PCM Flashcards Adult emergencies (.txt).txt

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PCM Flashcards Adult emergencies (.txt).txt
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  1. An episode of abnormal neurological function caused by an inappropriate electrical discharge of brain neurons
    seizure
  2. A seizure in which conciousness and mentation are not affected
    Simple
  3. A seizure in which consciousness and/or mentation are affected
    Complex seizure
  4. A seizure with wide spread electrical discharge, Loss of conciousness, often accompanied by tonic clonic movements tounge biting and incontinence
    Generalized seizure
  5. What should you do on PE after a seizure? (3)
    • Injuries- head and spine and musculoskeletal injuries, also lacerations (dont forget the mouth for tounge biting)
    • Neurological examination (Todd paralysis, transient focal deficiet)
    • Bedside glucose
  6. What is Todd paralysis?
    Foacalized weakness if this is present you should worry about stroke or TIA
  7. Why should you perform serial neurological exams in a pt who has had a seizure?
    Post ictal time will have changing neurological status
  8. What is the first question for a pt or bystander presenting post seizure?
    Was it a seizure
  9. What characteristics does syncope have that seizures do not
    preceeded by dizziness, diaphoresis, usually no post ictal symptoms
  10. What are 4 differential diagnoses to seizure?
    • Syncope
    • pseudoseizure
    • migraines
    • movement disorders
  11. What are 4 features of a seizure that set it apart from syncope?
    • Abrupt onset and termination
    • Lack of recall
    • Movement during attack is inappropriate and purposeless
    • Most followed by lethargy and confusion (postictal state)
  12. State of lethargy and confusion that follows a seizure
    post ictal state
  13. What are some things that could cause a patient with a known seizure to have an attack?
    Missed dosage, change in medication, change in dosage, sleep deprivision, infection, alcohol
  14. ___ is a drug used for depression and for smoking cessation that lowers the threshold for seizures to occur
    welbutrine
  15. What labs do you order for a pt who has a history of seizure disorder that has just had an acute attack?
    You may not need to get labs but you should check the level of anticonvulsant in their blood if you didn't give them any if their levels are low you should get either their perscribed medication on board or get phenytoin 10-20 mg/kg loading dose
  16. You have a pt who has a past history of seizure disorder who ran out of their anticonvulsant medication. They had a seizure and were taken to the ER for care you quickly ruled out any trauma prior to or after the seizure. After the post ictal period you administer 10mg phenytoin can you discharge this patient?
    Yes, you should have them go home with someone else and instructions to follow up
  17. Name some secondary causes of seizure
    • head trauma
    • intracranial hemorrhage
    • structural abnormalities
    • infection
    • metabolic disturbance
    • drugs
    • anoxic ischemia injury
    • hypertensive encephalopathy
  18. What labs/imaging should you order for a pt with a first time seizure event?
    • Labs: cbc, complete metabolic pannel, urinalysis, mg, toxicology screen, pregnancy
    • CT head no contrast or MRI
    • neurological consult
  19. Why would you order a pregnancy test for a first time seizure pt?
    Eclampsia can cause seizures
  20. Do you need a patient's permission for a toxicology screen?
    No
  21. ______ is continuous seizure activity for 30 or more minutes or tow or more seizures that occur without full recovery of consciousness between attacks
    status epilepticus
  22. How long should you wait before intervening in a seizure?
    5 minutes of seizure time
  23. What labs would you order on a Status epilepticus patient?
    Large bore IV, bedside glucose (tx hypoglycemia with glucose and thiamine), intubation, foley, NGT, Labs, cardiac Monitoring, EEG monitoring
  24. You have a patient in status epilepticus who you have to give paralytics to. Why do you need to get an EEG on this patient?
    If they are a tonic clonic seizure and you paralyze them, then the EEG is the only thing that can tell you if they are continuing to seize
  25. What medication do you start with for a patient with status epilepticus?
    Lorazepam (atavan)
  26. What do you give a status epilepticus patient if they cannot have lorazepam?
    Diazapam (valium) and phenytoin
  27. If the first line treatments for status epilepticus are not working what do you give next?
    Phenobarbitol
  28. If you have a patient in status epilepticus for 30 minutes what do you give?
    • General anesthesia
    • midazolam
    • profofol
    • pentobarbitol
    • admission to the ICU
  29. What are the ACEP guidelines for neuroimaging in the ED?
    • New focal deficit
    • persistent altered mental status
    • recent head trauma
    • first seizure
    • coagulapathy/anticoagulation therapy
    • HIV positive/immunosuppression
    • Meningismus
    • ETOH
    • Change in seizure pattern
  30. What are the ACEP recommendations for neurology consult?
    • New seizure
    • abnormal neurological examination
    • perisitent AMS
    • new intracranial lesion
    • change in seizure pattern
    • poorly controlled seizures
    • pregnant patient
  31. Who gets admitted to the hospital ACEP recommendations
    • persistent AMS
    • CNS infection
    • New focal abnormalities
    • new intracranial lesions
    • underlying correctable medial problem
    • acute head trauma
    • status epilepticus
    • eclampsia
  32. 4 things you should do if you are in the hospital and a pt begins to seizure
    • protect the patient from injury
    • if you can turn the patient to one side to prevent aspiration
    • watch and wait
    • Lorazepam (ativan) (not for uncomplicated seizure)
  33. T or F lorazepam helps prevent another seizure after the first if administered to a pt having a seizure
    True
  34. T or F lorazepam does not prolong the post ictal state
    False
  35. 3 situations that you want to advise your patient to be cautious with after a seizure or with a propensity to seizure
    • swimming
    • working at tall heights
    • operating machinery
  36. Hypoglycemia is a serum glucose that is less than ________
    50-60 mg/dL
  37. What are some conditions that can result in hypoglycemia
    DM, sepsis, liver disease, alcohol intoxication, certain toxic agents
  38. Two diabetic drugs that can cause hypoglycemia and mean the patient should be admitted
    insulin and sulfonylurea (OHA)
  39. Which insulin medication may or may not cause hypoglycemia
    nonsulfonurea secretagogues
  40. Which three DM meds do not cause hypoglycemia
    • biguanides
    • alpha glucosidase inhibitors
    • Thiazolidinediones
    • (BAT)
  41. What are some neuroglycopenic manifestations of hypoglycemia?
    • Lethargy
    • confusion
    • combativeness
    • agitation
    • seizure
    • unresponsiveness
  42. What are some hyperephinephrinemic symptoms of hypoglycemia
    anxious, irritability, N/V, palpitations, Tremors
  43. ANYONE who presents with AMS should have what test done?
    Bedside glucose check
  44. What is the best treatment for hypoglycemia?
    Oral replacement. Orange juice, or glucose tabs or a candy bar
  45. What is the problem with amp D50 for hypoglycemia?
    You need IV access
  46. Can you give Glucagon to an alcoholic with hypoglycemia? Why or why not?
    NO. in alcoholics and other people with depleted glycogen stores hypoglycemia will not improve
  47. If you have a pt with hypoglycemia who has had oral glucose therapy and is not responding what can you give them next?
    Octreotide
  48. When should you admit a hypoglycemia patient?
    • DM pts on long acting insulin and sulfonureas
    • recurrent hypoglycemia/ recurrent AMS
    • psychiatric
    • Precipitating factors (sepsis)
    • Lack of follow up, or supervision
  49. 45 y/o female presents via ambulance for AMS, when she was found she had a finger stick of 30 given amp D50 with resolution of symptoms. Pt med hx: dm metformin, afebrile and normal vitials should you adimit her or discharge her?
    Discharge
  50. 33 y/o pt presents after having AMS per friends. Arrived via EMS. Pt had glucose level 50 at site picked up and was administered amp D50 pt is on long acting insulin. Should you admit this patient or discharge them?
    Admit (they are on long acting insulin)
  51. A severe systemic hypersensitivity reaction characterized by multisystem involvement. This can include airway and cardiovascular compromise
  52. What are the 3 most common causes of anaphylaxis
    • ABX-penicillin
    • Insect bites
    • Food
  53. A pt presents to you with diffuse urticaria and angioedema what do they have?
    Anaphylaxis
  54. pt presents with a �lump� in their throat which is causing nausea and vomiting and shortness of breath what emergent condition is on your differential?
    Anaphylaxis
  55. What are some clinical manifestations of anaphylaxis
    • diffuse urticaria and angioedema
    • nausea
    • vomiting
    • abdominal pain
    • lump in throat or hoarsness
    • chest tightness
    • SOB
  56. What do you need to consider in any patient with acute respiratory distress, bronchospasm, hypotension or cardiac arrest?
    Anaphylaxis
  57. What is first thing you do with a patient who is in acute respiratory distress from anaphylaxis?
    Secure the airway
  58. with suspected anaphylaxis what do you give?
    Epinephrine
  59. If you have a pt with anaphylaxis who you have given epi, but they still remain hypotensive what should you give next?
    Normal saline bolus
  60. Name a second line therapy for anaphylaxis
    • methylprednisone
    • diphenhydramine
    • ranitidine
    • albuterol
    • glucagon � if the patient is on beta blockers then they will be refractory to epinephrine you need to give these patients glucagon for anaphylaxis
  61. what do you need to give a patient with anaphylaxis who is on Beta blockers?
    Glucagon because they will be refractory to epi
  62. How long do patients who have received epi need to be monitored
    at least 4 hours
  63. If you have an unstable anaphylaxis can you d/c that patient?
    No you should admit
  64. What anaphylactic patents besides those that are unstable should you consider admission?
    Asthmatic, social issues, comorbidities, age
  65. If a pt is on a beta blocker and has an anaphylactic response to peanuts can they return to their beta blocker? If so how soon?
    NO they should be switched off beta blockers and given an emergency epi pen
  66. When d/c an anaphylaxis patient medications should they be prescribed?
    • Prednisone 40-60 mg per day 3-5 days
    • Diphenhydramine and an H2 blocker
  67. your pt w/ a history of asthma has dyspnea wheezing, cough, chest tightness, and a prolonged expiratory phase what do you think they have?
    Asthma exacerbation
  68. Mr. Smith has a history of asthma, presents using accessory muscles cant catch his breath to speak, HR 120, O2 sat 88 % RR30 what treatment would you suggest
    intubate
  69. What do you give an acute asthma exacerbation first line?
    Albuterol nebulizer
  70. 22 y/o with past medical hx of asthma presents with exacerbation brought on by the cold weather. VS nl, pk flow 250 pt speaking in full sentences with diffuse wheezing what do you perscribe?
    • Albuterol nebulizer and O2 via nasal
    • possibly nebulized prednisone do another peak flow later
  71. 35 y.o. Male presents with acute asthma pk flow 100, pt cannot speak and has a quiet chest what should you do?
    INTUBATE
  72. 56 y.o. Male presents with crushing chest pain substernal with radiation to chest, jaw and left arm. He is also short of breath and states the pain is a 10/10 with no relief from rest what does he have?
    Ischemic chest pain prolly an MI
  73. Protocol says that if a pt is 30 yrs or older with chest pain they should have an EKG within ___ minutes from entering the ED
    10 mins
  74. How do you tell the difference between a STEMI and a NSTEMI?
    Cardiac enzymes
  75. What do you treat a STEMI with?
    • PCI
    • fibrinolytics
    • ASA, ntg, morphine, O2
  76. Chest pain that is unresolved even w/out being an NSTEMI (should/should not) be admited
    ADMIT it may evolve into an MI cath in the morning

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