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Emergency Medicine > Quiz #2 > Flashcards

Quiz #2 Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

2 situations that are considered an orthopedic emergency?

A

Open fractures

Neurovascular injury

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2
Q

What requires emergent intervention?

A

vascular compromise

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3
Q

What is required to dx or exclude a fracture?

A

imaging

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4
Q

1 view is ?

A

NO VIEWS

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5
Q

If your suspicious that a sample is not showing up on 1st day of injury what should be done?

A

splint as if fractured and F/U for imaging in 7-10 dys

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6
Q

What things should be known/ done with a high index of suspension?

A 
mechanism of injury
location
point tenderness
pain w/ PROM
"old school" tuning folk
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7
Q

In a extremity fracture what is the first thing that needs to be checked?

A

neurovascular status

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8
Q

What should always be checked and documented in a extremity fracture?

A

distal neurovascular status before and after splint

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9
Q

Once you have splinted what’s next?

A

document and check w/ repeat x-ray in splint

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10
Q

A splint should have what?

A

plenty of padding

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11
Q

What should you document with parents and they should understand?

A

potential growth plate involvement

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12
Q

Salter Harris I

A

A fracture across the physis

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13
Q

Salter Harris II

A

A fracture “A” fracture above the physis

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14
Q

Salter Harris III

A

A fracture below the physis

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15
Q

Salter Harris IV

A

A fracture through the physis

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16
Q

Salter Harris V

A

A compression fracture of the physis

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17
Q

When should a pt follow up after a extremity fracture?

A

2-3 days with orthopedic specialist

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18
Q

D/C instructions for a fracture?

A

Elevate and keep the splint clean, dry, and intact

Monitor the fingers or toes

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19
Q

Which injury can result in long-term disability?

A

Hand injuries and disorders

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20
Q

What are 3 types of hand injuries?

A

burns
tendon or nerve injury
injection injuries

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21
Q

Any type of ??? can lead to functional injuries?

A

hand

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22
Q

What type of hand injuries lead to abnormal digit movement and “Scissoring”

A

fractures

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23
Q

If a hand burn patient is being discharged, whom should they be referred to?

A

burn center or specialist

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24
Q

Always inspect wounds for ???

A

tendon damage

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25
Q

How is tendon damage inspected?

A

by having the pt fully flex and extend digits
Perform full AROM movements
Sensation tests

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26
Q

What are 3 types of injection injuries

A

air, water, others

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27
Q

What does high pressure injection injuries lead to?

A

dissection along planes of least resistence

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28
Q

How do you treat air and water injection injuries?

A

tetanus, abx, immobilization, monitor

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29
Q

How do you treat “other” injection injuries?

A

tetanus, abx, immobilization, monitor PLUS immediate debridement

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30
Q

What are considered high risk injuries?

A

fight bite, cat bites, other punctures

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31
Q

Treatment for hand infections?

A

drain any pus collection
immobilize and elevate in position of function
Start Abx
Admit for observation and ortho follow up

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32
Q

Flexor tenosynovitis

A

closed space infection of flexor tendon sheath

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33
Q

Ortho EMERGENCY!

A

Flexor tenosynovitis

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34
Q

What is the presentation of Flexor tenosynovitis?

A 
fusiform swelling (on both sides)
Finger in slight flexion
Pain w/ passive extension
Pain w/ palpation tendon sheath
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35
Q

Txt for Flexor tenosynovitis?

A

IV Abx w/ elevation

w/ emergent ortho consult

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36
Q

What is the goal of the ED when it comes to back pain?

A

r/o serious patho and improve pain

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37
Q

What are 6 serious back pain problems?

A 
Abdominal aortic aneurysm or dissection
Cauda Equina
Epidural abscess
Discitis
Tumor or mass
Fracture
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38
Q

What are 4 red flags of back pain?

A

Infection
Recent Fractures
Cauda Equina or Central Cord compression
Aortic Dissection/Aneurysm

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39
Q

What PE findings should be documented to rule out red flags?

A 
Temp
skin condition overlying pain
Abdominal exam
Midline spinal tenderness
ROM
Straight leg raise
LE strength, including bilateral great toes and foot plantar/dorsiflexion
LE sensation, including lateral foot, 5th toe, and medial thigh
LE reflexes
\+/- rectal tone
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40
Q

Who gets a emergent MRI in back pain?

A

S/S of central cord compression or cauda equina

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41
Q

Who gets a CBC in back pain?

A

infections

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42
Q

Who gets a X ray for back pain?

A

recent trauma, elderly or any concern for cancer

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43
Q

Who gets a CT for back pain?

A

increased details of fractures

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44
Q

Who gets a out patient MRI?

A

all other pathology w/o high risk for long term disability (herniated discs)

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45
Q

What are 3 types of infections?

A

soft tissue
open fracture
joints

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46
Q

Fast spreading, gas producing infection?

A

necrotizing fascitis

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47
Q

Often requires amputations?

A

Necrotizing faciitis

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48
Q

What should be done in necrotizing fasciitis?

A

mark outlines of cellulitis to follow progression

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49
Q

What should be palpated in necrotizing fascitis?

A

crepitus and severe TTP

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50
Q

What imaging is used for necrotizing fasciitis?

A

Xray or CT- looking for gas

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51
Q

What is a open fracture?

A

an open wound overlying fracture site

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52
Q

What abx are required for a open fracture?

A

1st gen Cephalosporin (Cefazolin)
Aminoglycoside (gentamicin) for large wounds
ADD- gram neg abx for wounds w/ organic matter

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53
Q

What is the txt for open fracture?

A

irrigate superficial debris from wound (NO HIGH PRESSURE)

Schedule for surgery

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54
Q

What are two types of joint infections?

A

spontaneous

associated w/ injury

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55
Q

How to determine if a penetrating injury compromises joint capsule?

A

wound exploration and joint capsule injection w/ sterile saline (or methylene blue)

56
Q

TXT for joint infection?

A

IV Abx and surgery

57
Q

If surgery is used to treat a joint infection what do orthopedics NOT want?

A

abx prior to surgery or arthrocentesis

58
Q

Joint is erythematous, warm to touch, w/ swelling and effusion

A

joint infection

59
Q

Pain w/ all ROM and axial load?

A

joint infection

60
Q

All suspected septic joints MUST have?

A

arthrocentesis

61
Q

What 3 things findings of septic arthritis?

A

purulent appearance
Leukocytosis > 50K
+ Gram stain and culture

62
Q

Injury leading to increased pressure within a fascial compartment compromising the circulation of the tissues within?

A

Compartment Syndrome

63
Q

What should be suspected in crush injuries, fractures, and soft tissue injuries w/ severe pain

A

Compartment syndrome

64
Q

What does compartmental pressure lead to if not corrected?

A

tissue necrosis

65
Q

pain out of proportion, pulsessness, wood like feeling w/ palpation

A

compartment syndrome

66
Q

Dx for compartment syndrome?

A

direct compartment pressure testing

67
Q

TXT for compartment syndrome?

A

Fasciotomy

68
Q

What are 3 skin injuries?

A

Lacerations
Abrasions
Bites

69
Q

What is the first thing that should be done with a laceration?

A

Stop bleeding

70
Q

When is a tetanus booster needed?

A

> 5yrs

71
Q

A laceration should be cleaned well with?

A

antiseptic

72
Q

What are 3 definitive closure options?

A

staples
glue
suture

73
Q

What are 2 temporary closure options?

A

suture

gauze/ occlusive dressing

74
Q

What is the first thing that should be done with a abrasion?

A

Stop the bleeding

75
Q

A huge depth and area should be treated where?

A

burn center

76
Q

What can be used to help with the scaring of a abrasion?

A

Asphalt

77
Q

What is the txt for a abrasion wound?

A

cover w/ antibiotic ointment
place a non-stick bandage over wound
Iodoform for continued debridement

78
Q

What is the txt for severe abrasions of palms and over joints?

A

PT to avoid contractures and maintain ROM

79
Q

What animals do we considered rabies?

A

animal acting aggressive, odd, or feral

animals vaccinations not up to date

80
Q

If an animal can be found.. what happens?

A

animal services sequesters animal and monitors for dx

81
Q

If an animal CAN’T be found.. what happens?

A

Rabies vaccine series

82
Q

What is the rabies vaccine series?

A

1st dose in ED

2nd-4th dose in public health or local clinic

83
Q

What is given in addition to the rabies vaccine series?

A

rabies immune globulin in ED

84
Q

What is the TXT for ALL bites?

A

clean well w/ antiseptic
tetanus booster as needed
closure
antibiotics

85
Q

What areas only get closure?

A

face or scalp

86
Q

Why is the face or scalp only given closures?

A

due to high vascularity and cosmetic reasons

87
Q

What abx is used for most bites (cats, dogs, humans)?

A

Amoxicillin- clavulanate- (Augmentin)

88
Q

A fight bite can lead to ?

A

rapidly spreading tendon sheath infection

89
Q

Means nothing without associated findings, corroborating or focal signs or symptoms

A

fever

90
Q

What are the 5 Ws of fever?

A 
Wind (atelectasis or lung infection)
Water (urinary tract infection)
Wound (wound/skin infection)
Walking (venous embolism)
Wonder Drug (medication induced fever)
91
Q

Wind

A

atelectasis or lung infection

92
Q

Water

A

Urinary tract infections

93
Q

Wound

A

wound/ skin infection

94
Q

Walking

A

venous embolism

95
Q

Wonder drug

A

medicated induced fever

96
Q

What is the 1st question to approaching fever?

A

“Have you checked your temperature or do you fell warm”

97
Q

NOT A FEVER

A

<100.4

98
Q

Who should receive a core temp?

A

All < 3mo patients
<2yr w/ complaint of fever and normal temp by other means
Immune compromised or severely ill

99
Q

What things should be done in a febrile fever pt?

A 
Vitals
IV access
IV hydration
Anti-pyretic or cooling blankets
CBC w/ diff
CMP
Blood cultures
\+/- Wound culture or indwelling device culture
UA w/ urine culture
Lactate
VB and ABG
Appropriate imaging
100
Q

What is considered neutropenia?

A

<500 mm3

101
Q

Fever is a temp over >

A

> 100.4

102
Q

What should never be done in a neutropenic fever?

A

a rectal exam due to potential bacterial seeding

103
Q

What are neutropenic pts at a increased risk for?

A

sepsis and worse outcomes

104
Q

Any fever in a neutropenic pt is suspicious for?

A

infection

105
Q

What is the TXT for neutropenic fever?

A

Abx within 60 min- Cefepime 2g q 8hrs

106
Q

What is the DX for neutropenic fever?

A

blood cultures x2 + culture from indwelling lines (prior to abx)
urine culture

107
Q

Why is Cefepime given in neutropenic fever?

A

bc it covers Pseudomonas

108
Q

What is a fever of unknown origin (FUO)

A

A fever without localizing signs or symptoms

109
Q

What is FUO?

A

fever > 100.9 for 3 weeks w/ no obvious source despite investigation (3 outpatient visits or 3 days in hospital)

110
Q

What are FUO mostly commonly due to?

A

infection, malignancy and vascular disease

111
Q

What is a febrile infant fever?

A

> 100.4 rectal/core temp

112
Q

Oral temps are ?? lower than rectal/core?

A

1 degree

113
Q

Axillary temps are ?? lower than rectal/core?

A

2 degree

114
Q

Tympanic and forehead temps are ?? to core temp?

A

1-2 lower

115
Q

What is the workup for a <28day old?

A 
CBC
CMP
Cath UA and urine culture
Blood culture x1
Chest xray
Lp
Abx
Admit
116
Q

What is the work up for 29days- 2 or 3mo?

A

guidelines based

117
Q

What are the guidelines that can be used for >29days old?

A

Boston
Rochester
Philadelphia
Milwaukee

118
Q

What is the difference between the guidelines?

A

avoid LP and admission

119
Q

What do many clinicians do on all infants < 2months regardless?

A

LP

120
Q

What are the 2 planes of least resistance?

A

neurovascular bundles and fascial planes

121
Q

Pathogen in neutropenic fever?

A

Pseudomonas

122
Q

Which guideline doesn’t require a lumbar puncture?

A

Rochester

123
Q

What is the difference between the febrile 3 mo- 3yr children ?

A

immunizations

124
Q

What is done with a 3mo-3yr child with immunizations and a known source?

A

No w/u needed

125
Q

What is done with a 3mo-3yr child with immunizations and a unknown source?

A

UA and urine culture via catherization

126
Q

What is done with a 3mo-3yr child with incomplete immunizations?

A

full work up

+/- LP

127
Q

What is done with a 3mo-3yr child that ill appearing?

A

full work up

LP regardless

128
Q

What is sepsis?

A

presence of bacteria in the blood w/ clinical/ systemic symptoms

129
Q

What is bacteremia?

A

presence of bacteria in blood stream

130
Q

What is Systemic Inflammatory Response syndrome?

A 
SIRS
Temp > 100.4 or <96.8
HR >90
RR> 20 or <32
WBC >12K
131
Q

What is sepsis?

A

SIRS + Infection

132
Q

What is severe sepsis?

A

Sepsis + End organ damage from hypotension

133
Q

What is Septic Shock?

A

Hypotension and increased Lactate w/ adequate hydration

134
Q

Why doesn’t qSOFA work?

A

its better at quantifying BUT not identifying sepsis

135
Q

What are the 4 types of shock?

A

Hypovolemic Shock
Distributive Shock
Cardiogenic Shock
Obstructive Shock

136
Q

What can shock lead to?

A

death

Emergency Medicine (6 decks)

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