OME > ER > Flashcards

ER Flashcards

(48 cards)

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1
Q

headache

-HPI

A 
OLDCARTS 
First one? 
Different from previous? Worst? 
Neck Stiffness? /
Menengeal signs (kernig =knee bend, +in SAH too! , brudzinski = kids, flex neck look for hips) 
Neruo Deficite
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2
Q

Headache - Exam

A

Fever, supple neck, photophobia
Pupils
Full neuro

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3
Q

Headache - DDX - non emergent w/ TX

A

Cluster - unilateral, sudden, orbital, tears, male, tobacco, 40’s - GIVE O2

Migrane - Unilateral, n/v, photophobia - Give NSAIDS / metoclopramide / IVF

Sinusitis - URI, sinus tenderness - nasal spray, pseudophedrine, abx?

Tension - b/l and tight - pain controll

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4
Q

Headache - DDX - emergent

A

acute glaucoma
corotid artery dissect

Encephalitis
Encephalopathy (HTN)
Meningitis
Temporal arteritis

Preeclampsia
Psuedotumor

SAH
Traumatic ICH

CO poisoning

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5
Q

Acute Glaucoma

A

Unilateral, blurry, fixed pupil

Topical + systemic dec IOP meds

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6
Q

Corotid Art dissec

A

Unilateral neck pain, trauma

CTA, MRA, US

Antigoagulation, CS NRSRG?

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7
Q

CO poisoning

A

Weakenss , N/v , exposure

CO - oximetry, VBG

100% 02

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8
Q

Encephalitis

A

Fever, AMS seizures

CT, LP

IV ABX, / antiviral / isolation

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9
Q

Hypertensive encephalopathy

A

dBP >120, AMS, vision changes

Check end organs ( CMP, …?)

Dec MAP 25%

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10
Q

Meningitis

A

Fever, stiff neck, photophobia, rash

LP —> CT

Steroids–> ABX, LP, isolation

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11
Q

Preeclampsia

A

> 20 weeks up to 6 weeks postpartum, inc BP, HA

LFTs, CBC, UA

Mag, BP controll, Cs OB/ GYN

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12
Q

Pseudotumor

A

overweight, young, visual sx

CT, LP

LP, acetazolamide

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13
Q

SAH

A

Sudden, worst, SYNCOPE

CT, LP

BP controll, cs nrsrg

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14
Q

Temporal arteritis

A

Unilateral, above 55, tender, jaw pain

ESR

Steroids, , FU with optho / reum

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15
Q

Traumatic ICH

A

Trauma, ETOH, elderly

CT

Neurosurg

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16
Q

acute HA and Syncope

A

Think SAH first!

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17
Q

Head Injury - HPI

A

Mechanism
LOC, N/V, seizure, whitnessed, intoxication, neuro deficit,
Blood thinners

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18
Q

Head Injury - Exam

A

GCS
Full Neuro
Pupils
Skull FX - raccon eyes, battle sign, nasal CSF leak, hemotympanum

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19
Q

Head injury - when to do CT

Brain

C Spine

A

Brain - Canadian Head CT rule

C Spine - Canadian C spine rule

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20
Q

Head Injury - acute general management of SAH, subdural hematoma, epidural, ICH, skull fx

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A

COnsult neurosurgery

Close obs of neuro status

Consider - antiseizure med,s dec ICP, ICU

21
Q

GCS

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A

out of 15

Eyes: 0-4

Verbal: 0-5

Motor : 0-6

Considered comatose if under 8

22
Q

SVT

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A

No p waves, rate over 150

Give adenosine - blocks AV conduction for a bit - 6-12-12

23
Q

Vtach

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A

give Amiodarone

24
Q

Afib

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A

Rate vs rythem

Cardiovert to rythem only if youngish or new onset

Rate: Propranolol or CCB (dilt / verap )

25
CHADS 2 score
To decide if someone with Afib needs anti coag ``` CHF HTN AGE > 75 DM Stroke / TIA (2) ``` 0 - none 1 - maybe 2 - yes Anticoag: Warfarin or NOAC
26
Sinus Brady
Atropine If hemodynamically unstable, pace
27
Types of heart block
1 - long PR interval (1 box, 0.04sec OR 400msec) give atropine - then pace 2a - wenkibach - give atropne then pace 2b - regular drop - pace 3 - dissasoc - pace
28
Idioventricular Rythem
Just Vents beating Atropine wont work, just pace
29
ACLS for: VT/VF PEA/ ASYSTOLE
Shock if: VT / VF VT/VF Epi -// 2min CPR // Atropine // 2min CPR // epi PEA/ ASYSTOLE Epi -// 2min CPR // (pulse, rythem, shock?) // 2min CPR // epi
30
When is someone considered hemodynamically unstable? (FOR ACLS)
CP SOB AMS SBP < 90
31
GENERAL: Someone comes in with an arrythmia, what do you think through?
Do the have symptoms? No - IVF, 02, monitor Yes: Are the stable? No (CP, SOB, AMS, SBP<90) - Brady: Pace Tachy: shock Yes - but have other symptoms: Fast+ wide - Amiodarone Fast + Narrow - Adenosine Slow: Atropine (unlass 2b or 3 HB)
32
Tachy Rythms
Narrow: Sinus SVT Afib Aflut MFAT Wide: VT VFIB Torsods
33
Brady Ryhthms
Sinus brady 1,2,3 degree Hblocks Junctional ( wut? ) Idioventricular (Vents on their own)
34
Pt with hypotension - how to solve in 30 seconds
PT HAS LOW BP Asses airway patency- visualize breaths - make sure air is getting to lungs HR - check HR - poor tone to brachial artery - could be the result of brady or non sinus tachy - check HR Venous Volume - check the IVC, see if its easily compressible via US. Could be trauma, sepsis, or loss over longer periods. If still full, check heart: US. Continuity of vascular circuit- is it a Tension Pneumo (auscultate) ? Is it a Tamponod (US)? Something obstructing lungs: Consider Massive PE, pulmonary arteriolar constriction, RV failure. NEXT you check LV function. Listen for MR or ventricular rupture Pause, see if it is just the brachial artery that is low CHECK the peripheral arteries - Bounding pulses and warmpth = too much dilation. Sepsis, histamine release, vasodilation OD, Neurogenic schock
35
Cough meds on tox screen can:
Come back positive for alcohol and opiates
36
Antivert
Meclizine
37
Options for complex uti
3rd gen cephalosporins - rocephin (iv only) - cephpodoxime - cephdinir - cefuroxime - cephtazidime Doxy- SA: achilis rupture, c-diff Don’t take nitrofurantoin or ffosphomyosin
38
Indications for Dialysis
``` Acidosis Electrolyte imbalance (K) Ingestion Overload Uremia ```
39
Headache cocktail
Benadryl Chlorpromazine Ketoralac (toradol)
40
Tx for asthma exacerbation Info about asthma tx
Duoneb-albuterol and ipratropium If chronic, will take time, if acute will clear up quick. Give three doses or write for one hour. Steroids 02, Mg Intimate if hypoxic, exhaustion, AMS
41
Cause Equina
Most likely in thoracic, not so much in lumbar. It is pinching of spinal cord Presenting most likely: urinary retention Saddle anesthesia, incontinance, b/l sciatica
42
Most common causes of pancreatitis
``` Stones Alcohol Medications Infections High triglycerides ```
43
Ransoms criteria for pancreatitis
``` WBC Age Glucose AST LDH ```
44
Hints exam
Nystagmus -unidirectional is peripheral Skew (cover uncover) - none in peripheral Head Impulse- look for savage after quickly turning head- + means it is peripheral
45
Types of fracture
Displaced Spiral Comminuted Greenstick Transverse Linear Oblique
46
Components of heart score
``` Hx Age Ekg Risk factors Initial triponin ``` Helps decide if you need to admit
47
Risk factors for heart attack
HTN HLD Dm Obesity Smoking Prior MI/PCI CVA/ TIA PAD
48
Wells criteria
``` Fits clinical picture 3 PE is 1 or equal likelihood 3 HR is over 100. 1.5 Immob/ surgery 4wks. 1.5 Hemoptysis 1 Malignancy 1 ``` If 2 or less, PERC IF 3 - dimer If 4 or more- CTA
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