E1 EM Review (quizlet)

What type of transport should be used for lifesaving maneuvers, BLS, & ALS

Ground transport

What type of transport should be used for critically ill patients or difficult terrain

Air transport

EMS picks up a choking 5 y/o female who is unable to breathe, where should they take her? (Regional or pediatric hospital)

Regional first, EMS might not be equipped for critically ill pts

Stabilize first at ER, then transfer

Pts in cardiac or respiratory arrest go where?

CLOSEST facility

What prohibits ERs from refusing to treat pts

EMTALA

Also prohibits inappropriate transfer of pts

Paramedics operating under a medical director is an example of what type of communication

Indirect

EMS giving vitals to the ER physician is an example of what type of communication

Direct

What should be used to preserve the spinal cord

C spine collar and back boards

What are the decontamination zones

Hot: patients without decontamination / area of spill

Warm: where decontamination and stabilization occurs

Cold: area where fully decontaminated pts go

What class of bioterroism would smallpox, anthrax, and botulism be in?

Class A: highest risk

Class C is lowest risk (B in the middle)

What are chemical agents such as sarin and mustard gas an example of?

Biologically produced toxins

What are contagious agents such as viruses and example of

Infectious agents

Plz know the reversal of opioids and benzos by now

Opioids: naloxone

Benzos: flumazenil

Foot, wrist, and digital blocks are examples of what type of block?

Peripheral nerve block

What should you document before administering a nerve block?

Neuro-vascular status

Your pt has severe pain when you insert the lidocaine, how should you proceed?

Withdraw and reposition

Severe pain = nerve contact

What areas should you not inject epinephrine

Nose, toes, fingers, and hose

What type of block is recommended for fracture reduction, large lacs or FB removal?

IV regional block (Biers block)

Infusion of lido+epi distal to inflated pneumatic tourniquet

Contraindications to biers block

PVD / Raynauds

Sickle Cell

Cardiac conduction probs

HTN

Cellulitis

Kids <5

Alt: Hematoma block

Opioid receptors

Delta, kappa, mu

How would you evaluate pain

Self report measurement : control pain to PATIENTs desires

*do NOT rely on non-self report measurement

4 clinical goals of sepsis

1. Blood cx BEFORE abx
2. Lactate < 90 mins
3. IV abx < 60 mins
4. 30 ml/kg of IVFs <180 mins

Treatment of choice for cardiogenic shock

PCI / CABG

Alt: thrombolytics

MCC: MI

PCI should be done within how long of presentation

90 mins

Management of anaphylaxis

Maintain airway

H1 & H2 blockers

Steroids

Epi

Your pt is in anaphylactic shock and is currently taking propranolol and Metformin, how should you adjust treatment?

Give glucagon b/c BBs can be resistance to epi

Management of neurogenic shock

Atropine and and fluids

d/t hypotension and bradycardia

AUB terminology review :)

Menorrhagia: heavy flow

Metrorrhagia: btwn cycles

Menometrorrhagia: irregular heavy cycles

Amenorrhea: no bleeding >6 mos

Post-menopausal: 6 mo-1 yr after cycles

What is considered of loss of pregnancy <20 wks

Spontaneous abortion

What is the MC abortion

Threatened abortion: 1st trimester bleeding w/o dilation

What is considered vaginal bleeding WITH cervical dilation

Inevitable abortion

dilation = lost pregnancy

Incomplete vs complete abortion

Complete has passage of ALL fetal tissue <20 wks

What is considered a fetal death <20 wks without any passage of fetal tissue x 4 wks

Missed abortion

What is the long term effects of PID and how do you treat?

Can cause tubular factor infertility

Tx: Cefoxitin / ceftriaxone + doxy

Add metronidazole for outpatient

GS diagnostic testing of PID

Laparoscopy

How do you r/o ovarian torsion

Pelvic / transvag US WITH DOPPLER

MC site of ectopic pregnancy

Ampulla (fallopian tube)

What should you think if a pt has abnrormally high bHCG

Gestation trophoblastic disease

1st line treatment of N/V during pregnancy

IVFs

How do you differentiate btwn abruptly placenta and placenta previa

Placenta previa is painLESS red bleeding

What should you do before delivering the body of a baby after the head is out

Suction nose and mouth to avoid aspiration

MCC of mitral stenosis

Rheumatic heart disease

Most pts develop a fib

Mid diastolic rumbling murmur with opening snap is indicative of

Mitral stenosis

Mid systolic click is indicative of

MVP

Not gonna ask specific murmurs but know key words (opening snap / click / systolic v diastolic

:)

Systolic: AS, MR
Diastolic: AR, MS

Rupture of the chordate tendinaea, papillary muscles or valve leaflets is known as

Mitral incompetence

Definitive diagnosis of valvular disorders

TEE

Classic triad of aortic stenosis

SAD : Syncope, angina, dyspnea

Harsh systolic ejection murmur (diamond)

MCC of aortic regurgitation (incompetence)

Infective endocarditis

What should you order if you suspect an MI

FIRST >> EKG within 10 mins

2. Troponin

3. CXR / echo

How does acute coronary syndrome present and what are sx caused by

-Chest/epigastric pain radiating to neck / jaw / ear / arm
-SOB / weakness

Sx d/t ischemia

Treatment of an MI

MONA - morphine, oxygen, nitroglycerin and aspirin 325mg

PCI within 90 mins

What type of CP is episodic lasting 5-15 mins that is worsened with exertion and relieved by rest

Stable angina

What are the 3 distinct forms of unstable angina

- new onset exertional angina
- inc frequency / duration
- angina at rest

What type of CP occurs at rest, is triggered by smoking, and is d/t coronary vasospasms

Variant (Prinzmetal)

Note: have ST elevations like an MI

Pt presents to the ED with dyspnea, orthopnea, PND, with tachycardia and peripheral edema / JVP, what should you order

CHF —>

Order BNP / CXR / Echo

Pt presents with sharp precordial pain that is better when she bends forward. You appreciate a friction rub on PE. What should you initial test be?

Pericarditis —>

Initial: Echo

EKG will show diffuse ST elevation and PR depression

Severe ripping pain is indicative of

Aortic dissection

Pain in abdomen, chest, or back

When is an aortic aneurysm considered emergent

Any symptomatic aneurysm (>5.5 cm needs sx)

Asx <5 cm : monitor carefully

Pt c/o of coughing up blood and notes that it is difficult to breathe and chest hurts. What's your work up?

pulmonary embolism:

- CTA is GS

- CXR (westermark, Hampton hump)

- D Dimer

- r/o DVT with Doppler

Virchows triad

Venous stasis
Venous injury
Hypercoagulable state

Indicative of DVT

Know wells score !!!

PE likely >4 pts

How do you diagnose a DVT

D dimer and Doppler US

Venogram is GS but US is MC

What is becks triad and what is it indicative of

JVD

Hypotension

Muffled heart sounds

Associate with cardiac tamponade

Test of choice for cardiac tamponade

Echo

EKG will show electrical alternanas

Tx with pericardiocentesis

What is almost always present in restrictive cardiomyopathy

S3

Also see: Kussmauls, JVD, ascites, edema

HOCM vs Restrictive Cardiomyopathy

KNOW IT

HOCM: syncope, sudden death in athletes, LVH

Restrictive: right sided CHF sx

Paradoxical pulse, Kussmauls sign, with a pericardial "knock" accompanying SOB is indicative of

Restrictive pericarditis

Kussmaul's sign (inc JVD w/ respiration) think....

RESTRICTIVE cardiomyopathy or pericarditis

(Look @ other sx to ddx)

What are the anterior leads

V3/4

What are the septal leads

V1/2

What are the lateral leads

V5/6, I, & aVL

What are the inferior leads

II, III, & aVF

EKG: flip and dont look at the answer lol

Posterior STEMI

EKG: flip and dont look at the answer lol

Anterior-septal STEMI

EKG: flip and dont look at the answer lol

Inferior STEMI

EKG: flip and dont look at the answer lol

Inferior-lateral STEMI

EKG: flip and dont look at the answer lol

V fib

EKG: flip and dont look at the answer lol

A flutter

EKG: flip and dont look at the answer lol

A fib

EKG: flip and dont look at the answer lol

Anterior STEMI

There's gonna be EKGs :(

It's gonna be a STEMI so know your lead locations

Management of HTN

BP lowered to 160/110 over 2-6 hrs

Dec MAP no more than 20% in first hr

Immediate tx only of exam reveals EOD

Preferred test and treatment for kidney stones

Dx: CT

Tx: IVFs, 4mg Zofran, 30mg Toradol

Pt is c/o of back pain that radiates to her groin. You do a CT and see a 3 mm stone, how should you proceed

Pt will likely be able to pass

>8 is unlikely

Ig 4-8 is really difficult ??

How do you treat paraphismosis

URO EMERGENCY

Compression of glans for several minutes, puncture wounds for drainage: 10 & 2 location

How to reduce testicular torsion

EMERGENCY

Manual Detorsion: twist outward and laterally

KNOW THIS

Treatment of prostatitis

Ciprofloxacin

Alt: bactrim

UTI treatment

Bactrim, FQ, macrobid

Phenazopyridine for analgesia

Pt presents with painful and frequent urination, you do a UA and suspect a UTI. What will it show?

+ LE
+ nitrates
+ WBCs

ALWAYS culture

Types of pneumothorax

Iatrogenic: secondary to procedure

Primary spontaneous: healthy pts, no trauma

Secondary spontaneous: known lung dx

GS diagnostic testing for pneumothorax

Upright PA CXR

Management of small vs large pneumothorax's

Small: monitor

Large: catheter aspiration

How should you manage a tension pneumothorax

Immediate needle decompression

2nd intercostal space, mid clavicular line

Mediastinal shift and tracheal deviation on CXR is indicative of

Tension pneumothorax

Visualization of visceral pleural line on CXR is indicative of

Pneumothorax

Pneumomediastinum on CXR (just a pic)

Hammans sign and subcutaneous emphysema is indicative of

Pneumomediastinum

CXR shows bronchial thickening/cuffing without consolidations or infiltrates.....what is the cause of the disease?

Acute Bronchitis —> MCC is VIRAL

What will XR findings show in retropharyngeal abscess

6 at 2, 22 at 6

6 mm at C2
22 mm at C6