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ED SAEM TEST QUESTIONS AND ANSWERS
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ED SAEM TEST QUESTIONS AND ANSWERS
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ED SAEM TEST QUESTIONS AND ANSWERS1. list ottawa ankle rules
2. where should you also check on exam/be aware of? - Answers -1. inability to walk 4
steps immediately & in ED + any of the following:
- medial malleolus tenderness
- lateral malleolus tenderness
- navicular tenderensss
- 5th metatarsal tendereness
2. check fibular head tenderness- twisting injury ~ fibular fx
name SIRS criteria (4)
Describe CHEST study findings - Answers -1. Temp < 36 or >38
2. HR >90
3. RR >20 or PaCO2 <32
4. WBC 4,000 > x > 12,000
CHEST study (JAMA): previous SCC (surviving sepsis campaign) studies did not look at
wards; found that SIRS reminders did not affect mortality
1. define sepsis
2. define severe sepsis- criteria?
(SBP, Cr, bili, PLT, INR, lactate)
3. define septic shock - Answers -1. pt who has potential infectious cause for SIRS
syndrome
2. sepsis-induced organ dysfunction. Criteria:
SBP <90 or MAP <70 or SBP decrease >40
Cr >2.0 or urine output <0.5ml/kg/hr
Bili >2
PLT <100,000
INR >1.5 or PTT >60s
lactate >2 mmol/L
3. low BP despite fluid administration
1. what lab is the ECG of sepsis?
2. list of labs to get for sepsis?
3. 3 hour bundle for sepsis?
4. 6 hour bundle? - Answers -1. lactate
2. CBC, CMP, PT/INR/PTT, blood Cx x2, UA, CXR
3. lactate measurement, blood Cx then administration of broad spectrum abx, admin. of
30mL/kg IV crystalloid for hypoTN or lactate >4
4. vasopressors for goal MAP >65, reassess & document volume, repeat lactate if
initially >4
name the AEIOUTIPS of AMS - Answers -A = alcohol
E = epilepsy, electrolytes, encephalopathy
I = insulin
,O = opiates & oxygen
U = uremia
T = trauma & temp
I = infection
P = poison & psychogenic
S = shock, stroke, subarachnoid hemorrhage, space-occupying lesion
1. MC cause of asthma exacerbation?
2. Qs to ask pt when they come in?
3. mainstay of therapy? (1st line)
4. if mod/severe, give what?
5. if severe & not improving with albuterol, use what? (4 things)
6. criteria for ICU admission? - Answers -1. URI
2. previous episodes, prior ED visits, hospitalizations or ICU admissions, steroid use,
past intubations
3. albuterol nebulizer continuous 6-8L/min or via nasal cannula, place on cardiac
monitor/continuous pulse oximetry with goal SpO2 >92%
4. oral/IV steroids
5. IM > SQ epinephrine 0.2mg or terbutaline 0.25 mg. Also ipratropium (anticholinergic)
combined w albuterol = Duonebs. Last line: MgSO4
6. <90% SpO2, FEV1 < 40%
1. how is dosing of drugs administered endotracheally? which drugs?
2. when do you think of H's and T's?
3. things to order during ACLS?
4. successful resuscitation dependent on what? Joules on biphasic & monophasic?
5. doses of Epi, vasopressin, amiodarone? - Answers -1. 2-2.5x the IV route. Drugs:
NAVEL- naloxone, atropine, vasopressin, Epi, Licocaine
2. during PEA/asystole
3. EKG, ABG, serum electrolytes, CXR, US
4. rapid defibrillation. biphasic: 200. Monophasic: 360
5. Epi 1mg (1:10,000), vaso 40U, amiodarone 300mg >150mg
1. name 4 areas of possible hemorrhage?
2. management of drowning victim?
3. at what T does shivering stop?
4. define moderate hypothermia & Sx/VS
5. define severe hypothermia & mgmt - Answers -1. intraperitoneal space,
retroperitoneal space, thorax, GI
2. ABCs, SpO2, rewarming if hypothermic, CXR, C-spine eval if suspect trauma, EKG.
NO role for abx!
3. Below 32 celcius
4. 28-32 celcius: AMS, bradycardia, bradypnea
5. T <28. Mgmt: core active rewarming w warm IV fluids
, 1. name the causes of metabolic acidosis? mnemonic for mgmt? - Answers -M -
methanol/metformin
U - uremia
D - diabetic ketoacidosis
P - paraldehyde
I - isoniazid/iron
L - lactate
E - ethylene glycol
S - salicylates: (both is an acid & uncouples oxidative phosporylation)
Mgmt mnemonic: KULTS?
1. what substances does activated charcoal not work on?
2. Tx for lithium overdose?
3. Tx for cocaine toxicity?
4. ASA overdose acid/base status?
5. Lethal acetaminophen dose? mgmt?
6. clonidine overdose Sx? mimics what?
7. pt drinks windshield wiper fluid- antidote?
8. pt drinks antifreeze- antidote? - Answers -1. Li, lead, Fe, caustic liquids
2. dialysis
3. lorazepam
4. Anion gap metab. acidosis + respir. akalosis
5. 150mg. Mgmt: activated charcoal early, measure serum levels @ hour 4-->ORAL N-
acetylcysteine
6. hypo-TN, bradycardia, AMS, respir. depression, miosis. Mimics opioids.
7. = methanol. Fomepizole
8. = ethylene glycol = Fomepizole. get Ca Oxalate crystals.
1. pt coming out of surgery has weird blood discoloration and SOB- dx? pulse ox? Tx?
2. define shock
3. name the 4 types
4. 1st invervention?
5. BP drops when what % intravascular volume is lost?
6. best IV method? reasonable fluids? - Answers -1. methemoglobinemia. Pulse ox not
helpful bc can't distinguish b/w oxy & methemoglobin. Tx: methylene blue.
2. inadequate end organ perfusion
3. hypovolemic, cardiac, distributive, obstructive
4. supplemental oxygen
5. 30%
6. 14 or 16g catheter- femoral > IJ, subclavian. NS, LR, blood, albumin
1. options in cardiogenic shock?
2. Tx spinal cord injury with neurogenic shock?
3. common organisms that cause sepsis?
4. possible complications of septic shock?
5. upper limit of normal body T? - Answers -1. dobutamine, intra-aortic balloon pump
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