Emergency Medicine Secrets

Emergency Medicine Secrets......Page 2
Copyright Page......Page 4
Dedication......Page 5
Contributors......Page 6
Acknowledgment......Page 15
Top 100 Secrets......Page 16
8. What is the most inaccurate vital sign taken in the field and ED?......Page 22
Keywords:......Page 23
15. Is a diagnosis always possible or necessary in the ED?......Page 24
21. What two questions should always be asked (and answered) before a patient is discharged from the ED?......Page 25
23. What about the chart?......Page 26
Questions......Page 27
5. What is passive oxygen insufflation?......Page 28
Keywords:......Page 29
14. Discuss the role of pharmacologic therapy during CPR.......Page 30
18. What are other reversible causes and immediate treatments of cardiopulmonary arrest?......Page 31
25. How should asystole be treated?......Page 32
30. Which vasopressor should I administer in the setting of cardiac arrest: epinephrine, vasopressin, or both?......Page 33
Bibliography......Page 34
Questions......Page 35
8. How do I predict patients who will be difficult to assist with a BVM?......Page 36
Keywords:......Page 37
11. What basic equipment is necessary for ET intubation?......Page 38
13. What are the steps (seven Ps) to RSI?......Page 39
22. What is an extraglottic airway?......Page 41
26. What factors make pediatric airway interventions more difficult?......Page 42
Bibliography......Page 43
Questions......Page 44
7. Describe compensated and decompensated shock.......Page 45
Keywords:......Page 46
15. What is the lactate clearance index, and how can it be used during resuscitation of a patient in shock?......Page 47
23. Define systemic inflammatory response syndrome (SIRS).......Page 48
33. Explain the mechanism of phenylephrine.......Page 49
Bibliography......Page 50
Questions......Page 51
5. Describe the basics of the trauma ultrasound examination.......Page 52
Keywords:......Page 53
8. How should I use ultrasound in my evaluation of patients with blunt trauma?......Page 54
11. What is extended focused assessment with sonography for trauma (EFAST)?......Page 55
16. How sensitive is ultrasound for the evaluation of ectopic pregnancy?......Page 56
20. Describe the uses of cardiac ultrasonography in the ED.......Page 57
22. How is lower extremity venous ultrasound performed in the ED to diagnose DVT?......Page 58
25. Has the political environment changed with respect to emergency physicians using ultrasound?......Page 59
Bibliography......Page 60
Questions......Page 61
5. How can prehospital personnel facilitate the care of elderly patients?......Page 62
Keywords:......Page 63
11. What is the significance of fever in elderly patients?......Page 64
18. Can procedural sedation be performed safely in the geriatric patient?......Page 65
23. What are the four types of elder abuse?......Page 66
Bibliography......Page 67
Questions......Page 68
6. Why would a hospice patient call 911? Shouldn’t they be calling their hospice provider?......Page 69
Keywords:......Page 70
10. What happens when patients or family members of patients change their goals of care while in the ED?......Page 71
15. Withdrawing or stopping resuscitation feels worse than not starting. Which is more ethical?......Page 74
Bibliography......Page 75
Questions......Page 76
7. What does number needed to treat mean?......Page 77
Keywords:......Page 78
12. Should I read reviews on clinical topics?......Page 79
Bibliography......Page 80
Questions......Page 81
6. Are clinical prediction rules helpful?......Page 82
Keywords:......Page 83
8. Which patients are at highest risk from imaging-related radiation exposure?......Page 84
15. What imaging other than CT-KUB should be considered for patients who often come to the ED with symptomatic urinary stone disease?......Page 85
19. What imaging should be done when appendicitis is suspected clinically?......Page 86
24. What is appropriate evidence-based imaging for left lower quadrant pain?......Page 87
30. Should imaging be repeated when a patient is transferred from another institution to my care?......Page 88
Bibliography......Page 89
Questions......Page 90
4. As a physician, can I personally be penalized for an EMTALA violation?......Page 91
Keywords:......Page 92
10. Who can perform the MSE?......Page 93
15. List the requirements for transferring a patient who is unstable.......Page 94
20. What is The Joint Commission?......Page 95
22. How is compliance with the standards evaluated and enforced?......Page 96
26. Where did the Privacy Rule come from?......Page 97
32. What steps should be taken to prevent disclosure of PHI in the ED?......Page 98
35. What must be proved in a malpractice case?......Page 99
39. What common deficiencies in the medical record exacerbate malpractice problems for emergency physicians?......Page 100
43. What physician behaviors may help avoid lawsuits?......Page 101
Bibliography......Page 102
Questions......Page 104
5. Can EDOUs provide services to pediatric patients?......Page 105
Keywords:......Page 106
14. What is the difference between observation and inpatient services?......Page 107
References......Page 108
Questions......Page 110
5. Aside from CMS, who are the other major players in performance measures and performance measurement?......Page 111
Keywords:......Page 112
12. How is cost of care playing into performance measures?......Page 113
14. What are the Choosing Wisely recommendations from ACEP?......Page 114
19. How much can be saved with no compromise in patient care?......Page 115
Bibliography......Page 116
Questions......Page 117
5. How can I perform a brief, directed physical examination on a patient with altered consciousness?......Page 118
Keywords:......Page 119
9. What is the significance of other vital signs?......Page 120
16. When should I order a CT scan of the head?......Page 121
20. I think my patient is faking it. How can I tell if this is psychogenic coma?......Page 122
Bibliography......Page 123
Questions......Page 124
6. Does the degree of fever indicate the severity of the illness?......Page 125
Keywords:......Page 126
10. What are some key elements of the history and physical in patients with fever?......Page 127
18. Is a fever a friend or foe?......Page 128
Bibliography......Page 129
Questions......Page 131
4. Why is the location of chest pain not diagnostic of its cause?......Page 132
Keywords:......Page 133
11. How does the patient’s appearance correlate with the origin of chest pain?......Page 134
15. What abnormalities may appear on the chest radiograph in diseases causing chest pain?......Page 136
20. What special considerations must be taken into account when evaluating chest pain in patients patients who are geriatric, have diabetes, or are female?......Page 137
Acknowledgments......Page 138
Bibliography......Page 139
Questions......Page 140
5. What is the relationship of peritoneal inflammation to loss of appetite?......Page 142
Keywords:......Page 143
13. Which are the most useful preliminary laboratory tests to order?......Page 144
20. Is there a reliable diagnostic test that will either rule in or rule out appendicitis?......Page 145
27. What else do I need to ask the patient?......Page 146
30. When should I order radiographs?......Page 147
32. What medications should I use?......Page 148
Abdominal Pain......Page 149
Nausea and Vomiting......Page 150
Questions......Page 151
5. What are some clinical clues to distinguish primary headaches from cannot miss headaches?......Page 153
Keywords:......Page 154
6. Why are age and context important in the history of a patient with a headache?......Page 155
11. How do I differentiate between a traumatic tap and an SAH?......Page 156
13. What are migraine headaches?......Page 157
19. How are cluster headaches different from migraines? How are they treated?......Page 158
22. Does sinusitis commonly cause headache? If a CT scan shows sinusitis, is that the likely cause of a patient’s headache?......Page 159
28. What is a blood patch?......Page 160
32. When should I be concerned about a brain tumor?......Page 161
Bibliography......Page 162
Questions......Page 163
6. What are the common characteristics of peripheral vertigo?......Page 164
Keywords:......Page 165
11. What is the head thrust maneuver? What does it mean?......Page 166
14. How do I treat peripheral (and central) vertigo?......Page 167
20. Summarize the initial concerns when treating a patient with syncope.......Page 168
28. What factors help to assign a patient to a high-risk or low-risk group?......Page 169
Bibliography......Page 170
Questions......Page 171
6. What do I do if the seizure does not stop?......Page 172
Keywords:......Page 173
10. What ancillary testing should I do in the patient with a history of seizures?......Page 174
11. And if the patient does not have a history of seizures?......Page 175
13. What should be the disposition of the patient who has a seizure?......Page 176
Acknowledgment......Page 177
Bibliography......Page 178
Questions......Page 179
7. What is the role of diagnostic studies?......Page 180
Keywords:......Page 181
14. What are the adjuncts to initial epinephrine and airway management?......Page 182
21. What follow-up instructions are given to patients treated for anaphylaxis?......Page 183
Bibliography......Page 184
Questions......Page 185
3. What are the emergent causes of LBP?......Page 186
Keywords:......Page 187
5. How should I focus my physical examination?......Page 188
7. How do I perform an SLR test? How do I interpret the results?......Page 189
13. How should patients with musculoskeletal LBP be treated as outpatients?......Page 190
Bibliography......Page 191
Questions......Page 192
7. How do I differentiate clinically between periorbital and orbital cellulitis?......Page 193
Keywords:......Page 194
8. What is the common clinical presentation of cavernous sinus thrombosis?......Page 195
13. What is a subconjunctival hemorrhage?......Page 196
18. In a patient with anisocoria, how does one determine which pupil is abnormal?......Page 197
23. What are other causes of sudden painless monocular loss of vision?......Page 198
Bibliography......Page 199
Questions......Page 200
6. How do I treat epistaxis?......Page 201
Keywords:......Page 202
8. What are the important discharge instructions?......Page 203
13. Didn’t you forget to mention laboratory studies?......Page 204
18. If the physical examination does not reveal the foreign body, what should be done next?......Page 205
22. How do I make the diagnosis?......Page 206
26. Any other pearls?......Page 207
32. How is the definitive diagnosis of epiglottitis made?......Page 208
38. What are the treatment options for a peritonsillar abscess?......Page 209
44. How do I make the diagnosis?......Page 210
Bibliography......Page 211
Questions......Page 212
6. How do I assess open TMJ lock?......Page 213
Keywords:......Page 214
8. How do I examine the parotid gland and parotid duct?......Page 215
14. What is luxation of a tooth, and how is it treated?......Page 216
19. What are the tooth fracture classifications, and how are they treated?......Page 217
25. How are odontogenic abscesses treated?......Page 218
30. What is Ludwig’s angina?......Page 219
35. How do you treat animal bites to the orofacial region?......Page 220
Bibliography......Page 221
Questions......Page 222
7. What are some of the potential mimics of acute stroke?......Page 223
Keywords:......Page 224
12. How do I differentiate between TIA and stroke?......Page 225
19. What is the sensitivity of noncontrast CT of the head for SAH?......Page 226
27. What is the evidence for tPA in acute ischemic stroke?......Page 227
31. Why is there controversy with tPA for acute ischemic stroke?......Page 228
35. How should I manage ICH in the setting of tPA?......Page 229
40. What about patients taking novel oral anticoagulants (NOACs)?......Page 230
Bibliography......Page 231
Questions......Page 232
6. What clinical signs are characteristic of meningeal irritation?......Page 233
Keywords:......Page 234
9. What tests should be done before doing an LP?......Page 235
17. What findings on LP are consistent with bacterial meningitis?......Page 236
19. What about steroids?......Page 237
Bibliography......Page 238
Questions......Page 239
4. How does pulse oximetry work?......Page 240
Keywords:......Page 241
11. What percentage of fraction of inspired oxygen (FiO2) corresponds with the various types of oxygen delivery systems?......Page 242
16. How do I determine the initial ventilator settings in someone who has just had his or her airway intubated?......Page 243
20. What are the most commonly used methods?......Page 244
22. What is auto-PEEP?......Page 245
bibliography......Page 246
Questions......Page 247
3. Which aspects of the asthmatic patient’s history are important to the current exacerbation?......Page 248
Keywords:......Page 249
5. What are the key objectives when treating an asthma exacerbation? How are they achieved?......Page 250
10. Does pregnancy change the management of acute asthma?......Page 251
13. Which diagnostic tests are helpful in the management of COPD?......Page 252
18. How can I decide whether a patient can be discharged or requires hospitalization?......Page 253
23. What are differences in presentation of typical pneumonia and atypical pneumonia?......Page 254
25. What are the presenting signs and symptoms in a patient with pneumonia?......Page 255
28. How do I determine the disposition of a patient with pneumonia?......Page 256
31. Has the epidemiology of pneumonia changed in recent years?......Page 258
32. What is the role of the sputum Gram stain and culture?......Page 259
Bibliography......Page 260
Questions......Page 262
8. When determining pretest probability for DVT, what are the Wells criteria?......Page 263
Keywords:......Page 264
11. How do I use the PERC rule?......Page 265
19. What noninvasive imaging methods are available for the diagnosis of DVT?......Page 266
25. What are the diagnostic test options for PE with the pregnant patient?......Page 267
32. Under what conditions can an inferior vena caval filter be considered in the treatment of VTE?......Page 268
Bibliography......Page 269
Questions......Page 270
5. Name the main determinants of cardiac function in CHF.......Page 271
Keywords:......Page 272
12. How do I interpret BNP levels?......Page 273
17. What about drug therapy?......Page 274
22. What are the usual precipitating causes of CHF exacerbations?......Page 275
Bibliography......Page 276
Questions......Page 277
6. How do patients with unstable angina experience symptoms?......Page 278
Keywords:......Page 279
14. List the key elements of the initial evaluation of a patient with a suspected ACS.......Page 280
17. What is the typical course of ECG changes in ischemic cardiac injury?......Page 281
19. Are cardiac markers useful in the ED?......Page 282
23. What are the indications for reperfusion therapy in acute MI?......Page 283
29. List the contraindications to thrombolytic therapy.......Page 284
34. What other medications are useful adjuvants to reperfusion therapy?......Page 285
37. Which patients with unstable angina are at highest risk for MI and benefit from more aggressive treatment?......Page 286
Bibliography......Page 287
Questions......Page 289
7. How do I treat tachydysrhythmias?......Page 290
Keywords:......Page 291
14. What is the most common cause of wide-complex tachycardia?......Page 292
21. What is synchronized cardioversion?......Page 293
24. When is it necessary to give anticoagulants to a patient with AF before cardioversion?......Page 294
31. What are the advantages of transvenous versus transcutaneous pacemakers?......Page 295
36. What does a pacer setting of DDD mean?......Page 296
42. What is pacemaker syndrome?......Page 297
46. What happens as pacemakers lose battery power?......Page 298
Bibliography......Page 299
Questions......Page 301
4. What else might cause HTN, often transient, in the ED?......Page 302
Keywords:......Page 303
9. What is hypertensive urgency?......Page 304
14. What is the pathophysiology of hypertensive encephalopathy?......Page 305
20. How do I treat a patient with severe HTN and chest pain caused by ischemia?......Page 306
27. How do aneurysms, pseudoaneurysm, and dissection differ?......Page 307
31. What symptoms may be present in a patient with thoracic aortic dissection?......Page 309
37. How do I treat a patient with aortic dissection?......Page 310
42. How do I treat a patient with a suspected ruptured AAA?......Page 311
46. What are the complications of endovascular aortic repair (EVAR)?......Page 312
Bibliography......Page 313
Questions......Page 314
7. How can acute pericarditis be distinguished from acute MI?......Page 315
Keywords:......Page 316
13. What is cardiac tamponade?......Page 317
19. What is myocarditis?......Page 318
25. How can acute myocarditis be distinguished from acute MI?......Page 319
Bibliography......Page 320
Questions......Page 321
6. How does esophageal obstruction present?......Page 322
Keywords:......Page 323
10. What are causes of abdominal pain that are gastric or duodenal in origin?......Page 324
15. How is a patient classified as low risk for having occult upper GI bleeding?......Page 325
18. What medications improve GI bleeding outcomes?......Page 326
23. What are the criteria that allow a patient with low-risk upper GI bleeding to be sent home?......Page 327
Bibliography......Page 328
Questions......Page 329
6. What radiologic study is best at imaging the appendix?......Page 330
Keywords:......Page 331
11. How is mesenteric ischemia treated?......Page 332
13. What is inflammatory bowel disease (IBD)?......Page 333
18. What are the clinical features of SBO?......Page 334
25. How does diverticulitis clinically present?......Page 335
33. How do I treat an anal fissure?......Page 336
Bibliography......Page 337
Questions......Page 338
5. What is the gold standard for diagnosing cholecystitis?......Page 339
Keywords:......Page 340
8. What are Courvoisier law, Klatskin tumor, and Fitz-Hugh-Curtis syndrome?......Page 341
17. What is the most common form of liver disease in the United States?......Page 342
20. What are complications of chronic liver disease to watch for in the ED?......Page 343
Bibliography......Page 344
Questions......Page 345
6. In which patients would imaging be absolutely indicated to confirm the diagnosis of renal colic?......Page 346
Keywords:......Page 347
14. What if the imaging study is normal, but the patient still appears to have renal colic?......Page 348
22. Who requires hospitalization and/or urology consultation?......Page 349
25. Why should patients be given a urine strainer on discharge?......Page 350
32. What clinical features are suggestive of testicular torsion?......Page 351
41. What is epididymitis?......Page 352
Bibliography......Page 353
Questions......Page 354
5. List the other causes of AUR.......Page 355
Keywords:......Page 356
11. What if nothing is working?......Page 357
12. What is suprapubic catheterization? How is it done?......Page 358
15. Summarize the different neurogenic causes of AUR.......Page 359
21. I have heard that gradual emptying of the distended bladder best helps prevent complications. Is this true?......Page 360
Bibliography......Page 361
Questions......Page 362
5. List the differential diagnoses of dysuria.......Page 363
Keywords:......Page 364
9. What comprises a complicated UTI?......Page 365
16. What is the presentation of acute bacterial prostatitis?......Page 366
Bibliography......Page 367
Questions......Page 368
5. What is the most common problem relating to the vascular access device in the ED?......Page 369
Keywords:......Page 370
9. How is PD-associated peritonitis treated?......Page 371
13. How should I treat hyperkalemia in a dialysis patient?......Page 372
18. What are the major causes of altered mental status in patients with end-stage renal disease (ESRD)?......Page 373
Bibliography......Page 374
Questions......Page 375
4. What are the intrinsic and extrinsic coagulation pathways? How can I tell the difference?......Page 376
Keywords:......Page 377
9. What are the five clinical signs of TTP?......Page 378
16. Do people with hemophilia A have low levels of factor VIII?......Page 379
22. What are heparin-induced thrombocytopenia (HIT) and HIT with thrombosis (HITT)?......Page 380
26. How does warfarin work? How do I deal with elevated INR?......Page 381
Bibliography......Page 382
Questions......Page 383
5. What are the typical laboratory findings?......Page 384
Keywords:......Page 385
11. How should I manage fever in a patient with SCD?......Page 386
17. What is the role and indication for blood transfusion in SCD?......Page 387
21. What are the orthopedic complications of SCD?......Page 388
Bibliography......Page 389
Questions......Page 390
5. Tell me about these.......Page 391
Keywords:......Page 392
7. What other problems are common in patients with an underlying malignancy?......Page 393
Bibliography......Page 394
Questions......Page 395
6. What are the clues to each of the entities in MUDPILES?......Page 396
Keywords:......Page 397
8. Why should normal saline (NS) or lactated Ringer (LR) solution, rather than half-normal saline (0.45 NS) dextrose in 5% water (D5W), be given to someone who needs volume replacement?......Page 398
13. How can K+ be moved intracellularly?......Page 399
17. What are the classic neurologic signs of hyperkalemia? What are the classic ECG signs of hyponatremia?......Page 400
23. Describe the emergency treatment of hypercalcemia.......Page 401
References......Page 402
Questions......Page 403
4. How do I determine whether a primary respiratory disturbance is acute or chronic?......Page 404
Keywords:......Page 405
7. What are four major etiologies of an AGMA, and which laboratory tests differentiate them?......Page 406
12. How can glucose and albumin affect calculation of the AG?......Page 407
18. How does a patient with metformin-associated lactic acidosis present, and what is the treatment?......Page 408
Bibliography......Page 409
Questions......Page 410
4. Describe the pertinent clinical and laboratory findings of DKA.......Page 411
Keywords:......Page 412
7. How should DKA be treated in the ED?......Page 413
13. What are the four key points in ED management of patients with HHS?......Page 414
20. Describe GDM.......Page 415
Bibliography......Page 416
Questions......Page 417
4. What laboratory tests should be ordered in a patient with suspected hyperthyroidism?......Page 418
Keywords:......Page 419
11. How is hyperthyroidism treated in the ED?......Page 420
12. What is Graves ophthalmopathy?......Page 421
15. What are the common clinical manifestations of hypothyroidism?......Page 422
22. What are the adrenal emergencies that I need to worry about?......Page 423
26. What are the most common causes of primary adrenal insufficiency?......Page 424
30. How is the presentation of secondary adrenal insufficiency different from that of primary adrenal insufficiency?......Page 425
37. How is acute adrenal insufficiency treated?......Page 426
Bibliography......Page 427
Questions......Page 429
8. What is the primary goal of resuscitation in a septic patient?......Page 430
Keywords:......Page 431
19. What are the implications of meeting these goals as quickly as possible?......Page 432
27. List the criteria for defining a case of TSS caused by S. aureus.......Page 433
34. What antibiotics should I use?......Page 434
Bibliography......Page 435
Questions......Page 436
7. What are the differential diagnoses for cellulitis?......Page 437
Keywords:......Page 438
17. What is the appropriate ED treatment of an abscess?......Page 439
23. What is necrotizing fasciitis?......Page 440
27. Who should be consulted for patients with suspected necrotizing fasciitis?......Page 441
Bibliography......Page 442
Questions......Page 444
2. How should I evaluate abnormal vaginal discharge?......Page 445
Keywords:......Page 446
7. How do I evaluate a sexually active young person who has an acutely swollen, warm, painful right ankle?......Page 447
12. What are the important points to address in the discharge instructions for STD patients?......Page 448
17. What tests should be done for the patient who is infected with HIV and has systemic symptoms?......Page 449
22. How should GI complaints be managed?......Page 450
28. What constitutes high-risk exposure to HIV?......Page 451
Bibliography......Page 452
Questions......Page 454
6. What is the time course of tetanus?......Page 455
Keywords:......Page 456
11. Is the tetanus vaccine safe for pregnant and immunocompromised patients?......Page 457
15. What is the presentation of infant botulism?......Page 458
22. Name the causes of food poisoning.......Page 459
28. What is scombroid poisoning, and how is it treated?......Page 460
30. What is tetrodotoxin poisoning, and how is it treated?......Page 461
33. Describe the four stages of A. phalloides mushroom toxicity.......Page 462
Bibliography......Page 463
Questions......Page 464
6. What clinical history should I obtain from the ill returned traveler?......Page 465
Keywords:......Page 466
15. What is the presentation of malaria in ED patients?......Page 467
20. How do I diagnose and treat dengue fever?......Page 468
27. Describe the three clinical stages of Lyme disease.......Page 469
29. How is Lyme disease treated?......Page 470
36. What are ehrlichiosis and anaplasmosis?......Page 471
42. What is the proper method for tick removal?......Page 472
Bibliography......Page 473
Questions......Page 474
7. Is radiography helpful in the diagnosis of arthritis?......Page 475
Keywords:......Page 476
13. Does a synovial fluid WBC count of less than 50,000 cells/mm3 completely rule out the diagnosis of a septic joint?......Page 477
20. What medications can be used to treat gout in the acute setting?......Page 479
23. What are the treatment options for OA?......Page 480
Bibliography......Page 481
Questions......Page 482
5. Identify the skin lesions found in meningococcal disease, Rocky Mountain spotted fever, toxic shock syndrome, and necrotizing fasciitis?......Page 483
Keywords:......Page 484
8. Which illness can mimic EM?......Page 485
15. Which spider bites cause necrosis?......Page 488
24. Which formulation of topical steroids is most potent?......Page 490
Bibliography......Page 491
Questions......Page 492
4. How does lightning cause injury?......Page 493
Keywords:......Page 494
5. What types of injuries does lightning cause?......Page 495
7. Is it true that lightning never strikes twice in the same place?......Page 496
15. I am treating a hiker who was found unconscious on the trail after a thunderstorm had passed. The patient has no memory of what happened. How can I tell if he was struck by lightning?......Page 497
22. What are the best ways to prevent lightning-related injury or death?......Page 498
25. What is an easy way to classify electrical injuries? Does this help determine the nature and severity of electrical injuries?......Page 499
32. What are the most common long-term complications of electrical injuries?......Page 500
38. Who needs to be admitted for lightning-strike or electrical injuries?......Page 501
41. What about pregnant patients who sustain electrical injuries?......Page 503
Bibliography......Page 504
Questions......Page 505
5. What happens in a drowning?......Page 506
Keywords:......Page 507
12. Does a normal chest radiograph rule out pulmonary injury?......Page 508
19. What is the disposition of a submersion victim?......Page 509
Bibliography......Page 510
Questions......Page 512
6. What decreases heat production?......Page 513
Keywords:......Page 514
15. What conditions mandate active rewarming?......Page 515
26. What is frostbite?......Page 516
38. How should frostbite be classified?......Page 517
Bibliography......Page 518
Questions......Page 519
7. Why is this epidemiologically important?......Page 520
Keywords:......Page 521
12. How are heat-related illnesses treated?......Page 522
16. How do I treat a patient with heat stroke?......Page 523
22. What about acclimatization?......Page 524
Bibliography......Page 525
Questions......Page 526
5. What is the number-one risk factor for AMS?......Page 527
Keywords:......Page 528
13. How do I treat HAPE?......Page 529
22. What is nitrogen narcosis?......Page 530
30. What is spinal cord DCS?......Page 531
Bibliography......Page 532
Questions......Page 534
6. What is meant by appearing toxic?......Page 535
Keywords:......Page 536
13. How should tiny babies with fever be evaluated?......Page 537
18. Must I always follow the guidelines, or is there room for clinical judgment in there somewhere?......Page 538
21. What is the risk of occult bacteremia (presence of bacteria in the blood stream with no apparent focus of infection)?......Page 539
Bibliography......Page 540
Questions......Page 541
2. What can be learned about the child’s history?......Page 542
Keywords:......Page 543
8. What are common reasons for a child to have a seizure?......Page 545
14. Under what conditions should a child having febrile seizures be treated, and what treatments should be used?......Page 546
21. What workup should be done after an afebrile seizure in an asymptomatic child?......Page 547
24. What are important side effects of the different antiepileptic drugs?......Page 548
32. What cautions should I give to parents of children who have seizures?......Page 549
Bibliography......Page 550
Questions......Page 551
6. Who needs nebulized epinephrine?......Page 552
Keywords:......Page 553
9. What is the appropriate initial management of a patient with suspected epiglottitis?......Page 554
14. How are suspected foreign bodies managed in pediatric patients?......Page 556
20. Who is admitted for bronchiolitis?......Page 557
24. Outline the evaluation and treatment of an asthma exacerbation in the ED.......Page 558
27. What about parenteral β-agonists?......Page 559
Bibliography......Page 560
Questions......Page 561
6. What are potential causes of vomiting without diarrhea in children?......Page 562
Keywords:......Page 563
12. How does hemolytic uremic syndrome (HUS) typically present?......Page 564
17. What are the advantages and disadvantages of the different radiographic tests for appendicitis?......Page 565
22. What is the significance of bilious emesis in a neonate?......Page 566
27. Why is jaundice concerning in a neonate?......Page 567
31. What is a Meckel diverticulum?......Page 568
Acknowledgment......Page 569
Bibliography......Page 570
Questions......Page 571
9. What is the incubation period for mumps, and when is the patient contagious?......Page 572
Keywords:......Page 573
19. What is the monospot test?......Page 574
26. What is the therapeutic approach to management of diphtheria?......Page 575
31. What are the typical stages of Reye syndrome?......Page 576
Bibliography......Page 577
Questions......Page 578
3. What are some red flags that suggest child abuse?......Page 579
Keywords:......Page 580
8. Why are metaphyseal fractures suggestive of abuse?......Page 581
12. What are the most common myths about physical abuse?......Page 582
17. When there is a report of abuse, should I take any history?......Page 583
22. Which children need an evidence collection kit?......Page 584
26. Which findings can mimic sexual abuse?......Page 585
29. When should I report my concerns to CPS?......Page 586
Bibliography......Page 587
Questions......Page 588
4. What are the different levels of sedation?......Page 589
Keywords:......Page 590
9. What physical examination findings are important to note before providing PSA?......Page 591
16. What medications would I use for a 2-year-old child with a facial laceration?......Page 592
20. What complications are seen with PSA?......Page 594
24. When can I discharge a child home after performing PSA?......Page 595
Bibliography......Page 596
Questions......Page 597
6. What are the etiologies of pediatric arrests?......Page 598
Keywords:......Page 599
11. How does the approach to the B (breathing) of ABCs (airway, breathing, and circulation) differ in pediatrics relative to adults?......Page 600
19. What should I expect in a normal newborn at the time of birth?......Page 601
20. After delivery in the ED, what is the first priority in the care of the newborn?......Page 602
25. For the newborn, define bradycardia and indications for intervention.......Page 603
30. What drugs should be available for use in newborn resuscitation, and when should they be given?......Page 604
Bibliography......Page 605
Questions......Page 607
3. What is the role of gastric lavage in treating acute poisonings?......Page 608
Keywords:......Page 609
8. Is forced diuresis of benefit in the treatment of acute poisoning?......Page 610
11. How can a toxicology screen and other ancillary laboratory tests make the diagnosis of acute poisoning?......Page 611
13. Discuss some other useful antidotes for common poisonings.......Page 613
Bibliography......Page 614
Questions......Page 615
6. List the signs and symptoms of methanol poisoning.......Page 616
Keywords:......Page 617
11. What is an osmolal gap?......Page 618
18. What are the indications for hemodialysis?......Page 619
23. What is the treatment for isopropyl alcohol poisoning?......Page 620
32. How does alcoholic ketoacidosis (AKA) develop?......Page 621
39. Is there a cure for a hangover?......Page 622
Bibliography......Page 623
Questions......Page 624
8. How is the severity of salicylate overdose assessed?......Page 625
Keywords:......Page 626
13. What is the rationale for alkaline diuresis?......Page 627
21. Describe the pathophysiology of acetaminophen toxicity.......Page 628
26. Outline the general treatment of acetaminophen poisoning.......Page 629
31. What is the acetaminophen-alcohol syndrome?......Page 630
Bibliography......Page 631
Questions......Page 632
6. What are the distinguishing features of scabies?......Page 633
Keywords:......Page 634
8. What are the signs of scorpion envenomation?......Page 635
14. After a patient has survived an anaphylactic reaction to a bee sting, what should be done to prepare the patient in case he or she is stung again in the future?......Page 636
20. Can dog bites be closed primarily (sutured)?......Page 637
25. How do I treat jellyfish or other coelenterate stings?......Page 638
32. True or false: Snakebites are uncommon but highly lethal in the United States.......Page 639
38. Can a crotaline bite cause compartment syndrome?......Page 640
44. What are other general guidelines for crotaline (pit viper) snakebite patient care?......Page 641
Bibliography......Page 642
Questions......Page 644
7. Name some toxins produced by smoke and the materials from which they derive.......Page 645
Keywords:......Page 646
14. Can I use the standard burn formula for intravenous (IV) fluids if smoke inhalation is present?......Page 647
18. When should I use the cyanide antidote kit?......Page 648
Bibliography......Page 649
Questions......Page 650
6. What is the appropriate naloxone dose?......Page 651
Keywords:......Page 652
12. Who should I observe in the ED, and for how long?......Page 653
17. How useful are toxicologic screens for opioids, and which opioids are not often detected?......Page 654
25. What are designer drugs, and what are the two most notorious designer drugs that have been used?......Page 655
31. What is a typical presentation of sedative hypnotic intoxication?......Page 656
34. How do I make the diagnosis of sedative/hypnotic overdose in a patient with undifferentiated CNS depression?......Page 657
41. Should flumazenil be given empirically to all patients with depressed mental status?......Page 658
46. What are the symptoms and signs of mushroom poisoning?......Page 659
55. What are examples of stimulants?......Page 660
62. What is “ecstasy,” and what is Eve?......Page 661
69. What are anticholinergic agents, and how do they present?......Page 662
Bibliography......Page 663
Questions......Page 665
5. What is the treatment for CCB overdose?......Page 666
Keywords:......Page 667
10. How is digoxin Fab administered?......Page 669
Bibliography......Page 670
Questions......Page 671
7. How should hydrocarbon exposures be managed?......Page 672
Keywords:......Page 673
15. How is methemoglobinemia treated?......Page 674
23. What is the pediatric dosage of calcium for calcium channel blocker ingestions?......Page 675
32. What are the cardiovascular effects that may be seen with clonidine ingestions?......Page 676
41. What newer opioid can result in significant toxicity with ingestion of one pill?......Page 677
Bibliography......Page 678
Questions......Page 680
5. What are the diagnostic criteria for PID?......Page 681
Keywords:......Page 682
11. Are there alternative outpatient treatment regimens for PID?......Page 683
14. What is the appropriate follow-up care for patients with PID?......Page 684
Bibliography......Page 685
Questions......Page 686
4. What information should be elicited in the patient history?......Page 687
Keywords:......Page 688
7. What laboratory studies are indicated?......Page 689
13. What are the current options for pregnancy prophylaxis?......Page 690
21. What is the risk of acquiring HIV after a sexual assault?......Page 691
Bibliography......Page 692
Questions......Page 693
2. What is spontaneous abortion or miscarriage?......Page 694
Keywords:......Page 695
11. What factors are associated with spontaneous abortion and/or fetal abnormalities?......Page 696
17. What is an EP?......Page 697
21. What clinical signs and symptoms are useful to increase suspicion of an EP?......Page 698
28. How else is quantitative β-HCG used?......Page 699
32. Which EPs should be treated medically with methotrexate?......Page 700
37. What is placenta previa?......Page 701
44. Describe the non–life-threatening causes of third-trimester vaginal bleeding.......Page 702
Bibliography......Page 703
Questions......Page 704
5. What are the diagnostic criteria for severe preeclampsia?......Page 705
Keywords:......Page 706
15. What are the findings of magnesium toxicity, and how should the patient be monitored?......Page 707
24. What is HELLP syndrome?......Page 708
31. How are the baby and pregnancy evaluated?......Page 709
38. What maneuvers are available to resolve shoulder dystocia during delivery?......Page 710
44. How is PPH managed?......Page 711
Bibliography......Page 712
Questions......Page 713
6. How should the patient be undressed?......Page 714
Keywords:......Page 715
12. How is breathing assessed?......Page 716
18. Where should cutdowns be performed?......Page 717
24. What is the secondary survey?......Page 718
Bibliography......Page 719
Questions......Page 720
7. What findings indicate the need for a lateral canthotomy?......Page 721
Keywords:......Page 722
9. Is there a role for screening patients with Le Fort fractures for blunt cerebrovascular injury?......Page 723
16. What are the typical findings of a mandible fracture?......Page 724
22. How do I recognize an injury to the Stensen duct?......Page 725
25. How is the ear anesthetized?......Page 726
Bibliography......Page 727
Questions......Page 728
8. Name the causes of reduced life expectancy in patients with SCI.......Page 729
Keywords:......Page 730
14. What should be assessed on physical examination?......Page 731
20. What are distracting injuries?......Page 732
23. How do I interpret the lateral cervical spine radiograph?......Page 733
26. What is SCIWORA?......Page 734
31. What is the status of steroids in spinal cord trauma?......Page 735
Bibliography......Page 736
Questions......Page 737
4. What is postconcussive syndrome?......Page 738
Keywords:......Page 739
9. How does an SDH present?......Page 740
12. List the four types of herniation syndrome.......Page 741
17. What is the ED treatment for increased ICP?......Page 742
19. If a patient has a normal CT scan after head trauma, is it completely safe to discharge him or her home?......Page 743
References......Page 744
Questions......Page 745
8. What is the treatment for a corneal abrasion?......Page 746
Keywords:......Page 747
16. What is traumatic mydriasis?......Page 748
24. What is the cause of a dilated pupil that fails to constrict with topical pilocarpine?......Page 749
Bibliography......Page 750
Questions......Page 751
6. What are the three anatomic zones of the neck?......Page 752
Keywords:......Page 753
10. What are the hard and soft signs of penetrating neck trauma?......Page 754
13. Which diagnostic studies are important in suspected esophageal injuries?......Page 755
19. What is the appropriate management of blunt vascular injuries?......Page 756
Bibliography......Page 757
Questions......Page 758
4. Which major organs may be injured in blunt or penetrating chest trauma?......Page 759
Keywords:......Page 760
12. How is a tension pneumothorax treated?......Page 761
21. What is the best management of an asymptomatic, hemodynamically stable patient after penetrating thoracic trauma with no pneumothorax or hemothorax on initial chest radiography?......Page 762
28. How is cardiac tamponade treated?......Page 763
35. How do blunt aortic injuries present, and how are they diagnosed?......Page 764
43. What are the signs and symptoms of esophageal injury and rupture?......Page 765
53. What is a flail chest?......Page 766
Bibliography......Page 767
Questions......Page 769
3. What are some of the biomechanical principles in blunt and penetrating trauma?......Page 770
Keywords:......Page 771
8. What abdominal injuries are associated with pelvic fractures?......Page 772
10. Describe the incidence of diaphragmatic rupture in trauma and how it can be diagnosed on a chest radiograph.......Page 773
16. How are DPL results interpreted?......Page 774
19. In the management of abdominal trauma, are children really just small adults?......Page 775
Bibliography......Page 776
Questions......Page 778
4. How are pelvic fractures classified?......Page 779
Keywords:......Page 780
10. What is the role of pelvic packing for pelvic trauma?......Page 782
18. How should bladder injury be evaluated?......Page 783
Bibliography......Page 784
Questions......Page 786
6. How do physiologic changes in pregnancy affect the evaluation of the trauma victim?......Page 787
Keywords:......Page 788
14. How should these patients be managed in the field?......Page 789
21. Which pregnant patients with abdominal trauma require admission for fetal monitoring?......Page 790
Bibliography......Page 791
Questions......Page 792
4. How does prioritization of the resuscitation ABCs (airway, breathing, and circulation) differ between children and adults?......Page 793
Keywords:......Page 794
9. Name the preferred sites for venous access.......Page 795
15. Which children need cranial imaging after head trauma?......Page 796
21. What are other examples of fractures that are more common in children than adults?......Page 797
27. What is the lap belt syndrome?......Page 798
Bibliography......Page 799
Questions......Page 801
4. What causes compartment syndrome?......Page 802
Keywords:......Page 803
8. Describe the joint fluid analysis consistent with septic arthritis.......Page 804
16. Does dorsal hand swelling always signify a dorsal hand injury or infection?......Page 805
24. Name the carpal bones, including the most commonly dislocated carpal bone?......Page 806
28. What is the appropriate treatment for a patient with pain in the snuffbox of the wrist and normal radiographs after a traumatic event to the wrist?......Page 807
33. What is a paronychia, and how is it treated?......Page 809
41. What is a fight bite?......Page 810
45. What should be done with a devascularized but still partially attached digit?......Page 811
53. How are clavicle fractures treated?......Page 812
63. Why can patients with pathologic conditions of the hip experience knee pain?......Page 813
71. What injuries are often associated with calcaneal fractures?......Page 814
76. Describe the neurologic complications associated with pediatric supracondylar humerus fractures.......Page 815
82. What is the ED management of a child with injury and tenderness over an open epiphysis but a normal radiograph?......Page 816
Bibliography......Page 817
Questions......Page 818
5. List the criteria for transfer to a burn center.......Page 819
Keywords:......Page 820
12. What are deep partial-thickness burns?......Page 821
19. Are there any pitfalls with using the Parkland formula?......Page 822
22. What are three ways smoke from a fire causes death by asphyxiation?......Page 823
26. What are characteristics of patients whose burns can be managed in the outpatient setting?......Page 824
34. Are there any issues in treating elderly adults who sustain burns?......Page 825
Bibliography......Page 826
Questions......Page 827
6. What are the most important aspects of the physical examination?......Page 828
Keywords:......Page 829
8. Which anesthetic agent should be used for local anesthesia?......Page 830
13. What are the contraindications to epinephrine as an adjunct to lidocaine and bupivacaine?......Page 831
24. Which types of foreign bodies found in wounds are visible on radiographs?......Page 832
33. What is surgical glue, and how is it used?......Page 833
40. Are there any controversies in wound care?......Page 834
Bibliography......Page 837
Questions......Page 839
8. What options can be exercised if the patient becomes increasingly disorganized, agitated, and violent?......Page 840
Keywords:......Page 841
16. Summarize the potentially reversible causes of psychosis.......Page 842
18. List pharmacologic agents that can cause acute psychosis.......Page 843
Bibliography......Page 844
Questions......Page 846
4. List medical conditions that might cause secondary depression.......Page 847
Keywords:......Page 848
10. What antidepressant medications are used to treat depression?......Page 849
16. Describe suicide precautions.......Page 850
23. What about other social support?......Page 851
31. What is the SAD PERSONS Scale?......Page 852
32. In general, which suicidal patients should be hospitalized?......Page 853
Bibliography......Page 854
Questions......Page 855
3. What can hospitals do to decrease the risk of violence?......Page 856
Keywords:......Page 857
6. What if that doesn’t work?......Page 858
9. What medications are recommended for emergency treatment of agitation?......Page 859
14. How should restrained patients be monitored?......Page 861
Bibliography......Page 862
Questions......Page 863
8. Why are victims of partner abuse reluctant to disclose the abuse to health care providers, even if asked?......Page 864
Keywords:......Page 865
15. What comments or questions are inappropriate when discussing IPV with women?......Page 866
Bibliography......Page 867
Questions......Page 869
6. In what conditions has EMS been demonstrated to have proven benefit?......Page 870
Keywords:......Page 871
11. What skills can be performed by prehospital providers at different levels of training?......Page 872
Bibliography......Page 873
Questions......Page 874
5. Why is there a need for disaster planning?......Page 875
Keywords:......Page 876
11. Describe each of the five key functions in ICS?......Page 877
17. Tell me more about START.......Page 878
18. What is the difference between START and SALT triage systems?......Page 880
24. What is critical incident stress management (CISM)?......Page 881
Bibliography......Page 882
Questions......Page 883
6. What should EPs do to prepare and protect themselves?......Page 884
Keywords:......Page 885
11. What are the types of radiation injury?......Page 886
13. Describe the three acute radiation syndromes (ARSs).......Page 887
18. When should treatment with KI tablets be considered?......Page 888
23. What is the easiest way to remember the effects of nerve agents?......Page 889
25. What is the treatment for nerve agent toxicity?......Page 891
31. What are the general descriptive characteristics of biologic agents?......Page 892
37. How will I know if a biologic attack has occurred?......Page 893
40. Describe the five blast injury categories after explosions.......Page 894
45. How do I decontaminate a patient who has been exposed to radioactive material?......Page 895
Bibliography......Page 896
Questions......Page 898
7. What is the role of SWAT, and why does it create a need for tactical medicine?......Page 899
Keywords:......Page 900
13. What comprises the tactical/military primary assessment, and how does it differ from the traditional primary assessment?......Page 901
20. What is the maximum time a tourniquet can be left in place without injury or loss of the limb?......Page 902
27. What is the advanced airway intervention of choice in the tactical or combat environment?......Page 903
Bibliography......Page 904
Questions......Page 906
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