Lecture 9- Abd US/CT Imaging Flashcards
1
Q
blunt vs penetrating trauma
A
- blunt: MVC, falls (tend to be multi-system and have higher risk mortality than penetrating)
- penetrating: gunshot, stabbing
2
Q
roadblocks to good history
A
- EtOH
- severe trauma
- substance abuse
- developmental delay
- psychiatric illness
- overlapping pain symptoms
3
Q
most common abd imaging modalities
A
US/CT
4
Q
describe FAST exam
A
- US done bedside by ED or trauma provider
- used as initial screening to evaluate for solid organ injury and intra-abd bleeding
- poorly evaluates hollow viscus injury
- does not exclude injury in blunt/penetrating traumas if negative
5
Q
6 places to do FAST exam
A
- R & L anterior chest
- RUQ/LUQ
- sub-xiphoid
- suprapubic
6
Q
CT scan types
A
- Non contrasted: do if contrast allergy, stone, renal insufficiency
- IV contrast: study of choice, identify devascularized areas, hematomas, active extravasation of blood, extraluminal urine
- rectal, oral
7
Q
Sx of contrast dye
A
- most common sx: itching, warmth, n/v, site irritation, hives, laryngeal irritation
- Acute tubular necrosis (24-48hrs post injection, fluids to mitigate risk, anuric ESRD ok for contrast)
- can premedicate w/ 40mg Solumedrol + 50mg Benadryl
8
Q
contrast complication- extravasation
A
- toxic to tissues (compartment syndrome, necrosis, ulceration)
- treat like burn, may require rad and surgical consult
- elevate + cold compress
9
Q
considerations for contrast dye w/:
* metformin use
* pregnancy
* breastfeeding
A
- metform: hold for 48hrs post CT due to risk of lactic acidosis/renal or liver failure
- pregnancy: crosses placenta, limited data on harm; if emergent do it, if non-emergent US preferred
- breast feeding: < 0.01% absorbed into milk, can pump & dump for 1d if concerned
10
Q
describe mild allergic rxn
A
- typical: limited urticaria, itchy/scratchy throat, nasal congestion, sneezing, rhinorrhea, conjunctivitis
- additional: mild HTN, HA, dizziness, anxiety, altered taste, flushing/warmth
- typically is limited/transient
- vasovagal rxn which resolves spontaneously
11
Q
describe moderate contrast rxns
A
- typical: diffuse urticaria/prutitis, erythema w/ stable vitals, facial edema w/out dyspnea, throat thightness or hoarseness, wheezing
- additional: protracted n/v, hypertensive urgency, isolated CP
- requires tx to fix
12
Q
describe severe contrast rxns
A
- typical sx: diffuse edema, dyspnea, erythema w/ hypotension, laryngeal edema w/ stridor, hypoxia, wheezing, bronchospasm, anaphylactic shock
- additional: cardaic arrhythmia, seizure, HTN emergency
- resistance to tx
13
Q
urticaria tx
A
- diphenhydramine or fexofenadine
14
Q
facial or laryngeal edeam tx
A
epinephrine
15
Q
bronchospasm tx
A
- beta-2 agonists
- epinephrine
16
Q
hypertensive crisis tx
A
- labetolol
- nitroglycerin
17
Q
hypotension unresponsive to fluid tx
A
epinephrine
18
Q
pulmonary edema tx
A
lasix (furosemide)
19
Q
seizure tx
A
lorazepam
20
Q
Liver injuries
A
- most common site of injury
- most common cause of death (perhepatic hemorrhage, intraperotneal, extraperitoneal hemorrhage)