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PEM Notes Qs Flashcards

1
Q

Varicella prophylaxis in pregnancy

A
  • if IgG negative and exposed: give VZIG w/in 96 hours, acyclovir is they develop symptoms
  • transmission risk 5 days before and 2 days after delivery
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2
Q

Evaluation of congenital syphillis

A
  • labs: cbc, lfts
  • Lumbar puncture for CSF studies
  • skeletal survey
  • serology
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3
Q

E’s of injury prevention (6)

A 
Engineering
Enforcement
Education
Empowerment
Enabling
Employment
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4
Q

Ways to minimize bias in RCT

A
  • double blinding
  • randomize groups
  • intention to treat analysis
  • objective measures
  • homogenous study population
  • pre-specified protocol, endpoints, statistical plan
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5
Q

poor prognostic factors in drowning (6)

A
  1. duration of submersion > 10 min
  2. absent pupillary reflexes
  3. hyperglycemia (glucose > 250)
  4. acidosis (pH < 7.1)
  5. No spontaneous circulation after 25 min
  6. prolonged coma
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6
Q

Name anatomical landmarks in three zones of neck

A
  1. sternal notch to cricoid
  2. cricoid to angle of mandible
  3. angle of mandible to skull base
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7
Q

What test would you do for penetrating injury in Zone 3

A

CT angiogram

Consult surgery

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8
Q

4 XR findings in epiglottitis

A
  1. Thumb sign - epiglottis > 8 mm
  2. hypopharynx overdistended
  3. thickening of aryepiglottic folds
  4. circumferential narrowing of subglottic portion of trachea
  5. reversal of normal lordotic curve
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9
Q

XR findings in retropharyngeal abscess (3)

A
  1. prevertebral space > 7 mm @ C2 and >14 mm @ C6 (>22 mm in adults)
  2. loss of lordosis
  3. soft tissue mass, gas or air fluid level
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10
Q

3 MC bacteria causing RPA

A
  1. Group A strep
  2. Staph aureus
  3. Oral anaerobes (bacteroides, prevotella, fusobacteria)
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11
Q

Tx of RPA (3)

A
  1. Consult ENT for possible I&D
  2. IV access, IVF, pain control
  3. Start IV antibiotics - Clindamycin
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12
Q

8 areas of the face you palpate looking for a fracture

A
  1. supraorbital ridge
  2. infraorbital ridge
  3. zygomatic arches
  4. infraorbital ridge/zygoma/maxilla from above
  5. nasal bone and maxilla (finger in mouth for stability)
  6. . nasal bridge / septum
  7. mandible
  8. occlusion of teeth
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13
Q

5 locations of mandibular fx

A
  1. condyles
  2. rami
  3. body
  4. symphysis
  5. angle
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14
Q

8 reasons for OR of neck injury

A
  1. airway obstruction/stridor
  2. cerebral ischemia/neuro deficit
  3. expanding/large hematoma
  4. hematemesis/hemoptysis
  5. severe bleeding
  6. vascular bruit or decreased pulses
  7. hemorrhagic shock
  8. massive subcutaneous emphysema / air bubbling through wound
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15
Q

Auricular hematoma - 2 steps in management

A
  1. Drain hematoma
  2. Apply compressive bandage
  3. ENT f/u for re-examination in 1-2 days
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16
Q

Complications of auricular hematoma

A
  1. peri/chondritis

2. cartilage deformation “cauliflower ear”

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17
Q

Complications of septal hematoma

A
  1. saddle nose deformity
  2. septal ischemia/necrosis –> septal perforation
  3. infection (septal abscess)
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18
Q

Child with 5 episodes of bilateral parotitis - what 2 tests would you do?

A
  1. Ultrasound - eval for stones
  2. Labs for immunodeficiency
  3. ENT consult –> sialography
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19
Q

Complications of chronic TM perforation? (4)

A
  1. Conductive hearing loss
  2. Cholesteatoma
  3. Mastoiditis
  4. Chronic otitis media
  5. Vertigo
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20
Q

Indications for ENT c/s with penetrating ear trauma

A
  1. assoc facial N injury
  2. persistent bleeding
  3. retained /protruding foreign body
  4. assoc basilar skull fx
  5. refractory N/V
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21
Q

Ways to get bead out of external ear canal? (4)

A
  1. Lighted currette
  2. Forceps with direct visualization
  3. Irrigation
  4. Dermabond
  5. Katz extractor
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22
Q

MCC of halitosis

A

retained nasal foreign body

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23
Q

Indications for repair of tongue laceration (2)

A
  1. Large flap
  2. Edge of tongue
  3. Significant bleeding
  4. Deep lacs on margins
  5. Through / through lacs
    * use 4.0 absorbable suture
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24
Q

Mastoiditis - 3 physical exam findings

A
  1. Protrusion of pinna
  2. Posterior mastoid erythema/warmth/swelling and tenderness
  3. Pain with manipulation of ear
  4. AOM
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25
Complication of mastoiditis
1. Meningitis 2. Intracranial abscess 3. Facial N palsy 4. Osteomyelitis 5. Bezold abscess 6. Hearing loss 7. Sinus venous thrombosis
26
Neck pain and fever but normal pharynx and no lymphadenopathy - ddx (4)
1. RPA 2. Meningitis 3. AOM 4. Discitis/osteomyelitis 5. Epidural abscess
27
2 nasal foreign bodies that require immediate removal
1. button battery 2. paired magnets 3. organic material ?
28
6 causes of halitosis
1. nasal foreign body 2. sinusitis 3. dental infxn 4. tonsilolith 5. GERD 6. gingivitis
29
4 ways to stop epistaxis
1. Direct pressure 2. Local vasoconstrictor: Epi, afrin 3. Nasal packing 4. Cautery
30
Auricular hematoma drainage - outline steps
1. Analgesia: local or auricular block 2. Wipe with betadine 3. Insert 18G needle or make small incision with scalper (Aspirate) 4. irrigate 5. apply compressive bandage
31
Causes of stridor (6) in newborn
1. Laryngotracheomalacia 2. Subglottic stenosis 3. Esophageal ring/sling 4. Vascular ring/sling 5. Tracheal web 6. Infectious - croup 7. Airway hemangioma
32
Impt structures to consider when repairing cheek laceration
1. facial N | 2. parotid gland/duct
33
Immediate mngmt steps with avulsed tooth
1. Rinse with saline or water, handle by crown not root 2. replace immediately and splint 3. If unable to replace, place in Hanks solution or milk, c/s dental
34
4 life-threatening injuries that can result from blunt neck trauma
1. laryngeotracheal fracture 2. vascular injury/hematoma 3. esophageal rupture 4. airway obstruction
35
Complications of parotitis
1. airway obstruction 2. septicemia 3. facial bone osteo 4. septic jugular thrombophlebitis 5. facial N paralysis 6. xerostomia (chronic dry mouth)
36
Classification of Supracondylar fx
Type 1: Nondisplaced Type 2: Displaced in one plane only, posterior cortex in tact Type 3: Displaced in 2 or 3 planes Type 4: Complete periosteal disruption with instability
37
Anterior shoulder dislocation - what N is injured? how do you assess this N?
Axillary N | - Assess for sensation over lateral deltoid
38
stimson method for shoulder reduction
Lay prone, arm draped over bed, attach 10-15 lb weights, muscle relaxation with benzos and should spontaneously reduce
39
External rotation method for shoulder reduction
Supine or sitting Arm held in adduction, elbow/forearm at 90 degrees, gradually rotate arm externally Can apply gentle traction at elbow and abduct arm to overhead position
40
Scapular manipulation method for shoulder reduction
Prone position, traction on arm, push inferior scapula medially and superior scapula pulled laterally
41
Monteggia fracture
Proximal ulnar fracture | Radial head dislocation
42
Galeazzi fracture
Distal radius fx | Distal radioulnar joint dislocation
43
4 causes of backpain (no trauma)
1. spondylolysis / spondylolisthesis 2. discitis/osteomyelitis 3. scoliosis 4. renal: nephrolithiasis / UTI 5. malignancy
44
SCFE - normal XR, next best test?
MRI
45
4 signs of tenosynovitis
Kanavel signs 1. Fusiform swelling 2. Pain with passive extension 3. Pain along flexor tendon sheath 4. Finger held in flexion
46
Compartment syndrome - sx
1. Pain - out of proportion 2. Pallor 3. Paresthesias 4. Poikolothermia 5. Paralysis 6. Loss of 2 point discrimination 7. Pulselessness
47
Tx of compartment syndrome
1. Measure cpt pressures > 30-40 or delta pressure < 30 2. Remove cast 3. Fasciotomy (ortho c/s)
48
Fracture of MT #2,3,4 from crush injury
Lis Franc injury - one or more MT are displaced from the tarsals (> 1 mm bw 1st and 2nd MT)
49
4 XR findings in SCFE
1. Klein's line 2. Flattening of epiphysis 3. Widening of growth plate 4. Steel sign - double density at metaphysis
50
3 High risk criteria - Canadian C-spine Rule
1. Dangerous MOI (fall > 5 steps, axial load, high speed MVC, bicycle collision) 2. Age > 65 years 3. Paresthesias
51
Low Risk Criteria - Canadian C-spine Rule
``` Simple MVC Sitting in ED Ambulatory at any time Delayed onset neck pain No midline C-spine TTP ```
52
4 classic RF SCFE
Obesity Male African American Adolescent
53
4 RF for SCFE in younger child
``` Hypothyroidism Renal osteodystrophy Steroid use Trauma Sickle cell disease ```
54
4 complications of SCFE
1. Osteonecrosis 2. Chondrolysis 3. Chronic pain 4. Osteoarthritis 5. Limited hip ROM
55
Laceration with metal on heel, cannot weight bear - 6 steps in mngmt?
1. Clean wound with soap/water 2. Update tetanus status 3. Check XR for foreign body 4. Give analgesia 5. Suture laceration with 4.0 nonabsorbable suture material 6. Bulky dressing 7. Crutches as needed for weight bearing
56
Indications to refer finger fx
- Displaced finger fx - Intraarticular finger fx - Malrotation - Joint instability
57
Tibial tubercle fx - vessels and N injury
Anterior recurrent tibial arteries Saphenous N injury At risk for compartment syndrome
58
NEXUS criteria (5)
- no midline ttp - no intoxication - no AMS - no distracting injury - no focal neuro deficits
59
Distal humerus oblique fx - N injury? How do you test it?
1. Ulnar N 2. Finger adduction 3. Sensation of little finger and ulnar aspect of 4th finger
60
3 common sites where avulsion injuries occur in pelvis (5 total listed)
1. Ischial tuberosity = hamstrings 2. AIIS = rectus femoris mm 3. ASIS = sartorius 4. Pubic symphysis = adductor 5. Iliac crest = rectus abdominis
61
Active adduction of thumb = what nerve?
ulnar N
62
Which nerve is injured with glenohumeral dislocation
Axillary N | all brachial plexus can be injured too
63
Ankle sprain classification
Grade 1 - minimal TTP, swelling Grade 2 -mod pain/swelling, decreased ROM Grade 3 - sig swelling/TTP, instability
64
What injury leads to Volkmann contracture?
Supracondylar fracture with compartment syndrome -- > injury to brachial AA and median N
65
Deformity seen with Volkmann contracture?
Claw hand - fixed flexion at elbow - pronated forearm - flexion at wrist - joint extension at MCP
66
2 labs to check in SCFE
1. Thyroid levels | 2. Calcium levels
67
5 bone/orthopedic complications with SCD
1. Vaso-occlusive crisis 2. Osteoarthritis/osteopenia 3. Avascular necrosis 4. Osteomyelitis/septic arthritis - salmonella 5. Chronic pain
68
Ossification centers / age in elbow
``` C - capitellum, 1 R - radial head, 3 I - int (med) epicondyle, 5 T- trochlea, 7 O - olecranon, 9 E - ext (lat) epicondyle, 11 ```
69
Tilleaux fracture
SH3 fx thru distal tibial physis / epiphysis w/ avulsion of anterolateral distal tibial epiphysis (occurs age 12-14 yrs when medial physis is partially closed)
70
Triplane ankle fracture
fx thru metaphysis (post aspect, seen on lateral), physis (transverse plane - seperated) and epiphysis (seen on AP, dx of lateral aspect); SH4
71
Management of triplane ankle fx
Need CT scan, if > 2 mm need reduction; surgical fixation assoc w/ lower rates of physeal arrest
72
What roles do you have to assign to your trauma team?
1. Trauma team lead (you) 2. Airway (1-2 people) 3. IV nurse 4. Med nurse 5. Primary/secondary survey 6. Recorder
73
History suspicious for NAT
1. Injury not c/w mechanism 2. Changing history 3. Delay in presentation 4. Injury not c/w developmental age of child 5. Hx of multiple ED visits for traumatic injuries
74
3 clinical features of urethral injury
1. Blood at meatus 2. Perineal ecchymoses 3. High riding prostate 4. Difficulty voiding 5. Hematuria
75
2 methods of decontamination after bomb detonation
1. Remove all clothing and store in closed bag 2. Wash/shower with soap/water 3. No specific PPE apart from regular PPE required for providers - no specific decon is needed for ionizing radiation
76
"RED" on triage system
RPM -2 can do | RR > 30 bpm, (-) radial pulse, CRT > 2 sec, AMS
77
"BLACK" on triage system
Deceased | Check respirations - if not breathing, position airway, if still not breathing = black
78
What is different for kids in assessment of BLACK vs RED in JUMP START triage?
1. Check breathing - if not breathing, reposition airway - if apneic, check pulse - if no pulse = BLACK - if (+) pulse = give 5 rescue breaths --> if still apneic = BLACK, if breathing = RED 2. RR < 15 or > 45 bpm for kids
79
What test do you perform 3 days post-detonation in patients affected by acute radiation exposure?
Complete blood count with differential (baseline --> repeat Q12hr x 2-3 days) - lymphocyte count is first to decrease. If < 100 in first 2 days, likely lethal. If 100-1000, severe but likely survivable. Lymphocyte @ 48 hrs is prognostic
80
Trauma patient with fixed/dilated pupils, GCS 3, HR 40, RR 10, 2 IV in place, intubated.
Cushing's triad c/f increased ICP 1. Hyperventilate PaCO2 30-35 mmHg 2. HOB @ 15-30 degrees, head midline/neutral 3. Hypertonic saline, 5 ml/kg bolus OR Mannitol 0.5-1 g/kg 4 4. Maintain adequate IV volume, normoglycemia, normothermia 5. Adequately sedate, pain meds and prophylactic seizure meds
81
3 common thoracic injuries with blunt chest trauma
1. Pulmonary contusion 2. PTX / hemothorax 3. Rib fracture 4. Cardiac contusion 5. Thoracic vascular injury
82
Thoracic trauma pt, CXR with widened mediastinum - dx? next best test?
``` Dx = ruptured aorta Test = angiography; if unstable - transesophageal echo ```
83
Thoracic injuries that require urgent surgical management
``` Tracheal/bronchial rupture Esophageal disruption Diaphragmatic rupture/hernia Pericardial tamponade Great vessel laceration Lung parenchyma, internal mammary artery laceration, intercostal artery laceration ```
84
4 historical suggestions of NAI
1. acute/chronic injury w/ inadequate, inconsistent or no explanation 2. Severe head injury due to minor reported trauma 3. unexplained symptomatic head injury in a child who was well when last seen 4. Multiple ED/doctor visits for fx / injuries
85
7 steps to log roll
1. Personnel - 3 people 2. Preparation - criss/cross, undo straps, tuck clothing 3. Immobilization 4. Rolling - roll 90 degrees 5. Exposure - clothing/board removed 6. Examination 7. End - roll back
86
Alternatives to log roll
1. straddle lift and slide 2. 6+ lift and slide 3. Scoop stretcher
87
PE findings of rib fx
1. TTP 2. Chest wall contusion/hematoma 3. Deformity of chest wall on palpation 4. splint/hypoventilation due to pain 5. crepitus
88
Questions to ask EMT about mechanism of MVC
1. Significant intrusion > 20 inch 2. Prolonged extrication > 20 min 3. Death of any other passengers? 4. Mechanism of impact 5. Airbag deployment? 6. Restrained? 7. Any assoc fire injury? 8. ejection or rollover?
89
Waddell triad of pedi struck by car?
1. Femur/pelvis fracture 2. Intraabdominal injury 3. Head injury (contralateral)
90
2 complications of being on a hard board
1. Pressure sores / pain | 2. Potential respiratory insufficiency
91
DDx fixed dilated pupils
1. Head trauma with ICP 2. intracranial mass with ICP 3. Medication - anti-cholinergic (atropine) 4. Hypoxia from cardiac arrest 5. Drowning/submersion injury
92
5 immediately life threatening thoracic injuries
1. tension PTX 2. traumatic rupture of aorta 3. cardiac tamponade 4. commotio cordis 5. diaphragmatic / esophageal rupture 6. flail chest
93
5 potentially life-threatening thoracic injuries
1. pneumothorax 2. hemothorax 3. cardiac contusion 4. pulmonary contusion 5. tracheobronchial injury
94
2 renal injuries not associated with hematuria
1. vascular pedicle injury (50%) | 2. penetrating injury (33%)
95
6 clinical findings suggestive of renal injury
1. Flank pain 2. Flank ecchymoses 3. Hematuria 4. Shock 5. Peritoneal signs/symptoms 6. Flank mass
96
Hallmark clinical indicator of "lap belt complex"
abdominal ecchymoses in distribution of seatbelt + abdominal/back pain
97
2 features of "lap belt complex"
1. Intraabdominal injuries - usually hollow viscous injury | 2. Lumbar spine fx - chance fx
98
IAI assoc with Chance fx
mesenteric disruption duodenal hematoma/perforation bladder rupture transection of small bowel
99
Clinical features of traumatic aortic rupture (aside from shock/hypotension) [5]
1. Pulse differential bw UE/LE 2. Paraplegia 3. Thoracic contusions 4. Anuria 5. Thoracic/back pain
100
5 CXR findings in TRA
1. widened mediastinum 2. tracheal/NGT deviation 3. L pleural cap 4. L pleural effusion 5. loss of aortic knob
101
5 CF in traumatic asphyxia (ie car ran over chest)
1. Facial edema 2. Petechiae of upper body, subconjunctival hemorrhage 3. Chest contusions 4. AMS 5. Respiratory distress
102
5 grades of renal injury
1. contusion, subcap hematoma 2. Lac < 1 cm, nonexp hem confined to retroperitoneum 3. Lac > 1 cm, no extravasation or collecting system rupture 4. Lac into collecting system or renal vascular injury 5. Shattered kidney or avulsion of renal hilum
103
What is a flail chest
2+ contiguous rib fractures with 2+ breaks/rib (Segment loses contiguity with thoracic cage)
104
4 causes of hypoxemia in flail chest
1. pulmonary contusion 2. splinting with hypoventilation 3. PTX/hemothorax 4. impaired normal inspiratory/exp fxn due to paradoxical chest wall movement
105
Indications of abdominal CT in pediatric trauma pt (6)
1. MOI suggestive 2. Slowly declining hematocrit 3. Unaccountable fluid/blood requirements 4. Neurologic injury precluding accurate abdominal exam 5. hematuria 6. acute "need to know" prior to OR for other reasons
106
MC solid organ injuries
spleen > liver > kidney > pancreas
107
Lab criteria for abdominal CT in trauma
1. declining Hb/Htc 2. gross hematuria 3. AST > 200, ALT > 125 4. amylase > 125
108
3 indications for laparotomy in BAT
1. Shock unresponsive to fluid / blood 2. Penetrating wound to abdomen 3. Pneumoperitoneum 4. Multisystem injuries with indications for craniotomy in presence of (+) DPL / FAST
109
Cervical distraction injury
Interspinous distance > 5mm (atlantooccipital and C1-C2 distance) --> assoc w/ vertebral or carotid injury, rapid acceleration/deceleration injuries, usually incomptability w/ life
110
4 RF for severe electrical injury
1. high voltage exposure > 1000V 2. Alternating current 3. Duration of exposure/contact 4. Associated traumatic injuries
111
Worse prognostic factors submersion injury
1. Duration > 10 minutes 2. No ROSC in 25 minutes or persistent need for CPR in ED 3. Acidosis pH < 7.1 4. Hyperglycemia > 13.8 or 250 mg/dL 5. Prolonged coma > 24 hours 6. Absent pupillary reflexes
112
Labs seen with submersion injury
1. pH < 7.1 (respiratory and metabolic acidosis) 2. Hypoxemia Hypercapnia 3. Hyperglycemia
113
Temperatures for grades of hypothermia
mild > 32 moderate 28-32 severe < 28
114
4 metabolic considerations in hypothermia
1. metabolic acidosis 2. hypokalemia 3. hypocalcemia 4. hypoglycemia 5. coagulopathy
115
2 complications from biting electrical cord
1. scarring/contracture | 2. Bleeding from labial artery when eschar falls off 7-10 days after injury
116
Management of hyperthermia
1. IVF 2. Remove clothing and initiate active cooling 3. Benzos for agitation/to stop shivering 4. Cardiovascular support as needed
117
6 complications of hyperthermia
1. Seizures 2. Respiratory failure 3. Cardiogenic shock 4. Rhabdomyolysis with renal failure 5. Coagulopathy 6. Electrolyte derangements 7. Dysrhythmias
118
3 signs of HAPE
1. Tachypnea, cyanosis 2. Tachycardia 3. Diffuse crackles on auscultation 4. Frothy / rust colored sputum 5. elevated JVD
119
3 symptoms of HAPE
1. cough 2. dyspnea out of proportion to activity 3. fatigue / weakness
120
Tx. HAPE
1. Descent 2. Supplemental oxygen 3. Limit exertion 4. Hyperbaric if severe
121
Ten complications of central venous cannulation
1. Vessel laceration 2. Missed vessel 3. Hematoma 4. Thrombus 5. Infection 6. Dysrhythmia 7. Cardiac injury 8. Dislodged catheter fragment 9. Air embolism 10. PTX
122
3 landmarks for chest tube insertion
1. Midaxillary line 2. 5th intercostal space at nipple line 3. Insert above lower (5th) rib to avoid neurovascular bundle
123
Complications of chest tube placement
1. Bleeding/hemothorax 2. Lac to visceral organs (heart, liver, spleen) 3. Diaphragmatic laceration 4. Re-expansion pulmonary edema 5. Pulm contusion/laceration 6. Pain
124
Landmark for needle cric
midline, inferior to thyroid cartilage, superior to cricoid cartilage (usually difficult to identify landmarks)
125
4 steps to thoracotomy
1. Supine position 2. Clean chest w/ povidone-iodine solution 3. L 5th intercostal space - anterolateral incision from sternum to axillary line 4. insert chest wall retractor / rid spreader 5. Inspect for tamponade --> pericardiocentesis, internal cardiac massage 6. Clamp pulmonary vessels and descending aorta (depending on where hemorrhage is
126
4 complications of casting/splint
1. compartment syndrome 2. skin breakdown 3. joint stiffness 4. pressure sores 5. muscle atrophy
127
4 locations you can place an IO
1. proximal tibia 2. distal femur (3cm above lateral condyle) 3. proximal humerus 4. distal tibia (1-2 cm above medial malleoli)
128
4 complications of IO
``` Subcutaneous abscess Infection (osteomyelitis) Extravasation into soft tissue Fat embolism Fracture (growth plate injury) ```

RCPEM (5 decks)

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