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EM > Emergency Medicine Study Guide Flashcards - Sheet1 > Flashcards

Emergency Medicine Study Guide Flashcards - Sheet1

1
Q

What percentage of patients with acute MI have ST elevations?

A

50%

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2
Q

What is an acute coronary syndrome?

A

Umbrella term including stable angina, unstable angina, acute MI, STEMI and NSTEMI

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3
Q

Which cardiac markers are used to evaluate for acute MI?

A

Troponins are used more often, though CK-MB was used more in the past (less specific to cardiac muscle)

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4
Q

Treatment for Acute MI

A

OH BATMAN “oxygen, heparin, beta-blockers, aspirin, thrombolytic, morphine, anti-platelet agent, nitrates

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5
Q

Cocaine-related chest pain treatment

A

give benzos, avoid beta blockers

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6
Q

what is the mechanism for cocaine-related myocardial ischemia/angina

A

vasopasm

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7
Q

Treatment for aortic dissection in the ED

A

fluid resuscitation, drop VP with IV nitroprusside plus beta blocker

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8
Q

Classic triad of PE presentation

A

Dyspnea, pleuritic chest pain and hemoptysis

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9
Q

Diagnostic labs/imaging for PE

A

ECG most often normal, can see S1Q3T3 for right heart strain, CXR can show hamptons hump, westermark sign, atelectasis

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10
Q

PE treatment

A

IV, oxygen, heparin

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11
Q

What is vertigo?

A

perception of rotation or a spinning sensation, pts describe as sea sickness or drunk

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12
Q

How do you figure out if vertigo is central or peripheral?

A

Central has slow onset, CN findings, peripheral has rapid onset, greater severity

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13
Q

If vertigo is associated with hearing loss, what is the cause?

A

acute labyrinthitis, typically after URIs, otitis media

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14
Q

If you do the Dix Hall pick maneuver on someone with vertigo, what do you see?

A

Patient with peripheral vertigo will have their nystagmus extinguished, patient with central vertigo will have persistent nystagmus

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15
Q

What is dysequilibrium?

A

A gait disturbance, unsteadiness or stumbling, caused b loss of proprioception, can be ataxic, cauesd by neuropathy, tabes dorsalis, B12 deficiency, cerebellar degeneration

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16
Q

What is the workup for dizziness?

A

D-stick, EKG, CT/MRI, CBC, electolytes

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17
Q

How do you treat vertigo?

A

Treat with meclizine (antihistamine), scopolamine (anticholinergic), diazepam (benzo)

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18
Q

How is pediatric fever defined?

A

Temp greater than 38 (100.5)

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19
Q

What is the workup for a child 0-28 days presenting with a fever?

A

Full septic work-up with CBC, UA, Ucx, BCx, LP, CXR (if resp sx), begin empiric treatment with ampicillin, cefotaxime and acyclovir

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20
Q

Most common organisms for infants

A

E. coli, GBS, listeria, HSV (<21 days)

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21
Q

Low-risk criteria for patients 29-56 days defined?

A

well-appearing, no focus of infection IDed on exam, WBC btwn 5-15k, neg gram stain on UA, no infiltrate on CXR

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22
Q

How are low-risk patients treated?

A

Can be discharged without antibiotics, followed outpatient

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23
Q

Causes of fever in child 2-36 months

A

Can be due to occult bacteremia (Hib, s pneumo) or occult UTI (E. coli, enterococcus)

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24
Q

What risk factors are there for UTI in children?

A

Females?males, uncircumcised males at greater risk

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25
Q

Treatment of UTI

A

Cefixime or TMP-SMX

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26
Q

For older children (>3 yrs), what’s the work up of fever?

A

most cases are viral, don’t require diagnostics, but think about sx to guide treatment (strep test, ua, CXR etc)

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27
Q

What is delirium?

A

state of disturbed consciousness assoc with motor restlessness, transient hallucinations, disorientation and dillusions ( can be hyper or hypoactive)

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28
Q

Delirium vs. dementia

A

Delirium has a fluctuating course with acute onset and a reversible cause, dementia is a stable course with insidous onset, irreversible

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29
Q

Differential diagnosis of delirium

A

AEIOU TIP: Alcohol, Endocrinopathy, encephalopathy, electrolytes, Insulin, infection, increased ICP, Opiates, oxygen, Uremia, Trauma, toxic, Inborn errors of metabolism, Psych, post-ictal, Seizures, stroke, shock, space-occupying lesions

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30
Q

Labs and diagnostics for delirium

A

CBC, BMP, LFT, NH3 level, PT/pTT, tox screen, CXR, eKG, CT head, U/s, LP, exam

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31
Q

What is shock?

A

Physiologic state characterized by decreased tissue perfusion and impaired oxygen delivery

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32
Q

What is sepsis?

A

Infection plus inflammation

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33
Q

What is warm vs cold shock?

A

Early in shock, compensatory mechanisms maintain blood pressure (warm shock), Late in shock, it becomes uncompensated resulting in hypotension and shunting from the periphery

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34
Q

Types of shock?

A

Hypovolemic (decreased preload), Cardiogenic (impaired contractility), distributive (drop in SVR, fxnal hypovolemia), neurogenic (loss of vascular tone)

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35
Q

What are the SIRS criteria?

A

Temp 100.4, HR >90, RR>20 or PCO2 >32, WBC 12 or bands >10%

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36
Q

What does CVP act as a surrogate for?

A

Preload

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37
Q

MAP goal in management of shock?

A

65-90, use dobutamine and norepinephrine

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38
Q

What is an important lab to get on everyone

A

Lactate

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39
Q

When should you start ABX in a patient with undifferentiated hypotension?

A

As early as possible, shown to decrease mortality

40
Q

What affects oxygen delivery?

A

hemoglobin, oxygen saturation, cardiac output

41
Q

What is severe sepsis?

A

Sepsis with organ dysfxn

42
Q

What is septic shock?

A

Sepsis with hypotension refractory to volume resuscitation

43
Q

Abx for community acquired meningitis

A

ceftriaxone and vancomycin for adults 50 (to cover listeria)

44
Q

Abx for brain abscess

A

ceftriaxone 2g IV q12h +/- metronidazole 500mg IV q12h

45
Q

Abx for acute sinusitis (< 3 weeks)

A

No abx recommended

46
Q

Abx for chronic sinusitis (>3 weeks)

A

TMP-SMZ DS BID x 10 days, amoxicillin/clavulanic acid 875 mg BID x 10 days, azithromycin, quinolone

47
Q

Abx for otitis media

A

ceftriaxone if not improved without abx

48
Q

Abx for otitis externa

A

Ciprofloxacin or levofloxacin

49
Q

Abx for pharyngitis

A

penicillin, amoxicillin or azithromycin

50
Q

Abx for bronchitis

A

Abx not recommended!

51
Q

abx for chronic bronchitis (COPD)_

A

Doxycycline, TMP-SMX, amoxicillin

52
Q

Abx for community acquired pneumonia

A

Azithromycine + doxy (for mycoplasma)

53
Q

Abx for aspiration pneumonia

A

Penicillin plus metronidazole

54
Q

Abx for UTI

A

simple: TMP-SMX, complicated: quinolone (cipro or levo)

55
Q

Abx for urethritis

A

Ceftriaxone IM plus azithromycin 1g PO

56
Q

Abx for trich

A

metronidazole

57
Q

Abx for bacterial vaginosis

A

metronidazole

58
Q

Abx for intestinal infection

A

Ampicillin/sulbactam (or levo) plus metronidazole

59
Q

How is the EMS curriculum set? Who sets scope of practice/length of training?

A

Curriculum set by federal department of transportation, states set scope of practice (not uniform), DOT sets length of trainingw hich is overseen by states

60
Q

In PA, how is the medical director involved with the paramedics practice?

A

Paramedics must be approved for practice by medical director, also need permission for certain procedures and for controlled substances

61
Q

When was the Emergency Medical Services Act enacted?

A

1973 - it defined and funded the crucial 15 elements of EMS systems

62
Q

What are the most common forms of primary headache?

A

Tension, migraine, cluster

63
Q

What is a tension headache like?

A

duration of 30 mins to 7 days with pressing quality, bilateral, associated without vomiting

64
Q

What is a migraine like

A

4-72 hours with unilateral location, pulsating quality, photophobia, nausea,vomiting

65
Q

What is a cluster headache like?

A

15-180 minutes, severe unilateral orbital/temporal pain associated with lacrimation, rhinorrhea, facial swelling, eyelid edema

66
Q

How do you treat a tension headache? migraine? cluster?

A

Tension - oral analgesics, migraine - reglan or triptan, cluster - 100%oxygen, lidocaine, NSAIDS

67
Q

In the ED, how do you manage acute stroke?

A

STAT head CT, MRI, neurology consult, basic labs, finger stick glucose, nail down timeline and give lytics if <3hours since onset

68
Q

What are the CSF findings in acute bacterial meningitis?

A

elevated opening pressure, WBC >5/mm3, elevated protein, low glucose, presence of organism on gram stain

69
Q

What is the classic disease you’re concerned about with “worst headache of life”?

A

Subarachnoid hemorrhage - caused by ruptured intracranial aneurysm (ex. berry aneurysm

70
Q

What is the workup for suspected SAH?

A

CTA

71
Q

How do you treat SAH?

A

emergent neurosurg consult, blood pressure control, analgesia,

72
Q

What is heat stroke? Treatment?

A

altered mental status with core temp >105, seen in patients with compromised homeostasis, treat with aggressive cooling (ice water, towels, lavage, cold dialysis)

73
Q

Major complications of heat stroke?

A

ARDS, DIC, rhabdo, ARF, liver failure, seizures

74
Q

What is hypothermia?

A

Core temp below 35 C, can be mild, moderate or severe. Early on there is shivering and increased HR, RR, BP. Then shivering stops, pt becomes bradycardia, decreased RR, hyporeflexia, see osborn J wave, in severe you have pulm edema, oliguria, loss of reflexes, hypotension, coma

75
Q

treat hypothermia?

A

Minimize heat loss, ABCs, give IVF, give glucose

76
Q

What is frostnip?

A

Mild case of cold injury, reversible

77
Q

What is chilblains/pernia?

A

Chronic vasculitis from repeated exposures, red/purple papules/nodules on feet

78
Q

What is trenchfood?

A

Characterized by redness, swelling, throbbiing pain with cold and wet

79
Q

What is frostbite?

A

frozen tissue - treat by rewarming, analgesia, leave blood-filled bilsters alone, drain clear bilsters, give aloe vera

80
Q

What are the most common causes of missed death in pediatric trauma?

A

Unrecognized hemorrhage and respiratory arrest

81
Q

What is the most common cause of trauma in kids 0-14? 14-18?

A

Falls and motor vehicle accidents

82
Q

When do you do a CT in a kid > 2with head trauma?

A

If they have altered mental status, signs of basillar fracture, definittely. CT vs obs in pts with LOC, vomiting, severe headache depending on history and physician preference

83
Q

When do you do a CT in a kid <2 with head trauma?

A

Change in mental status, occipital/parietal/scalp hematomaor history of LOC obs vs. Ct

84
Q

When should you consider abuse?

A

Always in a kid with trauma, but specifically with retinal hemorrhage

85
Q

What is laryngotracheobronchitis?

A

Croup

86
Q

What are the common etiologies of croup?

A

Parainfluenza, influenza, RSV

87
Q

What are the classic signs of croup?

A

Barking cough, stridor, fever, steeple sign on CXR

88
Q

How do you treat croup?

A

Hot shower/cool mist, dexamethasone in moderate cases, and racemic epi in severe cases

89
Q

How do you treat asthma?

A

Albuterol +/- ipratropium, corticosteriods (inhaled and parenteral), continous albuterol, magnesium, terb

90
Q

Why is bronchiolitis a huge concern in children < 1 month?

A

Can cause apnea

91
Q

When do you give tetanus Ig?

A

When patient is not fully immunized within the last 10 years, or has an unclear vaccination history, otherwise booster is sufficient

92
Q

What does opioid toxicity look like?

A

Pinpoint pupils, resp depression, lethargy to coma, bradycardia, hypotension, hypothermia

93
Q

What does anti-cholinergic toxicity look like?

A

Blind as a bat, mad as a hatter, dry as a bone, red as a beet, hot as a hare, altered mental status, flushing, urinary retention, hyperthermia, dry eyes/skin, decreased bowel sounds, tachycardia

94
Q

What does sympathomimetic toxidrome look like?

A

tachycardia, hyperthermia, mydriasis, with hypertension, hyperactive bowels and diaphoresis

95
Q

What does cholinergic toxicity look like?

A

DUMBBELLS - diarrhea/diaphoresis, urination, miosis, bradycardia, bronchorrhea, emesis, lacrimation, salivation/seizures

EM (2 decks)

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