Glossary of Emergency Medicine 2
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- The nasopharyngeal airway can be used in which types of patients?
- breathing semiconscious patients and when an oropharyngeal airway is technically challenging
- Prolonged use of a bag valve can lead to..?
- Distention of the stomach increasing the chance of an aspiration event
- What are the steps of successful intubation?
- 5P's Preparation, preoxygenation, pretreatment, paralysis, and placement
- How do you prepare for successful intubation?
- IV access, monitors, suction, appropriate sized ET tube, and meds for rapid sequence intubation
- What pretreatment may be necessary in small children prior to intubation and why?
- Atropine, to blunt the bradycardia induced by succinocholine
- What pretreatment prior to intubation may be used in adults with reactive airway disease? What about in adults where there is a concern about increased ICP?
- Reactive airway disease - lidocaine 1.5mg/kg
- What sedative agent is used prior to paralysis for intubation?
- Etomidate 0.3mg/kg
- volar =?
- Physical Exam of emergency ortho...?
Palpation for subtle deformities well beyond the area of subjective pain
- Ulnar nerve palsy causes..?
- Claw hand
- Inability to extend the knee could be caused by paralysis of which nerve?
- Femoral nerve
- Early treatment of ortho emergencies?
RICE (rest ice compression elevation)
Reduction of long bone deformities
- Don't forget to give _____ for open fractures?
- In children with trauma to a joint, what is important to consider on imaging?
- Comparison to the opposite extremity - difficult to tell the difference between a fracture and an epiphyseal growth plate
- Compartment syndrome defined?
- When the pressure in a compartment exceeds the arterial perfusion pressure
- Most reliable sign of compartment syndrome?
- ARDS, neuro involvement, and thrombocytopenia post- closed fractures in leg..?
- Fat embolism
- If you land directly on your shoulder, and hit hurts to reach across your body, what is the injury?
- Acromioclavicular joint separation
- when does Acromioclavicular joint separation require surgery?
- type iv or higher (when the clavicle is displaced into surrounding areas)
- 96% of shoulder dislocations are...?
- Aneterior shoulder dislocations
- how does the patient with an Anterior shoulder dislocation appear?
- holding arm in slight abduction and external rotation
- What is the most common fracture in Aneterior shoulder dislocations? what nerve should be tested?
- Hill-Sachs deformity - fracture of the posterolateral aspect of the humeral head
Test the axillary nerve
- Posterior disloactions are caused by...? always associated with...?
- fall on outstretched hand, convulsive seizure.
Assoc. with Hill Sachs deformity
- Most common mechanism of acute rotator cuff tear? Thisinjury impairs which movement?
- Forced abduction.
Impairs arm abduction to 30 degrees
- What important structures travel with the humerus?
- The deep brachial artery and the radial nerve
- Who gets supracondylar fractures? how?
- Kids < 15.
Falling backwards on an outstrertched hand
- Posterior fat pad sign indicates?
- In adults - radial head fracture
In kids - supracondylar fracture
- What is fracture of the proximal 1/3 of the ulna with radial head dislocation called?
- Monteggia fracture
- What is fracture of the distal 1/3 of radius with dislocation of the distal radioulnar joint called?
- Causes of carpal tunnel?
- RA, hypothyroid, DM, collagen vascular diseases
- Phalen's test?
- Fully flex the wrists for 60 seconds
- Tinel's sign?
- Light tapping over the median nerve produces pain or paresthesias
- Most common carpal injury..?
High risk of..?
- Fracture of the scaphoid. AVN
- Smith's fracture?
- Like colles, but distal fragment is displaced in the volar direction
- neurogenic shock?
- state of vasomotor instability resulting from impairment of the descending symp. pathways in the spinal cord, or just a loss of symp. tone
- does spinal shock signify permanent spinal cord damage?
- often times no
- anterior cord syndrome results in loss of which tracts?
- spinothalamic and corticospinal tract
- Central cord syndrome can be caused by? Affects?
- Hyper-extension injuries.
Nerves that cross over at that level
- if a penetrating spinal injury is diagnosed, begin treatment with..?
- High dose methylprednisolone
- if suspecting a c-spine fracture, what xrays should be ordered?
- lateral, AP, and odontoid view
- C1 burst fracture is called? Caused by...?
- Jefferson fracture. Caused by axial loading - someone falls on their head, or something falls on their head
- Odontoid fractures are caused by..?
- Hangman's fracture?
- Fracture of both pedicles of C2 - hyperextension mechanism
- Stable or unstable?
burst fracture of C5 with intact ligaments...
simple wedge fracture
flexion teardrop fracture
extension teardrop fracture
- atl - unstable
burst c5 - stable
simple wedge - stable
odontoid - unstable
flexion teardrop - unstable
extension teardrop - stable
- flexion teardrop fracture is associated with...?
- tearing of the posterior complex
- bilateral facet dislocation...? stable?
- flexion injury
subluxation of the dislocated vertebra
- Cullen's sign? Gray-Turner's sign?
- ecchymosis of the abdomen signifies late retroperitoneal hemorrhage
Gray-Turner's: same, but of the flanks
- 12% of patients with hyperthyroidism will suffer...?
- Pathologic fracture
- serious associated injuries are present in up to 95% of patients with a dislocated...?
- a pt with a posterior hip dislocation holds the hip how?
- flexed, adducted, and internally rotated
- most common ortho injury seen in the ED?
- knee - in particular, MCL (medial collateral ligament)
- 50% of patients with ACL injury have a concomitant...?
- Meniscal tear
- lachman's test?
- flex the knee to 30 degrees and pull anteriorly on the tibia
- donahue's unhappy triad?
- ACL, MCL, and medial meniscus tear
- Injury to the ________ occurs in 50% of knee dislocations...
- popliteal artery
- injury to the tibial nerve causes...?
- inability to stand on tiptoes
- which ankle fracture warrants a careful radiologic examination? of what specifically?
- medial malleolar fracture
proximal shaft of the fibula (Maisoneuve fracture)
- 10% of calcaneal fractures are associated with...?
- lumbar fractures
- when do you call for an ortho consult?
- compartment syndrome
anything that requires surgery
- what is the most frequent complication of orotracheal intubation?
- Right main stem bronchus intubation
- Patients with COPD, asthma, or CHF that are awake but cannot remain in the supine position may be intubated how...?
- Nasotracheal intubation
- Most serious complication of nasotracheal intubation?
- Intracranial passage of the tube
- advance airway adjuncts?
- fiberoptic intubation
laryngeal mask airway
- What is the preferred surgical airway for kids? Adults?
- Kids - needle cricothyroidotomy
Adults - surgical cricothyroidotomy
- if an airway will be needed for greater than 2-3 days, a surgical cricothyoidotomy should be converted to...?
- a tracheostomy
- slit lamp exam consists of...?
- eval the integrity of the cornea, conjunctiva, and the anterior chamber
fluorescein to light up corneal defects
- central retinal artery occlusion occurs in which people?
- men in their 60s
- fundoscopic exam in central retinal artery occlusion?
- pale retina with cherry red fovea
- what is amaurosis fugax?
- type of TIA - sudden vision loss (Shade over eye), transient, due to carotid-origin embolic shower
- classic triad of optic neuritis?
- marcus gunn pupil
central vision loss
red vision desaturation
- flashing lights, spider webs, or floaters that interfere with vision may be a sign of...? what meds should NOT be given?
- retinal detachment
- painful red eye - most often due to which things?
- conjunctivitis, corneal abrasion, or foreign body
- which conjunctivitis produces copious DC?
- punctate lesions in conjunctivitis?
- viral cause
- tx of conjunctivitis?
- broad spectrum antibx, pain meds
- soft contact wearers are especially prone to infection by.?
- severe unilateral eye pain, decreased visual acuity and photophobia...?
- tx of iritis?
- cycloplegic such as homatropine(not a mydratic)
- severe unilateral HA, eye pain, N/V assoc with loss of vision....?
- narrow angle glaucoma
- which drugs decrease aqueous production?
- acetazolomide and topical b blockers
- which chemicals causes coag necrosis? liquefaction necrosis?
- tx of chemical burn...
- what's hyphema?
- blurred vision after blunt trauma (dull eye pain)... bleeding
- basic approach to all tox patients in the ED?
- key things on physical exam for tox exposures....?
- Vital signs
- describe anticholinergic toxidrome?
- "mad as a hatter, dry as a bone, red as a beet, hot as a stove." Also - decreased GI motility, urinary retention, mydriasis.
- describe muscarinic toxidrome?
- narcotic toxidrome?
- resp depression, hypotension, depressed sensorium, miosis
- sympathomimetic toxidrome? compare with anticholinergic toxidrome?
- very similar except sympathomimetic involves diaphoresis
- withdrawal toxidrome?
- agitation, hallucination, mydriasis, diarrhea, cramps, lacrimation, tachycardia, insomnia, seizures
- major toxic effect of acetaminophen?
- metabolite NAPQI causes centrilobular hepatocellular damage
- tx of acetaminophen tox...?
- 4 hour level on rumack-matthew nomogram, activated charcoal, N-acetyl-cysteine (to regenerate glutathione)
- methanol tox?
- formic acid metabolite - causing a gap acidosis and direct optic nerve toxicity
- treatment of ethylene glycol tox?
- 4MP or EtOH
- which drugs can cause anticholinergic syndromes? tx?
- antihistamines, antipsychotics, TCAs...
tx - physostigmine
- symptoms of calcium channel blocker tox? tx?
- brady and hypotension
tx - CaCl2, glucagon, epinephrine, DA
- CO tox symptoms
- HA, N/V, flu-like syx, CNS dep, tachy, hypotension
- tx of CO tox?
- 100% O2
- date rape drug - euphoric and amnestic effects
- refractory seizures could be caused by what toxicity?
- Organophosphates can cause which toxidrome?
- opioid antagonist
- standard of care for salicylate poisoning?
- activated charcoal
- also consider alkalinization of urine and blood with bicarb
- benzo receptor antagonist that can rapidly reverse coma from benzo OD...? what's the problem with this drug/
can lower the sz threshold in pts with TCA OD and induce benzo withdrawal
- loxosceles bites can be treated with...?
- signs and symptoms of TCA OD?
- anticholinergic sx, cardiac dysfunction, intractible szs, and hyperthermia
- treatment of TCA tox?
- decontamination with MDAC
Sodium bicarb administration
Benzos for sz management
Alpha agonists for hypotension
- prerenal failure due to..?
- decreased renal perfusion (volume depletion, low CO, abnormal renal hemodynamics)
- most common cause of intrinsic renal failure?
- longstanding HTN
- majority of hospital-assoc episodes of ARF are caused by...?
- postrenal failure caused by?
- obstructive uropathy
- FENA <1 in which condition?
- Prerenal failure
- Urine Na <20 in which condition?
- Prerenal failure
- tx of prerenal failure?
- volume replacement, d/c offending meds
- intrinsic RF treatment?
- monitor fluid status,restrict protein, correct eletrolyte abnormalities
- dispo for patients with ARF?
- what drugs can cause ARF in pts with renal artery stenosis?
- ACE inhibitors
- #1 cause of death in 1-44 year olds?
- Trauma (specificallly, MVCs)
- Preparation for a trauma case includes?
- History from EMTs
Prep the trauma bay
O2 and suction
IVF and supplies
- Indications for intubation?
- GCS <8
Unable to protect airway
- Chin lift is contraindicated if...?
- A C-spine injury is suspected
- Radial pulse should have a BP of at least...? Femoral?
- 80 mmHg
- what % of ECF is plasma?
- which drug is an ineffective pressor in hypovolemic patients?
- GCS consists of which 3 categories?
- eye opening, verbal response, moto response
- most rapid means to lower ICP?
what other method?
- volume of blood in an adult?
- 5 L (7% of ideal body weight)
- physiologic response to acute hypovolemia?
- In order:
narrowed pulse pressure (increased diastolic press)
slowing of cap refill
decreased systolic pressure
- raccon eyes, and battle sign?
- late findings in basilar skull fractures
- assessment of C-spine in trauma?
- posterior midline - any tenderness?
focal neuro deficit?
evidence of intox?
any painful injury that may distract the pt?
- quick, non-invasive method of examining the abdomen and pericardium for blood
- how to check for pelvic frx?
- press down and in on both iliac crests simultaneously
- urine myoglobin can be elevated secondary to...?
- massive muscle breakdown (rhabdo)
- tx of rhabdo?
- IVF, sodium bicarb, and mannitol
- calculate cerebral perfusion pressure?
- MAP - ICP
- Cushing's reflex? sign of?
- HTN, brady, hypopnea
sign of increased ICP
- in traumatic head injury, what is the target MAP?
- intubation considerations for elevated ICP?
- intubate early but WITHOUT ketamine
- seizure prophy with head bleeds?
- how does cardiac tamponade present? findings?
- hypotension, muffled heart sounds, JVD, and pulsus paradoxus
electrical alternans on ECG
may present with pulseless electrical activity
- which condition can lead to hypotension, absent breath sounds, hyperresonance, distended neck veins, and high airway pressures?
- tnesion pneumothorax
- hypoxia occurs if an open pneumothorax is greater than?
- 2/3 trachea diameter
- flail chest?
- 3 or more rib fractures in 2 or more sites with paradoxical motion of chest wall with inspiration
- how to demonstrate fluid in the pericardium in tamponade?
- echocardiogram, or ED U/S
- tx of tension pneumothorax?
- angiocath in the 2nd intercostals space in the mid-clavicular line
chest tube if hemo or simple pneumothorax suspected
- tx of cardiac tamponade?
- subxyphoid pericardiocentesis
- splenic injury can cause pain referred to...? eponym?
- left shoulder...Kehr's sign
- which chief complaints warrant a stat EKG?
- chest pain/presure/discomfort
abdominal pain esp in elderly
N/V esp in elderly, diabetics
- shortened PR interval suggests?
- alternate, abnormal conduction pathway like WPW syndrome
- elongated PR interval suggests?
- some form of AV block
- quick and dirty way of determining the axis of the heart?
- leads I and aVF...
both up - normal
aVF down - LAD
I down - RAD
both down - RAD
- DDx of U waves?
meds (digoxin, quinidine)
- Describe possible characteristics of an unstable cardiac patient?
Ischemic chest pain
- tx basics for unstable cardiac patients?
- cardioversion (synch or un-synch) per ACLS protocol, then IV meds or other therapy
- tx of sinus tachy?
- tx the UNDERLYING CAUSE
- how can you tell there's paroxysmal supraventricular tachy? tx?
- abnormal/absent P waves
Tx: unstable --> synch cardioversion
stable --> AV node blockade via adenosis, calcium channel blockers (diltiazem, verapamil), b-blockers, manuevers
- tx of a fib?
- unstable --> synch cardioversion
stable w/ rapid vent. response --> AV blockade: calcium channel blockers, b blockers, digoxin
- pts with pre-excitation syndromes - be careful not to...?
- block the AV node by conventional meds
- premature ventricular contractions, etiology?
- 4 H's - hypokalemia, hypomagnesemia, hypoxia, hyperthyroidism
- what is trigeminy?
- every 3rd beat is a PVC
- tx of PVCs?
- iv lidocaine or amiodarone
iv magnesium sulfate
- tx of pulseless v tach?
- immediate UNSYCNHED cardioversion
- tx for unstable v tach?
- synchronized cardioversion, then amiodarone or lidocaine drip
- tx for stable v tach?
- medical cardioversion with lidocaine, amiodarone, adenosine, or procainamide
- etiology of torsades?
- ischemic heart disease
- tx of stable torsades?
- electrical overdrive pacing
also consider Mg sulfate
- tx of Vfib?
- unsynchronized cardioversion, ACLS protocols, and correction of lytes abnormalities
- pulseless electrical activity etiology?
H4- hypothermia, hyperkalemia, hypoxia, hypovolemia
- tx of ventricular asystole?
- IVF, epinephrine, atropine
- for Mobitz II 2nd degree AV block, what tx? What won't work?
- transcutaneous or transvenous pacing
Admit for implantable pacemakers
Atropine won't work
- tx for 3rd degree AV block?
- immediate temporary pacemaker
- you should consider a new LBBB to be _______ until proven otherwise?
- acute MI
- Indications for temporary cardiac pacing?
- hemodynamically unstable bradycardia
brady that fails to respond to tx
early bradyasystolic arrest
- how does digoxin cause toxicity?
- blockade of the NaKATPase
increased vagal tone and increased AV nodal blockade
- EKG signs of WPW?
- short PR interval
- EKG signs of hypokalemia?
- more prominent U waves
flattened t waves
- EKG signs of hyperkalemia?
- hyperacute T waves
wide QRS that eventually blends with the T wave to form a sine wave appearance
- ekg signs of hypocalcemia?
- prolonged QT
terminal T wave inversion
- ekg signs of hypercalcemia?
- shortened QT interval
- associated symptoms of ACS?
- dyspnea, diaphoresis, nausea, lightheadedness, or sense of weakness
- define stable angina?
- symptoms precipitated by exertion and relieved by rest or nitroglycerin
- define unstable angina?
- exertional angina of recent onset
angina of worsening character
angina at rest
- describe myoglobin as a cardiac marker?
- elevated as early as one hour and peaks at 4-12 hours
- describe CKMB as a cardiac marker?
- rises in 3-4 hours, peaks at 12-24 hours
can be elevated in skeletal muscle injury
- describe troponin as a cardiac marker?
- rises in 3-6 hours, peaks 12-24 hours
most specific and sensitive
- acute MI tx?
- MOAN B H
- in pump failure.. which pressors for hypotension in a volume unresponsive pt...?
- sbp 80-100 - dobutamine
sbp 70-80 - dopamine
sbp <70 - levophed
- pericarditis - presentation?
pain is worsened by..?
- sharp stabbing precordial or retrosternal chest pain...
pain worsened by inspiration or lying flat
- assoc symptoms of pericarditis?
- low grade fever
- test of choice for detection and f/u of pericarditis?
- tx for pericarditis
- NSAIDs for 1-3 weeks
- aortic dissections typically occur in what group?
- uncontrolled hypertensive males ages 50-70
- physical findings in aortic dissection?
- asymmetric pulses with BP differences between extremities
palpable pulsatile mass or tenderness
- chest tube required for what size pneumothorax?
- Nitro's relief of cardiac vs esophageal pain?
- Cardiac w/in 5 minutes, esophageal w/in 10 minutes
- life threatening etiologies of abdominal pain...?
- ruptured AAA, perforated viscous, intestinal obstruction, ectopic pregnancy, mesenteric ischemia, appendicitis, and MI
- INITIAL TEST OF CHOICE FOR BILIARY TRACT DISEASE, AAA, ectopic, or free peritoneal fluid?
- Plain films can rule out which abdominal emergencies?
- Perforation or obstruction
- Colicky pain usually responds to which drugs? Specifically...?
- NSAIDs, esp IV Ketorolac
- Triad of pain, hypotension, and a pulsatile abdominal mass...?
- _______ is virtually 100% sensitive in detecting AAAs?
- What is usually the primary inciting factor of appendicitis?
- Obstruction of the appendix usually by an appendicolith
- CBC in approx 75% of appy pts reveals?
- leukocytosis above 10,000
- Antibx for appy?
- risk factors for cholecystitis?
- fat, forty, and female
- radiation of pain in acute cholecystitis?
- tip of the right scapula
- most useful test if suspicious of cholecystitis?
- US of RUQ
- which agents should not be used in acute gastroenteritis?
- anti-motility agents (Imodium) because it diminishes diarrheal excretion of organisms
- Presentation of patients with acute hepatitis?
- Jaundice, dark urine/light stools, hepatomegaly, fatigue, malaise, RUQ pain, N/V, and fever
- coagulation should be normalized with FFP in which condition?
- presentation of acute mesenteric ischemia?
- severe, poorly localized colicky abdominal pain associated with recurrent forceful bowel movements
classic - abdominal pain out of proportion to the minimal physical exam findings
- Most useful test to diagnose acute mesenteric ischemia?
- Midepigastric abdominal pain usually assoc. with N/V?
- Acute pancreatitis
- An amylase raised _______ times the upper limit of normal is 98% specific to acute pancreatitis...
- All patients with acute pancreatitis should be....
- admitted and made NPO
- good narcotic choice for pain in acute pancreatitis
- Meperidine (better than morphine)
- fever, abdominal pain, and rebound tenderness...?
- Small bowel obstruction is caused by ________ more than 50% of the time...?
- postoperative adhesions
- Most significant complications of small bowel obstruction?
- Strangulation and bowel infarction
- etiology of bronchitis?
- viruses (influenza, adenovirus, etc.)
- Virchow's triad of the pathophysiology behind PE?
Vessel wall damage/inflammation
- Classic triad of PE presentation?
- EKG findings in PE?
- golden standard for diagnosing PE?
- pulmonary angiography
- ED treatment of CHF?
intubation or CPAP if no improvement
- treatment of COPD in the ED?
- ABCs monitoring
MgSO4 in severe exacerbations
antibiotics (empiric broad spectrum)
- ED eval of asthma?
- Monitors, O2, pulse ox
Peak expiratory flow rate
CXR - to rule out pneumonia
- signs of hyperventilation syndrome?
- tachypnea, chest wall tenderness, carpopedal spasm, Chvostek's/Trousseau's sign (hypocalcemia)
- this condition likely results from inflammation of CN VII as it courses through the styloid foramen?
- Bell's palsy
- tx of bell's palsy?
- acyclovir AND prednisone
eye patching to prevent keratitis and corneal ulceration
- work up of CVA?
- STAT head CT - esp if < 3 hrs
- in hemorrhagic stroke, you want to decrease SBP by no more than _____ to limit hypoperfusion...?
- Peripheral vertigo is caused by.?
- viral etiology (labyrinthitis)
decaying or "lost" otoliths
- peripheral vertigo presentation?
- acute onset
intense spinning sensation, N/V
unidirectional nystagmus that can be inhibited by fixation
- work-up of peripheral vertigo?
- hallpike maneuver
- most szs in the ED are due to...?
- Medical non-compliance in known seizure patients
- workup of szs in the ED...
LP if any possibility of intracranial hemorrhage or meningitis
- LOC occurs in ____ % of patients with SAH?
- 75% of SAH is due to...?
- ruptured congenital arterial aneurysm
- diagnostic test for SAH?
- noncontrast head CT
- if there is suspicion for SAH and it's not seen on CT, ____ must be performed?
- What other condition besides SAH could cause blood in the CSF?
- Herpes encephalitis
- goal of ICP management is to maintain the cerebral perfusion pressure greater than ______?
- A chronic headache that started out mild to moderate in severity and intermittent in nature, described as a deep, aching pain and worsened by coughing, and often maximal upon awakening...?
- intracranial tumor / mass
- 85% of people experiencing malignant hypertension complain of _____?
- Temporal arteritis affects women ______ than men, and is uncommon before the age of _____? ESR is usually ____?
- Women more than men
- Jaw claudication is strongly suggestive of...?
- temporal arteritis
- tx of temporal arteritis?
- prednisone 60mg po, arrange a biopsy to confirm diagnosis
- Often compression of ______________ can improve the pain of migraine?
- the ipsilateral superficial temporal or carotid artery
- ergotamine is contraindicated in... ? Should be used w/ caution in ....?
Caution in HTN or CAD
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