Emergency Medicine Flashcards

A 58-year-old man presents with crushing chest pain radiating to the left arm for 45 minutes. ECG shows ST elevation in leads II, III, and aVF. What is the most appropriate immediate management?

Answer: Administer aspirin 325 mg and arrange urgent percutaneous coronary intervention (PCI)

ST-elevation myocardial infarction (STEMI) requires immediate aspirin administration and urgent reperfusion via PCI within 90 minutes of first medical contact.

A 25-year-old woman develops urticaria, angioedema, and hypotension minutes after receiving penicillin. What is the first-line treatment?

Answer: Epinephrine 0.3–0.5 mg IM in the lateral thigh

Intramuscular epinephrine is the first-line treatment for anaphylaxis because it reverses bronchoconstriction, vasodilation, and mucosal edema simultaneously.

A 70-year-old man presents with sudden-onset right-sided weakness and aphasia. CT head shows no hemorrhage. Onset was 1.5 hours ago. What is the next best step?

Answer: Administer IV alteplase (tPA) after confirming no contraindications

IV alteplase is indicated for ischemic stroke within 4.5 hours of onset when hemorrhage is excluded and no contraindications are present.

Which set of criteria best defines the Systemic Inflammatory Response Syndrome (SIRS) used as a component of sepsis identification?

Answer: Fever >38°C, HR >100, RR >20, WBC >12,000 or <4,000 (2 of 4 criteria)

SIRS is defined by 2 or more of: temperature >38°C or 90, RR >20 or PaCO2 12,000 or 10% bands.

A 19-year-old with type 1 diabetes presents with blood glucose of 28 mmol/L, pH 7.22, bicarbonate 14 mEq/L, and large urinary ketones. What is the priority in initial management?

Answer: Start IV normal saline fluid resuscitation and monitor electrolytes

IV fluid resuscitation with normal saline is the first priority in DKA to restore intravascular volume before insulin is initiated, as insulin without fluids can worsen hypovolemia.

A 35-year-old woman who is 32 weeks pregnant presents with acute dyspnea, pleuritic chest pain, and tachycardia after a 10-hour flight. CT pulmonary angiography confirms pulmonary embolism. What anticoagulant is preferred?

Answer: Low-molecular-weight heparin (LMWH) such as enoxaparin

LMWH is the anticoagulant of choice during pregnancy because it does not cross the placenta, unlike warfarin, and direct oral anticoagulants are not approved in pregnancy.

A trauma patient develops sudden tracheal deviation to the left, absent breath sounds on the right, hypotension, and distended neck veins. What is the immediate treatment?

Answer: Needle decompression at the second intercostal space, midclavicular line on the right

Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression; delaying for imaging can be fatal.