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Allergy, immunology, infection > Emergency/Surgery > Flashcards

Emergency/Surgery Flashcards

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1
Q

Guillain-Barre syndrome

A

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

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2
Q

Wernicke’s encephalopathy

A

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

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3
Q

Reye’s syndrome

A

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.
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4
Q

Decerebrate

A

Arms are extended where as decorticate arms are flexed

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5
Q

Epidural hematoma

A

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)

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6
Q

Subdural hematoma

A

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

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7
Q

Sub arachnoid hemorrhage

A

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

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8
Q

Minimum MAP

A

90 mmHg

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9
Q

Basilar skull fracture: Sx/s

A 
Hemotympanum
Battle sign
Raccoon's eyes
Cerebrospinal fluid leaking form ear or nose
Hearing loss
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10
Q

Coma clinical eye movement

A

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

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11
Q

If increased innercranial pressure is suspected

A

Mannitol can decrease intravascular volume

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12
Q

altered mental status

A

Any change in emotional or intellectual function.

- Includes delirium, dementia, coma

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13
Q

Status epilepticus

A

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

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14
Q

syncope management

A 
CPR (if cardiac arrest0
EKG (arhythmia)
Echo (looking for structural abnorm)
Fluids
Oxygen
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15
Q

Hypothermia

A

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

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16
Q

Hypothermia treatment

A

Mild: passive external + heated IV fluids

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

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17
Q

Levels of frostbite

A

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

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18
Q

Chilbains

A

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

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19
Q

Heat cramps

A

Caused by salt depletion

Tx: oral fluid and salt replacement

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20
Q

Heat exhaustion

A

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

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21
Q

Head stroke

A

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

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22
Q

Heat stroke: dx and tx?

A

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

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23
Q

Pink froth from nose and mouth

A

Pulmonary edema

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24
Q

Decompression sickness

A

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

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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

Allergy, immunology, infection (12 decks)

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