ABEM ACCM flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

STEMI reperfusion time goals

Primary PCI should be performed within 90 minutes of first medical contact at a PCI-capable center; fibrinolysis should begin within 30 minutes when PCI is unavailable and symptoms started under 12 hours.

Cardiac tamponade decompensation trigger

Positive-pressure ventilation and intubation can precipitate cardiovascular collapse in tamponade because increased intrathoracic pressure further impairs right ventricular filling; drainage should precede or accompany induction when feasible.

Aortic dissection pressure target

In acute aortic dissection, intravenous beta-blockade slows heart rate to about 60 beats per minute before adding a vasodilator such as nicardipine, targeting systolic pressure near 100 to 120 mmHg.

High-risk pulmonary embolism treatment

Pulmonary embolism with hypotension or shock warrants systemic thrombolysis, catheter-directed therapy, or surgical embolectomy; anticoagulation alone is insufficient because right ventricular failure drives mortality.

ARDS lung-protective ventilation

Ventilate with tidal volumes of 6 mL/kg predicted body weight and target plateau pressure below 30 cm H2O, allowing permissive hypercapnia; higher PEEP may be added for refractory hypoxemia.

Tension pneumothorax decompression sites

Needle decompression is performed at the second intercostal space midclavicular line or the fifth intercostal space anterior axillary line, followed by tube thoracostomy; treatment must not await radiographic confirmation.

Light criteria exudate

Pleural fluid is exudative when the protein ratio exceeds 0.5, the LDH ratio exceeds 0.6, or fluid LDH exceeds two-thirds the upper limit of normal serum LDH.

Spontaneous bacterial peritonitis threshold

Ascitic fluid polymorphonuclear count of 250 cells per microliter or greater establishes spontaneous bacterial peritonitis; start cefotaxime and add albumin for renal impairment or bilirubin above 4.

Acute variceal hemorrhage bundle

Give octreotide bolus then infusion plus prophylactic ceftriaxone, resuscitate to a restrictive hemoglobin target near 7 g/dL, and arrange endoscopic band ligation within 12 hours.

Mesenteric ischemia imaging choice

Acute mesenteric ischemia presents with pain out of proportion to examination; CT angiography of the abdomen and pelvis is the diagnostic study of choice, followed by heparin and urgent revascularization.

Status epilepticus escalation sequence

Give a benzodiazepine first, then a second-line agent such as levetiracetam, fosphenytoin, or valproate; refractory status requires intubation and continuous propofol, midazolam, or pentobarbital infusion.

Thrombolysis blood pressure limits

Before alteplase for ischemic stroke, blood pressure must be below 185/110 mmHg; after administration keep it below 180/105 for 24 hours using labetalol or nicardipine.

Apnea test carbon dioxide target

In brain death determination, disconnect from the ventilator after preoxygenation while monitoring for respiratory effort; a rise in arterial carbon dioxide above 60 mmHg with no breathing supports the diagnosis.

Tranexamic acid in trauma

Give 1 gram of tranexamic acid intravenously over 10 minutes followed by 1 gram over 8 hours, ideally within 3 hours of injury, for trauma patients with significant bleeding.

Permissive hypotension exclusions

Target systolic pressure near 80 to 90 mmHg until hemorrhage control, but maintain higher pressure in traumatic brain injury and pregnancy; excessive crystalloid worsens coagulopathy and hypothermia.

Parkland burn formula

Estimate 2 to 4 mL per kg body weight per percent total body surface area of lactated Ringer solution in the first 24 hours, giving half in the first 8 hours from burn time.

Perimortem cesarean timing

In maternal cardiac arrest, begin cesarean delivery within 4 minutes of arrest and complete by 5 minutes to improve maternal hemodynamics and fetal survival when resuscitation is unsuccessful.

Acetaminophen toxicity antidote

N-acetylcysteine is most effective when started within 8 hours of ingestion; risk is stratified using the Rumack-Matthew nomogram applied to a level drawn 4 or more hours after ingestion.

Tricyclic overdose wide QRS

Sodium bicarbonate 1 to 2 mEq/kg treats tricyclic-induced sodium channel blockade when QRS exceeds 100 ms or arrhythmia or hypotension appears; avoid class IA and IC antiarrhythmics.

Lipid emulsion dosing

For local anesthetic systemic toxicity, give 20 percent lipid emulsion 1.5 mL/kg as a bolus followed by infusion of 0.25 mL/kg/min; repeat the bolus if circulation does not improve.

Heat stroke cooling

Exertional heat stroke with core temperature above 40 Celsius and central nervous dysfunction requires immediate cold water immersion; antipyretics are ineffective because the hypothalamic set point is normal.

High-altitude cerebral edema treatment

Give dexamethasone 8 mg then 4 mg every 6 hours and descend immediately; supplemental oxygen and a portable hyperbaric chamber are temporizing measures when descent is delayed.

Drowning resuscitation priority

Hypoxia is the primary insult in drowning, so begin rescue breathing and CPR promptly; routine cervical spine immobilization and attempts to drain aspirated water are not indicated.

Compartment syndrome delta pressure

Delta pressure, diastolic blood pressure minus compartment pressure, below 30 mmHg with compatible symptoms justifies fasciotomy; palpable pulses are typically preserved until late in the course.

Necrotizing fasciitis treatment

Immediate surgical debridement plus broad-spectrum antibiotics including clindamycin for toxin suppression; imaging should not delay surgery when clinical suspicion is high.

Open fracture antibiotics

Administer prophylactic antibiotics within 1 hour of an open fracture, provide tetanus prophylaxis, and proceed to irrigation and debridement; avoid probing the wound in the emergency department.

Septic shock initial bundle

Measure lactate, obtain cultures, give broad-spectrum antibiotics within 1 hour, and infuse 30 mL/kg crystalloid; start norepinephrine for persistent hypotension with a mean arterial pressure target of 65 mmHg.

Anaphylaxis epinephrine dose

Intramuscular epinephrine 0.3 to 0.5 mg of the 1 mg/mL concentration into the lateral thigh, repeated every 5 to 15 minutes, is first-line therapy; antihistamines and steroids are adjuncts only.

ACE inhibitor angioedema mechanism

ACE inhibitor angioedema is bradykinin mediated and responds poorly to epinephrine; treat airway compromise with fresh frozen plasma, icatibant, or C1 esterase inhibitor concentrate.

Hyperkalemia membrane stabilization

Give intravenous calcium gluconate or chloride for ECG changes, then shift potassium intracellularly with insulin plus glucose and nebulized albuterol; dialysis removes total body potassium.

DKA potassium replacement rule

Total body potassium is depleted in diabetic ketoacidosis; begin replacement once serum potassium is below 5.2 mEq/L and renal output is adequate, and add dextrose when glucose nears 200 mg/dL.

Thrombotic thrombocytopenic purpura treatment

Thrombotic thrombocytopenic purpura is a hematologic emergency treated with urgent plasma exchange; platelet transfusion is avoided unless bleeding is life-threatening because it can worsen microvascular thrombosis.