Emergency Medicine
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| labs to get in the w/u of sepsis | CBC, chems (LFTs, bicarb, creatinine), PT/PTT, Lactate
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| an important marker of global tissue hypoxia | lactate
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| additional labs to evaluate source of sepsis | blood cultures, UA,urine C & S, CXR, discharge from lesions, sterile fluids if suspected
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| CSF tube 1 is used for what purpose | appearance; cell count/diff
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| CSF tube 2 is used for what purpose | glucose and protein
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| CSF tube 3 is used for what purpose | gram stain and culture
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| CSF tube 4 is used for what purpose | cell count with differential
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| what patients with cystitis should get a urine culture | anyone who is not a healthy young female
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| pneumonia labs | CBC; CXR; sputum gr stain/cx; Blood cx; Pulse ox, ABG; Urine for streptococcal and Legionella antigen; PCR assays; Serologies; Influenza rapid antigen
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| Septic arthritis: Joint fluid analysis | Cell count/diff (WBC <200 normal; septic >50-60K); Diff: <25% PMN normal; >50% PMN infxs/inflam; Gr stain/cx; Crystals
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| What do you include in the work-up of a corneal abrasion | Slit lamp exam with fluorescein, evert lids to rule out foreign body
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| What should be included in the workup for central retinal artery occlusion | ESR for temporal arteritis
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| What should be done in the case of orbital cellulitis | Emergent CT of the orbits and sinuses, ophthalmologic consultation and admission for cefuroxime IV
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| What is the preferred topical ocular anesthetic used when assessing a corneal abrasion | Proparacaine
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| How will a corneal abrasion appear during fluorescein stain when using cobalt blue light on slit lamp | It will fluoresce green
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| A hyphema should be dilated with __ to prevent pupillary movement from tearing damaged blood vessels | Atropine 1%
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| A bright green streaming appearance to fluorescein instilled into the tear layer (Seidel test) is pathognomonic for what | Penetrating trauma or ruptured globe
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| What is a normal range for IOP | 10-20 mm Hg
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| What may be seen on funduscopic exam with giant cell arteritis? | Flame hemorrhages
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| What labs should be ordered when giant cell arteritis is suspected | Sed rate, c-reactive protein
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| Hyphema work-up | Assume open globe; poss CT (if suspect blow out fx); poss US to r/o vitreous hemo or retinal detach; SPE (pts w/SCD)
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| MI labs | troponin, CKMB
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| AAA imaging | xray: calcified arch or paravert ST mass; u/s accurate for dx/measuring diameter; CT most sensitive for ruptured AAA
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| Imaging modality of choice for acute pancreatitis | CT
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| Imaging modality of choice for aortic aneurysm | CT
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| Imaging modality of choice for acute appy | CT w/contrast: shows walls >2mm, abscess, free fluid, RLQ fat stranding, appendicolith
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| Imaging modality of choice for biliary obstruction | u/s is definitive initial test for GS; u/s or HIDA for cholecystitis; xray/CT for porcelain; u/s or ERCP for choledocho
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| GI bleed labs | CMP, CBC (H&H), type & cross, coags; BUN often elevated 2/2 GI blood breakdown; ECG; poss NG tube to distinguish upper/lower
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| GIB: angiography requires bleeding rates of: | 0.5 - 2.0 mL/min
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| imaging TOC for upper GIB = | endoscopy
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| GIB IVF resuscitation | 3:1 rule - 3L crystalloid per 1L blood lost
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| GIB RFs | EtOH, NSAIDs, steroids, anticoag meds
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| mesenteric ischemia TOC | angio/CTA; abd xray/CT shows wall thickening / pneumatosis intestinalis
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| biliary labs | ECG, CBC, lytes, LFTs, bili, amylase, lipase, UA, bHCG
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| appendicitis labs | UA, CBC, bHCG
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| what radiographs should be obtained to assess for intestinal obstruction | flat and upright abdominal, and upright chest
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| pancreatitis labs | elev WBC, hypocalcemia; Sens/Sens: lipase > amylase (both high in acute)
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| Fever, all peds: | ua/ucc; poss cxr
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| Fever (>38C), <28 days old | Admit; ucc, blood cx, LP, poss cxr; IV amp/gent
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| Fever (>38C), 28 day - 3 mos | ucc, blood cx, LP, poss cxr; Rocephin 50 mg/kg; dc if cxs neg; f/u in 24hr
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| Fever (>39C), 3 mos - 3 yo | ucc, poss cxr, stool cx; close f/u
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| imaging TOC for pyloric stenosis | u/s; spec, not always sensitive; 2nd line: upper GI series: shows string sign
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| imaging TOC for PE | ECG, CXR (atalectasis, pl effusion, elev hemidiaphragm); gold std = pulmonary angiogram, but invasive (mort = 1-5%), so most 1st order V/Q scan
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| testing for suspected stroke | glucose, EKG, lytes, CBC, coag
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| imaging tests for stroke | CT: noncontrast detects hemo, ischemic visible after 6 hrs; MRI sensitive for posterior fossa or <6 hr; gold std: angio
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| meningitis testing | CBC, coag, blood cx; CT (r/o mass lesion) before LP; empiric abx
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| CSF, viral meningitis | opening pressure <200, WBC <1000 & <50% PMN, glucose >40, pro <200, neg Gr Stain / cx
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| CSF, bacterial meningitis | opening pressure >300, WBC >1000 & >80% PMN, glu <40, pro >200, pos Gr Stain / Cx
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| seizure labs | anticonvulsant levels; lytes, glu, tox screen, poss CK; poss LP
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| seizure tx | 1stline: benzos (versed, ativan, valium), poss phenobarb; 2ndline: dilantin, depakote; Mg sulfate: eclampsia
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| status epilepticus tx | pentobarb infusion (coma), isoflurane aesthesia
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| SAH testing | CT 90% sensitive, esp within 12 hrs; LP 98%, esp >12 hrs, when xanthochromia present
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| AMI labs: troponin | Troponin rises first & stays high 5 to 14 days, and is most sensitive/specific for MI
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| AMI labs: CK-MB | CKMB rises within 4 hours and peaks at 24 hrs
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| CHF xray | cardiomegaly, pulmo edema (plump vessels, interstitial / alveolar edema, Kerley B lines)
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| imaging for aortic dissection | CXR: widened mediastinum, poss tracheal deviation to right, left hemothorax; CT contrast; TEE to ID type & valvular involvement; aortography is gold std but invasive
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