EM test 4

acidosis

pH less than 7.35

alkalosis ph

more than 7.45

Normal PaCO2 range

35-45 mmHg

Normal HCO3

21-27

high pH normal CO2 low HCO3

metabolic alkalosis

Normal HCO3 ranges

respiratory

Normal CO2

metabolic

What causes respiratory acidosis

Hypoventilation

What causes respiratory alkalosis

Hyperventilation

Most common causes of metabolic alkalosis

excessive diuresis

excessive loss of gastric secretion

Hypotonic fluids

goes OUT of the vessel Into the cell

Isotonic fluids

stays where I put it

HypErtonic fluids

Enter the vessel from the cells

Bolus fluid rate

20 ml/kg

Maintence fluid rate

4/2/1 rule

mainteance fluid rate for a 70 kg patient

10 x 4= 40

10 x 2= 20

50 x 1=50 50

total 110ml/hr

When altered, fluid and electrolyte should be corrected in the following order:

volume

pH

potassium, calcium, magenesium

sodium and chloride

Hyponatremia usually due to

water excess

Hyperkalemia causes

eKg changes

U wave on ekg

hypokalemia

Hypocalcemia most common cause

CKD

Signs of hypocalemia

Chovstek sign

Trousseau sign

chornic kindey disease suration

mimimum of 3 months

AKI vs CKD

AKI (acute kidney injury)

-sudden

-commonly caused by injury or necrosis

-oliguria

-elevated creatinine

-reversible

-infection causes death

CKD (chronic kidney disease)

-gradual/years

-caused by diabetic neuropathy

-GFR is

-kidney damage occurs after 3 mo

-CAD causes death

Emergency indications for Dialysis

AEIOU

Acidosis that is not responding

Electrolytes

Intoxication

Overloud in volume

Uremia

What distinguses bursal fluid from cellulitis

ultrasound the bursa

T/F Do not aspirate a purely microtrauamtic bursitis

true

When should a bursa be aspirated

when infection is suspected

first line for bursistis

iv antistaph abx

tense throbbing painful distal pulp

felon

A deep space infection of a digit's flexor tendon sheath, usually resulting from penetrating volar trauma. It is classified as a high-risk, low-prevalence emergency.

flexor tenosynovitis

kanavel's 4 cardinal signs

-Symmetric/*fusiform* swelling of digit

-Tenderness along entire tendon sheath (late finding)

-Severe pain with passive extension (earliest finding)

-Finger held in mild flexion

flexor tenosynovitis tx

iv abx

most common cause of osteomyelitis

MSSA

The diagnosis of osteomyelitis

culture from bone biopsy

most common site for compartment syndrome

calf

what is needed after all post reductions

post reduction films

superir reduction technique for pain contrpl

FARES

An isolated single bone forearm fracture needs

imaging of both elbow and wrist

fracture or dislocation with tented skin

reduce ASAP

KANAVEL 4 signs + volar puncture

IV ABX and emergent hand surgery, no imaging

first 5 min steps

1. airway and vitals

2. glucose check

3. who saw them last

4. focused exam

at what time frame are stroke patients eligible for iv thrombolysis

0-4.5 hours

T/F a low NIHSS stroke score can still be a disabling stroke

true

First-line IV thrombolysis

Tenecetplase 0.25 mg/kg IV bolus, max 25 mg

tenecetplase window

less than 4.5 hours in eligble patients with disabling deficets

What study catches a large vessel occlusion

CTA

LVO treatment

EVT

target BP before IV thrombolysis

less than 185/110

short term treatment for TIA

aspirin + clopidogrel short term then single antiplatelet therapy

star shapped blood in the cisterns and fissures

subarachnoid hemmorhage

crescent on the convexity crosses suture lines

subdural hematoma

hyperdense blood within brian parenchya

intracerbral hemorghage

Intracebral hemorhage bundle

control bp + reverse anticoagulation + call neurosuergy

warfarin reversal agent

4F-PCC + vitamin K 10 mg IV

Dabigatran reversal agent

Idarucizumab

factor Xa inhibitor reversal agent

4F-PCC

Heparin reversal agent

Protamine

What does a subarachnoid patient need within 6hours

CT

If you suspect subarachnoid and the CT is normal what do you do next

lumbar puncture

headache + seizure + focal deficits + papiledema + prothrombotic like pregnancy/postpartum

Cerebral venous thrombosis

Proptosis + chemosis + painful othmalgia

cavernous sinus thrombosis

Prolonged confusion, lateral tongue injury, or a convincing postictal period → favors

seizure

Vasovagal-type prodrome and rapid return to baseline → favor

syncope

Treat ongoing convulsive seizure activity at

5 min

status epilepticus tx

Lorazepam at 5 min

still seizing after lorazepam give

Levetiracetam 60 mg/kg IV (max 4.5 g) OR fosphenytoin 20 mg PE/kg IV (max 1.5 g PE)

Persistent seizure despite adequate benzodiazepine plus second-line therapy =

refractory status and requires escalation to airway control, continuous anesthetic therapy, and EEG

hypeventilation is a _______

TEMPORARY BRIDGE

Patients who need CT before LP because

focal neurologic deficits, new seizure, papilledema, significant immunocompromise, or markedly impaired consciousness

UNSTABLE

what is given afetr LP in bacterial men

dexamethasone +empric abx

For HSV encephalitis, think:

Fever

Behavioral/personality change

Confusion

Aphasia or focal findings

Seizure

Temporal-lobe abnormalities

high risk head injury

GCS

A normal head impulse, direction-changing/vertical nystagmus, or skew should raise concern for a

central cause

Progressive symmetric weakness with decreased reflexes

Guillain-Barré:

Guillain-Barré tx

IVIG or plasma exchange

NO STEROIDS

alling level of consciousness, new fixed pupil, and posturing are emergency findings.

herniation

3 things before any diagnosis made

glucose level

last known well

focused exam

Hot, dry, mydriatic

Agitation/confusion

Decreased bowel activity

Urinary retention

anticholinergic

Hot and agitated

Mydriasis

Tachycardia/hypertension

Diaphoresis

Sympathomimetic

Miosis

Secretions

Bronchorrhea/bronchospasm

GI/GU hyperactivity

cholinergic

Rapid onset of clonus and hyperreflexia

serotonin syndrome

lead pipe rigid + diminished reflex days after a med

neuroepileptic malignant

tx for malignant hyperthermia

Dantrolene

qrs greater than 100

sodium channel block

Terminal R in aVR

sodium channel block

sodium channel blockage tx

sodium bicarb

the Rumack-Matthew nomogram applies when

there is a signle acute ingestion

the Rumack-Matthew nomogram does NOT apply when

repetaed ingestions

unkown time of ingestion

IV NAC most effective

within 8 hours

Tinnitus + tachypnea/hyperpnea + altered mental status

Salicylates toxicity

What acid base disturbance do salicylates cause

respiratory alkalosis + anion gap metabolic acidosis

Salicylates toxicity tx

Bicarb bolus then bicarb infusion

what should be avoided in Salicylates toxicity

intubation

heat exhaustion vs heat stroke

stroke has mental status changes

delrium vs psychosis

delirum: INATTENTION with abnormal vitals

fda approved to treat frost bite

Iloprast