What abdominal surgery has further complications that can present later in the emergency department? The reason it is critical in the past medical history.
Bariatric Surgery
A fast exam should be considered in what traumas?
Are there any contraindications
All abdominal and throacic trauma
No absolute; should not delay treatment in unstable pts
Some diagnosis are not well defined on US and may require further imaging with CT
Where is the ultrasound placed in a FAST Exam?
- Subcostal: Pericardium
- RUQ: Perihepatic
- LUQ: Perisplenic
- Pelvis: Suprapubic
What is being looked at in the RUQ of the FAST Exam?
Assessing fluid around the liver and right kidney (Morsen’s Pouch)
In abdominal aortic aneurysm is it common to see an ischemic limb on exam?
Yes, usually at least one limb due a thromboembolism or decreased blood flow.
What is the triad of sympoms associated with a AAA?
- Hypotension
- Pain
- Pulsatile Mass
What labs should be ordered in a AAA?
What about imaging?
- CBC
- CMP
- Troponin
- Type and Screen
- PT/PTT
FAST exam, CTA, XR
What is the initial management of AAA?
Is hypotension acceptable in a patient with AAA?
- IV/O2/Monitor
- Call your friends
- Reverse coagulopathy
- Blood products if ruptured or hypotensive
- Time is of the essence
- REBOA: good to know about but less likely to use as surgery is definitive
Yes, allow for hypotension with goal SBP 90 mmHg
- Support with blood products
- If hypertensive give Nicardipine drip and Esmolol to prevent dysrhythmias
Who is at the highest risk for massive GI bleeds?
Alcoholics
Who most classicaly gets Mallory-Wiesse Tears?
What is being torn?
Drunk College Students
Typically after a binge drinking and throwing up
Incomplete tear, only affects mucosa and submucosa
What is the purpose for giving oxtreotide in GI bleeding?
Can help decrease portal venous pressure, decreases gastric acid and shunts away from spleen
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Introduction to Emergency Medicine16
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Trauma37
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EM Arrhythmia13
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Chest Pain and Cardiac Emergencies8
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Orthopedics EM8
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Respiratory Emergencies28
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OBGYN Emergencies16
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Questions1
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EM Neuro and Neurosurgery43
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Shock12
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EM Burn and Wound Management18
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Environmental Emergencies16
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Infectious Disease EM27
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AMS5
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Abdominal11
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Toxicology10
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EM Other15
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Psychiatric Emergencies14
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Electrolyte Emergencies11
