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90 Cards in this Set
- Front
- Back
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important Post-op care
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ARDS
fever PE post-op confusion |
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Acute respiratory distress syndrome symptoms
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1) hypoxia
2) tachypnea 3) accesory mm use with ventilation 4) hypercapnia |
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Acute respiratory distress syndrome diagnosis
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Dx:
CXR (bilateral pulmonary infiltrates w/o JVD (r/o CHF) |
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Acute respiratory distress syndrome treatment
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Tx: PEEP
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PE symptoms
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acute chest pain w/ clear lung exam
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PE diagnosis
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Dx:
EKG (best initial; sinus tachycardia w/o ST segment changes) CT angiogram of chest |
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PE treatment
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Tx:
Hepain as bridge to coumadin therapy; if 2nd PE while on coumadin-> IVC filter via inguinal cath |
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Post-op confusion symptoms
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hypoxic (PE, atelectasis, pneumonia) or septic
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Post-op confusion diagnosis
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Dx:
need ABG, CXR, blood cultures, urine cultures and CBC |
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Post-op confusion Treatment
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Abx
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Post-op causes of fever
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Wind (POD 1-2)
Water (POD 3-5) Walking (POD 5-7) Wound (POD 7) Wonder drug (8-15) |
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Treatment for POD 1-2 fever
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Tx:
Prevention by incentive spirometry, vancomycin and tazobactam-pipercillin for hospital acquired pneumo |
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Treatment for POD 3-5 fever
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Abx
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Treatment for POD 5-7 fever
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Tx:
Heparin for 5 days as bridge to coumadin for 3-6 months |
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Treatment for POD 7 fever
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Tx:
incision & drainage if abscess + Abx |
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Treatment for POD 8-15 fever
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Tx:
CT guided percutaneous drainage of abscess Surgery |
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Diagnosis for POD 8-15 fever
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Dx:
CT (deep fluid collection) |
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Diagnosis for POD 7 fever
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Dx: PE of wound (erythema, purulent d/c, swelling)
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Diagnosis for POD 5-7 fever
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Doppler U/S of extremities, change IV lines, culture IV tips
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Diagnosis for POD 3-5 fever
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Dx:
Urine analysis (+nitrates, + leukocyte esterase) and urine cultures |
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Diagnosis for POD 1-2 fever
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Dx:
CXR & sputum cultures |
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What are the 5 types of fractures
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Comminuted
Compression Open fracture Pathologic Stress |
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What is comminuted fracture?
How does it occur? |
Bone broken into multiple pieces
crash injuries |
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What is a stress fracture?
How does it ususally present? |
complete fracture from repetitive insults to bone
"Athlete w/ persistent pain" |
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How is a stress fracture diagnosed and treated?
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Dx: CT or MRI
Tx: Rehab, reduced physical activity, casting |
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What is a compression fractures?
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vertebra fracture in setting of osteoporosis
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What is a pathologic fracture?
How does it usually present? |
fracture do to disease not trauma
"older person fractures rib from coughing" |
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What are causes of pathological fractures?
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Mets
MM Pagets |
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How do you treat pathologic fractures?
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Tx: surgical realignment and tx underlying disease
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What is an open fracture?
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fracture when injury comes from broken bone to pierce skin
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How are open fractures treated?
Complications? |
Tx: skin must be closed & bone must be set in OR w/ debridement
high rates of bacteria infxn |
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What are the shoulder injuries?
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anterior shoulder dislocation
posterior shoulder dislocation clavicular fracture scaphoid fracture |
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How does anterior shoulder dislocation present?
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Sx: Arm held to side w/ externally rotated forearm w/ severe pain
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How is an anterior shoulder dislocation diagnoses and treated?
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Dx: X-ray (best initial) MRI (most accurate)
Tx: shoulder relocation& immobilization |
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what is the cause of anterior shoulder dislocation?
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any injury causing strain on glenohumeral ligaments (MC)
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How is the cause of posterior shoulder dislocation?
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seizure or electrical burn
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How does posterior shoulder dislocation present?
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arm in medially rotated & held to side
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How is posterior shoulder dislocation diagnosed and treated?
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Dx: x-ray (best initial) MRI (most accurate)
Tx: traction & surgery |
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What is the cause of clavicular fracture?
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trauma
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How does clavicular fractures present?
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pain over location
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How is clavicular fracture diagnosed and treated?
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Dx: x-ray
Tx: simple arm sling |
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How does a scaphoid fracture occur?
How does it present? |
falling on outstretched hand
Persisent pain in"snuffbox" |
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How is a scaphoid fracture diagnosed and treated?
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Dx: x-ray (takes 3 wks to show)
Tx: thumb spica cast |
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How does compartment syndrome present?
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Sx: Pain, pallor, paresthesia, paralysis, pulselessness, poikilothermia (cold to touch)
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How is compartment syndrome treated?
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fasciotomy
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How does fat embolism present?
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Sx: confusion, petechial rash, SOB & tachypnea w/ dyspnea
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What is the cause of fat embolism?
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fracture of long bone (MC femur)
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How are fat emboli diagnosed and treated?
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Dx: ABG (PO2<60), CXR (infiltrates), urinalysis (fat droplets)
Tx: O2 (keep O2 >95%), if severely hypoxic intubation + mechanical ventilation |
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Types of knee injuries
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ACL
Medial & lateral collateral ligament tear |
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How does anterior cruciate ligament or PCL tear present?
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Pain
+anterior drawer sign/ + posterior drawer sign |
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How do you diagnose and treat ACL or PCL tear?
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Dx: MRI
Tx: anthroscopic repair |
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How does a medial & lateral collateral ligament injury present?
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pain on opposite sign
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How do you diagnose and treat medial & lateral collateral ligament injury?
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Dx: MRI
Tx: surgical repair |
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How does a meniscal knee injury present?
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popping sound upon flexion & extension
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How is a meniscal knee inury diagnosed and treated?
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Dx: MRI
Tx: Arthroscopic |
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How is Abdominal aortic aneurysm diagnosed
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CT or MRI
U/S (must be done to determine size & monitor) |
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How is Abdominal aortic aneurysm treated
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Surgery when >5 cm
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What are complications of appendicitis
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complication: abscess formation & gangrenous perforation
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What is the treatment for appendicitis
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Laparoscopic surgery
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How is appendicitis diagnosed
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CT (most accurate)
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How does appendicitis present
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1) Anorexia
2) fever, 3) periumbilical pain w/ RLQ tenderness, 4) elevated WBC count |
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What are complications of Cholecystitis
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Complication: Perforation of gallbladder
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What is the treatment for Cholecystitis
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Lap surgery or Open surgery (if perforation of gallbladder is present)
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How is cholecystitis diagnosed
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1) U/S (pericholecystic 1fluid, wall thickening, stones)
2) HIDA scan (most accurate, delayed emptying of GB) |
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How does cholecystitis present
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1) fever
2) RUQ tenderness 3) Murphy sign, pain on inspiration causing a cessation of breathing 4) N/V |
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What is the cause of cholecystitis
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Gallstones occluding lumen of cystic duct
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What are complications for diverticulitis
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Complication: Abscess formation; No endoscopy 2/2 perforation risk
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How is diverticulitis treated
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Abx (for first attack)
Surgical resection (recurrence or perforation) |
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How is diverticulitis diagnosed
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CT (best test)
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How does diverticulitis present
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1) fever
2) nausea 3) LLQ pain 4) peritonitis |
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Cause of acute pancreatitis
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alcohol
gallstones |
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How does acute pancreatitis present
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1) fever
2) midabd pain radiating to back 3) N/V |
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How is acute pancreatitis diagnosed
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Dx:
CT (best test) Amylase (sensitive) Lipase (specific) |
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What is the treatment for acute pancreatitis
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1) NPO
2) IV fluids |
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What are complications of acute pancreatitis
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Complications:
1) hemorrhagic pancreatitis 2) pseudocyst formation |
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What is the treatment for ischemic bowel disease
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1) IV normal saline
2) surgery to remove necrotic bowel |
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How is ischemic bowel disease diagnosed
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1) initial ->CT scan of abdomen
2) most accurate-> angiogram |
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How does ischemic bowel disease present
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1) abd pain eating (bc incr oxygen requirements of bowel after contraction)
2) Bloody diarrhea |
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What is the cause of ischemic bowel disease
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lack of blood flow to the mesentery of the bowel
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What is the cause of mesenteric ischemia?
What is the most commonly affected vessel? |
(Afib, superior mesenteric artery)
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What is the treatment for gastric perforation
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4 steps:
1) NPO 2) NG tube to suction gastric juices 3) IV normal saline & broad-spectrum Abx 4) Surgical repair of perforation |
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How is gastric perforation diagnosed
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initial: CXR (free air under diaphragm)
most accurate: CT scan |
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How does gastric perforation present
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1) Abdominal pain that radiates to right shoulder 2/2 acid irritation of phrenic nerve,
2) signs of peritonitis (guarding, rebound ternderness, abdominal rigidity) |
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What are complications of esophageal perforation
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Complication: Mediastinitis
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What is the treatment for esophageal perforation
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Surgical exploration w/ debridement
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How is esophageal perforation diagnosed
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1) Esophogram
2) Gastrografin (cant use Barium bc it burns the tissues) |
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How does esophageal perforation present
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1) retrosternal chest pain
2) odynophagia, 3) Hamman sign (crunching heard w/ palpation of thorax), 4) pain radiate to left shoulder |
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What is the treatment for bowel obstruction
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1) NPO
2) NG tube to decompress bowel 3) IV fluids 4) Emergent surgical resection |
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How does bowel obstruction present
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1) Severe crampy abdominal pain, 2) N/V
3) fever 4) hyperactive bowel sounds 5) hypovolemia 2/2 third spacing |
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How is bowel obstruction diagnosed
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1) elevated WBC
2) elevated lactate w/ acidosis 3) abdominal x-ray: air fluid levels & dilated loops of small bowel 4) CT: transition zone from dilated loops of bowel w/ contrast to area of bowel w/ no contrast |
