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Emergency medicine #1
For the EM clerkship exam
20
Medical
Graduate
04/18/2012

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Cards

Term

What is the most important test for...

  1. Acute chest pain?
  2. Abdominal pain
Definition
  1. H&P
  2. Type and Screen/Cross
Term
What is an essential XR for abdominal pain?
Definition
Upright CXR (pneumonitis around diaphragm)
Term
What is the formula for A-a gradient?
Definition

Gradient = (150-1.2*PaCO2) - PaO2

>20 indicates either

  1. V/Q Mismatch (ex: PNA, CHF, ARDS, atelectasis, etc)
  2. Shunt (ex: PFO, ASD, PE, pulmonary AVMs)
  3. Alveolar Hypoventilation (ex: interstitial lung dz, environmental lung dz, PCP PNA)
Term
What are the treatments of hyperkalemia?
Definition
  1. Ca gluconate (to prevent arrhythmia)
  2. Insulin +D5W, ß2 agonist (to drive K+ into cell)
  3. Kayexalate (to promote K+ excretion)
  4. Hemodialysis
Term
What does the primary survey in trauma consist of?
Definition
 
  1. Airway & C-spine – jaw thrust/chin lift, clear foreign bodies, intubate obtunded/unconscious, cricothyroidectomy
  2. Breathing & ventilation – inspect, auscultate, palpate; treat tension pneumo, flail chest/pulmonary contusion, hemothorax, open pneumo
  3. Circulation – 2 14/16-gauge IVs, assess circulatory status (cap refill, pulse, skin color), direct pressure (not clamps)
  4. Disability – rapid neuro exam, pupil size & reactivity, level of consciousness (AVPU [alert/verbal/pain/unresponsive], GCS)
  5. Exposure, environment control – completely undress, hookup monitors (cardiac, pulse ox, BP, etc)
  6. Foley – 0.5cc/kg/hr (adult), 1cc/kg/hr (child >1), 2cc/kg/hr (child <1); retrograde urethrogram for urethral transection (blood at meatus, “hi riding” prostate, perineal/scrotal hematoma)

 

Term
What is the acute treatment of shock?
Definition
  • Resuscitation (isotonic crystalloid = NS, LR)
  • Bolus 
    • Adults: 1-2L/30-120min 
    • Peds: 10 (mild), 20 (mod), 30-50 (severe) cc/kg/hr
  • Maintenance 
    • 4 cc/kg/hr (for first 10kg), 2cc/kg/hr (for 10-20kg), 1cc/kg (for every kg >20) 
    • Simple rule for adults = 40 + kg / hr
    • 3 to 1 = 1/3 isotonic crystalloid remains in intravascular space
Term
What is the cardinal feature of hypovolemic/hemorrhagic shock? What are the different classes?
Definition

Low PCWP

  1. <15% volume depletion, <750cc lost
  2. 15-30%, 750-1500cc
  3. 30-40%, 1500-2000cc
  4. >40%, >2000cc

 

Term
What are the stages of hypovolemic/hemorrhagic shock?
Definition
  • Preshock (compensated up to 10%)
  • Shock (cool skin, tachy, hypotension, oliguria, AMS)
  • End organ dysfunction (anuria, coma)
Term
What is the cardinal feature of cardiogenic shock (CHF)
Definition
Increased PCWP
Term
What is the cardinal feature of distributive shock (neurogenic, septic, anaphylactic)
Definition
Low SVR
Term
What is the eye component for the Glasgow Coma Scale?
Definition
  1. No response
  2. Open eyes in response to pain
  3. Open eyes in response to verbal stimuli
  4. Open eyes spontaneously
Term
What is the motor component of the Glasgow Coma Scale?
Definition
  1. No response
  2. Decerebrate rigidity
  3. Decorticate rigidity
  4. Flexion withdrawl to painful stimulus
  5. Responds to painful stimulus
  6. Responds to verbal command
Term
What is the verbal component of the Glasgow Come Scale?
Definition
  1. No response
  2. Incomprehensible sounds
  3. Inappropriate words
  4. Disoriented & conversant
  5. Oriented & conversant
Term
What are the types of burns?
Definition
  • First degree - epidermis (sun)
  • Second degree - dermis (hot liquids)
  • Third degree - subcutaneous / fat (hot liquids, steam, hot oil, flame)
  • Fourth degree - bone
Term
What is the order of importance for the trauma series?
Definition
CXR, pelvic, C-spine
Term
A burn patient comes in with a PCO2 of 25, hyperventilating. What is the first course of action?
Definition
Intubate
Term
Patient comes in with gun shot wound and abdominal pain. What is high on your differential?
Definition
Small bowel obstruction
Term
Male with alcohol in breath s/p motor vehicle accident presents with alcohol in breath, C-collar, no pain, no focal deficits on neuro exam. Next course of action?
Definition
Do not remove collar until C-spine X-ray
Term
What are the major symptoms of basilar fracture?
Definition
  • Raccoon eyes (periorbital bruise)
  • Battle sign (retroauricular bruise)
  • CSF otorrhea
  • CSF rhinorrhea
  • Hemotympanum
  • CN palsies
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