Introduction to Complex & Emergency Medicine Study Guide

Vocabulary flashcards covering core concepts, terminology, triage systems, hemodynamic values, acid-base imbalances, and emergency medicine protocols from Unit 1.

Level 1 Trauma Center

A regional resource providing leadership and comprehensive care from prevention through rehabilitation.

Level 2 Trauma Center

A community hospital that provides care for the majority of injured patients.

Level 3 Trauma Center

A usually smaller or rural facility focused on initial stabilization and transfer.

Level 4 Trauma Center

A rural or remote facility providing Advanced Cardiovascular Life Support (ACLS) and transfer.

EMTALA

Emergency Medical Treatment and Active Labor Act; prevents refusing care to uninsured patients and mandates ED evaluation and stabilization before discharge or transfer.

Full Code

Full resuscitation measures.

DNR

Do Not Resuscitate; no CPR/resuscitation and no intubation per the lecture material.

DNI

Do Not Intubate; no intubation, though CPR and medications may still be performed.

MOLST

Medical Orders for Life-Sustaining Treatment.

MOST

Medical Orders for Scope of Treatment.

POLST

Physician Orders for Life-Sustaining Treatment.

POST

Physician Orders for Scope of Treatment.

Emergent Category

Triage category defined as an immediate threat to life or limb.

Urgent Category

Triage category defined as requiring quick treatment, but no immediate threat to life at the moment.

Nonurgent Category

Triage category defined as able to wait several hours without significant risk.

Emergency Severity Index (ESI) Level 1

Triage classification indicating resuscitation is needed for a patient who is dying and needs life-saving intervention.

Emergency Severity Index (ESI) Level 2

Triage classification indicating high risk, severe pain/distress, or a patient who would take the last empty bed.

Emergency Severity Index (ESI) Level 3

Triage classification indicating two or more resources are needed.

Emergency Severity Index (ESI) Level 4

Triage classification indicating one resource is needed.

Emergency Severity Index (ESI) Level 5

Triage classification indicating no resources are needed.

ABCDE Mnemonic

Primary trauma survey components: Airway (obstruction, secretions, loose teeth), Breathing ($\text{O}_2$, labored breathing, accessory muscles), Circulation (bleeding, fluid status, BP), Disability (GCS, blood sugar), and Environment (temperature, surroundings).

SAMPLE Mnemonic

History taking memory aid: Signs & Symptoms, Allergies, Medications, Past Medical History, Last Oral Intake, and Events leading up to injury.

MOVIES Mnemonic

Immediate emergency setup memory aid: Monitor, Oxygen, Vitals, IV Access, EKG, and Sugar.

Mean Arterial Pressure (MAP)

Average arterial pressure during one cardiac cycle, with a lecture value of $>65$ (usual $70-100$).

Central Venous Pressure (CVP)

Vena cava pressure or right ventricular preload, with a lecture value of $2-6$.

Cardiac Output (CO)

Calculated as $\text{CO} = \text{HR} \times \text{SV}$, with a normal lecture value of $4-8\,\text{L/min}$.

Cardiac Index (CI)

Cardiac output according to body surface area, with a lecture value of $2.5-4$.

Systemic Vascular Resistance (SVR)

Resistance required to push blood through circulation, with a lecture value of $800-1200$.

Stroke Volume Variation (SVV)

Changes in stroke volume driven by the respiratory cycle and fluid status.

End-Tidal \text{CO}_2 (EtCO_2)

Indicator of ventilation/respiratory status, with a normal lecture value of $35-45$.

Ejection Fraction (EF)

Percentage of blood ejected during contraction divided by total blood in LV, with a lecture value of $55-70\%$.

SBAR

Standardized communication framework consisting of Situation (what's happening?), Background (relevant history), Assessment (what you see), and Recommendations/Requests (what you need).

FYI Communication

Communication used for a change or finding the provider should know about that is not urgent and requires no immediate action.

CALL Communication

Communication used when a patient needs assessment, orders, clarification, or a decision, but is not an immediate emergency.

COME Communication

Communication used for a significant or potentially unstable change requiring the provider at the bedside immediately.

Respiratory Acidosis

Acid-base imbalance with a pH $<7.35$ and $\text{PaCO}_2 > 45$, caused by hypoventilation or $\text{CO}_2$ retention.

Respiratory Alkalosis

Acid-base imbalance with a pH $>7.45$ and $\text{PaCO}_2 < 35$, caused by hyperventilation.

Metabolic Acidosis

Acid-base imbalance with a pH $<7.35$ and $\text{HCO}_3 < 22$, caused by GI/renal bicarbonate loss, DKA, sepsis, or lactic acidosis.

Metabolic Alkalosis

Acid-base imbalance with a pH $>7.45$ and $\text{HCO}_3 > 29$, caused by vomiting, suctioning, excess bicarbonate, or diuretics.

Hypoxemic Respiratory Failure

Type of respiratory failure defined by $\text{PaO}_2 < 60$, driven by V/Q mismatch and shunt.

Hypercapnic Respiratory Failure

Type of respiratory failure defined by $\text{PaCO}_2 > 50$ AND pH $<7.35$, driven by alveolar hypoventilation ('pump failure').

SALT Mnemonic

Hypernatremia key findings memory aid: Seizure, Agitation, Low UOP, and Thirst.

SWELL Mnemonic

Hyponatremia key findings memory aid: Seizures, Weakness, cerebral Edema, Lethargy, and Low LOC/Confusion.

SLOW Mnemonic

Hypermagnesemia key findings memory aid: Sleepy/drowsy, Low reflexes, Oppressed respirations, and Weakness.

TORSAD Mnemonic

Hypomagnesemia key findings memory aid: Torsades risk, Overactive reflexes, Restless tremors, Seizures, Arrhythmias, and increased DTRs.

STONE Mnemonic

Hypercalcemia key findings memory aid: Stones, Tired/lethargy, Overactive bone pain, Nausea/constipation, and EKG changes.

SPASM Mnemonic

Hypocalcemia key findings memory aid: Seizures, Positive Chvostek, Arrhythmias, Spasms/tetany, and Muscle cramps.

Class I Antiarrhythmics

Sodium channel blockers (e.g., procainamide, flecainide, lidocaine) that slow action potential and prolong duration.

Class II Antiarrhythmics

Beta blockers (e.g., metoprolol, esmolol, propranolol) used for AFib/flutter and V-tach.

Class III Antiarrhythmics

Potassium channel blockers (e.g., amiodarone, dronedarone, sotalol) used for lethal arrhythmias, AFib, SVT, and ventricular arrhythmias.

Class IV Antiarrhythmics

Calcium channel blockers (e.g., diltiazem, verapamil) used for SVTs and slowing rapid ventricular response (RVR) in AFib/flutter.

Adenosine

Antiarrhythmic medication acting on the AV node to slow/block conduction; mainly for SVT; may cause a transient pause.

Atropine

Medication used to increase heart rate in symptomatic sinus bradycardia.

Digoxin

Medication that slows AV-node conduction and HR while increasing myocardial contraction when increased cardiac output is needed.

ABCDEF Bundle

Critical care bundle consisting of Assess pain, Breathing/SBT, Choice of analgesia/SAT, Delirium, Early mobility, and Family engagement.

Rapid Response

Team response for acute changes or deterioration in respiratory, cardiac, BP, mental status, or hypoxemia ('They're getting worse').

Code Blue

Emergency response for an unresponsive patient with no pulse or full cardiac arrest ('They're in cardiac arrest').

Sinus Pause

Dysrhythmia occurring when the electrical impulse from the SA node does not initiate or travel as expected.

Sinus Arrest

Complete loss of electrical conduction from the SA node, causing sustained asystole in the atria.