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57 Cards in this Set

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Identify the numbers in this schematic.
Drawing shows the major blood vessels in the area of the salivary glands and superior neck. 1 = retromandibular vein, 2 = external carotid artery, 3 = facial artery and vein, 4 = lingual artery and vein, 5 = external carotid artery, 6 = internal jugular vein, 7 = external jugular vein.
Where is the internal jugular vein in relation to the external jugular vein?
The internal jugular vein is anterior to the external ...
Is the cervical os open or closed in a threatened abortion?
CLOSED!
Concerning imaging, how is an AAA (Abdominal Aortic Aneurism or a descending aortic aneurism) best Dx?
NON-contrast CT (b/c blood is bright and ∴ doesn't need contrast)
List 5 indications for NON-CONTRAST CT of the head!
Head Trauma (R/O bleed)

Trauma on warfarin (R/O bleed ... I guess warfarin and IV contrast - gastrogaffin - don't mix)

Altered level of consciousness (R/Obleed)

? TIA

? stroke
Head and/or spine trauma should get what imaging modality in the ER?
Non contrast head and/or spine CT
Multi-system trauma should get what imaging modality in the ER?
CT with Contrast (IV vs PO)?
Right ventricular infarcts are a/w _____ _____ ______?
Inferior wall infarcts.

http://www.madsci.com/manu/indexekg.htm
If the BP drops heavily & suddenly during an MI ... ________________.
then it's probably a right ventricular infarct.
Before Rxing the NSAID Toradol (i.e., ketorolac) for pain, what must you always do for your pts?
CHECK THE CREATININE!

And don't give high dose NSAIDs to elderly pts b/c their kidney's can't take it (i.e., they willl fail). Also don't give Toradol longer than 3 to 5 days.
What must be done/protocol for any GI bleed?
Start 2 large bore IVs, type & screen, LFTs, Amylase, Lipase

(coags?)
What is the best method to place an IJ line?
Have Pt turn head to opposite side (remember thoracic duct is on the Right???) and puff cheeks (i.e., equivalent of valsalva).
What do I want to know concerning CHF exacerbation?
I want to know what tipped them off toward having a CHF exacerbation (i.e, ischemia, infection, hypoglycemia in the case of a diabetic???)
What is the best website for location of infarction?
http://images.google.com/imgres?imgurl=http://www.madsci.com/manu/ekg_pics/heart3d.gif&imgrefurl=http://www.madsci.com/manu/ekg_mi.htm&usg=__UcS6lA6eDGVMwlSNHyyvVuxzzZo=&h=262&w=238&sz=11&hl=en&start=2&um=1&itbs=1&tbnid=WKW98XBU295P3M:&tbnh=112&tbnw=102&prev=/images%3Fq%3Dinferior%2Bwall%2Bof%2Bthe%2Bheart%26hl%3Den%26sa%3DN%26um%3D1
How does 1 assess a pt's airway?
Is the Pt talking clearly? If so, they are passing air through their trachea. If they are UNCONSCIOUS then the airway might be in danger and they NEED to be INTUBATED!!!
How does 1 assess a pt's breathing?
Breathing is assessed with a stethascope when breathsounds are heard. It's also assessed through observation if the pt's chest-wall is expanding and retracting normally. But use of accessory muscles might be a harbinger of impending doom???
How does 1 assess a pt's circulation?
Must be able to feel pulses!
The BP will be an indicator of circulation.
How do you bring the scaphoid bone to the surface of the snuffbox when assessing for injury?
Have the patient ADDUCT his/her wrist (think about pt in the anatomical position).
How do you stop the bleeding from a finger?
Just compress the medial and lateral sides (b/c the arteries run together with the nerves in these locations) of the finger.
What is the toxic level of acetaminophen?
Toxic level = greater than 10 grams. But you can't even assess the pt until 4 hrs have passed.
How do you Tx acetaminophen overdose earlier on?
Give a charcoal lavage within a certain level ... You cant give N-acetyl cysteine until a certain time period has transpired.
What is the most sensitive method of eliciting hand weakness?
Have the patient spread fingers as I try to compress them back to adduction.
Where should I go in for an LP?
Find the Superior Iliac crests and then find L4 and GO DIRECTLY inferior to it. ANGLE YOUR NEEDLE TOWARD THE UMBILICUS.
1)measure
2)clean & prep
3)stick pt
4)collect 4 tubes
What are the four tubes for in an LP?
1)
2)
3)
4)
When performing an LP with suspicion of meningitis, what are we looking for?
Only looking for blood in the CSF (i.e., xanthochromia) not pressure.
What should we think about in a Pt with recurrent abscesses?
DM or other immunocomprimised state (i.e., HIV)
IV drug use will give a pt what type of hepatitis?
Hep C (so will sniffing cocaine via bill some1 else has used).
Kephlex (cephalexin) = ?
Anti staph Abx (a 1st generation cephalosporin =
1st generation (cefazolin, cephalexin)––gram-positive 1st generation––PEcK.
cocci, Proteus mirabilis, E. coli, Klebsiella
pneumoniae).
How long after an open fracture can we give Abx?
For open fractures, there is a 1 hour window to give Abx!
Osteomyelitis can cause _____
sepsis?????
What are the numbers that are important to remember concerning a Gaussian distribution (i.e, bel curve) with regard to STANDARD DEVIATION
32, 13.5, 2.5, etc... = 1SD, 2SD, 3SD, etc...

1 SD from the mean = +/- 32 (i.e., 64% of participants fall within 1SD of the mean)

2 SDs from the mean = +/- 32 +/- 13.5 (i.e., 45.5 + 45.5 = 91% of participants fall w/in 2 SDs of the mean)

3 SDs etc....
"lo siento"
Spanish:

"I'm sorry" (but literally translates into "I feel it")
What are the lateral EKG leads?
V5, V6, I & AVL

AV-L (L is for Lateral)
Recurrent abscesses in a Pt should deem what management/ Dx test?
Since recurrent abscesses may mean the Pt has DM, then a FINGER STICK is necessary for that Pt.

So always get a finger stick in Pts w/ recurrent abscesses.
For Pts who come to the ER w/ Dental problems (potential abscesses) always include _____ in your Hx?
Any TRISMUS (Trismus: Inability to open the mouth fully. This may be due to spasm of the jaw muscles and be a symptom of tetanus (lockjaw). Or it may be due to abnormally short jaw muscles, as in the trismus-pseudocamptodactyly syndrome.)
What is one method of checking for Abscesses in the mouth (PE finding)?
Tapping on the teeth will elicit pain if Pt has abscess located in the _____?_____ region.
What is needed in Pt who present to the ER w/ dental problems that suggest abscess or other pathology?
Pt's need a FACIAL BONE CT to r/o osteomyelitis. (If +, they need an OMS - orofaciallo-maxllio-surgery - consult)
For Mx or Tx of dysphagia via a food bolus (i.e, irritative esophagitis via Dr. Josephson) what would you give?
Tx w/ Glucagon (relaxes the smooth muscle of the esophagus).
What should you Tx Staph abscesses with?
Bactrin (TMP-SMX) or Unasyn (Ampicillin & Sulbactam).
Concerning PO contrast for CT, what is the Pt drinking?
Pt is drinking Gastrograffin in sterile H2O bottle. Usually to see if the bottle is perforated.
What is the relative strength of the various opioid analgesics?
strong, stronger, srongest =

1) Tylenol 3 (Tylenol with codeine)

2) Vicodin (acetaminophen & hydrocodone)

3) Percocet (oxycodone & acetominophen)
What is 1 Tx for migraine headaches?
Compazine = Prochlorperazine is a phenothiazine drug. Most drugs in this category are used as anti-psychotics (neuroleptics).[1] Neuroleptic means "nerve seizing," and describes the semi-paralyzing effect these drugs have on the brain and nervous system. Stemetil is no longer being manufactured for sale in Canada as an anti-psychotic, but it is still available for treatment of nausea, etc.
It is now relatively seldom used for the treatment of psychosis and the manic phase of bipolar disorder. It has a prominent antiemetic/antivertiginoic activity and is most often used for the (short-time) treatment of nausea and vomiting and vertigo as follows:


To alleviate the symptoms of Vertigo[2]
As an antiemetic, particularly for nausea and vomiting caused by chemotherapy, radiation therapy and in the pre- and postoperative setting[3]
In the UK, prochlorperazine maleate is available as Buccastem M in buccal form as an over-the-counter treatment for migraine.[4] In this indication it blocks the chemoreceptor trigger zone (CTZ) in the brain, which is responsible for causing severe nausea and vomiting. Its OTC use is strictly restricted to a maximum of 2 days, because of the potentially severe side effects of prochlorperazine, which mandate supervision by a health care provider.
In the UK prochlorperazine maleate has been prescribed to alleviate the symptoms of labyrinthitis, which include not only nausea and vertigo, but spatial and temporal 'jerking' and distortion[5]

TREATMENT
 Identify and eliminate triggers; this is half the battle.
 Treat according to severity:
 Mild: NSAIDs plus an antiemetic such as metoclopramide.
 Moderate: Abortive (triptans as soon as headache begins).
 Severe: IV hydration, metoclopramide, dexamethasone, prochlorperazine,
or ergotamine.
 Preventive therapy: TCAs, β-blockers, valproate.
For chest pain of suspected musculoskeletal origin, 1 should try to _________ & _________?
RECREATE THE PAIN VIA PALPATION (if the pain is recreated via palpation then it's probably of musculoskeletal origin) & always check for CREPTIUS especially if truama is involved.
Concerning trauma/laceration to the pinna of the ear, if the cartilage is damaged what must 1 do?
1 must consult OMS if the cartilage is impinged upon. Otherwise it can be sutured in the ER.
What are some older "typical" antipsychotics and what are their 4 major receptors they block?
chlorpromazine, droperidol, fluphenazine, haloperidol, thioridazine,

D2 blockade, muscarinic blockade, α blockade & histamine blockade

Extrapyramidal system (EPS) side effects, endocrine (often irreversible) side effects (e.g., dopamine receptor antagonism → hyperprolactinemia → gynecomastia), and side
effects arising from blocking muscarinic receptors (dry
mouth, constipation), α (hypotension), and
histamine (sedation) receptors.
What is the most feared side effect of giving older "typical" antipsychotics?
Neuroleptic malignant syndrome: Fever,
muscle rigidity, autonomic instability,
clouded consciousness (i.e., mental status Δ.
Why do you even Rx older "typical" antipsychotics?
Psychotic disorders and ACUTE AGITATION.
What are the 5 side effects of older typical antipsychotics (i.e., neuroleptics)?
1) Extrapyramidal symptoms (EPS).
2) Hyperprolactinemia.
3) Anticholinergic effects: Dry mouth, urinary
retention, constipation.
4) Seizures.
5) Neuroleptic malignant syndrome: FEVER, MUSCLE RIGIDITY, autonomic instability (i.e., Heart rate, GI, myopia/mydriasis, diaphoreses, etc), clouded consciousness = Mental status Δ.
What are Extra Pyramidal Symptoms?
EPS is an evolution of Sx consistent with a TIME SCALE, which occurs when neuroleptics/typical antipsychotics are administered:

4 HOURS = acute dystonia
4 DAYS = akinesia
4 WEEKS = akathisia
4 MONTHS = tardive dyskinesia
For deep lacerations and tying off bleeding vessels with FIGURE OF EIGHT suturing techniques,what type of sutures should be used?
VICRYL/absorbable sutures.
For avulsions, what type of guauze should be applied?
Xeroform no-stick guaze (or guaze with vaseline applied so it wont stick to the wound).
"5 & 2" is referring to what?
The doses of Haldol (i.e., haloperidol) IM & Ativan (i.e., lorazepam) IM, respectively, given to Mx acute agitation +/- psychosis.
What is the dosing regimen for Atropine?
For ACLS/ asystole/ PEA
1mg IV/IO q3-5 min prn
Max = 3 mg total so 1 can give 3 doses only!
What is the MOST COMMON inciting drug causing NMS?
Haloperidol is the most common inciting agent.
What drugs put Pts @ risk for NMS?
Patients taking neuroleptics
simultaneously with lithium, TCAs, MAOIs, or antiparkinsonian drugs (i.e., BALSA) are at
greatest risk.
How does 1 Tx NMS?
DIAZEPAM (VALIUM), in large doses if necessary, is the first-line drug treatment for neuroleptic malignant syndrome (NMS). If this fails, paralytic drugs (etomidate??/succinocholine???/etc.) are indicated. Other drugs that may be used in the treatment of NMS include
DANTROLENE (blocks Ca release from the sarcoplastic reticulum), bromocriptine, carbidopa/levodopa, or amantadine. Presenting symptoms for NMS include hyperthermia, muscular rigidity, altered level of consciousness, and autonomic instability.

Treat NMS with discontinuation of agent, cooling, benzodiazepines, and dantrolene. Consider carbidopa/levodopa to increase dopamine activity.
What does coffe-brown emesis denote?
Coffee-ground emesis is vomiting of dark brown, granular material that resembles coffee grounds. It results from upper GI bleeding that has slowed or stopped, with conversion of red Hb to brown hematin by gastric acid.