E-med Review for Exam 1

Introduction to EM

What is a major cause of death in young people?What is a major cause of death in young people? TraumaTrauma What are some leading mechanisms of death due to What are some leading mechanisms of death due to

trauma?trauma? MVA, falls, drowningMVA, falls, drowning What is included in the primary evaluation of a trauma What is included in the primary evaluation of a trauma

patient?patient? Airway with c-spine control, breathing and ventilation, Airway with c-spine control, breathing and ventilation,

circulation and hemorrhage control, disability and circulation and hemorrhage control, disability and neuro status, exposure and environmental control neuro status, exposure and environmental control

Intro to EM

How many IV’s should be established in How many IV’s should be established in trauma patient and what fluid?trauma patient and what fluid?

2 RL wide bore, 14 g2 RL wide bore, 14 g What are some common sites of What are some common sites of

hemorrhage?hemorrhage? External, hemothorax, spleen lac, External, hemothorax, spleen lac,

hemoperiteoneum, renal hematoma, liver hemoperiteoneum, renal hematoma, liver lac, injury to great vessellac, injury to great vessel

Intro to EM

What are two signs of basilar skull fracture?What are two signs of basilar skull fracture? Battle’s sign and raccoon eyesBattle’s sign and raccoon eyes Hot lights and cold steel refer to:Hot lights and cold steel refer to: The golden hourThe golden hour What x-ray studies are in protocol for trauma What x-ray studies are in protocol for trauma

patient? patient? C-spine, chest, pelvisC-spine, chest, pelvis When should the c collar be removed?When should the c collar be removed? Only when c spine clearOnly when c spine clear

Airway Emergencies

What is the classical presentation of GABS strep What is the classical presentation of GABS strep throat?throat?

Sudden onset of sore throat, odynophagia, chills, Sudden onset of sore throat, odynophagia, chills, fever, no cough or coryzal symptoms, tender fever, no cough or coryzal symptoms, tender anterior cervical adenopathy. anterior cervical adenopathy.

What are diagnostic tests?What are diagnostic tests? Rapid strep antigen detection test, throat cultureRapid strep antigen detection test, throat culture What is the management?What is the management? Penicillin/ e-mycin. Penicillin/ e-mycin.

Airway Emergencies

What is the classical presentation of What is the classical presentation of mononucleosis?mononucleosis?

Prodrome of malaise, anorexia, chill then fever, Prodrome of malaise, anorexia, chill then fever, malaise, sore throat, posterior cervical adenopathy, malaise, sore throat, posterior cervical adenopathy, enlarged spleen, rash possible. enlarged spleen, rash possible.

What are the diagnostic test results?What are the diagnostic test results? Monospot, atypical lymphocytes on blood smear. Monospot, atypical lymphocytes on blood smear. Treatment options?Treatment options? Rest, fluids, analgesics, glucocorticoidsRest, fluids, analgesics, glucocorticoids

Airway Emergencies

Diphtheria?Diphtheria? Pseudomembranous Pharyngitis, severe Pseudomembranous Pharyngitis, severe

sore throat, fever, cervical sore throat, fever, cervical lymphadenopathylymphadenopathy

Diagnostics for Diphtheria?Diagnostics for Diphtheria? Culture on tellurite medium Culture on tellurite medium What are the treatment options?What are the treatment options? Antitoxin, antibioticsAntitoxin, antibiotics

Airway Emergencies What are the clinical manifestations of What are the clinical manifestations of

peritonsillar abscess?peritonsillar abscess? Etiology: strep most common, sore throat, Etiology: strep most common, sore throat,

worsening unilateral pharyngeal discomfort, pus worsening unilateral pharyngeal discomfort, pus in supratonsillar space, trismus, muffled voice, in supratonsillar space, trismus, muffled voice, foul smelling breath, unilateral soft palate uvular foul smelling breath, unilateral soft palate uvular deviation. Cervical lymphadenopathydeviation. Cervical lymphadenopathy

What is the management?What is the management? I/D, tonsillectomy, penicillin or clindamycin, I/D, tonsillectomy, penicillin or clindamycin,

augmentin, NSAIDS or pain reliefaugmentin, NSAIDS or pain relief

Airway Emergencies

What is the difference between complete What is the difference between complete and partial airway obstruction?and partial airway obstruction?

Partial: good air exchange, coughs, Partial: good air exchange, coughs, wheezingwheezing

Total: poor/weak exchange, stridor, Total: poor/weak exchange, stridor, cyanosis, aphoniacyanosis, aphonia

How is airway obstruction diagnosed?How is airway obstruction diagnosed? Direct inspection with laryngoscopyDirect inspection with laryngoscopy

Airway Emergencies

How is it treated?How is it treated? AHA foreign body protocolAHA foreign body protocol Magill forceps, Surgical airway, Magill forceps, Surgical airway,

Endotracheal intubation, bronchoscopyEndotracheal intubation, bronchoscopy

Airway Emergencies

What are the benefits of oral intubation?What are the benefits of oral intubation? Airway, prevent aspiration, oxygenation, Airway, prevent aspiration, oxygenation, What is the difference between the macintosh and What is the difference between the macintosh and

the miller blade and the procedure for using each?the miller blade and the procedure for using each? Macintosh: curved. Tip of blade into vallecula an Macintosh: curved. Tip of blade into vallecula an

lifted: indirectly lifts the epiglottislifted: indirectly lifts the epiglottis Straight blade: Epiglottis lifted directly Straight blade: Epiglottis lifted directly

Airway Emergencies Indications for cricothyrotomy?Indications for cricothyrotomy? Acute laryngeal disease due to trauma, infection and Acute laryngeal disease due to trauma, infection and

prolonged intubation, not in children less than 12. prolonged intubation, not in children less than 12. What are the clinical manifestations of angioedema?What are the clinical manifestations of angioedema? Throat tight, dyspnea, cough, stridor, hoarseness, Throat tight, dyspnea, cough, stridor, hoarseness,

face, mouth, lips, tongue, extremitiesface, mouth, lips, tongue, extremities Diagnostics: fiberoptic nasopharyngoscopy to assess Diagnostics: fiberoptic nasopharyngoscopy to assess

for laryngeal edema. for laryngeal edema. What is the management?What is the management? Epi, antihistamines, steroidsEpi, antihistamines, steroids

Airway Emergencies What is the etiology of epiglottitis?What is the etiology of epiglottitis? Hamemophilus influenzae type BHamemophilus influenzae type B How does a patient present with epiglottitis?How does a patient present with epiglottitis? Worsening dysphagia, dysphonia, sore throat, Worsening dysphagia, dysphonia, sore throat,

fever, cervical adenopathy, drooling, stridorfever, cervical adenopathy, drooling, stridor Diagnostics?Diagnostics? Lateral soft tissue neck, edematous epiglottis, Lateral soft tissue neck, edematous epiglottis,

direct laryngoscopydirect laryngoscopy What is the management?What is the management? Intubation in the OR, IV cefuroxime. Intubation in the OR, IV cefuroxime.

Airway Emergencies

What is the etiology of croup?What is the etiology of croup? ParainfluenzaParainfluenza What are clinical manifestations of croup?What are clinical manifestations of croup? Barking cough preceded by 2/3 days of respiratory Barking cough preceded by 2/3 days of respiratory

infection, stridor, low grade fever, normal lung soundsinfection, stridor, low grade fever, normal lung sounds Diagnostics?Diagnostics? Anterior posterior soft tissue neck: steeple signAnterior posterior soft tissue neck: steeple sign Management?Management? Nebulized saline, racemic epinephrine, dexamethasoneNebulized saline, racemic epinephrine, dexamethasone

Airway Emergencies

When evaluating for strangulation, always look When evaluating for strangulation, always look for injury to::for injury to::

Cervical spine, airwayCervical spine, airway What are diagnostics used in strangulation?What are diagnostics used in strangulation? Posterolateral neck xay, chest x-ray, direct Posterolateral neck xay, chest x-ray, direct

laryngoscopy. laryngoscopy. What is the management?What is the management? Assure airway protection, c spine precautions. Be Assure airway protection, c spine precautions. Be

aware of delayed signs and symptoms. aware of delayed signs and symptoms.

BCLS review

Adult:Adult: What is the compression rate?What is the compression rate? At least 100/minAt least 100/min How is the airway opened?How is the airway opened? Head tilt, chin liftHead tilt, chin lift How many breaths are given initially after How many breaths are given initially after

opening the airway?opening the airway? 2, lasting one second each2, lasting one second each

BCLS review

If you are alone, after establishing If you are alone, after establishing unresponsiveness you should:unresponsiveness you should:

Activate EMS and get AEDActivate EMS and get AED Then Then Open the airway check for breathing (5-10 seconds)Open the airway check for breathing (5-10 seconds) ThenThen Give 2 full breathsGive 2 full breaths ThenThen Check pulse 5-10 secondsCheck pulse 5-10 seconds

BCLS review

What is the compression rate to ventilation What is the compression rate to ventilation rate for an adult? rate for an adult?

30:2 , 5 cycles30:2 , 5 cycles If you note a shockable rhythm?If you note a shockable rhythm? Shock and then resume CPR for 5 cycles. Shock and then resume CPR for 5 cycles.

BCLS review

ChildChild Check responsivenessCheck responsiveness Lone rescuer: 5 cycles of CPR prior to calling 911. If Lone rescuer: 5 cycles of CPR prior to calling 911. If

witnessed collapse then activate EMS first. witnessed collapse then activate EMS first. Open airway, 2 breathesOpen airway, 2 breathes Check pulse for 10 secondsCheck pulse for 10 seconds Rescue breathing: 1:3, recheck pulse every 2 minutesRescue breathing: 1:3, recheck pulse every 2 minutes 30:2, 2 rescuer 15:230:2, 2 rescuer 15:2 Defib only if child >1 year old. Defib only if child >1 year old.

BCLS review

InfantInfant Check for response, activate EMSCheck for response, activate EMS Head tilt chin liftHead tilt chin lift If no pulse or heart rate <60 then with signs If no pulse or heart rate <60 then with signs

of poor perfusion then: 15:2 if two man, of poor perfusion then: 15:2 if two man, 30:2 if one man. 30:2 if one man.

Use 2 thumb encircling techniqueUse 2 thumb encircling technique

BCLS review

ChokingChoking Severe: no air exchangeSevere: no air exchange Adult: abdominal thrusts. If unconscious Adult: abdominal thrusts. If unconscious

begin CPR. begin CPR. Infant: Conscious: 5 back slaps followed by Infant: Conscious: 5 back slaps followed by

5 chest thrusts. If unresponsive then CPR.5 chest thrusts. If unresponsive then CPR. Chain of survival: early access, early CPR, Chain of survival: early access, early CPR,

early defibrillation, early advanced care. early defibrillation, early advanced care.

Anaphylaxis/ Respiratory Instrumentation What is the pathophysiology behind Type I What is the pathophysiology behind Type I

anaphylaxis?anaphylaxis? Quick: 5-30min, IgE induced by antigens, first Quick: 5-30min, IgE induced by antigens, first

exposure is sensitization of mast cells, second exposure is sensitization of mast cells, second exposure leads to degranulation and release of exposure leads to degranulation and release of mediatorsmediators

Effects of histamine?Effects of histamine? Vasodilation: flushing, hypotensionVasodilation: flushing, hypotension Acetylcholine?Acetylcholine? Smooth muscle spasm, abdominal crampingSmooth muscle spasm, abdominal cramping

Anaphylaxis/ Respiratory Instrumentation Secondary response?Secondary response? Mucosal edema, mucus secretion, Mucosal edema, mucus secretion,

bronchospasmbronchospasm

Anaphylaxis/ Respiratory Instrumentation What are some clinical manifestations of What are some clinical manifestations of

anaphylaxis?anaphylaxis? Dyspnea, wheezing, stridor, chest tightness, Dyspnea, wheezing, stridor, chest tightness,

urticaria, pruritus, abdominal pain/ vomiting, urticaria, pruritus, abdominal pain/ vomiting, hypotension, dizziness, syncope, angioedemahypotension, dizziness, syncope, angioedema

Treatment ABC’s. Intubation, oxygen, nebulized Treatment ABC’s. Intubation, oxygen, nebulized bronchodilators, IV fluids, epinephrine (antidote bronchodilators, IV fluids, epinephrine (antidote for chemicals released in anaphylaxis), for chemicals released in anaphylaxis), antihistamines, steroidsantihistamines, steroids

Anaphylaxis/ Respiratory Instrumentation What is an anaphylactoid reaction?What is an anaphylactoid reaction? Not IgE, though similar to anaphylaxis. Not IgE, though similar to anaphylaxis.

Follows first time exposure to radiocontrast, Follows first time exposure to radiocontrast, aspirin, NSAIDS, blood, opioidsaspirin, NSAIDS, blood, opioids

Management:Management: Pre treatment with antihistamines/steroidsPre treatment with antihistamines/steroids

Respiratory Instrumentation

What is the BVM? What is the function of the What is the BVM? What is the function of the BVM?BVM?

Provide oxygen, ventilation, protect airwayProvide oxygen, ventilation, protect airway When should this devise be used?When should this devise be used? Failure to protect airway, patient can’t protect Failure to protect airway, patient can’t protect

airway, protect against aspiration, failure of other airway, protect against aspiration, failure of other methods, patient tiring or likelihood of deteriorationmethods, patient tiring or likelihood of deterioration

How much oxygen is provided?How much oxygen is provided? 15 l/min 100% oxygen15 l/min 100% oxygen


Where is the tube placed?Where is the tube placed? Between the vocal cords, confirm placementBetween the vocal cords, confirm placement What is the purpose of rapid sequence intubation?What is the purpose of rapid sequence intubation? Induce unconsciousness with muscular paralysis Induce unconsciousness with muscular paralysis

to provide optimal conditions for intubation. to provide optimal conditions for intubation. Provides NMBA and sedativeProvides NMBA and sedative How is placement of tube confirmed?How is placement of tube confirmed? End tital CO2 detector, aspiration technique, End tital CO2 detector, aspiration technique,

CXR. CXR.


What is the purpose of laryngeal mask airway?What is the purpose of laryngeal mask airway? Ventilation of trachea with minimal air into Ventilation of trachea with minimal air into

esophagusesophagus Esophageal combitube?Esophageal combitube? Easy and temporary, allows blind insertion. One Easy and temporary, allows blind insertion. One

lumen as an airway post esophageal insertion, lumen as an airway post esophageal insertion, other as tracheal airway. other as tracheal airway.

What is CPAP?What is CPAP? Continuous positive airway pressureContinuous positive airway pressure


What is the flow rate for simple face mask?What is the flow rate for simple face mask? 40-60% oxygen, 8-12 l/min40-60% oxygen, 8-12 l/min nonrebreather?nonrebreather? 10-15 l/min, 80-100% oxygen10-15 l/min, 80-100% oxygen venturi mask?venturi mask? Controlled amount of oxygenControlled amount of oxygen Nasal cannula? Nasal cannula? 20-40% oxygen, 1-6 l/min20-40% oxygen, 1-6 l/min Nebulizer: Nebulizer: Mist to airways. 6 l/minMist to airways. 6 l/min


Peek flow meter, pulse oximetryPeek flow meter, pulse oximetry What are the indications for endotracheal What are the indications for endotracheal

suctioning?suctioning? Coarse breath sounds, visible secretions in Coarse breath sounds, visible secretions in

airway, aspiration, deteriorating blood gas airway, aspiration, deteriorating blood gas values, sputum specimenvalues, sputum specimen

Hypertension Emergencies What is pre-hypertension, stage I hypertension, stage What is pre-hypertension, stage I hypertension, stage

II hypertension?II hypertension? <120/80, 120-139/80-89, 140-159/90-99, >=160/100<120/80, 120-139/80-89, 140-159/90-99, >=160/100 What are the clinical manifestations of essential What are the clinical manifestations of essential

hypertension?hypertension? Asymptomatic. Long term to kidneys, heart, eyes, Asymptomatic. Long term to kidneys, heart, eyes,

brain, blood vesselsbrain, blood vessels What is the management of stage I?What is the management of stage I? Thiazides, ACE I, ARB, BB, CCBThiazides, ACE I, ARB, BB, CCB Stage II? Stage II? Two drugs thiazide and aboveTwo drugs thiazide and above

Hypertension Emergencies

What is the definition of hypertensive emergency?What is the definition of hypertensive emergency? B/P diastolic >115-130, associated with end organ B/P diastolic >115-130, associated with end organ

damage to brain, heart, kidneys, eyes.damage to brain, heart, kidneys, eyes. What is the definition of hypertensive urgency?What is the definition of hypertensive urgency? Imminent end organ damage. Reduce B/P over 24-48 Imminent end organ damage. Reduce B/P over 24-48

hours . >180/120hours . >180/120 What is the definition of acute hypertensive episode?What is the definition of acute hypertensive episode? Systolic >180, diastolic >110. Patient asymptomatic. Systolic >180, diastolic >110. Patient asymptomatic.

No immediate treatment. Follow up neededNo immediate treatment. Follow up needed


What is transient hypertension?What is transient hypertension? Elevated B/P due to another condition such as anxiety, Elevated B/P due to another condition such as anxiety,

alcohol, cocainealcohol, cocaine What are the symptoms of end organ damage?What are the symptoms of end organ damage? CNS, cardiac, renal, optho. CNS, cardiac, renal, optho. What is hypertensive encephalopathy?What is hypertensive encephalopathy? Vasospasm and brain edemaVasospasm and brain edema What are the clinical manifestations?What are the clinical manifestations? Neuro symptoms, visual symptoms, cardiovascular, Neuro symptoms, visual symptoms, cardiovascular,

renal. confusion, seizures, coma, Diastolic > 130renal. confusion, seizures, coma, Diastolic > 130


What is the management of hypertensive What is the management of hypertensive encephalopathy?encephalopathy?

Sodium nitroprusside.Sodium nitroprusside. What is malignant hypertension?What is malignant hypertension? Acute and progressive end organ damage. CNS, Acute and progressive end organ damage. CNS,

optho, cardiovascular, renaloptho, cardiovascular, renal Treatment: lower B/P to prevent end organ Treatment: lower B/P to prevent end organ

damage. Use Sodium nitroprusside, labetalol, damage. Use Sodium nitroprusside, labetalol, phentolamine, hydralazine for eclampsiaphentolamine, hydralazine for eclampsia


What are the two types of strokes?What are the two types of strokes? Ischemic/hemorrhagicIschemic/hemorrhagic What is the clinical presentation?What is the clinical presentation? Depends on area involved. Headache, dizziness, Depends on area involved. Headache, dizziness,

visual changes, dysphasia, LOC, abnormal visual changes, dysphasia, LOC, abnormal neurological exam, hemiparesis or hemisensory neurological exam, hemiparesis or hemisensory deficit. MCA face and hand, ACA mostly leg and deficit. MCA face and hand, ACA mostly leg and foot, PCA: mostly ocolomotor. Vertebral arteries: foot, PCA: mostly ocolomotor. Vertebral arteries: vertigo, N/V. vertigo, N/V.

Most common artery is MCA Most common artery is MCA

Hypertension Emergencies What is the clinical presentation of subarachnoid What is the clinical presentation of subarachnoid

hemorrhage?hemorrhage? HA, hypertension, LOC, vomiting, nuchal rigidity, focal HA, hypertension, LOC, vomiting, nuchal rigidity, focal

deficitsdeficits What is the management?What is the management? Cerebral arteriography, supportive. Cerebral arteriography, supportive. What is a TIA?What is a TIA? Symptoms less than 24 hours usually one hourSymptoms less than 24 hours usually one hour Amaurosis fugaxAmaurosis fugax Management of TIA? Management of TIA? Antiplatelets, anticoagulants, endarterectomyAntiplatelets, anticoagulants, endarterectomy

Hypertension Emergencies What is the management of CVA?What is the management of CVA? CT to rule out intracranial bleedCT to rule out intracranial bleed CBC, electrolytes, coagulation studies, EKG, CXR CBC, electrolytes, coagulation studies, EKG, CXR

(widening aorta)(widening aorta) ABC’sABC’s Thrombolytics: for stroke >18, ischemic symptoms less Thrombolytics: for stroke >18, ischemic symptoms less

than 3 hours, antiplatelet therapy. First reduce B/P to than 3 hours, antiplatelet therapy. First reduce B/P to 185/110 with Labetolol. 185/110 with Labetolol.

Contraindications for thrombolytics;Contraindications for thrombolytics; Intracranial bleed, uncontrolled HTN,arteriovenous Intracranial bleed, uncontrolled HTN,arteriovenous

malformation, neurosurgery in past 3 months, malformation, neurosurgery in past 3 months, pregnancy, clinical improved,. pregnancy, clinical improved,.


What is bell’s palsy?What is bell’s palsy? 77thth CN palsy CN palsy What are some clinical manifestations?What are some clinical manifestations? Facial weakness, articulation difficulties, Facial weakness, articulation difficulties,

weakness to one side of face and foreheadweakness to one side of face and forehead What is the management?What is the management? Prednisone, acyclovir, artificial tears. Prednisone, acyclovir, artificial tears.


What are the clinical manifestations of a subdural What are the clinical manifestations of a subdural hematoma?hematoma?

Brain and dura. Progressive worsening headache, Brain and dura. Progressive worsening headache, progressive neuro deficitsprogressive neuro deficits

What are the clinical manifestations of a epidural What are the clinical manifestations of a epidural hematoma?hematoma?

Between dura and skull. Transient LOC, followed Between dura and skull. Transient LOC, followed by lucid interval and then rapid deterioration. by lucid interval and then rapid deterioration.


What is cushing’s triad?What is cushing’s triad? Hypertension, bradycardia, respiratory pattern Hypertension, bradycardia, respiratory pattern

irregularityirregularity What is the significance of raccoon eyes and battle What is the significance of raccoon eyes and battle

sign?sign? Basilar skull fxBasilar skull fx What is the management of epidural and subdural What is the management of epidural and subdural

hematoma?hematoma? Mannitol, prophylactic antibiotics, surgical Mannitol, prophylactic antibiotics, surgical

decompression. decompression.

Neurovascular Emergencies

What are some reasons for increased ICP?What are some reasons for increased ICP? Bleeding, edema, inflammation, tumorBleeding, edema, inflammation, tumor What is the location for subdural bleeding?What is the location for subdural bleeding? Below the duraBelow the dura Epidural? Epidural? Above the duraAbove the dura What glasgow score correlates with severe brain What glasgow score correlates with severe brain

injury? injury? Less than 8Less than 8


What is the pathology of decorticate posturing?What is the pathology of decorticate posturing? Lession to corticospinal tract superior to Lession to corticospinal tract superior to

brainstem. Flexion of elbows, wrists, fingers, brainstem. Flexion of elbows, wrists, fingers, plantar flexion of feet with extension and internal plantar flexion of feet with extension and internal rotation of legsrotation of legs

What is the pathology of decerebrate posturing?What is the pathology of decerebrate posturing? Lesions to brain stem. Extension of arms, flexion Lesions to brain stem. Extension of arms, flexion

of wrists, jaw clenching, back arching, plantar of wrists, jaw clenching, back arching, plantar flexion, neck extension, in response to pain or flexion, neck extension, in response to pain or spontaneous. spontaneous.


What positioning is done for patient with What positioning is done for patient with herniation?herniation?

HOB 30 degrees, HOB 30 degrees, Worst headache of life is:Worst headache of life is: Subarachnoid hemorrhageSubarachnoid hemorrhage What are clinical manifestations of What are clinical manifestations of

meningitis?meningitis? Fever, neck stiffness, confusionFever, neck stiffness, confusion

Neurovascular Emergencies In a seizure what is tonic?In a seizure what is tonic? Muscle rigidityMuscle rigidity Clonic?Clonic? Violent rhythmic jerking of extremitiesViolent rhythmic jerking of extremities Postictal?Postictal? Decreased LOCDecreased LOC What is a grandmal seizure?What is a grandmal seizure? Loss of consciousness, loss of bowel and bladder, Loss of consciousness, loss of bowel and bladder,

cyanosis. Lasts more than 5 minutecyanosis. Lasts more than 5 minute If second seizure follow this is known as:If second seizure follow this is known as: Status epilepticusStatus epilepticus


Focal seizures:Focal seizures: 1-2 min LOC, smacking lips, picking 1-2 min LOC, smacking lips, picking

things, swallowing, posticalthings, swallowing, postical Petit mal?Petit mal? Sudden lapse of consciousness. Small jerks Sudden lapse of consciousness. Small jerks

of face or arms, no postical periodof face or arms, no postical period Febrile seizure due to:Febrile seizure due to: FeverFever

Shock What is the pathophysiology of shock?What is the pathophysiology of shock? Circulatory insufficiency leading to inadequate Circulatory insufficiency leading to inadequate

tissue perfusion, tissue injury and deathtissue perfusion, tissue injury and death What are the categories of shock?What are the categories of shock? Causes that require infusion of volume, causes that Causes that require infusion of volume, causes that

require improvement in pump function, causes that require improvement in pump function, causes that require volume and vasopressor support, causes that require volume and vasopressor support, causes that require relief of obstruction, cellular poisons that require relief of obstruction, cellular poisons that need antidotes.need antidotes.

Percentage of blood loss:Percentage of blood loss: >35% cardiac output and arterial pressure fall to zero>35% cardiac output and arterial pressure fall to zero

Shock 10% can be asymptomatic10% can be asymptomatic What are some compensatory mechanisms for What are some compensatory mechanisms for

shock?shock? Sympathetic mediated: tachycardia, vasoconstrictionSympathetic mediated: tachycardia, vasoconstriction What are some early compensated responses? What are some early compensated responses? Tachycardia, tachypnea, pallor, decreased urinary Tachycardia, tachypnea, pallor, decreased urinary

output (ADH: vasopressin), AMS, thirst, output (ADH: vasopressin), AMS, thirst, Decompensated: pale, weak rapid pulse, n/v/thirst, Decompensated: pale, weak rapid pulse, n/v/thirst,

LOC, pupils dilated, severe acidosis, anuria, LOC, pupils dilated, severe acidosis, anuria, hypotension, acidosis. hypotension, acidosis.

Shock/

What are the clinical manifestations of What are the clinical manifestations of hypovolemic shock?hypovolemic shock?

AMS, pale, clammy skin, oliguria, tachypnea, AMS, pale, clammy skin, oliguria, tachypnea, tachycardia, metabolic acidosis, management is tachycardia, metabolic acidosis, management is ABC, control hemorrhage IV isotonic 1-2 liter, ABC, control hemorrhage IV isotonic 1-2 liter, 20cc/kg bolus in peds, crystalloids, cross matched 20cc/kg bolus in peds, crystalloids, cross matched blood, vasopressors such as dopamine, blood, vasopressors such as dopamine, norepinephrine is systolic <70pnorepinephrine is systolic <70p

Shock/

Cardiogenic shockCardiogenic shock What is the etiology?What is the etiology? MI, anterior wall. Decreased ejection and cardiac MI, anterior wall. Decreased ejection and cardiac

outputoutput What are the clinical manifestations?What are the clinical manifestations? Chest pain, SOB, S3 (CHF), JVD, AMS, hypotension, Chest pain, SOB, S3 (CHF), JVD, AMS, hypotension,

tachycardia, pulmonary edema, decreased urine outputtachycardia, pulmonary edema, decreased urine output Management: ABC’s, teat MI, vasopressors (inotropic Management: ABC’s, teat MI, vasopressors (inotropic

support (Dopamine/ Dobutamine, norepinephrine), support (Dopamine/ Dobutamine, norepinephrine), intra-aortic balloon pump intra-aortic balloon pump

Shock/ Types of distributive shockTypes of distributive shock Septic, anaphylaxis, neurogenicSeptic, anaphylaxis, neurogenic Septic: due to toxins which lead to loss of vascular Septic: due to toxins which lead to loss of vascular

tone, might not respond to fluid replacement, tone, might not respond to fluid replacement, extremities warm and flushed extremities warm and flushed

What is the managemet of septic shock?What is the managemet of septic shock? ABC, broad spectrum antibiotics, sluids, ABC, broad spectrum antibiotics, sluids,

norepinephrine, dopamine could be detrimental: norepinephrine, dopamine could be detrimental: heart working hard. heart working hard.

What is neurogenic shockWhat is neurogenic shockSympathetic denervation. No actual blood loss. Sympathetic denervation. No actual blood loss.

Shock/

What is the presentation of neurogenic What is the presentation of neurogenic shock?shock?

Warm skin, bradycardia, hypotension, Warm skin, bradycardia, hypotension, normal cardiac output.normal cardiac output.

What is the management?What is the management? IV fluids, vasoconstrictors such as IV fluids, vasoconstrictors such as

norepinephrine slowly. norepinephrine slowly.

Shock

What is obstructed shock?What is obstructed shock? Obstruction of blood flow leading to decreased Obstruction of blood flow leading to decreased

cardiac outputcardiac output ExamplesExamples PE, cardiac tamponade, tension pneumothoraxPE, cardiac tamponade, tension pneumothorax What is becks triad?What is becks triad? Hypotension, muffled heart sounds, JVDHypotension, muffled heart sounds, JVD What is psychogenic shock? What is psychogenic shock? Fainting due to vasovagal reaction, quickly resolvesFainting due to vasovagal reaction, quickly resolves

AMS Patient

Consciousness requires an intact:Consciousness requires an intact: Cerebral cortex and RASCerebral cortex and RAS What is obtundation?What is obtundation? Reduced alertness, lethargy. Respond to painful Reduced alertness, lethargy. Respond to painful

stimulistimuli What scores are given in Glasgow coma scale?What scores are given in Glasgow coma scale? Eye opening 4, verbal response 5, motor response 6Eye opening 4, verbal response 5, motor response 6 What is cheyne stokes respiratory pattern?What is cheyne stokes respiratory pattern? Increase and decrease in tidal volumeIncrease and decrease in tidal volume

AMS Patient What are apneustic respirations?What are apneustic respirations? Slow deep and heldSlow deep and held What medications are diagnostic and therapeutic What medications are diagnostic and therapeutic

in the AMS patient?in the AMS patient? Naloxone, thiamine, glucose. Naloxone, thiamine, glucose. What are the clinical manifestations of What are the clinical manifestations of

hypoglycemia?hypoglycemia? Elevated epi leading to diaphoresis, tremors, Elevated epi leading to diaphoresis, tremors,

hypertension, tachycardia, anxiety, neuro due to hypertension, tachycardia, anxiety, neuro due to decreased AMSdecreased AMS

AMS Patient

What is whipple’s triad?What is whipple’s triad? Symptoms of hypoglycemia, blood sugar <50, Symptoms of hypoglycemia, blood sugar <50,

recovery with glucoserecovery with glucose What is the management?What is the management? Glucose or glucagon if not responsiveGlucose or glucagon if not responsive What is diabetic ketoacidosis?What is diabetic ketoacidosis? Low insulin and glucagon excess. Glycogenolysis Low insulin and glucagon excess. Glycogenolysis

leading to production of ketones. Hyperglycemia leading to production of ketones. Hyperglycemia leading to osmotic diuresis.leading to osmotic diuresis.

AMS Patient

What are the clinical manifestations of What are the clinical manifestations of diabetic ketoacidosis?diabetic ketoacidosis?

Poly uria, dipsia, phagia, kussmauls Poly uria, dipsia, phagia, kussmauls respirations, acetone breath, dehydrationrespirations, acetone breath, dehydration

What is the management of this?What is the management of this? Fluid replacement, insulin, correct Fluid replacement, insulin, correct

metabolic acidosis, K with insulin to avoid metabolic acidosis, K with insulin to avoid hypokalemiahypokalemia

AMS Patient

What is hyperosmolar hyperglycemia?What is hyperosmolar hyperglycemia? Low insulin leads to hyperglycemia and osmotic Low insulin leads to hyperglycemia and osmotic

diuresis. Found in type II Diabetics, serum ketones diuresis. Found in type II Diabetics, serum ketones absent, still produce some insulinabsent, still produce some insulin

Clinical manifestations of this?Clinical manifestations of this? Thirst, oliguria, dehydration, hyperosmolarity, no Thirst, oliguria, dehydration, hyperosmolarity, no

kussmauls or acetone breath, glucose >600kussmauls or acetone breath, glucose >600 What is the management?What is the management? Fluids, replace electrolytesFluids, replace electrolytes

Poisoned Patient

Number for poison control?Number for poison control? 1212 POISONS or 1800222-12221212 POISONS or 1800222-1222 What is Flumazenil?What is Flumazenil? Specific antidote for benzodiazepinesSpecific antidote for benzodiazepines What are methods of gross What are methods of gross

decontamination?decontamination? Gastric lavage, activated charcoal, osmotic Gastric lavage, activated charcoal, osmotic

catharticscathartics

Poisoned Patient What is a toxidrome? What is a toxidrome? Physical findings common with a specific drug class Physical findings common with a specific drug class

that can narrow differential diagnosisthat can narrow differential diagnosis What are the clinical manifestations of the What are the clinical manifestations of the

anticholinergic toxidrome?anticholinergic toxidrome? Delirium, tachycardia, dry flushed skin and mucous Delirium, tachycardia, dry flushed skin and mucous

membranes, mydriasis, myosclonus, hyperthermia, membranes, mydriasis, myosclonus, hyperthermia, urinary retention, decreased bowel soundsurinary retention, decreased bowel sounds

Where is this found?Where is this found? Antihistamines, antiparkinsons, atropine, scopoamine, Antihistamines, antiparkinsons, atropine, scopoamine,

antidepressants, mydriatics, antispasmotics. antidepressants, mydriatics, antispasmotics.

Poisoned Patient What is a specific antidote for anticholinergic OD?What is a specific antidote for anticholinergic OD? Physostigmine. Don’t use in antidepressant OD leads Physostigmine. Don’t use in antidepressant OD leads

to asystoleto asystole What are clinical manifestations of the What are clinical manifestations of the

sympathomimetic syndrome?sympathomimetic syndrome? Delusions, mydriasis, diaphoresis, chest pain, Delusions, mydriasis, diaphoresis, chest pain,

palpitations, dyspnea, hypertension, hyperthermia, palpitations, dyspnea, hypertension, hyperthermia, weight loss, hyperreflexia, seizuresweight loss, hyperreflexia, seizures

What can lead to this?What can lead to this? Cocaine, amphetamines, ephedrine, Cocaine, amphetamines, ephedrine,

methamphetamines, ecstasymethamphetamines, ecstasy

Poisoned Patient

What are the clinical manifestations of the CNS What are the clinical manifestations of the CNS depressant syndrome?depressant syndrome?

Coma, euphoria, analgesia, uninhibited behavior, Coma, euphoria, analgesia, uninhibited behavior, hypotension, respiratory depression, miosis, slurred hypotension, respiratory depression, miosis, slurred speech, hyporeflexia, hypothermia, pulmonary speech, hyporeflexia, hypothermia, pulmonary edemaedema

Is there a specific antidote for opioids?Is there a specific antidote for opioids? Naloxone (Narcan)Naloxone (Narcan) What are some examples of opioids?What are some examples of opioids? Heroin, methadone, morphine, codeineHeroin, methadone, morphine, codeine

Poisoned Patient

What is alcohol metabolized by in the liver?What is alcohol metabolized by in the liver? Alcohol dehydrogenaseAlcohol dehydrogenase What are the clinical manifestations of the What are the clinical manifestations of the

cholinergic syndrome?cholinergic syndrome? Wet opposed to dry: salivation, lacrimation, Wet opposed to dry: salivation, lacrimation,

urination, defecation, GI cramping, emesis, CNS, urination, defecation, GI cramping, emesis, CNS, miotic pupilsmiotic pupils

Any specific antidote?Any specific antidote? Atropine, cholinesterase regeneratorsAtropine, cholinesterase regenerators

Poisoned Patient

What is the dose of acetaminophen considered What is the dose of acetaminophen considered lethal for adults? Peds?lethal for adults? Peds?

7.5grams, 150mg/kg7.5grams, 150mg/kg What is the antidote for this poisoning?What is the antidote for this poisoning? N-acetylcysteine. Degrades NAPQIN-acetylcysteine. Degrades NAPQI What are the clinical manifestations of aspirin OD? What are the clinical manifestations of aspirin OD? N/V/GI, hyperventilation, sweating, tinnitus, neuro N/V/GI, hyperventilation, sweating, tinnitus, neuro

dysfunction, noncardiogenic pulmonary edemadysfunction, noncardiogenic pulmonary edema

Poisoned Patient

What is the management of aspirin OD?What is the management of aspirin OD? Activated charcoal, hydration, alkalization Activated charcoal, hydration, alkalization

of urine and plasma, sodium bicarbonate, of urine and plasma, sodium bicarbonate, hemodialysishemodialysis

What is a complication of TCA OD?What is a complication of TCA OD? EKG, prolonged QRS, anticholinergic EKG, prolonged QRS, anticholinergic

effects that can progress rapidly to effects that can progress rapidly to convulsions, coma, cardiovascular collapseconvulsions, coma, cardiovascular collapse

Poisoned Patient

What are clinical manifestations of dig tox?What are clinical manifestations of dig tox? Cardiac dysrhythmias, AV blocks, bradycardia, Cardiac dysrhythmias, AV blocks, bradycardia,

ventricular dysrhythmias, GI (N/V/D), hyperkalemia, ventricular dysrhythmias, GI (N/V/D), hyperkalemia, CNS, visual changesCNS, visual changes

What is the management?What is the management? DigibindDigibind What are the clinical manifestations of LSD?What are the clinical manifestations of LSD? Visual, auditory, olfactory hallucinations, mydriasis, Visual, auditory, olfactory hallucinations, mydriasis,

conjunctival injection, dry mouth , flushing, tachycardiaconjunctival injection, dry mouth , flushing, tachycardia Management? Management?

Poisoned Patient

Supportive, benzos, sedationSupportive, benzos, sedation What are the clinical manifestations of OD What are the clinical manifestations of OD

on PCP (Phencyclidine)?on PCP (Phencyclidine)? Sympathomimetic, agitated, confused, Sympathomimetic, agitated, confused,

superhuman strength. Muscle rigidity, superhuman strength. Muscle rigidity, hyperthermia, convulsionshyperthermia, convulsions

Management?Management? Chemical sedation with haldol, ativanChemical sedation with haldol, ativan

Poisoned Patient

What are the clinical manifestations of cyanide What are the clinical manifestations of cyanide poisoning?poisoning?

Hypoxia without cyanosis, coma, seizures, Hypoxia without cyanosis, coma, seizures, cardiovascular collapse, cherry red retinal vessels, cardiovascular collapse, cherry red retinal vessels, mydriasismydriasis

What is the specific antidote?What is the specific antidote? Nitrite thiosulfate, sodium bicarbNitrite thiosulfate, sodium bicarb What are the clinical manifestations of carbon monoxide What are the clinical manifestations of carbon monoxide

OD?OD?AMS, coma, seizures, hypotension, cardiac arrest, AMS, coma, seizures, hypotension, cardiac arrest, metabolic acidosis, headache, N/V, cherry red skin latemetabolic acidosis, headache, N/V, cherry red skin late

Poisoned Patient

What is the management?What is the management? Oxygen, hyperbaric oxygenOxygen, hyperbaric oxygen

Diff Dx Syncope

What are the clinical manifestations of near syncope?What are the clinical manifestations of near syncope? Dizzy, weak, N, diaphoresis, visual change, no Dizzy, weak, N, diaphoresis, visual change, no

syncopesyncope Drop attack?Drop attack? Falling without warning, compression of vertebral Falling without warning, compression of vertebral

arteries, No LOCarteries, No LOC Be able to differentiate syncope from seizureBe able to differentiate syncope from seizure What is the etiology of Cardiac syncope-What is the etiology of Cardiac syncope- arrhythmia, organic heart diseasearrhythmia, organic heart disease

Diff Dx Syncope

What arrhythmias lead to cardiac syncope?What arrhythmias lead to cardiac syncope? Brady, tachy. No prodromeBrady, tachy. No prodrome What is cardioversion?What is cardioversion? Giving standardized amount of electricity at a precise time Giving standardized amount of electricity at a precise time

synchronized with R wavesynchronized with R wave What are the clinical manifestations of Obstructive What are the clinical manifestations of Obstructive

hypertrophic cardiomyopathy?hypertrophic cardiomyopathy? Sudden death on exertion due to v-fib. , SOB, chest pain, Sudden death on exertion due to v-fib. , SOB, chest pain,

syncope, palpitations of exertion, S4. syncope, palpitations of exertion, S4. Treatment?Treatment? BB, CCB, surgeryBB, CCB, surgery

Diff Dx Syncope What are the clinical manifestations of aortic What are the clinical manifestations of aortic

stenosis?stenosis? Dyspnea on exertion, chest pain, exertional syncopeDyspnea on exertion, chest pain, exertional syncope What is subclavian steal syndrome?What is subclavian steal syndrome? Occlusion of proximal subclavian artery and Occlusion of proximal subclavian artery and

development of retrograde flow to subclavian artery development of retrograde flow to subclavian artery from vertebral artery. Steals blood from cerebral from vertebral artery. Steals blood from cerebral circulation.circulation.

Signs of vertebral insufficiency? Brachial Signs of vertebral insufficiency? Brachial insufficiency? insufficiency?

Dizzy, ataxia, visual disturbances, syncope.Dizzy, ataxia, visual disturbances, syncope.

Diff Dx Syncope

What is carotid sinus hypersensitivity?What is carotid sinus hypersensitivity? Vagal stimulation inhibiting sympathetic toneVagal stimulation inhibiting sympathetic tone What is orthostatic syncope?What is orthostatic syncope? Heart rate and PVR not increased adequatelyHeart rate and PVR not increased adequately What are the symptoms?What are the symptoms? Sudden standing, lightheaded, weakness, syncopeSudden standing, lightheaded, weakness, syncope What is vasovagal syncope?What is vasovagal syncope? Normal compensatory sympathetic response not there. Normal compensatory sympathetic response not there.

Have parasympathetic response leading to bradycardia, Have parasympathetic response leading to bradycardia, vasodilation, hypotension, decreased cerebral perfusionvasodilation, hypotension, decreased cerebral perfusion

Diff Dx Syncope

What are the clinical manifestations?What are the clinical manifestations? Prodrome of diaphoresis, N, fatigue, weakness, Prodrome of diaphoresis, N, fatigue, weakness,

dizzy, vertigo then LOCdizzy, vertigo then LOC What is the management?What is the management? BblockersBblockers What are some forms of situational syncope?What are some forms of situational syncope? Coughing, defecation, eating, swallowing, Coughing, defecation, eating, swallowing,

micturitionmicturition

Diff Dx Syncope What is peripheral vertigo?What is peripheral vertigo? Problem with inner earProblem with inner ear What is etiology of central vertigo?What is etiology of central vertigo? Tumor, CVATumor, CVA What are the clinical manifestations of benign What are the clinical manifestations of benign

positional vertigo?positional vertigo? N/V, position change results in symptoms, N/V, position change results in symptoms, What is the management? What is the management? Meclizine, promethazineMeclizine, promethazine What is an acoustic neuroma?What is an acoustic neuroma? Vestibulo cochlear nerve 8Vestibulo cochlear nerve 8thth CN CN

Diff Dx Syncope

What are the clinical manifestations?What are the clinical manifestations? Gradual onset days to weeks of unilateral hearing loss, Gradual onset days to weeks of unilateral hearing loss,

tinnitus, ataxia and neuro signs as tumor enlarges.tinnitus, ataxia and neuro signs as tumor enlarges. What is meniere’s disease?What is meniere’s disease? Imbalance in secretion and absorption of endolymph Imbalance in secretion and absorption of endolymph

causes fluid to build up in cochlea. Leads to hair cell causes fluid to build up in cochlea. Leads to hair cell damagedamage

What are the clinical manifestations?What are the clinical manifestations? sensorineural hearing loss, tinnitus, fullness pressure sensorineural hearing loss, tinnitus, fullness pressure

in ears, n/v (HCTZ)in ears, n/v (HCTZ)

Diff Dx Syncope

What is labyrinthitis?What is labyrinthitis? Viral infection follows URI. Vertigo due to Viral infection follows URI. Vertigo due to

inflammation and infection of labyrinthinflammation and infection of labyrinth What are the clinical manifestations?What are the clinical manifestations? Lasts 7-10 days. n/v, vertigo with head movement Lasts 7-10 days. n/v, vertigo with head movement

lasting one minute, nystagmus, loss of balance, lasting one minute, nystagmus, loss of balance, tinnitus, CNS normal tinnitus, CNS normal

What is the management?What is the management? Steroids, antivert, tiganSteroids, antivert, tigan

Dyspnea

Asthma: Asthma: Bronchospasm, complain of dyspnea, cough, chest Bronchospasm, complain of dyspnea, cough, chest

tightness, wheezing, accessory muscle use. tightness, wheezing, accessory muscle use. Management: nebulized b adrenergic drugs, Management: nebulized b adrenergic drugs,

corticosteroids, anticholinergics, magnesium corticosteroids, anticholinergics, magnesium sulfate, oxygen, inhaled steroidssulfate, oxygen, inhaled steroids

COPDCOPD Tachypnea, accessory muscles, pursed lip weight Tachypnea, accessory muscles, pursed lip weight

loss, bronchodilator, glucocorticoids, antibiotics, loss, bronchodilator, glucocorticoids, antibiotics, oxygen, resp vaccines. oxygen, resp vaccines.

Dyspnea

PneumoniaPneumonia Respiratory viruses and mycoplasma. Dyspnea, chills, Respiratory viruses and mycoplasma. Dyspnea, chills,

high fever in classic pneumonia, cough, pleuritic chest high fever in classic pneumonia, cough, pleuritic chest pain.pain.

Management: supportive, bed rest, analgesics, Management: supportive, bed rest, analgesics, expectorants, antibiotics (macrolides, fluoroquinolones, expectorants, antibiotics (macrolides, fluoroquinolones, doxy)doxy)

PneumothoraxPneumothorax Dyspnea, chest pain, decreased breath sounds, Dyspnea, chest pain, decreased breath sounds,

hyperresonance, decreased tactile fremitus hyperresonance, decreased tactile fremitus Management: thoracostomy, aspiration Management: thoracostomy, aspiration

Dyspnea PEPE Hemoptysis, dyspnea, chest pain, VQ scan, pulmonary Hemoptysis, dyspnea, chest pain, VQ scan, pulmonary

angiography, CT, echo, D-dimer, hypotension due to angiography, CT, echo, D-dimer, hypotension due to corpulmonale. corpulmonale.

Management: fluids, anticoagulation, thrombolytics, Management: fluids, anticoagulation, thrombolytics, oxygen, pulse oxoxygen, pulse ox

CHFCHF Left sided: SOB, fatigue, cough, PND, orthopneaLeft sided: SOB, fatigue, cough, PND, orthopnea Right sided: build up of fluid in veins. edema of feet and Right sided: build up of fluid in veins. edema of feet and

anklesankles Common cause of CHF is CADCommon cause of CHF is CAD Peripheral edema, tachycardia, tachypnea, skin, Peripheral edema, tachycardia, tachypnea, skin,

wheezing, rales, ascites, hepatosplenomegaly. wheezing, rales, ascites, hepatosplenomegaly.

Dyspnea

Management: Management: Diuretics, digoxin, ntg, positive inotrophic Diuretics, digoxin, ntg, positive inotrophic

agents, ace inhibitors, beta blockers, agents, ace inhibitors, beta blockers, oxygen, MSO4oxygen, MSO4

Electrolyte Imbalance

What is the etiology of electrolyte What is the etiology of electrolyte imbalance?imbalance?

Illness, decreased fluid intake, v/dIllness, decreased fluid intake, v/d What systems are affected? What systems are affected? Respiration, Metabolism, CNSRespiration, Metabolism, CNS How are electrolytes measured? How are electrolytes measured? Electrolytes measured in meq/L.Electrolytes measured in meq/L.

Electrolyte Imbalance What is the etiology of hypernatremia (Na >145)? What is the etiology of hypernatremia (Na >145)? Water loss, diuretics, Na Excess Water loss, diuretics, Na Excess What are the clinical manifestations?What are the clinical manifestations? Fatigue, confusion, lethargy, edemaFatigue, confusion, lethargy, edema What is the management: What is the management: fluidsfluids What is the etiology of hyponatremia?What is the etiology of hyponatremia? Loss of sodium, water excess, GI lossLoss of sodium, water excess, GI loss What is the clinical presentation?What is the clinical presentation? Impaired GI motility, n/v, muscle weakness, Impaired GI motility, n/v, muscle weakness,

rhabdomyolysis, a/v arrhythmias. rhabdomyolysis, a/v arrhythmias.


What is the etiology of Hyperkalemia k>5.5?What is the etiology of Hyperkalemia k>5.5? Renal failure, acidosis, Renal failure, acidosis, What is the clinical presentation?What is the clinical presentation? N/v/d, muscle cramps, weakness, paresthesias, N/v/d, muscle cramps, weakness, paresthesias,

paralysis, areflexia, tetany, cardiac arrest, paralysis, areflexia, tetany, cardiac arrest, bradycardia, heart block, wide QRS, peaked T, bradycardia, heart block, wide QRS, peaked T,

What is the management?What is the management? CKIDA: Calcium, kayexalate, insulin and glucose, CKIDA: Calcium, kayexalate, insulin and glucose,

dialysis, albuterol. dialysis, albuterol.


What is the etiology of Hypokalemia <3.3?What is the etiology of Hypokalemia <3.3? Potassium wasting diuretics, d/v, alkalosis, Potassium wasting diuretics, d/v, alkalosis,

excessive sweating. excessive sweating. What are the clinical manifestations?What are the clinical manifestations? Impaired gastric motility, n, v, muscle weakness Impaired gastric motility, n, v, muscle weakness

and paralysis, rhabdomyolysis, a/v arrhythmias. and paralysis, rhabdomyolysis, a/v arrhythmias. What is the management?What is the management? Replace KReplace K


What is the etiology of Hypercalcemia ca>10.2 What is the etiology of Hypercalcemia ca>10.2 mg/dL?mg/dL?

Underlying malignancy, paget’s, osteoporosis, Underlying malignancy, paget’s, osteoporosis, acidosis, antacid abuse, thiazides, acidosis, antacid abuse, thiazides, hyperparathyroidismhyperparathyroidism

What is the clinical presentation?What is the clinical presentation? Malaise, Anorexia, n/v, weakness, ventricular Malaise, Anorexia, n/v, weakness, ventricular

idioventric, shortened QT. Treat with calcitonin, idioventric, shortened QT. Treat with calcitonin, biphosphonates, parathyroidectomybiphosphonates, parathyroidectomy


What is the etiology of Hypocalcemia <8.5mg/dLWhat is the etiology of Hypocalcemia <8.5mg/dL Hypoparathyroidism, vitamin D deficiency, Hypoparathyroidism, vitamin D deficiency,

alkalosis, pancreatitis, alkalosis, pancreatitis, What is the presentation?What is the presentation? Numbness, tingling, hyperactive reflexes, positive Numbness, tingling, hyperactive reflexes, positive

trousseau’s sign, chvostek’s sign, tetany, muscle trousseau’s sign, chvostek’s sign, tetany, muscle cramps. Prolonged QT. Calcium gluconatecramps. Prolonged QT. Calcium gluconate


What are the parameters for Respiratory acidosis? What are the parameters for Respiratory acidosis? pH <7.35, CO2>45pH <7.35, CO2>45 What is the etiology?What is the etiology? Hypoventilation, narcotics. Hypoventilation, narcotics. What are clinical manifestations?What are clinical manifestations? Respiratory depression, confusion, dizzy, lethargy, Respiratory depression, confusion, dizzy, lethargy,

headache, ventricular dysrhythmias, warm skin, headache, ventricular dysrhythmias, warm skin, muscle twitching. muscle twitching.

What is the management?What is the management? Hyperventilation, treat underlying causeHyperventilation, treat underlying cause


What are the parameters for Respiratory alkalosis? What are the parameters for Respiratory alkalosis? pH >7.45, CO2<35pH >7.45, CO2<35 What is the etiology?What is the etiology? Hyperventilation, shock, sepsis, pulmonary disease, Hyperventilation, shock, sepsis, pulmonary disease, What are clinical manifestations?What are clinical manifestations? Rapid deep breathing, chest pain, Dizzy, confused, Rapid deep breathing, chest pain, Dizzy, confused,

tachypnea, numbness, tingling, convulsions, comatachypnea, numbness, tingling, convulsions, coma What is the management?What is the management? Decrease ventilationsDecrease ventilations


What are the parameters for Metabolic acidosis? What are the parameters for Metabolic acidosis? pH <7.35, bicarb <22pH <7.35, bicarb <22 What is the etiology?What is the etiology? High anion gap: starvation, diabetic ketoacidosis, renal High anion gap: starvation, diabetic ketoacidosis, renal

failure, lactic acidosis, drug use (asa)failure, lactic acidosis, drug use (asa) What is the presentation?What is the presentation? Tachypnea with deep respiration, headache, lethargy, Tachypnea with deep respiration, headache, lethargy,

anorexia, abdominal crampsanorexia, abdominal cramps How is this managed?How is this managed? Correct underlying cause, bicarb. Correct underlying cause, bicarb.


What are the parameters for Metabolic alkalosis? What are the parameters for Metabolic alkalosis? pH > 7.35, bicarb >22pH > 7.35, bicarb >22 What is the presentation?What is the presentation? Vomiting, gastric secretions, hypokalemia, Vomiting, gastric secretions, hypokalemia,

hypercalcemia, excess aldosterone, use of drugs hypercalcemia, excess aldosterone, use of drugs (steroids, bicarb, diuretics)(steroids, bicarb, diuretics)

Numbness, tingling, tetany, muscle cramps.Numbness, tingling, tetany, muscle cramps. What is the management?What is the management? Correct underlying, fluids, Correct underlying, fluids,

OB/GYN Emergencies

What is the etiology of PID? What is the etiology of PID? N. gonorrhoeae, chlamydia, gram neg rods. N. gonorrhoeae, chlamydia, gram neg rods. What is the clinical presentation?What is the clinical presentation? Lower abdominal pain, abnormal vaginal discharge, Lower abdominal pain, abnormal vaginal discharge,

dyspareunia Fever. CMT, peritoneal signs. dyspareunia Fever. CMT, peritoneal signs. How is this diagnosed?How is this diagnosed? culturescultures What is the management?What is the management? Management: Doxycycline, cefoxitin or cefotetan. Management: Doxycycline, cefoxitin or cefotetan.

Ceftriaxone and Azithromycin Ceftriaxone and Azithromycin

OB/GYN Emergencies

When does an ovarian Cyst occur?When does an ovarian Cyst occur? Luteal phase. Luteal phase. What is the management?What is the management? NSAIDS, OCP, monitorNSAIDS, OCP, monitor What are clinical manifestations of rupture?What are clinical manifestations of rupture? Bleeding producing pelvic pain, rectal tenesmus, shock. Bleeding producing pelvic pain, rectal tenesmus, shock.

Peritoneal irritation. Culdocentesis or lap. Peritoneal irritation. Culdocentesis or lap. What are the clinical manifestations of adnexal torsion?What are the clinical manifestations of adnexal torsion? twisting. Constant pain. Peritonitis signs. Dx: sono and twisting. Constant pain. Peritonitis signs. Dx: sono and

lap lap

OB/GYN Emergencies

What are some etiologies of hemorrhage in early What are some etiologies of hemorrhage in early pregnancy?pregnancy?

Threatened abortionThreatened abortion Inevitable abortionInevitable abortion Complete abortionComplete abortion Incomplete abortionIncomplete abortion Missed abortionMissed abortion Ectopic pregnancyEctopic pregnancy

OB/GYN Emergencies What are some etiologies of hemorrhage in third trimester? What are some etiologies of hemorrhage in third trimester? Placenta previa: no vaginal or speculum exam. Painless Placenta previa: no vaginal or speculum exam. Painless

bright red bleeding. bright red bleeding. Abruptio placenta. Dark red painful bleeding. Uterus firm. Abruptio placenta. Dark red painful bleeding. Uterus firm.

Treatment is ABC, IV fluidsTreatment is ABC, IV fluids Preterm labor: 24-34 weeks. Premature contractions or Preterm labor: 24-34 weeks. Premature contractions or

PROM. PROM. Blunt trauma: Leads to abruptio placenta, intrauterine Blunt trauma: Leads to abruptio placenta, intrauterine

CVA, skull fx, uterine rupture, fetal or maternal CVA, skull fx, uterine rupture, fetal or maternal hemorrhagehemorrhage

Penetrating: Fetal mortality high. Penetrating: Fetal mortality high.

OB/GYN Emergencies

What is rape?What is rape? Sexual intercourse with penetrationSexual intercourse with penetration What is sodomy?What is sodomy? Sexual contact between persons not married, contact Sexual contact between persons not married, contact

between penis, anus, mouth and genitalsbetween penis, anus, mouth and genitals What is Sexual abuse? What is Sexual abuse? Sexual or other intimate contact for gratifying. Sexual or other intimate contact for gratifying. What labls are necessary for rape victim?What labls are necessary for rape victim? Hep B, C, CBC, VDRL, hCG, ETOH, tox screen, HIVHep B, C, CBC, VDRL, hCG, ETOH, tox screen, HIV

OB/GYN Emergencies

What management is given to rape victim?What management is given to rape victim? Hep B vaccine, antimicrobials for GC, trich Hep B vaccine, antimicrobials for GC, trich

and BV, HIV PEP, emergency and BV, HIV PEP, emergency contraceptive use. contraceptive use.

Compartment Syndrome

Increased incidence in long bone fracturesIncreased incidence in long bone fractures ““five p’s”five p’s”

Pain out of proportion to injuryPain out of proportion to injury ParesthesiasParesthesias PulselessnessPulselessness PallorPallor Pressures increasedPressures increased

Compartment pressures >30mm Hg or within 30 mm Compartment pressures >30mm Hg or within 30 mm Hg of diastolic pressureHg of diastolic pressure

Treatment = fasciotomyTreatment = fasciotomy

Definition of Open Fractures

See table 10-7. Classification of Open See table 10-7. Classification of Open FracturesFractures

Be content to know Type I-III; don’t Be content to know Type I-III; don’t memorize the subclasses of Type IIImemorize the subclasses of Type III

What is traction?What is traction? Pulling to achieve immobility and Pulling to achieve immobility and

alignment. alignment. X-ray: don’t forget joint above and below. X-ray: don’t forget joint above and below.

Treatment of Open Fractures

Local sterile irrigationLocal sterile irrigation Cover with betadine-soaked dressing. Might need Cover with betadine-soaked dressing. Might need

surgical exploration and debridement. surgical exploration and debridement. Immobilization: splinting, skeletal traction, Immobilization: splinting, skeletal traction,

external fixation external fixation Antibiotics appropriate to level of contaminationAntibiotics appropriate to level of contamination Tetanus boosterTetanus booster Formal debridement within 6 hoursFormal debridement within 6 hours

Fractures & Dislocations Commonly Associated with Nerve Damage Dislocations: Dislocations:

Anterior shoulder = axillary nerveAnterior shoulder = axillary nerve Hip = sciatic nerveHip = sciatic nerve Knee = peroneal and tibial nervesKnee = peroneal and tibial nerves

Fractures:Fractures: Humeral shaft = radialHumeral shaft = radial Supracondylar = radial and interosseusSupracondylar = radial and interosseus

Perioperative Fracture Considerations DVTDVT PEPE Fat Embolism SyndromeFat Embolism Syndrome

Increased incidence with pelvis and Increased incidence with pelvis and acetabular fracturesacetabular fractures

Infection with open fracturesInfection with open fractures Acute Respiratory Distress Syndrome Acute Respiratory Distress Syndrome

especially with long bone fracture fixationespecially with long bone fracture fixation

Fracture Morbidities

Delayed unionDelayed union NonunionNonunion Segmental bone lossSegmental bone loss Heterotopic ossificationHeterotopic ossification OsteomyelitisOsteomyelitis ContracturesContractures Loss of motionLoss of motion rhabdomyolysisrhabdomyolysis

Fracture Review

Colles = distal radius with dorsal Colles = distal radius with dorsal displacement of fracture fragmentdisplacement of fracture fragment

Smith = distal radius with volar Smith = distal radius with volar displacement of fracture fragmentdisplacement of fracture fragment

Barton’s = dorsal rim of distal radiusBarton’s = dorsal rim of distal radius Chauffer’s = radial styloidChauffer’s = radial styloid

Continued

Monteggia = fracture of the ulnar with Monteggia = fracture of the ulnar with radial head dislocationradial head dislocation

Galeazzi = radius fracture with distal Galeazzi = radius fracture with distal radioulnar joint dislocationradioulnar joint dislocation

Spine - see hand-outsSpine - see hand-outs Salter Harris ClassificationSalter Harris Classification

SH I = through physis (growth plate)SH I = through physis (growth plate)* not visible on x-ray** not visible on x-ray*

Continued

Femoral neck fracturesFemoral neck fractures Type I (nondisplaced) have increased Type I (nondisplaced) have increased

incidence of avascular necrosisincidence of avascular necrosis Hip fractures present with leg shortening Hip fractures present with leg shortening

and external rotationand external rotation Pelvis fracture = high volume blood lossPelvis fracture = high volume blood loss Closed long bone fractures = increased Closed long bone fractures = increased

incidence of compartment syndromeincidence of compartment syndrome

Continued

SH II = most frequentSH II = most frequent

–Through physis exiting through Through physis exiting through metaphysismetaphysis

SH III = through physis exiting through SH III = through physis exiting through epiphysisepiphysis

SH IV = “vertical splitting”SH IV = “vertical splitting” SH V = crush of the physisSH V = crush of the physis

General Joint Dislocation Management Document neurovascular status prior to Document neurovascular status prior to

relocation attemptrelocation attempt Attempt a relocationAttempt a relocation Repeat and document neurovascular examRepeat and document neurovascular exam Immobilize with a splintImmobilize with a splint

Dislocations

ShoulderShoulder Commonly = anteriorCommonly = anterior Seizure disorder = posteriorSeizure disorder = posterior

Hip Hip Presents with leg shortened and internally Presents with leg shortened and internally

rotatedrotated Nurse Maid elbow = radial head subluxes out of Nurse Maid elbow = radial head subluxes out of

annular ligamentannular ligament Reduce with flexion and supinationReduce with flexion and supination

Carpal Tunnel Syndrome

Tinnel = percussion of tunnel exacerbates Tinnel = percussion of tunnel exacerbates symptomssymptoms

Phalen = volar flexion of wrists held for 15 Phalen = volar flexion of wrists held for 15 seconds exacerbates symptomsseconds exacerbates symptoms

Epicondylitis

Lateral = supination and resisted Lateral = supination and resisted dorsiflexion produces paindorsiflexion produces pain

Medial = pronation and resisted Medial = pronation and resisted volarflexion produces painvolarflexion produces pain

Shock/ ACS

Unstable angina- Can progress to MIUnstable angina- Can progress to MI AMI- ST elevation (full thickness or transmural (Q AMI- ST elevation (full thickness or transmural (Q

wave infarct)wave infarct) Non ST elevation- inner most layers. Similar to Non ST elevation- inner most layers. Similar to

angina with elevated enzymes. angina with elevated enzymes. Compare and contrast angina and unstable anginaCompare and contrast angina and unstable angina Angina- pain relieved with rest and nitro. Usually Angina- pain relieved with rest and nitro. Usually

lasts no longer than 15 minuteslasts no longer than 15 minutes Unstable angina- >20 minutes. Chest pain at rest. Unstable angina- >20 minutes. Chest pain at rest.

SOB, n/v, diaphoresis, radiation SOB, n/v, diaphoresis, radiation

Shock/ ACS

What are signs of right ventricle MI? What are signs of right ventricle MI? JVDJVD Left ventricular failure- pulmonary edemaLeft ventricular failure- pulmonary edema EKG- ischemia vs. injuryEKG- ischemia vs. injury Cardiac enzymes: CK-MB, troponin, Cardiac enzymes: CK-MB, troponin,

myoglobin, echo, coronary angiographymyoglobin, echo, coronary angiography Location of MILocation of MI

Shock/ ACS

What is the management of MIWhat is the management of MI ABC, IV, treat life threatening arrhythmias, ABC, IV, treat life threatening arrhythmias,

aspirin, glycoprotein II B, heparin, NTG, aspirin, glycoprotein II B, heparin, NTG, morphine, ace inhibitors, beta blockers, morphine, ace inhibitors, beta blockers, thrombolytics up to 4-6 hours of symptoms thrombolytics up to 4-6 hours of symptoms up to 12 hours. No age requirement. ST up to 12 hours. No age requirement. ST elevation in 2 or more leads. elevation in 2 or more leads.

E-med Review for Exam 1

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