Iran Specialty Board - Emergency Medicine flashcards

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

Shock index

Heart rate divided by systolic blood pressure. Normal is about 0.5-0.7; values above 0.9 suggest occult hemorrhage or hemodynamic decompensation and should prompt further evaluation.

Defibrillation energy for VF

Biphasic defibrillators use 120-200 J depending on manufacturer, while monophasic devices use 360 J. Resume compressions immediately after shock delivery without a pulse check.

Post-ROSC oxygenation target

After return of spontaneous circulation, titrate oxygen to SpO2 92-98% and avoid hyperoxia. Target PaCO2 35-45 mmHg and avoid hyperventilation, which reduces cerebral perfusion.

Permissive hypotension

Strategy in hemorrhagic shock that limits fluid resuscitation to keep systolic blood pressure around 80-90 mmHg until hemorrhage control. Avoid in traumatic brain injury.

STEMI ECG criteria

ST elevation of at least 1 mm in two contiguous limb leads, or at least 2 mm in V2-V3 in men over 40, or new LBBB with ischemic symptoms.

Aortic dissection blood pressure control

Give intravenous beta-blocker to achieve heart rate around 60/min and systolic blood pressure 100-120 mmHg before adding a vasodilator, to reduce aortic wall shear stress.

Wells score for pulmonary embolism

Clinical prediction rule combining signs of DVT, alternative diagnosis less likely, tachycardia, immobilization or surgery, prior VTE, hemoptysis, and malignancy. Low scores allow D-dimer testing.

Synchronized cardioversion

Delivery of a shock synchronized to the QRS complex for unstable tachyarrhythmias with a pulse. Typical energies: 50-100 J narrow regular, 100 J wide regular, 120-200 J narrow irregular.

Tension pneumothorax decompression

Clinical diagnosis requiring immediate needle decompression followed by tube thoracostomy. Preferred site in adults is the 5th intercostal space at the anterior axillary line.

FAST examination windows

Four sonographic views: subxiphoid for pericardial fluid, right upper quadrant for Morison pouch, left upper quadrant for splenorenal space, and suprapubic for pelvic fluid.

Parkland burn formula

Estimate 4 mL/kg body weight per percent total body surface area of lactated Ringer solution in the first 24 hours, with half given in the first 8 hours from injury.

Compartment syndrome pressure threshold

Absolute compartment pressure above 30 mmHg, or a difference between diastolic pressure and compartment pressure under 30 mmHg, supports fasciotomy in the appropriate clinical setting.

Acetaminophen overdose antidote

N-acetylcysteine replenishes glutathione and is most effective within 8 hours of ingestion. Use the Rumack-Matthew nomogram at 4 hours or later to guide treatment.

Salicylate toxicity treatment

Urinary alkalinization with intravenous sodium bicarbonate targets urine pH 7.5-8.0. Hemodialysis is indicated for severe toxicity, renal failure, seizures, or pulmonary edema.

Tricyclic antidepressant overdose

Sodium channel blockade causes QRS widening and ventricular arrhythmias. Give sodium bicarbonate 1-2 mEq/kg for QRS above 100 ms or arrhythmia; avoid class IA and IC agents.

Heat stroke management

Core temperature above 40 C with central nervous system dysfunction. Rapid cooling by ice immersion or evaporative methods to below 39 C within 30 minutes improves outcomes.

Alteplase stroke dosing

Give 0.9 mg/kg intravenously, maximum 90 mg, with 10% as a bolus over one minute and the remainder over 60 minutes. Must be within 4.5 hours of symptom onset.

Status epilepticus treatment sequence

First-line benzodiazepine such as lorazepam 0.1 mg/kg or intramuscular midazolam. If seizures persist, give fosphenytoin, valproate, or levetiracetam, then intubate with continuous infusion.

Bacterial meningitis empiric therapy

Ceftriaxone plus vancomycin, with dexamethasone given before or with the first antibiotic dose. Add ampicillin for Listeria coverage in patients over 50 or immunocompromised.

ARDS Berlin criteria

Acute onset within one week, bilateral opacities on imaging, respiratory failure not fully explained by cardiac failure, and PaO2/FiO2 ratio of 300 or less on PEEP at least 5.

Lung-protective ventilation targets

Tidal volume 6 mL/kg predicted body weight, plateau pressure 30 cmH2O or less, and driving pressure 15 cmH2O or less. Permissive hypercapnia is acceptable if pH remains above 7.20.

Noninvasive ventilation indications

Strong evidence for COPD exacerbation with respiratory acidosis and acute cardiogenic pulmonary edema. Contraindicated with altered mental status, inability to protect airway, or facial trauma.

Pediatric assessment triangle

Three components: appearance, work of breathing, and circulation to skin. Abnormal appearance is the most sensitive predictor of serious illness in children.

Pediatric epinephrine cardiac arrest dose

Give 0.01 mg/kg intravenously or intraosseously, which equals 0.1 mL/kg of 1:10,000 concentration, every 3-5 minutes during pediatric cardiac arrest.

Croup treatment

Single dose of dexamethasone 0.15-0.6 mg/kg for all severities. Add nebulized epinephrine 1:1000 for stridor at rest or severe distress, and observe for rebound symptoms.

Magnesium sulfate for preeclampsia

Loading dose 4-6 g intravenously over 20 minutes, then 1-2 g per hour. Monitor deep tendon reflexes, respiratory rate, and urine output; treat toxicity with calcium gluconate.

Postpartum hemorrhage first steps

Uterine atony is most common. Give oxytocin, uterine massage, then methylergonovine, carboprost, or misoprostol. Add tranexamic acid 1 g intravenously within 3 hours.

Ectopic pregnancy management

Check beta-hCG and transvaginal ultrasound. Hemodynamic instability or rupture requires urgent surgery. Stable, small, unruptured cases with low beta-hCG may be treated with methotrexate.

Lung ultrasound for pneumothorax

Absence of lung sliding with A-lines suggests pneumothorax. The lung point, where sliding reappears, is specific. B-lines rule out pneumothorax at that location.

START triage categories

Mass casualty triage using respirations, perfusion, and mental status. Categories are immediate (red), delayed (yellow), minor (green), and expectant or deceased (black).

EMTALA obligations

Provide a medical screening examination and stabilizing treatment regardless of insurance status. Transfer requires stabilization or physician certification that benefits outweigh risks.

Number needed to treat

One divided by the absolute risk reduction. It estimates how many patients must be treated to prevent one additional bad outcome; lower values indicate greater clinical benefit.