EM Oral Boards Approach - Okuda Critical Actions Cases (Questions and Answers Updated and Already Graded A+ 100%)

EM Oral Boards Approach - Okuda Critical Actions Cases (Questions and Answers Updated and Already Graded A+ 100%) Aortic Dissection - CORRECT ANSWER-TEE or CTA, BP control, CT Surgery consult Iron poisoning - CORRECT ANSWER-Ingestion hx, Elemental Iron Calculation (call poison control), Whole bowel irrigation (500 cc/hr until the rectal effluent is clear), Deferoxamine, Look for bleeding, ASA/APAP level Spinal Epidural Abscess - CORRECT ANSWER-Back exam, Hx of IVDU, ESR/CRP, MRI, MRSA coverage, Neurosurgery consult, Find cause (e.g. UTI) Subarachnoid Hemorrhage - CORRECT ANSWER-CT, LP, Neuro-checks, Neurosurgery consult Sigmoid Volvulus - CORRECT ANSWER-Obstructive series, NGT, NPO, Surgery Consult Afib WPW - CORRECT ANSWER-Assess stability, procainamide OR cardioversion, repeat EKG, CCU consult Acute Chest Syndrome - CORRECT ANSWER-Retic count, Antibiotics, PRBCs, Hematology Consult for exchange transfusion DKA/HHS - CORRECT ANSWER-Early ACCU-check, IVF (lots if HHS), K repletion, Insulin gtt, look for trigger, MICU consult, Endocrine consult Trauma - CORRECT ANSWER-Prevent hypothermia, trauma consult, specialty consult Foreign Body Aspiration - CORRECT ANSWER-CXR, b/l decubitus films, ENT consult for bronch Asthma - CORRECT ANSWER-Albuterol, solumedrol, magnesium, epi/terbutaline (no Epi in preg), BIPAP, Peak flow Ruptured AAA - CORRECT ANSWER-Bedside US, Order 6U blood, Vascular consult Addison's Crisis - CORRECT ANSWER-Steroid use hx, Hydrocortisone 100mg IV, treat hyperkalemia, Endocrine consult Anaphalaxis - CORRECT ANSWER-Epi, fluids, pressors, airway, H2 blocker, steroids, nebs, benadryl In pediatrics: - Benadryl 1 mg/kg IV - Epi 1:1000 0.01 mg/kg IM (thigh) - Solumedrol 1 mg/kg IV - Ranitidine 1 mg/kg IV - Albuterol 2.5g in NS nebulizer - Epi gtt 1 mcg/kg/min - Racemic Epi 2.25% in NS nebulized ASA OD - CORRECT ANSWER-ASA levels q1hr, Charcoal, aggressive IVF, Bicarb 1 mEq/kg, then gtt (3 amp bicarb in 1L D5W @ 2 mL/kg/hr goal serum pH 7.5-7.6), Replace K 20 mEq IV, goal UOP 1 cc/kg/hr, Dialysis, treat hypoglycemia, Cause of ASA OD (septic joint etc), CT head, Call poison control Burn/CO poisoning - CORRECT ANSWER-Intubate (if oral soot), TBSA, Parkland (TBSA x kg x 4 = given 1/2 in 8hrs), hyperbaric, wound care, tetanus CHF exacerbation - CORRECT ANSWER-Nitro gtt, BiPAP, lasix, ASA Cocaine Packer - CORRECT ANSWER-Intubate early, benzos for abnormal VS, GI decontamination, Surgery Consult Pre-Enclampsia/Eclampsia/HELLP - CORRECT ANSWER-Magnesium 2-6g for seizure (then 1 g/hr), Fetal monitor/bedside US, Emergent C-section, OB consult, Labetalol/Hydralazine, Platelet transfusion if <20, Decadron 6mg IM for lung maturity if less 36 weeks Ruptured Ectopic Pregnancy - CORRECT ANSWER-Urine pregnancy, Bedside FAST, Call OB, Rhogam, T&C Epiglottitis - CORRECT ANSWER-- Humidified O2, DL + Cric kit at bedside, ENT/Anesthesia for emergent intubation, Neck XR to diagnose epiglottitis, + Abx (kid goes straight to OR, do not disturb) - Surgical Cric procedure if > 7 yo, otherwise needle cric. (quick sterile prep, palpate cricothyroid membrane, skin incision, incise membrane, place bougie, pass tube over bougie, and confirm placement) TCA overdose - CORRECT ANSWER-Charcoal, Bicarb, ICU consult, Psych consult, 1:1 Tylenol OD - CORRECT ANSWER-Charcoal, NAC, ICU consult, Psych consult, 1:1 STEMI - CORRECT ANSWER-ASA, plavix, heparin, reperfusion therapy Pediatric Sepsis - CORRECT ANSWER-Urine/blood/CSF studies, early abx, pressor Hypercalcemia - CORRECT ANSWER-NS 500 mL/hr, Furosemide, Hydrocortisone 100mg