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Allergy, immunology, infection > Emergency/Surgery > Flashcards

Emergency/Surgery Flashcards

1
Q

Guillain-Barre syndrome

A

Acute ascending progressive neuropathy starting in the LE; weakness is symmetric.
-2/3 of cases, a mild upper respiratory infection or gastroenteritis precedes the onset by 1-3 weeks

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2
Q

Wernicke’s encephalopathy

A

Neuro symptoms due to thiamine (vit b) def
Triad: ophthalmoplegia, ataxia, confusion, but only 10% of cases have all three.
- often from malnourished people from EToH abuse
- give 100 mg IV, immediately on suspicion of this

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3
Q

Reye’s syndrome

A

Encephalopathy associated with fatty degeneration of the liver.

  • Rare but severe cause of delirium progressing to coma
  • May be history of viral illness (varicella, influenza)
  • Linked to salicylates with virus
  • S/sx: protracted vomiting and delirium which progresses to coma within 2 days.
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4
Q

Decerebrate

A

Arms are extended where as decorticate arms are flexed

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5
Q

Epidural hematoma

A

Vessel: middle meningeal artery
S/sx: Out, lucid interval, follow by unconsciousness
CT: bioconvex lense hematoma
Dx: Does not cross suture lines,
Bad news if: ipsilateral pupil dialation with contralateral hemiparesis (sx of impending herniation)

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6
Q

Subdural hematoma

A

Vessel: bridging veins
Sx/s: Gradually increasing HA and confusion
CT: Crescent shaped bleed
Dx: Does cross suture lines

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7
Q

Sub arachnoid hemorrhage

A

Cause: 80% due to saccular aneurysm
Sx/s: thunderclap HA, photophobia
CT: non-contrast CT, but findings not always present
Tx: craniotomy, clipping the aneurysm

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8
Q

Minimum MAP

A

90 mmHg

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9
Q

Basilar skull fracture: Sx/s

A 
Hemotympanum
Battle sign
Raccoon's eyes
Cerebrospinal fluid leaking form ear or nose
Hearing loss
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10
Q

Coma clinical eye movement

A

The eyes may conjugately deviate toward the side of the hemorrhage.

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11
Q

If increased innercranial pressure is suspected

A

Mannitol can decrease intravascular volume

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12
Q

altered mental status

A

Any change in emotional or intellectual function.

- Includes delirium, dementia, coma

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13
Q

Status epilepticus

A

single seizure >or= 5 min in length
2 or more seizures without recovery between seizures
Tx: protect airway
- 1st: a lorazepam, Refractory: intubation + phenobarbitol

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14
Q

syncope management

A 
CPR (if cardiac arrest0
EKG (arhythmia)
Echo (looking for structural abnorm)
Fluids
Oxygen
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15
Q

Hypothermia

A

Rectal temps:
Mild: 90-95F: 34-36C
Moderate: 30-34C
Severe:

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16
Q

Hypothermia treatment

A

Mild: passive external + heated IV fluids

Mod-Sev: Active external, combined with warm peritoneal dialysis, warm IV, warm GI fluids)

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17
Q

Levels of frostbite

A

1st: partial skin freezing; erythema and edema, no blistering, stinging, burning
2nd: Full thickness freezing, vessicles that desquamate, black eschar
3rd: Full skin and subQ freezing, violaceous, skin necrosis
4th: Full skin, subQ and mus/tend/bone freeze, little edema, no pain

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18
Q

Chilbains

A

aka Pernia
Exposure to non freezing temp
Exp: chronic intermittent exp to damp, nonfreezing temp

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19
Q

Heat cramps

A

Caused by salt depletion

Tx: oral fluid and salt replacement

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20
Q

Heat exhaustion

A

Caused by primary water loss or sodium loss. (Hypernatremia or hyponatremia)
Sx: non specific, HA, N/V, malasie, cramps, dizziness

Rapidly leads to heat stroke, rehydrate and cool

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21
Q

Head stroke

A

Can no longer thermoregulate
Classicly associated with alteration in mental status
Body temp > 41C (105.8)
Same as heat exh + CNS dysnfunc: seizures, delirium and coma
Skin is usually dry and hot, anhidrosis not required

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22
Q

Heat stroke: dx and tx?

A

Dx: Diagnosis of exclusion: rule out infection, toxin, DKA, CNS disorder
Tx: Assess ABCs
IV fluids
Evaporative cooling (antipyretics not indicated)

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23
Q

Pink froth from nose and mouth

A

Pulmonary edema

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24
Q

Decompression sickness

A

Type 1: Deep aching pain in large joints (elbow and shoulder most common)
Cutaneous marmorata -> pathognomonic (skin marbling)
Type 2: gen fatigue, spinal para, vertigo, vis/speech disturbance. Multiorgan system disorder.
Tx: give O2 for at least 2 hours
Should wait 12-48 hours to fly

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25
Q

Arterial gas emboli

A

Sx/s: stroke-like with blindness, confusion.
Sx within 10 minutes of surfacing

Tx: Immediate decompression in HyperB
100% O2, supine on L side

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26
Q

Acute mountain sickness

A

6-24 hours after arrival at altitude
Sx worse on day 2-3, clear by day 7
Tx: go down, O2, severe may req: dexamethasone

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27
Q

High altitude pulmonary edema

A

> 8000ft
Cough dyspnea on exertion; pink, frothy sputum
CXR: pathcy infiltrates
Greatest mortality of AMS illnesses
Tx: rapid descent, positive pressure vent, O2, nifedipine, aetazolamide

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28
Q

High altitude cerebral edema

A

HA, ataxia, papilledema, global encephalopathy
Sx/s: apathy, agitation, focal neuro signs, obtundation, coma
Tx: rapid descent, O2, dexamethasone,
can use acetazolamide (watch cerebral perfusion pressure, so watch for hypoT. Mannitol

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29
Q

Altered Mental Status DDx

A 
Alcohols
Endocrine/Environment/Electrolytes/Encephalopathy
Infection
Oxygen/Opiates
Uremia

Trauma/Tumor/Toxin
Insulin,Infarction/Intracranial hemorrhage
Psychogenic/Poisons/Drugs/Porphyria
Stroke/Seizure/Shock/Space occupying

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30
Q

Concussion

A

Treat early: cognitive rest, physical rest, sleep

31
Q

Depressed skull fracture

A

Often found with inspection/palpation, swelling around the injury can mask depression.

Admit and refer to surgery subspecialist

32
Q

Black widow bite

A

Severe pain in extremity and stomach/trunk muscle spasms
Systemic systems>local symptoms
N/V, Diaphoresis, HTN
Tx: narcotic analgesics, antivenin

33
Q

Brown recluse spider bite

A

Sx/s: venom is cytotoxic (erythematous, blister, fever/V/arthralgia), leads to local progressive tissue destruction/necrosis
Tx: local wound care, tetanus shot, no antidote

34
Q

Tarantulas

A

Urticating hairs, minimally toxic to humans

35
Q

Scorpion stings

A

Sx/s: intesnsely painful, erythema

Tx: periodic ice, AVOID tourniquet, neuroleptics, antihypertensive, atropine

36
Q

Tick bites

A

Sx/s: Wood tick: ascending motor paralysis
Tx: supportive care, remove tick
Abx: doxycycline if infected

37
Q

Dog and cat bites

A

Irrigate, debride, leave open or loosely sutured
Abx: augmentin (dogmentin)
Tetanus

38
Q

Airway obstruction

presenting symptoms:

A

Stridor, forced ventilatory efforts,

intercostal, suprasternal or supraclavicular retractions or other signs of increased respiratory effort

39
Q

Airway obstruction managment

A

Remove foreign body if there is one
If laryngeal edema -> epinephrine subQ or IV
If progressing obstruction -> surgical cricothyrotomy

40
Q

Tension pneumothorax symptoms

A

Chest pain, respiratory distress, decreased breath sounds, tympany via percussion

& shift of the mediastinum, destined neck veins, hypotension, shock

41
Q

Simple pneumothorax symptoms

A

Chest pain, respiratory distress, decreased breath sounds, tympany via percussion
CXR: air in pleural space, and lung collapse

42
Q

Tension Pneumothorax management

A

Supp O2

Tube thoracostomy

43
Q

Simple pneumothorax management

A

Unilateral: needle decompression or thoracostomy
Bilateral: Immediate thoracostomy

44
Q

Pulmonary contusion signs/symptoms

A

Silent at initial presentation
Hypoxia, dyspnea, hemoptysis, tachycardia, chest injury, decreased breath sounds, crackles.
CXR: apparent within 6 hours, ranging from patchy infiltrates to complete lobar consolidation

45
Q

Flail chest symptoms

A

Painful paradoxical motion of the rib cage

Crepitation or subcutaneous emphysema, decreased breath sounds

46
Q

Status asthmaticus presentation

A

Severe acute asthma attack
Hypoxemia, tachypnea, tachycardia, accessory muscle use, wheezing
Tx: IV magnesium sulfate, pressure vent, ketamine, epinephrine, mechanical vent

47
Q

carbon monoxide poisoning/smoke inhalation presentation

A

Suspect in every fire victim
Cherry-red skin color is frequent but not reliable
Asymptomatic below when O2 decreased 10-15%
50-60% associated with coma and seizures
70% fatal
Findings: MI, arrhythmia, dementia, ataxia, sensory motor findings, loss of consciousness

48
Q

Anaphylaxis

A

Within seconds to an hour

Acute progression of organ system involvement that may lead to cardiovascular collapse

49
Q

Anaphylaxis symptoms

A

Derm: pruritus, flushing, urticaria, erythema multiforme angioedema
Respiratory: dyspnea, hypoxia, wheezing, cough, stridor
CardiV: dysrhythmias, collapse, arrest
GI: cramping, vomiting, diarrhea
GU: urgency, cramping
Eye: pruritus, tearing, redness

50
Q

Anaphylaxis management

A

Resuscitation: ABC, cardiac monitor, pulse ox, IV access
Admin: O2, epi IM in thigh, fluids if hypoT, steroids, antiH, albuterol, glucagon (in patients refractory to other treatments)

51
Q

Rule of nines

TBSA

A 
Back: 18
Front: 18
Leg each: 18
Arm each: 9
Head: 9
Patient palm surface = 1% of their body surface area
52
Q

Laparotomy

A

Surgical opening of the abdomen

53
Q

Laparoscopy

A

Abdominal exploration with an endoscope

54
Q

Enterostomy

A

Surgically created opening into a portion of the GI tract

55
Q

anastomosis

A

Natural connection between two vessels, or surgical connection of two tubular structures.

56
Q

Z-plasty

A

the use of Z-shaped incision in plastic surgery to relieve tension in scar tissue

57
Q

Fundoplication

A

Surgery for GERD:
Fundus of stomach is wrapped around esophagus.
Strengthens lower esophageal sphincter

58
Q

Colostomy

A

Procedure where part of the colon is diverted through the abdominal wall

59
Q

Colectomy

A

Removal of a piece of the colon

60
Q

Hemi-colectomy

A

Removal of an entire colonic side (ex. ascending or descending or transverse)

61
Q

Endarterectomy

A

Surgical removal of the lining (and plaque) of the carotid artery.

62
Q

Thoracotomy

A

Surgical incision into the chest wall

63
Q

Pleurodesis

A

Obliteration of the pleural space.

Used to treat pleural effusion or recurrent pneumothorax

64
Q

Sphincterotomy

A

Cutting of a sphincter muscle to decrease its resting tone.

Used to correct anal fissures and bile duct issues.

65
Q

Tamponade symptoms

A

Beck’s triad: hypotension, jugular venous distension, muffled heart sounds
Diminished cardiac output
Narrow pulse pressure

66
Q

ASA Physical status classification

A

ASA 1: normal healthy patient
ASA 2: mild systemic disease without limitations
ASA 3: severe systemic disease with functional lim
ASA 4: severe systemic disease with constant threat of life
ASA 5: moribund, not expected to survive without surgery
ASA 6: declared brain dead for organ donor procedure
ASA + E: patient requiring emergency operation

67
Q

What level predicts an increased risk of cardiac complication in surgery

A

4 mets or less is of risk

If some one can do 2 sets of stairs: at least 4 mets

68
Q

Post op bowel movement

A

24 hour for most operations that don’t involve abd cavity

69
Q

1st, 2nd, 3rd intention

A

1st: sutured
2nd: Wound left open
3rd: left open then closed 4-6 days later

70
Q

Most common bug for furuncle and carbuncle

A

Staph aureus

71
Q

Celllulitis

A

MC due to GABHS and staph

72
Q

Gas gangrene

A

C. perfingens most common microb
Incubation :12-24 hours
ABx: empiric combo

73
Q

Most common type of UTI bug

A

E.coli 27%
Enterococcus 13%
Candida, P. aeruginosa, Klebsiella

Allergy, immunology, infection (12 decks)

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