Part B 06 Flashcards
Most common site c-spine injury
Atlanto-axial region
Separation of nail from nail bed
Aka
Oncholysis
Septic arthritis
Tx
Analgesia
Aspirate joint to dryness
IV abx
If >3 aspirations/day
Or soft tissue affected
Or no response w/i 5 days
> washout
Brugada syndrome
Inheritance
Autosomal dominant
Salmonella typhi
Complications
Intestinal haemorrhage Intestinal Perf Secondary pneumonia Encephalitis Myocarditis Septic shock
Stroke
Definition
Rapidly developing Focal neurology Lasting >24h Or leading to death No apparent cause other than vascular
Advice with mydriatic drops
Sensitive to light: sunglasses
Blurry vision
Risk of AACG - return to ED of eye pain
Orbital blowout #
Define
# of orbital wall Rim of orbit remains in tact
Orbital blowout #
Sx
Diplopia esp upward gaze — inferior rectus Orbital emphysema Malar region numbness — inferior orbital nerve Enophthalmus Hypoglobus - inferior displacement globe
Orbital blowout #
Indication for surgery
Significant enophthalmus
Significant diplopia
Muscle entrapment
Large #
Malar region numbness (nose)
Affected nerve
Inferior orbital nerve
Blowout #
Diplopia on upward gaze
Entrapment which muscle
Inferior rectus
From inferior blowout
Painful 3rd nerve palsy
With blown pupil
Most common pathology
Posterior communicating artery aneurysm
ATLS
Life threatening chest injuries
ATOMFC Airway obstruction Tension pneumo Open pneumo Massive haemothorax Flail chest Cardiac tamp
Hill Sachs deformity
Define
Depression posterior aspect humeral head
Impact against glenoid rim
Tension pneumothorax
Initial Tx
Needle thoracocentesis
Raised ICP
Signs
Headache
Vomiting
Pappiloedema
Action of mannitol for Tx raised ICP
Decrease rate CSF production
Draws fluid across BBB
SIGN guideline
GI bleed admit for early endoscopy if
>70yo Witnessed haematemesis or haematochezia Haemodynamic disturbance Known liver ds or varices
SVCO
Stands for
Superior vena cava obstruction
CURB-65
Scoring
Confusion Urea>7 RR>30 sBP<90 Age
Atypical pneumonia
Organisms
Mycoplasma pneumonia
Chlamydia pneumoniae
Legionella pneumophillia
FAST scan
Views
Longitudinal RUQ, LUQ
Transverse subxiphoid
L+T suprapubic
FAST scan
RUQ view looking at
Hepatorenal recess
Aka
Morrison’s pouch
FAST scan
LUQ looking at
Splenorenal recess
FAST scan
Blood first seen in
Hepato renal recess
Aka
Morrison’s pouch
eFAST scan
Includes
L and R thoracic
To look for pneumothorax
Empty can test
Test for
Supraspinatus injury
Or
Suprascapular nerve palsy
Empty can test
Process
Abduct horizontally
Palm down
Resist downward pressure
RA X-ray findings
Joint space narrowing
Erosions
Subchondral cysts
Soft tissue swelling
Vestibular Schwanoma
Site
Cerebellopontine angle
Vestibular schwannoma
CN effected
5th - trigeminal
8th - vestibulocochlear
Otitis media
Organism
Streptococcus pneumoniae
Otitis media
Abx for
Children <2 w’ bilateral infx
Purulent discharge from ear
Systemically unwell
Recurrent infection
Otitis media
Abx for Tx
Amoxicillin
Or
Erythromycin
5 days
Otitis media
Complication
Mastoiditis Brain abscess Sepsis Meningitis TM perforation Hearing loss Facial nerve palsy
Otitis externa
Pathogen
Pseudomonas aeriginosa
Otitis externa
Tx
Sofradex Gentisone Ciprofloxacin \+/- aural toilet \+/- pope wick
Detecting ST elevation in presence of LBBB
Use
Sgarbossa criteria
Sgarbossa criteria
Used for
Detect st elevation in
LBBB
And
Ventricular paced rhythm
Sgarbossa criteria
> 1mm concordant ST elevation w’ positive QRS
1mm concordant ST dep in leads V1-3
5mm discordant ST elevation w’ neg QRS complex
Asthma
Mg sulphate dose
1.2-2g IV over 20min
Asthma
Aminophylline dose
5mg/kg over 20min (loading dose)
Arterial line placement
CI
Absent pulse
Full thickness burn at site
Arterial insufficiency distal
Vascular injury proximal
Pre oxygenation
Process
15L non rebreathe
For 3 min
RSI paralytic agents
Suxamethonium 1mg/kg
Thiopentone
Intubation in asthma
Induction
And
Paralytic agents
Induction:
Ketamine 2mg/kg
Para:
rocuronium, sux
Intubation in asthma
Indication
Severe hypoxia
Confusion
Failure meds/NIV
Resp arrest
Pericarditis and high trop
Ddx
Myopericarditis
Or
Missed MI and dressler syndrome
Hydrofluoric acid
Tx
Irrigate
Calcium gluconate and KY jelly (top)
>10% calcium gluconate inj
>10ml 10% Ca gluconate intra arterial inj
Biliary colic
Pathology
Gallstone transiently obstructs either cystic duct or Hartman’s pouch
Prostatitis
Pathogens
E. coli
S aureus
Neiserria gonorrhea
Prostatitis
Abx and course length
Not STI related
Cipro or trimethoprim
28d
Testicular cancer
Ix
USS testis
Testicular cancer
Types
Seminoma
Teratoma
Gilbert syndrome
Pathology
Deficient conjugation bilirubin
Gilbert syndrome
Genetics
% pop
Autosomal recessive
5% pop
Anorexia nervosa
Metabolic disturbances
Low K, Mg
High amylase, urea, LFT
Anaemia and low Plt
Anorexia nervosa
Admission criteria
Risk self harm/ suicide
BMI<15
Bradycardia, low glucose, electrolyte disturbance
Cyanosis of hands and feet
Aka
Acrocyanosis
Osteomyelitis
Tx
Fluclox (6w)
+/- rifampicin (1st 2w)
Clindamycin (pen allergic)
Vanc (MRSA)
Osteomyelitis
Pathogens
Staph aureus Streptococcus sp Enterobacter sp Haemophilus influenza Salmonella sp
Ankle ligaments
Medial
V
Lateral
Medial - deltoid Lateral - anterior talofibular lig - calcaneofibular lig - posterior talofibular lig
Coeliac
Ix
Serum IgA tTGA
(Tissue transglutaminase)
Intestinal biopsy
Carcinoid syndrome
Ix
24h urinary 5HIAA
ABCD2
High risk score =x
And
Management plan
Score>3
R/V within 24h
APGAR
Normal score
> 7
APGAR
Scoring
Appearance 0-2 1= blue extremities Pulse 1 = <100 Grimace (Reflex) 2 = cry on stimulation Activity 1 = some flexion Respiratory effort 1 = weak and irregular
TCA overdose
Sx start w/i
1-2h of overdose
TCA OD
Potential life threatening
> 10mg/kg
TCA overdose
Severe OD
Leading to cardiotoxicity and coma
> 30mg/kg
TCA overdose
Sx
Shock Dilated pupils Increased tone upward plantar Ataxia, jerky limb movements Reduced GCS Seizure Arrhythmia
TCA overdose
ECG signs and reason for them
Broad QRS
- blocked Na channels
Prolonged QT
- blocked K channels
TCA overdose
Do not give which drugs
Anti arrhythmiacs
Eg amiodarone
Worsens hypotension
TCA overdose
Tx
A to E
Activated charcoal
Na bicarbonate
Adrenaline for hypotension
Colles #
Comp
Malunion Median nerve palsy Carpal tunnel syndrome Reflex sympathetic dystrophy OA Extensor pollicis longus rupture
Transient global amnesia
RF
> 50yo
Associated with migraine
After strenuous exercise , cold temp or traumatic event
Transient global amnesia
Sx
Transient loss short term memory Rapid onset Perseveration - asks same Qs repeatedly Unable to recall episode once recovered
Transient global amnesia
Resolves within
Usually w/i hours
Completely resolves within 24h
Ranson criteria
Age>55 WCC>16 BG>10 AST>250 LDH>350
> 3 severe pancreatitis
Most common positions of appendix
Ascending retrocaecal (64%) Subcaecal (32%)
C. Difficile
Ix
Stool cytotoxin assay
Dabigatran reversal agent
Idarucizumab
Praxbind
Acute peripheral vertigo
Tx
Prochlorperazine
Cinnarizine
Pretibial laceration
Comp
Haematoma formation
Bed position for ventilated patient
15-30deg head up
Calculate tidal volume
Ventilator
7xIBW
Ideal body weight (kg)
Endotracheal tube size
Paeds
3mm - neonate
4mm - 6m
4.5 - 1 yr
- 5 - female
- 5 - male
Paeds
Meningococcal septicaemia
Most common pathogen
Neiserria meningitidis group B
Paeds
Meningococcal septicaemia
Tx
Ceftriaxone 80mg/kg
Paeds
IO access
Prox humerus - 1cm above surgical neck Prox tib - 3cm below tibial tuberosty Distal tib - 3cm prox to most prominent medial malleolus
