Term
| 1ry. Survey and Resuscitation |
|
Definition
A B C D E
Adjuncts to 1ry. Survey |
|
|
Term
|
Definition
Head to toe examination
Tubes and fingers in every orifice
Adjuncts to 2ry. survey |
|
|
Term
|
Definition
Airway + C spine protection
Breathing + Ventilation
Circulation + Control of Hemorrhage
Disabilities ( Neurologic evaluation )
Exposure + Environmental control |
|
|
Term
Airway
initial assessment and Management |
|
Definition
Signs and causes of airway obstruction
Methods to open the airway
airway protection is needed when GCS<8
In line stabilization of C spine :
Multi system trauma with altered LOC
Blunt trauma above the clavicle |
|
|
Term
|
Definition
Rule 1: Frequently evaluate the airway
Rule 2: Definitive airway is indicated if there is doubt |
|
|
Term
|
Definition
Obese short neck patient
ET tube in patient with incomplete upper airway transection or laryngeal fracture
Inability to intubate after paralysis
Equipment failure |
|
|
Term
Breathing/ventilation
Initial assessment management |
|
Definition
Expose the chest and Asses RR, R depth and Type
Give oxygen
Check chest wall, lungs and diaphragm by inspection , palpation, percussion and auscultation
Pulse oximeter
Identify and treat: Tension Pneumothorax
Open Pneumothorax
Flail chest
Massive Hemothorax (ecchomotic all over)
6. Needs for assisted ventilation |
|
|
Term
Breathing/ventilation
Rule 1 |
|
Definition
| CXR is always needed after intubation and ventilation, but not to diagnose Tension Pneumothorax |
|
|
Term
| Breathing/ventilation pitfalls |
|
Definition
Differentiation of ventilation problems from airway obstruction may be difficult
Intubation of Pneumothorax patient with ventilation may result in further deterioration of the patient |
|
|
Term
C- Circulation + Control of Hemorrhage
Initial Assessment and management |
|
Definition
Blood Volume and Cardiac output assessment depend on level of consciousness, skin color and the pulse
Start X2 I.V. lines, draw blood samples (Central line ?)
Identify the need of blood transfusion
Control Bleeding: Direct pressure on the wound
Pneumatic splinting devices
No Tourniquet except in amputation
Identify occult blood loss (bruising)
Assess for the need of operative intervention |
|
|
Term
| what to do to Control Bleeding: |
|
Definition
Direct pressure on the wound
Pneumatic splinting devices
No Tourniquet except in amputation |
|
|
Term
| C-Circulation + Control of Hemorrhage pitfalls |
|
Definition
P.R., ABP has little correlation with cardiac output in older patients
Children show few signs of hypovolemia
Use of medications affect the response to hypovolemia |
|
|
Term
D- Disabilities ( Neurologic evaluation )
Initial Assessment Management |
|
Definition
Level of consciousness L.O.C.
A alert
V to verbal stimuli
P to painful stimuli
U unresponsive
Pupils size and reaction |
|
|
Term
|
Definition
Level of consciousness L.O.C.
A alert
V to verbal stimuli
P to painful stimuli
U unresponsive |
|
|
Term
D-Disabilities ( Neurologic evaluation )
Rule 1 |
|
Definition
| Rule: Depressed L.O.C: may be due to decreased Cerebral Oxygenation , Brian injury or Drugs |
|
|
Term
D- Disabilities ( Neurologic evaluation )
Pitfalls |
|
Definition
| Lucid interval commonly occur with Acute Epidural Hematoma ( Talk and die ), this emphasizes the need for frequent Neurologic Re-evaluation |
|
|
Term
E- Exposure + Environmental control
Initial Assessment and Management |
|
Definition
Exposure / Environmental control
Undress completely (use trauma scissor)
Prevent hypothermia (warm blanket, room temp.)
Warm I.V. fluids and blood (warm in microwave 1 min) |
|
|
Term
E- Exposure + Environmental control
Pitfalls |
|
Definition
| Early control of hemorrhage will minimize hypothermia |
|
|
Term
| Adjuncts to 1ry survey and Resuscitations |
|
Definition
ECG monitoring
Urinary and Gastric Catheters
Monitoring: RR, ABG, Pulse Oximetry, ABP, PR,Urine O/P, Temp., CVP / JV
X-ray and diagnostic: CXR, Pelvis, Lat. C-spine and Diagnostic peritonel Lavage (DPL) and abdominal ultra sound
CONSIDER Need for patient transfer |
|
|
Term
| what's in the 2ry Survey for Truama |
|
Definition
Complete History
Head to toe examination
Re-assessment of vital signs
Complete neurological examination GCS.
Special procedures, Specific X-rays and laboratory studied
Head to toe examination |
|
|
Term
2ry Survey
Complete History is AMPLE what does this stand for |
|
Definition
A allergies
M medications
P past illness/pregnancy
L last meal
E events/environment / mechanism of injury: blunt, penetrating, burn, hazardous environment |
|
|
Term
2ry Survey
Re-assessment of vital signs how? |
|
Definition
1. Identify new Clinical findings
2. Discover deterioration
3. Assure that life threatening injuries are managed
4. Diagnose underlying medical problems
Done by:
1. Clinical Reassessment
2. Monitoring of LOC, PR, Urine O/P, ABP, ABG, CVP
3. Review of Diagnostic results
4. Use of Analgesia |
|
|
Term
2ry Survey
Complete neurological exam GCS how? |
|
Definition
LOC/GCS
Pupils
Lateralization
Blown pupil
Different reaction to pain (left vs. right)
Babinski on one side only
Deterioration of LOC/GCS |
|
|
Term
2ry Survey
what Special procedures, Specific X-rays and laboratory studied |
|
Definition
Additional X-rays Extremities, Spine
CT
Contrast X-rays, Urography, Angiography
Endoscopy
Not till the patient is stable |
|
|
Term
|
Definition
| penis will point to sign of pain |
|
|
Term
Priorities in Patients with Multiple Injuries
1-6
(tape is) |
|
Definition
First: thoracic hemorrhage or tamponade
Second: abdominal hemorrhage
Third: pelvic hemorrhage
Fourth: extremity hemorrhage
Fifth: intracranial injury
Sixth: acute spinal cord injury |
|
|
Term
| Priorities in Patients with Multiple Injuries |
|
Definition
First: thoracic hemorrhage or tamponade
Second: abdominal hemorrhage
Third: pelvic hemorrhage
Fourth: extremity hemorrhage
Fifth: intracranial injury
Sixth: acute spinal cord injury |
|
|
Term
| Lab Studies in Trauma Patient |
|
Definition
Blood type and cross match
ABG
Hb/ Hct, PLT count
PT, PTT, INR
Urine dipstick for blood, HCG (childbearing age ♀), UDS
ECG
Electrolytes, sugar, BUN, Cre
Amylase, lipase
Serum ETOH |
|
|
Term
| Revised Trauma Score includes? 3 things |
|
Definition
Respiratory frequency
Systolic pressure
Glasgow coma |
|
|
Term
| Glasgow Coma Scale includes: |
|
Definition
Eye opening
verbal response
Best motor response |
|
|
Term
RTS (revised trauma score) Score of
12
11
10-3
3or less |
|
Definition
12 =DELAYED (walking wounded)
11 =URGENT (intervention is required but the patient can wait a short time)
10-3 = IMMEDIATE (immediate intervention is necessary).
3 or < =MORGUE |
|
|
Term
|
Definition
Log rolling to examine these patients posteriorly is obviously necessary
It should be done very carefully.
Log rolling is very controversial
been shown to create a potential for neuro compromise.
This should not prevent us from completing a thorough examination of the patient. We should proceed with care. |
|
|
Term
| Upper Airway Injury Characterized by what signs and symptoms? |
|
Definition
Hoarseness
Apnea
Respiratory distress
Stridor
Subcutaneous emphysema
Bubbling blood during inspiration/expiration in open neck wounds |
|
|
Term
|
Definition
Intubate early before the patient develops prominent symptoms
Essential to secure the airway before transport
The approach must be individualized
Consider awake technique if a difficult airway is anticipated |
|
|
Term
| penetrating neck trauma: what are the most commonly injured structures |
|
Definition
|
|
Term
| What are Vascular Injury Soft signs? |
|
Definition
Pulse deficit in superficial temporal artery
Stable hematoma
Proximity to CA
Loss of pulse without neurologic deficit
Signs of air embolism
Widened mediastinum
Ipsilateral Horner’s syndrome
CN 9-12 dysfunction |
|
|
Term
|
Definition
|
|
Term
| Signs/Symptoms of Tension Pneumothorax |
|
Definition
Anxiety, agitation, and apprehension
Diminished or absent breath sounds
Cyanosis
Rapid shallow breathing
Distended neck veins
Abnormally low blood pressure (loss of radial pulse)
Cool, clammy skin
Decreased level of consciousness (AVPU)
Visible deterioration of casualty’s condition
Tracheal deviation (shift of wind pipe)
Tracheal deviation is a late sign of tension pneumothorax and will probably not be observed. |
|
|
Term
explain what this is:Tracheal Deviation & JVD
pneumothorax |
|
Definition
The trachea is shifted away from the collapsed lung
The jugular veins become engorged from restricted blood return to heart
LATE SIGNS! |
|
|
Term
| How to do NEEDLE CHEST DECOMPRESSION |
|
Definition
Locate 2d intercostal space at midclavicular line
Insert 14-gauge catheter-over-needle into chest cavity over superior edge of rib
Listen for gush of air and observe for improvement of symptoms
Tape catheter in place with cap or valve in place to prevent re-entry of air
Dress open chest wound if present |
|
|
Term
| Treatment of Tension Pneumothorax |
|
Definition
Immediate Needle chest decompression
ABC’s with c-spine as indicated
High Flow oxygen including BVM
Treat for S/S of Shock
All T-Pneumo patients admitted to hospital
If Open Pneumothorax and occlusive dressing present BURP occlusive dressing |
|
|
Term
|
Definition
Three or more ribs fractured in two or more places or a fractured sternum
Severe pain at site
Rapid shallow breathing
Paradoxical respirations (may be difficult to detect initially)
Pneumothorax may be present
Possible underlying contusion to lung could lead to hypoxia
Bruising/Swelling
Crepitus (Grinding of bone ends on palpation) |
|
|
Term
|
Definition
ABC’s with c-spine as indicated
High Flow oxygen including BVM
Treat for S/S of Shock
Stabilize the flail segment
Apply manual pressure
Adjustment of position to make the patient most comfortable and provide relief of pain.
Pain control
Good analgesia including intercostal blocks, avoiding narcotic analgesics as much as possible. (these people really need narcotics)
Chest tubes as required |
|
|
Term
| Flail chest Treatment (Cont.) |
|
Definition
Circulation
Check and maintain a central pulse
Stop Major Hemorrhage
IV normal saline TKO
» 20 cc/kg bolus if hypotension present
• Splint (DO NOT INTERFERE WITH ABILITY TO BREATHE OR VENTILATE)
Bindings
Tape
Large dressings
• Spinal precautions
• NPO
• Frequent vital signs |
|
|
Term
|
Definition
Myocardial Contusion
Occurs in 76% of patients with severe blunt chest trauma
Right Atrium and Ventricle is commonly injured
Injury may reduce strength of cardiac contractions
Reduced cardiac output
Electrical Disturbances due to irritability of damaged myocardial cells
Progressive Problems
Hematoma
Hemoperitoneum
Myocardial necrosis
Dysrhythmias
CHF &/or Cardiogenic shock |
|
|
Term
| Angina that occurs only with provocation, has been occurring for at least 2 months, and is symptomatically stable |
|
Definition
|
|
Term
| Chest pain due to coronary artery spasm, a sudden constriction of a coronary artery depriving the heart muscle (myocardium) of blood and oxygen. This is also called Prinzmetal’s Angina |
|
Definition
|
|
Term
| rest angina, new-onset angina, or increasing angina |
|
Definition
|
|
Term
T or F
True angina typically does not vary with respiration, position, or palpation. |
|
Definition
|
|
Term
True or false
Pain above the mandible, below the epigastrium, localized to an area less than one fingertip in size is rarely angina. |
|
Definition
|
|
Term
Cardiac specific marker?
highly sensitive and specific for MI
shows up as early as 3 hours after MI in a STEMI/NSTEMI |
|
Definition
|
|
Term
Hypertensive Emergencies
diastolic of what?
what do you tx with? |
|
Definition
Diastolic BP >130 mmHg with new or acutely progressive organ dysfunction (retinal hemorrhage, encephalopathy, pulmonary edema, acute MI, or unstable angina) is a true hypertensive emergency
Nitroprusside (Nipride)
Nitro gtt
Labetalol |
|
|
Term
|
Definition
Give intravenous Lasix
Must check renal function first
Consider patients home dose of lasix |
|
|
Term
| systolic or diastolic dysfunction? - due to impaired LV contractility (most common) |
|
Definition
|
|
Term
| systolic or diastolic dysfunction? – due to reduced LV filling |
|
Definition
|
|
Term
What is Beck’s triad
for cardiac tamponade? |
|
Definition
1. Distended neck veins
2. Distant heart sounds
3. Hypotension (narrow pulse pressure) |
|
|
Term
| An inflammation of the myocardium, the middle layer of the heart wall. |
|
Definition
|
|
Term
| These agents prevent recurrent thrombus formation and rapid restoration of hemodynamic disturbances. In addition, they remove pathologic intraluminal thrombus or embolus not yet dissolved by the endogenous fibrinolytic system. When given within 12 h of symptom onset, they restore patency of occluded arteries, salvage myocardium, and reduce morbidity and mortality rates of AMI. |
|
Definition
thrombolytic agents
Thrombolytic treatment should be started within 30 min of arrival (door-drug time). Maximum benefit occurs when administered within 1-3 h of symptom onset. |
|
|
Term
| contraindications to Thrombolytic agents |
|
Definition
| Documented hypersensitivity; active internal bleeding; intracranial neoplasm; known bleeding diathesis; severe uncontrolled hypertension; arteriovenous malformation or aneurysm; history of stroke; intracranial or intraspinal surgery or trauma within 2 mo |
|
|
Term
| Myocardial Contusion Signs & Symptoms |
|
Definition
Bruising of chest wall
Tachycardia and/or irregular rhythm
Retrosternal pain similar to MI
Associated injuries
Rib/Sternal fractures
Chest pain unrelieved by oxygen
May be relieved with rest
THIS IS TRAUMA-RELATED PAI |
|
|
Term
| Myocardial Contusion Management |
|
Definition
Administer oxygen
Initiate large bore IV – may need to limit fluids
EKG monitoring
Treat all dysrhythmias
Pulse oximetry |
|
|
Term
If enough motion is placed on
the heart (i.e.. Deceleration
From a motor vehicle accident, striking a tree while skiing etc) the heart may tear away from the aorta. What is this called? |
|
Definition
|
|
Term
| S/S Of Traumatic Aortic Rupture |
|
Definition
Burning or Tearing Sensation in chest or shoulder blades
Rapidly dropping Blood Pressure
Pulse Rapidly Increasing
Decreased or loss of pulse or b/p on left side compared to right side
Rapid Loss of Consciousness |
|
|
Term
| gold standard imaging traumatic aortic rupture |
|
Definition
|
|
Term
| Treatment of Traumatic Aortic Rupture |
|
Definition
ABC’s with c-spine control as indicated
High Flow oxygen that may include BVM
Treatment for Shock
Keep patient quiet & comfortable
Pain control
Contact Hospital Trauma Unit As soon as possible |
|
|
Term
commonly injured organs in abdominal trauma
with a penetrating trauma?
with blunt trauma? |
|
Definition
Organ injured in penetrating trauma is the liver
Blunt trauma: the spleen is often torn and ruptured. |
|
|
Term
| remains a frequent cause of preventable death after trauma. |
|
Definition
| Unrecognized abdominal injury |
|
|
Term
Signs and Symptoms of Abdominal Injuries
blunt trauma |
|
Definition
Significant mechanism
Abdominal pain
Distension
Discoloration of abdomen or flank
Unexplained shock |
|
|
Term
| Signs and Symptoms of Abdominal Injuries Penetrating trauma |
|
Definition
Visible truncal injury including chest or abdomen
Abdominal pain
Bleeding
Impaled object
Evisceration
Shock |
|
|
Term
| The indications for peritoneal lavage include: |
|
Definition
unexplained abdominal pain
trauma of the lower part of the chest
hypotension, hematocrit fall with no obvious explanation
any patient suffering abdominal trauma and who has an altered mental state (drugs alcohol, brain injury)
patient with abdominal trauma and spinal cord injuries
pelvic fractures. |
|
|
Term
| The relative contraindications for the Diagnostic Peritoneal Lavage are: |
|
Definition
pregnancy
previous abdominal surgery
operator inexperience
if the result does not change your management. |
|
|
Term
| Diagnostic Peritoneal Lavage Positivity is shown with what? |
|
Definition
5ml blood return
RBC > 100,000, WBC > 500 cell/mm
Amylase > 200 units per 100 ml
If bile or gastrointestinal contents is detected |
|
|
Term
| Pelvic fractures are often complicated by |
|
Definition
| massive hemorrhage and urology injury. |
|
|
Term
| The management of pelvic fractures includes: |
|
Definition
resuscitation (ABC)
Transfusion
immobilization and assessment for surgery
analgesia. |
|
|
Term
Impalement Injuries
What you should know? |
|
Definition
DO NOT REMOVE OBJECT OR EXERT ANY FORCE UPON IT!
Severe bleeding may occur causing shock
Check pulses distal to impaled object
Immobilize the object
Apply bulky support bandages to hold in place |
|
|
Term
|
Definition
| Extrusion of abdominal contents secondary to penetrating abdominal trauma |
|
|
Term
| Acute extradural (epidural) hemorahagia classic signs |
|
Definition
loss of consciousness following an lucid interval, with rapid deterioration
middle meningeal artery bleeding with rapid raising of intracranial pressure
the development of hemiparesis on the opposite side with a fixed pupil on the same side as the impact area. |
|
|
Term
|
Definition
| with clotted blood in the subdural space, accompanied by severe contusion of the underlying brain. It occurs from tearing of bridging vein between the cortex and the dura. slow bleed |
|
|
Term
| Management of epidural and subdural hematoma |
|
Definition
| The management of the above is surgical and every effort should be made to do burr-hole decompressions. |
|
|
Term
| bruising of the eyelids (Racoon eyes) or over the mastoid process (Battle’s sign), cerebrospinal fluid (CSF) leak from ears and/or nose are signs of what kind of fractures? |
|
Definition
|
|
Term
| temporary altered consciousness is referred to a? |
|
Definition
|
|
Term
| an impaction of fragmented skull that may result in penetration of the underlying dura and brain is called a? |
|
Definition
|
|
Term
| may result from acute injury or progressive damage secondary to contusion. |
|
Definition
|
|
Term
| the hallmark of brain injury is? |
|
Definition
| Alteration of consciousness |
|
|
Term
| The most common error in head injury evaluation and resuscitation are: |
|
Definition
failure to perform ABC and prioritize management
failure to look beyond the obvious head injury
failure to assess the baseline neurological examination
failure to re-evaluate patient who deteriorates. |
|
|
Term
| severity of head injury is when GCS is 8 or less |
|
Definition
|
|
Term
| severity of head injury is when GCS between 9 and 12 |
|
Definition
|
|
Term
| severity of injury is when GCS between 13 and 15. |
|
Definition
|
|
Term
| Unequal or dilated pupils may indicate? |
|
Definition
| indicate an increase in intracranial pressure |
|
|
Term
| this is never the cause of hypotension in the adult trauma patient |
|
Definition
|
|
Term
| specific response to a lethal rise in intracranial pressure. This is a late and poor prognostic sign? |
|
Definition
|
|
Term
| Cushing response hallmarks are: |
|
Definition
• Bradycardia
• Hypertension
• Decreased respiratory rate.
specific response to a lethal rise in intracranial pressure. This is a late and poor prognostic sign |
|
|
Term
| Head Trauma Medical Management |
|
Definition
Intubation and hyperventilation, producing moderate hypocapnia (Keep PCO2 to 35-40 mmHg). This will reduce both intracranial blood volume and intracranial pressure temporarily
Sedation with possible paralysis
Moderate IV fluid input with diuresis (do not overload)**
May use mannitol (osmotic diuretic)
Prevent hyperthermia. |
|
|
Term
| what is included in Spinal Cord Management? |
|
Definition
Failure to suspect leads to failure to detect injuries
ABCDE – Logroll and remove the spinal board
Look for markers of spinal injury
Secondary survey
Adequate X-ray’s
Emergency treatment
Neurosurgery consult
Definitive care & rehab |
|
|
Term
Ordinary physical activity does not cause angina, such as walking, climbing stairs. Angina occurs with strenuous, rapid, or prolonged exertion at work or recreation.
what class angina |
|
Definition
|
|
Term
Slight limitation of ordinary activity. Angina occurs on walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, or in cold, or in wind, or under emotional stress, or only during the few hours after awakening.
what angina classification |
|
Definition
|
|
Term
Marked limitations of ordinary physical activity. Angina occurs on walking one or two blocks on the level and climbing one flight of stairs in normal conditions and at a normal pace
what class angina |
|
Definition
|
|
Term
Inability to carry on any physical activity without discomfort – anginal symptoms may be present at rest.
what class angina |
|
Definition
|
|
Term
| what does ST Elevation in Precordial Leads (V1-V6) need to be for diagnosis of MI |
|
Definition
|
|
Term
what doesST elevation in Non-Precordial Leads
need to be for diagnosis of MI |
|
Definition
|
|
Term
A cardiac specific marker
Highly sensitive and specific for myocardial injury |
|
Definition
What is a Troponin?
Elevated in a STEMI / NSTEMI as early as 3 hours after myocardial injury |
|
|
Term
Clinical effects are manifested via activation of the autonomic and central nervous systems and at nicotinic receptors on skeletal muscle
3 broad categories of sx:
(1) muscarinic effects
(2) nicotinic effects
(3) CNS effects |
|
Definition
Anticholinesterases
Insecticides
Nerve gases
sarin
Ophthalmic agents
echothiophate, isoflurophate
Antihelmintics
trichlorfon
Herbicides |
|
|
Term
|
Definition
SLUDGE
salivation, lacrimation, urination, diarrhea, GI upset, emesis
DUMBELS
diaphoresis and diarrhea; urination; miosis; bradycardia, bronchospasm, bronchorrhea; emesis; excess lacrimation; and salivation |
|
|
Term
Anticholiesterase S/SX
Nicotinic effects |
|
Definition
muscle fasciculations, cramping, weakness,
diaphragmatic failure
hypertension
tachycardia
mydriasis
pallor |
|
|
Term
|
Definition
Airway control and adequate oxygenation are paramount!
Main concern is respiratory failure from excessive airway secretions
Intubate
Avoid Succinylcholine- may result in prolonged paralysis
atropine!
1-2 mg IV bolus, repeat q1-5min prn for desired effects |
|
|
Term
| benzodiazepiems CNS effects |
|
Definition
Mostly CNS effects
Dizziness, confusion, drowsiness, blurred vision, unresponsiveness, anxiety, agitation, amnesia |
|
|
Term
|
Definition
Activated charcoal w/in 4 hr of ingestion and protected airway
Ventilation if respiratory depression (biggest concern)
Antidote: Flumazenil
0.1-0.2 mg IV q1min to a total dose of 1 mg at one time or 3 mg in 1 h |
|
|
Term
| Beta Blockers toxicity s/sx |
|
Definition
Signs/Symptoms of Toxicity-
Hypotension, bradycardia, bronchoconstriction, pulmonary edema, hypoglycemia, & hyperkalemia |
|
|
Term
| Beta blocker toxicity tx: |
|
Definition
Activated charcoal
Airway protection, treatment of hypoglycemia
Treat hypotension-fluids & then glucagon if needed
Treat arrhythmias-glucagon or atropine, cardiac pacing if needed |
|
|
Term
| Calcium Channel Blockers(CCBs) Toxicity S/Sx |
|
Definition
Cardiovascular effects of CCBs
Slow AV nodal conduction, coronary & peripheral vasodilation, depress myocardial contractility
CCB Toxicity-hypotension, bradycardia, depressed mental function, arrhythmias (with AV block)
Severe myocardial depression may lead to asytole (death) |
|
|
Term
|
Definition
Airway
GI decontamination, charcoal, whole bowel irrigation for SR formulations
Constant cardiac monitoring is essential
Leg elevation/Trendelenburg positioning & fluids
For AV block & hypotension-Atropine; Cardiac pacing may be required
In refractory toxicity, calcium solutions may help (calcium chloride or calcium gluconate) |
|
|
Term
Carbon Monoxide Toxicity:
early Sx: |
|
Definition
| Earliest symptom-HA; (other symptoms-dizziness, nausea, memory & gait disturbances, lethargy, drowsiness) |
|
|
Term
| Carbon Monoxide toxicity Tx: |
|
Definition
Remove the source
100% O2 by nonrebreathing face mask or endotrach tube
½ life of CO @ room temp is 5 hours
½ life reduced to 1 hour on 100% O2
Hyperbaric 100% O2 works even more rapidly*
Recommended currently for patients with major symptoms (LOC, Myocardial ischemia, pregnancy) |
|
|
Term
|
Definition
Acts as a cellular asphyxiate that inhibits use of O2 by the body’s tissues
HA, N/V, confusion, anxiety, bitter-almond odor to breath
Initial HTN followed by significant hypotension, profound metabolic acidosis-requiring inpatient treatment/monitoring |
|
|
Term
| Treatment of Cyanide Toxicity |
|
Definition
Activated Charcoal
100% O2 with intubation if indicated;
Cyanide Antidote Kit-sodium nitrite, sodium thiosulfate, amyl nitrate inhalant
Nitrites-produce methemoglobin (binds free cyanide)
Amyl nitrate capsule-under patient’s nose for inhalation
Sodium Nitrite infusion
Caution—DO NOT overtreat, fatal methemoglobinemia may result from overzealous use of nitrites
Goal of nitrite therapy is a methoglobin level of 25-30%
Thiosulfate-converts cyanide to a less toxic metabolite
Vitamin B12(A)-hydroxycobalamin reverse cyanide toxicity |
|
|
Term
Cardiac Glycosides (Digoxin)
S/Sx |
|
Definition
effects-slow cardiac conduction (AV nodal), increase force of myocardial contractility, enhanced automaticity
Signs/Symptoms
Vision changes (blurred vision, yellow-green vision disturbance, halos), neurologic symptoms (confusion), complete heart block, bradycardia with re-entrant arrhythmias, GI (N/V/D) |
|
|
Term
| Life Threatening Sx of Dig |
|
Definition
Hemodynamic instability
Dysrhythmias
Increased automaticity
Decreased AV conduction
Paroxysmal A Tach c 2:1 block, accelerated junctional rhythm, torsades, PVCs, brady, HBs, VT |
|
|
Term
| Treatment of Digoxin Toxicity |
|
Definition
Activated charcoal
O2
Correct electrolyte abns-correct hypokalemia
Supportive tx for arrhythmias/blocks
Atropine, pacing , lido
VT/VF
Mg
Digibind |
|
|
Term
|
Definition
Used for TB
6-10g may be fatal; 15g = fatal
Common sx: N/V/D and light sensitivity
Acute neurotoxicity: seizures, metabolic acidosis, coma
Long term ingestion: peripheral neuritis, hepatitis/hepatotoxicity |
|
|
Term
|
Definition
Activated charcoal
10x the amount ingested or 50g
Benzos for seizures
Also help to correct the metabolic acidosis
Pyridoxine (vit B-6) 5g IV
For managing INH-induced seizures, metabolic acidosis, and mental status changes |
|
|
Term
Opioids
Common triad of sx |
|
Definition
CNS depression
Respiratory depression
Miosis
Look for ventricular arrhythmias, acute mental status changes, and seizures |
|
|
Term
| Management of Opioid Toxicity |
|
Definition
Airway management (most important)
Intubation
Activated charcoal
Whole bowel irrigation in body packers
Naloxone(Narcan) 0.4 – 2mg
Watch for agitation
Smaller/slower doses in chronic narc users secondary to withdrawal s/sx |
|
|
Term
The toxic effects of tricyclics are results of the
following 4 main pharmacologic properties: |
|
Definition
1) Inhibition of norepinephrine and serotonin reuptake
2) Anticholinergic actions
3) Direct alpha-adrenergic blockade
4) Disruption of the membrane stabilizing effect of the myocardium |
|
|
Term
| TCA Toxicity-Signs & Symptoms |
|
Definition
CNS
fatigue, drowsiness, confusion, coma
AntiCholinergic effects
Red as a beet, dry as a bone, blind as a bat, mad as a hatter, and hot as a hare
Cardiac
prolonged QRS, conduction delays, hypotension |
|
|
Term
|
Definition
Airway management
Tx of dysrhythmias
Sodium Bicarb, Mg
Seizures
benzos
Hypotension
IVFs, norepinephrine |
|
|
Term
| TCA Toxicity-EKG Findings |
|
Definition
brugada pattern
down sloping ST-segment elevation in leads V1-V3 in association with right bundle branch block |
|
|
Term
Caustics & Corrosives
Dos and Don'ts |
|
Definition
Dos
Dilute material with H20, NS, or milk
Endoscopy (eval extent of burns and location)
Correct systemic acid/base disturbances
Give IVFs
Hospitalize pts with inhaled or ingested source
Don'ts
Administer neutralizers
Induce vomiting
Aminister activated charcoal (interferes with endoscopy) |
|
|
Term
|
Definition
| Signs/Symptoms of ingestion-mouth & throat pain, dysphagia, drooling, substernal or abdominal pain |
|
|
Term
|
Definition
Sign/Symptoms of intoxication
Ataxia, dysarthria, depressed sensorium, nystagmus
Risks associated with intoxication-coma, respiratory depression, pulmonary aspiration |
|
|
Term
ETOH Withdrawal-Delirium Tremens
Sx: |
|
Definition
Fatal form of EtOH withdrawal
Usually begins within 6-48 hours of last drink.
S/sx: AMS, seizures, N/V, hallucinations, delusions, tachypnea, tachycardia, diaphoresis, hypertension, hyperthermia, CV collapse.
Must have long term h/o alcoholism
Clinical dx. Rule out other possibilities 1st |
|
|
Term
| Methanol Toxicity signs & symptoms |
|
Definition
Common Sx: HA, N, anorexia
Sx of intoxication with an increased osmolar gap and later metabolic acidosis
Eye is site of organ toxicity
May cause permanent blindness |
|
|
Term
|
Definition
Odorless, colorless, sweet tasting
Antifreeze
Sx of intoxication without smelling of alcohol
crystals are formed and can be deposited anywhere in the body |
|
|
Term
| Ethylene Glycol-3 Stages of Toxicity |
|
Definition
Stage 1(neurologic stage)
1 hour or less after ingestion.
CNS depression; appears intoxicated
Stage 2(cardiopulmonary stage)
12 hours later
Tachy, HTN, ARDS, hypocalcaemia, QT Prolongation
Stage 3(renal stage)
24-48 hours later
Flank pain, hematuria, renal failure |
|
|
Term
| Treatment of Methanol & Ethylene Glycol |
|
Definition
*block alcohol dehydrogenase*
Fomepizole
Loading dose of 15mg/kg IV then 10mg/kg q 12h x4 doses
Ethanol
Loading dose of 600mg/kg then infusion @ 66-154mg/kg/h |
|
|
Term
|
Definition
Metabolized to acetone
increase in the osmolar gap without acidosis
Fruity odor to breath
CNS depressant
Lethargy, ataxia, coma
GI upset
Abd pain, N, hematemesis
Tx mostly supportive: H2 or PPI |
|
|
Term
|
Definition
Acute
GI Sx
Tremors, dystonia, hyperreflexia, ataxia
EKG changes
Acute on chronic
GI and neuro sx
Chronic
Neuro sx
Mental status changes, seizure, coma |
|
|
Term
| Syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) |
|
Definition
| cognitive impairment, sensorimotor peripheral neuropathy, and cerebellar dysfunction |
|
|
Term
|
Definition
Gastric lavage w/in 1 hr of ingestion
Whole bowel irrigation w/ GoLytely
Aggressive IVFs to restore GFR
Control seizures with benzos
Hemodialysis w/ RF |
|
|
Term
| Management of Amphetamine Toxicity |
|
Definition
Activated charcoal
IVFs for rhabdo and myoglobinuria
Benzodiazepines for seizures
Propanolol -tachycardia |
|
|
Term
|
Definition
Euphoria , excitement
Psychosis, restlessness
Hypertension, tachycardia, arrhythmias, myocardial ischemia/infarction, aortic dissection |
|
|
Term
| Treatment of Cocaine Toxicity |
|
Definition
GI decontamination-activated charcoal & symptomatic tx
Peak effects occur quickly (usually within 1 hour), so methods to enhance elimination are unnecessary
If patient may have ingested packets of cocaine then whole bowel irrigation & surgical consult |
|
|
Term
|
Definition
Acute: N/V, Abd. pain
Hematemesis
Diaphoresis
Respiratory alkalosis with a metabolic acidosis
Tinnitus if >30 mg/dL
Chronic
AMS
ARDS
Elevated liver enzymes
Elevated PT
Minimum acute toxic dose is 150mg/kg, severe toxic dose is 300-500mg/kg |
|
|
Term
| Treatment of Salicylate Toxicity |
|
Definition
Intubate
Gastric lavage if ingestion w/in 1 hr
Activated charcoal
IVFs
Urinary alkalization if <35mg/dL |
|
|
Term
|
Definition
mucous membranes
subconjunctival hemorrhage
hematuria
epistaxis
ecchymoses |
|
|
Term
|
Definition
GI hemorrhage
intracranial bleeding
retroperitoneal bleeding
may involve the spinal cord or cerebral, pericardial, pulmonary, adrenal, or hepatic sites |
|
|
Term
| Treatment of Warfarin Toxicity |
|
Definition
Vitamin K is the only effective antidote for long-term management
reversal takes several hours
Careful with IV Vit K -> allg rxn and CV collapse
If significant bleeding & unstable patient
transfusions of packed red blood cells (RBCs)
fresh frozen plasma (FFP)
IV/PO vitamin K-1 |
|
|
Term
Treatment of Warfarin Toxicity- No Active Bleeding
INR > therapeutic levels but <5
if INR > 5 but < 9 |
|
Definition
If INR > therapeutic levels but <5
withhold Warfarin for 2-3 days
restart when the INR therapeutic
Rapid reversal
vitamin K-1
if INR > 5 but < 9
withhold Warfarin for the next 1-2doses
monitor the INR more frequently
resume at a lower dose when INR therapeutic
withhold one dose of Warfarin and administer vitamin K-1, esp if the patient is at increased risk of bleeding |
|
|
Term
| Inhaled Toxins-Signs, Symptoms & Tx |
|
Definition
Remove source
O2 by nonrebreather
Intubate, if indicated
Breathing treatments
Carboxyhemoglobin levels
CXR for pulmonary edema |
|
|
Term
| Leading cause of death from ingestion in <6 y/o |
|
Definition
|
|
Term
|
Definition
Stage 1-Gastrointestinal (1-4 hours)
Severe N/V, Abd. Pain
Hyperglycemia, leukocytosis
Stage 2-Latent (6-up to 24 hours)
Improvement in symptoms
Stage 3-Tissue absorption (12-24 hours)
Shock, acidosis, coagulopathy, hypoglycemia
Stage 4-Hepatic poisoning
Potential hepatic failure |
|
|
Term
| Treatment of Iron Toxicity |
|
Definition
Emesis, gastric lavage or whole bowel irrigation (esp. if pills identified)
Activated charcoal is NOT effective
IVFs
Chelation is the mainstay of therapy
Indicated for serum iron levels >350 mcg/dL w/ evidence of toxicity
or >500 mcg/dL regardless of s/sx
Deferoxamine (Desferal)
DOC for iron intoxication
100mg binds approx 8 mg of iron |
|
|
Term
|
Definition
IVFs
WBI
Chelation therapy
Edetate calcium disodium (Calcium Disodium Versenate)
Dimercaprol (British antilewisite; BAL) |
|
|
Term
| Treatment of Arsenic Toxicity |
|
Definition
ABCs/Intubate
WBI
Volume resuscitation and vasopressors
Correct dysrhythmias
Chelation
Dimercaprol (BAL in Oil)
Succimer (DMSA |
|
|
Term
Acute Arsenic Poisoning
Sx |
|
Definition
unique: Garlic smell to their breath and tissue fluids
Cholera-like GI Sx
vomiting (often times bloody) |
|
|
Term
Chronic Arsenic Poisoning
Sx: unique |
|
Definition
Classic dermatitis
hyperkeratosis with a classical "dew drops on a dusty road" appearance
Mees lines
Whitish lines on nails |
|
|
Term
| What don't you use decontamination with activated coal for: |
|
Definition
| alcohols, potassium, lithium & iron... Not with acidic or alkaline |
|
|
Term
|
Definition
| asymptomatic, anorexic, hepatic issued, renal ifailure follow hepatic, Pt and PTT increase cause coagulopathy |
|
|
Term
|
Definition
Antidote: N-acetlycysteine (NAC) /Mucomyst
—Activated charcoal |
|
|
Term
|
Definition
| Red as a beet, dry as a bone, blind as a bat, mad as a hatter, and hot as a hare” |
|
|
Term
| Anticholinergics Toxicity Tx: |
|
Definition
Single dose activated charcoal
—Gastric lavage if obtunded & w/in 1 hr of ingestion
Most cases respond to supportive care-sedation
Severe: Antidote-physostigmine salicylate |
|
|
Term
| Abdominal Blunt Trauma most common caused by? |
|
Definition
|
|
Term
| Just read: Patients with blunt trauma who initially have a benign abdominal examination should have serial and frequent abdominal examinations, appropriate diagnostic studies (CT scan or US) to ensure nothing is missed |
|
Definition
|
|
Term
Abdominal Penetrating Trauma
Commonly associated with |
|
Definition
Firearms
Stabbings
Physical assault |
|
|
Term
| Abdominal emergencies include? |
|
Definition
Abdominal trauma: blunt and penetrating
Acute Abdominal Pain: sudden onset |
|
|
Term
Bedside U/S utilized to determine if free blood is present in the peritoneal cavity (hemoperitoneum)
Most can identify free intra-abdominal fluid (especially if >500ml is present) |
|
Definition
Focused Abdominal Sonogram for Trauma
(FAST) |
|
|
Term
| What do you visualize with FAST? |
|
Definition
Pericardium (from subxiphoid view)
Splenorenal and hepatorenal spaces (Morison pouch)
Paracolic gutters
Pouch of Douglas in the pelvis
Morison pouch is more sensitive at detecting free fluid
Free fluid appears black and in the setting of abdominal trauma, it is assumed to be blood |
|
|
Term
After FAST
Abdominal Free fluid in a patient that is hemodynamically unstable warrants?
If patient is hemodynamically stable what is warranted? |
|
Definition
emergent laparotomy
A CT scan may better define the source of bleeding after FAST |
|
|
Term
Often defined as severe, persistent abdominal pain of sudden onset that is likely to require surgical intervention to treat its cause
Can be associated with n/v/d, constipation, fever, abdominal distension, hypotension, and shock
Often divided into 4 categories:
Traumatic (blunt or penetrating)
Inflammatory
Mechanical
Vascular |
|
Definition
|
|
Term
| 4 categories of acute abdominal pain? |
|
Definition
Traumatic (blunt or penetrating)
Inflammatory
Mechanical
Vascular |
|
|
Term
Acute Abdominal Pain
Right Upper Quadrant DDX: |
|
Definition
Cholecystitis
Biliary Colic
Cholangitis
Hepatitis
Liver abscess or tumor
Right lower lobe pneumonia
Appendicitis during pregnancy |
|
|
Term
Acute Abdominal Pain
Left Upper Quadrant DDX: |
|
Definition
Gastritis
Splenic rupture
Splenic infarct
Splenic Abscess |
|
|
Term
Acute Abdominal Pain
Epigastric or midline pain DDX: |
|
Definition
Peritonitis
Pancreatitis
Duodenal Perforation
Abdominal Aortic Aneurysm
Myocardial Infarction |
|
|
Term
Acute Abdominal Pain
Periumbilical DDX: |
|
Definition
Early appendicitis
Gastritis |
|
|
Term
Acute Abdominal Pain
Left Lower Quadrant Pain DDX: |
|
Definition
|
|
Term
Acute Abdominal Pain
Right Lower Quadrant Pain DDX: |
|
Definition
Appendicitis
Cecal Diverticulitis
Meckel’s diverticulitis
Mesenteric adenitis |
|
|
Term
| Diffuse Abdominal Pain Differential Diagnosis: |
|
Definition
Acute pancreatitis
Early appendicitis
Diabetic ketoacidosis
Gastroenteritis
Intestinal obstruction
Mesenteric ischemia
Peritonitis
Sickle Cell Crisis |
|
|
Term
Acute Abdominal Pain
Radicular Pain
Pain that radiates to the Shoulder: |
|
Definition
Diaphragm irritation on the same side caused by air, blood, or infection can cause shoulder pain.
Classic example: cholecystitis! |
|
|
Term
What is the pain like?
renal or biliary colic |
|
Definition
| Acute waves of sharp constricting pain that “take my breath away” |
|
|
Term
What is the pain like?
(intestinal obstruction |
|
Definition
| Waves of dull pain with vomiting |
|
|
Term
What is the pain like?
appendicitis, intestinal obstruction, mesenteric ischemia |
|
Definition
| Colicky pain that becomes steady |
|
|
Term
What is the pain like?
peritonitis |
|
Definition
| Sharp, constant pain, worsened with movement |
|
|
Term
What is the pain like?
(dissecting aneursym |
|
Definition
|
|
Term
What is the pain like?
appendicitis, diverticulitis, pyelonephritis |
|
Definition
|
|
Term
| what are some Critical Causes of Abdominal Pain? |
|
Definition
Cardiovascular
Abdominal Aortic Aneurysm
Myocardial Infarction
Gastrointestinal
Esophageal rupture
Intestinal obstruction
Mesenteric ischemia
Perforated viscus or solid organ rupture
Genitourinary
Ruptured ectopic pregnancy |
|
|
Term
| what are some Emergent Causes of Abdominal Pain |
|
Definition
Cardiovascular
Congestive heart failure with hepatosplenomegaly
Pulmonary
RLL Pneumonia
Gastrointestinal
Abscess (intra-abdominal, psoas)
Appendicitis
Biliary Disease
Diverticulitis
Gastritis
Gastroenteritis
Hepatitis
Hernia
IBD
Pancreatitits
Peptic Ulcer Disease
Spontaneous bacterial peritonitis |
|
|
Term
| Non-emergent Causes of Abdominal Pain |
|
Definition
Gastrointestinal
Constipation
Gastrointestinal Esophageal Reflux Disorder (GERD)
Inflammatory Bowel Disease (IBD)
Abdominal wall pain
Nonspecific abdominal pain
Genitourinary
Endometriosis
Mittelschmerz (ovulation pain- midcycle pain)
Other
Herpes zoster |
|
|
Term
|
Definition
| chronic lung disease, hypoxia |
|
|
Term
|
Definition
|
|
Term
|
Definition
| : LV dysfxn, severe HTN, aortic stenosis, CMO, MR |
|
|
Term
| Labs for pulm emergencies |
|
Definition
CBC: WBC, H/H
BNP
Serial Cardiac Enzymes: CK, CK-MB, Troponin
D-dimer (evaluate with caution!!)
EKG - eval MI, arrhythmias
ABG
Lower extremity ultra sound
Rule out DVT
Echocardiogram +/-
Eval cardiomyopathy, right heart strain, valvular disease |
|
|
Term
| Labs for pulm emergencies |
|
Definition
CBC: WBC, H/H
BNP
Serial Cardiac Enzymes: CK, CK-MB, Troponin
D-dimer (evaluate with caution!!)
EKG - eval MI, arrhythmias
ABG
Lower extremity ultra sound
Rule out DVT
Echocardiogram +/-
Eval cardiomyopathy, right heart strain, valvular disease |
|
|
Term
| Radiography for pulm emergencies. |
|
Definition
CXR
If possible always check PA/LAT CXR
Portable films are junk
Decubitus films to evaluate pleural effusion
CT
With contrast: rule out PE, evaluate LAD (lymphadenopathy)
Contraindications for contrast: allergy, renal insufficiency
Board Q: it's OK to give contrast in ESRD...just dialyze afterwards!
Without contrast: evaluate pulmonary parenchyma |
|
|
Term
|
Definition
|
|
Term
COPD / Asthma Exacerbation
Tx: |
|
Definition
Treatment:
If severe: intubation vs. BiPAP
Oxygen : watch for haldane effect!
IV steroids
Continuous nebs
Empiric abx: if indicated |
|
|
Term
COPD / Asthma Exacerbation
Tx: |
|
Definition
Treatment:
If severe: intubation vs. BiPAP
Oxygen : watch for haldane effect!
IV steroids
Continuous nebs
Empiric abx: if indicated |
|
|
Term
|
Definition
Somatic Pain
experienced as a signal of tissue damage
Deafferentation Pain
experienced as a result of a disturbed transmission which is a result of an injured neural pathway |
|
|
Term
|
Definition
acute: rapid, discrete onset
more likely somatic
brief duration
variable patterns
affective associations
socialization immobilized
Chronic:
often insidious, neuropathic or recurrent acute
usually continuous
psychopathology associations
ability to work & socialize variable or adaptive |
|
|
Term
Result of mechanical injury or inflammation
such as trauma, surgery or infection
ANS stimulation strongly associated
Patient’s tolerance, threshold & environment contribute to response
Most common problem is under-use of analgesia |
|
Definition
|
|
Term
| Recurrent, relapsing, acute pains or more commonly, neuropathic pains for at least six months |
|
Definition
|
|
Term
Pain due to medical disease eg. CA
Pain in association with psychiatric disease
eg. depression, h. compensation,or malingering
Pain related to neurological diseases
eg. herpes zoster, diabetes, spinal trauma
Pain of indeterminate cause |
|
Definition
|
|
Term
|
Definition
Need to increase the dose over time to maintain the same effect
Rarely seen when the disease state is stable
Can be helpful regarding side effects |
|
|
Term
|
Definition
Develop symptoms of withdrawal if
Medication stopped without tapering
Given antagonist |
|
|
Term
|
Definition
| is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include the following: impaired control over drug use, craving, compulsive use, and continued use despite harm. Physical dependence and tolerance are not the same as addiction. |
|
|
Term
| addiction characterized by the following behaviors |
|
Definition
Compulsive use
Total loss of control despite obvious harm
Total preoccupation with substance or activity |
|
|
Term
| pseudoaddiction to pain meds |
|
Definition
Substance abuse A drug-seeking behavior that stimulates true addiction in Pts with pain who are receiving inadequate
pain, medication. Cf Addiction, Drug-seeking. |
|
|
Term
|
Definition
Explained by ongoing tissue injury
also somatic pain |
|
|
Term
|
Definition
Believed to be sustained by abnormal processing in the PNS or CNS
also deafferentation pain |
|
|
Term
|
Definition
| Believed to be sustained by psychological factors |
|
|
Term
|
Definition
|
|
Term
| Inferred pain pathoophysiology |
|
Definition
Nociceptive pain
Neuropathic pain
Psychogenic pain
Idiopathic pain |
|
|
Term
| The most common chronic pain conditions in the United States |
|
Definition
| back pain, osteoarthritis pain |
|
|
Term
Used to treat moderate to severe pain
No ceiling effect, |
|
Definition
|
|
Term
| Long history of acceptance in malignant pain where addiction not felt to be a problem |
|
Definition
| Opioids in Malignant Pain |
|
|
Term
Opioid Therapy
Side effects: |
|
Definition
| Common: Constipation and nausea |
|
|
Term
| Why Long Acting Opioids (SROs) Are Preferred |
|
Definition
Control chronic pain better than short acting agents
Increase compliance
Less risk in those with addictive tendencies
No “Highs”
Avoid mini withdrawal
Less re-enforcement of drug taking behavior
Why try to control 24 Hour Pain with a 3 Hour Medication? |
|
|
Term
Immediate Released Opioids (IROs)
Class III |
|
Definition
Class III (can be called in & refilled)
Codeine (Tylenol #3, etc)
Hydrocodone (Lortab, Vicodin, Vicoprofen, Norco)
Propoxy (Darvocet, Darvon)
Poor choice |
|
|
Term
Immediate Released Opioids (IROs)
Class II (can not be called in or refilled) |
|
Definition
Fentanyl (Actiq, Fentora)
Oxycodone (Percocet, Tylox, Endocet, Oxy IR)
Morphine (MS IR)
Hydromorphone (Dilaudid)
Tapentadol (Nucynta )
Meperidine (Demerol)
Poor choice |
|
|
Term
Sustained Released Opioids (SROs)
Class II (can not be called in or refilled) |
|
Definition
Tramadol – Ultram ER (not controlled)
Class II (can not be called in or refilled)
Morphine
AVINZA® (morphine sulfate extended-release capsules)
Once-daily
Kadian® (morphine sulfate sustained-release capsules)
Once-to-twice daily
Oramorph® (morphine sulfate sustained-release tablets)
Twice-daily, TID is better *
MS Contin® (morphine sulfate controlled-release tablets)
Twice-daily, TID is better *
Generic (morphine sulfate SR)
Twice-daily, TID is better *
Embeda (sustained release morphine w/ naltrexone)
Once – twice daily |
|
|
Term
| Type of pain: deep to the body surface, diffuse, aching, burning or sharp and penetrating (knife-like) |
|
Definition
|
|
Term
| pain that is poorly localized, pain referred along regions innervated by same spinal segments |
|
Definition
|
|
Term
| MSK pain is usually referred to the ________while visceral discomfort is transmitted along ____________ |
|
Definition
overlying skin
spinal segments |
|
|
Term
|
Definition
| herpes zoster, diabetes, vitamin deficiency |
|
|
Term
| Neuropathic & Deafferentation Pains |
|
Definition
Phantom limb
Peripheral neuropathies
eg. herpes zoster, diabetes, vitamin deficiency
Causalgias (burning feeling) or RSD:
often associated physical findings such as shiny re skin over site & demineralization of underlying bone |
|
|
Term
| Pain Questions P,Q,R,S,T… |
|
Definition
| Presentation Quality Radiation Severity Timing |
|
|
Term
| The most common reason for drug seeking behavior is |
|
Definition
| inadequate relief of pain |
|
|
Term
| screen for H. pylori before giving what for pain? |
|
Definition
|
|
Term
|
Definition
Especially useful in treating chronic, deafferentiation & neuropathic pain :
TCA’s (get base line EKG)
and SNRI’s
Anticonvulsants
Phenothiazines
eg. neuroleptics & antihistamines
Stimulants
eg. amphetamines, caffeine |
|
|
Term
| list two classes of Analgesic Potentiators |
|
Definition
Anti-emetics:
Benzodiazepines: |
|
|
Term
| Non-pharmacologic Therapy |
|
Definition
Acupressure
TENS unit
Physical / Massage / Manipulative Tx
Behavioral Modification /Self-hypnosis
Relaxation / Aromatherapy
Nutritional and Megestrol / Megace Tx
Nerve blocks and/or Surgical ablation |
|
|
Term
| Acute and Post-operative Analgesia |
|
Definition
Continuous epidural
Parenteral analgesics
Patient Controlled Analgesia (PCA)
Oral analgesics |
|
|
Term
|
Definition
|
|
Term
| Most common problem with the management of acute pain |
|
Definition
|
|
Term
| Phenothiazines like phenergan or vistaril potentiate pain relief and? |
|
Definition
|
|
Term
Morphine is the gold standard
1 mg parenteral = |
|
Definition
|
|
Term
| Meperidine / Demerol characteristics |
|
Definition
Very short acting, average IV dose of 50-100 mg q2-3h
Classically Rx’d for biliary colic |
|
|
Term
After a patient has been on meperidine for several days,
Pearl 2 |
|
Definition
the dose usually needs to be adjusted downwards due to the metabolite, normeperidine
While its half-life is 3 hours, normeperidine’s half-life is 15 hours, and accumulation leads to CNS irritability
which can be misinterpreted or cause seizures |
|
|
Term
| Half life of normeperidine vs meperidine is |
|
Definition
|
|
Term
One mg of IV/IM morphine is =
? oral morphine
? of oxycodone
? of hydrocodone
? of codeine
? of ibuprofen |
|
Definition
Three mg of oral morphine
Two mg of oxycodone
Three mg of hydrocodone
20 mg of codeine, and ~
100-200 mg of ibuprofen |
|
|
Term
| Acetaminophen should not exceed _____G per 24 hours |
|
Definition
|
|
Term
| The most common Percocet contains |
|
Definition
| 5m of oxycodone and 500mg APA |
|
|
Term
|
Definition
| 5-15 mg hydrocodone plus 500-750 mg apap per tablet |
|
|
Term
best quickest/lesser expensive diagnostic tool for AAA
_________ is 100% accurate in the diagnosis of AAA |
|
Definition
|
|
Term
Rovsing’s Sign
Psoas Sign
Obturator Sign |
|
Definition
| Signs of appendicitis (<10%) |
|
|
Term
|
Definition
|
|
Term
| stone in common bile duct |
|
Definition
|
|
Term
| transient gallstone obstruction of cystic duct resulting in waxing/waning RUQ pain |
|
Definition
|
|
Term
| Inflammation of gallbladder secondary to obstruction of cystic duct |
|
Definition
|
|
Term
| common duct stone with obstruction of biliary tract and biliary stasis leading to bacterial infection |
|
Definition
|
|
Term
| stone erodes through wall of gallbladder and into adjacent small bowel |
|
Definition
|
|
Term
|
Definition
| A fat fertile female in her forties” = obesity, female, parous, 40th decade |
|
|
Term
|
Definition
| : fever, jaundice, RUQ pain (cholangitis) |
|
|
Term
|
Definition
| : fever, jaundice, RUQ pain, altered sensorium, hypotension (cholangitis) |
|
|
Term
| Biliary Tract Disease: Presentation |
|
Definition
RUQ pain that radiates to right scapula/shoulder
Worsens with eating
Colicky or steady
Nausea and vomiting
Fever and jaundice (cholecystitis/cholangitis)
Murphy’s sign |
|
|
Term
| Cholecystitis common lab findings |
|
Definition
| Serum aminotransferase, bilirubin and alk phos mildly elevated |
|
|
Term
|
Definition
| Leukocytosis, increased bilirubin, elevated alk phos, moderately increased aminotransferases (cholangitis) |
|
|
Term
|
Definition
Normal exam shows filling of the gallbladder, common bile duct, and small bowel within 30-45 minutes
Non-filling gallbladder indicates cholecystitis |
|
|
Term
Uncomplicated biliary colic patients without symptoms can be discharged and follow-up with surgery for elective cholecystectomy
Antispasmodics (glycopyrrolate) and NSAIDs may relieve biliary colic
Cholecystitis and cholangitis patients need to be treated how? |
|
Definition
NPO
IV hydration
Antiemectics
NG suction
Narcotic analgesia
IV Abx (more aggressive with cholangitis)
Surgical consultation
Hospital admission |
|
|
Term
|
Definition
UNinflamed diverticula
? Associated with low-fiber diet, constipation, and obesity |
|
|
Term
|
Definition
| inflammation or perforation of one or more of the diverticula |
|
|
Term
| Study of choice in dx of diverticulitis |
|
Definition
CT scan is preferred study of choice
Assess disease severity, presence of complications, and clinical staging
Possible CT findings: |
|
|
Term
| Diverticulitis: ED Management |
|
Definition
| Bowel rest (NPO), IV fluids, analgesia, broad-spectrum antibiotics to cover anaerobic bacterial (Bacteroides fragilis, clostridium, peptostreptococcus) and aerobic bacteria (E. coli, Klebsiella, Proteus, Streptococcus, Enterobacter) |
|
|
Term
|
Definition
Inflammatory process of the lining of the stomach
MCC: Helicobacter pylori (50% of adults) |
|
|
Term
|
Definition
Without evidence of bleeding, no real testing is available
If bleeding, approach the patient from the GI Bleeding workup |
|
|
Term
|
Definition
Without evidence of bleeding, no real testing is available
If bleeding, approach the patient from the GI Bleeding workup |
|
|
Term
|
Definition
Without evidence of bleeding, no real testing is available
If bleeding, approach the patient from the GI Bleeding workup |
|
|
Term
| Intestinal Obstruction types: |
|
Definition
Closed-loop obstruction
Adynamic ileus
Intussusception
Volvulus |
|
|
Term
| Proximal SBO presentation |
|
Definition
| Nausea, bilious emesis, severe colicky pain for several hours, abdominal distention |
|
|
Term
|
Definition
|
|
Term
| Partial SBO obstruction presenation |
|
Definition
| : flatulence and stool passes |
|
|
Term
|
Definition
|
|
Term
|
Definition
Insidious onset with vomiting late in the presentation
Changes in bowel habits
Constipation
Pencil-thin stools
Small amounts of diarrhea |
|
|
Term
Imaging findings in SBO
ABD series (supine or flat upright) |
|
Definition
small-bowel loops with air fluid levels (obstruction)
Absent or minimal colonic gas indicative of SBO
“string of pearls” sign suggestive of SBO |
|
|
Term
Imaging findings in SBO
ABD series (supine or flat upright) |
|
Definition
small-bowel loops with air fluid levels (obstruction)
Absent or minimal colonic gas indicative of SBO
“string of pearls” sign suggestive of SBO |
|
|
Term
Imaging findings in SBO
ABD series (supine or flat upright) |
|
Definition
small-bowel loops with air fluid levels (obstruction)
Absent or minimal colonic gas indicative of SBO
“string of pearls” sign suggestive of SBO |
|
|
Term
| LBO imaging ABD series findings |
|
Definition
Loss of haustra
Dilated bowel to width of >6cm |
|
|
Term
| Intestinal Obstruction: ED Management |
|
Definition
NPO
NG tube for decompression
IV hydration
Correct electrolyte imbalances
ABX for gram-neg and anaerobic organisms
Surgical consultation: observation vs resection
Partial obstruction: 75% have full resolution without surgical intervention, only bowel rest and decompression |
|
|
Term
| Intestinal Obstruction: ED Management |
|
Definition
NPO
NG tube for decompression
IV hydration
Correct electrolyte imbalances
ABX for gram-neg and anaerobic organisms
Surgical consultation: observation vs resection
Partial obstruction: 75% have full resolution without surgical intervention, only bowel rest and decompression |
|
|
Term
| Classic triad of SMA embolism |
|
Definition
| GI empting, abdominal pain, underlying cardiac disease. |
|
|
Term
| Tolerance is usually not noted until _____weeks of therapy |
|
Definition
|
|
Term
|
Definition
MAO inhibitors: relatively contraindicated due to high rate of hyperpyrexic coma & hypertensive responses
Tranquilizers, Sedative-hypnotics can accentuate CV problems & increase CNS and respiratory depression |
|
|
Term
|
Definition
| anticoagulate with Heparin and admit patient. |
|
|
Term
|
Definition
SUDDEN “ripping” or “tearing” chest or back pain that radiates in a migratory fashion.
Check CXR for widened mediastinum |
|
|
Term
| Classic findings of Aortic Dissection |
|
Definition
Hypertension
Pulse Deficits
Murmur of aortic insufficiency
Best heard at the lower left sternal border with the patient in the upright position, leaning forward and at maximal expiration. |
|
|
Term
|
Definition
IV fluids,
control HTN
consult cardiothroacic surgery |
|
|
Term
| the presence of an abnormal amount and/or character of fluid in the pericardial space. |
|
Definition
Pericardial Effusion
TX: removal of the pericardial fluid and alleviation of the underlying cause, |
|
|
Term
“Sharp” or “Knife like”
Exacerbated by respiration and thoracic motion – relieved by leaning forward. Aggravated by laying down. |
|
Definition
Pericarditis: Inflammation of the pericardium
Not related to exertion – can last for hours on end. |
|
|
Term
May be precipitation by recent URI
Worse with PALPATION
the friction rub
EKG may show diffuse ST elevation |
|
Definition
|
|
Term
|
Definition
| Aspirin and NSAIDS. Colchicine or steroids (only as last resort) for refractory cases |
|
|
Term
| Defined as infection of the vascular endocardium typically involving heart valves and congenital heart defects. |
|
Definition
Infective Endocarditis
Hallmark of the infection is known as vegetation |
|
|
Term
Infective Endocarditis
The onset usually dates to a preceding |
|
Definition
| suppurative infection or to IV drug abuse. Persistent fever, new heart murmurs, vasculitis, hemorrhagic petechiae, chest pain (more so in IV drug abusers) |
|
|
Term
| infected endocarditis tx: |
|
Definition
Antibiotic therapy for 4-6 weeks.
Possible Surgery if these occur:
Refractory CHF or infection
Worsening conduction defect
Prosthetic valve malfunction or dehiscence
Staph aureus infection
Recurrent emboli
Fungi infection |
|
|
Term
| Myocarditis: Signs & Symptoms |
|
Definition
Chest pain
A rapid or abnormal heartbeat (arrhythmia)
Shortness of breath, at rest or during physical activity
Fluid retention with swelling of your legs, ankles and feet
Fatigue
Other signs and symptoms you'd have with a viral infection, such as a headache, body aches, joint pain, fever, a sore throat or diarrhea |
|
|
Term
|
Definition
dx. endocardial biopsy
tx: admission to provide supportive therapy
transplant, antiviral |
|
|
Term
| a clinical syndrome caused by the accumulation of fluid in the pericardial space, resulting in reduced ventricular filling and subsequent hemodynamic compromise. |
|
Definition
|
|
Term
|
Definition
Cardiac Tamponade
1. Distended neck veins
2. Distant heart sounds
3. Hypotension (narrow pulse pressure) |
|
|
Term
|
Definition
|
|
Term
Syncope from arrhythmia
what kind of warning |
|
Definition
|
|
Term
| The most common cause of fainting. A brief loss of consciousness caused by a sudden drop in your heart rate and blood pressure, which reduces blood flow to the brain. Often precipitated by prolonged standing, dehydration, fear, severe pain, sight of blood, strong emotion. |
|
Definition
|
|
Term
syncope caused by?
Decrease in systolic BP >20 mm Hg
Increase in heart rate |
|
Definition
|
|
Term
| chest pain Often associated with a history of coughing, trauma, injury, or strenuous muscular exertion. |
|
Definition
|
|
Term
|
Definition
Palpate for tenderness
Have the patient use various muscle groups and see if it reproduces the exact pain.
Try Toradol 30 mg IV x 1 |
|
|
Term
|
Definition
| Dyspnea, orthopnea, paroxysmal nocturnal dyspena, fatigue, cough, weight gain |
|
|
Term
HF is a clinical condition (not a disease)
just remember this!!! |
|
Definition
| in which the output of blood from the heart is insufficient to meet the metabolic needs of the body. This clinical syndrome is characterized by dyspnea, fatigue, and fluid retention, with pulmonary and systemic venous congestion |
|
|
Term
|
Definition
| Elevated JVP, pulmonary rales, decreased breath sounds (pleural effusion), peripheral edema |
|
|
Term
|
Definition
Give intravenous Lasix
Must check renal function first
Consider patients home dose of lasix
Consider admission |
|
|
Term
|
Definition
| SBP 120-139 or Diastolic 80-89 |
|
|
Term
|
Definition
| SBP 140-159 or Diastolic 90-99 |
|
|
Term
|
Definition
| SBP >160 or Diastolic >100 |
|
|
Term
|
Definition
| Diastolic BP >130 mmHg with new or acutely progressive organ dysfunction (retinal hemorrhage, encephalopathy, pulmonary edema, acute MI, or unstable angina) is a true hypertensive emergency |
|
|
Term
Hypertensive Emergencies
tx: |
|
Definition
Nitroprusside (Nipride)
Nitro gtt
Labetalol |
|
|
Term
| are a sensory symptom. They are defined as an unpleasant awareness of the forceful, rapid, or irregular beating of the heart. Patients may at times describe the sensation as a rapid fluttering in the chest, flip-flopping in the chest, or a pounding sensation in the chest or neck, and these descriptions may help elucidate the cause of the palpitations. |
|
Definition
|
|
Term
I think my device fired!!!
Does the patient have a device?
work-up |
|
Definition
Have device interrogated: interrogated by the company
Wallet card
Cardiologist office
Hospital records
Check Chem7 and Mg |
|
|
Term
|
Definition
History
EKG
CBC, Chem7, TSH
_______ (depends on story) |
|
|
Term
Decreased intestinal blood flow that results in ischemia and hypoperfusion that may cause mucosal injury, tissue necrosis, and metabolic acidosis
Arterial or venous
Acute or chronic |
|
Definition
Acute Mesenteric Ischemia
Mortality 90% with infarction |
|
|
Term
Acute Mesenteric Ischemia
classica triad of SMA embolism? |
|
Definition
GI empting, abdominal pain, underlying cardiac disease.
Emboli are usually from cardiac thrombus and affect superior mesenteric artery more than IMA (small size) |
|
|
Term
| Blood supply to the abdomen come from 3 major arteries |
|
Definition
| celiac, superior mesenteric artery, and inferior mesenteric artery) |
|
|
Term
|
Definition
| ” (post-prandial abdominal pain) seen in mesenteric arterial thrombosis |
|
|
Term
Acute Mesenteric Ischemia: Diagnostics
Plain films of abdomen?
Gold standard is? |
|
Definition
Acute phase: normal findings, adynamic ileus, dilated loops of bowel, irregular bowel wall thickening (thumb printing)
Advanced stages: pneumatosis or portal system
Angiography
Classically described as the diagnostic and therapeutic gold standard |
|
|
Term
| Acute Mesenteric Ischemia: ED Management |
|
Definition
Aggressive approach to diagnosis and treatment is imperative
NG tube
IV hydration
Vasopressors (severe hypotension)
Antibiotics that cover bowel flora
Early angiography = more favorable outcome
Surgical consult early
admit to ICU |
|
|
Term
| Primary causes Acute Pancreatitis |
|
Definition
| Alcohol abuse and biliary tract disease |
|
|
Term
| Mnemonic for Pancreatitis |
|
Definition
I GET SMASHED”
I – idiopathic
G – Gallstone
E – ETOH
T – Trauma
S – Steroids
M – Mumps (Epstein-Barr, Cytomegalovirus)
S – Scorpion Stings
A – Autoimmune Disease
H – Hypercalcemia, Hypertriglyceridemia, hypothermia
E – ERCP
D - Drugs |
|
|
Term
| Acute Pancreatitis: Presentation |
|
Definition
Acute onset of epigastric pain radiating to the back partially relieved by sitting up or assuming fetal position
Pain is constant and severe, not colicky
Jaundice
Steatorrhea –pale, foul-smelling/oily stools |
|
|
Term
|
Definition
Mid-epigastric tenderness
Possibly guarding/rebound only with severe destruction of pancreas and damage to surrounding tissue
Hypoxia
Cullen’s and Grey Turner’s signs suggest retroperitoneal bleeding (hemorrhagic pancreatitis) |
|
|
Term
Acute Pancreatitis: Diagnostics
Lab findings
Imaging findings |
|
Definition
Lipase and amylase
Abdominal Series
Ileus with sentinel jejunal loop, pancreatic calcifications (chronic pancreatitis), gallstones, pulmonary findings
CT Scan with contrast
Most ordered |
|
|
Term
|
Definition
Acute Pancreatitis
Score 0-2 : 2% Mortality
Score 3-4 : 20% Mortality
Score 5-6 : 40% Mortality
Score 7-8 : 100% Mortality |
|
|
Term
| Acute Pancreatitis: ED Management |
|
Definition
Admission
NPO
IV hydration
Antiemetics
Pain control in ED
Morphine vs Demerol (MSO4 related to spasm of Sphincter of Oddi)
NG tube suction for intractable vomiting/ileus
Surgical consultation
ERCP for gallstones (GI) |
|
|
Term
| Ulcerations in the gastric or duodenal mucosa that extends through the muscularis mucosa |
|
Definition
| Peptic Ulcer Disease: Duodenal and Gastric Ulcers |
|
|
Term
Peptic Ulcer Disease: Duodenal and Gastric Ulcers
Primary cause? |
|
Definition
Helicobacter pylori (disrupts gastric mucosal surface causes inflammation and ulceration)
NSAID use (inhibit prostaglandin secretion and injury to mucosa) |
|
|
Term
| Peptic Ulcer Disease: Presentation |
|
Definition
Epigastric pain, gnawing or burning
Occurs 2-3 hours after meal
Relieved with food or antacids (duodenal ulcers) |
|
|
Term
| Peptic Ulcer Disease: ED Management |
|
Definition
Uncomplicated
Empirical antacids, H2 blockers, PPIs
H. pylori triple therapy with PPI/H2 blocker therapy with abx coverage |
|
|
Term
Sudden rupture of a hollow organ (stomach, small or large bowel, gallbladder)
Elderly, particularly with h/o PUD or diverticular disease |
|
Definition
|
|
Term
| Perforated Viscus Most Common Cause |
|
Definition
| duodenal ulcer eroding through serosa |
|
|
Term
| Perforated Viscus: Presentation |
|
Definition
Sudden onset mid-epigastric pain
Nausea
Vomiting
Fever
Patients may rock back and forth for relief of pain or sit perfectly still |
|
|
Term
| Perforated Viscus: Diagnostics |
|
Definition
Upright CXR or left lateral decubitus abdominal film – detect free air of perforation
Pneumoperitoneum: pathognomonic for perforated viscus
Diagnostic peritoneal lavage can diagnose
lavage can be avoided if gas/food/bowel contents/bile/turbid or bloody fluid is present on initial aspiration |
|
|
Term
| Perforated Viscus: ED Management |
|
Definition
NPO
NG tube
IV fluids
Abx
Immediate surgical consult
Avoid extensive contamination from spillage of gastric contents |
|
|
Term
|
Definition
1/3 of all elderly patients will require surgical intervention when presenting with abdominal pain
>50 y.o. patients have significantly elevated misdiagnosis and mortality rates
Have fewer classic presentation
Medications blunt typical response to pain |
|
|
Term
Esophageal varices which are extremely dilated sub-mucosal veins in the esophagus and prone to hemorrhage
Consequence of portal hypertension in patients with cirrhosis or other liver disease |
|
Definition
|
|
Term
| Esophageal Hemorrhage: Diagnostics |
|
Definition
Endoscopy
Under light sedation, direct visualization and possible therapy can be achieved |
|
|
Term
| Esophageal Hemorrhage: Diagnostics |
|
Definition
Endoscopy
Under light sedation, direct visualization and possible therapy can be achieved |
|
|
Term
| Esophageal Hemorrhage: ED Management |
|
Definition
NPO
IV hydration/transfusion
Correct clotting factor deficiencies with FFP, fresh blood, vitamin K.
Intubation with massive UGIB or AMS or hematemesis
NG tube
Assess the severity of bleeding and to lavage gastric contents before endoscopy
Octreotide or somatostatin initiated immediately
Endoscopy when pt stabilized
Sclerotherapy or variceal ligation
ICU admission |
|
|
Term
| Classic presentation of spontaneous esophageal rupture |
|
Definition
| severe vomiting or retching followed by acute, severe chest pain or epigastric pain |
|
|
Term
| Esophageal Perforation: PE |
|
Definition
Subcutaneous emphysema is palpable in neck or chest (60%) but may take an hour to form
Tachycardia
Tachypnea
Mackler triad
Hamman sign |
|
|
Term
| Mackler triad what is it and what is it seen it? |
|
Definition
vomiting , chest pain, and subcutaneous emphysema (associated with spontaneous perforation and is present in 50% of cases)
seen in esophogeal perforation |
|
|
Term
|
Definition
| raspy, crunching sound heard over the precordium with each heartbeat caused by mediastinal emphysema (often with thoracic or abdominal perforation) |
|
|
Term
|
Definition
| raspy, crunching sound heard over the precordium with each heartbeat caused by mediastinal emphysema (often with thoracic or abdominal perforation) |
|
|
Term
| Esophageal Perforation: Diagnostics |
|
Definition
Plain films
Pneumomediastinum or retropharyngeal air
Plain films
Pneumomediastinum or retropharyngeal air
Contrast swallow
Gastrograffin UGI series
Sensitivity 60-75%
Barium study |
|
|
Term
| Upper GI Bleed: location? |
|
Definition
between the pharynx and the ligament of Treitz
UGIB
Documented hematemesis
Blood in NG aspirate
Hyperactive BS |
|
|
Term
|
Definition
below ligament of Treitz
No documented hematemesis
Negative NG aspirate
Maroon stools
Hematochezia, especially with normal/hyperactive BS |
|
|
Term
|
Definition
| are enlarged, painful veins in the rectum. Patients will present with severe rectal pain, possibly h/o swelling, painful defecation, rectal bleeding, constipation, itching. |
|
|
Term
| Absolute contraindications to thrombosed external hemorrhoid incision |
|
Definition
Any concern lesion may not be thrombosed external hemorrhoid(PAINLESS rectal mass)
Grade IV internal hemorrhoid associated with thrombosed external hemorrhoid
Known severe coagulopathy
Hemodynamic instability |
|
|
Term
| Segment of bowel obstructed at 2-sequential sites with a high-risk of blood-flow compromise |
|
Definition
|
|
Term
EMTALA:
Emergency Medical Treamtment and Active Labor Act 1986 |
|
Definition
Requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay.
Patients must be stabilized prior to transfer
Know your facility’s transfer paperwork |
|
|
Term
|
Definition
From the French “trier”, which means “to sort”
In the ED: triage is used to identify patients who need care first
EM care is NOT “first come, first served” |
|
|
Term
|
Definition
ABCs ALWAYS
Unstable vitals
Hypotension, severe hypertension
Tachycardia, severe bradycardia
Hypoxia
Poor perfusion
Increased work of breathing
“Look Sick”
Altered mental status
Fever
Severe pain
Caregiver history does not make sense |
|
|
Term
Very Sick: EMERGENT
Means? |
|
Definition
Any threat to life or limb (illness or injury) for which immediate treatment is necessary
Need to be seen immediately
Active seizures, altered mental status, severe HA, stroke-like symptoms
Respiratory or circulatory failure
Compromised airway
Arterial bleeding or uncontrolled venous bleeding
Testicular torsion, ovarian torsion
Severe pain
Severe orthopedic injuries with compromised neurovascular status |
|
|
Term
| Who is Very Sick? Emergent |
|
Definition
Sickle cell patient with fever or severe pain, unstable vitals
Oncology patient with fever or uncontrolled pain
Decreased level of consciousness
Multiple system trauma
Any injury with neurovascular compromise
DKA
Impending delivery
Ophthalmologic injuries |
|
|
Term
Any illness or injury for which treatment should be initiated within 30 minutes is considered ?
Respiratory distress
Chest pain that may be cardiac
Significant dehydration
Early shock
Abdominal pain with peritoneal signs or obstruction
Ingestions or drug overdose |
|
Definition
Moderately Sick: URGENT
who is Moderately Sick?
Head trauma with persistent vomiting or LOC
Toxic-appearing
Extremity injuries with deformity
Non-accidental trauma
Burns <10% BSA
Fever
Infants <8weeks
Any toxic-appearing child
Elderly |
|
|
Term
injury for which minor delay in treatment will not alter outcome is considered
Can wait hours to days |
|
Definition
Not sick: NON-EMERGENT
Gastroenteritis without dehydration
Sprained ankle
Minor lacerations without active bleeding
Foreign body (ear/nose)
First-degree burns
Back strain
Uncomplicated afebrile UTI
Vaginal discharge
“Get checked” |
|
|
Term
| Rule No. 1: VITAL SIGNS ARE VITAL |
|
Definition
DO NOT ignore abnormal vital signs
DO NOT rely on one set of vital signs for a prolonged ED stay
Frequently reassess
If a number is out of whack, find out WHY
DO NOT discharge a patient with unstable vitals |
|
|
Term
RUle No. 2: Bleeding Must Be Stopped
How? |
|
Definition
Local pressure
Vasoconstrictors
Reverse anticoagulants
Surgical intervention when necessary
ABCs, ALWAYS |
|
|
Term
| RULE NO. 3: ALL BLEEDING STOPS…EVENTUALLY |
|
Definition
But you may run out of blood first
Bleeding must be stopped
Frequently reassess
Check indicators of volume loss
Watch out for shock
Some bleeding must be replaced
Do not discharge the actively bleeding patient
Do not neglect the actively bleeding patient |
|
|
Term
| Rule No. 4:Previously Stable Patients Can Become Unstable Quickly |
|
Definition
Frequently reassess
Know who warrants continuous cardiac monitoring
Don’t leave high-risk patients alone where they are out of sight and out of mind
Don’t assume the nurse is rechecking your patient |
|
|
Term
| Rule No. 5: Know Your Team |
|
Definition
Know your team members’ abilities and limitations
Know who’s got your back
Know who to call for help
Know how to transfer a patient
Know when to call for surgical help EARLY
Know your FACILITY
Know WHO is a good teacher and who is willing to teach |
|
|
Term
| Rule No. 6: Know Your Facility |
|
Definition
Know where things are kept
Know what studies are available, and when
Know how to call a code
Know when to transfer
Know HOW to transfer
Know your consultants
Learn from everyone who is willing to teach you…even the ward clerks and techs have knowledge you don’t |
|
|
Term
| RULE NO. 7: DON’T BE IGNORANT |
|
Definition
It’s OK to not know everything…but know what you do not know
Admit when you do not know
Ask someone who knows
LEARN what you do not know
Don’t make the same mistake twice! |
|
|
Term
| RULE NO. 8: DON’T FEED THE LAWYERS |
|
Definition
| Document, document, document |
|
|
Term
| RULE NO. 9: IF IT ISN’T DOCUMENTED, IT DIDN’T HAPPEN |
|
Definition
| Document what you DID, not what you SHOULD have done |
|
|
Term
| Rule No. 10: Everybody Dies |
|
Definition
But we try to not let it be today.
Not on our watch.
Not when we can prevent it.
And we really hope not to cause it. |
|
|
