Online Med Ed Flashcards
Minute ventilation equation
TV X RR
Goal for ET CO2
40 = adequate tube placement
Blood pressure in shock
MAP under 60
SBP under 90
Urine output in shock
less than 0.5 cc/kg/hr
MAP equation
CO x SVR
CO equation
HR x SV
Stroke volume equation
preload x contractility
What causes shock by altering SVR (4)
sepsis
anaphylaxis
anesthesia
spinal trauma
What causes shock by altering preload
hemorrhage obstruction (TPTX, pericardial tamponade, PE)
What causes shock by altering preload?
MI
contusion
CHF
Escalating steps in airway treatment
O2 –> bag valve mask –> ETT –> cric (ED) –> trach (OR)
What form of shock causes FLAT neck veins?
most = engorged, flat in hemorrhage due to loss of volume
Shock + tracheal deviation –> next step
needle decompression
this is tension pneumo
JVD + pulses paradoxus –> next step
needle decompression
this is tamponade
Structures in zone 1 of neck
esophagus trachea arteries
structures in zone 3 of neck
arteries
Interventions in trauma to each zone of the neck
3- arteriogram
2- straight to surgery
1- ateriogram, esophagram, bronchoscopy
Penetrating neck injury –> decision to operate depends on?
hard signs
hard signs –> opeate
soft signs –> angio
asx –> observe
What are “hard signs”
gurgling, stridor, loss of airway
expanding hematoma, pulsatile bleeding, shock
stroke
What are “soft signs”
dysphonia/dysphagia
subQ air or emphysema
mild hard signs
Spinal cord- main pathways in anterior/middle/posterior sections of spinal cord
posterior- DCLMS (proprioception and vibratory sense)
middle- motor
anterior- ALS (pain and temp)
Cord lesions- which symptoms are ipsilateral? contralateral?
ipsi- proprioception and motor
pain and temp- contra (cross at level of entry)
Anterior cord injury:
defecit and typical cause?
lose all but proprioception
spinal artery occlusion
central cord injury:
typical deficit and cause?
loss of pain and temp in cape like distribution
hyperextension/ syringomyelia
cord compression:
symptoms & dx/ tx
focal neuro symptoms
urinary or bowel dysfunction
treatment: dexa
dx: MRI
Two signs of basilar skull fractures
battlers eyes
clear rhinorrhea
Epidural hematoma
dx and tx
lens shaped well defined hematoma on CT
emergent craniotomy
Subdural hematoma
dx and tx
same as epidural but hematoma is crescent shaped
What must be done before subdural hematoma craniotomy
correct INR/ give FFP and platelets
How to decrease ICP
hyperventilate
mannitol
elevate bed
Diffuse axonal injury:
cause
dx
tx
angular injury
grey white blurring on CT
no treatment, fatal
Treatment for broken ribs
pain control x 6 weeks (otherwise get PNA)
hemothorax dx and tx
horizontal shadow on CXR
thoracostomy (rapid bleeding to OR)
Sucking chest wound treatment
occlusive dressing
Expect underlying organ damange in what blunt injuries
scapular fracture
sternal fracture
flail chest
Flail chest see sx and tx// assc condition
multiple broken ribs, paradoxical motion
use binder, weights
risk pulm contusion
Pulmonary contusion appearance on xray & tx
- 24-48 hours later get white out on xray
- give colloids, blood, albumin
- diurese
Appropriate ventilation in case of pulmonary contusion
high PEEP to push fluid back into capillaries
Myocardial contusiuon:
treatment and risk
MONA BASH
risk tamponade
When to take knife wound to abdomen to OR
peritoneal signs, shock, evisceration
Blunt trauma to abdomen eval
FAST and CT
MC abdominal bleed
liver lac
compress pacreatoduodenal ligament
ruptured spleen intervention
just resect
sign of ruptured diapgraghm
bowel sounds in chest
Air under diaphragm –> next step
exploratory lap
pelvic fracture
signs and treatment
+ hip rock test
need ex fix risk uretheral and other injuries
Sign of urethral injury
blood at meatus
high riding prostate
1-2-3rd degree burn skin findings
1- erythema (like sunburn)
2- blisters
3- full thickness, white, no feeling
Chemical burn to skin- first step in management
irrigate
Chemical ingection –> first step
serial exams/ EGD
Chemical inhalation –>
monitor O2/ feak flow
do bronch
intubate PRN
circumferential burns – risk and management
risk compromising vascular supply
cut the eschar
Electrical burns- labs to order
CK and Cr
Three risks assc with electrical burn
arrhythmia
rhabdo
posterior shoulder dislocation
Rule of 9s for burns
each limb= 9% of body surface
front chest/back chest and front abdomen/back= 9 each
head= 9 each side
genitals = 1
FLuid dose for burns
4 x kg x %BSA burnt
give half first 8 hours
half over next 16 hours
antidote for methanol/ethylene ingestion
fomepizole
acetaminophen antidote
NAC
salicylates antidote
alkalinize urine
organophosphates antidote
atropine –> 2PAM if early
Carbon monoxide treatment
hyperbaric O2
**need ABG, SpO2 is normal
Cyanide ingestion sign and treatment
cherry red sign/ nitroprusside dosing
thiosulfates
When to give rabies vaccine following dog bite
only with signs and symptoms –> give rabies Ig and vaccine
TReatment of bee sting without anaphylaxis
just remove pincer
Black widow appearance and treatment +risk
red hour glass on belly
give IV ca
risk pancreatitis
Brown recluse clue and treatment
attic/old boxes/in south –> get necrotic bite –> need to debride
Appropriate antibiotics for dog or cat bite
augmentin
Human bite appropriate treatment
irrigate, augmentin, Ig and tetanus toxoid
What xrays must be ordered for fracture
2 views, perpendicular to one another
when to take fracture to surgery
open, angular, comminuted
cause of posterior shoulder dislocation
lightning
seizures
massive trauma
colles fracture is at the ____
wrist
anterior shoulder dislocation damages what nerve?
arm is held in what position?
axillary nerve
adduction, external rotation (hand shake)
monteggia and galezzia fractures:
define
monteggia= ulna broken, displaced radius galezzua= radius broken, ulna displaced
Scahpoid fracture:
mechanism of injury
management
FOSH
cast even with normal xray if pain at anatomic snuff box
boxers fracture= what digits fractures
4-5th
management of hip fracture
femoral head- prosthesis
intertrochanteric- plates
shaft- rods
open- washout/emergent surgery
traction always helps
ACL/ PCL mechanism of injury + management
anterior blow- posterior tear and vice versa
MRI –> cast or surgery depending on need to get back on leg
MCL/ LCL injury mechanism + management
valgus stress (lateral) causes medial injury varus stress (medial) causes lateral injury
MRI –> cast or surgery
meniscal tear presentation
knee pain and click with extension
stress fracture
mechanism of injury and management
weekend warrior / tibial pain
xray will be normal, cast and crutch anyways
Tib/fib fractures
mechanism of injury and management
fall from height and massive trauma
xray –> cast vs surgery
Achilles tendon
presentation and management
gap where tendon should be
clinic dx –> cast vs surg
ankle fracture: presentation
these guys CANNOT WALK don’t xray unless not walking
carpal tunnel digits affected
1st three
two tests for carpal tunnel
flexion worsens= phalens
tapping over tunnel worsens= tinels
What should be ruled out before diagnosing carpal tunnel?
RA
What is a felon and how is it treated?
abscess at pulp of finger caused by penetrating injury
need incision and drainage
Dequervains tenosynovitis
presentation
management
weight lifter/ mom lifting baby pain with fist-thumb-twist
no surgery just splint/NSAIDs
(inflammatory)
Duptuyrens Contracture
patient
presentation
management
EtOH or Scandinavian
nodules at palm preventing extension
surgical release
Jersey Mallet Trigger fingers: describe
Jersey- torn flexor tendon
mallet- torn extensor tendon
trigger- mallet + a POP
Treatment for jersey, mallet, trigger fingers
splinting
NSAIDs
intraarticular steroids
Developmental dysplasia of the hip:
management
harness
Legg Calves Perthes
age
presentation
management
insidious antalgic age @ ~ 6 years
cast
SCAFE
age
presentation
management
fat teen
hip pain
frog leg xray –> surgery
how to dx septic arthritis
more than 50k WBC on arthro
Oscgood schlatters location of swelling
tibial
kid just needs to sit out
test for scoliosis
adams –> bend over look for one shoulder higher than other
Childhood bone tumors –> management
xray –> MRI –> bx –> resect
Ewings/ osteosarcoma genetic changes
t(11,22)
Rb
Ewings/osteosarcoma location
ewings: shaft
osteo: distal femur
Ewings/ osteo appearance
osteo- sunburt
ewings- onion skin
Bone cancer worrisome sign
focal bone pain without trauma
Special reason to operate on fracture in a kid
growth plate injured
BPH:
path
DRE findings
diagnosis
enlarged prostate obstructs urethra
large and smooth prostate on exam
empiric dx, do not order PSA
Treament BPH
a blockers for symptoms (tamsulosin)
5a reductase inhibitors (finasteride)
ED workup
night time tumescense to delineate psych from organic
Treatment of organic ED
pumps/ prosthesis if trauma
PDEi if 2/2 crap blood flow
What cannot be given with PDEi?
nitrates
Prostatitis presentation
old man with pyelo symptoms
exquisitely tender on DRE
Testicular torsion presentation
horizontal lie
pain on elevation
no cremasteric reflex
Treatment of torsion
bilateral orchipexy
Epididymitis
path
STD if young (ceftriaxone + azithro)
ecoli if old (FQ)
PResentation epididymitis
sudden pain
vertical lie
better with elevation
normal Doppler
Dx of epididymitis/ torsion
ultrasound look for flow on Doppler
Kidney stones diagnostic workup
non con CT –> US +/- UA
Treatment of stones: 0.5 or less cm 0.5-1.5 cm 1.5+ cm 7+ cm
less than 1/2 cm just fluids and pain control
1/2 cm –> 1.5 cm add CCV
1.5 and up stenting and lithotripsy
above 7 cm need surgery
Microhematuria in kids:
management
watch and wait
CT only in trauma
Macrohematuria in kids:
w/ casts workup
UA and kidney biopsy
Macrohematuria w/o casts workup
US; cystoscopy; CT or MRI
Ectopic ureter presentation
female with constant leak (attaches below ext sphincter in females)
Ectopic ureter workup
US no hydro
VCUG no reglux
radionucleotide scan = ectopic ureter
Treatment of ectopic ureter
surgically re-implant
Constant hypo and epi spadias
epi= pees on EYE (dorsal, upper side) hypo= ventral = under side
*don’t circumcise, save foreskin for reconstruction
posterior urethral valve presentation
no urine output
possible oligo on prenatal screen
how to dx posterior urethral valve
US shows hydro –> VCUG shows no reflux
how to tx posterior urethral valve
cath then surg when can
UPJO presentation
obstruction with increased flow (ie following heavy alcohol drinking)
Dx and Tx for UPJO
US shows hydro VCUG shows no reflux –> surgery
Vesicoureteral reflux presentation
recurrent UTI/pyelo in kid
dx = hydro on US + reflux on VCUG
treatment with suppressive abx and then surgery
Dx of prostate cancer
firm large nodular prostate
high PSA
++ transrectal bx
treatment of prostate cancer
resection –> rads –> brachy +++ meds
meds for prostate cancer
anti-androgen = flutamine
GnRH analog = leuprolide
carcinogens assc with bladder cancer
B alanine dye; smoking
Bladder cancer treatment
transurethral resection
BCG/cisplatin chemo
renal cell carcinoma dx/tx
nephrectomy, don’t bx because risk bleeding
Clue to renal cell cx
erythrocytosis
testicular cancer
path
age
presentation
germ cell
18-25
does not transluminate
testicular cancer
dx and tx
US –> orchiectomy no bx because seeding
Marker for:
seminoma
ylk sac
chorio
seminoma LDH
yolk sac AFP
chorio BHCG
SAH dx
CT –> LP –> MR/CTA
Early treatment of SAH
Keep BP under 140/90
coiling/ clipping
Treatment of hydrocephalus
LP serial/ VP shunt
Late complications of SAH + management
seizures (give levitiracetam)
high ICP (give mannitol, hyperventilate)
vasospasm (give CCB and ^^^ BP)
IPH presentation
high BP
FND
H/A and N/V –> coma
Most common sources of brain mets (3) + location
lung, breast, GI
found at grey white junction
How commonly are brain lesions primary?
30%, single lesion
Where are adult vs pediatric primary tumors located
adult- anterior fossa
peds- posterior fossa
Two adult/ anterior fossa tumors
glioblastoma (butterfly crossing midline)
meningioma (dural tail)
Two peds/ posterior fossa tumors + management
medulloblastoma = resection + rads ependymom= resection only
Specific location of ependymoma
IV ventricle
craniopharyngioma appearance
calcified sella
Appearance of basal cell vs squamous cell vs melanoma
basal cell- pearly lesion
squamous cell- red nodule
melanoma- jet black
Dx and tx of basal/squamous cell
excisional biopsy
mohs for face
limb just he ex bx unless aggressive –> amputate
Melanoma outcome based on
depth
Ambylopia definition and cause
cortical blindness
strabismus, cataracts
Two causes of kiddo cataracts
at birth –> TORCH
after birth –> galactosemia
Retinopathy of prematurity = baby at risk for what other complications
bronchopulmonary dysplasia
IVH
necrotizing enterocolitis
Cause of chemical conjunctivitis in babes + appearance
silver nitrate (will be bilateral within **24 hours ** no pus), use emycin instead
gonorrhea conjunctivitis time of onset in babes + appearance
2-7 days, bilateral, purulent
chlamydia conjunctivitis time of onset in babes + appearance
5-14 days, unilateral –> bilateral
Closed angle glaucoma cause
1) low light –> dilation
2) no flow out
3) pressure, pain, rigid eye/ non reactive and dilated
Treatment of closed angle glaucoma
laser, a agonist, b blocker
What drug to always avoid in closed angle glaucoma patients
atropine
Orbital cellulitis treatment
if EOMI give abx
if no EOMI need surg for RETROorbital abscess
Cause of orbital cellulitis in DM
mucormycosis
Retinal detachment presentation
instant floaters/ veil/ curtain
does not come and go
Treatment retinal detachment
laser
CRAO presentation
painless acute loss of vision in one eye without other focal defects
Eye appearance in CRAO
cherry red spots on fovea
Treatment of CRAO
intra aterial tpa
hyperventilation
cataracts presentation
loss of night vision
old diabetic
macular degeneration two types
wet = 20% = can treat dry= 80% = no treatment
Appearance of wet vs dry MD
wet= hemorrhages dry= drussen/ pigment
Dx of AAA
US
Management of AAA based on size
- 5 screen q12
- 5 screen q6
- 5 or rapidly growing need surg
Classic dissection presentation
widened mediastinum
different BP in each arm
two patients at risk for dissection
marfans
syphilis
two types of dissection
A before great vessels B after
Dx of dissection and treatment?
CTA/ TEE–> MRI
operate if ascending, medical management If descending
PVD leg appearance
shiny
loss of hair
change in temp
How to dx PVD
ABI –> US –> CTA
ABI that is normal/ diagnostic of PVD
normal- 1-1.4
PVD- under 0.9
Treatment of PVD
stent if above the knee or small
bypass for others
if cannot do surg can used cilostazol or pentoxyphylline to decrease pain
Medical therapy for PVD
ACEi
BBer
statin
antiplatelet
Acute limb ischemia three causes
cholesterol emboli after cath
clot from afib
thrombus from worsening PVD
Dx/ Tx acute limb ischemia
US/ angio –> embolectomy or TPA
3 L –> R shunt lesions
ASD
VSD
PDA
Three R –> L shunt lesions
transposition
tetralogy
coarctation
Risk assc with L –> R shunt
eisenmengers, becomes the worse R –> L shunt
When to repair VSD
at 1 year or with CHF
Transposition is assc with ?
maternal DM (at week 8 so regular not gestational)
Tetraology is assc with?
downs (endocardial cushion defect)
Aortic stenosis murmur location + dx + tx
2nd ICS (R)
echo
replace valve
mitral regurg location + two causes
apex –> axilla
infection or infarction
Aortic Regurg 3 causes
infection
infarction
dissection
Location of aortic regurg murmur
4th R ICS, blowing
Dx and tx of AR
echo –> replacement or CABG
Compare bovine and mechanical valves
bovine lasts less than 10 years but doesn’t need anticoag
mechanical lasts more than 10 years but needs anticoag
mitral stenosis murmur clue
opening snap
Cath findings:
when to stent
when to CABG
stent if 2 or less vessels involved
CABG is 3 or left main
Vessels used for CABG
left internal mammary
saphenous
High aldo manifestation
HTN and low K
Five causes of surgical HTN
Conns RAS Pheo Cushings Coarctation
Conns- define
primary hyperaldo
Conns dx and tx
aldo:renin above 20 salt suppression test failure adrenal vein sampling CT/MRI resect
RAS dx
aldo : renin under 10
US w/ Doppler
angiogram
RAS tx
stent in young person with FMD
medical treatment for atherosclerosis
Coarctation dx ad tx
angiogram –> resect and re-anastamose
Treatment of pheo
a block –> b block –> resect
Cushings evaluation
low then high
low dose dexa, acTHEN, high dose dexa
low dose = syndrome
then= primary adrenal
high= cushing disease/ ectopic tumor
Primary adrenal cushings –> further dx
imaging and vein sampling
cushing disease management
MRI and resect
common source of ectopic ACTH
lung cancer
Thyroid nodule first step in dx
TSH (low= low risk) (normal = high risk)
Management of thyroid nodule with normal TSH
US –> FNA is over 1 cm, W & W if under 1 cm
Management of low risk (low TSH) nodule
RAIU scan
if hyperfunctioning Tx and resect, if nonfunctioning US and FNA
Dx of gastrinoma
gastrin level –> secretin stim –> somatostatin receptor scintography
Tx of gastrinoma
resect, because benign but leads to gastric cancer
Insulinoma dx
insulin, C peptide, sulfonylurea level
Glucagonoma clue
migratory necrolytic dermatitis
Hyperparathyroidism
dx and tx
sestamibe scan
resect (but will risk low Ca post op)
Most common type of TE fistula
type C (proximal atresia distal fistula)
Presentation of TE fistula
NG tube coiling
Imperforate anus dx
xray
Gastroschisis/ omphalocele location
Gastro- R sided
Omphalocele- midline
Treatment for gastro/omphalocele
silo
Extrophy of bladder appearance
midline, no bowl, shining red structure
Congenital diaphragmatic hernia two types
posterior- bochladek
anterolateral- orgagni
Pt presentation CDH
scaphoid abdomen
bowel sounds in chest
Treatment (2) for CDH
surgery + surfactant
Biliary emesis –> first step in dx
xray (to look for double bubble)
Four causes of newborn bilious emesis
1) malrotation
2) duodenal atresia
3) annular pancreas
4) intestinal atresia
2 Causes of intestinal atresia
1) in utero infarct
2) cocaine
Malrotation exams beyond xray
contrast enema
UGI series
Treatment for all causes bilious emesis
surgery
NEC presentation and dx
bloody BM with first feed, acidotic
babygram shows pneumatosis intestinalis
Treatment NEC
NPO, TPN
Meconium ileus presentation, dx/ tx
FTPM
bilious emesis
baby gram= ground glass, loops of bowel
tx- gastrograffin
Hirschsprungs dx and tx
KUB and surg
Obstruction pain characteristics
colicky
no fever
no leukocytosis
Inflammatory pain characteristics
constant
fever
leukocytosis
Perforation pain characteristics
SAS
MOTIONLESS
constant
free air on KUB
Lower quadrant structures
colon/appendix kidneys ureters testes ovary
Structure found in both upper quadrants
lung + diaphragm
Anal cancer
dx
tx
anal pap
chemo and rads, no cutting
How frequent are colonoscopies completed?
q10 if clean
q5 with polyps
q3 with carcinoma in situ
q1 with dysplasia
Familial adenomatous polyposis treatment
prophylactic colectomy
“Bad” polyp appearance
villous
sessile
large
Dx and tx of hemorrhoids
anoscopy
external- resect
internal- band
Anal fissure treatment
lateral internal sphincterotomy
NG paste
Pilonidal cyst treatment
I&D –> surgery
When to start colonoscopies in UC
8 years post dx, prophylactic colectomy at first sign of dysplasia
Cholelithiasis dx/tx
RUQ US –> elective chole
Cholecystitis dx/ tx
RUQ US –> HIDA –> ERCP/elective chole
Choledocolithiasis dx/tx
RUQ US –> MRCP –> ERCP (urgent)/chole elective
Cholangitis dx/ tx
RUQ US –> STAT ERCP CHOLE LATER
Abx for gallbladder disease
Cipro + metro
How to dx pancreatitis
lipase –> only need CT if labs aren’t sufficient
Management of pancreatitis
NPO
IVF
Analgesia
Pseudocyst management
drain if above 6 weeks or 6 cm
Chronic pancreatitis management
insulin
enzymes
pain control
Dx SBO
upright abdominal film
When to operate on SBO
complete = urgent surgery
peritoneal signs = emergent surgery
incomplete= surgery if not better in a few days
Initial management of all SBO
NG tube, IVF
Appendicitis dx/tx
clinical –> straight to surgery
Carcinoid syndrome= tumor must be?
metastatic/ in liver
Carcinoid dx/ tx
5HIAA —> CT scan –> resect
When to operate on hernia
strangulated –> emergent surgery
reducible –> urgent surgery
reducible –> elective surgery
Achalasia:
what is absent?
dx/tx?
auerbach
barium –> manometry –> EGD/bx –> myotomy
GERD spectrum management
GERD PPi
Metplasia High dose PPi
Dysplasia ablation
adenocarcinoma resect
(all can get nissen)
Esophageal cancer:
sx
dx/tx?
progressive dysphagia
EGD/bx –> resection
Mallory Weiss tear management
supportive
Boerhaaves dx/treatment
air in mediastinum
gastrograffin –> barium –> EGD –> surgery
Pre-hepatic jaundice two types
hemolysis
hematoma
Two causes of intrahepatic jaundice
genetic
hepatitis
Three causes of posthepatic jaundice
strictures
cancer
gallstones
Obstructive jaundice –> next step in dx?
CT scan: obstruction in biliary tree, pancreas, or ampulla of vater?
Obstructive jaundice in biliary tree: cause?
stone or cholangiocarcinoma
Clue to pancreatic cancer as cause of obstructive jaundice
migratory thrombophlebitis
List four stages of skin ulcers
1: erythema/epidermis
2: epidermis + dermis
3: exposed fascia
4: exposed bone & muscle (osteo)
Path of diabetic vs aterial insufficiency ulcers
DM- microvascular changes
Arterial insufficiency- macrovascular
Location of diabetic vs arterial vs venous ulcers
diabetic- heels/balls of feet
arterial- tips of toes
venous- medial malleolus
Arterial insufficiency vs venous insufficiency skin appearance
arterial- shiny, hairless, pulseless
venous- edema, pigmented
Marjolin ulcer is caused by?
treatment?
SCC
wide resection
Dx and tx of arterial insufficiency
ABI/arteriogram –> stent/bypass/graft
Mammograms- whats the board answer for now?
When do we MRI?
50 q2
MRI only with BRCA or prior cancer
Management of a breast lump in patient under 30
watch and wait x 2 cycles –> US/ FNA if still there
FNA blood= cx, pus = abscess, fluids = cyst
Lump in a patient over 30 (or with prior mass/ bleeding)
mammogram and core bx
Which of the SERMs increases endometrial cancer risk?
tamoxifen
What are the systemic chemo drugs for bcx? targeted?
doxo/dauno +/-cyclophosphamide and paclitaxel
targeted- trastuzumab, tamoxifen, aromatasei
What severe ADR is assc with trastuzumab
CHF
Post op fever: immediately post op day 1 day 2 day 3 day 5 day 7 2 weeks
immediately- bacteremia day 1- atelectasis day 2- PNA day 3- UTI day 5- DVT/ PE day 7- cellulitis 2 weeks -abscess
(wind, water, walking, wound)
Treatment of post op DVT/PE
heparin –> warfarin
Ddx AMS post op
1) hypoxemia
2) delirium tremens at 48-72 hours post admission
3) sundowning
4) Na/Ca changes
Treatment of delirium tremens
BDZ
Normal urine output
0.5 cc/kg/hr
Oliguria three types
urge + = obstruction (scan)
urge - = mechanical (0 urine) or renal disease (some)
3 causes of post op abdominal distention
ileus
obstruction
ogilive syndrome
Ileus, obstruction, ogilive: KUB findings + which gets surgery
ileus= whole bowel distended ogilive= whole LARGE bowel distended in elderly obstruction= proximal dilation/distal narrowing
only obstruction gets surgery
ileus management
IVF, K get out of bed
Treatment ogilive syndrome
rectal tube
stigmine
colonoscopy
Evisceration management
warm saline dressing, never push back in, emergency surg
Cardiac reasons to avoid surgery
EF under 35%
MI in last six months
JVD
How to dx malnutrition
prealbumin
