Chapter 2 - Emergencies Flashcards Preview

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Flashcards in Chapter 2 - Emergencies Deck (21)
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1
Q

Areas involved by angioedema

A

Reticular dermis, SQ, submucosal layers of non-dependent areas

Non-pitting, non-pruritic, 24-96 hr (acute if <6 wk)

2
Q

Tests for hereditary angioedema

A

We C1 esterase inhibitor
C4

Recurrent angioedema also caused by ACEi.

3
Q

How Ludwig’s angina causes airway obstruction

A

FOM swelling —> tongue posterior

4
Q

Clinical Sign of IFS

A

Tissue lacks sensation

5
Q

When to convert cric to trach

A

Within 24 hours

6
Q

Bacteria causing Epiglottitis

A

H Flu, S Pyogenes (GABHS), S Pneumo, S Aureus

7
Q

Signs of epiglottitis

A

Kid: dyspnea, drool, stridor, fever

Adult: severe sore throat, odynophagia, hoarseness

Tripod!

8
Q

Diagnosis and Management of Epiglottitis

A

Lateral XR thumb print

Kids: DL in OR
Adults: may do fiberoptic nasal if stable
Intubate if distress, ICU observe if not
2/3 Ceph, humidified air, IV steroid, racemic epi

9
Q

Causes and Workup of Angioedema

A

Medication, foods, infxn, insect, latex, radiology contrast

Ask about laryngeal involvement (hoarse, voice change, odynophagia, stridor). May do Laryngoscopy. ICU if laryngeal involvement

10
Q

Treatment of angioedema

A
  • H1 and H2 anti-histamine
  • Steroids (if anaphylaxis, laryngeal edema, severe and unresponsive to anti-H
  • Epinephrine maybe

For Hereditary: Danazol prophy, FFP acutely

11
Q

MOE: Mortality, Bacteria

A

50-80% (near 100% if CN abnl, usually VII)

Pseudo (mucoid coat deters phagocytosis, neurotoxin)

If Ca/HIV: asperg, S Aureus, Proteus, Klebsiella, Candida

12
Q

Diagnosis of MOE

A
CT Temp (bone destruction)
Need 30-50% destroyed to show on CT
If NL but high suspicion: Bone scan or gallinium scintigraphy
13
Q

Treatment of MOE

A

Fluoroquin + Aminoglyc
Aural toilet, debride granulation tissue
HBO

14
Q

IFS Bacteria

A

Asperg
Zygomycetes (Rhizopus, Mucor, Rhizomucor)

Function as saprophytes in environment - pathologic in immunocomp host

15
Q

IFS Mortality and Tx

A

20-80%, worse if old, heme Ca, Brain/Eye involve

Culture-dir anti-fungal, debride, underlying dz

16
Q

Ludwig Angina: Site, Bugs, PE

A

Starts submandibular
Spreads sublingual, retrophar, pharyngomax

Poly: Staph/Strep, Bacteroides
Dental Infxn/Procedure

B/l SM swelling, elevated/protrude tongue

17
Q

Ludwig Angina: Workup, Tx

A

Airway!

Pen + Clinda/Flagyl

CT w contrast to determine if need surgery for abscess

18
Q

Causes of TI Fistula

A
Trach (1-2 wk later, more if tracheal infxn, steroids, anomalous, site usually cuff)
Mech Vent (long), neck tumor, tracheal surgery
19
Q

Can you do a jaw thrust if suspected cervical spine injury?

A

Yes

Also, must immobilize cervical spine when orotracheally intubating if suspected injury (may choose to do nasopharyngeal intubation)

20
Q

Describe needle cricothyroidotomy

A

12-14 g catheter into CTM
High flow O2 or jet insufflation
Lasts 30-45 min (bridge to trach/tube)

21
Q

Describe surgical cricothyroidotomy

A
Horizontal incision CTM
Dilate with hemostat
Insert ETT or trach tube
Convert w/in 24 hr
Not recommended if <12 yr

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