TRAUMA/SURG/er Flashcards by nancy Gillcrist

Blunt abdominal trauma and tachycardia + shoulder pain + history of mononucleosis

most likely abdominal injury?

splenic laceration

shoulder pain is due to phrenic nerve irritation

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cyanide has what odor?

almond odor

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for surgery being a male over ____yo is considered a risk factor

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if a male if <35 and has no hx of cardiac dz, what is the only presurg test needed

ekg

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cullen sign?

bruising around the umbilicus

hemorrhagic pancreatitis or ruptured AAA

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grey turner sign?

flank bruising

retroperitoneal hemorrhage

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best test to look for air under diaphragm?

upright cxr

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electrical alternans on ekg?

pericardial tamponade

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blackout on cxr (loss of vascular markings)

pneumothorax

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severe abdominal pain but no rebound tenderness or guarding??

acute mesenteric ischemia

get angiography!

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where are the two places bowel ischemia typically occurs?

watershed areas = hepatic and splenic flexures

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number one risk factor for mesenteric ischemia (acute occlusion of mesenteric arteries)

atrial fibrillation

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hamman sign

crunching due to subcutaneous emphysema from esophageal perforation

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how to dx esophageal perforation (mallory weiss or boerhoeves)

gastrograffin esophogram

dont use barium because it is caustic to the tissues

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do not do what two tests in acute divertiulitis?

colonoscopy and barium enema (increased risk of perforation)

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3 signs of appendicitis

rovsing
psoas (hip extension)
obturator (int rotation)

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most accurate test for cholecystitis

HIDA scan
(but we do U/S to dx typicallY)

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small bowel obstruction

usually hypo or hyperactive bowel sounds?

hyperactive!

high pitched tinkling sound indicates high pressure

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mechanism, sx, dx, and tx for the following:
1 anterior shoulder dislocation
2 posterior shoulder dislocation
3 clavicular fx
4 scaphoid fx

1 - strain on the glenohumoral joint, arm held to side externally rotated, xray then MRI (must rule out axillary artery and nerve injury), shoulder relocation and immobilization

2 - seizure or electrical burn, arm is medially rotated at side, xray then mri, traction and surgery is pulses or senses are diminished

3 - trauma, pain over location, xray is best test (must rule out subclavian artery/brachial plexus injury), simple arm sling

4 - FOOSH, pain at anatomical snuffbox, xray wont show for 3 weeks so clinical suspicion!, thumb spica cast

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tx for trigger finger?

steroid injection

if steroids fail, surgery to cut the sheath of the tendon

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fracture of long bones can often lead to what complication?

fat embolism ( confusion + petechial rash and dyspnea)

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walking pain that worsens with walking but improves when he sits down or leans forward

spinal stenosis! (pseudoclaudication)

get an MRI –> tx with NSAIDs or surgery

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best tx for torn ACL

arthroscopic repair followed by rehab

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mechanism, sx, dx, and tx for the following:
1 MCL and LCL injury
2 ACL injury
3 PCL injury
4 meniscal injury

1 - trauma to the opposite side, pain, MRI, surgical repair
2 - direct trauma to knee, pain and +anterior drawer, MRI, arthroscopic repair
3 - direct trauma to knee, pain and + posterior drawer, MRI, arthroscopic repair
4 - knee injury, popping sound on flexion or extension, , MRI, arthroscopic repair

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unhappy triad of sports trauma

ACL MCL and either Lateral or medial meniscus

management of AAA

3-4 cm US every 2-3 years 4-5.4 cm US or CT every 6-12 months >5.5 cm, asx = surgery surgery is indicated at 5 cm

aortic dissection

false lumen in the intima of the aorta sudden onset tearing chest pain radiating to back + asymmetric arm blood pressures dx is done with TEE if unstable (fastest) or MRA (best) if patient is stable tx ascending with surgery and BP control tx for descending is BP control (BB)

``` post op fevers POD 1-2 POD 3-5 POD 5-7 POD 7 POD 8-15 ```

``` 1-2 wind (atelectasis or pna) 3-5 water (uti) 5-7 walking (dvt/pe) 7 wound (wound ifx or cellulitis) 8-15 weird (drug fever or deep abscess) ```

mc finding for PE on ekg

nonspecfic ST changes s1-q3-t3 is NOT the most common change seen

tx for PE

heparin to coumadin bridge if PE while on coumadin therapy, place an IVC

old woman s/p total hip replacement 3 days ago now has 30 min of SOB and chest pain.....what do you do?

order EKG and spiral ct scan if patient had an allergy to contrast, get a VQ scan instead of spiral ct

noncon ct for... | contrast ct for...

noncon for trauma and bleeding | contrast for infection and cancer/mass lesions

can youuse metforman with contrast study?

no, stop med proior to scan

Charcoal is good for

Any ingestion Can't hurt and Is better than lavage

What is the treatment for acetaminophen overdose that was more than 24 hours ago

No therapy needed

What is next step if clearly toxic amount of acetaminophen was ingested(more than 8-10 g)?

N -acetylcysteine

What symptoms do you see with aspirin overdose and what is the treatment

Tinnitus and hyperventilation leading to respiratory alkalosis and metabolic acidosis from lactate Treatment is alkalinizing the urine which increases the rate of aspirin excretion

Treatment of TCA overdose

Sodium bicarbonate is cardioprotective but does not increase TCA excretion

What Will blood gas show for carbon monoxide poisoning?

Normal pO2 because oxygen does not detach from hgb Lactic aciddosis develops

What is the best diagnostic test for carbon monoxide poisoning

Routine oximetry will be falsely normal so the best and accurate test is carboxyhemoglobin level

How do you differentiate carbon monoxide and methemoglobinenia on exam

Blood is red with carbon monoxide and brown with methemoglobinemia

Treatment for methemoglobinemia

Methylene blue

Treatment for carbon monoxide poisoning

Hyperbaric oxygen for severe disease or just 100% oxygen

Cyanosis plus normal PO2 =

Methemoglobinemia

Treatment for organophosphate poisoning or or nerve gas

Atropine

What EKG abnormality will digoxin overdose show

Downsloping st segments And Hyperkalemia

Treatment for digoxin overdose

Digoxin specific antibodies

Treatment for lead poisoning

Chelating agent's to remove the blood from the body like succimer or EDTA or dimercaprol

Everyone with Mobitz two 2nd° AV block which is dropped Beats without progressive lengthening of PR interval Gets what...

They get a pacemaker even if they are asymptomatic

Next step if a patient is bradycardic and asymptomatic

Get an EKG… No atropine is needed if it is just an asymptomatic sinus bradycardia

Treatment for Wolf Parkinson White syndrome

If acutely in an arrhythmia give procainamide or amiodarone Curative therapy is radiofrequency ablation

When is adenosine used?

For supraventricular tachycardia

Treatment for atrial fibrillation and flutter

Control the rate with beta blocker or calcium channel blocker(dilt or verapamil) or digoxin Then once rate is controlled give warfarin or ruvaroxaban to anticoagulate

Hemodynamically unstable atrial arrhythmias are managed with…

Synchronized cardioversion

Differences between methanol and Ethylene glycol poisoning

Both are treated with fomepizole and dialysis Methanol presence with Eye toxicity and retinal inflammation and as the lingo I call presents with renal toxicity and envelope shaped crystals made of oxalate

Treatment of dog cat and human bites

Give amoxicillin clavulanate | And tetanus vaccination booster if more than five years the last one

When do you give rabies vaccine after bite?

Only if the animal has altered mental status or bizarre behavior or the attack was unprovoked by a stray dog that cannot be observed

First step for head trauma resulting in loss of consciousness

Head CT without contrast to detect blood

Treatment of subdural an epidural hematoma

Small ones are left alone… Large ones are treated with intubation and hyperventilation plus mannitol plus drainage

Crescent versus biconvex/lens hematoma

Crescent is a sub dural and lens is an epidural

After a successful surgery for epidural hematoma what will most likely benefit the patient

Ppi is given to prevent stress ulcers… Head trauma is a clear indication for stress ulcer prophylaxis

Fluid replacement formula

Four x percent body surface area burned x weight in kilograms Half is given in the first eight hours and then the other half is split up in the next 16 hours

What is the most common cause of death several days to weeks after a burn

Infection due to loss of skin

Tx for asystole

Epinephrine

If defibrillation is not working for ventricular fibrillation after two attempts what is the next step

Give epinephrine plus shock and then try amiodarone

TRAUMA/SURG/er Flashcards

(65 cards)