Alert Medical Series: Emergency Medicine Alert I

Ala Sarraj

Description

This series is a compilation of powerful high yield random notes and comparisons that will guarantee laser-sharp comprehensive and effective knowledge acquisition and high score passing rates in the fields of USMLE (US Medical Licensing Exam), Internal Medicine and Emergency Medicine boards.

Sujets

• Médecine
• Spécialités médicales
• Médecine d'urgence
• Emergency Medicine
• Medical

Informations

• Publié par: Outskirts Press
• Date de parution: 14 octobre 2016
• Nombre de lectures: 0
• EAN13: 9781478769446
• Langue: English

Extrait

The opinions expressed in this manuscript are solely the opinions of the author and do not represent the opinions or thoughts of the publisher. The author has represented and warranted full ownership and/or legal right to publish all the materials in this book.

Alert Medical Series: Emergency Medicine Alert I
All Rights Reserved.
Copyright © 2016 Ala Sarraj, MD
v4.0 r2.0

Cover Photo © 2016 thinkstockphotos.com. All rights reserved - used with permission.

This book may not be reproduced, transmitted, or stored in whole or in part by any means, including graphic, electronic, or mechanical without the express written consent of the publisher except in the case of brief quotations embodied in critical articles and reviews.

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ISBN: 978-1-4787-6944-6

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PRINTED IN THE UNITED STATES OF AMERICA
To My Mother
Preface
Alert M edical Series is a compilation of powerful random high yield notes and comparisons that will guarantee comprehensive and effective knowledge base and high score passing rates in the fields of USMLE (US Medical Licensing Exam), INTERNAL MEDICINE and EMERGENCY MEDICINE boards alike.
It reflects years of revision and update that will save medical students, residents and physicians measurable time of test prep and knowledge acquisition.
Alert Medical Series will serve you like multitude of pixels creating very high resolution and sharp picture.
The USMLE series notes (basic and clinical) were put in a random manner mixing basic and clinical notes to simulate real life knowledge building and to reflect the future trend in USMLE testing to combine clinical science and the clinically based basic science.
• Trauma Primary survey:
A : Airway patency, cervical spine immobilization.
B : Breathing, ventilation.
C : Circulation, pulse, skin color, capillary refill, urinary output.
D : Disability, pupillary reaction, AVPU (alert, verbal, responding to pain, unresponsive), Glasgow coma scale.
E : Exposure, avoid hypothermia.
F : Foley catheter.
G : Gastric tube insertion.
H : History: AMPLE (allergies, medications, past history, last meal, events leading to injury).
• Intubation indications:
Apnea.
Coma.
Inhalation injury.
Unable to handle secretions.
Absent gag reflex./ tolerates airway.
GCS < 8.
Expanding neck hematoma.
Severe shock.
Severe flail chest.
• Coma cocktail work up should cover:
Coma, seizures, poisoning.
• Neonates in 1 st 2 weeks of life with cyanosis:
Cardiac cyanosis, duct dependent lesion till proved otherwise, consider administering prostaglandins.
• Alcoholics: marked decrease in Glutathione stores.
• Shock:
1. Hypovolemic.
2. Cardiac.
3. Obstructive: tension pneumothorax, cardiac tamponade, pulmonary embolus.
4. Distributive: sepsis, anaphylaxis, spinal.
5. Dissociative: CO poisoning, methemoglobin.
• PNH (Paroxysmal Nocturnal Hemoglobinuria):
Non-immune hemolysis.
Dark urine in the morning.
Thrombosis: liver (Budd Chiari syndrome), mesenteric vein, CNS site.
• NPH (Normal Pressure Hydrocephalus):
1. Urinary incontinence.
2. Slow movements (bradykinesia).
3. Confusion.
(“Wet, Wacko, Wobbly”).
• ABO antibodies develop after infancy and are mostly IgM, which binds complement and may lead to intravascular hemolysis.
• An individual’s erythrocytes express A antigen only (group A), B antigen only (group B), neither antigen (group O), or both A and B antigens (group AB).
• An individual’s plasma contains antibodies against the A or B antigen that are not present on one’s erythrocytes.
• Rh antigens are transmembrane proteins that are present on erythrocytes.
One of these antigens,the Rh(D) antigen, is highly immunogenic and induces IgG anti-D antibody formation in most Rh(D)-negative individuals exposed either from pregnancy or the transfusion of Rh(D)-positive erythrocytes.
• Pre-transfusion compatibility testing begins with typing (ABO/Rh determination) and screening (detection of non-ABO antibodies).
• If a patient needs an emergency transfusion , group O erythrocyte units and group AB plasma units are used until the ABO/Rh type is determined.
• Group O erythrocytes can be transfused to anyone , because there are no A or B antigens on these cells to react with anti-A or anti-B hemagglutinins.
Similarly, group AB plasma can be transfused to anyone because it contains no hemagglutinins to react with A or B antigens.
• Rh positive patients can safely receive either Rh(D) positive or Rh(D) negative blood.
But Rh negative patients must receive Rh(D) blood to avoid alloimmunization.
This is a concern in women of childbearing age to prevent formation of anti-D antibodies, leading to severe hemolytic disease of the newborn.
• Tarsal tunnel syndrome:
Burning and numbness to the plantar surface and the medial side of the calf / tibia.
• 1 mg of protamine neutralizes 100 u of Heparin.
• Pulmonary embolism:
The most common symptom in decreasing frequency:
Chest pain, tachypnea, dyspnea.
T wave inversion, S1Q3T3.
• Comatose and hypotension:
DPL (diagnostic peritoneal lavage)/ US abdomen.
• Clozapine can cause agranulocytosis, check CBC.
• Avoid Metformin in renal insufficiency, it can lead to lactic acidosis.
• Precose inhibits the enzyme that cleaves complex carbohydrates, hence blocking the formation of absorbable sugars in small intestine.
• GHB (gamma hydroxybuterate) symptoms:
Amnesia.
Euphoria.
Respiratory depression.
Seizures.
Coma.
• Physostigmine is cholinergic, it can lead to heart block and asystole.
• Chlamydia, pertussis and cystic fibrosis can lead to prolonged cough.
• Hypercalcemia and hypokalemia increase the toxic effects of digoxin.
• Myxedema coma: use 300- 500 mcg of iv Thyroxine, then 50-100 mcg daily.
And 100-200 mg of iv Solucortef.
• Newborns stop losing weight in about 6-7 days.
• Bloody diarrhea in neonates:
Milk allergy.
Bacterial enteritis.
Necrotizing enterocolitis.
• Sepsis signs in neonates:
Lethargy, poor feeding, fever, jaundice, poor color.
• Thyroid storm treatment:
Check free T3, T4, cortisol level.
Avoid Aspirin, it can lead to increased free T3,4.
Solucortef 300 mg iv.
Iodine 1 gm q8 hrs iv, it inhibits thyroid hormone release.
Inderal 1 mg iv q 1 min up to 10 mg, it blocks thyroid hormone peripheral effects.
PTU 900-1200 mg or 400 mg tid, it inhibits thyroid hormone synthesis.
• Serotonin syndrome:
Altered mental status.
Autonomic instability.
Neuromuscular: fasciculations.
• Demerol, Dextromethorphan are serotonergic, do not use with:
Antidepressants, Lithium, Cocaine, LSD, Tramadol.
Watch for rhabdomyolysis, hyperthermia and seizures.
Use Periactin 4 mg qid x 1-3 days in symptomatic patients.
• Sickle cell trait: hematuria, decreased urine concentrating ability.
• Botulism: nausea and vomiting, neurologic symptoms 1-2 days after ingesting contaminated food, NO fever.
Most commonly involved: eye and bulbar muscles.
• Infant botulism : raw honey, lethargy, failure to thrive.
• Diphtheria: fever, decreased or absent DTRs.
• Myasthenia gravis: proximal muscle weakness, DTRs preserved.
• Methylene blue:
Used if methemoglobin > 30%.
Dose: 1-2 mg/ kg iv over 5 minutes.
• Roseola:
High fever x 3-4 days followed by macular/ papular rash, child feels well with rash.
• Amaurosis fugax (carotid artery disease) is the most likely cause of transient loss of vision.
• Adrenal crisis:
Use Solucortef 100 mg iv bolus + 100 mg / 1 L NS then 200 mg q 6 hrs x 1 day.