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Most common cause of fatal anaphylaxis



Dental fractures

Ellis II dental fracture involves enamel and dentin, has a yellowish tinge.

Ellis III dental fractures are characterized by exposure of pinkish pulp and often blood.

require immediate dental consultation to prevent abscess formation.


If you see a septal hematoma?

Requires urgent drainage


O’Riain wrinkle test

placing the digit in warm water and looking for wrinkling of the digital pulps. Presence of wrinkling indicates the nerve is intact.


The most sensitive bedside test for nerve injury in a finger after trauma is:

two-point discrimination


Ottawa ankle rules

validated (for adults) to determine if an ankle X-ray is needed after an injury.

If any present or if there is an X-ray should be obtained.

pain in the malleolar zone and tenderness along the distal edge of the tibia


Bone tenderness along the distal 6 cm of the posterior edge of the fibula or tip of the lateral malleolus


An inability to bear weight both immediately and in the emergency department for four steps.


tenderness over the navicular or base of the 5th metatarsal


The recommended insertion site for needle decompression of tension pneumothoraces is the second intercostal space along the _________.

midclavicular line- inserted over the superior edge of the rib


If a lateral approach is needed for needle decompression of tension pneumothoraces, the recommended insertion site is?

the fourth or fifth intercostal space in the midaxillary line- inserted over the superior edge of the rib


In a patient with a suspected ruptured globe from penetrating trauma to the eye, all of the following should be performed

-Tetanus status
-Broad-spectrum antibiotics
-Anti-emetic therapy may be helpful in preventing the elevations in intraocular pressure associated with vomiting.
-Visual acuity assessment is important
-Ophthalmology consultation is critical.


retrobulbar hematoma

↓ vision
eye protrudes from the orbit
pain with extraocular movement

traumatic proptosis with impaired extraocular movements is classic for retrobulbar hematoma.


A ruptured globe presents with?

enophthalmos as vitreous humor leaks out of the eye.


Orbital blowout fracture

Fractures of the floor of the orbit

often cause epistaxis (through the connection of the maxillary sinus with the nose)
subcutaneous emphysema (through the entry of air from the sinuses into the subcutaneous tissue).
anesthesia of the ipsilateral infraorbital region.


retrobulbar hematoma possible rx

Lateral canthotomy (eye lid snip) that may be indicated in some patients with ocular injury such as retrobulbar hematoma


The American Heart Association recommends perimortem cesarean delivery if mothers spontaneous circulation has not returned within ?

four minutes of maternal cardiorespiratory collapse

rapid intervention (within minutes) of maternal demise has resulted in viable births.


Central cord syndrome

results from a hyperextension injury, typically in old pts with degenerative joints. The ligamentum flavum buckles into the cord, resulting in a contusion of the cord’s central portion.

rx:Administration of IV steroids and ordering of cervical MRI


Sensation of the dorsal aspect of the foot and dorsiflexion of the foot are functions of the ____ (NS)

L5 nerve root.


Jefferson fracture- spine

"burst fx" multiple breaks around the circle


Hangman fracture- spine

hyperextension of neck- like being hanged
straight fracture across circle


Flexion tear drop fracture- spine

a little tear peiced bone breaks off
very severe, often --> paralysis


Zone I penetrating neck injuries are located ?

between the sternal notch and the cricoid cartilage.

workup= Angiography, esophogram, and admission for observation


key to successful treatment of a septic joint is ?

rapid diagnosis and treatment.
Hospital admission for wash out
IV antibiotics


Removal of swallowed foreign object

endoscopic or surgical intervention for
-sharp objects
-objects > 2 cm in width (which are likely to lodge at the pylorus or the ileocecal valve)
-long rigid objects (which may have trouble passing through the right angles of the duodenum).

-Surgery if an object fails to move after 24 hrs (indicating impaction) or develops s/s


The Cormack-Lehane scale

scale description of visualization of laryngeal structures during laryngoscopy and intubation


agent of choice for intubation of patients with reactive airways disease.

relaxes bronchial smooth muscle
(subject to debate)



agent in RSI- primarily indicated for induction when decreased myocardial contractility is a concern

acceptable side effect profile, but known to cause transient adrenal suppression and its use in septic patients is controversial.


Procaine and tetracaine are ?

anesthetic esters
slow in onset
Procaine is the least potent


Lidocaine and bupivacaine are ?

amides but the latter is much more potent, intermediate in onset and longer lasting


Adhesive arachnoiditis

spine problem
manifests as a progressive loss of nerve function


bleeding diathesis

unusual susceptibility to bleed (hemorrhage) mostly due to hypocoagulability, in turn caused by a coagulopathy (a defect in the system of coagulation).