Trauma

Front 1

What are 2 signs that an airway is present? ii)what takes precedence in cervical spine injury: the injury or the airway?

Back 1

i)pt is a)conscious b)speaking in normal tone of voice iv)airway takes precedence over cervical spine injury

Front 2

What are the 2 options in ER if need an airway?

Back 2

i)a)orotracheal b)nasotracheal over a fiberoptic bronchoscope

Front 3

How to assess breathing? x2

Back 3

i)hearing breath sounds on both sides of chest ii)having satisfactory pulse oximetry

Front 4

What are 2 options to get an airway if there is maxillofacial injuries? When can you not use PCTT?

Back 4

ii)a)cricothyroidotomy b)percutaneous transtracheal ventilation iii)if need hyperventilation for CNS injuries

Front 5

What are 2 examples of how an airway can become lost? x2

Back 5

ii)a)if there is an expanding hematoma or b)emphysema in neck

Front 6

What are signs that you need an airway x2?

Back 6

i)pt is unconscious ii)breathing is gurgly or noisy

Front 7

What are the clinical signs of shock? x5

Back 7

i)BP<90 sys ii)fast feeble pulse iii)low urinary output (<0.5 mL/kg/h) iv)pale, cold, shivering v)sweating and thirsty

Front 8

What are the 3 causes of shock in trauma? What must occur in order for tamponade or pneumo to happen?

Back 8

i)a)hypovolemia b)pericardial tamponade c)tension pneumo ii)blunt or penetrating trauma to chest

Front 9

What is the difference clinically between shock caused by tamponade/pneumo vs hemorrhagic ? What is the diff clinically b/w tamponade and pneumo?

Back 9

i)hemorrhagic has low CVP so flat neck veins; tamp/pneumo has distended head and neck veins ii)tamponade doesn't have respiratory distress

Front 10

What is the order of operations for hemorrhagic shock in trauma center that will require surgery anyway x2? What about all other cases?

Back 10

i)a)surgery to stop the bleed b)volume replacement ii)a)volume replacement w/2L Ringer lactate b)pRBCs until UOP is 0.5-2. Don't exceed CVP 15 mmHg

Front 11

What is preferred route of fluid resuscitation? If they can't be inserted, what are 2 alternatives?

Back 11

i)2 16 gauge peripheral IV lines ii)a)percutaneous femoral vein catheter b)saphenous vein cut-down

Front 12

How do you diagnose pericardial tamponade? what if its unclear? How do you treat it? What methods do you use to treat it x4? What do you want to give while setting up the treatment?

Back 12

i)clinical ii)sonogram (not xray) iii)prompt evacuation iv)a)pericardiocentesis b)tube c)pericardial window d)open thoracotomy v)fluid and blood administration

Front 13

How do you diagnose tension pneumothorax? What is first step? What is 2nd step?

Back 13

i)clinical (don't wait for ABG or xray) ii)insert big needle or big IV catheter into pleural space iii)put in chest tube connected to underwater seal (both inserted high in anterior chest wall)

Front 14

Nontrauma: What are other causes of massive fluid loss besides bleeding x4? What is the key finding? How do you treat x2?

Back 14

i)a)bad diarrhea b)pancreatitis c)peritonitis d)burns ii)low CVP iii)a)stop the bleeding b)blood volume replacement

Front 15

What are 3 types of shock?

Back 15

i)bleeding ii)cardiogenic iii)vasomotor

Front 16

What are 2 causes of cardiogenic shock? What is CVP? How to treat? Why is it being on the DDX of shock essential?

Back 16

i)a)MI b)fulminant myocarditis ii)high: distended neck veins iii)circulatory support iv)if give fluids and blood, then will be lethal

Front 17

When is vasomotor shock seen x3? What happens? what does the patient look like? What is the CVP? What is the main therapy and what else helps?

Back 17

i)a)anaphylactic rxn b)high spinal cord transection c)high spinal anesthetic ii)circulatory collapse in "pink and warm" pts iv)low v)pharm treatment to restore peripheral resistance and additional fluids will help

Front 18

What do you do for penetrating head trauma? x2

Back 18

i)surgical intervention and ii)repair of damage

Front 19

When are linear skull fractures left alone and when are they closed? What do you do if the fractures are comminuted(crushed into many pieces) or depressed?

Back 19

i)if they are closed(no overlying wound), leave alone; if open fracture, then close ii)take to OR

Front 20

What do you do for anyone w/head trauma that becomes unconscious? What happens if negative and neurologically intact?

Back 20

i)give head CT to look for intracranial hematomas ii)can go home if familiy can observe for 24 hours to ensure not getting worse

Front 21

What are signs of base of skull fracture? x4 What is the rule for therapy? What do you have to do? What don't you have to do for therapy?

Back 21

i)a)raccoon eyes b)rhinorrhea c)otorrhea d)ecchymosis behind ear ii)expectant therapy iii)get a cervical spine x ray or CT iv)ABx

Front 22

What are the 3 components of trauma that can cause neurologic damage and what are their treatments?

Back 22

i)initial blow--no treatment ii) hematoma that develops and displaces midline structures--surgery iii)subsequent increased ICP--medical measures prevent or minimizes

Front 23

When does acute epidural hematoma occur? What does CT show? What is the cure?

Back 23

i)modest trauma to the side of head ii)biconvex lens shaped hematoma iii)emergency craniotomy

Front 24

What is the classic sequence of epidural and subdural hematoma? x6

Back 24

i)trauma ii)unconsciousness iii)lucid interval (w/completely asymptomatic pt who returns to previous activity iv)gradual lapsing into coma again v)fixed dilated pupil (90% of time on side of hematoma) vi)contralateral hemiparesis w/decerebrate posture

Front 25

how is presentation of subdural hematoma diff from epidural?

Back 25

same sequence but: i)trauma is bigger ii)pt is much sicker (not fully awake and asymptomatic at any point) iii)neurologic damage is severe due to initial blow

Front 26

What does CT scan show in subdural hematoma? What is therapy if midline structures are deviated?

Back 26

i)semilunar, crescent shaped hematoma ii)craniotomy will help but bad prognosis

Front 27

What is therapy centered on for subdural hematoma if no deviation in midline structures? What are the things you want to do for the patient? x7 What do you not want to do in diuresis?

Back 27

i)preventing further damage from subsequent increased ICP ii)a)ICP monitor b)elevate head c)hyperventilate d)avoid fluid overload e)give mannitol or furosemide f)sedation to decrease brain activity and O2 demand; hypothermia is a better way of decreasing O2 demand iii)avoid lowering systemic arterial pressure

Front 28

What occurs in more severe trauma to the head? What does CT show x2? What is therapy directed at, and when to use surgery?

Back 28

i)diffuse axonal injury ii)a)diffuse blurring of gray-white matter interface b)multiple punctate hemorrhages iii)preventing damage from increased ICP; only if there is hematoma

Front 29

Who does chronic subdural hematomas occur in x2? How does it occur? What is presentation? What is diagnostic? What is cure?

Back 29

i)alcoholics; very old ii)shrunken brain is rattled around the head by minor trauma, tearing venous sinuses iii)over several days or weeks the mental function deteriorates as hematoma forms iv)CT scan v)surgical evacuation

Front 30

Can hypovolemic shock occur from loss of blood from head?

Back 30

no

Front 31

What are 4 cases where you need surgical exploration of trauma to the neck?

Back 31

i)a)expanding hematoma b)clear signs of esophageal or tracheal injury (coughing or spitting up blood) c)deteriorating vital signs d)GSW to middle zone of neck

Front 32

What is the approach for GSWs to the neck?

Back 32

i)GSW to upper zone: arteriographic diagnosis and management ii)GSW to base of neck: a)arteriography, b)esophagogram (water soluble, followed by barium if neg), c)esophagoscopy, and d)bronchoscopy before surgery to decide on specific surgical approach

Front 33

When can you just observe stab wounds in the neck?

Back 33

if i)upper and middle zones ii)asymptomatic

Front 34

If blunt trauma to the neck occurs, what must be ascertained? What is next step and what kind of patients do you do this in? What type of films x3? What is next step after?

Back 34

i)cervical spine integrity ii)need to radiologically check the spine for neuro deficit patients and neuro intact patients w/pain on palpation to cervical spine iii)a)AP, lateral cervical spine, odontoid iv)if still strong clinical suspicion, do CT scan. If there was head trauma, can extend the CT to the neck initially

Front 35

What is hemisection spinal cord injury due to? What is physical exam? x2

Back 35

i)clean cut injury like knife blade ii)a)loss of proprioception and motor on same side, below the lesion b)loss of pain on opposite side distally

Front 36

What is anterior cord syndrome typically seen in? What does physical exam show? x3

Back 36

i)burst fractures of vertebral bodies ii)a)loss of motor function b)loss of pain and temp on both sides distally c)preservation of vibratory and positional sense

Front 37

What situation does central cord syndrome present in? What is PE x2

Back 37

i)elderly w/forced hyperextension of the neck (rear end collision) ii)a)paralysis and burning pain in upper extremities b)preservation of most functions in lower extremities

Front 38

What is management of spinal cord injuries x2?

Back 38

i)precise diagnosis of cord injury w/MRI ii)high dose steroids immediately post-injury

Front 39

What is the progression in rib fracture, especially in elderly? x4 How to treat?

Back 39

i)a)pain-->b)hypoventilation-->c)atelectasis-->d)pneumonia. ii)local nerve block

Front 40

When does plain pneumothorax occur? What are the symptom/signs x3 What is treatment x3

Back 40

i)penetrating trauma (ie: jagged edge of broken rib or penetrating weapon) ii)a)SOB b)hyperresonance c)no breath sounds on one side iii)a)CXR b)place chest tube (upper, ant) c)connect to underwater seal

Front 41

How does hemothorax occur? what is diff in signs? How to diagnose? How to treat? What is the usual bleeding source? If the source is systemic vessel, what is needed?

Back 41

i) penetrating trauma (ie: jagged edge of broken rib or penetrating weapon) ii) Affected side is dull to percussion iii) Diagnose by CXR iv) place chest tube v> lung is bleeding source vii) thoracotomy

Front 42

What are the factors that dictate the need for surgery in hemothorax? x2

Back 42

i)recovering 1500 mL or more when chest tube is inserted ii)collecting over 600 mL in tube drainage over the ensuing 6 hours

Front 43

In severe blunt trauma to the chest, how do you monitor the hidden injuries?

Back 43

i)blood gases and CXR to detect developing pulmonary contusion ii)cardiac enzymes (trops) and EKG for myocardial contusion iii)traumatic transection of aorta (seek it out)

Front 44

What does PE show for sucking chest wounds(sound thru hole when breathe in)? What happens if untreated? What is first aid for this?

Back 44

i)flap that suck air w/inspiration and closes w/expiration ii)leads to deadly tension pneumo iii)occlusive dressing that allows air out (taped on 3 sides) but not in

Front 45

What is the problem in flail chest? Why? How to treat this problem? x3 What should you monitor and why? if need respirator, what should you do and why? What else should you actively seek out?

Back 45

i)the underlying pulmonary contusion ii)contused lung is very sensitive to fluid overload iii)a)fluid restriction b)use of colloids (plasma or albumin instead of crystalloids) c)diuretics iv)ABGs b/c pulm dysfcn may develop v)b/l chest tubes to prevent tension pneumo (broken ribs can puncture) vi)transection of aorta

Front 46

when does pulm contusion appear? x2 What are the signs? x2

Back 46

i)either a) immediately after chest trauma b)or up to 48 hours after (hidden injury) ii)a)white out on CXR b)deteriorating blood gases

Front 47

What should be suspected in sternal fractures? What will detect this x2? What other test is less reliable? What is the treatment?

Back 47

i)myocardial contusion ii)a)trops are specific; b)EKG iii)cardiac enzymes iv)treat for complications (arrhythmia)

Front 48

What would bowel in the chest indicate in chest trauma? What will lead you to suspect it? x2 What should you use to evaluate? From where do you do the surgery?

Back 48

i)traumatic rupture of diaphragm ii)a)PE b)CXR, both on the left side. ii)laparoscopy iii)from abdomen

Front 49

What is the ultimate hidden injury in chest trauma? Where does it happen? What situation will cause it? What is the mechanism of death? What are presenting signs and symptoms? x3

Back 49

i)traumatic rupture of aorta ii)junction of arch and descending aorta iii)big deceleration injury iv)asymptomatic until hematoma contained by adventitia blows up and kills patient v)a)knowing that patient suffered decel injury b)presence of fractures in chest bones that are hard to break (first rib, scapula, sternum) c)CXR with widened mediastinum

Front 50

In traumatic rupture of aorta w/o widened mediastinum, what tests are used? x3 Which is most practical in trauma setting? If there is widened mediastinum, what is indicated if noninvasive studies are inconclusive?

Back 50

i)noninvasive tests are used a)TEE b)CT Spiral c)MRI angiography ii)spiral CT iii)aortogram

Front 51

When would you be suspicious of raumatic rupture of trachea or major bronchus? x2 What is the diagnostic tests? x2

Back 51

i)a)developing SubQ emphysema in upper chest and lower neck b)large air leak from chest tube ii)a)CXR confirms presence of air in tissues b)fiberoptic bronchoscopy identifies lesion and allows intubation to secure an airway beyond the lesion

Front 52

What is the DDX of subcutaneous emphysema? x2

Back 52

i)rupture of esophagus (usually after endoscopy) ii)tension pneumo (but more alarming is the respiratory distress and shock)

Front 53

What is suspected when there is sudden death in chest trauma patient who is intubated and on respirator? When else does this happen and what are examples x3?

Back 53

i)air embolism ii)when subclavian vein is opened to air leading to sudden collapse and cardiac arrest: a)supraclavicular node biopsies b)central venous line placement c)CVP lines that get disconnected,

Front 54

What is the management of air embolism? What preventative measures can be used?

Back 54

i)immediately do a carotid massage ii)trendelenberg position when the great veins at base of neck are to be entered

Front 55

What is typical setting for fat embolism? What are the signs and symptoms x4? What is seen on CXR? What is mainstay of therapy?

Back 55

i)multiple trauma including several long bone fractures ii)respiratory distress with a)petechial rashes in axillae and neck b)fever c)tachy d)low plts iii)b/l patchy infiltrates iv)respiratory support

Front 56

What should you do for GSWs to abdomen and why? What level of the body is considered to involve the abdomen?

Back 56

i)exploratory laparatomy to repair intra-abdominal injuries (not to find bullet) ii)entrance or exit wound below the nipple line

Front 57

What are the indication for exploratory laparotomy in stab wounds? x3 What do you do if its not indicated? If that is equivocal?

Back 57

i)a)penetrating viscera b)hemodynamic instability c)signs of peritoneal irritation develop ii)digital exploration of wound in ER and observation iii)CT scan

Front 58

What are the signs of internal bleeding in a patient w/blunt trauma? x6 How much blood is lost in order to create these signs? Where can this amount of blood be found w/o being obvious on PE, CXR? x3 How do you narrow it down to the abdomen?

Back 58

i)a)drop in BP b)low CVP c)fast thready pulse d)low UOP e)cold, pale, anxious f)shivering, thirsty, perspiring ii)25% (1500mL) iii)a)thighs (femur fracture) b)pelvis (pelvic fractures) c)abdomen iv)multiple trauma pt w/normal CXR, normal PE going into hypovolemic shock

Front 59

What is best test for intraabdominal bleeding? what can be known from the CT? x4 What is the main limitation for CT scan?

Back 59

i)CT ii)a)if the patient has blood in ab b)will show the injury from where the bleeding is from c)gives an idea how bad the injury is d)w/the pt's response to fluids, it allows a decision to be made for surgery or expectant therapy iii)hemodynamically stable

Front 60

In intraabdominal bleeding, what type of patient doesn't need surgery? Who does require surgery?

Back 60

i)minor internal injuries who responds promptly to fluid resuscitation ii)major injuries and vital signs not improving w/fluid resuscitation

Front 61

How do you diagnose intraabdominal bleeding in pt who is hemodynamically unstable? x2 If positive, what should you do?

Back 61

i)a)DPL b)sonogram ii)proceed to exploratory laparotomy

Front 62

What is the most common source of significant intra-ab bleeding in blunt ab trauma and what is it due to? What is most common source in general? What is attempted to be done for these patients? What must you do if have to remove it?

Back 62

i)spleen, due to fracture of lower ribs on left side ii)liver iii)try to repair it, not remove it iv)post op immunization against encapsulated bacteria (pneumococcus, H flu, meningococcus)

Front 63

What occurs during prolonged ab surgery for multiple trauma w/multiple transfusions? How to treat? What do you do if hypothermia and acidosis?

Back 63

i)intraoperative coagulopathy ii)empirically treat w/platelet packs and FFP iii)termination of laparotomy w/packing of bleeding surfaces and temporary closure w/towel clips. Resume later when pt warmed and coagulopathy treated

Front 64

What happens when lots of fluids and blood are given during course of prolonged laparotomies? What do you do, and what materials can you use?

Back 64

i)abdominal compartment syndrome: tissues are swollen at closing time and abdomen can't be closed w/o too much tension ii)put temporary cover over ab contents: a)absorbable mesh b)nonabsorbable plastic thats removed later

Front 65

When does abdominal compartment syndrome often occur if not immediately? What do you do then?

Back 65

i)2 days Post op: pt gets distended w/retention sutures cutting thru tissues, hypoxia secondary to inability to breathe, and renal failure from pressure on vena cava. ii)abdomen must be opened and temporary cover provided

Front 66

What do you do for pelvic hematomas if not expanding?

Back 66

leave alone

Front 67

What must you rule out in any pelvic fracture? x4

Back 67

associated injuries: i)rectum (rectal exam and proctoscopy) ii)bladder iii)vagina via pelvic exam iv)urethra in men (retrograde urethrogram)

Front 68

How to diagnose pelvic fractures w/ongoing bleeding?

Back 68

i)hypovolemic shock in pelvic fracture w/r/o of other bleeds (-sono/-DPL; or --CT).

Front 69

In pelvic fracture, what are the ways to decrease bleeding? What don't you want to do?

Back 69

i)external fixation ii)arterial: arteriographic embolization iii)not surgery!: lose tamponade effect and often inaccessible

Front 70

What is the hallmark of urologic injuries? How is microscopic hematuria in traumatized but otherwise asympto adult differ from child and why?

Back 70

i)blood in urine in a person who sustained penetrating or blunt abdominal trauma ii)no w/u in adult, but child needs it b/c they could have a vulnerable GU tract due to congenital problems. Esp when magnitude of trauma doesn't justify development of hematuria

Front 71

What do you do for penetrating urologic injuries?

Back 71

surgically explore and repair

Front 72

when blunt urologic injuries occur, what 3 things can be affected and what is the usual source?

Back 72

i)kidney: due to lower rib fracture ii)bladder or urethra: pelvic fracture

Front 73

How does urethral injury present and what is ass'd w/? What 3 other signs can occur in the clinical picture? What is the key thing that you shouldn't do and what should be done instead?

Back 73

i)blood at meatus; ass'd w/pelvic fracture ii)a)scrotal hematoma b)posterior injuries: sensation of wanting to void but not able to c)high riding prostate on rectal exam iii)Don't insert a foley (worsens the injury); use retrograde urethrogram

Front 74

How do you treat anterior urethral injuries, and how do you treat posterior injuries? ii)what would be another diagnostic clue suggesting urethral injury?

Back 74

i)ant: surgery; post: suprapubic drainage and delayed repair ii)try to insert foley but have resistance

Front 75

How to dx bladder injury? What do you need w/the xray studies and why? How to treat bladder injury?

Back 75

i)DX by retrograde cystogram ii)xray study includes postvoid films to see extraperitoneal leaks at base of bladder that might be obscured by bladder full of dye iii)surgical repair, protected w/suprapubic cystostomy

Front 76

How to assess renal injuries in blunt trauma? how are they usually managed?what are 2 sequela that can occur?

Back 76

i)CT ii)nonsurgically iii)a)get an AV fistula leading to CHF b)if renal artery stenosis develops, get renovascular htn

Front 77

When do you need intervention in scrotal hematomas? How to assess this?

Back 77

i)if get rupture of testicle (can get huge prior to this) ii)sonogram

Front 78

What is fracture of penis? When does this happen? How does it present? How to treat this and if not done, what will happen?

Back 78

i)fracture of corpora cavernosa, fracture of tunica albuginea ii)accident during vigorous intercourse w/woman on top iii)sudden pain and devlopment of a large penile shaft hematoma, w/normal appearing glans. iv)emergency surgery is needed v)impotence due to AV shunts

Front 79

What is the main issue in penetrating injuries of extremities? What is the first clue?

Back 79

i)whether or not vascular injury occurred ii)anatomic location

Front 80

In penetrating injury of extremities, if no major vessels in vicinity of injury tract, what is needed? x2 If penetrates near a vessel and the pt is asymptomatic, what should be done? (2 options) When should surgical exploration and repair be done?

Back 80

i)tetanus shot and cleaning of wound ii)doppler or if needed, arteriograms iii)if obvious vascular injury (absent distal pulses, expanding hematomas)

Front 81

If there is injury of arteries, nerves and bone, what order do you repair? What else should you do and why?

Back 81

i)bone>vascular repair(would be ruined during bone repair if first)>nerve ii)do a fasciotomy b/c prolonged ischemia can lead to compartment syndrome

Front 82

What happens with high-velocity GSWs and what needs to be done?

Back 82

i)get a large cone of tissue destruction ii)requires extensive debridements and potential amputations

Front 83

What problems occur in crush injuries? x5 What do you do for each?

Back 83

i)hyperkalemia; myoglobinemia; myoglobinuria; renal failure; compartment syndrome. ii)a)everything besides compartment syndrome: give fluids, osmotic diuretics, and alkalinzation of urine b)fasciotomy

Front 84

What do you do immediately in chemical burns? Which is worse: alkaline or acidic burns?

Back 84

i)massive irrigation asap ii)alkaline

Front 85

What is needed in high voltage electrical burns?

Back 85

i)deeper and worse than they appear, so need massive debridements or amputations.

Front 86

In electrical burns, What other problems can occur? x3

Back 86

ii)a)myoglobinemia-myoglobinuria-renal failure (give lots of fluids and osmotic diuretics like mannitol and alkalinze the urine). b)orthopedic injuries due to massive muscle contractions: 1)post dislocation of shoulder, 2)compression fractures of vertebral bodies c)late development of cataracts and demyelinization syndromes

Front 87

What are respiratory burns (inhalation injury?) What are suggestive clues? x2 What is the key issue, and how do you go about figuring this out? How to DX? What should you monitor and what is the cure for it?

Back 87

i)chemical injury that occurs w/flame burns in closed space due to smoke inhalation. ii)a)burns around the mouth b)soot inside the throat iii)whether respirator is needed; use ABGs iv)Monitor carboxyhemoglobin. v)use 100%O2

Front 88

What is a sequela of circumferential burns of the extremities and how? What can happen in circumferential burn of chest? How to provide immediate relief?

Back 88

i)get cutoff blood supply b/c get edematous underneath the eschar ii)can get problems w/breathing iii)esharotomy at bedside, no anesthetic

Front 89

What should you think about w/scalding burns in children? What is a common method of doing so?

Back 89

i)child abuse, esp if description of what happened doesn't match the burn. ii)burns on buttocks b/c dipped into boiling water

Front 90

What is the rule of 9 for extent of burn?

Back 90

head and each of upper extremities=9%; lower extremity is 2 9%, trunk is 4 units of 9%

Front 91

How do you estimate the amt of fluids are necessary on day 1 and 2 for a burn victim? 3rd day what happens? What should you aim for in the pt's response?

Back 91

1st day: kgBW x %burn (up to 50) x 4 mL +2000ccD5W. Want to infuse 1/2 the first 8 hours; infuse 1/2 the next 16 hours. 2nd day: 1/2 of the above, and may use colloid. 3rd day: no need for further fluid infusion, and get a brisk diuresis. Aim for 1-2cc/kg/hr in UOP

Front 92

If you don't use the formula for figuring out fluids in a burn victim>20%, what can you do? What do you avoid in fluids?

Back 92

i)start at predetermined rate of infusion (1000mL/h) of LR (w/o sugar) on pt and adjust based on UOP. Make sure you don't induce osmotic diuresis from glycosuria thus no sugar (invalidates meaning of UOP)

Front 93

How do you use rule of 9 in babies? What is diff in 3rd degree from adults vs baby? What is amt of fluid you need for baby? What is appropriate rate of initial fluid infusion?

Back 93

i)Babies have bigger heads and smaller legs, so 2 units 9% in head; both legs share 3 9's. ii)3rd degree in adults vs babies: adults=dry, leathery, gray; babies=deep bright red. iii)To calculate fliuds, use same equation except 4-6mL vs 2-4mL.(% x Kg x 4ml) iv)rate of initial infusion: 20mL/kg/hr if burn>20%

Front 94

What other 3 things should you do in burn care besides fluids?

Back 94

i)tetanus ppx ii)cleaning of burn areas iii)use of topical agents

Front 95

What is the standard topical agent in burn care? What should you use for deep burns (thick eschar, cartilage)? What should you use for burns near eyes? How is pain medication given in early period? When is nutrition given and how? What happens after 2-3 weeks of wound care and general support? When does rehab start?

Back 95

i)silver sulfadiazine ii)mafenide acetate (not used everywhere b/c can hurt and produces acidosis iii)triple Abx ointment. iv)pain meds given IV v)Nutrition given after day or 2 of NG suction via the gut w/high-calorie/high-nitrogen diet. vi)burned areas are grafted vii)day 1

Front 96

Why do you do early excision and grafting? What does it mean? WHat kinds of burns can you do this in?

Back 96

i)save costs and minimize pain, suffering, complications ii)implies removal in OR (on day 1) of burned areas w/immediate skin grafting iii)limited burns (<20%)

Front 97

What is needed for all bites? x2

Back 97

i)tetanus ppx ii)wound care

Front 98

What do you do for provoked dog bites (pet while eating)? What if bitten on face?

Back 98

i)no rabies ppx but observe dog for signs of rabies ii)b/c close to the brain, give rabies ppx and dc if observation of dog is reassuring

Front 99

What do you do for an available unprovoked or wild animal bite? If can't catch the animal, what should you do?

Back 99

i)kill and exmaine brain for rabies ii)rabies PPX is mandatory (Ig + vaccine)

Front 100

Do poisonous snakes always lead to envenomation? What are the signs of envenomation (x3) and how long after bite? What tests should you get? x4 What is the treatment? How is the treatment dosed? What is the only valid 1st aid during transportation?

Back 100

i)no, 30% don't get envenomated ii)a)severe pain, swelling, discoloration present w/in 30 minutes of bite. iii)a)type and match b)LFTs c)RFTs d)coags iv)antivenin, and dosed to size of venom, not patient. v)1st aid: splint extremity during transportation

Front 101

Why do bee stings kill more than snakes? What is drug?

Back 101

i)anaphylactic rxn ii)epinephrine

Front 102

what are sxs of black widows? x3. What is antidote? What else might help?

Back 102

i)a)nausea b)vomit c)severe generalized muscle cramps ii)IV calcium gluconate iii)musce relaxants

Front 103

How does brown recluse spider bite present? what drug is helpful? When do you excise it surgically?

Back 103

i)skin ulcer develops the following day, and surrounded by halo of erythema. ii)dabsone iii)should be delayed until full extent of damage is evident (up to 1 week). May need grafting

Front 104

How to treat human bites? x2

Back 104

dirtiest bites: i)irrigation and debridement in OR