Clin Assess Flashcards
(138 cards)
1
Q
What is more common, LE or UE injuries?
A
LE
2
Q
What are the 2 most commonly injured blood vessels?
A
femoral and popliteal
3
Q
Which is more damaging, GSW or stabbing?
A
GSW
4
Q
What are signs of vascular trauma (6)
A
- absent/diminshed pulses
- obvious arterial bleeding
- large expanding hematoma
- audible bruit
- palpable thrill
- distal ischemia
5
Q
What should you do if there definitely is a vascular injury to an extremity?
A
Vascular consult ASAP!
6
Q
What should you do if you are highly suspicious of a vascular injury?
A
CT angiography
7
Q
What should you if there are no signs of a vascular injury but you want to r/o?
A
ABI
8
Q
What are some additional tests you can order when concerned for vascular bleeding?
A
- creatinine (before CT with contrast)
- CBC (if significant blood loss)
- xray (if concerned about fx)
9
Q
What is a complete disruption of joint?
A
dislocation
10
Q
What is a partial dislocation of a joint?
A
subluxation
11
Q
What is a tearing injury of muscle fibers called?
A
strain
12
Q
What is a tearing injury of ligament called?
A
sprain
13
Q
Patient presents with unilateral swelling in leg, pain out of proportion, discoloration, decreased pulses and coolness?
A
compartment syndrome
14
Q
What is the first step in an orthopedic PE?
A
Inspection!
15
Q
What is the second step in an orthpedic PE?
A
Palpation (check for bony step-off, extend palpation area beyond location of pain– pain may be referred)
16
Q
What nerve controls the pinky and half of ring finger?
A
ulnar nerve
17
Q
what nerve controls half the ring finger to the thumb
A
median
18
Q
What nerve controls the base of the thumb?
A
radial
19
Q
What nerve controls most of the top of the foot?
A
superficial fibular
20
Q
Which nerve has the lateral side of the foot?
A
dorsilateral cutaneous nerve
21
Q
Which nerve only has half the big toe and half the next toe?
A
deep fibular
22
Q
Which nerve has the medial malleolus and above?
A
saphenous
23
Q
What are different ways of describing a fracture? (6)
A
- open v closed
- location (midshaft, distal, proximal, intra-auricular)
- orientation of fracture line (transverse, oblique, spiral)
- displacement and separation
- shortening
- angulation
24
Q
What are steps you should take in the ER for someone with a fx?
A
- control pain and swelling
- withhold oral intake (if surgery)
- reduce fx deformity
- reduce dislocation
25
Why should you redice fx deformity?
- alleviates pain
- relieve tension on nerves/vessels
- minimize possibility of inadvertently closed changing to open
- restore circulation to pulseless distal extremity
26
What should you always do when reducing a joint?
get pre and post xrays
27
When should you use a shoulder immobilizer? (4)
- clavicle fx
- AC separation
- shoulder dislocation
- humeral head fx
28
When should you use an arm sling? (2)
-non-displaced radial head fx
29
When should you use a long-arm gutter? (2)
- elbow fx
| - elbow dislocation
30
When should you use a sugar tong? (1)
-wrist/forearm fx
31
When should you use a short-arm gutter? (1)
metacarpal/proximal phalanx fx
32
When should you use a thumb spica splint?
scaphoid, thumb, metacarpal
33
When should you use a knee immobilizer? (4)
- patellor fx/subluxation
- knee dislocation
- tibial plateau fx
- knee ligament/meniscus injury
34
When should you use a posterior ankle mold? (4)
- ankle dislocation
- unstable fx
- widened medial mortise
- metatarsal fx
35
When should you use an ankle stirrup? (2)
- simple ankle sprain
| - stable lateral malleolus fx
36
When should you use a hard-soled shoe? (1)
toe fx
37
When should you use a short-leg walking boot?
toe/foot fx with wt-bearing allowed
38
What are discharge instructions you should give someone with an orthopedic injury?
- rest
- elevate (above heart)
- ICE (keep splint dry)
- no weight-bearing until ortho
- pain meds prn
39
when should a patient call/return immediately? (3)
- pain severe/worsening
- numbness is new/worsening
- skin discoloration (dusky toes)
40
What are delayed complications of an orthopedic injury?
- fat embolus
- non-union/malunion
- joint stiffness
- traumatic arthritis
- avasculuar necrosis
- osteomyelitis
41
What does a BMP give you info on?
- kidneys
- electrolyte balance
- acid/base balance
- blood glucose
- Ca levels
42
What does an elevated Ca concern you for?
- Malignancy
| - hyperparathyroid
43
What does a low CO2 concern you for?
- Acidosis
| - possible ketoacidosis (esp of low K and high glucose)
44
What does a low glucose concern you for?
- insulin OD
| - sepsis
45
What does an elevated BUN AND elevated creatinine concern you for?
renal failure
46
What does an elevated BUN and normal creatinine concern you for?
diureased
47
What does the CMP have?
Everything the BMP has PLUS:
- Albumin
- Alka phos (ALP)
- total bilirubin
- total protein
- LFT's
48
What are reasons to order CMP?
- LFT's (alcoholics)
| - Nutritional status (albumin, total protein)
49
What does a low albumin worry you for?
malnutrition
50
What does an increase in alk phos worry you for?
gallstones
51
What does an increase in AST/ALT worry you for?
hepatitis
52
What does an increase in bilirubin concern you for?
cirrhosis, hepatitis
53
What does a low RBC, hemoglobin, hematocrit worry you for?
- blood loss
| - anemia
54
What does a high RBC, H/H concern you for?
- hemoconcentration due to DEHYDRATION
| - polycythemia
55
What does a CBC WITH DIFF show you?
breakdown of WBC's into types
56
What is the most abundant type of WBC normally?
Neutrophils
57
What does a low platelet count concern you for?
- acute infection
- BLEEDING
- DIC
- HELLP (preeclampsia in PG lady)
58
What does an increase in neutrophils concern you for?
BACTERIAL infection
59
What does a decrease in neutrophils concern you for?
Widespread infection (left shift)
60
What does an increase in lymphocytes concern you for?
VIRAL infection (mono, mumps, measles)
61
What does an increase in eosinophils concern you for?
acute allergic reaction
62
What does a VERY elevated eosinophil level concern you for?
parasitic infection
63
What urine glucose level concerns you for uncontrolled DM or possible DKA?
urine glucose over 130 with ketones
64
What do positive nitrates and leukoesterase on UA concern you for?
UTI
65
What if someone has UTI sxs but negative nitrates and leukoesterase on UA?
interstitial cystitis
66
What does metabolic acidosis concern you for?
DKA
67
What does metabolic alkalosis concern you for?
vomiting
68
What does resp. acidosis concern you for?
hypoventilation (PE, pna, COPD, heroin)
69
What does resp. alkalosis concern you for?
hyperventilation (PE, anxiety, pain, febrile illness)
70
What is present with DKA?
serum and urine ketones
71
What should you measure to monitor DKA tx response?
capillary blood ketones
72
What does a d-dimer measure?
fibrin content
73
What is d-dimer a good test for?
RULING OUT PE in pt w/low risk factors
74
Why is BNP secreted?
In response to volume overload/myocardial stretch
75
What is BNP used for?
CHF detection
76
What are cardiac troponins?
They are essential proteins in cardiac muscle contraction
77
What happens to troponins during myocardial injury?
extracellular leakage of troponins
78
What is the biomarker of choice, troponins or CK-MB?
troponins
79
What is considered an early presentation of someone with chest pain?
w/n 6hrs of sxs
80
What test do you order to monitor warfarin effect?
PT/INR
81
What pathway does PT/INR evaluate?
EXTRINSIC
82
What is the extrinsic pathway responsible for?
Most pro-coag activity (TF, factor VII)
83
What does coumadin do?
Inhibits Vit K (II, VII, IX, X)
84
What do you order to monitor heparin?
PTT (partial thrombin time)
85
What does PTT evaluate?
INTRINSIC pathway
86
What is the role of the intrinsic pathway
Involved in procoag activity related to inflammation and innate immunity
87
How soon will a monospot test become positive?
2-6 weeks after onset of sxs
88
What can cause a false-pos monospot test?
- toxoplasmosis
- rubella
- lymphoma
- malignancies
89
What can cause a false-neg monospot test?
testing too early
90
Which pathogen does rapid strep test detect?
Group A streptococci
91
What influenza strains do influnza swabs detect?
Both A and B
92
When should influenza swabs be done?
ASAP to start of sxs
93
What secretes amylase? and why?
salivary glands and pancreas to digest starch
94
Shat secretes lipase? and why?
Pancreas to breakdown dietary fats
95
What is the most specific pancreatic enzyme?
lipase
96
What are the 2 most common ED complaints?
- chest pain
| - abd pain
97
Where is the glottis located in normal adults?
level of FIFTH cervical vertebrae
98
What are pre-op airway assessments (6)
1. Mallampati classification
2. Neck ROM
3. TMD (3 finger lengths between hyoid bone and chin)
4. mouth-opening
5. Teeth
6. Bones
99
What is the usual cause of airway obstruction?
tongue
100
How can you get that damn tongue out of the way?
Chin lift/jaw thrust
101
How if chin lift/jaw thrust doesn't work and that tongue is still obstructing the shit out of the airway?
oral/nasal airway is next step
102
What, other than the tongue, can also cause airway obstruction?
dentures
103
Who are ORAL airways NOT good for?
people with gag reflexes
104
What can happen if an oral airway is poorly sized/improperly inserted?
can worsen obstruction
105
What are 2 oral airway insertion techniques?
- tongue depressor
| - insert and rotate
106
Why are nasal airways sometimes better than oral airways?
less stimulating, better tolerated
107
What is the most common complication from nasal airways?
hemorrhage
108
What are relative contraindications to using nasal airways?
- coagulopathies
| - head trauma
109
Who should you def not use nasal airways in?
someone taking anticoag
110
What are some advantages to using a laryngeal mask airway? (6)
- allows one-handed ventilation
- forms seal around larynx
- less stimulating than ETT (asthma, CAD)
- less S/T
- less risk eye/facial nerve injury
- helps w/difficult airway
111
What are contraindications to using LMA? (7)
- suspected gastric contents/acute abd
- gross obesity
- PG
- thoracic injury
- heavy opiate intox
- hiatal hernia
- low pulm compliance
112
What are insertion techniques for LMA?
- LMA held in DOMINANT HAND like pen
| - confirm placement iwth BBS and ETCO2
113
What should ventilatory pressure not exceed with LMA? and why?
20mm (risk aspiration)
114
What are indications for ETT? (9)
- controlled ventilation
- compromised/inaccessible airway
- failure of other methods
- aspiration risk
- PG
- airway disease/distortion
- lack gag reflex
- surgical procedure
- various positions
115
What are contraindications to using ETT?
No contraindications
116
What is monitoring equipment?
- pulse ox
- BP gauge
- cardiac monitor
117
What are some oxygenation equipment?
- O2 source and tubing
- face mask
- anesthesia bag or self-inflating amby bag (HIGH FLOW)
- suction catherter w/Yankauer tip
118
What classifies as high flow?
10-15L
119
What do you call a curved laryngscope blade?
Macintosh
120
How does a Macintoch blade work?
top of blade rests of valecular and epiglottis and lifts INDIRECTY
121
What do you call a straight laryngyscope blade?
Miller/Wisconsin
122
How do straight blades work?
Tip instered below epiglottis and lifts DIRECTLY (long-floppy epiglottis)
123
What cuff pressure should ETT tubes not exceed?
25 torrs
124
What length should ETT tubes be for females?
7-7.5
125
What length should ETT tubes be for males?
7.5-9
126
What are some equipment for verifying tube position?
- stethoscope
- CO2 detector/end-tidal CO2 monitor
- esophageal syringe
- CXR to confirm placement (REQUIRED)
127
How should you always hold a layngscope?
in LEFT hand
128
Why are stylets helpful?
allow curvature of ETT to be customized
129
What is a risk with stylets?
can cause trauma (LETHAL!)
130
What position should a patient be in for tracheal intubation?
sniffing position
131
What is sniffing position?
- enables alignment of axes of patients mouth for direct visualization of larynx
- moderate head elevation (7-10cm) and extension of A/O joint accomplishes flexion of lower CS and extension of upper CS
132
How should you open a patients mouth?
scissor maneuver
133
What are some common mistakes made when intubating? (3)
- Inserting blade too far-- into esophagus
- Pulling the lever- Wrist NEVER breaks (pull up and away)
- Inserting ETT too far-- bronchial intubation
134
What are subjective ways to verify correct placement of ETT (6)?
- chest wall rise
- EQUAL breath sounds
- condensation in ETT
- right "feel'
- no gurgling noise/vomit
- pink patient
135
What are objective ways to verify correct placement? (2)
- Continued presence ETCO2
| - interpreted CXR
136
What are Gllidescope applications (6)?
- potentially difficult airway
- trauma/emergency intubations
- morbidly obese
- C-spine immobilization
- reintubation in ICU
- awake intubations
137
What are predictors of a difficult airway? (8)
- protruding incisors
- permanent dentures/caps
- missing/mal-aligned teeth
- ornementation/tongue jewelry/braces
- macroglossia
- obese (morbidly)
- large breasts
- hoarseness/stridor
138
How far should normal adult be able to open their mouth?
4-5 cm (3 fingers)
