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1

What is the CT–scan appearance of subdural hematomas?

Subdural hematomas are crescent–shaped and epidural hematomas are lens–shaped.

2

What are the indications for cervical spine x–rays after head trauma?

Cervical spine x–rays should be obtained in head trauma if there are focal findings consistent with a cervical radiculopathy or if spinal tenderness is present.

3

What is the treatment for severe intracranial hemorrhage?

Lowering intracranial pressure with hyperventilation to pCO2 of 30–35, mannitol, elevation of head of bed. Surgical evacuation. Maintain the SBP 110–160. Slight degree of HTN maintains cerebral perfusion.

4

A 50–year–old woman with sudden loss of consciousness, severe headache, nuchal rigidity, photophobia, and a temperature of 38.5 C (101.3 F). What is the diagnosis?

Subarachnoid hemorrhage

5

What is subarachnoid hemorrhage?

Bleeding into caused by aneurysm. Around the circle of Willis. Association with polycystic kidney disease, Ehlers–Danlos syndrome. Occurs spontaneously. Head trauma is a rare cause.

6

What is the presentation of subarachnoid hemorrhage?

Sudden, severe headache, loss consciousness 50%. Focal neurologic symptoms 30% from compression of occulomotor nerve. Nuchal rigidity, photophobia, headache, papilledema. Seizures.

7

What are the long–term outcome of subarachnoid hemorrhage?

One–year mortality 50%, with half of the people dying immediately. Longer–term manifestations include focal deficits, seizures, rebleeding, hydrocephalus.

8

How is subarachnoid hemorrhage diagnosed?

CT of head without contrast has 95% sensitivity. If CT is normal and SAH is suspected, lumbar puncture is done. Lumbar puncture is most sensitive. The absence of red cells in CSF excludes SAH.

9

What is the treatment for subarachnoid hemorrhage?

Maintain SBP 110–160. Seizure prophylaxis with phenytoin. Nimodipine is a calcium–channel antagonist that lowers risk of blood vessel spasm.

10

What test should be done after subarachnoid hemorrhage has been diagnosed?

Angiography to determine the site of the bleeding. Surgical clipping of the AVM should occur before rebleeding develops.

11

What is the management of hydrocephalus after subarachnoid hemorrhage?

If hydrocephalus occurs, then shunting should be done.

12

What is the treatment for spinal headache after lumbar puncture?

A spinal headache is treated with a blood patch.

13

What are the signs of respiratory injury in burn injuries?

Soot in the mouth or nose, stridor, wheezing, altered mental status, burned nasal hairs, and burns involving closed spaces are signs of impending pulmonary and laryngeal edema.

14

What are the signs of carbon monoxide overdose?

Altered mental status, dyspnea, headache, and chest pain are clues to severe carbon monoxide poisoning.

15

What are the signs of pulmonary thermal injury?

Laryngeal edema can result in stridor, hoarseness, and dyspnea. Soot in the nose and mouth can imply impending airway compromise.

16

How is the severity of burn injury assessed?

Carboxyhemoglobin elevated in severe burns. Severe burns are defined as combined second– and third–degree burns >20% in adults or >10% in the old or very young or third–degree burns >5% of body surface area.

17

What is the management of severe respiratory injury?

If there are signs of severe respiratory injury, intubate the patient. If the carboxyhemoglobin level is significantly elevated (>5–10%), give 100% oxygen.

18

How is the fluid resuscitation requirement determined for burns?

Fluid resuscitation over first 24 hours is 4 ml per % BSA/kg. Ringer's to provide half fluid in first 8 h, with 1/4 in second 8 h, and 1/4 in final 8 h (Parkland formula). Maintain a urine output >0.5–1 mL/kg/h.

19

What is the treatment for burns?

Stress ulcer prophylaxis with H2 blockers. Silver sulfadiazine. Do not break blisters. Escharotomy for circumferential burns. Skin grafting.

20

What are heat cramps?

Mild fluid and electrolyte depletion. Painful muscular contractions lasting a few minutes. Body temperature normal. Treatment is oral rehydration and salt replacement.

21

What is heat exhaustion?

Weakness; body temperature slightly elevated; headache, anxiety. The patient is still able to sweat. Treatment with oral fluid and electrolyte replacement; may need intravenous hydration.

22

What is heat stroke?

Loss of ability to lose heat, inability to sweat. T >40 C, confusion, disorientation, nausea, blurred vision, seizures; hemoconcentration, rhabdomyolysis, elevation BUN, creatinine, WBC. Anuria, DIC, lactic acidosis.

23

What is the treatment of heat stroke?

Treatment with intravenous fluid replacement and rapid cooling. The body should be sprayed with water. Chlorpromazine and diazepam to control shivering.

24

What is malignant hyperthermia?

Nonexertional idiosyncratic heat reaction of rhabdomyolysis caused by anesthetic agents such as halothane or succinylcholine. Treatment is dantrolene.

25

What is neuroleptic malignant syndrome?

Idiosyncratic reaction to phenothiazines or butyrophenones, such as haloperidol. Muscular rigidity and rhabdomyolysis.

26

What is the treatment of neuroleptic malignant syndrome?

Treatment is bromocriptine or dantrolene.

27

What is hypothermia?

Core body temperature below 35 C (normal 37 C). Severe hypothermia is a core temperature below 30 C. Hypothermia often occurs with alcohol intoxication.

28

What is the presentation of hypothermia?

Lethargy, confusion, and weakness. Death from arrhythmia. Ventricular fibrillation or ventricular tachycardia. J–wave elevation may mimic ST segment elevation.

29

What is the effect of ionizing radiation on the body?

Ionizing radiation destroys DNA molecules. Lethal and can cause cancer. Nonionizing radiation includes infrared, ultraviolet, microwave radiation, which are less destructive and causes burns.

30

What are the symptoms of radiation exposure?

Nausea and vomiting early; intestinal ulceration, bleeding, infection later. Injury to skin, salivary glands, respiratory epithelium, thyroid, bone marrow.