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ER/ICU/Surg 10 Emerg
Surgical Emergencies and Transplantation
| Question | Answer |
|---|---|
| What would you suspect in an ER pt with blood in the urethral meatus or a high riding prostate? | Urethral injury or bladder rupture |
| What are the two measures of how severe the hypotension is in shock? | UOP, mental status |
| What causes a continuous machine-like heart murmur? | PDA |
| List some shotgun labs for a pt with abdominal pain. | CBC with diff, amylase/lipase, BMP with BUN/Cr/LFTs, beta hCG, UA, stool guiac, EKG (>45yo +/- cardiac enzymes esp if female or diabetic) |
| Cardiac cause of mesenteric ischemia? | A fib causing emboli formation |
| Mgmt of mesenteric ischemia? | Hemodynamic monitoring and support (dobumatine or dopamine PRN), broad spectrum abx, NG tube decompression, and angiogram |
| Classic presentation of chronic mesenteric ischemia? | Dull, crampy, postprandial epigastric pain within first hr after eating then subsiding over 2h. Abd bruit in 50%. |
| Tx options for chronic mesenteric ischemia? | Bypass, endarterectomy, angiography, stenting |
| What is seen on abd X-ray or CT scan that indicates a ruptured viscus? | Free air |
| What is the classic finding in the abd exam of a pt with mesenteric ischemia | Pain out of proportion to exam |
| During a surg procedure, anesth ntoices pt's temp has climbed quickly and her mm are ridgid. Recognizing this feared complication, the doctor should administer which med? | Dantrolene. |
| What are a few contraindications to the transplant of the following organ?: heart | smoking, pulmonary HTN |
| What are a few contraindications to the transplant of the following organ?: liver | alcohol, multiple suicide attempts |
| What are a few contraindications to the transplant of the following organ?: lung | smoking, poor cardiac/liver/renal f'n |
| What is the type of rejection that is treatable with immunosuppressive agents? What is the mechanism of this rejection? Within what time frame may it show up? | Acute rejection: prolif of anti-donor T cells (6d-1yr) |
| A pt who recently received a bone marrow transplant develops a rash, nausea, and vomiting and is having continued bleeding from her gums after brushing her teeth. What should be suspected in this pt? | Graft vs host disease |