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69 Cards in this Set
- Front
- Back
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What is Margolin Ulcer?
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squamous cell cancer in chronic burn wounds
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Where is most common location of aspirated objects and why? What is Tx?
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RIGHT MIDDLE bronchus (b/c greater vertical orientation)
Tx: Rigid bronchoscopy + direct laryngescopy (can give IV steroids before to decrease bronchial inflammation) |
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What is EKG abnormality classic for hypothermia? What will happen in final stage of hypothermia?
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J waves (small positive deflection after QRS)
- stop shivering + fatal increase of blood viscosity |
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When should you give Td vaccine to patient with a wound? TIG?
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Td vaccine given to all patients who are unsure of last vaccination or if >10 years ago
- also dirty or large wound if last shot was more > 5 yrs ago Give TIG when >10 years ago or unknown AND dirty/large wound |
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What is the treatment for Lead poisoning in adults? in Kids?
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EDTA or dimercaprol - adults
succimer - kids |
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What is the Parkland burn formula?
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LR(L) = 4 x %BSA x wt(kg)
1/2 over first 8 hrs 1/2 over last 16 hours |
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What is the treatment for a black widow spider bite?
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Clean wound + Calcium gluconate + antivenom + dapsone/erythromycin/steroids
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Patient with hand wound on dorsum after closed fist hitting victims mouth?
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Clean wound well (pressure cleaning), leave it open (hand surgery) give Td if need, get XR of hand
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What is treatment of patient with organophosphate poisoning?
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they will have high Ach (will be wet)
* remove clothing with gloves atropine + pralidoxmine |
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What meds are used in the treatment of cyanide poisoning?
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1. Thiosulfates (renally excretes)
2. hydroxycobalamin (S/E reddish discloration of skin, urine, mucus) 3. nitrates (induce methemoglobinemia -> binds cyanide) C/I in kids and anemics, and smoke inhalation ; need to give first then thiosulfate if use it |
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Patient w/ COPD comes to the ED with tachycardia and hypotension. He then begins to have seizures/hyperthermia. What is most likely etiology? How do you treat?
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Theopyhilline OD
activated charcoal |
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What is the ACLS treatment for ventricular fibrillation?
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1. (360 J shock + 2 min CPR) X 2
2. Epinephrine (q3-5min) or 1st does only vasopressin 3. Amoidarone, lidocaine (or Procainamide) alternating w/ Epi and shock |
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What is the ACLS treatment for asystole?
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1. Epinephrine + atropine (max of 3 doses)
2. Transcutaneous pacemaker NO SHOCK |
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What meds are used in bradycardia induced by B-blocker OD?
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Atropine, CaCl (or gluconate), GLUCAGON, dextrose/insulin
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What what point in a patient with an elevated INR due to Warfarin should you consider giving Vit K to reverse?
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any time there symptomatic (aka bleeding)
OR if INR > 9 (consider if > 5) |
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What meds should e given to a patient with muscle spasms, abdominal stiffness, altered mental status and tachycardia due to spider bite?
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1. Calcium gluconate + methocarbamol
2. benzos 3. antivenom |
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What happens with ASA OD (and which comes first)?
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Tinnitus (impt clue) +/- hyperthermia
Respiratory alkalosis (1st) then metabolic elevated anion gap acidosis |
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What meds are used in treating stable, asymptomatic ventricular tachycardia? What if unstable but have a pulse?
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amiodarone, lidocaine or procainamide
- do synchronized cardioversion |
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What is treatment for SVT?
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1. vagal maneuvers (carotid massage - never if think have carotid a. stenosis can mobilize plaque)
2. adenosine 3. CCB or B-blocker, digoxin 4. electric cardioversion |
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Where do you place a Swan-Ganz catheter?
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left subclavian or rt internal jugular
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What are the different forms of transplant rejection? what causes?
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Hyperacute (<24hrs) -> antidonor antibodies in receiver (untx, avoid with proper cross-matching)
Acute (6 days - 1 year) -> T cell proliferation (reversible with immunosuppressants) Chronic (>1yr) -> B and T cells (usually untx) |
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What is graft vs. host disease?
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reaction of DONOR cells to the host cells
- host is immunocompromised and unable to prevent this attack by the donor cells maculopapular RASH, N/V, diarrhea, easy bleeding, recurrent infections Tx: steroids, tacrolimus, mycophenolate |
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What is Cushing's Triad?
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1. HTN
2. Bradycardia 3. decreased RR = increased ICP |
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What are the different CAH's cause? Which is most common and how do you treat that?
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HTN then androgens
11-B= HTN + increased androgens 17-alpha = HTN and decreased androgens 21-alpha = HYPOtension + increased androgens * 21 is most common and treat with fludrocortisone b/c aldosterone (mineralcorticoids low) |
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What is the antidote for salicylates?
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sodium bicarb + carcolol
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What is the antidote for B-blockers or Verapamil?
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Atropine + Glucagon + CaCl +/- dextrose/insulin
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What is the antidote for Digoxin?
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Dig antibodies (Dfab), charcoal, atropine
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What is the antidote for Iron?
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DeFEroxamine
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What is the antidote for copper?
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penicillamine (think copper penny)
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What is the antidote for t-PA, streptokinase?
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Aminocapuric acid
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What study used to diagnose injury to the urethra?
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Retrograde urethrogram
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What are Sx of a Basilar skull fracture?
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1. Racoon eyes (orbital fracture)
2. battle sign (mastoid) 3. blood behind the TM 4. CSF from ear/nose |
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What is the next step in evaluation for penetrating injuries to different zones of the neck?
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Zone 2 - exploratory surgery
Zone 1 (low) - CT (4-vessel) angiogram Zone 3 (highest) = CT (4-vessel) angiogram + triple endoscopy |
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What are effective interventions in management of a patient with increased ICP?
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1. elevate head of bed 30 deg
2. hyperventilation (intubate if need to, use lidocaine) 3. mannitol 4. surgery - decompressive crainotomy |
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What criteria must be met PRIOR to d/c of a preggo women being observed after a traumatic event?
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1. NO vaginal bleeding
2. Good HR 3. Normal FHR tracing 4. No abdominal pain 5. Contractions > 10 mins apart |
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What is the next step in evaluation of patient with: pelvic fracture + DPL shows blood in pelvis?
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Emergent surgery
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What is the next step in evaluation of patient with: pelvic fracture + DPL shows urine in pelvis?
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urgent surgery
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What is the next step in evaluation of patient with: pelvic fracture + DPL shows nothing + unstable?
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Angiography w/ possible embolization (retroperitoneum)
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What is the next step in evaluation of patient with: blunt abdominal trauma + unstable + FAST shows fluid?
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Emergent surgery
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What is the next step in evaluation of patient with: blunt abdominal trauma + unstable vitals + FAST shows no fluid?
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Angiography w/ possible embolization (retroperitoneum)
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What is the next step in evaluation of patient with: blunt abdominal trauma + unstable vitals + FAST inconclusive?
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DPL
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What is the next step in evaluation of patient with: blunt abdominal trauma + stable vitals?
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CT scan of Abdomen
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What is the next step in evaluation of patient with: abdominal stab wound + hypotensive or peritonitis?
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Emergent surgery (any stab wound)
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What is the usual time frame for stopping warfarin prior to surgery? Aspirin?
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-Stop warfarin 3-4 days before and start heparin; continue both heparin and warfarin after surgery (wait 12hrs after surgery to given heparin); can stop heparin when INR is > 2
-Stop aspirin 5-7 days before surgery |
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What interventions are helpful in optimizing lung function in the post-op period in patients with pre-existing lung dz?
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Inhaled steroids + inhaled broncodilators (albuterol)
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When is the greatest risk for a post-op MI? What is recommended for patients peri-operatively with known CAD?
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greatest risk < 48hrs (2 days) post-op
- give B-blockers (+ telemetry monitoring) |
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Which vasopressor does this: theoretically causes renal vasodilation?
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Dopamine
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Which vasopressor does this: high does optimize the alpha-1 vasoconstriction?
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Epinephrine
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Which vasopressor does this: ADH analogue?
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Vasopressin
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Which vasopressor does this: best choice for anaphylatic shock?
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Epinephrine
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Which vasopressor does this: best choice for septic shock?
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Norepinephrine
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Which vasopressor does this: best choice for cardiogenic shock?
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Dobutamine
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Which vasopressor does this: causes vasoconstriction with bradycardia?
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Phenylephrine
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Which immunodeficiency increases the risk of anaphylatic transfusion rxn? What is treatment?
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IgA deficiency (resp. distress -> shock; no fever)
Epi |
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What is the most common type of transfusion rxn? How does it present? What is it due to?
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Febrile NON-hemolytic
1-6hrs after transfusion (fevers, chills, rigors, malaise) - HLA antigen antibodies (reaction to cytokines stored in transfused blood product) Tx: Tylenol (recurrence is uncommon) |
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How does Acute hemolytic transfusion rxn present? What causes it?
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onset DURING transfusion; tachycardia, hypotension, tachypnea, fevers, nausea flushing
ABO incompatibility |
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What is the most common cause of hemolytic transfusion reactions?
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Clerical errors
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How does delayed hemolytic transfusion rxn present? What is it due to?
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onset 2-10 days after; low H/H, high indirect bilirubin , slight fever
- Kidd or Rh antibodies (anamnestic antibody response ag. minor RBC antigen) no acute tx |
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How can you prevent NONhemolytic febrile transfusion rxn?
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cell washing, leukocyte depletion techniques
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What is a TRALI?
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transfusion related acute lung injury -> non-cardiogenic pulmonary edema
leading cause of transfusion-related fatalities in USA d/t rxn from cytokines stored in transfused blood product (HLA-antigen AB) like nonhemolytic - due to FFP + platelets > PRBCs |
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What blood product should you give if: severe anemia due to autoimmune hemolytic anemia?
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PRBCs
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What blood product should you give if: hemophilia?
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clotting factors (8 or 9) or DAAVP (desmopressin)
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What blood product should you give if: DIC?
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FFP
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What blood product should you give if: shock due to trauma or post-partum hemorrhage?
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PRBCs (or whole blood if very severe)
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What blood product should you give if: to maintain BP during large volume paracentesis?
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Albumin (if >4L)
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What blood product should you give if: hemorrhage due to Warfarin OD?
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FFP
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What blood product should you give if: need for vWF rich blood product?
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cyroprecipitate
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What blood product should you give if: thrombocytopenia?
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platelets
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What interventions can be used to protect the kidneys in times of anticipated insult? (like IV contrast)
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n-acetylcysteine (24hrs before and after)
hydrate with IVF bicarb IV (right before and 6 hours after) |
