EM/ Critical Care Step Up

Burns

-Def

-classified by

-Extent of burns estimated by

-SXS dependent on degree

Burns secondary to electrical shock are sometimes called

Determine IV fluid resuscitation need in second degree or higher burns with

Burns Treatment part 1

Burns Tx part 2

Burns Complications

Drowning

Treatment

-Complications

Drowning is most common in

Choking

-def

-food is

-SXS

-Radiology

-Tx

-Complications

Most common location of aspirated items that pass beyond trachea and reason why there

Heat Emergencies

-Hyperthermia

-Categorized as

Hypothermia

-Def

-RF

-SXS

-ECG

-Tx

In the final stage of hypothermia, the patient will

stop shivering

be unable to maintain body temperature

will undergo a fatal increase of blood viscosity

Heat exhaustion vs Heat Stroke

• symptoms

• Body temp

• Labs

• Tx

• Complications

Common types of bites and stings:

• symptoms and Treatments

Type of Bite

• Snake

• Scorpion

• Spider

  • Black Widow

  • Brown Recluse

• Mammals

• Human

Toxicology- General Principles

• initial eval must focus on

• The sooner treatment is

  • types of poisoning therapy

4. Supportive care includes airway protection, IV hydration, Cardiac support (tx for HTN, Hypotension, arrhythmias); control of seizures is important to adjunct to management of the poison itself

Next Step: Beware of alcohol abusers who come into ED fictitiously saying

they have ingested ethylene glycol and need ethanol for tx.

check for sweet breath and a toxin screen before giving ethanol

Common Poisons and Antidotes:

-CP

-OD Tx

• Acetaminophen

• Anticholinergics

• Benzos

• BB

Common Poisons and Antidotes:

-CP

-OD Tx

• CCB

• Cocaine

• Cyanide

• Digoxin

Common Poisons and Antidotes:

-CP

-OD Tx

• Heparin

• Isoniazid

• Methanol/Ethylene glycol

Common Poisons and Antidotes:

-CP

-OD Tx

• Opioids

• Salicylates

• Tricyclic antidepressants

• Warfarin

Common Poisons and Antidotes:

-CP

-OD Tx

• Caustics (acids/alkali)

• Organophosphates

• Iron

• Lead

• Mercury

Next Step: Organophosphates can also be absorbed

Ingested Poisons: 4 things to remember

Next Step: any patient with significant thermal burns, burns of the face, or exposure to large quantities of smoke require

CO poisoning

-def

-displaces

-SXS

-Labs

-Tx

Pulse ox may appear ____ in CO poisoning

Indications for hyperbaric O2:

Cardiac arrest lasting >10 mins without CO is generally considered

Cardiac Arrest

-def

-requires

-tx of vfib/vtach requires

-PEA consists of

-asystole is

DNR status should be

BLS initial tx pathway

Vfib/Pulseless Vtach pathway

PEA/asystole pathway

suspected stroke pathway

incomplete sadly

Causes of PEA mnemonic

Acceleartion-deceleration injuries

Penetrating injuries

Next Step: cound and pair all

Trauma Assessment

Next step: Address the _____ and secondary ____ in order. Do not

The use of _____ in assessment of trauma is reserved for ______

LOC is considered _______

head trauma until ruled out

Head Trauma

-def

-point of insult

-SXS

-Radiology

-Tx

HTN with bradycardia is suggestive of

increased ICP - cushing phenomenon

Next Step: rule out ____ before performing any examination requiring head movement

cervical fracture and spinal cord injury

Spinal Cord Trauma

-Def

-SXS

-Radiology

-Treatment

The spine is considered ______ and should NOT be _____

Neck Trauma

-neck is divided into

-penatrating injurings violating the platysma should be

-SXS

-Radiology

-Tx

Chest Trauma

-Can result in

-Aortic rupture (caused by)

-SXS

-Radiology

-Tx

Abdominal Trauma

-Def

-Penetrating trauma requires

-SXS

-Site of signficant (___mL) blood loss frequently not found by PE include

-Radiology

-NEXT Step: HD unstable pt with blunt trauma should be

-Tx

Gu and Pelvic Trauma

-Def

-SXS

-A foley catheter should NEVER be placed in a patient with a

-Radiology

-Tx

Next Step: Perform a ____ in any pt with a combined bone and neruovascular extremity injury because ____

Extremity Trauma

-def

-SXS

-Radiology

-Treatment

Next Step: ____ should be performed following any type of tx for an extremity for an extremity to detect an _____

Trauma during pregnancy

-Leading cause of

-Anatomic differences

-Low risk of fetal death with

-Trauma increases the risk of

-SXS

-Criteria that should be met in post traumatic women before discharge are

-Treatment

Where is the easiest two access points for insertion of swan-Ganz catheter insertion

Left subclavian and right internal jugular veins

Arterial line

Pulmonary artery catheter

Rh blood groups

What type of errors are most common cause of transfusion reactions

clerical errors

Transfusion reactions

-Nonhemolytic febrile

-Acute hemolytic

-Delayed hemolytic

-Anaphylactic

-Minor Allergic reactions

-Posttransfusion purpura

-general SXS

-Labs

-Tx

Greatest risk for postop MI is within

initial 48 hours after surgery

Cardiac risk

-young healthy patients

-high surgical risk for cardiac event

Pulmonary concerns of surgery

Renal concerns of surgery

Hepatic concerns of surgery

DM concerns of surgery

Coagulation concerns for surgery

LMWH should NOT be restarted for at least ____ after removal of an epidural catheter to avoid formation of _____

at least 2 hours

epidural hematoma

Causes of Post op fever

-when seen

-dx

• PNA

• UTI

• Wound/IV catheter

• DVT

• Pulmonary embolism

• Meds

• Transfusion reaction

Any post op fever should be evaluated with

CXR

CBC

UA

Urine and blood cultures should also be performed for any fever beyond the first post op day

5Ws of post op fever

Types of Wounds

Wound approximation and healing

What is no longer considered a cause of post op fever

atelectasis

Causes of acute abdomen

-SXS

-DX

-Tx

• Obstruction/Strangulation

• Diverticulitis

• Massive GI Hemorrhage/Perforation

Causes of acute abdomen

-SXS

-DX

-Tx

• appendicitis

• Mesenteric ischemia

• pancreatitis

• Ruptured ectopic pregnancy

• PID

Acute abdomen

-SXS

-LABS

-Radiology

-Tx

Malignant Hyperthermia

-Def

-SXS

-Labs

-Tx

Individuals with specific infection may be used as donors for

Indications and selection for transplantation

-considered in cases of

-Transplant frequency

-Donor selection

GVHD

-def

-host is

-RF

-SXS

-Labs

-Tx

-Complications

Forms of transplant rejection