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DIT STEP 2 > ER, TRAUMA, ICU, SURGERY > Flashcards

ER, TRAUMA, ICU, SURGERY Flashcards

1
Q

2 components of disability portion of trauma assessment

A

Glasgow coma scale and finger-stick blood glucose.

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2
Q

4 classic findings in a basilar skull fracture

A

Raccoon eyes
Battle sign (bruises on mastoid process)
Bloody TM
CSF coming out of nose or ears

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3
Q

Cushing’s triad

A

HTN + bradycardia + bradypnea

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4
Q

Rx involved in treatment of anterior spinal cord syndrome following a traumatic injury

A

Immediate high-dose IV steroids, ideally within 8 hours of methylprenisolone

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5
Q

Zone 1 of the neck

A

Clavicle – > cricoid cartilage. Includes great vessels, aortic arch, trachea, esophagus, lung apices, cervical spine, spinal cord, and cervical nerve roots.

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6
Q

Zone II of the neck

A

Cricoid cartilage –>angle of the mandible. Carotid and vertebral arteries, jugular veins, pharynx, larynx, trachea, esophagus, cervical spine, and spinal cord

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7
Q

Zone III of the neck

A

Angle of the mandible –>base of the skull. Salivary and parotid glands, esophagus, trachea, cervical spine, carotid arteries, jugular veinS*, major cranial nerves.

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8
Q

Penetrating injury to zone I: initial assessment

A

4 vessel CTA

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9
Q

Penetrating injury to zone II: initial assessment

A

surgical exploration or doppler US + selective exploration

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10
Q

Penetrating injury to zone III: initial assessment

A

4 vessel CTA + triple endoscopy

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11
Q

If chest tube placement is delayed in tension ptx, what should be done in the meantime?

A

Needle decompression on the affected side at the 2nd or 3rd IC space at midclavicular line or 5th IC space at midaxillary line

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12
Q

Important part of treatment in flail chest

A

ANALGESIA! otherwise, patient may become hypoxic from limiting breathing due to pain.

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13
Q

What are the next steps in mgmt of blunt abdominal trauma in a patient with STABLE vital sings?

A

ABC, establish IV access at 2 sites with large bore IV, NG tube and Foley, CT And/Pelvis, Stat H&H +/- blood type and cross.

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14
Q

What are the next steps in mgmt of patient with blunt abdominal trauma and UNSTABLE vitals?

A

Primary and secondary survey, asses for and manage pelvic fx, FAST, if no blood in pelvis and angio is normal, CT Abd/pelvis + observation +/- admission

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15
Q

If blunt trauma without blood in abdomen, next steps?

A

Follow H+H. If hemodynamically unstable or falling H+H, angio with possible embolization.

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16
Q

What are the classic signs for a urethral injury?

A

Look for blood at urethral meatus, high riding “blamable” prostate, or absence of palpable prostate. If signs of injury, perform retrograde urethrogram to rule out injury prior to Foley cather placement.

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17
Q

Criteria that must be met prior to discharge of pregnant woman after traumatic event?

A

Contractions occurring no more often than >1 q 10 min.
Normal fetal heart tracing
No vaginal bleeding
No abdominal pain

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18
Q

Chest trauma + hypotension + JVD + distant heart sounds –>next step?

A

Pericardiocentesis

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19
Q

Pelvic fracture + DPL shows blood in pelvis

A

Emergent lap

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20
Q

Pelvic fracture + DPL shows urine in the pelvis

A

Urgent lap

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21
Q

Pelvic fx + DPL shows nothing + hemodynamic instability

A

Angio with poss embolization

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22
Q

Blunt abdom trauma + unstable vital signs + FAST shows fluid in pelvis

A

Emerg lap

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23
Q

Blunt abdom trauma + unstable vital signs + FAST shows NO fluid in pelvis

A

Angio with possible embolization

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24
Q

Blunt abdominal trauma + unstable vital signs + FAST inconclusive

A

DPL

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25
Q

1-4 points in Eye Opening category of GCS

A

Spontaneous = 4
To voice = 3
To pain = 2
None = 1

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26
Q

1-5 points in Verbal Response category of GCS

A 
Oriented = 5
Confused = 4
Inappropriate words = 3
Incomprehensible = 2
None = 1
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27
Q

1-6 points in Motor response category of GCS

A 
Obeys commands = 6
Localizes pain = 5
Withdraws from pain = 4
Flexion with pain = 3
Extension with pain = 2
None = 1
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28
Q

While the head of an unconscious patient is turned, a patient’s eyes follow the movement, rather than being fixed at a point in space. This is suggestive of which injuries?

A

Vestibular, cranial nerve, pontine, or medullary.

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29
Q

Important part of treatment in neck trauma (penetrating injury)

A

Prophylactic abx due to increased risk of contamination by oropharyngeal flora.

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30
Q

Anatomic differences in post-traumatic pregnant patient

A

IVC compression by uterus makes pregnant women more susceptiblle to poor CO following injury.
Decreased risk of GI injury from lower and trauma because of superior displacement of bowel by the uterus (but greater risk of GI injury from upper abdominal or chest trauma)

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31
Q

Who gets examined first – mother or fetus?

A

Mother

32
Q

Describe superficial partial thickness burn

A

FIRST DEGREE. It is painful. There is erythema and BLISTERS. Capillary refill is INTACT.

33
Q

Describe signs and symptoms of second degree burn

A

Painful with blisters. Does NOT blanch with pressure.

34
Q

%BSA of palm

A

1%

35
Q

What is unique to mgmt of electrical burn patients as compared to heat burn patients

A

Aggressive IVF to prevent myoglobinuria, renal failure n and acidosis in the face of muscle necrosis.
High index of suspicion for compartment syndrome.
Obtain an EKG and monitor for dysrhythmias.

36
Q

When should a burn patient be transferred to a burn center

A 
Full thickness burn >5% BSA
Partial thickness >10% BSA
Any burn to face, genitals, perineum, or major joints
Circumferential burns
Electrical or lightning injury
Inhalation injury
Fracture or other trauma assoc with burn
Pre-existing medical problems (e.g. DM, sickle cell) or special psychosocial or rehab needs.
37
Q

5 Common life threatening complications in pt with substantial burns

A 
Hypovolemia -- > shock
Sepsis due to PNA or pseudomonas
Inhalation
Cardiac dysrhythmia
Renal failure
38
Q

In heat stroke, what is the best method of cooling

A

Via evaporation, so continuous fanning and spraying of skin with lukewarm water

39
Q

Treatment for black widow spider bite with mild skin reactions

A

Tetanus toxoid ppx

40
Q

Treatment for black widow spider bite with necrotic center >2 cm

A

5-7 days corticosteroids

41
Q

Abx if signs of infection in black widow spider bite

A

Erythromycin

42
Q

How can we possibly reduce extent of local necrosis in black widow spider bite

A

Consider dapsone due to leukocyte inhibitory properties. But obviously r/o G6PD deficiency first due to risk of hemolytic anemia

43
Q

If systemic symptoms after black widow spider bite ..

A 
Calcium gluconate q2 hrs for muscle pain
Benzos for AMS
Steroids
Nitrates for HTn
Methocarbamol for muscle spasm
Analgesia with acetaminophen +/- opioids
Antivenom ideally within 30 min
44
Q

Higher likelihood of infection after dog/cat bite if ..

A 
Cat bite 
Eats wet food
Presents >6-12 hrs post-bite
Presents >12-24 hrs post-bite to face
Immunocompromised host
45
Q

When do pts get rabies ppx after animal bite

A

If animal cannot be observed for 10 days or if animal is suspected to be rapid

46
Q

Abx choices for animal bites

A

Amp/sulbactam then Amox/clav
Clinda + FQ
Clinda + Bactrim DS

47
Q

Anticholinergic sx and antidote

A

Hot as a hare, dry as a bone, red as a beet, blind as a bat (mydriasis, cycloplegia) and mad as a hatter, bloated as a toad, tachycardia, decreased or absent BS.
Antidote: pralidoxime, atropine

48
Q

S&S of organophosphate poisoning

A

Diarrhea, urination, miosis, bronchospasm, bradycardia, emesis and excitation of skeletal muscle, lacrimation, sweating, salivation, and abdominal cramping.

49
Q

Describe phases of iron toxicity

A

GI phase 30 min - 6 hrs post ingestion
Latent/stable phase 6-24 hrs post ingestion
Shock and metabolic acidosis 6-72 hrs post ingestion
Hepatotoxicity/hepatic necrosis 12-96 hrs post ingestion
Bowel obstruction 2-8 wks post ingestion

50
Q

Treatments tO NOT USE ** for ingestion of alkali plumbing liquid

A

Ipecac, a neutraliz agent which will improve nothing but amy result in thermal injury
NG tube which may lead to perf or emesis of caustic

51
Q

Surveillance EGD after ingestion of alkali plumbing liquid

A

Beginning 15-20 yrs after ingestion at interval of q1-3 yrs to evaluate for esophageal SCC

52
Q

Almond scented breath

A

Cyanide poisoning

53
Q

Ingestion can cause delayed onset parkinsons

A

Cyanide ingestion as basal ganglia is sensitive to cyanide

54
Q

Accelerated junctional rhythm or bidirectional ventricular tachycardia suggests?

A

Digoxin toxicity until proven otherwise

55
Q

Characteristic EKG changes in digoxin at therapeutic levels

A

Prolonged PR interval

“scooping” of ST segments

56
Q

Most freq vital sign abnormality in digoxin toxicity

A

Bradycardia. Atrial tach with AV block is less common.

57
Q

How do we indicate severity of digoxin toxicity?

A

Hyperkalemia.

58
Q

When should hyperkalemia be treated in cases of dig toxicity?

A

Only if its causing EKG disturabnces. Avoid calcium which can worsen intracellular hyperkalemia.

59
Q

Acid base disturbance in aspirin OD

A

Resp alkalosis from hyperventilation THEN a mixed res alkalosis and metabolic acidosis with elevated anion gap.

60
Q

Why do pts that OD on aspirin often get tachypneic?

A

ASA stimulates medullary respiratory center

61
Q

Why do pts that OD on aspirin often get hyperthermic?

A

ASA uncouples mitochondrial oxidative phosphorylation.

62
Q

MCC of acute hemolytic transfusion reaction

A

ABO incompatibility

63
Q

Treatment of chronic mesenteric iscehmia

A

Bypass, angioplasty

64
Q

S&S of chronic mesenteric ischemia

A

“intestinal angina”
Dull crampy post prandial epigastric pain within first hour after eating then subsiding over 2 hours
Weight los d/t food aversion to avoid postprandial pain
N/V early satiety
Abdominal bruit in 50%

65
Q

When is greatest risk for postop MI?

A

48 hours post op

66
Q

What is recommended perioperatively for pts with known CAD?

A

Peri op beta blockers and telemetry monitoring

67
Q

High doses of which vasopressor optimize alpha 1 vasoconstriction

A

epinephrine

68
Q

Best vasopressor for septic shock

A

norepi

69
Q

Best vasopressor for cariogenic shock

A

dobutamine

70
Q

Which vasopressorr causes vasoconstriction and bradycardia

A

Phenylephrine

71
Q

Which blood product is most appropriate in DIC

A

FFP with or without platelets

72
Q

Which blood product is most appropriate in severe anemia due to autoimmune hemolytic anemia

A

PRBC

73
Q

Which blood product is most appropriate in shock due to trauma or post partum hemorrhage

A

Whole blood or PRBC

74
Q

Which blood product is most appropriate in hemorrhage due to warfarin overdose

A

FFP

75
Q

Which blood product is most appropriate when you need a vWF rich blood product

A

Cryo

76
Q

Preferred vessels in placement of Swan Ganz

A

Right IJ or left subclavian

77
Q

Some interventions to protect kidneys in times of anticipated insult

A

N-acetylcysteine 24 hours before and after
IVF
Sodium bicarb 1 hr before and about 6 hrs after

DIT STEP 2 (17 decks)

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