EM E1 -Study guide/bold (c/o 2024 quizlet)

Once communication has been established with the receiving facility, the care of the pt can be directed by _______

ER physician

Ground ambulance or air transport:

Lifesaving maneuvers such as BLS and ALS can be performed

Ground ambulances

ALS or BLS ambulance:

Equipped for the EMT-B level

BLS ambulance

ALS or BLS ambulance:

Capable of providing drug therapy and advanced medical procedures

ALS ambulance

When should air transport be used over ground ambulance?

For critically ill pts when ground transport time would be too long, or if terrain is difficult to navigate

What patients need to be first stabilized at the closest facility?

Pts in respiratory or cardiac arrest

Act that governs Medicare program participating hospitals considering patient transport

EMTALA

What masks are capable of filtering 99.97% of airborne particles?

HEPA, M95, N95, chemical-specific

What equipment can be used to immobilize the spinal cord?

Back boards & C-collars

Are cervical collars adequate for cervical immobilization alone?

No- requires lateral support, back board

What should be presumed as a cause of illness in any sick neonate?

Infection

Biological agents are classified into what two groups?

Infectious agents and biologically produced toxins

Infectious agents or biologically produced toxins:

Smallpox, anthrax, plague

Infectious agents

Infectious agents or biologically produced toxins:

Sarin gas, mustard gas

Biologically produced toxins

Which form of smallpox had a higher mortality rate: variola major or variola minor?

Variola major

Variola virus

Smallpox

Tx for smallpox

Supportive, Tecovirimat

What diagnostic test should be ordered if anthrax meningitis is suspected?

Lumbar puncture

Three major anthrax syndromes

Cutaneous, inhalation, and GI tract anthrax

Yersinia pestis

Bubonic plague

"Black death"

Bubonic plague

How long is the incubation period for the Bubonic plague?

2-8 days

What major clinical syndrome associated with plague accounts for the 80-95% of cases?

A) Septicemic plague

B) Bubonic plague

C) Pneumonic plague

B) Bubonic plague

Area of spill or chemical release, of the hospital area where arriving patients without decontamination are held

Hot zone

Area where thorough decontamination and medical stabilization occur

Warm zone

Area to which fully decontaminated patients are transferred

Cold zone

Transient period of self-limiting symptoms (anorexia, nausea, vomiting and diarrhea)

Prodromal phase

Symptom free interval, 1-3 weeks

Latent phase

Dose-dependent subsyndromes

Manifest illness phase

AKA bone marrow sickness

Hematopoietic syndrome

3 types of syndromes in the manifest illness phase

Hematopoietic syndrome, GI syndrome, CV and CNS syndrome

3 opioid receptors

Delta, kappa, mu

What is the basis for pain assessment and treatment in the ED?

Pt's subjective reporting of pain (NOT the physician's impression)

T/F: you should NOT rely on nonverbal signs (tachycardia, tachypnea, and changes in pt expression/movements) to determine the severity of the pt's pain

True

Control pain to the level the ______

Patient desires

Variation in respiratory and CV signs and changes and changes in pt expression/movement can occur due to pain

A) Self-report measurement

B) Non-self report measurement

B) Non-self report measurement

More commonly used in the pediatric setting

A) Self-report measurement

B) Non-self report measurement

B) Non-self report measurement

Mainstay of pain assessment

A) Self-report measurement

B) Non-self report measurement

A) Self-report measurement

Usually require only a verbal response, pain scale

A) Self-report measurement

B) Non-self report measurement

A) Self-report measurement

What is the preferred pain assessment tool when there are language difficulties or cross-cultural differences?

Visual analog scale

For acute pain management, the _____ approach unnecessarily subjects the pt to more prolonged suffering

Tiered

When should opioids be withheld in pain management?

Respiratory depression- <10 breaths/min

What drug class may increase the risk of cardiac death in patients with ischemic heart disease?

NSAIDs

What drug class may cause ARF in the elderly, volume depleted, preexisting renal/cardiac disease, and loop diuretics?

NSAIDs

What local anesthetic:

Shorter duration of action, lower toxicity profile

Lidocaine

What local anesthetic:

Short onset, longer duration of action

Mepivacaine

What local anesthetic:

Used in topical anesthetic preparations (eyes)

Tetracaine

What local anesthetic:

Oral procedures, GI

Cetacaine spray

For intercostal blocks, the recommended dose is _____ maximum for peripheral blocks

1/10

What local anesthetic has the highest incidence of CB toxicity?

Bupivacaine

MC usage of local anesthetics in the ED

Local infiltration into wound margins or in a "diamond-shaped wheal (Auricular block)"

Local anesthetic that is the drug of choice for brief procedures

Lidocaine

What needs to be documented before application of a peripheral nerve block?

Neurovascular status

What does it mean if the patient has severe pain during needle insertion of a peripheral nerve block?

Contact with the nerve- WITHDRAW AND REPOSITION before injection

What type of regional anesthetic:

Procedures on the digits, hands or feet

Peripheral nerve block

What type of regional anesthetic:

Requires less total LA medication, site of drug delivery is less painful than that for local infiltration

Peripheral nerve block

The ____ nerve is anesthetized by inserting a 27 gauge needle perpendicular to the skin between the tendons of the palmaris longus and flexor carpi radialis muscles

Median

The ____ nerve is anesthetized by passing a 27-gauge needle between the ulnar artery and the flexor carpi ulnaris at the level of the proximal volar skin crease

Ulnar

The ____ nerve can be blocked beginning at the level of the tendon of the extensor carpi radialis and extending around the dorsum of the wrist to the styloid process

Radial

What type of regional anesthesia is excellent for fingers, laceration repair, I&D of paronychia, and nail removal/repair?

Digital nerve block

CI to digital nerve block

Any compromise to digits' blood supply

What is avoided in a toe block due to irreversible ischemia?

Epinephrine

Type of block that is simple, quick, and effective for isolated closed fx reduction

Hematoma block

AKA IV regional block

Bier's block

Type of block that is good when IV block is contraindicated

Hematoma block

IV infusion of local anesthetic distal to an inflated pneumatic tourniquet

Bier's block

Block that is good for fx reductions, large lacerations, and FB removal

Bier's block

CI to Bier's block

PVD, Raynaud's, sickle cell, cardiac conduction abnormalities, HTN, cellulitis, children <5

Assess _____ status in the involved limb before application of the block to prevent masking a primary traumatic neurovascular injury

Neurovascular status

MC analgesics in PSA

Opioids

What patients should NOT receive ketamine?

Pts with psychosis or schizophrenia

What anesthetic agent should NOT be used in pts with psychosis or schizophrenia due to SEs of nightmares and hallucinations?

Ketamine

Agent for reversal of unwanted respiratory depression after opioid administration

Naloxone (Narcan)

Agent indicated for reversal of respiratory depression caused by benzodiazepine during PSA, routine use to "awaken" pts is NOT recommended

Flumazenil (Romazicon)

What is the goal of therapy when treating chronic pain?

Pain reduction and return to functional status

Classic sx of complex regional pain (type I and type II)

Allodynia, persistent burning/shooting pain

Early treatment with _____ may reduce ongoing sx in complex regional pain

Steroids

"Four Ds" to describe physicians who contribute to prescription drug abuse

Disabled, dishonest, duped, dated

______ patients are very persistent and successful

Drug-seeking

Circulatory insufficiency that creates an imbalance between tissue oxygen supply and oxygen demand

Shock

When compensatory mechanisms fail to correct the imbalance between tissue supply and demand, anaerobic metabolism occurs resulting in the formation of ______

Lactic acid

Primary tx of acidosis in shock

Reverse the underlying cause

T/F: Exogenous bicarb may be given to improve intracellular acidosis in pts with shock

False

3 goals in the ED for tx of a pt with hypovolemic/hemorrhagic shock

Maximize O2 delivery, control further blood loss, fluid resuscitation

When can O+ blood be given for a blood transfusion in patients with shock?

Someone who is over child-bearing age (male or female)

In an acute setting, what type of blood is normally given to hypovolemic/hemorrhagic shock patients?

O-

T/F: Every patient who meets SIRS criteria is considered septic

False

T/F: Increased WBC count does NOT always equal infectious process

True

2 MC used methods to identify early sepsis

qSOFA and NEWS2

What disease states are predisposing to sepsis?

Malignancy, DM, chronic liver disease, CRF, use of immunosuppressive agents

MCCs of sepsis

Respiratory tract infection and UTIs

Common presentation of sepsis in the elderly

Altered mental status

4 clinical goals of sepsis treatment in the ED

1) Blood cultures before abx

2) Lactate before 90 min

3) IV abx before 60 min

4) 30 mL/kg of IVF before 180 min

When should lactate be drawn when treating sepsis in the ED?

Before 90 min

When should IV abx be initiated when treating sepsis in the ED?

Before 60 min

When should IV fluids be initiated when treating sepsis in the ED?

Before 180 min

_____ mL/kg of IV fluids should be given before 180 min when treating sepsis in the ED

30 mL/kg

ALL clinicians need a ______ during ANY GENITAL exam

Chaperone

What is the #1 lab study that should be ordered for a pt who presents with AUB?

Urine or serum HCG

When should an US be ordered for a pt who presents with AUB?

If + pregnancy test, pain with bleeding, or no other etiology