Alert Medical Series: Emergency Medicine Alert I, II, III

By Ala Sarraj, MD

Alert Med Series 

 

Medical students, residents, physician assistants, nurse practitioners and physicians: shorten your knowledge acquisition, test prep, and study time by months with this series of medical study guides. Choose from USMLE I, II, III; Internal Medicine I, II, III; and Emergency Medicine I, II, III.

 

Simulating flash cards, this series is full of well thought out laser-sharp, updated, and edited comprehensive notes by Ala Sarraj, MD. 

Over the years, Dr. Sarraj has developed a unique study style for quickly and successfully gaining and retaining medical knowledge.

 

Supplement your notebooks or smart phones with this study series. The Alert Med Series offers a concise, straightforward, and efficient approach and a high yield.

• Language: English
• Publisher: Outskirts Press
• Release date: Feb 6, 2024
• ISBN: 9781977268136

Ala Sarraj, MD

The Author:  Ala Sarraj, MD, American board certified in Emergency Medicine and Internal Medicine. He graduated from Damascus Univ. Med. School / Syria. Trained at Georgetown Univ. Dept. of Medicine / DC General hospital, Washington, DC, and Rush Univ. Med. center / Chicago. Dr. Sarraj is a full time emergency medicine physician in Chicago metropolitan area since 1991. The Editor:  The series was reviewed and edited by Maggy Shamekh, MD. A graduate, residency trained and holding masters degree of family medicine from Cairo Univ. Med. School / Egypt. Performed collaboration research work between Cairo Univ. cancer institute and MD Anderson cancer center, Houston / Texas. Worked for the WHO for the eradication of polio in the Middle East. Dr. Shamekh is a diplomat in health care quality management from the American Univ. / Cairo.

Book preview

Alert Medical Series

Emergency Medicine Alert I, II, III

All Rights Reserved.

Copyright © 2024 Ala Sarraj

v2.0

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Table of Contents

PREFACE

Alert Medical Series: EMERGENCY MEDICINE - Alert I

Alert Medical Series: EMERGENCY MEDICINE - Alert II

Alert Medical Series: EMERGENCY MEDICINE - Alert III

Alert Medical Series references:

Abbreviations

To My Mother

PREFACE

Alert Medical 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.

Alert Medical Series

EMERGENCY MEDICINE

Alert I

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 (Glasgow coma scale) = 8.

Expanding neck hematoma.

Severe shock.

Severe flail chest.

Coma cocktail work up should cover:

Coma, seizures, poisoning.

Neonates in 1st 2 weeks of life with cyanosis:

Cardiac cyanosis, duct dependent lesion till proved otherwise, consider administering prostaglandins.

Alcoholics: marked decrease in Glutathione stores.

Shock:

Hypovolemic.

Cardiac.

Obstructive: tension pneumothorax, cardiac tamponade, pulmonary embolus.

Distributive: sepsis, anaphylaxis, spinal.

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):

Urinary incontinence.

Slow movements (bradykinesia).

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 pattern on EKG.

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 (deep tendon reflexes).

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.

TCA (tricyclic antidepressants):

Avoid Procainamide, Flumazenil.

Ferric chloride urine test:

Detects salicylic acid.

False + results with ketones, phenothiazines.

Salicylates toxicity leads to hypokalemia.

Cauda equina syndrome:

Urinary retention/ incontinence.

Saddle anesthesia.

Loss of anal reflex.

Closed head injury with increased ICP ( intracranial pressure) > 15:

Paralyze, mildly hyperventilate.

Fluid restriction.

Elevate head > 30 degrees.

Consider Mannitol 20% 500 cc over 20 min.(adults).

Only IHSS (idiopathic hypertrophic subaortic stenosis) is enhanced by Valsalva maneuver (due to decreased blood return to the heart).

Hydroflouric acid burn therapy:

Ca gluconate sq injections.

Ca gluconate 10% 10 cc/ 50 cc D5w over 4 hrs.

In the eye: Ca gluconate 1% solution (dilute 10% sol. with 10 parts NS.).

Hydroflouric acid leads to hypocalcemia.

EKG approach:

R/O artifacts.

Fast/ slow.

Wide/ narrow.

Regular / irregular.

Ps or not, connected to QRS?.

Axis.

Ischemia, infarcts.

Hypertrophy.

Specials: S1Q3T3, pericarditis, hyperkalemia, prolonged QT(TCA overdose), increased ICP, WPW, SVT, MAT, A.fib/flutter, wide complex.

Ignore