Urgent Care Flashcards
1
Q
What are the causes of RUQ pain?
A
biliary or hepatic
2
Q
What are the clinical features of biliary colic?
A
intense, dull discomfort located in the RUQ or epigastrium
- associated with nausea, vomiting, and diaphoresis
- generally lasts at least 30 minutes, plateauing within one hour
- benign abdmoinal examination
3
Q
What are the clinical features of acute cholecystitis?
A
prolonged (>4 to 6 hours) RUQ or epigastric pain, fever
-patients will have abdominal guarding and murphy’s sign
4
Q
What are the clinical features of acute cholangitis?
A
fever, jaundice, RUQ pain
5
Q
What are the clinical features of sphincter of Oddi dysfucntion?
A
RUQ pain is similar to other biliary pain
6
Q
What are the clinical features of acute hepatitis?
A
RUQ pain with fatigue, malaise, nausea, vomiting, and anorexia
-patients may also have jaundice, dark urine, and light-colored stools
7
Q
What are the clinical features of Periphepatitis (Fitz-Hugh-Curtis syndrome)?
A
RUQ pain with a pleuritic component, pain is sometimes referred to the right shoulder
8
Q
What are the clinical features of liver abscess?
A
fever and abdmoninal pain are the most common symptoms
9
Q
What are the clinical features of Budd-Chiari syndrome?
A
symptoms include fever, abdominal pain, abdominal distention (from ascites), lower extremity edema, jaundice, gastrointestinal bleeding, and/ore hepatic encephalopathy
10
Q
What are the clinical features of portal vein thrombosis?
A
symptoms include abdominal pain, dyspepsia, or gastrointestional bleeding
11
Q
What are the clinical features of acute myocardial?
A
may be associated with shortness of breath and exertional symptoms
12
Q
What are the clinical features of acute pancreatitis?
A
acute-onset, persistent upper abdominal pain radiating to the back
13
Q
What are the clinical features of chronic pancreatitis?
A
epigastric pain radiating to the back
14
Q
What are the clinical features of peptic ulcer disease?
A
epigastric pain or discomfort is the most promient symptom
15
Q
What are the clinical features of gastroesophagel reflux disease?
A
associated with heartburn, regurgitation, and dysphagia
16
Q
What are the clinical features of gastritis/gastropathy?
A
abdominal discomfort/pain, heartburn, nausea, vomiting, and hematemesis
17
Q
What are the clinical features of functional dyspepsia?
A
the presence of one or more of the following: postprandial fullness, early satiation, epigastric pain, or burning
18
Q
What are the clinical features of gastroparesis?
A
nausea, vomiting, abdominal pain, early satiety, postprandial fullness, and bloating
19
Q
What are the clinical features of splenomegaly?
A
pain or discomfort in the LUQ, left shoulder pain, and/or early satiety
20
Q
What are the clinical features of splenic infarct?
A
severe LUQ pain
21
Q
What are the clinical features of splenic abscess?
A
associated with fever and LUQ tenderness
22
Q
What are the clinical features of splenic rupture?
A
may complain of LUQ, left chest wall, or left shoulder pain that is worse with inspiration
23
Q
Where does the pain from an appendicitis localize to?
A
generarlly right lower quadrant
24
Q
What are the clinical features of appendicitis?
A
periumbicial pain initially that radiates to the right lower quadrant
-associated with anorexia, nausea, and vomiting
25
Where does the pain of diverticulitis localize to?
generally left lower quadrant; right lower quadrant more common in Asiant patients
26
What are the clinical features of diverticulitis?
the pain is usually constant and present for several days prior to presentation
-may have associated nausea and vomiting
27
Where does the pain of nephrolithiasis localize to?
either lower quadrant
28
What are the clinical features of nephrolithiasis?
pain most common symptom varies from mild to severe
| -generally, flank pain, but may have back or abdominal pain
29
Where does the pain from pyelonehritis localize to?
either lower quandant
30
What are the clinical features of pyelonephritis?
associated with dysuria, frequency, uregency, hematuria, fever, chills, flank pain, and costovertebral angle tenderness
31
Where does the pain from acute urinary retention localize?
suprapubic
32
What are the clinical features of acute urinary retention?
present with lower abdominal pain and discomfort; inability to urinate
33
Where does the pain from cystitis localize to?
suprapubic
34
What are the clinical features of cystitis?
associated with dysuria, frequency, uregency, and hematuria
35
Where does the pain from infectious colitis localize to?
either lower quadrant
36
What are the clinical features of infectious colitis?
diarrhea is the promident symptom, but may also have assciated abdominal pain, which may be severe
37
What is an allergic reaction/anaphylaxis?
an adverse cutaneous reaction in response to the administration of a drug
- skin reactions are the most common adverse drug reactions
- severity can range from mild eruprtions that resolve after the removal of the inciting agent to severe skin damage with multiogran involvment
38
How is anaphylaxis treated?
with epinephrine 1:1000 0.5 - 1 mL given IM or subQ
39
What are the characteristics of brown recluse spider bites?
- brown violin on the abdomen
- necrotic wound - local tissue reaction causes local burning at the site for 3-4 hours - blanched area (due to vasoconstriction) - central necrosis erythematous margin around an ischemic center "red halo" - 24/7 hours after hemorrhagic bullae that undergoes Eschar formation - necrosis
40
What is the tx for brown recluse?
for brown spider bites, use wound care, local symptomatic measures, and sometimes delayed excision
41
What are the characteristics of black widow spider bites?
- red hourglass on the abdomen
- neurologic manifestations - you may not see much at bite site: toxic reaction: nausea, vomiting, HA, fever, syncope, and convulsions
42
What is the tx of black widow spider bites?
anti-venom available for elderly and kids
43
What are the venomous insects (stingers)?
bee, wasp, hornet, yellow jacket, and fire ant
44
What is the main treatment to prevent itching of insect bites?
- cool the affected area
- apply topical calamine lotion or local anesthetic agent
- oral antihistamine reduces itch and weals
- use moderate potency topical steroids for papular urticaria or persistent reactions
-bites from insects carrying disease require specific antimicrobial therapy to treat the disease
45
What is the body percentage for burns?
- rule of 9's: Head 9%, each arm 9&, chest 9%, abdomen 9%, each anterior leg 9%, each posterior leg 9%, upper back 9%, lower back 9%, genitals 1%
- palmer method: patient's palm equates to 1%
46
What is a first degree burn?
sunburn
| -erythema of involved tissue, skin blanches with pressure, the skin may be tender
47
What is a second degree burn?
partial thickness
| -skin is red and blistered, the skin is very tender
48
What is a third degree burn?
full thickness
| -burned skin is tough and leathery, skin non-tender
49
What is a fourth degree burn?
into the bone and muscle
50
What is a minor burn?
<10 TBSA adults, <5 TBSA young/old, <2% full thickness, must not involve face, hands, perineum, feet, cross major joints or be circumferential
51
What is a major burn?
>25% TBSA adults, >20% TBSA young/old, >10% full thickness burn, burns involving the face, hands, perineum, feet, cross major joints/circumferential
52
What is the tx of burns?
monitor ABCs, fluid repletion, topical antibiotic
- cleans with mild soap and water, don't apply ice directly, irrigate chemical burns with running water x 20 min, topical antibiotic cream to superficial burns, fingers and toes wrapped individually to prevent maceration and gauze placed between them
- children with >10% total body surface area and adults with >15% need fluid resuscitation = LR IV x 24 hrs (1/2 in first 8 hours, 1/2 in remaining 16)
53
What is heart failure?
a syndrome of ventricular dysfunction
- left ventricular failure causes shortness of breath and fatigue
- right ventricular failure causes peripheral and abdominal fluid accumulation
- the ventricles can be involved together or separately
54
What are the characteristics of heart failure?
- either diastolic or systolic dysfunction can precede CHF
- ACEI needs to be used ASAP to decrease comorbidity and mortality
- three specific beta-blockers are used in reducing mortality from heart failure: bisoprolol, carvedilol, metoprolol succinate
- labs = BNP - released by ventricular tissue in response to elevated ventricular pressure, low levels are seen in obese individuals
55
What are the characteristics of systolic left heart failure?
- systolic - S3 (rapid ventricular filling during early diastole in the mechanism responsible for the S3)
- dilated thin-walled weak left ventricle: often due to CAD or heart attack which causes the muscle to die
- dyspnea, PND, orthopnea, rales, crackles, displaced downward and to the left apical impulse
- dilated left ventricle and a low ejection fraction <40%
- treat with Ace inhibitor + beta-blocker + loop diuretic
- systolic left heart failure is diagnosed and treated based on class: Class I, II, III and IV and patients can go from controlled class I to poorly controlled and worsening class II, III, or IV and back
- acute worsening of heart failure: O2 + Ace + stop beta-blocker + start nitroglycerine and a double dose of diuretic IV (once stable go back on beta-blocker and PO loop diuretics
56
What are the characteristics of diastolic left heart failure?
- diastolic - S4
- hypertrophic thick-walled left ventricle with impaired relaxation
- increases over 55 years of age, commonly in patients with hypertension
- patients will have problems when blood pressure increase, often when patients forget to take their medications
- dyspnea and rales with an apical heave or lift
- ejection fraction is usually normal
- treat with Ace inhibitor + beta blocker or CCB (do not use diuretics in stable chronic diastolic failure)
- never use digoxin for diastolic heart failure
- acute = same as systolic heart failure = Ace inhibitor + loop diuretic IV + NTG + O2
57
What are the characteristics of right heart failure (right ventricle)?
- causes: pulmonary HTN - the right heart is unable to easily pump blood into the lungs, the most common cause of right heart failure is left heart failure
- no rales, JVD, and leg edema
- diagnose with echo and doppler, gold standard is high heart cardiac catheterization
- treat the underlying condition
58
What are the characteristics of high output cardiac failure?
- caused by increased metabolic demand - metabolic demand is higher than the heart can pump at maximum
- hyperthroidism
- severe anemia
- beriberi or thiamine deficiency
- will have tachycardia at first but once the heart tires it will look like systolic failure because the heart will dilate and weaken
- treat like heart failure and acute CHF, treat the underlying condition
59
What are the characteristics of deteriorating mental status/unconscious patient?
level of consciousness is evaluated by attempting to wake patients first with verbal commands, then with non-noxious stimuli, and finally with noxious stimuli (eg, pressure to the supraorbital ridge, nail bed, or sternum)
- the Glasgow Coma Scale was developed to asses s patients with head trauma
- for head trauma, the score assigned by the scale is valuable prognostically
- for coma or impaired consciousness of any cause, the scale is used because it is a relatively reliable, objective measure of the severity of unresponsiveness and can be used serially for monitoring
- asymmetric motor responses to pain or deep tendon reflexes may indicate a focal hemispheric lesion
60
How does the scale assign points?
based on responses to stimuli
- eye-opening
- facial grimacing
- purposeful withdrawal of limbs from a noxious stimulus indicate that consciousness is not greatly impaired
- E + V + M = score
61
What is confusion?
a behavioral state of reduced mental clarity, coherence, comprehension, and reasoning
62
What is drowsiness?
the patient cannot be easily aroused by touch or noise and cannot maintain alertness for some time
63
What is lethargy?
depressed mental status in which the patient may appear wakeful but has depressed awareness of self and environment globally; cannot be aroused to full function
64
What is stupor?
the patient can be awakened only by vigorous stimuli, and an effort to avoid uncomfortable or aggravating stimulation is displayed
65
What is coma?
the patient cannot be aroused by stimulation and no purposeful attempt is made to avoid painful stimuli
66
What is delirium?
acute onset of fluctuating cognition with impaired attention and consciousness, ranging from confusion to stupor
67
What are the causes of altered level of consciousness?
AEIOU TIPS
- alcohol or AAA
- electrolytes, endocrine
- insulin
- opiates
- uremia
- trauma, temperature, or toxemia
- infections - sepsis, meningitis
- psychogenic or pulmonary embolus
- space occupying lesions, strokes, shock, seizure
68
What are the reversible causes of unconscious patient?
- hypoglycemia (check glucose, give dextrose)
- opiate overdose (trial of naloxone)
- thiamine deficiency (trial of thiamine)
- consider head CT for any patient with unclear etiology or neurologic abnormality
- consider empiric antibiotics in patients with fever of unclear etiology
69
What is a foreign body aspiration?
presentation (depends on the location of obstruction)
- inspiratory stridor if high in the airway
- wheezing and decreased breath sounds if low in the airway
70
What are the complications of foreign body aspiration?
pneumonia, acute respiratory distress syndrome, asphyxia
71
What is the treatment of foreign body aspiration?
remove foreign body with a bronchoscope
72
What are upper extremity disorders?
- shoulder fractures/dislocations
| - fractures and dislocations of the forearm, wrist, and hand
73
What are disorders of the hip?
fractures and dislocations of the hip
74
What are disorders of the knee?
fractures and dislocations of the knee
75
What are disorders of the ankle and foot?
fractures and dislocations of the ankle and foot
76
What is hypertensive urgency?
persisten asymptomatic SBP > 220 and/or diastolic > 125
77
What are the characteristics of hypertensive urgency?
- plus optic disc edema, progressive target organ complications, and severe perioperative hypertension
- mut be reduced within a few hours
- parenteral drug therapy is not required and the goal is a partial reduciton of blood presssure with a relief of symptoms
- TX with Clonidine
78
What is hypertensive emergency?
increase BP + target organ damage DBP >130
79
What are the characteritics of hypertensive emergency?
- BP must be reduced in 1 hour to avoid morbidity or death
- TX with Nicardipine IV - most potent and longest acting calcium channel blocker with potential to precipitate reflex tachycardia and should be used with a beta-blocker such as Labetalol (labetalol used in pregnancy)
- reduce pressure by no more than 25% within 1-2 hours and then towards 160/100 within 2-6 hours
- if reduced too fast may precipitate coronary, renal or cerebral ischemia
- avoid the use of sublingual or oral fast-acting nifedipine
80
What is malignant hypertension?
sustained elevated arterial blood pressure
81
What are the characteristics of malignant hypertension?
- DBP >130
- SBP >200
- characterized by encephalopathy or nephrophathy with papilledema
- treatment is identical to that of hypertensive emergencies
82
What are the pearls of Hydrocarbons (benzene, petroleum distillates, gasoline) ingestion?
- mucosal irritation
- vomiting, bloody diarrhea
- cyanosis, respiratoy distress, fever, tachycardia
83
How is ingestion of Hydrocarbons (benzene, petroleum distillates, gasoline) dx?
- CXR
- Urinalysis
- EKG
84
What is the tx for ingestion of Hydrocarbons (benzene, petroleum distillates, gasoline)?
- avoid emetics and lavage
- oxygen with mist
- antibiotics if pneumonia develops
85
What are the pearls of Bases (Clorox, Drano) ingestion?
- irritated mucous membranes
- stomach perforation, hepatotoxicity
- respiratory distress secondary to edematous epiglottis
86
What is the dx for ingestions of Bases (Clorox, Drano)?
EGD to determine the degree of damage to larynx, esophagus, stomach
87
What is the tx for ingestion of Bases (Clorox, Drano)?
- small amounts of water (diluent)
- avoid vomiting
- supportive care
88
What are the pearls of ingestion of Acetaminophen (Tylenol)?
- especially in depressed patients, acetaminophen converted to free radicals - liver necrosis (occurs in the hypoxic area around central veins, called zone III)
- hepatic failure: elevated LFTS
89
How is ingestion of Acetaminophen (Tylenol) dx?
- monitor APA plasma concentration (nomogram)
| - LFTs - nonemergent
90
What is the tx for ingestion of Acetaminophen (Tylenol)?
- gastriv lavage - only works in the first hour
- charcoal - prevents enteophepatic recirculation, but only works <2 h of ingestion
- N-acetylcysteine (antidote): increases glutathione levels, which acts as a neutralized or free radicals 4-h APAP levels to determine respone to therapy
91
What are the pearls of ingestion of Aspirin (salicylates)?
- vomiting
- hyperpnea, pulmonary edema
- fever
- encephalopathy, convulsions, coma
- renal failure
92
How is the ingestion of Aspirin (salicylates) dx?
- check serum salicylate level
- look for metabolic acidosis and hypokalemia
- high or reduced serum glucose
93
What is the tx for ingestion of Aspirin (salicylates)?
- induce emesis
- charcoal to bind the drug
- correct dehydration with IVF
- hemodialysis
94
What are the pearls of ingestion of Organophosphates (chlorthion, diazinon)?
- salvation, lacrimation
- sweating
- urination, diarrhea
- pulmonary congestion
- twitching, convulsions, coma
- miosis
95
How is ingestion of Organophosphates (chlorthion, diazinon) dx?
- measure red cell cholinesterase levels
| - blood glucose levels
96
What is the tx of ingestion of Organophosphates (chlorthion, diazinon)?
- ABCs
- Decontamination of skin
- Atropien + pralidoxime
97
What are the pearls of ingestion of iron?
- intestinal bleeding
- impaired coagulatino
- shock, coma
- red urine
98
How is iron ingestion dx?
- blood indices
- metabolic panel: acidosis
- UOP
- type and screen
- LFTs
99
What is the tx of iron ingestion?
- evoke emesis
- gastic lavage
- whole-bowel irrigation
- deferozamine
- dialysis
100
What are the pearls of ingetion of mercury?
- overconsumption of fish
- diarrhea, constricted visual fields, peripheral neuropathy, hyperhidrosis (sweating)
- renal failure
- tachycardia, hypertension,
101
What is the tx for ingestion of mercury?
chelating agents (succimer, dimercaprol, penicillamine)
102
What are the pearls of ingestion of lead?
- ingestion of lead-based paint, working with batteries or working with lead-based casting material
- neuropathy and renal failure
103
How is ingetion of lead dx?
- blood indices
- all childen should be screened with a blood lead test at ages 12 and 24 months or at ages 36-72 months if they have not previously been screened
104
What is the tx for ingestion of lead?
chelating agents (succimer, dimercaprol)
105
What are the pearls for ingestion of arsenic?
- pesticides or containated groundwater
| - severe headahces, abdominal pain, diarrhea, delirium, convulstions, and breath that smells like garlic
106
How is ingestion of arsenic dx?
- the urine test is the most reliable test for arsenic exposure withtin the last few days
- urine testing needs to be done within 24-48 hours for accurate analysis of acute exposure
- tests on hair and fingernails can measure exposure to high levels of arsenic over the past 6-12 months
107
What is the tx for ingestion of arsenic?
chelating agents (succimer, dimercaprol)
108
What are the pearls of carbon monoxide ingestion?
- house fires and automobile exhause ingestion
- headache, cherry-red skin
- lactic acidosis due to hypoxia
109
How is ingestion of carbon monoxide dx?
serum for carbon monoxide
110
What is the tx of carbon monoxide ingestion?
- 100% O2
| - hyperbaric oxygen
111
What are the pearls of cyanide ingestion?
- house fires
- cyanide - produced form the combustion of furnitue materials
- coma, seziure
- heart dysfunction
- metabolic acidosis and breath that smeels like bitter almonds
112
How is ingestion of cyanide dx?
- blood gasses - cyandie toxicity is characterized by normal arterial oxygen tension and an abnormally high venous oxygen tension, resulting in a decreased arteriovenous oxygen difference (<10%)
- a high anion-gap metabolic acidosis is a hallmark of significnat cyanide toxicity
- serum study for cyanide
113
What is the tx for ingetsion of cyanide?
- nitrited to oxidize Hb to Met-Hb which has a higher affinity for CN - (protecting cytochrome oxidase)
- thiosulfate to bind cyanide for renal excretion as thiocyanate
114
What is a non-ST-segment elevation (NSTEMI)?
a myocardial necrosis (evidenced by cardiac markers in the blood; troponin I or troponin T and CK will be elevated) WITHOUT acute ST-segment elevation or Q waves
115
What are the characteristics of NSTEMI?
- ECG changes such as ST-segment depression, T-wave inversion or both may be present
- coronary artery not completely blocked
- subendocardial infarct
- cardiac markers will be elevated
116
What are the cardiac markers for NSTEMI?
- troponin is most sensitivity and specific appears at 2-4 hours, peaks 12-24 hours and lasts for 7-10 days
- CK/CK-MB appears at 4-6 hours, peaks at 12-24 hours and returns to normal within 48-72 hours
- Myoglobin (Mb) is used less than the other markers and appears at 1-4 hours, the peak is 12 hours, and returns to baseline levels within 24 hours
117
What is the tx for a NSTEMI?
Beta blocker + NTG + aspirin and clopidogrel + heparin + ACEI + statins + reperfusion
- reperfusion via percutaneous coronary intervention (not thrombolysis)
- less time-senstiive than in STEMI
118
What is a ST-segment elevation myocardial infarction (STEMI)?
is myocardial necrosis (evidenced by cardiac markers in the blood; troponin I or troponin T and CK will be elevated) WITH acute ST-segment elevation or Q waves
119
What are the characteristics of a STEMI?
- coronary artery completely blocked; full thickness of myocardial wall involved
- ECG shows ST elevation, possible Q waves
120
What are the EKG findings for anterior wall infarcation?
Q waves and ST elevation in lead I AVL, and V2 to V6
121
What are the EKG findings for inferior wall infarcation?
Q waves and ST elevation in leads II, III, and AVF
122
What are the EKG findings for lateral wall infarction?
ST elevation in the lateral leads (I, aVL< V5-6), reciprocal ST depression in the inferior leads (III and aVF)
123
What are the EKG findings for posterior wall infarction?
ST depressions in V1 to V3
124
What is the tx for a STEMI?
beta blockers + NTG + aspirin and clopidogrel + heparin + ACEI + statins + reprofusion
- aspirin and clopidogrel are given at once
- very time sensitive - immediate (within 90 minutes) coronary angiography and primary PCI
- thrombolytic therapy within the first 3 hours if PCI not available
125
What are the absolute contraindications for fibrinolytic used in STEMI?
- prior intracranial hemorrhage (ICH)
- known structural cerebral vascular lesion
- known malignant intracranial neoplasm
- ischemic stroke within 3 months
- suspected aortic dissection
- active bleeding or bleedign diathesis (excluding menses)
126
What is orbital cellulitis?
decrease extraocular movement, pain with movement of the eye and proptosis, signs of infection
- often assocaited with sinusitis
- occurs more often in children than adults - ages 7-12 y/o
- decreased vision is a rare manifestation of orbital cellulitis
- CT scan of orbits (confirmatory)
127
What is the tx of orbital cellulitis?
hospitalization and IV broad-spectrum antibiotics (vancomycin)
128
What is a pneumothorax?
absence of breath sounds and hyperresonance to percussion wth tracheal deviation
129
What is a primary spontaneous pneumothorax?
occurs in the absence of underlying disease - tall, thin males between 10 and 30 years of age are at the greatest risk of primary pneumothorax
130
What is a secondary spontaneous pneumothorax?
occurs in presence of underlying disease - asthma, COPD, cystic fibrosis, interstitial lung disease
131
What is a tension pneumothorax?
- etiology: penetrating injury
- physical exam: hyperresonance to percussion and trachel shift to the contralateral side
- small pneumothoraces <15% of the diameter of the hemithroax will resolve spontaneously without the need for chest tube placement
- for large, >15% of the diatmeter of hemithorax, and symptomatic pneumothoraces, chest tube placement is performed
- patients should be followed with serial CXR every 24 hours until resolved
132
What are the symptoms of a pulomary embolus?
dyspnea (most common) and pleuritic chest pain
133
What is virchow's triad for pulmonary embolus?
hypercoagulable states, venous stasis, vascular injury
134
What are the risk factors for a pulmonary embolus?
cancer, surgery, oral contracpetive pills, pregnancy, long bone fracture (fat emboli)
135
What is Homan's sign for pulmonary embolus?
dorsiflexion of the foot causes pain in calf - indicative of deep vein thrombosis
136
What are the EKG findings for a pulmonary embolus?
tachycardia (most common), ST changes, S1Q3T3 (indicates cor pulmonale)
137
What imaging is done for pulmonary embolus?
- spiral CT: best initial test
- gold standard is pulmonary arteriography
- chest radiograph: Westermark's sign and Hampton's Hump - triangular infiltrate secondary to intraparenchymal hemorrhage
- treatment: heparin to coumadin bridge, 3-6 mo treatment
138
What is acute respiratory distress syndrome (ARDS)?
- Etiology: sepsis, severe trauma, aspiration of gastic contents, near-drowing
- Presentation: rapid onset of profound dyspnea occurign 12-24 hours after the precipitating event and tachypnea, pink frothy sputum, crackles
139
What are the diagnsotic studies for ARDS?
- chest readiograph: air bronchograms and bilaterally fluffy infiltrate
- normal BNP, pulomary wedge pressure, left ventricle function and echocardiogram
140
What is the tx for ARDS?
underlying cause and intubation positive pressure oxygen
141
What is the difference between a sprian and a strain?
a sprain involved ligaments and a strain involves muscles and tendons
- the symptoms of a sprain and a strain are very similar
- that's because the injuries themselves are very similar
142
What is a sprain?
a joint sprain is the overstretching or tearing of ligaments
- ligaments connect two bones together
- the most common location for a sprain is the ankle joint
- symptoms include pain, bruising, swelling, limited flexibility, decrease ROM
143
What is a strain?
a joint strain is the overstretching or tearing of muscle sor tendons
- tendons connect bones to muscles
- the most common locations for a muscle strain are teh hamstring muscles and the lower back
- symptoms include pain, muscle spasms, swelling, limited flexibility, decrease ROM
144
How is a sprain/strain dx?
often clinical = X-ray or MRI
145
What is the tx for a sprain/strain?
RICE, NSAIDs
| -more severe strains and sprains may require surgery to repair damaged or torn ligaments, tendons or muscles
146
What is abruptio placentae?
premature separtion of the placenta from the uterine wall
| -presents as heavy painful vaginal bleeding in teh 3rd trimester
147
What is the tx of abruptio placentae?
delivery of the fetus and placenta is the definitive treatment, blood type, crossmatch, and coag studies as well as placement of large-bore IV line
-cesarean section most often is the preferred route for delivery
148
What is placenta previa?
a condition in which the placenta lies very low in the uterus and covers all or part of the cervix
-placenta previa happens in about 1 in 200 pregnancies
149
What is complete previa?
placenta completely covers the internal os
150
What is partial previa?
placenta covers a portion of the internal os
151
What is marginal previa?
the edge of placenta reaches the margin of the os
152
What is low-lying placenta?
implanted in the lower uterine segment in close proximity but not extending to the internal os
153
What is vasa previa?
fetal vessel may lie over the cervix
154
What is the presenation of placenta previa?
painless vaginal bleeding - usually occurs after 28 weesk of gestation (third trimester bleeding)
- bleeding from placenta previa results from small disruptions in placental attachment during normal development and thinning of the lower uterine segment during third-trimester = may stimulate further uterien contractions = further placental separation and bleeding
- fetal complications assocaited with Previa: preterm delivery and its complications, preterm PROM, intrauterine growth restriction, malpresentation, vasa previa, congenital abnormalities
155
What are the RF for placenta previa?
prior c-section, multiple gestations, multiple induced abortions, advanced maternal age
156
How is placental previa dx?
ultrasound (transvaginal) - vaginal exam contraindicated - a digital exam can cause further separation
157
What is the tx of placenta previa?
strict pelvic rest (no intercourse) and modified bed rest, no vigorous exercise
- a blood transfusion may be necessary so get a type and screen if you discover previa vis U/S
- C-section is preferred delivery
- Give Rhogam if Rh-
- Some stuides show that delivery between 34-37 weeks may be optimal
