Management of Large Subungual Hematoma
Drainage (18-Gauge) or Hot Micro-Cauterization
Reason to Avoid Suction in Ear Foreign Body
... [Show More] Removal
Perforation of Tympanic Membrane
Management of Skin Abscess
Linear Incision for Non-Face vs. Needle Drainage for Face
Catheter for Bartholin Cyst
Word
Grading of Laryngeal Opening
Cormack-Lehane
Preferred Induction Agent in Reactive Airway Disease for Dilation Effects
Ketamine
Induction Agent Avoided in Sepsis Due To Adrenal Suppression
Etomidate
Sudden-Onset Back Pain Worsened by Coughing Soon After Epidural Anesthesia
Epidural Hematoma
Presentation of Adhesive Arachnoiditis
Progressive Neuropathy
Tom, Dick, and Very Nervous Harry
Anterior to Posterior of Medial Ankle: Tibialis Posterior, Digitorum Longus, Vein, Nerve, Hallucis Longus
Absolute Contra-Indication to Crico-Thyrotomy
Age Under 5
Anesthesia for Suturing D.I.P. of Finger in Patient with Underlying Vascular Disease
Lidocaine (2%) Without Epinephrine Around Digital Nerve for Fingers, Toes, Penis, Nose
Earliest Sign of Lidocaine Toxicity (Over 5 mg/kg)
Lightheadedness (Also Peri-Oral Numbness, Tinnitus, Visual and Auditory Disturbances, Shivering, Twitching, and Generalized Tonic-Clonic Seizures)
(1) Avoid Vertical Mattress Sutures.
(2) Avoid Topical Skin Adhesives (Risk of Dehiscence from Sweating).
Palm
Glottis Spasm and Chest Wall Rigidity from Sedative (Rapid High Dose of IV Form)
Fentanyl (Effects Not Always Reversed by Naloxone)
Management of Long-Lasting L.P. Headache
Autologous Blood Patch
Timing of Tetanus Prophylaxis
Within First Few Days (Suture Within First 24 Hours)
Normal C.S.F.-to-Blood Glucose Ratio
0.6
Size of Needle Decompression Needle
14 Gauge (2nd Intercostal at Midclavicular Line)
Large Paronychia and Cellulitis
Removal of Affected Nail Under Digital Block; Start Antibiotics
Signs of Acute Appendicitis
1. Rovsing: Right Lower from Left Lower.
2. Psoas: Extension.
3. Obturator: Rotation.
Suggested by Abdominal Pain Preceding Nausea and Vomiting
Surgery (Small Bowel Obstruction)
Peak of Gastric Acid Secretion at Rest
2 A.M.
Timing of Presentation of Hypertrophic Pyloric Stenosis (Non-Bilious) vs. Intussusception (Bilious)
4 Weeks vs. 8 Months
Over 95% Sensitive and Specific for Renal Stones
Helical C.T.
Intermittent Left Lower Quadrant Pain (Afebrile), Loose Stools (Non-Bloody); Good Follow-Up
Discharge on High-Fiber Diet (Consider Laxatives and Stool Softeners)
Abdominal Wall Condition in Anti-Coagulated Patient with Trauma or Coughing
Rectus Sheath Hematoma
(1) Age 30.
(2) Prior Abdominal Surgery or Pregnancy.
(3) Marathons.
Risk Factors for Cecal (Cross-Country) Volvulus
Possible Chest X-Ray Finding of Hepatic Abscess
Right-Sided Effusion and Elevated Hemi-Diaphragm
Referred Pain from Ureteral Colic
Inguinal (Ovarian Torsion Does Not Cause Sacral Pain)
Elderly Patient, Diverticulitis Without Perforation (Without Peritonitis)
I.V. Fluids (Elderly), Antibiotics, and Bowel Rest (Peritonitis Requires Surgery)
Proximal vs. Distal Esophageal Perforation
Iatrogenic vs. Spontaneous
Rigidity; Elevated Temperatures, Altered Mental Status, Choreo-Athetosis, Autonomic Dysfunction (Diaphoresis, Incontinence, Arrhythmia)
Dantrolene (Or Bromocriptine, Amantadine, Lorazepam) for Neuroleptic Malignant Syndrome
Indicated by Temperature Over 105
Non-Infectious
Extra-Pyramidal: Involuntary Periodic Movements of Tongue, Lips, or Mouth
Tardive Dyskinesia
Extra-Pyramidal: Torticollis, Fixed Upper Gaze (Oculogyric Crisis), or Arching of Back (Opisthotonus)
Benztropine (2mg Cogentin) or Benadryl (25mg) for Dystonia from Typical Anti-Psychotics
Extra-Pyramidal: Restlessness
Beta-Blocker for Akathisia
E.C.G. Finding of Haloperidol Toxicity
Long Q.T.
Illicit Drug Causing Vertical Nystagmus
Phencyclidine (PCP)
Controls Agitation Without Respiratory Depression (Negligible Anticholinergic Side Effects)
Haloperidol (5mg IM q30); B-52 is Benadryl (50 Milligrams), 5 Milligrams of Haloperidol, and 2 Milligrams of Lorazepam
Risk of Protracted Struggle in Restraints
Metabolic Acidosis
Risk of Flumazenil in Chronic Benzodiazepine User
Withdrawal Seizures
Altered Chronic Alcoholic, Non-Gap Metabolic Acidosis
Isopropyl Alcohol
Glucose and Magnesium Recommendations for Altered Alcoholic
1. Thiamine Before Glucose; and,
2. Give Magnesium Regardless of Magnesium Level (Low Stores).
Waxing and Waning Global Inability to Relate to Environment and Process Sensory Input (Increased Alertness and Psychomotor Activity)
Delirium
Most Common Dementia
Alzheimer More Common Than Vascular Dementia
Management of Seizures in Eclampsia
Magnesium; Consider Labetalol or Hydralazine for Diastolic Over 110 After Seizure Stops
Relationship Between Alcohol and Seizures
Direct Toxicity vs. Withdrawal vs. Head Injury from Fall
Most Common Cause of Delirium in Elderly
Medications
Tooth Fracture of Enamel and Dentin, Yellowish Tinge, No Blood
Ellis 2 Dental Fracture Requires Consultation to Prevent Abscess Formation
Obvious Nasal Bone Deformity After Blunt Trauma, Bleeding Controlled by Pressure; No Bone Tenderness, Cranial Nerves Intact; Swollen and Bruised Tender Unilateral Septum
Incision and Drainage of Septal Hematoma Followed by Nasal Packing
Eye Blunt Trauma; Pain, Double Vision from Upward Gaze
Entrapment of Inferior Rectus from Inferior Orbital Wall Fracture
Head Blunt Trauma, Loss of Consciousness, Currently Seizing; Previous Confusion, Vomiting, and Headache
R.S.I. with Paralytic (Before Addressing Intracranial Pressure)
Tension Pneumo-Thorax; Hemodynamically Unstable
Needle in 2nd Intercostal Mid-Clavicular (Anterior) or 4th Intercostal Mid-Axillary (Lateral), Before X-Ray (Chest Tube Takes Too Long)
Most Sensitive Bedside Test for Finger Nerve Injury
Two-Point Discrimination
O'Riain Test
Wrinkling of Digit in Warm Water Indicates Intact Nerve
Ottawa Ankle Rules (Any Positive Requires X-Ray) for Pain in Malleolar Zone
1. Inability to Walk 4 Steps At Time of Injury and Currently.
2. Tenderness Over Posterior Edge of Either Malleolus.
3. Tenderness Over Navicular or Base of 5th Metatarsal.
Suspected Globe Rupture (Enophthalmos and Leakage of Vitreous Humor)
Broad-Spectrum Antibiotics (Tetanus If Necessary); Visual Acuity Assessment Before Consultation (Avoid Pressure Tonometry)
Trauma; Unilateral Eye Pain with Extra-Ocular Movement, Proptosis, Decreased Visual Acuity
Lateral Canthotomy for Retro-Bulbar Hematoma
Blunt Trauma; Unilateral Epistaxis (Maxillary), Subcutaneous Emphysema, or Anesthesia of Ipsilateral Infra-Orbital Region (V2)
Orbital Blowout Fracture (No Proptosis)
Anterior Chamber Meniscus
Hyphema (Blood) vs. Hypopion (Pus)
Management of Subconjunctival Hemorrhage
Resolves Without Intervention
Gravid Female, Pulseless and Apneic for 2 Minutes; Detectable Fetal Heart Tones
Emergency C-Section (More Viable Than Gravid GSW with Undetectable Fetal Heart Tones)
Elderly Extension Injury; Decreased Bilateral Grip Strength
Steroids and Cervical M.R.I. for Central Cord Syndrome (Contusion from Buckling of Ligamentum Flavum)
Affected by L.X.-L.Y. Herniation
Y
(1) Jefferson Fracture of C1 (Image).
(2) Hangman Fracture of C2.
(3) Flexion Teardrop Fracture.
(4) Bilateral Facet Dislocation.
Unstable Fractures
Penetrating Trauma to Zone 1 (Sternal Notch to Cricoid Cartilage)
Angiography (4-Vessel CT), Triple Endoscopy, and Observation
Management of Hemodynamically-Stable Liver Laceration from Trauma
Conservative Management; No Emergency Laparotomy
Trauma Patient with Bloody Foley
C.T. with I.V. and Trans-Urethral Contrast
Chest G.S.W., Unconscious and Pulseless, Systolic of 60
Emergency Thoracotomy (Lower Success Rates for Blunt Trauma)
In Breast, Out Axilla; Hemodynamically-Stable and Clear Breath Sounds Bilaterally; I.V. Access Obtained
(1) Bedside Ultrasound.
(2) Intubation and Chest Tube.
(3) Portable X-Ray; and,
(4) Admit to I.C.U.
Stab Wound in 10th Intercostal Space, Absent Breath Sounds; Dyspnea But Hemodynamically-Stable
(1) Chest Tube.
(2) Portable X-Ray.
(3) Abdominal C.T.
Decreased Sensation Over Lateral Palm
Median Nerve Injury from Distal Radius Fracture
Leg Externally-Rotated (And Abducted)
Femoral Neck Fracture (ER = RE)
Leg Internally-Rotated
Posterior Hip Dislocation
Popliteal Pain After Impact on Planted Foot; Pale Cold Foot, No Distal Pulses
Sedate and Reduce Without X-Rays
Eikenella
Aggressive Mouth Flora Requiring Prophylactic Lactam-Lactamase After Human Bite
Definitively Determines Entry and Exit Points
Forensic Specialist (Emergency Department Must Describe Wounds But Never Speculate)
Small Pneumo-Thorax on Chest C.T.; Hemodynamically-Stable
100% Oxygen
Flexion and Compression of Vertebral Body, Resulting in Paralysis and Loss of Pain and Temperature Sensation Below
Anterior Cord from Anterior Spinal Artery Injury (From Anterior Flexion)
Severe Burns of Hands (Or Skull) and Heels; Risk of Cardiac Arrest or Loss of Consciousness
Deep Burns Distinguish Electrical Injury from Lightning
Hepatitis C Medication With Risk of Depression
S.S.R.I. Pretreatment for Interferon Alpha
Psychiatric Risk Associated with Breast Implants
Suicide
SAD PERSONS
1. Male (Caucasian).
2. Age Under 20 or Over 50.
3. Depression.
4. Previous Attempt.
5. Ethanol or Drugs.
6. Rational Thought Loss (Psychosis).
7. Social Support Issues.
8. Organized Plan.
9. No Spouse or Significant Other (1 Point, All Others 2 Points).
10. Sickness or Injury. [Show Less]