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Step2CK > EM Surg StepUp > Flashcards

EM Surg StepUp Flashcards

1
Q

1st degree burn

A

epidermis only

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2
Q

2nd degree burn

A

partial thickness dermal

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3
Q

3rd degree burn

A

full thickness dermal and maybe deeper

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4
Q

4th degree burn

A

additional involvement muscle and or bone

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5
Q

electrical shock burn classification

A

4th degree becuase likely involve mm and bones

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6
Q

when do you need inpatient Tx fo rburns

A

2nd degree with >10% body surface

3rd degree> 2% body surface

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7
Q

which burns require airway managment

A

2nd or 3rd with >25% body or involving face

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8
Q

formula for IV fluid resuscitation for burns

A

LR 4mL x Kg x % body surface burned

half volume in initial 8 hours with remaining half over 16 hours

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9
Q

burn surface area of adult

A

9% head, each leg, back, trunk
4.5% each arm
1% genitals

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10
Q

what antibiotic is used for burn dressing

A

topical sulver sulfadiazine or bacitracin

also give tetanus toxoid

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11
Q

infections with burns

A

pseudomonas, stress ulcers- curlings

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12
Q

complications burns

A 
infection
stress ulcers
apspiration
dehydration
ileus
renal insufficiency from rhabdomyolysis
compartment syndrome
epithelial contractures
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13
Q

age group highest risk of drowning

A

children

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14
Q

what happens with drowning to lungs

A

decreased compliance, V/P mismatch
shunting
cerebral hypoxia

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15
Q

freshwater drowning

A

hypotonic fluid absorbed causeing decreased electrolyte concentrations and RBC lysis

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16
Q

salt water drowning

A

hypertonic fluid draws water from pulm capillaries into alveoli causing pulmonary edema and increased serum electrolyte concentrations

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17
Q

Tx drowning vitim

A 
secure airway
resuscitation
supp O2
nasogastric tube placement
maintenance of body temp
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18
Q

complications drowning

A

depends on degree and length of hypoxemia and hypothermia

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19
Q

Tx foreign body aspiration

A

rigid bronchoscopy

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20
Q

comlications of choking

A

atelectasis, penumonia, lung abscess, hypoxemia

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21
Q

risk factors hypothermia

A

alcohol

elderly

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22
Q

signs of hypothermia

A

lethargy, weakness, severe shivering, confusion, dec temp, arrhythmias, hypotension

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23
Q

EKG

A

J waves, possible vtach or vfib

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24
Q

Tx hypothermia

A

warm externally
internally warm IV fluids
treat arrythmias

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25
Q

why do patients with severe hypothermia feel really hot before they die

A

increased blood viscosity

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26
Q

heat exhaustion

A

weakness HA and sustantial sweating

need hydration

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27
Q

heat stroke

A

confusion, blurred vision, nausea

little sweating

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28
Q

labs in heat stroke

A

inc WBC BUN and Cr

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29
Q

Tx for heat stroke

A

evaporative cooling

benzos for seizures

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30
Q

Tx for snake bite

A

immobilize and cleanse

need antivenom

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31
Q

signs scorpion bite

A

severe pain and swelling at site
increased sweating
vomiting
diarrhea

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32
Q

Tx scorpion bite

A

antivenin, atropine phenobarbital

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33
Q

complications scorpion bite

A

acute pancreatitis, myocardial toxicity, respiratory paralysis

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34
Q

signs of black widow spider bite

A

muscle pain and spasms
localized diaphoresis
abdominal pain
autnomic stimulation

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35
Q

Tx black widow spider bite

A

local wound care, benzos and antivenin

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36
Q

complications black widow spider bite

A

ileus, CV collapse

hemolytic anemia, DIC, rhabdo

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37
Q

signs of brown recluse bite

A

increasing pain and possible ulceration and necrosis

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38
Q

Tx brown recluse bite

A

local wound care and dapsone to prevent necrosis

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39
Q

Tx mammalian bite

A

saline irrgation, debridement, tetanus and rabies proph

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40
Q

Tx human bite

A

saline, broad coverage Antibiotic, debridement

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41
Q

how does charcoal work for ingestion

A

blocks absorption of poisons

repeat every few hours

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42
Q

Tx acetominophen toxicity

A

N acetylcysteine

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43
Q

Tx for anticholinergic OD

A

physostigmine

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44
Q

Tx benzo OD

A

flumenazil

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45
Q

Tx beta blocker OD

A

glucagon, Ca and insulin

dextrose

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46
Q

Tx CCB OD

A

glucagon, Ca, insulin and dextrose

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47
Q

Tx cocaine OD

A

supportive

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48
Q

Tx cyanide toxicityq

A

nitrates and hydroxocobalamine

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49
Q

Tx dig toxicity

A

Dig antibodies

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50
Q

Tx heparin toxicity

A

protamine sulfate

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51
Q

Tx isoniazid neuropathy

A

vit b6

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52
Q

Tx isopropyl alcohol OD

A

supportive

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53
Q

Tx methanol OD

A

ethanol, fomepizole and dialysis

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54
Q

Tx opioid OD

A

naloxone

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55
Q

pinpoint pupils

A

Opiate OD

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56
Q

Tx salicylate toxicity

A

charcoal, dialysis and NaHCO3

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57
Q

Tx sulfonylurea toxicity

A

octreotide and dextrose

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58
Q

Tx TCA OD

A

NaHCO3 and diazepam

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59
Q

Tx warfarin toxicity

A

Vit K and FFP

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60
Q

Tx of acids or alkali

A

copious irrigation

activated charcoal

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61
Q

Tx ethylene glycol ingestion

A

ethanol and dialysis

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62
Q

Sx ethylene glycol ingestion

A

ataxia
hallucination
seizures
sweat breath

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63
Q

Tx of organophosphate (insecticide) poisoning

A

atropine
pralidoxime
supportive care

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64
Q

Tx iron overload

A

deferoxamine

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65
Q

Tx lead poisoning

A

succimer, dimercaprol

EDTA

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66
Q

Tx mercury poisoning

A

dimercaprol

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67
Q

signs CO poisoning

A

HA, dizziness, nausea, myalgias
cherry red lips
mental status changes, hypotension

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68
Q

Tx CO poisoning

A

100% O2

hyperbaric O2

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69
Q

Tx Vfib and Vtach

A

alternating attempts at electrical and Rx cardioversion

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70
Q

pulseless electrical activity

A

detectable cardiac conduction with absense of CO

71
Q

asystole

A

no cardiac activity

72
Q

if come upon unresponsive patient with no pulse, next step

A

CPR 30:2

73
Q

if come upon unresponsive patient with pulse

next step

A

1 breath Q 5-6 sec
intubate and ventilate
recheck pulse Q 2 min

74
Q

order of pharmacology to use in Vfib or pulseless Vtach

A

epinephrine 1 mg

amiodarone 300mg IV bolus, second is 150 mg
or lidocarine 1-1.5 up to 3 mg/kg

75
Q

Tx torsades

A

Mg 1-2 g IV or IO loading dose

76
Q

protocol for PEA and asystole

A

CPR 30:2
epinephrine 1 mg Q 3-5 min
consider vasopressin 40 units

77
Q

common causes of pulseless electrical activity

A 
Hs and Ts
Hypovolemia
Hypoxia
Hyper K
hypo K
hypothermia
hydrogen ions
tamponde
tension pneumo
thrombosis
tablets
toxin drugs
78
Q

what gets injured in acceleration decceleration injuries

A

aortic arch and mesentery

79
Q

Trauma assessment

A

ABCs

80
Q

evaluation head trauma

A 
LOC assessment
sensation, motor
bowel and bladder
pupil responsiveness to light
presence skull fracture
ICP
81
Q

image for head trauma

A

CT

82
Q

Tx head trauma

A

maintain perfrusion
decrease high ICP
IV mannitol
hyperventilation

83
Q

HTN with bradycardia

A

increased intracranial P

cushing phenomenon

84
Q

spinal cord trauma

A

neuro exam

85
Q

imaging to assess spinal cord trauma

A

CT and MRI if normal CT with abnormal neurologic exam findings

86
Q

Tx spinal cord trauma

A

stabilized, give IV corticosteroids for 24 hours if presenting in initial 8 hours

87
Q

imaging for neck trauma

A

cervical XR, CT, carotid doppler US
esophagoduodenoscopy
angiography
bronchoscopy

88
Q

where is zone 3 in neck trauma

A

above mandible

89
Q

where is zone 2 in neck truma

A

mandible to bottom cricoid

90
Q

where is zone 1 in neck trauma

A

below cricoid to clavicles

91
Q

Tx penetrating abdominal trauma

A

ex lap

92
Q

Tx retroperitoneal hematomas

A

upper abdomen need laparotomy

lower need angiography embolization

93
Q

high riding prostate on rectal exam

A

urethral injury

94
Q

how to determine renal pelvis injury

A

IV pyelogram IVP

95
Q

differences of trauma during pregnancy than non pregnant

A

low CO from IVC compression

decreased risk GI low injury from superior placement of bowel by uterus

96
Q

trauma during pregnancy increases what

A

risk of placental abruption

97
Q

what position to examine trauma pregnant women

A

left lateral decubitus

98
Q

bleeding pregnant women from trauma

need to give what after stabilized

A

RhoGAM

99
Q

when doing exam for sexual assault

A

make sure chaperone is present

collect oral vaginal and penile cultures

100
Q

swan ganz catheter

A

P right atrium and pulm artery
pulm capillary wedge P
can measure CO and mixed venous O2 saturation and SVR

101
Q

nonhemolytic febrile transfusion reaction

A

most common
cytokines generated by cells in transfused blood while in storage
1-6 hours post transfusion get fevers, chills, rigors, malaise
Tx with acetominophen

102
Q

acute hemolytic blood transfusion reaction

A

ABO incompatibility
onset during transfusion with fever, chills, nausea flushin, tachy, hypotension, hemolysis of donor RBCs
need aggressive supportive care

103
Q

delayed hemolytic transfusion reaction

A

Ab to Kidd or D (Rh) Ag
2-10 days post transfusion
slight fever, falling H/H
mild inc in uncong bili

104
Q

Anaphylactic blood transfusion reaction

A

anti IgA IgG ab in those with IgA deficiency
cause mast cell degranulation
need epinephrine, volume maintenance and airway control

105
Q

urticaria from transfusion

A

from plasma in donor blood

Tx with benadryl

106
Q

post blood transfusion purpura

A

thrombocytopenia 5-10 days post transfusion
usually in women sensitized by pregnancy
Tx with IVIG and plasmapheresis

107
Q

when to give FFP

A

warfarin OD
clotting factor deficiency
DIC
TTP

108
Q

when to give cryoprecipitate

A

smaller volume FFP

109
Q

when to give packed RBCs

A

low Hct from blood loss or anemia

110
Q

when is whole blood used

A

massive transfusions for severe blood loss

111
Q

what is given in transfusion reactions to prevent hemolytic debris from clogging vessels

A

mannitol or bicarb

112
Q

Vasopresors used in EM for

A

cases shock and insufficient CO

113
Q

indication to give phenylephrine

A

sepsis or shock need to increase BP

114
Q

when to give norepi

A

shock, causes vasoconstriction and increased contractility

115
Q

when to give epi

A

anaphylactic shoc
septic shock
post bypass hypotension
causes increased contractility, vasodilation at low dose and vasoconstriction at high dose

116
Q

when to give dopamine

A

shock
increased HR and contractility
causes vasoconstricion at high dose

117
Q

when to give dobutamine

A

CHF and cardiogenic shock

118
Q

effects dobutamine

A

increased HR and contractility

mild reflex vasodilation

119
Q

when to give isoproterenol

A

contractility stimulant for arrest

120
Q

wheredoes isoporternol work

A

B1 and 2 agonist

121
Q

when to give vasopressin

A

resistent septic shock

causes vasoconstriction

122
Q

when should one stop smoking before surgery

A

8 weeks out

123
Q

COPD with crackles needs surgery

A

give preop antibiotics

124
Q

when to order preop CXR

A

> 50 years old
Hx pulmonary disease
anticipated surgical time >3 hours

125
Q

patient with renal insufficiency needs surgery with contrast

A

give N acetylcysteine to prevent damage

126
Q

when to stop warfarin before surgery

A

3-4 days out with INR kept

127
Q

which meds decrease risk postop thromboembolism

A

warfarin, heparin and LMWH

128
Q

epidural catheter, when do you start LMWH

A

more than 2 hours after removal of epidural catheter

129
Q

fever on postop day 3

A

pneumonia or UTI

130
Q

fever on post op day 5-8

A

wound or IV catheter infection

131
Q

any postop fever should be evaluated with

A

CXR, CBC, UA

132
Q

post op fevers

A 
Wind
Water
Wound
Walking
Wonder drugs
133
Q

is atelectasis a cause of postop fever

A

not anymore

134
Q

clean contaminated wound

A

GI or respiratory entry

135
Q

contaminated wound

A

gross contact of wound with GI or GU contents

136
Q

dirty wound

A

established infection before incision

continued infection following procedure including debridement

137
Q

secondary infection

A

wound left open and allowed to heal through epithelialization

138
Q

delayed primary closure

A

left open for a few days then cleaned again before closed

139
Q

how long do closed wounds require dressings

A

48 hours after closure

140
Q

what can inhibit wound healing

A 
malnutrition
corticosteroids
smoking
hepatic or renal failure
DM
141
Q

abdominal pain out of proportion to exam

A

mesenteric ischemia

142
Q

what can induce malingnat hyperthermia

A

halothane or succinylcholine

143
Q

Sx of malignant hyperthermia

A

rigidity
cyanosis
tachycardia
rising body temp

144
Q

uncontrolled hyperthermia can cause

A

arrhythmias, DIC, acidosis, cerebral dysfunction and electrolyte abnormalities

145
Q

labs of malignant hyperthermia

A

mixed acidosis acutely

abnormal increase in muscle conraction

146
Q

Tx for malignant hyperthermia

A 
evaporative cooling
cold inhaled O2
cold GI lavage
cool IV fluids
dantrolene
stop offending agent
147
Q

most common organ transplant

A

renal

148
Q

HLA Ag matching is most important for what transplants

A

kidney and pancreas

149
Q

when to do bone marrow transplant

A 
aplastic anemia
induction chemo
leukemia
lymphoma
hematopoietic disorders
150
Q

when to do heart transplant

A

severe heart disease with estimated death within 2 year

151
Q

Contraindication to heart transplant

A

pulm HTN and smoking in prior 6 mo
renal insufficiency
COPD
>70 years old

152
Q

when to do lung transplant

A

COPD, primary pulm HTN, CF

153
Q

CI to lung transplant

A

smoking in prior 6 mo
poor cardaic function
renal or hepatic insufficiency
terminal illness

154
Q

when to do liver transplant

A

chronic hep B or C

PBC PSC, biliary atresia, wilsons

155
Q

when to do renal transplant

A

ESRD requiring dialysis

156
Q

when to do pancreatic transplant

A

DM I with renal failure

157
Q

CI to pancreatic transplant

A 
age >60
CAD
PVD
obesity
DM II
158
Q

hyperacute transplant rejection

A

initial 24 hours

caused by antidonor Ab in recipient

159
Q

how to avoid hyperacute transplant rejection

A

crossmatching blood

160
Q

acute transplant rejection

A

6 days to 1 year

from antidonor T cell proliferation in recipient

161
Q

Tx acute transplant rejection

A

immunosuppressive agents

162
Q

chronic transplant rejection

A

over a year later

develop multiple cellular and humoral immune reactions to donor tissue

163
Q

what meds are used in early transplant rejection

A

murmonab-D3 which inhibits T cell function and depletes population
antithymocyt globulin which depletes T cell population

164
Q

what drugs are used in chronic graft vs host

A

hydroxychloroquine

thalidomide

165
Q

how dose hydroxychloroquine work and adverse effect

A

inhibits Ag processing

cause visual disturbances

166
Q

how dose thalidomide work and adverse effect

A

inhibit T cell function and migration

sedation, constipation and teratogenic

167
Q

how does cyclosporine work and adverse effect

A

helper T cel inhibition

can cause nephrotoxicity and HTN

168
Q

how does azathioprine work and adverse effect

A

inhibits T cell proliferation

can cause leukopenia

169
Q

how does tacrolimus work and adverse effect

A

inhibits T cell function

can cause nephrotoxicity and neurotoxicity

170
Q

what is graft vs host

A

reaction donor immune cells to host cells

171
Q

risk factors for graft vs host

A

HLA Ag mismatch
old age
donor-host gender disparity
immunosuppresion

172
Q

signs graft vs host

A

maculopapular rash, abdominal pain, n/v/d

recurrent infections and easy bleeding

173
Q

labs in GVH

A

inc LFTs
dec Ig
dec plaelets

174
Q

Tx GVH

A

corticosteroids, tacrolimus, nycophenolate to decrease graft response
thalidomide and hydroxychloroquine for chronic

Step2CK (26 decks)

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