Shelf Flashcards
How could you distinguish pericardial tamponade from tension pneumothorax?
CVP is high in both conditions.
In pericardial tamponade, there is NO respiratory distress.
What is the definition of shock
Systolic BP less than 90.
UOP less than 0.5mL/kg/hr
Fast feeble pulse
Trauma: shock is due to bleeding (most common), pericardial tamponade or tension pneumothorax. If shock is due to bleeding, CVP is low. If shock is due to pericardial tamponade or tension pneumothorax, CVP is high.
Circulatory collapse in flushed, “pink and warm” patient with signs of shock is concerning for
Vasomotor shock - seen in anaphylaxis and high spinal cord transaction.
A linear skull fracture that is closed with no overlying wound is….
Left alone
Rhinnorhea, otorrhea, raccoon eyes, ecchymosis behind ear concerning for
Base of skull fracture
Spinal cord injury
Primary - initial insult
Secondary - occurs in minutes to hours following the insult and involves spinal cord edema that leads to central hemorrhagic necrosis.
Management: ensure secure airway and Hemodynamic stability, next bladder catherization to ensure no acute urine retention.
Rule out vascular injury in clavicle fracture with:
Angiogram - examine subclavian artery
Brachial plexus is also at risk.
Clavicle injuries:
Middle third of clavicle:
Distal third:
Middle third: Brace, rest, ice
Distal third of clavicle: open reduction and internal fixation
Valgus stress test for MCL
Repeat. Only perform arthroscopy if MRI is inconclusive.
If PCWP increases in response to infusion but there is no sig change in BP in the setting of an accident, consider:
Myocardial contusion – meaning compromises LV function. Next step is urgent echocardiogram.
What rules against hypovolemic shock in this case is that hypovolemic shock has low starting PWCP.
Uncomplicated diverticulitis:
Bowel rest, oral antibiotics, observation. Hospitalize if elderly, immunosuppressed or have elevated Leukocytosis.
Complicated diverticulitis:
Drainage percutaneously if collection is greater than 3cm. Less than 3cm, treat with IV antibiotics and observation.
If after 5 days from drainage there is no symptom resolution, surgery for drainage and debridement.
Doppler pressure of ______ is threshold for escharotomy
25-40.
If escharotomy provides no relief, consider fasciotomy.
A patient with focal neurological signs and acute head trauma should get:
Emergency craniotomy
Tracheobronchial separation is treated with;
Surgery
No risk of adenal insufficiency in pt on prednisone of 5mg or less.
Repeat.
Children with blunt trauma to the abdomen who present with Epigastric pain and repetitive vomiting are concerning for…
Management:
Duodenal hematoma
Management: NG suction and parenteral nutrition. Most duodenal hematomas resolve in 1-2 weeks. The hematoma is between the sub mucosal and muscular layers. If conservative management fails, then laparotomy or laparoscopy.
A man over the age of 60 with back pain, hypotension, syncope is concerning for…
Abdominal aortic aneurysm rupture. If a RUPTURED AAA is suspected, he should be taken to the operating room right away.
Needle shaped crystals on urinalysis indicate
Uric acid stones. These stones must be evaluated by CT scan or IV pyelography because they are radiolucent.
Stones less than 0.6cm can pass with IV hydration and analgesia.
Colonoscopy should not be performed in setting of acute pathology because of increased risk of
Bowel perforation
If an esophageal rupture is suspected, management is:
Confirm diagnosis with water-soluble esophagogram. Then attempt primary closure and drainage of mediastinum (mutually left-sided pleural effusion) within 6 hours to avoid mediastinitis.
CXR in esophageal rupture demonstrates pleural effusion, pneumomediastinum, and/or pneumothorax.
Patients with a positive psoas sign concerning for appendiceal abscess (these patients usually have symptoms of appendicitis for over 5 days) should be manages with
IV antibiotics, bowel rest, and (if appropriate) Percutaneous drainage. They should have an INTERVAL appendectomy in 6-8 weeks because complication rate of immediate surgery is high.
Indications for surgical intervention in chest trauma
1500mL of blood loss when chest tube inserted or greater than 600mL over 6 hours.
Dyspnea, tachypnea, chest pain, hypoxemia especially worsened by intravascular volume expansion with patchy, irregular alveolar infiltrates on CXR in the setting of Motor vehicle accident is concerning for
Pulmonary contusion