EM Test Flashcards
(209 cards)
1
Q
ekg big box time
A
5 mm
200 msec
2
Q
suture for superficial face
A
6-0 non absorbable
3
Q
what cardiac marker peaks first?
A
myoglobin - peak sin 1-4, baseline in 18-24
4
Q
treatment for distal radius fracture
A
reduction and sugar tong splint
5
Q
Causes of second degree heart block mobitz I
A
Drugs: beta-blockers, calcium channel blockers, digoxin, amiodarone
Increased vagal tone (e.g. athletes)
Inferior MI
Myocarditis
Following cardiac surgery (mitral valve repair, Tetralogy of Fallot repair
Rarely require pacemakers, usually benign
6
Q
memory of sutures
A
high memory = stiff, hard to handle, come untied
low memory =
7
Q
lower frequency ultrasound
A
greater penetration –> deeper imaging but lower resolution
8
Q
thumb spica splint
A
for scaphoid fracture
9
Q
what size should bites be in suturing?
A
- Bite size: ¼-in bites at 90 degrees create wound eversion
- Needle driver placement: 1/2-2/3 back from tip
*
- Needle driver placement: 1/2-2/3 back from tip
10
Q
when do inflammatory reactions to suture peak?
A
first 2-7 days
11
Q
scaphoid fracture mechanism
A
FOOSH
snuffbox tenderness
risk for avascular necrosis
12
Q
Sgarbossa Criteria
A
MI diagnosis in LBBB
- Concordant ST elevation > 1mm in leads with a positive QRS complex (score 5)
- Concordant ST depression > 1 mm in V1-V3 (score 3)
- Excessively discordant ST elevation > 5 mm in leads with a negative QRS complex (score 2).
- A total score of ≥ 3 has a specificity of 90% for diagnosing myocardial infarction
13
Q
which sutures have the best strength?
A
polydiaxone/polygyconate
14
Q
when to use horizontal mattress stitches?
A
- Horizontal mattress is good for use on fragile skin and also for areas of high tension; risk is that it holds so well that it can cause necrosis of the skin involved – best to only use when absolutely necessary
15
Q
traquetrum fracture mechanism
A
hyperextension or hyperflexion injury
16
Q
palms/soles suture removal time
A
10-12 days
17
Q
FAST indications
A
- hypotensive truma pt
- tachy trauma pt
- dyspneic trauma pt
- suspect pneumothorax or hemothorax
- suspect abd injury
18
Q
higher frequency ultrasound
A
lesser penetration –> superficial imaging at higher resolution
19
Q
what type of ACS requires hospital admission
A
unstable angina, NSTEMI, STEMI
asx CAD and SA can be outpaitnet wrokup
20
Q
smiths fracture
A
volar displacement of distal wrist fracture
21
Q
suture elasticity
A
degree to which suture stretches and returns to original length
22
Q
vessel for inferior MI
A
RCA
23
Q
abdominal probe
A
low frequency curivlinear
- 2-5 MHz
- Greater depth, broader field
24
Q
A
anteroseptal MI
ST elevation is maximal in the anteroseptal leads (V1-4).
Q waves are present in the septal leads (V1-2).
There is also some subtle STE in I, aVL and V5, with reciprocal ST depression in lead III.
There are hyperacute (peaked ) T waves in V2-4.
These features indicate a hyperacute anteroseptal STEMI
25
where does the indicator go in ultrasound
facing the head or to the right
26
hyperechoic
ultrasound
: reflect higher amplitude waves (brighter)
27
wgat abx for tendon, joint, nerve injuries
1st gen cephalosporin
28
FAST exam in non-trauma
ruptured AAA
ectopic pregnancy
ruptured hemorrhagic cyst
29
what to do if ST elevations?
go to cath emergently
30
fundamentals of splinting
1. reduce first if needed
2. isolate and immobilize the joint above and below the injury
3. padding to prevent tissue necrosis
31
Right Bundle Branch Block
activation of the RV is delayed as depolarization has to spread across the septum from the LV.
LV is activated normally, meaning that the early part of the QRS complex is unchanged
delayed RV activation produces a secondary R wave (R’) in the right precordial leads (V1-3).
**RBBB Criteria:**
Broad QRS \> 120 ms
RSR’ pattern in V1-3 (‘M-shaped’ QRS complex)
Wide, slurred S wave in the lateral leads (I, aVL, V5-6)
32
QRS interval
60-120 ms
1.5-3 small boxes
33
what does the R wave do along the precordials
limb leads - should be positive (except aVR)
should be more dominant portion of the complex going from V1 to V6
34
tensile strength
amount of force required to break a suture divided by it's cross sectional area
related to size
12-0 (smallest/weakest) --\> 3 (largest/strongest)
35
how to calculate QTc?
QT/sqrootRR
36
unstable angina
CP at rest
nothing relieves the pain
no heart damage (no ST change or trop)
90% occlusion
37
vertical mattress stitch
## Footnote
The vertical mattress suture is recommended for **wounds under tension and for those with edges that tend to invert (fall or fold into the wound).** It acts as a deep and superficial closure all in one suture. The first portion of the suture loop (far-far) approximates the dermal structures. The second portion (near-near) closes the wound and everts the edges.
38
RVH
* R axis deviation
* Dominant R wave in V1 (\>7mm tall)
* Dominant S wave in V5, V6 (\>7mm deep)
* QRS \<120 ms (bc changes not due to RBBB)
* RV strain pattern: ST dep/t wave inversion in precordial (V1-V4) and inferior (II, III, aVF)
*
39
EKG Lead Diagram
40
Wellen's syndrome
* Wellens’ syndrome is a pattern of deeply inverted or biphasic T waves in V2-3, which is highly specific for a critical stenosis of the left anterior descending artery (LAD)
41
What to do if ECG and trops are negative
stress test (outpatient or obs stay) to see if CP is coronary
if stress is pos - elective cath
42
when to use morphine
all purpose "go to drug"
43
vessel for anterior MI
LAD
44
vessel for lateral MI
branches of LAD and L circ
45
cross tolerance
* Cross-tolerance is a phenomenon that occurs when tolerance to the effects of a certain drug produces tolerance to another drug. It often happens between two drugs with similar functions or effects – for example, acting on the same cell receptor or affecting the transmission of certain neurotransmitters.
* Even among opioids, cross tolerance is imperfect
* Most experts recommend a 25-50% reduction in first dose when using equivalency charts
*
46
First Degree AV Block
PR interval \> 200ms (five small squares)
47
what does QRS represent
begins at AV node
conducts into bundle branches
48
first view on FASt
subxyphoid
49
NSTEMI ECG findings
ST depression
dynamic T wave inversion
(NSTEMI or high-risk unstbale angina)
50
what does lung sliding look like on M Mode?
seashore sign is normal!
bar code sign or stratosphere sign is suggestive of pneuomothorax - no lung sliding! (obstructive shock)
51
causes of second degree av block mobitz II
* Intermittently dropped QRS complexes without PR prolongation
* More likely to be due to structural damage of the conduction system, such as infarction, fibrosis, necrosis
* More likely to have HD instability, severe bradycardia, progression to third degree heart block
* ~35% risk of asystole per year à mandates immediate admission for cardiac monitoring, backup temporary pacing, and ultimately pacemaker insertion
52
LVH
* Pressure 2/2 aortic stenosis or HTN
* Increased R wave on L leads (I, aVL, V4-V6)
* Increased S depth on R leads (III, aVR, V1-V3)
* Lateral leads – ST depression + T wave inversion in L sided leads
* R wave in V5, V6 + S wave in V1 \> 35 mm
* Largest R + largest S in precordial \> 45 mm
53
when to use vertical mattress stitches?
Vertical mattress is recommended for wounds under tension and those with edges that tend to invert; acts as a deep and superficial closure all in one – the far-far loop approximates the dermal structures and the near-near loop closes the wound/everts the edges
54
Inferior EKG Leads
II, III, aVF
55
suture for superficial foot/sole
3-0 non-absorbable
56
4 views on LUQ fast
1. L costophrenic rescess
2. subdiaphragmatic space
3. splenorenal rescess
4. inferior pole of L kidney
57
max dose of lidocaine 1%
5 mg/kg OR 35 cc
58
ekg small box time
1 mm = 40msec
59
volar splint
for triquetrum chip fracture
60
adequate pressure for irrigating wounds?
5-8 PSI
can use higher (25) for really dirty wounds
61
cardiac probe
* 3.5-5 MHz
* Greater depth, smaller field
*
62
max dose of lido with epi
7 mg/kg
OR
500 mg
about 50 ml for 70 kg person
63
scaphoid fracture treatment
thumb spica splint
64
how to treat anaphylaxis
* ABCs, be ready to intubate
* Epi 1:1000 0.3-0.5mg IM
* Can keep giving q5-15 minutes
* IVF boluses (1-2L NS)
* Benadryl (diphenhydramine) 50mg IV
* Ranitidine 50 mg IV
* Salumedrol 125mg
* Albuterol and Mg for bronchodilation
65
antibiotics if tendon, jouint, nerve infection
first gen cephalosporin - cefazolin or cefalexin
66
max volume of lido WITH epi - .5%, 1%, 2%
100 cc
50 cc
25 cc
67
where should p wave be negative?
aVR, V1
68
boxers fracture
69
QTc length
\<440 ms in men
\<460 ms in women
70
when to give tetanus vaccine for wound
if \<3 or never received
if last dose \>10 years prior
71
Causes of LBBB
aortic stenosis, ischemia, htn, dilated cardiomyopathy, dig tox, hyperkalemia, degenerative disease of conduction system
72
what does ST segment represent
slow ventricular repolarization
73
fentanyl standard dose
* Loading dose of 1mcg/kg to 1.5mcg/K
* Additional doses 0.25-0.5mcg/kg q15 min
74
what does T wave represent
rapid phase of ventricular repolarization
should be in same direction as QRS (normally upright but inverted in V1 and aVR)
75
hypoechoic
: reflect lower amplitude waves (less bright)
76
RBBB pattern
* Broad QRS \>120 msec
* RSR’ pattern in V1-V3
* Wide, slurred S wave in lateral leads (I, aVL, V5-6)
*
77
QT interval
\<400 ms
2 large boxes
inversely proportional to heart rate
78
what does the Q wave represent?
septal depolarization
first downward deflection not preceeded by upward deflection
often absent, but can be seen in lateral leads
79
benefit to monofilament suture?
less risk of infection
80
Piezoelectric effect
* when an electrical pulse is applied, crystals vibrate, causing US waves to travel into the tissue and then be reflected back at various times and intensity depending on the tissue they encounter. The returning sound waves hit the crystals, mechanically distort them, create an electric current that is captured by the computer to form the image
81
What does a wide P wave mean?
left atrial enlargement
P mitrale
82
P wave size
\<120 ms
\<2.5 mm high
83
causes of first degree AV block
* First degree: prolonged PR (\>5 small boxes/200 msec)
* increased vagal tone, athletic training, inferior MI, mitral valve surgery, myocarditis, hypokalemia, AV nodal-blocking drugs (BBs, Ca channel blockers, Digoxin, amiodarone), normal variant
* Does not cause HD instability, generally benign
84
extremities suture removal time - under tension vs not
not - 8-10 days
tension - 10-14 days
85
hand bones
86
vascular probe
high frequency linear probe
* 7.5-10 MHz
* Higher resolution for superficial structures
* ~6cm depth
87
preferred needle curvature
3/8 curved needle
88
Causes of third degree AV block
Causes of complete heart block: MI, AV-nodal blocking drugs (CCB, BB, dig), Idiopathic degeneration of conduction system
89
max volume of lido WITHOUT epi - .5%, 1%, 2%
70 cc
35 cc
18 cc
90
Second Degree AV Block Mobitz II Causes
While Mobitz I is usually due to a functional suppression of AV conduction (e.g. due to drugs, reversible ischaemia), Mobitz II is more likely to be due to structural damage to the conducting system (e.g. infarction, fibrosis, necrosis).
91
Pelvic view on FAST
92
causes of second degree Mobitz I AV block
* progressive PR prolongation à dropped QRS
* Usually benign, rarely require pacemakers; typically due to a functional suppression of AV conduction
* Causes: drugs (BBs, Ca channel blockers, digoxin, amiodarone), increased vagal tone, inferior MI, myocarditis, s/p cardiac surgery (mitral valve repair, tetralogy of Fallot repair)
93
when to use hydromorphone
when large doses are required! morphine releases more histamine
94
suture for deep face
5-0 absorbable
95
mechanism of distal radius fracture
: FOOSH (extended wrist) or fall onto flexed wrist. Direct blow to the wrist
96
T wave
represents normal ventricular repolarization
should be same direction as QRS
normally upright, but inverted in aVR, V1
97
what if contaminated wound and tetanus vaccine was completed \>5 years ago
* If 3+ doses, do not give Ig and only give vaccine if last dose \>5 years ago
98
suture for securing g tube
2-0 non absorbable
99
2015 joint commission on opioids
* tx strategies may consider both pharmacologic and nonpharmacologic approaches as well as risks (including dependency, addiction, and abuse) and benefits to pts when considering the use of medications to treat pain
100
parenteral agents opioid equivalency
morphine - 10 mg
hydromorphone - 1.5 mg
fentanyl - 125 micrograms
101
left axis deviation
I pos
aVF neg
102
antibiotics if wound contamination by saliva, vaginal, or feces
saliva - PCN
vag/feces - metronidazole + amox or cipro(vag)
103
normal heart conduction
SA node -\> intermodal tracts -\> AV node -\> R and L bundles -\> ventricular conduction pathways
104
treatment for NSTEMI
if high-risk or elevated trop with NSTEMI ECG findings:
- invasive if HDS, VTach,
- add nitro, heparin (+ plavix, + beta block)
105
running stitch - simple and locked
106
lateral MI
107
STEMI ECG findings
STE
New LBBB
108
Third degree AV Block
In complete heart block, there is complete absence of AV conduction – none of the supraventricular impulses are conducted to the ventricles.
Perfusing rhythm is maintained by a junctional or ventricular escape rhythm. Alternatively, the patient may suffer ventricular standstill leading to syncope (if self-terminating) or sudden cardiac death (if prolonged).
Typically the patient will have severe bradycardia with independent atrial and ventricular rates, i.e. AV dissociation.
109
what does a tall P wave mean?
Right Atrial Enlargement (P pulmonale)
110
who to avoid routine antihistamine?
(requests for diphenhydramine are associated with drug-seeking behavior
111
steps of wound closure
* Sterile prep and drape
* Debride tissue as needed
* Ensure approximation of skin margins
* Perform appropriate suture repair technique
112
steps in suturing
1. anethetize
2. irrigate
3. sterile prep
4. close
5. dress
113
Second Degree AV Block Mobitz II
Intermittent non-conducted P waves without progressive prolongation of the PR interval (compare this to Mobitz I).
The PR interval in the conducted beats remains constant.
The P waves ‘march through’ at a constant rate.
The RR interval surrounding the dropped beat(s) is an exact multiple of the preceding RR interval (e.g. double the preceding RR interval for a single dropped beat, treble for two dropped beats, etc).
Mobitz II is much more likely than Mobitz I to be associated with haemodynamic compromise, severe bradycardia and progression to 3rd degree heart block.
Onset of haemodynamic instability may be sudden and unexpected, causing syncope (Stokes-Adams attacks) or sudden cardiac death.
The risk of asystole is around 35% per year.
Mobitz II mandates immediate admission for cardiac monitoring, backup temporary pacing and ultimately insertion of a permanent pacemaker.
114
hydromorphone standard dose
* Single dose 0.015mg/kg; can repeat this dose or half this dose q5min
115
morphine standard dose
8 mg to start, subsequently increase by 4 mg
**acute pain:**.1 mg/kg
Can give 0.025-0.05mg/kg q5min as a loading dose initially to get pain under contro
116
where should QRS be positive?
limb leads EXCEPT aVR
precordial - R should become more dominant going from V1 to V6
117
half buried stitch
## Footnote
Version of horizontal mattress stitch that is used to suture wounds that have a dog-ear to keep flap under less tension.
118
right axis deviaton
I neg
aVF pos
119
PR interval
120-200 ms
| (3-5 small boxes)
120
ACS meds
**M**orphine IV (if nitro doesn't help)
**O**xygen
**N**itro (sublingual or spray)
**A**spirin (160-325)
121
first steps if think someone has ACS
- ABCs, vitals
- ECG
- IV access
- Trop, lyte, XR
122
Lateral EKG Leads
I, aVL, V5, V6
123
face suture removal time
3-5 days
124
benefits of suturing
aid wound healing
decrease infection risk
cosmesis
125
when give tetanus Ig with the vaccine
* Contaminated wounds (dirt, feces, soil, saliva, puncture wounds, avulsions, and wounds from missiles, crush injuries, burns, and frostbite)
* If **\<3 or unknown previous doses, give vaccine and Ig**
126
railroad tracks
## Footnote
Mattress sutures are notorious for causing railroad track scars, so best to never use on the face or if cosmesis is concerned.
127
unstable VS + pos FAST
* OR (hemoperitoneum), chest tube (PTX, HTX), pericardial window
128
triquetrum fracture treatment
volar splint
129
Inferior MI
Right ventricular infarction is suggested by:
- ST elevation in V1
- ST elevation in lead III \> lead II
Right ventricular infarction complicates up to 40% of inferior STEMIs. Isolated RV infarction is extremely uncommon. Patients with RV infarction are very preload sensitive (due to poor RV contractility) and can develop severe hypotension in response to nitrates or other preload-reducing agents.
130
How to risk stratify NSTEMI
* TIMI score can help with risk stratification in the setting of non-dx ECG/normal trops
* Tx also includes oxygen, anti-plt, antithrombotic, nitrates, morphine, and potential later PCI or CABG
131
running subcuticular
## Footnote
Often not used in the ed, takes longer time, harder to be precise
132
most common thing to anesthetize?
Lidocaine
rapid onset
133
volume of water for irrigating wounds?
1 cm = 100 cc
134
p wave size
\<3 small boxes (\<120 msec)
\<2.5 mm high
135
where put prbe for lung exam in eFAST?
* Linear probe in mid-clavicular line between 2nd-3rd intercostal space
* Assess for lung sliding on M-mode (+seashore sign)
* No lung sliding (bar-code sign/stratosphere sign) suggests PTX
136
what is morrison's pouch
the space between the liver and the kidney
137
where to NOT use epi + antedote
* Do _not_ use epinephrine at the following sites: feet, hands, genitals, ears, nose
* Risk of tissue necrosis
* If you mistakenly do this, use **phentolamine** as an antidote (alpha blocker, causes vasodilation)
*
138
ulnar gutter splint
for boxers fracture
139
simple interrupted stitch
140
reciprocal ischemic changes
**PAILS**
LS stands for P-posterior A-anterior I-inferior L-lateral S-septal. ST elevations in these leads most commonly create reciprocal ST depressions in the corresponding leads of the next letter in the mnemonic. That is to say, posterior ST elevation will usually cause anterior lead ST depressions and anterior lead ST elevations will usually be seen with inferior lead depressions.
141
NSTEMI
some ecg changes (st depressions, t wave inversions) - NO elevations
+ troponin!
142
Boxer's Fracture
from improper punch
4th, 5th metacarpal
143
acetaminophen with codeine
pros: low abuse potential, low resale value, good of cough involved
cons: some people get no effect (2D6 poor metabolizers)
144
Causes of RBBB
-Causes of RBBB: RVH/cor pulmonale, PE, MI, myocarditis, degeneration of conduction system
145
Opioid “allergy”
all opioids release histamine to some degree - not a true allergy
* For unclear allergy (red arm, N/V): probably can give anything but switch chemical class if possible
* For anaphylaxis: switch chemical class and proceed with close monitoring
Classes: phenanthrenes, phenylpiperidine, phenylheptane
146
NSTEMi
heart is damaged --\> increased biomarkers
90% occlusion
DEMAND ISCHEMIA - if decrase workload, dcrease oxygen needs
147
Stokes Adams attack
sudden onset HD instability due to mobitz type II av block
148
abx if cat, human, dog bites
augmentin, PCN, first gen cefalosporin (cefazolin, cefalexin)
149
most common preferred needle for suturing? for vascular cases?
most = reverse cutting needle
vascular = tapered
150
Pericarditis on EKG
* Stage 1: widespread ST elevation and PR depression with reciprocal changes in aVR (first 2 weeks)
* Stage 2: normalization of ST changes, generalized T wave flattening (1-3 weeks)
* Stage 3: flattened T waves become inverted (3-several weeks)
* Stage 4: EKG returns to normal
*
151
wound dressing
bacitracin - fewer infections (NOT on dermabond - it will inactivate)
sterile gauze and kerlex
152
sizes of sutures
number + 0 = progressively smaller
number alone = progressively bigger
153
ACS Tx when someone hits the door
Morphine
O2
Nitrates - if continually have angina, NOT if inferior (II, III, aVL)
ASA
Beta block (decrease arrhythmias and demand)
ACE
Statin
Heparin (therapeutic) - if think STEMI !
Clopidogrel - if get a stent
tPA --\> if no access to PCI or in rural setting (door to balloon = 90 min) give if transport time \> 60 min
154
complications of splinting
burns - from exothermic reaction of plaster
compartment syndrome - always perform neurovascular exam after reduction and immobilization (cap refill and sensation)
155
colles fracture
dorsal displacement of distal radius fracture
156
complications of splinting
burns from exothermic reactions of plaster
compartment syndrome (perform vascular exam!)
157
4 views in RUQ on FAST
1. R costophrenic rescess
2. subdiaphragmatic space
3. hepatorenal rescess
4. inferior pole of R kidney
158
stable VS + positive FAST
CT to refine mgmt
159
benefit to braided suture?
easier to handle and tie
160
oral agents opioid equivalency
morphine - 30 mg
hydromorphone - 7 mg
hydrocodone - 20 mg
oxycodone - 20 mg
tramadol - 50-100 mg
161
diffrent biomarkers for ACS
troponins - go up first and stay up! better for immediate test
CKMB - reinfarction !
162
when to give fentanyl
shorter duration or true morphine allergy
163
CYP2D6 polymorphism
mutation of the enzyme that metabolizes codeine --\>morphine
many drugs are inhibitors of metabolism (antidepressants, antihistamines, antipsychotics) as well as inducers
coadministration of one of these drugs with codeine can lead to lethal overdose
- if poor 2D6 metabolizers - don't get much effect from drug!
164
Anterior EKG Leads
V3, V4
165
Wrist bones
So Long To Pinky, Here Comes The Thumb
Scaphoid, Lunate, Traquitrum, Pisiform
Hamate, Capitate, Trapizoid, Trapezium
166
knot strength
force required for a knot to slip
167
wound care counseling
* Keep wound dry for **24-48 hour**s
* Keep area elevated if possible
* Do not soak (baths, swimming) – can decrease tensile strength
* **Do not swim in fresh bodies of water** – increases infection risk
* Return for suture removal if appropriate
* Seek immediate care if site is erythematous, swelling, draining pus, or increasingly painful especially with fevers and chills
168
STEMI
100% occlusion
increase markers
ST changes
SUPPLY ISCHEMIA
169
stable VS + neg FAST
clinical correlation
170
which type of suture has the most tissue reactivity?
surgical or chromic gut
171
confirmed STEMI tx
\< 12 h - PCI (balloon), fibrinolysis
\>12h - nitro, LMWH + ACE/ARB, statin, beta block, plavix
172
timeline of healing
50% original strength at 40 days
70-90% at 1 year
173
traquitrum chip fracture
174
Left Bundle Branch Block
- In LBBB, the normal direction of septal depolarization is reversed (becomes right to left), as the impulse spreads first to the RV via the right bundle branch and then to the LV via the septum.
- This sequence of activation extends the QRS duration to \> 120 ms and eliminates the normal septal Q waves in the lateral leads.
- The overall direction of depolarization (from right to left) produces tall R waves in the lateral leads (I, V5-6) and deep S waves in the right precordial leads (V1-3), and usually leads to left axis deviation. As the ventricles are activated sequentially (right, then left) rather than simultaneously, this produces a broad or notched (‘M’-shaped) R wave in the lateral leads.
**LBBB CRITERIA**
Dominant S wave in V1
Broad monophasic R wave in lateral leads (I, aVL, V5-V6)
Absence of Q waves in lateral leads (I, V5-V6; small Q waves are still allowed in aVL)
Prolonged R wave peak time \> 60ms in left precordial leads (V5-6)
175
Chest view on FAST - what are you looking for?
B mode - looking for lung sliding
176
Septal EKG Leads
V1, V2
177
scaphoid fracture
178
why lidocaine with epi for anesthesia?
- Vasoconstriction
- Decreased bleeding
- Prolongs duration of action by decreasing systemic absorption
179
horizontal mattress stitch
## Footnote
A horizontal mattress suture can also be **used to achieve wound eversion in areas of high skin tension.** The needle is introduced into the skin in the usual manner and brought out on the opposite side of the wound. A second bite is taken along the opposite side, approximately 0.5 cm from the first exit site, and is brought back to the original starting side, also 0.5 cm from the initial entry point.
**Good for use on fragile skin.**
Howeve**r holds so well that it can cause necrosis of the skin that is involve**d. SO best only to use when absolutely necessary, and if possible, use simple stitch where feasible in same laceration.
180
abx if through and through oral wound
PCN
181
sugar tong splint
for distal radius fracture
182
LBBB pattern
* Tall R waves w/ RSR’ in lateral leads (I, V5-6)
* Deep S waves in right precordial leads (V1-3)
Typically leads to L axis deviation
183
Second Degree AV Block Mobitz I
Progressive prolongation of the PR interval culminating in a non-conducted P wave
The PR interval is longest immediately before the dropped beat
The PR interval is shortest immediately after the dropped beat
**Rarely require pacemakers, usually benign**
184
Causes of first degree AV block
Increased vagal tone
Athletic training
Inferior MI
Mitral valve surgery
Myocarditis (e.g. Lyme disease)
Hypokalaemia
AV nodal blocking drugs (beta-blockers, calcium channel blockers, digoxin, amiodarone)
May be a normal variant
185
inferior MI
* RV infarction suggested by ST elevation in V1, III\>II
* Preload sensitive à no nitrates or other preload-reducing agents
*
186
Boxer' Fracture tratment
reduction and ulnar gutter splint
187
distal radius fracture
188
189
190
191
managment of PEA
**CPR, epi 1 mg q 3-5 min**
cardiac arrest where you see a HR but no pulse
not shockable
hypovolemia, hypoxia
192
Hs and Ts
hypovol, hypoxia, H+, hypo/er kalemia, hypothermia
ptx, tamponade, toxins, thrombosis
193
A fib managment
cardiovert if unstable
if stable - AV nodal blocker (adenosine)
194
V fib management
defibrilate (not synchronized)
195
V tach management
cardiovert if unstable
otherwise - lido, procainimide, amiodirone
196
torsades management
defibrillate
197
198
199
200
201
202
203
204
205
206
207
208
209
