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Emergency Medicine > Lecture 12: LE Pain Readings > Flashcards

Lecture 12: LE Pain Readings Flashcards

1
Q

Most severe presentations of DVT (2)

A
  • Phlegmasia cerulea dolens (cyanotic)
  • Phlegmasia alba dolens (Pale)

Alba = albino = white

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2
Q

If someone has a PE, whats the likelihood they might have clinical signs of a DVT?

A

50%

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3
Q

Well’s for DVT

A
  • Active CA in past 6 months
  • Paralysis/paresis of lower limb
  • Bedridden > 3 d 2/2 surgery in past 12 weeks
  • Localized tenderness along deep veins
  • Entire leg swollen
  • Unilateral calf swelling > 3 cm below tibial tuberosity
  • Unilateral pitting edema
  • Collateral superficial veins
  • Prior hx

>= 3 = high risk

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4
Q

When is venous US slightly impaired in dx DVT?

A
  • Pelvic DVT
  • Isolated calf DVT
  • Obese
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5
Q

Which physical exam sign is non-specific for DVT?

A

Homan’s sign

Calf squeeze

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6
Q

Management of DVT

A
  • LWMH
  • UFH
  • Xa inhibitor
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7
Q

What DVT subtype requires immediate tx with neutral position?

A

Phlegmasia cerulea dolens

Also consider IR for thombectomy

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8
Q

Top RFs for PAD

A
  • Smoking
  • > 70 years old
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9
Q

MC arteries for arterial embolism

A
  • Femoral
  • Popliteal
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10
Q

What 4 arteries are most likely to lead to limb ischemia?

A
  • Femoropopliteal
  • Tibial
  • Aortoiliac
  • Brachiocephalic
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11
Q

6 Ps of acute arterial limb ischemia

A
  • Pain (earliest)
  • Pallor
  • Poikilothermia (cold)
  • Pulsenessness
  • Paresthesias
  • Paralysis
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12
Q

Define claudication

A
  • Cramping pain/ache
  • Brought on by exercise, relieved by rest
  • Reproducible
  • Reocccurs at consistent walking distances
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13
Q

MCC of arterial embolism

A

Underlying thromboembolic dz

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14
Q

What ABI ratio is extremely concerning for critical limb ischemia?

A

< 0.41

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15
Q

Gold standard for diagnosing arterial occlusion

A

Arteriogram

Identify anatomy & directs tx of the limb

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16
Q

First steps to managing acute arterial occlusion

A
  • Fluids
  • Pain meds
  • Dependent positioning (idk, it just says improves perfusion pressure)
  • EKG & consider echo
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17
Q

What rutherford criteria requires immediate tx for acute limb ischemia?

A

2b or higher (immediately threatened)

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18
Q

What rutherford criteria may suggest amputation as tx for acute limb ischemia?

A

3 (irreversible)

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19
Q

Preferred AC for acute limb ischemia

A

UFH 80U/kg bolus + UFH 18U/kg/hr

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20
Q

Discharge meds for chronic PAD without comorbidities and no immediate limb threat

A
  • Baby asa
  • Loading dose of 325mg before d/c
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21
Q

Rutherford criteria chart for acute limb ischemia

A
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22
Q

How do community acquired MRSA skin lesions present?

A
  • Warm
  • Red
  • Tender
  • Abscesses that spontaneously drain

Similar to a SPIDER BITE

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23
Q

Tx for community acquired MRSA abscesses in a normal immune system

A

I&D

No abx unless accompanying cellulitis or systemic

24
Q

ABX post I&D for patient with community acquired MRSA abscess with comorbidities

A
  • Clinda 300mg PO QID
  • Bactrim DS 2 tabs BID + Keflex 500mg QID
  • Vanco BID IV if admitting.

7-10 days!

25
Top 2 organisms for monomicrobial necrotizing soft tissue infections
* GAS * S. Aureus | If you have bad hygiene, add clostridials
26
Classic presentation of necrotizing soft tissue infections
* **Pain out of proportion** * Sense of heaviness * Edema, brown, bullae * **Malodorous** * Crepitus
27
What suggests systemic toxicity 2/2 necrotizing soft tissue infections?
**Mental status changes** like delirium or irritability
28
Tx of necrotizing soft tissue infections
* Vanco BID + * Meropenem Q8h | Zosyn alternative. Clinda can be added. ## Footnote Tetanus if needed
29
What systemic condition are we scared of occurring with a necrotizing soft tissue infection?
Septic shock
30
Who do you consult as soon as you suspect a necrotizing soft tissue infection?
Gen surg
31
Who is cellulitis MC in? (3)
* Elderly * Immunocompromised * Peripheral Vascular Disease
32
How does cellulitis present?
* Localized tenderness * Erythema * Induration of skin | May have accompanying lymphangitis/lymphadenitis
33
Dx of cellulitis
Clinical
34
Outpatient tx of cellulitis that is unlikely to be MRSA
* Keflex QID * Dicloxacillin QID * Clinda QID
35
Inpatient tx of cellulitis
* Clinda IV Q8h * Cefazolin Q8h * Nafcillin Q4h
36
MCC of erysipelas
GAS | due to skin break
37
Clinical features of erysipelas?
* **Sudden high fever** * Chills/malaise/Nausea * **Demarcated** erythematous area with burning sensation
38
Dx of erysipelas
Clinical
39
How do you tx uncomplicated erysipelas?
Same as cellulitis: * Keflex QID * Dicloxacillin QID * Clinda QID
40
Mainstay of tx for simple skin abscess
I&D
41
What is a Bartholin gland abscess?
* **Unilateral painful** swelling of labia * Fluctuant 1-2 cm mass
42
Tx of Bartholin gland abscess | Only if sus of STD
* I&D * Insertion of Word catheter for 4 weeks * Sitz bath after 2d
43
What is hidradenitis suppurativa and the tx?
* Chronic skin infection of the **apocrine sweat glands** (axilla and groin) * I&D | Surgeon if recurrent
44
What are infected epidermoid & pilar cysts and tx?
* Erythematous, tender, cutaneous, fluctuant nodules * I&D and check in 2-3d * **MUST REMOVE CAPSULE TO PREVENT RECURRENCE** | but you remove capsule at a secondary visit
45
What is a pilondial abscess and tx?
* Tender, swollen, fluctuant mass **along the superior gluteal fold** * I&D and check in 2-3d * **Surgery is definitive tx**
46
MCC of folliculitis
S. aureus
47
Tx of regular folliculitis
* Warm compresses * Topical bacitracin
48
Tx of extensive/painful folliculitis
* Keflex * Dicloxacillin * Azithromycin
49
What causes sporotrichosis?
Sporothrix schenckii
50
How does fixed cutaneous sporotrichosis present?
* Takes 3 weeks to incubate! * **Crusted** Ulcer or verrucuous **plaque**
51
How does local cutaneous sporotrichosis present?
**Subcutaneous nodule** or pustule with surrounding **erythema**
52
How does lymphocutaneous sporotrichosis present? | **MC type overall** of the 3
Painless subcutaneous nodules that **migrate along lymphatic channels**
53
Dx of sporotrichosis
Clinical | Tissue biopsies too but not useful in ED setting
54
Tx of localized or systemic sporotrichosis
Itraconazole PO for **3-6 months**
55
Tx of pts with systemic symptoms or disseminated sporotrichosis?
Amphotericin B | A BOMB

Emergency Medicine (29 decks)

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