ER-Final Flashcards
(113 cards)
1
Q
body’s WBC enzymes lyse necrotic tissue
A
autolytic
2
Q
topical exogenous, enzymatics, most selective but least damaging debridement for eschar ulcer?
A
chemical
3
Q
most absorbent wound care?
A
foam
4
Q
Tx for granulative ulcer that is clean with little exudate?
A
hydrocolloid
5
Q
HCP exposed to ‘dirty’ bomb; at risk for?
A
alpha radiation
6
Q
? is non-selective and substandard care in chronic wounds; aka?
A
wet to dry, mechanical
7
Q
exudate- maintain ? (not wet, not dry)
A
moist
8
Q
stable eschar - dont ?
eschar on heels - deride once eschar ?
A
debride
separates
9
Q
infection: ? is most accurate but ? is MC
A
Bx, swab
10
Q
? may injure periwound skin
A
Dakin’s solution
11
Q
this antimicrobial reacts w/ cells DNA, prohibits repro
A
silver
12
Q
all pts w/ maxillfacial trauma presumed to have ? until excluded
A
unstable cervical spine injury
13
Q
GCS- moderate injury?
A
9-13
14
Q
HM of brain insult of any cause
A
consciousness
15
Q
severe head injury.. after ABCs?
A
ICE: IV access, cardiac monitor, elevate bed to 30 degrees
16
Q
? occurs in 1/3 of head trauma pts
A
DIC
17
Q
cerebral contusion has ? but concussion does NOT
A
structural injury
18
Q
? and ? are linked to the severity of post concussive sequellae; ? is not
A
amnesia, seizures, postconcussive syndrome isn’t
19
Q
MC cerebral herniation?
- ? pupillary changes
- ? motor weakness
A
uncal
ipsilateral
contralateral
20
Q
subdural hematoma
MC in ? and ?
on CT scan?
A
elderly, alcoholics
crescent-shaped, high attenuation lesion
21
Q
hyperdense, homogenous areas seen in ?
A
ICH- intracerebral hemorrhage
22
Q
skull fx- clinically important? not important?
A
depressed, linear
23
Q
MCC of penetrating head injury in US?
A
GSW
24
Q
no rxn to bulbocavernous reflex =
A
s.c. injury
25
dec height with concavity of anterior vertebral body, STABLE injury (posterior intact)
simple wedge fx
26
wedge shaped fragment of anteroinferior vertebral body, causes quadriplegia and loss of ant column senses only
FLEXION teardrop fx
27
oblique fractures of base of spinous processes of lower cervical vertebra, stable injury, usually no neuro involvement
clay shoveler's fx (flexion)
28
rupture of ligamentous complexes, possibly unstable if >50% override
subluxation
29
extremely unstable, high incidence of s.c. injury?
bilateral facet dislocation
30
only flexion rotation injury?
| ? views are helpful
unilateral facet dislocation
| oblique
31
hyperextension, spondylosis of C2, unstable
hangman's fx
32
may see ? syndrome in extension spinal injuries
central cord
33
extension injury- usually involves axis but can involve C5 and C7; stable in flexion/unstable in extension; DIVING ACCIDENTS
extension teardrop Fx
34
unstable injuries? 5
hangmans, extension teardrop, subluxation, bilateral facet dislocation, odontoid III
35
vertical compression fx
- c spine and l spine, comminuted fx, stable
- fx of C1 ring, axial loading injury, mechanically stable
- burst fx
| - jefferson/atlas C1 fx
36
complete spinal cord lesions: if sx are longer than 24h, 99% ?
do not have functional recovery
37
neurogenic shock triad?
hypotension, bradycardia, hypothermia
38
spinal shock has initial ? followed by ?
increase in BP, hypotension
39
anterior cord syndrome- anterior ? cord
- complete ? paralysis
- ? is preserved
2/3
motor
posterior column (spinothalamic)- propioception, vibration, crude touch
40
best for viewing maxilla? also zygomatic and other aspects of facial bones
water's view
41
MC facial fx?
| 2nd MC?
nasal
| zygomatic
42
don't blow nose in? 2
zygomatic, orbital floor fx
43
hanging drop sign
orbital floor fx
44
most traumatized teeth are ?
maxillary teeth
45
w/ frontal sinus fx, MUST evaluate?
posterior wall
46
intra/postop MI assessment?
goldman cardiac risk assessment
47
MC lab abn in pts
anemia
48
young pt- transfuse when Hct is ?
18
49
```
OR= ?
field = ?
```
aseptic
| sterile
50
w/ surgical gown, most important is ?
impermeability to moisture (wet transmits bacteria 'through' gowns)
51
gown:
surgery 2-4h?
>4h?
reinforced gown- double/triple layered
| plastic and reinforced-impervious & hot
52
? sterilization for instruments that might corrode (for moisture AND heat intolerant)
gas
53
wound care for OA or laporoscopy?
gauze
54
excellent at autolysis
transparent film
55
can be used for heavy exudate w/ alginates, no endpoint for change
absorbent clear acrylic
56
liquid impregnated gauze for minimal drainage, contain within wound edges
hydrogels
57
fills dead space, for large amount of drainage?
alginates
58
manage large amounts of exudate 20x their weight
absorbent wound fillers
59
unique blend of cations, manages hard to heal wounds
tegaderm
60
protect wound base from trauma during dressing changes
contact layers
61
stimulate wound healing, from bovine/porcine/avian source; soak up wound fluid/highly absorptive
collagen dressings
62
only available growth factor
Regranex
63
signs of shock?
MACHO: metabolic acidosis, AMS, cool/clammy skin, hypotension, oliguria
64
- compensatory mech?
| - when these fail... ?
- inc CO, tachycardia, vasoconstriction
| - change in VS and end organ dysfunction
65
SIRS (need 2 of these)
- body temp?
- HR?
- RR?
- peripheral leuk count?
38C
>90
>20
>12,000 or >10%bands
66
Txing shock:
| -if little/no improvement w/ O2 delivery? 2
continue IV, give type O neg blood
67
give calcium in massive ?
transfusion
68
adult urine output?
>50cc/hour
69
MC cardiac rhythm
sinus tachycardia
70
tx fractured ribs/sternum w/?
analgesics, nerve blocks
71
MC esophageal injury? can lead to?
tears, mediastinitis
72
MC fx:
shoulder
hip
knee
anterior
posterior
transverse
73
hanging cast for?
humerus fx
74
for first 48 hrs put colle's Fx in a ?
sugar tong splint
75
tibia fx- waddells triad?
knee/femur, chest, and c-spine injury
76
ortho min 2 X-rays to order?
AP & lateral
77
compartment syndrome- tx for CS and coagulopathy?
antivenom
78
common pathogen of animal bites
pateurella multocida
79
antihistamines for poison ivy
hydroxyzine, domeboro, calamine
80
peritoneal Sx
extraperitoneal renal injury
intra
no
| yes
81
malignant htn has a DBP of ?
>130
82
malignant htn lab finding?
microangiopathic hemolytic anemia
83
tx of rhabdomyolysis
hydration w/ IV isotonic saline
alkalinize w/ Na bicarb
forced diuresis (mannitol)
84
tx of sea bather's eruption
papain
85
mc nonbacterial fish poisoning in USA; sx? tx?
ciguaterra
reversal of hot/cold perception
mannitol IV (<48h 60% reverse sx)
86
MED average?
20 min at noon
87
4 most imp predictors of CS/AMI?
DEER: diaphoresis, emesis, exertional CP, radiating CP
88
MONA for MI even if on ? or ?
coumadin, plavix
89
do not give BB, MS, or NTG w/ ? or ?
RVMI, hypotension
90
dressler's syn sx? tx?
post MI- fever, pleuritic CP, pericardial friction/rub; stop anticoags & give NSAIDs
91
arteries:
inferior leads II, III, aVF?
septal/anterior aka V1,2/V3,4
lateral leads I, aVL, V5,6
RCA
LAD
Cx
92
RVI: V1? V2?
v1 ste; v2 std
93
IMI - may see ? before STe
TWI in aVL
94
IWMI: always think about ? and ?
RVI, PWI
95
tests in additional to tox screen to order separate?
TRIPLE A- acetaminophen, aspirin, alcohol
96
CANT use charcoal? 5
hydrocarbons (gasoline, benzene, motor oil, etc), metals (lead, iron, mercury), ions (lithium), alc (ethanol, methanol), CAUSTICS (bleach, ammonia, household products, etc)
97
isoniazid antidote?
pyridoxine
98
organophosphate antidote? 2
atropine, pralidoxime- tx repeated until recovery
99
check initial acetaminophen levels ? after ingestion
4 hours
100
no dialysis and no antidote**
NSAIDs
101
- no antidote but tx w/ charcoal and atropine for bradycardia?
- tx w/drawal s/e w/?
alpa 2 agonists (clonidine, methyldopa)
| phentolamine, propanolol (hypertensive crisis)
102
MAOI toxicity
- EKG?
- tx w/?
```
sinus tachycardia (MC)
phentolamine or nitroprusside
```
103
two that commonly use whole bowel irrigation w/ PEG?
iron, lithium (both = no charcoal)
104
no lab tests are helpful with determining ? withdrawal; clinical sx present
opiod
105
hallucinogen toxicity?
| marijuana toxicity?
- supportive, haldol for psychosis
| - supportive- BZD for anxiety, seroquel (quetiapine) for hallucinations
106
- PCP OD labs will show elevated ?
- plasma levels do not correlate well with ?
- Tx?
CPK (muscle overactivity, violent behavior, seizures)
clinical findings
lavage/charcoal, BZD for agitation
107
- 2nd MC OD drug ER visit?
- Tx OD w/ ?
- CI? bc?
- cocaine
- BZD (htn)> fail then try phentolamine, NTG, or verapamil
- BB, can cause MI
108
- seds/hypnotics number one choice in ?
- MC findings?
- besides lavage/charcoal, ? for ADULTS ONLY
- suicide method
- ataxia, slurred speech
- sorbitol (CI children- diarrhea; opioid are anti-motility drugs)
109
lithium toxicity:
- acute Sx?
- EKG changes? 3
- Tx?
- N/V/D
- T wave flattening and inversion, U wave (hypokalemia- Li acts as Na sub), prolonged PR
- PEG, hemodialysis
110
carbon monoxide toxicity
- lab?
- tx?
- MCC of ? death
- consider in any pt w/ unexplained ? or exposure to ?
- CO-Hb (pulseox and ABG may be falsely normal!)
- 100% oxygen
- toxin-induced
- HA, fire/smoke
111
caustics
- bleach, ammonia, mouth ?, etc
- sx?
- tx?
mouth pipetting
mainly GI
endoscopy, NPO, possible esophagectomy
112
carbamate insecticide (AchE inhibitor)- Tx ?
atropine
113
tx of hydrocarbon toxicity?
supportive, ABCs
