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NRS 410. Series > 410C Quiz 1: sensitive exam, MSK, IV injections/fluids > Flashcards

410C Quiz 1: sensitive exam, MSK, IV injections/fluids Flashcards

1
Q

When should you release the tourniquet when taking blood?

A

after the flash, before you use the tubes

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2
Q

Shoulder Joints

A
  • Contains the scapula, humerus, clavicle, glenohumeral joint, acromioclavicular joint
    • glenohumeral is the actual shoulder joint
    • scapulothoracic joint is in the back → important for impingement injuries
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3
Q

Rotator Cuff General info

A
  • consists of SITS: supra spinatus, infra spinatus, teres minor, sub scapularis
    • impingement syndrome → most important muscle = supra spinatus muscle b/c it passes beneath the acromion
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4
Q

Y view of the shoulder

A
  • aka transcapular view b/c it shoots down the body of the scapula
  • used to look for impingement
  • gets a good look at the acromion
  • used to assess the acromion
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5
Q

What is the grashey view?

A

Shoulder film

no overlap of the humerus and glenoid

  • Used to see the glenohumeral joint
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6
Q

Xray of (lateral & AP) Elbow vs radial-capitellar view

A
  • Xray Elbow:
    • cannot see the radial head that well
  • XR Elbow Radiocapitellar View:
    • if suspect elbow fracture (usually a radial head fracture) → need to order a radiocapitellar view
    • better view of the radial head
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7
Q

Posterior vs Anterior Fat Pads in the Elbow

A
  • Anterior can be normal
  • Posterior is always Pathological
    • indicative of a fracture
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8
Q

Galeazzi Fracture vs Monteggia Fracture

A

“Gruesome Murder”

  • Galeazzi: Radial fracture, ulnar dislocation (distal)
  • Monteggia: Ulnar fracture, radial dislocation (proximal)
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9
Q

Torus/Buckle Fracture

A
  • AP of the wrist
  • kids bones are covered with a very thick, fibrous periosteum
  • torus, buckle, and greenstick are all the same thing
  • **Only found in children → check for open growth plate
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10
Q

Salter Harris Classification

A
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11
Q

Pelvis Fractures

A

Super serious, major trauma!!

look for associated injuries

  • anticipate large blood loss
    • up to 9-15 units of blood in unstable fractures
    • external and internal iliac arteries are present anterior
    • femoral artery, profunda and circumflex artery are present posterior
  • tx:
    • admission
    • look for associated injuries → vessel/bladder/nerve/head trauma/ cervical spine injuries
    • Manage blood loss
    • often surgical
      • **side note: pelvis & ankle are a ring so if there is one fracture it is still stable, but two make it unstable!!!
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12
Q

Garden Classification of Hip Fractures

A
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13
Q

Names of Different Fractures

A
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14
Q

What do you do if you see a tibial plateau fracture?

A

if both side → need CT

could be due to MVA

need neurovascular exam ASAP

check hgb & HCT asap

give blood prn

check for compartment syndrome!

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15
Q

Mortise Joint

A
  • the medial malleolus of the tibia forms the top of the mortise joint
  • can order a mortise view -→ can see both sides
    • spaces in the mortise joint should be equal ~1mm
    • if there is a difference in the spaces = displaced ankle
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16
Q

Lisfranc Injury

A
  • VERY BAD, takes significant trauma
  • Can’t miss
  • usually requires surgery to repair
    • and often has residual issues after surgery
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17
Q

Phalangeal Fractures

A

Most are not problematic except the great toe

  • can often be reduced & taped
  • use postop shoe or split
  • great toe will often require surgery
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18
Q

Jones Fracture

A
  • Proximal 5’th metatarsal diaphysis fracture
  • Pain over the lateral border of the forefoot, especially with weight-bearing
  • The fracture is believed to occur as a result of significant adduction force to the forefoot with the ankle in plantar flexion
  • The area has a poor blood supply
  • Treatment: Walking boot/cast, RICE, surgery for displaced fractures. Requires 6 weeks of non-weight bearing
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19
Q

What should you never do with a fresh fracture?

A

put the pt in the cast → you need to splint then refer

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20
Q

What films do you need to order for a shoulder dislocation?

A

Axillary View and AP view before AND after reduction

21
Q

If pt fell on their arm in full extension what film do you need to order?

A

Grashey view

22
Q

What is the most important muscle for impingement?

A

Supraspinatus

23
Q

If pt has impingement syndrome what film do you always order & why?

A

Y film → b/c if you don’t order Y view you might not know that the acromion is a type III which requires surgery and that is why the injury isn’t resolving → not enough anatomical space for the supraspinatus tendon

24
Q

If pt comes in for a fall on their hand with positive snuffbox tenderness what film should you order and why?

A

Scaphoid view b/c this is a scaphoid fracture until proven otherwise

25
Q

What size angiocath is most appropriate for: IV maintenance fluids vs blood infusion

A

IV maintenance fluids: 20g

Blood infusion: 18g

26
Q

Why do we use a saline flush on extension tubing and a saline lock?

A

ensuring extension tubing is patent

prevent an air embolism

27
Q

How long should you leave the tourniquet in place?

A

no longer than 1-2 minutes at a time

28
Q

How often does the CDC recommend changing the peripheral IV site?

A

72-96 hours

29
Q

Calculating Body Water

A
  • BW = 60% of body weight
    • ICF = ⅔ of body water
    • ECF = ⅓ of body water
      • ¾ of ECF = interstitium
      • ¼ of ECF = plasma
30
Q

Osmolality Definition & normal values

A
  • Definition:
    • solute or particle concentration of a fluid
  • Normal range: 280-295 mOsm/kg
  • Symptomatic when numbers are:
    • >320-330 mOsm/kg or <265 mOsm/kg
31
Q

How to calculate osmolality?

A

2x (sodium) + glucose/18 + BUN/2.8

32
Q

Conditions that cause Hypovolemia

A
33
Q

Conditions that Cause Hypervolemia

A
34
Q

Renin-Angiotensin System

A
35
Q

What is the most common maintenance fluid?

A

D5W ½ NS

36
Q

How to Tx Volume Overload

A
37
Q

IV Cath size and flow rates

A
38
Q

5% albumin vs 25% albumin

A
  • if 1 liter of 5% albumin is given, all will stay in intravascular space because its too large to cross the cell membrane
    • 1000mL → 1000mL
  • if 100mL of 25% albumin is given, it will draw 5x its volume into the intravascular compartment
    • 100mL → 500mL
39
Q

Types & Cross

A

Blood is taken from the pt and typed and then crossed with a donor blood to look for agglutination/rxn

  • takes 45min -1 hour → so ACT EARLY!
  • type & cross is only good for 48-72hrs so may need a new one
  • how much do you ask for? 2-6 units
  • use O- is you cannot wait (often the case!)
40
Q

when do you give blood?

A

if Hgb of 7 without active bleed

if hgb of 9-10 with active bleed

41
Q

How much increase in hgb from packed red blood cells?

A
  • expect increase of 1gm/dl in Hgb (3%) in HCT from a unit (325-350ml) of PRBCs
42
Q

When do you start adding FFP, Cryo & platelets?

A

after 4 units of packed red blood cells

may be needed sooner based on findings → check fibrinogen, platelet count, ACT, INR

if FFP isn’t thawed it may reduce effectiveness of coagulation factors (due to the cold)

43
Q

What fluids are okay to bolus?

A

Normal Saline

Normosol R

Lactated Ringer’s

PLasma-Lyte 148

44
Q

Maintenance Fluids rates and additions

A
45
Q

Potassium Repletion Infusion Rates

A
46
Q

What is pelvic pain in a woman < 50yo until proven otherwise?

A

ectopic pregnancy

47
Q

What does the sexual history include?

A
  • Gender identity
  • sexual orientation
  • social hx
  • GU & Genital ROS
  • GYN hx → pregnancies, deliveries, menarche etc
48
Q

6 Ps of Sexual History

A
  1. Partners
  2. Practices
  3. Protection from STIs
  4. Past Hx of STIs
  5. Pregnancy Intention
  6. (Pleasure)

NRS 410. Series (18 decks)

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