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AAFP videos > Emergency & Trauma Care > Flashcards

Emergency & Trauma Care Flashcards

1
Q

Cat Bite

A

Highest risk of infection - 80% of bites become infected - 53-80% with Pasteurella multocida - Watch for bone and joint infection RX: Amoxicillin-clavulanate

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2
Q

Human Bite

A

• Copious irrigation, avoid closure • RX: Amoxicillin-clavulanate x 5 days

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3
Q

Dog Bite

A

• 80 to 90% of all reported bites (#1) • Only 5% of bites develop infection - Higher rate in hands, deep puncture, older pts. • Primary closure - OK • +/- Amoxicillin-clavulanate

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4
Q

Cat Scratch Disease

A

• Bartonella (Rochalimaea) henselae - small Gr (-) rod • Diagnosis: Cat scratch and serologic testing (IFA) • Self-limiting disease, 1 to 2 months Do NOT I & D!!! 5-day course of azithromycin.

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5
Q

A 24-year-old male presents with a 3-day history of a rash that is continuing to increase in size. The rash is not painful or tender. It is flat, oval, 14 cm x 7 cm in size, has central clearing and has no fluctuance. No associated fever/chills or systemic symptoms. No new medications. No recall of any insect bite. He recently vacationed on Martha’s Vineyard, MA.

A

Prescribe doxycycline 100 mg BID x 14 days

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6
Q

Lyme Disease

A

Due to spirochete: Borrelia burgdorferi

Transmitted by: Deer tick

–Ixodes scapularis and Ixodes pacificus

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7
Q

Lyme Disease: Early Stages

A

Early Lyme Disease – Erythema migrans: present 50-70% of cases

– Neurologic disease: • Cranial neuropathy (7th nerve), radiculopathy, lymphocytic meningitis

– Cardiac disease: think A-V block

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8
Q

Lyme Disease: Late Stages

A

Late Lyme disease

– Lyme arthritis: •Large joints, typically knees

– Neurologic disease: •Encephalopathy •Peripheral neuropathy

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9
Q

Lyme Disease: Testing

A

Stage 1: Erythema migrans Do not test, just treat

  • Doxycycline 100 mg BID, 10-21 days
  • Amoxicillin 500 mg TID, 10-21 days
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10
Q

Treatment of Lyme Disease Early Neurologic Disease

A

Early Neurologic Disease

– 7th cranial nerve palsy oral regimen (14-21 days)

– Meningitis/radiculopathy parenteral (10-28 days) • Lyme Carditis oral or parenteral (14-21 days)

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11
Q

Jarisch-Herxheimer reaction

A

– Fever, chills, myalgias, headache

Remember syphilis…

– Treat symptomatically, do not d/c or switch antibiotic

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12
Q

Two Tier testing system for lyme disease

A
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13
Q

3 Deer Tick-Borne Illnesses

A

Other Deer Tick-Borne Illnesses (besides lyme)

  • HGA: Human granulocytic anaplasmosis –Previously known as “ehrlichiosis”
  • Due to Anaplasma phagocytophilum –Within 3 weeks of tick bite…
  • Fever, chills, and headache, with • Thrombocytopenia, leukopenia, elevated LFT’s

Babesiosis –Malaria-like illness with intracellular protazoa –Hemolytic anemia, thrombocytopenia, elevated LFT’s

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14
Q

Other Tick-Borne Illnesses (not deer)

A

Rocky Mountain Spotted Fever – Organism: Rickettsia rickettsii, transmitted by • The American dog tick and the Rocky Mountain wood tick.

– Symptoms: 5-10 days after tick bite: • Flu-like illness • Rash • Later…multisystem involvement

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15
Q

Allergic Reaction: Treatment

A

• Vasoconstrictors: Epinephrine *Mild-moderate: 0.3-0.5 cc 1:1000 solution, SQ or IM

**Severe: 1-5 cc of 1:10,000 solution, IV

***If pt. On B-Blocker - Give glucagon 1-5 mg IV

If Epi-Pen is used, refer to ED for follow up Reason: chance of biphasic reaction “second wave ”

  • H1 antagonist: diphenhydramine 50mg IV
  • H2 antagonist: yes, H2-blocker du jour (ranitidine 50mg IV)
  • Steroids: - Do nothing for acute episode - May prevent recurrence
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16
Q

Scombroid Poisoning: “Pseudo ” Fish Allergy

A
  • Mimics allergic reaction – facial flushing, diaphoresis, hives, edema, diarrhea, peppery taste
  • Occurs minutes to 1-2 hours after eating contaminated fish
  • Classically tuna and mackerel (Scombroidae family), can occur in others
  • Histidine in muscle converted by bacteria to histamine.
  • Rx: H1 and H2 blockers • Self-limiting: 4-6 hours
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17
Q

Ciguatera Poisoning

A
  • Ingestion of reef fish that have accumulated sufficient amounts of the dinoflagellate – Most common: barracuda, amberjack, grouper, snapper, sturgeon, king mackerel
  • GI or neurologic symptoms (or a mixed) – Onset 1-6 hrs after eating, lasts weeks-months –Cold sensation reversal: perceives cold temperatures as hot sensations (and vice versa) – Occurs in 80% of patients and pathognomonic
18
Q

Heat exhaustion versus Heat Stroke

A
  • Heat exhaustion: nonspecific symptoms –Dizziness, weakness, N/V, HA, diaphoresis –Temp: normal - 104F (40C), normal neuro exam
  • Heat stroke: (+) CNS dysfunction

Treatment for heat stroke: “evaporate cooling ” or “immersion cooling ” Note: antipyretics don’t work

19
Q

Acetaminophen Toxicity

A

Max daily dosing: 4 g per day, toxic dose = 150 mg/kg

  • Acetaminophen levels: drawn at 4 hours after ingestion, treatment based on Rumack-Matthew nomogram
  • Treatment: N-acetylcysteine (NAC)
20
Q

A 21-year-old college student presents to the ED with friends who report the student swallowed “a whole bottle” of acetaminophen 1 hour before arrival. They also note the patient has been drinking alcohol. The patient is awake but appears intoxicated.

What of the following would be the best course of action?

A

Administer activated charcoal

  • If given < 30 min, decreases absorption by 70%
  • If given 30-60 min, decreases absorption by 30% - Dose: 1-2 g/kg (max 100 g)
21
Q

Toxicology Emergencies

  • Acetaminophen
  • Aspirin
  • B-blocker
  • Ca-channel blocker
  • Digitalis
  • Heparin
  • Isoniazid (INH)
  • Opiates
  • Organophosphates
  • TCA •
A
22
Q

Anticholinergic Presentation

A

– Hot as Hades……..Hyperthermia

– Blind as a Bat……..Mydriasis

– Dry as a Bone…….Thirst, decreased salivation

– Red as a Beet……..Flushing, vasodilation

– Mad as a Hatter…..Delirium, agitation, confusion

23
Q

Serotonin Syndrome Presentation

A
24
Q

Differences Between Serotonin and Anticholinergic Syndromes

A
25
Q

Treatment for the serotonin syndrome is:

A

Cyproheptadine (Periactin) - Has antiserotonergic properties - Only available orally

26
Q

Head-tilt-chin lift versus jaw thrust

A

Opening the Airway:

Head-tilt-chin lift: Preferred if no trauma

Jaw thrust maneuver: Preferred in (+) trauma

27
Q

Pediatric Trauma/Fluid Resuscitation

A
  • Initial: 20 mL/kg isotonic fluid (NS or LR)
  • After 3 boluses, if shock persists, Start PRBC 10 cc/kg

“3 in 1 Rule ”

28
Q

Head Trauma

A

A. Intracerebral hemorrhage

– Often not seen on initial CT (delayed presentation)

B. Epidural hematoma

– 80% due to rupture middle meningeal artery – Rare in the elderly, associated with skull fx – Lucid interval (“talk and deteriorate”)

C. Subdural hematoma

– Tear of bridging veins between dura and arachnoid – Common in elderly, alcoholics

29
Q

Subdural versus epidural hematoma on imaging

A
30
Q

Head Trauma and steriods

A

Steroids provide no benefit, possible harm

31
Q

2001 AAP Guidelines for Minor Head Injury in Children < 2 Years of Age

Low Risk

A

Low risk (needs all)

  • Low energy mechanism (eg, fall from < 3 feet)
  • No signs or symptoms (eg, no vomiting, no STS)
  • Older age more reassuring (eg, age > 12 months Observation

OK with reliable parents

32
Q

2001 AAP Guidelines for Minor Head Injury in Children < 2 Years of Age

High Risk

A

High risk (any one):

  • Depressed mental status
  • Focal neuro deficits
  • Signs of skull fracture
  • Seizure
  • Irritability
  • Bulging fontanel
  • Vomiting > 5x
  • LOC > 1 min

Go to CT

33
Q

2001 AAP Guidelines for Minor Head Injury in Children < 2 Years of Age

Intermediate risk

A

Everything else: Intermediate risk Observe 4-6 hrs in hospital setting or go to Radiology testing

34
Q

NEXUS (C-Spine) Guidelines

A
  1. No posterior midline cervical tenderness
  2. No alcohol intoxication
  3. A normal level of alertness
  4. No focal neurologic deficits
  5. No distracting injuries

If meets all, no C-spine x-ray required!!!

35
Q

Post- splenectomy vaccines:

A

• Pneumococcal • HIB • Meningococcal

36
Q

Wound Care Tetanus Prophylaxis

A

A. Tetanus Prophylaxis

– Clean wound > 10 years since last dose

– Dirty wound > 5 years since last dose

– Safe in pregnancy

37
Q

Nerve Function: Hand Median Nerve

A
  • Sensory: Palmer surface, thumb to radial 1/2 of ring finger
  • Motor: Flexion of wrist and fingers
  • Best test: Make “OK ” sign
38
Q

Nerve Function: Hand Ulnar Nerve

A
  • Sensory: little finger and ulnar 1/2 of ring finger
  • Motor: innervates interosseous muscles (intrinsics)

Test: Abduction of fingers

39
Q

Toddler’s Fracture – Is Not “Abuse”

A
  • Most common fx in age 9 mos - a 3 yrs that present with a limp (29 of 100)
  • Spiral fracture of distal tibia
40
Q
A

AAFP videos (10 decks)

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