Foundations of Emergency Medicine

Get ready EM world! We have a new, weekly series starting THIS MONDAY on Instagram (@foundationsem) fit for anyone looking for a sprinkle of learning on their daily insta scroll. First up: dental trauma! See you Monday 👀

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Appropriate imaging to evaluate for sternal fracture? A: Must include lateral CXR (consider CT if high suspicion and XR neg) #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

Dx and Tx of Flail Chest? A: >3 adjacent rib fractures with paradoxical motion during respirations - associated with pulmonary contusion - Tx with intubation, do chest tube prn #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

Tx of Traumatic Aortic Dissection A: if stable get XR (1/3 normal, mediastinal widening, obscured aortic knob, loss of AP window, R displaced NGT, L displaced bronchus, wide paratracheal stripe, L apical pleural cap) - if VERY stable get CTA - OR on beta blocker for BP control

Dx of Traumatic Aortic Dissection? A: (most die in field) high speed deceleration, chest pain/back pain, new murmur, pulse deficits BUT exam often unremarkable #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

Dx and Tx of Nasal Septal Hematomas? A: dark red hematoma associated with nasal fx/trauma - must incise and pack to prevent saddle nose deformity/pressure necrosis #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

Dx and Tx of Orbital Fractures? A: diplopia, proptosis, limited EOM, decreased VA - get CT, consult ophtho/ENT - check for infraorbital paresthesia or globe injury - give abx if sinus involvement #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

What are some injuries CT scans can commonly miss? A: diaphragmatic injury, pancreas injury, basilar skull fracture, hollow viscus injuries #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

What are the vital sign changes with brain herniation? A: Cushing's reflex (2/2 increased ICP): Hypertension, Bradycardia, Irregular Respirations #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

Treatment of seizures related to eclampsia? A: Magnesium 6gm IV #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

What medications are most appropriate for the treatment of Status Epilepticus? A: Benzodiazepines, phenytoin vs fosphenytoin (second line), phenobarbital (third line) #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

What is appropriate chemoprophylaxis for a healthcare worker exposed to N. meningitidis? A: Rifampin 600mg BID x2d OR Ceftriaxone 250 mg IM x1 OR Ciprofloxacin 500 mg PO x1 #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

Prophylaxis for close contacts of a patient with Neisseria Meningitis? A: Rifampin #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

Treatment for Brain Abscess A: IV ceftriaxone, Flagyl (for anaerobes), and neurosurgery consult #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

Describe the technique for Kernig and Brudzinski signs for meningeal irritation: Kernig: knees hips flexed, extend leg causing pain Brudzinski: flexion of the neck causes reflexive flexion at hips and knees #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

What is the most common cause of meningitis in an adult? A: Strep pneumo #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

Patient presents with diplopia with lateral gaze: A: Intranuclear ophthalmoplegia - associated with MS #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine

What is the dosing for tPA in ischemic stroke? A: 0.9 mg/kg (up to 90 mg) with 10% of the dose given as a bolus and the rest of the dose given as an infusion over 1 hour #FoEMPearls #GrowRoots #FoEM #EmergencyMedicine