EM Exam 2 (quizlet)

T/F: Part of a child abuse physical exam includes a speculum exam

False- no need for speculum exam unless it is an older adolescent or perforating vaginal trauma is suspected

Bites > ____cm are the bite marks of an adult

3

Cigarette burns are usually _____mm

5

______ fractures are suspicious for child abuse

Spiral

Any serious injury in a child < ____ y/o is suspicious

5

T/F: All states require you to report suspected child abuse

True

Parent induces or fabricates an illness in a child to secure for himself or herself prolonged contact with health care providers

Munchausen

Always put evidence of sexual abuse in (paper/plastic) bags

Paper

3 categories of elderly abuse

1. Domestic elder abuse that occurs in the home
2. Institutional elder abuse
3. Self-neglect or self-abuse

MC perpetrator of ED violence

Males with hx of substance abuse

MC functional disorder relating to violent behavior in the ED

Schizophrenia

3 phases of ED violence

Anxiety, Defensiveness, Physical aggression

Meds to manage violent behavior in the ED

IM Ketamine, B52, Geodon, Benzos

Cold extremities, Tachy, Pale conjunctiva. DDx?

Anemia

3 MCCs of anemia in US

Iron deficiency, Thalassemia, Anemic of chronic disease

A platelet transfusion should be considered when the platelet count is < _______ uL

10,000

ASA --> (reversible/irreversible) impairment in platelet aggregation

Irreversible

NSAIDs, Clopidogrel, Ticlopidine --> (reversible/irreversible) impairment in platelet aggregation

Reversible

What organ does Tylenol damage in an overdose?

Liver

What is one of the most sensitive tests to get in a Tylenol overdose?

PT/INR

Characterized by inappropriate & widespread activation of the coagulation system

DIC

Widespread arterial/venous thromboses, a sign of significant bacteremia

Purpura fulminans

Deficiency of factor VIII

Hemophilia A (Classic hemophilia)

Deficiency of factor IX

Hemophilia B (Christmas disease)

In a hemophiliac patient, the (PT/aPTT) will be ABNORMAL

aPTT

MC congenital bleeding disorder

Von Willebrand disease

What lab findings will be ABNORMAL in a patient with Von Willebrand?

Prolonged bleeding time & aPTT

Tx for Von Willebrand disease

DDAVP

Most distinguishing clinical feature of sickle cell disease

Pain crises

Mainstay of tx for sickle cell crisis

Opioids + Hydration

For sickle cell patients with frequent & severe pain, long term _______ is presently the accepted tx

Hydroxyurea

Hallmark of Thalassemias

Microcytic, hypochromic, hemolytic anemia

Microcytic, hypochromic, hemolytic anemia

Thalassemia

Common symptom of hereditary spherocytosis

Neonatal jaundice

T/F: Patients with hereditary spherocytosis are mostly asymptomatic

True

Antibodies formed against an individual's own RBCs

Autoimmune hemolytic anemia

Testing for autoimmune hemolytic anemia

DAT, Direct/Indirect Coombs test

MC precipitating event of TTP

Pregnancy

Schistocytes or helmet cells on peripheral blood smear

TTP

Tx for TTP

Daily plasma exchange

______ units of PRBCs increases in Hct 3%, Hgb 1 g/dL

1

1 units of PRBCs increases in Hct ____%, Hgb 1 g/dL

3

1 units of PRBCs increases in Hct 3%, Hgb _____ g/dL

1

Primary role of a cryoprecipitate transfusion

Replacement of fibrinogen or vWF

An immediate transfusion reaction indicates _____-

Human error

MC transfusion reaction

Fever

How do you prevent a febrile transfusion reaction?

Pretreat with Tylenol + Benadryl

Reversal of warfarin

Vitamin K + FFP (K-centra new med)

There is a risk of ________ with Warfarin reversal

Recurrent thrombosis

Reversal for heparin

Protamine

1st gen fibrinolytics

Streptokinase, Antistreplase

2nd gen fibrinolytics

Alteplase, tPA

Streptokinase & Antistreplase can be antigenic and should NOT be administered within 12 months of a ________

Streptococcal infection

Most catastrophic complication of fibrinolytics

Intracranial hemorrhage

Tx for CO poisoning

Normobaric O2

Nonfreezing cold injuries

Chilblains/Pernio & Trench foot

Mild, but uncomfortable inflammatory lesions of the skin caused by chronic intermittent exposure to nonfreezing cold temps

Chilblains/Pernio

Direct injury to soft tissue sustained from prolonged cooling, accelerated by wet conditions

Trench foot

Freezing cold injuries

Frostnip, Frostbite

3 zones of frostbite injury

Zone of coagulation, Zone of stasis, Zone of hypermia

What zone of frostbite injury:
Most severe and usually distal, irreversible

Zone of coagulation

What zone of frostbite injury:
Middle ground, severe, but possibly reversible, cell damage, Tx may have benefit

Zone of stasis

What zone of frostbite injury:
More superficial, typically proximal, with the least cellular damage, and generally recovers without tx in < 10 days

Zone of hyperemia

Superficial freeze injury in the absence of progressive tissue loss, symptoms resolve on rewarming

Frostnip

What degree frostbite injury:
Partial skin freezing, erythema, mild edema, lack of blisters, skin desquamation
Prognosis is excellent

1st degree

What degree frostbite injury:
Full-thickness skin freezing, formation of substantial edema, erythema, formation of clear blisters (form black, hard eschars)
Prognosis is good

2nd degree

What degree frostbite injury:
Extends into the subdermal plexus, hemorrhagic blisters, skin necrosis and a blue-grey discoloration of the skin
Prognosis is often poor

3rd degree

What degree frostbite injury:
Extends into subcutaneous tissues, muscle, bone, and tendon (dry, black, mummified eschar)
Prognosis is extremely poor

4th degree

Most effective tx of frostbite in ER

Rapid rewarming

Should you drain hemorrhagic blisters with frostbite?

No

Hypothermia = core temp of < ____F

95

Hypothermia results when _______

Body heat loss exceeds body heat production

Initial EKG findings with hypothermia

Brady & slow Afib

Terminal EKG rhythm with hypothermia

Vfib or asystole

In a stable hypothermic patient, the goal is to increase the core temp by ____C/hr

1

MCC of environmentally related deaths in the US

Heat illnesses

Postural hypotension from vasodilation, volume depletion, and decreased vascular tone

Heat syncope

Painful, contractions of calves, thighs, or shoulders in patient sweating liberally & drinking hypotonic soln (H2O)

Heat cramps

Salt & H2O depletion causing orthostasis & hyperthermia

Heat exhaustion

Hallmarks of heat stroke

- Cerebral dysfunction with impaired consciousness
- High fever
- Absence of sweating

- Cerebral dysfunction with impaired consciousness
- High fever
- Absence of sweating

Heat stroke

What meds should be avoided in the tx of heat stroke?

ASA & Tylenol

Leading cause of death in burn patients

Systemic infection

Rule of 9s adult:

Each arm

9%

Rule of 9s adult:

Each leg

18%

Rule of 9s adult:

Genitalia

1%

Rule of 9s adult:

Anterior trunk

18%

Rule of 9s adult:

Posterior trunk

18%

Rule of 9s adult:

Head

9%

Rule of 9s adult:

Each palm

1%

MC used IV fluid for burn patients

LR

Formula used to calculate initial fluid requirements in burn patients

Parkland formula

Parkland formula

4mL x BW (kg) x TBSA (%) = total fluids in first 24 hours
*half of total volume given in 1st 8 hours, other half given in next 16 hours

Urine output for a burns patient should be between ______ mL/kg/hr

30-50

Common topical agent used on burns

Silver sulfadiazine cream

Survival >24 hours after a submersion event

Near-drowning

Prolonged pain and injury to the TM, may hemorrhage or rupture, Sinus barotrauma from submucosal hemorrhage, Inner ear
a. Barotrauma of descent
b. Barotrauma of ascent

Barotrauma of descent

Air trapping in the middle ear --> alternobaric vertigo, Air expands in the lungs, swallowed air expands --> distention, abdominal cramps
a. Barotrauma of descent
b. Barotrauma of ascent

Barotrauma of ascent

- Air enters the left side of the vascular system from pulmonary barotrauma in diving
- Suspect in any diver who loses consciousness on ascent or loses consciousness within 10 min of surfacing

Arterial gas embolism

MC fish envenomation

Stingrays