In Service 2015 Flashcards
Shock in drowning
Shock is rare in drowning
R/o trauma
C spine precautions
Spinal shock
spinal cord shock
the loss of muscle tone and reflexes with complete cord syndrome during the acute phase of injury
typically lasts <24hrs
Drowning survival factors
Primary factor, duration of drowning
Low core temp correlates with bad outcome
Neurogenic shock
loss of autonomic tone
warm/hypotension 2/2 peripheral vasodilation
Nitrogen narcosis
X
Decompression sickness
type I - the bends
-severe arthalgias and pruritis
type ii - more serious
nitrogen bubble formation in high-fat-containing tissues like white matter
significant spinal cord damage can occur
Squeeze syndromes
x
Endometriosis
Most commonly involves ovary
Boerhaaves
Everything happens on left
Sigmoid volvulus
Bent inner tube
Cecal volvulus
Coffee bean
Midgut volvulus
Newborn
Indication for antibiotic ppx in endocarditis
x
Absolute contraindications to thromombolysis in ACS
x
Ventricular aneurysm
Ekg ***
heart block in inferior MI
Wenckebach
2nd degree Type I
heat block in anterior MI
2nd degree type II
High grade AV block
Get pacer ready
how to manage HTN in pheochromocytoma or MAOI
phentolamine then BB
no BB 1st due to unopposed alpha
HTN and cocaine
IV fluids
benzos
1 electrolyte abnormality in AICD dysrhythmias
hypoMag
cardiac pacemaker
pace sense trigger program shock
most specific troponin
Troponin I
tx of stable afib/flutter
CCB/BB
amiodarone
ibutilide - class III antidysrhythmic
anticoagulate
hypertrophic CM: tx
beta blocker
restrictive CM: tx
diuretics
dig
pericarditis: tx
nsaids, colchicine
idiopathic dilated CM: tx
diuretics
dig
vasodilators
penetrating chest trauma, pulseless
ed thoracotomy
atypical PNAs
legionella (macrolide)
mycoplasma (macrolide)
chlamydia (tetracycline/macrolide)
legionella
non productive cough elevated ast/alt hyponatremia gram stain w/ PMNs but no organsims diarrhea relative bradycardia
Contraindications to arthroscentesis
Overlying cellulitis
Bacteremia
EKG findings in HOCM
high QRS voltage
early R wave transition
TWI in anterior leads
deep narrow Q waves in lateral leads
diagnostic test of choice, echo
Intraosseous line peds
x
proximal tibia is the preferred site, followed by
distal tibia, and
distal femur
humerus, clavicle and calcaneous held in less regard
Conscious sedation
Benzodiazepine/opioid
give pain control first
Fentanyl 1.5-2 mcg/kg
Versed 0.05-0.1 mg/kg
causes of increased anion gap metabolic acidosis
ketones, uremia, lactic acidosis, toxic alcohols, salicylates
peripheral cyanosis w/o associ central cyanosis
low cardiac output states including dilated cardiomyopathy
environmental exposure to cold w/ vasoconstriction
arterial or venous occlusion
redistribution of blood flow
Midazolam:
Intubating dose
Conscious sedation dose
Intubating dose - 0.2 mg/kg
Conscious sedation dose - versed 0.05-0.1 mg/kg
kleb pneumo
alcoholic, cough, black/maroon sputum
abscess/empyema
gram neg rods in pairs
rx: cephalosporin + macrolide (eg gentamycin)
PCP pna tx
bactrim
pentamine
IV steroids if paO2 <70
peritonsillar abscess
sore throat, drooling, muffled voice
aspiration
rx penicillin, clindamycin
polymicrobial (GABHS)
ludwig’s angina
sore throat, drooling, muffled voice
organism
polymicrobial (aerobes, anerobes)
rx unasyn, clinda
airway!
retropharyngeal abscess
sore throat, drooling, muffled voice
stiff neck, extention more comfortable
ent
iv abx (clinda, unasyn)
icu admit
ethmoid fx
csf rhinorrhea/meningitis
posterior nose bleed
pack
admit
most common site of sinusitus
maxillary sinusitis
cavernous sinus thrombosis
sphenoid/ethmoid sinusitis
potts puffy tumor
frontal sinusitis
periorbital/orbital cellulitis
ethmoid sinusitis
tripod fx
punched in the cheek
zygomaticofrontal suture, sygomatic arch, infraorbital foramen
flat cheek
periorbital sweling
diplopia
anesthesia of the cheek, upper teeth, lip and gums
ellis type iii dental fx
broken tooth
blood on tooth, pulp involved
rx calcium hydroxide paste - paste on tooth, protects until they can get to the dentist
seat belt injuries
chance fx
rectus sheath hematoma
intestinal perf
MC organ injured following blunt abd trauma
splenic lac
MC organ injured following penetrating abd trauma
liver lac
chancroid
1 g azithro or
250 mg im ctx
painful ulcer, friable, jagged edges, inguinal bubos
etiology H Ducrei
pre eclampsia tx
hydralazine, labetalol
beefy red velvety ulcers, std
granuloma inguinale
glucagon
insulin antagonist
stimulates cAMP synthesis to accelerate hepatic glycogenolysis and gluconeogenesis
relaxes smooth muscle of the gi tract
drugs that are radioopaque
chipes
chlorohydrate heavy metals iron phenothiazines enteric coated solvents
rotator cuff tears
involve which muscles
subscapularis
supraspinatus
infraspinatus
teres minor
rotator cuff tears
most commonly injured
supraspinatus
assoc nerve injury in humeral shaft fx
radial
assoc nerve injury in elbow fx
median, ulnar
assoc nerve injury in colles/smith fx
median
assoc nerve injury in sacral fx
cauda equina
assoc nerve injury in acetabular fx
sciatic
assoc nerve injury in posterior hip dislocation
sciatic
assoc nerve injury in anterior hip disloc
femoral
assoc nerve injury in knee dislocation
peroneal/tibial
assoc nerve injury in lateral tibial plateau fx
peroneal
supracondylar fx assoc w/
volkmanns ischemic contracture
compartment pressures
normal = 10 mmHg
abnormal >30 mmHg
Lisfrac
fx dislocation at the base of the 2nd metatarsal
unstable fx
keystone of midfoot
requires ORIF
MC complication is degenerative arthritis
Jones fx
fx of the 5th metatarsal
high incidence of delayed/nonunion
anterior hip dislocations
assoc complications
10% of hip dislocations
abducted, flexed, externally rotated
femoral vein/artery thrombosis
w/ pulmonary embolism
posterior hip dislocations
assoc complications
90% of hip dislocations
flexed knee strikes dashboard shortened adducted internally rotated flexed at the ?knee]
avascular necrosis of femoral head
felon
organism
staph aureus
I&D, antibiotic
for I&D incise laterally - divide all the septa when you go in laterally
flexor tendon synovitis
organism
tx
staph>strep
surgical debridement, iv antibiotics PCN/cephalosporin
bells palsy
forehead sparing?
no forehead sparing
forehead sparing suggests central lesion
hangmans fx
mechanism
hyperextension
anterior cord syndrome
hyperFlexion
motor paralysis distal to lesion
loss of pain/temp
proprioceptions/vibration intact
pontine hemorrhage
pinpoint pupils occipital headache hyperventilating coma decerebrate posturing
brown sequard syndrome
penetrating injury
ipsilateral loss of motor, position, vibration
contralateral loss of pain and temp
brown sequard syndrome
penetrating injury
ipsilateral loss of Motor, Position, Vibration
contralateral loss of pain and temp
MC vessel involved in stroke
mca
double vision lateral gaze
MS
erythema multiforme
pattern?
associ w/?
target lesions
associ w/
malignancy
mycoplasma
DRUGS (SOAP) sulfa oral hypoglycemic agents anticonvoulants pcn
Vaccines in pregnancy
Live virus vaccines including
MMR, polio, varicella and intranasal influenza should not be administered.
Mgmt of hypertension in pregnancy
Labetalol
Methyldopa
Add long acting nifedipine if either of above fail to control bp
Contraindicated in pregnancy:
ACEI, ARBs
Toxic effects on fetal scalp, lungs and kidneys
Side effects of high or toxic levels of mag
Tx?
Flushing Diaphoresis Hypothermia Hypotension Flaccid paralysis Respiratory depression
When levels are approaching toxicity patellar reflexes diminish and respiratory rate slows
Tx: Calcium gluconate
Massive hemothorax
1500 cc
200cc/hr x 2 hrs
Endometriosis
Fever
Foul smelling profuse bloody discharge
Radial head fx
Sail sign
X
Ovarian cysts less than —cm can be managed expectantly
8
Most common skull fx in kids?
Parietal
Chest tube size for hemothorax
36F
Mgmt of clenched fist injury
X
Mgmt of toxic mega colon
Antibiotics, steroids, fluids
Tracheobronchial
MC w/in 2 cm of carina
Strawberry cervix
Trich
Salter Harris II
Most common
Rolando fx
x
Bennetts fx
X
Boxer’s fx
X
Boutonnière deformity
X
Mallet finger
x
Jersey finger
X
Supra condylar fx
Brachial a injury
Volkmann’s contracture
Lunate
X
Perilunate
X
MCC of lower GI bleed in children?
Anal fissure
Pins lesion
Ipsi lateral facial droop
Contra lateral hemiparesis
Treatment of poison ivy
may need systemic steroids and long steroid taper for severe cases
acute radiation syndrome
condition that results from whole-body irradiation from an internal or an external source over a short time period
4 phases:
1 prodromal -
2 latent - symptom free for weeks to hours depending on exposure dose
3 manifest
4 recovery or death
severe otitis externa
use an ear wick or gauze for antibiotic delivery when the ear canal is swollen shut
Raynauds tx
gentle rewarming combined
w/ topical or oral calcium channel blocker or nitrates
mgmt of PCP intoxication
iv benzos
for seizures: benzos or phenobarb, other ageants usually ineffective
buprenorphine
naltrexone
mgmt of PCP PNA
bactrim
?steroids
Tibial plateau fx
NO WEiGHT BEARING for several weeks
mgmt of tetralogy of fallot
1 oxygen 2 fluids 3. morphine 4 alpha agonist tx 5 prostaglandin E1 may be needed to prevent closure of the ductus arteriosus - can cause apnea and hypotension
sodium correction for hyperglycemia
Corrected Na = Nacalc + (1.6)(Glucal-100)/100
common complications of anterior shoulder dislocation
in order of decreasing frequency
axillary n injury
hillman-sacks deformity - humeral head fx
bankart lesion - glenoid rim disruption
bedside test for assessing severity of asthma exac
peak expiratory flow rate
first line tx in children w/ bacterial cystitis
bactrim
most common cause of large bowel obstruction in adults?
1 malignancy
2 volvulus
3 diverticulitis
age cutoff for surgical cric
> 8yo
needle cric for younger
