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125 Cards in this Set
- Front
- Back
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What are the first steps for acute management of a trauma patient presenting to the ED? |
ABCDE Airway Breathing Circulation Disability Exposure |
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Why should the airway of a trauma patient be visualized? |
To check for obstructions |
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What maneuver can lift the tongue off the posterior oropharanx in a patient that potentially may have neck trauma? |
Jaw thrust maneuver |
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What Glasgow Coma Scale threshold value requires immediate intubation? |
<= 8 |
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If a patient cannot be intubated and is suffocating, what should be done? |
Cricothyroidotomy |
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What part of the spine must be immobilized in a trauma patient? |
Cervical spine |
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What are some thoracic causes of immediate death? (7) |
- Tension pneumothorax - Open pneumothorax - Flail chest - Pulmonary contusion - Massive hemothorax - Cardiac tamponade - Airway obstruction |
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How is tension pneumothorax identified on exam? (5) |
- Absent breath sounds on affected side - Distended neck veins - Hypoxemia |
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What is the Tx for pneumothorax? |
Immediate needle decompression |
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What defines hemothorax? |
1500cc of blood from chest tube placement |
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How is hemothorax Txed? (2) |
Volume resuscitation and chest decompression |
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What gauge IV needle is needed for antecubital vein access? |
16 gauge |
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How many liters of isotonic fluid must be given for every 1 Liter of blood lost? |
3 liters |
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What is the triad of signs that suggest cardiac tamponade? |
- JVD - Hypotension - Muffled heart sounds |
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How is disability measured? |
Glasgow Coma Scale |
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What is a FAST scan? |
Focused Abdominal Sonography for Trauma |
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What Dx test can confirm whether the urethra is intact? |
Retrograde urethrogram |
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What are indications of CXR? Head CT? (2) C-spine CT? (4) |
CXR: any trauma to the chest |
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What device allows monitoring urine output? |
Foley catheter |
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When is surgical exploration mandatory for penetrating neck wounds? |
When a patient is in shock and has an active hemorrhage from neck wounds |
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What muscle defines true penetrating neck wounds? |
Platysma |
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What is required for any patient with a penetrating thoracic injury? |
Intubation |
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Why should foreign objects impaled into the chest be left inside until the patient is in the OR? |
To prevent tamponade |
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If a previously stable chest trauma patient suddenly dies, what should be suspected? |
Air embolism |
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Does the absence of pain rule out an abdominal injury? |
No |
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Below what intercostal should GSWs be explored with laparotomy? |
4th |
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If a patient with an abdominal stab is hemodynamically stable, what should be done? |
CT followed by inpatient observation |
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What should be checked for MSK penetrating wounds? (3) |
- Pulses - Motor function - Sensory function |
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If a nerve is injured in an MSK penetrating wound, what must be done? |
Surgical repair |
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What are the most important steps to Tx contaminated wounds? (2) What follows? (2) |
Early wound irrigation and tissue debridement Then, antibiotics and tetanus prophylaxis |
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What are signs of elevated intracranial pressure from blunt force trauma to the head? (6)
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- Bradycardia - Hypertension - Respiratory distress - Vomiting - Papilledema |
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How is elevated ICP Txed? (3) |
- Head elevation - Hyperventilation - IV mannitol |
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What kind of injury has a site at the bleed and on the opposite side across the impact? |
Coup-countrecoup injury |
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What does blurring and punctate hemorrhaging along the gray-white matter junction suggest? |
Diffuse axonal injury from rapid-deceleration head injury |
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What kind of hematoma is lenticular in shape on Head CT? |
Epidural Hematoma |
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What is bleeding in an epidural hematoma? |
Middle meningeal artery |
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What boundaries can epidural hematomas not cross? |
Suture lines |
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What blood vessels are damaged with subdural hematomas? |
Bridging veins |
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Which kind of cranial hematoma starts with LOC, then has a lucid period, and then is followed by coma? |
Epidural hematomas |
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What eye finding may suggest epidural hematoma? |
Ipsilateral blown pupil |
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What surgery is needed if a patient has an epidural hematoma with worsening neurological findings? |
Emergent craniotomy |
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What causes most tracheobronchial disruption? |
Deceleration shearing forces |
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What are physical findings of tracheobronchial disruption? (4) |
- Respiratory distress - Hemoptysis - Sternal tenderness - Subcutaneous emphysema |
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How can myocardial contusion present? (3) |
- Bundle branch block - Dysrhythmia - Hypotension |
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What sign suggests pulmonary contusion? |
Hypoxia |
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What is the classic cause of aortic disruption? |
Rapid-deceleration injury |
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Where is laceration of the aorta most common? |
Proximal to the ligamentum arteriosum |
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Besides a ripping sensation in the chest, what are clinical manifestations of aortic disruption? (2) |
- Upper extremity hypertension - Hoarse or quiet voice |
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What are signs of aortic disruption on CXR? (3) |
- Widened mediastinum (>8cm) - Loss of aortic knob - Pleural cap |
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What is the gold standard for evaluation of a possible aortic disruption? |
Aortography |
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What is flail chest? |
3 or more ribs fractured at 2 points leaving that part of the rib cage hanging by muscle |
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What are signs of flail chest? (2) |
- Crepitus - Abnormal chest wall movement |
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How is flail chest Dxed? (2) |
- CXR - Oxygen saturation |
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What are Tx for flail chest? (4) |
- Oxygen - Narcotic analgesia - Respiratory support (intubation, PAP) - Surgery to fix chest wall |
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What are complications of flail chest? |
Respiratory compromise |
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What are the most commonly injured organs in the abdomen due to blunt force trauma? (2) |
- Liver and spleen |
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What makes the duodenum susceptible to compression injury? |
Its position in front of the spine |
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What are Sx of liver or spleen injury? (3) |
(Sx of blood loss) - Tachycardia - Peritonitis |
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What would be seen on AXR if the duodenum is injured? |
Retroperitoneal air |
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What organ is likely to be injured if a patient's epigastric region hits the handlebars or steering wheel? |
Pancreas |
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What is Kehr's sign? |
Referred shoulder pain due to diaphragmatic irritation |
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What is the most commonly injured GU organ? |
Kidneys |
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How does work-up for hemodynamically stable patient with abdominal blunt force trauma differ from that of a hemodynamically unstable patient? |
If hemodynamically stable: use imaging, if unstable, use exploratory laparotomy |
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How are pelvic fractures diagnosed? (2) |
- Unstable pelvis upon manipulation - X-Ray or CT confirms fracture |
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What risk do pelvic fractures have? |
- Hemorrhage |
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How can a fractured pelvis be splinted? |
external pelvic binder |
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What are 2 Tx necessary when addressing a pelvic fracture? |
- Fixation - Angiography to see which bleeding vessels need embolization |
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What test must be used to rule out damage to the urethral meatus after pelvic fracture? |
Retrograde urethrogram |
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What is pulseless electrical activity? |
Heart has electrical activity on EKG but is not producing a pulse |
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What are 10 causes of PEA? |
5 H's and 5 T's - Hypovolemia - Hypoxia - Hydrogen ion (acidosis) - Hyper/hypokalemia - Hyperglycemia - Tablets (Drug OD) - Tension pneumothorax |
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What is the Tx for ventricular fibrillation? (7 steps) |
- CPR - Epinephrine - Defibrilate - Amiodarone - Defibrilate - Epinephrine |
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What is Tx for unstable supraventricular tachycardia? |
Cardioversion |
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What is Tx for stable supraventricular tachycardia? (2) |
- Control rate with valsava, carotid sinus massage, or cold stimulus - Give adenosine followed by CCB or beta blocker if those maneuvers don't work |
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How is stable A-fib/flutter Txed? |
- Use diltiazem or beta-blocker and anticoagulate if A-fib has been present for >48 hours |
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In what case should A-fib/flutter not be treated with nodal blockers? |
Wolff-Parkinson-White syndrome Use procainamide |
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What drug should be given for symptomatic bradycardia? If that is ineffective, then what? (3) |
Atropine Transcutaneous pacing, dopamine, or epinephrine |
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How is unstable abdominal aortic dissection Txed? (2) |
- Immediate laparotomy or endovascular repair |
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If a female patient has abdominal pain with cervical motion tenderness, what dz should be considered? |
Pelvic Inflammatory Disease |
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What abdominal etiology leads to sudden onset diffuse, severe pain and abdominal rigidity on exam? |
Perforation |
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What abdominal etiology has sudden onset of severe, radiating, colicky pain? |
Obstruction |
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If a female patient has shock and positive UPT, what is the likely etiology of her abdominal pain? |
Ectopic pregnancy |
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If a patient has abdominal pain with peritoneal signs in the presence of shock, what Tx is necessary? |
Exploratory laparotomy |
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What kind of patient presenting with abdominal pain must have emergent surgical management? |
Hemodynamically unstable patients |
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What test must be administered as a precaution for all hemodynamically unstable patients with abdominal pain? |
Type and cross
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Where is McBruney's point and what is its significance? |
1/3 distance from right anterior superior iliac spine to the umbilicus |
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What is Hamburger's sign and what does it mean? |
It is RLQ pain in a patient that "wants" to eat. Probably not appendicitis |
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What is Psoas sign? |
Passive extension of hip leads to RLQ pain |
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What is obturator sign? |
Passive internal rotation of the flexed hip leads to RLQ pain |
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What is Rovsing's sign? |
Deep palpation of the LLQ leads to RLQ pain |
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What signs and symptoms may present with appendicitis? (4) |
- RLQ pain - Fever - Leukocytosis with left shift - RBCs & WBCs on UA |
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What scans can help Dx appendicitis? (2) |
- CT scan with PO and IV contrast - US |
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What are the immediate Tx for appendicitis? (5) |
- NPO status - IV hydration - Analgesia - Antimetic - Antibiotics with G- coverage |
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What is the definitive Tx for appendicitis? |
Open or laparoscopic appendectomy |
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How does perforation of the appendix change the management of appendicitis? Abscess? |
Treat perforation with antibiotics and delayed primary closure Treat abscess with broad-spectrum antibiotics and percutaneous drainage |
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What is the second leading cause of death in children? |
Burns |
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How deep is a first degree burn?
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Only the epidermis is involved (no blisters) |
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How deep is a second degree burn? |
Through the epidermis and part of the dermis (painful with blisters) |
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How deep is a third degree burn? |
The whole extent of the dermis and sometimes deeper. (painless, white, charred) |
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What poisoning can be associated with burns? |
Carbon monoxide poisoning |
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What poisoning is associated with burned textiles or carpets? |
Cyanide poisoning |
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What is the Parkland formula? What does it tell us? |
IVF for first 24 hours post burn = 4 x weight in kg x percent body surface area burned Tells us how much fluids need to be replaced (50% in first 8 hrs, 50% in remaining 16 hours) |
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What are supportive measures for patients with burns? (3) |
- Tetanus prophylaxis - Stress ulcer prophylaxis - IV narcotic analgesia |
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What are complications of severe burns? (3) |
- Shock - Compartment syndrome - Superinfection |
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What bacteria are most likely causes of superinfection in burn patients? (2) |
- Pseudomonas aeruginosa
- Gram+ cocci |
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What are criteria for transferring patients to burn centers? (5) |
- > 10% BSA in pts <10yo or >50yo
- > 20% BSA in pts from 11-49yo - Any burns over critical areas: face, hands, feet, genitals, perineum, major joints - Chemical, electrical, or inhalation burns - Special needs |
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What are the 6 causes of postoperative fever? |
- Wind (atelectasis, pneumonia) - Water (UTI) - Wounds (infection) - Walking (DVT) - Wonder drugs - Womb (endometritis) |
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What can decrease the risk of postoperative fever? (5) |
- Incentive spirometry - Pre- and postoperative antibiotics - Short-term Foley catheter - Early ambulation - DVT prophylaxis |
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What is shock? |
- Inadequate tissue-level oxygenation to maintain vital organ function |
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What is the first vital sign to change with hemorrhagic shock? |
Heart rate |
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What drug type should be avoided in patients with hypovolemic shock? |
Pressors |
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How is malignant hyperthermia Txed? |
Dantrolene |
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What defines hypothermia? |
Body temp < 35^C (< 95^F) |
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What should be monitored on EKG for a patient who has hypothermia? |
Arrhythmias (J-wave) |
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Why is the pulse oximeter inaccurate when a patient has carbon monoxide poisoning? |
The pulse-ox recognizes carboxyhemoglobin as saturated hemoglobin and suggests that SpO2 is higher than it actually is. |
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What temp defines hyperthermia? |
Body temp over 40^C (104^F) |
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How should hyperthermia be treated? |
Cool the patient with cold water, wet blankets, and ice. |
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In a hyperthermic patient, what will prevent shivering? |
Benzodiazepine |
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What are Sx of acute carbon monoxide poisoning? (3) (AKA hypoxemic poisoning syndrome) |
- Cherry-red skin - Confusion - HA |
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What are Sx of chronic carbon monoxide poisoning? (4) |
- Flulike Sx - Myalgias - Nausea - HA |
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What Dx tests should be performed for a patient with suspected carbon monoxide poisoning? (2) |
- ABGs - Serum carboxyhemoglobin |
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What is the Tx for carbon monoxide poisoning? |
- 100% oxygen (hyperbaric O2 if pregnant) |
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What should be done for patients with airway burns or smoke inhalation? |
Intubation |
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Do rodents carry rabies? |
No |
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If a patient is bitten by an animal with signs of rabies, what Tx should be administered? |
1 dose of human rabies Ig and 4 doses of rabies vaccine over 14 days |
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What can be used to Tx PO OD of <2 hours old for substances that can adsorb to it? |
Activated charcoal
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