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Emergency Medicine
Emergency Medicine is a branch of medicine that deals with patients in need of immediate medical attention. Those who study emergency medicine often work in the emergency room (ER) of a hospital.
233 Questions
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How long should a tourniquet be left on a pt arm during venipuncture procedure?
how long should a tourniquet stay on a patients arm:There is no clearcut rule as to how long a tourniquet may be inflated safely, although various investigators have addressed effects of ischemia on muscle and nerve to define a relatively "safe" period of tourniquet hemostasis. In practice, safe tourniquet inflation time depends greatly on the patient's anatomy, age, physical status, and the vascular supply to the extremity. Unless instructed otherwise, report to the surgeon when 60 minutes of tourniquet time has elapsed. There is general agreement that for reasonably healthy adults, 90 minutes should not be exceeded without releasing the tourniquet for a short time.
Who invented the first tourniquet?
The first tourniquet is attributed to the French surgeon Dominique Jean Larrey, who developed its practical use during the Napoleonic Wars in the early 19th century. However, the concept of a tourniquet has been around for centuries, with earlier references in ancient medical texts. Larrey's innovations helped standardize its use in battlefield medicine, significantly improving the treatment of severe limb injuries.
What was the sedation medicine they put into IV at the emergency room?
It depends on the purpose. For some procedures like setting a dislocated shoulder it's a combination of Fentanyl (a narcotic) and Versed (a benzodiazepine); at other times it's just Propofol which is also a narcotic. For patients suffering from acute chest pain it's not uncommon to administer Morphine because it calms the patient and decreases the pre-load and after-load on the heart. For pure agitation or acute alcohol withdrawal they'll usually administer an IV benzodiazepine such as Ativan or Diazepam. For larger combative patients it's usually impossible to obtain IV access; in that case I recommend a combination of Haldol 10mg, Ativan 2 mg, and Benadryl 50mg IM.
A windlass is basically a rotating level. It has a crank that winds rope onto a spool. The spool is geared and able to withstand major amounts of pressure.
What is a 1.5 x 1.5 cm focal rotator cuff tear?
A group of 4 muscles form the rotator cuff and help to stabilise the shoulder joint. It means that there is a tear in the rotator cuff muscles about 1.5 x 1.5 cm g. Rotator cuff injuries causes difficulty in lifting your arm and may require surgical intervention
Volume remains the same
Tank (vessels) expands
High space shock goes by other names you may be familiar with, such as relative hypovolemia or distributive shock. In this form of shock, the fluid volume remains the same, but the vessels dilate causing poor perfusion and hypotension. Fluid can also shift from intracellular to extracellular space. This can be seen in neuogenic shock (spinal shock) where vessels lose sympathetic tone (which causes vasoconstriction), anaphylaxis, or sepsis. All of these forms of shock show hypotension that should be initially managed with fluid, but it is not due to true hypovolemia.
Can iv haldol solution be given orally?
Yes, you could give the haloperidol solution orally, but the onset of action will not be as rapid as if you give it parenterally (intravenously or intramuscularly) and at typical parenteral doses, the efficacy may not be as complete.
What are the requirements for Board Certification for an Emergency Physician in the United States?
After residency and any fellowship training, an Emergency physician is considered Board Eligible. This means he or she is eligible to take the next round of certification exams. Depending on the accrediting body of the residency (AOA or ACGME), the Board Eligible physician takes a specific set of board exams.
For ACGME residency graduates, they are Board Certified under the American Board of Emergency Medicine (ABEM). They take a written exam and an oral examination. If they perform well enough to pass both exams, they are then Board Certified for a period of 10 years from the date of initial certification. When that certification expires, they may retake a written board exam and remain board certified, provided they have also performed all the requisite Continuing Medical Education (CME) and LifeLong Learning Assessment (LLSA) tests in the interim years.
For AOA residency graduates, they are Board Certified under the American Osteopathic Board of Emergency Medicine (AOBEM). They take a written exam, and oral exam, and after those are passed, must submit 20 charts for peer review. Once that is complete and all steps passed successfully, they are Board Certified for a period of 10 years, to be recertified every 10 years, after completing all AOBEM required CME and COLA (Continuous Osteopathic Learning Assessment - the AOBEM version of the LLSA).
What are EKG changes associated with an inferior STEMI?
An STEMI, or ST-segment Elevation Myocardial Infarction, is a condition in which the blood flow to the heart is blocked. This typically occurs due to rupture of a lipid plaque in the wall of an epicardial artery. This causes muscle cell death due to lack of oxygen and other substrates necessary for cell growth/maintenance.
The EKG can be used to localize the likely location of the blockage by looking at changes on the EKG. An inferior STEMI is characterized by ST elevations in the inferior limb leads, leads II, III, and aVF, associated with ST depressions (called reciprocal changes) in the lateral limb leads, I and aVL. An inferior STEMI most commonly is associated with a blockage in the right coronary artery (80% of the time).
Inferior STEMIs have a slightly better prognosis than anterior MIs. There is typically less heart muscle lost in association with inferior STEMI than when the MI affects the bulkier left side of the heart.
Which is the first aid for open pnuemothorax?
That is also called a "sucking chest wound". You place plastic sheeting directly over the wound to keep the lung from collapsing. If your victim cannot breathe, there is a good chance the lung is already collapsed and you will need to perform rescue breathing (mouth-to-mouth). The air in the lung cavity can escape back out of the chest cavity under the plastic and the lung may re-inflate. It will escape more effectively if you roll the victim so the wound is high. Leave the plastic in place. Treat for shock. Arrange for immediate transport to higher-level medical care.
30 minutes
Which is the most important indicator of a serious injury in a victim of a shotgun wound?
A huge gaping wound, loss of consciousness, absent or impaired breathing, fast and weak or absent pulse.
Is visiting an emergency room considered a hospitalization?
Technically no, it is an outpatient visit. You are not admitted to the hospital until you go to a room or care unit.
How many times is the windless rod turned on the Combat Application Tourniquet CAT?
With a properly applied tourniquet (i.e. "Pull the band very tight..." - per the instructions), you will not need to turn the windlass more than 3 rotations to achieve full occlusion of blood flow to the extremity.
Do you do two minutes of compressions after the pulse returns during CPR?
No. Once signs of life return, you should turn the patient onto the recovery position to maintain a patent airway.
If you feel any sort of resistance while doing chest compressions, it could mean that the patient has recovered. Stop CPR and check for their breathing and pulse.
If there are NO signs of life, carry on with CPR.
If the patient has a pulse AND is breathing adequately, put the patient onto the recovery position.
If the patient has a pulse BUT no breathing, continue mouth to mouth breathing/bag masking only.
Gurgling, gasping or any other signs of abnormal breathing should not be taken as signs of life. In this instance, assume they have no breathing and carry on with the Patient Action Plan.
Can you get gangrene in the leg from being shot with a BB gun?
Sure you can. This medical condition is an old one and can turn up in the smallest of wounds if the conditions are right.
