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ER/Surg 7 (trauma)
Step-2
| Question | Answer |
|---|---|
| What is the classic ECG appearance in atrial flutter? | saw tooth pattern of P waves |
| What side effects can arise from theophylline OD? | seizures, hyperthermia (2/2 seizure), hypotension, cardiac tachyarrhythmias |
| What is the treatment for Kawasaki disease in the acute-phase? | high dose ASA, IVIG, and DO NOT use steroids |
| Hypertension with bradycardia is suggestive of ____________(cushing's phenomenon). | increased intracranial pressure |
| What should you rule out before performing any examination requiring head movement? | cervical fracture and spinal cord injury |
| What 3 categories are evaluated in Glasgows Coma Scale(GCS)? | eye opening, verbal response, motor response. |
| What does a GCS score of 12+ suggest? | minor brain injury with probable recovery |
| What does a GCS score of 9-11 suggest? | moderate severity requiring close observation for changes |
| What does a GCS score of 8 or less suggest? | <=8 after 6 hours associated with 50% mortality. <8 and the patient should be intubated. |
| What is the basic sequence of assessing a trauma patient? | ABCDE: airwary, breathing, circulation, diability(GCS), exposure(remove all clothes) |
| What are the classic physical exam findings in a basilar skull fracture? | racoon eyes, bruising over the mastoid process(Battle's sign), blood behind the TM, CSF rhinorrhea or otorrhea |
| What is cushing's triad? | HTN, bradycardia, bradypnea |
| What interventions can be used to lower intracranial pressure in a head injury pt? | head of the bed at 30 degrees, mannitol(monitor serum Na and osmolarity. Hold mannitol if Na>152 or osm>305mOsm/L), intubate and hyperventilate(until pco2 25-30 on ABG), decompressive craniectomy. |
| A pt presents to the ER after being involved in a MVA. He does not open his eyes or make any sounds, but he does withdraw to painful stimuli. What is his GCS? What need to be done? | Score of 6, he needs to be intubated to protect his airway (GCS <8 needs intubation) |
| MVA victim arrives @ the ER,he's able to carry on a convo & even comments on your hair. He's able to move all extremities on command, & has a significant periorbital eccymosis & surrounding superficial scrapes. What's his GCS? What imaging does he need? | GCS=15, he needs a CT of the head. |
| What is the tx for anterior spinal cord syndrome following traumatic injury? | ABCs, keep spine stable, if hypotension give fluid bolus but limit fluids once normotensive, give immediate high dose IV steroids, CT/MRI of spinal cord, once stable decompression via closed reduction or surgery. |
| Zone I of the neck is from ______to_________. | clavicle to cricoid cartilage |
| Zone II of the neck is from _________to________. | Cricoid cartilage to the angle of the mandible |
| Zone III of the neck is from _________to________. | angle of the mandible to base of the skull |
| In cases of neck trauma which prophylactic medication type may be indicated? | antibiotics may be indicated b/c of increased risk of contamination by oropharyneal flora. |
| What work-up is indicated for penetrating injury to zone I of the neck? | 4 vessel arteriogram + triple endoscopy |
| What work-up is indicated for penetrating injury to zone II of the neck? | surgical exploration or (doppler U/S + selective exploration)(institution dependent) |
| What work-up is indicated for penetrating injury to zone III of the neck? | 4 vessel arteriogram |
Created by:
shelybel
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