CEN study notes as questions Flashcards
What type of antibodies are produced during an allergic reaction
IgE antibodies
Scientific name of hives
Urticaria
Scientific name of species of bees, wasps, etc
Hymenoptera
Scientific name for itchiness
Urticaria
What is the standard dose of epinephrine IM for allergic reaction?
Epinephrine 1:1000 1mg/1mL 0.2 to 0.5mg IM
What factor missing from a person with Hemopheilia A?
Classic Factor VIII
What factor is missing from a person with Hemophilia B?
Factor IX
What kind of genetics is Hemophilia?
Recessive genes, sex-linked
Hemophilia A and B only occur in…
Males
What is the most common type of hemophilia that occurs in women, but can also occur in men?
Von Willebrand
What is the scientific name for bleeding in the joint cavity?
Hemarthrosis
What is something that you want to be aware of if you have a hemophiliac patient who hit their head?
They have decreased LOC, but easy to bleed in the brain
What kind of blood transfusions would you give a hemophiliac?
- Clotting factors specific to their type of hemophilia
- Cryoprecipitate (plasma that is rich in clotting factors)
- FFP
Treatment for hemophiliac patient with a laceration?
Topical thrombin and observe for 4 hours post suturing.
What do you need to be aware of for IVs and IM’s for hemophiliac patients?
No IM
Hold pressure over IV site for 5 mins after pulling out IV
What medications should hemophiliacs never receive?
No blood thinners including aspirin. No NSAIDs
What are the main causes of DIC?
- Trauma
- Sepsis
- Pancreatitis
- HELLP syndrome in OB
What blood work would you expect in a patient with DIC?
Prolonged PT/PTT times
Elevated D-dimer
Fibrin degradation products
Low H/H and platelets
Low fibrinogen
How can you tell from bloodwork if DIC treatment is working?
Platelets will be increasing
What is Idiopathic Thrombocytopenia Purpura (ITP)?
ITP is an autoimmune condition that seen after a viral infection in children 2-4 years old. It usually spontaneously resolves or it becomes chronic in adults. It causes low platelet count with normal bone marrow function which leads to excessive bleeding.
What are causes of anemia?
Blood loss, low iron, low vitamin B12, or low folic acid
What are side effects of oral iron?
Dark stools and constipation
What is Polycythemia?
Excess blood cells that increases blood viscosity
What causes secondary polycythemia?
The increased RBC’s are made from high altitudes or the hypoxia seen in COPD patients
What is polycythemia Vera?
It is a cancer that causes overactive bone marrow results in increase in RBC, WBC, and platelets.
What are some issues in the body caused by polycythemia Vera?
Hematocrit will be over 55%. Hepatosplenomegaly (enlarged liver and spleen), increased blood viscosity
What is treatment for secondary polycythemia?
Aspirin for clotting risk
What is treatment for polycythemia vera?
Phlebotomy to remove whole blood and infuse NS, chemotherapy to decrease blood cell production
What home medication helps with Sickle Cell Disease and how?
Hydroxyurea - decrease sickling and produce more Hgb.
Genetically, who does the Sickle Cell Disease come from, mother or father?
Gene must come from both parents.
What level of ESI triage should a Sickle Cell patient be and why?
Triage level 2 due to risk of acute chest syndrome, and Vaso-occlusive crisis.
What are some possible complications of Sickle Cell Crisis
- Acute Chest Syndrome - blood vessels in heart and lungs are blocked by sickle cells (immediately life threatening!)
- Vaso-occlusive crisis - most common - blood vessels in tissue is blocked by sickle cells (immediately life threatening!)
- Splenic ischemia
What are some triggers for Sickle Cell Crisis?
Low oxygen saturation, infection, dehydration, exposure to cold
What are diagnostics for Sickle Cell Crisis?
CBC to detect infection; reticulocyte count
What is the ultimate treatment goal for Sickle Cell Crisis patients?
Early stem cell transplantation
What level triage should you put someone who is neutropenic?
Triage level 2
What is leukemia?
Leukemia is a cancer that causes the bone marrow to produce leukemic (abnormal), immature WBC’s that do not function properly or provide adequate protection from infection.
What low lab value, presented with a low grade fever indicates a form of neutropenia?
Low neutrophil count presented with a low grade fever
What meds may help neutropenic patients?
Bone marrow stimulants (Filgrastim and Neupogen)
What are the standard fluid resuscitation amounts for adults, peds, and neonates?
Adults - 1-2L
Peds - 20mL/kg
Neonates - 10mL/kg
What can cause hyperkalemia?
Renal failure
Burns
Crush injuries
ACE inhibitors
Rhabdomyolysis
What EKG changes would you see with a patient who has hyperkalemia?
(Early; 5 - 6.5mEq) Peaked T waves
(Progressed) Widening of QRS, loss of P waves
(Advanced; >8mEq) Sine wave
What are medications used to treat hyperkalemia?
- Calcium gluconate 10% - 10mL IV over 10 mins (cardiac stabilizer)
- Beta agonists such as Salbutamol nebulizer or Sodium Bicarb (intracellular shift)
- Insulin 10units and D50W
- Kayexalate (K+ Removal for patients with chronic renal failure who can’t take lasix)
- Diuretics (K+ Removal via urinary system)
What are some causes of hypokalemia?
Metabolic Alkalosis
Overuse of diuretics
Acute alcoholism
Cirrhosis
Intestinal tract diseases (malabsorption)
Signs and symptoms of hypokalemia?
PARALYTIC ILEUS
FLAT T WAVES
POSSIBLE U WAVES
weakness, mental depression, leg cramps
Treatment for hypokalemia?
Correct K+, alkalosis, and hypomagnesemia
What is the normal range of calcium?
8.5-10.5mg/dL
What are some causes of hypercalcemia?
Renal disease
Prolonged immobility
hyperparathyroidism
How does alcoholism affect a person’s BGL and electrolytes?
It causes hypoglycemia and low electrolytes
What electrolyte imbalance can be caused by binge alcohol consumption?
Hypokalemia
What medical problem can be caused by the hypokalemia in binge alcohol consumption?
Rhabdomyolysis
Parathyroid gland controls which electrolytes in the blood?
Calcium and phosphorus
Signs of magnesium toxicity?
Beginning signs: Dizzy, flushed, somnolence, weakness, prolonged PR, QRS, QT intervals, bradycardia, loss of patellar reflexes
Advanced signs: hypotensive (refractive to pressors), resp paralysis, cardiac arrest
What medication should be given for magnesium toxicity?
Calcium Gluconate
What are two most common medications for bipolar disorder?
Lithium and Carbamazepine (Tegretol)
What are the signs of lithium toxicity?
SAD LITH
Seizures
Ataxia - impaired balance
Dystonia - muscle contractions
Lethargy/Leukocytosis - increase WBC’s
Insipidus (DI)
Tremors
Hypothyroidism
Two most common treatments for psychosis?
Haldol and Geodon
What are some adverse/side effects of Haldol?
Risk of neuroleptic malignant hyperthermia; prolonged QT interval; dystonic reactions
What is a side effect of Geodon?
It can cause prolonged QT interval
What medications are concerning for extrapyramidal symptoms?
Neuroleptic medications such as Haldol and Chlorpromazine (both can cause dystonic reactions)
What is the treatment for extrapyramidal symptoms and how do you know when it has worked?
Benadryl, Benztropine (Cogentin), and Trihexyphenidyl (Artane). It has worked when muscles relaxed.
What is Neuroleptic Malignant Syndrome?
A life-threatening condition that can be caused by antipsychotic medications, manifested by hyperthermia, muscle rigidity, and autonomic instability (fluctuations in BP)
What is the treatment for hyperthermia from neuroleptic malignant syndrome?
ABC’s and reduce temperature with cooling blankets and icepacks. Give Dantrolene (usually 35 vials)
What treatment is used when someone ingests an overdose of long-acting or enteric coated medications?
Activated charcoal with sorbitol (cathartic) every 4-6 hours for 12-24 hours (often used for acetaminophen overdose)
When would Gastric Lavage be used?
For toxic, symptomatic patients with recent ingestion (<1hr)
What is a risk of gastric lavage?
Risk of esophageal perforation
What is treatment for body packers (cocaine packs)?
Whole bowel irritation with Go-lytely or MiraLAX.
What are the signs and symptoms or iron overdose?
N/V, abdominal pain, hematemesis
What is treatment for iron overdose?
No charcoal (iron does NOT bind to charcoal). Desferal (Deferoxamine) - chelating agent that binds to free iron and it is excreted renally (rust, pink, or “vin rose” urine color expected).
What is the time frame for using activated charcoal?
Ideally within 1 hour of ingestion, but within 4 hours may be appropriate for people who take opioids (slows bowel motility) or who took EC medication.
What are diagnostic tests that would be ordered after an overdose of Tylenol?
Quantitative level at 4 hours from ingestion, monitor LFT’s
What are the best treatment options for Acetaminophen overdose?
Gastric Lavage and activated charcoal, N-acetylcysteine (Acetadote) within 8 hours for best response.
What are signs and symptoms of salicylate overdose?
Tachypnea to compensate for metabolic acidosis, N/V, abdominal pain, tinnitus, hypoglycemia.
What medications are considered salicylates?
Aspirin and Magnesium salicylate (OTC med for pain and inflammation)
What is the treatment for salicylate toxicity?
Sodium bicarb for urine alkalization
Dextrose for hypoglycemia
Hemodialysis
What are some tricyclic antidepressants?
Elavil
Tofranil
Amitriptyline
Trimipramine
Nortriptyline
What are some symptoms of tricyclic antidepressant overdose?
3 C’s
Coma (altered LOC)
Cardiac dysrhythmias (ventricular tachycardia)
Convulsions (seizures)
+ metabolic acidosis
What is the treatment for tricyclic antidepressant overdose?
Cardiac monitoring, intubation, sodium bicarbonate for urine alkalization, lidocaine, and magnesium sulfate if polymorphic tachycardia develops.
What is the antidote for acetaminophen?
N-Acetylcysteine (Acetadote)
What is the antidote for Tryicyclics (TCA’s)?
Sodium Bicarbonate
What is the antidote for Calcium Channel Blockers?
Calcium, Glucagon, Insulin
What is the antidote for beta blockers?
Glucagon, insulin
What is the antidote for organophosphates (insecticides and nerve gas)?
Atropine/2-PAM
What is the antidote for Ethylene glycol (found in antifreeze)?
Fomepizole (Antizol)
What is the antidote for Iron?
Deferoxamine
What is the antidote for Sulfonylureas (a class of meds that are used to lower BGL in diabetics by stimulating the pancreas - glipizide, tolbutamide)
Dextrose, Octreotide (Sandostatin)
What are some symptoms of hypercalcemia?
Lethargy, decreased deep tendon reflexes, constipation, “metallic taste”, risk of kidney stones
What is the treatment for hypercalcemia?
IVF’s, furosemide, glucocorticoids to decrease GI absorption of Ca+, dialysis
What causes hypocalcemia?
Pancreatitis, hypoparathyroidism, low albumin, burns, malignancy, and hyperventilation
What are some signs and symptoms of hypocalcemia?
Chvostek’s sign - spasm of lip and cheek, Trousseau’s sign - carpopedal spasms
Tetany
Confusion
Prolonged QTI - risk of Torsades VT (polymorphic VT)
What is the treatment for hypocalcemia?
Replace calcium, vitamin D, parathyroid hormone (as needed)
What are two types of causes of hypernatremia and their causes?
- Excess water and sodium (renal failure)
- Hypovolemic hypernatremia (DKA, HHS, DI)
What are symptoms of hypernatremia?
Thirst, dry membranes, orthostatic hypotension
What is the treatment for hypernatremia?
Correct slowly with D5W or 0.45NS to prevent cerebral edema; sodium restriction; vasopressin (ADH) for diabetes insipidus; diuretics and dialysis for renal failure.
What are the two types of hyponatremia and their causes?
- Hypovolemia (with hyponatremia) - vomiting diarrhea, or burns
- Hypervolemic hyponatremia - fluid overload, SIADH, excessive water ingestion
Symptoms of hyponatremia?
Fatigue, diarrhea, risk of seizures
What is the treatment for hyponatremia?
Hypertonic saline (or just NS if from n/v/d or burns)
Water restriction
What is the normal range of magnesium in blood?
1.5-2.5 mEq/L
What causes hypermagnesemia?
Renal failure and laxative abuse
What are symptoms of hypermagenesemia?
Respiratory depression, bradycardia, hypotension, decreased DTR’s
What is the treatment for hypermagnesemia?
Stop magnesium if infusing, furosemide, calcium gluconate 10% 10mL over 10 minutes, dialysis.
What causes hypomagnesemia?
Acute and chronic alcoholism (most common), malnutrition, malabsorption, thiazide diuretics (HCTZ) and loop diuretics (Lasix)
Signs and symptoms of hypomagnesemia?
Ventricular dysrhythmias like (Torsades de Pointes), agitation, hyperreflexia
What is the treatment for hypomagnesemia?
Give magnesium sulfate - 1-2 grams IV (rapid if emergency, over 2 hours if non-emergent) or IM depending on severity (monitor for respiratory depression, hypotension, and decreased DTR)
Hypomagnesemia can cause what other electrolyte imbalance
Hypomagnesemia can cause hypokalemia because hypomagnesemia can increase renal K+ loss and impair K+ reabsorption.
How do you calculate cerebral perfusion pressure?
MAP - ICP = cerebral perfusion pressure
What is normal ICP?
Normal ICP <15mmHg
Abnormal >20mmHg sustained
What is the Monroe-Kellie doctrine?
Monro-Kellie doctrine - an increase in one element must be accompanied by a corresponding decrease in one of the other elements, Brain 80%, CSF 10%, Blood 10%.
What is the GCS scores r/t severity of head injuries?
Minor head injury: 13-15
Moderate head injury: 9-12
Severe head injury: 8 or < (secure airway)
What score is most helpful for checking neuro status on vented patients?
FOUR score (Full outline unresponsiveness score) - includes reflexes and respiratory pattern
What vitamin (+dose) should be given to deficient patients to prevent Wernicke’s encephalopathy?
Thiamine (Vitamin B1) 50-100mg
What are the symptoms of Wernicke’s encephalopathy?
Confusion
Confabulation (creating false memories)
Ataxia
Nystagmus
What causes pinpoint pupils?
Opioids
OP pesticides
chemical warfare agent (CWA)
What causes nystagmus?
Drugs, tumor
Decorticate posturing signals that what part of the brain is injured?
Cerebrum
Decerebrate posturing signals that what part of the brain is injured?
Brainstem
What is it called when CSF leaks from the ear?
otorrhea
What is it called when CSF leaks from the nose?
rhinorrhea
What interventions for CSF leakage from nose or ears
Do NOT pack, just let it drain, place sterile nasal drip pad to prevent infection, not to prevent drainage. Instruct patient to not blow nose. Do NOT insert an NG tube.
How do you confirm whether clear drainage from ears or nose is mucus or CSF?
Check glucose. CSF should be 66% of glucose.
What clinical symptoms should you look for if you see blood from ears or nose to determine if it is a neurological injury?
bloody drainage - look for halo
What is Babinski reflex?
Fanning of toes, abnormal in adults
What is the name of the “Doll’s eyes” reflex and what does it signal?
Oculocephalic reflex - eyes look to opposite side that head is being rotated to;
No movement of eyes= brain death
What is the name of the “cold caloric” reflex?
Oculovestibular reflex - eyes look toward ear irrigated;
No response in brain death
What are cranial nerves 2-6 used for?
II - vision
III - assess extraocular movement
IV - assess extraocular movement
V - sensory to nerves of face and neck
VI - assess extraocular movement
What problem is caused by damage to cranial nerve 3?
Leads to limited upward gaze
What medical condition is associated with cranial nerve V?
Trigeminal neuralgia
What medical condition is associated with cranial nerve VII?
Bell’s palsy
What causes Multiple Sclerosis?
Demyelination of axons
What are the symptoms of Multiple Sclerosis?
weakness, unsteady gait, altered sensation in extremities and face
What is the treatment for Multiple Sclerosis?
Treated with steroids and immunosuppressants (interferon)
What is Myasthenia Gravis and what symptoms does it cause?
An autoimmune condition affecting women 20-30; affects acetylcholine binding sites leading to muscle fatigue, ptosis (drooping eyelids), dysphagia, and respiratory paralysis.
What is the test used to diagnose Myasthenia Gravis?
Tensilon test
What is treatment for cholinergic crisis in someone with Myasthenia Gravis?
Atropine (have at bedside; also give if excessive Neostigmine taken)
What is treatment medication for Myasthenia Gravis?
Neostigmine
What are s/s of Parkinson’s?
tremor at rest
facial “mask”
“Cogwheel” rigidity
Bradykinesia
What is Lou Gehrig Disease?
Lou Gehrig Disease (Amyotrophic lateral sclerosis) - genetic disorder that leads to progressive loss of voluntary muscle control (grip strength) but retains intelligence and personality.
Temporal Arteritis
- definition
- population
- s/s
- Dx
-Tx
- inflamed temporal artery (palpable cord-like)
- age >50 years
- throbbing headache in temporal area, fever, temporary unilateral vision loss
- Dx: ESR and C-reactive protein increased
- Tx: corticosteroids
Tension headache s/s and interventions?
Band-like pain across forehead; teach relaxation techniques
What are Migraine symptoms
Unilateral pulsating pain, photophobia and phonophobia, n/v, possible aura
Symptoms of Cluster headache?
excruciating, unilateral, episodic (multiple per day; short-lived), excessive tearing (lacrimation), and nasal congestion on affected side.
Initial treatment of cluster headaches?
Treat with oxygen initially
What is the most common bacterial source of meningitis?
Group B streptococcus
What is the name of the signs of when a person with meningitis legs pull up when head is bent?
Kernig’s and Brudzinski’s sign
What are symptoms of meningitis in infants?
Bulging fontanelles, opisthotonos (backward arch), and high-pitched cry
What is the most common bacteria that causes meningococcemia, but can also cause meningitis?
Neisseria Meningitides
What is key symptoms of meningococcemia?
Non-blanching petechial rash on torso/legs
What is first intervention for a stable patient who has meningococcemia?
Don PPE and place under droplet precautions
What are interventions for a patient with meningitis?
Tx: assume it is bacterial, institute isolation immediately, antibiotics STAT, assist with LP (side lying position preferred)
What does bacterial CSF look like?
High pressure, cloudy, low glucose
Status Epilepticus results from a sequelae of what 3 things?
hypoxia, acidosis, hypoglycemia
What is the protocol for giving Dilantin?
Mix Dilantin in NS only and infuse no faster than 50mg/minute, monitor closely for infiltration. Cardiac, BP, and RR monitoring during and 20 mins post infusion.
Nursing teaching for seizure medication
Cause drowsiness and avoid alcohol.
Differential diagnosis for strokes?
hypoglycemia, atypical migraines, Bell Palsy, Lyme disease facail paralysis
Paralysis will be on which side of the clot in an ischemic stroke patient?
Paralysis will be on opposite side of the clot
What is scientific name of slurred speech?
Dysarthria
Definition of homonymous hemianopsia
The loss of half of your visual field in one or both eyes. If the injury is to the RIGHT side of the brain, then there will be a loss of vision to the LEFT side of each eye.
Time for rTPA?
3-4.5 hours
Dose for TPA?
0.9mg/kg (maximum 90mg), bolus 10% of dose over 1 minute, remainder as a drip over the next hour. Flush with NS at same rate once infusion is complete
What is exclusion criteria for TPA?
Tumor, head trauma, AV malformation, current internal bleeding, platelets <1000,000mm2
Blood pressure parameters for giving TPA?
SBP<185mmHg
DBP <110mmHg
Timeline for TIA?
usually resolve within 10-20 minutes, defined as resolving within 24 hours
What is a cerebral infarct that lasts >24 hours, but <72 hours
Reversible ischemic neurologic deficit (RIND)
what is a sign that may help distinguish a hemorrhagic stroke and an ischemic stroke?
Hemorrhagic stroke will often have focal deficits
Medications given to hemorrhagic stroke patient to help stop the bleed
- Vitamin K, FFP, and/or TXA
- Anticoag reversal agents as needed
– Coumadin - Kcentra and vitamin K
– Xarelto or Eliquis - Andexxa
Symptoms of Subarachnoid hemorrhage
explosive or “worst HA of my life”, altered LOC, N/V, photophobia, focal deficits, and nuchal rigidity
What is the most common cause of subarachnoid hemorrhage?
Aneurysm or AV malformation
What medication is best used to control BP in a patient with subarachnoid hemorrhage?
Calcium channel blockers (such as Nimodipine)
What is the difference between primary and secondary brain injuries?
Primary brain injury is caused by trauma such as car accident, fall, sports, etc.
Secondary brain injury is caused by cerebral edema from hypotension, hypoxia, or hypercarbia
What are the degrees of brain injury?
Mild - GCS 13-15 with LOC <30 mins and no deficits
Moderate - GCS 9-12 with LOC and focal deficits
Severe - GCS of 8 or less with significant LOC, abnormal pupils, and posturing
Special consideration for scalp lacerations?
Very vascular so apply direct pressure
What is a concussion?
Short period of impaired neurological function that resolves spontaneously (GCS 13-15)
What are possible symptoms of concussion?
headache, dizziness, retrograde amnesia, vomiting, answers questions slowly
What are head injury precautions?
acetaminophen for pain only; no narcotics, no caffeine to stimulate the brain; cognitive brain rest and graduated return to play.
What happens if people return to physical play too quickly after a concussion?
Secondary impact syndrome (may lead to death)
When does the patient know that they can return to active play after a concussion?
They must be medically cleared by a physician
What are two complications after a concussion?
Secondary impact syndrome and post concussive syndrome
What are symptoms of post concussive syndrome?
cognitive impairment, slowed reaction time, and memory difficulties
What is a Diffuse Axonal Injury?
A severe, diffuse TBI
What are symptoms of diffuse axonal injury?
Widespread microscopic hemorrhage (no focal lesion) leads to immediate and prolonged coma (reticular activating system affected), hypertension, hyperthermia, excessive sweating, and abnormal posturing.
Symptoms of Basilar Skull Fractures
Altered LOC, combative behavior, headache, and vomiting, possible CSF leakage
How do you determine if bloody drainage from nose/eyes has CSF in it? What about clear drainage?
Bloody Drainage: Halo test
Clear Drainage: Glucose test (CSF BGL is 50-80)
What is the scientific name for “loss of smell”
Anosmia
What are the symptoms of an anterior fossa fracture?
“racoon eyes”, rhinorrhea, anosmia
What are the symptoms of Middle fossa fracture?
“battle sign”, otorrhea, ruptured tympanic membrane
What are some interventions for CSF drainage form ears or nose?
Place sterile drip pad under nose and over ears to prevent infection, do not pack ears and nose, let it drain, no NG tube
What is an epidural hematoma?
A rapidly forming hematoma between the skull and dura because of a temporal bone impact and laceration or tear of the middle meningeal artery.
How often does a patient with epidural hematoma present with the classical symptoms?
75% of the time
What is the classical presentation of an epidural hematoma?
Period of unconsciousness, followed by lucid period with severe headache, then second loss of consciousness; ipsilateral pupil dilation with contralateral weakness or paralysis. Appears as lens-shape on CT scan.
What are the time parameters for an acute, subacute, or chronic subdural hematoma?
Acute: <48 hours
Subacute: 48hr - 2 weeks
Chronic: >2 weeks
What is a subdural hematoma and who is it most often seen in?
A collection of blood between the dura and subarachnoid layer due to tearing of the bridging veins seen most in older patients (anticoagulants) and in chronic alcohol abuse (fall often).
What is shaken impact syndrome?
Triad of subdural hematoma, fractured (posterior) ribs, retinal hemorrhage seen more in infants and young children, and in interpersonal violence.
What are key points of an epidural hematoma?
- Arterial bleed
*Sudden loss of consciousness - Short period of unconsciousness followed by lucid period and subsequent deterioration
- Dilated, nonreactive pupil on ipsilateral side
- Younger population
What are the key points of subdural hematoma?
- Venous bleed
- Progressively decreasing LOC
- Elderly or alcoholic
- Shaken impact syndrome
What are interventions for increased ICP?
Monitor ICP and keep <20mmHg
Elevate HOB to 30-45, neutral alignment, avoid hip flexion
Maintain SBP 100 or higher to encourage cerebral perfusion CPP 50-70mmHg
Mannitol 1g/kg bolus or hypertonic saline (effective if urine output increases)
Avoid hypotonic fluids
Monitor sodium and serum osmolality closely, especially if administering Mannitol
Keep Hgb up (RBC’s deliver oxygen) using 1:1:1; give meds to stop bleeding
Avoid venous compression of neck (remove rigid cervical collar)
Maintain normothermia by treating fever aggressively
Low stimulus environment
Control agitation with benzos and short-acting opioids so you can assess frequently
What is NEXUS criteria?
NEXUS Criteria is a guide to determine which trauma patients don’t need spinal imaging. (Use NSAID mnemonic)
Neuro deficit
Spinal tenderness
Altered mental status
Intoxication
Distracting injury
What is SCIWORA and what should be ordered for these patients?
Spinal cord injury without radiographic injury seen in children under age 8. MRI to assess edema.
What is a “Chance” fracture?
Fracture of T12-L2 seen in hyperflexion “lap belt” injuries with concurrent hollow organ bowel or stomach injuries
What is Cauda equina syndrome?
Cord compression of L5-S1 “horse-tail” from fall onto coccyx. (All of nerves in the lower back suddenly become severely compressed)
What are symptoms of cauda equina syndrome?
“saddle anesthesia” (tingling and numbness in saddle area); sciatica-type back pain; bowel, bladder, and sexual dysfunction
What are the symptoms of a complete spinal cord injury?
Loss of all motor/sensory function and reflexes below level of injury
Loss of bowel and bladder function
Loss of proprioception
Priapism
Poikilothermic (difficulty regulating body temperature)
Spinal or neurogenic shock
Interventions for a patient with complete spinal cord injury
Protect airways and monitor breathing effectiveness
Keep pt warm
Remove backboard early to protect skin early
Insert gastric tube to prevent ileus
Insert urinary catheter if not contraindicated
What is the result of a cervical fracture?
Cervical - tetraplegia or quadriplegia when all four limbs are involved
C1-C4 - Requires 24 hour-a-day care, may be able to use powered wheelchair
C5-C6 - May be able to breath on their own and speak normally, needs assistance with ADL’s. Little or no control of bowel or bladder
What is the result of thoracic fracture?
Thoracic - Paraplegia, can use a manual wheelchair, learn to drive a modified car, stand in standing frame
What is the result of a lumbar fracture?
Lumbar - may walk with braces, no control of bowel and bladder
What is the result of a sacral fracture?
Most able to walk, no control of bowel and bladder
What is sacral sparing?
The patient maintains voluntary anal sphincter tone from an incomplete cords injuries
What are the four types of Incomplete Cord Injuries?
Anterior cord injury
Brown-Sequard Syndrome
Central cord injury
Posterior cord injury
What are the symptoms of an anterior cord injury?
Loss of motor function
Loss of sensory of pain, crude touch, and temperature
Retains proprioception
What are symptoms of a Brown-Sequard Syndrome from a incomplete cord injury?
Transverse hemisection (stab or GSW)
Loss of motor function on side of injury (ipsilateral)
Loss of pain and temperature on opposite side of injury (contralateral)
What are the symptoms of an incomplete central cord injury?
Loss of motor and sensory function, more pronounced in arms than legs (can walk to table, but can’t eat)
What are the symptoms of an incomplete posterior cord injury?
Loss of proprioception, vibration, fine touch, and fine pressure
Intact motor function
What is the basic patho of neurogenic shock?
An injury at T6 or above that causes loss of sympathetic nervous system innervation leaving unopposed parasympathetic nervous stimulation. This prevents the compensatory mechanisms that would increase HR to combat hypotension.
What are the symptoms of neurogenic shock?
Warm, flushed skin with full pulses, hypotension, and bradycardia (or lack of expected tachycardia), temperature instability (poikilothermia)
What are interventions for neurogenic shock?
Spinal motion restriction; support airway and breathing; augment vascular tone with IV fluids, vasopressors, and positive inotropes.
What type of shock is neurogenic shock?
Distributive shock (maldistribution of blood)
What is spinal shock?
Spinal shock is not actual shock. It can happen form an injury at any level. It causes:
* Loss of motion and sensation below level of injury
*Transient episodes of hypotension
*Flaccid paralysis
*Loss of reflexes.
What is a possible complication of a spinal cord injury above T6?
Autonomic Dysreflexia
What is autonomic dysreflexia?
Noxious stimulus in a patient with a fracture above T6 that leads to massive sympathetic nervous system response
What are symptoms of autonomic dysreflexia?
Sudden onset of severe HTN, pounding headache, nausea, nasal congestion, anxiety, flushed face, sweating with piloerection (goose bumps)
What is the treatment for autonomic dysreflexia?
Identify and treat cause (ex: over-distended bladder, bowel impaction, skin pressure, infection, ingrown toenail)
Lower blood pressure
What is utilitarianism?
benefit of the majority (disaster triage)
How to preserve a deceased patient’s eyes for corneal donation
Elevate HOB to 20-30 degrees, instill artificial tears and tape eyelids shut with paper tape, apply ice over eyes
What are some things to be careful of for forensic evidence collection?
Do NOT cut through any clothing tears, rips, holes or stains.
Place evidence in paper bags, fold top of bags, tape across, do NOT staple.
Do not remove bullet with metal instrument, used gloved fingers or rubber tip hemostats.
Do not label wounds as entrance and exit wounds, label them as wound 1 and wound 2.
What kind of documentation must accompany evidence for court?
Documentation that demonstrates the item’s location and responsible party to prove integrity of evidence
Types of pain scales and population they are used for:
N-PASS or NIPS - neonates
FLACC - children who are too young to used face scale (<7yrs) (can be used for adults too)
Wong-Baker Faces - children >7yr
PAIN-AD - dementia
What is Ricin?
made from castor bean; latent 8 hours; then flu-like symptoms
What are some pathogens used for biological weapons?
Ricin, Anthrax, Viral hemorrhagic fever (Ebola), Nerve agents, Botulism
What are 2 types of nerve agents?
Sarin or VX agents
What is the treatment for nerve agents?
Decontaminate, atropine with bronchial secretions dry, 2-PAM, benzodiazepine.
What are symptoms fo botulism
Ptosis, flaccid paralysis, blurred vision
What should nurse do before black-tagging a child in a mass casualty situation?
The nurse should provide 5 rescue breaths, then if no response, black tag the child
What is the decontamination flow in a large group of people?
Patient flow is in opposite direction.
Hot zone - HAZMAT gear to provide life-saving treatment only
Warm zone - decontamination
Cold zone - where patient care happens
How do you know if treatment has been effective for extrapyramidal reactions?
Decrease in muscle spasms
How do you know if treatment has been effective for STEMI/Prinzmetal’s/Pericarditis?
decrease in pain and ST elevation
How do you know if treatment has been effective for CHF/PE/Pneumo
Increase in breathing effectiveness
How do you know if treatment has been effective for shock/adrenal crisis/tamponade?
Increase in BP
How do you know if treatment has been effective for asthma?
increase in PEFR
How do you know if treatment has been effective for carbon monoxide poisoning?
Decrease in COHb to <10
How do you know if treatment has been effective for cirrhosis?
increase in LOC after lactulose
How do you know if treatment has been effective for thyroid storm?
decrease in pulse
How do you know if treatment has been effective for diabetes insipidus?
Decreased urine output
How do you know if treatment has been effective for SIADH?
Increase in sodium level
How do you know if treatment has been effective for cholinergic syndrome (Organophosphate Poisoning)
decrease in bronchial secreations
How do you know if treatment has been effective for acute angle glaucoma?
decrease in IOP <20
What is the formula for TPA dose for ischemic stroke?
0.9mg/kg with 10% over 1 minute followed by 90% as infusion over 60 minutes
Max dose: 90mg/kg
What is the most common cause of central cord injury?
Whiplash
Out of the incomplete spinal injuries, which one has the worst prognosis and which one is the best prognosis?
Best Prognosis - Brown-Sequard
Worst Prognosis - Anterior Cord injury
What are the 6 P’s of neurovascular assessment?
Pain
Paresthesia
Pallor
Pressure
Paralysis
Pulselessness
How should a nurse check the radial nerve?
Motor: extend wrist or thumb (thumbs up)
Sensory: sensation to thumb
How should a nurse check the median nerve to the hand?
Motor: oppose thumb to fingers
Sensory: Sensation to index finger
How should a nurse check the ulnar nerve?
Motor: abduct (fan) fingers
Sensory: sensation to 4th and 5th fingers
When is it appropriate to give tetanus toxoid (active immunity) vs tetanus immunoglobulin?
Tetanus toxoid - revaccinate q10 years for minimal contamination or q5years for grossly contaminated.
Tetanus immunoglobulin - no or unsure of initial vaccination with gross contamination
What are symptoms of tetanus?
Trismus, lock jaw
How should a splint be placed on a patient?
Splint the injury as it lies on the padded splint, immobilize above and below the joint
What are some considerations when fitting a patient with crutches?
- The crutches should be adjusted for the hieight of the patient with their shows on.
- Elbow at 30 degrees
- Keep crutches 6 inches to side
- good leg up; bad leg down
Dressing for abrasion?
Non-adherent dressing
What is an avulsion?
Peeling of skin from underlying tissue
What is a degloving injury?
Degloving injury is avulsion where skin is pulled away from the scalp, hands, digits, foot, and toes.
What is the preferred dressing for an avulsion?
Non-adherent dressing
For a wound with foreign bodies in it, what would the xray show?
Xray would show tempered glass.
What is plan of care for a patient with vegetative material in a wound (such as a thorn)?
Remove vegetative material ASAP, do not soak otherwise it will swell; tetanus, antibiotics; MRI is ordered for vegetative material in wounds
Which areas of the body should not have xylocaine with epinephrine and why?
Ears, nose, fingers, toes, and penis - decreased circulation to distal areas increases risk of infection
When a patient has a wound to the face, what should not be shaved?
Eyebrows - loss of landmarks or uneven/no regrowth
How long should adhesive tapes (butterfly tape) over a laceration be left on?
Until they fall off (usually 7-10 days)
When placing adhesive tapes (butterfly tape) over a laceration, what should not be put on skin?
Petroleum ointments (weakens glue)
What should be done for a scalp laceration?
Staple scalp (should be removed in 10-14 days)
What are nurse interventions for when wound bonding agents (skin glue) is used for a wound?
Leave a waterproof bandage over area; educate patient that the glue with slough off in 5-10 days and to avoid petroleum ointments as they weaken glue.
What are the times for suture removal for:
Face
Scalp/Trunks
Arm/Leg
Over joint
Face 3-5 days
Scalp/Trunks 7-10 days
Arm/Leg 10-14 days
Over joint 14 days
With a traumatic amputation, what are some factors contributing to poor outcomes?
Crush injuries, contamination, comorbidities, age, poor nutrition
How should a nurse prepare a patient with a traumatic amputation to go to another facility?
- Lightly brush off gross materials
2.Rinse gently with sterile saline (avoid iodine) - Wrap amputated part in sealable plastic bag, label with patient info
- Place bag with amputation on a separate bag of ice; avoid direct contact between amputated part and ice
What is compartment syndrome?
Excessive pressure develops within a body cavity enclosed by fascia; as pressure increases circulation decreases, and edema increases; leading to ischemia and necrosis
Where is compartment syndrome most common?
Lower leg and forearm
When is there irreversible damage from compartment syndrome?
After 4-6 hours of ischemia
What are some common causes of compartment syndrome?
fractures, external compression from circumferential burns, casts, splints, ace bandages, edema, soft tissue, or vascular injury (crush injury, bleeding, hemarthrosis, recent surgery)
What are the early and late signs of compartment syndrome?
Early - severe pain disproportionate to injury, unrelieved by narcotics
Late - pulselessness (permanent damage)
How is compartment syndrome diagnosed?
Measure compartment pressure with compartmental pressure monitoring device:
Normal: <10mmHg
High: 20-30mmHg
What is the treatment for compartment syndrome?
Elevate area to the level of the heart and in a neutral position
Remove any external compression
Surgical decompression (fasciotomy at >30mmHg)
What are the risks/interventions in an open fracture?
Risk is hemorrhage and infection, so irrigate with NS and administer antibiotics
What are the risks in a closed fracture?
Risk is compartment syndrome
What should be assessed when a patient has a clavicular fracture (fracture of scapula is rare)?
Assess for axillary nerve as well as damage to subclavian or axial artery
Assess for signs of pneumothorax/hemothorax or great vessel injury
What is the treatment for clavicular fracture?
Ice, sling & swath, figure 8 brace
What should the nurse assess for with a fracture to the humerus?
Assess for brachial nerve injury
What is the treatment for a fracture of the humerus?
Proximal fracture - sling & swath
Mid-shaft humeral fracture - sugar tong splint
Distal fracture - surgery
What is the most common cause of a forearm fracture?
Fall on outstretched hand (FOOSH)
What is a Colles fracture?
A fracture of the distal radius
What is the presentation of a patient with a Colles fracture?
“Silver fork deformity”
What is the name of a fracture of the distal radius?
Colles fracture
What is the name for a dislocation of radius and fracture of the ulna?
Monteggia’s fracture
What is a smith’s fracture?
Smith’s Fracture is a fracture of the distal end of the radius caused by a fall on the back of the hand (flexed), resulting in a volar displacement of the fractured fragment. It is also known as a reverse Colles fracture.
What are interventions for forearm fracture?
Assess for median nerve damage, splint with elbow flexed 90 degrees, use sling to support arm
What is the name of a fracture of the carpal bone below the thumb
Scaphoid fracture
Where is the scaphoid bone?
A bone in the carpal bones below the thumb
Where will the pain be located with a scaphoid fracture?
“Anatomic snuff box”
What is the treatment for a scaphoid fracture?
Splint with thumb abduction
What is a Boxer’s Fracture?
Fracture of the 4th or 5th metacarpal fracture
What are the s/s of and treatment for a boxer’s fracture?
S/S: depression of knuckles
Treatment: posterior ulnar splint
What is the difference between a stable and unstable pelvic fracture?
Stable - one point broken (often fall)
Unstable - multiple points broken (MVC)
How should one safely assess for a pelvic fracture?
If there is no obvious injury, gently compress inward and down over symphysis pubis (only do once so as to not dislodge clots)
What are some risk factors related to a pelvic fracture?
Hypovolemic shock, associated urethral damage, bladder rupture
What is the immediate treatment for a pelvic fracture?
- Apply pelvic binder over greater trochanter ASAP for pelvic ring fractures (any fracture around the pelvic ring)
- Massive transfusion protocol (10 units of PRBC’s plus plasma and platelets)
- Permissive hypotension
- Prepare for embolization (REBOA) or surgery
What is a high-risk post-op of pelvic repair?
DVT/PE/Fat emboli
What is the most common situation that causes femoral head fractures?
Elderly patients who fall (especially with osteoporosis)
What is the most common situation that causes femoral shaft fractures?
High energy forces (such as in an MVA)
What are symptoms of femur fracture?
Shortened leg, external rotation, swollen thigh
What is the treatment for a mid-shaft femur fractures?
Apply traction splint to align and reduce blood loss and pain
What is the treatment for femoral head fracture?
Open reduction and Internal Fixation surgery (ORIF) - only used for severe fractures
What is a major concern with femur fractures?
Fat emboli! (12-48 hours after injury)
What are the common causes of patella fracture?
Fall on knee, knee into dashboard
What is the treatment for a patella fracture?
Surgery, long leg splint/cast
What is the most common cause of tibia/fibula fractures?
sports injuries, axial loading (fall from height)
What is important to monitor for with tib/fib fractures?
Compartment syndrome
What is the most common cause of malleolus fracture?
Eversion injury (ankle bends medially)
Note: Inversion injury is caused by ankle bending laterally)
Where is the malleolus?
The bony projection on the medial side of the ankles
What is the treatment for a malleolus fracture?
Immediate reduction if dislocated
What is the cast for foot metatarsal fractures?
Short leg walking cast
What is the best cast for fractures of the foot phalanges
Buddy tape to adjacent toes if non-displaced
Where is the calcaneus bone?
Back and bottom of heal of foot
What is the most common cause of a calcaneus fracture?
Fall from height
What are some nurse considerations with a patient who presents with a calcaneus fracture?
Assess for associated lumbar spine injuries, compression dressing and cruthces
What is the most common cause of an anterior shoulder dislocation?
Direct blow to shoulder or a fall on extended arm
What is the presentation of an anterior shoulder dislocation?
inability to raise arm or adduct
What is treatment for anterior shoulder dislocation?
Shoulder will need to be reduced
May require sedation to overcome muscle spasms
Apply sling and swath
What causes a posterior shoulder dislocation?
(rare fracture)
blow to anterior shoulder
may be seen after seizure
What is the presentation of a posterior shoulder dislocation?
The arm will be held in adduction close at side
What is the treatment for a posterior shoulder dislocation?
Reduce, apply sling & swath or shoulder immobilizer
What is a main concern with an elbow dislocation?
Neurovascular compromise
What is the treatment for an elbow dislocation?
Immediate reduction and sling
What is the proper name for nursemaid’s elbow?
Radial head subluxation
What is the presentation of a radial head subluxation?
Limited supination
What is the presentation of a posterior hip dislocation and an anterior hip dislocation?
Anterior - abducted, external rotation
Posterior - adducted, internal rotation
What is the priority intervention for a patient with hip dislocation?
Reduce emergently within 6 hours to prevent femoral head necrosis
What other injury could take place with a patellar fracture or dislocation?
Damage to the peroneal and popliteal artery
What is the treatment for a patellar dislocation?
Extend leg to reduce
Compression
Place in a knee immobilizer
What is treatment for ankle dislocation?
Splint in neutral position, prepare for open reduction due to blood vessel and nerve impingement
What is the treatment for sprain/strain?
RICE
Ice for 20 minute sessions for first 48 hours
Compression during day (take off during the night)
Elevate above the level of the heart for first 24 hours
What is gouty arthritis?
Acute arthritis with uric acid crystals in synovial fluids, mostly in males
What are the symptoms of gout?
Intolerable pain in toes, increases at night
What are some medications used for gout?
Colchicine, allopurinol, steroids, NSAIDS
What is some teaching for a patient with gout?
Avoid high purine diet
Caution with aspirin, alcohol, and thiazide diuretics
Increased risk of kidney (uric acid) stones
What foods are high in purine?
Heart, herring, mussels, salmon, sardines, anchovies, veal, bacon organ meats
What is bursitis and what causes it?
Excessive fluid in or infection of the bursa. It is caused by overuse, repetitive movements, inflammatory disease, infection, trauma
What is the treatment of bursisits?
RICE, decrease movement of extremity
What is a joint effusion and what is the most common location of it?
Collection of fluid in joint space; knee is most common from trauma or overuse
What are the symptoms of a joint effusion?
pain, redness, warmth, swelling, stiffness, decreased ROM
What is the treatment and patient education for a patient with joint effusion?
NSAIDS, RICE, arthrocentesis
What is osteomyelitis?
Infection of the bone and surrounding tissue (may lead to sepsis)
What can cause osteomyelitis?
Open fractures, infection in area of fracture, puncture wounds (hand from fight bite or wound on bottom of foot)
What is Rhabdomyolitis?
Breakdown of skeletal muscle, resulting in release of myoglobin, CK, and potassium
What are some causes of rhabdomyolysis?
Prolonged immobilization, stimulant drug use, statins (Lipitor), heatstroke, and crush injuries
What are the symptoms of rhabdomyolysis?
Malaise, fever, myalgia (muscle soreness), dark brown urine, increased K+, myoglobin, and CK
What is the treatment for rhabdomyolysis?
- Large volumes of fluids IV (6-12 liters in 24 hours) to produce urine output >100-200mL/hour
- 1-2 amps of sodium bicarbonate in NS (urine alkalization pH>6.5)
- Loop diuretics
- Mannitol
- Hemodialysis
How do you know if treatmetn for rhabdomyolysis is effective?
Treatment effective if increased clear urine.
What is a complication of rhabdomyolysis
Acute tubular necrosis (renal failure)
What mechanical movement causes an achilles’ tendon rupture?
A sudden, unexpected dorsiflexion
What is an example of a person getting an Achilles’ tendon rupture (type of person and what happens)?
Sprinter or basketball player who hears “pop” when pushing off.
What increases the risk of achilles’ tendon rupture?
If patient is on fluoroquinolones (Cipro, Levaquin), especially for older patients
What is the diagnosis for Achilles’ tendon rupture?
MRI
What is the treatment for achilles’ tendon rupture?
Surgery
What are some major concerns with high pressure infection injuries (grease gun, pain gun, hydraulics)?
They cause massive underlying tissue trauma and are high risk for infection and compartment syndrome
What is something to remember about injuries related to guns and industrial incidents?
Appearance of wound may not reflect actual tissue damage
Which GSW’s usually require surgical intervention?
Most chest and abdominal GSW’s
What sounds to expect with percussing abdomen?
Tympany (hyperresonance) over hollow organs and dullness over solid organs
What is a classic peritonitis sign?
Lying rigidly still
What symptoms are suggestive of surgical conditions?
Fever, pain prior to vomiting, and/or syncope
If patient has altered mental status what position should you place them in to put in an NG tube?
Left side lying
Placing an NG tube increases the risk of what?
Rupturing an esophageal varices
What are some causes of the peritoneal inflammation in peritonitis?
Ruptured appendix, pancreatitis, penetrating trauma, or peritoneal dialysis
What are some symptoms of peritonitis?
Diffuse pain, rebound tenderness, guarding, and fever
What is the treatmetn for peritonitis?
gastric tube, IVF’s, analgesics, antiemetics, and antibiotics
What gender and age group most commonly develop appendicitis? And what is of note about other age groups?
Males ages 10-30; Extremes of age more likely to have atypical presentations
What are the symptoms of appendicitis?
Early - dull, steady periumbilical pain with anorexia and nausea
Later (12-48 hours) - RLQ pain (McBurney’s point) with rebound tenderness (Rovsing’s sing), Markle sign (heel jar causes RLQ pain), Obturator sign (pain on right hip flexion), Psoas sign (pain on extension of hip)
WHat blood work would be done for a paitne tiwht appendicitis?
CBC to detect leukocytosis (>10,000 with >10% bands)
What are some causes of an upper GI bleed?
Peptic ulcer disease, Mallory-Weiss syndrome, and frequent NSAID use
What are some symptoms of upper GI bleed?
Hematemesis (bloody vomit), signs of shock (dizziness, tachycardia)
What are some diagnostics for a patient with upper GI bleed?
Serial H&H, coagulation panel, TXM, endoscopy (vasopressin may cause cardiac ischemia, consider nitroglycerin, high BUN (dry)).
What is treatment for Upper Gi bleed?
Suction and secure airway if actively bleeding, blood transfusion as needed, questionable gastric tube (OK for PUD, not for bleeding varices), vasopressin, octreotide (Sandostatin)
What causes Mallory-Weiss syndrome?
Violent retching with alcohol or bulimia, aspirin use, or heavy lifting
What is esophageal varices?
Bleeding from dilated blood vessels secondary to liver disease from portal hypertension?
What causes lower GI bleed?
Inflammatory bowel disease
What are symptoms of lower GI bleed?
Hematochezia (blood from anus), painless bleeding, signs of shock
How is lower GI bleed diagnosed?
Colonoscopy and serial H&H
What are symptoms of cholecystitis?
Severe crampy RUQ pain radiating to right shoulder aggravated by deep breathing, pain often after fatty foods or large meal, fever, jaundice (sclera) and dark urine, Murphy sign (point tenderness under right costal margin); flatulence
What diagnostics for cholecystitis?
Elevated WBC (leukocytosis), ALT, and bilirubin; abdominal ultrasound
What is the treatment for cholecystitis?
Antiemetics, analgesics, NPO/possible gastric tube, antibiotics, possible surgery. If no surgery, D/C instructions focus on decreasing fat in diet
What is pancreatitis?
Inflammation and autodigestion of the pancreas
What are the symptoms of panceratitis?
Sudden onset of sharp epigastric pain radiating to the back, aggravated by eating, alcohol intake, or lying supine, pain relieved by leaning forward, fever, N/V/A, signs of shock
What is teh most common cause of pancreatitis?
Alcohol abuse
What diagnostics studies are done for pancreatitis?
Elevated WBC, amylase (early), lipase (late, but more specific), glucose, and triglycerides, LOW calcium level; CT or ultrasound or abdomen
What medications are given for pancreatitis?
Fluid resuscitation, antiemetics, analgesics, IV calcium gluconate, H2 blockers and glucagon to suppress pancreatic enzymes
What are some compilations of pancreatitis?
Hypocalcemic (Chvostek’s, Trousseau’s, and tetany), pleural effusion (may need thoracentesis), ARDS, hemorrhagic (Grey-Turner and Cullen sign), sepsis
What is the rhyme for hepatitis?
“Vowels (A&E) from the Bowels” (Fecal-Oral)
“B - body fluids” (Sex)
“C - circulation” (blood)
What is important to know about hepatitis A?
Fecal-oral (vaccination available), teach and return demonstration of handwashing
What is important to know about hepatitis B?
Transmitted through body fluids (sexual, human bites), vaccination available
What should be known about hepatitis D?
Patient must be infected with hepatitis B in order to be infected with hepatitis D so patient is protected by Hep B vaccine
What are symptoms of hepatitis?
Early - Malaise, N/V/A
Later - jaundice, clay-colored stool, steatorrhea, dark-colored foamy urine
What is treatment for hepatitis?
Fluid resuscitation for acute A&E. Interferon or Ribavirin for chronic hepatitis
What DC instructions should be provided to patients with hepatitis?
A&E - do not prepare other people’s food; B,C,D - do not donate blood, no sharing needles or razors, safe sex practices
What labs would you expect in a patient with cirrhosis/liver failure?
Increased direct bilirubin (jaundice), FLTs, PT, PTT, and ammonia (hepatic encephalopathy), decreased urea, albumin, calcium
What is the treatment for cirrhosis/ liver failure?
Lactulose or PED (MiraLAX) to remove amonia, neomycin to decrease production of ammonia, replacement of albumin, calcium, potassium, and vitamin K.
How do you assess if the treatment for cirrhosis/liver failure is affective?
Ammonia decreases and LOC increases
What complications should the nurse monitor for with cirrhosis/liver failure?
Monitor for esophageal varices from portal hypertension
What are some symptoms of diverticulitis?
Abrupt onset of crampy pain, localizes to LLQ, anorexia, nausea, vomiting, alternating episodes of explosive diarrhea and severe constipation
What is the treatmetn for diverticulitis?
Fluid resuscitation, bowel rest, antibiotic, antispasmodics, surgery if ruptured
What discharge instructions should the nurse give a patient with diverticulitis?
Avoid straining; during the acute phase: low-fat, flow-fiber, low-residue diet; then increase fiber, take stool softeners, and increase water intake
What is the treatment for esophageal obstruction?
Keep patient upright and consider a carbonated beverage, glucagon IV or NTG SL, esophagoscopy for removal
What sound is expected with a bowel obstruction?
High-pitched hyperactive bowel sounds (early) to absent bowel sounds (late)
What are the symptoms of small bowel obstruction?
Rapid onset, marked distension, rare vomiting, crampy pain
What are teh symptoms of large bowel obstruction?
Gradual onset, marked distension, rare vomiting, crampy pain
What is the treatment for bowel obstruction?
Fluid and electrolyte replacement for hypovolemic shock, bowel rest, prepare for surgery,
What is a risk factor for bowel (mesenteric) infarction?
History of atrial fibrilation
What are the symptoms of mesenteric infarction?
Severe abdominal pain with soft abdomen without guarding
What is the presentation of a bowel perforation along with a possible cause? And what is treatment?
Can present with peritoneal signs (rigidity and guarding) after colonoscopy. Prepare for surgery
What is the treatment for gastroenteritis in pediatric patients?
20mL/kg of isotonic crystalloid solution boluses, administer zofran, and frequently 5mL sips of pediatric rehydration solution
What is the treatment for pediatric patients with cyclic vomiting?
Fluid boluses and antiemetics. Prevent with antimigraine medication
What are the symptoms of pediatric patients with cyclic vomiting?
Recurrent disabling vomiting
What is pyloric stenosis?
A pediatric disorder that cuases the narrowing of the pylorus preventing the emptying of the stomach causing non-bilious projectile vomiting adn continual hunger, poor weight gain, “olive-shaped mass”, and signs of dehydration
What is the treatment for pyloric stensosis?
IVFs and prepare for dilate pylorus
What is intussusception and what are the symptoms?
Telescoping of one segment of bowel into another, most often seen in infants.
S/S: Episodic pain with currant jelly stools and bloody mucus, “sausage-shaped palpable mass in RUQ, diagnose and treat with air or barium enema, may require surgery.
How is intussusception diagnosed and treated?
Air or barium Enama to both diagnose and treat. May need surgery.
What is Volvulus (Malrotation)?
Bowel rotation resulting in strangulation, typically in first month of life
What are the s/s of Volvulus (Malrotation) and how is it treated?
Bilious vomiting with abdominal distension, blood stools, and visible peristaltic waves, prepare for surgery
What is the initial diagnostic test for abdominal trauma?
FAST exam (Focused assessment sonography for trauma)
What are symptoms of splenic trauma?
LUQ pain radiating to the left shoulder (Kehr’s Sign)
What is the grading system for splenic trauama?
Grade I-IV
(simplified:)
I - Large laceration
II - Laceration with hematoma
III - Deep vascular injury (so >25% of spleen is not being oxygenated)
IV - Ruptured spleen
What is the treatment for splenic trauma?
Nonoperative treatment is preferred vs splenectomy. Monitor H&H
What are symptoms of liver trauma?
RUQ pain, tachycardia, hypotensive, Cullen’s sign (ecchymosis around umbilicus.
What is the grading system for liver trauma?
Graded I-VI
What is treatment plan for liver trauma?
Allow permissive hypotension (SBP 70-80 max), damage control surgery, massive transfusion protocol
What is the most common cause of bowel trauma?
Gunshot wound or stab injury to the left side.
What is emergent treatment that a trauma nurse should do for an evisceration (possibly related to stab wound) until surgery?
Cover with sterile dressing until surgery
What are the symptoms of trauma to the pancreas?
Epigastric pain radiating to the back since pancreas sits retroperitoneal; flank ecchymosis (Grey-Turner’s sign).
What lab values should be monitored with pancreatic trauma?
Amylase, lipase, and glucose
What are some causes of urinary retention?
Enlarged prostate, renal calculi, neurogenic bladder, or side effects of antihistamines (parasympathetic effect of TOC cold medicines)
What are most common causes of UTI in women and then in men?
Women - most commonly E. coli
Men - BPH
What lab work would show UTI?
Urinalysis for WBCs and hematuria
What is treatment for UTI?
antibiotics, NSAIDS and phenazopyridine (turns bodily fluids bright orange) for pain, increase fluid intake
What is pyelonephritis?
Inflammation or infection (bacterial) of kidneys that can lead to urosepsis
What are the signs and symptoms of pyelonephritis?
Severe costovertebral (CVA pain), fever and chills, N/V, urinary symptoms
What is the diagnosis of pyelonephritis?
Dx: Urinalysis for pyuria and hematuria, BUN and creatinine, renal ultrasound
What is treatment for pyelonephritis?
Antibiotics and encourage fluids; admit if pregnant
What are symptoms of prostatitis?
Sudden onset of dysuria, frequency, and urgency; hematospermia (blood in semen); tender prostate
How do you diagnose prostatitis?
Possible elevated PSA, urinalysis
What is the treatment for prostatitis?
Antibiotics (fluoroquinolones) and increase fluid intake
What are the signs and symptoms of testicular torsion and what ages does it most commonly occur in?
S/S: Sudden onset of severe inguinal pain and nausea; lack of cremasteric reflex; worsens with elevation and ice
Most common in: infancy and peripubertal ages
What is the diagnostic and treatment for testicular torsion?
Dx: Color doppler ultrasound
Tx: Manual detorsion may be attempted, but surgical intervention required
What is Epididymitis?
Epididymitis is an inflammation of the coiled tube, called the epididymis, at the back of the testicle. The epididymis stores and carries sperm.
What are the signs and symptoms of epididymitis?
Gradual onset of scrotal pain, urinary frequency and urgency, urethral discharge (if caused by chlamydia) Pain relieved with elevation (Prehn’s sign) and ice.
What discharge teaching should be included for patients with epididymitis?
Safe sex practices and treating partner too.
What is Orchitis and what is treatment?
Inflammation of testicle from STI or mumps
Tx: NSAIDs and ciprofloxacin
What two STD’s generally go togehter?
Chlamydia and Gonorrhea
What symptoms are with chlamydia?
75% asymptomatic; thin mucopurulent discharge
What is the treatment for chlamydia? What are discharge instructions?
Levofloxin 500mg once daily for 7 days; Azithromycin 1 gram PO once or Doxycycline 100mg BID for 7 days; DC instructions abstain from sex for 7 days
Gonorrhea is the leading cause of what?
PID and can cause infertility and ectopic pregnancy
What are the s/s of gonorrhea?
UTI symptoms and mucoid discharge
What is the treatment of gonorrhea?
Ceftriaxone (Rocephin) IM once, azithromycin PO once or Doxycycline for 7 days (Chlamydia)
What are the syphilis?
Painless chancre with primary infection, rash on palms and soles in secondary infection, dementia in tertiary syphilis years later
How is syphilis diagnosed?
Venereal disease research lab test (VDRL) and rapid plasma reagin test (RPR) serology blood tests
What is the treatmetn for syphilis?
Penicillin IM once or doxycycline or tetracycline for 14 days
What is Genital Herpes Simplex?
Incurable STD with recurrence 5-8 times per year
What are the s/s of Genital Herpes SImplex?
Burning, painful grouped vesicles or crusted lesions on genitailia and flu-like symptoms
What is the treatment and discharge instructions for Genital Herpes Simplex?
Antiviral therapy (Zovirax or Valtrex - daily suppression);
DC instructions: abstain from sex 24 hours prodromal until lesions crusted over, protected sex always, C-section may be scheduled for pregnancy/delivery to avoid transmission
What are risk factors for developing vulvovaginal candidiasis?
Hx diabetes, IUD, antibiotics
What are s/s of vulvovaginal candidiasis?
Vulvar irritation, pruritic, cottage-cheese-like white vaginal discharge
How is vulvovaginal candidiasis diagnosed and treated?
Wet prep for budding yeast for Dx
Tx: intravaginal azole nystatin creams for 1-7 days or oral fluconazole (Diflucan - prolongs QT), PO once (contraindicated in pregnancy)
What are the s/s of trichomonas vaginalis?
Pruritis, vulvar irritation, dyspareunia (painful intercourse), malodorous “fishy” odor, yellow or green discharge
How is trichomonas vaginalis dx and treated? What are discharge instructions?
Dx: “strawberry cervix” wet prep
Tx: Metronidazole (Flagyl) PO once or Tinidazole (Tindamax);
D/C instructions: no alcohol with Flagyl (severe vomiting), frequent coinfection with gonorrhea
What are the s/s of bacterial vaginosis?
Thin, “fishy” odor, grayish discharge
How is bacterial vaginosis dx adn treated? WHat are discharge instructions?
Dx: clue cells, pH >4.5 + “whiff test” (KOH)
Tx: Metronidazole (Flagyl) PO for 7 days or gel for 5 days or Clindamycin cream for 7 days (preferred if alcohol dependency);
D/C instructions: No alcohol w/ Flagyl, treat sexual partners, avoid douching adn bubbling baths, clindamycin weakens condoms.
Genital warts causes increased risk of developing what?
Cancer in both sexes (increased neoplastic risk)
How can genital warts be prevented?
Gardasil vaccine at 11-12 years of age (and as early as 9 years of age)
What do genital warts look like and where are they found?
Cauliflower-like warts on vulva or penis
What are s/s of pelvic inflammatory disease?
Abdominal pain and dyspareunia with vaginal dishcarge and cervical motion tenderness “chandelier sign”
What is the treatment for pelvic inflammatory disease?
IV or IM antibiotics, analgesics, admit if pregnant
What are some complications of pelvic inflammatory disease?
Increased risk of ectopic pregnancy and infertility
What is phimosis?
Inability to fully retract foreskin over glans penis
What is the treatment for phimosis?
Manual reduction, consider circumcision or dorsal slit
What is paraphimosis and what is the treatment?
Retracted foreskin is entrapped causing ischemia to penis.
Tx: small incision and consider circumcision
What is priapism and what are the most common causes?
Prolonged painful erection causes a true urological emergency from sickle cell, leukemia, spinal cord injury, psychotropic meds (Trazodone) or erectile dysfunction medications (phosphodiesterase inhibitors)
How is priapism diagnosed and treated?
Dx: penile doppler or arteriography
Tx: urology consult, sedation and/or analgesia; injection of epinephrine, phenylephrine, or terbutaline; irrigation of corpora with NS and aspiration of clot
What are s/s of renal calculi?
Sudden onset of severe, colicky, flank (CVA-cortovertebral angle) pain that may radiate to the groin; restlessness and pacing; urgency, frequency, dysuria, and hematuria; diaphoresis
How is renal calculi diagnosed?
Urinalysis for hematuria; helical CT to rule out AAA
What is the treatment for kidney stones?
IVF’s, NSAIDs, antiemetics, increase fluid intake, opioids, strain urine for analysis of stone type (most are calcium). Hospitalize if unable to keep down PO fluids
What is penile fracture?
Rupture of tunica albuginea or corpus cavernosa of penile shaft due to torque (direct trauma or fall, sexual activity)
What are symptoms of penile fracture?
Report of “pop”; penile pain and immediate loss of erection; urethral bleeding; edema and ecchymosis
How is penile fracture diagnosed and treated?
Dx: penile doppler
Tx: immediate surgical repair
What are some causes of renal trauma?
Lacerations, contusions, or vascular injury associated with posterior rib fractures
What are some symptoms of renal trauma?
flank or back pain and ecchymosis (Grey-Turner’s Sign - turn over), with hematuria
What is the treatment for renal trauma?
Bed rest and increase fluid intake if stable, repair lacerations, monitor urine output closely.
What causes urethral/bladder contusions or rupture?
Straddle injuries, genital trauma, or foreign bodies associated with pelvic fractures
What are s/s of urethral/bladder contusions or ruptures?
Urge to, but inability or difficulty voiding, blood at urinary meatus, high-riding prostate
How is urethral/bladder rupture/contusions diagnosed?
Cystogram for bladder, retrograde urethrogram for urethra
What is treatment/nursing interventions for urethral/bladder rupture?
Do not catharize if suspected transection, catheter (suprapubic) for 7-10 days placed by urologist
What defines dysfunctional uterine bleeding? How is it diagnosed?
Fewer than 21 days between bleeding, typically painless; Dx: CBC, bleeding times, pelvic or transvaginal ultrasound
How is dysfunctional uterine bleeding treated?
Low-dose oral contraceptive therapy, iron supplements, treat hypovolemia,
How is vaginal foreign “lost” body found and treated?
Abdominal US to determine position, remove with IUD hook or ring forceps; diaphragm - remove with ring forceps
What is a Bartholin cyst and how is it treated?
A fluid-filled swelling (cyst) in the Bartholin’s glands, located at the either side of the vagina opening, due to infection or injury.
Tx: warm compresses and drainage
When do ovarian cysts hurt and what is that pain called?
Mittelschmerz is the pain; the ovarian cysts cause pain mid-cycle
What are s/s of ruptured ovarian cysts? What is the treatment?
Acute pain with sex or exercise; sharp unilateral pain.
Tx: analgesia and possible surgical intervention
What are most common causes of toxic shock syndrome?
Sepsis from retained tampons or sponges or secondary to nectotizing fasciitis
What are s/s of toxic shock syndrome?
Sudden onset of high fever, n/v, sunburn-like rash on palms and soles those peels (desquamation)
What is treatment/nursing interventions for toxic shock syndrome?
Contact isolation, ABC’s, identify and remove source of infection, immediate antibiotic administration (sepsis protocol)
What are things to remember with sexual assault cases?
Chain of custody to document integrity - never leave kit unattended
What are the steps for sexual assault evidence collection?
- Ensure safety and treat severe injuries
- Pla
What are normal variances of pregnacy?
- Increased risk of aspiration
- Compensated respiratory alkalosis (CO2 27-32)
- Increased circulating blood volume leading to increased pulse and decreased BP (supine vena cava hypotension syndrome)
- Increased clotting factors (risk of HELLP)
- Normal FHT’s 120-160
What are s/s of Hyperemesis gravidarum and what is the treatment?
S/S: (in pregnancy)intractable n/v, dehydration leads to electrolyte imbalances and malnutrition.
Tx: electrolyte and vitamin replacement, antiemetics, possible total parental nutrition
What are signs of fetal distress?
Fetal tachycardia is first sign of distress (FHT>160), loss of variability (HR increased with contraction), decreased fetal movement
What is spontaneous abortion and what are the two types?
Death or expulsion of fetus or products of conception before age of viability (15-20%), threatened - cervical is closed; inevitable - is open
WHat are symptoms of spontaneous abortion? WhatHow is it diagnosed?
S/S brown or bloody discharge to profuse vaginal bleeding with passage of tissue or products of conception
Dx: HCG, blood type and Rh, transvaginal ultrasound
What is the treatment and discharge instructions for spontaneous abortion?
Tx: oxytocin, suction curettage, RhoGAM to RH (-) motheres, psychosocial care for both parents
D/C instructions: Bed rest as much as possible for 2 days, avoid douching, tampons, and intercourse for at least 2 weeks; monitor for fever (seek medical attention), bleeding more than a heavy period, clots > a quarter.
What is an ectopic pregnancy?
Embryo plants outside the uterine cavity, most in fallopian tube, rupture at 6-12 weeks
What are s/s of ectopic pregnancy?
S/S: sudden onset of severe unilateral pelvic pain, radiating to shoulder, signs of schock, possible vaginal bleeding
How is ectopic pregnancy diagnosed and how is it treated?
Dx: HCG +, CBC, TXM, transvaginal ultrasound;
Tx: IVFs, RhoGAM if RH-, prepare for surgery or Methotrexate IM (no signs of bleeding, compliant about f/u)
What is placentae previa and what are the s/s?
Implantation of placentae over cervical os, hemorrhage may occur as uterus expands;
S/S: sudden, painless, bright red bleeding with signs of shock
What is the treatment for placentae previa?
OB consult, turn onto left side 15-30 degrees, treat shock, no vaginal exam until ultrasound completed, prepare for emergency C-section
What is abruptio placentae and what are the s/s?
Placental separation from uterine wall rupturing arterial vessels leading to hemorrhage and shock.
S/S: Painful contractions and backache with uterine rigidity; frank, dark red vaginal bleeding or concealed; abnormal FHT (normal 120-160)
What is the treatmetn for abruptio placentae?
Tx: OB consult, continuous fetal monitoring, turn onto left side 15-30 degrees, treat shock wiht blood products STAT, prepare for emergency C-section.
What is a high risk in patients with abruptio placentae?
HELLP syndrome
What does preeclampsia cause?
Dicreased oxygenation and perfusion, associated with coagulopathies, gestational HTN, edema, and proteinuria (can be present postpartum)
What is the treatment for preeclampsia?
OB admit, continuous fetal monitoring, minimize stimulation, antihypertensive, Magnesium loading dose and infusion (monitor respiratory effort, LOC, BP, and patellar reflexes - Calcium gluconate 10mL of 10% over 10 mins and antidote for Magnesium)
What is eclampsia and when is it high risk?
Preeclampsia progressed to convulsive state (seizures), at risk for up to 3 weeks postpartum
What is treatment for Eclampsia?
Tx: same as preeclampsia plus benzodiazepines to stop seizures and emergent C-section
What is HELLP syndrome and symptoms?
HELLP syndrome is associated with preeclampsia with RUQ
HELLP = hemolysis, elevated liver enzymes, low platelets (leads to DIC)
What is prolapsed cord?
Unbiblical cord precedes the neonate out of the vagina
What is the treatment for prolapsed cord?
Place mother in knee-to-chest position, insert sterile gloved hand into vagina to elevate the presenting part off cord so pulsating (prevent fetal anoxia) and leave hand in place, wrap exposed cord in saline gauze, emergent C-section
What are interventions for neonatal resuscitation?
- Thoroughly dry and warm (radiant warmer)
- Gentle stimulation (back rub, foot tapping)
- Place newborn in sniffing position
- Suction mouth, then nose, clamp and cut cord between clamps 30-60 seconds after cord stops pulsating
- Continuously monitor APGAR
- Assist breathing if HR<100; chest compressions if HR <60
What medications can and cannot be given for neonatal resuscitation?
Can give: epinephrine and glucose per NRP Guidelines; 10mL/kg of IVF
Do not give: Narcan
How long does it take for a neonate who is resuscitated to have his SpO2 come back up?
10mins
What time frame is post-partum hemorrhage a risk?
After delivery up to 6 weeks
What are the s/s of post-partum hemorrhage?
Bright red bleeding, signs of shock, boggy uterus
What is the treatment for postpartum hemorrhage?
Fundal massage with suprapubic pressure, treat shock with blood products STAT, Oxytocin (Pitocin) to stimulate uterine atony (contraction)
What is the timeframe for risk of postpartum infection?
Birth to 10 days
When is APGAR calculated?
At 1 minute and 5 minutes
What are the different APGAR outcomes?
7-10 good outcome
4-6 moderate outcome
1-3 poor outcome
Based on fundal height, when is fetus viable?
Above umbilicus = viable fetus (20-24 weeks)
What should be noted for pregnant mother with possible spinal injury?
Tilt backboard or manually displace uterus to side (supine vena cava syndrome); shield uterus for radiographic studies (including bedside ultrasound)
What is the most common OB complications following trauma?
Preterm labor
What are the symptoms of a burn to the airway?
Edema, hoarse voice, carbonaceous sputum, stridor, singed nasal hairs
What is the concern with circumferential chest burn and what is the intervention?
Not being able to ventilate due to restricted chest movement - intervention: Escharotomy
What is the fluid of choice for burn victims?
LR
What is the American Burn Association Recommendations of fluid resuscitation in adults, peds, and for electrical burns?
(2 adults, 3 peds, 4 electrical)
Adults: 2mL/kg X TBSA
Peds: 3mL/kg X TBSA
Electrical: 4mL/kg X TBSA
What should be remembered when calculating TBSA burns?
Only calculate based on partial and full thickness, not superficial burns
How does the parkland formula differ from the American Burn Association Recommendations for fluid resuscitation?
Parkland formula says 4mL/kg x TBSA instead ABA’s 2mL/kg x TBSA
Over how much time should fluid be given to burn victims?
Half of the fluids over 8 hours from time of injury; remaining half over next 16 hours
How much urine output should you be monitoring for in a burn victim receiving fluid resuscitation?
Adult thermal: 0.5-1mL/kg/hour
Peds thermal: 1-2mL/kg/hour
Electric: 75-100mL/hour at least
What are interventions for electrical burns?
Increased IVF’s (due to rhabdo), ECG monitoring for 24 hours (high risk of v-fib)
Why do electrical burns require more fluid resus?
Electrical burns cause high risk of rhabdomyolysis so they need more IVF’s to flush that out.
What are symptoms after lightening strike?
Lichtenberg feathering, ruptured tympanic membrane, cataracts long-term
What are top 3 things to think of first when caring for a patient with chemical exposure?
- Self-protect (Decontaminate outside if possible)
- Brush off dry chemicals first
- Consider inhalation injury and support oxygenation and ventilation
What are interventions for asphalt exposure?
Cool and apply emollient to loosen if ordered by burn professional
What are interventions for phenol (carbolic acid) burns?
copious irrigation with 50% PEG (MiraLAX) and water
What are interventions for burns from hydrofluoric acid (rust remover)?
Irrigate for at least 30 mins, until pain relief, then apply 2.5% calcium gluconate gel
What is alkalis in? What harm does it cause for the body? And what is the intervention?
Lye, cement, ammonia
Causes liquefaction or saponification (destroy tissue)
Requires large volumes of irrigation
Carbon monoxide poisoning can develop with exposure to what?
Smoke
What is the physiological process of carbon monoxide poisoning?
When you breath CO in, it attaches to and replaces the oxygen on the hemoglobin molecule, resulting in carboxyhemoglobin and reducing the oxygen content of the blood (aka “the silent killer”)
What are the s/s of carbon monoxide poisoning at the different percentages?
10-20% headache, n/v
20-40% confusion and lethargy
40-60% ST segment depression from hypoxia, arrhythmias, seizures
>60% death
any stage: cherry, red skin
How do you diagnose carbon monoxide poisoning?
Serum carboxyhemoglobin, do not trust SpO2
What is the treatment for carbon monoxide poising?
100% high flow O2 via tight fitting mask until level <10%, consider hyperbaric oxygenation HBO for pregnant patient (fetus most vulnerable)
What can cause cyanide poisoining?
Burning of plastics or carpets
What is the physiologic reaction to cyanide poisoning?
Interferes with cellular respiration (shifts oxyhemoglobin curve to left - hemoglobin holds onto O2)
What are s/s of cyanide poisoning?
Smell of bitter almonds on breath, headache, dizziness, seizures
What is the treatment for cyanide poisoning?
2 Options:
Cyanide Kit:
1. inhaled amyl nitrite (causes methemoglobinemia)
2. IV sodium nitrite
3. IV sodium thiosulfate
Cyanokit:
1. Hydroxocobalamin (vitamin B12) - turns urine pink
What does a black widow spider look like?
Red hourglass on abdomen of female
What are s/s of a black widow spider bite?
Immediate sting, dull ache in 20 minutes, then abdominal cramping, muscle spasms, HTN, tachycardia, n/v, weakness
What si the treatment for black widow spider bite?
Ice, elevate, analgesics and benzos for muscle spasms, antivenim cautiously
What does a brown recluse sipder look like?
“violin shaped” (also called a Fiddle-Back)
What are s/s of brown recluse spider bite by hour?
1-3 hours: Painless bite, peritus, redness, blister, bluish ring
<24 hours: fever, chills, n/v, malaise
Over time: necrotizing ulcerating wound (tissue sloughing)
What is the treatment for brown recluse spider bites?
Wound car, removal of necrotic tissue, hyperbaric oxygen therapy, antibiotics, steroids
What are the family names for pit vipers vs coral snakes and what does their venom’s affect?
Pit vipers belong to the crotalid family and their venom is hemotoxic.
Coral snakes belong to the elapidae family and their venom is neurotoxic.
What type of snakes are in the pit viper family and what are physical traits to identify this family by?
Rattlesnakes, copperheads, & water moccasins (cotton mouth)
They have diamond-shapded (triangular) heads; vertical elliptical pupils; fang(s), single row of caudal plates.
What are s/s of bite from pit viper?
Signs of envenomation: pain, redness, swelling to site, possible progressive edema, and possible blood-filled vesicles.
What is the treatment for pit viper bites and when is antivenom used?
2 large bore IV’s, remove constrictive clothing and jewelry, immobilize limb in neutral position, antivenom if severe hemorrhagic swelling., repeat until swelling subsides, NO ICE.
Most snake bites are dry bites which do not require antivenom. Antivenom is used with severe hemorrhagic swelling, progressive edema with blood-filled vesicles
What rhyme can one use to identify the coral snakes?
“Red on yellow, kill a fellow. Red on black, friend of Jack.”
What are symptoms of neurotoxic bite (coral snakes)?
Respiratory paralysis, local paresthesia, diplopia, ptosis, difficulty swallowing, increased salivation
What is the treatment for coral snake bites?
Supportive care, possible antivenom
What are stingrays’ barbs coated in?
Venom
What is the treatment for stingray stings?
Immerse in warm water (110F), for up to 2 hours until relief of pain; remove barbs with hemostats
What do jellyfish use to cause pain?
Nematocysts which are stinging darts that fire producing severe pain and reddened welts
What is the treatment for jellyfish stings?
Rinse in norma saline and remove tentacles using forceps (water stimulates venom)
What are 3 dangers of dog bites?
- Underlying crush injuries
- infections (5-15% become infected)
- Rabies
What is the treatment for dog bites?
Leave open, treat with antibiotics, consider rabies prophylaxis or watch dog closely for signs of rabies.
What are 3 concerns with cat bites?
- infection - cats have the highest rate of infection because long fanges penetrate deep into tissue
- Pasteurella - saliva contains pasteurella which can cause cellulitis or osteomyelitis
- Excrement toxoplasmosis
What is the treatment for cat bites?
Leave wound open unless on face, prophylactic antibiotics
What type of bacteria is in cat saliva and what can it cause?
Pasteurella - can cause cellulitis or osteomyelitis
What virus can be spread through a human bite?
Hepatitis B
What are the interventions for a human bite?
Copious irrigation and debridement, usually left open with a bulky dressing to decrease movement, prophylactic antibiotics.
What is the other name for decompression sickness?
Arterial Gas Embolism or “the bends”
What is the physiological process that causes “the bends”?
Inadequate decompression after exposure to increased pressure resulting in bubbles growing in tissue that causes local damage known as “the bends”; body absorbs nitrogen during ascent, if ascent is too quick the nitrogen forms bubbles - arterial gas embolism
What are s/s of decompression sickness?
SOB, crepitus, numbness, tingling, diplopia, petechial rash, seizures, joint discomfort, pain
What causes heat cramps?
Sweat-induced electrolyte depletion causes muscle cramps
What is the treatment for heat cramps?
Rest in a cool environment and fluid/electrolyte replacement
What is heat exhaustion?
Prolonged exposure to heat that leads to heat cramps, anorexia and vomiting, headache, syncope
What is the treatment for heat exhaustion?
Rest in cool enviroment with fluid/electrolyte replacement
What are heat related emergencies in advancing order?
- Heat cramps
- Heat exhaustion
- Heat stroke
What are symptoms of heat stroke?
Core body temp above 41C (105.8F) which affects CNS and cardiac
Tachycardia, tachypnea, hypotension, hot dry skin, decreased LOC, rhabdomyolysis from muscle breakdown - dark brown urine
Who are most vulnerable for heat stroke?
Young and elderly
Meds that increase risk: Thyroid meds, Haldol, antihistamines, anticholinergic
What is the treatment for heat stroke?
Cool patient quickly to 102F (remove clothing, evaporation, not immersion). Cover with wet sheets and blow fans on patient. Cool IV fluids, correct electrolyte (sodium) imbalances. Prevent shivering with benzodiazepines.
What body temperatures are mild, moderate and severe hypothermia?
Mild: >95F (35.3C)
Moderate: 33-35C
Severe: <33C
What are the s/s of hypothermia?
Hypoventilation, altered mental status, shivering (mild), hypotension, cardiac dysrhythmias (Osborn or J wave), bradycardia (<90F) to V-fib with severe hypothermia.
What is the treatment for hypothermia?
Severe hypothermia: active core warming (warmed IVF’s, heated humidified oxygen, warm peritoneal, gastric, or colonic lavage, hemodialysis).
Note: Rewarm core prior to periphery to prevent rewarming shock - may cause v-fib
What is the treatment for frostbite?
Pain meds and quickly rewarm the affected part for 15 to 30 mins in (104F to 107F) water; avoid friction or rubbing, NSAIDS to limit damage, administer narcotics for pain
What are s/s of rabies?
Delirium, hallucinations, excessive salivation
What is the treatment for rabies?
Early, agressive wound management, infiltrate rabies immunoglobulin (RIG) 20 units/kg in the wound if possible. Rabies vaccine given 1mL IM (deltoid in adult or vastus lateralis in young children) on days 0, 3, 7, and 14 for those never vaccinated. Vaccine provides active immunity.
How do you remove a tick and what are 2 illnesses (and their scientific names) that can come from ticks?
Remove with forceps, do not squeeze
1. Lyme disease (Borreliosis)
2. Rocky Mountain Spotted Fever (Rickettsia)
What are s/s of Lyme Disease?
Non-puritic, target-like, circular bulls-eye rash; flu-like symptoms (malaise and headache)
What is the treatment for Lyme Disease?
Antibiotics (Doxycycline), risk if untreated: facial paralysis, arthritis, and myocarditis
What are the s/s of Rocky Mountain Spotted Fever?
Non-puritic, non-blanching macules on the palms, wrists, forearms, soles, and ankles; nausea and vomiting; fever and chills
What is the treatment of Rocky Mountain Spotted Fever?
Antibiotics (doxycycline)
What are s/s of Measles (Rubeola)?
3 C’s - conjunctivitis, coryza (rhinitis), cough; fever, eyelid edema; Koplik spots rash first (small specks on buccal mucosa near molars “grains of salt”); maculopapular rash from head to trunk to lower extremities.
What is incubation period of Rubeola and how contagious is it?
High contagious; incubation period of 8-12 days
What is the treatment for Measles?
Supportive care, immunizations for patient’s family/contacts
What is the other name for Mumps? How long is it contagious for?
Parotitis. 16-18 days
What are the s/s of mumps?
Swollen salivary glands leads to puffy cheeks and swollen jaw
What is the other name for Rubella?
German or 3-day Measles
When is Rubella contagious?
Contagious up to a week prior to symptoms and a week after rash
What are the s/s of Rubella? And what are the complications?
Rash starts on face. Complication is birth defects and arthritis
What is pertussis? What is the other name for the illness? What bacteria causes it?
The other name for pertussis is Whooping cough. It is a highly contagious illness caused by the bacteria Bordetella Pertussis. It attaches to the respiratory tract adn limits the child’s ability to clear secretions.
How long is the incubation period for pertussis and what are the stages with corresponding symptoms?
Incubation: 7-10 days
Cartarrhal - coryza, sneezing, low-grade fever
Paroxysmal - unremetting paroxysmal bursts of coughing “whoop”, petechial rash above nipple line from burst blood vessels
Convalescent - gradual recovery
How is pertussis diagnosed?
Dacron swab in posterior nasopharynx
What is the treatment for pertussis?
Supportive care, erythromycin, antitussives, antipyretics, treat family with antibiotics, pertussis vaccination
What is the name of the chicken pox virus?
Varicella
What are the s/s of chicken pox and when is pt infectious?
Purulent vesicular rash starts on trunk, fever, pruritus, urticaria. Infectious for 48 hours before rash appears, contagious until all skin lesions are crusted over
What kind of isolation precautions should chicken pox patients be placed under?
Airborne precautions
How can chicken pox be prevented?
Varicella Zoster Vaccine
What is shingles? And how can it be prevented?
Reactivation of dormant varicella virus. Prevented with varicella zoster vaccine
What are the s/s of shingles?
Pain develops first, followed by vesicular lesions (typically does not cross the body’s midline), severe nerve pain
What is the treatment or shingles?
Antivirals, pain control with analgesics, xylocaine patches, and nerve blocks
What is the incubation period for diptheria?
1-8 days
What are the s/s of diphtheria?
sore throat; low-grade fever; thick-gray membranous (pseudo membrane) covering on tonsils and pharynx
What is the main concerning complication for diphtheria?
Airway obstruction
How is diptheria diagnosed?
Throat culture and gram stain
What is the treatment for diptheria?
Erythromycin STAT, diptheria antitoxin counteracts toxin produced by bacteria
What are s/s of mononucleosis?
Fatigue, myalgia, lymphadenopathy, abdominal pain
What are complications of mononucleosis?
Splenomegaly (watch for splenic rupture and teach to avoid strenuous activities and return for LUQ and left shoulder pain), hepatomegaly
How is mononucleosis diagnosed?
Monospot (+2nd week of illness), CBC’s, LFT’s
What is the treatment for mononucleosis?
Analgesics, corticosteroids, warm salt gargles
What kind of bacteria is C. difficile?
Gram +, anaerobic, bacillus
What are the s/s of C. diff?
profuse, frequent diarrhea; abdominal cramping and pain; fever; loss of appetite; dehydration
What is the treatment for C diff?
Stop antibiotics, IVF’s, antiemetics, Metronidazole (Flagyl), fecal transplant for chronic infection
What are two kinds of Multidrug-Resistant Organisms?
MRSA and VRE
What is the treatment for MRSA skin infections?
Incision and drainage (I&D), treat with mycins or tetracycline
What is the treatment for VRE skin infections?
Remove source of infection. Consult infection control and wound care
How much of TB infections are active?
Most TB infections are latent. 10% are progress to active disease, pulmonary TB90%, but sometimes spreads outside lungs
What are s/s of TB?
Chronic cough, night sweats, fever, chills, hemoptysis, weight loss, anorexia, fatigue
How is TB diagnosed?
Chest x-ray, sputum culture for acid-fast bacilli
What is treatment for TB?
6 months of combination antibiotic therapy - rifampin, isoniazid
What discharge teaching should be taught about TB?
Importance of medication compliance
Containment of respiratory secretions (zip lock bags)
Avoidance of close contact with others until medically cleared (work)
Rifampin stains body fluids bright orange (no contacts)
Prevention for others: TB vaccine
What is a peritonsillar abscess?
Collection of pus into the neck and chest tonsils
What are s/s of peritonsillar abscess?
Severe throat pain, deviated uvula, fever, halitosis, pain that radiates to ear, erythematic tonsils
What is the treatment for peritonsillar abscess?
Throat culture, IV fluids, analgesics, antibiotics, steroids, aspiration in incision and drainage (I&D)
What is Ludwig’s Angina?
Bacterial infection submandibular after a tooth abscess
What are s/s of Ludwig’s Angina?
Difficulty swallowing, drooling, swelling and redness of neck, tongue swelling
What is the treatment for Ludwig’s Angina?
Maintain airway, antibiotics
What is the treatment for an avulsed tooth?
Preserve tooth by placing back in socket or between in cheek/gum or under tongue only if patient alert and adult. If altered LOC, concurrent injury, or child, place tooth in saline, milk or in a calcium based solution; replant tooth within 6 hours if possible. Hold by crown, do not touch the root
What is the treatment for lip laceration?
Consider specialty consultation to suture if laceration is through vermillion border. First stitch prior to xylocaine due to swelling to approximate
What are the two types of nose bleeds and what causes them?
Anterior (most common) - picking nose (bright red blood)
Posterior (more serious) - caused by HTN and coagulopathies (heavier bleeding, darker red, drips out of nares and down throat, leads to clots, monitor airway)
What is the treatment for nose bleeds?
Elevate HOB, suction available, IV fluids, pinch nostrils firmly for 10-15 minutes for anterior, progress to cauterizing with silver nitrate or electrocautery, nasal packing soaking in TXA, phenylephrine, or lidocaine with epinephrine. Monitoring airway is most important, so may need to admit pt.
What is discharge teaching for anterior vs posterior nose bleeds?
BP management for posterior bleeding
Avoid blowing/picking nose and cool mist humidifier for anterior bleed
What is Bell’s Palsy adn what nerve does it effect?
Unilateral facial paralysis due to cranial nerve VII (facial) inflammation
What are the s/s of Bell’s Palsy?
Tears, drooling, unable to blink or close affected eye, facial drooping, ipsilateral loss of taste, increased sensitivity to sound (hyperacusis)
How is Bell’s Palsy diagnosed?
Rule out stroke and meningitis
What is the treatment for Bell’s Palsy?
Antivirals and corticosteroids to shorten progression, analgesics, and eye lubricants
What is discharge teaching for Bell’s Palsy?
Wear sunglasses/eye protection to help with eye irritation, moist heat from humidifier, artificial tears during awake hours, facial massage can help prevent permanent contractures/paralysis. Most resolve in 3-6months.
What is the other name for trigeminal neuralgia?
Tic doloreux
What causes Trigeminal neuralgia and what nerve does it affect?
Compression of Cranial Nerve V from tumor, AV malformation, trauma, or MS
What are s/s of trigeminal neuralgia?
Sudden, unilateral, severe, stabbing pain on one or more branches of the CN V (trigeminal nerve); facial twitching that is provoked by brushing teeth or chewing
What is the treatment for Trigeminal neuralgia?
Tegretol (Carbamazepine), phenytoin, valproic acid, gabapentin, lamotrigine, clonazepam
What are s/s of nasal foreign body?
Pain in nasal/sinus cavity, unilateral purulent drainage, recurrent epistaxis, fever
What is the treatment for nasal foreign body?
Use least invasive means possible - decongestants or pressor agent prior to removal to decrease swollen tissue; occlude unaffected nostril and ask child to blow nose, or ask mother to blow in mouth, or use BVM; Wall suction, forceps as last resort
What is one of the most dangerous things for a child to put up their nose?
Alkaline button batteries - causes saponification of tissue quickly
What are the s/s of foreign body in ear?
Pain, anxiety/fear (increased with live insects), bleeding, hearing loss on affected side, N/V, dizziness, purulent drainage from the ear
What is the treatment for foreign body in the ear?
Flying insects may fly to the light. Suffocate live insects with viscous lidocain or mineral oil, then irrigate and attach wall suction. Use alcohol base solution in irrigation of organic material (bread, pees, beans). Last resort - consider sedation, then use forceps to remove object, without pushing deeper in canal
What is the scientific name for Swimmer’s Ear?
Otitis Externa (happens outside the tympanic membrane)
What are the s/s of Swimmer’s Ear?
Pain wiht movement of tragus or auricle, possible periauricular cellulitis, hearing loss, drainage from ear, swelling, erythema.
What is the treatment for swimmer’s ear?
Analgesics, antibiotics, warm otic drops
What is discharge teaching for otitis externa?
Apply warm compresses, keep ear dry, no objects in ear, earplugs while swimming/bathing
What is otitis media?
Infection of inner ear canal; blocked Eustachian tubes causing fluid to build up behind tympanic membrane; common for ages 6 months to 3 years, after URI
What are the s/s of otitis media?
Sharp ear pain, pulling at ear, fever, hearing loss, sensation of fullness, bulging of TM, history of URI
What is the treatment for otitis media?
analgesics, possible systemic antibiotics, antipyretics
What is sinusisits?
Bacterial infection of mucosa of paranasal sinuses
What are s/s of sinusitis?
Pain, nasal congestion, purulent drainage, malaise, fever, facial swelling, decreased transillumination of sinuses
How is sinusitis diagnosed?
Frontal view of maxillary sinus, orbits, and nasal structures (Water’s View X-ray)
What is the treatment for sinusitis?
Oral antibiotics, analgesia, antipyretics, limited use of nasal decongestants
What is the discharge teaching for sinusitis?
Monitor BP for HTN from antihistamines, limit nasal sprays
What is mastoiditis?
Complication of otitis media that erodes mastoid and affects surrounding structures
What are the s/s of mastoiditis?
History of otitis media, pain and swelling in mastoid area, ear pain, fever, possible TM rupture, headache, hearing loss
What is the treatment for mastoiditis?
Prepare for admission, IV antibiotics, analgesics, surgical interventions
What is Labyrinthitis?
Inflammation of inner ear (labyrinth) from recent infective process (fluid), treatable
What are the s/s of labyrinthitis?
Nystagmus, vertigo, tinnitus, pain in ear, N/V, hearing loss
What is the scientific name for ear pain?
Otalgia
What is the treatment for labyrinthitis?
Corticosteroids, meclizine for motion sickness, antihistamines, fall risk
What causes Meniere’s Disease and who gets it?
Unknown etiology, more common in women 40-60 years old
What are s/s of Meniere’s disease?
Recurring episodes of nystagmus, vertigo, tinnitus, hearing loss, N/V
What is the treatment for Meniere’s disease?
Corticosteroids, meclizine (Antivert) for motion sickness, antihistamines, diuretics, anticholinergics
What is the treatment for Meniere’s Disease?
Bed rest, slow position changes to avoid falls, limit activity and sodium/sugar intake, avoid caffeine, nicotine, and alcohol
How many types of Maxillary Le Fort Fractures are there?
There are 3 - Le Fort I, Le Fort II, Le Fort III
What is the main interventions for Le Fort Fractures?
Mainstay of treatment is suctioning and maintain airway
What is a Le Fort I fracture and what is phrase to remember it?
“A man with a MUSTACHE” - Transverse detachment of the entire maxilla above the teeth at the level of nasal floor; free-floating maxilla
What are the s/s of a Le Fort I fracture?
malocclusion, lip laceration, fractured teeth, swelling to area
What is a Le Fort II fracture and what is a phrase to remember it by?
“Goes to the PYRAMIDS” - Pyramidal shaped fracture with transverse detachment of maxilla (base of pyramid), fracture at bridge of nose (top of pyramid), fracture through lacrimal and ethmoid bones (sides of pyramid)
What are s/s of Le Fort II fracture?
Nasal fracture, epistaxis, malocclusion, lengthening of face
What is Le Fort III fracture and what is a phrase to remember it?
“And take off his Halloween MASK.” - Free-floating segment of mid-face; craniofacial disjunction - involves maxilla, zygomatic arch, orbits, and cranial base bones
What are the s/s of Le Fort III
Commonly unresponsive, malocclusion, immense swelling “beach ball”, severe hemorrhage
What are the s/s of Mandibular Fracture?
Malocclusion, trismus (lockjaw), edema, ecchymosis, numbness (paresthesia) of lower lip, pain
What is the treatment of Mandibular Fracture?
Secure airway (loss of tongue control), elevate HOB, suction frequently, ice, surgery, analgesics, antibiotics
What is Orbital Wall Fracture?
Fracture of orbit, holds eye in proper placement
What are the s/s of Orbital Wall Fracture?
Ecchymosis, ocular entrapment (unable to look up with affected eye CN 3), diplopia, swelling, subconjunctival petechiae, infraorbital hypesthesia (reduced sensation)
What are some interventions for Orbital Wall Fracture?
Elevate HOB, ice pack (not chemical) to reduce swelling
What is the education teaching for an orbital wall fracture?
Ophthalmic follow-up; ice packs to face; avoid Valsalva maneuver, straining, and blowing nose
In which patient are zygomatic fractures most commonly seen?
Patients with orbital wall fracture
What are the s/s of zygomatic fractures?
TIDES - Trismus (reduced ability to open jaw related to muscle spasms; Infraorbital hypesthesia (abnormal loss of sensation to heat, cold, touch, or pain; Diplopia (double vision); Epistaxis (nosebleeds); Symmetrical abnormality (asymmetry); also Loss of cheekbone (malar) eminence.
What is the treatment for zygomatic fractures?
Elevate HOB, ice pack (not chemical) to reduce swelling, EENT consult
What is the education for pts with zygomatic fractures?
Opthalmic follow-up; ice packs to face; avoid Valsalva maneuver, straining, and blowing nose.
What are s/s of corneal abrasions?
ocular pain, sensation of foreign body, photophobia, tearing, blurred vision,
How is corneal abrasions diagnosed?
Visual acuity, topical anesthetic (Tetracaine), flouorescein staining
What is the treatment of corneal abrasions?
Ophthalmic antibiotics drops, nonsteroidal agents for eye, systemic analgesics
What are some d/c teaching for corneal abrasions?
No patching required since there is consensual movement of eyes
What are s/s of ocular burns?
Severe pain, photophobia, decreased visual acuity, tearing, involuntary spasms/closing of eyelid (blepharospasm)
What is the treatment for ocular burns?
Immediately irrigate (do not delay for assessment or visual acuity), Tetracaine and irrigate with NS or LR until pH is 7.0-7.4, tetanus, ophthalmology consult
What is some d/c teaching for occular burns?
ophthalmic appointment within 24 hours, dark environment
What types of chemicals are alkali and what are some things to know about when they get into the eye?
Lye, cement, ammonia, drain cleaner - deep penetration until neutralized (requires large amounts of irrigation), liquification or saponification
What are some things to know about when acid gets into the eye?
Limited penetration - does not need as much irrigation as alkali substances
If metal is not removed from the eye immediately, what would happen to the eye?
Metal may leave a rust ring
What is a big concern for organic material in the eye?
Can cause infection - remove quickly
What are some s/s of ocular foreign bodies?
pain, photophobia, sensation of “something in eye”, tearing, blurred vision,
What is the treatment for ocular foreign bodies?
Analgesics (tetracaine), before exam, remove object with cotton tipped applicator or 25-27 g needle, examine cornea for rust ring, treat as corneal abrasion after removal
What is normal intra ocular pressure?
<20
Why does ocular pressure build up so quickly and what happens if it gets too high?
Aqueous humor cannot move into anterior chamber, increase in antra ocular pressure (IOP), compression of CN 2 Optic Nerve; blindness within hours if left untreated
What are s/s of acute angle closure glaucoma?
Pain, decreased peripheral vision “tunnel vision”, halos around light, n/v, headache, reddened eye, dilated, fixed pupil, cloudy cornea, firm feeling globe, shallow chamber, due to pressure
What is the treatment for acute angel closure glaucoma?
HOB elevated, miotic drops (pilocarpine), topical beta blockers (timolol maleate), carbonic anhydrase inhibitors (acetazolamide), antiemetics, opioids for pain
What is D/C teaching for acute angle closure glaucoma?
Ophthalmology follow-up, no lifting > 5 pounds, avoid coughing/straining, do not lower head below waist
How can you tell if interventions are effective for acute angel closure glaucoma?
Treatment effective if IOP <20
What is the name of an “eye stroke”?
Central retinal artery occlusion
What happens in an eye stroke?
Loss of perfusion to the retina
What are some causes of eyes stroke?
emboli (a-fib increases risk), thrombosis, HTN, temporal arteritis
How quickly must circulation be restored before permanent blindness occurs in eye strokes?
60-90 mins
What are s/s of eye stroke?
Sudden onset of painless loss of vision, “curtain or shade came down over eye”, cherry red spot, Amaurosis fugax (transient episodes of blindness)
How are eye strokes diagnosed?
Increased IOP
What is the treatment for eye strokes?
High triage priority, digital massage by MD, topical beta blocker, acetazolamide, sublingual nitroglycerin to dilate vessel, fibrinolytic therapy, hyperbaric (HBO)
What is conjunctivitis?
Inflammation of membrane that lines the eyelid and sclera (conjunctiva)
What causes conjunctivitis?
Bacterial, viral, or fungal infection, allergic reaction, chemical irritation
What are the s/s of conjunctivitis?
crusty eyelids, sensation of foreign body, conjunctival erythema, discharge
What kind of discharge is seen in conjunctivitis?
Bacterial infection = purulent drainage
Allergic/viral = serous drainage
What is the treatment for conjunctivitis?
antibiotics (systemic if gonococcal), antivirals, compresses and decongestants for allergic reaction.
What is some discharge teaching for conjunctivitis?
Avoid contact lenses and eye make-up, compresses. Avoid spread - no swimming pools and hot tubs, do not share linens, hand washing
What is Iritis (Uveitis)?
Inflammation of iris, ciliary body, and choroid (middle portion of eye), from infection, trauma, rheumatic dx, syphilis, lupus
What are s/s of iritis?
pain, redness around the outer ring of iris, blurry vision, photophobia, tearing, decreased visual acuity, irregular shaped pupil
How is iritis (uveitis) diagnosed?
cycloplegics, warm compresses, ophthalmology consult
What is retinal detachment?
Tear in retina allowing vitreous humor to leak and reducing blood flow to retina so true ocular emergency, sudden from trauma
What are s/s of retinal detachment?
Sudden decrease or loss of vision, veil or curtain effect, flashes of light (photopsia), floaters or specks in vision
What is treatment for iritis (uveitis)?
Cycloplegics, warm compresses, ophthalmology consult
What is hyphema?
Blood in anterior chamber from trauma increases intraocular pressure (IOP)
What are s/s of hyphema?
pain, reddish hue to vision
What is treatment for hyphema?
Analgesia, steroids, maintain HOB elevated 30-45 degrees
What is discharge teaching for hyphema?
Avoid NSAIDs and aspirin, protect eye with rigid shield, keep HOB elevated 30 degrees, minimize activates to increase intraocular pressure, follow-up to monitor for rebleed (most common 3-5 days post event)
What is the treatment for eyelid lacerations?
Ice packs (not chemical) to reduce swelling, specialty consultation if through lacrimal gland
What are examples of blunt vs penetrating globe rupture?
Penetrating - knife, scissors, nail
Blunt - ruptures related to increased IOP
What are the s/s of globe rupture?
Tear-drop shaped pupil, visual disturbances, evisceration of aqueous or vitreous humor, decreased intraocular pressure
What is the treatment for globe rupture?
Secure protruding objects, DO NOT instill topical meds, protect with rigid shield, ophthalmology consult
What is corneal ulcerations and what causes?
Inflammation of epithelium of cornea; caused by trauma, bacterial, fungal, parasitic or viral infection; examples of causes: contacts, trauma, immunosuppression increases risk of infection
What are some s/s of corneal ulceration?
Pain, photophobia, sensation of FB, tearing, blurred vision, eyelid swelling, will see “white spots”, purulent drainage
What is treatment for corneal ulceration?
antibiotics, antifungals, antivirals, cycloplegics
What is Keratitis?
Inflammation of cornea caused by exposure to UV light
What causes keratitis?
Snow blindness, glare off of water, welding
What are s/s of keratitis?
Pain, photophobia, red sclera, decreased vision, purulent drainage,
What is the treatment for keratitis?
Antibiotics, antifungals, antivirals, cycloplegics, systemic analgesics
What is the discharge teaching for Keratitis?
Dark environment, warm compresses
What is Orbital cellulitis?
Inflammation of eye
What are s/s of orbital cellulitis?
Eyelid redness and swelling, painful and limited eye movement
What is a complication of orbital cellulitis?
Meningitis or cavernous sinus thrombosis
What is Retrobulbar hematoma?
Increased pressure in orbit from blunt trauma or Valsalva maneuver
What are s/s of Retrobulbar hematoma?
Proptosis from increased IOP (ocular compartment syndrome)
What are the treatments for Retrobulbar hematoma?
Lateral canthotomy or Mannitol to decrease pressure STAT or may have permanent vision loss
What is hirsutism?
Excessive hair growth on unexpected areas of the body, such as on the face, chest, and back.
What is opisthotonos?
Arching back
