Trigger - LE and male genitalia Flashcards
How do you prep an abscess
Clean overlying skin w povidone and drape in steril fashion.
what are the high risk features for endocarditis? how would this change your plan of care if you were treating a patient for an abscess?
- prosthetic heart valves or prosthetic material
- hx of previous endocarditis
- unrepaired cyanotic CHD
- repaired CHD w prosthetic material
- repaired CHD w residual defects
- Cardiac transplant recipients w valve regurg
give IV clinda or vanc 30-60 min prior to I&D
where do you measure for extremity swelling related to a DVT?
10cm below the tibial tubercle
A large proximal DVT that is white/pale
phlegmasia Alba dolens
A large proximal DVT that is dusky blue
Phlegmasia cerulea dolens
what are the risks for MRSA
- recent hospitalization, surgery, or hemodialysis
- HIV infection, drug use, or prior ABX
- incarceration, military
- sharing sports equiptment, needles or razors.
When do you use POCUS with a cutaneous abscess
to differentiate a edep abscess from cellulitis
For I&D of a drainage you should…
1. use a no. () or () scalpel blade
2. incise over the area of ()
3. incise deep enough to ()
4. express pus w ()
5. insert () into the abscess to ()
6. +/- irrigation of wound w saline
For LARGE abscesses what is the management
Send for drainage in the OR
which areas are considered areas of cosmetic concern and should be sent for management by a specialist
- palms
- soles
- nasolabial folds
How do you treat a mild, moderate and severe abscess
just say all of em, i know you can
- mild - I&D alone! no abx
- Moderate/severe - bactrim, clinda, doxy
- Severe + immunocomp or sepsis - IV (Vanc/linezolid/clinda) + (piptaz or meropenem)
only add pip/taz or meropenem if signs of sepsis
What do the Wells test scores for DVT
0 or less = D dimer
1-2 = high sensitivity d dimer
3+ = US
what is D dimer
Plasma D-dimer is a product of cloth breakdown, released upon degradation of polymerized crosslinked fibrin. Elevated plasma dimer levels indicate that coagulation has been activated, fiber clot has formed, and clot degradation by plasma has occurred.
What are the DOACs
- dabigatran (pradaxa)
- rivaroxaban (Xarelto)
- Apixaban (Eliquis
- Edoxaban (Lixiana, Savaysa)
Which DVT types require a surgery consult
- Proximal DVT without limb ischemia w high bleeding risk
- proximal DVT w ischemia
When do you use Serial proximal compressive US Qweekly for 2-4 weeks in a DVT
a DVT with distal vein involvement only that has a moderate/low risk of bleeding and is asymptomatic
what are the 4 criteria for amission w a DVT
- proximal DVT
- Concurrent symptomatic PE
- High bleeding risk
- comorbid conditions requiring hospitalization
What are the 6 P’s for?
Acute arterial occlusion
Which arteries correlate with which parts of the leg for arterial limb ischemia
what ABI is suggestive of severe disease
<0.4
chart for rutherford classification of ischemia
immediate consultation with vascular surgery about revascularization prior to additional diagnostic imaging is the management for which rutherford stage
IIb
How do you tx acute limb ischemia
UFH
Does pyuria on a UA rule out testicular torsion
no
pain localized to the upper pole of the testis
testicular appendage torsion
Mumps is the MC viral cause of
orchitis
- men who are <35 and DONT practice anal intercourse - MC etiology is ()
- Men >35 or those who do practice anal intercourse - MC etiology is ()
epididymitis!!!!
- gonorrhea and chlamydia
- urinary pathogens like E. coli and Klebsiella
testes in this disease hangs LOWER than normal in the scrotum
epididymitis
How do you treat epididymitis in:
1. not gono/chlam
2. + gono/chlam
3. anal intercourse exposure
- Levo or bactrim
- rocephin + doxy/azithro
- Rocephin + Levo
what is the treatment for a patient with an intrascrotal abscess
- immediate urology consult for surgical drainage
- broad ABX (zosyn) until cultures are back
CT w IV contrast shows air along fascial planes and deep tissue involvement
fournier’s gangrene
Tx for fournier’s gangrene
- zosyn
- fluids, opioids, NPO, septic work up.
- Urgent urology consult
What are the 3 options of tx for paraphimosis in order
- try anesthesia and manual reduction
- small punctures to release fluid (22-25g needle)
- dorsal slit
sickle cell disease is the MCC of () occuring in children
ischemic priapism
This disease is MC in ADULTS!!!! if in peds, sickle cell.
MCC of non-ischemic/high flow priapism
traumatic fistula
Prior to attempting removal of an object on an entrapped penis, what must you do
corporal aspiration
what size foley for urethral strictures
- 14 or 16 Fr straight
- if unsuccessful use 12 Fr Coude w lube
what is a positive post void residual bladder scan volume
> 50-150cc
