Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
339 Cards in this Set
- Front
- Back
|
5 routes of poison exposure
|
Inhalation, ingestion, insufflation, absorbtion, injection
|
|
|
Most common route of poison exposure
|
Ingestion
|
|
|
Poisoned patient - First priority
|
ABC's
|
|
|
4 empiric antidotes for poisoning
|
Oxygen, naloxone, glucose, thiamine
|
|
|
Main risks of naloxone
|
Acute opoid withdrawl. Their attitude will never improve.
|
|
|
Naloxone duration of action
|
20-60 minutes. May wear off before drug does.
|
|
|
Exposure history basic elements
|
Agent, dose, route, intent
|
|
|
Toxidrome
|
Classic physical findings for exposure to a class of agents
|
|
|
Importance of toxidrome identification
|
Allows for more timely care when history is not available or accurate.
|
|
|
General decontamination
|
Removal of patient of substance and then removal of substance from patient.
|
|
|
Gross decontamination
|
Thoroughly washing with water
|
|
|
Eye decontaminations
|
Copious irrigation with isotonic crystaloid
|
|
|
3 methods for GI decontamination
|
Removal from stomach through the mouth, binding in the lumen, expediting through the GI system
|
|
|
Onset of action for ipecac
|
Within 20 minutes
|
|
|
Indications for ipecac
|
Call 1-800-222-1222
|
|
|
Contraindications for ipecac
|
Prior vomiting, caustic ingestion, toxins that are pulmonary toxic than systemic, ALOC, seizures
|
|
|
Activated charcoal - mech of action
|
Binds toxins in the GI lumen, limits systemic absorption
|
|
|
Activated charcoal - benefits
|
Safe, fast, non invasive
|
|
|
Activated charcoal - route of administration
|
Oral, OG or NG tube
|
|
|
Activated charcoal - indications
|
Recent ingestion of selected toxins (800-222-1222)
|
|
|
Activated charcoal - contraindications
|
Perforation, if indication for endoscopy, substances that charcoal won't work on (800-222-1222)
|
|
|
Whole bowel irrigation - theraputic purpose
|
Produces rapid catharsis (not emotional)
|
|
|
WBI - indications
|
Extended release formulations, heavy metals, paint chips, condoms full of coke or heroin
|
|
|
WBI - contraindications
|
Diarrhea, lack of bowel sounds
|
|
|
WBI - route of administration
|
Oral, OG or NG tube
|
|
|
WBI - most commonly used agent
|
Polyethylene glycol in a balanced electrolyte balance
|
|
|
Opiod - agents
|
Heroin, morphine, oxy, etc.
|
|
|
Opiod - symptoms
|
Miosis, respiratory depression, bradycardia, AMS, hypothermia
|
|
|
Opiod - intervention
|
Airway management and naloxone
|
|
|
Sympathomymetic - agents
|
Cocaine, amphetamines
|
|
|
Sympathomymetic - symptoms
|
Agitations, mydriasis, tachycardia, HTN, hyperthermia, seizures, rhabdo, MI, diaphoresis
|
|
|
Sympathomymetic - intervention
|
Hydration, cooling, sedation with benzo's
|
|
|
Cholinergic - agents
|
Organophosphates, carbamates
|
|
|
Cholinergic - symptoms
|
SLUDGE
|
|
|
Cholinergic - intervention
|
ABC's, atropine
|
|
|
Anticholinergic - agents
|
Atropine, scopolamine
|
|
|
Anticholinergic - symptoms
|
AMS, mydriasis, urinary retention, dry membranes, hyperthermia, dysrhythmias
|
|
|
Anticholinergic - intervention
|
ABC's, sedation, cooling, physostigmine
|
|
|
Hypoglycemic - agents
|
Insulin, sulfonylureas
|
|
|
Hypoglycemic - symptoms
|
AMS, diaphoresis, seizures, slurred speech (they look drunk)
|
|
|
Hypoglycemic - intervention
|
ABC's, oral or IV glucose
|
|
|
Salicylate - agents
|
ASA, oil of wintergreen
|
|
|
Salicylate - symptoms
|
AMS, respiratory alkalosis, metabolic acidosis, tinnitis, N/V, tachycardia, ketonuria
|
|
|
Salicylate - intervention
|
ABC's, charcoal, hemodialysis, replace K
|
|
|
Extrapyramidal - agents
|
Psych meds
|
|
|
Extrapyramidal - symptoms
|
Dystonias, torticollis, tremor, muscle rigidity, seizures
|
|
|
Extrapyramidal - intervention
|
Antihistamines, benzo's
|
|
|
Goal of urinary alkalinization
|
Enhance clearance of specific toxins
|
|
|
Goal of hemodialysis
|
Remove life threatening toxins directly from blood
|
|
|
Goal of hemoperfusion
|
Removal of toxins directly from blood that charcoal absorb
|
|
|
Naloxone drug class
|
Opiod receptor antagonist
|
|
|
Naloxone clinical indicatons
|
Suspected opiod OD
|
|
|
Atropine drug class
|
Acetylcholine antagonist
|
|
|
Atropine clinical indications
|
Organophosphate or nerve agent poisoning
|
|
|
Dextrose food group
|
Sugar
|
|
|
Dextrose clinical indications
|
Hypoglycemia
|
|
|
Acetylcystine drug class
|
Antidote
|
|
|
Acetylcystine clinical indications
|
Tylenol overdose
|
|
|
Poisons that may cause HTN
|
Hypoglycemic, sympathomimetic
|
|
|
Poisons that may cause hypotension
|
Opioid, tricyclics, sedative-hypnotic
|
|
|
Poisons that may cause tachycardia
|
Sympathomimetic, salicylates, hypoglycemic
|
|
|
Poisons that may cause bradycardia
|
Opioid, cholinergic, sedative-hypnotic
|
|
|
Poisons that may cause hyperventilation
|
Salicylates, sympathomimetic
|
|
|
Poisons that may cause hypoventilation
|
Opioid, cholinergic, sedative-hypnotic
|
|
|
Poisons that may cause hyperthermia
|
Sympathomimetic, anticholinergic, hallucinogenic, serotonin
|
|
|
Poisons that may cause hypothermia
|
Opioid, sedative-hypnotic, EtOH
|
|
|
Poisons that may cause red skin
|
Anticholinergic, CO, cyanide
|
|
|
Poisons that may cause blue skin
|
Anything making you hypoxic or hypotensive
|
|
|
Poisons that may cause mydriasis
|
Sympathomimetic, anticholinergic, hallucinogenic
|
|
|
Poisons that may cause miosis
|
Opioid, sedative-hypnotic, cholinergic
|
|
|
Methanol poisoning - clinical features
|
CNS depression, sz, coma, acidosis, vision changes
|
|
|
Methanol poisoning - diagnosis
|
Hx, direct serum levels. Organ damage potential based on acidosis more than blood level
|
|
|
Methanol poisoning - treatment
|
Booze! Fomepizole
|
|
|
Ethylene glycol poisoning - clinical features
|
CNS, depression, sz, coma, acidosis, renal failure, cardiac failure
|
|
|
Ethylene glycol poisoning - diagnosis
|
Hx, direct serum levels
|
|
|
Ethylene glycol poisoning - treatment
|
Booze! Fomepizole
|
|
|
Vaginal bleeding - history key points
|
Age of menarche, LMP, bleeding pattern, pain, sexual activity, contraception, pregnancy possibility, STD and PID history, coagulopathies, history of ectopic
|
|
|
5 reproductive tract diseases with vag bleed
|
Leiomyomas, adenomyosis, endometriosis, neoplasia, infection
|
|
|
3 systemic diseases with vag bleed
|
Coagulopathy, hypothyoidism, cirrhosis
|
|
|
Importance of speculum exam for vag bleed
|
Visualize external and internal vaginal region for source of bleeding or other abnormalities
|
|
|
Importance of bimanual exam for vag bleed
|
Check for masses or tenderness
|
|
|
Labs/imaging for vag bleed
|
Preg test, CBC, coags, ultrasound, CT or MRI if needed.
|
|
|
Treatment for severe persistant uterine bleeding
|
D&C
|
|
|
Labs/imaging for pelvic/low abd pain
|
Preg test, CBC, UA, ultrasound, CT or MRI if needed.
|
|
|
Emergent conditions causing abdominal pain, excluding pregnancy
|
Ovarian cysts, ovarian torsion, appendicitis, ischemic bowel, PID
|
|
|
Risk factors for ectopic pregnancy
|
Prior ectopic, tubal surgery, IUD use, PID
|
|
|
Classic triad of ectopic pregnancy symptoms
|
Abdominal pain, spotting or bleeding, amenorrhea
|
|
|
Physical exam findings for ectopic pregnancy
|
May be normal. Adnexal mass, cervical motion tenderness, blood in vaginal vault, Chadwick sign, peritoneal signs, shock
|
|
|
Surgical treatment of ectopic
|
Laproscopic salpingectomy
|
|
|
Non-surgical treatment of ectopic
|
Methotrexate
|
|
|
Common causes of 1st trimester bleeding
|
Ectopic, implantation bleeding, abortion, gestational trophoblastic disease
|
|
|
Threatened abortion
|
Bleeding during first half of pregnancy without cervical dilatation
|
|
|
Inevitable abortion
|
Vaginal bleeding with cervical dilatation
|
|
|
Missed abortion
|
Fetal death at less than 20 wks without passage of tissue for 4 wks
|
|
|
Septic abortion
|
Evidence of infection during any stage of abortion
|
|
|
Complete abortion
|
Passage of everything
|
|
|
Most concerning diagnosis in painless 3rd trimester bleeding
|
Placenta previa
|
|
|
Examination to avoid in painless 3rd trimester bleeding
|
Digital or speculum exam
|
|
|
PID definition
|
Pelvic inflammatory disease
|
|
|
PID - risk factors
|
STDs, multiple sex partners, high risk behavior, delay in seeking medical care
|
|
|
PID - common presentation
|
Low abdominal pain
|
|
|
PID - clinical findings
|
Cervical motion tenderness
|
|
|
PID - usual pathogens
|
Chlamydia, gonorrhea, HSV, trich
|
|
|
PID - treatment
|
3rd generation cephalosporin plus doxycycline, oral or IV
|
|
|
PID - complications
|
Sterility, tubo-ovarian abscess, Fits-Hugh-Curtis Syndrome
|
|
|
PID - guidelines for admission
|
Pregnancy, outpatient failure, toxicity, tubo-ovarian abscess, potential surgery
|
|
|
Classic presentation of angina
|
Retrosternal left chest pain. Crushing, tightening, squeezing
|
|
|
Common causes of angina
|
Vasospasm, coronary lesion
|
|
|
Duration of symptoms for angina
|
2-20 min
|
|
|
Angina triggers
|
Exertion, stress, vasospasm
|
|
|
Initial approach for chest pain
|
Prompt triage, ID risks, monitor, IV, O2, EKG
|
|
|
Differential for chest pain
|
PE, pneumo, esophageal rupture, pneumonia, MI, costochondritis
|
|
|
Clinical features and presentation of pulmonary embolism
|
Pleuritic chest pain, heaviness, tightness, dyspnea, tachypnea, tachycardia
|
|
|
Clinical features and presentation of aortic dissection
|
Ripping tearing pain maybe radiating to back
|
|
|
Clinical features and presentation of spontaneous pneumothorax
|
Sudden sharp pleuritic CP and dyspnea
|
|
|
Clinical features and presentation of esophageal rupture (Boerhaave syndrome)
|
Sharp substernal CP after vomiting.
|
|
|
Clinical features and presentation of acute pericarditis
|
Constant, sharp, severe. Worse with breathing and lying down.
|
|
|
Clinical features and presentation of pneumonia
|
Sharp pleuritic pain. Fever, cough, consolidation
|
|
|
Clinical features and presentation of mitral valve prolapse
|
Often at rest, atypical presentation for MI
|
|
|
Clinical features and presentation of chest wall pain syndrome
|
Highly localized, sharp, positional chest pain
|
|
|
Clinical features and presentation of gastroesophageal disorders
|
Burning, gnawing, lower half of the chest. Acidic taste
|
|
|
Clinical features and presentation of panic disorder
|
Randy
|
|
|
Factors that do not suggest acute MI
|
Pleuritic, positional, sharp, reproducable, not with exertion
|
|
|
Factors that suggest acute MI
|
"Pressure", arm radiation, associated with exertion, N/V, diaphoresis
|
|
|
Cardiovascular disease risk factors
|
Sex, age, smoking, obesity, HTN, family Hx
|
|
|
What is considered silent acute MI?
|
No CP.
|
|
|
Most likely patient to present with silent MI
|
Old woman with a history of unstable angina
|
|
|
Bradycardia with ACS
|
Could be from inferior wall MI. If with anterior wall MI its bad
|
|
|
Hypo/HTN with ACS
|
BP extremes are bad in ACS
|
|
|
S3 sound with ACS
|
May imply a failing myocardium
|
|
|
S4 sound with ACS
|
Very common with HF patients
|
|
|
New systolic murmur with ACS
|
Flail leaflet of mitral valve, VSD, papillary muscle problem. Ominous sign.
|
|
|
Rales with ACS
|
Suggest L sided CHF
|
|
|
JVD with ACS
|
Suggest R sided CHF
|
|
|
STEMI vs non-STEMI diagnostic approach
|
STEMI on EKG=cath, serum markers for Dx of NSTEMI
|
|
|
Why ECG is number 1?
|
Fast and can Dx STEMI
|
|
|
Usefulness of AMI serum markers in STEMI and NSTEMI
|
STEMI on EKG doesn't need serum markers for dispo. NSTEMI needs serum markers for Dx.
|
|
|
Cardiac troponin - sensitivity
|
39% single 90-100% serial
|
|
|
Troponin - specificity
|
83-96%
|
|
|
Troponin - elevation patterns
|
Appearance 2-12 hours, peak in 12 hours, last for 7-10 days
|
|
|
CK-MB - sensitivity
|
Elevates later than troponin or myoglobin
|
|
|
CK-MB - specificity
|
Very specific timing of MI and extent of damage
|
|
|
CK-MB - elevation pattern
|
Appearance 4-8 hours, peak 12-24 hours, last 3-4 days
|
|
|
Myoglobin - sensitivity
|
More sensitive than CK but not as specific
|
|
|
Myoglobin - specificity
|
Can elevate with any muscle damage
|
|
|
Myoglobin - elevation patterns
|
Can elevate before troponin, peaks ~3 hours, latest to return to normal
|
|
|
General strategies for AMI
|
Individualized based on indings. Generally, persistant Sx STEMI gets cath or fibrinolytic
|
|
|
Percutaneous coronary intervention - indications
|
>90 min for STEMI, >48 hours for NSTEMI
|
|
|
Percutaneous coronary intervention - contraindicatioins
|
None listed
|
|
|
Percutaneous coronary intervention - limitations
|
Need cath lab
|
|
|
Percutaneous coronary intervention - major side effects
|
Restenosis, dissection, thrombus, hemmorrhage
|
|
|
Fibrinolytics - indications
|
STEMI < 12hrs
|
|
|
Fibrinolytics - contraindications
|
No Hx of recent bleeding, no HTN
|
|
|
Fibrinolytics - risk vs benefit
|
Benefits outweigh risks but 0.5-1% of pts have major ICH
|
|
|
Fibrinolytics - limitations
|
40-50% of the time it is not completely successful
|
|
|
Fibrinolytics - major side effects
|
Hypotension, immune response, bleeding
|
|
|
Antiplatelet agents - indications
|
Suspected MI
|
|
|
Antiplatelet agents - contraindications
|
Allergy
|
|
|
Antiplatelet agents - risk vs benefit
|
Benefit greatly outweighs risk
|
|
|
Antiplatelet agents - major side effects
|
GI upset, bleeding
|
|
|
Antithrombins - indications
|
AMI
|
|
|
Antithrombins - limitations
|
UFH can be unpredictable
|
|
|
Antithrombins - major side effects
|
Bleeding
|
|
|
Nitrates - indications
|
IV nitrates < 24-48hrs
|
|
|
Nitrates - contraindications
|
ED drugs, hypotensive pts
|
|
|
Nitrates - major side effects
|
Hypotension, immune response, bleeding
|
|
|
Beta blockers - indications
|
AMI, study showed no benefit in fast BB therapy
|
|
|
Beta blockers - contraindications
|
Hypotension
|
|
|
Beta blockers - major side effects
|
Hypotension
|
|
|
ACE inhibitors - indications
|
>24hrs
|
|
|
ACE inhibitors - contraindications
|
Hypotension, renal failure, renal stenosis
|
|
|
Magnesium - indications
|
Torsades, hypomagnesia
|
|
|
CCBs - indications
|
Ischemia with afib/RVR and no CHF, left failure, or AV block. Also if BB's are contraindicated
|
|
|
CCBs - contraindications
|
Contraindicated in most AMI
|
|
|
CCBs - risk vs benefit
|
Do not reduce mortality, increases mortality in certain pts
|
|
|
CCBs - major side effects
|
IR nifedipine can cause more ischemia
|
|
|
IV nitrate titration
|
Titrate to BP
|
|
|
Why be cautious with nitrates on inferior MI
|
1/3 have R side MI also
|
|
|
BB's effect on heart during AMI
|
Antiarryhthmic, antiischemic, antihypertensive
|
|
|
Current guidelines for BB use in AMI
|
>24 hours if no HF, low output, long PR
|
|
|
Post AMI sinus bradycardia - frequency
|
35-40%
|
|
|
Post AMI sinus brady - prognosis
|
Brady during MI does not increase mortality
|
|
|
Post AMI A-fib - frequency
|
4-10%
|
|
|
Post AMI A-fib - prognosis
|
Often transient
|
|
|
Post AMI AV block - frequency
|
1st degree 4-15%, 2nd degree-I 4-10%, 2nd degree-II 0.5-1%, 3rd degree 5-8%
|
|
|
Post AMI AV block - prognosis
|
15-30% mortality if progresses to complete block
|
|
|
Post AMI PACs - frequency
|
50%
|
|
|
Post AMI PACs - prognosis
|
No mortality change
|
|
|
Post AMI PVCs - frequency
|
99%
|
|
|
Post AMI PVCs - prognosis
|
No apparent predictive value
|
|
|
Post AMI V-tach - frequency
|
Sustained 2-6%, nonsustained 60-69%
|
|
|
Post AMI V-tach - prognosis
|
~50% mortality
|
|
|
Post AMI accelerated idioventricular rhythm - frequency
|
50-70%
|
|
|
Post AMI accelerated idioventricular rhythm - prognosis
|
Not even worth treating, does not affect prognosis
|
|
|
AMI vs CHF
|
15-20% get HF
|
|
|
Presentation of pericarditis post AMI
|
CP that may resemble MI, 2-4 days post MI
|
|
|
Frequency of pericarditis post AMI
|
10-20%
|
|
|
Cocaine induced chest pain and true AMI
|
6% have true MI
|
|
|
Preferred biomarkers for cocaine induced chest pain
|
Troponin
|
|
|
Treatment options for cocaine induced ACS
|
Standard MI treatment plus benzos
|
|
|
Contraindications for medical treatment of cocaine induced ACS
|
Beta blockers
|
|
|
Surgical treatment options for cocaine induced ACS
|
Same as regular MI
|
|
|
Ectopic focus vs reentry mechanisms in tachyarrhythmias
|
Ectopics generally have longer warm up and cool down on EKG
|
|
|
Mechanisms of bradyarrhythmias
|
Depression of SA activity or conduction block
|
|
|
Criteria for treatment of bradyarrhythmias
|
<50 bpm and signs of hypoperfusion
|
|
|
Treatment of bradyarrhythmias
|
Transcutanceous pacing, atropine, epi
|
|
|
SVT - causes
|
AV node reentry, WPW
|
|
|
SVT - treatment
|
Vagal manuever, adenosine, BBs, CCBs, electical cardioversion
|
|
|
Sinus arrhythmias - causes
|
Usually normal, changes due to respiration
|
|
|
Sinus arrhythmias - treatments
|
None
|
|
|
Sinus tach - cause
|
Physiologic (emotion, exertion), pharmacologic (drugs), pathologic (PE, hypovolemia, fever)
|
|
|
Sinus tach - treatment
|
No specific treatment. Treat underlying condition.
|
|
|
Sinus brady - causes
|
Physiologic (athletes, sleep, vagal stimulation), pharmacologic, pathologic (inferior MI, increased ICP)
|
|
|
Sinus brady - treatment
|
Usually does not require treatment. Pacing for unstable patient.
|
|
|
PAC - causes
|
Ectopic pacemakers
|
|
|
PAC - treatment
|
Usually no treatment required.
|
|
|
PVC - causes
|
AMI, digoxin, CHF, hypokalemia, hypoxia, normal variant
|
|
|
PVC - treatment
|
Lidocaine if needed
|
|
|
A-fib - causes
|
Rhuematoid heart disease, HTN, ischemia, thyrotoxicosis
|
|
|
A-fib - treatment
|
CCBs, BBs, digoxin, amiodarone, ablation
|
|
|
A-flutter - causes
|
Ischemia, PE, CHF, digoxin
|
|
|
A-flutter - treatment
|
CCBs, BBs, digoxin, amiodarone, ablation
|
|
|
1st degree AV block - causes
|
Increased vagal tone, digoxin, inferior MI, myocarditis
|
|
|
1st degree AV block - treatment
|
Usually none
|
|
|
2nd degree type 1 block - cause
|
MI, digoxin, myocarditis, prior heart surgery
|
|
|
2nd degree type 1 - treatment
|
Atropine as needed, pacing
|
|
|
2nd degree type 2 - cause
|
Infranodal pathway disruption
|
|
|
2nd degree type 2 - treatment
|
Atropine, pacing
|
|
|
3rd degree block - cause
|
Usually due to MI
|
|
|
3rd degree block - treatment
|
Pacing
|
|
|
Sick sinus syndrome - clinical significance
|
Variable rate, symptoms based on rate. Chemical or environmental factors may exacerbate.
|
|
|
Sick sinus syndrome - diagnosis
|
Ambulatory ECG or EP studies. Routine ECG will not demonstrate intemittent arrhythmias.
|
|
|
Sick sinus syndrome - permanent pacemaker use
|
Pacer should be implanted prior to any drug treatment
|
|
|
A-fib - predisposing factors
|
Increased atrial size, increased vagal tone
|
|
|
A-fib - relationship to heart failure
|
May produce heart failure
|
|
|
A-fib - emboli
|
Higher risk of emboli
|
|
|
A-fib - treatment of unstable patient
|
Syncronized cardioversion
|
|
|
A-fib - treatment of stable patient
|
Rate control, CCBs, BBs, digoxin, amiodarone
|
|
|
PSVT - criteria for conversion
|
Depressed cardiac output regardless of BP
|
|
|
PSVT - methods of converting
|
Adenosine, cardioversion
|
|
|
V-tach - causes
|
Ischemic heart disease, AMI
|
|
|
V-tach - treatment of unstable patient
|
Syncronized cardioversion
|
|
|
V-tach - treatment of stable patient
|
Amiodarone, procainamide
|
|
|
V-fib - causes
|
Ischemic heart disease, AMI, digoxin, hypothermia, electrocution, trauma
|
|
|
V-fib - significance
|
Duh!!!!!!!!!!!!
|
|
|
V-fib - treatment
|
CPR and Light 'em up! Amiodarone or lidocaine, epi, vasopressin
|
|
|
WPW - ECG appearance
|
Delta wave
|
|
|
WPW - mechanism
|
Bundle of Kent, reentry
|
|
|
WPW - complications
|
A-fib/flutter with rapid ventricular response
|
|
|
WPW - treatment
|
Cardioversion if unstable. Treat based on width of QRS complex.
|
|
|
Risk factors for DVT
|
Immobilization, cancer, coagulopathies, trauma, birth control & smoking
|
|
|
Virchow's triad
|
Stasis, tissue damage, hypercoagulable states
|
|
|
Presentation of DVT
|
Pain, swelling, cramping, varicosities, ulcers, warmth
|
|
|
Most common location of DVT
|
Calf
|
|
|
How DVT diagnosed by duplex
|
Compares flattening of vein to artery, if vein does not compress the test is positive.
|
|
|
DVT duplex sensitivity
|
90-95%
|
|
|
Usefulness of D-dimer in DVT
|
94-98% sensitive, 50-60% specific
|
|
|
Primary objective for DVT treatment
|
Prevent PE, salvage the limb
|
|
|
Proven treatment for proximal DVT
|
Anticoagulation
|
|
|
Admission criteria for DVT
|
Coexisting PE, compromised circulation, inability to use heparin
|
|
|
Outpatient management of DVT
|
Start LMW heparin and warfarin simultaneously
|
|
|
Indications for inferior vena cava filter in DVT
|
Contraindication for anticoagulation, stubbornly persistant DVT, emboli occurs after several weeks of therapy
|
|
|
Presentation of superficial thrombophlebitis
|
Red, swollen, tender, indurated vessel
|
|
|
Treatment of superficial vein thrombophlebitis
|
Oral NSAIDs, topical diclofenac
|
|
|
Complications of hypertensive emergency
|
Damage to brain, heart, kindey, aorta, eyes
|
|
|
Presentation of hypertensive encephalopathy
|
AMS, HA, seizures, vomiting, visual disturbances, fundoscopic changes
|
|
|
Treatment of hypertensive encephalopathy
|
Decrease mean arterial pressure (MAP) 15-20%
|
|
|
Indications for nitropursside
|
Aortic dissection, acute hypertensive pulmonary edema
|
|
|
Indications for labetolol
|
Aortic dissection, hypertensive renal failure, pre/eclampsia, hypertensive enchephalopathy, stroke, post op HTN
|
|
|
Risk factors for AAA
|
Age >50, HTN, atherosclerosis, smoking, male, family history
|
|
|
Predisposing factors for thoracic aortic aneurysm dissection
|
Bicuspid aortic valve, Marfan's, Ehlers-Danlos syndrome, family history
|
|
|
Common presentation of dissecting AAA
|
Abrupt, severe, "ripping", "tearing", may radiate to back
|
|
|
Physical exam findings for dissecting AAA
|
Pulsitile mass, aortic insufficiency murmur, unequal pusles, hyper/hypotension
|
|
|
Imaging findings for dissecting AAA
|
Mass, widening mediastinum, abnormal aortic contour.
|
|
|
Best imaging modality for aortic emergencies
|
CT is best. US if patient unstable
|
|
|
Most common cause of acute arterial occlusion in the limb
|
Mural thrombi
|
|
|
Most common location of arterial occlusion
|
Subclavian, popliteal, femoral, aortoiliac
|
|
|
Origin of the occlusion
|
Mural thrombi
|
|
|
P's of acute limb occlusion
|
Pain, pallor, parasthesia, paralysis, pulselessness, polar (cold)
|
|
|
Bedside exams to diagnose acute limb ischemia
|
Cap refill, doppler, AB index
|
|
|
Treatment options for acute limb ischemia
|
Heparin, ASA, analgesia, dependent position, protect from envirnment
|
|
|
Clinical features of chronic peripheral arterial insufficiency
|
Intermittent claudication, pain at rest, pain aggravated by leg elevation
|
|
|
Diff diagnosis in chronic peripheral arterial insufficiency
|
Nerve compression, spinal stenosis, arthritis, chronic compartment syndrome
|
|
|
Secondary sequelae (soliloquy) for victims of chest wall trauma
|
Pneumonia, persistent air leak, iatrogenic complications
|
|
|
Presentation of tension pneumo
|
Hypoperfusion, dyspnea
|
|
|
Physical exam findings with tension pneumo
|
Decreased breath sounds, tracheal deviation, distended neck veins
|
|
|
Treatment of tension pneumo
|
Needle decompression if time is needed then thoracostomy
|
|
|
Presentation of massive hemothorax
|
Hypoperfusion, dyspnea, no chest movement
|
|
|
Physical exam findings with massive hemothorax
|
Decreased breath sounds, dullness to percussion
|
|
|
Diagnosis of massive hemothorax
|
CXR or US
|
|
|
Treatment of massive hemothorax
|
Thoracostomy
|
|
|
Presentation of open pneumo
|
May be pretty obvious
|
|
|
Physical exam findings with open pneumo
|
Decreased breath sounds, dyspnea, decreased movement
|
|
|
Diagnosis of open pneumo
|
CXR, US if not obvious
|
|
|
Treatment of open pneumo
|
3 sided dressing
|
|
|
Presentation of flail chest
|
Paradoxical chest movement
|
|
|
Physical exam findings with flail chest
|
Decreased breath sounds usually
|
|
|
Complications of flail chest
|
Increased respiratory fatigue leading to arrest
|
|
|
Diagnosis of flail chest
|
CXR
|
|
|
Treatment of flail chest
|
Sick or old pts need intubation
|
|
|
Presentation of pulmonary contusion
|
CP, hypoxia, coarse or decreased breath sounds
|
|
|
Most common cause of pulmonary contusion
|
High speed MVC
|
|
|
Presentation of hemothorax
|
Hypoxia, dyspnea
|
|
|
Diagnosis of hemothorax
|
CT is best. Upright or decub CXR better than supine
|
|
|
Treatment of hemothorax
|
Thoracostomy
|
|
|
Best xray view for apical pneumothorax
|
thoracostomy
|
|
|
Sucking chest wound - ED treatment
|
3 sided dressing
|
|
|
Sucking chest wound - long term treatment
|
Chest tube
|
|
|
Why fractures to 1st and 2nd ribs are bad
|
Associated with injuries to sensitive stuff in the thorax
|
|
|
Cardiac box definition
|
Sternal notch to xiphoid. Nipple to nipple
|
|
|
Cardiac box significance
|
The heart lives in the box
|
|
|
Cardiac tamponade - causes
|
Blunt or penetrating injury
|
|
|
Cardiac tamponade - presentation
|
Sinus tach, narrow pulse pressure
|
|
|
Commortio cordis
|
Sudden cardiac arrest from blunt chest impact
|
|
|
Most commonly injured vessel in blunt trauma
|
Aorta
|
|
|
VTE
|
Venous thromboembolism
|
|
|
Presentation of PE
|
Sudden onset dyspnea, pleuritic CP
|
|
|
Well's Score for PE
|
>6 high risk, 2-6 moderate risk, <2 low risk
|
|
|
Labs/imaging for PE
|
D-dimer, CT
|
|
|
Most common causes of dyspnea
|
Asthma, COPD, cardiac, pneumonia
|
|
|
Most life threatening causes of dyspnea
|
PE, FB, pneumo, airway blockage
|
|
|
Presentation of pleural effusion
|
Dullness, decreased breath sounds. May be asymptomatic
|
|
|
Diagnosis of pleural effusion
|
CXR, CT, US
|
|
|
Treatment of pleural effusion
|
Thoracentesis
|
|
|
Relevance of CURB-65/CRB-65
|
Stratifies mortality risk but some places use as admit guidelines
|
|
|
Other factors to consider with pnuemonia
|
Immunocompromised? EtOH? Compliance issues?
|
|
|
Mortality risk for elderly pneumonia patients
|
40%
|
|
|
Non respiratory symptoms for elderly pneumonia patients
|
Falls, weakness, AMS, GI symptoms
|
|
|
Poor prognostic indicators for elderly pneumonia patients
|
Hypo/hyperthermia, immunosuppressed, staph or g-neg infection
|
|
|
Spontaneous pneumo - risk factors
|
Tall skinny immunosuppressed smokers with COPD, CF
|
|
|
Spontaneous pneumo - clinical features
|
Hypoxia, dyspnea, pleuritic CP
|
|
|
Spontaneous pneumo - imaging findings
|
Loss of lung markings
|
|
|
Spontaneous pneumo - diagnosis
|
CXR, CT, US
|
|
|
Spontaneous pneumo - treatment
|
Needle decompression if time is needed then thoracostomy
|
|
|
Significance of accessory muscle use in acute asthma exacerbation
|
Diaphramatic fatigue
|
|
|
Significance of paradoxical respirations in acute asthma exacerbation
|
Impending respiratory failure
|
|
|
Significance of altered mental status in acute asthma exacerbation
|
Impending respiratory failure
|
|
|
Significance of "silent chest" in acute asthma exacerbations
|
Really bad airflow obstruction
|
|
|
Treatment for severe asthma exacerbation
|
B-adrenergic agonist, anticholinergics, steroids
|
