Emergency Medicine

Front 1

Back 1

Epiglottis
Vocal cords
Trachea
Cartilage

Front 2

ACLS: to establish an aw:

-flex or extend neck?

Back 2

Extend neck (head tilt)

Flexing to chest will close aw

Front 3

ACLS: trauma pt without aw:

-perform head tilt/chin lift?

Back 3

No - may have C-spine injury

*Perform jaw thrust instead

Front 4

ACLS: trauma pt w/out aw:

-perform jaw thrust?

Back 4

Yes

Avoid head tilt/chin lift since may have C-spine injury

Front 5

ABCs: what is next step to establish aw:

-difficult time with ventilation using position and BVM alone

Back 5

Aw adjunct (oro or naso aw)

Front 6

Oropharyngeal airway: where should flange end up (in relation to patient)?

Back 6

Flange at lips

Front 7

Facial trauma/significant head injury: which better to establish aw?

Oropharyngeal or nasopharyngeal adjunct?

Back 7

Oro

Avoid naso if head trauma

Front 8

Intubate pt if GCS what value?

Back 8

<8 --> intubate

Front 9

RSI: pre-oxygenation:

-preO2 for how long? what %O2?
-buys you how much time before desat?

Back 9

100% O2 x 5 minutes

Buys you 8 MINUTES before you see desat <90%

Front 10

RSI:

-pre-treat all pts?
-what drug if head injury?
-what drug if peds pt?

Back 10

Pre-treatment falling out of favor

Head injury: lidocaine or fentanly
Peds: atropine

Front 11

RSI: induction or paralytic?

Etomidate

Back 11

Induction

Front 12

RSI: induction or paralytic?

Propofol

Back 12

Induction

Front 13

RSI: induction or paralytic?

Versed

Back 13

Induction

Front 14

RSI: purpose of induction agent?

Back 14

To sedate pt --> prepare for paralysis

Front 15

RSI: induction or paralytic?

Succinylcholine

Back 15

Paralytic

Front 16

RSI: what INDUCTION agent is fast on/off?

Back 16

Succinylcholine

Front 17

Succinylcholine:

-slow or fast on?
-slow or fast off?

Back 17

Fast on & off

Front 18

RSI: non/depolarizing?

Succinylcholine

Back 18

Depolarizing

Front 19

RSI: non/depolarizing?

Vecuronium

Back 19

Non-depol

Front 20

RSI: non/depolarizing?

Rocuronium

Back 20

Non-depol

Front 21

Induction agents: which has higher risk of S/E hyperkalemia?:

Succinylcholine or Rocuronium

Back 21

Succinylcholine (depolarizing)

Front 22

Induction agents: which is longer acting?

Succinylcholine or Rocuronium

Back 22

Roc

Front 23

RSI: which better position?

Sniffing (head tilt/chin lift) or jaw thrust?

Back 23

Sniffing (oropharynx & trachea in line)

-however cannot do in trauma, obesity, kyphosis

Front 24

Mac blade: tip in what anatomical location?

Back 24

Velecula --> indirectly lift up epiglottis

Front 25

Miller blade: tip in what anatomical location?

Back 25

Epiglottis --> lift directly (contrast Mac blade)

Front 26

What intubation blade:

-directly lift epiglottis
-lift velecula

Back 26

Direct: Miller

Indirect: Mac

Front 27

Intubation blade:

Which type preffered in peds?

Back 27

Miller (straight)

Front 28

RSI: sweep tongue to L or R?

Back 28

PATIENTS LEFT

Front 29

Endotracheal tube sizing:

-DIAMTER in adult F
- adult M
- peds

Back 29

adult F: 7.5-8.0mm
adult M: 8.0-8.5mm in adult men
Peds - Winters formula (age/4) + 4

Front 30

WINTERS FORMULA

-used when?
-what is it?

Back 30

To determine DIAMETER of endotrach tube in peds

Length (mm) = (age/4) + 4

Front 31

RSI: where should tube be located in relation to carina?

Back 31

2 cm above carina

Front 32

RSI: how estimate LENGTH of ETT?

-common length F?
-M?
-Peds?

Back 32

Mouth corner to sternal notch

F: 21 cm long, 7.5-8mm wide
M: 23 cm long, 8-8.5 mm wide
Peds:
wide: (age/4) + 4
Length: 3 x width

Front 33

Chest pain: BIG 5 (fatal causes of CP)

Back 33

1. Esophageal rupture
2. Ao dissection
3. Tension PTX
4. PE
5. MI

Front 34

Acute coronary synds:

What % pts with ACS presenting to ED will end up surviving to discharge?

Back 34

6%

Front 35

What % MIs are silent?

Back 35

30%

Front 36

MI: are cardiac risk factors (e.g. smokers) good predictors of MI?

Back 36

NO - NOT IN ED

*presence of chest pain outweighs all other risk factors in terms of predicting MI

Front 37

ACS: is physical exam helpful to distinguish "cardiac" vs "noncardiac" etiology of chest pain?

Back 37

NO

(unless obvious other dx, e.g. PTX)

Front 38

MI: what % pts have S3?

Back 38

20%
(i.e. few)

Front 39

MI: what % pts have "chest wall tenderness"?

Back 39

15%

(i.e. cannot say 'chest wall tenderness = chostochondr)

Front 40

MI: single best test to determine MI

Back 40

EKG

Front 41

MI & EKG:

-what % MI pts have ST elev?
-what % have initial normal EKG?
-what % unstable angina has normal EKG?

Back 41

ST elevation: only 50%

Initial normal: 5%

Unstable angina with normal EKG: 5-20%

Front 42

National guideline: it pt p/w possible ACS --> must obtain EKG w/in how many minutes?

Back 42

10 minutes

Front 43

ACS:

Is Troponin a standard of care?

Back 43

Yes

Front 44

Troponin:

What % sensitivity to detect MI? (initial troponin)

Back 44

Detects 40% MIs

(i.e. serial enzymes much better)

Front 45

Troponin:

Normal in unstable angina?

Back 45

Yes - normal in most unstable angina

Front 46

CK-MB:

-detect what % MI at presentation?
-what % have 5-6h MI?

Back 46

50% at present --> 90% after 5-6h

Front 47

What cardiac marker:

peaks at 12h (fastest marker)

Back 47

Troponin T

Front 48

Troponin T:

Peaks how many hrs s/p MI?

Back 48

12h

(fastest)

Front 49

CK-MB:

Peaks how many hrs s/p MI?

Back 49

18-24h

(slowest; Trop T peaks at 12h)

Front 50

Which elevated longer s/p MI:

Trop T or CK-MB
(what is duration elevated each)

Back 50

Trop T: 5-14d

CK-MB: 2d

Front 51

MI: which decreases mortality the most?

ASA or streptokinase

Back 51

SAME - 23%

Front 52

CP r/o MI:

What dose ASA?

Back 52

325 mg

Front 53

MI: ASA works via what mxn?

Back 53

Inh thromboxane A2 --> no plt agg

Front 54

What drug:

Inh thromboxane A2 --> no plt agg

Back 54

ASA

Front 55

Nitrates: decrease pre- or afterload?

Back 55

BOTH

Front 56

MI: are nitrates safe if pt has underlying....

-CHF
-HTN

Back 56

YES - EXCELLENT FOR BOTH

Front 57

Nitrates: do not use if MI in what area of heart?

Back 57

RV

Front 58

Unstable angina: give what drugs?

Back 58

ASA 325

PLUS HEPARIN (or enox)

Front 59

What drug:

Binds AT-III --> inactivates thrombin

Back 59

Hep

Front 60

Heparin: mxn of action

Back 60

Binds AT-III --> inactivates thrombin

Front 61

AMI: what drugs?

Back 61

ASA 325
Hep
BETA-BLOCKER

Front 62

Cocaine-induced CP:

Tx with what drugs?

Back 62

ASA
Nitrate
Benzo (tx HTN, tachy)
+/- heparin
+/- CEB

AVOID B-blockers

Front 63

Cocaine-induced CP: avoid what drug class when treating

Back 63

Beta-blockers

(CEBs are safe)

Front 64

Aortic dissection: disset what BV layer?

Back 64

Tear intima --> blood enters media

Front 65

Aortic dissection:

#1 location (anatomical)

Back 65

Ligamentum arteroisum (ASC ao)

Front 66

What dz:

Stanford Classification

Back 66

Aortic dissection

(A asc +/- desc; B desc only)

Front 67

Aortic dissection:

-What system to classify?
-What does A vs. B indicate? which more common?

Back 67

Stanford Classific.

A: 80%; ascending (+/- desc)
B: desc only

Front 68

Pregnant + CP: what is fatal etio?

Back 68

Aortic dissection

(preg --> increased risk dissect)

Front 69

Aortic dissection:

Increased risk in what connective tissue disease(s)?

Back 69

Marfan
AND
Ehler-danos

Front 70

Aortic dissection: does SURGERY improves outcomes in:

-type A
-type B

Back 70

A: decrease mortality from 75% --> 20%

B: no change (30%)

Front 71

What disease:

Tearing/ripping acute pain b/w scapulae

Back 71

Ao dissect

Front 72

Aortic dissection:

See DULL/PRESSURE-like pain?

Back 72

POSSIBLE

(not always ripping/tearing)

Front 73

Aortic dissection:

n/v, diaphoresis common?

Back 73

YES

(resembles MI)

Front 74

Aortic dissection:

-common/rare to see normal lung & cardiac exam
-what % have murmur (Ao insuff)
-what % have unequal/absent pulses?

Back 74

Common to have normal exam

20% have murmur

Only 50% have changes in pulses

Front 75

Aortic dissection:

What % have some abn on CXR?

Back 75

85%

Front 76

Aortic dissection:

If suspect dissect --> order EKG?

Back 76

Yes

IVs --> EKG

Front 77

Aortic dissection:

Tx - lower BP? (goal BP?)

Back 77

Yes -- decrease pressure on intima

Goal SBP: 100-110

Front 78

Aortic dissection:

Initial meds?

Back 78

NIPRIDE + ESMOLOL

Front 79

#1 non-surgical peripartum maternal death

Back 79

PE

Front 80

PE: due to DVT in what %?

Back 80

80-90%

UE in 10%

Front 81

#1 risk factor PE

Back 81

previous DVT or PE

Front 82

PE: what % pts have no identifialbe risk?

Back 82

10-15%

Front 83

PE: #1 sign OR symptom

Back 83

RR > 16 (90%)

(dyspnea 85%, pleuritic CP 75%)

Front 84

PE: what % have ST or T wave abns?

#1 EKG finding?

Back 84

only 40%

#1: sinus tachy

Front 85

PE:

-CLASSIC EKG finding?
-what % pts have this finding?

Back 85

S1Q3T3

6% pts

Front 86

PE:

Normal A-a gradient = (formula)

Back 86

Normal = 10 + 0.1(age)

Front 87

PE:

What % pts have normal A-a gradient?

Back 87

>20%

Front 88

PE: CXR shows atelectasis in what % pts?

Back 88

50%

Front 89

What is:

-Hampton's Hump
-Westermark's sign

Back 89

Hump: wedge-shaped infiltrate (PE)

Westermark: prox-dilated pulm art w/abrupt cutoff (PE)

BOTH RARE

Front 90

PE: name for:

-wedge-shaped infiltrate
-proximally dilated pulm art

Back 90

Wedge = Hampton's Hump

Dilated art = Westermark sign

Front 91

PE: if suspect:

-order imaging study OR anticoag 1st?
-What meds & dose to anticoag?

Back 91

if high pre-test --> ANTICOAG FIRST!

low pretest --> image 1st


Heparin 80 U/kg i.v. bolus; 18 U/kg/hr i.v. drip

Front 92

Spont PTX-

-what % occur w/exertion?

Back 92

only 10% with exertion

Front 93

Spont PTX:

-what % pts have pleuritic CP?
- % have >24 rr?
-hyperressonance?

Back 93

WOOOOAH!!!

pleuritic CP: 95%

Tachypnea: ONLY 5%

Hyperresonance: <1/3

Front 94

Spont PTX: observe for how long s/p decompression/CT?

Back 94

6h

Front 95

Ao dissection: can you use labetalol to lower the bp?

Back 95

YES

(or nipride + esmolol)
(NOT nipride alone)

Front 96

Dyspnea: what fraction pts have cardiac or pulm etio?

Back 96

2/3

Front 97

Hyperpnea: definition

Back 97

hyperventilation, minute ventilation in excess of metabolic demand; deep, rapid or labored respirations

Front 98

#1 chronic dz of childhood

Back 98

asthma

(not DM)

Front 99

Asthma: is BRONCHOSPASM the mxn of asthma or only a symptom?

Back 99

ONLY A SYMPTOM

(mxn is INFLAMMATION)

Front 100

Asthma: irreversible changes?

Back 100

If chronic & untx --> can see irrevers worsening

Front 101

Asthma: care about baseline peak flow from ED standpoint?

Back 101

Yes -- ask

Front 102

Asthma: risk factors for death:

->___ hosps in past year
-> ___ ED visits past year
-> ___ MD canisters in 1 mo

Back 102

2+ hosps

3+ ED visits

2+ MDI canisters

Also poor px: difficulty perceiving severity of aw obstrxn

Front 103

Asthma: do you hope to hear a silent chest (no wheezing)?

Back 103

NO --- REALLY BAD

Means not enough air moving to produce a wheeze

Front 104

Asthma: which is better estimate of severity of attack:

-Pt report OR peak flow measure?

Back 104

PEAK FLOW --- use these in ED!

Front 105

Asthma exacerb: order a CXR?

Back 105

Not unless suspect 2' comp (PTX, PNA)

Front 106

Asthma: order ABG?

Back 106

May be useful

-tachyp --> should see decreased PCO2
- if elevated PCO2 --> suspect fatigue

Front 107

Asthma: general classes of ED tx

Back 107

1. B-agonists
2. Steroids
3. Anticholinergics
4. Severe: magnesium, mech vent

Front 108

B2-agonists: dlilate LARGE or SMALL aws?

Back 108

SMALL

(contrast anticholinergics)

Front 109

Albuterol: which better

-Nebulized or MDI?
-what dose & freq each?

Back 109

SAME

Neb: 5 mg q 20 minutes
MDI: 6-12 puffs q 20 minutes

Front 110

B2-agonists: what S/E?

Back 110

Tachy
HTN
HA
Tremor

Front 111

Anticholinergics: dilate LARGE or SMALL aws?

Back 111

Large central aws

(contrast B2-agonists: small)

Front 112

What drug class:

Competitively antagonize ACh at neurogang jxn

Back 112

Anticholinergics

Front 113

Anticholinergics: mxn of action

Back 113

Comp inh ACh at NMJ

Front 114

Asthma: how deliver anticholinergics?

Back 114

MDI or neb

Front 115

Asthma: anticholinergics have what S/E?

Back 115

Dry mouth
Thirst
Irritability

Front 116

Asthma: deliver steroids w/in how long after presenting to ED --> decrease admit rates

Back 116

Deliver w/in <1h

Front 117

Asthma: steroids:

-better to deliver IV or PO?
-dose in adult?
-child?

Back 117

IV & PO equally effective (clinical picture)

Adult: 125 mg methylpred IV or 60 mg pred po

Child: 1 mg/kg methylpred IV or 1mg/kg pred po

5d (NO TAPER REQ)

Front 118

Asthma: what dose Mg?

Back 118

1-3g IV

Front 119

Asthma: benefit to POSITIVE PRESSURE aw?

Back 119

Yes - CPAP & BiPAP shown to improve outcomes

Front 120

Asthma:

-if decide ETT --> what is best induction agent?

Back 120

Ketamine -- bronchodil & resp stimulant

Front 121

Asthma: if ETT --> allow hypoventilation?

Back 121

YES - if maintains sat >90%

Front 122

Asthma: when admit?

Back 122

1. No improve s/sx
2. Peak flow <50%

Front 123

Asthma: give steroids to which pts presenting to ED?

Back 123

ALL PATIENTS

(no req taper if 5d; yes if 10-14d)

Front 124

PNA:

Suspect what pathogen if HEMATOGENOUS spread (rather than inhaled)?

Back 124

Staph aureus

Front 125

PNA:

ID pathogen in what % pts?

Back 125

50%

Front 126

PNA:

#1 pathogen

Back 126

Strep pneumo

Front 127

PNA:

3 atypicals

Back 127

Mycoplasma
CHlam
Legionella

Front 128

PNA:

Is CP related to resp?

Back 128

YES - pleuritic CP

Front 129

ATYPICAL PNA:

-fever?
-productive cough?

Back 129

LOW fever; non-productive cough

(contrast typical)

Front 130

Indicates what process (physically what's going on):


-Inspiratory rales
-Bronchial breath sounds
- Rhonchi

Back 130

Rales: = alveolar fluid

Bronchial breath sounds= consolidation

Rhonchi= Bronchial congestion

Front 131

Pneumococcal PNA: what 2 pt pops?

Back 131

1. Extreme ages
2. Chronic ill (e.g. HIV)

Front 132

What SPECIFIC dz:


Sudden onset of rigors, bloody sputum, high fevers, chest pain

Back 132

PNEUMOCOCCAL pneumonia

Front 133

Pneumococcal PNA: pleural effusion in what %?

Back 133

25%

Front 134

What PNA pathogen presents with ELEVATED LFTs?

Back 134

Pneumococcal PNA

Front 135

Pneumococcal PNA: see resistant strains?

Back 135

Increasing

Front 136

Staph aureus PNA: acute or insidious?

Back 136

INSIDIOUS/GRADUAL

(contrast pneumococcal: acute onset)

Front 137

Staph aureus PNA: see focal OR multiple infiltrates?

Back 137

MULTIPLE

(remember - hematogenous spread)

Front 138

What type of PNA (pathogen):

-EtOHics

Back 138

Klebs

Front 139

Klebsiella PNA: gradual or acute f/c & cp?

Back 139

ACUTE

(sim pneumococcus)
(contrast staph - gradual)

Front 140

Pseudomonas PNA: mild or severe?

Back 140

SEVERE - confusion, syst illness

Front 141

PNA: suspect what pathogen

Bilater lower lobe infiltrates

Back 141

PSEUDOMONAS

Front 142

Pseudomonas PNA: risks?

Back 142

hospitalized, recent abx or steriods

Front 143

Haemophilus PNA:

-what pt pops?
- how does CXR appear?

Back 143

Elderly, lung disease, alcoholics

Pleural effusions, multilobar infiltrates

Front 144

PNA: what pathogen?

-transplant pts

Back 144

LEGIONELLA

Front 145

PNA: what pathogen?

common in SUMMER months

Back 145

Legionella

Front 146

PNA: what pathogen?

p/w GI sxs! (n/v/d, abd pain)

Back 146

Legonella

Front 147

Legionella PNA:

-what time of year?
-how appear CXR?

Back 147

Summer

PATCHY INFILTRATES

Front 148

PNA: what pathogen

-also p/w sore throat, mild fever, non-prod cough

Back 148

Chlamydia OR mycoplasma

(mycoplasma also see rash)

Front 149

PNA: what pathogen:

May p/w RASH

Back 149

Mycoplasma

Front 150

PNA: CXR confirms dx in what % pts?

Back 150

only 50%

Front 151

PNA: suspect what pathogen:

LOBAR INFILTRATES

Back 151

PNEUMOCOCCUS

Front 152

PNA: a/typical:

Hilar adenopathy

Back 152

Atypical

Front 153

PNA: what 3 pathogens more likely in ETOHICS?

Back 153

1. Klebs
2. Pneumococc
3. Haemophilus

Front 154

PNA: DM pts:

-what is increased risk of PNA?
-what 3 pathogens?

Back 154

3-4 increased risk (vs. non-DM)


Staph aureus, gram negatives, Mucor

Front 155

PNA & pregnancy:

-what birth comps?
-suspect what pathogen if resp distress in mom?
-what pathogen if AIDS mom?

Back 155

low bw & preterm

Resp distress --> think VZV

AIDs: PCP pneumonia in preg

Front 156

PNA in elderly: common to see normal/low WBC?

Back 156

yes

Front 157

PNA: #1 pathogen in HIV pt

Back 157

Pneumococcus (same as gen pop)

Front 158

PNA in HIV pt: suspect what type (bact vs. viral vs. fung) if:


CD4>800
CD4 250-500
CD4< 200

Back 158

CD4>800: Bacterial more common
CD4 250-500: TB, cryptococcus, histoplasma
CD4< 200: PCP, CMV

Front 159

PNA: 3 drugs for OUTPT tx

Back 159

Doxycycline
Macrolide (azythromycin)
Fluroquinolone (levofloxacin, moxifloxacin)

Front 160

PNA: what pathogen in CF pt? tx w/what drug?

Back 160

Pseudomonas


Cefepime or ciprofloxacin

Front 161

PNA: how tx INPATIENT? (3 options)

Back 161

3rd gen cephalo

pen w/lactamase inh + macrolide

Fluoroquino

Front 162

What % CAP does NOT req admit?

Back 162

75%

Front 163

What dz:

Barrel chest

Back 163

COPD

Front 164

What is the only cause of death in US that is INCREASING?

Back 164

COPD

Front 165

COPD:

-#1 risk

Back 165

Smoking

(developing world: cooking in confined space)

Front 166

What % smokers develops COPD?

Back 166

only 15%

Front 167

What dz:

Part of pathogenesis is Protease-Antiprotease Imbalance

Back 167

COPD

Front 168

What dz:

Tripod

Back 168

COPD

Front 169

What dz: CXR shows:


Hyperinflation
Flattened diaphragms
Increased AP diameter
Increased parenchymal lucency
Attenuation of vascular shadows

Back 169

COPD

Front 170

COPD: EKG shows deviation in what direction?

Back 170

RAD

Front 171

Suspect what dz: EKG with:

Wandering pacemaker, multifocal atrial tachy, low voltage

Back 171

COPD

Front 172

2 signs of hypercapnia

Back 172

1 altered MS
2. Hypopnea

(NOT tachyp, tachyc, htn)

Front 173

COPD:

-danger of suppl O2
-goal sat

Back 173

Supp O2 --> decrease hypoxia & resp drive (despite fact that you are retaining CO2) --> resp arrest

90-92%

Front 174

COPD: what initial drug therapy in ED?

Back 174

Alb-ATROVENT (antichoin) neb ---> THEN alb alone

(IMPORTANT)

Front 175

COPD flair: give abx? steriuds? PPV?

Back 175

YES - doxy --> small improve in outcome

STeroids --> improved outcomes & longer time to relapse

CPAP/BiPap --> decreased need for ETT (note: pt must be able to cooperate)

Front 176

CHF: after develop pulm edema --> what % pts survive past 1 year?

Back 176

<50%

Front 177

CHF:

-CXR changes may lag behind clin picture by how much time?

Back 177

6h

Front 178

CHF: what % pts have pulm congestion on CXR?

Back 178

only 60%

--> do NOT base tx on CXR alone

Front 179

CHF: initial drug tx --> then what drug?

can you give morphine?

Back 179

Nitroglycerin sublingual or IV drip --> nitroprusside drip (if BP still elevated)

Morphine good! venodilator --> decreases preload

Front 180

CHF: goal to in/decrease:

-preload
-after

Back 180

Decrease both

Front 181

BNP: release via what mxn? what # considered negative?

Back 181

STretch VENTRICLES

<100 is negative

Front 182

CHF: affect mortality?

-BiPAP
-CPAP

Back 182

BiPAP: decrease ETT; no change mortality

CPAP: higher rates MI

Front 183

What % abd pain is NONSPECIFIC?

Back 183

25%

Front 184

Abdominal pain: diagnostic accuracy of physicians?

Back 184

50%

Front 185

Abd pain: awhat % require surg?

Back 185

15-30%

Front 186

Abd pain: top 4 etios in elderly

Back 186

1. Acute cholecystitis (25%)
2. Malignant disease
3. Ileus
4. NSAP

Front 187

Abd pain: top 2 SURGICAL etiologies

Back 187

1. Acute appendicitis
2. SBO

(cholecystitis is LOW - 5%)

Front 188

Cholecystitis: what % have localized RUQ pain?

Back 188

40%

Front 189

Appendicitis: what % pts do NOT have anorexia?

Back 189

>10%

Front 190

Acute abd pain: what % have TYPICAL presentations?

Back 190

60-70%

(30% present in ATYPICAL way)

Front 191

What portions of duodenum are intra-abd but EXTRA-peritoneal?

Back 191

2-4

(only 1st is intra-peritoneal)

Front 192

Intra- or extra-peritoneal?:

Pancreas

Back 192

Extra

Front 193

Visceral or somatic pain?:

Autonomic sensory fibers

Back 193

Visceral

Front 194

Visceral or somatic pain?:

Bilateral innervation --> midline perception

Back 194

Visc

Front 195

Visceral or somatic pain?:

Vague, deep, poorly localized

Back 195

Visc

Front 196

Midline visc abd pain: what nerves supply?:

EPIGASTRIC pain

Back 196

celiac sympathetic plexus; some parasymps

Front 197

Midline visc abd pain: what nerves supply?:

Periumbilical

Back 197

Celiac symp plexus
Superior mesenteric ganglia

Front 198

Midline visc abd pain: what nerves supply?:

HYPOGASTRIC

Back 198

inferior mesenteric ganglia
Pelvic parasymps

Front 199

Visceral or somatic pain:

Unilat innvervation (periph nerves)

Back 199

Somatic (peritoneal)

Front 200

Visceral or somatic pain:

Sharp, localized

Back 200

Somatic (peritoneal)

Front 201

Visceral or somatic pain:

INVOL GUARD & REBOUND

Back 201

Somatic (peritoneal)

Front 202

Rectocecal appendix: pain in which quadrant?

Back 202

UPPER LEFT!

Front 203

SBO: acute or gradual onset?

Back 203

GRADUAL

Front 204

Abd pain: exam pt in RECLINED or FLAT position?

Back 204

FLAT!

Front 205

Eponynms: what is it & what does it indicate?:

Cullen's sign

Back 205

Blue umbilicus

Retroperitoneal hemorr (pancreatitis, AAA)

Front 206

Eponynms: what is it & what does it indicate?:

Kehr's sign

Back 206

Severe L shoulder pain

splenic rupture, ectopic preg rupture

Front 207

What eponynm:

Severe L shoulder pain due to splenic/ecoptic preg rupture

Back 207

Kehr's sign

Front 208

Eponynms: what is it & what does it indicate?:

Iliopsoas sign

Back 208

extend R hip --> abd pain

Append

Front 209

Eponynms: what is it & what does it indicate?:

Obturator sign

Back 209

Int rotate (flexed) R hip --> pain

Append

Front 210

Eponynms: what is it & what does it indicate?:

Palpate LLQ --> pain in RLQ

Back 210

Rovsing's sign

Append

Front 211

Peritoneal signs: common to see with:

- extra-abd disease?
- intra-abd, extraperitoneal disease (e.g. pancreatitis)?

Back 211

NO!

Almost always due to intra-abd, intra-peritoneal dsease

Exceptions: SBO, mesenteric isch

Front 212

Microscopic hematuria:

Defin: how many RBCs per hpf?

Back 212

3+ RBCs/hpf

(contrast pyuria: 5+ WBCs)

Front 213

Microscopic hematuria:

How SENSITIVE for acute ureteral calculus?

Back 213

>90%

Front 214

Pyuria:

Defin: how many WBCs per hpf?

Back 214

5+ WBCs/hpf

(contrast hematuria: 3+)

Front 215

Abdominal pain: what % plain films ordered will have abnormality? Change management in what % pts?

Back 215

Only 10% will have abn

Change managements in 10%

Front 216

Abdominal PLAIN film: 2 uses

Back 216

1. Free air
2. Obstruction

Front 217

Abdom PLAIN film: can see what VOLUME (how many ccs) of free air? which view (PA or lat) is more sensitive?

Back 217

1 cc detectable
Lat most sensitive

Front 218

Acute abdominal series: includes what views? (3)

Back 218

upright CXR
Supine abd
Upright abd

Front 219

Suspect what dz:

RUQ U/S negative, HIDA scan positive

Back 219

Acalculous cholecystitis

Front 220

AAA: what % rupture into retroperitneum?

Back 220

75%

Front 221

AAA: classic triad

Back 221

1. abd pain
2. pulsatile mass
3. hypoT

Front 222

What should be 1st thought:

Old man with back pain

Back 222

AAA

Front 223

AAA: #1 mis-dx

Back 223

Renal colic

Front 224

Mesenteric ischemia: what % pts have occlusion:

-SMA
-IMA
-no occlusion

Back 224

SMA: 50% (50% thrombosis, 50% embolus)

IMA: 25%

non-occlusive: 25%

Front 225

Mesenteric ischemia:

common to see abd findings before irrevers injury?

Back 225

NO -- may have irrevers injury before any findings

Front 226

What dz:

abd XR: thumbprinting, bowel wall thickening, gas in bowel wall

Back 226

Mesenteric ischemia

Front 227

Mesenteric isch: how affect WBC?

Back 227

Increase WBC

Front 228

Perform angiography?:

-AAA
-mesenteric ischm

Back 228

AAA: no- usu too unstable; do CT

Mes Isch: YES - dx & therapteutic

Front 229

Appendicitis:

What is lifetime risk (%)

Back 229

7%

Front 230

Appendicitis:

Perforation rate highest in young, adult, or elderly?

Back 230

ELDERLY have highest perf

Front 231

Appendicitis:

-overall mortality
-mortality in elderly

Back 231

<1% overall

5-15% in elderly

Front 232

#1 surg emerg in preg

Back 232

Appendicitis

Front 233

Appendicitis:

What % exlaps are negative?

Back 233

15-20%

Front 234

What dz:

Alvarado score

Back 234

Appendicitis

Front 235

Suspect what dz:

RLQ --> sudden improvement

Back 235

Perforated appendix

(feels good at first!!!)

Front 236

Ectopic preg: triad

Back 236

1. Abd pain
2. Amenn
3. Vag spotting

(70% pts)

Front 237

Ectopic preg: common to see preg on U/S?

Back 237

No

Front 238

Heterotopic pregnancy:

-overall risk
-risk if s/p in vitro drugs

Back 238

1:3,000

1:300

Front 239

IUP: see pregnacny at WHAT HCG level? how many weeks?

-transvaginal
-transabd

Back 239

TV: 5 weeks, 1,200-2,000

TA: 6 weeks, 6,000

Front 240

Acute surgical abdomen: common to see pain OR vomit first?

Back 240

pain --> vomit

(except in elderly - may not have pain)

Front 241

#1 surg emergency in kids >1yo

Back 241

Appendicitis

Front 242

Does a NORMAL acute abd series r/o perforation?

Back 242

NO

Front 243

U/S: linear or curved probe:

higher freq

Back 243

Linear

Front 244

U/S: linear or curved probe:

Shallow penetration

Back 244

Linear

(higher freq --> shallow pen)

Front 245

U/S: linear or curved probe:

DVT

Back 245

Linear

(high freq --> shallow pen)

Front 246

U/S: linear or curved probe:

SubQ abscess

Back 246

Linear

(high freq- shallow pen)

Front 247

U/S: linear or curved probe:

Occular

Back 247

Linear

(high freq --> shallow pen)

Front 248

U/S: linear or curved probe:

Low freq

Back 248

Cuved

Front 249

U/S: linear or curved probe:

Chest, abd & pelvic scans

Back 249

Curved

Front 250

U/S: linear or curved probe:

higher resolution

Back 250

Linear

(high freq)

Front 251

What is dx?

Back 251

Pericarditis

Front 252

Which higher incidence:

Upper of lower GIB

Back 252

UPPER

Front 253

GI bleed: more common in:

-M or F?
-adult or elderly?

Back 253

M, elderly

Front 254

Upper GI bleed: anatomical definition

Back 254

Prox to ligament Treitz

Front 255

#1 etio upper GIB

Back 255

PEPTIC ULCER DZ

Front 256

Gastric ulcers:

-#1 location
-which type most likely to rebleed

Back 256

Duodenal #1

Gastric most likely to rebleed

Front 257

What dz:

Bright red hematemesis s/p repeated retching/cough/sz

Back 257

MW syndrome

Front 258

#1 etio Lower GIB

Back 258

*upper GIB mistaken as lower!

Front 259

Intestinal AVMs: most common location

Back 259

R colon

Front 260

Prox or distal lesion:

Hematochezia

Back 260

Distal (colorectal)

Front 261

GI bleed: what is initial fluid resuscit?

Back 261

2L NS --> then consider transfusion (if not improved)

Front 262

Significant GI bleed:

-lavage all pts?
-does negative lavage r/o upper source?

Back 262

ALL pts

negative does NOT r/o upper source (intermittent, pyloric spasm, etc)

Front 263

GI bleed tx: what is last ditch med?

Back 263

Vasopressin (vasocon) + IV nitro (prevents MI)

Front 264

GI bleed: does pt req stable hct to be discharged?

Back 264

YES - hct >30%

Front 265

Volvulus: small bowel twists around which artery?

Back 265

SMA --> compromise midgut

Front 266

Volvulus in neonate: assoc with which 2 CONGENITAL anomalies?

Back 266

1. Ladd's bands
2. Duodenal atresia (50% will have malrotation at some point)

Front 267

Volvulus:

ED tx?

Back 267

Gastric tube decompression --> broad abx & surg C/S

Front 268

Volvulus:

What imaging?

Back 268

Upright GI series (rarely helpful) --> barium enema if equivocal

Front 269

Volvulus:

In OR: if unclear viability of bowel --> next step?

Back 269

Close --> return in 24 hrs

Front 270

What dz:

Neonate abd film: DOUBLE BUBBLE

Back 270

Volvulus (dxistic)

Front 271

Suspect what dz in neonate:

Abd film: loops of bowel overlie liver shadow

Back 271

Volvulus

Front 272

Malrotation: is barium enema useful?

Back 272

NO - false positives & negs

Perform upper series w/fluoro

Front 273

Malrotation:

Best imaging

Back 273

Upper GI series w/fluoro

Front 274

What dz:

GI series: Ligament of Trietz on R side; corkscrew or obstructed duodenum

Back 274

Volvulus

Front 275

Volvulus: what % infants have vomit? Is it always bilious?

Back 275

90%

May not be bilious

Front 276

What dz:

GI films: pneumatosis intestinalis; dilated & thick loops;

Back 276

Necrotizing enterocolitis

Front 277

#1 surg or medical emergency in neonates

Back 277

NECROTIZING ENTEROCOLITIS

Front 278

NEC: only occur in preemies?

Back 278

No (although 85% cases are in premies)

Front 279

NEC: occur how many weeks after birth in

-premature
-term

Back 279

TERM EARLIER THAN PREMAT

Term : w/in 1 w

Premie: up to 3w

Front 280

NEC: incidence affected by breastmilk?

Back 280

Lower in breastfed

Front 281

NEC: mortality? what % develops comps? 2 common comps?

Back 281

20-40% mortality

50% comps; 1. short gut 2. intestinal stricturs

Front 282

Intussception:

Plain films useful?

Back 282

YES - dilated loops, pneumoperitoneum (2/2 perf); target sign

Front 283

What dz:

Abd plain film: TARGET sign (what is it?)

Back 283

= 2 concentric rings superimposed on R kidney

= INTUSSCEPTION w/peritoneal fat stranding

Front 284

What dz:

U/S: BULLS-EYE

Back 284

Intussception

Front 285

Intussception:

U/S useful?

Back 285

Yes - can be 100% accurate

Front 286

Intuscception w/suspeted perf:

What would barium enema show?

Back 286

TRICK - do NOT perform barium if suspect perf; use H2O-contrast

Front 287

Intussception:


-more common after what type of illness?
-what vaccine?

Back 287

Increased risk if: recent URI, ROTA VACCINE, CF/Chron's/celiac dz

Front 288

Intussception:

What % have triad (pain, sausage, currant jelly)

Back 288

15%

Front 289

Intussception:

What is risk of perf 2/2 barium or air enema?

Back 289

<1%

Front 290

Suspect appendicitis: give morphine?

Back 290

YES - does not mask sxs

Front 291

Suspect appendicitis in CHILD:

-1st imaging in non-obese?
-obese?

Back 291

Non-obese: U/S --> CT if unequiv

Obse: CT

Front 292

Suspect what dz:

Neonates w/distension, vomit, abd wall cellulitis, palp mass

Back 292

Appendicitis!

Front 293

Appenditicits: risk of perforation in:

-<4yo
-adols & adults

Back 293

<4yo: 70%

adol & adult: 10-20%

Front 294

Fever in infant: definition (CELSIUS)

Back 294

rectal > 38

Front 295

Nuchal rigidity in what % 0-6mo with meningitis?

Back 295

Only 25%

Front 296

#1 etio SBI in 0-3mo w/rectal temp 38

Back 296

UTI

(>occult bacteremia, meningitis)

Front 297

Neonatal infxn: top 2 BACTERIAL pathogens

Back 297

GBS
Ecoli

(account for 80% bact infxns)

Front 298

Neonate w/fever: does HEIGHT of fever correl w/risk of serious bact illness?

Back 298

YES - higher fever --> higher risk

Front 299

Neonate w/fever: does response to Tylenol predict risk of SBI?

Back 299

YES

Non-SBI: 90% fevers resolve
SBI: only 50% resolve

Front 300

UTI in neonate: what % have bactermia? meningitis?

Back 300

3% bacteremia; 0.5% meningitis

Front 301

Neonate w/suspected meningitis: does normal CSF WBC r/o BACTERIAL mening?

Back 301

NO

Front 302

Suspect what dz: <4w neonate with fever plus:

CSF pleocytosis (>8 WBC) & negative G stain

Back 302

HSV meningitis

Front 303

How tx neonatal HSV meningitis? (drug & dose)

Back 303

ACV 20 mg/kg IV

Front 304

AOM in febrile infant: increased risk of serious bact illness?

Back 304

NO

i.e. AOM does NOT explain why they have SBI --> do w/u as if the infant did not have an AOM

Front 305

Infant w/fever & diarrhea: test stool for WBC & RBC?

Back 305

YES

Front 306

Ovarian torsion:

Does Color Doppler have low or high PPV?

Back 306

High

Front 307

What % kids with abd pain have ovarian torsion?

Back 307

3%

Front 308

Ovarian torsion: salvage ovary in what % pts if operate within:

-8h
-24f

Back 308

8h: salvage 40%

24h: 0%

Front 309

Definition of premature birth

Back 309

<37w

Front 310

Which is better predictor of pulm infxn:

O2 sat or rr

Back 310

O2 sat

Front 311

What % infants (0-6mo) with bact meningitis have nuchal signs?

Back 311

only 25%

Front 312

Strep pneumo:

Increase or decrease risk from neonate to 3mo

Back 312

at 3mo: higher risk than neonate

Front 313

#1 SBI in 0-3mo

Back 313

UTI

Front 314

SBI in 0-3mo: what 2 bact account for 80%?

Back 314

E coli
GBS

Front 315

0-3mo: does Strep pneumo have low or high mortality?

Back 315

HIGH (15%)

Front 316

0-3mo: does higher fever correlate with higher risk of SBI?

Back 316

yes

Front 317

0-3mo: if tactile fever at home but no fever in ED --> req further w/u?

Back 317

NO

However if rectal fever at home but afebrile ED --> still need w/u

Front 318

0-3mo fever: what % respond to acetaminophen if:

-non-SBI
-SBI

Back 318

non-SBI: >90%

SBI: only 50%

Front 319

1mo with fever:

How collect urine?

Back 319

CATH (not bag)

Front 320

0-3mo with UTI:

-what % also have bactermia?
-what % also have meningitis?

Back 320

Bact: 3%

Mening: 0.3%

POINT: just because they have UTI --> doesn't mean they don't have another SBI

(i.e. don't stop the w/u)

Front 321

0-3mo w/fever: if normal WBC in CSF --> r/o meningitis?

Back 321

No

Front 322

Suspect what dz:

0-3mo with fever & CSF pleocytosis (≥8 WBC/hpf) with negative gram stain

Back 322

HSV meningitis

Front 323

0-3mo with fever: is HSV meningitis assoc with:

-PROM
-fetal electrodes

Back 323

Yes-- both increase risk HSV

Front 324

0-3mo with fever:

How dx HSV menignitis?

Back 324

1. CSF PCR
2. Culture oro/urine/lesion/CSF
3. PCR lesion

Front 325

0-3mo with fever: how tx HSV meningitis? (drug & dose)

Back 325

Acyclovir 20 mg/kg/dose IV

Front 326

0-3mo with CXR evidence of PNA: req admission?

Back 326

YES

Front 327

Infant with viral illness (e.g. bronchiolitis):

-high risk of concurrent SBI?
-if SBI is present --> what is #1 source?

Back 327

If viral illness --> very low risk of SBI

Usually UTI

Front 328

>1mo old with known viral illness & fever:

-what labs do you need to order?

Back 328

can limit labs to UA & Ucx

Front 329

If 0-3mo with fever:

-if detect AOM --> need to continue w/u?

Back 329

YES! AOM does not account for fever

Front 330

0-3mo with diarrhea: culture for what pathogen?

Back 330

Salmonella
(Can lead to meninigitis)

Front 331

<1mo with fever: if negative w/u --> req admission?

Back 331

YES --> until afebrile

(contrast 1-2mo: can d/c home with abx & with PCP f/u in 1d)

Front 332

<1mo with fever: admin what abx?

Back 332

Amp & gent

Front 333

<1mo: safe to give ceftriax?

Back 333

NO --> unconjugated hyperbilirubinemia

Front 334

1-2mo & fever: admin what abx:

-UTI
-CSF pleo

Back 334

UTI: amp & gent

mening: CTX (safe >1mo) & amp

Front 335

Febrile infant --> require LP?:

-0-1mo
-1-2mo
-2-3mo

Back 335

0-2mo: YES; always admit <1mo (even if CSF neg), consider d/c home 1-2mo if CSF neg

2-3mo: if no perform LP --> f/u PCP in 1d

Front 336

Definition of fever in:

0-3mo

3mo-3yo

Back 336

0-3mo: >38

3mo-3yo: >39

Front 337

3mo-3yo with oral lesions: suspect what dz:


-Anterior ulcers
-Pharyngeal vesicles

Back 337

Anterior ulcers → herpes gingivostomatitis

Pharyngeal vesicles → coxsackie virus

Front 338

Admin H flu vaccine (Hib) at what ages?

Back 338

2mo
4mo
6mo
1yr

Front 339

Hib vaccine effective in what % pts?

Back 339

98%

Front 340

Prevnar:

-what pathogen?
-admin vaccine what ages?

Back 340

pneumo

2,4,6,12 mo (same as Hib)

Front 341

Prevnar: leads to what changes in:

-serotypes infecting kids?
-abx-resistance?

Back 341

Increasing rates of non-covered serotypes

PCN & cephalo resistance

Front 342

Which pneumo vaccine: covers serotype 19A?

Back 342

PCV-13

(increasing rate & resistance)

Front 343

3mo-3yo: suspect what dz if gram-POS rods in blood cx?

Back 343

CONTAMINANT

Front 344

Infant with fever: elevated CRP indicates bact or viral infection?

Back 344

EITHER

Front 345

Pedi UTI: what % E coli UTI resistance to amox?

Back 345

50%

Front 346

3mo-3yo with UTI: admin what abx?

Back 346

2-3rd gen cephalo: cefixime or cefurox

Front 347

Children >____ (age) with pyelonephritis can be treated out-pt

Back 347

2mos!!

Front 348

<3yo with UTI & vomiting: able to tx as outpt?

Back 348

NO -- if vomit --> need to admit

Front 349

3mo-3yo: how tx PNA?

Back 349

Amox + CTX

Front 350

What % US children have 1 episode of asthma?

Back 350

10%

Front 351

most sensitive indicator of lower airway obstruction in children

Back 351

tachypnea

Front 352

How classify (as % of PEF):

-mild asthma exac
-mod
-severe

Back 352

mild: >80%
mod: 50-80
severe: 30-50
life-threatening: <30%

Front 353

Severe asthma exacerb: admin via what route:

-epi
-steroid

Back 353

Epi: SQ or IM

Steroid: IV

Front 354

Asthma exacerb: goal O2 sat?

Back 354

>90%

Front 355

Asthma exacerb:

What is most effective drug to releive obstruct? time of onset?

Back 355

albuterol --> onset <5min

Front 356

Albuterol: mxn of action

Back 356

Selective B2-AGONIST

Front 357

Albuterol: S/E --- how affect:

-K+
-glucose

Back 357

HypoK

Hyperglyc

Front 358

Atrovent: generic name

Back 358

Ipratropium

Front 359

Atrovent in pediatric pts:

-improve outcomes?
-increase S/E?

Back 359

Improved outcomes without increased in SE

Front 360

Atrovent: mxn of action

Back 360

weak bronchodilator by blocking acetylcholine-mediated bronchoconstriction

Front 361

Atrovent:

-how long until onset?
-better in mod or severe asthma exacerb?
-use for how long during hosp?

Back 361

use in severe

takes 60-90min to effect --> give early

only useful in 1st hr of tx

Front 362

Which more effective:

nebulizer or MDI with spacer?

Back 362

SAME

Front 363

asthma exacerb:

when initiate CONTINUOUS albuterol neb?

Back 363

IF no improvement after 3 doses of alb in 1hr

Front 364

Steroids in asthma exacerb: more effective IM/po or IV?

Back 364

SAME!!!

GIVE STEROIDS ORALLY (Same bioavail as inhaled)

Front 365

Asthma exacerb:

what is prednisone dose?

Back 365

2mg/kg

Front 366

Asthma exacerb: what is dose of epi?

Back 366

0.01 cc/kg/dose of 1:1000 Epi SQ or IM (max 0.3cc)
`

Front 367

Asthma exacerb: what is mxn of Mg sulfate?

Back 367

counteract calcium ions to prevent bronchial smooth muscle contraction

Front 368

Asthma exacerb: Mg sulfate:

-route of admin?
-improve outcomes?

Back 368

IV

improves outcomes

Front 369

Asthma exacerb:

Give terbutaline?

Back 369

Last resort

Front 370

Asthma exacerb:

If give terbutaline --> concerned about S/E?

Back 370

Yes --- cardiac monitor (EKG, troponin, CK)

(hypo/HTN, lyte abns)

Front 371

Asthma exacerb: proven to be useful?

-Heliox
-BiPAP

Back 371

YES

Front 372

Asthma exacerb: what agents used in RSI?

Back 372

Atropine (decrease secretions) --> ketamine (has bronchodil effects) --> roc

Front 373

Asthma exacerb: if intubate:

-allow hypercap?
-maximize PEEP?

Back 373

Permissive hypercap

try to minimize PEEP

Front 374

Definition of fever in:

0-3mo

3mo-3yr

Back 374

>38

>39

Front 375

The drug likely to be associated with the greatest toxicity in the treatment of severe asthma is:

Back 375

terbutaline

Front 376

A 2 yr old has severe asthma. She is anxious, crying, and not responding to albuterol by nebulizer. An appropriate next step would be to administer:

Back 376

EPI (sq or im)

(NOT continuous alb if not responding)

Front 377

Our 8 yr old patient has received 3 albuterol/atrovent nebs and prednisone. Exam demonstrates much better air movement, but she is still tachypneic with mild retractions. A treatment that may prevent PICU admission would be:

Back 377

Mg sulfate IV

Front 378

Trauma: #1 death in what age groups?

Back 378

0-40yo

Front 379

Trauma: which greater - permenant disability or mortality?

Back 379

Disability 3x > mortality

Front 380

Trauma: death occurs in how many PEAKS (Describe each)? What is GOLDEN HOUR? ATLS focuses on which peak?

Back 380

peak 1: instant (secs-mins)

peak 2 (GOLDEN HOUR; focus of ATLS): TBI, PTX, hemorrhage

peak 3: days-wks

Front 381

Trauma: 3 most imp assessors that influence survival

Back 381

1. ID injuries
2. Establish aw
3. Expedite disposition

Front 382

Trauma: when logroll pt (between which steps)?

Back 382

ABCDE --> LOG ROLL --> CXR/FAST

Front 383

Trauma: should you impose a tx/intervention if you are not 100% sure about dx?

Back 383

YES - apply tx

Front 384

Trauma: req detailed hx to being eval?

Back 384

No

Front 385

If pt is talking --> assume they have an airway?

Back 385

Yes

Front 386

Trauma: AIRWAY: what steps if not speaking & no chest rise?

Back 386

Sweep mouth --> 2 breaths with bag (look for chest rise) --> endotrach tube (combi --> THEN try cricothyrotomy)

Front 387

Trauma: BREATHING: what steps?

Back 387

Inspect: cyanosis, JVD (tension pneumothorax or cardiac tamponade), asymmetric movement of the chest (flail chest), accessory muscle use (tension pneumothorax) or open chest wounds (open pneumothroax).
Ausculate: listen for stridor (upper airway injury), lung breath sounds (pneumo or hemothorax)
Percuss: feel for hyper-resonance (pneumothorax) or dullness (hemothorax), subcutaneous emphysema (airway injury), paradoxical movements (flail chest) crepitence & point tendnerness(rib fractures) or bruising (pulmonary contusion).

***If ETT --> attach a ventilator now!

Front 388

Trauma: if sucking chest wound --> what intervention?

Back 388

Occlusive dressing

Front 389

If suspect tension PTX --> next step

Back 389

NEEDLE DECOMPRESSION (14-16g angiocath)

(NOT chest tube, CXR)

Front 390

Massive hemothorax: definition

Back 390

> 1500 mL blood loss initially
> 400 cc per hour for 2 hours

Front 391

Trauma: CIRCULATION:

1st step to stop bleeding

Back 391

direct pressure

(tourniquet is last resort)

Front 392

Trauma: CIRCULATION:

What steps to assess?

Back 392

1. Radial pulse (SBP 80) --> femoral/carotid (SBP 60)
2.

Front 393

Requires what SBP?:

1. Radial pulse
2. Femoral pulse
3. Carotid pulse

Back 393

Radial: >80

Femoral & carotid: >60

Front 394

Trauma: CIRCULATION:

Is normal HR reassuring?

Back 394

Not always -- many pts not mount tachycardic response (spinal shock, CEBS/Bbs)

Front 395

What CLASS (I-IV) of blood loss?:

750mL

Back 395

I

Front 396

What CLASS (I-IV) of blood loss?:

750-1,500 mL

Back 396

II

Front 397

What CLASS (I-IV) of blood loss?:

1,500 - 2,000 mL

Back 397

III

Front 398

What CLASS (I-IV) of blood loss?:

>2,000

Back 398

IV

Front 399

What CLASS (I-IV) of blood loss?:

15% blood loss

Back 399

I

Front 400

What CLASS (I-IV) of blood loss?:

15-30% loss

Back 400

II

Front 401

What CLASS (I-IV) of blood loss?:

30-40% loss

Back 401

III

Front 402

What CLASS (I-IV) of blood loss?:

>40%

Back 402

IV

Front 403

What CLASS (I-IV) of blood loss?:

100-120 pulse

Back 403

II

(15-30% loss)

Front 404

What CLASS (I-IV) of blood loss?:

p120-140

Back 404

III

(30-40%)

Front 405

What CLASS (I-IV) of blood loss?:

p >140

Back 405

IV

(>40%)

Front 406

Trauma: if TREATED pelvic fx --> what % survive?

Back 406

only 50%

Front 407

2 most common pelvic binders

Back 407

T pod

Sam sling

Front 408

Traumatic arrest (pulseless & apneic): how long continue CPR?

Back 408

15minutes

(universally fatal -- but good for family)

Front 409

Trauma: CIRCULATION:

Initiate NS at what dose?

Back 409

20 cc/kg

Front 410

Trauma: how assess DISABILITY (neuro)?

Back 410

1. AVPU : alert, verbal response, pain, unresponsive

2. GCS

3. WIGGLE TOES (not a full neuro exam in 1' survey)

Front 411

Uncal herniation: how appear pupils?

Back 411

BLOWN PUPILS

(lose parasymp to CN III)

Front 412

Trauma: indicates what underlying patho?:

Blown pupils

Back 412

Uncal herniation

Front 413

Standard trauma XRays (2)

Back 413

AP chest
AP pelvis

(NOT abdomen)

Front 414

FAST: how accurate (%)

Back 414

85-95%

Front 415

If FAST+ and unstable pt --> next step?

Back 415

Immed to OR (NOT CT)

Front 416

Trauma: remove impaled objects?

Back 416

NO

Front 417

Name for:

ecchymosis behind ear indicative of basilar skull fracture

Back 417

Battle sign

Front 418

Name for:

periorbital ecchymosis without edema indicative of basilar skull fracture

Back 418

Raccoon sign

Front 419

Trauma: motor/strength grading: what indicate:

-1 out of 5 strength
-2
-3
-4
-5

Back 419

0: Total paralysis
1: Palpable/visible contraction
2: FROM w/gravity eliminated
3: FROM against gravity
4: FROM, less than normal strength
5: Normal strength

Front 420

Where is aw obstruction:

-insp stridor
-exp stridor

Back 420

Inspiratory stridor (supraglottic)
Expiratory stridor (subglottic)

Front 421

Trauma: suspect what injury:

subcutaneous emphysema --> chest tube fails to inflate lung

(also -- how tx?)

Back 421

Tracheobronchial tree disruption
[
if 2nd CT tube fails --> OR

Front 422

Trauma: what injury:

Mild hypoxia --> worse hypoxia s/p fluid resuscitation

Back 422

Pulmonary contusion

Front 423

Pulmonary contusion:

-how dx?
-tx?

Back 423

*can see on CXR

Tx w/normovolemia (don't overload with fluid) --> often req ETT

Front 424

Trauma: what injury:

ECHO: hypokinetic heart

Back 424

blunt cardiac injury

Front 425

Trauma: what injury:

wide mediastinum

Back 425

Ao dissection

Front 426

Trauma: what injury:

Unequal leg lengths

Back 426

Pelvic fx

Front 427

Trauma: pelvis can hide how much blood? (L)

Back 427

5L

Front 428

Crush injury: common what 2 anatomic locations?

Back 428

Forearm
Tibia

Front 429

How much time for results?:

-fully x-matched blood
-type-specific & Rh-tested blood
-type O negative (fem) or pos (male)

Back 429

Fully crossmatched blood: 1 hour processing time
Type-specific blood: ABO and Rh only tested, 10 minute processing time.
Type O Negative (males may receive O Positive blood): is immediately available

Front 430

C-spine X-ray: lateral view detects what % fxs?

Back 430

80%

Front 431

C-spine: what XR view detects most fxs?

Back 431

Lateral

Front 432

Trauma: what imaging if suspect ureter injury?

Back 432

Retrograde-urethrogram if concern for urethral injury.

Front 433

DPL: how sensitive? great at what type of injury?

Back 433

98% sensitive for bleeding and is used to detect bowel injury (more sens than CT!)

Front 434

DPL: positive if:

-___ mL blood
- ____ RBC/hpf
-____ WBC/hpf

Back 434

10mL blood

100,000 RBC/hpf
500 WBC

Front 435

Suturing:

If ligate minor vessels --> NON/ABSORBABLE sutures

Back 435

absorbable

Front 436

Wound irrigation:

-low/high pressure?
-low/high volume?

Back 436

low pressure, high volume

Front 437

Wound cleaning:

use povidone iodine? hydrogen peroxide?

Back 437

Avoid both

Front 438

Suturing: if give ppx abx --> how long duration?

Back 438

3-5d

Front 439

Bites: what pathogen #1? what abx?:

-human bite
-animal bite

Back 439

Human: eikenella --> AUGMENTIN

Animal: pasteurella --> AUGMENTIN

Front 440

Bite: what ABX for full-thickness bite?

Back 440

Penicillin

Front 441

Wound: what pathogen? give which abx?

-fresh H2O contam
-puncture thru shoe

Back 441

H2O: AEROmonas --> cipro

Shoe: PSEUDOmonas --> cipro

Front 442

What abx:

open fx or tendon

Back 442

IV ancef+/-gent+/- pcn

Front 443

Tenatus: update if:

>__yrs clean wound
>__ yrs dirty wound

Back 443

Clean: >10y
Dirty: >5y

Front 444

When give tetanus IMMUNOGLOBULIN?

Back 444

If never recieved 3 dose series

Front 445

Non/absorbable?:

Vicryl

Back 445

ABSORB

(VVVVVery abosrb)

Front 446

Non/absorbable?:

Nylon

Back 446

NON-ABSORB

Front 447

Non/absorbable?:

Lower infection rate

Back 447

NON-absorbable!

Front 448

Non/absorbable?:

Use for deep sutures

Back 448

Absorb

Front 449

Non/absorbable?:

Use on mucus membranes

Back 449

Fast absorb (e.g. gut)

Front 450

Non/absorbable?:

Use on face

Back 450

Fast absorb (e.g. gut)

Front 451

What SIZE suture:

face

Back 451

6-0 face; 5-0 hand; 4-0 trunk/extremity; 3-0 high tension, thick skin

Front 452

What SIZE suture:

hand

Back 452

6-0 face; 5-0 hand; 4-0 trunk/extremity; 3-0 high tension, thick skin

Front 453

What SIZE suture:

trunk/extrem

Back 453

6-0 face; 5-0 hand; 4-0 trunk/extremity; 3-0 high tension, thick skin

Front 454

What SIZE suture:

high-tension/thick skin

Back 454

6-0 face; 5-0 hand; 4-0 trunk/extremity; 3-0 high tension, thick skin

Front 455

When remove sutures (days):

face

Back 455

3-5d

Front 456

When remove sutures (days):

scalp

Back 456

5-7d

Front 457

When remove sutures (days):

Extrem/torso

Back 457

7-10d

Front 458

When remove sutures (days):

Mobile (joint) or high-tension skin

Back 458

10-14d

Front 459

What type of KNOT?:

significant tension of skin

Back 459

Horizontal mattress or deep

Front 460

What type of KNOT?:

skin edges invert

Back 460

Vertical mattress

Front 461

Deep knot: disadvantage?

Back 461

Increased infxn

Front 462

Horizontal mattress: advantages?

Back 462

Good under high tension

Everts skin (vertical mattress also everts)

Front 463

What type of knot?:

far-far-near-near

Back 463

Vertical mattress

Front 464

ACLS:

if no breathing --> 1st step

Back 464

2 slow breath

Front 465

Normal value:

CVP

Back 465

3-8

Front 466

Normal value:

Pulm artery

Back 466

15-30 / 3-12

Front 467

Normal value:

A-a gradient

Back 467

5-15

Front 468

Normal value:

Ejection fraction

Back 468

60-75%

Front 469

Asystole: can be caused by which electrolyte abn(s)?

Back 469

Hypo OR hyperkalemia

Front 470

ACLS - asystole:

-what dose of epi? how often?
-give atropine?

Back 470

Epi 1mg IV push q3-5min

Atropine 1 mg IV push q3-5min to MAX 0.04 mg/kg total (*different dose & max total than brady)

Front 471

ACLS: what is MAX TOTAL DOSE of atropine you can give in:

-asystole
-bradycardia

Back 471

asystole: 0.04 mg/kg
(admin as 1 mg pushs q3-5m)

Brady: 0.5 mg IV push --> total 3 mg

Front 472

ACLS: brady w/serious s/sx:

-what dose epi?
-give dopamine?
-give atropine?
-transQ pace?

Back 472

Epi 2-10 MICROgrams/min
Dopamine 2-10 MICROgram/min
Atropine 0.5 mg IV push (max 3mg)

TransQ pace

Front 473

ACLS: use cardioversion if HR >____

Back 473

>150

(generally not used if <150)

Front 474

ACLS - shock: admin what drug if:

-SBP <70 & s/sx
-SBP 70-100 & s/sx
-SBP 70-100 w/out s/sx
-SBP >100:

Back 474

<70 w/sx: NORepi 0.5-30 ug/min

70-100 w/sx: dopamine 5-15 ug/kg/min IV

70-100 w/out sx: dobutamine 2-20 ug/kg/min

>100: nitroglycerin 10-20 ug/min IV --> nitroprusside

Front 475

ACLS: pulmonary edema --> admin what 3 drugs?

Back 475

1. Nitroglycerin subling
2. Furosemide 0.5-1.0 mg/kg IV
3. morphine IV 2-4mg

Front 476

ACLS: VF/PVT --> admin shocks at which doses?

Back 476

3 shocks: 200 --> 200-300 --> 360

Front 477

ACLS: AMI --> give 02 at what rate

Back 477

4L/min

Front 478

AMI: give what 4 interventions immed?

Back 478

MONA

1. morphine
2. O2 at 4L/min
3. Nitrogly SL or spray
4. ASA 325mg po

Front 479

Contraindications to fibrinolytics:

Surgery w/in how many mos?

Back 479

2mos

Front 480

Contraindications to fibrinolytics:

BP?

Back 480

>180/110

Front 481

Contraindications to fibrinolytics:

Pregnancy?

Back 481

YES -- contraI to fibrinolytics

Front 482

AMI: goal time ED --> fibrinolytic

Back 482

<30min

Front 483

ACLS - pulseless electrical activity:

-epi dose & freq
-atropine?

Back 483

Epi 1 mg IV push q3-5min

ATropine 1 mg IV q3-5 (max total 0.04mg/kg)

Front 484

ACLS tachycardia:

1st step if p >150 & unstable pt

Back 484

Immed cardioversion (3 jolts)

Front 485

ACLS tachycardia:

Use VAGAL maneuvers if NARROW or WIDE qrs?

Back 485

NARROW

Front 486

ACLS tachycardia:

What drug if narrow QRS & regular rhythm?

Back 486

Adenosine 6mg IV push over 1-3sec

(adeno - Decels heart; atropine accels)

Front 487

Wide QRS tachycardia: give what drug if:

-vent tachy OR uncertain rhythm
-SVT w/aberrance

Back 487

VT: amiodarone 150 mg IV over 10 min

SVT: adenosine 6 mg rapid IV push over 1-3 sec

Front 488

Torsades de pointes: give what drug?

Back 488

MAGNESIUM 1-2 g over 5-60 min --> then infusion

Front 489

ACLS VF/VT algorithm:

-epi dose & freq
-defib: dose (J) & time
-amiodarone?
-lidocaine?

Back 489

EPi 1 mg IV push q3min

Defib 360 J w/in 30-60s

Amiodarone 300 mg IV push

Lidocaine 1 mg/kg push q3min

PATTERN: CPR--> DRUG --> SHOCK

Front 490

Stroke: you can admin fibrinolytics w/in how much time?

Back 490

<3h

Front 491

Asthma exacerb: steroids req taper if:

-5d?
-10-14d?

Back 491

5d: no

10-14: yes

Front 492

Dilate SMALL or LARGE aws?:

-b-agonists
-anticholin

Back 492

Beta: small

anti-cholin: large

Front 493

How tx in ED:

-intussception
-volvulus

Back 493

Intussception: air enema

Volv: NGT & Abx --> OR