E med Flashcards
1
Q
low flow system
A
2-8 L
2
Q
low flow system examples
A
nasal cannula, simple/partial rebreathing, non re breathing, trach collar
3
Q
high slow system
A
up to 40L
4
Q
high flow system examples
A
aerosol, T piece, venture
5
Q
which can deliver the most % of oxygen?
A
Manual rescue (AMBU) > mask w reservoir > simple face > oxygen cannula (the least)
6
Q
Anaphylaxis
A
IgE, mast cells, vasodilation, bronchoconstriction
tx: Epi (IM pref)
7
Q
Hymenopytera
A
bee sting
8
Q
Persistent cough
Unilateral wheezing
A
Foreign body
9
Q
with Foreign Body in toddler, what are we worried about?
A
post obstructive Atelectasis or PNA
10
Q
Type II and III Le Forte fracture
A
NO NASAL AIRWAY. there is a big risk of cribiform plate fracture
11
Q
Battle sign and Raccoon eyes are signs of what
A
Basilar skull fracture
12
Q
Angioedema
A
Larger swollen area involving DERMIS and SUBCUTANEOUS
13
Q
Angioedema
A
usually involving head and neck
onset: min to hours
14
Q
What causes angioedema (head and neck, subQ and dermis)
A
C1 esterase inhibitor deficiency (hereditary) OR
taking ACE-I (acquired)
15
Q
How long does it take for Angioedema to resolve?
A
Hours to days
tx: C1 est inh, Epi, Antihist, steroid, danazol, ecalantide, icatibant
16
Q
Ludwig’s Angina
A
Bilateral, rapidly spreading, submandibular CELLULITIS
17
Q
Suffocating sensation Tongue elevated Hard, firm induration on floor of mouth Trismus Mediastinitis
signs of what?
A
Ludwig’s angina
18
Q
2nd and 3rd molars
A
Ludwig’s angina
19
Q
Tx for Ludwig’s angina
A
Surgery
Intubation (fiber-optic)
Tracheostomy
20
Q
Pain swallowing Fever Drooling Torticollis Airway obstruction
signs of what?
A
Retropharyngeal abscess
21
Q
Compare Ludwig’s vs Retropharyngeal abscess
A
Ludwigs: bilateral, suffocating sensation, trismus
Retro: stridor, airway obstuction, drooling, torticollis
22
Q
Mixed gram (-), tonsillitis, otitis media, pharyngeal trauma can lead to:
A
RARE condition which is Retropharyngeal abscess
23
Q
Dx of Retroph abscess
A
Clinical dx, or
X Ray or CT
soft tissue lateral neck
24
Q
Epiglottitis
A
Age 2-7 ABRUBT onset Toxic appearing! Altered LOC Cyanotic Airway obstruction FEVER
25
Epiglottitties
Thumbs up sign
DONT USE TONGUE BLADE
26
Epiglottities
Ceftriaxone (Rocephin)
Surgery/abx once airway is secured
27
Croup
Barking seal cough
Para-influenza
"steeple sign"
28
Usually self limiting and benign, "steeple sign", barking seal cough
There is a seal in the chicken coop with the steeple
CROUP
If needed, supportive tx: cool mist, O2, Epi, steriods
29
Pertussis
Paroxyms of cough
| Post tussive emesis
30
Pertussis dx
Nasopharyngeal swab Culture (gold stand)
31
Tx for Pertusssis
Erythromycin/Azithro
Treat contacts also
32
Bronchiolitis
RSV!!
Tachypnea, retractions, wheezing
33
Sx of Bronchiolitis are d/t
Submucosal edema and mucous plugging
Clinical dx unless bad sx, then order CXR
34
For severely ill pts with Bronchiolitis, what do we give?
Ribavirin
35
Tx for acute Asthma exacerbation
Stacked SVN w/SABA
3 tx every 30 minutes
36
Status asthmaticus!
if FEV1 does not increase >40% with treatment
complication: PNA
Tx: B agonist, HIGH DOSE steroid, O2, and ADMIT
37
Tracheal deviation to opposite side
Marked resp distress
Dec breath sounds, tachypnea, tachycardia
Tension PNX
38
Tx for PNX
<20% involved: observe
>20%: Intervene: needle decomp, simple aspiration, thoracostomy (chest tube)
39
Most common cause of preventable mortality
Hemorrhage
40
Early death after trauma is 1-4 hrs after, d/t
Pulm or CV collapse
41
Late death after trauma is
days to weeks after injury
Sepsis or multiple organ failure
42
Interventions to try, SALT Mass casualty protocol
Control hemorrhage
Open airway
Chest decomp
Inject antidotes
43
ABCDEF
```
Airway
Breathing
Circulation
Disability (neuro)
Exposure (check body)
FAST (focued assess w sonography)
```
44
What is the definitive airway that protects the airway from collapsing?
Endotracheal intubation
45
Order of trach and crico
Do endotracheal intubation first,
THEN
if no success: Cricothyroidotomy
46
Tension PNX
Massive hemothorax
Cardiac tamponade
are
immediate threats to life
47
Where to do Needle Decompression to tx PNX?
4th or 5th ICS, mid axillary line
| tube thorac immediately following
48
Lethal triad of trauma/shock
Hypothermia
Coagulopathy
Acidosis
49
How to treat lethal triad?
hypothermia
coag
acid
1L NS
1-2 units O(-) blood
Start MTP (Massive transfusion protocol)
50
MTP includes
1:1:1 ratio of
PRBC: FFP: Platelets
51
<35C is considered
Hypothermia
52
AMPLLE stands for
```
Allergies
Medicine
PMHx
Last meal
Last menses
Event leading to this
```
53
NEXUS criteria
If pt meets all of these, does NOT need X Ray
```
No midline spinal tend
No focal neuro def
Normal alert
No intox
No painful distracting injury
```
54
PECARN criteria for YOUNG pts <2YO
YES get a CT if:
AMS
GCS <15
Can feel a skull fracture
```
MAYBE get a CT if:
LOC >5 sec
Non frontal hematoma
Not acting normal
Severe mechanism
```
55
PECARN for OLDER than 2YO
YES get a CT if:
AMS
GCS <15
Signs of Basilar fx
```
MAYBE get a CT if:
LOC
Vomiting
Severe HA
Severe mechanism
```
56
Most freq injured organ in PENETRATING Trauma
Liver (RUQ)
57
Most comm injured organ in BLUNT Trauma in adults
Spleen (LUQ)
58
What to do if you have soft signs of penetrating trauma and ABI is <0.9:
CT angiogram
59
Hard sings of vascular injury with penetrating trauma
```
Active/pulse bleeding
Expanding hematoma
Pulseless limb
Shock
Compartment synd
Bruit thrills
```
60
Soft signs of penetrating trauma
Non expanding hematoma
Venous oozing
Hx of pulsatile bleeding
Unexp neuro def
61
Normal ABI
>0.9
62
Order of how to handle big fracture
1: assess neurovascular
2: pressure
3: immobilize
4: Tetanus/abx
63
6 Ps of compartment synd
```
Pain
Paresthesia
Pallor
Poikilo
Paralysis
pulseless
```
64
Trauma PAN SCAN
all are NON CONTRAST, except
trunk (chest, abd, pelvis): use contrast
65
Ringer's Lactate for burn
2-4 mL x %body surface area burned x weight
66
Ringer's lactate administration
first 8 hrs: give 1/2
next 16 hrs: give rest
67
BURN:
| Red, cap refill is fast, sensation/pain (+), heals 1-2 wks
Superficial
| 1st degree
68
```
BURN:
wet, PINK, blisters
cap refill fast
sensation/pain (++)
heals 2-4 wks
```
Partial superficial
| 2nd degree
69
BURN:
more red, less wet
cap refill slow or absent
may or may not have sensation
heals in 3-8 wks w SEVERE scarring
Needs graft
Partial deep
| 2nd degree
70
```
BURN:
dry, WHITE
No cap refill
No sensation
Needs grafting
```
Full thickness
| 3rd degree
71
HSV1 Keratitis
ACUTE onset
| Ciliary flush & Dendritic lesions
72
HSV1 Keratitis
URGENT ophtho referral
Topical/oral antivirals
Acyclovir, Gangyclovir, or Corneal transplant
73
What do we not want to use with HSV1 Keratitis?
do NOT use topical glucocorticoid
74
UV Keratitis/Photokeratitis
Intensely painful
Usually self-limited though
75
UV Keratiits/Photokeratitis
Pt is acting cray cray bc it hurts so badly
Photophobia/ FB sensation
76
UV Keratitis/photokeratiits
SO PAINFUL
Tearing, injection, chemosis of bulbar conjunctiva
Cornea hazy
Superfifcial punctate staining of cornea
pupils are miotic
77
What causes Photokeratitis?
UV exposure
usually self limited, better in 24-72 hrs
Pain med, abx
F/u in 1-2d
78
Tx for UV Keratitis/photokeratisis
Just pain med, usually better in 1-3 days
79
Preseptal cellulitis
Unilateral eye edema w red, warm, tender
tissue anterior to orbital septum
80
Orbital cellulitis
TRUE EMERGENCY
structures deep to orbital septum
Vision loss, impaired EOM, diplopia, proptosis
81
Other signs of orbital cellulitis (more serious)
```
Deep eye pain
Pain w eye mov
Proptosis
Vision impairment
Chemosis
Fever
Leukocytosis
```
82
What causes preseptal and orbital cellulitis?
Complication of other infection: sinusitis, strep PNA, strep pyogenes, staph, H inf
83
Dx of preseptal/orbital cellulitis
CT WITH contrast
84
Tx of preseptal cellulitis
Oral abx
| F/u in 1-2 days
85
Tx of Orbital cellulitis
Admit
IV abx
Consult ophtho and ENT
86
Corneal ulcer
break in epithelium exposing the underlying corneal stroma
87
Corneal abrasion
defect in corneal surface (not a complete break)
88
Sx of corneal abrasion/ ulcer
Severe eye pain
FB sensation
can impair vision leading to --> scarring
89
PE of corneal ulcer/abrasion
Mild conjunctival injection or
| Ciliary flush
90
Tx of corneal abrasion
Topical lubricant and ABX
```
Erythromycin
Sulfa
Polymyxin
Cipro
Oflaxin
```
91
What to NOT do with corneal abrasion/ulcer?
NO steroid
| NO patching
92
Tx for Abrasion AND Ulcer
URGENT ophtho if
- blunt trauma
- impaired vision
- ulcer
- wears contacts
93
Uncomplicated lid laceration
Superficial lac, horizontal, follows skin lines
If <25% (clean and surgical tape)
If >25% (suture)
94
Complicated lid laceration
REFER
95
Dx of Orbital floor fracture
Thin cut coronal CT
96
Tx of orbital fracture
```
Proph abx
Cold pack (first 48 hr)
Raise head of bed
Avoid sniffling/blowing nose
Surgery
```
97
Open globe rupture
following blunt eye injury
AVOID pressure to eyeball (eyelid retraction, IOP)
Dx: Axial and coronal CT of eye WITHOUT contrast
98
Optic neuritis
Inflammatory, demyelinating condition
Acute, monocular vision loss
High associated with MUSCULAR SCLEROSIS
99
Optic neuritis sx
Vision loss (hours to days), peak at 1-2 weeks
Eye pain, worse w mov
Afferent pup defect
Loss/reduced color vision
100
Tx of Optic neuritis
| assoc w/ Multiple sclerosis
Steroids (IV)
do NOT recommmend Oral prednisone
101
Normal Intra Ocular Pressure
8-21
102
Closed angle glaucoma pressure
>30
103
Gold standard dx of Close angle Glaucoma
Gonioscopy
104
Tx of Acute angle glaucoma
Emergent ophto eval
if >1 hr, empirically tx with pressure lowering eyedrops: Timolol, apraclonidine, Pilocarine
105
3 meds for glaucoma
Timolol
Apraclonidine
Pilocarpine
106
What to give IV for Glaucoma?
Acetazolamide
| check pressure 30-60 min after tx
107
Sudden onset floaters- cobweb
| Vision loss
Retinal detachment
108
Tx of Retinal detachment
emergent eval ophtho
109
FB in ear
Neutralize bugs w mineral oil
| Do not irrigate organic material- may cause infection
110
Acute Otitis Externa
Pseudomonas aeruginosa
Ear fullness, drainage, pain-tragal motion tenderness
111
Acute Otitis Externa tx
Debridement
Abx drops-Ciprodex or Cipro HC
caution Malignant otitis
112
Viral Acute Otitis Externa
Ramsey-Hunt (herpes zoster)
Vesicles in ear canal
Facial PARALYSIS whaat
Hearing loss
Vertigo
113
Viral Acute Otitis Externa tx
Antivirals
Steroids
MRI brain to r/o skull base tumor
114
Facial paralysis
Vesicles in ear canal
Haring loss
Ramsey Hunt- Herpes zoster virus
Viral AOE
115
Malignant Otitis externa
Pseudomonas aeruginosa
HIGH RISK: Old, DM, immunocomp
116
Sx like Acute Otitis Externa but pt appears acutely ill
Consider Malignant Otitis Externa
117
Dx of Malignant AOE
CBC- leukocytosis
Culture
Head CT- osteomyelitis skull base
118
Tx of Malignant Otitis Externa
Admit
Debridement
Parenteral abx
(Cipro)
119
Abx to use with Malignant OE
Cipro
120
Tx for TM perforation
Most resolve on own! (95%)
If needed,
Abx- ofloxacin drops
Tympanoplasty in refractory cases
121
Auricular hematoma
Cauliflower ear
Tx: drain/aspirate, f/u in 24 hours for 3-5 days
Refrain from sports for 7 days!!
F/u right away if worse
122
Perichondritis
inflammation and infection of cartilage
red, pain, abscess, systemic sx
123
Dx and Tx of Perichondritis
C&S
| I&D if indicated
Empiric abd
CIPRO
124
Imaging usually not needed for FB in nose UNLESS
suspect Button battery or magnet
125
If more than 2 unsuccessful attempts at removing nose FB,
refer to ENT
126
Which type of nosebleed are far more common?
Anterior nosebleed
127
Tx of nosebleed
Step wise fashion
Conservative:
-Oxyemtazoline (Afrin) 2 sprays
-Direct pressure against septum 10 min
If no further, nasal hydration
128
If source of nosebleed is easily identified,
Cauterize
avoid large areas
remove excess silver nitrate with cotton tip applicator
129
When to remove nasal packing
3 days normal pt
| 5 days for pt on anticoags
130
Abx with nasal packing
Keflex, Augmentin
131
Nasal trauma imaging
CT WITHOUT contrast
132
Nasal trauma
If really swollen, wait 4-6 wks before surgery BUT
| attempt closed reduction right away (maximize airway)
133
Nasal obstruction and pain are signs of
Septal hematoma
PE: Soft, tender swelling of septum
134
Tx of septal hematoma
Iand D
if untreated, can --> septal perforation or "saddle nose" deformity
pack nose (remove in 24 hrs)
Recheck
re-pack
135
Mastoiditis
suppurative infection of mastoid air cells
Acute if sx < 1month
136
Mastoiditis
no sx OR
| ear pain, drainage, tenderness, erythema over mastoid process
137
what do we want a CT WITH contrast for?
Mastoiditis
best to see temporal bone changes
Culture if infection
138
Tx of Mastoiditis
If good immune system: Oral abx
If recurrent dz or compromised: Mastoidectomy and IV abx
139
Abx to use for Peridontal Abscess
Augmentin or Clinda 7-14 d
f/u with dentist
140
If unable to re-implant tooth immediately after avulsion
Store in:
balanced saline
cold milk
pt's saliva
141
Success of re-implant tooth
85-97% at 5 min
| nearly 100% at 1 hour
142
Tx for tooth losss
Tetanus proph
| Abx
143
When to repair tongue lac
```
Large >1cm
Deep on lateral border
Large flap or gap
Significant hemorrhage
May have improper healing
```
144
Tongue lacs that don't need repair
<1 cm
| non gaping
145
First degree frostbite
Numbness, central paleness with surrounding redness
NO blisters
146
Second degree frostbite
blisters of skin w surrounding red/edema
147
Third degree frostbite
Entire thickness tissue loss, hemorrhagic blisters
148
Fourth degree frostbite
Entire thickness tissue loss involving deep structures, resulting in LOSS OF LIMB
149
Frostbite tx, immerse in water what temperature
101.5-102.2
until red and pliable
20-30 min
consider pain med
150
When to do CT angiography in frostbite?
if cyanosis PROXIMAL to ITP joints
151
Hypothermia
<95 F
152
4 clinical stages of hypothermia
Mild- confused, increased shivering
Moderate- lethargy, bradycardia, decreased shivering
Severe- unconscious
Level 4- no vitals, cardiac arrest
153
Heat stress (exhaustion)
Heat cramps PLUS systemic sx (n/v, dizzy, ortho hypo)
154
Heat stress (exhaustion) PE
temp <104
| No signs of CNS impairment
155
Heat stroke
Temp >104
| PLUS Altered Mental Status
156
Goal temperature in treating Heat Stroke
102.2
157
Alternating current
cyclical
standard in homes
most power lines
pt can't let go
158
Direct current
lightning
batteries
long distance power lines
pt jolted away
159
Augmentin or Clinda
Peridontal abscess
160
Cipro
Malignant AOE
| Perichondritis (oozing ear)
161
Ceftriaxone (rocephin)
Epiglotittis
162
Ribavirin
Severe bronchiolitis
163
Erythro/Azithro
Pertussis
WHOOPING cough
paroxysms
post tussive emesis
164
Steroids
```
Optic neuritis (MS)
Viral Ramsey Hunt (AOE)
```
165
numbness, central pale w surrounding red/swelling. NO blisters
1st degree frostbite
166
blisters w surrounding red/swelling
2nd degree frostbite
167
tissue loss entire thickness, hemorrhagic blsisters
3rd degree frostbite
168
tissue loss entire thickness, deep structures --> loss of ENTIRE part
4th degree frostbite
169
CT angiography when
cyanosis proximal to ITP joint
170
Consider tPA and Lovenox in frostbite patients if:
within 24 hrs of injury, high risk of amputation and there are no CONTRA
171
primary hypothermia
| <95F
d/t exposure to weather (wind, rain, water, snow)
172
secondary hypothermia
d/t lack of thermoregulation
173
secondary causes of hypothermia
```
alcohol
sepsis, shock, hypothyroid, burn
meds
newborns
malnutrition
blood transfusion
other cold infusion
```
174
89-95 F
mild hypothermia
| stage 1
175
82-89 F
moderate hypothermia
| stage 2
176
below 82 F
severe hypothermia
| stage 3
177
consicous but confused, increased shivering
stage 1 hypothermia
178
lethargy, bradycardia, decreased shivering
stage 2 hypothermia
179
vitals present but UNCONSCIOUS, hypotension, pulm edema, rigid
stage 3 hypothermia
180
NO VITALS, cardiac arrest
temp 82-89
stage 4 hypothermia
181
Can use rectal and bladder temps in pts:
who are conscious and have not have lavage
182
In severe hypothermia, how can you take temp?
Esophageal temp with ET intubation
183
How does insulin react with hypothermia?
Can have initial HYPERglycemia then low levels after rewarming
insulin doesnt work below 86F
184
Cold blood is prone to
hemolysis (rupture/destruction of RBC)
185
Tx for mild hypothermia
| stage 1
passive external
| encourage movement
186
tx for moderate hypothermia
| stage 2
ABC
intubate prn
AVOID ROUGH MOV
active external AND internal
beware paroxysmal temp drop
187
tx for severe hypothermia
| stage 3
ABC
intubate prn
AVOID ROUGH MOV
active external AND internal PLUS
Irrigation w warm saline (104-107)
188
tx for hypothermia stage 4
High quality CPR
Prevent further heat loss (wet clothes)
Thorac lavage
ACLS protocol
189
How mnay cycles of ACLS to do with hypothermia stage 4?
up to 3 then defer until core temp increases or pt improves
190
Complications of re-warming
```
Hypotension
Electrolyte abn
Rhabdo
Multi syst organ failure
Late Lung, Kidney, Neuro failure
```
191
Tx for Heat exhaustion (cramps PLUS systemic sx, n/v/dizzy)
Bolus infusion of IVF
if not responding after 30 min, may need external cooling
goal core temp:102.2
192
Heat STROKE tx
```
Fluids
Evap cooling
Ice packs
Immersion
Invasive
```
many options
193
Direct current has how many wounds?
2
| Entrance AND exit
194
Classic electrical injury
wounds can be underestimated
body IS part of circuit
entry AND exit wounds
195
Flash (arc) electrical injury
strikes skin but does NOT enter body
196
Lightening electrical injury
Direct current
shock wave transmitted THROUGH body
Mechanical trauma
"lichtenberg figures" (flowers)
197
Burns with lightning shock?
rare, superficial
blast effect
198
Burns with high voltage?
common, deep
199
Type of current associated with low voltage
usually ALTERNATING
200
Type of current associated with high voltage
BOTH
| Direct or Alternating
201
What type of injury is common of High voltage?
Neuro
Vascular
Muscle
*risk of compartment syndrome
202
Tx for High voltage
Same as trauma
FAST
CT head and spine
X ray spine and extremitis
203
Tx for High voltage
FAST (ultrasound)
CT
X Rays
204
Tx for Low voltage injury
EKG
| thorough exam
205
black widow
southwest
| OUTSIDE in AZ
206
brown recluse
inside houses in the midwest bc it's cold
207
black widow
sx onset sooner, within 3 hours
systemic effects in 4-6
spasm and muscle pain back, chest, abdomen
sweating
Severe: n/v, HA, tachy, HTN
208
brown recluse sx
pain and itching
ulcer and necrosis
pale, gray, eroded center w halo of swelling/hemorrhage
RARELY: rhabdo, DIC, acute hemolytic anemia
209
which type of spider bite can RARELY result in Rhabdo, DIC, acute hemolytic anemia?
Brown recluse
210
Which spider bite has Antivenom?
Black widow
211
How long does it take for BROWN recluse bite to heal?
5-10 days
212
Sx of Tachy, HTN, tachypnea, muscle spasm
Bark scorpion
213
How long to monitor pt after Bark scorpion sting?
8-12 hrs
214
Is there an antivenom for Bark scorpion?
YES
| give to all pts w severe sx who are not responding to supportive care
215
Fibrinolysis
Thrombocytopenia
Unstable vitals, AMS
Rattlesnake bite
216
Serum sickness is assoc w what type of antivenom
Rattlesnake
Give oral prednisone to treat serum sickness for 1-2 wks
217
Neurotoxic venom
no local injury
can take hours for effects to onset
Coral snake
218
Closely monitor respiratory fx bc once these sx onset they are irreversible
Coral snake
219
During DESCENT
unable to eq pressure b/w TM and external canal
pain, fullness, conductive hearing loss, hemotympanum
Barotitis (ear squeeze)
220
Descent
Barotitis
221
Sinus barotrauma
Sinus ostia occluded
DURING DESCENT as well
Bleeding into mask
pain over affected sinus
epistaxis
222
Inner ear barotrauma
pt attempts Vasalva
Ruptures OVAL/ROUND window, tearing vestibular membrane
inner ear
223
Sensineural hearing loss
INNER ear barotrauma
224
Stat ENT consult, head of bed up, no nose blowing, Antivertigo meds
INNER ear barotrauma
225
Ascent injuries
Pulm barotrauma
| Arterial gas embolism
226
Pulmonary barotrauma
overinflation "burst lung"
227
SOB, CP, subQ air, PNX
Pulm barotrauma
Tx: If only pneumomediastinum: symptomatic
PNX: intervene
228
Arterial gas embolism
ANY neuro sx in the setting of pulmonary barotrauma
229
Tx for Arterial gas embolism
| NEURO sx
```
ABC
High flow O2
IV hydrate
Immediate recompression (HYPERBARIC O2)
Stat Neuro consult
```
