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Emergency Medicine > Lecture 12: LE Pain Readings > Flashcards

Lecture 12: LE Pain Readings Flashcards

1
Q

Most severe presentations of DVT (2)

A
  • Phlegmasia cerulea dolens (cyanotic)
  • Phlegmasia alba dolens (Pale)

Alba = albino = white

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2
Q

If someone has a PE, whats the likelihood they might have clinical signs of a DVT?

A

50%

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3
Q

Well’s for DVT

A
  • Active CA in past 6 months
  • Paralysis/paresis of lower limb
  • Bedridden > 3 d 2/2 surgery in past 12 weeks
  • Localized tenderness along deep veins
  • Entire leg swollen
  • Unilateral calf swelling > 3 cm below tibial tuberosity
  • Unilateral pitting edema
  • Collateral superficial veins
  • Prior hx

>= 3 = high risk

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4
Q

When is venous US slightly impaired in dx DVT?

A
  • Pelvic DVT
  • Isolated calf DVT
  • Obese
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5
Q

Which physical exam sign is non-specific for DVT?

A

Homan’s sign

Calf squeeze

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6
Q

Management of DVT

A
  • LWMH
  • UFH
  • Xa inhibitor
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7
Q

What DVT subtype requires immediate tx with neutral position?

A

Phlegmasia cerulea dolens

Also consider IR for thombectomy

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8
Q

Top RFs for PAD

A
  • Smoking
  • > 70 years old
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9
Q

MC arteries for arterial embolism

A
  • Femoral
  • Popliteal
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10
Q

What 4 arteries are most likely to lead to limb ischemia?

A
  • Femoropopliteal
  • Tibial
  • Aortoiliac
  • Brachiocephalic
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11
Q

6 Ps of acute arterial limb ischemia

A
  • Pain (earliest)
  • Pallor
  • Poikilothermia (cold)
  • Pulsenessness
  • Paresthesias
  • Paralysis
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12
Q

Define claudication

A
  • Cramping pain/ache
  • Brought on by exercise, relieved by rest
  • Reproducible
  • Reocccurs at consistent walking distances
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13
Q

MCC of arterial embolism

A

Underlying thromboembolic dz

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14
Q

What ABI ratio is extremely concerning for critical limb ischemia?

A

< 0.41

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15
Q

Gold standard for diagnosing arterial occlusion

A

Arteriogram

Identify anatomy & directs tx of the limb

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16
Q

First steps to managing acute arterial occlusion

A
  • Fluids
  • Pain meds
  • Dependent positioning (idk, it just says improves perfusion pressure)
  • EKG & consider echo
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17
Q

What rutherford criteria requires immediate tx for acute limb ischemia?

A

2b or higher (immediately threatened)

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18
Q

What rutherford criteria may suggest amputation as tx for acute limb ischemia?

A

3 (irreversible)

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19
Q

Preferred AC for acute limb ischemia

A

UFH 80U/kg bolus + UFH 18U/kg/hr

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20
Q

Discharge meds for chronic PAD without comorbidities and no immediate limb threat

A
  • Baby asa
  • Loading dose of 325mg before d/c
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21
Q

Rutherford criteria chart for acute limb ischemia

A
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22
Q

How do community acquired MRSA skin lesions present?

A
  • Warm
  • Red
  • Tender
  • Abscesses that spontaneously drain

Similar to a SPIDER BITE

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23
Q

Tx for community acquired MRSA abscesses in a normal immune system

A

I&D

No abx unless accompanying cellulitis or systemic

24
Q

ABX post I&D for patient with community acquired MRSA abscess with comorbidities

A
  • Clinda 300mg PO QID
  • Bactrim DS 2 tabs BID + Keflex 500mg QID
  • Vanco BID IV if admitting.

7-10 days!

25
Q

Top 2 organisms for monomicrobial necrotizing soft tissue infections

A
  • GAS
  • S. Aureus

If you have bad hygiene, add clostridials

26
Q

Classic presentation of necrotizing soft tissue infections

A
  • Pain out of proportion
  • Sense of heaviness
  • Edema, brown, bullae
  • Malodorous
  • Crepitus
27
Q

What suggests systemic toxicity 2/2 necrotizing soft tissue infections?

A

Mental status changes like delirium or irritability

28
Q

Tx of necrotizing soft tissue infections

A
  • Vanco BID +
  • Meropenem Q8h

Zosyn alternative. Clinda can be added.

Tetanus if needed

29
Q

What systemic condition are we scared of occurring with a necrotizing soft tissue infection?

A

Septic shock

30
Q

Who do you consult as soon as you suspect a necrotizing soft tissue infection?

A

Gen surg

31
Q

Who is cellulitis MC in? (3)

A
  • Elderly
  • Immunocompromised
  • Peripheral Vascular Disease
32
Q

How does cellulitis present?

A
  • Localized tenderness
  • Erythema
  • Induration of skin

May have accompanying lymphangitis/lymphadenitis

33
Q

Dx of cellulitis

A

Clinical

34
Q

Outpatient tx of cellulitis that is unlikely to be MRSA

A
  • Keflex QID
  • Dicloxacillin QID
  • Clinda QID
35
Q

Inpatient tx of cellulitis

A
  • Clinda IV Q8h
  • Cefazolin Q8h
  • Nafcillin Q4h
36
Q

MCC of erysipelas

A

GAS

due to skin break

37
Q

Clinical features of erysipelas?

A
  • Sudden high fever
  • Chills/malaise/Nausea
  • Demarcated erythematous area with burning sensation
38
Q

Dx of erysipelas

A

Clinical

39
Q

How do you tx uncomplicated erysipelas?

A

Same as cellulitis:

  • Keflex QID
  • Dicloxacillin QID
  • Clinda QID
40
Q

Mainstay of tx for simple skin abscess

A

I&D

41
Q

What is a Bartholin gland abscess?

A
  • Unilateral painful swelling of labia
  • Fluctuant 1-2 cm mass
42
Q

Tx of Bartholin gland abscess

Only if sus of STD

A
  • I&D
  • Insertion of Word catheter for 4 weeks
  • Sitz bath after 2d
43
Q

What is hidradenitis suppurativa and the tx?

A
  • Chronic skin infection of the apocrine sweat glands (axilla and groin)
  • I&D

Surgeon if recurrent

44
Q

What are infected epidermoid & pilar cysts and tx?

A
  • Erythematous, tender, cutaneous, fluctuant nodules
  • I&D and check in 2-3d
  • MUST REMOVE CAPSULE TO PREVENT RECURRENCE

but you remove capsule at a secondary visit

45
Q

What is a pilondial abscess and tx?

A
  • Tender, swollen, fluctuant mass along the superior gluteal fold
  • I&D and check in 2-3d
  • Surgery is definitive tx
46
Q

MCC of folliculitis

A

S. aureus

47
Q

Tx of regular folliculitis

A
  • Warm compresses
  • Topical bacitracin
48
Q

Tx of extensive/painful folliculitis

A
  • Keflex
  • Dicloxacillin
  • Azithromycin
49
Q

What causes sporotrichosis?

A

Sporothrix schenckii

50
Q

How does fixed cutaneous sporotrichosis present?

A
  • Takes 3 weeks to incubate!
  • Crusted Ulcer or verrucuous plaque
51
Q

How does local cutaneous sporotrichosis present?

A

Subcutaneous nodule or pustule with surrounding erythema

52
Q

How does lymphocutaneous sporotrichosis present?

MC type overall of the 3

A

Painless subcutaneous nodules that migrate along lymphatic channels

53
Q

Dx of sporotrichosis

A

Clinical

Tissue biopsies too but not useful in ED setting

54
Q

Tx of localized or systemic sporotrichosis

A

Itraconazole PO for 3-6 months

55
Q

Tx of pts with systemic symptoms or disseminated sporotrichosis?

A

Amphotericin B

A BOMB

Emergency Medicine (29 decks)

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