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Review for Emed Exam 2

Review for Emed Exam 2. ACLS. V-fib Cardiac Arrest: What do you do first? CPR Then what? Defib at 360j Then? 5 cycles of CPR Then? Shock and resume CPR Then?. ACLS. Then what meds? Vasopressor such as Epi or Vasopressin Then? Shock once Then?

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Review for Emed Exam 2

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  1. Review for Emed Exam 2

  2. ACLS • V-fib Cardiac Arrest: • What do you do first? • CPR • Then what? • Defib at 360j • Then? • 5 cycles of CPR • Then? • Shock and resume CPR • Then?

  3. ACLS • Then what meds? • Vasopressor such as Epi or Vasopressin • Then? • Shock once • Then? • Antiarrhythmics such as amiodarone or lidocaine • Then? • 5 cycles CPR and repeat. • When is magnesium used? • torsades de pointes

  4. ACLS • What is the first step in Asystole? • CPR • Vasopressor such as epi or vasopressin • Then? • Atropine • Then? • CPRThen? • Repeat • What about witnessed? • Pace

  5. ACLS • What is the treatment of PEA? • Same as asystole. • Atropine if rate <60 only. • Look for etiology including hypovolemia, hypoxia, hydrogen ion, hypo/hyper kalemia, hypoglycemia, hypothermia, toxins, tamponade, tension pneumo, PE, trauma

  6. ACLS • Bradycardia • Pulse <60 and symptomatic (signs of poor perfusion such as AMS, chest pain, hypotension, shock) • Oxygen, IV access • What is the management if poor perfusion? • Atropine, epi or dopamine infusion

  7. ACLS • Tachycardia • What is patient is unstable? • Synchronized cardioversion post IV access. Give sedation if conscious • If stable and narrow QRS? • IV, vagal maneuvers, adenosine. • If does not convert? • Might be a flutter, a tach or junctional tach so use diltiazem, b-blockers

  8. ACLS • What about if wide QRS and regular? • Amiodarone, Lidocaine or cardioversion.

  9. ACLS • You are going to give a drug via ET, how is the dose adjusted? • Give 2.5x the dose then dilute to 10cc • Which medications are given via ET tube? • LEAN- lidocaine, epinephrine, atropine, and narcan.

  10. PALS • Know a little regarding the protocols utilized especially asystole, v-fib, PEA, bradycardia, shock.

  11. Heat Emergencies • How is heat lost from the body? • Conduction, convection, radiation, evaporation. • Define heat cramps: • Severe muscle cramps resulting from overexertion in heat. Occur after stopping the activity. Na deficiency. • Define heat edema: • Swollen feet and ankles. Vasodilation with vascular leak. Elevate extremity .Resolves after climate acclimatization.

  12. Heat Emergencies • What is heat rash? How is this treated? • Prickly heat. Blockage of sweat gland pores and can have staph infection. Pruritic vesicles Topical antibacterial cream • What is heat syncope?How is this treated? • LOC. Brain hypoperfusion due to hypotesnion due to peripheral vasodilation and vascular leak. Dehydration predisposes to this. Rehydrate.

  13. Heat Emergencies • What is heat exhaustion? What is the clinical presentation? What is the management? • Dehydration/ salt depletion. Sweating, weakness, fatigue, headache, n/v, dizziness. <104. Oral salt, IV rehydration • What is heat stroke? • Life threatening. >106. Loss of thermoregulation, tissue damage. Neurologic dysfunction and cerebral edema. Dehydrated with seizures, unconsciousness. Treatment Rehydration, rapid body cooling

  14. Cold Emergencies • Define frostbite • Vasoconstriction, extracellular ice crystals, intracellular dehydration, lysis. Leads to ischemia and tissue damage • What are the clinical manifestations of frostbite? • First degree: partial skin freezing. Erythema, edema, hyperemia, no blisters. Thrombing and aching • Second degree: full thickness. Erythema, edema, vesicles with clear fluid

  15. Cold Emergencies • Third degree: full thickness, subcutaneous. Hemorrhagic blisters, skin necrosis, blue gray color. First no sensation then shooting pains, burning, aching • Fourth degree: full thickness, sub cutaneous, muscle, bone freezing: little edema, mottled deep red or cyanotic, to dry black mummified. Possible joint discomfort. • What is the management? • Re-warming in water of 107 degrees.

  16. Cold Emergencies • What are the signs of moderate Hypothermia? • Temp of 86-90f 30-32c. Clinical: stupor, no shivering, bradycardia, decreased respiratory rate, hypotension, afib.

  17. Cold Emergencies • What about severe hypothermia? • <86f <30c. Coma, pupils dilate, no corneal reflex, v-fib, apnea, asystole, areflexia, flat EEG • What is the management? • Supportive, rewarming, warm IV fluids. Metabolism slows so hypothermic patients tolerate long periods of hypoperfusion and anoxia. Do not pronounce until rewarmed.

  18. Abdominal Trauma • Which abdominal organs are more susceptible to injury from blunt trauma? • Spleen and liver. Spleen most frequently injured. • What is kehr’s sign? • Referred left shoulder pain (splenic rupture). • Sign of liver trauma? • Pain to right shoulder. Acute blood loss. Tachycardia, hypotension, acute abdominal tenderness.

  19. Abdominal Trauma • Number one danger with hollow Visceral Injuries? • Blood loss and peritoneal contamination • What is the classic presentation of Pancreatic injury? • Rapid deceleration. Pain radiates to back. Retroperitoneal abscess due to leakage of enzymes and bacteria. • What about kidneys? • Pain from flank to groin and hematuria. • Diaphragmatic? • Bowel sounds in thoracic cavity.

  20. Abdominal Trauma • How is abdominal trauma diagnosed? • Peritoneal lavage (DPL). • FAST: focused assessment with sonography for trauma: Notes free fluid in dependent areas • CT • What is the management? • ABC’s. Fluids isotonic, blood 0-, oxygen, • What about eviscerated organs? • Cover with sterile moist dressing prior to surgery

  21. Burns • Categorized by size and depth. • Burn size is rule of nines.

  22. Burns • Burn depth • What is the presentation of a superficial burn? • Epidermis. Dry red, painful, blanches with pressure. • What is the management? • Antipruritics, lubricants, corticosteroids • Superficial partial thickness burns: What is the etiology and clinical presentation? • Scald. Epidermis and superficial dermis. Blisters, moist, red, weeping, blanches with pressure, pain to air and temperature. • Management: debridement, topical antibiotics, dressings, analgesics

  23. Burns • What about deep partial thickness burn? • Scald, flame, oil. Involves epidermis and deep dermis. Presents as blisters, wet/ waxy, dry skin if sweat glands destroyed, patchy to cheesy white to red in color. Does not blanch with pressure. Perceive pressure not pain if nerves destroyed. • What is the management? • Cleaning, debridement, dressing and analgesics.

  24. Burns • What about full thickness burn? • Scald, flame, steam, oil. Epidermis, dermis and sub cutaneous layers. Nerve ending, blood vessels, hair follicles, sweat glands destroyed. • How does this appear? • Waxy white to leathery gray to charred and black. Skin dry, inelastic, does not blanch with pressure. No pain, deep pressure sensation only. • What is a major complication? • Contractures

  25. Burns • Which burns should be treated at a burn center? • burns to eyes, ears, genitalia, hands, feet, joints • What is the parkland formula? • 4 x kg x %BSA . Half in first 8 hours, remainder in next 16 hours.

  26. Burns • What are the risks for smoke Inhalation? What is the presentation? • Risk is fire in enclosed space. • Facial burns, singed nasal hairs, soot in mouth or nose, hoarse, black sputum, wheezing • What type of poisoning is suspected with smoke inhalation? • CO poisoning. Arterial carboxyhemoglobin >10% is CO exposure. • What is the management of smoke inhalation? • Bronchodilators, hyperbaric O2 if Cohb >10%

  27. Burns • What benefit is associated with acid burns? • Coagulation necrosis limiting injury • What is the complication of alkali burns? • Liquefacation necrosis. Continues to penetrate deep into tissue. • What is the presentation of low voltage AC electrical injury? • Muscle tetany. V fib • What is the presentation of high voltage AC/DC? • single violent muscle contraction throwing individual. Asystole

  28. Burns • What is the presentation of lightening injuries? • AMS, amnesia, Headache, muscle pain, paresthesias, Tachycardia, hypertension, ruptured TM • What type of radiation leads to the acute radiation syndrome? • Ionizing

  29. Emerg of Eye, Ear, Nose, Oral • What is the presentation of a Corneal Abrasion? • Ocular pain, sensation of foreign body, blurred vision, photophobia, Conjunctival injection, visual acuity defects • How is this diagnosed? • Fluorescein staining, proparacaine, blue cobalt light. • What is the management? • Management: Anesthetics, cycloplegic eye drops, irrigation with NS, broad spectrum antibiotics. Oral analgesics

  30. Emerg of Eye, Ear, Nose, Oral • What is a complication of Acute Angle closure glaucoma? • Blindness due to optic nerve injury. • What is the presentation? • Sudden eye pain, blurred vision, headache, n/v, halos, visual acuity defects, conjunctival injection, cloudy cornea, midway positioned pupil, IOP elevated • What is the management: • Pilocarpine (miotic), laser, timolol (reduces IOP), mannitol.

  31. Emerg of Eye, Ear, Nose, Oral • What is the classic presentation of Central Retinal Artery Occlusion? • Painless vision loss. • What is the appearance of the retina? • Edematous gray with cherry red macula. Pupil does not constrict to direct light • What is the management? • Ocular massage, paracentesis.

  32. Emerg of Eye, Ear, Nose, Oral • What is orbital cellulitis? • Posterior to orbital septum within orbit. Little conjunctival injection, fever, edematous erythematous periorbital soft tissue, tenderness with EOM, elevated IOP, loss of vision. • How is this diagnosed? • CT • Management? • Broad spectrum antibiotics. Clindamycin, ceftazidime, admission, surgical drainage.

  33. Emerg of Eye, Ear, Nose, Oral • What is the etiology and presentation of acute mastoiditis? • S pneumoniae, s pyogenes, s aureus. • Fever, pain, swelling and erythema at mastoid. • What is the management? • Admission, IV antibiotics

  34. What is the etiology and presentation of Otitis externa? • Pseudomonas, staph, fungal • Ear pain, itching, erthematous canal, pain with pinna movement, canal occluded • Management: topical steroid, antibiotics (cortisporin otic)

  35. Emerg of Eye, Ear, Nose, Oral • What is the etiology, presentation and management of Acute Otitis media? • Etiology: s pneumonia, h flu • TM erythematous, dull light reflex, limited motility, landmarks distorted • Amoxicillin ten days, augmentin, ceftriaxone, analgesics • What is the presentation and treatment of Perf TM? • Pain, bleeding, decreased hearing • No antibiotics unless infection.

  36. Emerg of Eye, Ear, Nose, Oral • What is the management of anterior epistaxis? Posterior epistaxis? • What is a complication of nasal fracture? • septal hematoma

  37. Emerg of Eye, Ear, Nose, Oral • What is dental extrusion? • Tooth dislodged • What is subluxation? • Tooth loose without displacement • What is dental avulsion? • Tooth out. Root must be moist

  38. Emerg of Eye, Ear, Nose, Oral • What is the presentation and management of periodontal abscess? • Oral antibiotics, Analgesics, I/D, Dental referral

  39. Bites, Stings and Poisons • Define an occlusion bite and location: • Distal phalanges, ears, nose, genitalia • Define Closed fist injury. What complication is associated with this? • Clenched fist is lacerated against opponents teeth. High rate of infection. Concern is joint capsule integrity.

  40. Bites, Stings and Poisons • What is the etiology of dog bites? • Staph, strep, pasteurella multocida, pseudomonas, gram neg aerobes/anaerobes • What is the etiology of cat bites? • Pasteurella multocida (gram – anaerobic) • What complication is associated with cat bites? • Produces cellulitis, lymphangitis, lymphadenitis. Can cause cat scratch disease- lymphadenitis with ulcer (bartonella henselae)

  41. Bites, Stings and Poisons • What is the etiology of human bites? • Strep viridans, staph, eikenella corrodens • What is the management of suspected rabies exposure? • Soap and water • HRIG up to 8 days post exposure. Half into wound, half IM, Vaccine 1 cc of HDCV IM on days 0,3,7,14,28.

  42. Bites, Stings and Poisons • What is the care for uninfected bite wounds? • Debridement, irrigation with normal saline. Suture if within 12 hours of occurrence. Recheck in 48 hours • Don’t suture if signs of infection. No suturing high risk wounds such as punctures, cat, human bites of hand, CFI • Tetanus or tetanus immunoglobulin.

  43. Bites, Stings and Poisons • What antibiotics for dog bite? • Augmentin (3-5 days), clindamycin and cipro • What antibiotic for cat bites? • Augmentin, cefuroxime, doxycycline • What about human bites? • Augmentin • What about Cat bite with cellulitis caused by pasteurella multocida? • Penicillin • What is the treatment for infected dog bite? • Penicillin, and Dicloxacillin

  44. What about infected human bite? • IV antibiotics with cefoxitin and gentamycin, Augmentin, oxacillin and gentamycin

  45. Bites, Stings and Poisons • Brown recluse spider bite. What is the presentation? • Blister formation and tissue necrosis • What is the management? • Supportive, no antivenin, ice, surgically debride, administer antibiotics • What is the presentation of the Black widow spider bite? • Erythematous skin lesion, diffuse muscle cramps, severe abdominal pain, hypertension, resp failure, shock coma. Managed with Analgesics, benzo, antivenin, calcium gluconate

  46. Bites, Stings and Poisons • What topical insecticides are used for lice? • Permethrin, lindane, pyrethrin • Scabies? • Permethrin, crotamiton, lindane

  47. Bites, Stings and Poisons • What is the presentation of Stingray sting? • Venomous spine punctures skin causing painful local reaction. Also systemic symptoms such as n/v/d, weakness, paralysis, shock • What is the MOA of jellyfish ting? • Tentacles with stinging cells that release venom. Localized pain, erythema, urticaria

  48. Bites, Stings and Poisons • What is the presentation of Tarantula sting? • Flick barbed hairs, painful bite, erythema, edema and local joint stiffness. Tx analgesics, potho consult for barbed hairs • What is the presentation of Scorpion sting? • Burning, tachycardia, roving eye movements, excessive secretions, opisthotonos, fasiculations • What is the management? • Benzo, antivenin

  49. Bites, Stings and Poisons • What are some delayed reactions to bites and stings? • Serum sickness, fever, malaise, headache, urticaria, lymphadenopathy, polyarthritis • What is the local management for bites and stings? • Remove stinger, cleanse, RICE, debride ulcers, drain abscess, topical antipruritics

  50. Chest Trauma • What is the MOA, clinical manifestations and management of a clavicle injury? • Fall on shoulder or outstretched arm • Pain, point tenderness, deformity • Sling and swathe • What is a complication of rib fracture? • Underlying injury • Which ribs are most commonly fx and why? • Ribs 3-8 (thin/ poorly protected)

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