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Flashcards in Emergency/Surgery Deck (73):
1

Guillain-Barre syndrome

Acute ascending progressive neuropathy starting in the LE; weakness is symmetric.
-2/3 of cases, a mild upper respiratory infection or gastroenteritis precedes the onset by 1-3 weeks

2

Wernicke's encephalopathy

Neuro symptoms due to thiamine (vit b) def
Triad: ophthalmoplegia, ataxia, confusion, but only 10% of cases have all three.
- often from malnourished people from EToH abuse
- give 100 mg IV, immediately on suspicion of this

3

Reye's syndrome

Encephalopathy associated with fatty degeneration of the liver.
- Rare but severe cause of delirium progressing to coma
- May be history of viral illness (varicella, influenza)
- Linked to salicylates with virus
- S/sx: protracted vomiting and delirium which progresses to coma within 2 days.

4

Decerebrate

Arms are extended where as decorticate arms are flexed

5

Epidural hematoma

Vessel: middle meningeal artery
S/sx: Out, lucid interval, follow by unconsciousness
CT: bioconvex lense hematoma
Dx: Does not cross suture lines,
Bad news if: ipsilateral pupil dialation with contralateral hemiparesis (sx of impending herniation)

6

Subdural hematoma

Vessel: bridging veins
Sx/s: Gradually increasing HA and confusion
CT: Crescent shaped bleed
Dx: Does cross suture lines

7

Sub arachnoid hemorrhage

Cause: 80% due to saccular aneurysm
Sx/s: thunderclap HA, photophobia
CT: non-contrast CT, but findings not always present
Tx: craniotomy, clipping the aneurysm

8

Minimum MAP

90 mmHg

9

Basilar skull fracture: Sx/s

Hemotympanum
Battle sign
Raccoon's eyes
Cerebrospinal fluid leaking form ear or nose
Hearing loss

10

Coma clinical eye movement

The eyes may conjugately deviate toward the side of the hemorrhage.

11

If increased innercranial pressure is suspected

Mannitol can decrease intravascular volume

12

altered mental status

Any change in emotional or intellectual function.
- Includes delirium, dementia, coma

13

Status epilepticus

single seizure >or= 5 min in length
2 or more seizures without recovery between seizures
Tx: protect airway
- 1st: a lorazepam, Refractory: intubation + phenobarbitol

14

syncope management

CPR (if cardiac arrest0
EKG (arhythmia)
Echo (looking for structural abnorm)
Fluids
Oxygen

15

Hypothermia

Rectal temps:
Mild: 90-95F: 34-36C
Moderate: 30-34C
Severe:

16

Hypothermia treatment

Mild: passive external + heated IV fluids
Mod-Sev: Active external, combined with warm peritoneal dialysis, warm IV, warm GI fluids)

17

Levels of frostbite

1st: partial skin freezing; erythema and edema, no blistering, stinging, burning
2nd: Full thickness freezing, vessicles that desquamate, black eschar
3rd: Full skin and subQ freezing, violaceous, skin necrosis
4th: Full skin, subQ and mus/tend/bone freeze, little edema, no pain

18

Chilbains

aka Pernia
Exposure to non freezing temp
Exp: chronic intermittent exp to damp, nonfreezing temp

19

Heat cramps

Caused by salt depletion
Tx: oral fluid and salt replacement

20

Heat exhaustion

Caused by primary water loss or sodium loss. (Hypernatremia or hyponatremia)
Sx: non specific, HA, N/V, malasie, cramps, dizziness

Rapidly leads to heat stroke, rehydrate and cool

21

Head stroke

Can no longer thermoregulate
Classicly associated with alteration in mental status
Body temp > 41C (105.8)
Same as heat exh + CNS dysnfunc: seizures, delirium and coma
Skin is usually dry and hot, anhidrosis not required

22

Heat stroke: dx and tx?

Dx: Diagnosis of exclusion: rule out infection, toxin, DKA, CNS disorder
Tx: Assess ABCs
IV fluids
Evaporative cooling (antipyretics not indicated)

23

Pink froth from nose and mouth

Pulmonary edema

24

Decompression sickness

Type 1: Deep aching pain in large joints (elbow and shoulder most common)
Cutaneous marmorata -> pathognomonic (skin marbling)
Type 2: gen fatigue, spinal para, vertigo, vis/speech disturbance. Multiorgan system disorder.
Tx: give O2 for at least 2 hours
Should wait 12-48 hours to fly

25

Arterial gas emboli

Sx/s: stroke-like with blindness, confusion.
Sx within 10 minutes of surfacing

Tx: Immediate decompression in HyperB
100% O2, supine on L side

26

Acute mountain sickness

6-24 hours after arrival at altitude
Sx worse on day 2-3, clear by day 7
Tx: go down, O2, severe may req: dexamethasone

27

High altitude pulmonary edema

>8000ft
Cough dyspnea on exertion; pink, frothy sputum
CXR: pathcy infiltrates
Greatest mortality of AMS illnesses
Tx: rapid descent, positive pressure vent, O2, nifedipine, aetazolamide

28

High altitude cerebral edema

HA, ataxia, papilledema, global encephalopathy
Sx/s: apathy, agitation, focal neuro signs, obtundation, coma
Tx: rapid descent, O2, dexamethasone,
can use acetazolamide (watch cerebral perfusion pressure, so watch for hypoT. Mannitol

29

Altered Mental Status DDx

Alcohols
Endocrine/Environment/Electrolytes/Encephalopathy
Infection
Oxygen/Opiates
Uremia

Trauma/Tumor/Toxin
Insulin,Infarction/Intracranial hemorrhage
Psychogenic/Poisons/Drugs/Porphyria
Stroke/Seizure/Shock/Space occupying

30

Concussion

Treat early: cognitive rest, physical rest, sleep

31

Depressed skull fracture

Often found with inspection/palpation, swelling around the injury can mask depression.

Admit and refer to surgery subspecialist

32

Black widow bite

Severe pain in extremity and stomach/trunk muscle spasms
Systemic systems>local symptoms
N/V, Diaphoresis, HTN
Tx: narcotic analgesics, antivenin

33

Brown recluse spider bite

Sx/s: venom is cytotoxic (erythematous, blister, fever/V/arthralgia), leads to local progressive tissue destruction/necrosis
Tx: local wound care, tetanus shot, no antidote

34

Tarantulas

Urticating hairs, minimally toxic to humans

35

Scorpion stings

Sx/s: intesnsely painful, erythema
Tx: periodic ice, AVOID tourniquet, neuroleptics, antihypertensive, atropine

36

Tick bites

Sx/s: Wood tick: ascending motor paralysis
Tx: supportive care, remove tick
Abx: doxycycline if infected

37

Dog and cat bites

Irrigate, debride, leave open or loosely sutured
Abx: augmentin (dogmentin)
Tetanus

38

Airway obstruction
presenting symptoms:

Stridor, forced ventilatory efforts,
intercostal, suprasternal or supraclavicular retractions or other signs of increased respiratory effort

39

Airway obstruction managment

Remove foreign body if there is one
If laryngeal edema -> epinephrine subQ or IV
If progressing obstruction -> surgical cricothyrotomy

40

Tension pneumothorax symptoms

Chest pain, respiratory distress, decreased breath sounds, tympany via percussion

& shift of the mediastinum, destined neck veins, hypotension, shock

41

Simple pneumothorax symptoms

Chest pain, respiratory distress, decreased breath sounds, tympany via percussion
CXR: air in pleural space, and lung collapse

42

Tension Pneumothorax management

Supp O2
Tube thoracostomy

43

Simple pneumothorax management

Unilateral: needle decompression or thoracostomy
Bilateral: Immediate thoracostomy

44

Pulmonary contusion signs/symptoms

Silent at initial presentation
Hypoxia, dyspnea, hemoptysis, tachycardia, chest injury, decreased breath sounds, crackles.
CXR: apparent within 6 hours, ranging from patchy infiltrates to complete lobar consolidation

45

Flail chest symptoms

Painful paradoxical motion of the rib cage
Crepitation or subcutaneous emphysema, decreased breath sounds

46

Status asthmaticus presentation

Severe acute asthma attack
Hypoxemia, tachypnea, tachycardia, accessory muscle use, wheezing
Tx: IV magnesium sulfate, pressure vent, ketamine, epinephrine, mechanical vent

47

carbon monoxide poisoning/smoke inhalation presentation

Suspect in every fire victim
Cherry-red skin color is frequent but not reliable
Asymptomatic below when O2 decreased 10-15%
50-60% associated with coma and seizures
70% fatal
Findings: MI, arrhythmia, dementia, ataxia, sensory motor findings, loss of consciousness

48

Anaphylaxis

Within seconds to an hour
Acute progression of organ system involvement that may lead to cardiovascular collapse

49

Anaphylaxis symptoms

Derm: pruritus, flushing, urticaria, erythema multiforme angioedema
Respiratory: dyspnea, hypoxia, wheezing, cough, stridor
CardiV: dysrhythmias, collapse, arrest
GI: cramping, vomiting, diarrhea
GU: urgency, cramping
Eye: pruritus, tearing, redness

50

Anaphylaxis management

Resuscitation: ABC, cardiac monitor, pulse ox, IV access
Admin: O2, epi IM in thigh, fluids if hypoT, steroids, antiH, albuterol, glucagon (in patients refractory to other treatments)

51

Rule of nines
TBSA

Back: 18
Front: 18
Leg each: 18
Arm each: 9
Head: 9
Patient palm surface = 1% of their body surface area

52

Laparotomy

Surgical opening of the abdomen

53

Laparoscopy

Abdominal exploration with an endoscope

54

Enterostomy

Surgically created opening into a portion of the GI tract

55

anastomosis

Natural connection between two vessels, or surgical connection of two tubular structures.

56

Z-plasty

the use of Z-shaped incision in plastic surgery to relieve tension in scar tissue

57

Fundoplication

Surgery for GERD:
Fundus of stomach is wrapped around esophagus.
Strengthens lower esophageal sphincter

58

Colostomy

Procedure where part of the colon is diverted through the abdominal wall

59

Colectomy

Removal of a piece of the colon

60

Hemi-colectomy

Removal of an entire colonic side (ex. ascending or descending or transverse)

61

Endarterectomy

Surgical removal of the lining (and plaque) of the carotid artery.

62

Thoracotomy

Surgical incision into the chest wall

63

Pleurodesis

Obliteration of the pleural space.
Used to treat pleural effusion or recurrent pneumothorax

64

Sphincterotomy

Cutting of a sphincter muscle to decrease its resting tone.
Used to correct anal fissures and bile duct issues.

65

Tamponade symptoms

Beck's triad: hypotension, jugular venous distension, muffled heart sounds
Diminished cardiac output
Narrow pulse pressure

66

ASA Physical status classification

ASA 1: normal healthy patient
ASA 2: mild systemic disease without limitations
ASA 3: severe systemic disease with functional lim
ASA 4: severe systemic disease with constant threat of life
ASA 5: moribund, not expected to survive without surgery
ASA 6: declared brain dead for organ donor procedure
ASA + E: patient requiring emergency operation

67

What level predicts an increased risk of cardiac complication in surgery

4 mets or less is of risk
If some one can do 2 sets of stairs: at least 4 mets

68

Post op bowel movement

24 hour for most operations that don't involve abd cavity

69

1st, 2nd, 3rd intention

1st: sutured
2nd: Wound left open
3rd: left open then closed 4-6 days later

70

Most common bug for furuncle and carbuncle

Staph aureus

71

Celllulitis

MC due to GABHS and staph

72

Gas gangrene

C. perfingens most common microb
Incubation :12-24 hours
ABx: empiric combo

73

Most common type of UTI bug

E.coli 27%
Enterococcus 13%
Candida, P. aeruginosa, Klebsiella