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Step 2/Level 2 > EM and Surgery > Flashcards

EM and Surgery Flashcards

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1
Q

Bugs most commonly associated with dog/cat bites?

A

-Pasteurella multocida and S. aureus

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2
Q

What types of animal bites should NOT be sutured closed?

A
  • puncture and other bites to the hand
  • Cat bites (more likely to be dirty)

-DO suture facial wounds

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3
Q

PPX ABX given to animal bites?

A
  • Amoxicillin-clavulanate

- Doxy + metronidazole or clinda

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4
Q

If a patient has a dirty, contaminated, puncture or crush injury wound but they had their last tetanus booster 6 years ago, do they need a booster?

A

-YES! In these situation, give a booster if >5 years since last dose

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5
Q

If a patient has a dirty, contaminated, puncture or crush injury wound and does not know their immunization history, what should they be given?

A
  • Td + complete the series

- Also give tetanus immune globulin if person was unimmunized or not sure

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6
Q

What degree burn is painful, erythematous with blisters but does NOT blanch with pressure?

A

Deep partial thickness 2nd degree (epidermis and partial dermis)

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7
Q

Burn that is painless, white or shared and does not blanch with pressure?

A

3rd degree (epidermis and full dermis)

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8
Q

Burn that is painful, erythematous, no blisters and cap refill is in tact?

A

1st degree (just epidermis)

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9
Q

What is the parkland formula?

A

4ml x (weight in kg) x (%BSA burned)

  • Half of this amount is given in the first 8 hours.
  • Second half given over the next 16 hours
  • In addition, need maintenance fluids
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10
Q

What are the 2 features that distinguish heat stroke from heat exhaustion?

A

Heat stroke: body temp >104F and brain dysfunction

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11
Q

What is a J wave? When can it be seen?

A

small positive deflection after QRS complex

-hypothermia

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12
Q

When is peak LFT elevation seen after an acetaminophen OD?

A

stage III (72 -96 hours after ingestion)

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13
Q

Tx of acetaminophen OD?

A
  • activated charcoal within 4 hours

- N-acetylcysteine (within 8 hours)

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14
Q

Treatment of beta blocker and CCB toxicity?

A
  • IV fluids
  • atropine
  • glucagon
  • calcium
  • insulin and glucose
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15
Q

Tx for anticholinergic toxicity?

A

Physostigmine (you can FIX atropine OD)

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16
Q

Digoxin toxicity?

A

change in color vision

  • prolonged PR
  • bradycardia
  • PVCs* (most common)
  • hyperkalemia (indicates severity)
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17
Q

Heparin antidote?

A

protamine sulfate

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18
Q

Isoniazid antidote?

A

Vitamin B6

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19
Q

Sulfonylurea antidote?

A

octreotide and dextrose

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20
Q

TCA antidote?

A

sodium bicarbonate (QRS >100ms) and diazepam

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21
Q

First sign of aspirin overdose?

22
Q

Tx of aspirin toxicity?

Study These Flashcards
A

charcoal, dialysis, sodium bicarbonate

23
Q

Treatment of methanol and ethylene glycol toxicity?

Study These Flashcards
A

Fomepizole (alcohol dehydrogenase inhibitor) or Ethanol

24
Q

At what INR do you consider vitamin K in a warfarin OD? What about FFP?

Study These Flashcards
A
  • INR >5 –> oral vit K

- INR >20 –> IV Vit K and FFP

25
What should NOT be given in a caustic ingestion?
- anti-emetics - neutralizing agents - NG tube can all lead to further damage.
26
Symptoms of organophosphate poisoning?
``` DUMBBELSS Diarrhea Urination Mitosis Bronchospasm Bradycardia Emesis and Excitation of skeletal muscle Lacrimation Sweating Salivation ```
27
Tx or organophosphate poisoning?
- Atropine (anticholinergic) | - Pralidoxime (reactivates acetylcholinesterase)
28
Tx for moderate lead toxicity in a kid (45-69mcg/dL)?
Succimer
29
Tx for severe lead toxicity in a kid (>70mcg/dL)?
dimercaprol and calcium disodium edetate
30
Tx of arsenic toxicity?
dimercaprol, succorer, penicillamine
31
Tx of copper toxicity?
penicillamine
32
Almond scented breath after exposure to a fire?
Cyanide toxicity
33
Tx of cyanide toxicity?
- sodium thiosulfate (facilitates conversion to thiocyanate to be excreted) - Hydroxocobalamin (form cyanocobalamin to be excreted) - Amyl nitrate and sodium nitrate (causes cyanometemoglobin)
34
GCS Scale
``` Eyes: 4-open spontaneously 3-open to voice 2-open to pain 1-no opening ``` ``` Verbal 5-oriented 4-confused 3-inappropriate words 2-incomprehensible sounds 1-Nothing ``` ``` Motor 6-obey commands 5-localize 4-withdrawal 3-flexion (decorticate) 2-extension (decerebrate --> brainstem damage) 1-Nothing ```
35
What is Cushing's triad?
-hypertension -bradycardia -bradypnea (2/2 increased ICP)
36
Treatment of elevated ICP after trauma?
- Head of bed to 30 degrees - Mannitol - intubate and hyperventilate - Craniectomy
37
Absent breath sound and hyper resonance on the left, distended neck veins and hypotension? Tx?
- tension pneumothorax | - chest tube placement (preferred) or needle decompression
38
What can an IV pyelogram detect?
injury to the renal pelvis
39
What can a retrograde urethrogram detect?
urethral or bladder injury
40
Blood seen at urethral meatus or high riding prostate on rectal exam? What should you NOT do?
- suspect urethral rupture - Do NOT put in a foley - Retrograde urethrogram=imaging needed
41
Next step in a pelvic fracture with DPL showing urine int he pelvis?
Urgent laparotomy
42
Blunt abd trauma + unstable vitals +FAST showing no fluid in pelvis?
Ex lap
43
Blunt abd trauma + unstable vitals + FAST inconclusive?
DPL
44
Blunt abd trauma + stable vital signs?
CT abd/pelvis
45
Signs of Elder abuse?
Can be malnutrition and bed sores
46
What antibiotic prophylaxis should be given to a rape victim?
- Ceftriaxone (gonorrhea) - Azithromycin or Doxycycline for chlamydia - Metronidazole for trichomoniasis - Heb B vaccine if not vaccinated - HIV prophylaxis for 3-7 days
47
Post-op fever causes?
``` Wind: pneumonia Water: UTI Walking: DVT and PE Wound: infection 5-8 days later Wonder drugs; antimicrobials, heparin, SSRIs ```
48
What 2 infections are more common in neurosurgery?
Meningitis and DVT/PE (less anti-coagulation)
49
During surgery, muscle rigidity, hyperthermia, rise in end-tidal CO2, cyanosis, tachycardia, DIC, acidosis...Cause?
Malignant hyperthermia (from inhaled anesthetics or succinylcholine)
50
Treatment of malignant hyperthermia?
Dantrolene Cool the body O2

Step 2/Level 2 (18 decks)

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