Emergency Medicine 2b

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HuskerDevil
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86603
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Emergency Medicine 2b
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2011-05-18 16:26:45
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DPAP2012 Emergency Medicine
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Emergency Medicine 2 questions made by previous students
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  1. Burn epidemiology
    • Adult: flame burns/clothing ignition
    • kids: scalds
  2. 1st degree burns heal within:
    3-6 days
  3. Superficial 2nd degree
    • d/t flame, scalding, chem;
    • Edema; skin pink/ red, often blisters;
    • hypersensitivity;
    • healing 10-21 days
  4. Deep 2nd degree
    • More destruction than superficial;
    • involves some skin appendages;
    • large blisters or bullae, often ruptured, skin red or pale;
    • decreased sensation/ circulation, may be pale;
    • healing >21 days
  5. 3rd degree
    • d/t prolonged exposure to heat or severe exposure;
    • extensive edema;
    • skin moist/ weeping, charred skin or pale;
    • no sensation, circulation;
    • will not heal spontaneously, requires grafting
  6. Laryngeal edema d/t smoke inhalation usually occurs:
    • within 24 hours of the injury (but poss any time);
    • intubate pre-emptively
  7. Baseline labs:
    • ABG
    • CBC
    • Electrolytes
    • Glucose
    • UA
    • carbon monoxide level
    • determine tetanus status
  8. Pt's hand is ___% of BSA
    1
  9. BSA chest + abdomen
    9 + 9 = 18%
  10. BSA head
    2 X 4.5 = 9%
  11. BSA: arms
    • 2 X 4.5 = 9% each arm
    • 18% for both arms
  12. BSA: lower extremities
    • 2 x 9 = 18% each leg
    • 36% both legs
  13. Major burns: disposition
    transfer to the nearest regional burn center
  14. Definition of major burns
    • Partial thickness >25% BSA
    • Full thickness >10% BSA
    • burns of the face, eyes, ears, hands, feet or perineum
  15. Moderate burns
    • Partial thickness of 15-25% BSA
    • Full thickness burns of 2-10% of BSA (except if it includes critical areas);
    • excludes high voltage electrical injury, inhalational injury, high risk-patients, or a multi-trauma burn pt
  16. Parkland formula
    • 4 cc of LR x weight in kg x % BSA burned = total volume for 1st 24 hrs;
    • half in the 1st 8 hrs
  17. Smoke inhalation
    • 33% of pts admitted to burn ctr;
    • d/t toxic damage to resp epithelium;
    • inflammation/ necrosis
  18. Most common cause of morbidity in smoke inhalation patients
    Pneumonia
  19. To dx smoke inhalation injury:
    Fiberoptic bronchoscopy
  20. Smoke inhalation injury: tx
    • Humidified O2 (100% if CO tox);
    • mucolytics;
    • pulmonary physiotherapy;
    • consider intubation;
    • usu heal in 2-3 wks
  21. Electrical injury
    • may be worse than it looks;
    • may need fasciotomy;
    • poss extensive mx damage & cardiac arrhythmias;
    • 1/3 of pts need amputation
    • Monitor electrical burn pts for:
    • Myoglobinuria
  22. Escharotomy/Fasciotomy may be needed for:
    • Electrical burns;
    • circumferential full-thickness burns;
    • chest wall involvement impairing resp;
    • compartment syndrome
  23. Chemical burns
    • Wash thoroughly, copious amounts water to decontaminate;
    • get pH to 7.0 (litmus paper)
  24. Alkali vs acid burns
    Alkali cause more damage than acid
  25. conjunctival pallor is due to:
    severe ocular injury from alkali
  26. Most common pathogens in burns:
    S. Aureus and Pseudomonas (topical Abx prevent invasion)
  27. Which topical antimicrobial agent has the ability to penetrate eschar?
    Mafenide acetate
  28. Topical Abx
    • Ag NO3,
    • Ag sulfadiazine;
    • Mafenide acetate
  29. If systemic Abx are indicated (discolored, erythema, edema, high temp):
    Broad spectrum: PCN, ceph, macrolides
  30. skin grafting is indicated for:
    3rd degree and deep 2nd degree
  31. Biologic dressings
    Gold standard: Human allograft; also porcine xenografts, synthetics
  32. MESS Score > ____ needs trauma center
    >7
  33. Hemodynamically Unstable Fx imaging/look for:
    AP lateral xray: Inspect inner/ outer main ring cortices; 2 small rings; SI joint spaces (equal); symphysis pubis should align, < 5mm joint space; acetabulum
  34. Hemodynamically Unstable Fx: if fx identified or suspected:
    CT (+/- MRI)
  35. True Orthopedic Emergencies
    • Pelvis, Femoral neck;
    • Extremity Arterial Injury;
    • Compartment Syndrome;
    • Mangled Extremity and Traumatic Amputations;
    • Threatened Soft Tissues / Open Fx;
    • Hip Dislocation ;
    • Septic Joint / Osteomyelitis
  36. Open fx Type I
    • <1 cm, clean;
    • minimal mx contusion;
    • simple transverse/oblique fx
  37. Open fx Type II
    • Lac >1 cm;
    • extensive tissue damage;
    • min crushing
  38. Open fx Type IIIA
    extensive ST damage w/mx, skin, neurovasc
  39. Open fx Type IIIB
    ext ST damage with periosteal stripping & bone exposure
  40. Open fx Type IIIC
    High energy features with art damage
  41. Septic joint/osteo: orgs: bone
    Bone: GAS, S. aureus
  42. Septic joint/osteo: orgs: joint
    H. flu, GAS, E. coli, NG
  43. Septic joint/osteo: sx
    Fever, joint or bone pain, leukocytosis
  44. Septic joint/osteo: Dx tests
    • Bone scans localize osteomyelitis;
    • Joint aspiration to identify organism
  45. MS trauma complications
    • Most common: Nerve compression, compartment syndrome, DVT, fx comps;
    • Other: Rhabdomyolysis; Reflex Sympathetic Dystrophy; Myositis Ossificans
  46. Fx complications
    • Delayed union;
    • nonunion;
    • infxn;
    • N/V injury
  47. MS Imaging
    • Plain films (at least 2 views);
    • consider joints above/below injury;
    • CT (bony);
    • MRI (ST);
    • nuc med (tumors);
    • EMG/NCS
  48. Trauma x-ray series
    • Lateral C-Spine;
    • PA Chest;
    • AP Pelvis
  49. ____ are prone to avascular necrosis
    Femoral neck fractures and hip dislocations
  50. Injuries assoc w/arterial damage:
    • Knee dislocations,
    • displaced tibial plateau fx,
    • floating joint,
    • GSW or knife wounds,
    • mangled extremity
  51. Compartment syndrome: compartment pressure of ____ warrants decompression with fasciotomy
    > 30 mm Hg
  52. Time from amputation to replantation
    • Warm ischemia: 6 hrs;
    • Cold ischemia: 12 hrs;
    • up to 30 hrs for digits
  53. Septic joint/ Osteomyelitis Rx:
    Parenteral Abx, I&D
  54. MS injuries: plain films
    • At least 2 views;
    • Check entire film;
    • Consider joint above & below injury
  55. Nuclear med studies to:
    define tumors, etc
  56. Dislocations
    • shoulder 95% ant;
    • hip 90% posterior
  57. Avulsion of the antero-inferior glenoid labrum =
    Bankart lesion
  58. Compression fx of posterior humeral head =
    Hill-Sachs lesion
  59. Shoulder dislocation: xray & reduction maneuvers (3):
    • Rowe (opposite ear over head),
    • Stimson (prone),
    • Hippocratic (traction)
  60. Shoulder xrays
    • AP Grashey (30 deg),
    • scap Y,
    • axillary
  61. Posterior fat pad is always:
    Pathologic
  62. Hand lac: close within:
    8 hrs
  63. Kanavel sx (fusiform swelling, tendon TTP, passive extension pain) =
    • septic tenosynovitis (staph, strep);
    • I&D, Abx;
    • tetanus/rabies prn
  64. High pressure injection injury: paint vs grease
    • Paint: tissue necrosis;
    • Grease causes fibrosis
  65. Hip dislocation tx
    Allis maneuver
  66. Femur fx tx
    • usually ORIF;
    • femoral fx = closed reduction & Nail;
    • femoral neck fx: Garden III & IV need prosthetic
  67. Bucket-handle or corner fracture on xray =
    • Metaphyseal Corner fx;
    • less common, more specific for abuse than diaphyseal fx;
    • represent planar fx through primary spongiosa
  68. Vertebral fx & child abuse
    • spinous process avulsions > vertebral fractures;
    • most are Asx; consequent neuro or kyphosis rare
  69. Epiphyseal Separation
    • True physeal injuries unusual in the abused child;
    • result of violent traction or rotation;
    • MRI or arthrogram may be needed for dx
  70. planar fx through primary spongiosa =
    Metaphyseal Corner fx
  71. Monro-Kellie Doctrine:
    Total intracranial volume is fixed
  72. Epidural hematoma
    • temporal/temporoparietal;
    • btw skull & dura;
    • usu younger pts (not elder or <2 yo);
    • 80% meningeal art inj;
    • parenchyma compressed to midline;
    • lens shape on CT
  73. Trauma-induced alteration in mental status that may or may not involve a loss of consciousness =
    Concussion
  74. Concussion Grade I
    No LOC, transient confusion
  75. Concussion Grade II
    No LOC, transient confusion; sx last longer (>15 min)
  76. Concussion Grade III
    LOC of any duration
  77. Layers of SCALP:
    • skin,
    • connective tissue,
    • aponeurosis,
    • loose areolar tissue,
    • pericranium
  78. EDH s/s
    • lucid interval in 30%;
    • late: ipsilateral fixed/dilated pupil, contra hemiparesis
  79. CPP =
    MAP - ICP (cerebral perfusion P = mean art P - intracranial P)
  80. SDH =
    • venous blood btw dura & arachnoid;
    • bridging v.;
    • often 2/2 accel/decel,
    • in EtOH/elderly
  81. SDH acute vs chronic
    • acute usu s/s in 24 hr;
    • chronic >2 wks
  82. On CT: concave density adjacent to skull, crosses suture lines =
    SDH
  83. On CT: biconvex density adj to skull, does not cross suture lines =
    EDH
  84. Cushing triad
    • HTN,
    • bradycardia,
    • resp irregularity;
    • 2/2 markedly elevated ICP
  85. brain ischemia results from CPP less than:
    40 mm Hg
  86. GCS ≥ 13 =
    mild brain injury
  87. GCS 9-12 =
    moderate brain injury
  88. GCS ≤ 8 =
    severe brain injury
  89. GCS eye 1 =
    no response
  90. GCS eye 2 =
    to painful stimuli
  91. GCS eye 3 =
    to verbal command
  92. GCS eye 4 =
    Spontaneously
  93. GCS verbal response 1 =
    no response
  94. GCS verbal response 2 =
    incomprehensible sounds
  95. GCS verbal response 3 =
    inappropriate words
  96. GCS verbal response 4 =
    confused conversation
  97. GCS verbal response 5 =
    Oriented
  98. GCS motor 1 =
    no response
  99. GCS motor 2 =
    decerebrate posturing (arms & legs held straight out, toes pointed downward, & head & neck arched backwards)
  100. GCS motor 3 =
    decorticate posturing (rigidity, flexion of arms, clenched fists, & extended legs (held out straight); arms are bent inward toward body w/wrists & fingers bent & held on chest)
  101. GCS motor 4 =
    flexion withdrawal
  102. GCS motor 5 =
    localizes pain
  103. GCS motor 6 =
    obeys commands
  104. Most sig cause of mortality in pts with TBI
    • Diffuse axonal injury (DAI)
    • Types of stroke
    • ischemic (thrombotic, embolic 20%, hypoperfusion);
    • hemorrhagic (intracerebral, subarachnoid)
  105. Contralateral weakness (lower > upper), AMS, incontinence; likely source of stroke =
    anterior cerebral artery
  106. Contralateral weakness (face/arm > lower), contra sensory deficits, poss dysphasia; likely source of stroke =
    MCA
  107. Contralateral visual field deficits, AMS, cortical blindness; likely source of stroke =
    posterior cerebral artery
  108. vertigo/nystagmus, syncope, dysarthria, dysphagia, contralat pain/temp deficits; likely source of stroke =
    vertebrobasilar arteries
  109. stroke PE
    neuro, CV (carotid bruit), EKG (A-fib, AMI/hypoperfusion)
  110. meningitis PE
    • fever,
    • HA,
    • photophobia,
    • seizure;
    • petechiae/purpura (60-80% of Neisseria pts),
    • poss AMS,
    • +Kernig & Brudzinski
  111. Hunt-Hess scale grades severity of:
    SAH (I = mild HA, stiff neck; V = coma)
  112. SAH RFs
    • HTN, s
    • moking,
    • cocaine,
    • FH,
    • prior SAH,
    • PKD,
    • CTD,
    • coarctation
  113. SAH tx
    • control HTN (labetalol / nitroprusside);
    • nimodipine for vasospasm;
    • surg (resect / embolization)
  114. Insect in ear canal
    • kill with oil, alcohol, or lidocaine;
    • remove w/microscopic forceps
  115. Malignant OE, aka ___; who & what
    • temporal bone osteomyelitis;
    • immunocompromised (uncontrolled DM);
    • pseudomonas
  116. To dx/tx Malignant OE:
    • non-contrasted CT temporal bone and/or bone scan;
    • ENT consult and IV Abx
  117. TM perf
    • Usually posterior;
    • get audiogram;
    • non-ototoxic ear drops (Floxin, Ciprodex)
  118. OM with effusion
    • Chronic ETD;
    • Acute OM;
    • Barotrauma;
    • sx hearing loss, ear fullness, tinnitus
  119. Weber test
    • If OM w/effusion, will lateralize towards effusion;
    • if SNHL, will lateralize away from affected side
  120. Barotrauma
    • nasal steroids & time;
    • audiogram to check for significant HL
  121. Acute mastoiditis sx
    • fever,
    • otalgia,
    • post auricular erythema,
    • swelling,
    • tenderness with protrusion of the auricle
  122. Acute mastoiditis dx/tx
    • CT scan to detn amount bone involvement;
    • IV abx, ENT consult, admit for observation;
    • often mastoidectomy
  123. Bullous Myringitis
    • very painful (esp if coughing/sneezing);
    • caused by Big 3
  124. Bullous Myringitis tx
    • Abx (macrolide: Biaxin) & topical Abx if vesicles rupture;
    • ST pain mgmt w/ opiate is acceptable
  125. Bell palsy sx
    • Abrupt onset upper & lower (ipsilateral) facial paresis/ paralysis,
    • mastoid pain,
    • hyperacusis,
    • dry eyes,
    • altered taste
  126. SNHL tx
    When in doubt, tx w/HD prednisone and REFER
  127. SNHL sx
    • No warning;
    • often hear a pop;
    • 30 dB loss in 3 frequencies;
    • Needs MRI of IAC with contrast
  128. Vertigo: lasts seconds, head movements, no hearing loss; Positive Dix-Hallpike maneuver
    BPPV; tx with Epley maneuvers
  129. Vertigo: episodic, lasts several hrs, associated HL (usu low freq/ unilateral), tinnitus, ear fullness
    Ménière
  130. Meniere tx
    • Diuretics;
    • Low Na diet;
    • Anti-vertigo meds;
    • Surgery (to prevent vertigo)
  131. Vertigo: severe disabling vertigo lasts 1-2 days, gradual recovery
    • V. Neuritis (semicircular canals only) or Labyrinthitis (vertigo & HL);
    • tx steroids & PT
  132. Sinusitis Emergencies
    • Periorbital cellulitis;
    • Brain Abscess;
    • orbital abscess
  133. Acute sinusitis: etiology
    Big 3, SA
  134. Extrusive luxations
    Reposition tooth manually & splint into place ASAP
  135. commonly associated with an alveolar bone fracture
    Lateral luxations
  136. Intrusive luxations
    • Most serious;
    • do not manipulate initially, allow it extrude itself or refer (orthodontist)
  137. Post extraction alveolar osteitis, aka:
    • dry socket;
    • Plain films to R/O retained root tip
  138. ANUG most assoc with:
    • HIV and/or prior ulcerative gingivitis;
    • life threatening if left untreated
  139. ANUG tx
    • Chlorhexidine rinses,
    • debridement by oral surgeon or ENT,
    • PO flagyl TID
  140. Can be d/t hereditary C1 esterase inhibitor deficiency, allergic rxn, ACEI, or idiopathic
    Angioedema
  141. Tonsillitis tx
    GP coverage: Amox, EES, Quinolones, Bactrim
  142. Parapharyngeal Abscess sx
    • Nuchal rigidity;
    • Stridor;
    • Sore Throat;
    • Drooling
  143. Acute viral laryngotracheitis, aka ___; sx/tx
    • Croup;
    • stridor,
    • seal-like cough;
    • Glucocorticoids,
    • Nebulized epinephrine
  144. Epiglottitis etiology
    HIB, staph, strep
  145. Epiglottitis sx
    • Trismus,
    • drooling,
    • dysphagia;
    • Lateral Neck X-Ray will show Thumb Sign
  146. Airway Foreign bodies: surgical intervention:
    rigid bronchoscopy
  147. Mandible Dislocation sx
    • Jaw pain,
    • trismus,
    • malocclusion;
    • anterior dislocation is the most common;
    • Can also have posterior, lateral, or superior dislocations
  148. Mandibular fx tx
    • Nondisplaced fx: closed reduction;
    • Displaced or condylar fx: ORIF;
    • Wire Osteosynthesis for 6 weeks
  149. Nasal fx: Non-displaced fx:
    do not require reduction
  150. Temporal bone fx: complications
    • hearing loss,
    • facial paralysis,
    • CSF leak,
    • vertigo,
    • TM perforation,
    • nystagmus
  151. Temporal bone fx: dx
    • CT Temporal Bone, non-contrasted;
    • ENT Consult
  152. croup bugs
    • parainfluenza 1&2,
    • adenovirus,
    • RSV
  153. croup s/s
    • afebrile, normal sats;
    • retractions, tachypnea, audible stridor;
    • steeple sx on neck xray
  154. croup tx
    • normal: neb mist, O2, poss neb epinephrine, steroids if stridor at rest;
    • if upper airway obstruction, intubate (watch for post pulmo edema)
  155. bronchiolitis
    • paraflu, 100k hosps/yr;
    • 2-6 mos old, winter-spring
  156. bronchiolitis s/s
    • tachypnea, fever, tachy, hypoxia, nasal flaring, retractions;
    • rales, wheezes, long exp phase;
    • xray hyperinflation, hypoxia on ABG
  157. Fever (>38C), <28 days old
    • Admit,
    • blood cx,
    • ucc,
    • LP;
    • poss cxr;
    • IV amp/gent;
    • NO ROCEPHIN d/t kernicterus risk
  158. Fever (>38C), 28 days - 3 mos
    • blood cx,
    • ucc,
    • LP,
    • poss cxr;
    • Rocephin 50 mg/kg;
    • d/c home if cxs neg;
    • f/u in 24 hr
  159. Fever (>39C), 3 mos - 3 yo
    • ucc (M <6 mo, F <2 yo);
    • poss cxr if sxs;
    • poss stool cx;
    • close f/u
  160. SIDS epidemiology
    • usu 2-4 mos old;
    • 90% are <60 mos;
    • 40% reduction since Back to Sleep;
    • 2-10% may be undx'd abuse
  161. most common site of intussusception
    ileocecal valve (pt of ileum into ascending colon)
  162. intussusception s/s
    • 6-9 mos;
    • abd pain,
    • n/v,
    • colicky,
    • drawing up legs,
    • currant jelly stools;
    • early: sausage-like abd mass;
    • in 48 hrs lethargy, tachyp, fever, hypotension
  163. intussusception dx/tx
    • cardiac monitor,
    • IVF,
    • CMP,
    • coag,
    • cbc,
    • T&C;
    • u/s or xray;
    • barium or air enema both dx/tx
  164. pneumothorax s/s
    • dyspnea, ipsilateral pleuritic CP;
    • tension PTX = hypotension, tracheal deviation, elevated JVP
  165. PTX tx
    needle or tube thoracostomy
  166. tension PTX tx
    needle decompression: 14-ga IV cath into 2nd intercostal space, midclav line
  167. PE EKG
    • S1 Q3 T3;
    • sinus tach, nonspecific TW changes;
    • RAD, new RBBB, TWI in v1-v4
  168. PE tx
    Heparin
  169. PE PE
    • tachy/tachy,
    • dyspnea,
    • pleuritic CP,
    • rales,
    • wheezes,
    • hemoptysis,
    • syncope,
    • anxiety,
    • loud P2,
    • S3/S4 gallop,
    • cyanosis
  170. Asthma tx
    • O2;
    • B2 agonists (neb or MDI);
    • poss neb anticholinergics,
    • steroids
  171. Typical pneumonia bugs
    SP, SA, H flu, PA
  172. Atypical pneumonia bugs
    mycoplasma, Chlamydia pneumo, Legionella
  173. pneumonia PE
    • tachy/tachy, febrile;
    • fremitus, dull to percussion, egophony, rales;
    • poss decreased breath sounds
  174. PORT scores predicts M&M for:
    Pneumonia
  175. CHF / pulmo edema tx
    • pt upright;
    • O2 / CPAP;
    • nitro;
    • lasix;
    • morphine;
    • pressors (dopamine, dobutamine)
  176. Hypertensive emergency etiology
    fibrinoid necrosis of small arteries causes end organ damage (heart, brain, kidneys, eyes)
  177. Hypertensive emergency definitions
    • crisis >180/110;
    • urgency DBP >130;
    • emergency is EOD;
    • malignant is papilledema
  178. Hypertensive emergency tx
    • nitroprusside (CI in PG) or labetolol;
    • to 110 over several hrs
  179. pericarditis PE
    • beck triad, fever, friction rub sitting/leaning forward (pain less);
    • pulsus paradoxus
  180. Roth spots
    small white spots on retina surrounded by hemorrhage
  181. Osler nodes
    tender lesions on finger/toes fat pads (= immune complex deposition)
  182. Janeway lesions
    painless red macular lesions on hands/feet
  183. infective endocarditis
    • Janeway/Osler/Roth;
    • Duke criteria to dx; Staph, strep, entero, HACEK;
    • EKG, blood cx;
    • tx w/nafcillin & gent
  184. DKA vs HHNS
    • HHNS: no ketosis/acidosis;
    • both: dehydration, hypotension
  185. DKA labs
    • glucose >250,
    • HCO3 <15,
    • pH<7.3
  186. HHNS labs
    • glu >600,
    • serum osmo >320;
    • prerenal azotemia
  187. DKA/HHNS tx
    • ABCs,
    • cards monitor,
    • pulse ox,
    • O2,
    • IV insulin
  188. thyroid storm
    • monitor,
    • cooling,
    • tx dehydration,
    • PTU,
    • dexamethasone
  189. myxedema coma testing
    • high TSH, low T4, low glucose/sodium /chloride;
    • CXR: pulmo edema, lg card silhouette;
    • EKG: brady, long PR, TWI
  190. adrenal crisis labs:
    • low Na,
    • high K+,
    • hypoglycemia
  191. sutures stay in for:
    • Face and Neck: 3–5 days;
    • Trunk: 7–10 days;
    • Upper extremities: 10–12 days;
    • Lower extremities: 12–16 days
  192. hypokalemia
    • areflexia, paralysis, ortho hypotension, ileus;
    • EKG: U waves, ST flattening, TWI, ST depression
  193. hyperkalemia
    • short QT, wide QRS, peaked TW;
    • bicarb; Ca CO3 / Ca gluconate;
    • IV insulin/glucose
  194. Rumack-Matthew nomogram assesses:
    APAP toxicity level
  195. ASA tox dx/tx
    • tachy, hyperpnea/resp alkalosis, metab acidosis, hyperthermia;
    • charcoal, IV urine alkalization, HD?
  196. cocaine tox tx
    • NO beta blockers;
    • tx w/benzos
  197. methanol / ethylene glycol toxicity tx
    • gastric lavage in 1st 2 hrs;
    • ethanol or 4-MP; HD if severe
  198. For general OD: coma cocktail =
    glucose, thiamine, naloxone, and O2
  199. ketosis without acidosis may be due to:
    isopropyl toxicity
  200. hot as a hare, dry as a bone, mad as a hatter, blind as a bat =
    • anticholinergic toxicity (benadryl, flexeril, atropine, cogentin);
    • tx with charcoal, poss physostigmine
  201. AMPLE
    • Allergy/Airway;
    • Medications;
    • PMH;
    • Last meal;
    • Event: what happened?
  202. What are some of the general guidelines in the treatment of hyphema
    • Shield eye (no patch),
    • bedrest (with b/r privileges),
    • elevate head of bed to 30 degrees,
    • topical atropine,
    • no aspirin/NSAIDs,
    • consider topical steroids,
    • monitor intraocular pressure
  203. What is the treatment for a corneal abrasion in a non-contact lens wearer
    • Erythromycin or Polytrim drops,
    • cycloplegic agent,
    • consider patch
  204. What is the treatment for a corneal abrasion in a contact lens wearer
    • Must cover pseudomonas (tobramycin ointment, fluoroquinolone drop),
    • cycloplegic agent,
    • consider patch
  205. What is the treatment for infectious keratitis
    Broad spectrum antibiotic drops
  206. What is the treatment for central retinal artery occlusion
    Although no treatment has been proven to improve outcome you can try, lowering IOP with topicals, Diamox, anterior chamber paracentesis
  207. The immediate treatment for angle closure glaucoma is to lower eye pressure, how is this done
    • Drops (timolol, dorzolamide, brimonidine),
    • oral agents (Diamox, isosorbide),
    • IV agents (mannitol),
    • hold pilocarpine until seen by an ophthalmologist
  208. What is the treatment of endophthalmitis
    Injection of intravitreal antibiotics or surgery ASAP
  209. What is the treatment for viral conjunctivitis
    • Supportive,
    • throw out contact lens/case/solution,
    • wash sheets/towels,
    • wash hands religiously
  210. Gonococcal conjunctivitis requires __ treatment
    Systemic
  211. Treatment for hordeolum/chalazion
    • Start conservatively,
    • warm compresses, e
    • rythromycin ointment,
    • consider I&D,
    • steroids sometimes injected to prevent recurrence
  212. Treatment of blepharitis
    • Warm compresses,
    • lid scrubs,
    • consider erythromycin ointment or doxycycline
  213. What is the treatment for periorbital cellulitis
    PO or IV antibiotics
  214. Treatment for stye (external hordeolum)
    • Warm wet compresses 4x day,
    • erythromycin ointment 2x/day for 7-10 days
  215. Treatment of viral conjunctivitis
    • Cool compresses 4x/day,
    • naphazoline/pheniramine drops for conjunctival congestion or itching.
    • Follow up in 7-14 days
  216. What is the initial empiric treatment for endophthalmos
    Vancomycin and ceftazidime
  217. What should be done in the case of orbital cellulitis
    • Emergent CT of the orbits and sinuses,
    • ophthalmologic consultation and admission for cefuroxime IV
  218. How should superficial conjunctival abrasions be treated
    • Erythromycin ointment 2x/day for 2-3 days,
    • ocular foreign body should be excluded
  219. What is the preferred topical ocular anesthetic used when assessing a corneal abrasion
    Proparacaine
  220. What is the treatment for a simple corneal abrasion
    • A cycloplegic (cyclopentolate, homatropine) for the pain,
    • and a topical antibiotic (tobramycin, erythromycin, bacitracin/polymyxin)
  221. What is the antibiotic treatment for a corneal abrasion for a person with contact lenses
    Should include coverage for pseudomonas (ofloxacin or ciprofloxacin)
  222. A hyphema should be dilated with __ to prevent pupillary movement from tearing damaged blood vessels
    Atropine 1%
  223. Treatment for ruptured globe
    • Call ophthalmologist immediately.
    • Metallic eye shield,
    • first gen cephalosporin,
    • antiemetic (prevent Valsalva),
    • tetanus update,
    • CT to look for foreign body.
  224. How long after the first 2L of irrigation fluid should you wait to check the pH in an eye that has suffered a chemical burn
    5-10 minutes
  225. What are some treatments used to reduce IOP
    • Timolol,
    • apraclonidine,
    • prednisolone
    • acetate drops
  226. What can you use to decrease pressure if the IOP is greater than 50 mmHg
    Acetazolamide IV
  227. What can you use to decrease IOP if it does not do so with first line agents after 1 hour
    Give 1-2g/kg mannitol IV
  228. Once IOP is below 40 mmHg in acute angle closure glaucoma, what can be given as long as the patient has an intact lens in place
    Pilocarpine drops
  229. What should be done if there is a strong suspicion of giant cell arteritis
    Pt should be admitted for methylprednisolone 250 mg IV every 6 hours
  230. What may be done if there is a low suspicion for giant cell arteritis
    Pt may be discharged with prednisone with close follow up
  231. sudden painless monoarticular vision loss =
    • central retinal (art or vein) occlusion;
    • CRAO: cherry red spots, h/o amaurosis fugax;
    • CRVO: cotton wool spots, retinal edema

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