SAEM
1
Generally speaking, a patient with a TIA records who affords with a brand new stroke,
probably has which sort of stroke?
A. Thrombotic
B. There may be identical probability for any stroke type
C. Hemorrhagic
D. Hypoperfusion
E. Embolic - ANS-The answer is A. TIAs are associated with elevated chance for thrombotic
strokes, the result of ulceration of cerebral artery plaque. Patients with TIA have a 5 to six%
percent danger consistent with yr of having a stroke. Antiplatelet therapy reduces threat of
stroke in those sufferers.
1. Dry, heat, position, suction, stimulate
2. Oxygen
three. Ventilation
4. Chest compressions
5. Medicinal drugs - ANS-order of operations for neonatal resuscitation
140mg/kg - ANS-weight bosed dose of unmarried ingestion of acetaminophen known to be
toxic
four again blows
If nevertheless obstructed four chest compressions
If still obstructed jaw thrust, mouth inspected and removal of visible FB
If still obstructed, mouth to mouth ventilation
Repeat - ANS-control of choking little one underneath 1 year of age
A 14 year-vintage child gives to the emergency department. His blood pressure is 210/140.
He complains of a headache, nausea, and recent blurred imaginative and prescient. Of the
subsequent selections, the great intention for reducing his imply arterial blood stress is to
have it drop through:
A. 50% in the first hour
B. To regular for his age within the first hour
C. Until signs clear up
D. Five% in the first five-6 hours
E. 25% in the first hour - ANS-A 14 12 months-antique child offers to the emergency
department. His blood stress is 210/140. He complains of a headache, nausea, and recent
blurred imaginative and prescient. Of the subsequent selections, the great goal for lowering
his suggest arterial blood strain is to have it drop by:
A. 50% inside the first hour
,B. To everyday for his age within the first hour
C. Until signs and symptoms clear up
D. 5% within the first 5-6 hours
E. 25% inside the first hour
A. A ordinary magnesium stage is reassuring and obviates the want for magnesium
alternative.
The solution is A. Patients with DKA are generally seriously dehydrated with a total body
water deficit of about 70-80 mL/kg, further to being general body depleted of potassium,
magnesium, and phosphorous no matter to start with everyday serum ranges of these
electrolytes. - ANS-In a 70kg male DKA patient with serum glucose of 573 mg/dL, all of the
following statements with reference to fluid and electrolyte imbalances are true EXCEPT:
A. A regular magnesium degree is reassuring and obviates the need for magnesium
substitute.
B. Total body water deficit is approximately 5L.
C. Serum sodium of 129 mEq represents dilutional hyponatremia and the corrected fee is
about 137 mEq.
D. Despite a serum potassium stage of 4.Eight mEq, the affected person is probably total
body potassium depleted.
E. The affected person is in all likelihood to be total body phosphorus depleted.
A. An antibiotic which include doxycycline - ANS-A sixty five 12 months vintage male with a
records of COPD presents to the emergency branch with growing dyspnea, rhinorrhea,
cough, and sputum production during the last 3 days. He denies fever or chest ache. His
remaining acute fitness visit become 6 months in the past. His essential signs are as follows:
BP 135/seventy five, HR eighty five, RR 19, SpO2 95%, Oral temp 98.0 °F. His examination
is huge for a diffuse expiratory wheeze and prolonged expiratory time. His chest X-ray and
EKG are unchanged from baseline and your patient responds in your ED medical therapy. In
addition to an inhaled beta agonist your affected person's endorsed outpatient
pharmacotherapy includes:
A. An antibiotic which includes doxycycline
B. A mucokinetic which include guaifenesin
C. A excessive-dose oral corticosteroid inclusive of prednisone
D. A methylxanthine together with theophyline
A. Heat stroke
Heat stroke is a lifestyles-threatening infection defined clinically as a core frame temperature
that rises above 40.5 stages Celsius and is commonly followed via warm, dry pores and skin
(though in some cases sweating can be gift) and valuable anxious system abnormalities
such as delirium, convulsions, and coma. Treatment dreams consist of reducing the middle
temperature to < 39.4 degrees Celsius by promoting cooling through conduction and
evaporation and treating the complications that might arise with heat stroke, including
seizures, respiratory failure, hypotension, rhabdomyolysis, and multi-organ dysfunction
syndrome. Acute anticholinergic toxicity may sometimes present with a picture like that of
,heat stroke, and although the answer options C, D, and E may lead to confused behavior
and/or fever in an elderly individual, the constellation of symptoms seen in this woman is
most suggestive of heat stroke. - ANS-An 80 year old female presents to the ED with mental
status changes after her neighbors found her this morning wandering in the stairwell. Patient
was last seen normal 4 days ago and has no medical problems. On arrival to the ED, she is
agitated and confused. Vital signs include RR of 20, HR of 100, BP of 90/50, and
temperature of 40.6 Celsius. Pt is oriented to person only and is inattentive to exam, but
appears to move all extremities symmetrically. She does not follow commands. Mucous
membranes are dry and skin is dry and hot. What is the most likely diagnosis?
A. Heat stroke
B. Encephalitis
C. Serotonin syndrome
D. Thyroid storm
A. Maternal drugs
The answer is A. Mucus, blood, meconium, the tongue, and pulmonary prematurity are the
most frequent reasons for airway obstruction (and subsequent arrest) in the neonate.
Maternal drugs can cause respiratory depression, not primary airway obstruction. -
ANS-Which of the following is NOT a frequent cause of airway obstruction in the neonate?
A. Maternal drugs
B. Tongue
C. Meconium
D. Mucus
E. Blood
age (somewhere between 5-12, controversial) - ANS-only absolute contraindication to
cricothyrotomy
asystole (followed by bradycardia) - ANS-most common rhythm seen in pediatric arrest
b
Immersion of the affected extremity is the mainstay of treatment for patients with frostbite.
Numbness of the affected area is the most common initial symptom and severe pain is
frequently encountered after rewarming. Tetanus prophylaxis and debridement is indicated ,
but is not the most appropriate initial step in the management of patients with frostbite.
CDEM Hypothermia. - ANS-A 36 year old male backpacking in the wilderness loses his way
in a snowstorm. Temperatures are well below zero degrees and his clothing is inadequate.
He is rescued 5 days later and presents to the ED. Rescue crew has already initiated
passive rewarming and have removed patient's damp clothing. On arrival, vital signs show
pulse of 100 and temperature of 35.5C. On physical exam, you note patient has several toes
that are purple with hemorrhagic blisters on his feet. Which of the following is the most
appropriate initial management?
A. Debridement of necrotic tissue
B. Immersion in warm water bath
, C. Tetanus prophylaxis
D. Administration of morphine
B Digoxin
The answer is B. The drugs which may be given by endotracheal route can be remembered
by the mnemonic "LEAN" — lidocaine, epinephrine, atropine, naloxone. Up to 10 times the
IV dose diluted to 5mls and followed by 3-5 positive pressure breaths is necessary to
achieve equivalent plasma concentrations. Digoxin must be given by the IV route. - ANS-In
pediatric resuscitation the following drugs may be given by the endotracheal route, EXCEPT:
A. Atropine
B. Digoxin
C. Lidocaine
D. Epinephrine
E. Naloxone
B Memory Loss
The answer is B. Lead toxicity affects a variety of systems. The central nervous system
effects are many and range from encephalopathy and seizure to sleep disturbance and
memory deficits. The peripheral nervous system can also be involved, with paresthesias and
wrist drop being common. Colicky abdominal pain is often present. While dermatitis is not
common in lead poisoning, you can see bluish lead lines on the gingiva. - ANS-Severe lead
toxicity can commonly result in which of the following clinical symptoms
A. Stocking glove peripheral neuropathy
B. Memory loss
C. Dermatitis
D. Constipation
B. 25% - ANS-Using the rule of 9s, what is the approximate burn surface area of a victim
who has sustained second-degree burns to the anterior chest and anterior area of both
arms?
A. 20%
B. 25%
C. 30%
D. 35%
B. Anticholinergics by inhalation may be beneficial
Salmeterol is a long-acting beta2-selective adrenergic agonist that has no role in the
treatment of an acute asthma exacerbation, but it is frequently preferred for outpatient
asthma management due to its BID dosing schedule. - ANS-Which of the following is true
regarding the treatment of acute asthma exacerbation in the Emergency Department?
1
Generally speaking, a patient with a TIA records who affords with a brand new stroke,
probably has which sort of stroke?
A. Thrombotic
B. There may be identical probability for any stroke type
C. Hemorrhagic
D. Hypoperfusion
E. Embolic - ANS-The answer is A. TIAs are associated with elevated chance for thrombotic
strokes, the result of ulceration of cerebral artery plaque. Patients with TIA have a 5 to six%
percent danger consistent with yr of having a stroke. Antiplatelet therapy reduces threat of
stroke in those sufferers.
1. Dry, heat, position, suction, stimulate
2. Oxygen
three. Ventilation
4. Chest compressions
5. Medicinal drugs - ANS-order of operations for neonatal resuscitation
140mg/kg - ANS-weight bosed dose of unmarried ingestion of acetaminophen known to be
toxic
four again blows
If nevertheless obstructed four chest compressions
If still obstructed jaw thrust, mouth inspected and removal of visible FB
If still obstructed, mouth to mouth ventilation
Repeat - ANS-control of choking little one underneath 1 year of age
A 14 year-vintage child gives to the emergency department. His blood pressure is 210/140.
He complains of a headache, nausea, and recent blurred imaginative and prescient. Of the
subsequent selections, the great intention for reducing his imply arterial blood stress is to
have it drop through:
A. 50% in the first hour
B. To regular for his age within the first hour
C. Until signs clear up
D. Five% in the first five-6 hours
E. 25% in the first hour - ANS-A 14 12 months-antique child offers to the emergency
department. His blood stress is 210/140. He complains of a headache, nausea, and recent
blurred imaginative and prescient. Of the subsequent selections, the great goal for lowering
his suggest arterial blood strain is to have it drop by:
A. 50% inside the first hour
,B. To everyday for his age within the first hour
C. Until signs and symptoms clear up
D. 5% within the first 5-6 hours
E. 25% inside the first hour
A. A ordinary magnesium stage is reassuring and obviates the want for magnesium
alternative.
The solution is A. Patients with DKA are generally seriously dehydrated with a total body
water deficit of about 70-80 mL/kg, further to being general body depleted of potassium,
magnesium, and phosphorous no matter to start with everyday serum ranges of these
electrolytes. - ANS-In a 70kg male DKA patient with serum glucose of 573 mg/dL, all of the
following statements with reference to fluid and electrolyte imbalances are true EXCEPT:
A. A regular magnesium degree is reassuring and obviates the need for magnesium
substitute.
B. Total body water deficit is approximately 5L.
C. Serum sodium of 129 mEq represents dilutional hyponatremia and the corrected fee is
about 137 mEq.
D. Despite a serum potassium stage of 4.Eight mEq, the affected person is probably total
body potassium depleted.
E. The affected person is in all likelihood to be total body phosphorus depleted.
A. An antibiotic which include doxycycline - ANS-A sixty five 12 months vintage male with a
records of COPD presents to the emergency branch with growing dyspnea, rhinorrhea,
cough, and sputum production during the last 3 days. He denies fever or chest ache. His
remaining acute fitness visit become 6 months in the past. His essential signs are as follows:
BP 135/seventy five, HR eighty five, RR 19, SpO2 95%, Oral temp 98.0 °F. His examination
is huge for a diffuse expiratory wheeze and prolonged expiratory time. His chest X-ray and
EKG are unchanged from baseline and your patient responds in your ED medical therapy. In
addition to an inhaled beta agonist your affected person's endorsed outpatient
pharmacotherapy includes:
A. An antibiotic which includes doxycycline
B. A mucokinetic which include guaifenesin
C. A excessive-dose oral corticosteroid inclusive of prednisone
D. A methylxanthine together with theophyline
A. Heat stroke
Heat stroke is a lifestyles-threatening infection defined clinically as a core frame temperature
that rises above 40.5 stages Celsius and is commonly followed via warm, dry pores and skin
(though in some cases sweating can be gift) and valuable anxious system abnormalities
such as delirium, convulsions, and coma. Treatment dreams consist of reducing the middle
temperature to < 39.4 degrees Celsius by promoting cooling through conduction and
evaporation and treating the complications that might arise with heat stroke, including
seizures, respiratory failure, hypotension, rhabdomyolysis, and multi-organ dysfunction
syndrome. Acute anticholinergic toxicity may sometimes present with a picture like that of
,heat stroke, and although the answer options C, D, and E may lead to confused behavior
and/or fever in an elderly individual, the constellation of symptoms seen in this woman is
most suggestive of heat stroke. - ANS-An 80 year old female presents to the ED with mental
status changes after her neighbors found her this morning wandering in the stairwell. Patient
was last seen normal 4 days ago and has no medical problems. On arrival to the ED, she is
agitated and confused. Vital signs include RR of 20, HR of 100, BP of 90/50, and
temperature of 40.6 Celsius. Pt is oriented to person only and is inattentive to exam, but
appears to move all extremities symmetrically. She does not follow commands. Mucous
membranes are dry and skin is dry and hot. What is the most likely diagnosis?
A. Heat stroke
B. Encephalitis
C. Serotonin syndrome
D. Thyroid storm
A. Maternal drugs
The answer is A. Mucus, blood, meconium, the tongue, and pulmonary prematurity are the
most frequent reasons for airway obstruction (and subsequent arrest) in the neonate.
Maternal drugs can cause respiratory depression, not primary airway obstruction. -
ANS-Which of the following is NOT a frequent cause of airway obstruction in the neonate?
A. Maternal drugs
B. Tongue
C. Meconium
D. Mucus
E. Blood
age (somewhere between 5-12, controversial) - ANS-only absolute contraindication to
cricothyrotomy
asystole (followed by bradycardia) - ANS-most common rhythm seen in pediatric arrest
b
Immersion of the affected extremity is the mainstay of treatment for patients with frostbite.
Numbness of the affected area is the most common initial symptom and severe pain is
frequently encountered after rewarming. Tetanus prophylaxis and debridement is indicated ,
but is not the most appropriate initial step in the management of patients with frostbite.
CDEM Hypothermia. - ANS-A 36 year old male backpacking in the wilderness loses his way
in a snowstorm. Temperatures are well below zero degrees and his clothing is inadequate.
He is rescued 5 days later and presents to the ED. Rescue crew has already initiated
passive rewarming and have removed patient's damp clothing. On arrival, vital signs show
pulse of 100 and temperature of 35.5C. On physical exam, you note patient has several toes
that are purple with hemorrhagic blisters on his feet. Which of the following is the most
appropriate initial management?
A. Debridement of necrotic tissue
B. Immersion in warm water bath
, C. Tetanus prophylaxis
D. Administration of morphine
B Digoxin
The answer is B. The drugs which may be given by endotracheal route can be remembered
by the mnemonic "LEAN" — lidocaine, epinephrine, atropine, naloxone. Up to 10 times the
IV dose diluted to 5mls and followed by 3-5 positive pressure breaths is necessary to
achieve equivalent plasma concentrations. Digoxin must be given by the IV route. - ANS-In
pediatric resuscitation the following drugs may be given by the endotracheal route, EXCEPT:
A. Atropine
B. Digoxin
C. Lidocaine
D. Epinephrine
E. Naloxone
B Memory Loss
The answer is B. Lead toxicity affects a variety of systems. The central nervous system
effects are many and range from encephalopathy and seizure to sleep disturbance and
memory deficits. The peripheral nervous system can also be involved, with paresthesias and
wrist drop being common. Colicky abdominal pain is often present. While dermatitis is not
common in lead poisoning, you can see bluish lead lines on the gingiva. - ANS-Severe lead
toxicity can commonly result in which of the following clinical symptoms
A. Stocking glove peripheral neuropathy
B. Memory loss
C. Dermatitis
D. Constipation
B. 25% - ANS-Using the rule of 9s, what is the approximate burn surface area of a victim
who has sustained second-degree burns to the anterior chest and anterior area of both
arms?
A. 20%
B. 25%
C. 30%
D. 35%
B. Anticholinergics by inhalation may be beneficial
Salmeterol is a long-acting beta2-selective adrenergic agonist that has no role in the
treatment of an acute asthma exacerbation, but it is frequently preferred for outpatient
asthma management due to its BID dosing schedule. - ANS-Which of the following is true
regarding the treatment of acute asthma exacerbation in the Emergency Department?
