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Emergency Medicine > Peer IX > Flashcards

Peer IX Flashcards

(48 cards)

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1
Q

Conditions causing cyanosis in neonates

A 
Tetralogy of fallot
Total anomalous pulm venous return
Transposition of great arteries
Tricuspid atresia
Truncus arteriosis
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2
Q

Physical exam findings of tetralogy of fallot

A

Right ventricular heave
Harsh systolic murmur
Single second heart sound

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3
Q

Pulm contusion fluid management

A

Limit fluids to only what’s necessary

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4
Q

Fingertip infections

A

Characteristics of fingertip infections
Felon • Located on the finger tuft, treated with lateral fingertip incision and drainage
Paronychia • Located on the nail bed edge, treated with elevation of the paronychium for drainage
Whitlow • Located anywhere on the finger, a small ulcerative lesion, don’t cut it! Treated with a clean dressing, NSAIDs, elevation, possibly antiviral medication

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5
Q

Tx of felon

A

Longitudinal lateral incision

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6
Q

Early/later Sxs of HAPE

High altitude pulm edema

A

Early: Decreased exercise performance
Dry cough

Later: DOE, At rest, fever, tachypnea, tachycardia

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7
Q

Tx for HAPE

A

descent

O2

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8
Q

When do you stop resus on hypothermic codes?

A

32C

89.6F

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9
Q

Hx of WPW with REGULAR NARROW complex tachycardia. What’s first med of choice?

A

Adenosine because this is orthodromic AVRT.

If you have regular wide (antidromic) AVRT, or a fib with WPW then procainamide or cardioversion.

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10
Q

Hx of WPW with WIDE or IRREGULAR tachycardia.

What’s tx?

A

Procainamide or cardioversion

Wide regular tachy is antidromic AVRT

Irregular is afib.

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11
Q

How do you distinguish PSVT (AVNRT) from AVRT, in WPW?

A

Can’t tell until post conversion EKG.

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12
Q

3 keys to the management of sepsis

A
  1. Early recognition
  2. Early anrimicrobials
  3. Adequate fluid hydration
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13
Q

Basic Sepsis management

A 
30cc/kg bolus
If MAP<65 after Bolus start norepinephrine and continuous fluids. Or once adequate volume by vitals or ultrasound. 
Abx
Reduce lactate by 10% first 1-2 hours
Search for and control source
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14
Q

Definition of septic shock

A

Evidence of infection, persistent hypotn MAP <65 despite fluid resus, serum lactate >2mmol/L

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15
Q

Signs of organ hypoperfusion

A

Decreased uout <0.5cc/kg/hr
Elevated lactate
Low mixed venous oxygen saturation
AMS

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16
Q

Meds for cirrhosis with UGIB not from varices.

Melena, ascites

A

Pantoprazole or omeprazole 80mg bolus with 8mg/hr infusion to increase gastric pH to allow clot formation

Ciprofloxacin 400mg iv or
Ceftriaxone 1g iv
Ppx because of gut translocation of bacteria and is proven to reduce mortality rates, decrease infection, lowers risk of bleeding, and shortens hospitalization.

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17
Q

5 Locations for IO placement

A 
Proximal tibia
Proximal numeral head 
Distal femur
Medial malleolus
Iliac spine
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18
Q

Most common Sxs of pna

A

Fever
Fatigue
Cough

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19
Q

3 Atypical pna pathogens and type of atypical pna cough

A

Legionella pneumophilia
Chlamydophila pneumoniae
Mycoplasma pneumoniae

Signs: dry nonproductive cough

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20
Q

Hemorrhagic trach tx
(Tracheoinnominate artery fistula)

Minor bleeding trach

Study These Flashcards
A

Hyperinflate cuff
Apply traction
Put finger in atoms and apply pressure
OR with ENT or Thoracic.

If not controlled intubated with ett with flexible naso/bronchoscope

Moist Gauze pressure and silver nitrate

21
Q

Features, diagnosis, and treatment of idiopathic intracranial hypertension

Study These Flashcards
A

Features: ha, vision changes, papilledema, visual field defect, blind spot

Dx: elevated CSF opening pressure >20mmHg and normal CSF analysis

Tx: intermittent CSF drainage and acetazolamide

22
Q

First line tx for stable V-tach

23
Q

Tx for 1st degree burns

Study These Flashcards
A

Management of a first-degree burn consists of providing an NSAIDs, cooling the skin immediately using tap water or a cool compress (but not ice), and applying aloe vera topically. Pcp f/u.

24
Q

What is the Parkland Formula

Study These Flashcards
A

4ml x % BSA x kg weight

25
What type of emergent blood should be given?
O- for child bearing age women | O+ for men and post menopausal women
26
Colicky flank pain rad to groin with nausea and vomiting Dx? U/a? Locations?
Kidney stone 80% have microscopic hematuria There are three common locations where kidney stones get stuck: the ureteropelvic junction, the pelvic rim, or the ureterovesicular junction Stones greater than 5-6mm are unlikely to pass on own accord.
27
Tx for scarlet fever
Treatment is 10 days of oral penicillin VK 50 mg/kg per day (40,000-80,000 units) in four divided doses in children or 250 mg four times a day. Intramuscular benzathine penicillin (given as Bicillin C-R) is another option; dosing is 300,000 units in patients weighing less than 30 pounds, 600,000 units in patients weighing 31 to 60 pounds, 900,000 units in patients weighing 61 to 90 pounds, and 1.2 million units in patients weighing more than 90 pounds. In patients allergic to penicillin, the treatment is 10 days of erythromycin, 250 mg four times a day in adults or 40 mg/kg per day in children.
28
Hemodynamics goals in acute aortic dissection
SBP 100-120 HR <60 Beta blocker first then vasodilators
29
After testicular trauma get an u/s what finding on U/s warrent urology consult?
If rupture, large hematocele, dislocation, or torsion is identified, the patient should undergo urgent surgical intervention within 72 hours
30
Tet spell: hypoxic during or after feeding or while crying or agitated and then become cyanotic How do you treat babies with tet spells What not to do
Therapeutic options for a tet spell: oxygen, fluids, knee-chest positioning, morphine, bicarbonate, phenylephrine, and propranolol. Anything that decreases pulmonary blood flow or decreases systemic vascular resistance is harmful.
31
Sxs of costochondritis | Tx
Costochondritis is an inflammatory condition of the costochondral junction that causes sharp pain followed by dull pain Costochondritis chest pain is typically reproducible on examination Antiinflammatories
32
STEMI EKG
STEMI. These criteria include two contiguous leads with ST-segment elevation of more than 2 mm in leads V2 and V3 or more than 1 mm in all other leads
33
Leads with ST-segment elevation and corresponding location of the MI
``` V1-V4, anterior or anteroseptal I, aVL, V5-V6, lateral I, aVL, V1-V6, anterolateral V1-V2, septal II, III, aVF, inferior I, aVL, V5-V6, II, III, aVF, inferolateral V1-V4 / V8, V9, posterior indirect/posterior direct RV1-RV6 or RV4, right ventricular ```
34
When to consult high pressure injection injuries Tx
Always!!! Initial management of a high-pressure wound: pain control, splinting, elevation, intravenous antibiotics, and tetanus prophylaxis.
35
G-tube pulled out When to not replace it
Don’t try to replace a G-tube in the first 2 to 3 weeks after it was placed – get imaging, abx, consult instead.
36
Swallowed battery Indications for endoscopy:
Endoscopy indications: symptomatic, ingestion of more than 1A magnet, button battery lodged in the esophagus.
37
Gastric lavage 8 contraindications Timeline to do it
``` Unprotected airway Hydrocarbon ingestion (unless intubated) Corrosive ingestion Foreign body ingestion Bleeding diatheses Known esophageal strictures History of gastric bypass surgery Small children ``` First 60-120 min
38
Should you dilute ingestion of caustic substance?
Yes: water or milk within first 60 min
39
Contraindications to flumazenil in benzo OD
Here are the contraindications for using flumazenil to reverse benzodiazepine poisoning: the presence of a proconvulsant coingestant and a history of convulsions
40
Potential treatment for stable monomorphic VT
1st line: Procainamide (25-50mg/min, max 17mg/kg) don't use if MI, LV dysfxn, or QTc prolongation Amiodorone: ok if mi or LV dysfxn ``` Others: Sotalol Lidocaine Overdrive pacing Synchronized cardioversion ``` Don't use sotalol or procainamide if prolonged QTc
41
Lefort fracture classification
I: pterygoid plate II: + orbit III: + zygoma IV: III + frontal bone
42
ED workup for old man with painless gross hematuria Risk factors for bladder cancer
CT ab/pelvis Urgent urology follow up Risk factors for bladder cancer: - strongest: tobacco, htn, obesity - age >40 - excessive analgesic use - pelvis radiation - cyclophosphamide - occupational exposure to aromatic amines or benzenes - in Africa exposure to schistosoma haematobium.
43
Baby <3 mo choking and gagging episodes. Dx? How can you tell if it's GERD?
Congenital malformation of esophagus: tracheoesoohageal fistula. GERD: multiple spit ups or wet burps soon after feeds.
44
How do you remove foreign body in eye?
1. Anesthetize eye 2. Slit lamp to assess size and depth 3. Remove with irrigation or moist cotton tip applicator 4. Remove rust ring with burr drill if not in visual axis 5. Topical antibiotic and cycloplegic 6. Tetanus 7. Ophtho f/u
45
Signs of breast cancer
Nipple retraction, discoloration or erythema, skin thickening
46
Ab pain , vomiting, normal mental status in alcoholic with significant acidosis after etoh binging and low food intake. Dx? Tx?
Dx: alcoholic ketoacidosis, elevated beta hydroxybutyrate Tx: hydration with glucose containing solutions, thiamine, food. Make sure to rule out pancreatitis
47
High risk animals for rabies How to treat post exposure prophylaxis
US: Bats, foxes, raccoons, skunks Outside US: dogs Tx: 1. Wash wound soap, water, and iodine 2. HRIG (human rabies Ig injected around wound 3. Human diploid cell vaccine injected away from HRIG, repeated days 3, 7, 14 and day 28 if immunocompromised.
48
Most common causes of ataxia in children Life threatening causes you must rule out
Postinfectious cerebellar ataxia (acute cerebellar ataxia: occurs 2 weeks after viral illness) and drug ingestion Rule out hypoglycemia, intracranial infections, intracranial mass/bleed/stroke Consider Guilin barre

Emergency Medicine (1 decks)

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