Emergency Medicine COMAT

Emergency Medicine (COMAT)

TIMI score - CORRECT ANSWER - a prognostic tool for patients with unstable angina or

NSTEMI

Categorizes patient's risk of death and ischemic events & helps clinicians with therapeutic decision-making.

A point of one for each of the following:

• aspirin use in the last seven days
• ST changes of at least 0.5 mm on EKG
• Elevated serum cardiac biomarkers
• Age greater than 65
• known CAD (coronary stenosis greater than or equal to equal to 50%)
• At least two angina episodes within the last 24 hours
• At least three risk factors for CAD such as: HTN, DM, current cigarette smoker, family

hx of premature CAD (CAD in male first-degree relative or father less than 55, or female first-degree relative or mother less than 65)

most common complication associated with giving pediatric patients succinylcholine - CORRECT ANSWER - Rhabdomyolysis with associated hyperkalemia Tx - copious IV Fluid hydration

Contraindications to succinylcholine - CORRECT ANSWER - burns, crush injuries, renal failure, immobilization for >48 hours, narrow angle glaucoma & malignant hyperthermia.

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What cases is hyperkalemia a huge concern? - CORRECT ANSWER - Severe burns, crush injuries, & renal failure.

Glasgow Coma Scale -

What to do with a patient with a GCS of 8? - CORRECT ANSWER - Intubation

Thoracic injuries secondary to blunt chest - CORRECT ANSWER - The plain CXR remains the standard initial diagnostic remains the standard initial diagnostic study for the evaluation of chest trauma in a hemodynamically stable patient.CXR in blunt trauma patients are usually taken in the supine position initially until unstable spinal fractures have been ruled out. Then, it is important to get a PA view to appropriately evaluate for small hemothorax, pneumothorax or diaphragm injury.

What is first line in supraventricular tachycardia? - CORRECT ANSWER - Vagal maneuvers

Compartment syndrome - CORRECT ANSWER - Associated with five P's - pain, paraesthesia, pallor, pulselessness, & poikilothermia Critical level = Btwn 10 mmHg & 35 mmHg Poor outcomes = >30 mmHg Fasciotomy is the definitive treatment

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Normal compartment pressure - CORRECT ANSWER - <10 mmHg

Interstitial cystitis - CORRECT ANSWER - also known as bladder pain syndrome Is a chronic condition diagnosed in patients with symptoms of dysuria, frequency, urgency with no other causes of such symptoms.

Tx'ment of DKA (steps) - CORRECT ANSWER -

• Volume expansion with IVF (0.45% NACl or 0.9% NaCl at 250-500 ml/hour)

--Bolus anywhere from 2-4 liters of fluid prior to starting IV insulin

• Check potassium levels is checked and replace as needed
• An insulin drip will need to be started at 0.1 unit/kg/hour

--after serum glucose

• Check serum pH level to determine if bicarbonate is needed in the fluids
• When serum glucose is at a reasonable level 200 mg/dL), the fluids should be changed to

D5 0.45% NaCl & the insulin drip is weaned.

Influenza Treatment - CORRECT ANSWER - Immunoprophylaxis - inactivated vaccine ---Trivalent vaccine - prepared on annual basis with two strains of influenza A & one strain of influenza B---- Chemoprophylaxis - influenza-specific antiviral agents

• Anantadine
• Rimantadine
• Zanamivir
• Oseltamivir
• Peramivir

Prophylaxis & treatment of influenza type A in person >= 1 y.o. - CORRECT ANSWER - Anantadine & Rimantadine

Treatment (only) of influenza A or B in persons >= 7 y.o., who have been symptomatic for =< 2 days - CORRECT ANSWER - Zanamivir

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