EM Surg Uworld Flashcards
eschar causes compartment syndrome
do escharotomy
if Sx don’t improve then fasciotomy
lithium in pregnancy
ebstein anomaly
malformed inferiorly attached tricuspid valve
causes right ventrilce to become part of right atrium
lithium in second or third trimester
goiter
transient neonatal Neuromuscular dysfunction
Tx tourette
risperidone
Sx iron poisoning
abdominal pain, comiting, diarrhea, hypotensive shock with reflex tachycardia
metabolic acidosis
Dx findings for iron poisoning
anion gap metabolic acidosis and radiopaque pills
Tx iron poisoning
whole bowel irrigaiton
deferoxamine
supportive ABC
aspiritn OD
tinnitus, fever, hyperapnea (respiratory alkalosis) and metabolic acidosis
acute OD of vitamin A
nausea vomiting and blurry vision
can lead to pseudotumor cerebri (ICP)
vit D toxicity
hypercalcemia: n/v confusion, polyuria and polydipsia
vit K toxicity
hemolytic anemia and hyperbilirubinemia in infants
when to kids have imaginary friends
2-6 years old
how does NaHCO3 help with TCA OD
sodium alleviated depressant action on myocardial Na channels
signs of TCA OD
mental status changes
seizures and resp depression
sinus tachy, hypotension
prolonged PR QRS QT
arrhythmias
dry mouth, blurred vision, dilated pupils
urinary retention, flushing, hyperthermia
Tx TCA OD
O2
IV
activated charcoal if within 2 hours
IV NaHCO3 for QRS widening or arrhythmia
methanol toxicity
nausea, HA vomiting, epigastric pain
can cause vision loss and coma
what ingestion causes extremely low bicarb and metabolic acidosis
methanol ingestion and ethylene glycol ingestion
hyperemic optic disc
methanol ingestion
what causes heat stroke
inadequate/failure of thermoregulation
screening serum lead is elevated in child, next step
measure venous lead
when is chelation Tx given for lead poisoning
> 45 ug/dL
Tx trichotillomania
CBT
target rate for rewarming patient with hypothermia
1-2 C/hr
benzo OD signs
slurred speech
ataxia
drowsiness
what to use of neuroleptic malignant syndrome
dantrolene
then bromocriptine and amantadine
what drugs cause neuroleptic malignant syndrome
haloperidol
and aytpicals like risperidone
PCP intoxication
hallucinations, dissociative feelings, agitaiton, confusion, pupillary dilation tachy and nystagmus
patient beginint to have alcohol withdrawl
give chlordiazepoxide (librium) its a benzo and used for this
next step after caustic ingestion
upper GI endoscopy within first 12-24 hours in hemodynamically stable patients
if suspect perforation after ingestion caustic material
abcominal XR with water soluble contrast
smoke inhalation at risk for
cyanide poisoning and carbon monoxide poisoning
Tx cyanide poisoning from inhalation
hydroxocobalamin
Na thiosulfate
what induce methemoglobinemia
nitrites
acute toxicity cyanide
HA, vertigo, dizziness, hyperventilation,t achy nausea and vomiting
Cv and resp depression
coma, seizures, brady, hypotension and cardioresp arrest
how do nitrites induce methemoglobinemia
increase ferric iron Fe3+ in circulating Hb and cyanide binds this
how does cyanide cause lactic acidosis
inhibit ETC in mitochondria blocking production ATP from ox phos
forces anaerobic metabolism
causes tachypnea and fall in arterial PaCO2
effects of heroin and methadone on fetus
IUGR, macrocephaly, SIDS, neonatal abstinence syndrome
neonatal abstinence syndrome
first few days of life with irritability, high pitch cry, poor sleeping, tremors, seizures, sweating, sneezing, tachypnea, poor feeding, vomiting and diarrhea
signs of ethylene glycol ingestion
flank pain, hematuria, oliguria cranial nerve palsies and tetany
lab results in ethylene glycol ingestion
high osmolar ga
high anion gap metabolic acidosis
Ca oxalate crystals in urine
Tx for ethylene glycol ingestion
fomepizole which competetively binds alcohol dehydrogenase
NaHCO3 for acidosis
hemodialysis may be required
signs opioid withdrawl
n/v/d cramps dysphoria restlessness rhinorrhea, lacrimation, myalgias and arthralgias
mydriasis, goose bumps, hyperactive bowel sounds
Tx withdrawl opioid
methadone
bath salt intoxication
severe agitation, combativeness, psychosis, delirium, myoclonus and rarely seizures
signs of CO poisoning
HA, n/v abdominal pain, confusion, coma
pink hue to skin color
Tx CO poisoning
hyperbaric O2
which antipsychotic can contribute to hypothermia
fluphenazine because it inhibits the body’s shivering mechanism and autonomic thermoregulation
Patient with tourrettes is most likely to develop what at later age
ADHD and OCD
patient with normal labs but claims to have taken lots of acetominophen 2 hours ago
give activated charcoad if within 4 hours of ingestion
how long can acetominophen intoxication be asymptomatic
24 hours
signs of benadryl toxicity
anticholinergic
dry mouth blurry vision hyperthermia urinary retention decreased bowel sounds
serotonin syndrome
tachy hyperthermia, inc bowel sounds, HTN, metnal statu changes, dilated pupils and clonus or hyperreflexia
what do people die from in TCA Od
TCA induced hypotension
what is buspirone
anti anxiety drug
Cyanide poisoning
HA vomiting, abdominal pain and flushed skin
inhalational can cause bitter almond odor
thoracic GSW and FAST exam was limited due to body habitus
next step
ex lap
US shows blood in peritoneal cavity in hemodynamically unstable patient
urgent laparotomy
CT shows ruptured aorta with blood collection in adventitial layer
next step
exploratory abdominal surgery
hemodynamically stable patient with US showing blood in spleno renal angle after MVA
next step
CT scan
chronic growth on hard palate of mouth
torus palatinus
patient had last tetanus shot 12 years ago and has deep laceration from rusty barbed wire fence
next step
administer tetanus diptheria toxoid vaccine only
when do you give tetanus Ig
if dirty or severe wound in unimmunizaed, or less than 3 tetanus toxoid doses
preferred airway in someone with facial lacerations or temporal skull fracture but no significant facial trauma
orotracheal
what intubation is contraindicated with basilar skull fractures
nasotracheal
MVA accident and BP not responding to IV fluids
abdominal distention and absent bowel sounds
go to surgery ex lap
post MVA
persistent pneumothorax despite chest tube placement
subcutaneous emphysema
tracheobronchial performation
components of glascow coma scale
eye opening, verbal response
motor response
management penile fracture
retrograde urethrogram followed by surgical exploration of penis
next step after seeing pneumoperitoneum (air under diaphragm) on CXR
abdominal CT
complicaiton of rhinoplasty that results in whistling noise during rsepiration
septal perforation from a hematoma
penetrating injury to abdomen
ex lap
how to identify splenic injury
abdominal CT with contrast if patient is stable
blunt abdominal trauma, FAST is negative
8 hours later has LUQ pain with left shoulder pain and mild nausea, low BP and tachycardia
fluids help a little
splenic injury
what is msot sensitive vital sign for blood loss
heart rate
abdominal pain that refers to the shoulder
peritonitis and irritation of diaphramg. kehr sign
‘
which part of bladder is convered by peritoneum
the dome is the only park
bladder area most susceptible to rupture from blunt trauma if bladder is distended
dome
nasopharyngeal carcinoma is associated with what
EBV
mediterranean or far eastern descent
smoking
nitrosamine consumption (salted fish)
