Common Problems In Acute Care Flashcards
Differentiate between 1st, 2nd, and 3rd degree burns
1st: Dry, Red, NO BLISTERS, epidermis only
2nd: (Partial thickness), Moist, Blisters, extends beyond the dermis
3rd: (Full thickness), Dry, leathery, waxy, extend from epidermis to dermis, underlying fat/muscle/bone
Rule of nines for burns
Each arm= 9%
Each Leg= 18%
Thorax: 18% front, 18% back
Head= 9%
Genitals= 1%
Fluid resuscitation in Burns; include Parklands Formula
PF: 4mls/kg x TBSA% burned during the first 24 hours
1/2 needs to be administered in the first 8 hours and the remaining is given over the next 16 hours
Metabolic complications of burns
Metabolic acidosis
Hyperkalemia during the first 24 -48 hours then hypokalemia 3 days post
Indications for prophylactic intubation in burns
Burn to the face
Singed eyebrows
Dark soot from nares or mouth
What is the immediate post burn regimen
Submerse the area in clean water
Wrap in clean dry towels and go to hospital
Sterile saline to area
Maintain temp 37-37.5 C
Fentanyl or morphine for pain
What is used to remove tar from a tar burn
Petroleum based products
What constitutes a burn center referral
-Partial thickness >10% TBSA
-Burns to face, hands, feet, genitalia, or joints
-3rd degree
-Electrical/chemical/inhalation
-Trauma
-Children
Differentiate between a fracture and dislocation
F: Broken or crushed bone
D: disruption between relationship of normal joint surfaces
Subluxation
Incomplete dislocation
Differentiate between a closed, open, and avulsion fracture
C: skin is not broken
O: Skin is broken
A: Bone fragments are pulled off by attached ligaments and tendons
What is Giant Cell Arteritis, S/S, Labs, and Management
Inflammatory condition that can lead to blindness
S/s: headache, scalp tenderness, jaw claudication, temporal artery is nodular/enlarged/tender, fever (104), chills/rigors
Labs: high ESR, normal WBC, and temporal artery biopsy
TX: prednisone and a referral
Describe Diabetic Retinopathy on exam and what is the earliest sign
Earliest sign is micro aneurysms, flame shaped hemorrhages, cotton wool spots
What is AV nicking a sign of
Chronic hypertension
What is arcus Aenilis
A cloudy appearance of the cornea with a gray/white arc due to the deposition of lipids, has no effect on vision
Treatment for chemical conjunctivitis
Flush with NSS
Bacterial conjunctivitis discharge and tx
Purulent
Flouroquiniolone drops or tobramycin, gentamycin drops
Gonococcal conjunctivitis discharge and treatment
Copious purulent
Ceftriaxone 250mg IM + azithromycin
Chlamydia conjunctivitis treatment
Ceftriaxone 250mg IM + azithromycin
Allergic conjunctivitis discharge and treatment
Stringy, tearing
Oral antihistamines, referral to allergist and ophthalmologist
Viral conjunctivitis discharge and treatment for mild and moderate
Watery
Mild: saline drops and artificial tears
Moderate: antihistamines, NSAIDs, ABX drops
Herpetic conjunctivitis discharge and treatment
Bright red and irritated
Refer to an ophthalmologist
Corneal abrasion tx
Anesthetize eye for exam
Topical ABX especially for those with contacts
NO steroid drops
S/S of open vs closed Glaucoma
Increased intraoccqular pressure
Open (Chronic): asymptomatic, elevated IOP, cupping of disc, constriction of visual fields
Closed (Acute): Extreme pain, blurred vision, halos around lights, pupils fixed or dilated
Labs/ Diagnostics and treatment of Glaucoma
Labs: Tonometry
Tx:
-Open: Prostaglandin analogs (Prost drops), Alpha 2 adrenergic agonists (Brimonidine), Beta adrenergic blockers (Timolol), Mitotic agents (pilocarpine)
-Closed: Carbonic anhydrase inhibitors (Acetazolamide/ Diamox), Osmotic diuretics (mannitol), Surgery
What is the highest treatable cause of blindness
Cataracts
causes of cataracts
Aging, heredity, trauma, toxins, congenital, diabetes, UV sun exposure
S/s of cataracts
Painless, clouded vision, difficulty seeing at night, diplopia, no red reflex, opacity of lens
Cataract management
Refer to surgery
S/s of HIV
Flu like symptoms
Fever, night sweats, and weight loss
when does HIV become AIDS
CD4 count <200
And/or an opportunistic infection is present in an HIV patient
Labs and diagnostics of HIV/AIDS
HIV 1/2 antigen/antibody conversion, if positive then test HIV1/HIV2 antibody differentiation immunoassay
CD4 count
PCR for viral load
Normal CD4 Count
500-1200
What is given to HIV patients to prevent PJP and Mycobacterium Adium
PJP: Bactrim
MA: Azithromycin
Indications for HIV pre exposure prophylaxis
Anal/vaginal sex in the past 6 months and have:
-HIV + partner, not consistently used a condom, been diagnosed with an STD in the past 6 months
For People who inject drugs:
-HIV + partner
-Share needles
Which PrEP agent is recommended for patients who have high risk sex AND drug use
Truvada
What PrEP agent is recommended for patients with high risk sex EXCLUDING vaginal sex
Descovy
Differentiate the patho behind OA and RA
OA: denegerative joint disease
RA: autoimmune inflammation of connective tissue
Differentiate the inflammation of OA vs RA
OA: Asymmetrical
RA: Symmetrical
Herberden’ s vs Bouchard’s nodes
H: DIPs
B: PIPs
Stiffness and pain in OA vs RA
OA: better in morning worse as day goes on
RA: worse in morning, better as day goes on
Synovial aspirate in OA vs RA
OA: normal
RA: WBCs
Management of OA
ASA, Acetaminophen, NSAIDS, COX2 inhibitors (Celebrex)
RA management
High dose salicylates, NSAIDS, DMARDS, corticosteroids
S/s of Lupus
Fever, anorexia, malaise, weight loss, butterfly rash, alopecia, raynauds, joint symptoms (early manifestation)
SPLINTER HEMORRHAGES
Labs and diagnostics in SLE
ANA positive
Antiphospholipid antibodies
Anemia, leukopenia, and thrombocytopenia
Management of SLE
Bed rest, naps, sun protection, topical glucocorticoids for skin lesions, NSAIDS, hydroxychloroquine, glucocorticoids
Which joints are mainly effected in OA and RA
PIPs
What are 2 herbals that women take for cramps?
Primrose and black kohosh
What medication can mimic lupus symptoms
Procanimide
Who is the worst off in ALL
> 60 yrs old, difficult to get into remission
What xray results indicate RA
Osteopenia
What effect does hodgkins lympphoma have on RBCs, EBCs, and plasma cells
Increases them
What is Thromboangitis obliterans and how do you treat it?
Small blood clots that get stuck in small vessels
Pentoxifylline
What is sodium polystyrene sulfonate
Kayexalate used to treat hyperkalemia
Typical antiregection meds
Corticosteroid plus antimetabolites (Imuran or cellcept) plus CAlcineurin inhibitor (prograf)
What are two normal artery to vein ratio in the retina
4:5 and 2:3
What drugs are contraindicated with ST. Johns wort
SSRIs, Oral contraceptives, digoxin, alprazolam, amitryptilyine, narcotics, antiretrovirals
What is given to patients with corneal abrasions to decrease itching
Levocalbastine
