Alert Medical Series: Emergency Medicine Alert II

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: 02 novembre 2016
• Nombre de lectures: 0
• EAN13: 9781478783992
• 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 II
All Rights Reserved.
Copyright © 2017Ala Sarraj, MD
v5.0 r2.0

Cover Photo © 2017 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: 978-1-4787-8399-2

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PRINTED IN THE UNITED STATES OF AMERICA

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.
• VWF made by endothelial cells facilitates adhesion between exposed collagen and platelets.
Platelet adhesion leads to platelets activation.
Platelet activation leads to release of adenosine diphosphate (ADP), serotonin, thromboxane A2 (TXA2) from platelets and ADP-receptor expression on platelets.
• TXA2 has chemotactic effect on platelets, starting cascade leading to expression of glycoprotein llb/llla (GPllb/llla).
• Acetylsalicylic acid (ASA; Aspirin): nonselective inhibitor of cyclooxygenase that irreversibly inhibits platelets; decreases platelet aggregation and expression of GPllb/llla receptors by limiting generation of TXA2.
• ADP-receptor antagonists:
Thienopyridines: Ticlopidine (Ticlid), Clopidogrel (Plavix), Prasugrel (Effient),Ticagrelor(Brilinta).
All bind to ADP receptor to prevent binding of ADP; inhibit platelet aggregation.
• Dabigatran (Pradaxa):
Direct thrombin inhibitor (DTl) that targets factor lla.
Other DTls: Hirudin (leech saliva), Bivalirudin, and Argatroban; approved for prevention of stroke in patients with nonvalvular AF.
• Factor Xa inhibitors:
Direct inhibitor: Rivaroxaban (Xarelto) oral.
Indirect inhibitor: Fondaparinux (Arixtra) SQ.
• Normal serial lactate reduces the likelihood of mesenteric ischemia.
• Consider Octreotide 25-50 ug/ hr in bleeding esophegeal varices.
• Coins in the esophagus : frontal plane.
In the trachea : sagittal plane.
• Button battery ingestion: true emergency.
• Objects > 5x2 cm rarely pass the stomach.
• Crohn’s disease: up to 1/3 of patients can present with uveitis, erythema nodosum or pyoderma gangrenosum.
Hyperoxalurea with stone formation in ¼ of cases.
• Neurogenic shock:
Bradycardia and hypotension secondary to interruption of sympathetic outflow especially with lesions above T1.
• Swan neck deformity: disruption of the volar plate of PIP (proximal interphalangeal joint).
• Boutonnière deform ity: rupture of central slip/ extensor tendon at PIP level.
• Do not use Flumazenil (Romazicon) in chronic benzodiazepines use or in TCA overdose.
• Esters: Procaine, Tetracaine.
• LET: Lidocaine, Epinephrine, Tetracaine.
Emla : Lidocaine, Prilocaine.
• Gelfoam: absorbent gelatin sponge, works with pressure only.
Oxycel : oxidized cellulose
Actifoam : collagen sponge.
Both form an artificial clot.
• Wounds of fresh water : use Cipro to cover pseudomonas and aeromonas.
• Lacerations to the DIP extensor tendons ---> mallet finger.
Lacerations to the PIP extensor tendons ----> Boutonnière deformity.
• Tetanus immunoglobulin 250 u IM:
To be used if there is no history of primary series or less than 3 TD shots.
• Troponin I: not found in skeletal muscle.
• Mobitz 1: due to vagal tone, inferior wall MI.
Mobitz 2, complete block: structural, anterior wall MI.
• Subendocardial ischemia: ST depression.
Transmural ischemia : ST elevation.
• Elevated Troponin I, T : predictive of complications in acute MI.
• Plavix should be held 5 days before CABG.
• INR (international normalized ratio) : 2-3.5 with prosthetic valve disease.
• Pulmonary embolism: the most common symptom is dyspnea then chest pain then syncope.
• The presence of cyanosis with normal PaO2 suggests abnormal hemoglobin (CO hemoglobin or methemoglobin).
• Mycoplasma and chlamydia account for most atypical pneumonia,
H.flu: more common in smokers and the elderly.
• Active primary TB can present in any lung area.
Reactivated TB : upper lobes or superior segments of lower lobes.
• Heliox (Helium/ O2: 80/20) : decreases airway resistance in asthmatics.
• Elevated alk.phos. / GGT : reflect intra or extra hepatic obstruction.
• SBP (spontaneous bacterial peritonitis):
WBC > 1000 / ml, neutrophils > 250 in peritoneal fluid.
• Lipase has longer half life than amylase (7 vs 2 hrs).
• Normal saline, Mucomyst, Fenoldopam : useful in the prevention of radio contrast nephropathy.
• Dialysis is generally indicated when:
BUN > 100, Cr > 10.
• Dialysis disequilibrium:
Develops at the end of dialysis.
Hypertension, nausea/ vomiting.
Use Mannitol iv to increase osmolarity.
• Testicular torsion:
Pain is non positional(ischemic).
Detorsion: like “opening a book”.
• Balanitis: inflammation of the glans.
Posthitis : inflammation of the foreskin.
• Priapism treatment:
Terbutaline: 0.25-0.5 mg sq.
Pseudoephedrine 60-120 mg po.
• Ovarian hyper stimulation syndrome:
Occurs in 10% of in vitro fertility patients.
Weight gain, abdominal pain, thirst, fluid loss.
Ovarian enlargement.
Abdominal/ pelvic exams should be avoidable.
Treatment: iv fluids.
• Hyperthyroidism in pregnancy:
Treatment: PTU (Propyl thiouracil).
• Hyperemesis gravidarum:
Use D5 NS to prevent prolonged ketosis.