By Bobby Desai, Brandon Allen
This ebook is a accomplished and updated learn advisor for these getting ready to take the written emergency drugs board exam. It serves as a concise textual content of emergency medication. it's exclusive by means of a problem-oriented procedure and is gifted in a visible and simply understandable layout. The reader is walked via the way to arrive on the analysis for every power emergency state of affairs, with every one prognosis or challenge damaged down into symptoms, signs, workup (labs and imaging), and disposition. this beneficial advisor captures the most recent advancements in emergency medication, together with the most recent applied sciences and methodologies, akin to ultrasound, and simulation, that are turning into an more and more vital a part of emergency medication schooling and perform, as mirrored within the board examination. this can be an excellent software for emergency medication citizens and school, serious care trainees, medical professional assistants and nurses operating in emergency medication, and scientific scholars.
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Additional info for Nailing the Written Emergency Medicine Board Examination
Blockers Medications to decrease obstruction? Negative inotropes Surgical treatment? Surgical myomectomy Disposition Depends on clinical condition Arrhythmias Echo β–blockers Exacerbation? Holter OR Calcium channel blockers Admit Due to Risk for sudden cardiac death Cardiovascular Emergencies 55 Restrictive Cardiomyopathy Sarcoid Most common cause of Restrictive CM? May be familial Autosomal dominant Idiopathic Multiple other causes Amyloid Scleroderma Hemochromatosis Systolic function is usually normal Restrictive CM LV end diastolic Restrictive CM Normal or decreased filling of one or both ventricles But… RV end diastolic pressure Ventricular wall thickness may be normal or increased Early diastolic pressure has a decrease followed by a rapid rise & plateau Normal LV systolic function pressure EF ≥ 50 % Restrictive Cardiomyopathy: Clinical Features Exam JVD Rales PND Symptoms & signs of CHF Peripheral edema Orthopnea Dyspnea Right sided CHF Hepatomegaly CP uncommon RUQ pain Except in amyloidosis CXR Pulmonary congestion Ascites EKG Normal heart size Nonspecific ST-T changes CHF Kerley B lines Upper lung field hyperemia Overall increase in vascular markings Echo Confirmatory Low voltage may be seen A.
Desai 52 Dilated Cardiomyopathy: Clinical Features Symptoms & signs of CHF Exam Murmurs Rales PND Due to poor closure of valves, not necessarily valvular issues Peripheral edema Orthopnea Peripheral embolization Dyspnea CP usually due to lack of vascular reserve Sudden death is possible EKG CXR Pulmonary congestion Cardiomegaly CHF Globular heart LVH LAE Poor R wave progression Rhythm disturbances A. fib Most common findings Kerley B lines Ventricular ectopy Upper lung field hyperemia Overall increase in vascular markings Echo Ejection fraction Systolic volume Diastolic volume May see a mural thrombus due to these factors Ventricular enlargement Atrial enlargement Conduction defects 53 Cardiovascular Emergencies Dilated Cardiomyopathy: Treatment Treatment is largely supportive Chronic therapy Diuretics Digoxin Survival ACE inhibitors β–blockers Ventricular ectopy?
OR Titrate nitroglycerin rapidly BP improves Until BP is controlled Start Nitroglycerin Increased mortality Vasodilator Consider IV nitroprusside Vasodilation contraindications Preload dependent states Preload dependent states RV infarction IV ACE inhibitor? Volume depletion Worsened renal function May prolong survival Aortic stenosis Non-cardiogenic Pulmonary Edema Amniotic fluid emboli Strangulation Toxins Non-Cardiogenic Pulmonary Edema Fat emboli Salicylates Phenobarbital Carbon monoxide Opioids Environmental High altitude pulmonary edema Thermal injury Drowning Use IV diuretics in settings of volume overload Hypertrophic cardiomyopathy Cardiovascular Emergencies 31 Valvular Emergencies New Murmur Systolic Murmur Diastolic Murmur Normal Heart OR New murmur with Sx at rest Consider Pregnancy Thyrotoxicosis Fever High output state Echocardiogram Echocardiogram ere Sev Anemia Urgent Cardiology referral Emergent Cardiology referral Admission Symptoms No t se ver e Symptoms are most important to consider, not the murmur New Systolic Murmur Syncope Outpatient referral Aortic Stenosis Until proven otherwise Pregnant New Murmur Mitral Stenosis Until proven otherwise New Aortic Regurgitation?