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Emergency Medicine > Unit 3 Lecture 1 > Flashcards

Unit 3 Lecture 1 Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

how much blood can be in the pleural space before it shows on CXR?

A

200-300ml

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2
Q

signs/sxs of penetrating chest traum

A

hemoptysis, pneumothorax, subcutaneous emphysema, mediastinal emphysema, dullness/absent breath sound

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3
Q

beck’s triad (tamponade)

A

JVD, hypotension, and muffled heart sounds

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4
Q

workup for penetrating chest trauma

A

CT, Echo, angio (if bleeding out but not sure form where)

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5
Q

what is the LD50 for falls

A

4 stories (stated in class, slide 8)

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6
Q

most common side for traumatic diaphragmatic hernia

A

left side

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7
Q

signs of traumatic diaphragmatic hernia

A

resp. distress, decreased breath sounds, BS in the chest, abd pain, paradoxical respiration

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8
Q

tx for traumatic diaph. hernia

A

trans-abdominal repair (come from below and pull intestines down)

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9
Q

how many ribs involved for flail chest

A

3+

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10
Q

tx for pt with 1-2 non-displaced rib fractures with no signs/sxs of more significant injury

A

treat for pain (NSAIDs +/- narcotics) and d/c

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11
Q

complications of rib fractures

A

atelectasis and PNA

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12
Q

if pt does not improved from rib fracture, when should follow up xray be taken

A

4-6 week

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13
Q

how often should you get a chest xray when pt has a hemothorax

A

q8h

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14
Q

xray finding for pulmonary contusion

A

irregular, nonlobular opacification of the pulmonary parenchyma

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15
Q

complications of pulm. contusion

A

resp. distress, hemoptysis, PNA

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16
Q

tx of pulmo. contusion

A

pain control and pulm. toilet

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17
Q

most common cause of sternal fractures

A

steering wheel impact

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18
Q

level of the carina

A

T5

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19
Q

level of esophageal hiatus

A

T9-10

20
Q

what is achalasia

A

loss of peristalsis in the distal esophagus and a failure of lower esophageal sphincter relaxation with swallowing

21
Q

most common epidemiology of achalasia

A

primary dysmotility

22
Q

sxs of achalasia

A

dysphasia with solids, followed by dysphagia to liquids, regurg after meals, heartburn

23
Q

dx of achalasia (test of choice)

A

esophageal manometry

24
Q

finding on barium esophagram c/w achalasia

A

bird’s beak

25
Q

tx for achalasia

A

nitrate or Ca channel blockers to reduce LES tone

-botulism, pneumatic dilatation

26
Q

most common cause of esophageal perf.

A

trauma (iatrogenic)

27
Q

location of instrument esophageal perfs

A

cervical esophagus

28
Q

location of spontaneous esophageal perfs

A

distal esophagus

29
Q

hamman’s sign

A

audibly crunchy rasping sound synchronous with the heart beat

30
Q

dx of esophageal perf

A

CXR-signs of perf

esophagogram- with gastrograffin

31
Q

tx of esophageal perf

A

NPO, IVF, abx, NGT
-observe vs surgery
(large perf +/- signs of mediastinitis, sepsis, shock require emergent surgery)

32
Q

boerhaave syndrome is a/w what?

A

violent vomiting an wretching

33
Q

most common location of perf with boerhaave syndrome

A

left posterolateral distal esophagus

34
Q

tx of boerhaave

A

ABC, abx, surgery!

35
Q

most common cause of hemoptysis

A

bronchitis

bacterial accounts for 70%

36
Q

management of hemoptysis

A

ABCs, bronchoscopy->angiography (dx and tx)

37
Q

definition of spontaneous pneumothorax

A

collection of air within the pleural space with collapse of the affected lung

38
Q

who is most likely to have spontaneous pnuemothorax

A

teens, young adults, tall thin men

39
Q

sxs of spont. pneumo.

A

sudden onset of pleuritic chest pain and dyspnea

40
Q

PE of spont. pneumo.

A

tachycardia, decreased breath sounds, hyperresonance

41
Q

tx of spont. penumo.

A

30%=chest tube

42
Q

when should pt with spont. pneumo undergo video assisted thoroscopy (VATs)

A

recurrent pneumothorax, failure to resolve, persistent air leak

43
Q

definition of tension pneumothorax

A

pneumothorax with mediastinal shift which can impair venous return and cause HYPOtension and cardiac arrest

44
Q

PE of tension pneumothorax

A

hyperresonance, decreased breath sounds, tracheal shift, HYPOtension or PEA

45
Q

placement of angiocatheter to treat tension penumothorax

A

2nd ICS MCL

Emergency Medicine (6 decks)

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