Emergency Medicine Inservice
thickened gall bladder wall (cm)
>3 cm
tx for cholinergic toxicity
(i.e. 2/2 pesticide, organophosphate poisoning) ATROPINE!! to relieve respiration then pralidoxime (2-PAM) !! 2-pam restores cholinesterase activity
Globe Rupture (management; just read)
- Hammering metal - Teardrop pupil - CT orbit - Seidel sign: aqueous flow on fluorescein testing - IOP measurement contraindicated - Bed elevation, ABX, emergent ophthalmology consultation
rx tx for cocaine HTN?
- benzos - phentolamine (alpha adrenergic antagonist)
Parkland Formula
- fluid resuscitation in burns - total body surface area burned x weight (kg) x 4 mL - first 1/2 in first 8 hours - second 1/2 in next 16 hours
PNA by Age - neonates (0-3 weeks): - 3 weeks to 3 months: - 3 months to 2 years: - 2 years to 5 years: - 5 years to 8 years:
- neonates (0-3 weeks): GBS, E.Coli, Listeria - 3 weeks to 3 months: Chlamydia trach - 3 months to 2 years: RSV - 2 years to 5 years: RSV - 5 years to 8 years: Mycoplasma
BP Goal in hypertensive emergency
- reduce mean arterial pressure by 25% in first hour - normal BP over next 8-24h
scrombroid poisoning
- spoiled fish - hella histamine - skin flushing, HA, abd. cramps, n/v/d, palpitations - usually rapid onset (30 mins) - tx: h1/h2 blockers, ex. diphenhydramine, cimetidine *often mistaken for allergic rxn
Dig Bind Criteria (do your best; 5)
1. K > 5.5 2. cardiovascular collapse 3. heart blocks (mobitz II, 3rd degree) 4. ventricular dysrhythmia 5. dig level >10
define status epilepticus (2)
1. continuous seizure activity >5-10min OR 2. 2+ seizures w/o full recovery
1st line drugs in status epilepticus (3, give doses)
1. lorazepam: 2-4 mg IV 2. diazepam: 5-10 mg IV 3. midazolam: 2-4 mg IV
2nd line drugs in status epilepticus (2, give doses)
1. phenytoin (or fosphenytoin): 20 mg/kg IV 2. valproic acid: 20 mg/kg IV
What is considered a normal intracranial pressure?
15 mm Hg or less
size of objects that REQ removal in esophagus
5cm long 2cm wide Sharp
inferior STEMI - which a. - what if inferior AND anterior ST-elevations
80% RCA 18% left circumflex if inferior AND anterior ST-elevations, possibly wrap-around LAD *make sure to do R-side leads rV3, rV4 ST-elevations
toxo at what cd4
<100
when do you see aortoenteric fistula?
AAA repair then patient comes in with LGIB
staccato cough, eye findings PNA
C. trachomatis
level of esophagus where FB lodges in child
C6 (cricopharyngeus)
medication for FB in esophagus (bonus points: dose?)
Glucagon (bonus points: 1mg IV --> 2mg IV)
esophageal varices, massive hematemsis -- rx? MoA? bonus: what other medication improves outcomes w/ variceal bleeding?
IV octreotide -- somatostatin analog --> splanchnic vasoconstriction *B-blocker propranolol for prophylaxis bonus: ceftriaxone (to decrease rates of SBP)
tx HTN pheochromoctyoma
IV phentolamine
C-Spine Fracture Unstable mnemonic
Jefferson Bit Off a Hangman's Thumb Jefferson: C2 burst fx Bifacet Dislocation or Fracture Odontoid: II-body or III-lateral masses Any fx w/ dislocation/subluxation Hangman's: posterior C2 2/2 hyperextension Teardop: anterior chip of any vertebrae
PNA associated w/ bullous myringitis
M. pneumoniae
what is bifacet dislocation or fx c-spine
unstable; when vertebral body is anteriorly displaced; lateral plain film
NEXUS criteria mnemonic
NSAID N - neuro deficit S - spinal i.e. midline ttp A - AMS I - intoxicaiton D - distracting injury
test to dx corneal perforation?
Seidel test: instills a large amount of fluorescein onto the eye and after the patient blinks a stream of fluorescein will flow down from the site of perforation. The aqueous humor leaking from the perforation fluoresces.
Which coagulation profile is abnormal in patients with hemophilia A?
PTT - same w/ all the hemophilias, yo
which bacterial gastroenteritis associated w/ febrile seizures?
Shigella
what coronary a. supplies AV node
RCA
rust colored sputum PNA
S. pneumoniae
Shigellosis (just read)
Shigellosis (aka, bacillary dysentery) is highly infectious and is primarily spread by fecal-oral transmission. Patients present with high fever, crampy abdominal pain, and diarrhea that is watery and greenish-yellow. Bloody mucoid stools (dysentery) occur in approximately one-third of patients. A CBC with a leukocytosis and marked left shift (absolute band count >800) is characteristic of shigellosis.
what toxin can mimic tetanus!!
Strychnine (pesticide chemical, ACh antagonist)
level of esophagus into stomach
T11
level of esophagus where FB lodges in adult
T11 (LES)
absolute contraindication to cricothyrotomy
age; <10 y/o 2/2 very small cricothyroid membrane (instead --> needle cric, then transtracheal jet ventilation)
most common congenital heart defect
VSD
xanax -- generic
alprazolam
complete loss of motor, pain & temperature below injury, but retains proprioception and vibratory
anterior cord (like a stroke of cord)
what's the one drug you're always thinking of without the max dose? gotta use the whole hospital's amount?
atropine, yo! with pesticide i.e. cholinergic toxicity
tx for acute dystonic reactions w/ antipsychotics?
benztropine (anti-cholinergic) & diphenhydramine
rx for neuroleptic malignant syndrome
bromocriptine
ipsilateral loss of motor, vibratory sensation and proprioception w/ contralateral loss of pain and temperature
brown-sequard
tx for Tb, - sx - abx
sx: benzos abx: metronidazole +TIG, immunization
tx for Tetanus - sx - abx
sx: benzos abx: metronidazole +TIG, immunization
level of cricopharyngeal muscle
c6
what med contraindicated in dig toxic + hyperkalemic?
calcium!
major AE of IV phenytoin
cardiac depression & hypotension - actually 2/2 propylene glycol dilutent, not parent drug
sensory and motor deficit upper > lower
central cord (forced hyperextension is the cause, ex. whiplash)
rx for seretonin syndrome
cyproheptadine (can also give benzos and cool patient; dantrolene is really 2nd line and more for malignant hyperthermia)
bidirectional vtach associated w/ ...
dig toxicity
scandinavia / europe --> fever, diarrhea (initially profuse, water, later becomes bloody); possible RLQ abd. pain - dx? - tx
dx: yersinia enterolitica tx: TMP-SMX, fluoroquinolone
Oculocephalic response
eyes moving in opposite direction of head turning = intact brainstem function
effect of magnet on - pacemaker: - AICD:
effect of magnet on - pacemaker: reset to fixed rate - AICD: turns off
cholinergic toxicity sx
ex. pesticidies SLUDGE S - salivation L - lacrimation U- urination D - defecation G - GI cramps E - Emesis + Killer B's -- bradycardia, bronchorrhea, bronchospasm
ankle sprain, fx -- which joints you thinking of
fibulotalar and tibiotalar
kawasakis tx?
first-line: IVIG !! also give high dose ASA, then low dose ASA
give someone reglan and they become restless?
give benadryl!! you gave 'em akisthesia
feeling of FB in throat when nothing there
globus hystericus
tx for b-blocker overdose
glucagon
ciguatera toxin
hot/cold reversal; tx: supportive
Cushing reflex
hypertension + bradycardia + respiratory depression
H's and T's
hypo/hyperkalemia, hypovolemia, hypothermia, hypoxia, H+ trauma, tension pneumo, tamponade, toxins, thrombosis (PE, MI)
brown-sequard _______ loss of motor, vibratory and proproception, w/ _________ loss of pain and temp
ipsilateral, contralateral
Oculovestibular response
irrigation of saline into the ear; no eye movement = brainstem injury
Salmonellosis (just read)
is one of the most common causes of foodborne illness in the United States. Depending on the specific species, infection can result in a variety of clinical syndromes, including gastroenteritis, septicemia, typhoid fever, and an asymptomatic carrier state. Infection usually results in stools that are watery, foul, and brownish-green often with blood.
ativan -- generic
lorazepam
Lisfranc Fracture-Dislocation - mechanism - where is pain - test to differentiate from ankle sprain - tx bonus: xr finding
mech: severe plantar flexion, ex. sports, tripping, fall, mvc pain: dorsum of MIDfoot (not perimalleolar like ankle shit); key exam: forefoot rotation against stabilized hindfoot (stabilize calcaneus and rotate forefoot gives clicking and pain), shouldn't hurt w/ ankle shit tx: immobilization if non-displaced, surgery if displaced xr: AP view shows lateral shift of 2nd metatarsal off middle cuneiform
escharotomy of extremity -- what locations?
medial and lateral edges of the extremity
large R wave in V1?
not that normal, consider posterior wall STEMI!! esp if you see an ST depression, yo!!
Jefferson Fx on xr shows what?
odontoid view, will see C1 laterally displaced
how do you treat anti-cholinergic toxicity?
physostigmine!! anticholinergic toxicity (mydriasis, dry skin, urinary retention, decreased GI motility, altered mental status, tachycardia)
preservation of motor function w/ loss of proprioception and vibration below the level of injury
posterior
posterior / anterior hip dislocation - presentation of leg - complication: 1 similar, 1 dif - tx
posterior: WAY MORE COMMON; internally rotated; sciatic n. injury anterior: externally rotated; femoral artery, vein, nerve injury both: avascular necrosis, which is why emergent reduction under conscious sedation is tx
opioid toxicity ECG finding
prolonged QTc, risk of torsades
neuroleptic malignant syndrome, seretonin syndrome, malignant hyperthermia -- myoclonus?
seretonin syndrome is the one w/ myoclonus!!
Tdap vs Tetanus immune globulin!! when do you give latter?
so Tdap if you've had primary series in life and wound is not quite clean/minor, give Tdap if last booster >5 y/o; immune globulin if unknown, incomplete or lack of primary tetanus immunization series
intubation in massive PE? what you worried about?
stopping their heart -- massive PE makes you preload dependent, intubate w/ positive pressure will reduce preload, uh oh!! prolly intubate anyway tho... not like you know for sure what's going on!!
puffer fish toxin
tetrodotoxin
tx for unstable heart blocks
time to pace, bro
diazepam -- brand name
valium
midgut volvulus vs. intussusception - age range?
volvulus -- new borns usually intussusception -- 3mo - 3 years
pseudoappendicitis
yersinia enterocolitis
