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EmergMed PAprogStFU
Spring 2006 St Francis PA prog prof Bunn
| EM STFU PAprog spg06 | Ans 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
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