Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Royal College: Emergency Medicine > Soft Tissue > Flashcards

Soft Tissue Flashcards

This deck covers Chapters 52-57 in Rosens, compromising all of burns, wounds, bites, envenomations, and foreign bodies.

1
Q

What are 5 indications for hospital admission for human bites of the hand?

A
  1. Infection at time of presentation
  2. Tendon/Joint/Bone violated
  3. Crush/Avulsion/Contaminated/FB
  4. High-risk patient (immunocompromised)
  5. Wound >24h old
  6. Social issues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List 5 features that indicate a snake is more likely to be venomous

A
  1. Triangular head
  2. Elliptical eyes
  3. Pits
  4. Fangs
  5. Single row anal plate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

For the following bites, give “Yes/No” for suturing and prophylactic antibiotics:

  • Dog
  • Cat
  • Human
  • Hand
  • Oral Mucosa
  • Oral Mucosa through and through
A

Dog

  • ABx: No except hand
  • Sutures: Yes except hand

Cat

  • ABx: Yes
  • Sutures: No except face

Human

  • ABx: Yes
  • Sutures: No except face

Hand

  • ABx: Yes
  • Sutures: No

Oral Mucosa

  • ABx: No
  • Sutures: Yes

Oral Mucosa through and through

  • ABx: Yes
  • Sutures: Yes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the zones created in the pathophysiology of burns?

A
  1. Zone of Coagulation
    * Irreversible necrosis
  2. Zone of Stasis
    * Fixable
  3. Zone of Hyperemia
    * Recovery likely
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Outline the mechanism of injury and management of a HF acid burn

A

Hydrofluoric Acid

  • Causes coagulative and liquefactive necrosis
  • Necrosis can lead to hyperkalemia
  • F- binds Ca2+ and Mg2+
  • Hypotension
  • Long QTc
  • Ventricular arrhythmia

Treatment

  • Poison control
  • Water/Saline irrigation
  • Titrate treatment to pain-free status
  • Calcium gluconate paste
  • 3.5g in 150 mL lubricant, put in glove, wear glove
  • Calcium gluconate locally SC or intra-arterially
  • To ICU for monitoring
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are 6 indications for transfer to a burn unit?

A

Burn Unit

  1. Hands/Feet/Head/Genitalia/Joint
  2. Inhalational injury
  3. Non-thermal burn
  4. >10% TBSA
  5. Any 3rd degree burn
  6. Trauma + Burn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

A lab worker presents following a macaque monkey bite. How do you manage this?

A
  • Clean, irrigate wound
  • ABx
  • No sutures
  • Tetanus prophylaxis if needed
  • Monkey B virus prophylaxis
  • Valacyclovir 1g TID x2 weeks
  • Give if:
    * Skin/Mucosal exposure to sick monkey
    * Inadequately cleaned wound on scene
    * Head/Neck/Torso bite
    * Deep wound
    * Needle-stick injury
    * Basically anything….
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List 5 strategies for managing an esophageal food bolus

A
  1. Carbonated beverage
  2. Glucagon
  3. Nitroglycerin
  4. Benzos
  5. Foley
  6. Bougie
  7. Endoscopy
  8. Wait

No real evidence for anything other than endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the mechanism of action of the toxin from a black widow spider? How do you manage this?

A

Lactrodectus mactans

  • Neurotoxin - depletes ACh in presynapse

Symptoms

  • Dull crampy pain
  • Facial swelling
  • HTN, sweating
  • Weakness, speech issues

Treatment

  • Symptomatic
  • Wound care
  • Ice pack to bite
  • Poison control
  • Benzos for cramps
  • Antivenin if child, elderly, pregnant, or sick
  • 1 vial over 15 min
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you approach a choking infant?

A

Mild

  • Allow them to cough

Severe

  • 5 back blows then 5 chest compressions, repeat

Unconscious

  • 30 chest compressions, check airway
  • 2 breaths and 30 compressions, check airway
  • 15:2 if two-person rescue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does a scorpion sting (centruroides) present? Management?

A

Symptoms

  • Immediate, severe pain
  • Allodynia
  • Systemically sympathomimetic

Treatment

  • Symptomatic
  • Wound care
  • Ice pack to sting
  • Poison control
  • Benzos for cramps
  • Atropine for bradycardia
  • Alpha-blockers/NTG for HTN
  • Antivenin if severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Differentiate the various degrees of burns

A
  • 1st Degree
  • Pink, no blisters, dry
  • Epidermis
  • 2nd Degree (superficial)
  • Pink, clear blisters, moist
  • Superficial (papillary) dermis
  • 2nd Degree (deep)
  • Pink, hemorrhagic blisters, moist
  • Deep (reticular) dermis
  • 3rd Degree
  • White, insensate, dry
  • Subcutaneous fat
  • 4th Degree
  • Leathery, dry, insensate
  • Bone/Tendon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Compare and contrast a pit viper and coral snake bite. How do you manage these?

A

Pit Viper (Viperidae)

  • Hematologic toxin (Blocks coagulation)
  • Immediate pain
  • Swelling, bullae, compartment syndrome
  • Die from shock, DIC

Coral Snake (Elapidae)

  • Neurotoxin (Blocks AChR)
  • Ptosis, Paresthesias, Slurred speech
  • Weakness
  • Die from respiratory failure

Treatment

  • Supportive
  • Send DIC b/w and crossmatch blood
  • Wound care (clean, irrigate, Td, ABx if necessary)
  • Tourniquet only if <30 min ago
  • Antivenin for pit viper/coral snake
  • Give 4 vials over 1 hr and R/A.
    * If stable stop.
    * If not, give 4 more. Repeat until stable.
  • Maintenance = 2 vials q6h x3 once stable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How can you tell if a snake is poisonous by its colours?

A
  • Red next to yellow, kill a fellow
  • Red next to black, venom lack

But not reliable so don’t mess with snakes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the indications for tetanus prophylaxis?

A

>10 years since vaccine/Unsure

  • Td vaccine

5-10 years since vaccine

  • None if clean
  • Td vaccine if dirty

<5 years since vaccine

  • None

Didn’t have primary series

  • Td vaccine if clean
  • Td + TIg if dirty
  • TIg dose = 4 IU/kg (max 250 IU) IM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do you manage a box jellyfish sting?

A
  • Remove from water
  • Remove stinger
  • Heat/Vinegar to neutralize remaining stingers
  • CCBs for tachydysrhythmia
  • Antivenin
  • Td prophylaxis
17
Q

List 4 methods of heat transfer

A
  1. Conduction
  2. Convection
  3. Radiation
  4. Evaporation
  5. Respiration (listed in some)
18
Q

List 4 risk factors for infection by Capnocytophagia carnimorus

A
  1. Asplenia
  2. Alcoholic liver disease
  3. Lung disease
  4. Steroids

  • Causes gangrene at site and overwhelming sepsis
  • Adrenal hemorrhage
  • Mortality = 30%
19
Q

List 5 factors that determine the rate of heat transfer

A
  1. Heat capacity of agent
  2. Temperature of agent
  3. Duration of contact
  4. Conductivity of local tissues
  5. Transfer coefficient
20
Q

List 5 discharge instructions relevant to wound care

A
  1. Elevate
  2. Clean/Dry
  3. Analgesia
  4. Immobilize until sutures out
  5. Signs of infection
  6. Suture removal time
21
Q

What are the toxic doses of lidocaine/bupivacaine with and without epi?

A
  • Lidocaine w/ = 7 mg/kg
  • Lidocaine w/o = 5 mg/kg
  • Bupivacaine w/ = 3 mg/kg
  • Bupivacaine w/o = 2.5 mg/kg
22
Q

Outline the rule of 9’s in adults. What changes are made for children?

A

Adults

  • 9% head
  • 9% each arm
  • 18% chest
  • 18% back
  • 1% genitalia
  • 18% each leg

Children

  • 18% head
  • 9% each arm
  • 18% chest
  • 18% back
  • 14% each leg
  • Difference is no % for genitalia and head is bigger
23
Q

List the types of local anesthetics. Give 2 examples of each.

A

Amide (have two i’s)

  • Procainamide
  • Lidocaine
  • Bupivacaine
  • Ropivacaine

Esters (more likely to have allergy)

  • Tetracaine
  • Cocaine
  • Procaine
24
Q

List 10 indications for antibiotic prophylaxis for lacerations

A
  1. Human
  2. Cat
  3. Dog (hand)
  4. Thru buccal
  5. Nose
  6. Ear
  7. Foot puncture
  8. Open fracture
  9. Exposed joint/tendon
  10. Crush
  11. Contaminated
  12. Immunocompromised
25
Q

List 5 indications for intubation in a burn victim

A
  1. Hypoxia
  2. Hypoventilation
  3. Low GCS
  4. Stridor
  5. Soot around face
  6. Can’t handle secretions
  7. Fatiguing
26
Q

List 8 risk factors for wound infection

A
  1. Location (leg > arm > feet > chest > back > face > scalp)
  2. Delay to clean/present >8h
  3. Contaminated
  4. Crush
  5. Human/Cat Bite
  6. GSW
  7. Anesthesia with epinephrine
  8. Repair type (Suture > Staples > Tape)
  9. Immunocompromised (DM, Cancer, HIV, Transplant)
  10. Elderly
  11. Cirrhosis
27
Q

List 3 venomous families of snakes

A
  1. Viperidae (vipers)
  2. Elapidae (coral snakes)
  3. Crotalidae (rattlesnakes)
  4. Hydrophilidae (sea snakes)
  5. Colubridae
28
Q

List and describe 2 formulas for fluid resuscitation in burns

A

Parklard

4 cc/kg/TBSA

  • Ringer’s Lactate
  • ½ over 8h (time from burn)
  • ½ over 16h

Galveston

5000 mL/m2 * %Burned + 2000 mL/m2

  • RL + Albumin 12.5g/L + D5 PRN
  • ½ over 8h (time from burn)
  • ½ over 16h

Target U/O 1-2 cc/kg

29
Q

List 6 complications of esophageal foreign body

A
  1. Obstruction
  2. Airway compromise
  3. Erosion
  4. Perforation
  5. Migration
  6. Mediastinitis
  7. Stricture
  8. Fistula
  9. Abscess
  10. Spondylodiskitis
30
Q

What is the mechanism of action of the toxin from a brown recluse spider? How do you manage this?

A

Laxosceles reclusa

  • Sphingomyelinase D toxin - local tissue destruction

Symptoms

  • Bleb with a red ring at the bite site
  • Fever, petechiae, N/V
  • Hemolysis, Thrombocytopenia
  • Pulmonary edema, Renal failure

Treatment

  • Symptomatic
  • Wound care
  • Poison control
  • Dapsone for local wound

Royal College: Emergency Medicine (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions