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EM Final Study Guide > Pages 31-40 > Flashcards

Pages 31-40 Flashcards

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1
Q

Abx for perforated viscous?

A
  1. Ciprofloxacin
  2. Metronidazole
  3. Piperacillin/tazobactam
  4. Imipenem
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2
Q

What to consider in female patients presenting to ED with syncope or unexplained hypotension?

A

Ectopic

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3
Q

Sign of IUP on US?

A

Double decidual sac sign occurring at ~ 4.5-5 weeks after LMP

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4
Q

Rate at which BhCG increases?

A

Produced by trophoblasts that doubles approximately every 48-72 hours in the first trimester

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5
Q

What what HCG should IUP be visualized?

A

1500-2000 mIU/mL

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6
Q

How is alloimmunization prevented in expected ectopic?

A

50 mg RhoGAM

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7
Q

Rx mgmt ectopic? MOA? Success rate?

A

Methotrexate

  • Interferes w/ syntheses of DNA and cell replication of fetal cells, resulting in involution of the pregnancy
  • Failure w/ single dose methotrexate occurs in up to 36% of patients necessitating second dose
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8
Q

Side effects methotrexate?

A
  • Abdominal pain 3-7 days after administration secondary to tubal abortion or expanding hematoma within the fallopian tube
  • Worsening pain need be evaluated for tubal rupture, and the need for immediate rescue laparoscopy
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9
Q

What is purulent cervical discharge indicative of?

A

PID

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10
Q

Rx PID Inpatient?

A
  1. Cefoxitin 2 g q6 IV + Doxycycline 100 mg PO
    OR
    2 Cefotetan 2 g q 12 IV + Doxycycline
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11
Q

O/P treatment PID?

A
  1. Ceftriaxone 250 mg IM
    OR
  2. Cefoxitin 2 grams IM + Probenecid 1 gram PO
    OR
    AND
    Doxycycline 100 mg BID for 14 days
    - Addition of Metronidazole 500 mg BID for 14 days should be considered
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12
Q

What is cremasteric reflex and what does it indicate?

A

Loss of cremasteric reflex is most accurate sign of testicular torsion
- Elicited by stroking ipsilateral thigh which leads to reflex elevation of ipsilateral testicle by greater than 0.5cm

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13
Q

In which type of shock does HR go down?

A

None

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14
Q

When does CVP go up in shock?

A
  1. Cardiogenic

2. Obstructive

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15
Q

When does CVP go down in shock?

A
  1. Hypovolemic

2. Distributive

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16
Q

Types of distributive shock?

A
  1. Septic
  2. Neurogenic
  3. Anaphylactic
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17
Q

When does contractility increase in shock?

A

Hypovolemic

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18
Q

When does contractility decrease in shock?

A

Cardiogenic

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19
Q

When does SVR increase in shock?

A
  1. Cardiogenic
  2. Tamponade
  3. PE
  4. Hypovolemic
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20
Q

When does SVR decrease in shock?

A
  1. Tension pneumothorax

2. Distributive

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21
Q

Define anaphylaxis?

A 
Acute onset illness w/ involvement of:
1. Skin: hives, pruritus
 or 
2. Mucosal tissue: swollen lips/tongue  
AND either
1. Respiratory compromise 
OR
2. Reduced BP (<90 Sys or > 30% dec) 
- or associated symptoms of end-organ dysfxn
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22
Q

Anaphylaxis rx and dosing?

A
  1. STOP EXPOSURE
  2. EPI in anterolateral thigh (1:1000=IM or 1:10000 IV).
    - Adults: .3-.5 mg every 5-10 minutes
    - Kids: .01mg/kg up to .3mg q 5-10 minutes.
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23
Q

Fluids in anaphylaxis?

A

1L NS bolus over 5-10 minutes, can need up to 5-7L in severe cases

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24
Q

Secondary Rx anaphylaxis?

A
  1. H1 blockers: Diphenhydramine 50mg IV
  2. Steroids: DEXAMETHASONE 10mg IV
    or
    2.a Methylprednisolone 125mg IV)
  3. O2
  4. Glucagon
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25
What is the SIRS criteria?
2 of the following: 1. Temperature less than 36or greater than 38 2. HR greater than 90 BPM 3. RR > 24 breaths per minute or PaCO2 < 32 4. WBC less than 4,000 or greater than 12,000
26
Definition of sepsis?
SIRS plus presence of infection
27
What is severe sepsis?
Sepsis plus evidence of organ failure or lactate > 4
28
Examples of end organ failure?
1. CNSL Delirium 2. Pulmonary: ALI/ARD 3. Thrombocytopenia 4. Liver: Hyperbilirubinemia 5. Acute renal failure 6. Lactate more than 4
29
Definition septic shock?
Sepsis plus hypotension unresponsive to 2 fluid boluses of 20-30 cc/kg - Hypotension defined as a systolic less than 90 or 40 below baseline BP
30
Tests for sepsis at Loyola?
1. WBC 2. Lactate 3. Procalcitonin 4. Cultures 5. Radiographs 5. ABG 6. Platelets 7. LFTs 8. BUN/creatinine
31
What does lactate represent?
Global HYPOperfusion
32
When is procalcitonin elevated?
Systemic bacterial / fungal infections, NOT viral
33
Central venous O2 sat goal in sepsis?
ScvO2 greater than 70mm Hg
34
Afterload goal in sepsis?
Titrate vasopressors to achieve MPA 65 - 90
35
CVP goal in sepsis
Rapid, early fluid boluses to achieve aCVP 8-12
36
UO goal in sepsis?
0.5 cc/kg/hour in adults
37
What to do if ScvO2 is less than 70% in sepsis?
1. Hematocrit less than 30%: transfuse PRBC | 2. Hematocrit is greater than 30%: dobutamine
38
When do abx need to be given in sepsis?
Within 3 hours of arrival
39
How to confirm proper ET tube placement?
End-tidal CO2 is most accurate technology
40
Compression to ventilation ratio w/o secured airway?
30 Compression : 2 breaths
41
Ventilation rate in a patient 2/ ongoing CPR and advanced airway?
1 Ventilation every 5-6 seconds (8-10/minute)
42
Rhythms requiring defibrillation?
Vfib or Vtach WITHOUT PULSE
43
Where to place need in tension pneumo?
14-16 gauge long angiocath in midclavicular line at 2nd intercostal, over rib to avoid NV bundle
44
Ddx pulseless electrical activity?
1. Tension Pneumo 2. HYPERkalemia 3. HYPOglycemia
45
What to do if TACHY causes HYPOtension, AMS, signs of shock, ischemic chest pain, or acute HF?
Synchronized cardioversion!!! - 100J if regular Narrow or wide - 200J mono/biphasic if narrow irregular
46
Management narrow QRS v-tach?
1. Vagal maneuvers, 2. Consider Adenosine IF REGULAR 3. BB and CCBs
47
Management Vtach with QRS greater than .12?
1. Adenosine IF regular and monomorphic Otherwise 2. Amiodarone 150mg over 10 minutes followed by 1mg/min for 1st 6 hours
48
Meds used in cardiac arrest?
1. 1mg EPI every 3-5 minutes IV/IO 2. Vasopressin 40U IV/IO can replace 1st or 2nd dose of EPI 3. Amiodarone 300mg bolus IV/IO ONLY for V-FIB/VTACH, second dose is 150mg bolus.
49
Whats does palpable radial pulses suggest?
Systolic blood pressure of at least 80
50
What does palpable femoral and carotid but no radial suggest?
Systolic of at least 60
51
Most common cause preventable death in kids?
Failure to control airway
52
What is Cardiopulmonary Failure?
When Resp Failure (AMS) + Shock Leads directly to Cardiopulmonary arrest
53
Only type SHOCK IS ONLY TYPE OF SHOCK THAT WORSENS WITH FLUID BOLUSES?
CARDIOGENIC
54
Difference between respiratory distress and failure?
DISTRESS:=increased WOB | FAILURE= AMS from inadequate oxygenation or ventilation
55
In kids does BP assess volume well in early schok?
No
56
Definition HYPOtension in kids based on age?
1. 0-1mo: 60 2. 1mo-1yr: 70 3. 1yr-10yr (70 +(2*age)) > 4. 10 yrs =90mmHg
57
Verbal GCS scale in infants?
1. Coos: 5 2. Irritable cries: 4 3. Cries to pain: 3 4. Moans to pain: 5. Nothing: 1
58
Most common cause bradycardia in kids?
Hypoxia
59
Urine output consideration in young kids?
Less than 2 yrs cannot concentrate urine | - NORMAL=1-2cc/h
60
What is special about catecholamines?
They are catecholamine deplete: don’t use Vasopressin or Dopamine **Better EPI and NE, Dobutamine and Milrinone
61
What does PGE1 do?
PGE1 MAINTAINS PATENCY OF DUCTUS: can cause resp depression so READY TO INTUBATE
62
What to do in kids with anaphylaxis?
Use both H1 and H2 blockers
63
How to give fluids in hypovolemic shock in kids?
1. 20cc/Kg bolus: always NS/LR | 2. After 3 Crystalloid GIVE 1 COLLOID
64
FiO2 management in kids in schock?
Ttrate to Sats over 94% BUT under 100% to prevent hyperoxia
65
First sign shock in kids?
Tachycardia | - Hypotension = decompensation in kids
66
What is otalgia?
Pain in ear
67
Ddx otalgia?
1. External otitis 2. Otitis media 3. Mastoiditis, 4. Auricular infections. 5. TMJ 6. Neoplasm 7. Dental problems 8. Tonsillitis 9. Laryngitis 10. Sinusitis
68
What is odynophagia?
Painful swallowing
69
Most common cause OM?
1. S.pneumo 2. Hflu 3. RSV
70
Presentation mastoiditis?
Purulent otorrhea and tenderness over mastoid
71
Rx OM?
Cipro/Dexamethasone
72
Diagnosis Peritonsillar abscess?
Needle aspiration, CT or US
73
Most common cause Retropharyngeal abscess?
GABHS
74
When is thumbprint sign seen?
Eppiglotitis
75
Rx epiglottitis?
1. Humidified O2 | 2. Cephalosporins
76
What is Ludwig's Angina? Cellulitis of submandibular and lingual space→spread of odontogenic infection (2nd/3rd molars
Cellulitis of submandibular and lingual space from spread of odontogenic infection in 2nd/3rd molars with get dysphagia, trismus, edema of floor of mouth
77
Rx Ludwig's angina?
Early decadron and Abx
78
What is CENTOR Criteria?
``` Criteria for pharyngitis CERVICAL LAD NO cough TONSILLAR EXUDATE TENDER NO cough Hx of FEVER 0-1: NO test no tx 2-3 rapid strep 4 empiric Abx ```
79
Rx pharyngitis?
IM benzathine penicillin or Pen-VK po
80
Rx epistaxis?
1. Pinch x20 minutes 2. Vasoconstrictor soaked Q-tips x 10 minutes 3. Cauterize w/Silver nitrate 4. Pack, then prophylactic CEPHALEXIN
81
What is DKA?
State of absolute insulin deficiency, hyperglycemia, anion gap acidosis, and dehydration seen in Type 1 diabetics
82
Causes DKA?
1. Infections 2. Disruption of insulin therapy 3. Presentation of new onset diabetes
83
What is HHS?
"Hyperosmolar Hyperglycemic State" | - Seen in type II diabetics
84
What are Kussmaul respirations?
Fast and deep breaths seen in DKA

EM Final Study Guide (29 decks)

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