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SD- ER pt 1 > ER Pearls Lecture > Flashcards

ER Pearls Lecture Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

2nd MC joint to dislocate

done by abducting and externally rotating arm

high re-dislocation rate in young people and athletes (90%)

A

Shoulder dislocation

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2
Q

When should you Xray a shoulder dislocation?

A

BEFORE and AFTER reduction

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3
Q

External rotation technique
Scapular rotation technique
Stimson’s technique
Traction counter-traction

A

Ways to reduce shoulder dislocation

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4
Q

2 people required

common for muscular pts/dislocated for long periods of time

A

Traction Counter-Traction

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5
Q

What is the Stimson’s technique?

A

Lying prone with weight attached to arm

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6
Q

Immobilize with sling, swath
Get post reduction films
Circulatory and sensory status (axillary N.)
Advise pt to avoid abduction and external rotation (ie brushing hair)

A

Steps following shoulder reduction

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7
Q

ALWAYS follow up with ortho
Immbolization for 2-4 weeks
PT

*older pts at risk for developing adhesive capsulitis

A

Shoulder dislocation

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8
Q
  1. inflammatory phase
  2. proliferative phase
  3. remodeling phase
A

phases of wound healing

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9
Q

Immediate to 2-5 days

Hemostasis: vasoconstriction, platelet aggregation, thromboplastin makes clot

A

Inflammatory phase

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10
Q

In the ______ phase, bacteria and debris are phagocytosed and removed, and factors are released that cause the migration and division of cells involved in the proliferative phase.

A

Inflammatory

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11
Q

the _________ phase characterized by angiogenesis, collagen deposition, granulation tissue formation, epithelialization, and wound contraction.

A

proliferative

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12
Q

2 days-3 weeks

Granulation
Contraction
Epithelialization

A

Proliferative phase

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13
Q

3 weeks-2 years

New collage forms which increases tensile strength to wounds

A

Remodeling phase

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14
Q

Scar tissue is only ___% as strong as original tissue

A

80%

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15
Q

Wound edges are approximated at or close to the time of injury

Typically allows for the best cosmetic result to follow

Best performed on wounds that are ‘clean’ and uncomplicated

A

Primary intention

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16
Q

Wound is not surgically closed

Allowed to heal on own through granulation and re-epitheliazation

Often allowed for abscesses, fight bites or other dirty wounds

May be chosen as closure method for wounds >12 hrs old

A

Second intention

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17
Q

Delayed primary closure or secondary suture

Pt’s wound is intentionally left open for 1-several days and then surgically closed.

Often done to allow tissue edema to reduce (orthopedic injuries)

Often chosen for wounds with a likely chance of infection (ab. incision post ruptured appendix etc.)

A

Tertiary intention

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18
Q

True or False…

Road rash must be scrubbed and washed thoroughly to prevent “tattooing” (esp on the face)

“ragged” edges should be debrided or trimmed with scissors

A

True

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19
Q

True or False

you can use a temporary tourniquet during suture repair

A

True

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20
Q

How should you use antibotics with lacerations?

A

Sparingly!

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21
Q

what is the time frame you can suture in?

A

6-12 hours (controversial)

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22
Q

Initial dressing is often left on for..

A

24-48 hours

*second dressing applied back in office

23
Q

Advise pts to avoid sun/use sunblock post injury to avoid…

A

hyperpigmentation at site

24
Q

Time frame for suture removal of:

face, extremities, hands, feet?

A

4-14 days

25
Q

A collection of blood between the nailbed and the fingernail

*painful
*usually the result of a crush type injury
*often results in nail deformities
*often associated with distal phalanx tuft fracture

A

Subungal hematomas

26
Q

Tx used in subungal hematomas

Can dramatically reduce pain
May save nail
Always indicated in hematomas>50% of nailbed
May be indicated in hematomas<50% depending on pain level

A

Nail trephination

27
Q

Sedation and analgesia administered to pts for the benefit of facilitating diagnostic or therapeutic interventions

IV typical but IM can be utilized

Pharmacologic agents used alone or in combination produce a depressed level of consciousness while the pt still can maintain patent airway and airway reflexes (i.e. gag)

A

Conscious sedation

28
Q

Desired effects=

Relaxation
Cooperation
Maintains protective airway reflexes
Purposeful responses to verbal or tactile commands
Safe return to baseline and ambulatory D/C

A

Conscious sedation

29
Q

Benzos
Narcotics
Dissociative agents
Hypnotics

…drugs typically used for..?

A

Conscious sedation

30
Q

Can be used in conscious sedation

*these drugs are sedatives and hypnotics
They help with anxiolysis, sedation and amnesia

Midazolam, Diazepam, Lorazepam

A

Benzos

31
Q

All produce anterograde amnesia
All produce tranquility
All produce drowsiness

all CAN produce respiratory depression

A

Benzos

32
Q

Will last 20-40 mins
Will reverse respiratory depression caused by narcotics
May potentiate aggression

A

Narcan

33
Q

This dissociate agent has an onset of 10 mins
often choice with pediatric population who need sedation

A

Ketamine

34
Q

Short acting, IV hypnotic drug
shortest recovery time

A

Propofol

35
Q

MC cause of abscesses?

A

Staph Aureus

36
Q

Definitive treatment…….scalpel!

If not drainable initiate antibiotic therapy and recheck in 24-48 hrs.

If incised, drained and packed antibiotic therapy remains controversial but typically prescribed.

A

Abscesses

37
Q

If treated correctly, when is the only time an abscess pt should be discomfort?

A

during initial anesthetization

38
Q

Where should you cut into an abscess?

A

at the apex

39
Q

Inflammation of the nail fold
Can be accute or chronic
More frequent in smokers

A

Paronychia

40
Q

MC cause of paronychia

A

Staph aureus

41
Q

Warm soaks can be used 3 or 4 times a day for acute paronychia

Antibiotics such as Cephalexin or Dicloxacillin. Bactrim/Doxy /Clinda if MRSA suspected (obtain Cx perhaps)

A

Paronychia

42
Q

Do topical abx or anti-bacterial ointments work for paronychia?

A

NO

43
Q

Treatment of choice for paronychia on toe involving an ingrown toe nail

A

Wedge resection

44
Q

Radial head subluxation (nursemaid elbow) is seen in kids…

A

under 5

45
Q

Proximal radius is held in proximity to the ulna by a ligament known as the _______ ligament

A

annular

46
Q

Which ligament is displaced in nursemaid’s elbow?

A

Annular

47
Q

Kid usually holds arm at side in a semi extension, NOT 90 degree flexion

A

Nursemaid elbow

48
Q

2 motions to do when reducing nursemaids elbow

A

Flex

Supinate

49
Q
A
50
Q

Child should exhibit spontanous and full ROM of affected arm within..

A

10-15 mns post reduction (nursemaids elbow)

51
Q

As the joint moves into plantar flexion, the talus becomes narrower, resulting in decreased stability

This combined with inversion can create a set up for…

A

dislocation of the ankle

52
Q

Because of the force involved with ankle dislocations, what else is typically seen with it?

A

Fractures!!

(and neurovascular is main priority)

53
Q

most common type of ankle dislocation?

A

Posterior

54
Q

plantar flexion and axial traction 1st

downward pressure on tibia 2nd

anterior replacement

A

reduction of ankle dislocation

SD- ER pt 1 (8 decks)

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