - Delayed onset of neck pain - Absence of midline C-spine tenderness ```

Answer 57

- Immobilize, ABCs - Inserting NG and Foley catheter - Hypotension: maintain sBP >90 mmHg with pressors (dopamine), hydration, and atropine - Monitor CBC/electrolytes - Signs of autonomic dysfunction - Radiographic evaluation - Continually reassess high cord injuries as edema can travel up cord - If cervical cord lesion, watch for respiratory insufficiency

Answer 58

Altered level of perspiration, bowel or bladder incontinence, priapism

Answer 59

Abdominal breathing (phrenic innervation of diaphragm still intact but loss of innervation of intercostals and other accessory muscles of breathing)

Answer 60

Intubation and ventilation

Answer 61

- Lateral C1-T1 +/- swimmer’s view - Odontoid view: space between lateral mass of C1 and odontoid should be equal, the lateral aspects of the lateral masses should be less than 1mm - AP view: alignment of spinous processes in the midline

Answer 62

- Adequacy: Must see C1 to C7-T1 junction - Alignment – anterior spinal line, posterior spinal line, spinolaminar line - Line extending inferiorly from clivus should transect odontoid - Atlanto-axial articulation, widening of predental space (normal: <3 mm in adults, <5 mm in children) indicates injury of C1 or C2 - Bodies - Cortical outline - fractures - Disk spacing – should be the same heights - wedging anteriorly or posteriorly suggests vertebral compression - Edges and soft tissues – prevertebral soft tissue thickness C2/3 <7mm (1/3 of the vertebrae body width), C6 <22mm (1 vertebral body width). Increase in this space may be due to hematoma or infection

Answer 63

Posterior ligamentous disruption

Answer 64

Cauda Equina Syndrome can occur with any spinal cord injury below T10 vertebrae. Look for incontinence, anterior thigh pain, quadriceps weakness, abnormal sacral sensation, decreased rectal tone, and variable reflexes

Answer 65

- Warm blanket, Trendelenburg position (occasionally), provide airway support, fluids - Monitoring and controlling BP - atropine (for bradycardia), vasopressors for BP support

Answer 66

Transient loss of all neurologic function below the level of the SCI, causing flaccid paralysis and areflexia for variable periods

Answer 67

- Spinal shock | - Neurogenic shock

Answer 68

Hypotension that follows SCI (sBP usually <80 mmHg)

Answer 69

- Interruption of sympathetics (unopposed parasympathetics) below the level of injury - Loss of muscle tone due to skeletal muscle paralysis below level of injury - venous pooling (relative hypovolemia) - Blood loss from associated wounds (true hypovolemia)

Answer 70

Hypotension (lacking SNS), bradycardia (unopposed PNS), poikilothermia (lacking SNS so no shunting of blood from extremities to core)

Answer 71

Pounding headache, nasal congestion, feeling of apprehension or anxiety, visual changes, dangerously increased sBP and dBP

Answer 72

- GU causes: bladder distention, urinary tract infection, and kidney stones - GI causes: fecal impaction or bowel distension

Answer 73

Autonomic dysreflexia: in patients with an SCI at level T6 or above

Answer 74

- Open head injuries involve penetration of the scalp and skull (and usually the meninges and underlying brain tissue) - Closed head injuries typically occur when the head is struck, strikes an object, or is shaken violently, causing rapid brain acceleration and deceleration. Acceleration or deceleration can injure tissue at the point of impact (coup), at its opposite pole (contrecoup), or diffusely; the frontal and temporal lobes are particularly vulnerable to this type of injury.

Answer 75

- Concussion - Hematoma: Acute subdural hematoma, Chronic subdural hematoma, epidural hematoma - Diffuse axonal injury - Skull Fractures: Vault fracture, Basal skull fractures

Answer 76

Transient mental status alteration (eg, loss of consciousness or memory) lasting < 6 hours

Answer 77

Hyperdensity in subdural space, classically crescent-shaped. Degree of midline shift important

Answer 78

Gradual headache, somnolence, confusion, sometimes with focal deficits or seizures

Answer 79

Hypodensity in subdural space (abnormality is isodense during subacute transition from hyperdense to hypodense)

Answer 80

Hyperdensity in epidural space, classically lenticular-shaped and located over the middle meningeal artery (temporal fossa) due to a temporal bone fracture

Answer 81

Occurs when rotational deceleration causes shear-type forces that result in generalized, widespread disruption of axonal fibers and myelin sheaths

Answer 82

- CT: At first, may be normal or show small hyperdensities (microhemorrhages) in corpus callosum, centrum semiovale, basal ganglia, or brain stem - MRI: Multiple small microhemorrhages in deep white matter or subcortical areas and brain stem

Answer 83

Open, depressed

Answer 84

Typically occur over temporal bone, in area of middle meningeal artery (commonest cause of epidural hematoma)

Answer 85

- Lose consciousness (usually for seconds or minutes), although some patients with minor injuries have only confusion or amnesia (retrograde amnesia) - Young children may simply become irritable. - Seizures, often within the first hour or day. - After these initial symptoms, patients may be fully awake and alert, or consciousness and function may be altered to some degree, from mild confusion to stupor to coma

Answer 86

- Increasing headache - Decreased level of consciousness - Focal neurologic deficits (eg, hemiparesis) - Some patients who have an epidural hematoma lose consciousness, then have a transient lucid interval, and then gradual neurologic deterioration.

Answer 87

- Headache - Seizures - Hemiparesis - Symptoms of increased ICP - Pupillary asymmetric, abnormal brain stem reflexes, and coma from brain stem compression due to uncal herniation

Answer 88

- Hypertension (usually with increased pulse pressure) - Bradycardia - Respiratory depression

Answer 89

- Battle’s sign (bruised mastoid process) - Hemotympanum - Raccoon eyes (periorbital bruising) - CSF rhinorrhea/otorrhea

Answer 90

- Postconcussion syndrome - A range of cognitive and neuropsychiatric deficits can persist after severe, moderate, and even mild TBI, particularly if structural damage was significant. Common problems include - Amnesia - Behavioral changes (eg, agitation, impulsivity, disinhibition, lack of motivation) - Emotional lability - Sleep disturbances - Decreased intellectual function - Late seizures (> 7 days after the injury) - Persistent vegetative state can result from a TBI that destroys forebrain cognitive functions but spares the brain stem.

Answer 91

Persistent headache, dizziness, fatigue, difficulty concentrating, variable amnesia, depression, apathy, and anxiety. Commonly smell (and thus taste), sometimes hearing, or rarely vision is altered or lost. Symptoms usually resolve spontaneously over weeks to months.

Answer 92

Spastic motor impairment, gait and balance disturbances, ataxia, and sensory losses may occur.

Answer 93

Forebrain cognitive

Answer 94

The capacity for self-awareness and other mental activity is absent; however, autonomic and motor reflexes are preserved, and sleep-wake cycles are normal. Few patients recover normal neurologic function when a persistent vegetative state lasts for 3 months after injury, and almost none recover after 6 months.

Answer 95

- 14 or 15 is mild TBI - 9 to 13 is moderate TBI - 3 to 8 is severe TBI

Answer 96

- Transient alteration in mental status that may involve loss of consciousness - Loss of consciousness (if present) must be less than 30 min, initial GCS must be between 13-15, and post-traumatic amnesia must be less than 24 h

Answer 97

- Close observation over 24-48h - Wake every hour - Judicious use of sedatives or pain killers during monitoring period - Follow Return to Play guidelines

Answer 98

- GCS score <15 at 2h after injury - Suspected open or depressed skull fracture - Any sign of basal skull fracture (hemotympanum, "raccoon" eyes, CSF otorrhea/rhinorrhea, Battle's sign) - Vomiting >2 episodes - Age >65 yr

Answer 99

- Clear airway and ensure breathing; intubate if necessary - Secure C-spine - Maintain adequate BP - Monitor for clinical deterioration - Monitor and manage increased ICP if present

Answer 100

- Skull fracture (indirect signs of basal skull fracture - Confusion, impaired consciousness, concussion with >5min amnesia - Focal neurological signs, extreme H/A, vomiting, seizures - Unstable spine - Use of alcohol - Poor social support

Answer 101

- Amnesia before impact >30min (i.e. cannot recall events just before impact) - Dangerous mechanism (pedestrian struck by MVC, occupant ejected from motor vehicle, fall from height >3 ft or five stairs)

Answer 102

- Period of LOC, post-traumatic amnesia, loss of bowel/bladder control, loss of sensation, weakness, type of injury/accident - In urgent situations, remember “SAMPLE-F”: signs/symptoms, allergies, medications, past medical history, last meal, events leading up to the trauma, and baseline functioning

Answer 103

- ABCs - Vital signs: Shock (not likely due to isolated brain injury, except in infants), Cushing's response to increasing ICP (bradycardia, HTN, irregular respirations) - GCS - Brainstem reflexes (if appropriate) - Cranial nerve exam - Motor and sensory exam, including peripheral reflexes - Spine (pain/tenderness, palpable deformity) - Sphincter tone and saddle sensation - Record and repeat neurological exam at regular intervals, as appropriate

Answer 104

1. LOC - GCS <8 intubate, any change in score of 3 or more = serious injury - Mild TBI = 13-15, moderate = 9-12, severe = 3-8 2. pupils: size, anisocoria >1 mm (in patient with altered LOC), response to light 3. lateralizing signs (motor/sensory) - May become subtler with increasing severity of injury - Reassess frequently

Answer 105

- Assume C-spine injury until ruled out - C, T, L spine x-rays - Labs: ABG, cross and type, CBC, electrolytes, INR/PTT, glucose, toxicology screen - CT scan head and neck (non-contrast) to exclude intracranial hemorrhage/hematoma

Answer 106

1. General - ABCs - Ensure oxygen delivery to brain through intubation and prevent hypercarbia - Maintain BP (sBP >90) - Treat other injuries 2. Early neurosurgical consultation for acute and subsequent patient management 3. Seizure treatment/prophylaxis - Benzodiazepines, phenytoin, phenobarbital - Steroids are of no proven value

Answer 107

- Intubate - Calm (sedate) if risk for high airway pressures or agitation - Paralyze if agitated - Hyperventilate (100% O2) to a pCO2 of 30-35 mmHg - Elevate head of bed to 20o - Adequate BP to ensure good cerebral perfusion - Diurese with mannitol 1g/kg infused rapidly (contraindicated in shock/renal failure)

Answer 108

- Irreversible and diffuse brain injury resulting in absence of clinical brain function - Cardiovascular activity may persist for up to 2wk

Answer 109

- Prerequisites: no CNS depressant drugs/neuromuscular blocking agents, no drug intoxication/poisoning, temperature >32oC, no electrolyte/acid-base/endocrine disturbance - Absent brainstem reflexes: pupillary light reflex, corneal reflexes, oculocephalic response, caloric responses (e.g. no deviation of eyes to irrigation of each ear with 50 cc of ice water - allow 1 min after injection, 5 min between sides), pharyngeal and tracheal reflexes, cough with tracheal suctioning, absent respiratory drive at PaCO2 >60 mmHg, >20 mmHg rise above baseline, and pH <7.28 (apnea test) - 2 Evaluations separated by time, usually performed by two specialists (e.g. anesthetist, neurologist, neurosurgeon) - Confirmatory testing: flat EEG, absent perfusion assessed with cerebral angiogram

Answer 110

Hypothermia is defined as a core temperature below 35C, in which the body's heat loss is greater than heat production

Answer 111

1. Decreased heat production - Endocrine (hypopituitarism, hypothyroidism, adrenal insufficiency) - Insufficient fuel (hypoglycemia, malnutrition) - Neuromuscular inactivity (age, impaired shivering) 2. Impaired thermoregulation - Central: Metabolic (cirrhosis, uremia), Drug/OD (barbiturates, phenothiazines, tricyclics, insulin), CNS (stroke, trauma, SAH, Parkinsonism, hypothalamic dysfunction, MS) - Peripheral (spinal cord transection, neuropathy, DM, neuromuscular disease) 3. Increased heat loss - Accidental/immersion hypothermia (exposure to cold air, water) - Vasodilatation (drugs, EtOH, tox, sepsis) - Skin disorders (burns, exfoliative dermatitis) - Iatrogenic (cold infusion)

Answer 112

Concomitant EtOH/other tox, Hx of previous illness, namely thyroid disease, CV/Resp dis- ease, neuromuscular or CNS disease, endocrinologic etiologies such as adrenal insufficiency, and hypopituitarism

Answer 113

ECG, rectal thermometer, Foley catheter, NG tube, monitor metabolic status frequently

Answer 114

- Labs: CBC, electrolytes, ABG, serum glucose, Cr/BUN, Mg2+, Ca2+, amylase, coagulation profile, TSH - Imaging: CXR (aspiration pneumonia, pulmonary edema are common)

Answer 115

- Mild (32-34.9C) - Moderate (28-31.9C) - Severe (<28C)

Answer 116

Tachypnea, tachycardia, ataxia, dysarthria, shivering

Answer 117

Loss of shivering, dysrhythmias, Osborne (J) waves on ECG, decreased LOC, combative behaviour, muscle rigidity, dilated pupils

Answer 118

Coma, hypotension, acidemia, VFib, asystole, flaccidity, apnea

Answer 119

Involves covering patient with insulating blanket; body generates heat and re-warms through metabolic process, shivering

Answer 120

Suitable for most stable patients with core temperature >32.2°C

Answer 121

Involves use of warming blankets, heating pads – to thorax, bath immersion >40C

Answer 122

Warming of extremities causes vasodilation and movement of cool pooled blood from extremities to core, resulting in a drop in core temperature leading to cardiac arrest

Answer 123

Generally for patients with core temperature <32.2°C, and/or with cardiovascular instability

Answer 124

- warmed humidified oxygen, IV fluids - peritoneal dialysis with warm fluids - gastric/colonic/pleural irrigation with warm fluids - external circulation (cardiopulmonary bypass machine) is most effective and fastest

Answer 125

- Passive external re-warming - Active external re-warming - Active core re-warming

Answer 126

Damage to tissues from freezing due to the formation of ice crystals within cells, rupturing the cells and leading to cell death

Answer 127

- 1st degree - 2nd degree - 3rd degree - 4th degree - extension into subcuticular, osseous, and muscle tissues

Answer 128

- symptoms: initial paresthesia, pruritus | - signs: erythema, edema, hyperemia, no blisters

Answer 129

- symptoms: numbness | - signs: blistering (clear), erythema, edema

Answer 130

- symptoms: pain, burning, throbbing (on thawing); may be painless if severe - signs: hemorrhagic blisters, skin necrosis, edema, no movement

Answer 131

- Treat for hypothermia: O2, IV fluids, maintenance of body warmth - Remove wet and constrictive clothing - Immerse in 40-42C agitated water for 10-30min (very painful; administer adequate analgesia) - Clean injured area and leave it open to air - Consider aspiration/debridement of blisters (controversial) - Debride skin - Tetanus prophylaxis - Consider penicillin G as frostbite injury has high risk of infection - Surgical intervention may be required to release restrictive eschars - Never allow a thawed area to re-chill/freeze

Answer 132

Survival following submersion in a liquid and subsequent distress requiring medical attention

Answer 133

- Elicit a Hx of the events surrounding the submersion and if resuscitative measures were started. - Determine the quality of the liquid in which the patient was submerged-mud, sewage, and particulates significantly increases the risk of developing ARDS and pulmonary infections. - Try to discover the relative temperature of the liquid into which the patient was submerged.

Answer 134

- ABCs, vitals: watch closely for hypotension - Respiratory: rales (ARDS, pulmonary edema), decreased breath sounds (pneumothorax) - CVS: murmurs, dysrhythmias, JVP (CHF, pneumothorax) - H&N: assess for C-spine injuries - Neurological: GCS, pupils, focal deficits

Answer 135

- Labs: CBC, electrolytes, ABGs, Cr, BUN, INR, PTT, U/A (drug screen, myoglobin) - >50% have renal dysfunction due to lactic acidosis and hypoperfusion; may develop rhabdomyolysis - Imaging: CXR (pulmonary edema, pneumothorax) ± C-spine imaging - ECG

Answer 136

Anxiety, vomiting, wheezing, and altered consciousness are common. Patients may have respiratory failure with tachypnea, intercostal retractions, or cyanosis. Respiratory symptoms are sometimes delayed for up to 8 hours after submersion.

Answer 137

Hypoxia | Brain hypoxia may cause cerebral edema and, occasionally, permanent neurologic sequelae

Answer 138

Chemical pneumonitis | Secondary bacterial pneumonia

Answer 139

Diving reflex

Answer 140

Slowing the heart rate, and constricting the peripheral arteries, shunting oxygenated blood away from the extremities and the gut to the heart and brain

Answer 141

- ABCs, treat for trauma, shock, hypothermia - rewarm - Cardiac and O2 monitors, IV access - Intensive respiratory care: Ventilator assistance if decreased respirations, pCO2 >50 mmHg, or pO2 <60 mmHg on maximum O2. May require intubation for airway protection, ventilation, pulmonary toilet - Dysrhythmias: usually respond to corrections of hypoxemia, hypothermia, and acidosis - Vomiting: very common, NG suction to avoid aspiration - Convulsions: usually respond to O2; if not, diazepam 5-10mg IV slowly - Bronchospasm: bronchodilators - Bacterial pneumonia: prophylactic antibiotics not necessary unless contaminated water or hot tub (Pseudomonas)

Answer 142

Hypothermic

Answer 143

An exaggerated immune mediated IgE hypersensitivity reaction that leads to systemic histamine release, increased vascular permeability, and vasodilation

Answer 144

- Drugs (eg, beta-lactam antibiotics, insulin, streptokinase, allergen extracts) - Foods (eg, nuts, eggs, seafood) - Proteins (eg, tetanus antitoxin, blood transfusions) - Animal venoms - Latex

Answer 145

Interaction of antigen with IgE on basophils and mast cells triggers release of histamine, leukotrienes, and other mediators that cause diffuse smooth muscle contraction (eg, resulting in bronchoconstriction, vomiting, or diarrhea) and vasodilation with plasma leakage (eg, resulting in urticaria or angioedema).

Answer 146

- Skin: generalized urticaria (hives), angioedema - Airway: wheezing, swelling of the throat - CNS: Anxiety, headache, confusion - CVS: chest pain, low blood pressure - GI Tract: N/V, diarrhea, abdominal cramping

Answer 147

- Epinephrine (1:1000) 0.3-0.5 mg (IM in anterolateral thigh) - Antihistamines: diphenhydramine (Benadryl) 25-50 mg PO/IV - Salbutamol (Ventolin) 1 cc via MDI

Answer 148

- ABCs, may need definitive airway (e.g. ETT) due to airway edema - Epinephrine (1:1000) 1-10 ug/min IV (or via ETT if no IV access) titrated to desired effect - Antihistamines: diphenhydramine (Benadryl) 50 mg IV (~1 mg/kg) - Glucocorticoids: methylprednisolone 125-250 mg IV or prednisone/prednisolone 40-60 mg PO - Large volumes of crystalloid may be required

Emergency Medicine Flashcards

(172 cards)