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Emergency Medicine Part 1 > ER/Acute Care Pearls > Flashcards

ER/Acute Care Pearls Flashcards

1
Q

What is the second most common joint in the body to dislocate?

A

shoulder

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2
Q

How is the arm positioned with a shoulder dislocation?

A

arm is moved away from the body (abducted) & externally rotated

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3
Q

What is the re-dislocation rate in young athletes?

A

up to 90%

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4
Q

Which type of shoulder dislocation is most common?

(it is also the easiest to put back in place)

A

anterior

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5
Q

Which shoulder reduction technique is good for the elderly?

A

external rotation technique

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6
Q

Which shoulder reduction technique might be best for people without a significant amount of muscle mass?

A

scapular rotational maneuver

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7
Q

Which shoulder reduction technique uses weights?

A

Stimson’s technique

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8
Q

Which shoulder reduciton technique requires 2 people & is commonly employed for muscular patients/dislocated for long periods?

A

tractoin counter-traction

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9
Q

What should be done following shoulder reduction?

A

shoulder should be immobilized in a sling (2-4 weeks)

post reduction films

circulatory & sensatory status should be reassessed (axillary nerve)

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10
Q

With shoulder dislocations, older patients are at an increased risk for what?

A

adhesive capsulitis

(frozen shoulder)

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11
Q

Typical population/age group for nursemaid’s elbow

A

usually under 5 years old

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12
Q

What is the classic mechanism for a nursemaid’s elbow?

A

sudden pull on a young child’s arm

parent swings child around

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13
Q

What is the reduction method for nursemaid’s elbow?

A

with clinician’s thumb over the radial head & the other hand holding the child’s hand, the forearm is supinated & flexed then pronated & flexed

telltale ‘click’ signifies reduction

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14
Q

When should a child exhibit spontaneous & full movement after reduction of a nursemaid’s elbow?

A

within 10-15 minutes

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15
Q

What is the most commonly dislocated joint in the body?

A

PIP joint of finger

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16
Q

What is the hallmark of a dislocated finger?

A

deformity

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17
Q

Finger dislocations are usually ______

A

dorsal

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18
Q

With a finger dislocation, what do we want to confirm?

A

tendon function

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19
Q

What is the rule rather than the exception with ankle dislocations?

A

associated fractures

20
Q

What is a principle concer with ankle dislocations?

A

neurovascular injury

21
Q

With ankle dislocations, tented skin may be subject to what?

A

ischemic necrosis

22
Q

What are the primary goals of treatment with ankle dislocations?

A

immediate reduction of the joint

and

relief of neurovascular stress

23
Q

What are some ways to attempt to remove nasal foreign bodies?

A

patient may “blow their nose” while blocking opposite nostril

“mother’s kiss” technique

24
Q

Attempts at removing nasal foreign bodies can cause?

A

airway hazards (by pusing the FB into the pharynx)

consult ENT before complications are created

25
Q

Is sedation encouraged or discouraged with nasal foreign bodies?

A

discouraged

it can increase complications by reducing the gag & cough reflexes

26
Q

Can the tempanic membrane be damaged by pushing an ear foreign body further in the canal when attempting to remove it?

A

yes

27
Q

What are the keys to a successful removal of an ear foreign body?

A

adequate visualization

appropriate equipment

a cooperative patient

skilled clinician

28
Q

What are some methods for ear foreign body removal?

A

irrigation with water

grasping with forceps

cerumen loop

right-angle needle

suction catheter

29
Q

inflammation fo the nail fold

can be acute or chronic

A

paronychia

30
Q

What does a paronychia usually result from?

A

mild trauma

nail biting

31
Q

What is the usual bacterial agent that causes paronychias?

A

S. aureus

32
Q

In rare cases, paronychias may be accompanied by what?

A

fever & painful glands at axilla

33
Q

What is the treatment of choice for an ingrown toenail?

What is required for this?

A

wedge resection

digital block is REQUIRED

34
Q

What is the most common agent causing skin abscesses?

What is increasing?

A

most common: S. aureus

increasing: MRSA

35
Q

collection of blood between teh nail bed & the fingernail

A

subungal hematoma

36
Q

What type of fracture is often associated with a subungal hematoma?

A

distal phalanx tuft fracture

37
Q

What is the treatment for subungal hematomas?

A

nail trephination (with cautery stick)

reduces pain & may save the nail

38
Q

Stages of wound healing:

immediate to 2-5 days

hemostasis

vasodilation, phagocytosis

A

inflammatory phase

39
Q

Stages of wound healing:

2 days to 3 weeks

angiogenesis, collagen deposition, granulation tissue formation, epithelialization, wound contraction

A

proliferative phase

40
Q

Stages of wound healing:

3 weeks to 2 years

new collagen forms which increases tensile strength to wounds

scare tissue is only 80% as strong as original tissue

A

remodeling phase

41
Q

wound edges are approximated at or close to the time of injury

typically allows for the best cosmetic result to follow

best performed on wounds that are “clean” & uncomplicated

A

primary intention

42
Q

wound is not surgically closed

allowed to heal on own through granulation & re-epithelialization

often allowed for abscesses, fight bites, or “dirty” wounds

may be chose as closure method for wounds > 12 hrs old

A

secondary intention

43
Q

delayed primary closure or secondary suture

wound intentially left open for 1 to several days & then surgically closed

often done to allow tissue edema to reduce

often chosen for wounds with likely chance of infection

A

tertiary intention

44
Q

With topical anesthesia, what is the “key to success”?

A

blanching

45
Q

What are the desired effects of conscious sedation?

A

relaxation & cooperation

patient maintains protective airway

purposeful responses to verbal or tactile commands

safe return to baseline & ambulatory discharge

46
Q

What are some undesirable effects of conscious sedation?

A

deep & non-arousable state

decreased respiration & dyspnea/apnea

airway obstruction

hypotension & bradycardia

agitation/non-cooperative

47
Q

What are some comonly used medications for conscious sedation?

What side effect do they all have the potential to produce?

A

benzos, narcotics, dissociative agents, hypnotics

all can produce respiratory depression

Emergency Medicine Part 1 (8 decks)

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