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Flashcards in EM Surg StepUp Deck (174):
1

1st degree burn

epidermis only

2

2nd degree burn

partial thickness dermal

3

3rd degree burn

full thickness dermal and maybe deeper

4

4th degree burn

additional involvement muscle and or bone

5

electrical shock burn classification

4th degree becuase likely involve mm and bones

6

when do you need inpatient Tx fo rburns

2nd degree with >10% body surface
3rd degree> 2% body surface

7

which burns require airway managment

2nd or 3rd with >25% body or involving face

8

formula for IV fluid resuscitation for burns

LR 4mL x Kg x % body surface burned
half volume in initial 8 hours with remaining half over 16 hours

9

burn surface area of adult

9% head, each leg, back, trunk
4.5% each arm
1% genitals

10

what antibiotic is used for burn dressing

topical sulver sulfadiazine or bacitracin
also give tetanus toxoid

11

infections with burns

pseudomonas, stress ulcers- curlings

12

complications burns

infection
stress ulcers
apspiration
dehydration
ileus
renal insufficiency from rhabdomyolysis
compartment syndrome
epithelial contractures

13

age group highest risk of drowning

children

14

what happens with drowning to lungs

decreased compliance, V/P mismatch
shunting
cerebral hypoxia

15

freshwater drowning

hypotonic fluid absorbed causeing decreased electrolyte concentrations and RBC lysis

16

salt water drowning

hypertonic fluid draws water from pulm capillaries into alveoli causing pulmonary edema and increased serum electrolyte concentrations

17

Tx drowning vitim

secure airway
resuscitation
supp O2
nasogastric tube placement
maintenance of body temp

18

complications drowning

depends on degree and length of hypoxemia and hypothermia

19

Tx foreign body aspiration

rigid bronchoscopy

20

comlications of choking

atelectasis, penumonia, lung abscess, hypoxemia

21

risk factors hypothermia

alcohol
elderly

22

signs of hypothermia

lethargy, weakness, severe shivering, confusion, dec temp, arrhythmias, hypotension

23

EKG

J waves, possible vtach or vfib

24

Tx hypothermia

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