Emergency Medicine Inservice

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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


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