Emergency 3 Flashcards
Describe the first step in managing a trauma patient.
Secure the airway.
What should be done if a trauma patient with a Glasgow Coma Scale (GCS) of less than 8 is encountered?
Intubation.
When should intubation be considered for a trauma patient with head and neck trauma developing hoarseness of voice?
Immediately.
What action is recommended for a patient with burns on the face in terms of airway management?
Intubation.
In a trauma patient with soot in the airway, what is the next step in management?
Intubation.
If intubation fails in various trauma scenarios, what is the subsequent step?
Cricothyroidotomy.
Where is a tracheostomy typically performed for trauma patients?
In the operating room.
What should be suspected in a patient with severe head and neck injury?
Cervical neck injury.
How should the airway be maintained in a patient with suspected cervical neck injury?
Endotracheal tube (ETT).
What is the first indicator of hypovolemia?
Change in pulse.
What is the initial step in managing hypovolemia in a trauma patient?
Establishing an IV line and administering normal saline.
What is the second step in managing hypovolemia after establishing an IV line and giving normal saline?
Transfusing packed red blood cells after cross-matching.
What is the correct sequence for managing hypovolemia in a trauma patient: IV line, saline, cross-matching, packed red blood cells?
IV line, saline, cross-matching, packed red blood cells.
What does a change in blood pressure in a trauma patient indicate regarding volume loss?
At least 20-25% of intravascular volume.
What is the likely diagnosis in a trauma patient with hypotension, congested neck veins, and distant heart sounds?
Cardiac tamponade.
What is the typical X-ray finding in a patient with cardiac tamponade?
Enlarged cardiac shadow.
What is the immediate treatment for cardiac tamponade?
Emergent pericardiocentesis.
What is the diagnosis in a trauma patient presenting with dyspnea, absent breath sounds, hyperresonance in one lung, and tracheal deviation to the opposite side?
Tension pneumothorax.
What is the first-line management for tension pneumothorax?
Needle thoracotomy.
What are two incorrect answers for the first-line treatment of tension pneumothorax?
Oxygen and tube thoracotomy.
In a patient with chest trauma and a wide mediastinum on chest X-ray, what is the likely diagnosis?
Aortic rupture.
How should aortic rupture be managed in a patient with chest trauma?
Emergent surgery.
What is the initial step in managing a patient with rib fractures, severe pain, and difficulty breathing?
Administer IV morphine.
What is the likely diagnosis in a patient with chest trauma, paradoxical movement of a segment of the thoracic wall, and multiple contiguous fractured ribs on X-ray?
Flail chest.
Describe the treatment of flail chest.
Pain control, strapping of chest, mechanical ventilation.
What is the diagnosis for a head trauma patient with ecchymosis around the eye, behind the ear, and clear fluid dripping from the ear and nose?
Basal skull fracture.
How is a basal skull fracture typically treated?
Conservative approach (no antibiotics, no packing, advice not to sniff).
Define epidural hematoma.
A collection of blood between the skull and the dura mater.
What is the most important investigation for epidural hematoma?
CT scan (biconvex shaped hematoma).
What is the emergency treatment for epidural hematoma?
Emergent craniotomy.
What is the most important nerve to be affected in epidural hematoma?
Oculomotor nerve.
Describe the diagnosis for a head trauma patient, especially in older or alcoholic individuals, presenting with chronic headache, personality changes, and gradual memory loss.
Subdural hematoma.
How is a subdural hematoma typically managed?
Conservative treatment.
What is the imaging modality of choice for subdural hematoma?
CT scan (lens shaped hematoma).
What is diffuse axonal injury characterized by?
Diffuse small bleeding at the junction between gray and white matter on CT scan.
What is the first step in managing any patient with increased intracranial pressure?
CT scan.
What is the initial step in a patient with signs of meningitis, vomiting, and papilledema before performing a lumbar tap?
CT scan.
What is the first step in managing a patient with penetrating abdominal trauma?
Control the site of bleeding.
What is the second step after controlling bleeding in a patient with penetrating abdominal trauma?
Establish an IV line, administer normal saline, then packed RBCs if needed.
What is the final step in managing a patient with penetrating abdominal trauma involving a foreign object?
Exploratory laparotomy (removal of object only in the operating room).
In a scenario where a patient has a knife in the chest and presents with low oxygen saturation and hemothorax, what is the first intervention?
Intubation.
If a patient with a knife in the chest has low oxygen saturation and hypotension, what is the initial step?
Intubation.
What is the first intervention for a patient with a knife in the chest, low oxygen saturation, and pneumothorax?
Needle thoracotomy.
In a patient with a knife in the chest and normal oxygen saturation but hemothorax, what is the first step?
Chest tube insertion.
If a patient with a knife in the chest has normal oxygen saturation but hypotension, what is the initial action?
Establish an IV line, administer normal saline.
What is the recommended approach if a peripheral line fails in an infant or child with hypotension?
Intraosseous cannulation in the proximal tibia.
Describe the first step in managing a blunt abdominal trauma patient with hemorrhagic instability.
Perform a FAST exam.
Describe the first step in managing a blunt abdominal trauma patient with hemorrhagic stability.
Perform a CT scan without contrast.
What is the next step if a FAST or CT scan shows internal bleeding in a blunt abdominal trauma patient?
Perform a laparotomy.
What is the likely injury in a blunt abdominal trauma patient experiencing left upper quadrant pain radiating to the shoulder?
Splenic injury.
What is the typical management approach for a blunt abdominal trauma patient with stable hemorrhage and a liver injury?
Conservative treatment.
What is the recommended treatment for a blunt abdominal trauma patient with stable hemorrhage and a kidney injury?
Conservative treatment.
What is the potential risk associated with blunt abdominal trauma at the epigastrium?
Risk of stomach injury.
Why does pain from spleen, liver, and gallbladder pathology often radiate to the shoulder in blunt abdominal trauma patients?
Due to irritation of the diaphragm (phrenic nerve and supraclavicular nerve have the same cervical nerve origin; C3, C4).
What is the initial step in managing an acute abdomen with suspected perforated abdominal viscera?
Perform an abdominal X-ray to check for air under the diaphragm.
What does the presence of air under the diaphragm on an X-ray indicate, and what is the recommended action?
It indicates an emergent laparotomy.
What is the preferred diagnostic investigation for esophageal rupture?
Gastrographin contrast esophagography.
Describe the typical presentation of a patient with intestinal obstruction.
Colicky abdominal pain, persistent vomiting, absolute constipation (no stool, no flatus).
What are common findings on abdominal examination in a patient with intestinal obstruction?
Distension, diffuse tenderness, hyperactive bowel sounds.
What is the initial investigation for suspected intestinal obstruction?
Abdominal X-ray showing multiple air-fluid levels.
What is the first step in managing a patient with intestinal obstruction?
Insertion of a nasogastric tube, IV fluid administration, and antibiotics (conservative treatment).
What is the next course of action if there is no improvement after conservative treatment for intestinal obstruction?
Surgical intervention.
What is the most common cause of intestinal obstruction overall?
Hernia.
What is a likely cause of intestinal obstruction in a patient with a history of recent abdominal surgery?long time
Post-operative adhesions.
What is a probable cause of intestinal obstruction in an elderly patient with sudden onset abdominal pain?
Volvulus.
What is a potential cause of intestinal obstruction in an elderly patient with anemia and weight loss?
Colon cancer.
What condition should be suspected in an elderly nursing home resident with chronic constipation, recurrent lower left quadrant abdominal pain, and intermittent soiling, with a full rectum on digital rectal examination?
Fecal impaction.
What is the recommended treatment for fecal impaction?
Enema.
Describe the presentation of a patient with sigmoid volvulus.
Sudden onset abdominal pain in old age, empty rectum in DRE.
What is the diagnostic finding on abdominal x-ray in a patient with volvulus?
Omega loop.
How is sigmoid volvulus initially managed?
Endoscopic decompression.
What is the next step if endoscopic decompression fails or perforation occurs in sigmoid volvulus?
Surgery.
Describe the first step in the management of cecal volvulus.
Surgery.
What is the classic presentation of intussusception in a child?
Attacks of abdominal pain during which child draws his leg toward abdomen + red currant jelly stool.
What is the imaging modality of choice for diagnosing intussusception?
Abdominal US.
How is intussusception managed, both diagnostically and therapeutically?
Hydrostatic reduction (barium or air enema).
Describe the clinical features of paralytic ileus.
Absent bowel sounds (silent abdomen), no abdominal pain after abdominal surgery, marked dilated intestinal loops in x-ray.
What are important causes of paralytic ileus?
Hypokalemia, spine fracture.
What is the treatment approach for paralytic ileus?
Conservative.
What is the likely diagnosis when a patient on antiparkinsonian medications develops signs of intestinal obstruction?
Pseudoobstruction.
Describe the presentation of an elderly patient with a history of chronic constipation who develops fever, LLQ abdominal pain, tachycardia.
Likely diverticulitis.
What is the imaging modality of choice for diagnosing diverticulitis?
CT scan.
Describe the clinical presentation of acute appendicitis.
Low-grade fever, anorexia, tachycardia, pain at right iliac fossa.
What is the most specific sign of acute appendicitis?
Localized pain at right iliac fossa.
What is the imaging modality of choice in diagnosing appendicitis?
CT scan.
What is the treatment of choice for appendicitis?
Laparoscopic appendectomy.
In a pregnant patient with RUQ abdominal pain, normal LFTs, and positive viral serology, what is the likely diagnosis?
Appendicitis.
How is appendicitis managed in pregnancy?
Laparoscopic appendectomy.
What is the most common complication after appendix rupture?
Pelvic abscess.
Describe the presentation of a patient 10 days after appendicitis with a painful defecation and a fluctuant tender mass in DRE.
Likely pelvic abscess.
What sign would be positive in a patient 10 days after appendicitis with a psoas abscess?
Psoas sign.
Describe the presentation of a young patient with chronic abdominal pain and bloody diarrhea.
Incomplete, more information needed for a specific diagnosis.
Describe the first step in the management of toxic megacolon.
Decompression, IV fluid, and IV antibiotics.
What is the next step if initial management fails in toxic megacolon?
Surgery.
Define ischemic colitis in a patient with chronic atrial fibrillation presenting with acute severe abdominal pain and bloody diarrhea.
Ischemic colitis.
Describe biliary colic in a female patient who is fatty, forty/fifty, and fertile with recurrent right upper quadrant abdominal pain radiating to the shoulder.
Biliary colic (due to gallbladder stone).
What is the recommended treatment for an asymptomatic gallbladder stone incidentally found on ultrasound?
No treatment.
Define the most common type of gallbladder stone.
Cholesterol stone.
How does the type of gallbladder stone differ in patients with hemolysis?
Pigment stone.
What is the imaging modality of choice for gallbladder stones?
Ultrasound.
What is the next step if an asymptomatic gallbladder stone is found incidentally on ultrasound but the common bile duct is markedly dilated?
ERCP.
Describe the management of acute cholecystitis in a patient with chronic gallbladder stones presenting with severe right upper quadrant pain, fever, and leukocytosis.
IV fluid, antibiotics, followed by cholecystectomy within 72 hours.
What is the most important investigation for acute cholecystitis?
Ultrasound.
Describe the most specific sign of cholecystitis seen on ultrasound.
Pericholecystic fluid and gallbladder wall thickness (not gallbladder stone).
What is the treatment for acute cholecystitis?
IV fluid, antibiotics, followed by cholecystectomy within 72 hours.
Describe the presentation of acute cholangitis in a patient with chronic gallbladder stones presenting with severe right upper quadrant pain, fever, chills, and jaundice.
Acute cholangitis.
What is the best initial investigation for acute cholangitis?
Ultrasound (to show dilated common bile duct).
Describe the treatment approach for acute cholangitis.
IV fluid, antibiotics first, followed by ERCP decompression and then cholecystectomy.
What is the first step in the treatment of acute cholangitis?
IV fluid.
Describe the management of cholecystitis in a patient with a history of myocardial infarction.
Conservative treatment initially, then percutaneous cholecystectomy if conservative management fails.
When is the best time to perform cholecystectomy in pregnancy?
2nd trimester (due to increased risk of cholestasis in pregnancy).
What is the first step in the management of priapism?
Repeated saline flushing.
Describe the management of a fractured penis.
Immediate surgery.
