CDEM M4 Curriculum
How many pts with aortic dissection have normal CXR?
Forty%
preliminary actions in stomach ache patients?
UPT, blood merchandise for hemorrhage, abx, bedside ultrasound, instant surgical consult if
volatile or rigid abdomen, analgesia
hemodynamic instability and stomach ache should provide you with a warning to...
Possible AAA, hemorrhage, sepsis, perforated viscus, necrotic bowel - think bowel edema or
fluid placing strain on IVC and splinting respiratory
hemodynamic instability and abdominal ache on the spot actions...
Seek advice from surgical treatment, 2 PIV large bores, NS bolus, O2, monitors, kind and
move (give kind O if wished)
differential for lifestyles/organ threatening stomach pain:
Infectious: sepsis
GI: biliary, appendicitis, SBO, perforated bowel, mesenteric ischemia, pancreatitis,
diverticulitis
GU: PID, tubo-ovarian abscess, testicular/ovarian torsion, ectopic pregnancy
CV: AAA, dissection, schemia, CAS
initial actions in affected person providing with AMS?
ABCDE-G:
- airway: visible check, pulse O2, O2 prn
- breathing - RR (i.E. Narcan?), ventilation (BVM?)
- move - rhythm screen vs EKG, BP, pulses, fluids, PIV access
- incapacity - GCS, neuro deficits, pupils, trauma, pain (imaging?)
- publicity - undress, trauma, patches, PIC or dialysis get right of entry to, petechiae, bruising
- GLUCOSE
AMS differential for: Primary CNS/Structural
- tumors: number one vs mets
- hemorrahge: spontaneous vs trauma
- edema: HTN, hydrocephalus, tumor
- seizure: submit-ictal vs todd paralysis
,- dementia: degenerative vs vascular
AMS differential for: Metabolic/autoregulatory
- excessive/low: glucose, sodium, calcium, thyroid, temperature
- hypercarbia - poor ventilation?
- hypoxemia
AMS differential for: pharm/toxic
- Meds: HTN, anti/seasoned-epileptics, overdose, sedatives, opiods, TCA, anticholinergics,
polypharmacy, steroids, sleep aids, tylenol
- Toxins: ETOH, methanol (WWF) vs ethylene glycol (antifreeze)
- Illicit drug use
- Withdrawal: benzos, cocaine, ETOH, opiods
AMS differential for: infectious
CNS: meningitis, encephalitis, abscess (viral vs bacterial...)
Other: UTI, pneumonia, cellulitis, GI,
AMS differential for: CV
hemorrhagic, cardiogenic, hypovolemic, distributive, anaphylaxis
AMS differential for: psych
migraine, psych dx, psychosis, psychosomatic
mnemonic for AMS
AEIOU TIPS
A: alcohol
E: ethylene glycol, epilepsy, encephalopathy
I: insulin
O: opiates, O2
U: uremia
T: temp, TCA, trauma
I: infecious
P: poisons, psychogenic
S: intercourse (TSS vs PID), stroke, subarachnoid, area lesions
petechiae differential; labs?
Low plts, meninococcemia, emesis, ITP, HTP, HSP, DRESS
Rocky Mountain noticed fever,
,Labs: CBC with diff, retic count, smear, Ig stages, HIV, Hep C, H. Pylori, LFTs,
antiphospholipid Abs, SLE serology,
Diagnostic testing to keep in mind for AMS
No shotgun orders except in reality necessary:
- Met/Endo - fingerstick glucose, BMP (Na, Ca, BUN, Cr), ABG/VGB, TSH, T4, ammonia,
cortisol
- Meds/pollutants - serum osmolality, ETOH, drug screen, drug degrees (i.E. Antiepileptics)
- CBC w/ diff, UA, UC, BC, LP
- CXR, CT head/spine, MRI, EEG
- Cardiac: ECG, trops, cardiac echo, carotid/vertebral US
vasogenic edema from CNS lesions. Deliver
glucocorticoids
what are the goals of BLS primary survey?
Assist or repair early oxygenation, air flow, and circulate until you get a return of
spontaneous circulation or until ACLS may be initiated
T/F sufferers with shockable rhythm and in desperate want for intubation should be intubated
first
F: pts with shockable rhythm need to be defibrillated without delay
What consists ABC of ACLS?
Airway - jaw thrust, oropharyngeal or nasopharyngeal airlines, or intubation
Breathing - auscultation of lung sounds, ETCO2, CZR, and so forth.
Circulation - IV/IO access
What tablets are secure for ET administration? What dosage shuold be used?
NAVEL
Naloxone, atropine, vasopressin, epinephrine, lidocaine
2-2.Five times the IV course dosage
ACLS recommends that compressions have to be interrupted for...
Air flow, rhythm exams, and shock shipping
after what number of mins of resuscitation with BLS and ACLS is it ok to cesate?
20 mins of unsuccessful rescucustation - research have proven that resuscitation efforts are
not likely to achieve success
, what are the 2 shockable rhythms?
V fib and V-tach
you see a affected person with cardiac arrest. What need to you do first?
1) shout for help, activate emergency response
2) begin CPR
3) provide O2, assault video display units and defibrillator
4) determine whether or not rhythm is shockable (VF/VT) or not (asystole or PEA)
you see a affected person with cardiac arrest, provoke CPR, and decide has shockable
rhythm. What are the next few steps?
1) shock right away w/o postpone
2) Give CPR 2 mins whilst you obtain IO/IV get entry to
three) decide rhythm again
4) repeat if still shockable rhythm starting epinephrine 1 mg q3-5m IV/IO, take into account
advanced airway
five)maintain set of rules until develops ROSC or non-shockable rhythm
you spot patient with shockable rhythm, obtained CPR, 3x defibrillations, and epinephrine
q2-q5m, and got LMA and continues to have a shockable rhythm. What extra step do you're
taking?
- Continue CPR, shocks, and epineprhine q2-5m
- Add antiarrhythmics: amiodarone 300 mg bolus, a hundred and fifty every 2 shocks till no
longer has shockable rhythm, or lidocaine 1-1.5 mg/kg bolus, then 0.Five-zero.Seventy five
mg/kg q5-10m
you spot a pt in cardiac arrest, achieve help, begin CPR and decide they've a non-shockable
rhythm. What are your next steps?
- Continue CPR
- Establish IV/IO get entry to
- Administer Epinephrine 1 mg q2-5m
- Consider superior airway
- Check in the event that they have shockable rhythm
- Treat reversible causes
you spot a pt in cardiac arrest, begin CPR, and decide they've shockable rhythm. You
provoke the set of rules and decide they V-tach developed into Torsades de Pointes. In
addition to the normal shockable algorithm. What medication are you able to administer?
Magnesium 1-2 g (in 10 mL of D5W) bolus, then zero.5-1 g/hr
How many pts with aortic dissection have normal CXR?
Forty%
preliminary actions in stomach ache patients?
UPT, blood merchandise for hemorrhage, abx, bedside ultrasound, instant surgical consult if
volatile or rigid abdomen, analgesia
hemodynamic instability and stomach ache should provide you with a warning to...
Possible AAA, hemorrhage, sepsis, perforated viscus, necrotic bowel - think bowel edema or
fluid placing strain on IVC and splinting respiratory
hemodynamic instability and abdominal ache on the spot actions...
Seek advice from surgical treatment, 2 PIV large bores, NS bolus, O2, monitors, kind and
move (give kind O if wished)
differential for lifestyles/organ threatening stomach pain:
Infectious: sepsis
GI: biliary, appendicitis, SBO, perforated bowel, mesenteric ischemia, pancreatitis,
diverticulitis
GU: PID, tubo-ovarian abscess, testicular/ovarian torsion, ectopic pregnancy
CV: AAA, dissection, schemia, CAS
initial actions in affected person providing with AMS?
ABCDE-G:
- airway: visible check, pulse O2, O2 prn
- breathing - RR (i.E. Narcan?), ventilation (BVM?)
- move - rhythm screen vs EKG, BP, pulses, fluids, PIV access
- incapacity - GCS, neuro deficits, pupils, trauma, pain (imaging?)
- publicity - undress, trauma, patches, PIC or dialysis get right of entry to, petechiae, bruising
- GLUCOSE
AMS differential for: Primary CNS/Structural
- tumors: number one vs mets
- hemorrahge: spontaneous vs trauma
- edema: HTN, hydrocephalus, tumor
- seizure: submit-ictal vs todd paralysis
,- dementia: degenerative vs vascular
AMS differential for: Metabolic/autoregulatory
- excessive/low: glucose, sodium, calcium, thyroid, temperature
- hypercarbia - poor ventilation?
- hypoxemia
AMS differential for: pharm/toxic
- Meds: HTN, anti/seasoned-epileptics, overdose, sedatives, opiods, TCA, anticholinergics,
polypharmacy, steroids, sleep aids, tylenol
- Toxins: ETOH, methanol (WWF) vs ethylene glycol (antifreeze)
- Illicit drug use
- Withdrawal: benzos, cocaine, ETOH, opiods
AMS differential for: infectious
CNS: meningitis, encephalitis, abscess (viral vs bacterial...)
Other: UTI, pneumonia, cellulitis, GI,
AMS differential for: CV
hemorrhagic, cardiogenic, hypovolemic, distributive, anaphylaxis
AMS differential for: psych
migraine, psych dx, psychosis, psychosomatic
mnemonic for AMS
AEIOU TIPS
A: alcohol
E: ethylene glycol, epilepsy, encephalopathy
I: insulin
O: opiates, O2
U: uremia
T: temp, TCA, trauma
I: infecious
P: poisons, psychogenic
S: intercourse (TSS vs PID), stroke, subarachnoid, area lesions
petechiae differential; labs?
Low plts, meninococcemia, emesis, ITP, HTP, HSP, DRESS
Rocky Mountain noticed fever,
,Labs: CBC with diff, retic count, smear, Ig stages, HIV, Hep C, H. Pylori, LFTs,
antiphospholipid Abs, SLE serology,
Diagnostic testing to keep in mind for AMS
No shotgun orders except in reality necessary:
- Met/Endo - fingerstick glucose, BMP (Na, Ca, BUN, Cr), ABG/VGB, TSH, T4, ammonia,
cortisol
- Meds/pollutants - serum osmolality, ETOH, drug screen, drug degrees (i.E. Antiepileptics)
- CBC w/ diff, UA, UC, BC, LP
- CXR, CT head/spine, MRI, EEG
- Cardiac: ECG, trops, cardiac echo, carotid/vertebral US
vasogenic edema from CNS lesions. Deliver
glucocorticoids
what are the goals of BLS primary survey?
Assist or repair early oxygenation, air flow, and circulate until you get a return of
spontaneous circulation or until ACLS may be initiated
T/F sufferers with shockable rhythm and in desperate want for intubation should be intubated
first
F: pts with shockable rhythm need to be defibrillated without delay
What consists ABC of ACLS?
Airway - jaw thrust, oropharyngeal or nasopharyngeal airlines, or intubation
Breathing - auscultation of lung sounds, ETCO2, CZR, and so forth.
Circulation - IV/IO access
What tablets are secure for ET administration? What dosage shuold be used?
NAVEL
Naloxone, atropine, vasopressin, epinephrine, lidocaine
2-2.Five times the IV course dosage
ACLS recommends that compressions have to be interrupted for...
Air flow, rhythm exams, and shock shipping
after what number of mins of resuscitation with BLS and ACLS is it ok to cesate?
20 mins of unsuccessful rescucustation - research have proven that resuscitation efforts are
not likely to achieve success
, what are the 2 shockable rhythms?
V fib and V-tach
you see a affected person with cardiac arrest. What need to you do first?
1) shout for help, activate emergency response
2) begin CPR
3) provide O2, assault video display units and defibrillator
4) determine whether or not rhythm is shockable (VF/VT) or not (asystole or PEA)
you see a affected person with cardiac arrest, provoke CPR, and decide has shockable
rhythm. What are the next few steps?
1) shock right away w/o postpone
2) Give CPR 2 mins whilst you obtain IO/IV get entry to
three) decide rhythm again
4) repeat if still shockable rhythm starting epinephrine 1 mg q3-5m IV/IO, take into account
advanced airway
five)maintain set of rules until develops ROSC or non-shockable rhythm
you spot patient with shockable rhythm, obtained CPR, 3x defibrillations, and epinephrine
q2-q5m, and got LMA and continues to have a shockable rhythm. What extra step do you're
taking?
- Continue CPR, shocks, and epineprhine q2-5m
- Add antiarrhythmics: amiodarone 300 mg bolus, a hundred and fifty every 2 shocks till no
longer has shockable rhythm, or lidocaine 1-1.5 mg/kg bolus, then 0.Five-zero.Seventy five
mg/kg q5-10m
you spot a pt in cardiac arrest, achieve help, begin CPR and decide they've a non-shockable
rhythm. What are your next steps?
- Continue CPR
- Establish IV/IO get entry to
- Administer Epinephrine 1 mg q2-5m
- Consider superior airway
- Check in the event that they have shockable rhythm
- Treat reversible causes
you spot a pt in cardiac arrest, begin CPR, and decide they've shockable rhythm. You
provoke the set of rules and decide they V-tach developed into Torsades de Pointes. In
addition to the normal shockable algorithm. What medication are you able to administer?
Magnesium 1-2 g (in 10 mL of D5W) bolus, then zero.5-1 g/hr
