EM Surg StepUp Flashcards
(174 cards)
1
Q
1st degree burn
A
epidermis only
2
Q
2nd degree burn
A
partial thickness dermal
3
Q
3rd degree burn
A
full thickness dermal and maybe deeper
4
Q
4th degree burn
A
additional involvement muscle and or bone
5
Q
electrical shock burn classification
A
4th degree becuase likely involve mm and bones
6
Q
when do you need inpatient Tx fo rburns
A
2nd degree with >10% body surface
3rd degree> 2% body surface
7
Q
which burns require airway managment
A
2nd or 3rd with >25% body or involving face
8
Q
formula for IV fluid resuscitation for burns
A
LR 4mL x Kg x % body surface burned
half volume in initial 8 hours with remaining half over 16 hours
9
Q
burn surface area of adult
A
9% head, each leg, back, trunk
4.5% each arm
1% genitals
10
Q
what antibiotic is used for burn dressing
A
topical sulver sulfadiazine or bacitracin
also give tetanus toxoid
11
Q
infections with burns
A
pseudomonas, stress ulcers- curlings
12
Q
complications burns
A
infection stress ulcers apspiration dehydration ileus renal insufficiency from rhabdomyolysis compartment syndrome epithelial contractures
13
Q
age group highest risk of drowning
A
children
14
Q
what happens with drowning to lungs
A
decreased compliance, V/P mismatch
shunting
cerebral hypoxia
15
Q
freshwater drowning
A
hypotonic fluid absorbed causeing decreased electrolyte concentrations and RBC lysis
16
Q
salt water drowning
A
hypertonic fluid draws water from pulm capillaries into alveoli causing pulmonary edema and increased serum electrolyte concentrations
17
Q
Tx drowning vitim
A
secure airway resuscitation supp O2 nasogastric tube placement maintenance of body temp
18
Q
complications drowning
A
depends on degree and length of hypoxemia and hypothermia
19
Q
Tx foreign body aspiration
A
rigid bronchoscopy
20
Q
comlications of choking
A
atelectasis, penumonia, lung abscess, hypoxemia
21
Q
risk factors hypothermia
A
alcohol
elderly
22
Q
signs of hypothermia
A
lethargy, weakness, severe shivering, confusion, dec temp, arrhythmias, hypotension
23
Q
EKG
A
J waves, possible vtach or vfib
24
Q
Tx hypothermia
A
warm externally
internally warm IV fluids
treat arrythmias
25
why do patients with severe hypothermia feel really hot before they die
increased blood viscosity
26
heat exhaustion
weakness HA and sustantial sweating
| need hydration
27
heat stroke
confusion, blurred vision, nausea
| little sweating
28
labs in heat stroke
inc WBC BUN and Cr
29
Tx for heat stroke
evaporative cooling
| benzos for seizures
30
Tx for snake bite
immobilize and cleanse
| need antivenom
31
signs scorpion bite
severe pain and swelling at site
increased sweating
vomiting
diarrhea
32
Tx scorpion bite
antivenin, atropine phenobarbital
33
complications scorpion bite
acute pancreatitis, myocardial toxicity, respiratory paralysis
34
signs of black widow spider bite
muscle pain and spasms
localized diaphoresis
abdominal pain
autnomic stimulation
35
Tx black widow spider bite
local wound care, benzos and antivenin
36
complications black widow spider bite
ileus, CV collapse
| hemolytic anemia, DIC, rhabdo
37
signs of brown recluse bite
increasing pain and possible ulceration and necrosis
38
Tx brown recluse bite
local wound care and dapsone to prevent necrosis
39
Tx mammalian bite
saline irrgation, debridement, tetanus and rabies proph
40
Tx human bite
saline, broad coverage Antibiotic, debridement
41
how does charcoal work for ingestion
blocks absorption of poisons
| repeat every few hours
42
Tx acetominophen toxicity
N acetylcysteine
43
Tx for anticholinergic OD
physostigmine
44
Tx benzo OD
flumenazil
45
Tx beta blocker OD
glucagon, Ca and insulin
| dextrose
46
Tx CCB OD
glucagon, Ca, insulin and dextrose
47
Tx cocaine OD
supportive
48
Tx cyanide toxicityq
nitrates and hydroxocobalamine
49
Tx dig toxicity
Dig antibodies
50
Tx heparin toxicity
protamine sulfate
51
Tx isoniazid neuropathy
vit b6
52
Tx isopropyl alcohol OD
supportive
53
Tx methanol OD
ethanol, fomepizole and dialysis
54
Tx opioid OD
naloxone
55
pinpoint pupils
Opiate OD
56
Tx salicylate toxicity
charcoal, dialysis and NaHCO3
57
Tx sulfonylurea toxicity
octreotide and dextrose
58
Tx TCA OD
NaHCO3 and diazepam
59
Tx warfarin toxicity
Vit K and FFP
60
Tx of acids or alkali
copious irrigation
| activated charcoal
61
Tx ethylene glycol ingestion
ethanol and dialysis
62
Sx ethylene glycol ingestion
ataxia
hallucination
seizures
sweat breath
63
Tx of organophosphate (insecticide) poisoning
atropine
pralidoxime
supportive care
64
Tx iron overload
deferoxamine
65
Tx lead poisoning
succimer, dimercaprol
| EDTA
66
Tx mercury poisoning
dimercaprol
67
signs CO poisoning
HA, dizziness, nausea, myalgias
cherry red lips
mental status changes, hypotension
68
Tx CO poisoning
100% O2
| hyperbaric O2
69
Tx Vfib and Vtach
alternating attempts at electrical and Rx cardioversion
70
pulseless electrical activity
detectable cardiac conduction with absense of CO
71
asystole
no cardiac activity
72
if come upon unresponsive patient with no pulse, next step
CPR 30:2
73
if come upon unresponsive patient with pulse
| next step
1 breath Q 5-6 sec
intubate and ventilate
recheck pulse Q 2 min
74
order of pharmacology to use in Vfib or pulseless Vtach
epinephrine 1 mg
amiodarone 300mg IV bolus, second is 150 mg
or lidocarine 1-1.5 up to 3 mg/kg
75
Tx torsades
Mg 1-2 g IV or IO loading dose
76
protocol for PEA and asystole
CPR 30:2
epinephrine 1 mg Q 3-5 min
consider vasopressin 40 units
77
common causes of pulseless electrical activity
```
Hs and Ts
Hypovolemia
Hypoxia
Hyper K
hypo K
hypothermia
hydrogen ions
tamponde
tension pneumo
thrombosis
tablets
toxin drugs
```
78
what gets injured in acceleration decceleration injuries
aortic arch and mesentery
79
Trauma assessment
ABCs
80
evaluation head trauma
```
LOC assessment
sensation, motor
bowel and bladder
pupil responsiveness to light
presence skull fracture
ICP
```
81
image for head trauma
CT
82
Tx head trauma
maintain perfrusion
decrease high ICP
IV mannitol
hyperventilation
83
HTN with bradycardia
increased intracranial P
| cushing phenomenon
84
spinal cord trauma
neuro exam
85
imaging to assess spinal cord trauma
CT and MRI if normal CT with abnormal neurologic exam findings
86
Tx spinal cord trauma
stabilized, give IV corticosteroids for 24 hours if presenting in initial 8 hours
87
imaging for neck trauma
cervical XR, CT, carotid doppler US
esophagoduodenoscopy
angiography
bronchoscopy
88
where is zone 3 in neck trauma
above mandible
89
where is zone 2 in neck truma
mandible to bottom cricoid
90
where is zone 1 in neck trauma
below cricoid to clavicles
91
Tx penetrating abdominal trauma
ex lap
92
Tx retroperitoneal hematomas
upper abdomen need laparotomy
| lower need angiography embolization
93
high riding prostate on rectal exam
urethral injury
94
how to determine renal pelvis injury
IV pyelogram IVP
95
differences of trauma during pregnancy than non pregnant
low CO from IVC compression
| decreased risk GI low injury from superior placement of bowel by uterus
96
trauma during pregnancy increases what
risk of placental abruption
97
what position to examine trauma pregnant women
left lateral decubitus
98
bleeding pregnant women from trauma
| need to give what after stabilized
RhoGAM
99
when doing exam for sexual assault
make sure chaperone is present
| collect oral vaginal and penile cultures
100
swan ganz catheter
P right atrium and pulm artery
pulm capillary wedge P
can measure CO and mixed venous O2 saturation and SVR
101
nonhemolytic febrile transfusion reaction
most common
cytokines generated by cells in transfused blood while in storage
1-6 hours post transfusion get fevers, chills, rigors, malaise
Tx with acetominophen
102
acute hemolytic blood transfusion reaction
ABO incompatibility
onset during transfusion with fever, chills, nausea flushin, tachy, hypotension, hemolysis of donor RBCs
need aggressive supportive care
103
delayed hemolytic transfusion reaction
Ab to Kidd or D (Rh) Ag
2-10 days post transfusion
slight fever, falling H/H
mild inc in uncong bili
104
Anaphylactic blood transfusion reaction
anti IgA IgG ab in those with IgA deficiency
cause mast cell degranulation
need epinephrine, volume maintenance and airway control
105
urticaria from transfusion
from plasma in donor blood
| Tx with benadryl
106
post blood transfusion purpura
thrombocytopenia 5-10 days post transfusion
usually in women sensitized by pregnancy
Tx with IVIG and plasmapheresis
107
when to give FFP
warfarin OD
clotting factor deficiency
DIC
TTP
108
when to give cryoprecipitate
smaller volume FFP
109
when to give packed RBCs
low Hct from blood loss or anemia
110
when is whole blood used
massive transfusions for severe blood loss
111
what is given in transfusion reactions to prevent hemolytic debris from clogging vessels
mannitol or bicarb
112
Vasopresors used in EM for
cases shock and insufficient CO
113
indication to give phenylephrine
sepsis or shock need to increase BP
114
when to give norepi
shock, causes vasoconstriction and increased contractility
115
when to give epi
anaphylactic shoc
septic shock
post bypass hypotension
causes increased contractility, vasodilation at low dose and vasoconstriction at high dose
116
when to give dopamine
shock
increased HR and contractility
causes vasoconstricion at high dose
117
when to give dobutamine
CHF and cardiogenic shock
118
effects dobutamine
increased HR and contractility
| mild reflex vasodilation
119
when to give isoproterenol
contractility stimulant for arrest
120
wheredoes isoporternol work
B1 and 2 agonist
121
when to give vasopressin
resistent septic shock
| causes vasoconstriction
122
when should one stop smoking before surgery
8 weeks out
123
COPD with crackles needs surgery
give preop antibiotics
124
when to order preop CXR
> 50 years old
Hx pulmonary disease
anticipated surgical time >3 hours
125
patient with renal insufficiency needs surgery with contrast
give N acetylcysteine to prevent damage
126
when to stop warfarin before surgery
3-4 days out with INR kept
127
which meds decrease risk postop thromboembolism
warfarin, heparin and LMWH
128
epidural catheter, when do you start LMWH
more than 2 hours after removal of epidural catheter
129
fever on postop day 3
pneumonia or UTI
130
fever on post op day 5-8
wound or IV catheter infection
131
any postop fever should be evaluated with
CXR, CBC, UA
132
post op fevers
```
Wind
Water
Wound
Walking
Wonder drugs
```
133
is atelectasis a cause of postop fever
not anymore
134
clean contaminated wound
GI or respiratory entry
135
contaminated wound
gross contact of wound with GI or GU contents
136
dirty wound
established infection before incision
| continued infection following procedure including debridement
137
secondary infection
wound left open and allowed to heal through epithelialization
138
delayed primary closure
left open for a few days then cleaned again before closed
139
how long do closed wounds require dressings
48 hours after closure
140
what can inhibit wound healing
```
malnutrition
corticosteroids
smoking
hepatic or renal failure
DM
```
141
abdominal pain out of proportion to exam
mesenteric ischemia
142
what can induce malingnat hyperthermia
halothane or succinylcholine
143
Sx of malignant hyperthermia
rigidity
cyanosis
tachycardia
rising body temp
144
uncontrolled hyperthermia can cause
arrhythmias, DIC, acidosis, cerebral dysfunction and electrolyte abnormalities
145
labs of malignant hyperthermia
mixed acidosis acutely
| abnormal increase in muscle conraction
146
Tx for malignant hyperthermia
```
evaporative cooling
cold inhaled O2
cold GI lavage
cool IV fluids
dantrolene
stop offending agent
```
147
most common organ transplant
renal
148
HLA Ag matching is most important for what transplants
kidney and pancreas
149
when to do bone marrow transplant
```
aplastic anemia
induction chemo
leukemia
lymphoma
hematopoietic disorders
```
150
when to do heart transplant
severe heart disease with estimated death within 2 year
151
Contraindication to heart transplant
pulm HTN and smoking in prior 6 mo
renal insufficiency
COPD
>70 years old
152
when to do lung transplant
COPD, primary pulm HTN, CF
153
CI to lung transplant
smoking in prior 6 mo
poor cardaic function
renal or hepatic insufficiency
terminal illness
154
when to do liver transplant
chronic hep B or C
| PBC PSC, biliary atresia, wilsons
155
when to do renal transplant
ESRD requiring dialysis
156
when to do pancreatic transplant
DM I with renal failure
157
CI to pancreatic transplant
```
age >60
CAD
PVD
obesity
DM II
```
158
hyperacute transplant rejection
initial 24 hours
| caused by antidonor Ab in recipient
159
how to avoid hyperacute transplant rejection
crossmatching blood
160
acute transplant rejection
6 days to 1 year
| from antidonor T cell proliferation in recipient
161
Tx acute transplant rejection
immunosuppressive agents
162
chronic transplant rejection
over a year later
| develop multiple cellular and humoral immune reactions to donor tissue
163
what meds are used in early transplant rejection
murmonab-D3 which inhibits T cell function and depletes population
antithymocyt globulin which depletes T cell population
164
what drugs are used in chronic graft vs host
hydroxychloroquine
| thalidomide
165
how dose hydroxychloroquine work and adverse effect
inhibits Ag processing
| cause visual disturbances
166
how dose thalidomide work and adverse effect
inhibit T cell function and migration
| sedation, constipation and teratogenic
167
how does cyclosporine work and adverse effect
helper T cel inhibition
| can cause nephrotoxicity and HTN
168
how does azathioprine work and adverse effect
inhibits T cell proliferation
| can cause leukopenia
169
how does tacrolimus work and adverse effect
inhibits T cell function
| can cause nephrotoxicity and neurotoxicity
170
what is graft vs host
reaction donor immune cells to host cells
171
risk factors for graft vs host
HLA Ag mismatch
old age
donor-host gender disparity
immunosuppresion
172
signs graft vs host
maculopapular rash, abdominal pain, n/v/d
| recurrent infections and easy bleeding
173
labs in GVH
inc LFTs
dec Ig
dec plaelets
174
Tx GVH
corticosteroids, tacrolimus, nycophenolate to decrease graft response
thalidomide and hydroxychloroquine for chronic
