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EmergMed PAprogStFU

Spring 2006 St Francis PA prog prof Bunn

EM STFU PAprog spg06Ans J. Bunn teacher
Laryngoscopic Views Grade I can see the epiglottis, vocal cords, posterior structures of the larynx
Laryngoscopic Views Grade II can see the epiglottis, but only posterior elements of larynx
Grade III Laryngoscopic Views can only see the epiglottis
Laryngoscopic Views Grade IV none of the above are seen
Mallampati Classes of Laryngoscopic Views Grade I – (best view possible) can see the epiglottis, vocal cords, posterior structures of the larynx
Why doEnd-tidal carbon dioxide detection? Confirmation of Endotracheal Tube Placement
Confirmation of Endotracheal Tube Placement name 4 ways Clinical assessment 2)End-tidal carbon dioxide detection 3)Aspiration techniques 4)Chest radiograph
Clinical Assessment of Confirmation of Endotracheal Tube Placement name 6 1) Visualize ET tube passing through 2)Chest auscultation 3)Gastric auscultation 4)Bag resistance 5)Condensation within ET tube 6)Pulse oximeter reading
best way : Confirmation of Endotracheal Tube Placement End-tidal carbon dioxide detection
what drug:Reduces the :intracranial response to laryngoscopy ? Lidocaine (used during intubation)
What drug:Reduces the bronchospastic response to laryngoscopy and intubaton Lidocaine (used during intubation)
Do not forget to__?____ to patients after they are placed on the ventilator! sedate patients after they are placed on the ventilator!
Plastic double-lumen tube with one lumen functioning as an esophageal airway and the other lumen functioning as a tracheal airway. whats it called? Combitube (Esophagotracheal)
DOC for SVT ? Adenosine
Drug forsymptomatic sinus bradycardia ? Atropine... dopamine is second line
Vasopression.. What is it? naturally occurring antidiuretic hormone; potent vasoconstrictor
What drug? use for known or suspected hyperkalemia? Calcium chloride
Adenosine DOC for what? SVT DOC
Shock name 6 types 1) hemorrhagic 2)septic 3)cardiogenic 4) Anaphylatice shock 5) Anaphylactoid 6) spinal shock
Give crystalloids in what 3 types of shock ?: hemorrhagic, septic, and anaphylactic shock
Pt presents with = bradycardia + peripheral vasodilatation after an MI. Whats this reflex called? Bezold-Jarish reflex
hemorrhagic shock is what?... By how much? decrease intravascular volume by 20%
pts. with adequate oxygenation but impaired ventilation whats good to give'em? Heliox
rapid sequence intubation ..what do you want to give them? (hint :K____) Ketamine – sedation
RV enlargement secondary to malfunction of the lungs causing pulmonary artery HTN Cor Pulmonale
ST-T changes most common but non-specific of what? PE
PE EKG b. Most common rhythm? tachycardia
Whats the name of the condition: pulmonary edema in the absence of volume overload or depressed left ventricular dysfunction ARDS
b. PE – GOLD standard imaging ? Angiogram
a. 3rd trimester normal BP ? 125/75 mm Hg
What you give'em??? for HTN Emergency.... quick think fast! nitroprusside
what is a HTN emergency in a pregnate patient? BP > 140/90 w/ signs and symptoms
How fast do you reduce BP in a Patient with diastolic over 115 but NO endorgan damage? reduce BP over 24 – 48 hours
mild HTN how is it defined? less than 115 diastolic w/ no organ damage
HTN Urgency how defined ? diastolic over 115 with no end organ damage
How fast do you reduce BP in an HTN urgency? a. reduce BP over 24 – 48 hours
kids who present with bradycardia .. what endocrine problem do you suspect? hypoglycemia do an Accucheck
adults have focal neurologic deficit what endocrine problem do you keep in you dif dx 1. Suspect hypoglycemia
combo of lack of insulin & excess stress hormones what endocirne emergency? DKA .
IV TX for Hypoglycemia – D50
In DKA acidosis masks what ? low potassium
DKA TX 1 L of NS in the first hour
5. HH Nonketotic Coma – underlying illness such ... Infection
5. HH Nonketotic Coma –slow increase in ___? How high?? sugar; usually gets at least 800 -1000
5. HH Nonketotic Coma –underlying illness such? infection
6. Alcoholic ketoacidosis what do you give them? b. Give D5NS, thiamine prior to glucose;
6. Alcoholic ketoacidosis : Dont give them what? Do NOT give insulin!!!!!!
myxedema coma: the pt HYPO or HYPER thermic? 7. Hypothermia is a very common symptom of myxedema coma
goiter, exophthalmous, pretibial edema what disease? Graves Disease
in hyperthyroidism .. do you give ASA? NO! Donot give ASA to hyperthyroid Pt.
I am having a thyroid storm what can you give me? help I may die! Beta blockers
12. insufficient glucocorticoid & mineralcorticoid is primary adrenal insufficiency
Coma cocktail whats in it? Glucose, Oxygen Narcan
Toxicology: Pinpoint pupils .. what? narcotics
dilated pupils .. what? sympathomimetics & withdrawal
Cholinergics what sx/signs? (hint there is a 6 letter word that helps remembering) SLUDGE – Salivation, lacrimation, urination, defecation,gastric cramping, emesis
Cholinergic poisening ...Most common is..what ?and who? organic phosphate poisoning seen in farmers
Tocicology :sedative-hypnotics what skin sign? Bullae
8. Goosebumps (piloerection) are characteristic of ? withdrawal
The best airway endotracheal tube
Tox.: High BP & tachycardia amphetamines, cocaine
Tox: BP & bradycardia opiates, barbiturates, beta blockers
Tox: Tachycardia & low BP Tricyclics
Tox: Rapid respirations Acidosis, sepsis
Tox: Hypothermia narcotics
Tox: vii. Diaphoresis & salivation cholinergics
Tox:dry skin & dry mouth Anticholinergics
Tox: Rotational nystagmus PCP
Tox: Horizontal nystagmus ETOH
11. Arterial Blood gases detectwhat 3 things: PH (acidosis); CO2 (ventilation); O2 = hypoxemia
what is Na – (HCO3 + Cl) calculating? Anion gap
Anion gap how do you calculate? Na – (HCO3 + Cl)
iii. Accumulation of inorganic acids (hint : At Mud Piles) cause what? High anion gap: ( think of a High mud pile)
ii. Loss of bicarb via diarrhea what does that do to Anion gap? Nothing ,its a Normal Anion gap
AT MUD PILES what is it a reminder of:? Alcohol, Toluene, Methanol, Uremia, DKA, Paraldehyde, Iron, Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates, Strychnine
i. Osmolar gap = calculated osmoles – serum osmoles; Whats the most common cause? ethanol - most common cause of osmolar gap
(ME DIE) or 1. Methanol, Ethanol, Diuretics, Isopropanol, Ethylene glycol do what to the 13. Osmolar gap? i. > 10 is abnormal: caused by ME DIE
CHIPES stands for what? i. Chloral hydrate, heavy metals, iron, phenothiazines, enteric coated tabs, solvents
CHIPES effect what ? How? Radioopaque ( or white on Xray) :Chloral hydrate, heavy metals, iron, phenothiazines, enteric coated tabs, solvents
I am having a seizer and injested a caustic subtance what poisen TX do you AVOID giving me? Syrup of ipecac
I have a nonobstruvtive nonsharp FB in my Bowl what can you givw me? GoLYTELY or whole bowel irrigation
liquification necrosis of an eye is caused by Alkaline material
definitive therapy for ASA overdose is? ???? Im confused
with your wood’s lamp you see a Pts urine fluoresces what did they drink? Antifreeze ingestion
Antifreeze ingestion : what do you look for in the urine Oxalate crystals seen in urine ( and wood’s lamp to see if urine fluoresces)
POSTERIOR CIRCULATION includes what vessel and what 7 areas? Vertebral artery : brain stem, cerebellum, thalamus, auditory and vestibular centers, medial temporal lobe and the visual cortex
ANTERIOR CIRCULATION what vessel and what areas? optic nerve, retina,and frontal, parietal, and anterior-temporal lobes
What vessel perfuses the largest portion of the brain? Carotid circulation & perfuses 4/5 of brain
area of the brain in which small amounts of flow are preserved by collateral circulation what is it called? Ischemic Penumbra
ischemic penumbra is it electricaslly active? Electrically silent
What overdose will cause pulmonary edema? Narcotic overdose
What is drug of choice for cocaine O.D.?? Diazepam
TX for OD of Sulfonylurea? hypertonic dextrose
Antizol what does it do? prevents the formation of oxalate crystals
CCB overdose: what can your give? 20. Calcium, glucagons, & phosphodiesterase inhibitors
TX for Cyanide ? w/ oxygen, bicarb, nitrates, thiosulfates (cyanide kit)
Tylenol overdose < 8 hrs i. don’t initiate NAC therapy
Tylenol overdose > 8 hrs NAC (N-acetylcysteine) or Mucomyst
Methanol injestion TX for ? ethanol, formepizole, or hemodialysis
slow onset disturbance of cognitive functioning, NO clouding of consciousness what is it called? Dementia
acute onset impairment of cognitive functioning with rapid deterioration what is it called? Delirium
Delirium name 3 things it can be caused by? overdose, intercerebral hemorrhages, and electrolyte imbalances
same symptoms as schizophrenia but they are present less than 6 months.. whatit called 3. Schizophreniform disorder
5. Most common types of delusional disorders ? – persecutory
c/o of symptoms but no medical disorder can be identified what is it called? Somatoform disorder
social and occupational functioning impairment.. what is it called? Personality disorder
Psych patients: first thing you asess? ABC’s !
continuous and chronic (at least 6 months) than panic disorder Generalized Anxiety Disorder GAD
Ovral pregnancy prophylaxis given within 72 hours
pregnancy prophylaxis given within 72 hours.. what substance? Glycoprotein p30
what substance?: high levels found in semen; use when no sperm is found Acid phosphatase
pessimistic outlook w/o psychotic features Dysthymic disorder
trauma is “converted” into physical signs and symptoms Conversion disorder
g. Genetic typing uses what 4 markers ?: i. ABO blood group antigens, peptidase A, phospoglucomutase, DNA
dissociative agent – produces “trancelike state” Ketamine
How to sedate kids? , initial IM dose of Ketamine
for sedation: opioid of choice? Fentanyl
for sedation: Benzo drug of choice? Midazolam (Versed)
Barbiturate drug of choice? Methohexital (Brevital)
benzo antagonist; IV what? 12. Flumazenil (Romazicon)
Ticlopidine (Ticlid) - PO is what class? GP IIb/IIIa Inhibitors
Abciximab (ReoPro) - IV is what class? GP IIb/IIIa Inhibitors
Lamifiban / Tirofiban (Aggrastat) is what class? GP IIb/IIIa Inhibitors
Clopidogrel (Plavix) - PO is what class? GP IIb/IIIa Inhibitors
Reduces preload and O2 requirements but SE include hypotension, histamine response...what drug? Morphine
Smooth muscle relaxant that Should NOT be used in right ventricular infarction Nitroglycerin
Why becarful with using Nitroglycerin during a inferior wall MI ? It is the Rt side of the heart .. BP may tank
Other then ischemic-type pain name 3 other conditions nitromay help HTN, CHF, large anterior wall MI
what drug good for all 3: Non-ST segment elevation MI, PTCA and PTCA? plavix, Glycoprotein IIb/IIIa Inhibitors
Convert PSVT, A-fib, A-flutter to NSR Can Beta Blockers do that? YES Beta Blockers CAN Convert PSVT, A-fib, A-flutter to NSR
Heparin Therapy optimal PTT ? 50 to 70 seconds is optimal
aPTT of >70 seconds increases risk of ??? ICH
Rate control for rapid atrial arrhythmias in patients with impaired LV function . What Drug? Amiodarone
Termination of ectopic or multifocal AT with preserved LV function what drug? Amiodarone
Polymorphic VT, wide-complex tachycardias of uncertain origin Amiodarone
Control of hemodynamically stable VT when cardioversion is unsuccessful, especially in patients with LV dysfunction Amiodarone
Dalteparin (Fragmin) and Nadroparin (Fraxiparin) are examples of what drug? LMWH
Rate control for AF/Afib when other therapies are ineffective Amiodarone
Amiodarone Precautions : others then CVS renal failure use with caution and extremely long half life ( 40 days)
Wide-complex tachycardias uncertain type? Lidocaine , Amiodarone
Wide-complex PSVT ? what drug Lidocaine
what is replacing Lidocaine in many cases? Amiodarone
Refractory VF after lidocaine Magnesium Sulfate
digitalis toxicity causing Life-threatening ventricular arrhythmias Drug TX? Magnesium Sulfate
Wide variety of arrhythmias: Proarrrythmic, especially in the setting of AMI, hypokalemia, hypomagnesemia Procainamide
Stable wide-complex tachycardia of unknown origin, Wide-complex tachycardias uncertain type Procainamide, Lidocaine, Amiodarone, Procainamide.. looks like all 3 emailed J Bunn
Diltiazem big percaution: Do not use in wide-complex tachycardias or for poison/drug-induced tachycardia, WPW, SSS, or patients with AV block without a pacemaker
Diltiazem is used to control : what? ventricular rate in AF
Alternative drug (after adenosine) to terminate PSVT with narrow QRS complex and adequate BP and preserved LV function Verapamil, Diltiazem
Created by: pnelson