Rosh PGY-2 Flashcards
(112 cards)
1
Q
What do you want to avoid cutting in ED thoracotomy?
A
Phrenic nerve
2
Q
What approach do you use in ED throacotomy and how can you help distinguish the aorta?
A
Left anterior-lateral: incision is made along the fifth rib from the sternum to the posterior axillary line
NG tube in the E. You want to cross clamp the aorta to help perfuse the coronaries and the brain
3
Q
What would you be treating with a ED throacotomy? 5 reasons
A
1- relieve cardiac tamponade,
2- support cardiac function with open massage
3- aortic cross-clamping
4- internal cardiac defibrillation
5-control cardiac, pulmonary, or great vessel hemorrhage.
4
Q
What is the indications for ED thoracotomy?
A
Penetrating: cardiac arrest after initially good vital signs in the field OR SBP <50 after fluids OR ED arrest
Blunt: ED arrest
OR air embolism
5
Q
Scalp hematoma on the side or back of childs head- you should suspect…
A
underlying skull fracture
NOT predictive on frontal bone
6
Q
Tx for flail chest?
A
Intubation or Non invasive ventilation
7
Q
Output from CT to go to OR?
A
> 1,500 mL of blood immediately or > 200 mL/hour for 3 hours
8
Q
Isolated sternal Fx disposition?
A
Pain control and DC home
Mortaliy rate is <1%
9
Q
Most Common finding in basilar skull Fx?
A
Hemotympanum?
10
Q
+ FAST, when do you go to the scanner?
A
when stable
11
Q
What are the reverisble causes of hemorrhagic shock in trauma?
A
HemoPTX
Long bone deofrmity
Pelvic bleeding
pericardial tamponade
12
Q
Where do you put the Chest tube in preggos?
A
Same spot but 3rd rib and not 4-5th. diaphragm is up 4 cm
13
Q
Testicualr trauma DDx
A
hemaotcele hematoma fracture avulsion dislocation into inguinal canal or abomdinal wall trauamtic epipdidymitis scrotal lacs or contusion truamtic torision
14
Q
Which bad c spine fx has rare neuro deficts?
A
Hangmans (bilateral pars inter. fx from extension)
15
Q
Axial load fx?
A
Jefferson fx, disruption of ant and post ring of C1
16
Q
5 NEXUS criteria
A
- Injury
- GCS
- Intoxication
- Neuro deficits
- Midline tender
17
Q
Hemorrhagic shock criteria HR goes up Pulse pressure narrows RR increases UOP starts to drop slightly BP drops Confused and Lethargic
A
2 2 2 2 3 4
18
Q
unilateral facet dislocation dispo
A
Home and follow up in c collar
19
Q
MC blunt injury to peds?
to adults
A
Both spleen
20
Q
When do you go to IR for pelvic traumatic injury?
A
Negative fast, positive Pelvic X ray ro exam
If positive FAST its OR
21
Q
What type of extrmemities do you have in neuro shock?
A
Warm and Dry
T5 or above, possible bradycardia
22
Q
S/p Heart transplant Basal Heart rate?
A
90-110 (loss of vagus nerve!)
acute rejection leads to shock- give pressors
23
Q
How do you use the PERC
A
If they are low risk pre test, then go thru the criteria. if you have any 1 + then get a d dimer. if not then no test needed
24
Q
3 things to do in late decels?
A
oxygen
bolus
lateral recumebtn positiion
25
```
what OD?
Hyperpyrexia
acidosis
gypolcyemia
pulm edema/septic picutre
hypoK
```
Aspirin
get uRine Alkoltic w/ bicarb
Give D5W Bicarb + K
26
Stable V tach- Sync shock or Procainamide?
Procainamide
27
```
What is the evolution of STEMI on EKG between these?
STEMI
Q wave
Hypercute T waves
J point elevation
TWI
```
```
Hyperacute Ts- minutes after
J point elevation
STEMI - flat to convex
Q Wave
TWI
```
28
MC Amiodoarone Side effect
Hypotension (25%) Bradycardia (5%)
```
class 1 2 3 4
Blocks K and slows AP mechanism of aciton
```
29
Deep inverted Ts or Biphasic T=?
Wellens LAD- urgent cath
30
MC ACS complaint from old ppl?
SOB
weak andd dizzy too
atypicals from Dm2 patient
31
ETT meds?
```
Naloxe
Atropine
!!Vasporessin
Epi
Lido
```
32
Dont give what imed in WPW and why?
BB
| Urges accessory pathway usage
33
compression rate for newborn?
The optimal ratio is 3 compressions to 1 ventilation for a total of 90 compressions per minute and 30 breaths per minute
34
Trop
earliest?
Peak?
Return to baseline?
3 hours
24-48
5-14 days
Most sensitve and speciifc than others
35
Vtach Ddx?
Ischemic/Non ischemic cardiomyopathy
CAD
Lytes
Meds
36
what is a J point?
end of the QRS complex and the beginning of the ST segment. A positive deflection of the J point is termed an Osborn wave and can be seen in hypothermia. Notching of the J point can be seen in benign early repolarization.
37
why procainamide in VT and WPW?
blocks accessory pathway too
38
difference on x ray between AICD and pacemaker?
Thick distal leads (big shock) for AICD
Thin for pacemaker
Implant for brugagada, HOCM, HEart failure, Dysthrmias etc
39
What is pacemaker syndrome (20%) and how do you treat it surgically?
loss of atrioventricular synchrony and the presence of retrograde ventriculoatrial conduction
syncope or near-syncope, heart failure, fatigue, exercise intolerance, dizziness
Get a dual chamber and nto a VVI pacemekaer
40
First 3 letters of PAcemaker means what?
| VVI?
chamber paced ventricle (atrial, dual, none O)
chamber sensed ventricle ""
pacing response inhibited (triggered, dual, none 0)
41
etoligies for A flutter and Tx
Still BB/CCB/ or electicity
HTN, ischemic, Rheumatic, Cardiomyopathy
42
Etiologies for A fib
```
Ischemic
valvular heart disease
thyrotoxicosis
cardiomyopathies
myocaridtis
```
43
DDx for Sinus Tahc?
```
Poor HEart function
PE
Hypovolemia (fluids or hemorrhage)
Hypoxia
DKA
HyperTSH
fever
drugs
withdrawal
Pain/anxiety
```
44
use mroe adenosine in? less in?
More ceffeine
less carbamazpeine, dipryamdole, heart transplant
45
tx unstable torsades?
ddx torsades?
shock- it is polymorphic v tach that can turn into v fib
thyroid, drugs, lytes, nutrition, intracranial, congenital, cards problems
46
high risk syncope needs admit?
abnormal ECG, a history of structural heart disease or heart failure, persistent hypotension, shortness of breath, hematocrit less than 30%, family history of sudden cardiac death, and older age or presence of multiple comorbidities
47
what to do in torsades if mag doesnt work?
```
tv PACING (OVER DRIVE PACING 90-120 BPM)
which has the effect of reducing the QT interval and preventing a recurrence of torsade. Unstable patients should undergo unsyncronized cardioversion.
```
48
3 things seen ekg in wpw
| tx?
slurred up
short pr
wide qrs
100 mg procaine
49
syncope stats
cause of syncope remains unknown in nearly 40% of patients.-vasovagal (21%), followed by cardiac (9.5%), orthostatic (9%), medication related (7%) and neurologic (4%). Patients with vasovagal syncope had no increased risk of death compared to the general population.
50
DDx for bilateral lower edema
Think oncotic or hydrostatic
```
Nephrotic syndrome (SLE)
Pulm HTN!!!
CHF
Liver disease
Lymph Edema or lymphatic congestion
Venous insufficiency
Lytes
Medications
```
51
Blood transfusions. Stable. Itching urticaria. Continue or stop?
Benadryl and continue
Be aware of Iga def
52
how old can you get NEC
up to 6 months
53
NRP stuff
Warm dry stimulate- MR SOPA
If apneic or <100 PPV @ 40-60 RR
if still then intubat and THEN CPR 3:1
54
RSV or flu + but looks good lso get...
UA
55
which bugs in peds fever in neonte?
e coli amp and GBS = AMP and Gent
56
no risk factors, a fitting URI fever- what lab do you get and if they are nromal can you send them home to follow up
Bloo Cx
UA
CRP CBC
57
acrocyanosis lasts for...
up to 48 hours and Os2 sat is normal
58
Seizure meds for neonatates
phenobarb
lip smacking in kid
59
worse whens tanding and better when laying down headached with VP shunt
slit shunt syndrome
60
DX and Tx?
clusters of myoclonic seizures on awakening
hypsarrhythmia EEG
developmental delay.
4-8 months old
Infants will demonstrate brief contractions of the neck, trunk, and extremities lasting five to ten seconds each, occurring in clusters.
INfantile spasms or WEST syndrome
ACTH
prednsione
AEDs
61
2 month old menignits bugs
Neisseria, strep, H flu
| CFTX????? vanc
62
```
5-9 yrs old
morning headaches, lethargy , ataxia
chornic ysmptoms
Dx and tx
CN 6
```
meduloblastome--- MC
MRI
Surgery and aggressive tx
63
What do you need to do a needle cric?
12-14 gauge needle
Use the angiocath
3.5 or 3.0 endotrach tube end
a 3 or 5 ml syringe with no plunger
Adapter with 7-0 tube can be attached to the syringe
Age<8
64
Peds dose anaphylaxis Epi
.01 mg/kg max .3
65
Difference in epiglottis and bacterial tracheitis
Teach- ins and exp stridor with UTI prodrome. Subglottic narrowing. Staph. 3-8 years
Epi- drooling stridor, thumbprint, dame age group
66
When can you use adult pads on kids?
Above 10 kg
67
Kids IO
Pink in kids less Th an 40kg
| Distal femur: 2 cm proximal to end of femur in midline
68
lots of URIs
stridor on expiratoin and in supine
feeding difficutlies
tracheomalacia
| goes away by 1
69
risk facotrs and when to admit in croup
Admit: stridor after rac epi (given to kids with stridor at rest), repepat rac epi doses or stirodr returns
look sout for stridor, AMS, cyanosis, air entry and retractions
70
amio
lido
epi
doses in acls of rkids
5 mg/kg
1 mg/kg
.01 1:10k
71
what is your first step for foreign body in airway with hypoxia/resp distress?
Direct Laryngoscopy - with magill forceps (not VL)- and if it is below the cords then mainstem it and push it down
then cric
72
eye lid lac with fat protrusion needs...
CT and optho- concern for orbtial septum injury with damage to msucle and globe
73
one abx needed in nec fasc
CLinda for the toxins
74
recurrent pancreatitis with cholecystitis but no stones or cause found...=?
sphincter of oddi spasm/dusfunction
HIDA > Scinitgripahy >ERCP Oddi testing
Use ROME 4 to help diagnose
75
What is endopathlamitis
Hypopyn + conjucitvitis from inflammation of post/ant and vitreous part of eye
trauma or inefection
76
EVALI
bilateral hazy opacties - hemppytsis - not infectious
fibrinous pneumonitis, diffuse alveolar hemorrhage, and eosinophilic or lipoid pneumonia
77
When to transfer for a burn?
```
Face/Genitals/Eye/Hands
>10%
Comorbids!!!
Type 3
Inhalational
electrical
Chemical
```
- If they are young you can debride and refer
78
priapism in trauma?
Spinal cord injruy
79
What is your post sedation doses?
20-30 mcg/kg/min propofol
1 mcg/kg fentanyl or 100 mcg bolus and 100 mcg/hr
Versed 2 mg boluses (Not dialyzable for CKD)
Terrible liver- avoid versed and give ativan (for the metaoblite than can be cleared)
80
Airway Burn
1. Blast less likely to be worse than chronic inhalational fire
2. Do a burn a lert if there is airway
3. Hoarseness, fullness big physicla exam- more likely to intubate
4. you can try albuterol
5. think of thier traijectory
6. on your own? you may need ot be safe and pull the tirgger if the burn center is a long ways away
7. NP scope it!
81
where do you look when you think rash cleiacs?
elbows- itchy little vesicle - dermaitis herpitiformis
82
Men UTI stuff
Even 1 WBC in the righ setting is enough
| UTI like symptoms gotta think STD
83
post paetum headache and blurry vision?
Venous thormbosis
Delta sign or trianlge and the posterior part of head CR is white
look for tinnitus and other focal findings (CN, motor, sezireus)
84
Most sensitive symptom for Cauda equina?
```
Urinary retention (100 ml) and then urinary incontinence
all the regualr stuff plus flaccid parlaysis
```
Etiologies are most commonly herniated discs, bone fragments, hematomas, epidural abscesses, tumors, or vascular insufficiency.
85
post paetum headache and blurry vision?
Venous thormbosis
| Delta sign or trianlge and the posterior part of head CR is white
86
What is wellens warning
Biphasic T or deep inverted T
Can be painless at first and trop negative
Prox LAD
can cause sudden cardiac arrest- urgent cath needed
87
what is De Winters? EKG
AVR: 1/2 mm elevation and then inverted T (looks like wellens)
Precoridal: deep depresison into tall T waves
STEMI - LAD
88
patient is aysynchronius on the vent- change the setting to ?
2 other things ot do here?
Pressure support
Paralyze/Sedate
89
What is a segond fracture and why is it improtant?
Lateral avulsion fraction of the knee - possible ACL tear
90
patient is aysynchronius on the vent- change the setting to
Pressure support
91
spotnaneous PTX in young helathy kid- when do you put a CT in?
>20%
92
Go to vent srttings?
```
Volume control
TV 6 cc/kg
FiO2 over 60% at first
PEEP 5
Rate 12-16
```
If hypoxic then creep up Fio2- get ABG and make sure nto too high and abvoe 60 for sure
If still hypoxi then give more PEEP (14 is too high, stay below)
Keep plateau pressures below 35 (parlayze if need be)
93
What is plateau pressure?
alevoli pressure. there will be a peak and then a plateau this is the resistance int he smal airways
once the alevoli empty then the pressure goes back to baseline
94
kid comes in with umbilicated papules- tx?
None- moluscum contagiousum
| adults get it too
95
Isopropyl acohol gap stuff an docm plications
Osmol- no anion gap (ketosis without acidosis)
| Hemorrhaigc gastritis and tracheobronchitis
96
epidiymitis tx
>35 yrs old = Levoflox! or bactrim
<35 yrs old is STD = CFTX and doxy
-posterior lateral and releif with elevation
if anal= its CFTX and levo for enteric bacteria
97
```
young
fever
night sweats
weight loss
gotta check for...
```
Lymphadenopathy (non tender)! Hodgkin lymphoma or leukoemias
get CXR for wide mediastinum
98
200/110 symptomatic tx
go home if good follow up
| if not, check BMP
99
candidiaissi tx
fluconoazole
100
```
tick
LFTs
thrombocytopenia
leukopenia
Fever sypmtoms
```
Erlichiosis
101
how long tx for moderate to severe posion ivy tx
prednisone taper for 3 weeks!
if mild is clamine and benadryl
102
SCFE tx and complciations
Operative
| avbascular nescoriss
103
Juvenile arthritis stuff
Systemic: rash/Fever/liver/spleen ANA - RF - Tx: Steroids, Tx MTX/Steroids/Nsaids
Oligo: no fever or rash 3 years old female, 1-4 joints, ANA + RF - ESR -
poly: mild ysystmiec, uveitis, 5 joints, ANA + RF + ESR +
all similar tx
104
MC fx leading to compartment syndorme?
TIbia
| foreamrs get it too!
105
what 3 complications can happen with Massive transfusions?
1. Coagulopathy (thats why you give platelts and ffp)
INR >1.5 - give FFP
Plates > 50 - give plates
fibinogen <100 - give cryo
2. Hypothermia- warm the fludis and patient
3. Hypocalcemia
1 unit of reds should raise hgb hct 1/3
106
pulse ox right at 85% and doesnt get better withO2?
Methemoglobinemia Fe3+
107
first tests for syph?
RPR or VDRL
then darkfield
108
ESRD new fistula, what are the complications you need to think of?
Thrombosis of graft- US
bleeding- topical TXA, figure of 8, pressure, gelatin spognes or oturniquet before and after site
Steal syndorme- arterila blood shunted to venous (poor helaing and ischemia
Hypotension right after session- voleume down before
still think sepsis, MI, PE shock
HA, AMS, HTN!, right after dialysis = disequilbirium syndrome High solute removal during dialysis will cause lower osmolality in the blood compared to the brain, resulting in fluid shifting and subsequent cerebral edema... give mannitol (also look at ICH and lytes)
109
recurrent anpahylaxis, Dx and TX
C1 esterase FFP (contasins C1 inhibtior)
lips toungue (spiekd on the side) but nonpurutis edema
if ACE, supportive care
cryo has no role here
110
dashboard injruy to knee think
PCL, dislocaiotn
111
infant macrocephaly, nausea, lehtargy
TUmor
112
rewarm the body to 35 core first before extremites
that sall
