May 30 Flashcards Preview

Emergency Lectures > May 30 > Flashcards

Flashcards in May 30 Deck (36):
1

What are the Big 6 for Chest Pain?

Squeeze: tamponade, tension pneumothorax
Starve: MI/UA, PE
Burst: esophageal rupture, aortic dissection

2

Chest Pain - other causes:

Myocarditis, pericarditis
Chest wall pain syndromes
GERD, spasm, PUD
Pancreatitis, cholecystitis
Pneumothorax, pneumonia, pluritis
Psych: hyperventilation...

3

Most frequent critical chest pain dx?

MI
- time is muscle
- get EKG and CXR promptly

4

Why harsh HSM radiating to axilla in MI?

Papillary muscle ischemia

5

What 3 things does Dr. Sharpless want?

Story, risk factors, hard clinical findings

6

Aside from vitals, what tells me the pt is critically ill or hypo-refused?

Diaphoresis - sweating pt makes me sweaty
Cool, clammy skin
Poor capillary refill
AMS
Poor urine output

7

What are 4 anginal equivalents?

Substernal pressure/pain rad to left arm = classic
- dyspnea
- weakness
- syncope
- confusion

8

What are the top 6 MI risk factors?

1. DM
2. Hypercholesterolemia
3. HTN
4. Smoking
5. Family history early CAD
6. Age (Men>45, women>55)

9

How can you tell if systolic ejection murmur rad to carotids is severe?

Aortic Stenosis
- Parvus et tardus
- late peak in intensity of the murmur = tight

10

What order for eval Chest Pain?

EKG, CXR, telemetry
IV, O2, Pox
Troponin, CBC, BMP, Mg, PT/PTT

11

What is classic EKG changes in MI?

ST elevation >1mm in 2 contiguous leads

12

Describe 4 shapes of ST elevations:

Smile: you have chance not MI
Concave upward: often MI but others

Convex: huge risk MI (frown or elevated but flat)

13

Inferior wall MI: leads? worry?

II, III, AvF
- may be assoc w/ RV MI = NO nitrates

14

What are reciprocal leads for inferior wall?

I, L

15

What is an anterior wall MI?

V1-V4 - knock on the anterior door

16

What are reciprocal leads to anterior wall?

II, III, AvF

17

What is a lateral wall MI?

V5-6, I, L

18

How see posterior wall MI on EKG?

ST depression in V1-V4
- but also could be sub-endocardial infarct

19

What is Acute MI therapy?

Aspirin - 4x 81mg chewable - MOST important
Nitroglycerin (sub-lingual + IV)
Morphine
Heparin (bolus + drip)
Cardiology - ASAP

20

Chest pain + back pain = ?

Aortic Dissection
- abrupt, excruciating, tearing pain

21

What kind of murmur w/ aortic dissection?

Aortic regurg - proximal dissection
- dilation of aortic valve ring
- loss of commissural support of aortic valve

22

Risk factors for aortic dissection?

HTN
Bicuspid aortic valve
Marfan / Ehlers-Danlos
Pregnancy

23

What is common in proximal aortic dissections?

Aortic insufficiency (regurg)

24

Tests/imaging for aortic dissection?

EKG - usually normal
CXR - abnormal 80% of the time

25

What is the egg shell sign on CXR for aortic dissection?

Separation > 5mm of intimal calcium from outer aortic contour

26

How treat aortic dissection?

Lower BP to reduce sheer forces
- give BB esmolol - short acting

- can also give nitroprusside after the BB

27

Classic triad for PE?

TEST TEST TEST

Dyspnea - labored breathing
Hemoptysis
Pleuritic chest pain

28

What may suggest massive PE?

Vascular collapse

29

Types of PE?

Thrombus - emboli
Amniotic fluid - usu during labor
Fat embolism - long bone fx
Air embolism - iatrogenic

30

Rick factors for PE?

Prior DVT/PE
Lupus anticoagulant
Protein C/S deficiency
Central lines, surgery, cast/immobilization
Cancers (ovarian/colon)
Pregnancy, high dose estrogens
IBD - Crohn's (often decreased C/S)

31

What hear on auscultation with a PE?

Wide split S2
- pipe is obstructed, takes more time to get all blood through pulmonary valve so it closes after aortic

32

What is Virchow's triad?

Venous stasis
Hypercoagulability
Endothelial injury

33

Low pulse ox + normal pulmonary exam...

PE

34

CXR findings for PE

Westermark's cut-off sign
- following a vessel and it just cuts off
Hamptom's hump

35

Two main scans for PE?

V/Q scan
CT scan w/ contrast - so need good kidneys

36

How treat PE?

IV heparin bolus + drip (or lovenox)
Give tPA if:
- shock + PE
- PE + right heart failure