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60 Cards in this Set
- Front
- Back
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chest injury of ribs in elederly. Rib pain. Tx
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Nerve block --local anesthetic
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Stabbed in chest. No breath sound on R and hyperresonance to precussion dx:
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Plain Pneumothorax not Tension Pneumothorax: air was in pleural space got bigger everytime he breath.
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Plain Pneumothorax
Next step: Step after that: |
Chest x-ray
chest tube |
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Base of R chest has no breath sounds and dull to precussion
DX Next step |
Hemothorax
Chest x-ray after that Bleeding from the lungs (low pressure circuit) usually stops by itself very seldom have to operate patient to stop bleeding. Having blood in pleural cavity from stab wound is contaminated causes empyema--trauma surgeon will drain blood from chest tube. |
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Need for thoractomy from Hemothorax is --- cc of blood
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1000cc of blood or blood keeps draining at like 200cc per hour for next couple hours if adds to 600cc for 6 hours.
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significance of single large air fluid level in lungs
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Hemopneumothorax
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Sign of multiple air fluid level in lungs
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Bowel in chest
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SOB,No breath sound in left hemithorax(hyperresonance) and big distended veins and shock
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Tension Pneumothorax
Next step: Needle and than chest tube. |
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severe decellaration injury --
Actively look for : |
traumatic transcetion of aorta
Steps: chest x-ray (wide mediastinum very likely) Next: Spiral CT scan of chest ( if negative with wide mediastinum) Next: arteriogram |
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Large flaplike wound in chest: Inspiration the air goes through flap but does not come out with exhale
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vaseline gauze
Dressing gets taped on 3 sides rather than 4 (clue) so the air can still come out DX: Tension Pneumothorax |
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paradoxical breathing
Dx caves in while inhale and comes out with exhale |
flial chest
TX: underlying pulmonary contuse lung which is ? Fluid restriction also colloid rather than crystalloid Managment: Do not overload with fluid and fluid restriction. Blood gases detriorated: lady needs to intubated. Also need chest tube where ribs are injured. Monitor EKG, cardiac enzymes and traumatic transection of aorta. |
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3 hardest bone to break in chest is
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sternum, 1st rib and scapula only break with crazy trauma.
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Traumatic Diaphramatic rupture
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Left side manily bowel comming into the chest.
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3 causes of Thoracic subcutaneous emphysema
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1. ruptur of esophagus(endoscopy)
2. Tension Pneumothorax 3. Tracheobronchial injury Major(need fiberoptic bronchoscopy) |
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Enormous air is coming through the tube and lung doesn't expand
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maybe bronchial injury
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sudden death from trauma think of
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air embolism
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Multiple long bone fracture with few hours later resp distress(low Po2)
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Fat embolism
Next step: Resp support and monitor blood gases. |
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Trigger finger Tx
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steriods
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felon
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Pulp of index finger with absecess
immedi surgery |
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Late 20's and early 30's.Pain and stiffness inc. Pain and stiffness worse with rest and better with activity.
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Ankylosing spondylitis
Bamboo spine Physical therapy and antiinflammatory. |
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thick and hyperpigmented ulcer. frequent episodes of cellulitis and has varicose veins.
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venous statis ulcers
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pressure point
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diabetic ulcer
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above malleouls and other charca
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venous statis ulcers
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chronic irritation
Heaped up tissue growth around the edges which is growing |
squamous cell carcinoma
Marjolin ulcer biopsy of the ulcer |
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presence of pulses does not rule out compartment syndrome (T,F)
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T
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Pt with moderate but persitent pain from cast for ankle fracture. Only one correct answer
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Cast has to be removed immediately.
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young man with MVA open fracture of R thigh femur is sticking out through skin laceration.
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ortho emergency
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deadly soft tissue reactions
most to immunocompromised. Murcormycosis: extensive burns and immunosuprressed. |
T
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Gas gangrene can happen to anyone and way it happens is
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Deep puncture wound
2 to 3 days of incubation and moribound. |
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Liquid are more hard to swallow than solids
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Mechanical problem
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54 y old black man w ith history of smoking and drinking and progressive dysphasia with solids and than liquids, lost 30 pounds of weight
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Cancer of esophagus
Next step: Barium swallow (map for esophscopy) |
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24 y old man with alchololc vomits repeated eventually bright red blood.
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Mallory weiss tear
Only affecting mucosa (bright red blood),endoscopy. |
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24 y old man with alchololc vomits repeated eventually had violent episode of vomitting,fever,leukocytosis and midsternum pain looks very sick
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perforation of barrettes esophagus, sick looking pain.
Gastrograffin swollow b/c it might estravasate not very effective pictures. If gastrograffin swallow is negative: cont with barium swallow and than immediated surgerical repair and perforation. |
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66 y old with upper GI endoscopy, 6 hours after procedure with severe constant upper retrosternal pain
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Gastrograffin swallow followed by
Barium swallow Recognize early |
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72 y old man lost 42 pounds of weight with vagues epigastric discomfort discomfort for 3 weeks
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malignancy
Next step: Endoscopy and biopsy |
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If cancer of stomach is found next step is
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CT scan of stomach
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64 y colicky abd pain and with bowel distention and coincide with colicky pain and air fluid level,protacted vomitting with distention. 5 years ago had expl lap.
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Possible due to adhesions formed the adhesion. small bowel is moving has avoided falling in trap. NG suction, nothing by mouth, let the bowel extrisate by itself if complete obstruction.
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54 y old with colicky pain with vomit, does have any BM, high pitched bowel sound, air fluid level.
6 hours after hospitalization, fever,leuks,abd tenderness |
strangulation obstruction
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22y old male anorexia, sharp severe pain localized near umbilicus, t:100, wbc 12
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Acute appendicitis
Emergency appendectomy |
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if the pt does not have anorexia
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pt does not have appendicitis
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Non typical acute appendicitis
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CT scan
sonogram(operator dependent) |
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most cancer of colon are
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adenocarcinoma
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59 Y old man fainting at job,pale and 4+ occult blood of stool hemoglobolin of 5.
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cancer of cecum or R colon
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77 y old M,colon villous adenom sigmoid,descending colon.
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yes
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FAP,gardner syndrome,turcot
Villous adenoma:50% will become cancerous adenomatous polyp: SNARE |
resecetion is mandatory
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Juvenile polyp,puetz jeger polyp,hyperplastic polyp
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Not premaligannat
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42 Y old chronic UC,90 pounds,recent relapse high steroid adn imurine, T: 104, luekocytosis, abd tender, muscle guarding and rebound, gas within wall of colon, distended colon
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chronic UC initally handle Medically
can be cured with operation by removing colon and rectal mucosa, by remove the disease. |
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27 Y old gangrenous appendicitis on clindamycin and
When u hear clindamycin |
clostridium difficle
8 hour ago cramps diarrhea c.diff: 1.stool culture and 2.proctosigmoidscopy, 3. Identify toxin |
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If c.diff toxin do not use anti diarrheal med b/c the toxin will stay there.
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true
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Anorectal dz always begin with
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Ruling out cancer
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60 y with hemmoroid, itching and discomfort and mild pain
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Internal hemmoroid: Painless bleeding
External hemmoroid: Pain but no bleed. |
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Internal hemmoroids with no pain can be cured by
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Rubber band ligation
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23 Y old w existe pain with defecation b/c of pain she avoid defecation. Physical exam is barely done b/c she is scared of pain dz
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Anal fissure
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Anal fissure occurs b/c pt has
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very tight spincter all the time
all of us creates small tear all the time but b/c of great blood supply heal immediately but thight spincter cut the blood to mucosa but if more aggressive therapy required lateral internal spincterotomy and botulism toxin |
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M 4 months ago, operation of perianal fistula but did not heal while has purulent discharge
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chrons dZ affecting anus
operation in this area heals quickly, immediatelty know if it does not heal post op it is most likely chrons. Hopefully not anorectal cancer become necrotic |
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44 Y old M, exiquisite perianal pain, he cannot sit down, chill and fever. hot tender red fluctuant mass
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peri-rectal abscess
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Perirectal abscess in normal individual
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improves
If on exam pt happen to be diabetic or immunosuppressed: it becomes necrotizing fascitis |
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Vomit blood or big evacuation of blood,gross GI bleed. where is the bleeding coming from.
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3 out of 4 comes from upper GI tract.
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abd pain in very old person
1. 2. |
sigmoid volvulus
mesenteric ischemia |
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53 Y old vague RUQ abd discomfort
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CEA has been within normal limit
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