ED SAEM test study guides latest version 2023

1. list ottawa ankle rules 2. where should you also check on exam/be aware of? - 1. inability to walk 4 steps immediately & in ED + any of the following: - medial malleolus tenderness - lateral malleolus tenderness - navicular tenderensss - 5th metatarsal tendereness 2. check fibular head tenderness- twisting injury ~ fibular fx name SIRS criteria (4) Describe CHEST study findings - 1. Temp 36 or 38 2. HR 90 3. RR 20 or PaCO2 32 4. WBC 4,000 x 12,000 CHEST study (JAMA): previous SCC (surviving sepsis campaign) studies did not look at wards; found that SIRS reminders did not affect mortality 1. define sepsis 2. define severe sepsis- criteria? (SBP, Cr, bili, PLT, INR, lactate) 3. define septic shock - 1. pt who has potential infectious cause for SIRS syndrome 2. sepsis-induced organ dysfunction. Criteria: SBP 90 or MAP 70 or SBP decrease 40 Cr 2.0 or urine output 0.5ml/kg/hr Bili 2 PLT 100,000 INR 1.5 or PTT 60s lactate 2 mmol/L 3. low BP despite fluid administration 1. what lab is the ECG of sepsis? 2. list of labs to get for sepsis? 3. 3 hour bundle for sepsis? 4. 6 hour bundle? - 1. lactate 2. CBC, CMP, PT/INR/PTT, blood Cx x2, UA, CXR 3. lactate measurement, blood Cx then administration of broad spectrum abx, admin. of 30mL/kg IV crystalloid for hypoTN or lactate 4 4. vasopressors for goal MAP 65, reassess & document volume, repeat lactate if initially 4 name the AEIOUTIPS of AMS - A = alcohol E = epilepsy, electrolytes, encephalopathy I = insulin O = opiates & oxygen U = uremia T = trauma & temp I = infection P = poison & psychogenic S = shock, stroke, subarachnoid hemorrhage, space-occupying lesion 1. MC cause of asthma exacerbation? 2. Qs to ask pt when they come in? 3. mainstay of therapy? (1st line) 4. if mod/severe, give what? 5. if severe & not improving with albuterol, use what? (4 things) 6. criteria for ICU admission? - 1. URI 2. previous episodes, prior ED visits, hospitalizations or ICU admissions, steroid use, past intubations 3. albuterol nebulizer continuous 6-8L/min or via nasal cannula, place on cardiac monitor/continuous pulse oximetry with goal SpO2 92% 4. oral/IV steroids 5. IM SQ epinephrine 0.2mg or terbutaline 0.25 mg. Also ipratropium (anticholinergic) combined w albuterol = Duonebs. Last line: MgSO4 6. 90% SpO2, FEV1 40% 1. how is dosing of drugs administered endotracheally? which drugs? 2. when do you think of H's and T's? 3. things to order during ACLS? 4. successful resuscitation dependent on what? Joules on biphasic & monophasic? 5. doses of Epi, vasopressin, amiodarone? - 1. 2-2.5x the IV route. Drugs: NAVEL- naloxone, atropine, vasopressin, Epi, Licocaine 2. during PEA/asystole 3. EKG, ABG, serum electrolytes, CXR, US 4. rapid defibrillation. biphasic: 200. Monophasic: 360 5. Epi 1mg (1:10,000), vaso 40U, amiodarone 300mg 150mg 1. what is the leading cause of systolic HF? 2. Tx for CHF exacerbation? 3. prognosis at Dx? - 1. myocardial infarction 2. nitrates are 1st line. IF fluid overloaded, then lasix. If in cardiogenic shock, levophed. 3. 5 years 1. classic triad of ruptured AAA 2. imaging of choice? 3. continuous abd bruit & palpable thrill? 4. bloody stool? 5. Mgmt of AAA? goal MAP? - 1. pain, hypo-TN, pulsatile abd mass 2. US 3. aortovenous fistula 4. aortoenteric fistula 5. 2 large bore IVs, type/cross, goal MAP 90-100, emergent surgery 1. name 4 causes of mesenteric ischemia & presentation? 2. which patients should you watch for? Sx? 3. MC cause? RF? 4. which has worst prognosis? 5. which occurs in younger pop? 6. Imaging used & gold standard? 7. Tx? For artery thrombus, embolus, veinous thrombosis. - 1. mesenteric artery embolus, thrombus, mesenteric vein thrombosis 2. elderly- N/V/D, sudden onset diffuse abd pain 3. Mesenteric a embolus- MR, valvular heart DZ, arrhythmias 4. Mesenteric artery thrombosis 5. Mes. vein thrombosis 6. CTA. Gold standard: angiography 7. 2 IVs, triple lumen for CVP, Abx. If thrombus: surgery, heparin. Embolus: Sx/Embolectomy. VT: thrombectomy with endarterectomy & lifelong anti-coagulation 1. Perforated viscus: sensitivity of XR? 2. test of choice? 3. labs? 4. Tx? 5. mortality? - 1. 30-80% having pt sit upright 10mins incr sens. 2. CT most sens & spec 3. type/cross, H/H, PT/INR, WBC, lactate, lipase, LFTs, BMP 4. 2 IVs, O2, IVF, Abx (cipro, metro, Pip/Tazo, imipenem) 5. up to 50% 1. MC causes SBO? 2. MC cause LBO? 3. Sx? 4. Dx testing? + test? 5. management? - 1. adhesions hernias/tumors strictures, gallstones, Crohn's 2. malignancy 3. abd pain, initial diarrhea, distention, vomiting 4. upright radiograph-CT w PO & IV contrast. + if loop 2.5 cm 5. NPO, IVF, GI consult, serial abd exams 1. initial mgmt of testicular torsion? 2. MC age of presentation? 3. PE signs? 4. golden time period?