EM Pre-Test Flashcards
Think of this when a pt presents with dyspnea with a hx of long bone fracture, major trauma, or ortho procedure?
Fat embolism - unlike thromboemboli, these can pass into arterial circulation
Trmt = supportive in ICU
COPD is divided into emphysema and what two other categories? Trmt for emphysema?
Asthma and chronic bronchitis.
Trmt of emphysema exacerbations = corticosteroids, anticholinergics, and intermittent B2-agonists to decrease inflammation, decrease mucous production, and relax smooth muscles
Most effective study to order when considering rib fracture? Potential respiratory risks 2/2 fracture? MC location of rib fractures?
Rib series - danger lies in possible penetration injury
Risk of hypoventilation 2/2 to respiratory splinting - increases risk for PNA and atelectasis. Trmt = pain relief to prevent above - if multiple rib fractures, several intercostal nerve blocks appropriate
MC location = point of impact or posterior angle
What physical complaint involving extremities can pts with anxiety attacks p/w?
Carpal-pedal spasms 2/2 transient decrease of calcium 2/2 respiratory alkalosis (elevated pH causes albumin to become more charged and bind more Ca)
What should be given to a pt w/ a recent asthma attack in addition to B2-agonist?
3-10 days of prednisone (40 - 60 mg)
Trmt for a pt p/w decreased RR, pinpoint pupils (2mm or less) and AMS?
Naloxone 2/2 probable opioid intoxication = mu-opioid competitive antagonist
Causative agent of pt ℅ initial flu-like symptoms with severe deterioration in 1-2 days: septic shock, respiratory failure, and mediastinitis, widened mediastinum w/ h/o sheep/cattle/horse exposure
B Anthracis
Causes of exudative vs. transudative effusions?
Exudative: malignancy, infection, connective tissue disease, PE, trauma, uremia, pancreatitis, post-surgical, esophageal rupture, drug-induced
Transudative: CHF, hypoalbuminemia, cirrhosis, myxedema, nephrotic syndrome, SVC syndrome, peritoneal dialysis
Labs and their respective cut off points for deciphering transudative v. exudative effusions?
LDH: > 200 (or LDH ratio > 0.6)
Protein: ratio > 0.5
Also - amylase, cell count, gram stain, cytology, glucose
When to give steroids before PCP antibiotic trmt? And why?
Give steroids if PO2 < 70 or A-a gradient > 35mmHg. Abx use causes organism death with subsequent inflammation - if no pretreatment w/ steroids in above settings, inflammatory response could precipitate worsening respiratory symptoms
What can you use to monitor asthmatic’s response to trmt?
Peak Expiratory Flow (FEV1). Asthma triggers = dust, perfumes, exercise, menstruation, smoking, aspirin, infections, etc.
How does cholinergic crisis present? Trmt? MCC via toxicity routes?
SLUDGE = Salivation, Lacrimation, Urination, Defecation, GI problems, Emesis and Miosis (small pupils). Commonly contained in insecticides = organophosphates = Anticholinesterase inhibitors = cholinergic crisis! Treat with Atropine (anti-cholinergic) and Pralidoxime (restores Anticholinesterases)
What helps distinguish GHB toxicity?
LOC fluctuates b/w periods of respiratory arrest w/ apnea and periods of combative behavior after noxious stimuli
What clues you into CO toxicity? Order what test? Trmt?
Flu-like illness (normally w/o high fever), MC in winter months (2/2 heaters, etc), entire family is symptomatic and improves while away from source. Order carboxyhemoglobin levels (NL = 0-5%). Give O2 unless CO level >25%, then hyperbaric therapy
Trmt for acetaminophen (tylenol) toxicity? Possible damage to…?
N-acetylcysteine reduces risk of hepatotoxicity
Anticholinergic presentation? Trmt? Key to distinguishing from sympathomimetic syndrome?
“Blind as a bat (mydriasis), red as a beet (flushed), hot as a hare (hyperthermia), dry as a bone (dry membranes), and mad as a hatter (AMS)”. Phyostigmine = reversible cholinesterase inhibitor. Sympathomimetic syndrome = diaphoretic
Heroine (opioid) intox presentation and trmt? Trmt for BDZ overdose?
Low respiratory effort, miotic pupils, and CNS depression. Naloxone should be administered after attention is given to airway management. Give Flumazenil for BZD overdose.
What substance can cause seizure activity refractory to standard rx protocol (which is???)? What’s the trmt? Beware of???
Isoniazid. Std = diazepam (BZD), phenobarbital, and phenytoin. Pyridoxine (B6) = trmt. Look out for acidosis and respiratory compromise.
What type of diabetes medication can cause recurrent episodes of hypoglycemia?
Glyburide = common Sulfonylurea. Insulin is the MCC of iatrogenic episodes of hypoglycemia but patients recover after dextrose or a meal unlike glyburide where recurrent episodes are seen despite above therapy.
Aspirin toxicity presentation? Vs. Pseudoephedrine or diphenhydramine?
Tinnitus, hyperthermia, diaphoresis, confusion, N/V. Commonly see metabolic acidosis with anion gap and respiratory alkalosis
Benadryl = decongestant having anticholinergic properties and anti-histaminic properties (may cause sedation)
Pseudoephedrine = stimulation, tachycardia, dysrhythmia, hypertension
Serotonin syndrome presentation?
Diaphoresis, tachycardic, fever, agitation, tremor, myoclonus, ataxia, sometimes diarrhea, hyperreflexia, and shivering. Difficult to distinguish b/w sympathomimetic syn so med hx will help
What things can’t charcoal NOT bind?
Lithium (needs to be dialyzed), hydrocarbons, metals (Fe), ethanol, and ions
Trmt for cocaine intox?
BZD’s (ie: Diazepam)
What is happening with a pt with known drug abuse who is yawning, has rhinorrhea, piloerection, N/V/D, hyperactive bowel sounds, diaphoretic, anxiety, fear and tachycardia?
Opioid withdrawal
Wthdrawal of _____ leads to tachycardia, autonomic hyperactivity, tremors, HTN, hyperreflexia? Life threatening?
Ethanol - yes.
Withdrawal from ____ leads to HA, flushing, sweating, hallucinations, anxiety, and reflex tachycardia?
Clonidine
Hallmark of PCP intox? Typical neuro findings? Trmt?
Recurring delusion of superhuman strength and invulnerability. Nystagmus (vertical/horizontal/rotary). Trmt = conservative, sometimes antipsychotics or BZD’s are used for sedation purposes.
How to calculate Anion Gap? NL: gap? Causes of increased anion gap?
[Na+] - [Cl- & HCO3-]. NL = 6-12.
MUDPILES = methanol/metformin, uremia, DKA, paraldehyde (anticonvulsant/sedative). Iron/INH, lactate, ethylene glycol, ethanol, salicylate
How to calc serum osmolarity? NL level? Common causes of increased osmolar gap? Differentiating them?
[2xNa+] + [Glucose/18] + BUN/1.8 + EtOH/4.6. Gap > 50 = osmolar gap typical of alcohol intox but 10-15 = NL.
“MAE DIE” = Methanol, Acetone, Ethanol, Diuretics (mannitol/sorbitol), Isopropyl Alcohol, Ethylene Glycol
Methanol (wood alcohol forms formic acid) usually has hallucinations in presentation. Isopropyl (rubbing alcohol becomes acetone) has no anion gap met acidosis seen. Ethylene Glycol (antifreeze becoming oxalic acid) causes Calcium Oxylate kidney stones
TCA toxicity p/w? Trmt?
Widened QRS (2/2 Na blocking), dysrhythmias. Greater risk of toxicity b/c anticholinergic effects of TCA causes absorption to slow. Can give activated charcoal for this! Sodium bicarb also administered until QRS = 7.55
How does NAC work?
It’s a glutathione precursor to reduce NAPQI, the toxic metabolite of acetaminophen.
Why does ethylene glycol cause problems? Trmt?
Metabolized to glycol acid, making an anion gap metabolic acidosis, and further metabolized into oxalic acid. This combines with Ca to form calcium oxalate crystals that precipitate in renal tubules, brain and other tissues. Wood lamp can also show fluorescence of urine. Trmt = Fomepizole
Which alcohol is NOT associated with anion gap metabolic acidosis?
Isopropyl alcohol - but it can cause hemorrhagic gastritis. It’s “bitter”. Remember, “ketosis without acidosis” b/c metabolized to acetone, giving it distinct breath smell.
What clue involving PO2 tips you off to Methemoglobinemia?
Normal PO2 but the patient doesn’t respond to supplemental O2
3 mainstays of Salicylate tox?
1) charcoal to prevent further absorption 2) hydrate 3)sodium bicarb for those with levels > 35 - this helps alkalize the urine to promote excretion. If levels >100, coma, or end-organ failure, then dialysis is key!
Side Effect of N-AC?
Anaphylactoid rxns = rash, bronchospasm, hypotension, and death
What are some common Hydrocarbons (HC) and what would happen to someone who recently abused them and tried to perform physical activity?
Household polishes, Glues, Paint Remover, Industrial Solvents. Mainly affects lungs, heart, and CNS = crackles/bronchospasm/edem, sensitization of the cardiac cells, and euphoria. Can precipitate sudden cardiac death 2/2 ventricular arrhythmias.
Bradycardia + Hypotension in a pt with BP medications has what tox? Trmt?
B-adrenergic blocker (BBlocker). Treat hypotn with fluid resuscitation and atropine. Charcoal to inhibit further absorption. And Glucagon for inotropic and chronotropic effects
Effects of MDMA?
MDMA = ecstasy. Restless, ataxic, euphoric. Causes the release of Serotonin and this causes increase in vasopressin (ADH), resulting in increased thirst and hyponatremia. The hyponatremia = hallmark finding.
Patients who swallow drugs should receive…?
Charcoal and whole-bowel irrigation
What pain killer should be avoided in pts taking MAOI’s? Other drugs to avoid?
Meperidine (Demerol). Avoid any TCA or SSRI’s but also keep in mind that cocaine, amphetamine, and dextromethorphan can cause indirect increases in serotonin.
What helps distinguish a cerebral concussion from a contusion?
A concussion is not seen on imaging; they normally have periods of amnesia and can’t recall the incident, +HA, and V but NO prolonged neural deficits; the LOC is due to impairment of RAS. A contusion is normally seen on imaging and results from the brain hitting the skull - this results in prolonged focal neuro deficits
Classes of hemorrhage and their findings?
Class I - 0-15%/0-750mL blood loss, mostly asymptomatic, mild tachycardia
Class II - 15-30%/750-1500mL blood loss, tachycardic, tachypnea, mild anxiety, slight decrease in urine production
Class III - 30-40%/1500-2000mL blood loss includes above + AMS and decrease in SBP
Class IV- >40%/>2000mL blood loss includes above + lethargy, little to no urine production
Leading cause of death and disability in trauma victims?
Head injury = immediate cause of death (sec-min) > c-spine injury > great vessel injury > obstruction of breathing
Where could you identify fluid quickly if suspected intraperitoneal hemorrhage is suspected? Next step?
Morrison’s Pouch (b/w R kidney and liver) - only need 70 cc to see fluid. Exploratory laparotomy
In a trauma situation (stab/GSW/blunt trauma) with unstable/crashing vitals, what’s the next step when you have hypotensive pt with JVD and muffled heart sounds?
Emergency thoracotomy - cardiac tamponade is likely. Pericardiocentesis is not appropriate now because the blood is likely clotted in there pericardium vs. viscous in a stable pt.
How would you advise a patient to bring an avulsed tooth to the ED?
If pt can put it back in socket, it’s ideal! If not possible: under tongue > milk > saline
Top 2 MC’ly injured organs in stabbing? Blunt Trauma?
(Stabbing) Live (size) > small bowel
(Blunt Trauma) Spleen > Liver > Kidney > SB > Bladder
PE signs of PTX? Trmt of stable vs. unstable pt?
Decreased breath sounds over affected lung, and subcutaneous emphysema. Unstable = needle thoracostomy vs. stable pt gets chest tube
How does the neurologic exam look in pt with Brown Sequard syndrome?
Ipsilateral motor paralysis and loss of proprioception and vibratory sense; contralateral loss of pain and temperature.
Anterior cord syndrome p/w what kind of neurologic exam?
Loss of motor and pain sensation bilaterally below the lesion. hallmark is preservation of vibratory sensation and proprioception because of an intact dorsal column.
How many ribs are affected in flail chest? Hallmark sign?
3 adjacent ribs with 2 sites of fracture per rib. Paradoxical breathing = hallmark.
Define the anatomical landmarks of the neck and which is most concerning for injury?
Zone I: sternal notch & clavicles to cricoid cartilage
Zone II: cricoid cartilage to angle of mandible
Zone III:angle of mandible to base of skull
Zone II is much more exposed than the others so it’s often at higher risk to injury which is why they are most often taken to OR for exploratory sx.
Describe the fracture and it’s typical cause:
1) Hangman’s Fracture
2) Colle’s Fracture
3) Boxer’s Fracture
4) Jefferson’s Fracture
5) Clay Shoveler’s Fracture
1) Hyperextension of neck causing bilateral fracture of C2 pedicles (head-on collisions and abrupt decelerations)
2) MC wrist fracture in adults from outstretched falls - dorsally displaced and angulated metaphysics of radius
3) Fracture of the neck of 5th metacarpal from closed fist impact
4) C1 anterior/posterior arch fracture from axial impact on skull (diving)
5) A complete fracture of spinous process in c-spine 2/2 hyperextension
Describe 3 types of LeFort Fractures:
I) transverse fracture above the teeth; can move alveolar plate and hard palate
II) apex at bridge of nose and lateral triangulated fractures involving infraorbital ridges with movement of maxilla, nose, and infraorbital rims
III) complete transection running from one zygomatic arch to the other
Vascular supply affected by Epidural Hematoma vs. Subdural?
Epidural = Middle Meningeal Artery = doesn't cross suture lines Subdural = Bridging Veins = crosses suture lines
Describe neuro findings of Central Cord lesion and who’s at risk?
Those with DJD and experience hyperextension of the neck can cause ligamentum flavum to cause central cord damage. See loss of rectal tone, loss of upper extremity sensation > lower extremity, and more distal extremities tend to be preserved because of lateralized position in corticothalamic tract.
When to give blood in trauma pts? If unable to match, what kind of blood should be given to men vs. women?
Blood products should be administered if vital signs transiently improve or remain unstable despite resuscitation with 2 to 3 L of crystalloid fluid.
Men - Type O Rh +
Women - Type O Rh -
Immediate stabilization method of pelvic fractures? Subsequent trmt if unstable?
Pelvic binding garment. Angiography
Who should get c-spine radiographs even with no neck pain or limited ROM on PE?
Those > 65 yrs old
Pt has _______ if they present with pain with upper ward gaze, hypoesthesia in infraorbital area, intact visual acuity, possible diplopia? What would radiographs show?
Orbital floor fracture. Facial X-ray should show “tear drop” sign into maxilla with air-fluid level; “tear drop” = fat/muscle herniating through orbital floor.
Pt has exopthalmost, periorbital ecchymosis/edema, decreased visual acuity, and afferent pupillary defect = ?
Retrobulbar hematoma
Trismus (tightening of masseter muscle) could be indicative of what kind of facial fracture?
Zygomatic arch
Approach to penetrating abdominal wounds…
Stable = FAST or DPL; radiograph to locate trajectory if GSW pt Unstable = OR for ex lap
Mgmt of posterior nasal epistaxis?
If elevated INR, give FFP. Silver nitrate is for anterior nasal epistaxis only! Need to use posterior nasal packing, abx, and admit to hospital. (complications = MI, aspiration, card dysrhythmia, CVA)
What else should you suspect in near drowning pt? What PE sign would help distinguish c-spine injury?
Possible diving injury. If abdominal breathing is noted without thoracic respirations accompanying them, could mean damage below C3, 4, 5 level (poorly functioning diaphragm 2/2 nerve injury)
How do pulmonary contusions present? (PE and radiology)
Clinical manifestations include dyspnea that is usually worsening, tachypnea, cyanosis, tachycardia, hypotension, chest wall bruising, decreasing oxygen saturation, and increasing A-a gradient. Hemoptysis may be present in up
to 50% of cases. Typical radiographic findings begin to appear within minutes of injury and range from patchy, irregular, alveolar infiltrate to frank consolidation.
Mgmt of penetrating extremity trauma?
If no signs of distal ischemia (pallor, poikilothermia, pulselessness, pain, paralysis, paresthesia) then angiography can be used for localization purposes. If signs of ischemia - OR!!
MC presentation of brain herniation?
Herniated brain causes compression of cranial nerve III leading to anisocoria, ptosis, impaired extraocular movements, and a sluggish pupillary light reflex. As herniation progresses, compression of the ipsilateral oculomotor nerve eventually causes ipsilateral pupillary dilation and nonreactivity.
S/p chest tube for hemothorax, indications for thoracotomy are?
1) Initial chest tube drainage of 1000 to 1500 cc of blood
2) 200 cc/h of persistent drainage (c).
3) Patient remains hypotensive despite adequate blood replacement, and
other sites of blood loss have been ruled out.
4) Patient decompensates after initial response to resuscitation.
5) Increasing hemothorax seen on chest x-ray studies.
Describe Cauda Equina Syndrome and it’s trmt
Leg pain, saddle anesthesia,
and impaired bowel and bladder function (retention or incontinence). Loss of rectal tone and display other motor and sensory losses in the lower extremities. Patients with suspected
cauda equina syndrome require an urgent CT scan or MRI.
Acute trmt of elevated ICP?
Hyperventilation to produce an arterial PCO2 of 30 to 35 mm Hg will temporarily reduce
ICP by promoting cerebral vasoconstriction. The onset of action is within 30 seconds. In most patients, hyperventilation lowers the ICP by 25%. Hyperventilation is a
temporary maneuver and should only be used for a brief period of time during the acute resuscitation. Mannitol can be tried after.
Hx, PE findings and radiographic findings suggestive of mesenteric ischemia?
Hx = afib
PE = pain out of proportion to exam
Rads = pneumatosis intestinalis or gas in the portal venous system
SURG EMERGENCY!!!
MCC of acute episodes of diarrhea? Trmt?
Viral diarrheal diseases = Rotavirus (children), Norwalk virus, Enteric Adenovirus
Trmt = supportive care (hydrate!)
MC site of impaction of foreign body in adults?
LES
Lab findings in Alcoholic Ketoacidosis? B-OH/AcAc ratio? Trmt?
Anion gap metabolic alkalosis 2/2 V and volume depletion. Beta-hydroxybutyrate/Acetyl Acetate ratio = 5:1
Trmt = hydration with 5% dextrose in NS or 1/2NS. Thiamine can be given as prophylaxis for Wernicke’s encephalopathy
Test of choice to dx acute cholecystitis?
U/S Imaging - use HIDA if negative U/S in setting of very suspicious hx or equivocal U/S findings
Pain med considerations for ureteral stones?
Ketorolac = non-NSAID; possible maintenance with morphine. NSAIDS decrease uterospasm and renal capsular pressure in obstructed kidney
Classic triad for ruptured AAA? When to go to OR?
Hypotension, pain, and pulsatile abdominal mass. Go to OR is hemodynamically unstable
Lab findings in alcoholic hepatitis? Trmt?
AST > ALT presenting with stigmata of hepatic dysfunction = spider angiomata, gynecomastia, dupotrens contracture.
Trmt = supportive to correct fluid/electrolytes - monitor glucose, Mg, and consider thiamine in chronic alcoholics.
Trmt for Spontaneous Bacterial Peritonitis? When to begin trmt? Common causative organisms?
Treat with 3rd generation cephalosporin (cefotaxime) if neutrophil count is > 250. MCC = gram-negative enterococcus (E. Coli/Klebsiella/Strep. Species/Strep PNA)
MC times pts p/w testicular torsion?
First year of life and puberty. Order U/S and can attempt manual detorsion with analgesia, followed by surgical intervention if refractory
Study findings for + CT in setting of acute appendicitis?
Abd CT with contrast might show: fecolith, pericecal inflammation, or enlarged appendix (>6mm)
Triad for cholangitis presentation?
Fever, RUQ pain, jaundice.
Diagnostic criteria for pancreatitis?
2/3 of the following: amylase or lipase 3x upper limit, classic abdominal pain, and consistent imaging.
Approach to possible ovarian torsion?
If suspicion is high with classic hx, laparoscopy = diagnostic choice b/c diagnostic and therapeutic. If not, U/S is the next best choice.
Two possible complications of ERCP?
Pancreatitis or ascending cholangitis
Sonographic findings of ascending cholangitis?
Intrahepatic or ductal dilation.
Tests for stable AAA?
Evidence of an AAA is seen on plain radiograph approximately 66% to
75% of the time. The most common findings are curvilinear calcification of
the aortic wall or a paravertebral soft tissue mass.
Ultrasound and CT are the best diagnostic tools for the stable patient.
Prognostic labs for pancratitis?
LDH, glucose levels, WBC
Causative agent for epididymitis for men > 35 and < 35 yo?
> 35 = E. Coli
< 35 = C. Trachomatis & N. Gonorrhea
Trmt for male urethritis?
3rd generation cephalosporin or Cipro for probable gonococal infection + azithromycin or doxycycline or erythromycin for non-gonococcal urethritis (chlamydia)
Hx of visit to tropical climate w/ poor sanitation, bloody BM’s, RUQ abdominal tenderness, leukocytosis, fever = ? Trmt?
Entamoeba Histolytica - identify pathologic protozoan in stool. Supportive care + metronidazole. Might need to use percutaneous catheritization to drain abscess if refractory.
RF’s for pyogenic abscess in liver?
MC type of liver abscess. RF’s = underlying biliary disease with extra hepatic biliary obstruction leading to ascending cholangitis and abscess formation - associated with choledocholithiasis, benign and malignant tumors, or post-surgical strictures
Trmt of acute diverticulitis?
If complicated, admission with antibiotics (anaerobic and gram-neg bacteria). abscess formation >5cm need intervention, <5 can attempt abx alone
When to get an US vs. laparoscopy in setting of suspected ectopic?
If the pt is unstable or is showing signs of surgical abdomen, then get laparoscopy instead of US
Predictors of mortality in setting of pancreatitis?
(Ranson's Criteria): Age >55 WBC > 16,000 Glucose > 200 LDH > 350 AST > 250 Hematocrit falls > 10% in 48 hrs BUN rise > 5 (48hrs)
What radiographs should be ordered in setting of SBO?
Flat and upright abdominal X-rays - flat one shows distended loops and upright illustrates step-ladder progression of air-fluid levels
MCC of LBO?
Neoplasm, Diverticulitis, and Sigmoid Volvulus
If replacement of a G-tube is needed, how long will the track typically remain patent to allow for replacement?
7-10 days. Water soluble contrast should then be pushed through with a supine abdominal radiograph to ensure proper replacement
How often do kidney stones pass on their own depending on size?
< 4 mm = 90% time
4-6 mm = 50% time
> 6 mm = 10% time
When should you not try and manually reduce a hernia?
If there is evidence of strangulation (compromised vascular supply) evidenced by erythema
What type of hx makes you think of acute mesenteric ischemia?
Pts over 50 with a hx of afib (arterial embolism etiology) or CHF/recent MI/hypovolemia in the setting of non-occulsive etiologies for Acute Mesenteric Ischemia
Meds for sexually assaulted victim?
Gonorrhea (Ceftriaxone), Chalmydia (Azithromycin or Doxy), syphilis, and trich (metronidazole). HIV (postexposure prophylaxis with antiretrovirals). Tetanus and Hep B vaccination if update needed.
What extra intestinal manifestation is unique to Crohns (not seen in pts with UC)?
Nephrolithiasis b/c of ileal involvement and resultant hyperoxaluria
Dx, best test, and MCC of: immunocompromised pt with slowly progressive localized back pain, fever, and progressive weakness?
Epidural abscess. MCC = Stap. Aureus > Gram - bacilli > tuberculosis. MRI
MC tumors to met to spine?
“BLT with Kosher Pickles” = breast, lung, thyroid, kidneys, prostate
Early Goal Directed Therapy includes 3 basic steps:
For those unresponsive to initial fluid bolus, place central line with broad spectrum abx followed by EGDT:
1) Begin crystalloid therapy or fluid bolus until CVP 8 - 12 mmHg
2) If fluid alone doesn’t help, administer vasopressin for MAP > 65 mmHg
3) Check systemic venous O2 saturation; if < 70%, transfuse until HCT = or > 30%…if still low saturation, begin Dobutamine
Differentiate SIRS, Sepsis, Severe Sepsis, and Septic Shock
SIRS = (2 or more) RR > 20, HR > 90, T > 100.4, WBC > 12,000 or < 4,000
Sepsis = SIRS + likely/proven infectious source
Severe Sepsis = Sepsis + end organ damage
Septic Shock = Sepsis + Refractory Hypotension
Treatment of Epididymitis?
Scrotal elevation, avoiding lifting heavy objects, and abx for infection.
PE signs of Fournier’s Gangrene and trmt?
PE Signs: crepitus in genital/thigh area, fever, warm/edematous genital area with extreme discoloration. It’s a polymicrobial necrotizing fasciitis of perineal subcutaneous tissue originating from skin, urethra, or rectum.
Trmt = widespread abx, surgical debridement, and aggressive fluids.
Complication = necrosis and end-artery thrombosis
