Emergency Medicine Anesthesiology Flashcards

24 sample cards from the Anesthesiology deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. When is a D-dimer test most useful in the workup of pulmonary embolism?

   In low/intermediate pretest probability patients: a negative (normal) D-dimer effectively rules out PE, avoiding imaging. It is not useful in high-probability patients (proceed directly to CTPA).

2. What is the ECG finding classically (though uncommonly) associated with pulmonary embolism?

   The $S_1Q_3T_3$ pattern: a prominent S wave in lead I, a Q wave in lead III, and an inverted T wave in lead III (indicating right heart strain); sinus tachycardia is the most common finding.

3. What is the treatment for massive (high-risk) PE with hemodynamic instability?

   Systemic thrombolysis (e.g., tissue plasminogen activator/alteplase) if no contraindications, or catheter-directed therapy/embolectomy; anticoagulation alone for hemodynamically stable PE.

4. What imaging is required before administering IV thrombolysis (tPA) for acute ischemic stroke, and what must it exclude?

   A non-contrast CT head to exclude intracranial hemorrhage before giving thrombolytics.

5. What is the time window for IV alteplase (tPA) in acute ischemic stroke from symptom onset?

   Within $4.5$ hours of symptom onset (standard window is up to $3$ hours, extended to $4.5$ hours in eligible patients).

6. What does the acronym FAST represent for rapid recognition of stroke?

   Face drooping, Arm weakness, Speech difficulty, Time to call emergency services.

7. How is mechanical thrombectomy time window generally defined for large-vessel occlusion ischemic stroke?

   Up to $24$ hours from last known well in selected patients with a large-vessel occlusion and favorable imaging (salvageable penumbra), and standardly within $6$ hours.

8. Define status epilepticus in operational (treatment) terms.

   A single seizure lasting $\geq 5$ minutes, or $\geq 2$ seizures without full recovery of consciousness between them; treatment should begin at 5 minutes.

9. What is the first-line pharmacologic treatment for status epilepticus?

   A benzodiazepine (IV lorazepam, IV/IO diazepam, or IM midazolam), followed by a second-line antiepileptic (e.g., levetiracetam, valproate, or fosphenytoin) if seizures persist.

10. Classify traumatic brain injury severity by the Glasgow Coma Scale.

    Mild TBI: GCS $13$-$15$; Moderate TBI: GCS $9$-$12$; Severe TBI: GCS $\leq 8$ (indicates coma and typically the need for definitive airway/intubation).

11. State the Monro-Kellie doctrine relevant to traumatic brain injury.

    The skull is a fixed volume containing brain, blood, and CSF; because their total volume is constant, an increase in one component (e.g., a hematoma) must be offset by a decrease in another or intracranial pressure rises.

12. Give the formula for cerebral perfusion pressure (CPP) and the typical target in TBI.

    $$\text{CPP} = \text{MAP} - \text{ICP}$$ Target CPP is generally $60$-$70\,\text{mmHg}$ in traumatic brain injury.

13. What is Cushing's triad, and what does it indicate?

    Hypertension (widening pulse pressure), bradycardia, and irregular respirations; it indicates raised intracranial pressure and impending brain herniation.

14. Contrast the CT appearance of epidural versus subdural hematoma.

    Epidural hematoma: biconvex/lens-shaped (lentiform), does not cross suture lines, often from middle meningeal artery. Subdural hematoma: crescent-shaped (concave), crosses suture lines, from bridging veins.

15. What is the classic triad of bacterial meningitis?

    Fever, neck stiffness (nuchal rigidity), and altered mental status; headache and photophobia are also common.

16. What is the most common pathogen of community-acquired bacterial meningitis in adults, and the key management priority?

    Streptococcus pneumoniae is most common; management priority is not to delay empiric antibiotics (± dexamethasone) for lumbar puncture or CT.

17. Contrast typical CSF findings in bacterial versus viral meningitis.

    Bacterial: high neutrophils, low glucose ($\frac{\text{CSF}}{\text{serum}}$ glucose ratio low), high protein, high opening pressure. Viral: lymphocyte predominance, normal glucose, normal/mildly elevated protein.

18. What are Kernig's and Brudzinski's signs used to detect?

    Meningeal irritation (meningismus): Kernig's sign is pain/resistance on knee extension with hip flexed; Brudzinski's sign is involuntary hip/knee flexion when the neck is passively flexed.

19. In the initial trauma assessment, what are the components of the AMPLE history?

    Allergies, Medications, Past medical history/Pregnancy, Last meal, and Events/Environment related to the injury.

20. List the classic components of Beck's triad, and what condition it indicates.

    Muffled heart sounds, distended neck veins (elevated JVP), and hypotension; it indicates cardiac tamponade.

21. What are the immediately life-threatening thoracic injuries identified during the primary survey (the 'lethal six'/deadly chest injuries)?

    Airway obstruction, tension pneumothorax, open pneumothorax, massive hemothorax, flail chest, and cardiac tamponade.

22. Describe tension pneumothorax and its immediate emergency treatment.

    A one-way air leak causes progressive pleural air accumulation, collapsing the lung and shifting the mediastinum, compressing venous return (obstructive shock). Treat with immediate needle decompression followed by tube thoracostomy.

23. How much blood loss in the pleural space defines a massive hemothorax requiring thoracotomy?

    Immediate drainage of $>1500\,\text{mL}$ ($\approx 1.5\,\text{L}$) of blood, or ongoing output of $>200\,\text{mL/hr}$ for 2-4 hours.

24. Classify hemorrhagic (hypovolemic) shock by ATLS Class I-IV according to approximate percent blood volume loss.

    Class I: $<15\%$ loss; Class II: $15$-$30\%$; Class III: $30$-$40\%$; Class IV: $>40\%$. Adult blood volume is $\approx 70\,\text{mL/kg}$.

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