Misc EM Topics Flashcards
(95 cards)
1
Q
Define TIA
A
Transient episode of neuro dysfunction WITHOUT evidence of infarct (return to baseline in less than 24 hrs)
2
Q
Define stroke
A
Neuro dysfunction 2/2 cerebral infarct (as evidenced by neuroimaging or signs of permanent injury)
3
Q
Define penumbra stroke
A
Ischemic but not infarcted tissue (potentially viable if circulation restored promptly)
4
Q
Etiology of ischemic stroke
A
Cerebral artery blockage
5
Q
Types of ischemic stroke
A
- Thrombotic (clot forms in brain)
- Embolic (clot forms away from brain and swept through to brain)
6
Q
Etiology of hemorrhagic stroke
A
Arterial leakage or rupture 2/2 HTN, AVM, anticoagulants, aneurysm
7
Q
Types of hemorrhagic stroke
A
- Intracerebral hemorrhage (vessel within the brain)
- Subarachnoid hemorrhage (vessel on brain surface)
8
Q
How should onset of stroke be described if unable to determine specifically?
A
“Last known well”
9
Q
Diagnostics of stroke
A
- NIH stroke scale calculation
- HINTS testing (Head Impulse, Nystagmus, Test of Skew)
10
Q
What is HINTS testing?
A
To determine if vertigo is peripheral or central (cerebellar)
11
Q
Which patients will present with abnormal (positive) head impulse testing?
A
Peripheral vertigo
12
Q
Which patients will present with unidirectional, horizontal nystagmus?
A
Peripheral vertigo
13
Q
Which patients may reveal skew deviation with alternate eye cover testing?
A
Central vertigo
14
Q
How will peripheral vertigo patients perform on HINTS testing?
A
- Head impulse: abnormal (positive)
- Nystagmus: unidirectional, horizontal
- Skew: absent
15
Q
How will central vertigo patients perform on HINTS testing?
A
- Head impulse: normal (negative)
- Nystagmus: rotatory, vertical, or direction changing horizontal
- Skew: deviation with alternate eye cover testing
16
Q
Most ischemic strokes will be evident on head CT within:
A
6 hours
17
Q
When is head/neck CTA obtained in stroke evaluation?
A
If onset was less than 3 hours ago
18
Q
When is MRI ordered for stroke evaluation?
A
Confirming diagnosis in TIAs OR if not giving tPA
19
Q
Treatment of stroke
A
- If less than 3 hrs onset, give tPA unless contraindicated
- Intra-arterial fibrinolysis
- Mechanical thrombectomy
- Aspirin if out of tPA window
- BP reduction (labetalol, nicardipine)
20
Q
BP reduction in stroke treatment
A
- Ischemic: reduce BP if SBP is over 185
- Hemorrhagic: reduce BP if SBP is over 140
21
Q
How to treat hemorrhagic stroke?
A
- Reverse anticoagulants
- Hematoma evacuation
- Aneurysm clipping or embolization
22
Q
What is EMTALA?
A
- Protects medically indigent pt from being refused care
- Mandates a minimum of “medical screening exam” and treatment if emergent
23
Q
Why are pediatric patients more susceptible to CT radiation than adults?
A
Children’s cells proliferate more rapidly
24
Q
Define priapism
A
Pathologic erection involving corpora cavernosa but NOT glans or corpus spongiosum
25
Treatment of priapism
- Urology consult but don't wait to treat
- Terbutaline SC deltoid, repeat in 30 min prn
- Pseudoephedrine
- Corporal aspiration of blood then injection of phenylephrine (local pressure then compression dressing)
26
Define phimosis
- Inability to retract foreskin (rarely emergent)
- Generally from poor hygiene leading to infection or scarring
- Treat w/topical steroids, dilation or circumcision
27
Define paraphimosis
- Inability to reduce retracted foreskin back over glans
- Venous engorgement can lead to gangrene
- Emergency reduction necessary! Manual compression or wrapping distal penis w/phlebotomy tourniquet
28
Define Fournier gangrene
- Polymicrobial necrotizing fasciitis of perineal, perianal or genital areas
- Infection tracks along fascial planes and may spare deep muscular structures or even overlying skin
29
Pathophys of Fournier gangrene
- Microorganisms produce enzymes which cause coagulation of local nutrient vessels
- Allows for proliferation of anaerobes which release enzymes responsible for degradation of fascial barriers
30
Risk factors for Fournier gangrene
- DM
- PVD
- Immunocompromise
- Obesity
- Alcoholism
31
Treatment of Fournier gangrene
- Management of shock if present
- Emergent surgical consult
- Abx (cipro and clindamycin)
32
Methods of ring removal
- Ring cutter: can be painful, ring must be bent open
- String technique: painful, may be difficult to pass string under ring
- Tourniquet
33
Describe tourniquet method of ring removal
- Elevate above heart
- Apply tightly distal to proximal
- Quickly remove after a few min and apply lubrication
- Retract skin proximally with one hand while pulling ring distally
34
Options for fish hook removal
- Push through (push it)
- String technique (yank it)
- Needle over barb (cover it)
35
Treatment of plantar puncture wound
- Core out, irrigate, pack x 24 hrs
- Ensure tetanus is UTD
- Consider abx proph (but limited evidence)
36
Plantar puncture wound infections
- Within first 72 hrs is MC staph/strep (use Keflex)
| - After 72 hrs is MC pseudomonas (use Cipro)
37
Treatment of AV fistula bleeding
- Apply direct, localized pressure
- BP cuff above and below fistula may help
- Very superficial suture followed by pressure bandage (temporary measure, best to consult vascular surgery first)
- Address BP, correct any coagulopathies
38
Treatment of fistula aneurysm
Emergent vascular consult to avoid rupture
39
Describe Ottawa knee rules
If 1 or more, x-ray indicated:
- Patella tenderness
- Fibula head tenderness
- Inability to flex 90 degrees
- Inability to bear weight
- Age over 55
40
Describe Ottawa ankle/foot rules
If 1 or more, x-ray indicated:
- Malleolar, navicular OR base 5th MT pain on palpation
- Inability to bear weight
41
Describe Salter-Harris
Classification of pediatric fractures
1: through growth plate
2: through growth plate and metaphysis
3: through growth plate and epiphysis
4: through all 3 elements
5: crush injury of growth plate
42
Prescription writing guidelines
- Use leading zeros (0.1 mg) but not ending zeros (1.0 mg)
- Use correct formulations
- Adjust for renal or hepatic dysfunction
- Verify correct drug when using EMR
43
Every prescription requires:
- Name and DOB
- Drug name, dosage, frequency
- Duration, quantity, refills
- How to administer
44
Every order requires:
- Date and time
- Initials or ID stamp
- Drug name
- Dosage
- Route
- Frequency (if more than 1 dose)
45
Examples of bio-equivalent IV and oral meds?
- Fluoroquinolones
- Azithro, clarithromycin
- Bactrim
- Metronidazole
- Cephalosporins
46
Amoxicillin and Augmentin uses
- OM
- Sinusitis
- Pneumonia
- Tonsillitis (Pen Vee K 1st line)
- UTI
47
Adult dosing of amoxicillin
500 mg PO TID OR 875 mg PO BID
48
Peds dosing of amoxicillin/augmentin
45 mg/kg/day PO (divide into 2-3 doses)
| 90 mg/kg/day PO (divide into 2-3 doses) for otitis media
49
Duration of amoxicillin use
7-10 days
| 5-7 days for high dose otitis media
50
Uses of cephalexin (keflex)
- Skin infections
- OM
- Tonsillitis
- UTI
- Bronchitis
51
Adult dosing of cephalexin (keflex)
250-500 mg PO QID
52
Duration of cephalexin (keflex)
7-10 days
53
Describe PCN allergy cross-reactivity rate
Approximately 1%
| Lower for 3rd-4th generation cephalosporins
54
Uses of ceftriaxone (rocephin)
- PNA
- Cellulitis
- Meningitis
- Pyelonephritis
- Chlamydia
55
Adult dosing of ceftriaxone
1 gm QD (IM or IV)
56
Duration of ceftriaxone
Generally transitioned to PO alternative after few days; single dose for chlamydia
57
Bactrim uses
- UTI/pyelonephritis
- PCP PNA
- Bronchitis
- MRSA skin
58
Adult dosing of Bactrim
- 1 DS (double strength) BID
| - PCP rx is weight based
59
Duration of Bactrim
7-10 days
| 3 days for uncomplicated UTI
60
Bactrim drug interations
Known to inhibit warfarin clearance (results in high INR)
61
Uses of Ciprofloxacin
- UTI/pyelonephritis
- Diverticulitis
- Infectious diarrhea
62
Adult dosing of Ciprofloxacin
250-500 mg BID OR 400 mg IV q12h
63
Duration of Cipro
- 3 days for UTI
- 5-7 days for diarrhea
- 10-14 days for diverticulitis
64
Cipro drug interactions
Known to inhibit warfarin clearance
65
Azithromycin uses
- Bronchitis/PNA
- Sinusitis
- Tonsillitis
- Chancroid/chlamydia
66
Adult dosing of Azithromycin
- "Z pack" (500 mg day 1, then 250 QD x 4d) for respiratory
- 1 gm PO single dose for chancroid/chlamydia
- IV usually 500 mg QD x 2d then PO transition
67
Doxycycline uses
- Lyme/Anaplasmosis/RMSF
- PNA/bronchitis
- Cellulitis including MRSA
68
Adult dosing of Doxy
100 mg PO BID
69
Duration of Doxy
- 7-10 days
| - 21 days for Lyme/tick
70
Side effect of Doxy?
Photosensitivity
71
Uses of acetaminophen (tylenol)
Pain, fever
72
Adult dosing of acetaminophen (tylenol)
325-1000 mg q4-6h prn (325 or 500 mg tablets)
73
Peds dosing of acetaminophen (tylenol)
15 mg/kg q4h
| 160 mg/5 mL elixir, 120 mg or 325 mg suppository
74
Uses of ibuprofen (motrin/advil)
Pain, fever
75
Adult dosing of ibuprofen (motrin/advil)
400-800 mg q6-8h prn (200 mg tablets)
76
Peds dosing of ibuprofen (motrin/advil)
10 mg/kg q6h prn
| 100 mg/5mL elixir
77
Adult dosing of hydrocodone/tylenol (Vicodin)
1-2 tab q4h prn
| 5, 7.5, or 10 mg/300 mg; Norco Tylenol is 325 mg
78
Adult dosing of oxycodone/tylenol (Percocet)
1-2 tab q4h prn
| 5, 7.5, or 10 mg/325 mg
79
Adult dosing of morphine sulfate
2-6 mg IV/IM/SQ q 15mins - 4hrs
| shorter intervals for IV routes
80
Adult dosing of hydromorphone (Dilaudid)
0.5 - 2 mg IV/IM/SQ q 30 mins - 4 hrs
81
Adult dosing of Fentanyl
25-100 mcg IV/IM q 30-60 mins
82
Describe Fentanyl
Shorter duration than morphine/dilaudid
Less hypotension
Consider Duragesic patch for home pain management
83
Adult dosing of Ketorolac (Toradol)
30 mg IV or 60 mg IM q6h prn
84
Describe Ketorolac
- NSAID side effects/contraindications
| - Good for renal/gallbladder pains
85
Describe Tramadol (Ultram)
Non-narcotic, non-NSAID pain med
86
What is a non-narcotic and non-NSAID pain med?
Tramadol (Ultram)
87
What is Ultracet?
Tramadol with 325 mg Tylenol
88
Adult dosing of Tramadol
25-100 mg PO q6h prn
89
What does "mindful medicine" utilize?
Thorough DDX and bias elimination
90
Types of bias
- Availability
- Anchoring
- Framing
- Confirmation
- Premature closure
91
Define availability bias
- Favors the common diagnosis w/o proving its validity
| - Providers tend to be influenced by recent events or info
92
Define anchoring bias
- Prior diagnosis/opinion is favored and misleads provider from correct current diagnosis
- Provider relies on established diagnosis/opinion which impacts subsequent judgments
93
Define framing bias
- Failure to recognize that the data available does not fit diagnostic presumptions
- Provider connects data in a manner that suggests a diagnosis but all relevant data has not been gathered
94
Define confirmation bias
- Info is selectively interpreted to confirm a belief
- Provider has a preferential diagnosis and a finding, or lack of specific finding, during the hx/PE/workup used to support that diagnosis
95
Define premature closure bias
- Rushed diagnostic conclusion
| - Provider jumps to a conclusion but fails to see additional relevant info
