Chapter 2 - Emergencies

Question 1

Areas involved by angioedema

Answer 1

Reticular dermis, SQ, submucosal layers of non-dependent areas

Non-pitting, non-pruritic, 24-96 hr (acute if <6 wk)

Question 2

Tests for hereditary angioedema

Answer 2

We C1 esterase inhibitor
C4

Recurrent angioedema also caused by ACEi.

Question 3

How Ludwig’s angina causes airway obstruction

Answer 3

FOM swelling —> tongue posterior

Question 4

Clinical Sign of IFS

Answer 4

Tissue lacks sensation

Question 5

When to convert cric to trach

Answer 5

Within 24 hours

Question 6

Bacteria causing Epiglottitis

Answer 6

H Flu, S Pyogenes (GABHS), S Pneumo, S Aureus

Question 7

Signs of epiglottitis

Answer 7

Kid: dyspnea, drool, stridor, fever

Adult: severe sore throat, odynophagia, hoarseness

Tripod!

Question 8

Diagnosis and Management of Epiglottitis

Answer 8

Lateral XR thumb print

Kids: DL in OR
Adults: may do fiberoptic nasal if stable
Intubate if distress, ICU observe if not
2/3 Ceph, humidified air, IV steroid, racemic epi

Question 9

Causes and Workup of Angioedema

Answer 9

Medication, foods, infxn, insect, latex, radiology contrast

Ask about laryngeal involvement (hoarse, voice change, odynophagia, stridor). May do Laryngoscopy. ICU if laryngeal involvement

Question 10

Treatment of angioedema

Answer 10

• H1 and H2 anti-histamine
• Steroids (if anaphylaxis, laryngeal edema, severe and unresponsive to anti-H
• Epinephrine maybe

For Hereditary: Danazol prophy, FFP acutely

Question 11

MOE: Mortality, Bacteria

Answer 11

50-80% (near 100% if CN abnl, usually VII)

Pseudo (mucoid coat deters phagocytosis, neurotoxin)

If Ca/HIV: asperg, S Aureus, Proteus, Klebsiella, Candida

Question 12

Diagnosis of MOE

Answer 12

CT Temp (bone destruction)
Need 30-50% destroyed to show on CT
If NL but high suspicion: Bone scan or gallinium scintigraphy

Question 13

Treatment of MOE

Answer 13

Fluoroquin + Aminoglyc
Aural toilet, debride granulation tissue
HBO

Question 14

IFS Bacteria

Answer 14

Asperg
Zygomycetes (Rhizopus, Mucor, Rhizomucor)

Function as saprophytes in environment - pathologic in immunocomp host

Question 15

IFS Mortality and Tx

Answer 15

20-80%, worse if old, heme Ca, Brain/Eye involve

Culture-dir anti-fungal, debride, underlying dz

Question 16

Ludwig Angina: Site, Bugs, PE

Answer 16

Starts submandibular
Spreads sublingual, retrophar, pharyngomax

Poly: Staph/Strep, Bacteroides
Dental Infxn/Procedure

B/l SM swelling, elevated/protrude tongue

Question 17

Ludwig Angina: Workup, Tx

Answer 17

Airway!

Pen + Clinda/Flagyl

CT w contrast to determine if need surgery for abscess

Question 18

Causes of TI Fistula

Answer 18

Trach (1-2 wk later, more if tracheal infxn, steroids, anomalous, site usually cuff)
Mech Vent (long), neck tumor, tracheal surgery

Question 19

Can you do a jaw thrust if suspected cervical spine injury?

Answer 19

Yes

Also, must immobilize cervical spine when orotracheally intubating if suspected injury (may choose to do nasopharyngeal intubation)

Question 20

Describe needle cricothyroidotomy

Answer 20

12-14 g catheter into CTM
High flow O2 or jet insufflation
Lasts 30-45 min (bridge to trach/tube)

Question 21

Describe surgical cricothyroidotomy

Answer 21

Horizontal incision CTM
Dilate with hemostat
Insert ETT or trach tube
Convert w/in 24 hr
Not recommended if <12 yr