Med Year Exam Flashcards
presence of microorganisms in a wound
Contamination
When organisms invade the tissue and produce ill effects (inflammation)
Infection
Non-suppurative invasive infection of the skin + subcutaneous tissues
Cellulitis
Acute spreading inflammation of the outer dermis + superficial lymphatics.
Erysipelas
is a localized suppurative inflammation.
Acute abscess
Rapidly progressive poly-microbial cellulitis, of the sublingual + submandibular space Involving floor of mouth + suprahyoid area (both sides of the neck)
Ludwig’s angina
Inadequate tissue perfusion with decreased oxygen delivery + impaired cellular metabolism
Shock
End diastolic ventricular volume (represented by: end diastolic pressure)
Preload
Vascular resistance (represented by: mean arterial blood pressure MAP)
Afterload
Diminished blood volume
Hypovolemic shock:
Due to pump failure. Alteration of the heart failure + inability maintain adequate cardiac output OR restriction of cardiac work.
Cardiogenic shock:
Mal-distribution of blood flow leads to inadequate tissue perfusion in spite of NORMAL BLOOD VOLUME + normal cardiac function.
Distributive shock:
Allergic reaction IgE antibodies against certain antigens (drugs, insect bite, foods)
Anaphylactic shock:
Persisting hypotension despite adequate volume resuscitation, occurring in a patient with SEPSIS.
Septic shock:
presence of bacteria in the blood stream
Bacteremia
presence of toxins in blood stream
Toxemia
presence of both bacteria + toxins
Septicemia
Aqueous solution of low molecular weight ions (salt) with or without glucose (dextrose)
Crystalloids
Solution containing high molecular weight substances such as proteins or large glucose polymers
Colloids
Mere presence of microorganisms in a wound.
Contamination
When organisms invade the tissues and produce ill effects (inflammation)
Infection
Q1- What are Components of wound healing?
- Wound contraction
- Granulation tissue formation
- Epithelialization
Q2- what are Stages of wound healing?
1- Haemostasis and inflammation phase, 72 hours
2- Proliferation phase
3- Maturation and remodeling phase
Q3- what are Types of wound healing?
1- Healing by primary intention
2- Healing by secondary intention
3- Healing by tertiary intention
Q4- what are general Factors affecting wound healing?
1- Age
2- Nutritional state
3- Debilitating diseases
4- Drug intake Steroids
Q5- what are local Factors affecting wound healing?
1- Vascularity
2- Irradiation
3- Tension
4- Infection delays healing
5- Foreign bodies
Q6- what are Classification of surgical wound?
1- Clean wound
2- Clean contaminated wound
3-Contaminated wound
4-Dirty infected wound
Q1- What are the definition of shock?
is a state of inadequate tissue perfusion with decreased oxygen delivery & impaired cellular metabolism.
Q2- what are Types of shock?
1-Cardiogenic shock
2-Hypovolaemic shock
Q3- Types of Cardiogenic shock?
Cardiomyopathy
Myocardial infarction
CHF - ventricular anuerysm
Depressed myocardium
Arrythmias - Pulmonary hypertension, drugs
Q4- Types of Hypovolaemic shock?
1 - Constrictive
2 - Distributive
Q4- Types of constrictive Hypovolaemic shock?
Tension pneumothorax
Pulmonary embolism
constrictive pericarditis
pericardial tamponade
Q4- Types of Distributive Hypovolaemic shock?
Anaphylactic
Septic
Neurogenic
Endocrine
Hypo and hyperthyroidism
Adrenal insufficiency
Q5- what are Effect of shock on organs?
• Heart… / COP, hypotension, myocardial depression
- Lung…. V gas exchange , lung oedema tachypnea
- Renal … I GF, I urine out put
- GIT …. Mucosal ischemia, bleeding
…. Liver damage
- Blood …. Coagulation abnormalities , DIC
- Endocrine …. ^ADH - 1 water retention
• CNS
… V Perfusion, altered mental function
Q6- What are Classification of hemorrhagic shock?
1-Class I hemorrhage (<15% or 750 cc blood loss)
2-Class Il hemorrhage (15% to 30% or 750 to 1500 cc blood loss)
3-Class IIl hemorrhage (30% to 40% or 1500 to 2000 cc blood loss)
4-Class IV hemorrhage (> 40% or >2000 cc blood loss)
Q7- what are Symptoms and sign of hypovolaemic shock?
O Thirst, anxiety
O Fainting
O Sweating
O Coldness And shivering
O Systolic pressure may not drop till loss of 30% of blood volume
O Tachycardia in adults > 100 BPM
Q8-what are Goals for emergency treatment?
- Maximize oxygen delivery
- Control further blood loss
- Fluid resuscitation
Q9- what is Management of hypovolaemic shock?
1-Apply A B C D E of resuscitation in injured patients
2-Give oxygen 100% , May need intubation
3-Secure venous access by two large bore short cannulas
4-Do ABG
5-Start fluid therapy , (Crystalloid - Ringer Lactate or Hartmann solution)
010- How to get venous access ?
0 - Arm veins.
0 - Intra osseous route .
0 - Central lines.
0 - Cut down of long saphenous vein
Q11- what is Endpoints of resuscitation?
- Vital sign ..pulse<100,, BP>100
- Urine output >=0.5ml /hr/1kg
- CVP .. 5-10 cm H20
- MAP 65-90
- Central venous oxygen concentration > 70%
- Improvement in mental state
012- what are causes of Cardiogenic shock?
• Acute mvocardial infarction
• Aortic or mitral stenosis , Myocarditis
• Sepsis & myocardial depression
• Myocardial contusion, Cardiomyopathy, Arrhythmias.
• Massive pulmonary embolism.
013- what are Clinical picture of the original cause:?
O Pulse decreased or increase.
O Dyspnea, Tachypnea.
O Blood pressure decreased, Hypotention
O Congested neck veins with high CVP.
O Cool mottled skin of extremities.
- SBP < 90 mmHg
- PCWP > 18 mmHg
Q14- Management of Cardiogenic shock?
18 Oxygen therapy
28 continuous fluid therapy, ( according to pt. condition)
31 treat underlying cause
42 support myocardium
57 needs special management in ICU
Q15- what are causes of Anaphylactic shock?
- Drugs : contrast media, vaccines, local anesthetic drugs,
- Insect bite
- foods
Q16- Management of anaphylactic shock?
B Oxygen therapy. 02 mask.
R Airway management, may need intubation, ICU care.
A Intravenous access , start IV fluids, needs large volume.
A Adrenaline 1:1000 0.2-0.5ml & 0.01 mg/kg in children S/C or IM
El Repeat the dose 2-3 times in 10-15min.
Antihistamines, provide dramatic relief of symptoms
B Use of nebulizers if wheezing or respiratory distress
- IV Aminophylline may be considered
A Use of steroids , Hydrocortisone IV
Q17- Causes of septic shock?
> Most common is bacteria
- Gram negative in two thirds 2/3
- Gram positive in one third 1/3
Gram negative as eg.
- E. coli, klebsiella
- Entrobacteria, bacteriods
Gram positive as
- Streptococci, Staph, Pneumococci, Clostridia
018- What are Clinical picture two stages?
1-Hyper dynamic (warm) septic shock i.e-early
stage, Fever.
2-Hypo-volaemic (cold) septic shock: - late stage.
Q19- - Treatment ( principle of treatment)?
>
- Needs I.C.U if no response to initial ED treatment
- Oxygen
- fluid therapy correct hypo perfusion
- Antibiotics
Q20- Treatment started with?
A) - Dealing with the infection by : -
• - Drainage of abscesses or peritonitis etc….
• -I.V. strong antibiotics
B) Anti-shock measure as : -
• Fluid replacement and may be fresh blood until
normal urine output and normal C.V.P.
• Drugs as inotropics and vasopressors.
• Oxygen support.
