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Surg200 > EM > Flashcards

EM Flashcards

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1
Q

Tx Acute MI

A

OHBATMAN
O2, heparin, BB, aspirin, thrombolytic (+/-), morphine, anti-PLT, nitrates

Nitrates inc coronary perfusion
BBs decrease infarct size, complications, mortality

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2
Q

Indications for fibrinolytics in AMI

A

ST elevation >0.1mV in 2+ contiguous leads or new LBBB and time to Tx <12hrs (class I) or 12-24 hrs (class IIb)

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3
Q

Tx aortic dissection

A

SBP 90-100 HR 60-80

IV nitroprusside +esmolol or labetolol

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4
Q

DDx Peripheral vertigo

A

acoustic schwannoma, Meniere’s (hearing loss, tinnitus), labyrinthitis (after URIs, otitis media), BPPV (Dix-Halpike), trauma (endolymphatic fistula), labyrinthine concussion

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5
Q

Febrile neonate (age, organisms, Tx)

A

0-28d
E Coli, GBS, Listeria, HSV 1/2
ABX + anti-virals, sepsis w/u

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6
Q

Febrile infant Tx

A

Philadelphia Criteria
-29-60d T > 38.2
-reliable caregiver able to f/u in 24 hrs
-PE: well-appearing and non-focal
-Lab: WBC 5-15k and Band/PMNs <8WBCs, neg CXR, Stool: no blood, few or no WBCs.
-Home, no Abx, follow-up
High NPV

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7
Q

Febrile young child (age, what are you worried about, w/u, Tx)

A

2-36 months

  • Occult bacteremia (Hib, S Pneumo) – WBC, ANC, BCx, t/c empiric abx. However if well-appearing, no source, don’t need to Tx!
  • Occult UTI (E Coli, GNs, enterics): risks White > Latino > black, age 39 or > 2 d, no source. Test cath’ed urine only. Udip or UA. always send UCx if (+). Tx: cefixime, TMP-SMX, cephalexin
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8
Q

Febrile child

A

> 3years: overwhelmingly viral

-Use Sx to guide w/u, Tx

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9
Q

Coma, MCS, stupor, obtundation

A

Coma: complete failure of arousal system with no spontaneous eye opening (brainstem or b/l cortex)
Stupor: pts awaken w stimulus but little motor/verbal activity
Obtundation: awake but not alert, with PMR

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10
Q

multi-lobar PNA

A

Legionella! Levo

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11
Q

UTI Tx

A

simple: Bactrim DS BID x3d
Complicated: quinolone x7d
Pyelo: 14d

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12
Q

Tx GC/CT

A

CFT IM, azithro 7d

Same Tx cervicitis/PID

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13
Q

Heat edema

A

early in heat exposure
elderly
increased aldosterone
self-limited

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14
Q

Heat tetany

A

hyperventilation –> resp alkalosis –> paresthesias, carpopedal spasm, tetany
Remove from heat!

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15
Q

heat rash

A

under clothes! inflammation of obstructed sweat glands Tx: antihistamine, loose clothing

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16
Q

Heat cramps:

A

during cooling, hypoNa/Cl

More predisposed to malignant hyperthermia

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17
Q

Heat exhaustion

A

hours-days … non specific Sx, T < 40C, normal neuro exam

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18
Q

Heat stroke

A

altered MS with T >40.5C
Seen in poor hosts, or in exertion, MDMA, EtOH
Leukocytosis, LFTs, EKG: QT/ST prolongation, RBBB,AFib, SVT, MI
Complications: DIC, ARDS, rhabdo, ARF, liver failure, Szs
Tx: Cool, but stop at 39C!

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19
Q

Hypothermia degrees

A

Mild (33-35): shivering, inc HR/RR/BP, ataxia, hyperreflexia, dysarthria, impaired judgment, diuresis, bonchospasm, GI motility
Mod (28-32): decreased RR/CO, CNS depression, hyporeflexia, paradoxical undressing, Osborn J wave can –>VFib with jostling
Severe (<28C): pulm edema, oliguria, loss of reflexes, hypotension, acidosis, coma, VFib, asystole

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20
Q

Hypothermia Management

A 
ABCs
Lay flat (hypotension
Glucose, no caffeine
monitor for hyper K
re-warm 1-2C/hr unless unstable
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21
Q

Pernio/chillblains

A

chronic vasculitis from repeated cold exposure

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22
Q

Trenchfoot

A

redness/swelling/throbbing/ulcers

Can occur up to 60F if wet

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23
Q

Frostbite

A

Frozen tissue, smokers, vascular disease

Rewarm with 40-42C water, analgesia, leave blood-filled blisters alone, drain clear blisters, tetanus PPx

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24
Q

unique injuries in peds trauma

A

more common: multiple injuries, head trauma, SCIWORA, normal bp with early shock
-major causes of preventable death: airway compromise, unrecognized hemorrhage

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25
Wadell Triad
pediatric injury pattern: closed head injury, intra-abdominal injury, mid-shaft femur fracture (hit by car)
26
Peds solid organ injury Tx
most can be managed conservatively with ICU monitoring
27
TBI in kids
leading cause of trauma death/disability LOC not indepedent predictor of ICI, adjusting for mental status <2, must be concerned for abuse (scalp hematomas!)
28
Kuppermann rules for CT >2 yo
GCS 14/AMS/basilar skull fx --> CT LOC, vomiting, severe mech, severe HA --> obs vs CT based on MD/parent If none of the above --> no CT
29
Kuppermann rules for CT <2 yo
GCS 14/AMS/palpable skull fx --> CT | scalp hematoma or LOC >5 seconds or severe mechanism --> CT vs obs
30
Toddler's fracture
spiral Fx through distal 3rd of tibia, non-displaced | often unwitnessed fall, limp/refuse to walk
31
Croup
``` stridor paraflu >60%. Always viral Steeple sign racemic epi, dexamethasone Admit for toxic, dehydration, persistent stridor ```
32
bronchiolitis
<3 months | Tx: supportive care, ventilation, albuterol if benefit seen in pt, racemic epi if severe. Steroids if c/f asthma
33
PNA pathogens peds by age
neonates - GBS, GN enterics 2w- 2mo -- CT, virus, S Pneumo, S Aureus, H flu 2mo-3y -- viruses, S pneumo, S aureus, H flu 3y-19y -- viruses, S pneumo, mycoplasma
34
Ovarian torsion
most cases due to underlying pathology 2/3 on R side dx w/i 4 hrs to save ovary enlargement is most sensitive u/s finding, but abnormal Doppler flow is specific
35
discriminatory zone
TV: >1500 TA: >4000
36
PEC def
bp >140/90 or increase in SBP >20 or DBP >10 above baseline, after 20w gestation on 2 separate measurements Severe: >160/110, proteinuria, SOB, oliguria HA, thrombocytopenia Sequelae: ecclampsia, HELLP
37
Closing wounds rules
Golden hrs: 6 for extremities, 24 hrs face/scalp | But can close up to 19hrs
38
Tetanus indicatiosn
3 doses primary series: 10 = toxoid <3 doses primary series: clean/minor = toxoid others = toxoid + Ig OK in pregnancy
39
Whole body irrigation
CCBs, lithium, SR drugs
40
TCA EKG
RAD, R wave in AVR, QRS prolongation
41
Antipsychotic EKG
QT prolongation --> Torsade
42
anticholinergic poisoning
blind as a bat, mad as a hatter, red as a beet, hot as a hare etc Tx: physostigmine
43
Cholinergics poisoning
(organophosphates, AChEI - donepezil, physostigmine, pyridostigmine, nerve gas) - AMS, secretions, diarrhea, urination, miosis, bradychardia, emesis, lacrimation, Szs, - Tx: atropine
44
pulse-echo princple
distance = 1/2 time to detect echo
45
freq medical U/S
2MHz - 20 MHz
46
properties determining U/S reflection
- impedence mismatch (high impedence = good transmission) - specular reflection (smooth = better) - angle of insonation (90 = best)
47
Meningitis Community acquired
Ceftriaxone, vanc, amp
48
Brain abscess
Ceftriaxone, metronidazole
49
Chronic sinusitis
Bactrim, amox/clav, azithro, quinolone
50
Otitis media
don't treat unless need to. IM ceftriaxone
51
Otitis externa
mild - acetic acid Mod Corticosporin drops Severe/refractory Ofloxacin/cipro Malignant Levo
52
Pharyngitis bacterial
PCN, amox, benzathine, azitrho
53
Chronic bronchitis
Doxy, Bactrim, Axithro
54
CAP
S Pneumo: Azitrhomycin + PCN Myco Azitrho + doxy multi-lobed Levo
55
Aspiration PNA outpt
PCN + metro
56
HCAP
Cefepime
57
UTI - simple
Bactrim x 3d
58
UTI - complicated
quinolone x 7d
59
Pyelo
quinolone x 14d
60
Urethritis
Ceftriaxone + azithro
61
PID
ceftriazone + azithro
62
Folliculitis
anti-staph + I&D
63
Intestinal infection
Amp/sul + metro OR levo + metro

Surg200 (2 decks)

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