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AHN 577 > ED/Trauma > Flashcards

ED/Trauma Flashcards

1
Q

What is flail chest

A

Fracture of two or more consecutive ribs in two or more places

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2
Q

S/S of flail chest

A 
Paradoxical chest wall movement- "Inspiration=in"
Dyspnea
Chest pain
Hypoxia
Cyanosis
SubQ emphysema
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3
Q

Flail chest interventions

A 
Assist with ventilation (positive pressure)
supplemental oxygen
Volume replacement
Think about underlying injuries
Pain managment (intercostal blocks)
Avoid barotrauma
Chest tubes as required
Aggressive pulmonary toilet
Surgery
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4
Q

What is tension pneumothorax

A

When air enters the pleural space on inspiration but it can’t escape on expiration
Increased pressure collapses the lung on the side of the injury followed by mediastinal shift

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5
Q

S/S of tension pneumothorax

A 
Severe dyspnea
Chest pain
Distended neck veins
Percussion findings (hyper resonance)
Decreased breath sounds
hypotension
tracheal deviation
expanded chest
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6
Q

Intervention for tension pneumothorax

A

Immediate needle thoracotomy in the 2nd intercostal space miclavicular line (advance needle until there is a gush of air)
Prepare for chest tube
-4-5 ICS at the MAL
-Should not be used lightly, can have complication

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7
Q

Open/sucking chest wounds

A

Allows free passage of air into the pleural space which is sucked back out
Can lead to tension pneumo
Can result in respiratory insufficiency
Be careful with occlusive dressing

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8
Q

s/s of open sucking chest wound

A

Dyspnea
Sucking sound on inspiration
Penetrating chest wound
Decreased or absent BS

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9
Q

Interventions for open chest wound

A

Administer oxygen
Seal the defect on three sides only
Remove dressing if s/s of tension pneumonia after application
Prepare for CT

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10
Q

Pneumothorax

A

Accumulation of air in pleural space

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11
Q

S/S of Pneumothorax

A

Sudden onset of pain with radiation to shoulders
Hyperressonance
Tactile and vocal fremitus decreased on effected side
Decreased BS

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12
Q

Interventions for pneumothorax

A

If small, monitor respiratory status

If larger or respiratory compromise than place chest tube

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13
Q

Hemothorax

A

Results from the accumulation of blood in the pleural space

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14
Q

s/s of hemothorax

A

If major, signs of shock
Dullness to percussion
Decreased BS
Tracheal shift is possible if large amount of blood

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15
Q

Interventions for hemothorax

A

Prepare for CT insertion
Monitor amount and rate of drainage (may need surgery)
Large bore chest tube

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16
Q

Pericardial tamponade

A

Life threatening
Accumulation of blood in the pericardium
Obstructive shock

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17
Q

s/s of pericardial tamponade

A

Signs of shock
Penetrating trauma 3-5th rib
Becks Triad (Decreased BP, JVD, Muffled heart sounds)
Pulsus paradoxus (decreased in SBP by 10 during inspiration)
ST segment changes
Cyanosis

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18
Q

Interventions for pericardial tamponade

A

Pericardiocentesis
Emergent pericardial window
Surgery to stop bleeding

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19
Q

Imaging for pericardial tamponade

A

Echocardiography is the diagnostic test of choice

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20
Q

Aortic rupture

A

Usually fatal at scene
Transverse tear with exsanguination or a partial tear with tamponade
Usually damage to proximal descending aorta

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21
Q

s/s of aortic rupture

A

Signs of hypovolemic shock
Chest wall ecchymosis
Marked variation of BP from right to left
Decreased or absent femoral and pedal pulses
Loud murmur in parascapular region
Widened mediastinum

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22
Q

Interventions for aortic rupture

A

CPR
Administer IVF and Blood products
Prepare for emergency thoracotomy/surgical repair
CT surgery consult

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23
Q

Blunt injuries are the most common cause of…

A

Abdominal trauma

Injuries to liver, spleen and kidneys

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24
Q

Seat belt sign shows there could be…

A

GI injury

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25
Q

Abdominal and Pelvic injuries are more likely associated with…

A

side-on collisions

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26
Q

Intra abdominal hypertension is pressures greater than…

A

12 mmHG

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27
Q

Intraabdominal compartment syndrome is pressure greater than…

A

20 mmHG

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28
Q

Surgery is required for abdominal pressures greater than

A

25 mmHG

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29
Q

How do you calculate BSA for burns

A 
Rule of nines
arms-9% each
Legs-18% for whole leg each
Trunk- 18% on each side
Perineum, hand-1%
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30
Q

Parkland formula of resuscitation for burns

A

4 cc/kg x % BSA that was burned over 24 hours

1/2 in the first 8 hours

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31
Q

Mechanisms of burn injuries

A

Inhalation
Thermal
Electrical
Chemical

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32
Q

Concerns with inhalation burn

A

Edema, Obstruction, Hypoxia

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33
Q

Electrical injury

A

Entrance and Exit wound
Do not look bad but do have a lot of nerve, vessel and muscle damage
Unable to calculate surface area burned

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34
Q

Chemical injury

A

Length of contact and concentration is needs to be taken into account

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35
Q

Burn patients are at risk for…

A

hypovolemic shock

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36
Q

Burn patients should be assessed for what electrolyte imbalance

A

Hypernatremia

Hypokalemia

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37
Q

1st degree burn

A

Superficial partial thickness
Redness, no blisters
Blanches/tender

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38
Q

2nd degree burn

A

Deep partial thickness
Appears moist, may blister
Painful-nerve endings exposed

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39
Q

3rd degree burn

A

Full thickness burns
Pale yellow to brown
Dry leathery
No pain-superficial nerve endings destroyed
Somatic pain from inflammation and ischemia

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40
Q

Emergency management for burns

A 
Airway- TOP PRIORITY
Remove clothing
Cool, moist NS compresses
2 large bore IVs
IVF replacement- LR fluid of choice
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41
Q

Burn management

A 
Monitor for dysrhythmias- hypokalemia
Monitor NGT output- can get ileus
Monitor UO- can go into rhabdo
Prepare for escharotomies
Topical antimicrobial agents
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42
Q

Chlamydia symptoms

A

Copious amounts of purulent discharge

Mild discomfort

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43
Q

Chlamydia Treatment

A

gram stain, Giemsa stain and culture
Tetracycline
erythromycin
single dose azithromycin

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44
Q

Allergic conjunctivitis symptoms

A

Bilateral tearing and stringy discharge

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45
Q

Allergic conjunctivitis treatment

A

Topical antihistamines and/or steroids
Naphazoline
H1 receptor antagonist (Ketotifen (gtts), loratadine (PO), fexofenadine (PO), cetirizine (PO)
NSAIDS (Ketorolac)

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46
Q

Bacterial conjunctivitis Symptoms

A

Purulent discharge

Mild discomfort

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47
Q

Bacterial conjunctivitis treatment

A 
Usually self-limiting
Topical antibiotic solutions and ointments
Gentamicin
Neomycin
Polymyxin
Sulfacetamide
Ofloxacin
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48
Q

Acute conjunctivitis symptoms

A

Redness
Discharge
Irritation
Possible photophobia

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49
Q

Acute conjunctivitis treatment

A

Most are benign, with a self-limited process

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50
Q

Emergency care of corneal abrasion

A

Tetanus prophylaxis- indicated for foreign objects with dirt
Eye patch- no longer indicated
Antimicrobial therapy

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51
Q

Opthalmologic consultation is warranted for…

A

suspected retained foreign body

suspected corneal ulcerations

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52
Q

How do corneal abrasions present?

A 
Eye pain (occasionally described as severe)
Tearing
Sensation that a foreign body is present
Inability to open effected eye
Photophobia
Pain with movement
Blurred vision
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53
Q

How does acute angle-closure glaucoma present?

A 
At least two of these:
Unilateral Ocular pain
Nausea and Vomiting
History of intermittent blurring or vision with halos
At least three of these:
IOP > 21 mmHG
Conjunctival injection (bloodshot eye)
Corneal epithelial edema
mid-dilated nonreactive pupil
shallower chamber in the presence of occlusion
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54
Q

Treatment for acute angle-closure glaucoma

A

Acetazolamide (Diamox)- Diuretic- reduce the amount of aqueous fluid (can use mannitol or glycerol as well)
Topical beta blocker
Topical alpha blocker
Topical steroid
Emergent opthamologic consultation (once pressure is down, laser peripheral iridectomy is the permanent cure)

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55
Q

Corneal ulceration presentation

A

*

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56
Q

Corneal ulceration treatment

A

Topical antibiotics- fluoroquinolones

Topical steroid- once you have confirmed its bacterial

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57
Q

Hordeolum is…

A

Staphylococcal abscess on the upper and lower eyelid

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58
Q

Hordeolum s/s are.

A

localized edema
acutely tender
pain is proportional to the amount of edema

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59
Q

Hordeolum is diagnosed…

A

based on physical findings alone, no tests need to be run

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60
Q

Hordeolum treatment

A

Warm compress
Bacitracin or erythromycin
I/D

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61
Q

Chalazion is…

A

A granulomatous inflammation of a meibomian gland

May follow a hordeolum

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62
Q

Chalazion s/s…

A 
May not be any
Visual distortion if large enough
Itching
Hard, non-tender cyst
red conjunctiva
63
Q

Chalazion treatment…

A

Incision and curettage

64
Q

Blepharitis is..

A

A chronic, bilateral inflammation of the lid margins

65
Q

Blepharitis causes…

A

Staphylococcus, Seborrhea, Meibomian gland dysfunction

66
Q

Blepharitis s/s…

A 
Irritation
Burning
Itching
Erythema
Crusting of lid margins
Red rimmed eyes
67
Q

Blepharitis treatment…

A 
Clean scalp and eyebrows
removal of scales
antibiotic ointment
expression of meibomian gland
systemic antibiotics
topical steroids
68
Q

Conjunctivitis is..

A

inflammation over the posterior surface of the lids and up over the sclera to the cornea

69
Q

Viral conjunctivitis symptoms…

A

Watery discharge

70
Q

Viral conjunctivitis treatment…

A

Symptomatic treatment only

71
Q

Cataracts are…

A

an abnormal progressive opacity of the eye causing visual blurring and decrease in acuity
(occurs in 46% of people age 75-85)

72
Q

Causes of cataracts

A 
Age
Congenital
Systemic disease (diabetes)
Systemic corticosteroid use
Substance abuse (tobacco, alcohol)
73
Q

Cataract symptoms

A 
Enhanced glare
decrease in vision
painless
Loss of red reflex
Opacity
74
Q

Cataract management

A

Lens replacement- only definitive treatment
(Contact lenses
magnifying glasses- in interim while waiting for surgery)

75
Q

Otitis Externa is caused by…

A 
Bacterial infection (gram negative bacteria)
Recent water exposure (swimmers ear)
Mechanical trauma (Qtip use)
Fungal infection (will look like tiny poppy seeds in the external canal
76
Q

Otitis externa symptoms…

A

Otalgia
Pruritis
Purulent discharge

77
Q

Otitis externa managment

A

Remove exudate (warm water lavage)
Topical otic drops
Protect from moisture

78
Q

Otic drop medication options for otitis externa…

A

Cortisporin
Aminoglycoside and anti-inflammatory
Cipro

79
Q

Otitis media symptoms…

A 
Decreased hearing
Otalgia
Fever
Pressure
Vertigo
Nausea/vomiting
80
Q

Acute Otitis media is…

A

A bacterial infection of the mucosally lined air contained spaces of the temporal bone

81
Q

The causes of Acute Otitis media…

A

Streptococcus
H. Flu
M. Catarrhalis

Often follows a viral Upper respiratory infection

82
Q

Otitis media PE findings…

A

Erythematous tympanic membrane (TM)
Bulging or retration
Occasional bull
Decreased TM movement

83
Q

Otitis media management..

A 
Amoxicillin
Cephalexin
Septra (for beta lactase producing bug)
Ceclor
Cipro
Nasal decongestant
84
Q

Serous Otitis media is due to…

A

a blocked eustachian tube and an inability to equalize the pressure.
May be precipitated by allergy, barotrauma, neoplasm or subacute infection

85
Q

Serous otitis media symptoms..

A 
Hearing loss
Ear fullness
Popping sounds with pressure changes
Air bubble posterior to the TM
Decreased membrane mobility
Changes in Rinne, Weber (conductive hearing loss)
86
Q

Serous otitis media management…

A

Oral decongestants

87
Q

Cholesteatoma is…

A

chronic otitis media from prolonged auditory tube dysfunction, chronic middle ear pressure which creates a a sec which causes chronic infection and can eventually erode into the bone.

88
Q

Cholesteatoma symptoms…

A

Hearing loss
Dependent on the degree of bone erosion
Tympanic membrane retraction or perforation

89
Q

Cholesteatoma management…

A

Surgical- removal of the sec

90
Q

Vertigo causes…

A

Medication
Middle ear infection
CNS disorder
Labyrinthitis

91
Q

Vertigo symptoms…

A 
Room spinning
Sensation of falling
Nausea/vomiting
Tinnitus
Hearing loss
92
Q

Vertigo lab workup should include…

A

Serum B12
Medication levels to check for toxicity (digoxin)
CT/MRI of the head
Syphillis testing

93
Q

Vertigo management…

A

Diazepam- for acute symptom management
Antihistamines
Anticholinergics
Antiemetics

94
Q

Conductive hearing loss causes..

A 
Due to something blocking the conduction of sound
Cerumen impaction
Foreign body
Otitis media
Otosclerosis
Cholesteatoma
95
Q

Conductive hearing loss management…

A

Correct the source of blockage

96
Q

Causes of sensorineural hearing loss…

A

Neuro problem, can get overlap with vertigo

Acoustic neuroma
Meniere's disease (if hearing loss and vertigo think)
Presbycusis
Syphilis
CNS disease
Medication toxicity
97
Q

Sensorineural hearing loss management…

A

Refer to ENT

98
Q

Common cold has an official name of…

A

“Viral Rhinitis”

Caused by Rhinovirus and adenovirus

99
Q

Infectious mononucleosis symptoms

A 
sore throat
fever
malaise
anorexia
myalgia
100
Q

Mono is caused by…

A

Epstein-barr virus

101
Q

Mono PE findings..

A

Posterior cervical chain lymphadenopathy
Exudative tonsillitis
Splenomegaly
Rash

102
Q

Mono management…

A

Supportive care

Corticosteroids

103
Q

Lab work for Mono…

A

Monospot will be positive
Lymphocytic leukocytosis
Early rise in IgM
Permanent rise in IgG

104
Q

Sinusitis symptoms…

A 
Pain and pressure over the maxillary sinuses, worse with dependent head positions
Headache
Toothache
Discolored nasal discharge
Postnasal drip and cough
105
Q

Sinusitis diagnostics…

A

X-ray may show thickening of the sinus mucosa with or without air/fluid levels
Head CT is more sensitive but more expensive
You can culture the nasal discharge

106
Q

Sinusitis management…

A 
Amoxicillin
Bactrim DS
Ceclor
Afrin nasal spray
Guaifenesin
Sudafed
107
Q

Normal IOP

A

10-21 mmHG

108
Q

Open angle glaucoma

A 
Initially asymptomatic
Cupping of the disc
Constriction of visual fields
Central vision is good until late
IOP > 21 (30-50)
109
Q

Open angle glaucoma management

A 
Beta blockers
Carbonic anhydrase inhibitors (Trust, adopt)
Prostaglandin analogs (Xalatin)
Adrenergic agonists (Alphagan, iodine, propine)
Cholinergic agonists (Pilocar, isopto carbachol)
110
Q

Narcotic overdose treatment…

A

Respiratory support
Gastric lavage
Nalaxone 5 ug/kg IV then 2-20 mg if unresponsive

111
Q

Acetaminophen presentation…

A

Nausea/vomiting
RUQ pain at 24-48 hr
Hepatotoxicity- jaundice prolonged bleeding time, hepatic encephalopathy

112
Q

Acetaminophen treatment…

A 
Blood levels 4 hours after ingestion
Induce emesis/gastric lavage
Activated charcoal
N-acetylcysteine
Blood levels every 4 hours
113
Q

Benzo/GHB toxicity presentation…

A 
Drowsiness
Ataxia
Confusion
Slurred speech
Unsteady gait
Respiratory depression
Hypoactive reflexes
114
Q

Benzo/ GHB treatment…

A

Monitor BP and support respirations
Gastric lavage
Flumazenil

115
Q

Stimulant overdose presentation…

A 
Insomnia
Irritability
Dry mouth
Anorexia
Arrhythmias
Chest pain
heart block
HTN
Seizures
116
Q

Stimulant OD treatment…

A 
Induce emesis (Ipecac)
NS lavage
Activated charcoal
Reduce stimuli
Administer Chlorpormazine or diazepam
Beta blockers
117
Q

Alcohol toxicity presentation..

A 
Respiratory depression
Nystagmus
Mydriasis
Diplopia
Coma
Seizure
Tachycardia
Hypotension
Hypoglycemia
118
Q

Alcohol toxicity management…

A

ABCs
HD for severe toxicity
IV glucose
Thiamine, multivitamin, folic acid

119
Q

Class I antiarrhythmics presentation…

A 
Nausea
Vomiting
Diarrhea
Dizziness
Blurred Vision
Bradycardia
Hypotension
Cardiovascular collapse
Tinnitus
Hearing loss
Confusion
Delirium
Psychosis
Seizures
120
Q

Class I antiarrhythmic management

A

12 lead and tele
Charcoal
Atropine, overdrive pacing, Isuprel

121
Q

Barbiturate Presentation

A 
CNS depression
Drowsiness
Confusion
Coma
Hypothermia
Respiratory depression
Respiratory acidosis
Absent DTR, gag, corneal
Miosis
122
Q

Barbiturate OD managment

A

Maintain airway
charcoal within 1 hour of OD
Insert NGT
hemodynamic support

123
Q

Beta blocker presentation…

A 
Bradycardia
Hypotension
CNS depression
Coma
Bronchospasm
Myocardial depression
Cardiogenic shock
Heart failure
124
Q

Beta blocker OD managment

A 
ABCs
Glucagon
Charcoal or whole bowel irrigation
Calcium IV
Monitor K and glucose
Treat hypotension
Temporary pacing
125
Q

Calcium channel blocker presentation

A 
Bradycardia
Conduction disturbances
hypotension
cyanosis
seizure
coma
death
126
Q

Calcium channel blocker managment

A 
IV calcium
Glucagon
Atropine, Isuprel
Aggressive GI decontamination
Activated charcoal
Insulin with glucose
Tele monitoring
127
Q

Carbon monoxide presentation…

A 
Dysrhythmias
Cardiac arrest
Heart failure
Respiratory depression
hypoxia
128
Q

Carbon monoxide management

A

100% oxygen

Hyperbaric oxygen for carboxyhemoglobin level greater than 25%

129
Q

Digoxin presentation…

A 
N/V/D
Blurred vision
Green halos
Anorexia
Abdominal pain
Fatigue
Dizzy
Hallucinations
130
Q

Digoxin OD managment

A

Maintain high normal K levels
Lidocaine for dysrhythmias
Activated charcoal
Digibind

131
Q

Lithium OD presentation…

A 
N/V/D
Muscle weakness
tremor
rigidity
ataxia
dementia
delirium
132
Q

Lithium OD managment

A 
Saline bolus
No charcoal
Gastric lavage
Supportive care
Diuretics for levels > 2-3
HD for levels > 4
Benzos for seizures
133
Q

Salicylate presentation findings

A 
Tachypnea
cyanosis
metabolic acidosis
respiratory alkalosis
dehydration
hyperthermia
134
Q

Salicylate managment

A 
Monitor serum concentrations and electrolytes
volume replacement
activated charcoal
Sodium bicarb
HD
135
Q

Narcotic OD presentation

A

Shallow respirations
Respiratory depression
Pinpoint pupils
Coma

136
Q

Organophosphates (insecticides) Presentation…

A 
Miosis
Seizures
paralysis
coma
bradycardia
conduction defect
respiratory depression/paralysis
137
Q

Organophosphates management…

A

Maintain airway
Wash skin thoroughly
Activated charcoal if ingested
Atropine 2 mg IV every 15 min (up to 40 mg/day not uncommon) until atropinization (flushing, dry mouth, dilated pupils, tachycardia)
Pralidoxime (reverse nicotinic signs such as muscle weakness and respiratory depression- not for asymptomatic patients)
Urinary catheter

138
Q

Antipsychotic OD presentation…

A 
Dystonia
Extrapyramidal symptoms (rigidity, stiff neck, hyperreflexia) 
Deep sleep
Neuroleptic malignant syndrome 
urinary retention
Hypotension
AV block
widened QRS
prolonged QT
139
Q

Antipsychotic OD treatment…

A

Activated charcoal
Benzotriptine mesylate (cogent)- for EP signs
Dantrolene for Neurleptic malignant syndrome
Supportive care
Vasopressors

140
Q

Antidepressant OD presentation…

A 
Hallucination
Confusion
Blurred vision
AMS
Urinary retention
tachycardia
hypotension
seizures
arrhythmias
141
Q

Antidepressant OD treatment…

A 
activated charcoal
sodium bicarb to target pH 7.5-7.55
Benzos for seizures
Ativan for rigors
Cyproheptadine for delirium, skeletal muscle tone
Montior for hypotension
142
Q

Theophylline OD presentation…

A 
Vomiting
Hematemesis
Restlessness
Agitation
Irritability
Tachycardia
PVCs
Atrial arrhythmias
Seizures
143
Q

Theophylline OD management..

A 
Airway
Treat arrhythmias
Activated charcoal until level less than 20
Consider whole bowel irrigation
Ativan for seizures
144
Q

Anticoagulant OD presentation…

A

severe hemorrhage

145
Q

Anticoagulant OD management…

A

For heparin- given protamine
For coumadin- give Vitamin K for FFP
No antidote for other anticoagulants

146
Q

Methanol OD presentation…

A 
drowsiness
Ataxia
metabolic acidosis
pupillary dilation
hypotension
rapid pulse
147
Q

Methanol OD management…

A

Correct acidosis
Administer folic acid
HD for severe cases

148
Q

Ethylene glycol OD presentation…

A 
Euphoria
Nausea
Seizures
CNS depression
Progressive metabolic acidosis
Flank pain
Tubular necrosis
Renal failure
149
Q

Ethylene glycol OD management…

A

Maintain ABCs
Fomepizole every 12 hours until methanol levels below 20
Bicarb infusion
To facilitate metabolism (Pyridoxine, thiamine, magnesium)
In severe cases- HD

150
Q

Retinal detachment presentation

A

Painless visual changes
Floaters
Light flashes
Blurred vision

151
Q

Retinal detachment management

A

Immediate Ophthalmologist referral

152
Q

Gonorrhea conjunctivitis Treatment

A

Gram stain
Giemsa stain
Culture
Single dose ceftriaxone

153
Q

Corneal abrasion treatment

A

Gentamicin

Sulfacetamide

AHN 577 (4 decks)

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