ER Quick Facts
✅✅
a flutter - --flutter (sawtooth) atrial waves
-transthoracic echo preferred imaging for a flutter
-stable: BB or verapamil/diltiazem
-unstable: direct cardioversion
-definitive: radiofrequency catheter ablation
AAA - ✅✅ --focal aortic dilation >1.5 normal
-MC site infrarenal
-MEN 65-75 SMOKER
-triad: acute abdominal pain or back pain, abdominal distension,
hemodynamic instability
-CT with contrast, US
-TX: surgical repair, BB
AC joint dislocation - ✅✅--direct blow to adducted shoulder
-deformity at AC joint
-mainly conservative
acanthamoeba keratitis - ✅✅ --acanthamoeba in soil, dust, etc
-unilateral ocular pain with photophobia
-stromal infiltrates, stromal thinning, corneal perforation
-characteristic rink infiltrates
-get culture of cornea scraping
-TX: topical anti-infective agents (polyhexamethylane biguanide for 6
months-1year)
ACL - ✅✅ --MC knee ligament injury
-pop, click, knee swelling, instability
-positive lachmans and anterior drawer test
acute abdomen - ✅✅ -EMERGENCY
-infectious, inflammatory, ischemic, obstructive
acute appendicitis -✅✅ --inflammation of the appendix (usually obstructive)
-periumbilical pain that migrates to the RLQ, anorexia, nausea after pain
-McBurneys point, peritoneal signs, Rovsings sign, psoas sign
-alvarado score, US initial imaging, CT with contrast showing fat stranding
-antibiotics (ceftriaxone), appendectomy
,acute ascending cholangitis - ✅✅ -biliary tract inflammation and infection
secondary to obstruction of common bile duct
-e coli MC infectious, choledocholithiasis MC cause
-charcot triad: fever with chills, RUQ pain, jaundice
-reynolds pentad: fever with chills, RUQ pain, jaundice, hypotension and
shock or AMS
-lekocytosis, increased alk phos and GGT, increased bilirubin, AST and ALT
elevated
-RUQ US, CT
0cholangiography via ERCP or PTC
-TX: IV abx (ceftriaxone and metronidazole) with decompression and stone
extraction (ERCP)
acute bronchiolitis -✅✅ --infection and inflammation of the bronchioles
-MCC RSV or rhinovirus
-MC in infants in fall or winter
-viral URI prodrome
-clinical diagnosis
-supportive care mainstay
-palivizumab prevention
-in adults its mainly from smoking and they will have the characteristic
smokers cough
acute bronchitis -✅✅ --an inflammation of the lower respiratory tract that is
usually due to infection (virus)
-cough hallmark, URI sx, wheezing and rhonchi
-acute onset of persistent cough lasting 1-3 weeks, and no findings of
pneumonia
-self limited, dextromethorphan of guaifenesin for cough
acute cholecystitis -✅✅ -inflammation/infection of gallbladder due to
obstruction of cystic duct by gallstones
-E coli MC
-RUQ epigastric pain severe and steady
-fever, enlarged palpable gallbladder, positive murphy, positive psoas
-increased WBC, increased LFT, increased alk phos, US, HIDA
-PATIENT WITH RUQ PAIN, FEVER, LEUKOCYTOSIS
-TX: supportive, IV abx (metronidazole with cephalosporin or fluoroquinolone),
early cholecystectomy within 72hrs
,acute coronary syndrome - ✅✅ --A group of symptoms caused by
myocardial ischemia; includes angina and myocardial infarction (STEMI and
N-STEMI)
-caused by acute plaque rupture and varying degrees of coronary artery
thrombosis
-Non positional, non reproducible, non-pleuritic, pain not relieved by rest or
nitro
-full cardio work-up
acute epidural hematoma - ✅✅ --arterial bleed between skull and dura from
middle meningeal artery
-loss of consciousness, neuro deterioration
-heat CT without contrast (convex, does NOT cross suture line)
-hematoma evacuation and craniotomy
Acute Epiglottitis -✅✅ --MCC H flu
-rapid onset of dysphagia, drooling, distress
-high fever, tripoding, inspiratory stridor, muffled hot potato voice, respiratory
distress, very ill appearing
-XR showing thumb print sign
-laryngoscopy definitive
-airway control, ceftriaxone with vanco
acute narrow angle-closure glaucoma - ✅✅ --SEVERE EMERGENCY
-damage to the optic nerve, aqueous humor is blocked
-sudden onset severe unilateral pain, N/V, HA, vision changes (tunnel vision)
-increased intraocular pressure
-cloudy, steamy cornea, mid-dilated fixed pupil and hard on palpation
-optic disk blurring and cupping of optic nerve
-TX: reduce intraocular pressure
-definitive TX is iridotomy
acute osteomyelitis - ✅✅ --MC in children in femur, tibia
-MC in vertebrae in adults
-staph aureus MCC
-nonspecific constitutional sx, signs of bone inflammation
-increased inflammatory markers, XR , MRI, CT, bone aspiration definitive
-abx for 3-6 weeks and may need debridement
, acute otitis media -✅✅ --MC with strep pneumoniae, H flu, M catarrhalis
-fever, ear tugging, decreased TM mobility
-Amoxicillin DOC
acute pancreatitis -✅✅ --acinar cell injury
-MCC gallstones and alcohol abuse
-epigastric pain that radiates to the back, fever, N/V, abdominal distension,
decreased bowel sounds, Cullen's and Grey turner sign
-increased amylase and lipase, increased ALT, hypocalcemia, hyperglycemia,
increased bilirubin
-abdominal CT, US
0XR showing sentinel loop and colon cut off sign
-Ransons criteria
-REST the pancreas, supportive care
✅✅
acute pericarditis - --infection/inflammation of the endothelium
-MCC idiopathic or viral etiology
-ECG can show widespread diffuse ST segment elevation in V1-V6
-usually clinical diagnosis with chest pain that is worse with deep inspiration
and worse when leaning forward
-pericardial friction rub
-TX: NSAID, aspirin, colchicine, glucocorticoids
acute pharyngitis -✅✅ --viral MC cause overall
-bacterial MC cause is group A strep
acute respiratory distress syndrome (ARDS) - ✅✅ --acute diffuse
inflammatory form of lung injury
-alveolar damage usually seen in critically ill patients with pneumonia or
sepsis
-acute onset of progressive sx of profound dyspnea, hypoxemia
-severe hypoxemia refractory to oxygen
-XR showing bilateral diffuse infiltrates and spares the costophrenic angles
-noninvasive or mechanical ventilation and treat the underlying cause
acute stress disorder - ✅✅ --characterized by acute stress reactions that
may occur in the initial month after exposed to event and last 3-30 days
-similar to PTSD but event <1 month ago and last 3-30 days
-TX: cognitive and behavioral therapy
✅✅
a flutter - --flutter (sawtooth) atrial waves
-transthoracic echo preferred imaging for a flutter
-stable: BB or verapamil/diltiazem
-unstable: direct cardioversion
-definitive: radiofrequency catheter ablation
AAA - ✅✅ --focal aortic dilation >1.5 normal
-MC site infrarenal
-MEN 65-75 SMOKER
-triad: acute abdominal pain or back pain, abdominal distension,
hemodynamic instability
-CT with contrast, US
-TX: surgical repair, BB
AC joint dislocation - ✅✅--direct blow to adducted shoulder
-deformity at AC joint
-mainly conservative
acanthamoeba keratitis - ✅✅ --acanthamoeba in soil, dust, etc
-unilateral ocular pain with photophobia
-stromal infiltrates, stromal thinning, corneal perforation
-characteristic rink infiltrates
-get culture of cornea scraping
-TX: topical anti-infective agents (polyhexamethylane biguanide for 6
months-1year)
ACL - ✅✅ --MC knee ligament injury
-pop, click, knee swelling, instability
-positive lachmans and anterior drawer test
acute abdomen - ✅✅ -EMERGENCY
-infectious, inflammatory, ischemic, obstructive
acute appendicitis -✅✅ --inflammation of the appendix (usually obstructive)
-periumbilical pain that migrates to the RLQ, anorexia, nausea after pain
-McBurneys point, peritoneal signs, Rovsings sign, psoas sign
-alvarado score, US initial imaging, CT with contrast showing fat stranding
-antibiotics (ceftriaxone), appendectomy
,acute ascending cholangitis - ✅✅ -biliary tract inflammation and infection
secondary to obstruction of common bile duct
-e coli MC infectious, choledocholithiasis MC cause
-charcot triad: fever with chills, RUQ pain, jaundice
-reynolds pentad: fever with chills, RUQ pain, jaundice, hypotension and
shock or AMS
-lekocytosis, increased alk phos and GGT, increased bilirubin, AST and ALT
elevated
-RUQ US, CT
0cholangiography via ERCP or PTC
-TX: IV abx (ceftriaxone and metronidazole) with decompression and stone
extraction (ERCP)
acute bronchiolitis -✅✅ --infection and inflammation of the bronchioles
-MCC RSV or rhinovirus
-MC in infants in fall or winter
-viral URI prodrome
-clinical diagnosis
-supportive care mainstay
-palivizumab prevention
-in adults its mainly from smoking and they will have the characteristic
smokers cough
acute bronchitis -✅✅ --an inflammation of the lower respiratory tract that is
usually due to infection (virus)
-cough hallmark, URI sx, wheezing and rhonchi
-acute onset of persistent cough lasting 1-3 weeks, and no findings of
pneumonia
-self limited, dextromethorphan of guaifenesin for cough
acute cholecystitis -✅✅ -inflammation/infection of gallbladder due to
obstruction of cystic duct by gallstones
-E coli MC
-RUQ epigastric pain severe and steady
-fever, enlarged palpable gallbladder, positive murphy, positive psoas
-increased WBC, increased LFT, increased alk phos, US, HIDA
-PATIENT WITH RUQ PAIN, FEVER, LEUKOCYTOSIS
-TX: supportive, IV abx (metronidazole with cephalosporin or fluoroquinolone),
early cholecystectomy within 72hrs
,acute coronary syndrome - ✅✅ --A group of symptoms caused by
myocardial ischemia; includes angina and myocardial infarction (STEMI and
N-STEMI)
-caused by acute plaque rupture and varying degrees of coronary artery
thrombosis
-Non positional, non reproducible, non-pleuritic, pain not relieved by rest or
nitro
-full cardio work-up
acute epidural hematoma - ✅✅ --arterial bleed between skull and dura from
middle meningeal artery
-loss of consciousness, neuro deterioration
-heat CT without contrast (convex, does NOT cross suture line)
-hematoma evacuation and craniotomy
Acute Epiglottitis -✅✅ --MCC H flu
-rapid onset of dysphagia, drooling, distress
-high fever, tripoding, inspiratory stridor, muffled hot potato voice, respiratory
distress, very ill appearing
-XR showing thumb print sign
-laryngoscopy definitive
-airway control, ceftriaxone with vanco
acute narrow angle-closure glaucoma - ✅✅ --SEVERE EMERGENCY
-damage to the optic nerve, aqueous humor is blocked
-sudden onset severe unilateral pain, N/V, HA, vision changes (tunnel vision)
-increased intraocular pressure
-cloudy, steamy cornea, mid-dilated fixed pupil and hard on palpation
-optic disk blurring and cupping of optic nerve
-TX: reduce intraocular pressure
-definitive TX is iridotomy
acute osteomyelitis - ✅✅ --MC in children in femur, tibia
-MC in vertebrae in adults
-staph aureus MCC
-nonspecific constitutional sx, signs of bone inflammation
-increased inflammatory markers, XR , MRI, CT, bone aspiration definitive
-abx for 3-6 weeks and may need debridement
, acute otitis media -✅✅ --MC with strep pneumoniae, H flu, M catarrhalis
-fever, ear tugging, decreased TM mobility
-Amoxicillin DOC
acute pancreatitis -✅✅ --acinar cell injury
-MCC gallstones and alcohol abuse
-epigastric pain that radiates to the back, fever, N/V, abdominal distension,
decreased bowel sounds, Cullen's and Grey turner sign
-increased amylase and lipase, increased ALT, hypocalcemia, hyperglycemia,
increased bilirubin
-abdominal CT, US
0XR showing sentinel loop and colon cut off sign
-Ransons criteria
-REST the pancreas, supportive care
✅✅
acute pericarditis - --infection/inflammation of the endothelium
-MCC idiopathic or viral etiology
-ECG can show widespread diffuse ST segment elevation in V1-V6
-usually clinical diagnosis with chest pain that is worse with deep inspiration
and worse when leaning forward
-pericardial friction rub
-TX: NSAID, aspirin, colchicine, glucocorticoids
acute pharyngitis -✅✅ --viral MC cause overall
-bacterial MC cause is group A strep
acute respiratory distress syndrome (ARDS) - ✅✅ --acute diffuse
inflammatory form of lung injury
-alveolar damage usually seen in critically ill patients with pneumonia or
sepsis
-acute onset of progressive sx of profound dyspnea, hypoxemia
-severe hypoxemia refractory to oxygen
-XR showing bilateral diffuse infiltrates and spares the costophrenic angles
-noninvasive or mechanical ventilation and treat the underlying cause
acute stress disorder - ✅✅ --characterized by acute stress reactions that
may occur in the initial month after exposed to event and last 3-30 days
-similar to PTSD but event <1 month ago and last 3-30 days
-TX: cognitive and behavioral therapy
