TRAUMA/SURG/er Flashcards
Blunt abdominal trauma and tachycardia + shoulder pain + history of mononucleosis
most likely abdominal injury?
splenic laceration
shoulder pain is due to phrenic nerve irritation
cyanide has what odor?
almond odor
for surgery being a male over ____yo is considered a risk factor
45
if a male if <35 and has no hx of cardiac dz, what is the only presurg test needed
ekg
cullen sign?
bruising around the umbilicus
hemorrhagic pancreatitis or ruptured AAA
grey turner sign?
flank bruising
retroperitoneal hemorrhage
best test to look for air under diaphragm?
upright cxr
electrical alternans on ekg?
pericardial tamponade
blackout on cxr (loss of vascular markings)
pneumothorax
severe abdominal pain but no rebound tenderness or guarding??
acute mesenteric ischemia
get angiography!
where are the two places bowel ischemia typically occurs?
watershed areas = hepatic and splenic flexures
number one risk factor for mesenteric ischemia (acute occlusion of mesenteric arteries)
atrial fibrillation
hamman sign
crunching due to subcutaneous emphysema from esophageal perforation
how to dx esophageal perforation (mallory weiss or boerhoeves)
gastrograffin esophogram
dont use barium because it is caustic to the tissues
do not do what two tests in acute divertiulitis?
colonoscopy and barium enema (increased risk of perforation)
3 signs of appendicitis
rovsing
psoas (hip extension)
obturator (int rotation)
most accurate test for cholecystitis
HIDA scan (but we do U/S to dx typicallY)
small bowel obstruction
usually hypo or hyperactive bowel sounds?
hyperactive!
high pitched tinkling sound indicates high pressure
mechanism, sx, dx, and tx for the following: 1 anterior shoulder dislocation 2 posterior shoulder dislocation 3 clavicular fx 4 scaphoid fx
1 - strain on the glenohumoral joint, arm held to side externally rotated, xray then MRI (must rule out axillary artery and nerve injury), shoulder relocation and immobilization
2 - seizure or electrical burn, arm is medially rotated at side, xray then mri, traction and surgery is pulses or senses are diminished
3 - trauma, pain over location, xray is best test (must rule out subclavian artery/brachial plexus injury), simple arm sling
4 - FOOSH, pain at anatomical snuffbox, xray wont show for 3 weeks so clinical suspicion!, thumb spica cast
tx for trigger finger?
steroid injection
if steroids fail, surgery to cut the sheath of the tendon
fracture of long bones can often lead to what complication?
fat embolism ( confusion + petechial rash and dyspnea)
walking pain that worsens with walking but improves when he sits down or leans forward
spinal stenosis! (pseudoclaudication)
get an MRI –> tx with NSAIDs or surgery
best tx for torn ACL
arthroscopic repair followed by rehab
mechanism, sx, dx, and tx for the following: 1 MCL and LCL injury 2 ACL injury 3 PCL injury 4 meniscal injury
1 - trauma to the opposite side, pain, MRI, surgical repair
2 - direct trauma to knee, pain and +anterior drawer, MRI, arthroscopic repair
3 - direct trauma to knee, pain and + posterior drawer, MRI, arthroscopic repair
4 - knee injury, popping sound on flexion or extension, , MRI, arthroscopic repair
unhappy triad of sports trauma
ACL
MCL
and either Lateral or medial meniscus
management of AAA
3-4 cm US every 2-3 years
4-5.4 cm US or CT every 6-12 months
>5.5 cm, asx = surgery
surgery is indicated at 5 cm
aortic dissection
false lumen in the intima of the aorta
sudden onset tearing chest pain radiating to back + asymmetric arm blood pressures
dx is done with TEE if unstable (fastest) or MRA (best) if patient is stable
tx ascending with surgery and BP control
tx for descending is BP control (BB)
post op fevers POD 1-2 POD 3-5 POD 5-7 POD 7 POD 8-15
1-2 wind (atelectasis or pna) 3-5 water (uti) 5-7 walking (dvt/pe) 7 wound (wound ifx or cellulitis) 8-15 weird (drug fever or deep abscess)
mc finding for PE on ekg
nonspecfic ST changes
s1-q3-t3 is NOT the most common change seen
tx for PE
heparin to coumadin bridge
if PE while on coumadin therapy, place an IVC
old woman s/p total hip replacement 3 days ago now has 30 min of SOB and chest pain…..what do you do?
order EKG and spiral ct scan
if patient had an allergy to contrast, get a VQ scan instead of spiral ct
noncon ct for…
contrast ct for…
noncon for trauma and bleeding
contrast for infection and cancer/mass lesions
can youuse metforman with contrast study?
no, stop med proior to scan
Charcoal is good for
Any ingestion
Can’t hurt and Is better than lavage
What is the treatment for acetaminophen overdose that was more than 24 hours ago
No therapy needed
What is next step if clearly toxic amount of acetaminophen was ingested(more than 8-10 g)?
N -acetylcysteine
What symptoms do you see with aspirin overdose and what is the treatment
Tinnitus and hyperventilation leading to respiratory alkalosis and metabolic acidosis from lactate
Treatment is alkalinizing the urine which increases the rate of aspirin excretion
Treatment of TCA overdose
Sodium bicarbonate is cardioprotective but does not increase TCA excretion
What Will blood gas show for carbon monoxide poisoning?
Normal pO2 because oxygen does not detach from hgb
Lactic aciddosis develops
What is the best diagnostic test for carbon monoxide poisoning
Routine oximetry will be falsely normal so the best and accurate test is carboxyhemoglobin level
How do you differentiate carbon monoxide and methemoglobinenia on exam
Blood is red with carbon monoxide and brown with methemoglobinemia
Treatment for methemoglobinemia
Methylene blue
Treatment for carbon monoxide poisoning
Hyperbaric oxygen for severe disease or just 100% oxygen
Cyanosis plus normal PO2 =
Methemoglobinemia
Treatment for organophosphate poisoning or or nerve gas
Atropine
What EKG abnormality will digoxin overdose show
Downsloping st segments
And
Hyperkalemia
Treatment for digoxin overdose
Digoxin specific antibodies
Treatment for lead poisoning
Chelating agent’s to remove the blood from the body like succimer or EDTA or dimercaprol
Everyone with Mobitz two 2nd° AV block which is dropped Beats without progressive lengthening of PR interval
Gets what…
They get a pacemaker even if they are asymptomatic
Next step if a patient is bradycardic and asymptomatic
Get an EKG… No atropine is needed if it is just an asymptomatic sinus bradycardia
Treatment for Wolf Parkinson White syndrome
If acutely in an arrhythmia give procainamide or amiodarone
Curative therapy is radiofrequency ablation
When is adenosine used?
For supraventricular tachycardia
Treatment for atrial fibrillation and flutter
Control the rate with beta blocker or calcium channel blocker(dilt or verapamil) or digoxin
Then once rate is controlled give warfarin or ruvaroxaban to anticoagulate
Hemodynamically unstable atrial arrhythmias are managed with…
Synchronized cardioversion
Differences between methanol and Ethylene glycol poisoning
Both are treated with fomepizole and dialysis
Methanol presence with Eye toxicity and retinal inflammation and as the lingo I call presents with renal toxicity and envelope shaped crystals made of oxalate
Treatment of dog cat and human bites
Give amoxicillin clavulanate
And tetanus vaccination booster if more than five years the last one
When do you give rabies vaccine after bite?
Only if the animal has altered mental status or bizarre behavior or the attack was unprovoked by a stray dog that cannot be observed
First step for head trauma resulting in loss of consciousness
Head CT without contrast to detect blood
Treatment of subdural an epidural hematoma
Small ones are left alone… Large ones are treated with intubation and hyperventilation plus mannitol plus drainage
Crescent versus biconvex/lens hematoma
Crescent is a sub dural and lens is an epidural
After a successful surgery for epidural hematoma what will most likely benefit the patient
Ppi is given to prevent stress ulcers… Head trauma is a clear indication for stress ulcer prophylaxis
Fluid replacement formula
Four x percent body surface area burned x weight in kilograms
Half is given in the first eight hours and then the other half is split up in the next 16 hours
What is the most common cause of death several days to weeks after a burn
Infection due to loss of skin
Tx for asystole
Epinephrine
If defibrillation is not working for ventricular fibrillation after two attempts what is the next step
Give epinephrine plus shock and then try amiodarone
