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ED/Surg > ED > Flashcards

ED Flashcards

1
Q

What is EMTALA?

A

“anti dumping law”

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2
Q

What does this law make providers do? -EMTALA

A

allow medical screening

address any emergency medical condition by appropriately treating, stabilizing, transferring

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3
Q

Who does EMTALA apply to?-EMTALA

A

all hospital/providers participating in medicare

all pts regardless of pay, insurance, national, origin, race, creed, color

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4
Q

What are the boundaries of being on grounds?-EMTALA

A

on campus

off campus - 250yd

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5
Q

Who can be transferred out?-EMTALA

A

pt is stable
pt needs higher care
pt wants to transfer

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6
Q

How can you transfer?-EMTALA

A

call must be made ahead of time
official forms must be filled out
all paperwork, reports sent

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7
Q

What does medical screen consist of? -EMTALA

A 
CC
vital signs
general appearance
mental status
ability to walk
focused PE
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8
Q

What is “medical emergency”?-EMTALA

A

acute sx of sufficient severity - severe pain

if no help is given then it could end fatally

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9
Q

What is HIPPA?

A

consent is needed before sharing info
health info is to only be used for health purposes
when it does get shared, min amount should be given

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10
Q

When can info be shared without HIPPA?

A

purpose of treatment
payment
operaiton

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11
Q

What are reportable events? -HIPPA

A 
death
child/elder abuse/neglect
sexual assault
knife/gun wound
animal bites
epilepsy
threat of harm to self/others
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12
Q

What is tx without consent?

A

BATTERY

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13
Q

What is the universal gaol of health care?

A

do what is best for the pt

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14
Q

What are the types of consent?

A

general consent - general consent
informed consent - for dx studies/procedures/invasive
-dx, purpose of tx, risk/benefits, alt tx, and consequence of tx
implied consent- assumption b/c pt is not able to formally give consent

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15
Q

What if pt refuses tx?

A

Against Medical Advice - AMA: pt is able to make decision, paperwork is needed; but if prob if pt is drunk/psychiatric disorder

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16
Q

What is DNR?

A

do not resuscitate

-can get IV, fludis. O2, meds

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17
Q

What is malpractice?

A

negligence by provider

  • duty to care: relationship between pt was made
  • breach of duty to care: failed to provide tx
  • proximate cause: negligence caused the injury
  • damages: monetary value by the jury
  • statue limitation of 2 yrs
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18
Q

What is good samaritan law? not apply to?

A

helping those who need it

does NOT apply when working

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19
Q

What is pt abandonment?

A

unilateral termination of provider-pt relationship WITHOUT pt consent and notice

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20
Q

What is the main difference between somatic and visceral pain? -chest pain

A

somatic: able to point
visceral: hard to pin-point

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21
Q

What is the difference between visceral, pleurtic, and chest wall?

A

visceral: deep, poorly localized, radiates
pleuritic: deep BREATHING, coughing
chest wall: pain can be reproduced w/ palpation, movement

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22
Q

Pt has crushing, tightness,s squeezing, pressure? Location? radiates? other sx?

A

angina pectoris
location: retrosternal/epigastric
radiates: R/L shoulder/arm, jaw
other sx: dyspnea, diaphroresis, nausea

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23
Q

Pt has heaviness, tightness? Location? Other sx?

A

massive PE
location: whole chest
other sx: dyspnea, unstable vital signs, feeling of impending doom

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24
Q

Pt has pleuritc pain? Location? other sx?

A

PE
location: focal chest
other sx: tachycardia, tachypnea

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25
Q

Pt has ripping, tearing? Location? radiates? other sx?

A

Aortic dissection
location: midline, substernal
radiating: intrascapular area of back
other sx: secondary artery branch occlusion

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26
Q

Pt has sudden, sharp, lancinating, pleurtic pain? Location? radiates? other sx?

A

pneumothorax
Location: one side of chest
radiation: shoulder, back
other: dyspnea

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27
Q

Pt has sudden, sharp, AFTER forceful vomiting? Location? radiates? other sx?

A

esophageal rupture
location: substernal
radiation: back
other sx: dyspnea, diaphoresis, sepsis

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28
Q

Pt has sharp, constant pleuritic pain? Location? radiates? other sx?

A

pericaditis
location: substernal
radiates: back, neck, shoulder
other sx: fever, friction rub

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29
Q

Pt has sharp, pleurtic pain on chest and fever?

A

pneumonia

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30
Q

Pt has severe sharp pain at epigastric that goes back up into chest? Other sx?

A

Perforated peptic ulcer

other sx: acute distress, diphoresis

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31
Q

What are sx of acute coronary sx?

A

anginal apin for 2-20min

AMI pain 2min-2hrs

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32
Q

Pt has hypotension, JVD, muffled heart sounds? What is this called?

A

cardiac tamponade

becks triad

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33
Q

What work up to do for chest pain?

A

EKG
troponin
CXR

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34
Q

How to stabilize chest pain?

A

ABC
IV fluids
O2
cardiac monitoring

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35
Q

How to tx ACS/AMI?

A

MONA (morphine, O2, nitro, ASA) +/-Beta

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36
Q

How to tx cardiac tamponade?

A

pericardiocentesis

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37
Q

How to tx aortic dissection

A

initial: central line, morphine (pain), fluids (hypotension)
stabe: propranolol, diltiazem, enalapril
unstable: surgery

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38
Q

How to tx esophageal spasm/rupture?

A

spasm: nitro
rupture: airway, fluids, surgery

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39
Q

How to tx pericarditis?

A

NSAID

colchincine

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40
Q

How to tx pneumothorax (tension)?

A

severe/unstable: needle decompression

definitive: chest tub ethoracotomy

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41
Q

What is the diff between dyspnea and respiratory distress?

A

dyspnea: subjective

respiratory distress: objective

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42
Q

What are red flags for dyspnea?

A

decreased mental status
labored breathing
speaking in fragmented sent
cyanosis

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43
Q

What can trigger CHF/PE?

A

ischemia

arrhythmias

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44
Q

Pt has wheezing, poor air movement, coughing? Triggers?

A

Asthma/COPD

triggers: pulm infxn, allergens, chemical irritants

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45
Q

Pt has moist crackles, JVD, pedal edema? What other sx?

A

CHF/PE
S3
pink/frothy sputum

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46
Q

Pt has stridor, drooling, hoarseness, swelling? Triggers?

A

upper airway

triggers: FB, infxn-epiglottitis, hypersensitive rxn-angioedema

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47
Q

Pt has cough, fever, pleuritic chest pain? Triggers?

A

pneumonia

triggers: viral URI, influenza, hx of resp probl

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48
Q

Pt has dyspnea, tachypnea, tachycardia, hemoptysis? Triggers?

A

PE

triggers: hx of PE/DVTm smoking, OCP use, cancer, immobilization, recent trauma

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49
Q

Pt has pleurtic hcest pain, uneven chest rise/breath sounds, tracheal shift? Trigger?

A

pneumothorax

triggers: young, tall, male, smoker

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50
Q

Work up for dyspnea?

A

CXR

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51
Q

How to tx CHF/PE?

A

BiPAP
lasix
nitro
morphine

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52
Q

How to tx ashtma/copd?

A

duoneb
solumedrol
PPV
+/-abx

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53
Q

How to tx pneumothorax?

A

15-20%: tube thoracotomy

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54
Q

How to tx pneumonia?

A

empiric IV abx w/in 6hrs

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55
Q

How to tx PE?

A

stable: enoxaparin
unstable: alteplase

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56
Q

How to tx croup?

A

racemic

decardron

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57
Q

How to tx angioedema?

A

epi
H1/H2 blockers
glucocorticoid

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58
Q

How to tx epiglottis?

A

do not examine airway

rocephin + solumedrol

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59
Q

How to tx FB in throat?

A

stable: NO blind attempts
unstable: back blows, heimlich, compression

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60
Q

Which ones do you have to be ready to intubate, crich?

A

epiglottis

FB

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61
Q

What is the diff between parietal and visceral? -abdominal

A

parietal: pt does NOT move; peritoneum is irritated
visceral: pt moves EVERYWHERE

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62
Q

Murphy sign?

A

gallbladder

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63
Q

Mcburney?

A

appendix

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64
Q

Psoas?

A

retrocecal appendix

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65
Q

Obturator sign?

A

pelvic inflammation
lower appendix
diverticuluosis

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66
Q

Pt has low grade fever, epigastric tenderness, then right lower quad? GI sx? Location? Labs?

A

appendicities
GI sx: anorexia, +/-N/V
location: periumbilical to LLQ
Labs: high WBC, CT

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67
Q

Pt has abdominal distension, high pitched rushes? GI sx? Location? other sx? Labs?

A 
intestinal obstruction
GI: vomiting
location: diffuse
other: crampy
lab: Xray- dilated, fluid filled loops; CT w/contrast
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68
Q

Pt has epigastric tenderness, involuntary guarding? GI sx? Location? other sx? Labs?

A 
perforated duodenal ulcer
GI: anorexia, N/V
location: epigastric
other: abrupt, worse when supine
labs: xray- air under diaphragm; CT
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69
Q

Pt has fever, mass and tenderness in LLQ? GI sx? Location? other sx? Labs?

A 
diverticulitis
GI: diarrhea
location: LLQ
sx: crampy
labs: CT
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70
Q

Pt has fever and diffuse abdominal tenderness, diarrhea (blood and mucus)? Location? other sx? Labs?

A

IBD

location: diffuse in lower abdomen
other: crampy
location: diffuse
labs: blood and WBC in stool; CT scan; barium enema

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71
Q

Pt has RUQ tenderness and fever? GI sx? Location? other sx? Labs?

A 
acute cholecystitis
GI: anorexia, N/V
location: epigastric, RUQ, referred pain to shoulder 
other: acute
labs: US
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72
Q

Pt has RUQ tenderness that is intermittent?

A

biliary colic

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73
Q

Pt has diffuse abdoiminal tenderness, vascular dz somewhere else w/ diarrhea (bloody)? Location? other sx? Labs?

A

ischemic colitis

location: epigastric, diffuse
other: crampy
labs: CT, barium enema w/ thumbprinting

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74
Q

Pt is in shock, abdominal aneurysm, pulsatile mass? Location? other sx? Labs?

A

AAA

location: epigastrium and back
other: abrupt, sharp and severe
labs: US, CT

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75
Q

Pt is in shock, peritonitis, LUQ tenderness, fx left ribs? Location? other sx? Labs?

A

ruptured spleen

location: LUQ, diffuse, left shoulder
other: abrupt, severe
labs: CT for liver/spleen, US for free fluid

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76
Q

Pt has flank tenderness? GI sx? Location? other sx? Labs?

A 
renal colic
GI: N/V
location: costvertebral/along ureter
other: sudden, severe and sharp
labs: UA - hematuria; CT non contrast for obstruction
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77
Q

Pt has epigastric tenderness w/ elevated serum lipase?GI sx? Location? other sx? Labs?

A 
acute pancreatitis
GI: anorexia, N/V
location:epigastric penetrating to back
other: acute, dull and severe
labs: CT
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78
Q

Pt has cervical motion tenderness? GI sx? Location? other sx? Labs?

A 
acute salpingitis (infxn and inflammation of ovaries)
GI: N/V
location: bilateral adnexal 
other: progressively getting worse
labs: US
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79
Q

Pt has adnexal mass and tenderness? Location? other sx? Labs?

A

ectopic preg
location: unilateral, shoulder pain
other sx: sudden pain
labs: US, hcg positive

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80
Q

Pt has violaceous center w/ faint spreading erythema-type of spider bite?

A

brown recluse spider

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81
Q

Pt has HA and similar sx to brown recluse spider-what are they?

A

hobo spider bite

violaceous center w/ faint spreading erythema

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82
Q

Pt has muscle spasms and is in severe pain-spider bite?

A

widow spider

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83
Q

How should spider bites be tx?

A

no abx; tx symptomatically

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84
Q

What to update when bit by animal?

A

tetanus

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85
Q

Which ones are concern for rabies?

A 
bats
monkeys
dogs
skunks
raccocons
foxes
carnivores and omnivores
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86
Q

What are the bugs for cat bite? Tx?

A

pasteurlla multocida: amox-clav

bartonella hensalae: azithromycin

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87
Q

What are bugs for dog bite? Tx?

A

pasteurella, streptococci, c. cnaimorsus: amox-clav

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88
Q

What are bugs for human bite? Tx?

A

eikenella, satphylococci, streptococci: amox-clav

HSV: acyclovir

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89
Q

What is first deg frostbite?

A

aka frost nip
partial freezing
stinging- no perm cold weather injury
redness, mild swelling, pale, edema

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90
Q

What is second deg frostbite?

A

clear blistering
numbness/burning
grayish color in dark people, redness in fair people

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91
Q

What is the def of frostbite?

A

true freezing injury of tissue
sudden blanching skin of nose, ears, cheeks, toes
PAINLESS

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92
Q

What is 3rd deg frostbite?

A 
blue gray color
bleeding blisters
loss of sensation
poor cap refill
hemorrhagic bullae
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93
Q

When do you do an urgent endoscopy?

A 
sharp, elongated object-toothpick
MULTIPLE FB
button batteries
evidence of perforation
coin at the cricopharyngeus muscle
airway compromise
FB there for more than 24hrs
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94
Q

Pt has dizziness, HA, nausea, unsteady walk, muscle cramps?

A

heat injury

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95
Q

Carbon monoxide sx?

A

HA -> throbbing HA, dyspnea -> impaired judgement, nausea, fatigue, visual disturbances -> confusion, syncope-> coma, seizures -> hypotension, resp failure

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96
Q

Carbon monoxide tx?

A

cardiac monitor

O2 100%

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97
Q

Pt looks gray?

A

BIG organs are dying

98
Q

Pt looks blue?

A

NOT getting O2

99
Q

Pt is awake and alert means..?

A

reticular activating system is on

100
Q

What do neurons need?

A

glucose ONLY

101
Q

What does the cortex do?

A

modifies rxn/personalty - responds to painful stimli

102
Q

What to look for if pt is NOT awake?

A

O2
glucose
pump - blood: BP, cap refill, pulses

103
Q

What does the O2 sat tell us?

A

NOTHING about how much Hgb is in teh body

104
Q

What if pt has O2, glucose, and pump is ok?

A

check whole body for anatomical changes, infxn, and toxic causes

105
Q

What body cavities to check for w/infxn?

A 
head - meningitis
lungs - pneumonia
-stomach - abodminal process (age dependent)
kidneys - urosepsis
skin
CORE TEMP
106
Q

What are toxic causes to check for?

A

med list; DI
self inflicted: ETOH, drugs
endy: hyperTHRYOID, steroid withdrawal; HYPOnatremic (VERY COMMON)

107
Q

What to watch out for in pts w/ intracranial bleed-secondary HA?

A

coumadin
HA on exertion
thunderclap HA

108
Q

Pt wakes up with a HA? Sx? next step?

A

intracerebral mass
sx: pain changes w/ body position, progressive hA
CT w/ contrast

109
Q

Pt is old and has a tender hard nodule on side of head?

A

temporal artertisis - secondary HA

110
Q

What can cause secondary HA?

A

closed angle glaucoma
temporal artertsis
intracerebral mass
intracranial bleed

111
Q

What are the phases of wound healing?

A 
hemostasis
inflammation
epithelialization
fibroplastic collagen syntehsis
scar maturation
scar remodleing
112
Q

Wha tis hemostasis?

A

vasoconstriction

clotting cascade activated

113
Q

What is inflammation?

A

cytokines come to the injury site

114
Q

What is scar maturation?

A

6wks after injury
colagen syntehsis breaks down
avoid UV to reduce scar for 1 yr

115
Q

How to clean wound?

A

3D
debris removed
debride wound
devitalized tissue removed

116
Q

What is primary intention?

A

closing wound

117
Q

When NOT to close wound?

A

open for 8hrs - except face

DIRTY

118
Q

What is secondary intention?

A

closing wound and letting it heal on it’s own

119
Q

What is tertiary intention?

A

keeping wound open then closing it LATER

120
Q

What is collagen synthesis?

A

new collagen and cap beds are made

121
Q

What part of face should NEVER be shaved?

A

eyebrows

122
Q

How to do hemorrhage control?

A

compression for 10min

avoid tourniquets, blind clamping

123
Q

What are the 2 goals for wound closure?

A

prevention of infxn

best possible functional and cosmetic result

124
Q

What wounds need initial open management?

A 
wound greater than 8 hrs
face more than 24hrs
contaminated/DIRTY
need excessive tension to approximate edges
gunshot wounds
stabwounds
bits: animals and humans
puncture wounds
125
Q

Which suture is the least scarring?

A

monofilament

126
Q

What gauge should be used?

A

4.0

127
Q

When and how to tx paronychia?

A

fluctuance/purulence

tx: I+D and abx

128
Q

When and how to tx subungual hematoma?

A

painful subungual hematoma w/ nail edges still intact

tx: needle or electrocautery

129
Q

When and how to tx toenail removal?

A

ingrown toenail, traumatic partial avulsion, nail bed laceration
tx: use scissors if needed to do partial, grasp and pull + abx after

130
Q

When and how to tx epistaxis?

A

persistent bleeding

Tx: 1) stabilize w/ pressure 2) cautery 3) nasal packing w/ tampon

131
Q

When and how to tx auricular hematoma?

A

tender auricular swelling that deforms anatomy

tx: small incision to be made, express hematoma, pressure

132
Q

How tx nasal FB?

A

positive pressure

smooth objects - suction tip

133
Q

How to tx refractory bleeds- nose?

A

surgicel and gelfoam w/ PT

134
Q

How to tx posterior bleeds - nose?

A

foley catheter

135
Q

How to tx nasal FB - rough objects?

A

alligator forceps

136
Q

How to tx nasal FB - smooth objects?

A

suction tip

137
Q

How to tx nasal FB - refractory?

A

catheter, glue and swab, right angle hook

138
Q

How to tx ear FB - rough object?

A

alligator forcep

139
Q

How to tx ear FB - smooth object?

A

suction tip

140
Q

How to tx ear FB -refractory object?

A

glue and swab

right angle hook

141
Q

How to tx ear FB - bug?

A

liquid

lidocaine

142
Q

How to tx eye FB- superficial?

A

irrigation

moist swab

143
Q

How to tx eye FB - embedded?

A

bent 20g need to scrap

144
Q

What is imp after txing eye FB?

A

abx

tetanus

145
Q

What are the techniques for removing fish hooks?

A

string pull
needle cover
advance and cut

146
Q

What is string pull?

A

tie string around bend in hook and depress shaft of the hook and tug

147
Q

What is needle cover technique?

A

need next to shank of embedded hook and sheath barbe then remove

148
Q

What is advacen and cut technique?

A

push barb through and clip off then remove

149
Q

How to remove ring?

A

string technique
ring cutter
vise grip

150
Q

When to do I+D?

A

any infxn w/ suspect abscess

151
Q

When to do joint aspiration?

A

suspicion of infectious arthritis (red, warm swollen)

removal fo large joint effusion

152
Q

What position for shoulder joint aspiration?

A

soft spot inferior and medial to tip of acromion and go towards coracoid

153
Q

What position for elbow joint aspiration?

A

flex 90deg, between radial head and lateral epicondyle

154
Q

What position for wrist aspiration?

A

ulna side of EPL

155
Q

What position for knee aspiration?

A

slightly flexed; come from lateral side under patella

156
Q

What position for ankle aspiration?

A

tip of the lateral malleolus

157
Q

When to do LP?

A

meningitis = HA, fever, nuchal rigidity

subarachnoid hemorrhage = worst HA ever; thunderclap

158
Q

How to do LP?

A

locate L3-L4 and poke 4-5cm until “pop”

159
Q

When to do central line?

A

rapid adminstriation of fluid, blood, vasopressor, nutrients

160
Q

How to do central line?

A

locate internal jugular (between heads of sternocelodomastoid)
subclavian (ankle of clavicle to suprasternal notch)
femoral (medial to femoral artery pulsing)

161
Q

What is first deg burn?

A

sunburn

PAIN

162
Q

What is second deg burn?

A

blistering
PAIN
blanching

163
Q

What is third deg burn?

A

NO pain

NO blanching

164
Q

What is fourth deg burn?

A

ELECTRICLA BURN

interla organ damage b/c of ENTRY and EXIT wound

165
Q

What are the rules of 9 for adult?

A

9: face, arms
18: front, back, legs
1: neck

166
Q

What are the rules of 9 for baby?

A

9: arms
14: legs
18: face, front, back

167
Q

What if pt has small burn?

A

loss fxn
deformity
infxn risk incr

168
Q

What if pt has large burn? Kids?

A

pulm damage
cardiac contractility damage
children can have hormonal changes?

169
Q

BOTH small and large burns?

A

PTSD

170
Q

What haps in hypermetabolic syndrome?

A

pt need higher intake of cal b/c of increase in SV

171
Q

What to do in the first 48hrs of burn?

A

resuscitate w/ IV fluids -normal

172
Q

What is teh parkland/brooke, consensus formula?

A

204cc/kg/%BSA w/in 24hrs; 1/2/ w/in 8hrs

173
Q

What can be used to gauge fluid resuscitation?

A

urine output

174
Q

What is normal urine output?

A

adult: 30-50cc/hr
children: 1cc/kg/hr

175
Q

What to keep in mind when resuscitating?

A

update tetanus

overfluid is bad as underfluid

176
Q

How to monitor resuscitation?

A

HR 120

MAP >70

177
Q

What is teh biggest factor in wound management after burn?

A

sepsis

178
Q

Complication during wound management-burn?

A

ileus

compartment sx in abdomen d/t increase in fluid

179
Q

How to tx first deg burn?

A

clean

bactiracin -WET dressing

180
Q

Tx for sec deg burn?

A

irrigate and clean
DRY dressing
NO ointment

181
Q

How to tx third and fourth deg burn?

A

fluid in interstitial
decrease sepsis risk
excise primary and secondary closure - bleeding = new skin

182
Q

Pt has vaginal bleeding-what to check for?

A

pregnant?

183
Q

What to check if pt has vaginal bleeding, not pregnant and unstable?

A

OR

184
Q

What to check if pt has vaginal bleeding, not pregnant and stable?

A

nothing

185
Q

What to check if pt has vaginal bleeding, pregnant and unstable?

A

OR

186
Q

What to check if pt has vaginal bleeding, pregnant and stable?

A

check if ectopic

  • yes: OR
  • no: nothing
187
Q

Genital bleeding - neonates?

A

estrogen withdrawal

188
Q

Genital bleeding - premenarch?

A 
FB
trauma
infxn
urethral prolapse
ovarian tumor
precocious puberty
189
Q

Genital bleeding - early postmarche?

A 
ovulatory dysfnxn
bleeding diathesis
stress
pregnancy
infxn
190
Q

Genital bleeding - reproductive age?

A 
ovulatory dysfxn
pregnancy
cancer
polyps
leiomyomas
adenomyosis
infxn
endocrine dysfxn 
bleeding diathesis
meds
191
Q

Genital bleeding - menopausal transition?

A 
anovulation
polyps
fibroids
adenomyosis
cancer
192
Q

Genital bleeding - menopause?

A

cancer

hormone therapy

193
Q

Labs for vaginal bleeding?

A 
prenancy test
pelvic US
CBC
CMP
H&H
coag panel 
UA
BC
194
Q

What are life threatening, do not miss for vaginal bleeding?

A

early preg: ruptured ecoptic preg

late preg and peripartum: placental abruption, placenta previa, postpartem hemorrhage

195
Q

What are causes of vaginal bleeding?

A 
spontaenous abortion
rupture ovarian cyst
ovarian torsion 
PID
FB
drugs
coag
cancer
196
Q

Common cx of vaginal bleeding?

A

premenopausal: AUB, fibroid, uterine polyps, PID, endorine dysfxn
postmenopausal: CANCER

197
Q

What vital signs are dangerous?

A

HR and BP goes DOWN or UP together

198
Q

How to tx toxin poisoning?

A

stablizize airway
brain perfusion
gastric decontamination (gastric lavage, activated charcoal)

199
Q

What labs to order for toxin poisoning?

A 
CBC
CMP
AB
urine tox
eTOH
salicylate
acetaminophen
hcG
200
Q

Pt has pain, tearing, eyelid twitching, decreased visual acuity? What are the 2 etiology? What is worse? What should pt bring in?

A

chemical ocular injury
1) acid 2) alkalai
alkali is worse b/c it penetrates more rapidly unlike acid that denatures proteins –> “protective layer”
bring agent

201
Q

How to tx chemical ocular injury?

A

proparicaine -anesthetic
irrigation until pH 7
erythromycin -abx
cycloplegic to relax ciliary

202
Q

Pt has curtain/shadow over visual field? Other sx?

A

retinal detachment

other sx: painless vision loss, loss of red reflex

203
Q

How to tx retinal detachment?

A

rest head on pillow on the SIDE of detachment

204
Q

Pt has cherry red fovea, pallor of the disc? Hx? What to r/o?

A

central retinal artery artery occlusion
hx: amaurosis fugax
r/o: temporal arteritis

205
Q

Retinal vein occlusion vs central retinal artery occlusion?

A

retinal vein occlusion: flame hemorrhage

206
Q

How to tx central retinal artery occlusion?

A

ocular massage- pressure for 10-15sec w/ sudden release
acetalmide
timolog

207
Q

Pt has hazy cornea and fix mid-dilated pupil? Other sx?

A

acute angle closure glaucoma

other sx: sudden unilateral eye pain, firm globe

208
Q

How to tx acute angle closure glaucoma?

A

1) timolol
2) acetazolamide
+/-mannitol

209
Q

Pt has chemosis and proptosis?

A

orbital cellulitis

chemosis: conjunctival edema
proptosis: protrusion/displacement of the eye

210
Q

How to tx orbital cellulitis?

A

IV abx-ampicillin

211
Q

orbital cellulitis vs periorbital?

A

periorbital -infxn of the eyelid

212
Q

Erythema multiforme minor vs major?

A

minor: rash in kids - self limiting
major: adults; severe-SJS, TENS

213
Q

Pt has dull red macules, papules?

A

erythema mutliforme minor

214
Q

Pt has red macules w/ target lesions - what “sign” would you also see?

A

erythmea mutliforme major

sign: niolsky - pushing on the blister and the skin on the side peels off

215
Q

How to tx erythema multiforme?

A

burn unit

216
Q

Pt has abnormal bleeding, bruising? Tx?

A

thrombocytopenia

tx: transfusion - platelets, FFP

217
Q

What are indications to tx thrombocytopenia?

A

less than 50,00 w/bleeding or less than 10,000 prophatically: transfusion w/platelts, FFP

218
Q

Pt has fatigue, SOB, bleeding? When to tx?

A

anemia

Hbg

219
Q

Pt has bruising and bleeding w/ abnormal vitals? Tx

A

DIC

supportive

220
Q

What are the sx for neutropenic fever?

A

temp >101F

neutrophil ct

221
Q

How to tx neutropenic fever?

A

empiric abx and STOP CHEMO

222
Q

Sx for rhabdomylosis?

A

musle pain
muslce weakness
dark urine

223
Q

What labs to order for rhabdomylosis?

A

high CKP

high myoglobinuria

224
Q

How to tx rhabdomylosis?

A

IV

+/- bicarb, kayexalate, diuretics

225
Q

What is status epilepticus?

A

seziure lasting more than 5min

2+ seizures without recovery

226
Q

How to tx status epilepticus?

A

1) benzo -lorazepam/diazepam

2) antieplipetics

227
Q

When to use long arm posterior splints?

A

distal and HUMERUS fx

both bone forearm fx

228
Q

When to use double sugar tong?

A

proximal, mid, distal RAIDUS AND ULNAR fx

better for DISTAL forearm and elbow fx

229
Q

What does double sugar tong prevent arm to do?

A

flex and extension

pronation and supination

230
Q

When to use shoulder sling and swathe?

A

dislocation
rotater cuff injury
shoulder strain
humerus fx

231
Q

When to use forearm sugar tong?

A

distal RADIUS and ULNAR fx

232
Q

What splints can be used for radius and ulnar fx?

A

double sugar tong and forearm sugar ton

233
Q

Difference between forearm sugar tong and double sugar tong?

A

forearm only prevents pronation and supination

double sugar tong includes pronation/supination + flex and extension

234
Q

When should forearm volar splint NOT be used?

A

distal radius or ulnar fx - use sugar tong

235
Q

Pt injured little and ring finger?

A

ulnar gutter

236
Q

Pt injured index and long fingers?

A

radial gutter

237
Q

Pt has scahpoid fx?

A

thumb spica

238
Q

Pt has spring, carpal tunnel night splints, wrist fx?

A

forearm volar splint

239
Q

When can thumb spica be used?

A

scaphoid fx

de quervain tenosynovitis

240
Q

Pt injured knee/calf?

A

jones compression dressing

241
Q

When to use posterior ankle splint?

A

distal tibia/fibular fx
bad sparins
tarsal/metatarsal fx

242
Q

When to use stirrup splint?

A

ankle sprains

ED/Surg (9 decks)

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