Download Review for Emed Exam 2

Review for Emed Exam 2
ACLS
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V-fib Cardiac Arrest:
What do you do first?
CPR
Then what?
Defib at 360j
Then?
5 cycles of CPR
Then?
Shock and resume CPR
Then?
ACLS
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Then what meds?
Vasopressor such as Epi or Vasopressin
Then?
Shock once
Then?
Antiarrhythmics such as amiodarone or
lidocaine
Then?
5 cycles CPR and repeat.
When is magnesium used?
torsades de pointes
ACLS
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What is the first step in Asystole?
CPR
Vasopressor such as epi or vasopressin
Then?
Atropine
Then?
CPR
Then?
Repeat
What about witnessed?
ACLS
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What is the treatment of PEA?
Same as asystole.
Atropine if rate <60 only.
Look for etiology including hypovolemia,
hypoxia, hydrogen ion, hypo/hyper
kalemia, hypoglycemia, hypothermia,
toxins, tamponade, tension pneumo, PE,
trauma
ACLS
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Bradycardia
Pulse <60 and symptomatic (signs of poor
perfusion such as AMS, chest pain,
hypotension, shock)
Oxygen, IV access
What is the management if poor
perfusion?
Atropine, epi or dopamine infusion
ACLS
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Tachycardia
What is patient is unstable?
Synchronized cardioversion post IV access.
Give sedation if conscious
If stable and narrow QRS?
IV, vagal maneuvers, adenosine.
If does not convert?
Might be a flutter, a tach or junctional tach so
use diltiazem, b-blockers
ACLS
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What about if wide QRS and regular?
Amiodarone, Lidocaine or cardioversion.
ACLS
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You are going to give a drug via ET, how is
the dose adjusted?
Give 2.5x the dose then dilute to 10cc
Which medications are given via ET tube?
LEAN- lidocaine, epinephrine, atropine,
and narcan.
PALS
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Know a little regarding the protocols
utilized especially asystole, v-fib, PEA,
bradycardia, shock.
Heat Emergencies
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How is heat lost from the body?
Conduction, convection, radiation, evaporation.
Define heat cramps:
Severe muscle cramps resulting from
overexertion in heat. Occur after stopping the
activity. Na deficiency.
Define heat edema:
Swollen feet and ankles. Vasodilation with
vascular leak. Elevate extremity .Resolves after
climate acclimatization.
Heat Emergencies
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What is heat rash? How is this treated?
Prickly heat. Blockage of sweat gland pores and
can have staph infection. Pruritic vesicles
Topical antibacterial cream
What is heat syncope?How is this treated?
LOC. Brain hypoperfusion due to hypotesnion
due to peripheral vasodilation and vascular leak.
Dehydration predisposes to this. Rehydrate.
Heat Emergencies
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What is heat exhaustion? What is the clinical
presentation? What is the management?
Dehydration/ salt depletion. Sweating,
weakness, fatigue, headache, n/v, dizziness.
<104. Oral salt, IV rehydration
What is heat stroke?
Life threatening. >106. Loss of
thermoregulation, tissue damage. Neurologic
dysfunction and cerebral edema. Dehydrated
with seizures, unconsciousness. Treatment
Rehydration, rapid body cooling
Cold Emergencies
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Define frostbite
Vasoconstriction, extracellular ice crystals,
intracellular dehydration, lysis. Leads to
ischemia and tissue damage
What are the clinical manifestations of frostbite?
First degree: partial skin freezing. Erythema,
edema, hyperemia, no blisters. Thrombing and
aching
Second degree: full thickness. Erythema,
edema, vesicles with clear fluid
Cold Emergencies
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Third degree: full thickness, subcutaneous.
Hemorrhagic blisters, skin necrosis, blue gray
color. First no sensation then shooting pains,
burning, aching
Fourth degree: full thickness, sub cutaneous,
muscle, bone freezing: little edema, mottled
deep red or cyanotic, to dry black mummified.
Possible joint discomfort.
What is the management?
Re-warming in water of 107 degrees.
Cold Emergencies
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What are the signs of moderate
Hypothermia?
Temp of 86-90f 30-32c. Clinical: stupor, no
shivering, bradycardia, decreased
respiratory rate, hypotension, afib.
Cold Emergencies
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What about severe hypothermia?
<86f <30c. Coma, pupils dilate, no corneal
reflex, v-fib, apnea, asystole, areflexia, flat EEG
What is the management?
Supportive, rewarming, warm IV fluids.
Metabolism slows so hypothermic patients
tolerate long periods of hypoperfusion and
anoxia. Do not pronounce until rewarmed.
Abdominal Trauma
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Which abdominal organs are more susceptible
to injury from blunt trauma?
Spleen and liver. Spleen most frequently injured.
What is kehr’s sign?
Referred left shoulder pain (splenic rupture).
Sign of liver trauma?
Pain to right shoulder. Acute blood loss.
Tachycardia, hypotension, acute abdominal
tenderness.
Abdominal Trauma
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Number one danger with hollow Visceral
Injuries?
Blood loss and peritoneal contamination
What is the classic presentation of Pancreatic
injury?
Rapid deceleration. Pain radiates to back.
Retroperitoneal abscess due to leakage of
enzymes and bacteria.
What about kidneys?
Pain from flank to groin and hematuria.
Diaphragmatic?
Bowel sounds in thoracic cavity.
Abdominal Trauma
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How is abdominal trauma diagnosed?
Peritoneal lavage (DPL).
FAST: focused assessment with sonography for
trauma: Notes free fluid in dependent areas
CT
What is the management?
ABC’s. Fluids isotonic, blood 0-, oxygen,
What about eviscerated organs?
Cover with sterile moist dressing prior to surgery
Burns
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Categorized by size and depth.
Burn size is rule of nines.
Burns
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Burn depth
What is the presentation of a superficial burn?
Epidermis. Dry red, painful, blanches with
pressure.
What is the management?
Antipruritics, lubricants, corticosteroids
Superficial partial thickness burns: What is the
etiology and clinical presentation?
Scald. Epidermis and superficial dermis.
Blisters, moist, red, weeping, blanches with
pressure, pain to air and temperature.
Management: debridement, topical antibiotics,
dressings, analgesics
Burns
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What about deep partial thickness burn?
Scald, flame, oil. Involves epidermis and deep
dermis. Presents as blisters, wet/ waxy, dry skin
if sweat glands destroyed, patchy to cheesy
white to red in color. Does not blanch with
pressure. Perceive pressure not pain if nerves
destroyed.
What is the management?
Cleaning, debridement, dressing and
analgesics.
Burns
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What about full thickness burn?
Scald, flame, steam, oil. Epidermis, dermis and
sub cutaneous layers. Nerve ending, blood
vessels, hair follicles, sweat glands destroyed.
How does this appear?
Waxy white to leathery gray to charred and
black. Skin dry, inelastic, does not blanch with
pressure. No pain, deep pressure sensation
only.
What is a major complication?
Contractures
Burns
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Which burns should be treated at a burn
center?
burns to eyes, ears, genitalia, hands, feet,
joints
What is the parkland formula?
4 x kg x %BSA . Half in first 8 hours,
remainder in next 16 hours.
Burns
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What are the risks for smoke Inhalation? What is
the presentation?
Risk is fire in enclosed space.
Facial burns, singed nasal hairs, soot in mouth
or nose, hoarse, black sputum, wheezing
What type of poisoning is suspected with smoke
inhalation?
CO poisoning. Arterial carboxyhemoglobin >10%
is CO exposure.
What is the management of smoke inhalation?
Bronchodilators, hyperbaric O2 if Cohb >10%
Burns
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What benefit is associated with acid burns?
Coagulation necrosis limiting injury
What is the complication of alkali burns?
Liquefacation necrosis. Continues to penetrate
deep into tissue.
What is the presentation of low voltage AC
electrical injury?
Muscle tetany. V fib
What is the presentation of high voltage AC/DC?
single violent muscle contraction throwing
individual. Asystole
Burns
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What is the presentation of lightening
injuries?
AMS, amnesia, Headache, muscle pain,
paresthesias, Tachycardia, hypertension,
ruptured TM
What type of radiation leads to the acute
radiation syndrome?
Ionizing
Emerg of Eye, Ear, Nose, Oral
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What is the presentation of a Corneal Abrasion?
Ocular pain, sensation of foreign body, blurred
vision, photophobia, Conjunctival injection,
visual acuity defects
How is this diagnosed?
Fluorescein staining, proparacaine, blue cobalt
light.
What is the management?
Management: Anesthetics, cycloplegic eye
drops, irrigation with NS, broad spectrum
antibiotics. Oral analgesics
Emerg of Eye, Ear, Nose, Oral
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What is a complication of Acute Angle closure
glaucoma?
Blindness due to optic nerve injury.
What is the presentation?
Sudden eye pain, blurred vision, headache, n/v,
halos, visual acuity defects, conjunctival
injection, cloudy cornea, midway positioned
pupil, IOP elevated
What is the management:
Pilocarpine (miotic), laser, timolol (reduces IOP),
mannitol.
Emerg of Eye, Ear, Nose, Oral
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What is the classic presentation of Central
Retinal Artery Occlusion?
Painless vision loss.
What is the appearance of the retina?
Edematous gray with cherry red macula.
Pupil does not constrict to direct light
What is the management?
Ocular massage, paracentesis.
Emerg of Eye, Ear, Nose, Oral
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What is orbital cellulitis?
Posterior to orbital septum within orbit. Little
conjunctival injection, fever, edematous
erythematous periorbital soft tissue, tenderness
with EOM, elevated IOP, loss of vision.
How is this diagnosed?
CT
Management?
Broad spectrum antibiotics. Clindamycin,
ceftazidime, admission, surgical drainage.
Emerg of Eye, Ear, Nose, Oral
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What is the etiology and presentation of
acute mastoiditis?
S pneumoniae, s pyogenes, s aureus.
Fever, pain, swelling and erythema at
mastoid.
What is the management?
Admission, IV antibiotics
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What is the etiology and presentation of
Otitis externa?
Pseudomonas, staph, fungal
Ear pain, itching, erthematous canal, pain
with pinna movement, canal occluded
Management: topical steroid, antibiotics
(cortisporin otic)
Emerg of Eye, Ear, Nose, Oral
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What is the etiology, presentation and
management of Acute Otitis media?
Etiology: s pneumonia, h flu
TM erythematous, dull light reflex, limited
motility, landmarks distorted
Amoxicillin ten days, augmentin, ceftriaxone,
analgesics
What is the presentation and treatment of Perf
TM?
Pain, bleeding, decreased hearing
No antibiotics unless infection.
Emerg of Eye, Ear, Nose, Oral
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What is the management of anterior
epistaxis? Posterior epistaxis?
What is a complication of nasal fracture?
septal hematoma
Emerg of Eye, Ear, Nose, Oral
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What is dental extrusion?
Tooth dislodged
What is subluxation?
Tooth loose without displacement
What is dental avulsion?
Tooth out. Root must be moist
Emerg of Eye, Ear, Nose, Oral
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What is the presentation and management
of periodontal abscess?
Oral antibiotics, Analgesics, I/D, Dental referral
Bites, Stings and Poisons
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Define an occlusion bite and location:
Distal phalanges, ears, nose, genitalia
Define Closed fist injury. What
complication is associated with this?
Clenched fist is lacerated against
opponents teeth. High rate of infection.
Concern is joint capsule integrity.
Bites, Stings and Poisons
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What is the etiology of dog bites?
Staph, strep, pasteurella multocida,
pseudomonas, gram neg aerobes/anaerobes
What is the etiology of cat bites?
Pasteurella multocida (gram – anaerobic)
What complication is associated with cat bites?
Produces cellulitis, lymphangitis, lymphadenitis.
Can cause cat scratch disease- lymphadenitis
with ulcer (bartonella henselae)
Bites, Stings and Poisons
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What is the etiology of human bites?
Strep viridans, staph, eikenella corrodens
What is the management of suspected
rabies exposure?
Soap and water
HRIG up to 8 days post exposure. Half
into wound, half IM, Vaccine 1 cc of HDCV
IM on days 0,3,7,14,28.
Bites, Stings and Poisons
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What is the care for uninfected bite wounds?
Debridement, irrigation with normal saline.
Suture if within 12 hours of occurrence. Recheck
in 48 hours
Don’t suture if signs of infection. No suturing
high risk wounds such as punctures, cat, human
bites of hand, CFI
Tetanus or tetanus immunoglobulin.
Bites, Stings and Poisons
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What antibiotics for dog bite?
Augmentin (3-5 days), clindamycin and cipro
What antibiotic for cat bites?
Augmentin, cefuroxime, doxycycline
What about human bites?
Augmentin
What about Cat bite with cellulitis caused by
pasteurella multocida?
Penicillin
What is the treatment for infected dog bite?
Penicillin, and Dicloxacillin
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What about infected human bite?
IV antibiotics with cefoxitin and
gentamycin, Augmentin, oxacillin and
gentamycin
Bites, Stings and Poisons
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Brown recluse spider bite. What is the
presentation?
Blister formation and tissue necrosis
What is the management?
Supportive, no antivenin, ice, surgically debride,
administer antibiotics
What is the presentation of the Black widow
spider bite?
Erythematous skin lesion, diffuse muscle
cramps, severe abdominal pain, hypertension,
resp failure, shock coma. Managed with
Analgesics, benzo, antivenin, calcium gluconate
Bites, Stings and Poisons
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What topical insecticides are used for lice?
Permethrin, lindane, pyrethrin
Scabies?
Permethrin, crotamiton, lindane
Bites, Stings and Poisons
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What is the presentation of Stingray sting?
Venomous spine punctures skin causing
painful local reaction. Also systemic
symptoms such as n/v/d, weakness,
paralysis, shock
What is the MOA of jellyfish ting?
Tentacles with stinging cells that release
venom. Localized pain, erythema, urticaria
Bites, Stings and Poisons
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What is the presentation of Tarantula sting?
Flick barbed hairs, painful bite, erythema,
edema and local joint stiffness. Tx analgesics,
potho consult for barbed hairs
What is the presentation of Scorpion sting?
Burning, tachycardia, roving eye movements,
excessive secretions, opisthotonos, fasiculations
What is the management?
Benzo, antivenin
Bites, Stings and Poisons
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What are some delayed reactions to bites and
stings?
Serum sickness, fever, malaise, headache,
urticaria, lymphadenopathy, polyarthritis
What is the local management for bites and
stings?
Remove stinger, cleanse, RICE, debride ulcers,
drain abscess, topical antipruritics
Chest Trauma
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What is the MOA, clinical manifestations and
management of a clavicle injury?
Fall on shoulder or outstretched arm
Pain, point tenderness, deformity
Sling and swathe
What is a complication of rib fracture?
Underlying injury
Which ribs are most commonly fx and why?
Ribs 3-8 (thin/ poorly protected)
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What is the clinical presentation of a rib
fx?
Pain worse with movement, breathing,
coughing, crepitus, splinting on respiration
What are complications associated with a
rib fracture?
Atelectasis, ventilation perfusion
mismatch.
Chest Trauma
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What is a flail chest?
Two or more adjacent ribs fx in two or more
places producing free floating segment of chest
wall
What is the clinical presentation and
management?
Underlying pulmonary contusion. Paradoxical
chest movements. Creptius
Stabilize flail segment, high conc oxygen
Chest Trauma
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What is the MOA of a sternal fx?
Deceleration compression injury
What are some complications?
Myocardial or lung injury (Pneumothorax).
Closed: air in pleural space.
What is the management?
Ventilation assistance, needle
thoracostomy
Chest Trauma
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What is the clinical presentation of a sucking
chest wound
Hypoventilation. SOB, pain, sucking sound,
subcutaneous emphysema. Tachypnea,
tachycardia,
What is the management?
Seal defect and secure on 3 sides to avoid
pressure and tension pneumo
What complication is associated with this?
Tension pneumo
Chest Trauma
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Define a tension pneumo
Air in thoracic cavity cannot exit
What are the clinical manifestations?
Dyspnea, difficult ventilations, tracheal deviation,
hypotension, JVD
What is the management?
Needle thoracostomy/ chest tube, Needle into
2nd intercostal space mid clavicular line
Chest Trauma
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What complications are associated with
hemothorax? What is the presentation?
Associated with great vessel or cardiac injury,
hypovolemia, hypoxemia, dull to percussion,
JVD possible
Tachypnea, dyspnea, cyanosis, narrowed pulse
pressure
What is the management?
Fluids, ventilation support
Chest Trauma
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What is the presentation of a pulmonary
contusion?
Tachypnea, tachycardia, cough, hemoptysis,
respiratory distress, evidence of blunt trauma
What is the management?
Oxygen, ventilation if necessary, restrict IV fluids
What is the MOA and etiology of traumatic
asphyxia?
Compression force to chest. Blood from right
side of heart into veins of upper thorax, neck
and face.
Chest Trauma
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What is the presentation of traumatic asphyxia?
Reddish, purple discoloration of face and neck,
JVD, swelling to lips and tongue, swelling of
head and neck, conjunctiva with petechiae,
hypotension when pressure released.
What is the presentation of Myocardial
contusion?
Chest pain, tachycardia, EKG changes, new
murmur, pericardial friction rub, hypotension
What is the management?
Oxygen, antidysrhythmics, vasopressors.
Chest Trauma
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What is becks triad? What does it
represent?
Narrowing pulse pressure, JVD, muffled
heart sounds, cyanosis of head, neck,
upper extremities, hypotension. Pericardial
tamponade.
What is the management?
IV fluid challenge, pericardiocentesis
Chest Trauma
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What is the management of aortic rupture?
Upper extremity hypertension, absent femoral
pulses
Interscapular pain, harsh systolic murmur over
pericardium, dyspnea, dysphagia, chest wall
contusion, asymmetric pulses, fracture to rib 1 or
scapula, widening mediastinum, aortogram.
Urologic disease
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What is the presentation of Testicular torsion?
Painful testes with high lie, hx of cryptorchidism,
red swollen scrotum, negative prehn’s sign
(relief of pain with elevation of scrotum). Need
surgery
What is the presentation of Epididymitis?
Painful enlargement of epididymis, fever, scrotal
swelling, erythematous scrotum, positive prehn’s
sign
What is the management?
Antibiotics, UC, bed rest
Urologic disease
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What is Orchitis?
Inflammation of testes due to STD
How does it present?
Painful testes, tender and swollen, parotid
swelling
What is the management?
Antibiotics
What is a Hydrocele?
Enlarged painless scrotum, transilluminating
scrotal mass.
What is the management?
hydrocelectomy
Urologic disease
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What is a Varicocele?
Scrotal mass, infertility, bag of worms
What is the management?
Surgical ligation
What is a Direct hernia
Painless groin mass for years. Outside inguinal
canal
What is an Indirect hernia
Painless scrotal mass. In inguinal canal
Urologic disease
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What is the common etiology of Nephrolithiasis?
Calcium, uric acid, cystine, struvite
What is the presentation?
Back pain, renal colic, pain radiates to groin,
testicles, suprapubic, hematuria, dysuria, fever
chills, CVAT, n/v
What is the diagnosis/ management?
CT without contrast, US, IVP, KUB
>1cm do not pass spontaneously, less do
Analgesics (morphine, Ketorolac, fluid hydration,
antibiotics if UTI
Bioterrorism
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Bioterrorist agents:
Bacterial
Bacillus anthracis- anthrax. Spores. Gram
positive. Cutaneous(most common), GI, Inhaled.
Pruritic macule, round ulcer, black eschar,
lymphadenopathy.
Sepsis, abdominal pain, tenderness, ascites,
hemorrhagic diarrhea. IV ciprofloxacin,
doxycycline.
Inhalation: first stage: influenza prodrome,
sudden fever, resp failure, shock. Widened
mediastinum. Late is sepsis with high grade
bacteremia, meningitis. Treat with ciprofloxacin
60 days if no vaccine.
Bioterrorism
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Yersinia pestis- plague. Incubation 2-6 days.
Pneumonic plaque- Acute pneumonia, bloody
sputum, rapid respiratory distress, GI symptoms,
sepsis. Treatment is streptomycin for 10 days,
tetracyclines, vaccine.
Bubonic plaque- 2-8 days incubation. Fever,
chills, painful lymph node in groin, axilla, cervical
region. Skin inoculation. Septicemia, DIC,
purpura, gangrene
Bioterrorism
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Viral
Variola- small pox
12-14 days incubation. High fever, malaise,
headache, severe abdominal pain,
maculopapular rash starts on face, forearms
spreads to trunk, legs, lesions on palms, and
soles. Macules to vesicles to pustules.
Treatment is vaccine and supportive.
Bioterrorism
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Toxin
Clostridium botulinum toxin- botulism.
Cranial nerve abnormalities, descending
progressive symmetrical weakness and
paralysis, no sensory or central deficits, no
fever. Need equine botulinum antitoxin,
pentavalent toxoid.