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209 Cards in this Set

  • Front
  • Back
What are some associated symptoms during chest pain that indicate a twofold higher risk of ischemia?
Dyspnea, Diaphoresis, Nausea, and Vomiting
pg 362

radiation to jaw, should, arm, hand also increases probability but absence does not exclude AMI
Which pt with stable angina is more more likely to experience pain at rest, sleep, or stress? (Men or Women)
Women
pg 362
Which drug is associated with AMI in young people, even without coronary artery dz?
Cocaine
pg 363
Chest wall tenderness with palpation is reported in ___ % of pts with confirmed MI.
15%
pg 363
What other life threatening conditions should be considered when working up chest pain? (6)
1) Aortic Dissection, 2)PE, 3)Hemo / Pneumothorax, 4) Pericardial Tamponade, 5) PNA, 6)Esophageal Rupture
pg 363
What are some chest wall pain syndromes (musculoskeletal) characterized by sharp, positional chest pain? (6)
1) Costochondritis, 2) Tietze Syndrome, 3) Texidor twinge (pericordial catch syndrome), 4) Esophageal Spasm, 5) PUD, 6) Panic Disorder
pg 364-65
Troponin levels are detectable as early as 2hrs in AMI, but not reliably elevated in all pts until __ - ___ hrs.
6-12hrs
pg 366
Troponin levels reach their peak by __hrs and remain elevated for __ to ___ days.
12hrs, 7 to 10 days
pg 366
2007 consensus guidelines state diagnosis of MI is troponin elevation with at least on of what additional criteria? (5)
1) ischemic symptoms (chest pain), 2) new ST and T-wave changes, 3) new Left Bundle Branch Block, 4) new Q-waves, 5) wall motion abnormality
pg 366
Creatine Kinase (CK) levels become elevated at __ to ___hrs after occlusion.
4 to 8 hrs
pg 366
CK levels peak btwn __ and ___ hrs, and return to normal at __ to __ days.
12 to 24hrs and 3 to 4 days
pg 366
Myoglobin levels are elevated in >80% of pts at __ to __ hrs.
6 to 8hrs
pg 366
Myoglobin peaks at __ to ___hrs and returns to baseline at __ day(s).
4 to 9 hrs and 1 day
pg 366-67
T/F: In the ED, cardiac risk factors are strong predictors of risk for MI or other ACS.
False: Poor Predictors
pg 369
Cardiac risk factors for CAD have significantly less predictive value for an acute event than the mere presence of _____.
symptoms
pg 369
Why is the presence of a new systolic murmur an ominous sign?
1) Signifies papillary muscle dysfxn, 2) Flail leaflet of the mitral valve w/ regurge or 3) a VSD
pg 370
What is the time frame for the initial 12-lead ECG to be interpreted by for pts with ACS symtpoms?
10 minutes
pg 370
_____ wall AMI's should have a right sided lead V4 (V4R) obtained.
Inferior Wall, V4R is an additional lead placed on the right side of the chest
pg 370
What leads will you see a Anteroseptal MI in?
V1 - V4
pg 370
What leads will you see a Anterolateral MI in?
V4 - V6 and aVL
pg 370
What leads will you see a Lateral MI in?
I and aVL
pg 370
What leads will you see a Inferior MI in?
II, III, and aVF
pg 370
What leads will you see a Inferolateral MI in?
II, III, aVF, and V5, V6
pg 370
How many mm or greater does new ST changes have to be in multiple leads to presume a high likelihood of ACS?
1mm
pg 370 see chart
What is the percent chance that a person with a normal ECG can be having a AMI?
1-5% chance
pg 371
What is the percent chance that a person with evidence of ischemia that is age-indeterminate is having a AMI?
4-7% chance
pg 371
How do you choose which fibrinolytic to use for reperfusion therapy?
Based on Institution
pg 377
Pt w/ unstable angina/ NSTEMI with elevated troponins, new ST changes, + stress test, v-tach, or CABG in past 6 months?
Early invasive therapy
(w/in 48hrs)
pg 378
How much ASA needs to be given to all STEMI/ NSTEMI, and unstable angina?
ASA 325mg
pg 378
Which medication is preferred for antiplatelet agents, clopidogrel or ticlopidine?
Clopidogrel
pg 378
T/F: Cardiac Troponins and CK-MB have independent predictive value for prediction of adverse events and diagnosis of ACS.
True
pg 373
Patients with persistent symptoms and STEMI should receive ______ therapy.
Reperfusion
pg 373
What are the two general cardiac reperfusion therapy options?
Percutaneous Coronary Intervention (PCI)
or Fibrinolytic Therapy
pg 374
What the goals for time to have PCI or fibrinolysis accomplished?
PCI – 90minutes
Fibrinolytics – 30minutes
pg 374
Which is the preferred reperfusion strategy?
PCI in 90 minutes
pg 374
Fibrinolytic therapy is indicated for STEMI pts if the time from symptom onset is < ___ to ___hrs.
6 to 12 hrs
pg 376
STEMI pts who receive fibrinolytic therapy should also receive full dose _____ for at least 48hrs.
Anticoagulants (UFH, enoxaparin, fondaparinux)
pg 376
What percent of cardiogenic shock after AMI is caused by mechanical complications?
25%
pg 386
What ancillary studies are important for cardiogenic shock?
ECG, CXR, Echo, Cardiac monitoring
pg 386
ED care is a _____ measure while arranging for revascularization.
temporizing
pg 387
When should ASA and Heparin be given in the setting of AMI?
Always, unless there is a contraindication.
pg 388
What time frame should BB be given to pts with STEMI/ NSTEMI in cardiogenic shock?
Beta Blockers SHOULD NOT be given
pg 388
What is the definitive treatment for cardiogenic shock?
Coronary intervention in the cath lab
pg 388
What pain features are in the low risk ACS group?
pleuritic, positional, reproducible, sharp/stabbing
pg 390
Does low risk exclude ACS?
No
pg 390
54yo M smoker w/ c/o heavy chest pain with exertion, ST changes in II, II, AVF. Negative stress test 3 months ago at cardiologist. What is the likely diagnosis that must be r/o?
ACS must be ruled out despite negative cardiac testing.
pg390
It is unlikely that a pt with previously normal or near-normal cath has developed stenosis w/in __ yrs of the procedure.
2yrs
pg 390
Plaque rupture is unpredictable and often occurs in lesions that were previously _____.
nonobstructive
pg 390
What symptoms put a pt in the probable high risk category, >2% likelihood?
Pressure, N/V, diaphoresis
pg 390
If the clinician feels the likelihood of ACS is > __% than the diagnosis of "possible" ACS is made.
2%
pg 391
What should be done for pts with > 2% risk for ACS.
further cardiac testing
pg 392
T/F: Negative cardiac biomarkers can exlcude unstable angina.
False: Cannot, unstable angina is chest pain at rest with no ECG changes or elevated biomarkers
pg 392
What types of "risks" pt will cardiac stress testing not help you with?
Very low or Very high risk groups, due to false negative and false positives
pg 393
T/F: A normal resting echo can exclude ACS in the ED.
False: Cannot
pg 394
What approach is the foundation of traditional cardiac observation units?
Serial cardiac markers and objective cardiac testing
pg 395
What medication is first line is ACS and should be given to all potential pts, no matter what stratification level, unless contraindicated?
ASA
pg 397
How long do pts need to be off antiplatelet therapy before undergoing a CABG?
5 days of Clopidogrel
pg 398
Who should make the decision to withhold dual oral antiplatelet therapy?
Multidisciplinary , institution-specific treatment protocols
pg 398
Pt's at immediate risk for adverse events may be given ____ if concerning features (T wave inversion, known CAD, indeterminate markers) are present.
antithrombin therapy
pg 398
The exact role of ____ medications in the treatment of patients with possible ACS is unclear.
Beta Blockers
pg 398
Which etiology of syncope is the most concerning due to a 6-mon mortality rate >10%?
cardiac
pg 400
What cardiac abnormality should be excluded as a cause of syncope in the elderly?
Aortic Stenosis
pg 400
This type of cardiac syncope is sudden and usually without prodromal symptoms.
syncope from dysrhythmias
pg 400
Elderly pts with recurrent episodes of syncope and negative cardiac workups should be suspected of having ______ _____ hypersensitivity.
carotid sinus
pg 401
When should you consider orthostasis as a cause for syncope?
when other life threatening conditions have been excluded.
pg 401
A ___ cause of syncope should be one of exclusion in addition to orthostasis.
pyschiatric
pg 401
Definition of Syncope is?
brief loss of consciousness with inability to maintain postural tone that spontaneously and completely resolves with medical intervention.
pg 399
T/F: pt with LOC with persistent neuro deficit or AMS is not true syncope.
True
pg 401
How do most medications contribute to syncope?
by orthostatic syncope
pg 401
What is the goal of the ED eval for syncope pts?
identify those at increased risk for immediate decompensation and future risks
pg 402
Pt are at increased risk if they have non-sinus rhythms, ECG changes, ___ or shortness of breath.
CHF
pg 403
What must always be considered as a potential cause of heart failure exacerbation until excluded?
AMI
pg 406
Approach to HTN acute heart failure steps are?
1) O2 and SL nitro, 2) if BP >150 add IV Nitro, 3)IV Furosemide, 4)if dyspnea start BiPAP, 5) assess severity (AMS, +troponins, SBP >210), 6) admit to ICU
pg 410
Approach to Hypotensive acute heart failure?
1) assess for low BP, cap refill, or AMS, 2) ECG for ST changes, 3) Inotrope (dobutamine or dopamine) goal 90-100 SBP, 4) admit to ICU, 5) consider vasodilator w/ inotrope
pg 411
Does normal O2 sats r/o PE?
No, diversion of blood to areas of high ventilation can cause a increase in O2 sats.
pg 431
Define Phlegmasia Alba Dolens.
Swollen painful and pale/ white limb due to proximal venous thrombosis
pg 433
Define Phlegmasia Cerulea Dolens.
Swollen painful and dusky/blue limb due to proximal venous thrombosis
pg 433
T/F: Phlegmasia Alba or Cerulea indicates a potential threat to loss of limb and requires aggressive txmt, thrombectomy.
True
pg 433
What is the McGinn-White sign on ECG indicative of?
PE
(S1, Q3, T3)
pg 433
The D-Dimer's half life is ___ hrs but remain elevated for __ days in a PE pt.
8hrs and 3 days
pg 434
What are the Wells Score for PE?
1) suspected DVT, 2) Alt Dx < PE, 3) HR >100, 4) prior DVT, 5) Immobilized, 6) Cancer, 7) Hemoptysis
pg 434
What are the PERC rules?
1)Age <50, 2) O2> 94%, 3)HR <100, 4) No VTE hx, 5) No recent sug/trauma, 6) No hemoptysis, 7) No estrogen use, 8) No unilat leg swelling
pg 437
How many of the PERC rules have to be met for it to be low probability of PE?
All Eight
pg 438
Systemic fibrinolysis should be considered in which carefully selected pts?
1) cardiac arrest, 2) hypotension, 3) respiratory failure (O2 <90%) , 4) right sided heart strain on echo, 5) elevated troponins
pg 440
Which medication is contraindicated in pregnant pts with PE?
Warfarin (Coumadin)
pg 441
Define Hypertensive Emergency.
Elevated BP (>180/120) that results in end organ damage (heart, kidney, aorta, eyes, brain)
pg 442
Define Hypertensive Urgency.
severely elevated BP without end organ damage. BP >180/120 has been arbitrarily used with no clinical benefit of txmt
pg 442
Pt with BP 210/120, HA, N/V, and some diplopia is at risk for ?
Hypertensive encephalopathy
other sx: AMS, papilledema, seizures, or hematuria
pg 443
What is the therapeutic goal in acute aortic dissection for BP?
<140 and >110
pg 443
What is the preferred initial txmt of an acute sympathetic crisis due to cocaine or amphetamine abuse?
IV Benzo's (Lorazepam or Diazepam) repeated IV doses as needed.
pg 445
What drug is contraindicated in acute sympathetic crisis?
Beta Blockers leaves unopposed alpha storm
pg 445
What is the antiHTN of choice in preeclampsia?
1) Labetolol, 2) Nifedipine
ACE-I are contraindicated
pg 445
T/F: Blood pressure reduction is recommended for acute vascular lesions, SAH, and intracranial hemorrhage.
FALSE: it is controversial
pg 445
Dyspnea is a ___ feeling of difficult, labored, or uncomfortable breathing.
Subjective
pg 465
What is tachypnea?
Rapid breathing, may or may not be associated with dyspnea.
pg 465
What is orthopnea?
Dyspnea in the recumbent position.
pg 465
What is Paroxysmal Noctural Dyspnea?
orthopnea that awakens the pt from sleep.
pg 465
What is hypoxia?
Insufficient delivery of oxygen to the tissues.
pg 466
What is hypoxemia?
Abnormally low arterial oxygen tension. defined as PaO2 <60mmHg
pg 466
What is a normal P(A-a)O2 [aveolar arterial oxygen partial pressure gradient]?
<10mmHg in young healthy adults
pg 467
What are the five distinct mechanisms causing hypoxemia?
1) Hypoventilation, 2) Right to Left shunt, 3) Vent/ Perfus mismatch, 4) Diffusion impairment, 5) Low inspired Oxygen
pg 467
What is the hallmark of the Right to Left shunt?
failure of arterial oxygen to improve with supplemental O2
pg 467
Except in ______ arterial O2 responds to supplemental oxygen.
Right to Left shunts.
pg 467
A CXR is not indicated in which one of these patients; COPD, CHF, asthma?
Asthma
pg 469
Acute cough is cough lasting ____ weeks and is usually associated with self limiting URI.
< 3 weeks
pg 469
Chronic cough is present for _____
> 8 weeks
pg 469
The incidence of pertussis in adolescents has increased ____ percent to waning vaccine immunity with age.
400%
pg 469
What are the 5 most common causes of chronic cough?
1) Smoking with chronic bronchitis, 2) Upper Airway Cough Syndrome (post nasal drip), 3) Asthma, 4) GERD, 5)ACE-I
pg 469
Central cyanosis affects the mucous membranes and tongue and is due to ?
Inadequate Pulmonary Oxygenation or abnormal Hb.
pg 471
Peripheral cyanosis affects the fingers or extremities and is due to?
vasoconstriction and diminished peripheral blood flow
pg 471
What two situations will the pulse ox overestimate the O2 sats?
Carboxyhemoglobin and Methemoglobin
pg 471
In which case does the pulse ox read normal but O2 saturation is truely low?
Carboxyhemoglobin displaces O2 but is read by the pulse ox as normal.
pg 471
Two most common bacteria involved in dog bites to the hand and which abx to use?
Staph A. and Pasturella
Augmentin is best abx.
What is the gold standard in the assessment of cyanosis?
ABG and co-oximetry.
pg 471
T/F: A significant pleural effusion is large enough to produce a pleural fluid strip >10mm wide on lat decub or US.
TRUE.
pg 472
Pneumococcal pneumonia responds to a variety of abx, but there is increased resistence to ___, ____, and _____ abxs.
PCNs, Macrolides, and Fluoroquinolone
pg 481
Legionella is most seen during what season?
No seasonality
pg 482
Which pneumonia is complicated by ab pain, N/V/D?
Legionella
pg 482
T/F: Most pts do not require ID of a specific organism through bld or sputum cx in order to direct abx txmt.
True. Most are treated with broad spec abx.
pg 482
Which pts are bld and sputum cx recommonded in?
1) ICU admissions, 2) leukopenia, 3) cavitary lesions, 4) liver dz or ETOH abuse, 5) asplenia
pg 482
What is the most common cause of pneumonia in alcoholics?
Strep. pneumo, but Klebsiella is important to consider
pg 483
What pathogens are seen mostly in DMII pts?
Staph aureus, Mycobacteruim tuberculosis
pg 483
Is CXR recommended in pregnant pts with respiratory tract infections and varicella exposure?
Yes.
pg 483
Which PNA typically presents in the elderly following a influenza illness?
Strep pneumo, Staph aureus, H. influenza
pg 483
Central cyanosis affects the mucous membranes and tongue and is due to ?
Inadequate Pulmonary Oxygenation or abnormal Hb.
pg 471
Peripheral cyanosis affects the fingers or extremities and is due to?
vasoconstriction and diminished peripheral blood flow
pg 471
What two situations will the pulse ox overestimate the O2 sats?
Carboxyhemoglobin and Methemoglobin
pg 471
In which case does the pulse ox read normal but O2 saturation is truely low?
Carboxyhemoglobin displaces O2 but is read by the pulse ox as normal.
pg 471
Two most common bacteria involved in dog bites to the hand and which abx to use?
Staph A. and Pasturella
Augmentin is best abx.
What is the gold standard in the assessment of cyanosis?
ABG and co-oximetry.
pg 471
T/F: A significant pleural effusion is large enough to produce a pleural fluid strip >10mm wide on lat decub or US.
TRUE.
pg 472
What are the 7 risk factors associated with nursing home PNA?
1) tachycard, 2) RR > 30, 3)fever, 4)AMS, 5) Lung crackles, 6) No wheeze, 7) high WBCs
pg 483
Most common nursing home PNA?
Strep pneumo and H. Flu
pg 483
T/F: Nursing home pts are at risk for organisms linked to CAP and txmt for MRSA in generally not indicated.
FALSE: risk health care related PNA and MRSA coverage is recommended
pg 483
Most common cause of PNA in HIV pts?
Strep pneumo
pg 484
What is another concerning pathogen causing PNA in HIV pts?
Pseudomonas
pg 484
What are the 3 leading noninfectious causes of pleural effusions in HIV pts
Non-Hodgkin lymphoma, Kaposi sarcoma, and adenocarcinoma
pg 484
Renal, Liver, Heart, and Lung transplant pts are all at risk for PNA in the first 3 months after surgery, which is transplant is least common?
Renal
pg 484
After 6 months posttransplant, bacteria of ___ aquired PNA are most likely pathogens.
CAP
pg 484
Most common outpt txmt of PNA?
Levoquin 750mg or Augmentin +Azithromycin
pg 484
Most common inpt txmt of PNA?
Levoquin 750mg, or Ceftriaxone + Azithromycin
pg 484
CDC is concerned with building resistence to what abx type?
Fluoroquinoles
pg 486
Which type of abx should not be used in myasthenia gravis pts?
Flouroquinoles
pg 486
What does the CURB-65 rule apply to?
Eldery. C-confusion, U-uremia, R->30breathes/min, B- BP (diastolic <60), age >65
score < 2 is low risk
pg 486
Gastric pH and volume aspirated are what to risk aspiration pneumonitis?
pH <2.5 and volume 20-30ml
pg 487
Prophylactic abx and steroids are / are not recommend to prevent lung injury after aspiration?
Are NOT
pg 488
What type anemia to r/o if MCV is low, RDW is high and ferritin is low?
Microcytic (Iron Deficiency)
Anemia
pg 1459
What type of anemia to r/o if MCV is low, RDW is normal, and RBC is high?
Microcytic (Thalassemia)
pg 1459
What type of anemia to r/o if MCV is normal, reticulocyte count is normal, and RDW is normal?
Normocytic (Anemia of chronic dz)
pg 1459
What type of anemia to r/o if MCV is elevated, RDW is high?
Macrocytic (Folate or B12 deficiency)
pg 1459
What type of anemia to r/o if MCV is high, RDW is normal?
Macrocytic (ETOH abuse, Liver Dz)
pg 1459
At what platelet level does spontaneous bleeding more likely to occur?
Below 10,000 - 20,000
pg 1464
24yo F is sent from PCM to ED due to a routine lab screening showing platelets 50,000. She is otherwise healthy and has no complaints, what treatment is recommended?
None, asympatomatic pts otherwise healthy require no txmt
pg 1465
76yo M c/o unsteady gait and weakness x 1 month. CBC shows platelets of 30,000 but no other cell line abnormality. What treatment is recommended?
Platelets of <30,000 or <50,000 w/ bleeding or significant risk (organ dz, PUD, HTN or fall risk) require txmt.
Steroids or IV IG.
pg 1465
At what point in the treatment process should platelets be given?
Steroids first, IV IG second then platelets; this order has shown the greatest rist in the platelet count
pg 1466
What are some mechanisms of thrombocytopenia?
Decreased platelet production, increased destruction, platelet loss (ie. hemorrhage), or splenic sequestration
pg 1464
What are organs involved in platelet disorders?
Renal (uremia inhibits platelet aggregation), Liver (liver dz affects all coag factors except Factor VIII), Spleen (sequesters or hepatic portal htn backs up flow), Bone marrow (low output)
pg 1465-66
Who does Hemophilia A or B affect more, men or women?
Men, X-linked recessive gene defect
pg 1475
How are platelet disorders different than hemophilia?
Platelet disorders present with easy bruising and capillary bleeding (gums, urine, nose) and Hemophilia is hemarthrosis, internal bleeding (abdomen or intracranial)
pg 1475
Which bleeding time could be affected by hemophilia, intrinsic (aPPT) or extrinsic (PT)?
Intrinsic (aPPT), though bleeding times are often normal and not helpful
pg 1476
22yo M with hx of Hemophilia A c/o knee pain and a pickup basketball game.Feels tight and painful. No swelling or discoloration on exam. ROM is limited by pain. Ligaments intact. What must be r/o?
Hemarthosis. clinical evidence may or may not be present but pt's report are reliable.
pg 1476
When should Factor replacement be given to a pt being transferred to another hospital before transport or after arrival?
Before
pg 1477
When should you contact a hemophilia center once a hemophiliac has entered the ED?
Everytime
pg 1477
What is Desmopressin's effect on bleeding disorders?
Desmopressin increases von Willebrand factor release from the endothelial walls, increasing the ability of vWF to carry more Factor VIII clotting proteins.
pg 1479-80
What are some potential causes of COPD exacerbation?
PNA, PTX, PE, asthma, CHF,
pg 513
For every increase of 10mmHg of PCO2 on ABG what does the serum Bicarb raise by in acute and chronic resp. acidosis?
acute - 1mEq
chronic - 3.5mEq
pg 513
A PEF rate of < ___ L per minute in a COPD pt indicates severe exacerbation.
100 L
pg 514
What is the DDX for a pt with a thought to be severe COPD exacerbation that is not responding to standard therapy?
Asthma, CHF, PE, ACS, PTX, and PNA
pg 514
What is the goal PaO2 and SaO2 range when treating COPD exacerbation with O2?
PaO2 >60mmHg
SaO2 >90%
pg 515
What is a danger with elevating a COPD pt's O2 level to high and what can be done?
Respiratory Acidosis - increased CO2 production from excess O2. Serial ABGs to monitor acid-base status, Increase ventilations
What are the initial txmt options for COPD exacerbations?
Beta agonists, Anticholinergics, and brief course of steroids.
(Albuterol + Ipratropium + prednisone)
pg 515
When should abx be given and what are they covering for in COPD exacerbation?
increased sputum production or evidence of infection.
directed at Strep pneum. H flu, and Moraxella
pg 515
What are some contraindications to NPPV (noninvasive positive pressure ventilation)?
AMS, inability to clear secretions, hemodynamic instability, respiratory arrest, extreme obesity, burns, poor mask fit
pg 516
What are normal starting levels for CPAP and BiPAP?
CPAP - 15cm H2O
BiPAP - 8 / 4 cmH2O
pg 516
What is the effect of 2 units of PRBCs on the H/H?
Hemoglobin +2 and Hematocrit + 6% (1 and 3 per unit)
pg 1495
What are indications for FFP?
Rapid reversal of Warfarin, Active bleeding, Correct coag defects, massive transfusion, and angioedema (FFP contains C1 esterase)
pg 1496
T/F: In NONemergent blood transfusions, the initial rate of transfusion is high for the first 30min to allow for identification of a transfusion reaction.
FALSE: rate is slow
pg 1499
When should IV Vit K be given?
INR > 20 or symptomatic poisoning pts (warfarin suicide or rat poison ingestion).
pg 1502
What is the most reliable way for achieving therapeutic effect with Heparin?
Weight based dosing
pg 1503
How is Lovenox cleared and what pt type is it dangerous in?
Cleared Renally and dangerous in renal impairment pts
pg 1503-04
Pts who have a rxn to heparin (tachycardia, CP, dyspnea) should be evaluated for ___ and have an immediate ___ count.
Heparin Induced Thrombocytopenia (HIT) and platelet count
pg 1505
What type of ASA is not indicated in ACS?
Enteric-coated ASA
pg 1505
If pt has been treated with fibronytics what needs to be avoided (4)?
1) avoid unnecessary needle sticks, 2) avoid arterial punctures, 3) limit venous access, 4) avoid nasogastric or nasotracheal intubation
pg 1508
How the should the provider act towards the violent pt?
1) keep distance, 2) avoid excessive eye contact, 3) maintain submissive tone, 4) do not block exits
pg 1939
Sudden changes in behavior, mood, or thoughts in the psych pt should stimulate the provider to do?
eval for underlying medical condition
pg 1940
A pt w/ visual hallucinations should be assumed to have ______ pathology until proven otherwise.
Organic
pg 1942
Hostile behavior, verbal aggressiveness, and statements about violent intent are clues of what?
potential violence
pg 1943
Which age group after making a suicide attempt are higher risk of suicide (young, middle age, or old)?
Older patients
pg 1943
The most common suicide attempt is drug overdose (85%). It is important to ascertain the pt's knowledge of the ____ of the drug and their _____.
toxicity and intent
pg 1943
Pt dispo can be estimated by the _____ of the suicide attempt.
lethality
pg 1945
What is the purpose of the medical clearance exam in the psych pt?
determine if a medical condition exists that is worsening the psych illness
pg 1946
Define Axis I disorders.
clinical syndromes fo mental disorders (schizophrenia, malingering, anxiety, eating, sleeping, factious)
pg 1946
Define Axis II disorders.
personality disorders, developmental disorders (retardation, paranoid, schizoid, antisocial, boarderline, OCD)
pg 1946
Define Axis III disorders.
general medical conditions that could contribute to the psych illness (infectious, neoplasm, endocrine, pregnancy)
pg 1946
Define Axis IV disorders.
psychosocial and environmental stressors (housing, economic)
pg 1946
Define Axis V disorders.
overall functioning using global level of functioning scale
pg 1946
The presence of nonauditory hallucinations suggestion a ___etiology as the cause of psychosis.
Medical not psychiatric
pg 1949
An elderly pt with new onset psych issues (depression, anxiety, or psychosis) should increase suspicion for ____.
Dementia
pg 1948
Delirium is differentiated from Dementia by two major ways, which are?
reduction in awareness of environment and decrease in alertness
pg 1948
Schizophrenia is a d/o marked by delusions and hallucinations. Auditory hallucinations are the most common type. The presence of nonauditory hallucinations suggests what type of cause?
Medical cause, as opposed to psychosis
pg 1949
Schizophrenic's poor judgement and disorganization may lead to disregard of _____ problems, so attn must be given to their physical status.
medical
pg 1949
What is the best way to avoid frustration with the antisocial patient in the ED?
Set firm limits and focus on chief complaints
pg 1952
What is "cotton fever" in reference to IV drug users?
Fever and flu-like illness as a result of using cotton balls as filters for drug suspensions
pg 1991
What should you do first with a febrile, dyspnic IV drug user with abnormal findings on CXR?
Place in isolation, until TB is r/o
pg 1991
What is the likelihood for an IV drug user to acquire endocarditis compared to the population?
40x greater chance
pg 1993
Most common organism to cause infective bacterial endocarditis?
Staph aureus
pg 1993
What is the best initial txmt option for suspected bacterial endocarditis in the unstable IV drug user pt?
Vancomycin 15mg/kg q 12hrs +
Gentimycin 1mg/kg q 8 hrs
pg 1994
What type of infxn is the most common in the IV drug user?
Skin and soft tissue infxns
pg 1995
Increased rates of ________ infxns have been found in injection drug users who engage in skin popping, particularly when using Mexican black tar heroin.
Clostridium botulinum
pg 1995