Treatments 3 Flashcards Preview

Step 2 DIT > Treatments 3 > Flashcards

Flashcards in Treatments 3 Deck (115):
1

Trauma assessment, primary

ABCDE
Airway (ET/cricothyroid)
Breathing (O2, pulse ox, ventilation, pneumothorax)
Circulation (pulse, vitals, IVF x2 PIVs or central line, bleeding)
Disability (GCS, glucose)
Exposure (remove clothes, DRE/Foley, blanket)

2

Trauma assessment, secondary

Reassess ABCs
DRE/Foley (not if high riding prostate/blood at urethral meatus)
NGT placement
Hx
Head-to-toe exam
Examine back, remove backboard
X-rays, FAST, CT, labs, fx management

3

Lower ICP

Head of bed at 30 degrees
Mannitol IV (q6 hrs Na and osmolarity)
Intubate and hyperventilate (temp relief)
Decompressive craniectomy
Ventriculostomy, barbiturate coma, paralysis

4

Neck trauma, zone I

Clavicles to cricoid
CT angiogram, EGD, bronchoscopy, laryngoscopy

5

Neck trauma, zone II

Cricoid to angle of mandible
Surgical exploration

6

Neck trauma, zone III

Angle of mandible to base of skull
CT angiogram, EGD, bronchoscopy, laryngoscopy

7

Abdominal trauma, penetrating injury

(Emergent) exploratory laparotomy

8

Pelvic fx + DPL shows blood in pelvis

Emergent laparotomy

9

Pelvix fx + DPL shows urine in pelvis

Urgent laparotomy (bladder repair)

10

Pelvic fx + DPL shows nothing + hemodynamically unstable

Angiography + possible embolization

11

BAT + unstable vital signs + FAST shows fluid in pelvis

Emergent laparotomy

12

BAT + unstable vital signs + FAST shows no fluid in pelvis

Angiography + possible embolization

13

BAT + unstable vital signs + FAST inconclusive

DPL

14

BAT + stable vital signs

CT abdomen/pelvis, observation

15

Tension pneumothorax

Immediate chest tube placement
Needle decompression if CT delayed (2/3rd IC space mid-clavicular or 5th IC midaxillary)

16

Flail chest

O2
BiPAP or ET
Analgesia

17

Gonorrhea prophylaxis

Ceftriaxone 125 mg IM

18

Chlamydia prophylaxis

Azithromycin 1 g PO or
Doxycycline 100 mg PO bid x7 days

19

Trichomonas prophylaxis

Metronidazole 2 mg PO

20

Post-op to improve pulmonary fxn

Incentive spirometry
Deep breathing exercises
PT
Analgesia

21

Pre-op labs concerning for liver disease

Increased PT/PTT
Decreased platelets
Decreased albumin
Increased bilirubin

22

Obstruction (abdominal)

Surgical lysis of adhesions

23

Diverticulitis

Metronidazole and fluoroquinolone (PO outpatient or IV inpatient)

24

Massive GI hemorrhage (perforation)

Angiography w/ embolization, surgical repair of detectable site of bleeding

25

Appendicitis

Appendectomy

26

Acute mesenteric ischemia

NPO
NG tube
Antibiotics
Resection of necrotic bowel

27

Malignant hyperthermia

Evaporative cooling
Dantrolene
Cold inhaled O2, GI lavage, IV fluids

28

Chronic mesenteric ischemia

Bypass, endarectomy, or angioplasty and stenting

29

Graft vs. host disease

Corticosteroids
Tacrolimus, mycophenolate

30

Hyperacute transplant rejection

(First 24 hrs)
Untreatable

31

Acute transplant rejection

(6 days - 1 year)
Immunosuppressive agents

32

Chronic transplant rejection

(>1 year)
Usu untreatable
Immunosuppressive agents may help a bit

33

Common cold

Rest, analgesia, symptomatic treatment
NO Abx

34

Pharyngitis

Self-limited
Abx reduce infection time, reduce acute rheumatic fever (B-lactams)

35

Peritonsillar abscess

Needle aspiration or I&D
Pain meds + abx (amoxicillin/clavulanate or clindamycin)

36

Sinusitis

Symptomatic (nasal irrigation, analgesics, oral decongestants, intranasal steroids)
Amoxicillin-clavulanata, doxycycline or levofloxacin

37

PNA in neonates

Amp + gent +/- vancomycin

38

PNA in 1-4 months

Macrolides (-mycin) +/- cefotaxime

39

PNA in 4 months - 4 years

Amoxicillin, Ampicillin

40

PNA in 5-15 years

Amoxicillin + clarithromycin
Azithromycin
Amoxicillin + doxycycline

41

Acute bronchitis

Azithromycin, erythromycin, tetracycline, fluoroquinolone

42

Viral PNA

Self-limited

43

Strep pneumo PNA

B-lactam, macrolide (-mycin)

44

H. influenzae PNA

B-lactam, TMP-SMX

45

S. aureus PNA

B-lactam, MRSA coverage (vancomycin, etc)

46

Klebsiella PNA

Cephalosporin + aminoglycoside (gentamicin, tobramycin)

47

Pseudomonas PNA

Antipseudomonal B-lactam (piperacillin-tazobactam, cefepime, imipenem, meropenem, aztreonam) + one or two of following:
Antipseudomonal quinolone (cipro or levofloxacin)
Aminoglycoside (tobramycin, gentamicin or amikacin)
Azithromycin

48

GBS PNA

B-lactam (+ gentamicin in neonates)

49

Enterobacter PNA

TMP-SMX

50

Mycoplasma PNA

Macrolides (-mycin)

51

Legionella PNA

Macrolides (-mycin), fluoroquinolones (-floxacin)

52

Chlamydophila PNA

Doxycycline, macrolides (-mycin)

53

Coccidiomycosis PNA

Amphotericin B or Ketoconazole (systemic)
Fluconazole

54

Histoplasmosis PNA

Amphotericin B or Ketoconazole (systemic)
Itraconazole

55

Blastomycosis PNA

Amphotericin B or Ketoconazole (systemic)
Itraconazole

56

Latent TB (asymptomatic +PPD)

INH x 9 months

57

Primary or secondary active TB

Rifampin, Isoniazid Pyrazinamide, Ethambutol x 4 months
THEN Rifampin and Isoniazid x 2 months
Vitamin B6 w/ INH to prevent peripheral neuritis

58

ARDS

ICU, treat underlying cause
Mechanical ventilation w/ low tidal volume, adequate PEEP
Conservative fluid management

59

Mild intermittent asthma

Inhaled short acting B2 agonist

60

Mild persistent asthma

Inhaled short acting B2 agonist +
Low dose inhaled corticosteroid

61

Moderate persistent asthma

Inhaled short acting B2 agonist +
Low-medium dose inhaled corticosteroid +
Long acting B2 agonist
Consider LT inhibitor, ipratropium

62

Severe asthma

Inhaled short acting B2 agonist +
High dose inhaled corticosteroid +
Long acting B2 agonist
Consider LT inhibitor, ipratropium
Consider systemic steroids, theophylline

63

Asthma + persistent allergic rhinitis

LT inhibitor (montelukast, zafirlukast, zileuton)

64

COPD A (Gold 1-2, mild sx)

Short acting bronchodilator (albuterol)

65

COPD B (Gold 1-2, mod-severe sx)

Short acting bronchodilator (albuterol) +
Long acting bronchodilator (ipratropium, maybe long acting B2 agonist)

66

COPD C (Gold 3-4, mild sx)

Short acting bronchodilator (albuterol) +
Long acting bronchodilator (ipratropium, maybe long acting B2 agonist) +
Inhaled corticosteroids

67

COPD D (Gold 3-4, mod-severe sx)

Short acting bronchodilator (albuterol) +
Long acting bronchodilator (ipratropium, maybe long acting B2 agonist) +
Inhaled corticosteroids +/-
Theophylline, home O2 if indicated, PDE4 inhibitor (roflumilast)

68

Bronchiectasis

Pulmonary hygiene including chest PT
Antibiotics for increased sputum
B2 agonists/corticosteroids for symptoms
Resection of diseased lung segments

69

Superior vena cava syndrome

Steroids, stent
Tumor removal

70

Non-small cell lung cancer w/o metastasis

Surgical resection
Adjuvant chemo, radiation

71

Non-small cell lung cancer w/ LN

Radiation
Consider surgery, chemo

72

Non-small cell lung cancer w/ metastasis

Palliative

73

Small cell lung cancer

Chemo
Radiation (adjuvant)

74

Laryngeal cancer

Laryngectomy
Radiation, chemo

75

Idiopathic pulmonary fibrosis

Steroids
Azathioprine or cyclophosphamide
N-acetylcysteine
Lung transplant

76

Sarcoidosis

Occasionally self-resolving
Steroids, cytotoxic drugs, rarely transplant

77

Pneumoconioses

Usu no successful treatment (steroids may help)

78

Goodpasture syndrome

Plasmapheresis
Corticosteroids and immunosuppressants

79

Granulomatosis w/ polyangiitis (Wegener)

Cytotoxic (cyclophosphamide) and steroids

80

Pulmonary embolism

Supplemental O2
IVF or pressors if needed for hypotension
AC w/ LMWH or warfarin 3-6 months
IVC if AC C/I
Possible thrombolysis

81

Pulmonary HTN

Supplemental O2
Vasodilators to decrease pulm vascular resistance (prostanoids, endothelin receptor antagonists/-sentans, PDE inhibitors/sildenafil, DHP CCB/nifedipine)
AC to decrease risk of pulm thrombus formation
Diuretics for pulm congestion

82

Pulm edema

Treat like CHF (NO LIP)
Nitrates, O2 if hypoxic, Loop diuretics, Inotropes (last ditch), Positioning

83

Pleural effusion

Treat underlying condition
Thoracocentesis and CT relieve pressure
CT required for empyema
Pleurodesis if recurrent malignant

84

Closed pneumothorax, <15%

Supplemental O2, observe

85

Closed pneumothorax, >15%

CT

86

Open PTX, small wound

CT + occlusive dressing

87

Open PTX, larger wound

Attempted closure, low threshold for intubation

88

Tension pneumothorax

Immediate needle decompression and CT

89

Recurrent PTX

Maybe pleurodesis

90

Hemothorax

O2, CT, treat underlying cause

91

Malignant mesothelioma

Surgery, chemo, radiation -> all have poor prognosis

92

Sleep apnea

Weight loss
No sedatives (including alcohol)
CPAP
Surgery

93

Atelectasis

IS, early ambulation, PT
Upper airway suctioning
Lower airway suctioning w/ bronchoscopy

94

Croup

Supportive care (humidified/cool air)
Inhaled steroids, epinephrine (if stridor)

95

Epiglottitis

Intubation
IV abx 7-14 days

96

Bronchiolitis

Supportive care
Inhaled albuterol, epinephrine

97

Respiratory distress syndrome of the newborn

Corticosteroids before labor if <37 wks)
Surfactant replacement therapy

98

Meconium aspiration syndrome

Suction nose, mouth, upper airway
Supplemental O2, intubate if needed
Surfactant therapy may help
Empiric abx if concerned about PNA

99

Cystic fibrosis

B2 agonists, DNAse I, chest PT
Antibiotics PRN (Azithromycin, fluoros)
Pancreatic enzymes and vitamins A, D, E, K

100

Hepatitis A

Self limited, supportive care
Vaccine before travel

101

Hepatitis B

HBV immediately after exposure in unvaccinated pt
IFN-a
Antivirals (lamivudine, adefovir, entacavir)

102

Hepatitis C

IFN-a
Consider ribavirin

103

Hepatitis D

IFN-a

104

Hepatitis E

Self-limited, supportive care

105

Salivary gland disorders

Warm compresses, massage, lemon drops (ductal stones)
Abx and hydration (infx)
Surgery (refractory)

106

Achalasia

Nitrates and DHP CCB (rarely used)
Pneumatic dilation
Botulinum injections
Myotomy

107

Diffuse esophageal spasm

CCP, nitrates, TCAs

108

Zenker diverticulum

Cricopharyngeal myotomy or diverticulectomy

109

GERD

Elevate HOB, weight loss, dietary modification
Antacids
H2 blockers or PPIs
Nissen fundoplication or hiatal hernia repair (refractory)

110

Esophageal cancer

Surgical resection (early)
Radiation/chemo (nonoperative or adjuvant)
Poor prognosis

111

Hiatal hernia

Sliding - reflux control
Paraesophageal - surgery (gastropexy, Nissen fundoplication)

112

Gastritis

Stop alcohol/medications
H2 blockers/PPIs
Type A - vitamin B12
Type B - PPI + clarithromycin + amoxicillin or metronidazole 10-14 days

113

PUD

R/o active bleeding (CBC, EGD, stool guiaic)
PPI/H2 antagonist to decrease gastric acid
Sucralfate, bismuth subsalicylate, misoprostol (NSAID use) to protect mucosa
Surgery for acute perforation, refractory

114

Zollinger-Ellison syndrome

Surgical resection if localized
PPI/H2 blockers
Octreotide in metastatic

115

Gastric cancer

Subtotal gastrectomy (distal third of stomach)
Total gastrectomy (upper/middle stomach, invasive)
Radiation/chemo as adjuvants