Emergency Medicine

Neck Trauma

Chest Trauma

Abdominal Trauma

Shock

Pre-Shock → SIRS Presence of 2 or more of Temp <36℃ >38℃ HR >90 Respiration RR >20 PCO2 <32 WBC <4000 >12000 Shock Main First → Tachycardia Then → Hypotension Brain Confusion Kidney ↑ BUN/Cr ratio Liver ↑ AST and ALT Heart Chest pain SOB Blood ↑ Lactic acid Cardiac Index (CI) = CO/BSA → Range...

Bites

Snake bite 30% → Local wound Death from Hemolytic toxin Hemolysis DIC Neurotoxin Respiratory paralysis Ptosis Dysphagia Diplopia Treatment Pressure Immobilization Antivenom WRONG choices Torniquet blocking artery Compression bands are OK Ice Incision and suction by mouth Spider bite Stepped on a nail, piece of glass in shoe Etiology Black...

Toxic Ingestion

Unknown Substance Alert patient Stomach empties after 1 hour. Emptying not useful after 2 hours Most common overdose death Acetaminophen Aspirin Charcoal Benign, not dangerous, given in any overdose Removes toxins even after absorption NOT effective for Lithium Iron Lead Hydrocarbons Toxic alcohols Gastric lavage 1h → 50% removal 2h →...

Heat

Heat Cramps/Exhaustion Etiology Exertion High temp Presentation Normal body temp Normal CPK Normal K Treatment Oral fluids Oral electrolytes Heatstroke Etiology Exertion High temp Presentation ↑ body temp ↑CPK ↑K Treatment IV fluids Evaporation Benzodiazepine to prevent shaking Neuroleptic Malignant Syndrome Etiology Antipsychotics Presentation ↑ body temp ↑ CPK...

Cardiac Rhythm Disorders

Cardiac Arrest Initial management Make sure truly unresponsive Call 911/EMS Airway Head tilt Chin lift Jaw thrust Breathing → Rescue breaths Circulation → Chest compression Precordial thumb → Only effective <10min (Witnessed) Defibrillation = Unsynchronized (120-200J Biphasic) Cardioversion → Synchronized Rhythms Asystole/PEA (Pulseless Electrical Activity) CPR Epinephrine/Vasopressin Simultaneously find underlying cause Tamponade Tension pneumothorax Hypovolemia...

Drowning

Presentation Salt water → Like CHF → Wet heavy lungs Fresh water → Hemolysis (Hypotonic fluid absorption) Treatment Control airway Positive pressure ventilation Steroid is WRONG Antibiotic in WRONG

Hypothermia

Presentation Intoxicated person + ↓ Body Temp Unintoxicated people don’t fall sleep in cold! Diagnosis Best initial step → ECG → J waves Osborn wave Where QRS hits ST segment Complications Most common cause of death → Arrhythmia Treatment 32-35 → Passive external rewarming 28-32 → Active external rewarming <28 → Active...

Burns

Etiology 1st cause of death → Smoke inhalation, CO poisoning 2nd cause of death Airway injury present → Airway burn Airway injury NOT present → Volume depletion Most common cause of death several days after → Staph infection Treatment → TOPICAL silver sulfadiazine (NO IV) Degree 1st degree → Only epidermis Painful No blister 2nd degree → Epidermis...

Head Trauma

Diagnosis LOC ⇒ Best initial → CT without contrast Concussion → Normal CT NO focal NO lucid interval Treatment → 24h observe at HOME Contusion → Ecchymoses Rare focal NO lucid interval Treatment → 24h observe at HOSPITAL Subdural hematoma → Crescent (venous) Focal possible No lucid interval Treatment → Drain if LARGE Compression to...