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40 Cards in this Set
- Front
- Back
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L MCA stroke results in?
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face and arm weakness>leg and aphasia if left is dominant (80%)
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Crossed deficits with stroke implies what vessel involvement?
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vertebral nd basilar: ipsilateral CN w contralateral motor.
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Management of suspected stroke?
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O2, withould thrombolytics until CT is done. Elevated bed to decrease ICP. workup clotting abnormalities and neurosurg consult if evacuation needed
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Management of TIA?
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aspirin and admit for workup of etiology
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at what GCS score is endotrach performed?
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<9
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treatment of status epilepticus?
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IV lorazepam, then phenytoin, then pheno and intubate, then propofol, EEG and neuro consult.
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Isoniazid tox may present how and how to reverse?
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seizure and status epi; tx with 5g pyridoxine
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Seizures; who to admit?
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those in status, first timers with secondary cause
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seizures; who to discharge?
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first timers with no secondary cuase, normal MS, or those with known but subtherapeutic drug levels.
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Brief history for those in trauma?
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AMPLE: allergies meds, PMH, last meal, events before trauma
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Fluid replacement should be what in trauma pts?
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3x EBL;
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GCS score is out of how many points?
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3-15; eye opening motor response verbal response...
EVM:456 |
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GCS eye opening to pain, how many pts?
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2
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GCS motor response withdrawing to pain points?
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4; 5 is localizing to pain
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GCS inappropriate verbal respone?
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3; 2 is incomprehensible
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Grade 1, 2, and 3 concussions are?
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1) <15 mins, 2 >15 mins symptoms, and grade 3 any LOC
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Most common mechanism of spinal cord injury?
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vehicular trauma, assault
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most common site of c spine fracture?
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C2
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most common site of c spine dislocation?
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C5-C6 nd C6-7
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most common c spine injuries in children/eldery? teenagers and adults?
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C1-3 upper, while teens C6-T1
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How are c spine injuries classified? which is unstable?
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flexion, extension, and axial load injuries. Extension and axial load burst fractures are extremely unstable
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loss of bulbocavernosis reflex suggests?
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complete cored injury
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Childresn with neuro deficits but normal initial imaging should undergo what?
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MRI, they may have SCIWORA due to laxity of their spinal ligaments and bones.
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Which pts are considered low prob of spinal injury and thus do not require xrays?
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NEXUS SCORE <5: cervical tenderness, focal neuro, alertness, no intox, no other distracting pain
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What should be given to pts with spinal cord injureis?
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steroids within 3 hrs
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Mechanism of blunt aortic injury?
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falling from > 3 stories or deceleration injuries at >30 mPH
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When does flail chest occur? Why is it deadly?
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3 adjacent ribs with fractures in 2+ places; punding causes pulmonary contusion which affects respiration.
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What can CXR detect after blunt trauma to chest?
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blunt aortic injury, pulm contusion, hemothorax, pneumothorax, rib fractures
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What is used to screen for blunt myocardial injury?
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EKG: abnormalities; or CT angio in stable pts.
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What is Kehr's sign?
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pain in shoulder that is not associated with acual shoulder pain; means spleen or liver laceration and blood irritating diaphram.
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Indications for laparotomy after abdominal trauma?
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unstable vitals, positive FAST, positive DPL, postiive CT, free air gross blood, retained stuff etc
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Fluid requirement for burns?
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FOUR ml/mg x TBSA percent FOUR FLUIDS FOR BURNS; half in first 8 hrs rest in next 16 hrs
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criteria for transfer to burn center?
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thrid degree, >10% TBSA, chem electrical inhilation burns.
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first second and thrid degree sprins?
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streching, partial and complete ligament tears
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When to admit for lower extremity emergency?
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if potential for compartment syndrome and fat embolism
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Pt with pain radiating down both legs and bowel bladder dysfunction should get:
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MRI to r/o cauda equina syndrome
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end result of compartment syndrome?
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volkmann's ischemic contractures; muscle contractures
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most sensitive sign for compartment syndrome?
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pain with passive stretching of muscle; then sensory loss pulselessness nad pallor are LATE findings
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how to measure compartment pressures?
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stryker STIC device. elevated is > 10 , admit; > 30 fasciotomy is indicated
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angioedema from ACEI; how to treat?
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FFP to replace enzyme that breaks down bradykinin; otehrwise discontinuing will lead to resolution in 24-48 hrs.
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