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Flashcards in EMERGENCY MEDICINE Deck (13)
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1
Q

I HAVE BLOOD IN MY STOOLS

DZ X

HEMORRHOIDS
ANGYODISPLASIA
COLONIC POLYPS
ULCERATIVE COLITIS
CHRON DISEASE
DIVERTICULITIS
SOLITARY RECTAL ULCER
A

IWU:

CBC
BUN
CREATNINE
NGT PLACEMENT AND LAVAGE
PT/PTT
ELECTROCARDIOGRAM

FM:
COLONOSCOPY
RADIONULCIDE SCINTYGRAPY IF BLEEDING IS TO RAPID TO MAKE COLONOSCOPY EFFECTIVE

*CLASSIC SPIDER ANGIOMA LIKE LESIONS IN THE COLON RIGHT
SURGERY CONSULT

ENDOSCOPIC ELECTROCOAGULATION
LASER ETC
RIGHT HEMICOLECTOMY IF FAILS

2
Q

I’VE BEEN COUGHING AND WALKING FOR 2 WEEKS
PMH: EPISODE OF INTOXICATION

DZ X

FOREIGN BODY ASPIRATION
ASPIRATION PNEUMONIA CLINDAMICIN METRO PCN ABSCENSE GAG REFLEX EX: STROKE
ASTHMATIC BRONCHITIS

FBA

A
IM:
CXR
FM:
BRONCHOSCOPY AND TOOTH FRAGMENT REMOVAL FROM THE BRONCHUS
BRONCHIAL SECRETIONS ARE PURULENT
ABX OBSTRUCTIVE PNA
BRONCHIAL WASH CULTURES
3
Q

I’VE BEEN COUGHING AND WALKING FOR 2 WEEKS
PMH: EPISODE OF INTOXICATION OF ALTERED MENTAL STATUS UNCONSCIOUS

DZ X

FOREIGN BODY ASPIRATION
ASPIRATION PNEUMONIA CLINDAMICIN METRO PCN ABSCENSE GAG REFLEX EX: STROKE
ASTHMATIC BRONCHITIS

FBA

A
IM:
CXR
FM:
BRONCHOSCOPY AND TOOTH FRAGMENT REMOVAL FROM THE BRONCHUS
BRONCHIAL SECRETIONS ARE PURULENT
ABX OBSTRUCTIVE PNA
BRONCHIAL WASH CULTURES
4
Q

LEAVE ME ALONE!

DXZ

BACTERIAL MENINGITIS
SCHIZOPHRENIA
ALCOHOLIC HALLUCINOSIS
SUBDURAL HEMATOMA

A

IWU:

LYTES
ALCOHOL LEVEL
MAGNESIUM LEVEL
ABG
CT SCAN OF THE HEAD
LUMBAR PUNCTURE CSF
FURTHER DIAGNOSTIC PLAN:
CHLORODIAZEPOXIDO
IVF D5NS
MAGNESIUM SULFATE REPLACEMENT 
THIAMINE FOLIC ACID
CLONIDINE TO SUPPRESS CARDIAC HYPER EXCITABILITY
ATENOLOL
5
Q

I CAN’T WALK RIGHT

SUBDURAL
CONTUSION COULD FND CT SCAN+ LOC
CONCUSSION LOC NO FND CT NEG
EPIDURAL
SUBARACHNOID

A
CT SCAN OF THE HEAD WITHOUT CONTRAST
INTUBATION AND HYPERVENTILATION TO P CO2 25-30 mmHg
IV MANITOL USE
NEUROSURGICAL EVALUATION AND EVACUATION
SBP > 100
STRESS ULCER PROPHYLAXIS PPI INHIBITOR
6
Q

CONFUSION AND IRRITABILITY
BROAD SPECTRUM CASE
DO NOT WANDER!

DZ X

HYPOGLYCEMIA
DELIRIUM
DRUG OVERDOSE
CEREBROVASCULAR ACCIDENT
MENINGITIS
HYPER HYPO THYROID
SEPSIS SYNDROME

DZX HYPOGLYCEMIA

ISULINOMA
SEVERE LIVER DZ
ADRENAL INSUFFICIENCY
ALCOHOL INTOXICATION
MIXEDEMA 
MALNUTRITION
REACTIVE HYPOGLYCEMIA*
FACTITIOUS DISORDER
A

BLOOD GLUCOSE BY FINGERTICK
SERUM LYTES

IM:
50 ml OF D50%

FURTHER STUDIES:

BLOOD CULTURES
URINE CULTURES
CONSIDER THYROID FUNCTION TEST
VIT B12 LEVEL
LP CSF STUDIES
URINE TOXICOLOGY
HEAD CT SCAN

INSULIN LEVEL* IN REACTIVE POSTPRANDIAL OR POSGASTRECTOMY HYPOGLYCEMIA

7
Q

ORGANOPHOSPHATE POISONING

ES UN ARDS*

DXZ

CHOLINERGIC CRISIS

AT TIMES MECHANICAL VENTILATION MAY B REQUIRED

REMOVE PT CLOTHES BEFORE PE ASSESSMENT AN IWU DO NOT LOSE POINTS IN CCS*

A

IWU:

RED BLOOD CELL CHOLINESTERASE LEVEL
ADMIT ALL PTS
OXYGEN *OXYMETRY*
EKG BP
CARDIAC MONITORING
IM:
REMOVE FROM SIT EXPOSURE
ATROPINA*
PRALIDOXIMA = PAM 2
AIRWAY PROTECTION
FU:
HENNT: PUPILS DIAMETER FREQ CHECKS TO RESPONSE
8
Q

SUDDEN SOB

PE
PNA
BRONCHITIS PNEUMOTHORAX
PULMONARY HYPERTENSION
ENLARGING PLEURAL EFFUSION
MYOCARDIUM
CARDIOMYOPATHY
S3Q3 R HEART STRAIN ON 2D ECHO
SINUS TKC (MCF) ST-T UNSPECIFIC
ABG A-a GRADIENT> 40 V/Q MISMATCH
ABG: RESP ALKALOSIS PCO2 20 
CXR: SHOULD B NORMAL

THINK ALWAYS IN THROMBOPHILIAS IN YOUNG PTS*

PROTHAMINE

A

IWU:

CXR
CBC
SMA 20
ABG
EKG

SO:
SPIRAL CT SCAN* ENOUGH LESS INVASIVE
VENTILATION PERFUSION SCAN
PULMONARY ANGIOGRAM* GOLD STANDARD
D DIMER BUT IT RAISES IN ANY CLOT SO SPECIFICITY IS ALMOST ZERO SO IN LOW PROBABILITY SCENARIOS TO RULE OUT NOT TO RULE IN.
FM:
UNFRACTIONED HEPARIN* OR LMWH FONDOPARINAUX ENOXIPARINA
PTT 2XX NORMAL PT 1.5-2.5 NORMAL
THROMBOLYTIC IF SHOCK SBP <90 OR PE WHILE ON HEPARIN
IVC FILTER: C/I HEPARIN OR PE WHILE ON HEPARIN
BRIDGE TO WARFARIN DABIGATRAN ……
FU: INR 6MOS 2X-3XXX NORMAL

9
Q

I HAVE BEEN NAUSEOUS AND VOMITING ALL DAY

ACETAMINOPHEN OVERDOSE

DZ X

APPY
CHOLE
PANCREATITIS

A

IWU:

CBC
LFT
LIPASE/AMYLASE
PT

FWU:
SERUM ACETAMINOPHEN LEVEL
ASPIRIN LEVEL

FM:

NGT: ASPIRATION LAVAGE
INDUCE VOMITING IPECAC < 1HR BEST
ACETYL CISTEINA < 24 HRS OF INGESTION
CHARCOAL ADMINISTRATION BETWEEN DOSES OF ACETYLCYSTEINA

10
Q

I’M VOMITING AND MY LIPS ARE SWOLLEN

ACUTE ANAPHYLAXIA
ASTHMA
PE
FOREIGN BODY ASPIRATION

ALARM SIGNS:
HYPOTENSION
WHEEZING
STRIDOR

A

IWU:

PULSE OXYMETRY 92*
OXYGEN
IV ACCESS
NORMAL SALINE
EPINEPHRINE 1: 1000 SC EVERY 15 MIN TO IMPROVEMENT
DIPHENHIDRAMINA e / 4 -6 HRS
CORTICOSTEROIDS
ENDOTRACHEAL INTUBATION
ALBUTEROL INHALERS
11
Q

CEREBRAL CONCUSSION

DZ X

CONTUSION BLOOD MIXED W BRAIN IN CT NO SURGERY
CONCUSSION CT NEG
EPIDURAL AND SUBDURAL HEMATOMA: BOTH SURGERY IF LARGE

A

OBSERVATION FOR 24 HRS AND NEURO CHECKS EVERY 3 HOURS

12
Q

EXTENSIVE BODY BURNS

SKIN BURNS
CARBON MONOXIDE BURNS
AIRWAY BURN

HEAD             9
ARMS             9
CHEST           18
LEGS              18
BACK              18 
PERINEUM       1
A

IWU:

CBC
SMA
CARBOXIHEMOGLOBIN LEVEL
CHEST X RAY

IMMEDIATE BRONCHOSCOPY

FLUID RESUSCITATION
PREVENTION OF INFECTION
ENDOTRACHEAL INTUBATION IF THERE IS EVIDENCE OF SIGNIFICANT RESPIRATORY INJURY
SULFADIZINE TOPICALLY TO ALL BURNED AREAS

ESCAROTOMY IF COMPARTMENT

13
Q

BP HAS DROPPED DRAMATICALLY
PMH: RECENT MI
PE: CANNON a WAVES

DZ X

HYPOVOLEMIA 
CARDIOGENIC SHOCK
VALVULAR OR CORDAE TENDINOSA RUPTURED
PAPILLARY MUSCLE
JARISCH BEZOLD
COMPLETE HEART BLOCK
VENTRICULAR TACHYCARDIA
SINUS BRADYCARDIA
VENTRICULAR RUPTURE
VENTRICULAR SEPTAL DEFECT

ISOPROTEREENOL ES B INESPEC AGO PERO WRONG ANSWER IN BRADI + HYPO&raquo_space; MIO O2 CONSUMPTION
RIGHT VENT SAME VASC OF INFERIOR WALL

A

IWU:

EKG
COMPLETE AV BLOCK

FM:
ATROPINE
DOPAMINE
IVF
BRIDGE TO

PACEMAKER*

END OF THE CASE

RIGHT VENTRICLE TREATED WITH FLUIDS
SIMPLE HYPO TENSION TREATED W FLUIDS AND DOPAMINE
VENTRICULAR TACHYCARDIA AND HYPOTENSION SYNCHRONIZED CARDIOVERSION
WALL AND VALVE RUPTURE IMMEDIATE OPERATIVE REPAIR