Week 2 Flashcards
Treatment for the bends:
- O2, analgesics, crystalloid fluids
- Immediately put in hyperbaric chamber
What should you do with asymptomatic near-drowning patients?
Observe for 8 hours and admit if deterioration
Mgmt of altitude sickness:
- Immediate descent to below 5000 ft
- Analgesics and antiemetics
- Dexamethasone, acetazolamide, nifedipine or mannitol for HAPE/HACE
True or false: anything that increases metabolism also increases fluid need.
True. Fever, tachypnea, burns, etc. all increase fluid needs.
What does a subdural hematoma look like on CT?
Crescent shaped
What does an epidural hematoma look like on CT?
Football or lens shaped
How should you manage a patient with a basilar skull fracture?
Admit and possibly prophylax for meningitis (cefazolin)
Treatment options for severe chillblains:
Nifedipine and steroids
Beck’s Triad:
- Classic finding in cardiac tamponade
- Hypotension, muffled heart sounds, and JVD
What lab finding distinguishes alcoholic pancreatitis from gall stone pancreatitis?
Lipase and amylase: very elevated in gall stone pancreatitis, only moderately with alcoholic.
Treatment for cholangitis:
Abx and ERCP to remove obstruction
What IV fluid would you use for DKA or a hyperosmolar hyperglycemic state?
- 1/2 NS for hyperosmolar hyperglycemic state
- NS or 1/2 NS for DKA, depending on whether you want to treat low volume or shift fluid into intracellular compartment
What IV fluid should you use to treat hypernatremia?
D5W
What should you do before closing a laceration on the eyelid, nose, mandible, or around the orbit?
Get an x-ray
What should you get before closing a scalp laceration in which the pt suffered a loss of consciousness?
CT
Possible complications of septal hematoma if it isn’t drained immediately:
Saddle deformity and/or necrosis
What should antibiotic therapy be directed towards in a patient with a nasal fracture or septal hematoma?
Staph (augmentin, cephalexin, erythromycin, etc.)
Management of posterior epistaxis:
- Nasal balloon (Nasostat, Epistat)
- ENT consult
Most common bone fractured in an orbital blow out fracture:
Maxillary bone
S/S of orbital blowout fracture:
- Diplopia (upward gaze)
- Enophthalmos
- Ipsilateral anesthesia (V2)
What do you want your patients to avoid if they have an orbital blowout fx?
- Valsalva
- Prophylax for vomiting
- Don’t blow nose
How should you manage an avulsed tooth?
- Chest x-ray if it can’t be found
- Hanks Balanced Salt Solution for transport
- Re-implant directly in socket and splint
- Get dental consult
- Abx X 5d
Medical treatments for central retinal artery occlusion:
Timolol, acetazolamide or inhaled carbogen
Important risk factor for general anesthesia:
Malignant hyperthermia
Drugs used for general anesthesia:
- Propofol
- Inhaled ethers or propofol drip for maintenance
- Others: ketamine, etomidate
How should you treat someone with a hemolytic transfusion reaction?
Fluids, mannitol and/or furosemide (Lasix), vasopressors for shock
How would you treat someone with an anaphylactic transfusion reaction?
- Antihistamines if mild
- Epi injection in thigh or brochodilators if severe
Fluid of choice for resuscitation and maintenance:
- NS
- Can also give LR for resuscitation
Good fluid to give for GI loss, fistula drainage, and burns/trauma patients:
LR
Fluid to use for maintaining daily body fluid requirements:
D5 1/2NS
Good option for someone with a history of transfusion reactions:
Leukocyte poor blood
Used to transfuse patients with liver disease or who are over-anticoagulated and need clotting factors:
Fresh frozen plasma
Fresh vs frozen packed red blood cells:
- Both used to treat anemia due to blood loss
- Frozen is better for rare blood types.
Other colloids sometimes given intravenously:
- Synthetics: Dextran and Hespan (hetastarch)
- Plamanate (plasma protein fraction)
What drugs are most commonly used in epidural or spinal anesthesia?
- Bupivacaine, lidocaine, ropivacaine and chloroprocaine are commonly used, along with narcotics, in epidurals
- Bupivacaine (mostly), lidocain, ropivacaine and sometimes epinephrine in spinal blocks
Two potential uses for a penrose drain:
- Large abscesses
- Peritoneal space
Medical and surgical treatment for ectopic pregnancy:
- Medical = methotrexate
- Surgical = laparoscopic surgery and salpingectomy if tube isn’t salvageable
Medical and surgical treatment for leiomyoma:
- Medical = Mifepristone
- Surgical = myomectomy or hysterectomy
Workup for endometrial cancer:
Biopsy, then hysterectomy + pelvic and aortic lymphadenectomy
Labs suggestive of testicular carcinoma:
- Hcg, alpha fetoprotein, lactate dehydrogenase
Workup for suspected testicular cancer:
Abdominal CT + chest x ray or chest CT for mets, scrotal ultrasound
Do you biopsy a suspected testicular carcinoma?
No
Features of a solitary pulmonary nodule (coin lesion):
- Less than 1 cm, stable for 2 years
- Target/popcorn appearance
Workup for coin lesion:
- CT
- Fine needle aspiration
- PET scan
- Sputum culture
- Bronchoscopy
Indications for wedge resection:
- Secondary lung cancers except solitary SCC or adenocarcinoma
- Benign neoplasms such as hamartomas and fibromas
Treatment for non small cell lung cancer:
Lobectomy, radiation and chemo
Mnemonic for acute coronary syndrome treatment:
MONA = morphine, O2, Nitroglycerin, ASA
Presurgical medical interventions for aortic dissection:
Esmolol (beta blocker) and nitroprusside
Surgical management of ruptured spleen:
Splenectomy
Imaging for suspected splenic rupture:
FAST or CT if stable
Workup for perforated bowel:
- 3 view x ray or CT for suspected duodenal perf
- Blood and urine cultures
Surgical mgmt of cholecystitis, cholangitis
- Laparoscopic cholecystectomy then abx
- Cholangitis is surgical emergency with ERCP
Imaging for diverticulosis/diverticulitis:
- Barium enema x ray for diverticulosis
- CT for diverticulitis
Management of diverticulitis:
- IV abx, surgical resection, drainage of abscesses
Evisceration:
- Usually occurs 5 - 8 days post op
- Return to OR, rinse peritoneal cavity with LR
- Abx
Time frame for fat embolism:
12 - 72 hours post op
Time frame for ileus:
- Peristalsis usually returns after about 72 hours
- During this time fecal impaction likely
Time frame for urinary retention:
4 - 5 days post op
Most common cause of fever after third day post op:
Phlebitis
Timeline for post surgical wound infection:
5 - 10 days
Most common pathogen in furuncle/carbuncle:
Staph
Most common pathogen in cellulitis:
Group A strep
Drugs to use for cellulitis:
Dicloxicillin (Bactrim if staph), IV PCN for strep, Nafcillin or Vanco for staph.
Treatment for gas gangrene:
IV PCN, clindamycin may be useful to reduce production of toxins
Timeline for post op pneumonia:
24 - 96 hours
