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218 Cards in this Set
- Front
- Back
lab changes seen in a patient with hyperaldosteronemia |
metabolic alkalosis
hypokalemia mild hypernatremia incr'd 24-hr urine aldosterone |
|
lab findings a/w hashimotos thyroiditis
|
high TSH
Low T4 anti-thyroid peroxidase (TPO) AB's anti-thyroglobulin AB's anti-microsomal AB's |
|
5 criteria for metabolic syndrome
|
ABDOMINAL OBESITY:
waist circumference > 40" (M) & > 35" (F) "PRE-HTN": BP > 130/85 "PRE-DM": FSBG 100+ mg/dl (2-hr post-oral 140+) DYSLIPIDEMIA: TG's 150+ HDL < 40 (M) & < 50 (F) |
|
complications a/w electrical burns
|
cardiac disarrhythmia
various neurological disturbances rhabdomyolysis --> myoglobinuria --> renal failure bony injuries --> compartment syndrome acidosis |
|
what are some life threatening complications of a px with substantial burns
|
inhalation injury
cardiac dysrhythmias renal failure sepsis (pneumonia & pseudomonas wound infection) hypovolemia/shock |
|
what is the parkland burn formula
|
Lactated Ringer:
4ml x body wt in kg x % BSA 1/2 in first 8 hours + maintenance fluids 1/2 in following 16 hours + maintenance fluids |
|
how can you prevent renal failure from electrical burns
|
aggressive IVF's
urine output goal: > 1.5 - 2 cc / min |
|
pulmonary pathology seen in a px with salt water near-drowning experience
|
pulmonary edema
|
|
where would an aspirated object most likely end up
|
right mainstem bronchus
|
|
next step in a px who aspirated an object that cannot be dislodged and is having difficulty breathing
|
emergent tracheotomy
|
|
degree of burn:
epidermis only |
1st degree
|
|
degree of burn:
epidermis & partial dermis |
2nd degree
|
|
degree of burn:
epidermis & full dermis without muscle/bone involvement |
3rd degree
|
|
degree of burn:
epidermis & full dermis with muscle/bone involvement |
4th degree
|
|
degree of burn:
no blisters |
1st degree
|
|
what differentiates the two 2nd degree classifications
|
SUPERFICIAL PARTIAL-THICKNESS:
capillary refill intact (i.e. does blanch with pressure) DEEP PARTIAL-THICKNESS: capillary refill NOT intact (i.e. does not blanch with pressure) |
|
degree of burn:
painless |
3rd or 4th degree
|
|
degree & depth of burn:
epidermis only; painful, erythema, no blisters |
1st degree - superficial
|
|
degree of burn:
epidermis & partial dermis; painful, erythema, blisters capillary refill intact |
2nd degree - superficial partial-thickness
|
|
degree of burn:
epidermis & partial dermis; painful, erythema, blisters capillary refill not intact |
2nd degree - deep partial-thickness
|
|
degree of burn:
epidermis & full dermis + no muscle/bone white &/or charred, painless capillary refill not intact |
3rd degree - full thickness
|
|
degree of burn:
epidermis & full dermis + muscle/bone white &/or charred, painless capillary refill not intact |
4th degree
|
|
degree of burn:
burns 2nd/2 electrical shock |
4th degree
(b/c they may involve muscles, bones, & other structures) |
|
Extent of burns: Rule of 9's
|
9% head
9% chest; 9% upper back 9% stomach; 9% lower back (down to gluteal folds) 9% left arm; 9% right arm 9% left anterior leg; 9% left posterior leg 9% right anterior leg; 9% right posterior leg 1% genitalia |
|
Dx & initial w/u
obese patient with dirty, velvety patch on back of neck |
dx: DM (pathology = acanthosis nigricans)
w/u: glucose & H&P (r/o malignancy) |
|
what is the appropriate tx fo HTN in cases of pheochromacytoma
|
FIRST: a-Blocker (e.g. pheoxybenzamine, phentolamine)
THEN: B-Blocker |
|
What is the classic presentation of a pt with hyperprolactinemia
|
galactorrhea/gynecomastia
amenorrhea/decr'd libido infertility (low sperm count)/decr'd libido/impotence |
|
Tx of heat stroke
|
ABC's
O2 (4L/min) COOLING: ice packs to neck, axilla, & groin continuous fanning & spraying with lukewarm water +/- cold gastric lavage, cooling blankets, cold IVF's IVF's Benzo's (if seizures) |
|
why are acetomenophen and NSAIDs ineffective against heat stroke
|
hypothalamus is not underlying problem
|
|
after an animal bite when should rabies prophylaxis be used
|
if animal cannot be observed for 10 days
or if highly suspected of having rabies |
|
EKG finding in hypothermia
|
j wave
|
|
What is the tx for black widow spider bite
|
antivenin within 30 minutes
benzo's to prevent lactodectism (i.e. muscle spasm) observe pt for 24 hrs consider oral antibiotics if secondary infection |
|
underlying problem for hyperthermia that must be corrected
|
dehydration
|
|
after appropriate wash out should a dog bite wound be closed
|
no
except facial bites (due to low rate of infection b/c well perfused), which should be sutured close |
|
Mgmt of skin laceration from human bite
|
copious irrigation
leave wound open prophylactic antibiotics |
|
which antibiotics are given after human bites
|
amoxicillin + clavulanic acid
or clindamycin + levofloxacin or clindamycin + TMP/SMX |
|
what rx should be given to a pt with muscle spasms, abdominal stiffness, AMS, & tachycardia due to spider bite
|
dx aka "lactodectism"
tx: antivenin (within 30 minutes) & benzo's |
|
Rx for hyperparathyroidism due to parathyroid hyperplasia
|
remove 3.5 glands
mark remaining 1/2 gland with surgical clip |
|
what is the LDL goal in a px with diabetes
|
LDL < 100
|
|
how is fluid repletion calculated after a burn
|
PARKLAND FORMULA:
Lactated ringer: 4mL x weight in kg x % BSA 1/2 in first 8 hrs 1/2 in following 16 hrs |
|
tx for bradycardia due to B-blocker overdose
|
IVF's (bolus)
atropine GI decontamination (activated charcoal, gastric lavage, or whole bowel irrigation) |
|
symptoms of anticholinergic toxicity
|
hyperpyrexia (hot as a hare)
decr'd secretions (dry as a bone) cutaneous flushing (red as a beet) cycloplegia & mydriasis (blind as a bat) disorientation (mad as a hatter) constipation & urinary retention (bloated as a toad) + tachycardia QRS widening + decreased or absent bowel sounds |
|
antidote for anticholinergics
|
physostigmine
|
|
a/w almond-scented breathe
|
cyanide poisoning
|
|
early & late findings of cyanide poisoning
|
EARLY (everything is incr'd):
tachycardia, HTN, tachypnea, flushing --> obtundation --> coma --> death LATE (everything is decr'd): bradycardia, hypotension, bradypnea, cyanosis, hepatic necrosis, renal failure |
|
what is a long term neurological effect in survivors of severe cyanide poisoning
|
delayed-onset parkinsonism
|
|
Rx for cyanide poisoning
|
ABC's
high-flow O2 (regardless of pulse-ox readings) sodium thiosulfate hydroxocobalamin nitrates (e.g. amyl nitrate and sodium nitrate) |
|
cradiac meds that are safe to treat tachycardia and HTN in cocaine overdose
|
CCB's
a-Blockers Benzos AVOID B-BLOCKERS (unopposed alpha --> incr'd BP) |
|
what is given to tx acetaminophen overdose; what other uses does this medication have
|
TX: N-Acetylcysteine
OTHER USES: CF pt's (for mucous plugs) pre-IV contrast |
|
what lab abnormality is classically seen in digoxin toxicity
|
hyperkalemia
elevated digoxin levels |
|
what are some non-specific sx's of digoxin toxicity
|
fatigue
blurred vision, change in color (e.g. "yellow vision") anorexia, n/v/d, abd'l pain HA, dizziness, confusion, delirium |
|
what characteristic cardiac changes may be seen with digoxin toxicity
|
DYSRHYTHMIAS:
bradycardia atrial tachycardia bidirectionl V-tach (digioxin toxicity until proven o/w) EKG CHANGES: prolonged PR interval ST segment "scooping" (seen at therapeutic levels) |
|
what should be avoided in digoxin overdose because it could worsen intracellular hyperkalemia
|
Ca2+ (can worsen intracellular hyperkalemia)
|
|
what is the MC sign of digoxin toxicity
|
bradycardia
|
|
what indicates the severity of digoxin toxicity
|
hyperkalemia (inhibits the Na-K-ATPase)
|
|
what is rx for digioxin toxicity
|
activated charcoal (in repeated doses)
digoxin antibody fragments, if necessary Atropine, if bradycardia ACLS medications as needed (except calcium) |
|
when is digoxin antibody fragments necessary in digoxin toxicity
|
hemodynamic instability
life-threatening arrhythmias/severe bradycardia "digoxin-toxic" rhythm (e.g. bidirectional V-tach) in setting of elevated [digoxin] [K+] > 5 mEq/L [digoxin] > 10 ng/mL ingestion of > 10 mg (adults) or > 4 mg (children) |
|
Rx for methanol or ethylene glycol (antifreeze) poisoning
|
Na bicarb
(to correct acidosis & limit penetration of toxic metabolites into tissues such as retina) dialysis if severe or evidence of organ damage (e.g. vision changes or renal failure) fomepizole/ethanol (to inhibit the alcohol dehydrogenase enzyme) thiamine (B1), pyridoxine (B6), & folic acid (B9) supplementation (to optimize elimination pathways) |
|
diagnostic features of salicylate overdose
|
n/v, dehydration
AMS tinnitus hyperthermia (ASA uncouples mt'l oxidative phosphorylation) resp alk --> mixed resp alk + met acid with incr'd AG |
|
what is the electrolyte abnormalities seen in ASA overdose & what is the pathophysiology of these abnormalities
|
resp alk --> mixed resp alk + met acid with incr'd AG
RESPIRATORY ALKALOSIS is due to hyperventilation 2nd/2 ASA stimulation of medullary respiratory center METABOLIC ACIDOSIS is 2nd/2 accumulation of lactic acid & ketoacids |
|
antidote for:
aspirin |
charcoal
Na+ bicarb dialysis |
|
what is rx used to tx warfarin overdose & at what point would you consider tx'ing the warfarin overdose
|
Administer Vitamin K
Consider if INR b/w 5 - 9 Administer if INR > 9 or any serious bleed |
|
what can be used in place of FFP in warfarin overdose
|
prothrombin complex concentrate
recombinant human CF VIIa |
|
antidote for:
acetaminophen |
N-acetylcysteine
|
|
antidote for:
opioids |
naloxone
|
|
antidote for:
benzos |
flumazenil
|
|
antidote for:
TCA |
Na+ bicarb (if QRS > 100 msec's)
Benzo's (for seizures) |
|
antidote for:
atropine |
physostigmine
|
|
antidote for:
propanolol |
glucogon
Ca2+ gluconate insulin dextrose |
|
antidote for:
digoxin |
Digoxin AB's
atropine (if bradycardic) |
|
antidote for:
cyanide |
Na+ thiosulfate
nitrates (e.g. amyl nitrate & Na+ nitrate) hydroxocobalamine |
|
antidote for:
methemoglobin |
methylene blue
|
|
antidote for:
methanol |
fomepizole
ethanol |
|
antidote for:
isoniazid |
Vit B6
|
|
antidote for:
heparin |
protamine sulfate
|
|
most sensitive test for multiple sclerosis
|
MRI brain & orbits
(asymmetric white matter lesions of different ages) |
|
what type of bite/sting can cause acute pancreatitis
|
scorpion sting
|
|
in which endocrine disorder might weight loss completely eliminate the need for medication
|
DM2
PCOS |
|
what is the next step in mgmt of a sx'c pt who has ingested alkali plumbing liquid
|
ABC's:
resp distress --> laryngoscopy +/- tracheostomy emergent surgery if perforation, mediastinitis, or peritonitis AVOID: emetics (e.g. ipecac), neutralizing agent, & NG tube |
|
What classic toxic ingestion mgmt. options should NOT be chosen in pt's with alkaline fluid ingestion
|
emetic agent (ipecac)
neutralizing agent NG tube |
|
what are the determining factors for out-pt vs in-pt care in a pt who has ingested alkali plumbing liquid
|
OUTPATIENT TX if: reliable h/o low-vol, accidental ingestion
INPATIENT TX if : unreliable hx, high-vol ingestion, or intentional ingestion |
|
what is the proper in-pt care of an asx'c pt who has ingested alkali plumbing liquid
|
EGD ASAP
ICU care to manage life-threatening complications (mediastinitis, peritonitis, respiratory distress, shock) esophageal dilations (3-6 weeks after injury if necessary for strictures) SURVEILLANCE EGD's: starting 15-20 yrs after ingestion q1-3 yr intervals |
|
for what is a px who ingests alkali plumbing liquid at long-term risk
|
esophageal squamous carcinoma
|
|
what happens within 6 hours of iron ingestion
|
abdominal pain
vomiting/hematemesis diarrhea/hematochezia/melena lethargy shock |
|
what happens within 6-72 hours of iron ingestion
|
wide-spread cellular dysfunction
multisystem organ failure |
|
what happens within 12-96 hours of iron ingestion
|
heptotoxicity
|
|
what happens withig 2-8 weeks of iron ingestion
|
bowel obstruction (2nd/2 GI scarring, classically at the gastric outlet)
|
|
antidotes for:
iron toxicity |
deferoxamine
|
|
Rx for lead poisoning in adults
|
EDTA or succimer
|
|
Rx for lead poisoning in children
|
EDTA or succimer
SEVERE toxicity: succimer + dimercaprol |
|
symptoms of theophylline overdose
|
seizures
hypotension tachyarrhythmias |
|
antidote for:
arsenic |
dimercaprol
succimer penicillamine |
|
Tx for theophylline overdose
|
supportive care (IVF's + maintain nl [K+])
ACLS protocols for arrhythmias (SVT or V-Tach) benzo's for seizures (avoid phenytoin) GI decontamination (activated charcoal) hemodialysis in severe cases |
|
signs/sx's of cholinergic toxicity (e.g. organophosphates)
|
"DUMBBELSS"
Diarrhea Urination Miosis Bronchospasm Bradycardia Emesis & Excitation of skeletal muscle Lacrimation Sweating Salivation |
|
antidote for:
anticholinesterases, organophosphates |
atropine + pralidoxime
|
|
antidotes for:
carbon monoxide |
100% O2 (hyperbaric O2 therapy)
|
|
antidote for:
copper |
penicillamine
|
|
antidotes for:
mercury |
dimercaprol
|
|
antidote for:
tPA, streptokinase |
aminocaproic acid
|
|
if you suspect an MI and are waiting for an EKG, what treatments should be initiated immediately
|
"MONA"
morphine O2 Nitrates Aspirin |
|
antidote for:
opioids |
naloxone or Naltrexone
|
|
antidote for:
heparin |
protamine sulfate
|
|
antidote for:
benzo |
flumazenil
|
|
antidote for:
barb |
bicarb (to alkalinize the urine)
dialysis activated charcoal |
|
antidote for:
carbon monoxide |
100% O2 (hyperbaric O2)
|
|
Dx & Rx
patient presents with new skin pigementation, hyponatremia and hyperkalemia |
Dx: Addison's
Tx: glucocorticoids & mineralcorticoids (e.g. fludracortisone) |
|
what drugs are used in treating stable, asymptomatic ventricular tachycardia
|
amiodarone (1st line)
procainamide sotalol synchronized cardioversion if pt fails to respond to pharmacological measures |
|
Rx for supraventricular tachycardia
|
vagal maneuvers/carotid massage
adenosine (IV push: 6mg --> 12mg --> 6mg) ventricular rate control (CCB or B-blocker) |
|
what adverse SE's should you be expecting with adenosine IV push
|
intense, transient flushing
chest pain hypotension "flat line" on monitor (turn volume down) NOTE: SE's are UNCOMFORTABLE but only last a few seconds |
|
initial Rx for new atrial fib with RVR of unknown duration
|
RATE CONTROL:
B-blocker Non-DHP CCB (e.g. diltiazem or verapamil) Digoxin Amiodarone ANTICOAGULATE: Heparin (initially) Warfarin (later) |
|
ACLS protocol for PEA or asystole
|
CPR (30:2)**
epinephrine 1mg q 3-5 mins (OR vasopressin 40 U's in place of 1st or 2nd epi) Evaluate & Tx causes ("H's" & "T's") **NOTE: PEA & asystole are NOT shockable rhythms |
|
causes of PEA
|
hypothermia
hypovolemia hypoxia hypoglycemia hyper acidosis hyper/hypokalemia tamponade thrombosis (MI) thrombosis (PE) tension pneumothorax trauma toxins |
|
ACLS protocol for V-Fib & pulseless V-tach
|
Shock 360 J + CPR (30:2)
Check rhythm Shock 360 J + CPR (30:2) Check rhythm Epi 1 mg OR vasopressin 40 units (in place of 1st or 2nd epi) Check rhythm Shock + CPR (30:2) Check rhythm Consider Antiarrhythmics (i.e. amiodarone 300 mg or lidocaine 150 mg or lidocaine 1 - 1.5 mg/kg (max 3 mg/kg) CONTINUE: q2 minutes: check rhythm --> shock 360 J + cpr (30:2) q3 - 5 mins: check rhythm --> epinephrine 1mg IV |
|
What is max number of epinephrine doses that can be given when treating cardiac arrest
|
There is no max:
Epinephrine 1 mg IV q3-5 minutes |
|
antidote for:
antimuscarinics, anticholinergic agents |
physostigmine
|
|
antidote for:
benzo's |
flumazenil
|
|
antidote for:
TCA |
Na+ bicarb
|
|
antidote for:
warfarin |
Vit K
FFP |
|
antidote for:
ethylene glycol |
fomepizole
EtOH |
|
antidote for:
arsenic |
dimercaprol
succimer penicillimine |
|
Dx
systolic murmur at apex and LLSB increases in intensity while standing after squatting |
hypertrophic cardiomyopathy
|
|
clinical definition of HTN
|
>140/90
on 3 separate occasions at least 2 wks apart |
|
blood product most appropriate for:
severe anemia due to autoimmune hemolytic anemia |
PRBC's
|
|
blood product most appropriate for:
hemophilia |
Hemophilia A: CF VIII
Hemophilia B: CF IX |
|
blood product most appropriate for:
DIC |
FFP +/- plt's
|
|
blood product most appropriate for:
shock due to trauma or postpartum hemorrhage |
PRBC's
whole blood (rarely) |
|
blood product most appropriate for:
to maintain blood pressure during large volume paracentesis |
colloid (e.g. albumin)
|
|
blood product most appropriate for:
hemorrhage due to warfarin overdose |
Vitamin K
FFP |
|
blood product most appropriate for:
need for vWF-rich blood product |
cryoprecipitate
|
|
blood product most appropriate for:
thrombocytopenia |
platelets
|
|
which blood product replaces clotting factors
|
FFP
cryoprecipitate whole blood |
|
vasopressor a/w:
theoretically causes renal vasodilation |
dopamine
|
|
vasopressor a/w:
high doses optimize the a1 vasoconstriction |
epinephrine
|
|
vasopressor a/w:
ADH analogue |
vasopressin
|
|
vasopressor a/w:
best choice for anaphylactic shock |
epinephrine
|
|
vasopressor a/w:
septic shock |
NE
|
|
vasopressor a/w:
best choice for cardiogenic shock |
dobutamine
|
|
vasopressor a/w:
causes vasoconstriction but with bradycardia |
phenylephrine
|
|
a swanz catheter is a good estimate of what pressure
|
LA of heart
|
|
what are the preferred vessels in the placement of swan ganz catheter
|
R jugular
L subclavian |
|
what is seen on ECG of atrial flutter
|
sawtooth pattern of p wave
|
|
side effects of theophylline
|
seizures with hyperthermia
hypotension tachyarrhythmias |
|
Rx for kawasaki disease in acute phase
|
IVIG + high-dose ASA
|
|
what are common findings of basilar skull fracture
|
racoon eyes (i.e. bruising around the eyes)
battle sign (i.e. bruising over mastoid) hemotympanum (i.e. blood behind the TM's) CSF rhinorrhea or otorrhea |
|
when is cushings triad seen and what are the components
|
Triad seen with elevated ICP
HTN Bradycardia bradypnea |
|
how is elevated intracranial pressure managed
|
elevate head of bed to 30 degrees
IV mannitol intubate (pre-tx with lidocaine) & hyperventilate decompressive craniectomy other: ventriculostomy, barbiturate coma, paralysis |
|
what are the 3 categories of the Glasgow Coma Scale & the components/points for each
|
EYE OPENING:
spontaneous (4) to voice (3) to pain (2) none (1) VERBAL RESPONSE oriented (5) confused (4) inappropriate words (3) incomprehensible (2) none (1) MOTOR RESPONSE obeys command (6) localizes pain (5) withdraws from pain (4) flexion with pain (3) extension with pain (2) none (1) |
|
heart disease a/w:
ST segment elevation in leads corresponding to the perfusion of multiple arteries (i.e. "diffuse") |
acute pericarditis
|
|
heart disease a/w:
hypotension, distant heart sounds, distended neck veins |
cardicac tamponade
|
|
heart disease a/w:
cardiac cath shows equal pressures in all heart chambers |
constrictive pericarditis
|
|
heart disease a/w:
chest pain that is relieved by leaning forward |
acute pericarditis
|
|
what is the next step in evaluating a pulsitile abdominal mass and bruit
|
abdominal US
|
|
what is the treatment for ventricular fibrillation
|
immediate cardioversion --> ACLS protocol
|
|
what are the different zones of the neck & structures contained in each zone
|
ZONE I: clavicle --> cricoid cartilage
great vessels, aortic arch cervical spine, spinal cord, cervical nerve roots lung apices, trachea, esophagus ZONE 2: cricoid cartilage --> angle of mandible carotid & vertebral arteries, jugular veins cervical spine, spinal cord pharynx, larynx, trachea, esophagus ZONE 3: angle of mandible --> base of skull carotid arteries, jugular veins cervical spine, major cranial nerves salivary & parotid glands, trachea, esophagus |
|
what is initial w/u to penetrating injury to the neck when platysma has been violated
|
IMMEDIATE:
ABC's, O2, 2 large bore IV's, type & cross blood IF UNSTABLE: OR STAT if unstable, obvious bleeding, or rapidly expanding hematoma IF STABLE: prophylactic AB's (incr'd risk of contamination from oropharyngeal flora) follow protocol for each zone |
|
protocol tx:
stable pt with Zone I neck injury where platysma has been breached |
prophylactic AB's
ASSESS: 4-vessel arteriogram (CTA) triple endoscopy |
|
protocol tx:
stable pt with Zone II neck injury where platysma has been breached |
prophylactic AB's
surgical exploration |
|
protocol tx:
stable pt with Zone III neck injury where platysma has been breached |
prophylactic AB's
Assess w/ 4-vessel arteriogram (CTA) |
|
what is included in a triple endoscopy
|
broncoscopy
laryngoscopy esophagoscopy |
|
what CXR findings might indicate a ruptured thoracic aorta
|
widened mediastinum
loss of aortic knob pleural cap deviation of trachea & esophagus to the right depression of the left main stem bronchus |
|
what is the next step in a patient with chest trauma, hypotension, JVD, and distant heart sounds
|
dx = cardiac tamponade
pericardiocentesis pericardial window |
|
what are the signs of tension pneumothorax (PTX)
|
absent breathe sounds
hyperresonance on side of PTX distended neck veins hypotension deviation of trachea away from side with PTX |
|
how is a tension pneumothorax Rx
|
immediate chest tube placement
if delay in chest tube, needle decompression |
|
what is proper location to place needle for tension pneumothorax
|
2nd or 3rd midclavicular IC space
5th midaxillary IC space |
|
what is a flail chest
|
area of chest wall that moves paradoxically (i.e. inward motion with inspiration) to the rest of the chest wall
results from 3 or more sequential rib fractures |
|
what is tx for flail chest
|
O2 supplementation
close monitoring for early signs of respiratory compromise BiPAP by mask (or by endotracheal intubation w/mech vent) analgesia |
|
initial w/u:
abdominal stab wound |
ABC's
ABDOMINAL EXAM |
|
next step:
abdominal stab wound ABC'S --> hypotensive |
emergent laparotomy/surgical exploration
|
|
next step:
abdominal stab wound ABDOMINAL EXAM --> signs of peritonitis |
emergent laparotomy/surgical expoloration
|
|
next step:
abdominal stab wound normotensive no signs of peritonitis |
EXPLORE STAB WOUND UNDER LOCAL ANESTHESIA:
if anterior fascia is penetrated --> dx'c laparoscopy if anterior fascia is not penetrated or unable to assess --> admit for serial 24 hr exams |
|
initial w/u:
blunt abdominal trauma stable vitals |
ABC's, 2 large bore IV's
CT of abdomen/pelvis |
|
initial w/u:
blunt abdominal trauma unstable vitals |
ABC's, 2 large bore IV's
assess for & manage pelvic fracture FAST Ultrasound (Focused Assessment with Sonography for Trauma) |
|
next step:
blunt abdominal trauma unstable vitals FAST shows no fluid/blood in pelvis |
angiography with possible embolization
(possible retroperitoneal hemorrhage) |
|
next step:
blunt abdominal trauma unstable vitals FAST shows no fluid/blood in pelvis angiography normal |
CT abd/pelvis
observation +/- admission |
|
next step:
blunt abdominal trauma unstable vitals FAST shows fluid/blood in pelvis |
emergent laparotomy
|
|
next step:
blunt abdominal trauma unstable vitals FAST is inconclusive |
Dx'c peritoneal lavage (DPL)
|
|
next step:
blunt abdominal trauma unstable vitals FAST shows fluid/blood in pelvis |
emergent laporotomy
|
|
initial w/u:
pelvic fracture |
ABC's, primary/secondary survey, with thorough neurovascular exam
IVF's +/- blood FAST pelvic binder (until external fixator is placed) |
|
next step:
pelvic fracture FAST inconclusive or shows no fluid in pelvis |
Dx'c peritoneal lavage (DPL)
|
|
next step:
pelvic fracture FAST inconclusive or shows no fluid in pelvis dx'c peritoneal lavage (DPL) shows nothing hemodynamic instability |
angiography with possible embolization
|
|
next step:
pelvic fracture FAST inconclusive or shows no fluid in pelvis dx'c peritoneal lavage (DPL) shows urine in pelvis |
urgent laporotomy
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next step:
pelvic fracture FAST inconclusive or shows no fluid in pelvis dx'c peritoneal lavage (DPL) shows blood in pelvis |
emergent laporotomy
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what are some common signs of urethral injury
|
blood in urethral meatus
high riding "ballotable" or nonpalpable prostate scrotal or penile hematoma |
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what study can help diagnose injury to the urethra
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retrograde cystourethrogram
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how can a bladder injury be diagnosed
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CT cystogram or cystography
|
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what are the 2 classifications of bladder injury determined by CT cystogram
|
EXTRAPERITONEAL:
below dome of bladder usually 2nd/2 pelvic fxr or penetrating trauma CT: variable path of extavasated contrast material (i.e. urine in the pelvis only) INTRAPERITONEAL: involving dome of bladder CT: intraperitoneal contrast material around bowel loops, b/w mesenteric folds, & in the paracolic gutters (i.e. urine in the pelvis AND peritoneum) |
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what is tx for bladder rupture
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EXTRAPERITONEAL:
foley catheter x 10 - 14 days (will resolve on its own) INTRAPERITONEAL: urgent (not emergent) laparotomy for definitive bladder repair |
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what type of immunodifeiciency increases the risk of anaphylactic transfusion reaction
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IgA deficiency
|
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what would you find on physical exam of a pt with pericardial effusion
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diminished heart sounds
apical impulse is difficult to palpate |
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A pt comes to the ER with chronic A-fib with RVR. What study must be performed prior to cardioversion
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TEE
|
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what antibiotic prophylaxis should be provided for rape victims; what other prophylactic measures should also be given
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ANTIBIOTIC COVERAGE:
Gonorrhea Chlamydia Trichomonas Hep B vaccine (#1 of 3 if not given) +/- Hep B Ig HIV prophylaxis OTHER: emergency contraception (plan B) antiemetic (for nausea 2nd/2 HIV meds) |
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Rx for gonorrhea
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ceftriaxone
|
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Rx for chlamydia
|
azithromycin
doxycycline |
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Rx for trichomonas
|
metronidazole
|
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what should be done to evaluate an extremity trauma
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full sensory, motor, & vascular exam
|
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Since bleeding b/w the fetus & mother is a concern in trauma, what actions should be taken once the pt & fetus are stabilized
|
administer Rhogam to Rh- mothers
|
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what antidepressant causes hypertensive crisis
|
MAOI
|
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what substance shouldn't be eaten while taking MAOIs
|
tyramine
|
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what is seen on a EKG of hypothermia
|
j wave (small upward deflection after the QRS)
|
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physical findings of endocarditis
|
fever
new heart murmur janeway lesions osler's nodes roth spots splinter hemorrhages conjunctival hemorrhages |
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when is the greatest risk for post-op MI
|
first 48 hours
|
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what is recommended perioperatively to a px with known CAD
|
telemetry monitoring
|
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what lab findings suggest hepatic disease during pre-operative work up
|
increase PT/PTT
decreased platelets increased bilirubin decreased albumin |
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what interventions help optimize lung function in the post-op period
|
ALL PT'S:
incentive spirometry pain control deep breathing PT PRE-EXISTING LUNG DS: + bronchodilators + inhaled steroids |
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what studies are ordered to evaluate the cause of a fever in a post-op pt
|
CXR & sputum culture
UA & culture blood culture examine surgical wound +/- wound culture |
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Dx
px with blood in urethral meatus of a high riding prostate |
bladder rupture
OR urethral injury |
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what can help measure how severe hypotension is in shock
|
urine output & mental status
|
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MCC's of abd'l obstruction
|
"ABC"
adhesion "bulge" = hernia cancer |
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what is the typical ER lab w/u for pt with acute abd'l pain
|
"SHOT-GUN" APPROACH:
CBC w/ diff, BMP UA (UTI's/pyelo), urine B-HCG (if childbearing age) FOBT LFT's, amylase, lipase EKG & cardiac enzymes (if > 45 y/o) |
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signs/sx's of ACUTE mesenteric ischemia
|
sudden severe abdominal pain (periumbilical) that is out-of-proportion to the physical exam
vomiting & diarrhea (usually bloody) EARLY PE: abd'l distension, +/- occult blood in stool LATE PE: abd'l distension, absent BS's, peritoneal signs, feculent odor to the breath |
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tx for acute mesenteric ischemia
|
broad spectrum AB's
NG tube decompression angiogram (dx'c & tx) heparin anticoag papaverine infusion if embolism --> embolectomy + resection of necrotic bowel if thrombus --> thrombectomy + resection of necrotic bowel |
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what does papaverine do when given to a px with mesenteric ischemia
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decreases arterial vasospasm
|
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classic signs/sx's of CHRONIC mesenteric ischemia
|
dull, crampy postprandial epigastric pain within the 1st hour after eating then subsides over 2 hours
"food fear" --> wt loss possibly n/v & early satiety abd'l bruit (50%) |
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Rx for chronic mesenteric ischemia
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SAME AS TX FOR ATHEROSLEROSIS ANYWHERE:
bypass endarterectomy angioplasty & stenting |
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what is seen on an xray or CT that indicates a ruptured viscus
|
"viscus" = internal organ
Xray/CT: pneumoperitoneum (i.e. free air under the diaphragm) |
|
which rejection is treatable with immunosuppressives
|
acute rejection
|
|
what is the mechanism of acute rejection
|
proliferation of antidonor T-cells by recepient
|
|
what time period does acute rejection occur
|
6 days to 1 year, post-transplant
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