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CCFP 3 > SOB + Trauma > Flashcards

SOB + Trauma Flashcards

1
Q

RF for PE

A

DVT
Virchow’s triad: endothelial damage, venous stasis, hypercoagulability
Hospitalisation
Immobility
Trauma
Prev VTE
OCP
Postpartum
Pregnancy
Cancer
FDR

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2
Q

Sx of PE

A

SOB, pleuritic CP, syncope, hemoptysis
Tachypnea, tachycardia, hypoxemia

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3
Q

Ix for ?PE

A

Ix:
ECG: sinus tachy, RBBB, T wave inversion in anterior leads, right heart strain (big R waves in V1/ V2), S1Q3T3
D dimer for low risk Wells
CTPA for high risk Wells
VQ if pt unable to tolerate radiation

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4
Q

Rx for PE

A

O2
UFH or LMWH then switch to DOAC or NOAC

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5
Q

Prophylaxis of PE

A

Prophylaxis:
Risk assess all hospitalised pts
Early ambulation
Compression stockings
Intermittent pneumatic compressions
LMWH for high risk (pregnant woman w/ >2 RF)

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6
Q

Causes of SOB

A

Respiratory:
PE
FB aspiration
Anaphylaxis
Cardiac
MI
Hematological
Environmental
New pets
Dietary changes
Psychogenic
Anxiety
Gastro
Deconditioning

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7
Q

What is the MIST handover?

A

Mechanism of injury, injury found/suspected, symptoms/signs, treatments initiated

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8
Q

How to prep for incoming trauma

A

Warmed IV fluid (consider microwave if no fluid warmer)
Warm blankets
Chest tube tray
Adult chest tube sizes 28-32Fr
Intubation set
Supraglottic (LMA): Size 3 small female, 4 large female or small male, 5 large male
Cricothyroidotomy
Medication
Broselow tape for pediatrics
Fabric pelvic binders
Blood
Monitoring
Precautions (Face mask, eye protection, gown, gloves)

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9
Q

Airway assessment + management

A

clear, suction, O2, secure, assume C spine injury, use conscious sedation, plan for difficult airway

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10
Q

Breathing assessment + management

A

check trachea, jugular vein distension, chest wall expansion, RR, air entry, O2 sats O2 for all,

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11
Q

Circulation assessment + management

A

control bleeding, assess blood volume and cardiac output status, initiate blood/ fluids

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12
Q

Disability assessment + management

A

GCS, pupils, head injury, lateralising signs, blood glucose, temp

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13
Q

Exposure assessment + management

A

Exposure and environmental control - Undress but prevent hypothermia (warm blankets)
Microwave can be used to warm crystalloids (eg. 50s in 800W microwave), but not blood products
IV fluid warmer (Level One, Ranger) for blood products

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14
Q

What is in a secondary survey?

A

AMPLE history from patient, family, EMS
Allergies, Meds, PMH, Last meal, Events
Recheck ABCDE
Head to toe (including log roll, rectal exam, vaginal exam)
NG or OG tube if no sign of basal skull fracture
Urinary foley catheter if no blood at meatus or perineal ecchymosis
Urine output goal of 0.5mL/kg/h in adults (1mL/kg/h in pediatric, 2mL/kg/h in <1yo)
Pelvic binder
Immobilize deformed joints/bones
Resolve reversible arterial compromise (dislocations)
Bedside ultrasound (eFAST), Chest/Pelvis X-rays, DPL
Medications

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15
Q

Ix in trauma

A

ECG
Labs: CBC, coag, electrolytes, VBG, blood type and crossmatch, serum ETOH, bhCG
If stable, consider imaging

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16
Q

Rx for tension pneumo

A

Needle thoracostomy at 2nd ICS mid-clavicular line or 5th ICS anterior/mid axillary line, do not wait for X-ray (can do bedside ultrasound)
Chest tube at fifth intercostal space at anterior axillary line

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17
Q

Features of cardiac tamponade

A

Penetrating chest wound, Beck triad (hypotension, distended neck veins, muffled heart sounds), pulsus paradoxus, Kussmaul sign (rise in JVP on inspiration)

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18
Q

Complications of trauma

A

Tension pneumo
Cardiac tamponade
Hemothorax
Flail chest
Upper airway obstruction
Aorta lesion

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19
Q

Types of shock + causes

A

Hypovolemic
Hemorrhagic (Ectopic) until proven otherwise
Non-hemorrhagic (GI, skin-burns, renal, third space, pancreatitis)
Obstructive
Pulmonary vascular (PE)
Mechanical (Tension pneumothroax, pericardial tamponade)
Cardiogenic
Cardiomyopathic (MI)
Arrhythmogenic (tachy/bradyarrhythmia)
Mechanical (valvular)
Distributive
Sepsis
Neurogenic (TBI, spinal cord injury)
Anaphylactic
Inflammatory
Endocrine (adrenal insufficiency, thyrotoxicosis, myxedema coma)
Metabolic (acidosis, hypothermia)
Drugs (CCB, BB, Digoxin)

20
Q

Adjuncts to primary survey

A

ECG
VS
Urine output
ABG
Pulse oximetry
Imaging

21
Q

Abx for open fracture

A

cefazolin IV 3g plus ciprofloxacin or gentamicin IV for gram + and - coverage

22
Q

Management of rhabdomyolysis

A

fluids to target urine >100ml/hr or administer mannitol

23
Q

How to manage Bleeding

A

Give blood! Not crystalloids.
If INR high give Vit K 10mg IV x1 and stop Warfarin if pt is taking it.
If PTT high and pt on heparin give 25-50mg Protamine
If fibrinogen low give fibrinogen 1g IV
TXA 1g IV

24
Q

What is the YEARS criteria?

A

Criteria for pregnant pts with ?PE:
- clinical signs of DVT? if yes = US
- hemopytsis?
- PE most likely?
- YES to 0 r/o PE w/ D Dimer <1000
- YES to 1, 2 or 3 r/o PE w/ D Dimer <500

25
Q

Basic workup for SOB

A

ECG, echo, trop, CXR, PFTs, office pulse ox, exetional post ox, BNP

26
Q

COPD end stage treatments

A

mucomist, azithromycin, daytime BiPAP, PDE4 inhibitors (roflumilast)

27
Q

PERC criteria

A

3 numbers + 5 nos

age <50
pulse <100
o2 >94

no unilateral leg swelling
no hempptysis
no trauma
no prev VTE
no estrogen use

28
Q

What criteria to use to determine if COPD pts should get abx?

A

Winnipeg

29
Q

What can worsen COPD in the home?

A

Biofuels

30
Q

COPD function tools

A

COPD assessment test + mMRC (modified medical research council)
Dyspnea Scale

31
Q

Rx for chronic hypercapnia in COPD

A

daytime BiPAP

32
Q

COPD chronic management (aside from puffers)

A

daily macrolide (azithromycin) reduces exacerbations, written action plan, CPAP for COPD + OSA

33
Q

Blood eosinophils >300 cells in COPD - what to add

A

use steroid

34
Q

When to avoid steroids in COPD

A

Avoid steroid if eosinophils <100, hx of mycobacterium or repeated PNA

35
Q

What criteria for whether to give abx in COPD, and what score would you give abx for?

A

Winnipeg criteria: sputum purulence, sputum volume, dyspnea.
Abx for COPD if 2 or more Winnipeg sx or if CRP >40

36
Q

monoclonal antibodies for asthma

A

mepolizumab resilizumab benrulizamab

37
Q

What is a risk of LTRA?

A

Suicidality

38
Q

1st line treatment for asthma

A

symbicort (formeterol) - use daily and as a reliever

39
Q

CATCH 2 tool

A

CT head for child w/ minor head injury and 1) GCS <15 2 hrs post injury, open skull fracture, worsening HA, irritability, sign of basal skull fracture, boggy scalp hematoma, dangerous mechanism, >4 episodes of vomiting

40
Q

Rx for thermal burns

A

cool running water x20 mins

41
Q

How to determine burn fluids?

A

Modified brooke formula = 2ml x BSAB x weight. Half in first 8 hrs then half next 16 hrs

42
Q

Burn areas that are more complex + need referral

A

face, hand, foot, genitals, perineum, joint

43
Q

Frostbite rx

A

rapid rewarming in water bath, consider thrombolysis, heparin and iloprost, sterile wound care, consult surgery, tetanus vax

44
Q

Trauma imaging

A

US, CXR, C spine XR, chest/ abdo/ pelvis CT if pt is stable

45
Q

Points for trauma response in pregnant pts

A

chest tube 1-2 spaces higher, NG tube, left lateral position, no vaginal exam until previa ruled out

CCFP 3 (67 decks)

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