ED SAEM test questions and
answers
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?
answers
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?
