trauma/acute care Flashcards
Carnett sign
- patient tenses abdominal wall
- pain worsens = abdominal wall issue
- pain lessens = intra-abdominal process
Murphy’s sign
pain with palpation of the RUQ during inspiration, indicative of cholecystitis
Rovsing’s sign
Pain in RLQ with palpation of LLQ indicative of appendicitis
Psoas Sign
RLQ pain with extension of right leg indicative of appendicitis
Obturator Sign
RLQ pain on internal rotation of right thigh indicative of appendicitis, diverticulitis, or PID
General management of acute abdomen
stabilize, NPO, IVFs, antiemetics, analgesics, surgery consult
Whirl wind or bird beak pattern on Abdominal CT
sigmoid volvulus
Coffee bean or comma sign on abdominal CT
cecal volvulus
what isthe management of stable cecal volvulus without bowel compromise
open detorsion + ileocecal resection
what is the management for unstable cecal volvulus without bowel compromise
open detorsion + cecopexy
What is the management for cecal volvulus with bowel compromise in a stable patient?
resection and anastomosis
What is the management for cecal volvulus with bowel compromise in an unstable patient?
resection with ileostomy
Intussusception presentation
recurring paroxysms of abdominal pain, screaming, knees to chest
currant jelly stool
sausage shaped mass on R side
Intussusception diagnosis
US: bullseye lesion
Barium enema: coiled spring
treatment of intussusception
barium or air enema
what is the treatment of toxic megacolon
Bowel rest, NG suction, abx
+/- corticosteroids
Surgery (colectomy with ileocecal anastomosis)
location that differentiates upper from lower GI bleed
Ligament of Treitz
GCS Eyes
4 - spontaneous
3 - to voice
2 - to pain
1 - none
GCS Verbal
5- oriented
4- confused
3- inappropriate
2- incomprehensible
1- none
GCS Motor
6 - Obeys commands
5 - Purposeful movement to pain
4 - Withdraws from pain
3 - Decorticate
2 - Decerebrate
1 - None
interpretation of GCS score
15: normal
13-14: mild TBI
9-12: moderate TBI
<8: severe TBI, likely coma.
presentation of persistent vegetative state
spontaneous eye opening, sleep-wake cycle, no comprehension/spoken words/purposeful movement
Persistent Vegetative State (PVS)
condition in which a person is alive but unable to communicate or to function independently at even the most basic level
what damage causes persistent vegetative state
intact brainstem & autonomic function
severe bilateral hemispheric damage
Locked-in syndrome (LIS)
Individual is aware and capable of thinking but is paralyzed and cannot communicate
causes of Locked-in syndrome
embolic occlusion of basilar artery, infarction, hemorrhage, demyelination, encephalitis
presentation of locked in state
voluntary eye opening, moves vertical, possible decerebrate posturing
Brain Death presentation
complete unresponsiveness to speech & painful stimuli
abscent brainstem reflexes
no respiratory response
Diagnostic confirmation of brain death
6 hours with flat EEG
12 hours without EEG + serial exams
24 hours for anoxic brain injury without EEG
initial management of altered consciousness
IV access + labs
administer fluids (D50W, thiamine, glucose, naloxone)
empiric ABX
Reflexes to test for brain death
pupillary reaction to light (CNIII)
corneal reflex (CN V)
Dolls eyes/cold caloric (CN III, IV, VI)
gag reflex (CN IX, X)
Response to pain
Respiratory drive
Compound fracture
break in the bone where the bone comes through the skin; open fracture
ORTHO EMERGENCY
Compound fracture management
irrigation/debridement + sterile dressing
NPO, pain meds, IV ABX
surgery
types of compound fractures
- Grade 1: <1 cm wound
- Grade 2: >1 cm wound
- Grade 3: most severe, 3 levels
types of grade III compound fractures
IIIA: wounds with contaminated soft tissue or high energy fractures
IIIB: exposed bone due to soft tissue damange/loss
IIIC: need vascular intervention
types of shock
Hypovolemic
Distributive (MC)
Cardiogenic
Obstructive
cardiogenic shock presentation
- Hypotension (SBP<90)
- Signs of diminished perfusion: low urinary output, confusion, cold extremities
- Doesn’t respond to fluid resuscitation
- Systemic vasoconstriction
- Elevated JVP
- May be evidence of pulmonary edema with respiratory compromise in the setting of left-sided heart failure
MCC of cardiogenic shock
MI
Septic shock (distributive) presentation
Hypotension, mental confusion, pale cool clammy extremities, SOB, decrease urinary output
Neurogenic shock (distributive) presentation
warm, peripherally vasodilated, dry skin, hypotensive, bradycardia
hypovolemic shock presentation
hypotension
anxiety
altered mental state
cool, clammy skin
rapid and thready pulse
thirst
fatigue
tachypnea
oliguria
indications for a platelet transfusion
include a platelet count <10K,
active bleeding with a platelet count <50K or
major planned surgery
indications for fresh frozen plasma
-Replacement of factor deficiencies (use specific factor if able)
-Reversal of warfarin effect (immediate effect)
-Massive blood transfusions
-Liver disease
Indications for cryoprecipitate
- Has Fibrinogen and Factor 8
- Hemophilia, von Willebrand, DIC
