EM and Surgery Flashcards
Bugs most commonly associated with dog/cat bites?
-Pasteurella multocida and S. aureus
What types of animal bites should NOT be sutured closed?
- puncture and other bites to the hand
- Cat bites (more likely to be dirty)
-DO suture facial wounds
PPX ABX given to animal bites?
- Amoxicillin-clavulanate
- Doxy + metronidazole or clinda
If a patient has a dirty, contaminated, puncture or crush injury wound but they had their last tetanus booster 6 years ago, do they need a booster?
-YES! In these situation, give a booster if >5 years since last dose
If a patient has a dirty, contaminated, puncture or crush injury wound and does not know their immunization history, what should they be given?
- Td + complete the series
- Also give tetanus immune globulin if person was unimmunized or not sure
What degree burn is painful, erythematous with blisters but does NOT blanch with pressure?
Deep partial thickness 2nd degree (epidermis and partial dermis)
Burn that is painless, white or shared and does not blanch with pressure?
3rd degree (epidermis and full dermis)
Burn that is painful, erythematous, no blisters and cap refill is in tact?
1st degree (just epidermis)
What is the parkland formula?
4ml x (weight in kg) x (%BSA burned)
- Half of this amount is given in the first 8 hours.
- Second half given over the next 16 hours
- In addition, need maintenance fluids
What are the 2 features that distinguish heat stroke from heat exhaustion?
Heat stroke: body temp >104F and brain dysfunction
What is a J wave? When can it be seen?
small positive deflection after QRS complex
-hypothermia
When is peak LFT elevation seen after an acetaminophen OD?
stage III (72 -96 hours after ingestion)
Tx of acetaminophen OD?
- activated charcoal within 4 hours
- N-acetylcysteine (within 8 hours)
Treatment of beta blocker and CCB toxicity?
- IV fluids
- atropine
- glucagon
- calcium
- insulin and glucose
Tx for anticholinergic toxicity?
Physostigmine (you can FIX atropine OD)
Digoxin toxicity?
change in color vision
- prolonged PR
- bradycardia
- PVCs* (most common)
- hyperkalemia (indicates severity)
Heparin antidote?
protamine sulfate
Isoniazid antidote?
Vitamin B6
Sulfonylurea antidote?
octreotide and dextrose
TCA antidote?
sodium bicarbonate (QRS >100ms) and diazepam
First sign of aspirin overdose?
tinnitus
Tx of aspirin toxicity?
charcoal, dialysis, sodium bicarbonate
Treatment of methanol and ethylene glycol toxicity?
Fomepizole (alcohol dehydrogenase inhibitor) or Ethanol
At what INR do you consider vitamin K in a warfarin OD? What about FFP?
- INR >5 –> oral vit K
- INR >20 –> IV Vit K and FFP
What should NOT be given in a caustic ingestion?
- anti-emetics
- neutralizing agents
- NG tube
can all lead to further damage.
Symptoms of organophosphate poisoning?
DUMBBELSS Diarrhea Urination Mitosis Bronchospasm Bradycardia Emesis and Excitation of skeletal muscle Lacrimation Sweating Salivation
Tx or organophosphate poisoning?
- Atropine (anticholinergic)
- Pralidoxime (reactivates acetylcholinesterase)
Tx for moderate lead toxicity in a kid (45-69mcg/dL)?
Succimer
Tx for severe lead toxicity in a kid (>70mcg/dL)?
dimercaprol and calcium disodium edetate
Tx of arsenic toxicity?
dimercaprol, succorer, penicillamine
Tx of copper toxicity?
penicillamine
Almond scented breath after exposure to a fire?
Cyanide toxicity
Tx of cyanide toxicity?
- sodium thiosulfate (facilitates conversion to thiocyanate to be excreted)
- Hydroxocobalamin (form cyanocobalamin to be excreted)
- Amyl nitrate and sodium nitrate (causes cyanometemoglobin)
GCS Scale
Eyes: 4-open spontaneously 3-open to voice 2-open to pain 1-no opening
Verbal 5-oriented 4-confused 3-inappropriate words 2-incomprehensible sounds 1-Nothing
Motor 6-obey commands 5-localize 4-withdrawal 3-flexion (decorticate) 2-extension (decerebrate --> brainstem damage) 1-Nothing
What is Cushing’s triad?
-hypertension
-bradycardia
-bradypnea
(2/2 increased ICP)
Treatment of elevated ICP after trauma?
- Head of bed to 30 degrees
- Mannitol
- intubate and hyperventilate
- Craniectomy
Absent breath sound and hyper resonance on the left, distended neck veins and hypotension? Tx?
- tension pneumothorax
- chest tube placement (preferred) or needle decompression
What can an IV pyelogram detect?
injury to the renal pelvis
What can a retrograde urethrogram detect?
urethral or bladder injury
Blood seen at urethral meatus or high riding prostate on rectal exam? What should you NOT do?
- suspect urethral rupture
- Do NOT put in a foley
- Retrograde urethrogram=imaging needed
Next step in a pelvic fracture with DPL showing urine int he pelvis?
Urgent laparotomy
Blunt abd trauma + unstable vitals +FAST showing no fluid in pelvis?
Ex lap
Blunt abd trauma + unstable vitals + FAST inconclusive?
DPL
Blunt abd trauma + stable vital signs?
CT abd/pelvis
Signs of Elder abuse?
Can be malnutrition and bed sores
What antibiotic prophylaxis should be given to a rape victim?
- Ceftriaxone (gonorrhea)
- Azithromycin or Doxycycline for chlamydia
- Metronidazole for trichomoniasis
- Heb B vaccine if not vaccinated
- HIV prophylaxis for 3-7 days
Post-op fever causes?
Wind: pneumonia Water: UTI Walking: DVT and PE Wound: infection 5-8 days later Wonder drugs; antimicrobials, heparin, SSRIs
What 2 infections are more common in neurosurgery?
Meningitis and DVT/PE (less anti-coagulation)
During surgery, muscle rigidity, hyperthermia, rise in end-tidal CO2, cyanosis, tachycardia, DIC, acidosis…Cause?
Malignant hyperthermia (from inhaled anesthetics or succinylcholine)
Treatment of malignant hyperthermia?
Dantrolene
Cool the body
O2
