EM case files > Deck 1 > Flashcards

Deck 1 Flashcards

(40 cards)

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1
Q

What other bacterial illnesses can mimic common bacterial pharyngitis?

A
  • Peritonsilar abcess
  • retropharyngeal abcess
  • ludwig angina
  • epiglottitis
  • vincent angina
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2
Q

What are the centor criteria for predicting strep pharyngitis?

A
  • Tonsillar exudates = 1 pt
  • tender anterior cervical LAD = 1 pt
  • Fever by history = 1 pt
  • Absence of cough = 1 pt
  • Age under 15 = add 1 pt
  • Age over 45 = subtract 1 pt
  • 4 points = tx w/ Abx, no further testing
  • 2-3 = RAT….+ = tx , - = throat culture
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3
Q

Tx for strep pharyngitis?

A

-Penicillin po x 10 days

Or…..IM Penicillin G 600k units once

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4
Q

Tx for retropharyngeal, peritonsillar abcesses, and ludwig angina?

Tx of epiglottitis?

A
  • PCN and Flagyl

- Cefuroxime

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5
Q

What are initial diagnostic steps in working up Acute MI?

A
  • EKG
  • Troponin
    * Other labs: BMP, PT, PTT, CBC
  • Cardiac monitor
  • Get IV access
  • CXR
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6
Q

What are immediate THERAPIES for Acute MI?

A
  • Aspirin 325
  • O2
  • Sublingual nitro
  • IV beta blocker
  • IV nitro
  • LMW Heparin
  • Plavix
  • Thrombolytics if no cath available
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7
Q

What are other life-threatening conditions that can mimmick MI? (present with cp)

A
  • Aortic dissection
  • PE
  • Pneumothorax
  • Boerhaave syndrome
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8
Q

What EKG findings are indications for immediate reperfusion therapy for ACS?

A
  • ST elev > 1 mV in 2 contiguous leads

- New LBBB

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9
Q

When should troponins be repeated after first draw?

A

4 to 12 hours after

*normal level at 8 to 12 hours after pain onset essentially excludes infarction

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10
Q

How do you decide on tx for UA or NSTEMI?

A
  • ASA and nitro are minimum of therapy
  • Beta-blockers (IV) added for persistent pain, tachycardia, or HTN
  • High risk = Heparin and Plavix

-Possible cath

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11
Q

Bradyarrythmias are common complication of _________ MI, and are an indication for _________.

A
  • Anterior
  • Transvenous Pacing

*Heart block in setting of MI usually due to irreversible damage of HIS-purkinje system

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12
Q

________ MI frequently causes AV node dysfunction and _________ degree block that is transient and responsive to what medication?

A
  • Inferior
  • 2nd degree block
  • may respond to Atropine
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13
Q

Viral etiologies of pharyngitis

A

-rhino
-corona
-coxackie
-HSV
-adeno
-influenza
-CMV and EBV
-HIV
etc

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14
Q

Pt with palpitations and dyspnea on exertion…..DDx?

A
  • A-fib
  • PE
  • MI
  • anemia
  • sepsis
  • pneumonia
  • Hyperthyroidism
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15
Q

In the acute setting, what is the most important gaol of A-fib therapy?
Why?

A

Rate control

-slowing ventricular response provides positive hemodynamic effects

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16
Q

For A-fib pts who need cardioversion, who needs anticoagulation?

A

> 48 hours duration A-fib

or….

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17
Q

What are the 2 anticoagulation options for pts with A-fib receiving cardioversion?

Study These Flashcards
A
  • Coumadin (3 weeks)

- TEE + Heparin if no clot is seen ….then cardioversion can be done immediately

18
Q

What are some options for rate control of A-fib?

Study These Flashcards
A
  • Verapamil
  • Beta blockers
  • Amiodarone
  • Cardioversion (unstable pt)
  • Diltiazem
  • Digoxin
19
Q

What is the tx for pts with A-fib after cardioversion?

Study These Flashcards
A
  • AC with coumadin (from “atrial shock”)

- Antiarrhythmic therapy with Amiodarone or propafenone

20
Q

What are some things to have on your DDx for severe abd pain and ams?

Study These Flashcards
A
  • Sepsis
  • Intra-abdominal infxn
  • ruptured appendicitis
  • toxic ingestion
  • illicit drug use
  • Pancreatitis
  • Severe metabolic process like DKA
21
Q

In an adult with shock should receive ____ Liters of normal saline?

22
Q

What insulin is given in DKA patients? How is it given? For how long?

Study These Flashcards
A
  • Regular insulin
  • Continuous IV infusion
  • Until the anion gap returns to normal
23
Q

What is given to DKA patients when their glucose gets to 200-300?

Study These Flashcards
A

Dextrose to prevent hypoglycemia

24
Q

What is the proper dose of insulin for DKA patients?

25
Name a rare, but devastating complication of DKA:
-Cerebral edema....especially in kids
26
Diagnostic work-up in an elderly pt presenting with concern for sepsis:
- IV access - EKG - Troponin - CBC - BMP - UA - CXR - ABG - LFTs - Glucose
27
Most common pathogens for urosepsis in elderly?
- E,Coli - Proteus Other GNRs
28
Initial empiric tx for urosepsis in elderly?
- Aminoglycosides - Quinolones - Ampicillin sometimes added
29
How can Sepsis be divided into phases?
Early = Hyperdynamic phase - incr capillary leakage and periph vasodilation - decr SVR - decr venous return - end result = HoTN - tachycardia, tachypnea, warm extremities clinically Late = Hypodynamic phase - presents as shock - Cardiac output decreased - incr Lactate - Hyperglycemia
30
What are the 4 classes of hemorrhagic shock?
1: - 120 - BP decr 4: - >2L loss - HR>140 - BP significantly dropped
31
Name some treatments used for Anaphylaxis with resp compromise?
-Epinephrine (IV or subQ...but IV better) give 1 ampule in 1L NS....infuse at 1 to 4 cc/min -Albuterol -Racemic epi -IV glucagon for pts on Beta blockers -Systemic steroids to prevent 2nd anaphylaxis (continue for days) -Histamine blockers
32
DDx for a wheezing patient:
- Asthma - COPD - CHF - Foreign body - Pneumonia - anaphylaxis - PE - toxic inhalation - tumor
33
What dose of steroids is given to pts with asthma attack?
- 40 to 60 of po prednisone | - IV for pts with severe sx who may not be able to swallow a pill
34
What else (other than albuterol/ipratroprium, epi, etc) can you give for asthma attack?
- IV Mg | - 2 to 4 g
35
What criteria should an asthmatic meet in order to be discharged?
-Improvement of PEFR of FEV1 to 70% or greater of predicted or personal best
36
What should asthmatics be given upon discharge?
- Albuterol - MDI spacer device - 3-10 day course of oral steroids Maybe...Leukotriene inhibs or inhaled steroids
37
What should initial vent settings be in an intubated asthmatic patient?
- Assist control mode - RR 8-10 - TV 6-8 mL/Kg - no PEEP - flow rate of 80 - 100 L/min
38
What should you use to close a scalp or forehead wound?
Scalp: -4-0 monofilament suture -remove 7-10 days later Or.....staples Forehead: - close in layers - approximate skin with 6-0 nonabsorbable continuous running or interrupted suture - remove after 5 days
39
What should be avoided when repairing a wound of the nose?
-Epinephrine
40
What suture do you use for a lip laceration?
- 6-0 non-absorbable suture --> 5 days | * Vermillion border = call plastics
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