Quiz #2 Flashcards
(136 cards)
1
Q
2 situations that are considered an orthopedic emergency?
A
Open fractures
Neurovascular injury
2
Q
What requires emergent intervention?
A
vascular compromise
3
Q
What is required to dx or exclude a fracture?
A
imaging
4
Q
1 view is ?
A
NO VIEWS
5
Q
If your suspicious that a sample is not showing up on 1st day of injury what should be done?
A
splint as if fractured and F/U for imaging in 7-10 dys
6
Q
What things should be known/ done with a high index of suspension?
A
mechanism of injury location point tenderness pain w/ PROM "old school" tuning folk
7
Q
In a extremity fracture what is the first thing that needs to be checked?
A
neurovascular status
8
Q
What should always be checked and documented in a extremity fracture?
A
distal neurovascular status before and after splint
9
Q
Once you have splinted what’s next?
A
document and check w/ repeat x-ray in splint
10
Q
A splint should have what?
A
plenty of padding
11
Q
What should you document with parents and they should understand?
A
potential growth plate involvement
12
Q
Salter Harris I
A
A fracture across the physis
13
Q
Salter Harris II
A
A fracture “A” fracture above the physis
14
Q
Salter Harris III
A
A fracture below the physis
15
Q
Salter Harris IV
A
A fracture through the physis
16
Q
Salter Harris V
A
A compression fracture of the physis
17
Q
When should a pt follow up after a extremity fracture?
A
2-3 days with orthopedic specialist
18
Q
D/C instructions for a fracture?
A
Elevate and keep the splint clean, dry, and intact
Monitor the fingers or toes
19
Q
Which injury can result in long-term disability?
A
Hand injuries and disorders
20
Q
What are 3 types of hand injuries?
A
burns
tendon or nerve injury
injection injuries
21
Q
Any type of ??? can lead to functional injuries?
A
hand
22
Q
What type of hand injuries lead to abnormal digit movement and “Scissoring”
A
fractures
23
Q
If a hand burn patient is being discharged, whom should they be referred to?
A
burn center or specialist
24
Q
Always inspect wounds for ???
A
tendon damage
25
How is tendon damage inspected?
by having the pt fully flex and extend digits
Perform full AROM movements
Sensation tests
26
What are 3 types of injection injuries
air, water, others
27
What does high pressure injection injuries lead to?
dissection along planes of least resistence
28
How do you treat air and water injection injuries?
tetanus, abx, immobilization, monitor
29
How do you treat "other" injection injuries?
tetanus, abx, immobilization, monitor PLUS immediate debridement
30
What are considered high risk injuries?
fight bite, cat bites, other punctures
31
Treatment for hand infections?
drain any pus collection
immobilize and elevate in position of function
Start Abx
Admit for observation and ortho follow up
32
Flexor tenosynovitis
closed space infection of flexor tendon sheath
33
Ortho EMERGENCY!
Flexor tenosynovitis
34
What is the presentation of Flexor tenosynovitis?
```
fusiform swelling (on both sides)
Finger in slight flexion
Pain w/ passive extension
Pain w/ palpation tendon sheath
```
35
Txt for Flexor tenosynovitis?
IV Abx w/ elevation
| w/ emergent ortho consult
36
What is the goal of the ED when it comes to back pain?
r/o serious patho and improve pain
37
What are 6 serious back pain problems?
```
Abdominal aortic aneurysm or dissection
Cauda Equina
Epidural abscess
Discitis
Tumor or mass
Fracture
```
38
What are 4 red flags of back pain?
Infection
Recent Fractures
Cauda Equina or Central Cord compression
Aortic Dissection/Aneurysm
39
What PE findings should be documented to rule out red flags?
```
Temp
skin condition overlying pain
Abdominal exam
Midline spinal tenderness
ROM
Straight leg raise
LE strength, including bilateral great toes and foot plantar/dorsiflexion
LE sensation, including lateral foot, 5th toe, and medial thigh
LE reflexes
+/- rectal tone
```
40
Who gets a emergent MRI in back pain?
S/S of central cord compression or cauda equina
41
Who gets a CBC in back pain?
infections
42
Who gets a X ray for back pain?
recent trauma, elderly or any concern for cancer
43
Who gets a CT for back pain?
increased details of fractures
44
Who gets a out patient MRI?
all other pathology w/o high risk for long term disability (herniated discs)
45
What are 3 types of infections?
soft tissue
open fracture
joints
46
Fast spreading, gas producing infection?
necrotizing fascitis
47
Often requires amputations?
Necrotizing faciitis
48
What should be done in necrotizing fasciitis?
mark outlines of cellulitis to follow progression
49
What should be palpated in necrotizing fascitis?
crepitus and severe TTP
50
What imaging is used for necrotizing fasciitis?
Xray or CT- looking for gas
51
What is a open fracture?
an open wound overlying fracture site
52
What abx are required for a open fracture?
1st gen Cephalosporin (Cefazolin)
Aminoglycoside (gentamicin) for large wounds
ADD- gram neg abx for wounds w/ organic matter
53
What is the txt for open fracture?
irrigate superficial debris from wound (NO HIGH PRESSURE)
| Schedule for surgery
54
What are two types of joint infections?
spontaneous
| associated w/ injury
55
How to determine if a penetrating injury compromises joint capsule?
wound exploration and joint capsule injection w/ sterile saline (or methylene blue)
56
TXT for joint infection?
IV Abx and surgery
57
If surgery is used to treat a joint infection what do orthopedics NOT want?
abx prior to surgery or arthrocentesis
58
Joint is erythematous, warm to touch, w/ swelling and effusion
joint infection
59
Pain w/ all ROM and axial load?
joint infection
60
All suspected septic joints MUST have?
arthrocentesis
61
What 3 things findings of septic arthritis?
purulent appearance
Leukocytosis > 50K
+ Gram stain and culture
62
Injury leading to increased pressure within a fascial compartment compromising the circulation of the tissues within?
Compartment Syndrome
63
What should be suspected in crush injuries, fractures, and soft tissue injuries w/ severe pain
Compartment syndrome
64
What does compartmental pressure lead to if not corrected?
tissue necrosis
65
pain out of proportion, pulsessness, wood like feeling w/ palpation
compartment syndrome
66
Dx for compartment syndrome?
direct compartment pressure testing
67
TXT for compartment syndrome?
Fasciotomy
68
What are 3 skin injuries?
Lacerations
Abrasions
Bites
69
What is the first thing that should be done with a laceration?
Stop bleeding
70
When is a tetanus booster needed?
> 5yrs
71
A laceration should be cleaned well with?
antiseptic
72
What are 3 definitive closure options?
staples
glue
suture
73
What are 2 temporary closure options?
suture
| gauze/ occlusive dressing
74
What is the first thing that should be done with a abrasion?
Stop the bleeding
75
A huge depth and area should be treated where?
burn center
76
What can be used to help with the scaring of a abrasion?
Asphalt
77
What is the txt for a abrasion wound?
cover w/ antibiotic ointment
place a non-stick bandage over wound
Iodoform for continued debridement
78
What is the txt for severe abrasions of palms and over joints?
PT to avoid contractures and maintain ROM
79
What animals do we considered rabies?
animal acting aggressive, odd, or feral
| animals vaccinations not up to date
80
If an animal can be found.. what happens?
animal services sequesters animal and monitors for dx
81
If an animal CAN'T be found.. what happens?
Rabies vaccine series
82
What is the rabies vaccine series?
1st dose in ED
| 2nd-4th dose in public health or local clinic
83
What is given in addition to the rabies vaccine series?
rabies immune globulin in ED
84
What is the TXT for ALL bites?
clean well w/ antiseptic
tetanus booster as needed
closure
antibiotics
85
What areas only get closure?
face or scalp
86
Why is the face or scalp only given closures?
due to high vascularity and cosmetic reasons
87
What abx is used for most bites (cats, dogs, humans)?
Amoxicillin- clavulanate- (Augmentin)
88
A fight bite can lead to ?
rapidly spreading tendon sheath infection
89
Means nothing without associated findings, corroborating or focal signs or symptoms
fever
90
What are the 5 Ws of fever?
```
Wind (atelectasis or lung infection)
Water (urinary tract infection)
Wound (wound/skin infection)
Walking (venous embolism)
Wonder Drug (medication induced fever)
```
91
Wind
atelectasis or lung infection
92
Water
Urinary tract infections
93
Wound
wound/ skin infection
94
Walking
venous embolism
95
Wonder drug
medicated induced fever
96
What is the 1st question to approaching fever?
"Have you checked your temperature or do you fell warm"
97
NOT A FEVER
<100.4
98
Who should receive a core temp?
All < 3mo patients
<2yr w/ complaint of fever and normal temp by other means
Immune compromised or severely ill
99
What things should be done in a febrile fever pt?
```
Vitals
IV access
IV hydration
Anti-pyretic or cooling blankets
CBC w/ diff
CMP
Blood cultures
+/- Wound culture or indwelling device culture
UA w/ urine culture
Lactate
VB and ABG
Appropriate imaging
```
100
What is considered neutropenia?
<500 mm3
101
Fever is a temp over >
>100.4
102
What should never be done in a neutropenic fever?
a rectal exam due to potential bacterial seeding
103
What are neutropenic pts at a increased risk for?
sepsis and worse outcomes
104
Any fever in a neutropenic pt is suspicious for?
infection
105
What is the TXT for neutropenic fever?
Abx within 60 min- Cefepime 2g q 8hrs
106
What is the DX for neutropenic fever?
blood cultures x2 + culture from indwelling lines (prior to abx)
urine culture
107
Why is Cefepime given in neutropenic fever?
bc it covers Pseudomonas
108
What is a fever of unknown origin (FUO)
A fever without localizing signs or symptoms
109
What is FUO?
fever > 100.9 for 3 weeks w/ no obvious source despite investigation (3 outpatient visits or 3 days in hospital)
110
What are FUO mostly commonly due to?
infection, malignancy and vascular disease
111
What is a febrile infant fever?
>100.4 rectal/core temp
112
Oral temps are ?? lower than rectal/core?
1 degree
113
Axillary temps are ?? lower than rectal/core?
2 degree
114
Tympanic and forehead temps are ?? to core temp?
1-2 lower
115
What is the workup for a <28day old?
```
CBC
CMP
Cath UA and urine culture
Blood culture x1
Chest xray
Lp
Abx
Admit
```
116
What is the work up for 29days- 2 or 3mo?
guidelines based
117
What are the guidelines that can be used for >29days old?
Boston
Rochester
Philadelphia
Milwaukee
118
What is the difference between the guidelines?
avoid LP and admission
119
What do many clinicians do on all infants < 2months regardless?
LP
120
What are the 2 planes of least resistance?
neurovascular bundles and fascial planes
121
Pathogen in neutropenic fever?
Pseudomonas
122
Which guideline doesn't require a lumbar puncture?
Rochester
123
What is the difference between the febrile 3 mo- 3yr children ?
immunizations
124
What is done with a 3mo-3yr child with immunizations and a known source?
No w/u needed
125
What is done with a 3mo-3yr child with immunizations and a unknown source?
UA and urine culture via catherization
126
What is done with a 3mo-3yr child with incomplete immunizations?
full work up
| +/- LP
127
What is done with a 3mo-3yr child that ill appearing?
full work up
| LP regardless
128
What is sepsis?
presence of bacteria in the blood w/ clinical/ systemic symptoms
129
What is bacteremia?
presence of bacteria in blood stream
130
What is Systemic Inflammatory Response syndrome?
```
SIRS
Temp > 100.4 or <96.8
HR >90
RR> 20 or <32
WBC >12K
```
131
What is sepsis?
SIRS + Infection
132
What is severe sepsis?
Sepsis + End organ damage from hypotension
133
What is Septic Shock?
Hypotension and increased Lactate w/ adequate hydration
134
Why doesn't qSOFA work?
its better at quantifying BUT not identifying sepsis
135
What are the 4 types of shock?
Hypovolemic Shock
Distributive Shock
Cardiogenic Shock
Obstructive Shock
136
What can shock lead to?
death
