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Emergency 2 Exam

Emergency Medicine: Abdominal, Head, Back, Pediatrics

Percentage of ED visits abdominal pain comprises? 5-10%
What is the goal of Dx abdominal pain in the ED? Rule out any life threatening disease
3 types of abdominal pain 1) Visceral 2) Somatic 3) Referred Pain
Generated by stretch receptors, dull, achey, cramping. What kind of pain? Visceral
Receptors located in parietal peritoneum, sharp, discrete, localized. Responsible for palpation, guarding, rebound. What kind of pain? Somatic
Discomfort perceived at cutaneous site is distant from diseased organ. What pain? Referred
Initial approach to abd pain? Determine stability!
4 things not to miss in the elderly: (or anyone really) 1) AAA 2) Mesenteric Ischemia 3) MI 4) Aortic Dissection
Deleted...Bad card Sorry!
Biggest risk factor for AAA? SMOKING
Rebound tenderness hallmark of _____________? Peritoneal irritation
One thing you should get for every abdominal exam? Rectal exam
T/F: Appendicitis will not always have rebound tenderness True, retrocecal appendix requires a rectal exam
Most common cause of abdominal pain in the ED? Non-specific abdominal pain
T/F: Chest XRAY is more helpful than a Abdominal XRAY in abdominal complaints True, CXR helps Dx pneumonia, pleural effusion, and other pulmonary causes of abd pain. Abd XR helpful with intestinal obstruction
Free air on CXR? Viscous rupture --> Surgery!
RUQ pain? Best imaging/testing for evaluation? Ultrasound
Unclear abdominal etiology? Best imaging/testing to figure it out CT can make Dx 95% of the time
When is angiography used in abdominal complaints? Reserved for mesenteric ischemia or GI bleeding
What routine labs are used in helping Dx abdominal pain? NO ROUTINE LABS, must be indicated in some other part of a condition
Important for a decision to discharge with abdominal pain complaint? Patient able to take fluids
Anorexia and periumbilical pain followed by nausea. RLQ and vomiting in 50%. One of the most common surgical emergencies. Initial Tx? (3) Appendicitis; Tx: NPO, Intravenous fluids, Surgery consult
Poorly localized, crampy pain with change in bowel habits, diffusely tender and distended with high pitched bowel sounds. Dx? Tx? (4) Intestinal Obstruction; Dx: Abdominal XRAY: dilated loops of bowel w/ air-fluid levels. Tx: NG tube, IVF, surgical consultation, admission
Burning epigastric pain, sharp, dull, achy, empty, hungry. RF? (4) PUD (Pelvic Ulcer Disease); RF: H. pylori, NSAIDs, smoking, hereditary
Sudden and severe abdominal pain. Pain may subside, then return after peritoneal secretions dilute the leaking gastric contents. Upper abdominal tenderness w/ rigidity of the abdomen will be present Perforation
Tx for Perforated Peptic Ulcer (4) NG tube, IVF, IV ABX, immediate surgical consultation
Steady, deep discomfort in LLQ, low grade fever, localized tenderness, rebound and guarding, left sided pain on rectal exam, occult blood. Dx? Tx? (3) Diverticulitis; Dx: CT: Pericolic fat stranding; Tx: Metronidazole IV 500 mg and Ciprofloxacin IV 400 mg, IVF, NPO
Pain occuring in discrete episodes usually after eating a meal; Female, 40, fertile, fat, upper abdomen but usually localizes RUQ referring to scapula. Dx? Tx? Biliary Colic; Dx: U/S: gallstones, dilated gallbladder or cystic duct; Tx: Disposition depends on exact etiology, but surgical consultation and pain control
RUQ or epigastric pain radiating to the back or shoulders. Initially dull and achy, later sharp and localized. Pain lasts longer than 6 hours, N/V, anorexia, fever, chills. Dx? Acute Cholecysitis; Dx: U/S RUQ thickened gallbladder wall, sonographic Murphy's sign, HIDA (hepatobiliary iminodiacetic acid) scan.
Severe abdominal pain of sudden onset radiating to back, confined to low back, groin, genitalia, flank. Discrete palpable abdominal mass. Unequal lower extremity pulses palpated. Cullen Sign, Grey-Turner's Sign, Dx? Tx (4)? Ruptured Abdominal Aortic Aneurysm (AAA); Dx: CT eval of choice, but may be unstable and resort to ultrasound. Tx: IV access, lab studies, type RBCs, emergent surgical consultation
Cullen's Sign Periumbilical ecchymosis
Grey-Turner's sign Flank ecchymosis
Consider in all elderly patients w/: AFib, recent MI, atheroscelrosis, CHF, digoxin, hypercoag, prior DVT, liver disease; sudden, severe, diffuse abd pain in mid/lower abdomen. May not look sick. Pt out of proportion to exam, unrelieved by narcotics. Dx Mesenteric Ischemia; Dx: CT angiogram
Alcoholic w/ gallstones, severe hyperlipidemia; severe epigastric pain radiates toward back, N/V. Can present RUQ. Low grade fever, resp Sx -> pulm effusion, tachycardia, HypoTN, Cullen/Grey-Turner. Tx? (2) What do you not give unless severe? Pancreatitis; Tx: NPO, IVF, no ABX unless disease severe
What should be considered in any women of child-bearing age that presents w/ abdominal pain? Amenorrhea, abd pain, vaginal bleeding. What should confirm (2)? ED management? (2) Ectopic pregnancy. Preg test and U/S looking for free fluid or adenexal mass. M: large bore IVF, emergent OB consult and admission
Sudden unilateral lower abd or pelvic pain radiating to back, groin, flank. Hx of ovarian abnormalities. Dx? Management? Ovarian Torsion Dx: U/S, but negative imaging CAN NOT rule out torsion. M: OB/GYN surgical consult
Most common cause of N/V? Viral gastroenteritis
T/F: Most N/V requires intervention False, most cases are self-limiting
2 ways emesis triggered? Multiple medullary neurons activated in sequential fashion (chemoreceptor trigger at postrema of 4th ventricle), and vagal activation
Unpleasant sensation preceding vomiting. Sx? (2) Nausea; Sx: hypersalivation and repetitive swallowing
Pain preceding N/V indicative of obstruction
Fever and diarrhea indicative of Acute gastroenteritis
High urine specific gravity indicative of dehydration
Ketones in urine indicative of (2): 1) Diabetic ketoacidosis 2) Hyperemesis gravidarum
Secretory diarrhea w/ significant dehydration, not usually associated w/ fever or abd pain. Management? Viral Gastroenteritis; M: self-limiting and requires only supportive care
Inflammatory or secretory diarrhea, possibly dysentery. Define dysentery. Tx? () Bacterial Gastroenteritis; Dysentery: abd pain, bloody diarrhea, anorexia, dehydration/wt loss, stool Cx. Tx: supportive/hydration status/IVF, careful administration of ABX (Cipro)
Most common UGI bleed Peptic Ulcer Disease
What should you do if someone is coughing up or vomiting bright red blood? (3) What if it is significant? Large bore IV, NPO, surgical consult; significant: NG Tube
Most important lab of UGI bleed? Dx study of choice? Type and Cross match blood. UGI endoscopy study of choice
Decreases the rate of gastric emptying, reduces smooth muscle contraction and blood flow within the intestine. Also suppresses pancreatic secretion Octreotide
Passing of bright red, bloody stools or dark, tarry stools (melena). Common causes (4) Lower GI bleed. Causes: Diverticular disease, colitis, polyps, malignancies
What do you always get with a lower GI bleed? What else will the patient get for Dx and Management? (3) Digital rectal exam; Imaging (Either angiography, scintigraphy, or colonoscopy), will be admitted and most will go to surgery
Initial stabilization procedures for GI bleeding (management) (3) 1) ABCs 2) cardiac monitor 3) 2 large bore IV catheters
Difference between primary HA and secondary HA Prime: HA itself is disease, Tx HA (60%). Second: HA underlying Sx of another disease, Tx disease (40%)
>50 yo w/ a new onset of headaches what, generally, is this a strong predictor of? Intracranial pathology
DD: Thunderclap HA (1) Subarachnoid Hemorrhage (SAH)
DD: Worst HA ever (2) SAH, cerebral venous thrombosis
DD: HA in pregnancy (2) Eclampsia, central venous thrombosis
HA w/ change in vision and eye movement pain Optic neuritis, glaucoma
Fever, HA, confusion, seizures, viral, requires LP for Dx Encephalitis
Fever, global HA, stiff neck, photophobia, malaise, LP for Dx (w/in 30 min of arrival) Meningitis
How does cold weather/winter associate w/ HAs? Carbon monoxide poisoning from heaters
3 physical signs of head trauma Battle's sign, depressed skull, scalp laceration
Battle's sign mastoid ecchymosis or bruising behind an ear
Horner's Syndrome Ptosis (droopy eyelid), miosis (constricted pupil), anhydrosis (can't sweat)
Periorbital eccymosis (raccoon eyes) indicates (more specific than trauma) basilar skull fracture
Papilledema on fundoscopic exam reflects: elevated intracranial pressure (ICP)
2 conditions a unilateral red eye (on fundoscopy) indicates. What should you do (during said fundoscopy?) 1) Glaucoma 2) cluster headache; measure IOP
CSF otorrhea and hemotympanum suggests skull fracture
CSF rhinorrhea suggests basilar skull fracture
Maneuver for Meningitis Kernigs and Brudzinski
Jolt Maneuver ask patient to rapidly shake head from side to side. With fever, if this accentuates a HA, "100% sensitive and 54% specific" for meningitis
Petechial rash with HA may be indicative of meningitis
Motor deficit? What is very sensitive and well used to test for it? Pronator Drift
What lab test would be elevated in someone with temporal arteritis Sed rate
When can carbon monoxide be incidentally elevated? In smokers!
Xanthrochromia is Dx for what? SAH (Subarachnoid Hemorrhage)
Most widely available and useful neuroimaging test available Non-contrasted Head CT scan
Absolute CONTRA to LP (2) 1) Unequal pressures btwn supra and infratentorial compartments and 2) infected skin over needle site
Relative CONTRA to LP (3) 1) ICP 2) Coagulopathy 3) Brain Abscess
Main indications for head/brain CT PRIOR to LP (6) 1) immunocompromised 2) known CNS lesions 3) who have had a seizure w/in 1 week of presentation 4) LOC 5) papilledema 6) suspect subarachnoid hemorrhage
H/A w/o aura caused by physiological, dietary, environmental aspects Common migraine
H/A w/ aura (transient focal neurological phenomenon such as scotoma [spotted lights]), unilateral and pulsating, N/V, photo/phonophobia, duration 4-72 hours Classic migraine
T/F: Narcotics not generally recommended for migraines True
Tx of migraines (specify that combo she liked IV) NSAIDs, caffeine, TRIPTANS, ergotamines, Reglan/Decadron/Benadryl cocktail IV
HA w/ ipsilateral lacrimation, rhinorrhea, eyelid edema 4-6th decades in life. Sharp/stabbing unilateral pain. Tx? (3) Cluster HAs; Tx: O2, Triptans, analgesia
Bilateral pain with tightness like a band. Tx? Tension HAs; Tx: NSAIDs.
Intermittent sharp pain in head and face, normal neuro exam; Management? Trigeminal neuralgia: M: refer to Neuro, should include eval for more serious causes
SSNOOP red flags...for what? Headache! Systemic sx, Secondary rf, Neurologic sx, Onset, Older, Positional/Prior HA/Papilledema
Major etiology of SAH ruptured saccular aneurysm
African Americans 2x than whites, women> men, >50 yo, as many as 60% die in the first month, smokers and drinkers, coarctation of aorta, HTN. Imaging based off demographics and RF? SAH; CT head is what we typically use. Gold standard is angiography (CTA or MRA)
3 general things we do for SAH in ED. 1) Dx 2) Emergent Neurosurgery Consult 3) Supportive therapy.
Classically occurs first thing in the AM or causes pt to awaken. More common in adults? More common in children? Brain tumors; Supratentorial (Cerebrum) more common in adults. Infratentorial (cerebellum) more common in pediatrics
First line imaging for suspected intracranial mass CT head w/ contrast
Unilateral HA, jaw claudication, temporal artery tenderness, blurred vision, ESR> 50, Dx? Tx? Temporal arteritis; Dx: temporal artery Bx; Tx: High dose steroids
HA, diplopia, neurological deficit. Rare. Can be caused by OCPs, sinusitis/mastoiditis/meningitis. Dx? Tx? Cerebral Venous Thrombosis; Dx: CT Venography or MRI. Tx: anticoagulation
HA, N/V, double vision, papilledema. Dx? Tx? Pseudotumor Cerebri; Dx: LP w/ CSF opening pressure >25 cmH2O. Tx: Diamox or Lasix
Tx for acutely ill patients with Encephalitis: Administration of acyclovir and/or ABX and/or steroids ASAP
HA w/ pulsatile pain exacerbated by upright position usually in cervical/sub-occipital position. After previous ER visit or admission (Hint: what happened during that visit?) Tx? Post-LP HA: Tx: Blood patch
Primary vs Secondary Head Injury Primary: irreversible cellular damage as a direct result. Prevent event. Secondary: Damage to cells not initially injured. Prevent hypoxia and ischemia
How to airway control w/ cervical spine immobilization (as seen w/ head injuries) Orotracheal RSI (Rapid Sequence Intubation
Management of circulation in head injury (3 main things) 1) Aggressive fluid resuscitation (doesn't raise ICP) 2) Vasopressors 3) Transfuse if HypoTN and Hct <30
Severity of TBI? GCS (Glasgow Coma Score) 14-15, 80% of TBIs, LOC, amnesia, vomiting, diffuse HA Mild TBI of medium risk
Severity of TBI? GCS <9, 40% mortality Severe TBI
T/F: All pediatric patients that come in with a severe head injury should get a CT FALSE! Should try to avoid if you can since it can lead to blood cancer down the road
How do you Dx a TBI? Concussion Sx Dx! (not CT) (Clinically)
What is normal cranial pressure? ICP? What kind of management can help with ICP and how? Normal: <15 mmHg; ICP: >20-25 mmHg (NOTE: ICP not usually available in EDs and must rely on PE). M: Hypertonic saline improves cerebral cranial pressure (CCP) by lowering ICP by 35%. Mannitol also effective
CSF otorrhea and rhinorrhea, Battle Sign, Racoon sign, vertigo, hearing loss, hemotympanum. Prophylaxis? Basilar fracture w/ dural tear; P: Ceftriaxone 1-2 gm IV
Most common CT finding in moderate to severe TBI. What Tx helps? Traumatic Subarachnoid Hemorrhage. Nimodipine (CCB) reduces death and disability by 55% (reduces vasospasm and free bleeding)
Brain anatomy from brain to scalp Brain -> Pia mater -> Subarachnoid space w/ CSF -> Arachnoid mater -> subdural space -> Dura mater -> epidural space -> skull -> scalp
Head injury -> awake lucid interval -> decline in mental status -> alterations of consciousness -> collapse and death. Often associated w/ skull fractures Epidural hematoma
Sudden acceleration-deceleration injury w/ tearing of bridging veins Subdural hematoma
Disruption of axons in white matter and brainstem. Injury occurs immediately and is irreversible. Usually left in a persistent vegetative state. What are some examples where this occurs? (2) Diffuse Axonal Injury; MVC or shaken baby syndrome
What percentage of people recover from a concussion after 1 year? 85-90%
First of all, what direction is axial or an axial load. What vertebrae is vulnerable to it? What is the fracture of that vertebrae called? Stable/unstable? Axial load is when the head comes down caudally. C1 is vulnerable and it is called a Jefferson's Fracture. Extremely unstable
What is C2 vulnerable to? What is that fracture called? Stable/unstable? Hyperextension; Hangman's fracture. Unstable
Strong flexion of the vertebrae forces a wedge shaped fragment to break off body. Stable/unstable? Flexion teardrop injury. Unstable.
Direct blow to the back of the neck or MVC causes what fracture? Stable/unstable? Clay Shovelers fracture (abrupt flexion of head in opposition to strong supraspinous ligament resulting in avulsion fracture). Stable
Name for flexion distraction fractures Chance Fracture
No motor or sensory function below injury level Complete SCI (Spinal Cord Injury)
Any Sensory/motor function below level of injury Incomplete SCI (Spinal Cord Injury)
Descending motor pathway. What spinal tract? Corticospinal tract
Pain/temperature. What spinal tract? Spinothalamic tract
Vibratory/proprioception. What spinal tract? Dorsal column pathway
Primary spinal injury is a mechanical injury
Secondary spinal injury is (3) vascular abnormalities/free radicals/inflammation etc.
Which tracts are injured during an incomplete SCI that is anterior spinal cord syndrome? Corticospinal and spinothalamic
Where is the injury during an incomplete SCI that is a posterior spinal cord syndrome? Dorsal column
Decreased strength and pain/temperature of upper extremities compared to lower extremities due to hyperextension injuries or _____ spinal stenosis Incomplete SPI: Central cord syndrome; central spinal stenosis
Affects the transverse hemisection of spinal cord. Ipsilateral loss of motor function and contralateral loss of pain/temperature sensation. Cause? Brown Sequard Syndrome (Incomplete SCI); Penetrating injury or lateral cord compression.
Phenomenon charcterized by loss of all spinal cord function caudal to level of injury: flaccid paralysis, hypotonia, areflexia, priapism, venous pooling. Outcome? Spinal Shock; spastic paresis and hyper-reflexia
Type of distributive shock characterized by loss of adrenergic tone due to sympathetic denervation: HypoTN, Bradycardia, Hypothermia classic triad. Management? (3) Neurogenic Shock; IVF, Vasopressor support, atropine
First management other than ABCs with spine injury? Immobilization
T/F: No difference in immobilization with a cervical collar than there is with a cervical collar and spine board FALSE, there is significant improvement w/ both
Indications for spinal XR (4) TRAUMA: 1) midline tenderness 2) Neuro deficits 3) altered consciousness 4) Intoxicated pts
What view exposes 90% of cervical spine fractures on XR? What must be seen to be considered an adequate XR? Lateral C-Spine XR; Top of T1 must be seen
Which is better for detecting C-spine injuries: Nexus or CCR (Canadian C-Spine)? Canadian C-Spine
3 high risk factors based on CCR chart (rules in needing radiography) 1) >65 yo 2) Dangerous mechanism 3) Paresthesias in extremities
5 low risk factors based on CCR chart (rules out needing radiography) 1) simple MVC 2) sitting position in ED 3) Ambulatory at any time 4) Delayed onset of neck pain 5) absence of midline C-spine tenderness
How do steroids effect spinal cord trauma? Inhibit free radical induced lipid peroxidation
Why is the use of methyprednisolone controversial in spinal cord trauma Linked w/ increased mortality in isolated head injury
T/F: About 90% of all LBP episodes will resolve within 6 weeks regardless of treatment approach or lack of treatment True
Most common cause of disability in people younger than 45 yo Low back pain
5 DDs where Sx of these DDs are red flags in a low back assessment 1) Cauda Equina Syndrome 2) Spinal fracture 3) Cancer 4) AAA 5) Infection
Dull and achy, exacerbation w/moving, relieved w/ rest, no radiation, no dermatomal pattern, normal DTRs (Benign or malignant?) Benign Sx of LBP
Irritation of sciatic nerve passing under ________ muscle --> pain on resisted abduction/external rotation (Patrick maneuver) Piriformis syndrome
Subtle presentation: pain w/ walking (shopping cart sign), mistaken for claudication. Management long term? Lumbar Spinal Stenosis; Ortho consult if progressive long term
Tx for benign backpain (4) Cortico dose pack, NSAIDs, Flexiril (muscle relaxer), minimal pain meds if any
Urinary retention/incontinence, saddle anesthesia. Where is the injury below? Management? Cauda Equina Syndrome; Injury below L1; orthopedic or neurosurgical emergent consult and MRI
Most common aneurysm of arterial tree. 50% mortality if ruptured. Usually presents as flank pain or a painless throbbing mass. Can complain of back pain or syncope. Dx? Tx? (5) Abdominal Aortic Aneurysm (AAA); Ultrasound! Tx: 1) O2 2) Two large bore IVs 3) Cardiac monitoring 4) BP control 5) Surgical consult
T/F: Observation of the child is more predictive of serious illness than standard PE techniques True
Breathing Red flags (3) 1) RR >60 <2 yo; 2) RR >40 >2 yo; O2 <92%
#1 cause for pediatric cardiopulmonary arrest? 4 causes of that? Primary Respiratory Disturbance; 1) Localized infxs 2) Asthma 3) Upper Airway Obstruction 4) Sepsis
Airway management in alert vs lethargic child Alert: Allow child to maintain position of comfort. Leth: head tilt/chin tilt and padding under shoulder so head flops back
Medications for imminent respiratory failure in a child (2) 1) Albuterol 2) Nebulized epinephrine
Initial fluid support for peds not in shock but that need a bolus. Boluses in shock? 20 cc/kg; 60cc/kg
What is the Broselow Pediatric tape used for? (3) estimates weight, doses, and equipment sized based on heights
Tachypnea, tachycardia, oliguria, mottled extremities, altered mental status. Late sign? Pediatric shock; HypoTN is a late sign in children...30-50% acute blood loss!!!
Acute wt loss, sunken eyes, dry mucous membanes, delayed cap refill, tachycardia. Cause? Best Tx(s) Dehydration: CV emergency! Cause: V/D. Best Tx: water by mouth, but IV indicated if necessary. Odansetron if necessary (they have dissolving tablets
Base dehydration based off of these 3 things 1) Mucus membranes 2) cap refill 3) pulse
Respiratory Sx: tachypnea, wheezing, rales, rhonchi, poor feeding, sweating or color change. Hepatomegaly, weak pulses WORSENING W/ FLUID ADMINISTRATION. Tx? (3) Congestive Heart Failure; Tx: Furosemide, Digoxin, Dopamine
Causes of CHF in: 1 day old, 2 weeks, 10 years + PDA (patent ductus arteriosus), Coarctation of the Aorta, Rheumatic Fever
Describe the steps of the hyperoxia test for CHF (3) 1) Obtain room air ABG 2) administer 10 min of 100% O2 3) repeat ABG will be unchanged (pts w/ CHF will have unchanged ABG)
Apnea in infants: Definition D: cessation of breathing for 20 seconds
Apnea with stressors such as scolding: Definition. Tx? Breath Holding Spells; D: transient episodes of breath holding up to 1 minute; No intervention required
inspiratory stridor, dyspnea, tachypnea, nasal flaring, retractions Upper Airway Obstruction
Classic association of stridor? Dx? Epiglottits (rare now), but lateral neck XR will show thumb sign
Main Tx for anaphylaxis other than ABCs (4) Epinephrine, H1 blockers, corticos, H2 blockers
Abrupt complete obstruction w/ protracted course of wheezing. Management: Laryngoscopy or bronchoscopy for removal
Which side does a lower airway foreign body usually choose? Tx? Right side; bronchoscopy
Barky cough w/ retraction and tachypnea but no hypoxia; Imaging? Dx? Tx? Croup; Imaging: AP XR w/ steeple sign. Dx: Clinical Dx. Tx: Nebulized racemic epinephrine, albuterol if that epi doesn't work
What must you do if you give epinephrine? Observe child for 2 hours to ensure there is no rebound
Main indications for hospitalization for croup (3) 1) No improvement w/ Tx 2) Decreased LOC 3) Family unable to care for child
Sudden onset w/o barking cough, drooling, febrile. Prevalence? Etiology? Tx? Epiglottis; Rare due to Hib vaccine. Tx: DO NOT agitate child w/ exams/labs/Tx
"hot potato" voice, no barky cough, fever, drooling/difficulty swallowing Peritonsillar or Retropharyngeal Abscesses
Acute lower respiratory tract infection in December. Etiology? Management? Bronchiolitis; E: RSV (Respiratory Syncytial Virus). M: Supportive care, albuterol trial ONLY if benefit is noted.
Wheezing, cough, SOB, chest tightness. Loud biphasic (ex and inspiratory) wheezing (most severe obstruction may be absent). Tx? (FOR ACUTE) ACUTE Asthma 1) SABA (albuterol) 2) Ipratropium (anti-cholinergic) 3) Magnesium sulfate
Pediatric Glascow Coma scale score that indicates intubation? < 8
Seizures that are precipitated by fever Simple Febrile Seizures
Focal or prolonged or multiple seizures Complex Febrile Seizures
Major seizure cause in younger children metabolic disturbance
New seizure evaluation labs (5) CBC, CMP, CSF, EEG, U/A
Local warmth, erythema, refusal to move limb, knees and hips most commonly affected. Etiology for Neonates? Adolescents? Tx? Septic Arthritis; E: N- S aureus or GBS OR A- gonorrhea. Tx: IV ABX for at least 3 weeks and ortho admission
Most common cause of acute hip pain. Inflammation --> arthralgia/arthritis, presents as limp. Low grade fever. Recent viral infection. Tx? Toxic synovitis; Tx: NSAIDs and rest
Difference between Septic Arthritis and Toxic Synovitis Dx Septic Arthritis: ESR>40, WBC>12,000
Fever, warmth, erythema, swelling; usually hematologic spread involving femur, tibia, humerus (long bones). Etiology? Etiology w/ foot wound? Initial Imaging? Tx? Acute Osteomyelitis; E: staph aureus. Puncture: Pseudomonas; Imaging: XR initially, MRI after). Tx: IV ABX 4-6 weeks
When is endoscopy indicated regarding GI foreign bodies? 3 days (only 2 days w/ a battery
Microangiopathic, hemolytic anemia, thrombocytopenia, acute renal failiure often following viral/bacterial illness. Can develop bloody diarrhea/prodromal gastroenteritis. Etiology? Hemolytic Uremic Syndrome (HUS); E.coli 0157:H7
Lab evaluation for HUS (4). Tx? (3) What to avoid? CBC, elevated creatinine, U/A, stool Cx. Tx: supportive, steroids, dialysis. Avoid: anti-motility, ABX
Polyuria, polydipsia, V, altered mental status, Kussmaul breathing, sweet odor, hypovolemic. Tx? Diabetic Ketoacidosis; Tx: Fluid resuscitation and small dose insulin
Tx of cerebral edema (HA, V, worsening altered mental status, sudden onset) Osmotic diuresis (mannitol which lets tissues shrink)
Created by: crward88