Term
| Term used to characterize a SUBJECTIVE experience of breathing discomfort that is comprised of qualitatively distinct sensations that vary in intensity. The experience derives from interactions among multiple physiological, psychological, social and environmental factors, and may induce secondary physiological and behavioral responses. |
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Definition
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Term
| lung sound heard with airway obstruction (inspiratory) |
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Definition
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Term
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Definition
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Term
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Definition
| : LV dysfxn, severe HTN, aortic stenosis, CMO, MR |
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Term
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Definition
| : LV dysfxn, severe HTN, aortic stenosis, CMO, MR |
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Term
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Definition
| chronic lung disease, hypoxia |
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Term
| JVD is seen with what disorders |
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Definition
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Term
| Distal hearts sounds seen with what disorders |
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Definition
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Term
| Suggests extreme resp. distress – COPD, asthma, foreign body |
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Definition
Accessory muscle use/retractions
Tripod position |
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Term
| Crackles are heard with what lung disorders |
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Definition
| pneumonia, CHF, pulmonary fibrosis, atx |
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Term
| Decreased breath sounds suggests: |
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Definition
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Term
| Tachycardia is seen with what disease? |
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Definition
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Term
| Afib is seen with what pulmonary disorders |
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Definition
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Term
| films to evaluate pleural effusion |
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Definition
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Term
CT
With contrast is used when? |
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Definition
rule out PE, evaluate LAD
Contraindications for contrast: allergy, renal insufficiency
Board Q: it's OK to give contrast in ESRD...just dialyze afterwards! |
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Term
| CT without contrast used to evaluate? |
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Definition
| evaluate pulmonary parenchyma |
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Term
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Definition
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Term
| flattened diaphragms, hyperinflation on chest x-ray |
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Definition
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Term
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Definition
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Term
Intubation vs BiPap
Indications:
Initiate early for moderate/severe dyspnea
Decreased pH, elevated CO2, RR > 25
Contraindications:
Altered mental status
Inability to cooperate, clear secretions – aspiration risk
Hemodynamic instability, GIB
Pneumonia |
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Definition
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Term
Intubation vs BiPap
Indication:
ABG results:
PaO2 < 55-60
Elevated CO2
Decreased pH
Elevated RR, respiratory fatigue
Altered mental status
Hemodynamic instability
Contraindications:
pt/family's wishes: DNR/DNI |
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Definition
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Term
ABG phases of Asthma
mild Phase 1 |
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Definition
| Phase I: respiratory alkalosis with low PCO2, normal to high PO2 |
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Term
ABG phases of Asthma
Moderate:Phase II |
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Definition
| Phase II: normal pH, near normal PCO2, decreased PO2 |
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Term
ABG phases of Asthma
Severe: |
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Definition
Respiratory acidosis, high PCO2, low PO2
Prepare to intubate! |
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Term
HX:
Dyspnea increased over several weeks
Weight gain
Pink frothy sputum
Hx CHF, cardiomyopathy, reduced ejection fraction
what might this patient have? |
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Definition
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Term
what might this patient have?
PE:
Tachypnea
Lungs: bilateral crackles at bases
Heart: S3
Extremities: pitting edema in lower extremities |
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Definition
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Term
Elevated BNP, > 500 means what
and CXR Cardiomegaly, interstitial edema – Kerley B lines
Pleural effusions
? |
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Definition
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Term
| Treatment for Decompensated CHF is: |
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Definition
L: lasix
M: morphine (decreases dyspnea, vasodilator, reduces afterload)
N: nitrates (vasodilator)
O: oxygen, BiPAP, intubation
P: position (sitting up, legs hanging on side of bed) reduces preload |
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Term
History:
Fever, cough, sputum production, dyspnea
PE
Vitals: fever, tachycardia, dyspnea, ?hypotensive
Lungs: crackles, coarse rhonchi
Heart: tachycardic |
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Definition
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Term
| Infiltrate RML/RLL: consider |
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Definition
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Term
| Infiltrate Upper lobes: consider |
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Definition
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Term
| Infiltrate seen on previous CXR: consider |
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Definition
| malignancy or post-obstructive pneumonia |
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Term
| Pleural effusion? : likely parapneumonic, if > 1cm then |
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Definition
| 1cm then requires thoracentesis, rule out empyema |
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Term
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Definition
Resp. floroquinolone: Levaquin, Avelox OR
3rd gen. Ceph + macolide: Rocephin + Zithromax |
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Term
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Definition
Antipseudomonal PCN or 3rd gen. Ceph + floroquinolone + vancomycin
Vancomycin / Ciprofloxacin / Zosyn
PCN Allergic: Vanc / Cipro / Cefepime or Aztreonam |
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Term
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Definition
Anaerobic coverage: Zosyn
3rd gen. Ceph or floroquinolone |
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Term
| hypotension, tachycardia, trachea deviated from midline (away from ptx), decreased breathsounds, chest pain |
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Definition
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Term
| decreased breath sounds, dyspnea, chest pain |
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Definition
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Term
| Tension PTX: requires IMMEDIATE? |
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Definition
| needle decompression prior to obtaining CXR |
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Term
Spontaneous PTX or secondary to trauma Tx:
< 2
>2 |
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Definition
If < 2cm: can place on high flow O2, monitor overnight and repeat CXR in AM.
If stable: send home, repeat CXR outpt with close follow-up
If larger: place chest tube
If > 2cm insert chest tube, place to suction, repeat CXR to assure complete resolution of PTX |
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Term
What is this-
History:
Acute onset dyspnea, chest pain, cough, hemoptysis
Recent surgery, immobilization, travel
Family hx of PE/DVT
Hx malignancy
Recent calf pain/swelling
Virchow's triad: venous stasis, hypercoagulability, endothelial damage |
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Definition
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Term
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Definition
| : venous stasis, hypercoagulability, endothelial damage |
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Term
What could this be:
CXR: usually normal, Hampton's hump,
EKG: sinus tach, RV strain, RBBB, R axis deviation, S1Q3T3: large S lead 1, large Q lead 3, inverted T lead 3 |
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Definition
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Term
| Gold Standard for diagnosing Pulmonary embolism |
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Definition
| Pulmonary angiogram: for board purposes this is GOLD STANDARD.....rarely ever used. |
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Term
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Definition
Open Fractures or Joints
Neurovascular Injuries
Dislocations
Septic Joints |
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Term
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Definition
Open Fractures or Joints
Neurovascular Injuries
Dislocations
Septic Joints |
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Term
| Open Fractures- from within from without? |
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Definition
Compound from within (inside-out):
The broken end of the bone breaks through or pierces the skin
Compound from without (outside-in):
External violence causes laceration or tissue trauma
Higher likelihood of contamination |
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Term
Open Fractures- Classifications/types
Type 1
Type II
Type III |
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Definition
Type I:
Small wound (<1cm), usually clean; low energy
Type II:
Moderate wound (>1cm), minimal soft tissue damage or loss; low energy
Type III:
Severe skin wound, extensive soft tissue damage; high velocity |
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Term
Open Fractures- Management
DOs: |
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Definition
Control the bleeding
Cover with sterile dressing
Splint
IV antibiotics
Tetanus prophylaxis
Anti Gas Gangrene Serum (AGGS, Clostridium perfringes) |
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Term
Open Fractures- Management
Dont's |
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Definition
Scream and pass out
Replace protruding bone
Explore wound
Clamp vessels |
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Term
| Any open wound over or near a joint should be assumed to extend to the joint until proven otherwise |
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Definition
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Term
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Definition
Vascular trauma
Trauma to peripheral nerves
Acute compartment syndrome |
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Term
An injury or condition that causes prolonged elevation of interstitial tissue pressures
Increased pressure within enclosed fascial compartment leads to impaired tissue perfusion
Prolonged ischemia causes cell damage which leads to increased vessel permeability
Plasma leaks into interstitium causing further increase in pressure
Extensive muscle and nerve death >8 hours |
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Definition
| Acute Compartment Syndrome |
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Term
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Definition
Pain
Paresthesias
Paralysis
Pulses
Palpation |
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Term
Pressure Monitoring
Normal tissue pressure ranges between?
Capillary blood flow is compromised at what pressure?
muscles and nerves are at risk for ischemic necrosis at pressures greater than |
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Definition
between 0-10mmHg
20mmHg
Greater than 30-40mmHg |
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Term
| Treatment for acute compartment syndrome? |
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Definition
a surgical emergency.
Delays over 24 hrs can result in myoglobinuria, renal failure, metabolic acidosis, hyperkalemia, ischemic contracture. |
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Term
| Indications for fasciotomy: |
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Definition
clinical signs of CS
tissue pressure over 30 mmHg with clinical picture of CS
interrupted arterial circulation over 4 hours. |
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Term
| Always check neurovascular status after moving patient, manipulating injured limb, before and after applying cast or splint, and at frequent intervals if transfer is delayed. |
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Definition
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Term
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Definition
Anterior (31%)
Caused by hyperextension
Often ACL and PCL both torn
MCL and/or LCL usually injured
Popliteal artery- intimal tear
Posterior (25%)
ACL and PCL torn
Possible tear of extensor mechanism
Avulsion or disruption of popliteal artery |
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Term
Second most common major joint dislocation
Usually closed and posterior
Fall on extended elbow
Posterior, posterolateral, posteromedial, lateral, medial, or divergent |
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Definition
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Term
Complex- dislocation
Simple- dislocation |
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Definition
- dislocation with fracture (35-40%)
Radial head fracture most common
- dislocation without fracture
Rupture of capsule, rupture of MCL and lateral ligaments, rupture of flexor pronator mass, possible injury to brachialis muscle and rupture of brachial artery |
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Term
Dislocation- Elbow
Nerve injury? |
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Definition
Neuropraxia involving median or ulnar nerve in 20% of elbow dislocations
Ulnar nerve palsies more common in pediatric
Most neuro deficits are transient |
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Term
Dislocation- Sternoclavicular
Most common |
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Definition
Anterior
More common
Traumatic or atraumatic
Posterior
Rare |
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Term
| Most common major joint dislocation |
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Definition
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Term
| Most common shoulder dislocation |
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Definition
Anterior (95%)
Arm abducted and externally rotated |
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Term
Inflammation of a synovial membrane with purulent effusion into the joint capsule
Usually monoarticular |
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Definition
| Septic Joint/Septic Arthritis |
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Term
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Definition
Knee- 40-50%
Hip- 20-25%*
*Hip is the most common in infants and very young children
Wrist- 10%
Shoulder, ankle, elbow- 10-15% |
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Term
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Definition
Knee- 40-50%
Hip- 20-25%*
*Hip is the most common in infants and very young children
Wrist- 10%
Shoulder, ankle, elbow- 10-15% |
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Term
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Definition
IV antibiotics
Drainage
Repeated aspirations
Consider lavage |
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Term
| Septic Joint- Complications |
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Definition
Rapid destruction of joint with delayed treatment (>24 hours)
Degenerative joint disease
Soft tissue injury
Osteomyelitis
Joint fibrosis
Sepsis
Death |
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Term
| Septic Joint- Complications |
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Definition
Rapid destruction of joint with delayed treatment (>24 hours)
Degenerative joint disease
Soft tissue injury
Osteomyelitis
Joint fibrosis
Sepsis
Death |
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Term
| “Red Flag” symptoms included with back pain |
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Definition
| “Red Flag” symptoms include: age over 50, trauma, fever, incontinence, night pain, weight loss, progressive weakness. |
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Term
Bilateral leg symptoms that include sciatica, weakness, sensory changes and gait disturbance.
Physical examination demonstrates bilateral weakness as well as decreased sensation, in particular in the “saddle” region.
Sphincter tone is decreased in 60 to 80% of patients
All patients who complain of urinary or fecal incontinence should be considered to have CES until proven otherwise. |
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Definition
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Term
Clinical diagnosis:Cauda Equina Syndrome
Treatment: |
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Definition
loss of bladder control; perianal numbness; pain and weakness involving both legs
Neurosurgical consultation
High dose systemic corticosteroids
Emergent surgical decompression
Evaluation of the urinary post-void residual volume assists with diagnosis:
the absence of a post-void residual volume of over 100ml, essentially excludes a diagnosis of CES, with a negative predictive value of 99.99% |
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Term
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Definition
Perilunate and lunate dislocations result from hyperextension injuries.
Most common mechanism of injury is a FOOSH, followed by an MVA. |
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Term
Progressive Injuries of the wrist: stages:
stage 1
stage 2
stage 3
stage 4 |
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Definition
Stage I: scapholunate dissociation
Stage II: perilunate dislocation
Stage III: dislocation of the triquetrem
Stage IV: lunate dislocation |
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Term
| The most commonly fractured metatarsal |
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Definition
The most commonly fractured metatarsal is the fifth.
These fractures may result from direct or indirect trauma. |
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Term
Clinical Presentation of 5th metatarsal fracture?
3 types:
Tuberosity
Jones
Stress |
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Definition
In a tuberosity fracture there is pinpoint pain over the base of the fifth metatarsal
In an acute Jones fracture the pain is distal to the tuberosity at the fracture site
History of prodromal symptoms is important to r/o stress fracture |
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Term
Treatment
5th metatarsal
Tuberosity fractures
Jones fractures |
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Definition
Tuberosity fractures rarely need referral, unless displaced over 3mm. Initially treated in a firm-soled shoe, and transitioned to a SLWC or fracture boot as needed.
Jones fracture: treated in a posterior splint and referred for either a SLNWBC or operative fixation. |
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Term
| most common ligamentous injuries of the hand |
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Definition
PIP dorsal joint dislocations are the most common ligamentous injuries of the hand
Potentially serious PIP joint injuries are commonly misdiagnosed as a simple sprain or “jammed finger
Hyperextension is the most common mechanism |
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Term
The PIP joint is a concentric bicondylar hinge joint
Primary stabilizers of the PIP joint are? |
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Definition
collateral ligaments
volar plate |
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Term
| Treatment PIP Joint dislocations: Jammed finger |
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Definition
Stable dorsal dislocation
Splint for 3 weeks in 30 degrees of flexion, followed by buddy taping
refer fracture over 30% articular surface
Collateral ligament injury
buddy taping for 3 to 4 weeks
refer large avulsion fractures, displaced > 2 mm or articular surface > 30 %
Extensor mechanism injury
PIP splint full extension for 6 to 8 weeks |
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Term
| 2nd most common gynecologic complaint after vaginal bleeding |
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Definition
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Term
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Definition
Physical exam should include general, cardiac, lungs, abdominal and pelvic exam, +/- rectal exam
Focus on presence of cervical motion tenderness, adnexal masses or vaginal/cervical discharge
Pelvic Ultrasound
Quantitative HCG
Cervical cultures and smears |
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Term
| Leading cause of pregnancy related death in the 1st trimester |
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Definition
Ectopic Pregnancy
Extrauterine implantation of embryo
95% in fallopian tubes
Risk Factors
History of PID
IUD
Previous ectopic |
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Term
| Pelvic Inflammatory Disease mostly due to? |
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Definition
Mostly due to gonorrhea and chlamydia
Gonoccocal PID
More fulminant
Occurs within one week of menses or one week of the onset of menses
Chlamydial PID
Subacute course with mild symptoms |
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Term
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Definition
Broad spectrum abx x 10-14 days
Hospital Admission |
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Term
Abrupt, severe lateral pain
Cramping or lower abdominal pain 1-2 weeks before rupture
Lightheadedness associated with severe bleeding
Rectal pain (fluid in cul-de-sac) |
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Definition
Ruptured Ovarian Cyst
Occurs between days 20-26 of cycle or cause a delay in menses |
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Term
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Definition
SURGICAL EMERGENCY!!
Pain secondary to ischemia
Bimodal age: adolescent and women >50 |
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Term
| Excessive blood loss during menstruation > 80 cc or > 7 consecutive days of menstruation |
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Definition
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Term
| Abnormal bleeding at irregular intervals or between cycles |
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Definition
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Term
| Prolonged or heaving bleeding at irregular intervals |
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Definition
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Term
| most common cause of postmenopausal bleeding |
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Definition
| Endometrial cancer is the most common cause of postmenopausal bleeding – refer to GYN for endometrial biopsy |
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Term
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Definition
Resuscitation for unstable patients
Estrogens for heavy uterine bleeding
IV conjugated equine estrogen 25mg q 4-6 hours x 24 until bleeding ceases or PO estrogen 2mg q 4-6 hours
Medroxyprogesterone acetate 10 mg daily x 7-10 days for withdrawal bleed
NSAIDS
D&C or hysterectomy
Consult GYN |
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Term
| Pair of pea-sized, vulvovaginal, mucous-secreting vestibular glands located in the labia minora in the 4- and 8-o’clock positions |
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Definition
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Term
| Abscess forms when Bartholin's cyst becomes infected or the Bartholin gland itself becomes infected |
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Definition
Bartholin Gland Abscess
Vs
Bartholin cyst:Fluid-filled sac that develops either in the gland or duct |
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Term
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Definition
Many hospitals utilizes SANE (sexual assault nurse examiner) nurse
Collect evidence
Police must be present in the ED but not in the exam room |
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Term
| Sperm has been identified in oral smear up to 6 hours after attack despite brushing teeth, mouthwash or drinking most fluids |
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Definition
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Term
Sexual Assault Victim
ED Mgt |
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Definition
Prevention of STDs with prophylactic meds
Cetriaxone 125 mg IM single dose plus
Azithromycin 1 g orally single dose or doxycycline 100mg po bid x 7 days
Metronidazole 2g po single dose for trich/BV
Prevention of pregnancy with prophylactic meds (repeat HCG in 2 wks)
Ethinyl estradiol/levonorgestrel
Ovral or Preven Kit 2 tab po BID (12 hours apart) or
Lo/Ovral, Levelen, Tri-Levlen, Tri-Phasil, Nordette 4 tabs po BID (12 hours apart) |
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Term
| Persistent vomiting, dehydration, ketosis, electrolyte disturbances and weight loss (> 5% of body weight), elevated specific gravity in urine, ketonuria with pregnancy |
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Definition
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Term
Vaginal Bleeding: 1st Trimester
Emergent |
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Definition
Spontaneous abortion
Ectopic pregnancy
Gestational trophoblastic disease
Placenta previa
Placental subchorionic hematoma |
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Term
Vaginal Bleeding - 2nd Trimester
Emergent |
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Definition
Spontaneous abortion
Ectopic pregnancy
Gestational trophoblastic disease
Preterm labor
Abdominal or pelvic trauma |
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Term
Vaginal Bleeding: 3rd Trimester
Emergent |
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Definition
Placental causes
Placenta previa
Placental abruption
Maternal causes
Uterine rupture
Coagulopathy
Abdominal/pelvic trauma
Fetal causes
Vasa previa |
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Term
Premature separation of placenta from endometrium
Partial or complete |
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Definition
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Term
Abnormal implantation of the placenta in lower uterine wall
Often dx in 2nd trimester but resolve by 3rd trimester
Painless bright red bleeding, may be spotting or a hemorrhage |
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Definition
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Term
Abnormal implantation of the placenta in lower uterine wall
Often dx in 2nd trimester but resolve by 3rd trimester
Painless bright red bleeding, may be spotting or a hemorrhage |
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Definition
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Term
| Placenta Previa Management |
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Definition
Pre-hospital
NEVER do a digital exam (may puncture)
IV fluids
Oxygen
Rapid transportation
Hospital
Conservative management as long as Mom and baby stable
Delivery by C/S for bleeding |
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Term
Hypertensive Emergencies of Pregnancy
3 types |
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Definition
Gestational hypertension
Preeclampsia
Eclampsia |
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Term
| REGARLESS OF PRESENTING COMPLAINT: any woman presenting to the ER in third trimester gets U/A and blood pressure readings |
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Definition
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Term
“Pregnancy-induced hypertension”
BP > 140/90 mm Hg without presence of proteinuria or edema
Occurs in
Patients > 20 wks gestation
Postpartum patient otherwise normotensive |
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Definition
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Term
Gestational hypertension plus renal involvement
Hypertension 140/90 mm Hg or 30/15 mm Hg over baseline
Proteinuria (>300mg/24 hours or 1+ on dipstick)
Edema |
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Definition
Preeclampsia
Only cure is delivery of baby and placenta |
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Term
Gestational hypertension plus renal involvement
Hypertension 140/90 mm Hg or 30/15 mm Hg over baseline
Proteinuria (>300mg/24 hours or 1+ on dipstick)
Edema |
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Definition
Preeclampsia
Only cure is delivery of baby and placenta |
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Term
Preeclampsia With Worsening HTN
Treatment |
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Definition
Treatment
Magnesium sulfate (MgSO4) while severity being evaluated, in labor & for 24 hours PP
4-6 gram bolus, then 2 grams/hour
Maintenance meds: aldomet, apresoline, labetalol
Monitoring of urine output, BP, pulse ox
Hypertensive crisis: apresoline, labetolol,procardia—must be CLOSELY monitored |
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Term
| New onset seizure activity or coma in a woman with gestational hypertension or pre-eclampsia |
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Definition
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Term
| Preeclampsia/Eclampsia Treatment and Disposition |
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Definition
Mild preeclampsia
Proteinuria is trace to 1+, blood pressure less than 105 diastolic
Bed rest and monitor twice weekly
Mod to Severe
Proteinuria >2 and diastolic BP is > 105, seizures, anuria, severe edema
Hospitalization
Hyperreflexia
MgSO4 4-6 grams given over 30 minutes followed by infusion 2 g/h
Hypertension
Hydralazine 5-10 mg IV, repeated q 20-30 minutes for control
Nipride or labetalol my also be used
Foley catheter to monitor urine output |
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Term
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Definition
H: hemolysis
EL: elevated liver enzymes
LP: low platelets
Gestational hypertension plus hepatic involvement
May develop in untreated preeclampsia
Seen in 2-12 % of pre-eclamptic pregnancies |
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Term
| MCC of Trauma in Pregnancy |
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Definition
Most common causes of trauma and maternal death
Blunt Trauma
MVA
Assault
Penetrating Trauma
GSW
Stabbings
Most common cause of fetal death
Death of the mother |
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Term
Other Traumas in Pregnancy
Burns |
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Definition
63% mortality rate for mom and fetus with 25% to 50% total surface burns
Add 5% to Rule of Nines when term gravid abdomen is involved
Care: hydration and oxygenation
Treatment priorities do not change with pregnancy |
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Term
Other Traumas in Pregnancy
Burns |
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Definition
63% mortality rate for mom and fetus with 25% to 50% total surface burns
Add 5% to Rule of Nines when term gravid abdomen is involved
Care: hydration and oxygenation
Treatment priorities do not change with pregnancy |
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Term
| Full thickness uterine wall tear, usually at site of prior uterine scar |
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Definition
| Painless Fetomaternal Hemorrhage |
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Term
| Fetomaternal Hemorrhage Testing |
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Definition
Kleihauer-Betke test
detects fetal blood cells in maternal circulation; helps identify fetal hypovolemia before fetal distress occurs |
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Term
| MCCauses of Traumatic Fetal Death |
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Definition
Maternal Death
Vasa Previa |
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Term
Perimortem Delivery
Best chance for survival: occurs within |
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Definition
| 4-5 minutes of maternal arrest |
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Term
| Emergency OB consultation needed if: |
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Definition
Fetal bradycardia <100 beats per min, during or after contractions
Vaginal bleeding
Presentations: transverse, breech, or cord
Maternal illness: eclampsia, coma, major trauma |
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Term
| Infants under 36 weeks require |
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Definition
NICU
20-30 minutes after delivery, gentle pull on the cord to deliver the placenta
Massage fundus to maintain hemostasis uterine tone
Delivery of an incomplete placenta is an O.B. EMERGENCY
After delivery, monitor vital signs of mother and baby |
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Term
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Definition
| distance from the symphysis pubis to top of fundus |
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Term
| abdominal breathing may be a sign of what cervical spine injury |
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Definition
| below C5 (phrenic nerve compromised) |
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Term
cervicle spine injury
Horner syndrome may tell you what? |
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Definition
Damage to cervical sympathetic chain
Ipsilateral ptosis, miosis, anhydrosis |
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Term
in cervical spine injury
Priampism may signify what? |
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Definition
| In males with complete spinal cord transection |
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Term
what type of fracture
Burst fracture of C1 due to axial load transmitted from a direct blow to the top of the head, resulting in fractures of the anterior and posterior arches of C1 |
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Definition
Jefferson fracture
Mechanism of action
Vertical compression injury |
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Term
Occur concomitantly with 1/3 of all C1-ring fractures
Most common subtype of C2 fxs
Classification system Type I-III
Type I – avulsion fractures of the lateral tip by the alar ligament
Type II – (most common) located at the waist of the odontoid in an area covered by the transverse ligament
Type III – extend caudally into cancellous bone of the axis |
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Definition
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Term
“Traumatic spondylosis of C2”
Fracture of the pedicles of the axis due to extreme hyperextension that occurs with rapid deceleration
+/- anterior displacement of C2 on C3
Spinal cord injury usually does not occur or is minimal due to diameter of spinal canal at level of C2 |
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Definition
Hangman Fracture
Mechanism of Action
Extension injury
Signs & Symptoms
Horner’s syndrome due to sympathetic trunk damage in the neck
Ipsilateral pupil constriction |
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Term
| Avulsion fracture in which a teardrop fragment avulsed from portion of the vertebral body where the anterior longitudinal ligament inserts |
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Definition
Tear Drop Extension Fracture
Mechanism of Injury
Violent extension force that results in hyperextension |
|
|
Term
| Oblique avulsion fracture of the base of the spinous process of one of the lower cervical vertebrae |
|
Definition
Clay-Shovelers Fracture
Extreme forced hyperflexion as a result of
A direct blow to the spinous proces
A sudden deceleration MVA
Direct occipital trauma leading to forced flexion |
|
|
Term
Dislocation of skull from cervical spine
Mechanism of Injury
Hyperextension and distraction mechanism due to MVAs
Usually fatal
More common in children
Mostly anterior dislocations |
|
Definition
| Atlantooccipital Fracture |
|
|
Term
Hyperextension injury of the neck that results in injury to the soft tissues of the neck (ligaments, tendons, and muscles) due to abnormal motion or force applied to your neck that causes movement beyond the neck's normal range of motion
Associated with motor vehicle accidents (especially rear-impact), sporting activities, accidental falls, and assault |
|
Definition
Cervical Sprain/Strain (Whiplash)
Rest, ice, NSAIDS, muscle relaxants |
|
|
Term
| Clinical Clearance for Cervical spine injuries includes what? |
|
Definition
Alert patient who has never lost consciousness
Not under the influence of drugs or alcholol
No cervical tenderness
No distracting injury
No neurologic deficit |
|
|
Term
|
Definition
Spinal Shock
Complete spinal cord transection
Central cord syndrome
Hemisection of spinal cord |
|
|
Term
What spinal syndrome?
Acute severe spinal cord injury
Clinical Presentation
Flaccid quadri- or paraplegia
Areflexi
Neurogenic hypotension |
|
Definition
|
|
Term
What spinal syndrome?
Clinical Presentation
Loss of motor and sensory below the level of lesion |
|
Definition
| Complete Spinal Cord Transection |
|
|
Term
what spinal syndrome?
Hyperextension injury
Produces contusion of central portion of the spinal cord that results in an injury to the central gray matter and the most central portions of the corticospinal and spinothalamic tracts
Weakness of arms worse than legs
Some loss of pain and temp sensation
(upper extremity>lower extremity)
Bladder control lost in extreme cases |
|
Definition
|
|
Term
what spinal syndrome?
Hyperflexion injury
Damages corticospinal and spinothalamic pathways of spinal column
Results in
Incomplete motor paralysis
loss of motor function below the level of lesion
Dissociated sensory loss
LOSS of pain and temperature (Spinothalamic) sensation distal to the level of injury
PRESERVATION of vibration, light
touch and position sense (Dorsal Columns)
Variable loss of sphincter tone |
|
Definition
|
|
Term
what type of spinal syndrome?
Rare incomplete lesion with primary damage to the posterior cord
Results in
preservation of motor function, sense of pain and light touch
loss of proprioception and sensations below the level of lesion |
|
Definition
|
|
Term
what spinal syndrome?
Loss of sensation and motor function caused by the lateral hemisection of the spinal cord
Results from penetrating injury or lateral cord compression due to intervertebral disk protrusion, hematomas, lateral mass fractures of the c-spine
Ipsilateral loss of motor
Loss of proprioception and vibratory sense
Contralateral loss of pain and temperature |
|
Definition
| Spinal Cord Hemisection/Brown Sequard Syndrome |
|
|
Term
| Critical Diagnoses of back pain? |
|
Definition
AAA
Cauda equina
Spinal Cord Syndrome
Epidural hematoma/ Epidural abscess |
|
|
Term
Sudden onset of severe abdominal pain radiating to the back
Hypotension
Syncope
Signs of shock
Distended, tight abdomen
Pain radiating to groin, testes, thigh, inguinal area, chest |
|
Definition
AAA
Decreased femoral pulses indicate rupture or leaking |
|
|
Term
|
Definition
Treatment
Establish 2 large-bore IVs
Type and crossmatch for 2 units of blood
Surgical consult STAT
Often unable to fully resuscitate in ED due to hypovolemic shock
Transfer to appropriate facility when warranted |
|
|
Term
Weakness or paraplegia of the muscles of the lower extremeties innervated by the compressed roots
Asymmetric, areflexic marked paraplegia
Sphincter weaknesses resulting in urinary retention and post-void residual incontinence
Urinary retention with overflow incontinence presents late
Decreased anal tone (fecal incontinence)
Erectile dysfunction with sensory loss
saddle anesthesia: unilateral LE in dermatomal distribution numbness without sensory dissociation
bilateral leg pain and weakness
bilateral absence of knee/ankle reflexes
Graudual, unilateral presentation
MORE severe radicular pain
LESS severe low back pain |
|
Definition
|
|
Term
| Etiology of Cauda Equina Syndrome? |
|
Definition
Peripheral nerve injury most commonly caused by a central disc herniation
L4-5 is most common culprit |
|
|
Term
| Tx: Cauda Equina Syndrome |
|
Definition
ED: high-dose IV steroids and urgent neurosurgical consultation
Surgical decompression and disc excision should occur between 48-72hours |
|
|
Term
|
Definition
Diagnosis
postvoid residual urine >200cc indicates urinary retention
Emergent MRI is best to define compression and should include the entire spine
CT myelogram can be utilized when MRI in contraindicated |
|
|
Term
Sudden onset of severe constant back pain
+/- radiculopathy
Possibly associated with a straining episode
Neurological sxs (progress from hours to days)
+/- anticoagulant therapy |
|
Definition
|
|
Term
| DX and TX for an Epidural Hematoma |
|
Definition
Diagnosis
MRI is study of choice, but CT scan/CT myelography/plain myelogram may confirm dx
Coag profile may be abnormal
Treatment
Correct coagulopathy
Emergent neurosurgical consult for decompressive laminectomy |
|
|
Term
Backache that becomes more severe and more localized
Fever
Sweats, rigors
Radicular symptoms may develop with progression of disease
Later signs: bowel and bladder disturbances, weakness |
|
Definition
|
|
Term
Inflammatory process involving the intervertebral disks and end plates of the vertebral bodies. Lumbar spine more commonly involved
Signs & Symptoms
Fever
Moderate to severe pain localized to involved area, worsened with movement
Radicular pain |
|
Definition
Diskitis
usually the lumbar spine |
|
|
Term
|
Definition
Treatment
Start IV antibiotics and admit to hospital
Surgical intervention is often unnecessary |
|
|
Term
Unrelenting pain, may be worse at night, with no increase pain associated with changes in position
Associated unexplained weight loss or night sweats |
|
Definition
Secondary bone cancer due to metastases from primary site: breast, lung, prostate, kidney, thyroid
< 1% of back pain |
|
|
Term
| starts as diskitis and spreads to the bone |
|
Definition
|
|
Term
Focal inflammatory disorder of the s.c. that results in acute or subacute spinal cord dysfunction
Signs/Symptoms
Back pain, leg weakness, sensory disturbances below level of lesion
Sphincter dysfunction, esp urinary retention
Onset from few hours to few days…sometimes evolves over several weeks
Etiology
Incidence peaks in adolescence, middle age, elderly
Viral prodrome in 30%
Associated with
Heroin addiction
Systemic inflammatory disorders (SLE, Behcet disease, SjÖgren syndrome)
May be first symptom in patients ultimately diagnosed with Multiple Sclerosis |
|
Definition
|
|
Term
Arthritis diseases that are negative for rheumatoid factor
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis
Arthritis related to IBD (Ulcerative colitis or Crohn's disease)
Higher prevalence of positive HLA-B27 |
|
Definition
Seronegative Spondyloarthropathies
usualy oligoarthritis and asymmetrical |
|
|
Term
| Dx of Seronegative Spondyloarthropathies |
|
Definition
Diagnosis
HLA-B27 positive
RF negative |
|
|
Term
Signs/Symptoms
Onset usually preceded by repetitive movements or sudden heavy straining
Diagnosis
Xrays indicated if red flags present: elderly, IV drug use, h/o trauma
Treatment
NSAIDS
Opioids, muscle relaxants if severe pain present |
|
Definition
|
|
Term
Signs/Symptoms
Acute, colicky flank pain with radiation to groin
Dysuria, urinary urgency, hematuria, nausea
Etiology
Stone formation in GU tract
MC stone: calcium oxalate
Hydration status, urinary sodium concentration, and UTIs contribute to stone formation |
|
Definition
|
|
Term
|
Definition
Treatment
Pain control – Ketorolac IV, narcotics
IV fluids
Urology consult if stone >5mm, or signs of obstruction, infection
Stones <5mm will pass spontaneously >90% time
Admit patients with urinary extravasation, severe vol depletion, inability to tolerate oral meds, new renal insufficiency |
|
|
Term
|
Definition
Diagnosis
Hematuria >80%
Electrolyte panel for renal function (BUN, creatinine)
Noncontrast CT scan ob abd/pelvis to eval for stones |
|
|
Term
Signs/Symptoms
Dysuria, fever, back pain, flank pain, N/V, arthralgia/myalgias |
|
Definition
|
|
Term
Signs/Symptoms
Dysuria, fever, back pain, flank pain, N/V, arthralgia/myalgias |
|
Definition
|
|
Term
|
Definition
Diagnosis
UA with pyuria (>10,000 WBCs), positive leukocyte esterace, positive nitrites
Urine cx > 100,000 CFUs
CBC – nonspedific
Helical CT scan to r/o stones/obstruction and in males refractory to tx
Renal ultrasound for pregnant patients
Treatment
IV access, IV fluids, antiemetics, analgesia, antibiotics
ABX: 3rd generation cephalosporins, fluoroquinolones, trimethoprimsulfamethoxazole or aminoglycosides
Admit pregnant patients for IV abx |
|
|
Term
Signs/Symptoms
Pain in the distribution of a lumbar or sacral nerve root, +/- associated neurosensory and motor deficits
Etiology
Diagnosed in 1% of patients with back pain
Present in almost all patients with symptomatic herniated disk
5th-6th decade more prevalent
Herniation of nucleus pulposus in 95-98% of cases at disk between L4-L5 or L5-S1
10% of cases demonstrate herniation in 2 disk levels |
|
Definition
Sciatica – Lumbar Radiculopathy
Symptomatic treatment: NSAIDs, opiates, muscle relaxants
MRI with admission if
Neuro deficits appear acutely or progress rapidly
If patient unable to ambulate
No relief with analgesics |
|
|
Term
Occurs in 6th decade of life
Signs/Symptoms
Long history of back pain
90% have significant leg pain with ambulation or numbness of leg/foot
LBP and leg pain may be
Exacerbated by back extension or prolonged standing
Relieved with rest and forward flexion |
|
Definition
|
|
Term
Signs/Symptoms
Very low in the back pain, unilateral or bilateral that may radiate to the buttock, groin and anterior thigh
Common for the pain worsen nocturnally and be associated with back stiffness
Aggravated by:
Prolonged standing
Bearing weight more on one leg than the other
Stair climbing
Running
Large strides
Extreme postures |
|
Definition
|
|
Term
Etiology
Defect in the thin isthmus of bone connecting the superior and inferior facets
Unilateral
Bilateral
Found at any level, most commonly involves L5
Can be congenital or induced
PE/Diagnosis
Usually without clinical symptoms with incidental findings on radiographs (seen best on oblique view)
“Scotty dog” has a collar on oblique x-ray
Treatment
Activity modification, NSAIDS, PT |
|
Definition
Pars Interarticularis Defects: Spondylolysis
spondylolithesis: when it breaks |
|
|
Term
| State of organ hypoperfusion cause by a variety of failures of the body’s normal homeostatic mechanisms |
|
Definition
Shock
Organs most susceptible: brain, kidneys, GI tract, immune system |
|
|
Term
|
Definition
is the perfusion pressure, or the amount of blood that the organs receive
MAP > 60 in order to perfuse organs adequately and anything below this level may result in organ death |
|
|
Term
|
Definition
CO: volume of blood being pumped by the ventricle in a minute
SVR: amount of resistance in systemic system that must be overcome to push blood through
BP = cardiac output x systemic vascular resistance |
|
|
Term
Progression of Shock
Characterized by 3 stages |
|
Definition
Preshock (warm shock, compensated shock)
Shock
End organ dysfunction |
|
|
Term
| Signs of inadequate perfusion |
|
Definition
Altered mental status
lethargy, coma
Tachycardia
Pallor
Diaphoresis
Pale conjunctiva
Delayed capillary refill
Systolic BP < 90 mm Hg |
|
|
Term
| Initial signs of end organ dysfunction |
|
Definition
Tachycardia
Tachypnea
Metabolic acidosis
Oliguria
Cool and clammy skin
End Organ Dysfunction irreversible:
Oliguria or anuria
Progressive acidosis and decreased CO
Agitation, obtundation, and coma
Patient death |
|
|
Term
|
Definition
| Mediated by neuroendocrine system through release of catecholamines, renin, antidiuretic hormone, glucagon, cortisol, and growth hormones which are all responsible for the clinical manifestations of shock: tachycardia, oliguria, delayed capillary refill, increasing agitation, insulin resistance |
|
|
Term
| Decreased blood volume causes underperfusion of end organs |
|
Definition
Hypovolemic Shock - Nontraumatic
Hemorrhage
trauma, GI bleed, ruptured aneurysm
Fluid loss
diarrhea, vomiting, burns, third spacing, iatrogenic |
|
|
Term
| Hypovolemic Shock - Traumatic causes |
|
Definition
Ongoing blood loss secondary to trauma
Chest
Abdomen
Retroperitoneum
Severe burns |
|
|
Term
Organ hypoperfusion due to decreased CO and myocardial dysfunction despite adequate intravascular volume
Etiology
Myopathic
Arrhythmic
Mechanical
Extracardiac (obstructive): PE, aortic dissection, pericardial tamponade, vascular disease |
|
Definition
|
|
Term
– highly suggestive of cardiogenic shock
Signs and symptoms. |
|
Definition
| pulmonary edema with hypotension |
|
|
Term
Vasogenic shock from body’s response to systemic inflammatory response which causes increased venous capacitance, causing a relative hypovolemia
Capillary leak due to vasoactive mediators worsens hypovolemia |
|
Definition
Distributive Shock (Septic)
Etiology
Secondary to infection from virus, bacteria or fungus
Results in systemic inflammatory response which progresses to septic shock if untreated
10th mcc of death
Predisposed: extreme ages, underlying chronic diseases, immune deficiencies |
|
|
Term
Definition
Shock usually a result of spinal cord injury above level of T6
Etiology
Loss of neurologic function and autonomic tone below the level of the spinal cord injury
Shock results from
disruption of sympathetic outflow from T1-L2 and
unopposed vagal tone which leads to decreased vascular resistance and associated vascular dilatation and a relative hypovolemia despite preserved blood volume |
|
Definition
| Distributive Shock (Neurogenic) |
|
|
Term
results from sudden degranulation of mast cells and basophils
Organ systems most directly affected: heart, lungs, circulatory system
There can be transfer of 50% of intravascular fluid into the extravascular space within 10 mins |
|
Definition
|
|
Term
| : Definitive Management of All Types of Shock |
|
Definition
Hypovolemic – Fluid resuscitate (blood or crystalloid) and control ongoing loss
Cardiogenic - Restore blood pressure (chemical and mechanical) and prevent ongoing cardiac death
Distributive – Fluid resuscitate, pressors for maintenance, immediate abx/surgical control for infection, steroids for adrenocortical insufficiency |
|
|
Term
| Sudden and brief loss of consciousness associated with a loss of postural tone, from which recovery is spontaneous |
|
Definition
Syncope
A symptom, not a disease
In all forms, consists of a sudden decrease or brief cessation of cerebral blood flow |
|
|
Term
| Cardiovascular Causes of Syncope |
|
Definition
Dysrhythmias
Obstructive Etiology
Subclavian Steal Syndrome |
|
|
Term
Shunting of blood from the vertebrobasilar system to the subclavian artery
Usually affects left side. Movement shifts blood from going into the carotid and to the brain and instead goes backwards, causing fainting.
Affects people >50
BP differ by 45mmHg in affected arm |
|
Definition
| Subclavian Steal Syndrome |
|
|
Term
Etiology: Vessel occlusion or vertebrobasilar insufficiency of the midbrain
Basilar Artery insufficiency
Basilar Migrains: young girls
Subarachnoid HA (worst ha of life) |
|
Definition
|
|
Term
| Syncope MCC, esp in young adults |
|
Definition
| Vasomotor Causes of Syncope |
|
|
Term
| Metabolic Causes of Syncope |
|
Definition
Hypoglycemia- ↓ BS. Give glucose
Hyponatremia- Dehydration. Give fluids
Drugs and OD |
|
|
Term
Vasovagal, Situational, and Carotid Sinus Syncope
Most Common Cause of syncopal episodes |
|
Definition
| Neural Reflex-Mediated Syncope |
|
|
Term
Decline of >20mm Hg in SBP/ 10mm Hg in DBP from supine to standing
Supine HTN common in these patients
Elderly especially vulnerable |
|
Definition
| Orthostatic Causes of Syncope |
|
|
Term
Pre-syncopal episode”
Feeling that fainting may occur in the next few moments
Usually occurs when a person gets up too quickly
Due to decreased blood flow or decreased availability of vital nutrients (glucose and O2) to the brain |
|
Definition
|
|
Term
Unremitting seizure activity
2 or more seizures without return to normal neurologic function in between
A single seizure lasting > 30 mins
May involve generalized, complex partial, or simple partial seizures |
|
Definition
|
|
Term
| Features to distinguish syncope from seizure |
|
Definition
Prodromal/ Premonitory symptoms
Precipitating event
Events that follow it |
|
|
Term
|
Definition
Primary Seizures
Seizures that occur without clear provoking factor
Epileptic seizures
Recurring primary seizures |
|
|
Term
|
Definition
| Reactive seizures that occur in response to a specific pathophysiologic stress or underlying disorder |
|
|
Term
| Epilepsy Diagnosis Criteria |
|
Definition
| Requires two or more separate seizures without identifiable cause or precipitating factor (primary or idiopathic seizures) |
|
|
Term
Classic seizure
Aura, repeated muscle contraction and relaxation
Lasts 2-5 minutes
Incontinence
Postictal state (confusion, HA, sleepy)
Tx: Phenytoin, Valproate, Carbamazepine |
|
Definition
|
|
Term
seizure?
Starts before age 20
Lasts 10-30 seconds
LOC with eye or muscle fluttering
Unresponsive (stares into space)
No postictal state
Tx: Ethosuximide or Valproate |
|
Definition
|
|
Term
Imparied LOC or complete LOC
Usually arises from temporal lobe but can be from anywhere
Patient can sometimes perform simple behaviors or make simple verbal responses.
Can becomes aggressive
Purposeless movements
Usually don’t remember event
Last 30sec to 2 min
Tx: Phenytoin, Valproate, Cambamazepine |
|
Definition
|
|
Term
No LOC, aura may occur
Motor (Jacksonian March:usually begins with tingling in fingers, sudden muscle contractions that may progress)
-lasts briefly, may be ignored/thought as nl
Sensory (hallucinations)
Psychic (cognitive symptoms)
Tx: Phenytoin, Valproate, Carbamazepine |
|
Definition
|
|
Term
| Seizure most common electrolyte abnormality is |
|
Definition
|
|
Term
Seizure Medications
First-Line Therapy |
|
Definition
Benzodiazepines
Lorazepam 4-8 mg IV (long lasting) – first line tx
Diazepam 10-20mg IV (faster onset)
Assist with alcohol withdrawal and DTs
Complications: respiratory depression and hypotension |
|
|
Term
Second line
If seizure is > 10 minutes |
|
Definition
| Phenytoin 18-20mg/kg IV or Phosphenytoin 15-20 mg/kg IV or IM |
|
|
Term
| Organic Disease vs Functional Disease |
|
Definition
Organic
Non-psychological diseases
Functional
Originates from a psychological source |
|
|
Term
a disorder of thought perception, emotion, and behavior.
Acute episodes: abrupt onset of one or more of the following: delusions, hallucinations, bizarre behavior and posture, disorganized speech.
May exhibit rapid mood changes, disorientation, unusual behavior, and even a catatonic state |
|
Definition
|
|
Term
| A false, unshakeable belief out of keeping with the patient's educational, cultural, and social background, held with unusually strong conviction |
|
Definition
|
|
Term
| a sensory perception experienced in the absence of a real stimulus, may be visual, olfactory, tactile, or auditory |
|
Definition
|
|
Term
A transient and usually reversible state of cerebral dysfunction
Typically a lack of alertness, altered or changing level of consciousness, disorientation, memory loss, and hallucinations
Most often has an identifiable, underlying medical cause |
|
Definition
|
|
Term
Treatment
for
Delirium
and
Psychosis |
|
Definition
Delirium should be treated by identifying the underlying medical condition and correcting it
Psychosis is usually treated with brief hospitalization for evaluation and protection along with use of anti-psychotic medications |
|
|
Term
| psychiatric emergency Patients will generally present to the ED in one of 3 main ways: |
|
Definition
Self referral, often in depressed or substance abuse pts
Family member or other 3rd party referral
Law enforcement/ Public safety |
|
|
Term
| Any suicidal patient should be assumed to be homicidal until properly assessed. |
|
Definition
|
|
Term
|
Definition
In particular agitated or violent pts, it may be necessary to sedate/tranquilize pt for safety reasons
Most often done with Haldol or Geodon |
|
|
Term
|
Definition
Withdrawal from ETOH
Potentially fatal if not recognized and treated
Signs/Sx: tremors, N/V, seizures, hallucinations/delusions, agitation, sympathetic overload, CV collapse
Supportive care, glucose monitoring, thiamine, benzos |
|
|
Term
Stimulants
causing psychosis |
|
Definition
Cocaine, amphetamines, MDMA, etc
HTN, tachycardia, dilated pupils, diaphoresis
Dysphoria, paranoia, less inhibitions, increased chance of violence
Supportive care, benzodiazepines |
|
|
Term
|
Definition
Reversible by Narcan
Morphine, heroin, etc
AMS, respiratory depression, dilated pupils
Supportive care
Reversible by Narcan |
|
|
Term
|
Definition
Supportive care, quiet environment, benzos
LSD, PCP, etc.
Hallucinations, bizarre behavior, violence, suicidal ideation |
|
|
Term
8th leading cause of death in US
Success: Men>Women
Attempts: Women>Men
Highest rate exists among elderly >65y.o. |
|
Definition
|
|
Term
| Management in ED for suicidal patients |
|
Definition
Management in the ED
NEVER LEAVE THE PATIENT ALONE
Remove objects that may be used for self-harm
Determine risk management plan
No imminent risk – outpatient management
Hospitalization |
|
|
Term
Signs/Sx: delusions, hallucinations, disorganized speech, disorganized behavior or catatonic state, withdrawal, flattened/blunted affect
Treatment: general medical screening and treatment, safe environment, suicide screening, sedation if necessary, referral to mental health resources |
|
Definition
|
|
Term
Also called manic depressive
Alternating periods of depression and mania
Mania Sx: grandiosity, decreased need for sleep, excessive talking, racing thoughts or flight of ideas, easily distractible, increased level of goal focused work at home, work, personally, sexually, excessive pleasure activities often with painful consequences
Treatment: Supportive care, suicide screening, possible inpt treatment if severely depressed or if mania is excessive/self-destructive, referral to proper mental health resources |
|
Definition
|
|
Term
|
Definition
Mechanisms:
Puncture by a contaminated object
Crush Injury
Lacerations |
|
|
Term
| : In contrast to dog bite marks human bites are usually superficial abrasions or contusions. |
|
Definition
|
|
Term
Human Bite Facts
Infections: |
|
Definition
| : Risk of HIV, Hepatitis B and C, Syphilis transmission |
|
|
Term
| The current recommendations from the Infectious Disease Society of America (IDSA) call for the use of amoxicillin/clavulanate or ampicillin/sulbactam. Cephalexin, which is commonly used for skin and soft-tissue infections, is ineffective against Eikenella corrodens, an important pathogen in infected human bites. TMP/SMX plus clindamycin is an acceptable alternative in the penicillin-allergic patient.6 |
|
Definition
|
|
Term
|
Definition
TIME OUT
time injury occurred
Instrument of injury
Mechanism of injry
extremity preference
Occupation
Underlying disease
tretments (1st aid) |
|
|
Term
|
Definition
Gauze sponges: Soaked in 10% povidone-iodine solution diluted 1:10 to 1:20 may be used for cleansing the wound periphery.
Gentle mechanical scrubbing: Used for grossly contaminated wound. Cleansing continues until the area is visibly free from contaminants. |
|
|
Term
Wound Care: ED Arrival
Tetanus Vaccination
Rabies Vaccination (New Guidelines) |
|
Definition
Tetanus Vaccination
If original series finished, give if > 5 years
Never immunized give primary series and TIG
Rabies Vaccination (New Guidelines)
Depends on type of animal, ability to observe and locality
Days 0,3,7,14, and 28 AND hyperimmune globulin |
|
|
Term
Animal-specific Pathogens
Humans: |
|
Definition
| S. aureus, streptococci, and anaerobes such as Eikenella corrodens |
|
|
Term
Animal-specific Pathogens
Small Cats: |
|
Definition
Pasteurella multocida and others
Bartonella henselae in cat bites with |
|
|
Term
Animal-specific Pathogens
Dogs: |
|
Definition
| : S. Aureus, Pasteurella multocida, Capnocytophaga canimorsus |
|
|
Term
Gram negative rod
Normal oral flora in dog and cat
In asplenic patients:
Can cause fulminant sepsis and meningitis
Mortality rate 30-36% for sepsis |
|
Definition
| Capnocytophaga canimorsus |
|
|
Term
Wound Infections: P. multocida
tx |
|
Definition
Temperature
Usually normal
Penicillin Sensitivity
Penicillin G: 4 million units IV q 6h
Penicillin VK: 500 mg PO, QID
Resistance
Resistant to penicillinase resistant penicillins in 18% to 50% cases |
|
|
Term
| Antibiotics -- Animal Bites |
|
Definition
Augmentin covers most organisms
Dicloxacillin plus Penicillin |
|
|
Term
Spider Bite Reactions
Three types: |
|
Definition
Local reactions (including necrotic lesions)
Systemic reactions
Allergic reactions |
|
|
Term
| Venomous spiders found in the United States include |
|
Definition
| black widow, brown recluse, and hobo spiders. |
|
|
Term
| Best known venomous spider in world |
|
Definition
|
|
Term
Black Widow Venom Causes
Muscle spasms: explain
Cholinergic symptoms: explain |
|
Definition
Muscle spasms: 5-60 minutes after bite
Abdomen, back and chest
“Board-like” abdomen…acute abdomen appearance
Cholinergic symptoms:
Diaphoresis, salivation, lacrimation, vomiting and diarrhea |
|
|
Term
Lactrodectus facies
What is it-Characterized by: |
|
Definition
Spasm of facial muscles,
Edematous eyelids
Lacrimation
Can be mistaken for an allergic reaction. |
|
|
Term
Black Widow Treatment
First Aid: |
|
Definition
No specific 1st aid measures
Ice pack (reduce pain and toxin spread) and transport
Soap and water
Tetanus immunization
Observed for about 4 hours
If no symptoms and no spider positive ID, patient may be discharged with instructions to return |
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Term
| Tx of Muscle cramps from black widow bite: |
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Definition
Benzodiazepines: Diazepam, lorazepam, etc. (IV) useful for relieving muscle spasms
Opioid Analgesics: Standard doses of narcotics
Antivenom: Relief in 30 minutes after antivenom. (See indications) |
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Term
Black Widow Treatment
of HTN? |
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Definition
| : Generally responds to other treatments. Nitroprusside if high BP |
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Term
Black Widow Treatment
symptomatic? |
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Definition
| Admit, , IV, fluids, appropriate labs, EKG and control cramps |
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Term
Black Widow Antivenom
given to want ages |
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Definition
< 12 years > 65 may be given Latrodectus antivenin Also pregnant, severe envenomations, heart disease
Horse serum antivenom can also be used but anaphylaxis can kill must do skin test first |
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Term
: Violin-shaped markings on backs
Also be known as fiddleback spiders |
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Definition
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Term
what type of Bite
Minimal initial sensation
Pain intensifies several hours later
Severe Pain: After 6-8 hours
Local Vasospasm: Causes tissue ischemia |
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Definition
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Term
Seen in what type spider bite
Discoloration: Erythematous, violaceus, or hemorrhagic at the site of the bite
Vasoconstriction White Area: Surrounds bite
Bleb Formation: Occurs in center and erythematous ring arises resembling a bull’s-eye |
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Definition
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Term
Seen with what spider bite?
Bleb darkens and necroses occurs over several hours to days-eschar
Spreads slowly and gravitationally
Involves skin and SQ fat |
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Definition
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Term
| Brown Recluse Bites: ED Treatment |
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Definition
Identify specimen
Soap and water wash
Ice to bite site:
Sphingomyelinase D is temperature dependent
Intravenous line and baseline labs
Monitor closely
Don’t excise |
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Term
Brown Recluse Bites: ED Treatment
Less 6 Hours: |
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Definition
Observed in the ED if envenomation suspected but no signs present
No sign of envenomation after 6 hours-- discharge with return instructions |
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Term
Intravascular Hemolytic Syndrome
seen in what type of bite |
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Definition
Brown recluse
Loxosceles reclusa can induce a severe intravascular hemolytic syndrome known as viscerocutaneous loxoscelism that may result in death. |
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Term
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Definition
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Term
It is large and brown with a distinct pattern of yellow markings on its abdomen:
Unlike many other similar looking spiders
these do not have dark bands on their legs. |
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Definition
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Term
| What WMD agent looks like a spider bite? |
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Definition
| Cutaneous anthrax is a boil-like skin lesion that eventually forms an ulcer with a black center or crust (similar in appearance to some spider bites). |
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Term
Bee and Wasp stings
Hymenoptera: Three major subgroups or superfamilies of medical importance |
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Definition
Apidae: Honeybees and bumblebees
Vespidae: Yellow jackets, hornets and wasps
Formicidae: Ants (Formic Acid in venom) |
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Term
: Most important venomous insects known to humans (70% of venom deaths)
Fatal Bites: More people die from these bites than any other arthropod
40-150 deaths per year
Venom: Envenomate with immunoreactive substances |
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Definition
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Term
Barbed Stinger: One shot and suicide mission
Unbarbed Stinger: May inflict many stings without damaging itself or its stinging apparatus. |
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Definition
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Term
Anaphylactoid Reactions and Fatal Venom Load
for wasp
for bees |
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Definition
| As few as 30 vespid stings or 200 honeybee stings |
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Term
| This type of bee is not more toxic, only more aggressive. |
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Definition
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Term
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Definition
Stinger immediate removal
Wash soap and water
Ice packs to delay swelling
Oral antihistamines for itching
NSAIDs for pain
Elevation and rest of limb |
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Term
Bee Sting Treatment
Systemic signs and symptoms |
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Definition
Epinephrine hydrochloride (1:1,000)
0.3 mL to 0.5 mL IM (1 mg or 1000 micrograms/ml)
Children: 0.01 mg/kg (Max 0.3 mg or 0.3 mL)
Antihistamines (diphenhydramine 25-50 mg)
H2 Receptor Antagonists (ranitidine 50 mg)
Steroids (methylprednisolone 125 mg)
Beta agonist for bronchospasm
Volume replacement with crystalloids for hypotension
Dopamine for unresponsive hypotension
Admission |
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Term
| A severe, potentially fatal, systemic allergic reaction that occurs suddenly after contact with an allergy causing substance. |
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Definition
Anaphylaxis
1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g., generalized hives, pruritus or flushing, swollen lips-tongue-uvula)
AND AT LEAST ONE OF THE FOLLOWING
a. Respiratory compromise (e.g. dyspnea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia)
b. Reduced BP or associated symptoms of end-organ dysfunction (e.g., hypotonia [collapse], syncope, incontinence)
2. 2 or more (skin-mucosal involvment, Respiratory compromise, Reduced BP
Persistent Gastro)
3. Reduced BP: |
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Term
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Definition
| Epinephrine Immediately: When a patient fulfills any of the 3 criteria of anaphylaxis outlined above, the patient should receive epinephrine immediately because epinephrine is the treatment of choice in anaphylaxis. |
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Term
Intramuscular Epinephrine
concentration
IV Epi concentration |
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Definition
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Term
1:1000 Adult
IM dose
IV dose |
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Definition
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Term
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Definition
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Term
| epi dose for children for IV and IM administration |
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Definition
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Term
| Intramuscular administration of injectable epinephrine in the |
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Definition
| anterior lateral thigh is preferred over subcutaneous injection. |
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Term
How do you tell it’s a pit viper?
Head
Pupils
Pits
Subcaudal plate |
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Definition
Head: Triangular or diamond-shaped heads.
Pupils: Elliptical pupils
Pits: Facial pits inferior to eyes
Subcaudal Plates: Single row of subcaudal plates distal to the anal plate |
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Term
| If you had a choice, which U.S. pit viper would you most want to be bitten by? |
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Definition
Rattlesnakes
Produce most severe toxicity, local and systemic
Water moccasins
Less severe local, with some systemic effects
Copperheads
Tend to cause local effects only |
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Term
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Definition
Have patient lie down, keep calm
Keep bitten extremity below heart level
Remove all rings, bracelets or other jewelry
Lymphatic constriction bands and pressure immobilization techniques
Clean wound |
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Term
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Definition
Do not incise the fang marks
Do not use oral suction
Do not apply ice
Do not give alcohol
Do not apply a tourniquet
Do not use electric shock gun |
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Term
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Definition
Tetanus prophylaxis
Prophylactic antibiotics:
Not routinely given. Treat infections
Retained foreign body (fang) can be cause of infection
All should be at least observed 6-8 hours
Discharge possible with minimal symptoms
Especially with copperhead bites
Persistent Hypotension: Vasopressors may be needed
Early Intubation: Consider in bites to head and neck |
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Term
| If you see asymmetric extremity movement do these tests? |
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Definition
| DTR, Perineal reflex assessment |
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Term
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Definition
Cross table lateral view: Alignment, bony adnorm, cartilage , soft tissue
Open mouth odontoid
Anteroposterior view (lower cervical spine C4 and below
Oblique view- looking at facet joints, pedicles, lamina
Flexion/extenstion view: used to see ligamentous injury |
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Term
Odontoid Fracture
Classification system Type I-III |
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Definition
Type I – avulsion fractures of the lateral tip by the alar ligament
Type II – (most common) located at the waist of the odontoid in an area covered by the transverse ligament
Type III – extend caudally into cancellous bone of the axis (collar) |
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Term
| Hangman fracture of what and what signs and symptom is key |
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Definition
fracture of pedicles of C2
Horners syndrom
extension injury: rapid deceleration |
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