Tintinellis EMED Ph 2 Flashcards
Cardiogenic Shock MC results from ?
These are more likely to occur from ? type of injury
What causes coronary artery hypoperfusion to occur
LV infarct induced pump failure leading to decreased tissue perfusion despite adequate volume avail in circulation
STEMI- leading cause of death in PTs w/ AMI
Lack of systemic resistance= dec DBP
Why does pulmonary edema occur during cardiogenic shock
Augmenting ? can improve coronary artery perfusion
What is the risk of this augmentation
Inc after load/dysfunction increases LV end diastolic pressure
Vasoconstriction
Dec CO
Why does cardiogenic shock induce systemic vasodilation
Euvolemic cardiogenic shock occurs subacutely in ? Pts
Finding of diaphoresis on these Pts indicates ?
Triggers systemic inflammatory response= inc NO w/ negative inotropic effects
Heart failure
Activation of sympathetic nervous system
Shock is indicated by SBP <90 or a MAP below ?
? type of view on E-FAST is used for suspected tamponades/effusions
Pericardial effusion and aortic root bigger than ? suggest ascending aortic dissection
<65mmHg
Sub-costal 4 chamber view
> 3cm
? is the most important definitive intervention for acute ischemia related cardiogenic shock
Add O2 to keep sats above ?
What issue happens after intubation w/ pos-pressure ventilation and how is this countered
Emergent revascularization via PCI/CABG
> 91%
Dec preload and CO= worsened HOTN;
Fluid bolus
How is HOTN during cardiogenic shock Tx
How is congestion w/out HOTN Tx
What is the nest step if these meds fail to correct the shock
Vasopressor- Dopamine, NorEpi
Inotrope- Dobutamine: inc contractility; if SBP <70: NorEpi
Intra-aortic balloon pump/assist device
Pts taking BBs and suffering from cardiogenic shock may not have appropriate response to dobuatmine, in which case ? med is used
Acute HF management is improved by ? therapies
? new medication is FDA approved for use but does not improve outcomes
Milrinone- selective phosphodiesterase 3 inhibitor
BB ACEI Resynch therapy Spironolactone
Nesiritide
What are the 3 cardinal Sxs of HF
MI induced reduction of CO causes the neurohormonal release of ?
What are the counter-regulatory responses to this activation
SOB Edema Fatigue
NorEpi Endothlin ADH TNF-a: activate RAAS/Symp-NS
Natriuretic peptide- inhibit RAS/sympathetic NS
A: atrial B: ventricle C: endothelium
EF normally is ?
? dysfunction is seen early on in ischemic induced HF cascade
What Sxs have the highest sens/spec for HF
60%; Systolic failure <50%
Diastolic dysfunction leading to CADz
Sensitivity: dyspnea w/ exertion
Specificity: PNDyspnea, Orthopnea, Edema
What PE finding has the highest positive likelihood for acute HF
What CXR findings are the most specific for Dx of Acut HF
? E-FAST finding suggests elevated central venous pressure
S3 sound
Pulm congestion, Megaly, Interstitial edema
IVC >2cm, Collapse <50%
Acute HF Pts need to keep O2 levels above ?
? intervention can help avoid intubation for these Pts
What is the next step for persistent HOTN after Nitro use
95%
Dec after load w/ vasodilators- Nitro then Nitroprusside
Dec volume or RV infarct- give NS bolus
? is the best predictor for recurrence of syncope
Prolonged QTc is defined as ?
Myocarditis can lead to ? and is definitively Dx by ?
Syncope w/in preceding year
> 470msec
Dilated myopathy, Biopsy
? is the MC Sx of Pericarditis
? is a distinguishing feature
? is the MC and most important PE finding
Chest pain worse w/ supine, relieved w/ sitting
Pain referred to L trap
Friction rub w/ diaphragm at LLSB
What rare CXR finding may aid w/ Dx pericarditis
? is the image modality of choice for detection and confirmation
How do Pts die from PE
Epicardial fat pad sign
Echo
PEA/Asystole or RV failure and circulatory shock
? joint are most and least likely to be the origin of PEs
? combo causes the greatest risk for VTEs
? surgical procedures have the highest rates of VTE formation
Least: Elbow Shoulder Ankle Knee Hip- most
Same sided hip-knee immobile w/ non-weight bearing
Abdominal to remove cancer
Joint replacement
Brain/spine w/ neuro deficits
When are cancer Pts at highest risk for developing VTEs
? are the two MC Sxs of PE
What are the two rare CXR findings of PE
During chemo Tx
Dyspnea, Chest pain
Westermark- lobar artery obstruction
Hampton- pulmonary infarction
Leg size difference of ? suggests PE
Where are these measurements taken
PE R/o Criteria
≥2cm
10cm below tibial tubercle
HAD CLOTS:
Hormones Age >50 +DVT/PE Hx
Coughing blood Leg swollen O2 <95 Tachy >100 Surgery/Trauma <4wks
Well’s Score for DVT
EAT CHIPS: Edema/Pain/DVT Sx- 3 Alternative Dx unlikely- 3 Tachy- 1.5 Ca- 1 Hemoptysis- 1 Immobile >3 days: 1.5 Previous DVT/PE: 1.5 Surgery <1mon: 1.5
MC imaging modality for PE
Criteria for Pre-E
What are the 4 etiologies of catecholamine induced HTN emergencies
CT angiography w/ contrast
≥140/≥90 after 20wks
Clonidine d/c or withdrawl
Autonomic dysfunction
Pheo
Sympathetic drug use- cocaine, meth, PCP
How quickly is BP lowered during HTN Emergency
What is the therapeutic goal for aortic dissections
? is the mainstay of Tx
Dec SBP x 25% in first hour
<160/100 over 2-6hrs
To normal <48hrs
SBP 100-20 w/ HR ≤60bpm w/in first hour
Nitrates
How are HTN Emergencies induced by cocaine/meth Tx
What is used if Pts don’t respond to this Tx
What is used as 3rd line agents
IV Benzos, avoid BBs (except labetalol- +A-blocker effect)
Nitro or Phentolamine
CCBs
First line Tx for Pheo induced HTN Emergency
? medication is used pre-op
Aortic dissections occur d/t damage to ?
Phentolamine
Phenoxybenzamine
Intima- blood enters between intima and adventitia
How are aortic dissections Dx
If properly trained, ? is equally sensitive and specific
Criteria for P-HTN
CT w/ and w/out contrast
TEE
Aterial pressure >25mm at rest, >30 w/ exertion
Definitive method to Dx P-HTN
Why does P-THN lead to RV failure
? is the MC EKG finding
R-sided catheter
RCA perfusion depends on diastolic, RA pressure during systole and diastole. Dz dec systolic perfusion, CO
RAD
? is the best initial test to assess P-HTN
What Tx step is avoided if possible in this population
Size criteria for AAA and repair is needed ?
TTE
RV failure exacerbated w/ intubation (pos-press ventilation)
≥3cm w/ repair indicated at ≥5cm
? part of the GI tract is involved in aortoenteric fistula development
? images are used to Dx AAA
Define Trepopnea
Duodenum
Unstable: bedside US
Stable: CT w/ contrast
Dyspnea when laying on side w/ more diseased lung
What does negative inspiratory force assess
What is this used to Dx
Define Hypoxia and Hypoxemia
Diaphragm/Inspiration muscle strength
Neuromuscular dz
Insufficient O2 content/delivery to tissues
Low arterial oxygen tension
Only medication FDA approved to Tx hiccups
Define Pneumonia
Organisms can distribute through the lungs by spreading through the pores called ?
Chlorpromazine
Infection of alveolar portion of lungs
Pores of Kohn
MC microbe identified in CAP
What are the two MCC of infections of nursing homes
How is Aspiration pneumonia Tx
How is CAP Tx
Pseudomonas
UTIs > Aspiration pneumonia
Clinda, Amp-Sulbactam, Moxifloxacin
Clinda, Azith, Doxy
MC PE finding during pneumothorax
? is the initial image ordered
What are two normal findings on US
Tachypnea
Standing PA CXR
Comet tail, Sliding sign
When can pneumothorax be observed for Tx
These Pts are observed for a minimum of ? long
When are f/u exams needed after d/c
First time and stable w/ <20% of lung volume affected
4hrs
1-2wks
Needle decompressing pneumothorax need ? size
What are the two locations decompression is performed
What size chest tube are used
14g, 2”/5cm long
2nd ICS above rib at mid-clavicular line
4th ICS above rib at anterior axillary line
Non-traumatic: 10-14F
14-22F: larger w/ need for mechanical vent
? is the MC chronic dz of childhood w/ ? MC acute stimulus of attacks
What are three PE findings suggesting a severe case is present
Asthma; Viral respiratory infections
Accessory muscle use
Inability to speak in full sentence
Pulsus paraduoxus
? is the preferred initial therapy for asthma bronchospasms
? maintenance therapy meds are used
What is given to Pts upon d/c after attack/exacerbation
Albuterol (B2-agonist): promote broncho/vaso-dilation
LABAs: Salmeterol, Formoterol
5-10 day non-tapered course of Pred or,
2 day course of Dexamethasone or,
Non-compliant Pt: Methylprednisolone x 1 dose
? medication can be added to Albuterol in the ED during asthma exacerbations to reduce severity and admission
Pts are safe to d/c home w/ ? FEVR measurement
Criteria for COPD O2 therapy
Ipratropium bromide
FEVR >70%
PaO2 ≥55, SaO2 ≤88%
Define Visceral pain
Define Parietal pain
Define Referred pain
Crampy/dull pain d/t unmyelinated fiber stretching/inflammation
Irritated mylinated fibers covering anterior peritoneum causing tender/guard/rebound= immobile Pt
Ipsilateral pain d/t embryological development
Why does appendicitis pain begin in umbilical region
How much blood loss is needed for systolic changes
to be seen
PE sine a quon for peritonitis
Bilateral, T-10 innervation causing sensation at midline
30-40%
Rebound tenderness
? type of image to Dx appendicitis, kidney/ureter stones
? type of image to Dx aortic aneurysms and mesenteric ischemia
? is the MCC of N/V in USA
Non-contrast CT
IV contrast CT
VGE
Where is the vomit center in the brain
? type of image used for suspected intestinal obstruction
? medication can help w/ frequency of BMs in adults w/ chronic constipation
4th ventricle- chemo receptors outside of BBB
CT w/ IV/PO contrast
Psyllium (bulking agent)
Define Ogilvie Syndrome
What causes this syndrome to develop
MCC of upper GI bleeds
Colonic pseudo-obstruction w/ S/Sxs and image findings of large bowel obstruction but no evidence of distal obstruction
Dysregulated autonomic control of colonic motor activity
PUDz
BUN elevation above ? suggests bleeding source from upper GI
? study is c/i in these Pts
? is the most reliable method to Dx this issue in ED
≥30
Barium contrast studies
Visual inspection of aspirate for blood/maroon/coffee ground appearance (endoscopy- study of choice)
When Tx upper GI bleeds in Pts taking anti-coagulant therapy, ? are the indications to reverse their therapy
Why are PPIs used during Tx
? other medication can be used to help reduce bleeding
INR ≥1.5= predictor;
Reverse elevated INR or platelets <50K
Platelet aggregation needs pH >6.o for clot formation
Octreotide
What Pts w/ upper GI bleeds need ABX
What ABX are used for Tx
What two meds are promotility agents used to enhave endoscopic visualization in these Pts
Cirrhosis- impaired immune system
Cipro, Ceftriaxone
Erythromycin, Metoclopramide
What two meds are used for scoping upper GI bleeds in the ED
MCC of lower GI bleeds
MCC of intestinal ischemia
Etomidate/Ketamine- cardiovascular stable meds
Upper GI bleeds are the MC source but, Diverticular dz (MC on L-side, but R-sided bleed more)
Ischemic colitis Dx w/ angiography
? is the Dx test of choice for Ischemic Colitis/Mesenteric Ischemia
? is the MC source of anorectal bleeds
Define Vascular Ectasia
CT Angiography or Scintigraphy
Hemorrhoids
Causes lower GI bleeds d/t AV malformations and dysplasia of colon
Meckels Diverticulum are MC found in ? area
What are the 3 locations the esophagus constricts in adults
Define Barretts Esophagus
Embryonic tissue in terminal ileum
C6- cricopharyngeal
T4- aortic arch
T10-11- GE junction
Gastric epithelium extends into distal esophagus w/ risk for dysplasia
MCC of esophageal perforations
MC site of Boerhaave Syndrome
What image is used for Dx
Iatrogenic
Full thickness perf on L-side of distal esophagus
CT w/ IV contrast
Ingested foreign bodies can be Dx w/ ? images
? can be administered to help relax LES and pass objects in distal esophagus
? is the MC food impaction and ? is c/i for Tx
CXR then CT
Glucagon
Meats, Proteolytic enzymes d/t risk for mucosal damage and perf
How are battery ingestions Tx
What are the lab results Dx for pancreatitis
? enzyme becomes activated and causes the pain of pancreatitis
Lithium- bad prognosis
Through esophagus- 24 f/u scans/ensure passage
Amylase x 3, Lipase x 2
Trypsinogen into Trypsin
? lab result indicates pancreatitis d/t gallstone etiology
? is the image modality to Dx pancreatitis
When are Pts w/ pancreatitis admitted
Alanine aminotransferase >150
CT w/ IV contrast
First time Dx, Biliary etiology, IV pain med/NPO
Chronic pancreatitis is MC d/t ?
What stimulates gallbladder to contract
? types of stones are radiolucent vs paque
Alcoholism
Cholecystokinin
Black/Brown pigmented: -paque
Jaundice from compression of CBD from regional inflammation is called ? syndrome
? is the MC non-OB emergency in pregnancy
Appendicitis w/ nausea will present ?
Mirizzi’s Syndrome
Appendicitis- RUQ tenderness but RLQ still MC location for tenderness
Nausea after pain onset
Scoring System for Appendicitis
? is the next step in Tx for straightforward cases of suspected appendicitis in adults
What US finding aids w/ Dx
Alvarado: MANTRELS
Migration Anorexia Nausea Tenderness Rebound Eleveted temp Leukocytosis Shift, WBC (T, L- 2pts; Toal- 10)
Early surgical consult
Appendix >6mm in diameter
Where do diverticula form in the intestines
What are the MC microbes isolated from diverticulitis
What are the RFs for perforations
Vasa recta- site of vasculature penetration of circular muscle layer
Bacteroides fragilis, E Coli
Steroid Opioid NSAID
What UA result may be seen during diverticulitis flares
What imaging modality is used for Dx
Define Un/Complicated cases
Sterile pyuria d/t bladder inflammation
CT w/ IV contrast
Un: inflammation isolated to bowel wall
Comp: Fistula Obstruction Perf Abscess Stricture
How are cases of uncomplicated diverticulitis Tx
Complicated diverticulitis is classified per ?
MCC of acute mesenteric ischemia
1st: Metro + TMP/Levo/Cipro/Cefuroxime
Alt: Augmentin or Moxifloxacin
Hinchey:
1: small 2: large abscess 3: perf 4: perf w/ fecal contamination
Arterial embolism
What 3 structures supply blood to the mesentery
Celiac: liver, spleen, prox duodenum
SMA: pancreatic head, distal duodenum, small bowel (MC, usually d/t Afib)
IMA: transverse colon through rectum
Image modality of choice to Dx mesenteric ischemia
2 MCC of Small Bowel Obstructions
? type of bowel obstruction has dec/absent bowel sounds
CT w/ IV contrast
1st: adhesion 2nd: incarcerated hernia
Adynamic ileus
What is the image of choice for suspected bowel obstructions
What is the image appearance of sigmoid volvulus
Name of anal mucosal columns
CT w/ IV contrast
Coffee bean shaped large bowel dilation
Morgagni
Parasympathetic control of rectal wall comes from ?
Sympathetic control of rectal wall comes from ?
? is the MC and LC location of rectal abscesses
S2-4
L1-3
MC: perianal LC: Supralevator/pelvirectal
? is the only type of rectal abscess that can be Tx in the ED
MCC of intrinsic AKIs
AKIs usually remain ASx until ? develops
Simple/Isolated and fluctuant perianal
ischemic tubular necrosis
Severe uremia: N/V/AMS, Coma
What are 3 common Sxs seen w/ AIN
MOA of ACEI
Normal GFR is ?
Fever Arthralgia Rash
Efferent dilation
> 90 mL/min
Rhabdomyolysis muscle damage is d/t increased amounts of ?
What causes mental status changes to occur
? is the most reliable Dx method
Disrupted NaKATP pump and Ca transport- inc intracellular Ca and necrosis
Urea induced encephalopathy
Inc serum CrK levels 5x above normal
Only two time ASx bacteriuria is Tx
Define Uncomplicated UTI
Catheter induced UTI is Dx w/in ? hrs
Pregnancy, Prior to invasive urinary procedures
Normal anatomy/function
No comorbidities
No GU instrumentation
<48hrs from cath
What are 3 etiologies of UTIs that don’t react on nitrite dipstick
How are UTIs Tx
First line choice for Tx of uncomplicated UTIs
Pseudomonas Enterococcus Acinetobacter
Fosfomycin TMP-SMX, Nitro
Fosfomycin 3g x 1 dose
First line Tx for ASx Bacteriuria and Simple Cystitis during pregnancy is ?
What is the MCC of hematuria
Pt w/ recent Urologic Surgery and now has urinary retention, ? is the next step
Amoxicillin or Cephalexin
UTIs
Uro consult prior to cath placement
? two elements aid w/ prevention of urologic stone formation
What types of stones are commonly seen in females w/ recurrent UTI infections
These stone are the MCC of ?
Mg, Citrate
Struvite- Mg Ammonium Phosphate
Staghorn calculi- forming casts in renal pelvis
What causes the pain associated w/ urologic stones
Nephrolithiasis is the MC mis-dx given to ? Dx
? is the Dx imaging of choice
Pressure against Gerota’s fascia= flank pain
AAA rupture/expansion
Non-contrast CT
? is the MC used drug for urological stone expulsion
Stones larger than ? size need Uro consult
Testicular torsions occur d/t abnormal fixation within ? structure
Tamsulosin
> 5mm
Tunica vaginalis- bell clapper deformity
Most sensitive finding to r/o suspected testicular torsions
What direction are detorsion maneuvers performed
? etiology of epididymal infection is considered in men who practice insertive anal intercourse
Present cremaster reflex
Medial to lateral x 1.5 rotations
Coliform
? is the leading cause of maternal death in the first trimester
MC location of ectopic implantation
Abdominal ectopic pregnancies MC occur d/t ?
Ruptured ectopic pregnancy d/t exsanguination after rupture
Ampulla
Early rupture/abortion of tubal pregnancy
Only MedHx that totally excludes ectopic pregnancy
How are ectopic pregnancies monitored in stable Pts
MC medical Tx for ectopic pregnancy
Hysterectomy w/ oophrectomy
b-HCG trends q2 days
Methotrexate- folic acid antagonist= dec D/RNA synthesis
Stable Pts w/ b-HCG levels above discriminatory zone and empty uterus on US are given ? Dx and ? next step
MCC of death d/t PIDz
What can cause chronic PID infections
Ectopic pregnancy- OB consult in ED
Tubo-Ovarian abscess
M tuberculosis
? microbe causes PID in Pts w/ IUDs in place
Untreated chlamydia can lead to the development of ?
Gold standard for Dx of PIDz
Actinomyces
Perihepatitis: Fitz Hugh Curtis syndrome w/ peritonitis
Laparoscopy
How is PIDz Tx OutPt
How is PID Tx if IUD is in place
How are tubo-ovarian abscesses Tx
Ceftriax 1g IM w/ Doxy and Metronidazole x 14d
Placement <21d- OB consult
> 9cm- surgical consult
Doxy w/ Clinda or Metronidazole x 14d but f/u in 72hrs to ensure response to Tx
? is the MCC of soft tissue infections
MC valves affected by endocarditis in order
MC microbe to cause endocarditis
Community acquired MRSA
Mitral Aortic Tricuspid Pulmonic
Staph > Strep
? is the MC neuro complication to arise from endocarditis
Coronary artery emboli during endocarditis MC arise from ? location
How is this condition Dx
Embolic stroke in middle cerebral artery
Aortic valve
TTE then TEE
How is bacterial endocarditis Tx
What Pts need prophylaxis
What meds are used for prophylaxis
Ceftriax or Naf/Oxa-cillin or Cefepine + Vanc
Prosthetic material/valve
Cyanotic lesion
Previous Dx
MRSA: Vanc and Clinda
Amox/Amp-cillin, Cefazolin/Ceftriaxone
PCN Allergy: Cephalexin Clinda Az/Clar-ithromycin
What are the two MC Sxs of bacterial meningitis
What are two lab results that indicate LP c/I
Once bacterial meningitis is considered, what s the next step
HA > Fever
Platelets <20K, INR >1.5
Empiric ABX- Cefotax/Ceftriax + Vanc w/ Dexamethasone to reduce CSF inflammation
When are CTs not needed prior to LP
Bacterial meningitis will have ? predominance in CSF results
What results are seen w/ viral meningitis
Healthy MedHx, Normal neuro exam
1-2K w/ neutrophilic predominance
Normal opening pressure, Neg Gram stain, normal glucose
What is the risk of HSV-2 induce viral meningitis
How are PTs Tx
TIAs are viewed and Tx similar to ? CV Dx
Necrotizing encephalitis
Admit w/ IV Acyclovir
Unstable Angina
What is done for medical Tx of TIAs
Carotid revascularization via endarterectomy is best done in ? time frame
? is the standard assessment for delirium
Dipyridamole w/ ASA- prevents future events
<2wks from TIA
MMSE
? is the MCC of vertigo
This form of vertigo tends to last ? long
? is the 2nd MCC of vertigo
BPPV
<2min
Vestibular neuritis- viral infection of vestibular nerve w/ vertigo x days but no pain, HL, or tinnitus
Labyrinthitis is a complication from ?
What do Pts present w/
How are these peripheral vertigos Tx
AOM
Pain HL Tinnitus Vertigo
Mainstay: antiemetic, vestibular suppression-
Scopolamine then CCB (Cin/Flu-narizine Nimodipine)
Promethazine/Metoclopramide- Tx N/V
Odansetron- anti-nausea
Betahistine- inc cochlear blood flow, dec peripheral vestibular input
How is vertigo d/t MS Tx
Define Ataxia and Gait D/o
Define Apraxic Gait
Gabapentin
Ataxia: uncoordinated movement
Gait d/o: abnormal pattern/style of walking
Pt has lost ability to initiate walking process
Define Status Epilepticus
Define Refractory Status Epilepticus
What meds are approved for monotherapy in adults after their first seizure
Seizure activity >5min or two seizures w/out return to baseline
Persistent seizure activity despite two antiepileptics
Valproate Topiramate Oxcarbazepine Lamotrigine Levetiracetam
? is the MCC of provoked seizures in the developing world
How are seizures during pregnancy Tx
Why does status epilepticus become an emergency after 5min
Taenia solium induced neurocysticercosis
IV Mg sulfate
BBB compromised and invaded by K, Albumin.
Diminished seizure threshold
What is the initial medical Tx of choice for status epilepticus
What medication can be used for Trench Foot Tx
What medication can be used for Chilblain/Pernio Tx
IV Lorazepam
Limaprost
Nifedipine, Pentoxyfilline, Triamcinolone cream
? medication may be started for Tx of Cold Induced Urticaria
What are the 3 zones of injury during frost bite
Frostbite is Tx by submerging in warm water at ? temp and blisters are managed by ?
Loratadine
Coagulation: most severe, usually distal
Hyperemia: most superficial, usually proximal, least damage
Stasis: middle ground
98-102*F, Aloe cream q6hrs
How is vasculature assessed in Pts w/ frostbite
Heat stress Tx
What are the two cardinal features of heat stroke, and how is this heat injury Tx
Doppler US then Tech-99 scintigraphy
Fluid/E+ replacement and rest
Temp >104 and AMS; Cool until temp of 102.2 w/ cooling method to tolerance; Most rapid: CardioPulm bypass
Shivering during the Tx of Heat Stroke are managed by ?
What is the sequence of Tx for DKA
What are the goals of Tx
Benzos, Phenothiazines
Fluid, K, Insulin
Glucose <200, BiCarb ≥18, pH >7.3
How quickly are fluids given during Tx of DKA
When is the fluid use changed per glucose levels
How does pH correlate to HypoK levels
First 2L: 0-2hrs
Next 2L: 2-6hrs
Additional 2L over 6-12hrs
Glucose <250- change to 5% dextrose in 1/2NS
0.1 dec in pH= K rises 0.5mEq
Do not give insulin for DKA Tx until K is over ?
? type of insulin is used
Only give BiCarb during Tx if below ?
≥3.5
Regular
≤6.8
DKA is more likely to occur in ? while HHS is more common in ?
Glucose criteria to Dx HHS
Define Endophthalmitis
DKA: Type 1, HHS: Type 2
Glucose >600
Infection of eye globe
How is Pre-Septal cellulitis Dx and Tx
Post-Septal cellulitis is MC d/t ?
Stye is infection d/t ? located ?
CT w/ contrast; Augmentin
Ethmoid sinusitis
Staph infected follicle/Zeis or Moll gland
Define Chalazion
Blepharitis is d/t over growth of ? microbe
Define Keratoconjunctivitis
Inflammation d/t blocked meibomian gland
Strep epidermis
Corneal involvement of conjunctivitis w/ corneal involvement of punctate ulcerations
Epidemic= viral
How is Bacterial Conjunctivitis Tx
Contact wearers need coverage for Pseudomonas which is done w/ ?
? is avoided when Tx Herpes Simplex Keratoconjunctivitis and ? can be used to prevent secondary infection
TMP-Polymyxin B, Neomycin
-floxacin, -mycin
Steroids, Erythromycin
Herpes Zosther Opthalmicus involves ? nerve and indicates ? emergency
How are corneal ulcers Tx
? is used if fungal etiology is suspected
Huthcingson Sign: V1 of Trigeminal, ocular involvement
Cipro/Oflox-acin
Natamycin, Amphotericin, Fluconazole
? test is performed for eye trauma to exclude globe perforations
How are conjunctival abrasions Tx
? PE finding makes a ruptured globe Dx certain
Seidel test- will be pos w/ corneal lacerations
Erythromycin 0.5%
Flat anterior chamber
If a flat anterior chamber is observed on PE, ? are the next steps
Hyphemas develop from bleeding from ? structure
Spontaneous hyphemas are associated w/ ? MedHx
Stop exam, place metal shield on injured eye, consult Ophtho
Iris root vessel
Sickle Cell
Blow out Fxs frequently occur at ? two locations
Suspected Fxs need to avoid ? maneuver
Because of the location of sinus wall Fx, ? ABX is used
Inferior wall (maxillary sinus) and medial wall (ethmoid sinus)
Sneezing/Blowing nose- subcutaneous emphysema
Cephalexin
Suspect globe ruptures w/ ? PE findings
What are the next steps once suspicion is present
What ABX are used
Eyelid puncture/laceration injuries
Cover eye w/ metal shield, Consult immediatley
Vanc + Cefriax
If able, avoid ? RSI medication in Pts w/ suspected globe ruptures
Rocuronium
