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Pestana pearls Flashcards

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1
Q

Securing an airway in someone with subcutaneous emphysema in the neck?

A

Fiberoptic bronchoscope required

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2
Q

How is an airway actually inserted in an awake patient?

A

Orotracheal. Rapid induction with monitoring of pulse ox w/ laryngoscope

Topical anesthesia less common

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3
Q

Securing airway in C-spine injury?

A

Orotracheal too! As long as HEAD IS SECURED and not moved.

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4
Q

Running out of time but need airway?

A

Cricothyrotomy NOT UNDER 12 YO.

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5
Q

How do you verify that breathing is ok?

A

Bilateral breath sounds on chest

Good pulse ox

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6
Q

Way to figure out if shock is hemorrhagic?

A

Check CVP…it’s LOW (empty veins)

3-8 is normal

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7
Q

When is CVP high?

A

In both pericardial tamponade and tension pneumo

you see big distended neck veins

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8
Q

Tension pneumo physical exam findings?

A

No breath sounds / hyperresonant to percussion/ tracheal deviation

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9
Q

When you’re giving fluids when should you stop?

A

Don’t exceed CVP of 15 mmHg

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10
Q

Tamponade management?

A

Pericardial window, give fluids and blood while doing it

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11
Q

Anyone with head trauma who becomes unconscious…

A

…gets a CT scan

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12
Q

Acute subdural hematoma on CT with a midline shift

A

Craniotomy

Prognosis still bad

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13
Q

Acute subdural hematoma on CT WITHOUT midline shift

A

ICP monitoring, elevate HOB, hyperventilate, avoid fluid overload, mannitol or furosemide

Hypothermia to decrease oxygen demand

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14
Q

When do you see anterior cord syndrome?

A

Burst fractures of the vertebral bodies

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15
Q

What do you do for suspected cord fracture?

A

MRI and give some high dose steroids

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16
Q

How do you stop the source of bleeding for a hemothorax?

A

You don’t; it’s usually a source from the LUNG which will stop by itself as it’s a low pressure system

Rarely it’ll be a systemic vessel (usually intercostal artery)–> thoracotomy

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17
Q

Factors that dictate whether surgery is needed after chest tube inserted to hemothorax?

A

> 1500 mL out on insertion
200mL/hr
600mL over 6 hours

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18
Q

Someone comes in with flail chest. What do you do?

A

Fluid restriction + diuretics (contused lung is sensitive to fluid overload)

AND LOOK FOR traumatic transection of the aorta!

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19
Q

What makes you worry about traumatic rupture of the aorta?

A

It’s a “hidden injury” until it blows up and kills patient.

Be suspicious with broken hard-to-break bones or wide mediastinum.

TEE, spiral CT (CT angio), or MRA

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20
Q

Who gets an air embolism?

A

Chest trauma patient who is intubated and on a respirator

Also happens when subclavian vein is open to the air (CVP line disconnected, supraclavicular node biopsies)

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21
Q

What do you see in someone with a fat embolism?

A

Petechial rashes in the axillae and neck, fever, tachycardia, low platelet count

Hypoxemia and bilateral patchy inflitrates on CXR.

RX: RESPIRATORY SUPPORT

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22
Q

Stab wound to the abdomen that has clearly penetrated (viscera are protruding)?

A

Ex lap MANDATORY

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23
Q

Stab would to abdomen with peritoneal irritation?

A

Ex lap MANDATORY

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24
Q

Stab wound to the abdomen without penetration or peritoneal irritation?

A

Digital exploration and observation

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25
If you're highly suspicious of intraabdominal bleeding in hemodynamically stable patient?
CT SCAN
26
Suspicious of intraabdominal bleeding in hemodynamically UNSTABLE patient?
FAST exam
27
Pt develops coagulopathy intraoperatively?
Platelet packs + FFP (~10 units each)
28
Pt gets intraoperative coagulopathy with ACIDOSIS and HYPOTHERMIA?
Stop right away, pack the bleeding surfaces before closing
29
How do you treat a pelvic hematoma?
Leave it alone ! as long as it's not expanding
30
Pelvic fracture. Next step?
Rule out associated injuries by checking all holes (rectum, bladder, vagina F, urethra M)
31
Pelvic fractures with ongoing significant bleeding?
Controversial! Pelvic fixators. External fixation Angiographic embolization for ARTERIAL bleeding
32
Penetrating urologic injury ("Shot right above the pubis")
SURGICALLY EXPLORED/REPAIRED
33
Scrotal hematoma/high riding prostate/urge to void but unable
Urethral injury Do retrograde urethrogram
34
Suspected bladder leak w/ pelvic fracture?
Retrograde cystogram w/ postvoid films to see extraperitoneal leaks. Extraperitoneal leak= treat with Foley Intraperitoneal leak= SURGICAL REPAIR/ suprapubic cystostomy
35
Suspected renal injury
CT scan
36
Scrotal hematoma
Check for testicle rupture w/ u/s
37
Penis fracture?
Risk of AV shunts; repair asap
38
#1 worry about penetrating injuries of the extremities
Vascular injury
39
Extremity injury near no major vessels?
Tetanus ppx & wound cleaning only
40
Extremity injury near major vessels but asx patient?
Doppler or CTA
41
Extremity injury with obvious vascular one?
Surgery & repair obvi Bone stabilization then vascular repair then nerve Add fasciotomy bc prolonged ischemia can lead to compartment syndrome
42
Crush injury
IVF, osmotic diuretics, alkalinization of urine to prevent renal issues/hyperkalemia
43
Kid swallowed draino
Scope them to r/o perf
44
Electrocution? Late sequelae?
Same as crush injury plus massive debridement Ortho injuries Cataracts, demyelinization syndromes
45
Respiratory burns
Fiberoptic bronch to confirm | DECIDE respirator or not w/ ABGs
46
Treatment of burns
Tetanus ppx, topical silver sulfadiazine (mafenide acetate for deep...can produce acidosis) (triple abx ointment for eyes) NG suction 1-2d then high calorie/high nitrogen diets 2-3wks of wound care then GRAFTING for areas that didn't regenerate
47
Who gets EARLY excision and grafting?
Minimal burn (
48
How do you dose snake antivenin?
By size of bite not size of patient! Splint during transportation, otherwise no messing with it
49
Black widow bite?
Red hourglass N/V/muscle cramps IV calcium gluconate + Muscle relaxants
50
Brown recluse bites?
Necrotic center with surrounding halo of erythema skin ulcer Dapsone May need surgery or skin grafting
51
Developmental dysplasia of hip rx?
Abduction splinting w/ Pavlik harness for ~6 mo
52
Legg Calve Perthes dz?
Avascular necrosis of capital femoral epiphysis ~6 yo Dec hip ROM, hip or knee pain Walk with limp, guarding of passive hip motion "Atrophy of prox thigh muscle" AP & lateral hip x-ray Rx by keeping the femoral head within the acetabulum w/ casting & crutches
53
Slipped capital femoral epiphysis?
Sole of foot turned inward when legs dangle Hip flexed-> thigh into external rotation and CAN'T GO INWARD Dx: x-ray Rx: Tack it back with pins
54
Septic hip?
Have had febrile illness then refuse to move hip ORTHO EMERGENCY Hold hip flexed Dx: Aspiration under GENERAL anesthesia; if pus comes out more open drainage happens
55
Little kid has febrile illness then gets severe LOCALIZED bone pain (no hx of trauma there)
MRI then ABX (acute hematogenous osteomyelitis) X-ray is useless it's negative for a few wks.
56
Genu varum
Bowlegs normal up to 3 yo. | After 3 its probably Blount dz--> SURGERY.
57
Genu valgus?
Knock-knee. Normal 4-8yo. No rx.
58
Osgood-Schlatter dz
Osteochondrosis of tibial tubercle Teens w/ localized pain over tibial tubercle, NO knee swelling RICE If still no relief--> extension or cylinder cast 4-6 wks
59
Club foot
Serial plaster casts in neonatal pd | If no response, surgery betw 9-12 mo
60
Bone fracture areas that are problematic in kids?
Supracondylar fractures of humerus | Anywhere involving growth plate
61
Kid falls on hand w/ arm extended. What is it?
Supracondylar fracture of humerus Casting/traction...AND MONITOR FOR VASCULAR OR NERVE INJURY
62
Fracture in kid involving growth plate?
Closed reduction if laterally displaced If growth plate in transected need OPEN REDUCTION & INTERNAL FIXATION to prevent uneven growth
63
Osteogenic sarcoma
10-25 yo growing near knee, "sunburst" on x-ray
64
Ewing sarcoma
5-15yo, diaphysis of long bones, "onion skinning" on x-ray
65
Multiple myeloma rx?
CHEMO Thalidomide if that fails
66
Badly broken bones that are misaligned...
...need open reduction and internal fixation
67
Sx of anterior shoulder dislocation?
May have numbness over deltoid from stretching of the axillary nerve Dx: AP and lateral x-ray
68
Who gets posterior shoulder dislocation?
Epileptic and electrical burn X-ray view needs to be axillary or scapular lateral view
69
Hit by a nightstick?
Diaphyseal fracture of proximal ulna with anterior dislocation of radial head OPEN REDUCTION AND INTERNAL FIXATION for broken bone CLOSED REDUCTION for dislocated bone
70
Workup for FOOSH?
H&P alone then thumb spica cast for udisplaced fractures...x-ray usu neg Displaced/angulated fracture needs open reduction-internal fixation
71
Metacarpal neck fracture
X-ray Mild- closed reduction/ulnar gutter splint Bad- Kirschner wire or plate fixation
72
Femoral neck fracture?
Replace the femoral head with a prosthesis for faster healing! (Bc you're worried about avascular necrosis)
73
Intertrochanteric fracture?
ORIF Watch out for DVT/PE bc they're immobile...heparin
74
Femoral shaft fracture?
Intramedullary rod fixation Bilateral and comminuted can lead to blood loss Open is an ortho emergency- OR cleaning & closure within 6 hrs
75
Collateral ligament tears rx?
Hinged cast
76
Meniscal tear rx?
Open repair
77
Who gets tibial stress fractures?
Men forced to march. TTP over very specific part of bone but NORMAL x-ray Rx: Cast, repeat x-ray in 2 wks
78
Tibia/fibula fractures that can't be aligned?
Intramedullary nailing | Otherwise casting
79
Achilles rupture?
Loud pop, gap when palpating tendon Cast in equinus position (months of healing) or surgery faster
80
Ankle fracture?
BOTH malleoli break AP, lateral, mortise x-ray ORIF if displaced
81
Knees hit steering wheel?
Posterior dislocation of hip Emergent reduction...risk of avascular necrosis
82
Gangrene rx?
IV penicillin, extensive debridement, HBO
83
Fracture in middle to distal third of humerus?
Radial nerve involvement-->wrist drop
84
You waited too long to restore flow to popliteal artery so...
...do a prophylactic fasciotomy
85
Facial fracture/closed head injury?
CHECK C-SPINE
86
What do you do if surgery is needed for median nerve injury?
EMG before
87
Trigger finger?
Wake up in middle of night w/ finger acutely flexed, painful "snap" with extension STEROID INJECTION
88
De quervain tenosynovitis?
Mom holding baby. Give steroids
89
Felon?
Pressure can build up and lead to tissue necrosis; SURGICAL DRAINAGE
90
Mallet or Jersey finger?
Splint
91
Lumbar disc herniation?
Peak age 45-46. Several months of vague aching back pain THEN sudden onset of neurogenic pain precipitated by A FORCED MOVEMENT Exacerbated by coughing, sneezing, defecating Bed rest for 3 weeks
92
Cauda equina syndrome?
Distended bladder, flaccid rectal sphincter, perineal saddle anesthesia IMMEDIATE SURGICAL DECOMPRESSION
93
Where are venous stasis ulcers?
Edematous, indurated, hyperpigmented skin above medial malleolus Painless w/ granulating bed Pt has varicose veins and frequent cellulitis Dx: Duplex scan Rx: Support stockings, unna boot
94
Who gets plantar fasciitis?
Older overweight ppl Disabling sharp HEEL pain each time foot touches ground. Worse in morning X-ray: Bony spur at pain location (though this is not a problem in and of itself) Rx: Self limiting in 12-18 months
95
Rx for an acute attack of gout?
Indomethacin and colchicine
96
Rx for chronic gout?
Allopurinol and probenicid

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