Term
|
Definition
- Unfractionated Heparine 5000 units subcu every 8-12 hours started before surgery and contined until ambulatory
- Enoxaparin 40 mg subcu daily, started 12 hours before or after surgery and contined until ambulatory or until 14 days following surgery
- Warfarin can be used in ortho patients after initial heparin use
- Fondapariunix lower DVT incidence in hips surgery patients
- Sequential compression devices
Stockings NOT recommended |
|
|
Term
|
Definition
- lost 10% of his/her leand body mass and/or
- has not had adequate nutritional intake for more than 7 days |
|
|
Term
| catheter related problems with tube feedings: |
|
Definition
- Air embolus
- Sepsis
- Pneumothorax
- Hemothorax
- Hydrothorax
- Cardiac rupture |
|
|
Term
| Solution related problems with tube feedings: |
|
Definition
- Hyperglycemia
- Hepatic steatosis
- Electrolyte abnormalities
- Trace element/vitamin deficiencies |
|
|
Term
| leading cause of death b/w ages 1 and 44: |
|
Definition
|
|
Term
| Leading cause of accidental death in US: |
|
Definition
|
|
Term
| Most common indication for intubation: |
|
Definition
|
|
Term
| tension pneumothorax PE findings: |
|
Definition
- Hypotension
- Tracheal deviation away from injury site
- Jugular venous distention
- Lack of or decreased breath sounds on affected side
- Hyperresonance on affected side
- Subcutaneous emphysema |
|
|
Term
| Flail chest is characterized by ___ __. |
|
Definition
|
|
Term
| lactated ringers may cause ___. |
|
Definition
|
|
Term
| What is Beck's Triad and what does it characterize: |
|
Definition
Beck's Triad= Cardiac Tamponade
- Jugular Venous Distention
- Hypotension
- Muffled Heart Sounds |
|
|
Term
| Most penetrating chest traumas can be managed with ___ alone. |
|
Definition
|
|
Term
| Test of choice for Blunt Abdominal Trauma: |
|
Definition
| FAST examination (Focused Assessment with Sonography for Trauma) |
|
|
Term
| FAST exam is used to evaluate pts with blunt abdominal trauam. It assesses the abdominal cavity for air or fluid in what areas? |
|
Definition
- Perihepatic
- Perisplenic
- Pericardial
- Pelvic regions
A specific dx of an injured organ doese NOT have to be made
CT may be added as needed to clarify FAST results
CT and other tests should only be given if pt is hemodynimically stable |
|
|
Term
| FAST exam of abdomen reveals inraperitoneal air, what next? |
|
Definition
|
|
Term
| In a pt with penetrating abdominal trauma with signs of __, __ __, or ___, an immediate ___ is indicated. |
|
Definition
- shock
- peritoneal irritations
- evisceration
- laparotomy |
|
|
Term
| Useful diagnostic tests for determining arterial injury: |
|
Definition
- Arteriography
- Ankle-brachial index |
|
|
Term
| Glasgow coma scale, mild head injury score: |
|
Definition
|
|
Term
| Glasgow coma scale, moderate head injury score: |
|
Definition
|
|
Term
| Glasgow coma scale severe brain injury score: |
|
Definition
|
|
Term
|
Definition
Motor
- 6: Obeys commands
- 5: Localizes pain
- 4: Withdraws to pain
- 3: Abnormal flexion
- 2: Abnormal extension
- 1: None
Verbal
- 5: Oriented
- 4: Confused
- 3: Inappropriate words
- 2: Incomprehensible sounds
- 1: None
Eyes:
- 4: Spontaneous opening
- 3: Open to voice
- 2: Open to pain
- 1: None |
|
|
Term
| PE findings of basilar skull fracture: |
|
Definition
- Rhinorrhea
- Otorrhea
- Raccoon eyes (bruising of lids)
- Battle's Sign (ecchymosis behind ears) |
|
|
Term
| Epidural hematomas are caused by injuries to the __ __ __. |
|
Definition
|
|
Term
| An ___ hematoma is characterized by a brief period of unconciousness, followed by a lucid interval. |
|
Definition
|
|
Term
|
Definition
- Coma
- Dilated fixed pupils
- Decerebrate posturing
may occur with epidural hematoma |
|
|
Term
| How do you dx epidural hematoma and what do you do about it? |
|
Definition
- Dx: CT
- Emergent craniotomy |
|
|
Term
| Subdural hematomas occur from injury to the __ __. They are associated with severe head injury and can result in signifcant __ injury even after evacuation. |
|
Definition
- bridging veins
- axonal injury |
|
|
Term
| Chronic subdural hematomas are more common in: |
|
Definition
|
|
Term
| Dx and management of subdural hematoma: |
|
Definition
- Dx: CT
- Managment: Burr holes over hematoma for clot evacuation |
|
|
Term
| First degree burns involve minor damage to the __. |
|
Definition
|
|
Term
| Second degree burns are divided into __ __ __ burns that extend into the __ __, and __ __ __ that extend into the __ __. |
|
Definition
- superficial partial-thickness burns that extend into the papillary dermis
- deep superficial burns that extend into the reticular dermis |
|
|
Term
| 2 classes of 2nd degree burns: |
|
Definition
- Superficial partial thickness: extend into the papillary dermis
- Deep superficial burns: extend into the reticular dermis |
|
|
Term
| Third degree or __ __ burns, destroy the __ and __. |
|
Definition
- full thickness
- dermis and epidermis |
|
|
Term
| 4th degree burns destroy the: |
|
Definition
- skin
- subcutaneous tissue
- fascia, muscle, bone, and other structures |
|
|
Term
| ____ burns are the most common type of burn. |
|
Definition
|
|
Term
| Characteristics of first degree burns: |
|
Definition
- Erythema
- Tenderness
- NO blisters |
|
|
Term
| You are examining a burn that has thin-walled blisters, is blanchable, moist, and painful to pressure. How would you classify this? |
|
Definition
| 2nd degree superficial burn |
|
|
Term
| You are examining a burn that has thick walled blisters, many of which are ruptured, and is a mixture of erythema and pallor. It is painful to pressure. How would you classify this? |
|
Definition
|
|
Term
| Necessary labs for burn patients? |
|
Definition
- Hematocrit
- Electrolytes
- BUN
- Cr
- Urinalysis
- Chest radiography
(may also consider a arterial blood gas, EKG, carboxyhemoglobin, glucose level) |
|
|
Term
|
Definition
|
|
Term
| White phosphorous burns require neutralization with __ __ ___ and adminstration of __ __ to address hypocalcemia. |
|
Definition
- 1% copper sulfate
- calcium gluconate |
|
|
Term
| How do you treat burns caused by hydrofluouric acid? |
|
Definition
- copious lavage for at least 30 minutes
- calcium gluconate gel to affected area |
|
|
Term
| Parkland formula for fluid needs in a burn patient: |
|
Definition
%age of burn area x body weight(kg) x 4mL/hour= total amount of fluid needed in next 24 hours
- Half of this fluid is given in the first 8 hours, with the rest given over the remaining 16 hours
- Ringer's lactate solution is recommended
- Monitor urine output as a measure of adequate circulation and hemodynamic stability |
|
|
Term
| Burn patients need a __ __to avoid gasstric distention. |
|
Definition
|
|
Term
| Required urine output in an adult and child: |
|
Definition
- Adult: at least 0.5ml/kg/hour
- Child: at least 1ml/kg/hour |
|
|
Term
| ___ probably needs to be done on circumferential burns of the extremities and anterior trunk as these may cause compartment syndrome or make ventilation difficult. |
|
Definition
|
|
Term
| Most commonly used topical burn ointment: |
|
Definition
Sulfadiazine (Slivadene)
also can use Mafenide (Sulfamylon)- be careful b/c large amounts may cause metabolic alkalosis |
|
|
Term
| Deep dermal burns and fill thickness burns are excised on __ __. |
|
Definition
|
|
Term
| Common complications of burns: |
|
Definition
- Inhalation injury
- Hypovolemic shock
- Nuerogenic shock secondary to pain
- Renal fialure
- Multiorgan system dysfunction
- Gastric/duodenal ulceration (Curling's ulcers) |
|
|
Term
| Chronic healilng burns wounds can undergo malginant transformation into a __ __ __ called a __ __. |
|
Definition
- squamous cell carcinoma
- Marjolin's ulcer |
|
|
Term
| 5 W's that may cause post-op fever: |
|
Definition
- Wind
- Water
- Wound
- Walking
- Wouder drugs/Whopper |
|
|
Term
| __ is usually the cause of fever in the first 24-48 hours postoperatively. examination may reveal __ __ and in very severe cases, the trachea may be deviated. |
|
Definition
- Atelectasis (Wind)
- bronchial breathing |
|
|
Term
| Explain the "Water" cause of post-op fevers and when it most likely occurs: |
|
Definition
- UTI
- most commonly develops 48-72 hours post-op |
|
|
Term
| __ __ are the most common cause of post op fevers after 72 hours. __ __ is MC pathogen. There may be mild changes in vital signs with or without pain at site. Superficial infections involve the __ and __ __, while deep infections involve the areas below the __. |
|
Definition
- Wound infections
- Staphylococcus aureus
- skin and subcutaneous tissues
- fascia |
|
|
Term
| Explain the "Walking" cause of post-op fevers: |
|
Definition
| - Thrombophlebitis, after 72 hours |
|
|
Term
| Superficial thrombophlebitis, which may cause a post op fever (walking), is commonly associated with __ __. What might you see on physical exam of this? |
|
Definition
- intravascular catheters
- purulent drainage around indwelling catheter with induration of the vein |
|
|
Term
| Deep thrombophlebitis can be associated with __ __ __ or ___. |
|
Definition
- indwelling central lines
- DVT |
|
|
Term
| Thrombophlebitis of the LE may be associated with __ __ or __ __ of the extremity. |
|
Definition
- Homan's sign
- Unilateral edema of the extremity |
|
|
Term
| Wonder drugs like __, __ __ __, and others may cause a post-op fever greater than __ __ post op. This is a dx of exclusion and should only be considered after there has been a negative sepsis work up. |
|
Definition
- anesthetics
- sulf containing antibiotics
- 1 week |
|
|
Term
| Explain the "Whopper" cause of post-op fever: |
|
Definition
- postoperative abscess
- if intra-abdominal fluid collected > occult abscess> ileus
- polymicrobial culture suggests anastomitic leakage |
|
|
Term
|
Definition
1. Wind
2. Water
3. Wound
4. Walking
5. Wonder drugs
6. Whopper |
|
|
Term
| work up of post-op fever: |
|
Definition
- CBC
- wound culture
- sputum culture
- blood culture
- chest xry
- abdominal CT |
|
|
Term
|
Definition
| - shfiting of mediastinum TOWARD the affected side |
|
|
Term
| when atelectasis develops post-op what should be done? |
|
Definition
- incentive spirometry
- mucolytics
- expectorants
- inhaled beta agonists |
|
|
Term
| In critically ill pts on multipel abx, a UTI may be caused by : |
|
Definition
|
|
Term
| Managment of superficial thrombophlebitis as source of post-op fever: |
|
Definition
- termination of IV lines at that site
- warm compresses
- systemic symptoms, immunocompromised, or diabetic> abx that coer staph and strep |
|
|
Term
| management of septic thrombophlebitis: |
|
Definition
| vein stripping of affected site b/c will act like abscess and make abx penetration difficult |
|
|
Term
| possible tmt for keloid scar: |
|
Definition
| Topical triamcinolone (steroid), 40 mg/mL in a dosage of 2 mL every 6-8 weeks |
|
|
Term
| topical steroids may cause: |
|
Definition
- dermal atrophy
- telangiectasias
- hypopigmentation |
|
|
Term
|
Definition
- Removal of pressure
- Nutritional support
- Surgical intervention (skin graft or rotation flaps
- Abx only for those with sepsis |
|
|
Term
| Necrotizing fascitis is mc in: |
|
Definition
- diabiteics (20-30%)
- alcholics
- IV drug abusers |
|
|
Term
| MC associated disease with necrotizing fascitis: |
|
Definition
|
|
Term
| pathogens with Necrotizing fascitis: |
|
Definition
- Polymicrobial
- Group A Strep
- Clostridal infections
- Salwater fascitis= Vibrio species |
|
|
Term
| Necrotizing Fascitis triad; |
|
Definition
- WBC elevated (>14,000)
- BUN elevated (>15)
- Hyponatremia (<135) |
|
|
Term
| Necrotizing fascitis treatment: |
|
Definition
- Surgical debridement is mainstay
- Abx: PCN G, Clindamycin, Gentamycin
- Monitor renal function |
|
|
Term
|
Definition
Stage I is the most superficial, indicated by nonblanchable redness that does not subside after pressure is relieved. This stage is visually similar to reactive hyperemia seen in skin after prolonged application of pressure. Stage I pressure ulcers can be distinguished from reactive hyperemia in two ways: a) reactive hyperemia resolves itself within 3/4 of the time pressure was applied, and b) reactive hyperemia blanches when pressure is applied, whereas a Stage I pressure ulcer does not. The skin may be hotter or cooler than normal, have an odd texture, or be painful. Although easy to identify on a light-skinned patient, ulcers on darker-skinned individuals may show up as shades of purple or blue in comparison to lighter skin tones.
Stage II is damage to the epidermis extending into, but no deeper than, the dermis. In this stage, the ulcer may be referred to as a blister or abrasion.
Stage III involves the full thickness of the skin and may extend into the subcutaneous tissue layer. This layer has a relatively poor blood supply and can be difficult to heal. At this stage, there may be undermining damage that makes the wound much larger than it may seem on the surface
Stage IV is the deepest, extending into the muscle, tendon or even bone. A graphic presentation of severe stage IV ulcers is visible here.
Unstageable pressure ulcers are covered with dead cells, or eschar and wound exudate, such that the depth cannot be determined. |
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|
