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EMed - Emergency / Life-threatening situations

Terms in this set (42)

what are PE findings of spinal shock?
bradycardia and warm skin
what are PE findings of septic shock?
people with high fever (subjective)
what are conditions associated with hypovolemia?
shock (MCC) and PEA
what is the Cushing triad for ICP?
systolic HTN, bradycardia, decreased RR
what are PE findings of a postical state?
tongue lacerations, urinary incontinence
what is status asthmaticus?
acute severe asthma exacerbation that does not respond to usual tx
What is status epilepticus?
prolonged seizure or series of seizures that occur without recovery of consciousness
what is the difference between seizures and epilepsy?
seizures have a pinpoint issue, can be given medication

epileptics MOA is unknown, idiopathic seizures essentially
when can a seizure pt be sent home?
after 4+ hours without another seizure
what are some life-threatening conditions that lau decided were important?
airway obstruction, impaired ventilation and hypoxemia, hypovolemic shock, hemorrhage
What makes up the primary assessment?
ABCDE
A - airway maintenance
B - breathing
C - circulation
D - degree of responsiveness
E - exposure (strip pt)
what is the Glasgow scale used for?
to quantify consciousness in patients with head trauma or hypoxic event

scored 3-15 (15 is best)
what makes up the secondary assessment?
head-to-toe survey:
1. anatomic problems
2. other potentially life-threatening conditions
3. PMH
what is the abbreviation for the history during secondary assessment?
(S)AMPLE
(S) - symptoms
A - allergies
M - medications currently taken
P - past illnesses
L - last meal
E - events preceding the incident
What does the secondary assessment focus on? (exam-wise)
HEENT, chest, abdomen, extremities/back, rectum and perineum, neurologic, and re-eval
what is the most likely organ to be injured in the abdomen?
liver
what is the most likely organ to bleed in the abdomen?
spleen
- grey turner sign
- Cullen sign
Can you give a pt on metformin contrast if they have abdominal bleeding?
yes totally worth it pls do
what should the re-evaluation of the pt focus on?
vital signs, level of consciousness, have a high level of suspicion
what are raccoon eyes?
ecchymotic discoloration and swelling around either or both eyes

may indicate basilar skull fx or facial bone fx after head trauma
what is the Cullen sign?
blueish "halo" discoloration of the skin around the umbilicus, bleeding into the tissues

may indicate intraperitoneal/intraabdominal hemorrhage, rupture of uterine tube in ectopic, or acute hemorrhagic pancreatitis
what is the hamman sign?
precordial crunching, clicking, or knocking sound synchronous with the heartbeat

may indicate hemothorax, acute mediastinitis, pneumothorax, or respiratory failure
what is the battle sign?
ecchymotic discoloration and swelling behind either or both ears in line of the posterior auricular artery

may indicate basilar skull fx
what is the grey-turner sign?
discoloration and induration of the skin of the flanks, umbilicus, and CVA

may indicate retroperitoneal hematoma or acute hemorrhagic pancreatitis
what is the kehr sign?
severe pain in the sub scapular area of the shoulder, typically on the left

may indicate ruptured spleen, ectopic pregnancy, or GI dz
what are the acute medical emergencies?
pulmonary edema (difficulty breathing), TIA/stroke (weakness/LOC), MI (chest pain), acute abdominal (r/o AAA), upper GI bleed, acute glaucoma, retinal detachment
what are the three types of trauma?
blunt, penetrating, burns
what are mechanisms of blunt trauma?
car crash, falls, struck by object, sports
what are the mechanisms of penetrating trauma?
firearms, stabbings (pull out), impalements (stay in)
what are the mechanisms of burns?
smoke, heat, toxic chemical inhalation, CO poisoning
what is the AVPU scale?
assess pt level of consciousness (useful with children in ER)
Alert - knows who he is, where he is
Verbal - patient is not alert, but responds to verbal commands
Pain- responds to pain
U- unresponsive
when do we start tx HTN in children?
8 years old
when do we start measuring BP in children?
2 years old
pt is a 2 year old with HTN, what is the most likely dx?
coarctation of the aorta (tetralogy of fallot)
how do you measure a child in the ER?
Barlow tape

- tells you exactly how much medication to give, dependent on the child's size
BEST original tx for hypotensive shock?
as MANY fluids as you can
what medication makes patients unable to compensate and increase their HR in cases of shock or dehydration?
beta blockers
what is the life-threatening dz time to get consent for tx?
treat first, get consent later
what is an advanced directive?
formal statement of medical care desired in result of injury or illness

MUST know if pt has advanced directive

important in case of cognitive impairment
what is a living will?
formally set forth conditions under which a patient wants specific medical interventions utilized, limited, or forbidden if unable to make health care decisions
what is a durable power of attorney for health care?
close relative or other trusted person to make health care decisions when the patient is unable to themselves
(proxy)
what is the initial tx for chest pain?
OMI -
O2, monitor, IV
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