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What are the abcde's of life treatening conditions in primary survey?
- Airway (with cervical spine contol) breathing circulation disability (quick neurologic check using AVPU alert, visual stimuli esposure, responds to pain, unresponsive)
- Exposure ( remove all clothing)
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After a primary survey in a trauma case what is the next step?
Head to toe examination, head ct and lumbar ct
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What is first step in extremity injury?
Assesment of neurovascular
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How many of units of blood can be lost in a tibia fracture?
1.5 units
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Define compartment syndrome
Occurs when interstitial pressure rises above capillary bed
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What pressure for compartment syndrome is diagnostic?
30mmHg
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How long do amputated parts remain viable?
4-6 hrs at room temperature or 18 hrs if cooled
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What are contraindications to closed reduction?
No displacement, no reduction is possible due to comminution, open fracture,
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Indications for ooen reduction?
Articular surface involvement
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What is the most common fracture of forefoot?
Distal phalanx of hallux
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Pressure caused by hematoma can damage the nail matrix if not relieved within how long?
6-12 hrs, if more than 25% of nail plate is involved avulsion of nail should be considered.
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What is the most common lesser digit fracture?
5th digit due to night walking
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Wha tis conservative tx for sesamoid fx?
NWB 4-6 wks
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Jahss classification of 1st MTPJ dislocation
All have dorsal dislocation of proximal phalanx and sesamoids with 1. Intersesamoidal ligament intact. Hyperextention. 2A. Rupture of intersesamoidal ligament. 2B. Transverse fx of one of sesamoids. 2C. Complete disruption of intersesamoidal ligament and transverse fx of both sesamoid.
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What is important to consider with metatarsal fractures?
sagital plane deformity in order to prevent subsequent metatarsalgia
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Virchows triad
Stasis ( arrhythmias, MI, CHF, heart failure, immobilization), blood vessel injury), hypercoagulability
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Toe pressures in diabetics associated with healing wounds?
>55mmhg = healing , 45-55mmhg = range of uncertainty, <45mmhg = no wound healing
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ABI breakdown
.5-.8 IC, <.5 is associated with rest pain and ulcers
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Which antifungal uses pulse dosing starting with 200 mg x 1 week, then 3 weeks off. 3 pulses for nails, 2 for finger nails
Itraconazole
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What is augmentin?
Amoxacillin/clavulonic acit
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What is unacyn?
Ampicillin/sulbactam
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What is zosyn?
Piperacillin/tazobactam
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What is rocephin?
Cephtriaxone
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Which drug is nicknamed gorillamycin?
Imipenem because it has the broadest spectrum
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What is dosing for unasyn?
3.0 g IV q 6, 1.5g IV q6 for renal impairment
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When is unasyn used?
Polymicrobial infection
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What is an alternative to unasyn for a patient with PCN allergy?
Cipro/clinda, levaquin
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Does unasyn work against pseudomonas?
No
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What is the dosing for augmentin?
500 or 875 mg one tab po bid
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How much clavulonic acid is in augmentin 500?
125 mg
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When is zosyn used?
Infections of skin and skin structured
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Dosing for zosyn?
3.375 g IV q 4-6, renal dosing 2.25 g IV q 4-6
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What to watch out for ticaricillin?
Increased Na+ load
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What is the doc for diabetic foot infection for someone with penicillin allergy?
Clindamycin
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Which penicillins are not excreted renally?
Mezlocillin,azlocillin,piperacillin
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Name 4 alternative IV antibiotics for PCN allergic pts?
Clindamycin,levaquin,vanco,bactrim
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What PCN are antipseudomonal?
The fourth and fifth generation PCN, ticarcillin,timentin,piperacillin,zosyn,carbenicillin,mezlocillin,azlocillin
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Percent cross sensitivities between cephalosporins and PCN?
1-5%
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Are cephalosporins contraindicated for pt with PCN allergy?
Only if pt has anaphlactic response, if had stomach ache will give, if had rash no only if pt has taken without issue.
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Which cephalosporins are not excreted by kidneys?
Ceftriaxone and cefoperazone
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