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ER/ICU/Surg 2

Accidents and Injuries

QuestionAnswer
A 60yo obese pt presents with dirty, velvety patches on the back of the next. Dx? Initial w/u? Acanthosis nigricans. Check glucose and do full H&P.
What is the appropriate tx of HTN in cases of pheo? alpha blocker (like phenoxybenzamine or phentolamine) first. Then beta blocker. Then surgical resection.
What is the classic presentation of a pt with hyperprolactinemia? Hypogonadism: amenorrhea (women), low libido (men), infertility
Can heat stroke be treated with acetaminophen or NSAIDs? No b/c hypothalamus set up is not the underlying problem.
What lab findings would you see in heat stroke? Increased WBCs, increased BUN, increased creatinine. Also may see evidence of ARDS, DIC, and hepatic and renal failure.
What is the difference in sweating between heat exhaustion and heat stroke? Heat stroke is a failure of the body's cooling mechanisms so there is little to no sweat. Heat exhaustion will have substantial sweating.
What is the final stage of hypothermia? Pt stops chivering and undergoes fatal increase of blood viscosity
What is the definition of hypothermia? Body temp <95F/35C 2/2 cold exposure
What characteristic EKG change will you see with hypothermia? J waves (small + deflection after QRS)
What vaccine is important to give to anyone with a bit? Tetanus toxoid
Name 3 key tx for black widow bites. Calcium gluconate, benzos, and steroids.
What 3 potential drugs for tx a brown recluse bite. Dexamethasone (if necrotic center), oral erythromycin (if s/s of infxn), dapsone (to reduce extent of local necrosis). Remember can't give dapsone to someone with G6PD deficiency
How long should a black widow bite pt be observed? 24h
What drug can be given to black widow spider bite pt with m spasms? Methocarbamol
What is an underlying problem with hyperthermia that must be corrected? Dehydrated
Which types of bites should NOT be sutured? Puncture bites and dog bites to the hand, wounds with high rates of infection
How should facial bites be managed? Sutured close (unless presenting after 12-24h). Face is well perfused so less likely to develop infection
Which type of bites should get abx for 10-14 days? Hand bites, deep puncture wounds, cat bites, and human bites
Name 3 abx regimens for bites. 1. Unasyn (amp/sulbactam) + Augmentin (amox/clavulanate) 2. Clinda + fluoroquinolone 3. Clinda + bactrim (TMP/SMX)
What should you do in case of infected hand wound? Consult hand surgeon (yay plastics!) Start IV abx
What f/u assessment should be done in kiddos who are victims of bites? F/u psych assessment for PTSD. Over 50% of kids get it after a bite. :(
Td should be given to every adult every __ years. 10
If a wound is dirty in a pt who was fully immunized, the pt should receive a Td (booster) if the last shot was < __ years ago. 5
If a wound is clean, a fully immunized pt should be given a Td if the last shot was <__ years ago. 10
If a pt's immune status is unknown or a pt has not received a complete series of 3 tetanus vaccines, what should be done if they get a clean bite? Give Td (booster). If less than 7yo, give them DT (tetanus/diphtheria vaccine minus pertussis coverage).
If a pt's immune status is unknown or a pt has not received a complete series of 3 tetanus vaccines, what should be done if they get a dirty bite? Td booster (DT vaccine if <7yo) + tetanus IM Ig
Should a dog bite wound to the arm be left open or sutured closed after appropriate washout? Leave open
What is the treatment for a skin laceration on the dorsum of the hand that resulted from a closed fist hitting a victim's mouth? Clean wound with copius irrigation, IV abx, leave wound open
What meds should be given to a pt with m spasma, abd stiffness, AMS, and tachy due to a spider bite? M relaxants, calcium gluconate, and antivenom
Created by: sarah3148



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