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EM SAEM
AEIOU TIPS (differential for AMS) - correct answer A Alcohol E Epilepsy, Electrolytes, and Encephalopathy I Insulin O Opiates and Oxygen U Uremia T Trauma and Temperature I Infection P Poisons and Psychogenic S Shock, Stroke, Subarachnoid Hemorrhage and Space-Occupying Lesion Delirium vs psychosis hallucinations - correct answer delerium= visual psychosis=auditory systolic vs dystolic failure - correct answer Systolic failure is the hearts inability to pump the blood forward in the circulatory system. It is essentially has lost the "squeeze." Diastolic heart failure occurs due the fact that the muscles of the heart are unable to relax adequately and allow the heart to fill appropriately. lung sounds in - correct answer Anterior MI -leads and artery affected - correct answer V1-V6 Left Anterior Descending Septal MI - correct answer V1-V3 Left Anterior Descending Inferior MI - correct answer II, III, aVF (recipricol changes in I, aVL) Right coronary artery (80%) or Left Circumflex (20%
Lateral MI - correct answer Lateral MI I, aVL, V5, V6 left circumflex posterior MI - correct answer v5 v6 RCA or L Circumflex ACS markers (initial, peak, baseline) - correct answer Myoglobin 1-4 h 6-7 h 18-24 h CK-MB 4-12 h 10-24 h 48-72 h Cardiac Trop I 3-12 h 10-24 h 3-10 d Cardiac Trop T 3-12 h 12-48 h 5-14 d For STEMI what are you looking for on EKG? - correct answer ST-elevations of 1 mm or more in two contiguous limb lead TIMI Risk Score for Unstable Angina and Non-ST-Elevation MI's (UA/NSTEMI - correct answer •65 or older?
- 3+ CAD risk factors? •Known CAD? •Aspirin use in past week? •Severe angina? •ST segment changes? •Positive cardiac markers blood pressures in arms in aortic dissection - correct answer measurement of bilateral upper extremity blood pressures with increased concern for thoracic aortic dissection when a systolic BP differential of greater than 20 mmHg between arms is obtained. Blood pressure is typically elevated, especially in patients with type B dissection, though a normal or hypotensive reading may indicate complications of the dissection, such as retroperitoneal hemorrhage or cardiogenic shock from myocardial ischemia or acute aortic insufficiency
hyperglycemia fluids - correct answer Average fluid loss in DKA 3-6 liters and HHS 8- 10 liters 1-Start with isotonic saline (0.9%) at 15-20 ml/kg per hour for the first few hours (in the average adult this will be approximately 1 liter/hr) 2-Switch to one-half isotonic saline (0.45%) when the serum sodium normalizes 3-Add dextrose to the intravenous fluids when serum glucose reaches 250 mg/dL bicarb in hyperglycemia - correct answer Severe acidosis with pH < 6. Severe life-threatening hyperkalemia Seizures Cardiac or persistently hypotensive patient cerebral edema Hyperglycemia - correct answer It is mainly seen in children and young adults, occurring 4-12 hours into treatment with a high degree of morbidity and mortality. Clinically it is often preceded by headache, lethargy, and then neurologic deterioration (seizures, coma) with bradycardia and respiratory arrest. Although not completely understood development of cerebral edema is correlated with bicarbonate administration and massive fluid resuscitation. EKG changes w/hyperkalemia - correct answer K 6.5-7.5 mEq/L Peaked T waves K 7.5-8.0 mEq/L Widening of QRS, decreased amplitude of P waves K 10-12mEq/L Sine wave, ventricular fibrillation, asystole Dose of calcium gluconate - correct answer Calcium gluconate 10ml (1 ampule) IV over 2-5 minutes. This dose may be repeated after 5 minutes if no improvement. Onset within minutes, and lasts approximately 30-45 minutes. Calcium chloride can be substituted, but may cause tissue necrosis if extravasation occurs. Intravenous calcium salts should be used with caution in patients with hyperkalemia and digoxin toxicity.
What do you need to give with glucose in alcoholic patients? - correct answer Remember to consider giving thiamine to alcoholic patients to prevent Wernicke's Encephalopathy. IV dextrose in hypoglycemia - correct answer In adults start with 50 ml of 50% Dextrose in Water (D50). In pediatric patients use 1 ml/kg of 25% Dextrose in water or 2-4 ml/kg of 10% Dextrose in water. Monitor mental status and blood glucose measurements every 15-30 min after glucose administration. Octreotide: - correct answer May be useful in the setting of sulfonylurea-induced hypoglycemia not responsive to other therapies. Initial dose of 50-125 ug subcutaneously. thryoid storm treatment - correct answer https://image.slidesharecdn.com/2012- gemc-resident-fry-thyroidstorm-oer-edited-140301231147-phpapp02/95/gemc- thyroid-storm-resident-training-43-638.jpg?cb= presentation of hyperthermia - correct answer Typically temperature exceeds 40C Tachycardia Commonly normotensive, but may be hypotensive Severe CNS dysfunction Pupils may be fixed, dilated, pinpoint or normal Nystagmus or oculogyric episodes may be present Typically hyperdynamic cardiovascular state Hypodynamic state signifies impending CV collapse Tachypnea and hyperventilation Gastrointestinal hemorrhage occurs frequently Jaundice and elecated liver enzymes occurs commonly Fulminant hepatic failure and DIC rarely occur
Heat vs smoke and the airways - correct answer heat affects the upper airway smoke affects the lower airway parkland formula - correct answer %TBSA burn x wt in kg x 4cc/kg = volume of LR that should be administered over the first 24 hours appropriate antibiotics for uncomplicated appendicitis include - correct answer ampicillin-sulbactam, or cefoxtin, or a combination of metronidazole and ciprofloxacin. exam finding on mesenteric ischemia - correct answer One of the distinctive findings in mesenteric ischemia is that of abdominal pain that is out of proportion to examination. The patient may be screaming in pain, but their abdomen is soft with no guarding or rebound.
