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ER/ICU/Surg 2
Accidents and Injuries
| Question | Answer |
|---|---|
| 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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