CK Flashcards
pre surgery - cardiovascular RF
- EF below 35
- recent MI (must be 6months before, if not, admit to ICU to optimize)
- CHF (optimize medically)
cardiovascular tests needed prior to surgery
- EKG
- stress test
- echo for stractural disease and EF
if under 35 yearsol with no history –> only EKG
pre surgery - when PFT
- known lung disease
2. smoking
pre surgery in patients in dyalisis
dialysis 24 hour before
intubation in facial trauma
crycothyroidotomy
intubation in cervical trauma
with flexible bronchoscopy
SIRS criteria
2 or more
- body Q less than 36 or more than 38
- HR more than 90
- tachypena more than 20 or PCO2 less than 32
- wbc less than 4 or more than 12
Barium in esophagus leakage
Never
Tests contraindicated in diverticulitis
Barium enema + coloniscopy
Most accurate test for cholecystitits
HIDA
Methylnatrexone (Relistor)
Alleviate obstruction from stool impaction in patients on chronic opioids
Fecal incontinence
Continuous or recurrent uncontrolled passage of fecal material (more than 10 ml) for at least 1 month in an individual older than 3
fecal incontinence - diagnosis
- clinical history combined with flexible sigmoidoscopy or anoscopy as the best initial test
- the most accurrate is anorectal manometry
- if history of anatomy injury –> endorectal manometry
fecal incontinence - treatment
3 forms
- medical therapy: bulking agents (fibers)
- biofeedback: exercises + muscle strenthening
- if fails: sugery
SIRS criteria
2 or more
- body Q less than 36 or more than 38
- HR more than 90
- tachypena more than 20 or PCO2 less than 32
- wbc less than 4 or more than 12
SIRS - interpretation
2 criteria = SIRS
2 criteria + source of infection = sepsis
2 criteria + source + organ dyfunction = severe septis
2 criteria + source + organ dyfunction + hypotension = septic shock
shock is not only tachycardia and hypotension
also end organ dysfunction
types of shocks (and skin and PCWP)
- hypovolemic: pale and cool, low
- cardiogenic: pale + cool, high
- neurogenic: warm, low
- septic: warm + faint, no change
types of shocks and treatment
- hypovolemic: fluids + pressors
- cardiogenic: treat cardiac problem
- neurogenic: fluids + pressors
- septic: fluids + pressors + antibiotics
how to find the type of shock
skin?
- pale/cool –> PCWP: elevated: cardiogenic, low: hypovolemic
- warm/flushed –> CO changes:
- low: neurogenic
- elevated: low PCWP in anaphylaxis, no change in PCWP in septic
sings associated with abd trauma and descripion
- cullen sign: periumbilical
- grey turner: flank
- kerh: pain in left shoulder
- balance sign: dull percussion on the let and shifting dullness on the right
- seatbelt sign: bruising
sings associated with abd trauma and cause
- cullen sign: retroperitoneal hemor
- grey turner: retroper hemor
- kerh: splenic rupture
- balance sign: splenic ruptur
- seatbelt sign: deceleration injury
balance sign
dull percussion on the let and shifting dullness on the right
- in splenic rupture
mallory weiss sybdrine vs Boerhave in diagnosis
gastrografin esophgogram:
leakage onky in boerhave
management of AAA
- 3-4 cm: U/S every 2-3 years
- 4-5,4 cm, U/S or CT every 6-12 monhts
- 5,5 or more: surgery
general rules in fractures therapy
- closed reduction: mild without displacement
- open reduction and internal fixaton: severe with displacement or misalignment of bone pieces
- open: skin must be closed and bone must be set in the operating room with debridement
types of fracture
- comminuted: multiple pieces (crash injuries)
- stress
- compression
- pathologic: from minimal trauma (metastasis)
- open (high risk of bacterial infection, SURGERY)
shoulder injuries - types + etiology
- anteriod dislocation: any injury that causes strain (MC)
- posterior dislocation: seizure or elect burn
- clavicle fracture: trauma
- scaphoid fracture: falling on an outstretched hand
shoulder injuries - types + treatment
- anteriod dislocation: shoulder relocation + immobilization
- posterior dislocation: traction and surgery in pulses or sensation are diminished
- clavicle fracture: simple arm sling
- scaphoid fracture: thumb spica cast
shoulder injuries - types + sings + symptoms
- anterior dislocation: externally rotated
- posterior dislocation: medially rotated
- clavicle fracture: pain over location
- scaphoid fracture: pain
anterior vs posterior dislocation regarding rotation
anterior: externally
posterior: internally
trigger finger
acutely + painful finger
try steroid injections first –> if fail –> surgery
Dupuytren contraction - treatment
surgery
diagnostic tests of fat embolism
- PO2 under 60
- infiltrates in chest x-ray
- urine analysis: fat droplets
