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90 Cards in this Set

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Trauma ABC: airway


- indication for intubation


- best method of intubation


- in ceervical spin injury


- extensive facial trauma + bleeding of airway (gurgling sound)

- altered mental status


- best: orotracheal intubation


- cervical: use flexible bronchoscope = OT intubate w/ manual cervical immobilization


- airway bleeding: cricothyroidotomy or percutaneous tracheostomy

Trauma ABC: breathing


- what to do

1. check O2 sat. if <90 do


- ABG, deetermine likely cause of hypoxia

Trauma ABC: circulation


- etiology + dx signs

- hypovolemic shock: look fo bleeding (abd or thich after femur fracture)


- pericardial tamponade: electrical alternanas, pulsus paradoxus, enlarged heart on xRAY


- tension pneumothorax: trach dev, hyperressonance, decr breath sounds.


To do: large-bore needle or IV catheter => chest tube. NEVER wait for CXR for dx

Circulation to do:


- 2 stepts

1. control bleeding site: direct local pressure (never clamping/turniquet)


2. fluid resuscitation


3. prepare for exploratory laporotomy: 2 large gauge IV lines, fluids, type and screen, foley catheter, admin IV antibx

Vasomotor shock


- signs


- etiology


- tx

- sx: warm, flushed, tachy, hypotension


- etio: medication (penicillin), spinal anesthesia, exposure to bee sting


- tx: fluids and vasoconstrictors

Trauma to localized site


- to do

All PENETRATING wounds need to go to OR


Never remove embedded object until in OR

Head trauma: what to do


1: scalp lac + linear skull fracture on CT. no loss in consciousness (NLC)


2. scalp lac + comminuted, depressed frac, NLC


3. NLC for few sec + nl neuro exam

1. clean any lac


2. surgery even if pt unsx


3. CT had and neck w/o contrast. if nl, can go home if close ob for next 24 hrs (wakhime freq)

Basak skull fracture


- sx


- tx steps

- sx: Battle's signs (behind ears), raccoon eyes, clear fluid dripping from ear or nose (CSF leak)


- tx: CT head and neck, tetanus toxoid & ppx antibx for all FRACTURES (except when?)


Expect facial palsy 2-3 days 2/2 neurapraxia


CSF leak will stop by itself = antbx C/I

Epidural hematoma


- etio


- sx


- mgmt

- middle meningeal artery


- sudden loss of consciousness => regain = lucid interval


- mgmg: CT w/o contrast see lens-shaped w/o midline deviation) => emergency craniotomy

Chronic subdural hematoma


- etio


- sx


- mgmg

- etio: bridging veins


- sx: head trauma w/ fluctuating consciousness (gradual headaches, memory loss, confusion, drowisness)


- mgmt: CT = semilunar, emergency cranio if ONLY there is lateralizing or midline displacement

diffuse axonal injury


- etio


- tx

- etio: aceleration-decel injries

- surgery does NOT help = prognosis bad.


To do: prevent further injury from ICP


elevated intracranial pressure (ICP)


- classic hx


- dx

- hx: briefly depressed consciousness => improvement => progressive drowisness

- dx: gradual dilatation of one pupil & decr responsiveness to light (clot expansion on ipsi). CT head w/o contrast for midline shif or dilated ventricles


ICP


- goal


- first line


- second line (use of steridos)

- goal: preserve brain perfusion (not lower ICP so don't OVERTREAT)


- 1st line: head elevationn, hypervent, avoid fluid overload


- 2nd line: mannitol (can reduce cerebral perfusion), sedation w/ hypothermia


- steriods: good for edema 2/2 tumors or abscesses. NOT TRAUMA

Acute abdomen


- etio (4)


- nonsurg causes (8)

- perofration, obstruction, inflam/infxn, ischemia

- nonsurg: MI, pancreatitis, LL penumo, GERD, hepatitis, DKA, sickle cells crisis, acute porphyria


Acute abdomen


- when to treat surgically (caveat)

- r/o pancreatitis first

- peritonitis (exclude primary [spon] even if fever & leukocyotsis present)


- abd pain + sx of sepsis


- acute intestinal ischemia


- pneumoperitoneum


GI Perforation


- classic case


- etio (w/ calssic sx)


- dx testing

- case: acute abd pain that is constant & generalized. excruciating w/ any mvmt

- etio: diverticulitits (LQR + fever), perforated peptic ulcer (epigastric waking pt at night), Crohn's


- erect chest xray( free air under diaghram). if can't then left lateral decubitus x-ray


GI perforation

- tx


1. NPO + IV fluid hydration

2. IV antibx: metro + cipro, 2nd gene cepha (cefotetan, cefoxitin), ampi-sulbactam, zosyn


3. emergency surgery


Esophageal perforation


- etio


- sx


- dx testing


- tx

- etio: iatrogenic: after endoscopy

- sx: pain in chest, dysphagia or odynophea, subq emphysema


- dx: gastrografin contrast esophagram


- tx: surgery emrg


Abdomen Obstruction


- sx (4)


- risk factors (5)

- sx: severe colicky pain, absent flatus, high-pitched bowel sounds, constatn mvmt

2. risk factors: N/V with


- prior surgery (adhesions)


- elderly pt w/ wt loss, anemia (tumor)


- hx of recurrent lower abd pain (diverticulitis)


- hx of hernia


- elderly (volvulus)


Abdomen obstruction


- dx test


- tx

- dx: elevated CBC & lactate, supine & erect abd xray, CT w/ contrast (see TRANSITION PT)

- tx: NPO, NG suction, IV hydration


- Volvulus: proctosigmoidoscopy w/ rigid instrument. leave rectal tube in place. sigmoid resection for recurrence


- Abd hernia: elective repair except umbilical hernia in <2 yo & esophageal sliding hiatal


- All others surgical emergency


Abdomen Inflammation


1. etio (3)


2. classic case


1. etio: acute diverticulitis

- acute pancreatitis (NO peritoneal sign)


- acute appendicitis


2. case: gradual, building constant abd pain


- initial ill-difined pain that localized to site


Inflammation: diverticulitis


1. sx


2. why location


3. to do

1. LLQ, middle age/older w/ fever, leukocyotiss, LLL peritoneal irritation w/ palpable tender mass

2. sigmoid smallest DM = highest intraluminal p


3. give preg test to ALL women of childbearing age, CT


Abdomen inflammation


1. dx


2. tx: peritoneal vs no

1. CT w/ contrast: fat stranding = inflammed bowel

2. tx: no peritoneal sign = OP antibx


- peritoneal sign & abscess: admit, NPO, IV fludis, IV antibx, CT guided perQ drainage of abscess


- generalized peritonitis: emergency


- recurent diverticulitis: elective surgery


Acute pancreatits


1. types


2. sx (3)


3 complications

1. hemorrhagic, edematous, suppurative (abscess)

2. alcoholic w/ acute (sever hr) upper pain radiating to back, N/V


3. pancreatic pseudocyst, chronic pancreatitis




Acute pancreatitis


1. risk factors (6)

- alcoholism

- gallstones


- meds (pentamidine, flagyl, tetracycline, diuretics)


- hypertriglyceridemia


- trauma


- post-ERCP


Acute pancreatitis

- lab values of hemorrhagic type (5)

- falling hematocrit

- very hgi WBC (>18000)


- high glucose, BUN


- low calcium (free fatty acids chelate salts = Ca depositis in retroperitoneum)


Acute pancreatitis


1. dx


2. tx


3. tx of complications (3)

1. serum (12-48hrs) or urinary (3-6 days) amylace [highest sens] or lpase [highest spec], CT

2. NPO, IV lfuids, suction


3. abscess (appear after 10 days): surgical drainage


- pseudocyst (5 wks after): painless = nothing, pain & > 6cm & > 6wks: surigcal internal drainage or endosopic drainage. if infected, perQ external drainage


- chronic damage: insulin (diabetes), pancreatic enzyme supplements (steatorrhea)



Acute appendicitis


1. prog of sx


2. dx testing

1. begins w/ anorexia => periumbilical pain => RLQ pain, tenderness, guarding, rebound


2. rovsing sign: LLQ palpation = incr RLQ pain


- fever, leuko 10 - 15mil, CT

Acute appendicitis


- tx

1. IV antbx before appendectomy

- cipro & metro


- ampi/sulbactam


- cefoxitin or feotetan


- levofloxacin and clindamycin


2. if perforated, continue IV until WBC normalized


chronic ulcertaive colitis


1. tx


2. when for elective surgery (4)

1. mangaged medically


2. dz > 20 yrs (malig)


- mulitple hospitalization


- high dose steroids, immunosup


- toxic megacolon (abd pain, fever, leuko, massive distended colon on xry)

Abdomen ischemia (MC is SMA b/c angle)


1. risk factors (4)


2. sx labs


3. tx (CCS tip)

1. older pts, hx of afib, CAD, MI hx

2. pain out of proportion ot exam, acidosis, elevated lactate


3. surgery = embolectomy & revas or resection


- if dx during angiography: vasodilators or thrombolysis


- GET surgical consultation for any acute abdomen on CCS


Abd abscess

1 indcation


2 dx


3 tx


1. hx of operation, trauma or abd infection

2. CBC, contrast CT


3. drain (surg or perQ), antibx to prevent spread of infxn


Obstructive jaundice from stones


1. epidimeo


2. dx imaging sign


3. dx labs


4. tx

1. obsese women in 40s w/ recurrent abd pain

2. US: diated ducts. can confirm with EUS (endoscopic US) or MRCP


3. high direct bili, high alkaline phosphatase


4. tx: ERCP w/ sphincterotomy, cholecystectomy


Obstructive jaundice by tumor

1. common locations


2. sx


3. dx


4. tx


1. adeno in pancreatic head, adeno in ampulla of Vater, cholangiocarcinoma (common duct)


2. sx: pprog sx with wt loss


3. US, CT (if lesion, get bx via EUS. if not see lesion, get MRCP and bx via ERCP)


4. resection

Biliary colic


- sx


- dx


- tx

- sx: brief (20min) colicky pain, radiating to right shoulder and back, caused by fatty founds. NO peritoneal sx

- dx: US


- tx: elective chole


Acute cholecystitis

1 sx


2 dx findings


3. tx



1. constant pain, fever, leuko, peritoneal sx

2. murphy's sign: hurts when inhalation


- US: thick wall gallblader, pericholecystic fluid


3. NG suction, NPO, IV fluids, antbx


- chole after 6-12 wks. emerg chole onlif if generalized peritonitis or emphysematous chole



Acute ascending cholangitis


1. etio


2. sx


3. dx labs


4. tx

1. obstruction of common duct

2. reynold's pentad: jaunidce, fever, pain, AMS, shock


3. fever, high WBC, alkaline phosphatse, high total bili and direct


4. IV antbx, emerg decompression fo common duct via ERCP, eventual chole


Fecal incontinence


1. def


2. dx test


3. tx

1. involuntary BM for at least 1 mth for age > 3

2. 1st test: flexible sigmoidoscopy or anoscopy. if anatomic injury, get endorectal manometry


3. best initial = bulking agents (fiber) w/ biofeedback (muscle strengthening exercise)


- next level: endoscopic injuction of dextranomer/hyaluronic acid (create pesudo-sphincter)


- next: surgery


preop assessment


1. goal


2. cardiac risk (4 + to do for each)

1. identify comorbidities that preclud surgery

2. EF < 35% = no noncardiac surgery


- JVD: optimize ACEi, BB, digitilis prior to surgery


- recent MI: defer surgery until 6 mths


- severe prog angina: caridac cath to evaluate for revascularization


PreOp Assessment


- pulm risk

- high pCO2: get PFTs for FEV1

- FEV1 < 1.5: get blood gas


- cessation of smoking 8 wks before surgery


PreOP assessment


- hepatic risk

- bili > 2.0

- PTT > 16


- serum albumin < 3


- encephalopathy


- 40% mortalitiy with any one; 80% wi/ 3 or more


PreOp assessment


- nutritioanl risk

- loss of 20% wt over mths: 5-10 days fo supplements via gut before surgery

- albumin < 3: same


- serum trasnferrin < 200, diabetic coma: no surgery. stablize, rehydrate, normalize acidosis


Post op fever dx of 101-103F


- list 4, day of post op, their dx testing, tx

1. wind: atelectasis. POD1 = CXR, spirometry

2. water = UTI POD 3. urinalysis and cx


- tx: CXR, sputum cx, antibx of hospital-acq


3. walking = thrombophlebitis POD5. doppler


- anticoag


4. wound POD 7. complete physical exam and consider CT scan adn then drain


Pos op:


1. if disorientation


2. fecal, gastric, duodenal leakage to outside

1. hypoxia most likely, get blood gas

- sepsis: bld cx, CBC


2. observe. correct fluids/electrolytes.


Post op complciation fever


1. malignnat hyperthermia (>104F): 4


2. bacteremia >104F


3. periop MI

1. after halothane or succinylcholine: IV dantrolene, 100% O2, acidosis correction, cooling blankets, watch for myoglobinuria


2. within 30-40min of procedure: bld cx x3, empiric antibx


3. 2/2 hypotension druing surgery = no thrombolytics

Post op complication: sx, dx, tx


1. PE (day 7)


2. aspiration


3. intraop tnesion pneumo


4. ARDS


5. alcoholics

1. tachy, SOB: CTA, anticoag w/ heparin

2. CXR. tx with lavage, bronchodilators, resp support


3. pt more difficult to bag, BP decline, CVP incr


- needle depcression


4. PEEP


4. delirium tremens (day 2-3): tachy, hypertemp, hypertension. give benzo (watch for seizures, rhabdo)


VACTERL syndrome


1. define and what to order

- Vetebral anomalies: xry

- Anal atresia: exam. look for fistula nearby. if have, delay repair until growth. if nto colostomy


- Cardiac anomalies: echo


- TracheoEsoph fistula: NG tube dx


- Renal anomlies: US


- Limb defects: XRY


Congenital diaphragmatic hernia


1 assoc dz


2 sx


3 dx test


4 tx

1. hypoplastic lung

2. dyspnea at birth


3 XRY: loops of bowel in left chest. right side hernia cause liver herniation


4. endotracheal intubation, low-pressure vent, sedation, NG suction. delay repiar 3-4 days to allow lung maturition


1. gastroschisis: cause, sign


2. omphalocele: cause, sign


3. dz assocation


4. tx

1. gastro when neural crest fails to migrate = defect R of cord, no membrane

2. omp: incomplete fusion = cord goes to defect, has memrane


3. omphalocele assoc w/ Trisomy 18 adn 13


4. small defects = close indep.


- large: silo to protect bowel, manual replacement of bowel, parenteral nutrition, IV anbx


Exstrophy of urinary bladder


1 sx


2. tx

1. abd walld efect ove rpubis

2. transfer pt to specialized site for surgery in first 1-2 days of life. NO DELAY


ddx for double-bubble sign

annular pancreas

duodenal atresia


malrotation


intestinal atresia


1. cause


2. sx


3. dx testing

1. vascualr acciden in utero. no need to look for other anomalies

2. green vomiting


3. XRY multiple air fluid levels in abdomen


Necrotizing enterocolitis


1. sx (3)


2. etio


3. tx

1. feeding intolerance in premies, abdominal distention, rapid platelet drop (sign of sepsis in babies)

2. E.coli, Klebsiella


3. stop all feeds, IV fluids & nutrition, broad-spec antibx, surgery if encrosis or perforation




Meconium ileus


1. sx


2. dx testing


3. tx

1. feeding intolerance & bilious vomiting in baby for CF

2. XRY: multiple dilated loops of small bowel


3. gastrografin enema is diagnostic (pellets in emrinal ileum) and therapeutic (draws fluid in adn dissolves pellets)


Hypertrophic pyloric stenosis


1. sx (3)


2. dx testing


3. tx

1. nonbilious projectile vomiting after feeding, gastric peristaltic waves, olive mass

2. US


3. 1st correct dehydrdation, hypochloremic, hypokalemic metabolic alkalosis followed by pyloromyotomy


biliary atresia


1. sx


2. dx testing


1. peristent progr incr jaundice (conjugated)

2. gett serologies and sweat test to r/o other etio


- HIDA scan after 1 week of phenobarbital (powerful choleretic)


- if no bile get to duodenum after pheno, surgical exploration


Hirschsprung disease


1. sx


2. dx testing

1. chronic constipation

2. full-thickness bipsy of rectal mucosa.


3. tx: rectal exam lead to explosive expulsion fos tool and flatus


1. Surgical conditiosn in 1st 2mths of life


2. surgical conditions later in infancy

1. necrotizing enterocolitis, meconium ileus, pyloric stenosis, bilary atresia, Hirschsprung

2. intussusception, Meckel diverticulum


Intussusception


1. classic sx (5)


2. dx testing


3. tx

1. chubby, healthy-looking baby w/ brief episodes of colicky abd pain that "double over and squat", mass on right side, currant jelly stools

2. barium or air enema both diagnostic and therapeutic


3. surgery if enema fails


Meckel diverticulum: true = consist of all 2 layers


1. sx


2. dx testing


3. tx

1. lower GI bleeding

2. radioisotope scan looking for gastric mucosa in lower abdomen


3. resection


General rules on bone fractures


1. XRY orders


2. complication to dirty or deep-penentrating


3. facial fractures


4. tx for open fracture

1. 2 views at 90 to one another, include joitns abvoe and below brokoen bone

- get XRY of sites in line of force: lumbar spine for landing on feet, hips for MVA knee on dash


2. gas gangrene: IV penicillin, hyperbaric O2


3. get cervical spine films


4. clean in OR & reduction within 6 hrs of injury


When to answer


1. closed reduction


2. open reduction and internal fixation

1. fractures not badly idsplaced or angulated


2. severly displaced, angulate dor cannot be aligned

1. Anterior dislocation: sx, dx testing


2. Posterior: etio, sx, dx desting

1. arm hled close to body but externally roated forearm


- numbness over deltoid (axillary n stretched)


- PA films


2. etio: seizure, electrical burn, shoulder injury


- sx: arm held close to body, forearm internally roated


- dx: axillary or scapular xry views

Mgmt of


1. clavicular fractures


2. colles': sx, tx


3. direct blow to ulna (Monteggia) or radius (Galeazzi)

1. figure eight sling


2. painful wrist w/ dinner-fork deformity in elder women falling on wrist


- txx: closed reduction and casting


3. open reduction & internal fixationf or diaphyseal fracture and closed reduction for dislcoated joint

Mgmt of:


1. scaphoid fracuterre: sx, tx


2. hip fracture: sx, complications


3. femoral neck fractures


4. intertrochanteric fractures


5. femoral shaft fractures

1. snuffbox pain, thumb spica cast


2. elderly who falls, external rotated & shortened leg


3. femoral head replacement (watch for avascualr necrosis)


4. open reduction and pinning


5. intramedullary rod fixation (watch for fat emboli)

Mgmt of


1. trigger finger: sx


2. De Quervain tenosynovitis: sx


3. Depuytren contracture: sx


4. posterior dislocation fohip sx(2)

1. woman awken at night w/ flexed finger than snaps: steriods


2. mother carrying baby with flexed wrist & extended thumb: steriods


3. palm contracturew/ fascial nodules: collagenase, if fails surgery


4. internally rotated leg (defer from hip frac), hx of MVA w/ kneeds at dashboard


- tx: emerg reduction

Mgmt of


1. Medial/lateral collateral ligament (direct blow on opposite side joint)


2. ant/post cruciate ligament: sx


3. meniscal injury: sx



1. casting if isolated ligametn, surgical repair if multiple


2. swelling pain. arthroscopic reapir for young atheletes. immobilization & rehab for elder


3. prolonged pain & swelling w/ catching adn locking. anthroscopic repair

Mgmt of


1. Tibial strss injury: sx


2. Achilles rupture: etio, sx, tx

1. sx = hx of miliary or cadet marches (xry neg)


- tx: cast, order not to bear wt, repeat films in 2 wks


2. etio: over tennis/basketball, quinolone use


- sx: sudden popping and limping


- tx: casting in equinus position or surgical repair

Carpal tunnel syndrome


1. anatomic def


2. risk factors (3)


3. dx testing


4. tx

1. median n entrapment = pain, paresthesia


2. RF: rheumatoid arthritis, acromegaly, hypothy


3. Tinel's (tapping nerv) > specificity than Phalen's (flex wrist adn hold position)


4. NSIADS adn splinting. local steriods. surgical release if splinting not work

compartment syndrome


1. classic case


2. sx


3. tx

1. pain at site of cast = remove it and look for


2. excruciating pain with passive extension, pulses often normal


3. emrg faciotomy

Oblique distal humerus injury


1. complication


2. sx


3. mgmt

1. radial n


2. can't extend wrist, function return after reduction


3. surgery if paralysis continues after reduction

Posterior dislocation of knee


1. complication


2. sx


3. mgmt

1. popliteal artery


2. decr distal pulses


3. doppler, arteriogram


- if reduction delayed, get prophy faciotomy

Disk herniation


1. location


2. sx


3. dx


4. tx

1. L4/L5, L5/S1


2. sudden shooting pain


3. + straight leg. no imaging necessary


4. NSAIDS + rest

Nerve involved in


1. sluggish ankle jerk reflex


2. sluggish patellar reflex

1. S1/S2


2. L4/L5

Annkylosing spondylitis


1. sx


2. dx testing


3. tx

1. male w/ chronic back pain and morning stiffness that improves w/ activity


2. XRY = bamboo spine, screen for uvieitis and IBD (HLA-B27 antigen but DO NOT get testing)


3. NSAIDS, physical therapy

Metastic malignancy


1. classic case


2. etio for blastic


3. etio for lytic


4. orders

1. elderly w/ progr & constant back pain worse at ngiht & unrelieved by rest


2. prostate, breast


3. lung, renal, breast, thyroid, multiple myeloma


4. order XRY (for MM), bone scan (do not order in lytic), MRI

Plantar fascilits


1. sx


2. dx testing


3. tx

1. older, overweight pts w/ sharp heel pain when strikes ground, worse in morning but quickly resolves after walking


2. XRY show bony spur but does not change mgmt


3. sx tx. resolves spon in 12-18 months. DO NOT remove spur

morton neuroma


1. def


2. sx


3. tx

1. inflam of common digital n at 3rd interpace btw 34d and 4th toes (from pointy shoes)


2. neuroma plapable, very tender at site


3. analgesics, appropriate footwear

Testicular torsion


1. sx (3)


2. dx


3. tx

1. sever sudden testicu pain w/o fever or pyruia


- tender testis, high riding w/ horiz lie


2. US but do not wait for results before surgery


- no cremasteric reflex (L1/L2)


3. surgical untwisting w/ b/l orchiopexy

acute epididymitis


1. sx


2. dx testing


3. tx

1. acute scrotal (abd) pain, fever, urinary sx


2. UA, cx, and cx of discharge


3. male <35 = tx GC/CH w/ ceft * doxy


older: tx UTI (E.coli) w/ levofloxacin

Urologic obstructions


1. emergency situation


2. tx

1. obsturction w/ infxn (fever, chills, flank pain) = kidney destruction + sepsis in few hrs


2. ureteral stent or precutaneous nephrostomy to depcress urinary tract above obsruction, IV antibx

Congenital urologic dz


1. posterior urethral valves: sx


2. hypospadias (ventral side)


3. child w/ hematuria from trivial trauma





1. boy do not urinate

- catheterize, dx w/ voiding cystourethrogram


2. plastic reconstruction (no circumcision)


3. undx congeital anomaly until prove otherwise


Congenital urologic dz


1. child w/ UTI


2. low implantation foureter: sx


3. Ureteropelvic junction obstruction: sx

1. get voding cystogram (vesicouretheral reflux). if found give antibx until child grows out of it


2. in girls who void but constantly wet from urinating into the vagina


3. teenage drinks large volumes of beer and develops colicky flank pain

Subclavian steal syndrome


1. expaln sx


2. similar dzz to


3. dx


4. tx

1. arteriosclerotic stenotic plaque that allow enough blood for nl activity of arm but exercise (arm raises), vessels in arm dilate = steal from vertebral artery


- sx: arm claudication (tingling), neuro sx (dizzy, blurred vision, equilibrium problems)


2. thoracic outlet syn (no neuro sx)


3. angiography


4. bypass surgery

Abdomenal Aortic aneurysm


1. screening


2. mgmt


3. urgent surgery

1. 1-time US in men 65-75 who ever smoked


2. <5cm = serial annual imaging


- >5cm: elective repair


3. only when tender AAA or excruciating back pain in pt w/ large AAA (sign of leaking)

Thoracic aortic aneurysm


1. sx


2. risk factors (5)


3. tx

1. hypertension w/ sharp chest and back pain down spine


2. chronic HTN, hyperlipidemia, smoking, marfan, tertiary sphyilis


3. asy lesions: BP mgmt


- sx lesion: surgicla intervention

Arterioscleroti occlusive dz of LE


1. sx


2. dx


3. tx


4. sx of end-stage

1. intermittent claudication (leg pain w/ walking that relieved by rest)


2. if pain is severe, get doppler for ABI (<.9), arteriogram for stenosis


3. if not disabling: no smoking, cilostazol & aspirin


- if disabling, angioplasty and stenting or bypass grafts


4. pain at rest = calf pain at night



Arterial embolization of extremities


1. risk factor


2. dx


3. tx

1. afib, recent MI w/ pale, cold, paresthetic extremity


2. dopller


3. if early, thrombolytics; if late, embolectomy w/ faciotomy

Catheter-associated UTI (CAUTI)


1. dx def


2. dx testing


3. tx


4. prevention

1. fever, sprapubic tender, CVA, SIRS


2 most accurate test: urine cx


3. catheter removal + antibx


3. early removal of catheter, intermittent cath

Central line-associated bloodstream infection (CLABSI)


1. PROTOCOL


1. tx (etio)

1. if pt have sx OR in palce for 7-10 days, culture catheter adn another peripheral vein


2. if cultures match, remove line and get anti-staph antibx


- etio: S. aureus, coagulase neg staph, Candida