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
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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
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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
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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
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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
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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
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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….
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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

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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
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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
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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
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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
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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
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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.

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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
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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
List 5 indications for intubation in a burn victim
1. Hypoxia 2. Hypoventilation 3. Low GCS 4. Stridor 5. Soot around face 6. Can't handle secretions 7. Fatiguing
26
List 8 risk factors for wound infection
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
List 3 venomous families of snakes
1. Viperidae (vipers) 2. Elapidae (coral snakes) 3. Crotalidae (rattlesnakes) 4. Hydrophilidae (sea snakes) 5. Colubridae
28
List and describe 2 formulas for fluid resuscitation in burns
**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
List 6 complications of esophageal foreign body
1. Obstruction 2. Airway compromise 3. Erosion 4. Perforation 5. Migration 6. Mediastinitis 7. Stricture 8. Fistula 9. Abscess 10. Spondylodiskitis
30
What is the mechanism of action of the toxin from a brown recluse spider? How do you manage this?
**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