-
Burn epidemiology
- Adult: flame burns/clothing ignition
- kids: scalds
-
1st degree burns heal within:
3-6 days
-
Superficial 2nd degree
- d/t flame, scalding, chem;
- Edema; skin pink/ red, often blisters;
- hypersensitivity;
- healing 10-21 days
-
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
-
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
-
Laryngeal edema d/t smoke inhalation usually occurs:
- within 24 hours of the injury (but poss any time);
- intubate pre-emptively
-
Baseline labs:
- ABG
- CBC
- Electrolytes
- Glucose
- UA
- carbon monoxide level
- determine tetanus status
-
Pt's hand is ___% of BSA
1
-
BSA chest + abdomen
9 + 9 = 18%
-
-
BSA: arms
- 2 X 4.5 = 9% each arm
- 18% for both arms
-
BSA: lower extremities
- 2 x 9 = 18% each leg
- 36% both legs
-
Major burns: disposition
transfer to the nearest regional burn center
-
Definition of major burns
- Partial thickness >25% BSA
- Full thickness >10% BSA
- burns of the face, eyes, ears, hands, feet or perineum
-
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
-
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
-
Smoke inhalation
- 33% of pts admitted to burn ctr;
- d/t toxic damage to resp epithelium;
- inflammation/ necrosis
-
Most common cause of morbidity in smoke inhalation patients
Pneumonia
-
To dx smoke inhalation injury:
Fiberoptic bronchoscopy
-
Smoke inhalation injury: tx
- Humidified O2 (100% if CO tox);
- mucolytics;
- pulmonary physiotherapy;
- consider intubation;
- usu heal in 2-3 wks
-
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
-
Escharotomy/Fasciotomy may be needed for:
- Electrical burns;
- circumferential full-thickness burns;
- chest wall involvement impairing resp;
- compartment syndrome
-
Chemical burns
- Wash thoroughly, copious amounts water to decontaminate;
- get pH to 7.0 (litmus paper)
-
Alkali vs acid burns
Alkali cause more damage than acid
-
conjunctival pallor is due to:
severe ocular injury from alkali
-
Most common pathogens in burns:
S. Aureus and Pseudomonas (topical Abx prevent invasion)
-
Which topical antimicrobial agent has the ability to penetrate eschar?
Mafenide acetate
-
Topical Abx
- Ag NO3,
- Ag sulfadiazine;
- Mafenide acetate
-
If systemic Abx are indicated (discolored, erythema, edema, high temp):
Broad spectrum: PCN, ceph, macrolides
-
skin grafting is indicated for:
3rd degree and deep 2nd degree
-
Biologic dressings
Gold standard: Human allograft; also porcine xenografts, synthetics
-
MESS Score > ____ needs trauma center
>7
-
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
-
Hemodynamically Unstable Fx: if fx identified or suspected:
CT (+/- MRI)
-
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
-
Open fx Type I
- <1 cm, clean;
- minimal mx contusion;
- simple transverse/oblique fx
-
Open fx Type II
- Lac >1 cm;
- extensive tissue damage;
- min crushing
-
Open fx Type IIIA
extensive ST damage w/mx, skin, neurovasc
-
Open fx Type IIIB
ext ST damage with periosteal stripping & bone exposure
-
Open fx Type IIIC
High energy features with art damage
-
Septic joint/osteo: orgs: bone
Bone: GAS, S. aureus
-
Septic joint/osteo: orgs: joint
H. flu, GAS, E. coli, NG
-
Septic joint/osteo: sx
Fever, joint or bone pain, leukocytosis
-
Septic joint/osteo: Dx tests
- Bone scans localize osteomyelitis;
- Joint aspiration to identify organism
-
MS trauma complications
- Most common: Nerve compression, compartment syndrome, DVT, fx comps;
- Other: Rhabdomyolysis; Reflex Sympathetic Dystrophy; Myositis Ossificans
-
Fx complications
- Delayed union;
- nonunion;
- infxn;
- N/V injury
-
MS Imaging
- Plain films (at least 2 views);
- consider joints above/below injury;
- CT (bony);
- MRI (ST);
- nuc med (tumors);
- EMG/NCS
-
Trauma x-ray series
- Lateral C-Spine;
- PA Chest;
- AP Pelvis
-
____ are prone to avascular necrosis
Femoral neck fractures and hip dislocations
-
Injuries assoc w/arterial damage:
- Knee dislocations,
- displaced tibial plateau fx,
- floating joint,
- GSW or knife wounds,
- mangled extremity
-
Compartment syndrome: compartment pressure of ____ warrants decompression with fasciotomy
> 30 mm Hg
-
Time from amputation to replantation
- Warm ischemia: 6 hrs;
- Cold ischemia: 12 hrs;
- up to 30 hrs for digits
-
Septic joint/ Osteomyelitis Rx:
Parenteral Abx, I&D
-
MS injuries: plain films
- At least 2 views;
- Check entire film;
- Consider joint above & below injury
-
Nuclear med studies to:
define tumors, etc
-
Dislocations
- shoulder 95% ant;
- hip 90% posterior
-
Avulsion of the antero-inferior glenoid labrum =
Bankart lesion
-
Compression fx of posterior humeral head =
Hill-Sachs lesion
-
Shoulder dislocation: xray & reduction maneuvers (3):
- Rowe (opposite ear over head),
- Stimson (prone),
- Hippocratic (traction)
-
Shoulder xrays
- AP Grashey (30 deg),
- scap Y,
- axillary
-
Posterior fat pad is always:
Pathologic
-
Hand lac: close within:
8 hrs
-
Kanavel sx (fusiform swelling, tendon TTP, passive extension pain) =
- septic tenosynovitis (staph, strep);
- I&D, Abx;
- tetanus/rabies prn
-
High pressure injection injury: paint vs grease
- Paint: tissue necrosis;
- Grease causes fibrosis
-
Hip dislocation tx
Allis maneuver
-
Femur fx tx
- usually ORIF;
- femoral fx = closed reduction & Nail;
- femoral neck fx: Garden III & IV need prosthetic
-
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
-
Vertebral fx & child abuse
- spinous process avulsions > vertebral fractures;
- most are Asx; consequent neuro or kyphosis rare
-
Epiphyseal Separation
- True physeal injuries unusual in the abused child;
- result of violent traction or rotation;
- MRI or arthrogram may be needed for dx
-
planar fx through primary spongiosa =
Metaphyseal Corner fx
-
Monro-Kellie Doctrine:
Total intracranial volume is fixed
-
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
-
Trauma-induced alteration in mental status that may or may not involve a loss of consciousness =
Concussion
-
Concussion Grade I
No LOC, transient confusion
-
Concussion Grade II
No LOC, transient confusion; sx last longer (>15 min)
-
Concussion Grade III
LOC of any duration
-
Layers of SCALP:
- skin,
- connective tissue,
- aponeurosis,
- loose areolar tissue,
- pericranium
-
EDH s/s
- lucid interval in 30%;
- late: ipsilateral fixed/dilated pupil, contra hemiparesis
-
CPP =
MAP - ICP (cerebral perfusion P = mean art P - intracranial P)
-
SDH =
- venous blood btw dura & arachnoid;
- bridging v.;
- often 2/2 accel/decel,
- in EtOH/elderly
-
SDH acute vs chronic
- acute usu s/s in 24 hr;
- chronic >2 wks
-
On CT: concave density adjacent to skull, crosses suture lines =
SDH
-
On CT: biconvex density adj to skull, does not cross suture lines =
EDH
-
Cushing triad
- HTN,
- bradycardia,
- resp irregularity;
- 2/2 markedly elevated ICP
-
brain ischemia results from CPP less than:
40 mm Hg
-
GCS ≥ 13 =
mild brain injury
-
GCS 9-12 =
moderate brain injury
-
GCS ≤ 8 =
severe brain injury
-
-
GCS eye 2 =
to painful stimuli
-
GCS eye 3 =
to verbal command
-
GCS eye 4 =
Spontaneously
-
GCS verbal response 1 =
no response
-
GCS verbal response 2 =
incomprehensible sounds
-
GCS verbal response 3 =
inappropriate words
-
GCS verbal response 4 =
confused conversation
-
GCS verbal response 5 =
Oriented
-
GCS motor 1 =
no response
-
GCS motor 2 =
decerebrate posturing (arms & legs held straight out, toes pointed downward, & head & neck arched backwards)
-
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)
-
GCS motor 4 =
flexion withdrawal
-
GCS motor 5 =
localizes pain
-
GCS motor 6 =
obeys commands
-
Most sig cause of mortality in pts with TBI
- Diffuse axonal injury (DAI)
- Types of stroke
- ischemic (thrombotic, embolic 20%, hypoperfusion);
- hemorrhagic (intracerebral, subarachnoid)
-
Contralateral weakness (lower > upper), AMS, incontinence; likely source of stroke =
anterior cerebral artery
-
Contralateral weakness (face/arm > lower), contra sensory deficits, poss dysphasia; likely source of stroke =
MCA
-
Contralateral visual field deficits, AMS, cortical blindness; likely source of stroke =
posterior cerebral artery
-
vertigo/nystagmus, syncope, dysarthria, dysphagia, contralat pain/temp deficits; likely source of stroke =
vertebrobasilar arteries
-
stroke PE
neuro, CV (carotid bruit), EKG (A-fib, AMI/hypoperfusion)
-
meningitis PE
- fever,
- HA,
- photophobia,
- seizure;
- petechiae/purpura (60-80% of Neisseria pts),
- poss AMS,
- +Kernig & Brudzinski
-
Hunt-Hess scale grades severity of:
SAH (I = mild HA, stiff neck; V = coma)
-
SAH RFs
- HTN, s
- moking,
- cocaine,
- FH,
- prior SAH,
- PKD,
- CTD,
- coarctation
-
SAH tx
- control HTN (labetalol / nitroprusside);
- nimodipine for vasospasm;
- surg (resect / embolization)
-
Insect in ear canal
- kill with oil, alcohol, or lidocaine;
- remove w/microscopic forceps
-
Malignant OE, aka ___; who & what
- temporal bone osteomyelitis;
- immunocompromised (uncontrolled DM);
- pseudomonas
-
To dx/tx Malignant OE:
- non-contrasted CT temporal bone and/or bone scan;
- ENT consult and IV Abx
-
TM perf
- Usually posterior;
- get audiogram;
- non-ototoxic ear drops (Floxin, Ciprodex)
-
OM with effusion
- Chronic ETD;
- Acute OM;
- Barotrauma;
- sx hearing loss, ear fullness, tinnitus
-
Weber test
- If OM w/effusion, will lateralize towards effusion;
- if SNHL, will lateralize away from affected side
-
Barotrauma
- nasal steroids & time;
- audiogram to check for significant HL
-
Acute mastoiditis sx
- fever,
- otalgia,
- post auricular erythema,
- swelling,
- tenderness with protrusion of the auricle
-
Acute mastoiditis dx/tx
- CT scan to detn amount bone involvement;
- IV abx, ENT consult, admit for observation;
- often mastoidectomy
-
Bullous Myringitis
- very painful (esp if coughing/sneezing);
- caused by Big 3
-
Bullous Myringitis tx
- Abx (macrolide: Biaxin) & topical Abx if vesicles rupture;
- ST pain mgmt w/ opiate is acceptable
-
Bell palsy sx
- Abrupt onset upper & lower (ipsilateral) facial paresis/ paralysis,
- mastoid pain,
- hyperacusis,
- dry eyes,
- altered taste
-
SNHL tx
When in doubt, tx w/HD prednisone and REFER
-
SNHL sx
- No warning;
- often hear a pop;
- 30 dB loss in 3 frequencies;
- Needs MRI of IAC with contrast
-
Vertigo: lasts seconds, head movements, no hearing loss; Positive Dix-Hallpike maneuver
BPPV; tx with Epley maneuvers
-
Vertigo: episodic, lasts several hrs, associated HL (usu low freq/ unilateral), tinnitus, ear fullness
Ménière
-
Meniere tx
- Diuretics;
- Low Na diet;
- Anti-vertigo meds;
- Surgery (to prevent vertigo)
-
Vertigo: severe disabling vertigo lasts 1-2 days, gradual recovery
- V. Neuritis (semicircular canals only) or Labyrinthitis (vertigo & HL);
- tx steroids & PT
-
Sinusitis Emergencies
- Periorbital cellulitis;
- Brain Abscess;
- orbital abscess
-
Acute sinusitis: etiology
Big 3, SA
-
Extrusive luxations
Reposition tooth manually & splint into place ASAP
-
commonly associated with an alveolar bone fracture
Lateral luxations
-
Intrusive luxations
- Most serious;
- do not manipulate initially, allow it extrude itself or refer (orthodontist)
-
Post extraction alveolar osteitis, aka:
- dry socket;
- Plain films to R/O retained root tip
-
ANUG most assoc with:
- HIV and/or prior ulcerative gingivitis;
- life threatening if left untreated
-
ANUG tx
- Chlorhexidine rinses,
- debridement by oral surgeon or ENT,
- PO flagyl TID
-
Can be d/t hereditary C1 esterase inhibitor deficiency, allergic rxn, ACEI, or idiopathic
Angioedema
-
Tonsillitis tx
GP coverage: Amox, EES, Quinolones, Bactrim
-
Parapharyngeal Abscess sx
- Nuchal rigidity;
- Stridor;
- Sore Throat;
- Drooling
-
Acute viral laryngotracheitis, aka ___; sx/tx
- Croup;
- stridor,
- seal-like cough;
- Glucocorticoids,
- Nebulized epinephrine
-
Epiglottitis etiology
HIB, staph, strep
-
Epiglottitis sx
- Trismus,
- drooling,
- dysphagia;
- Lateral Neck X-Ray will show Thumb Sign
-
Airway Foreign bodies: surgical intervention:
rigid bronchoscopy
-
Mandible Dislocation sx
- Jaw pain,
- trismus,
- malocclusion;
- anterior dislocation is the most common;
- Can also have posterior, lateral, or superior dislocations
-
Mandibular fx tx
- Nondisplaced fx: closed reduction;
- Displaced or condylar fx: ORIF;
- Wire Osteosynthesis for 6 weeks
-
Nasal fx: Non-displaced fx:
do not require reduction
-
Temporal bone fx: complications
- hearing loss,
- facial paralysis,
- CSF leak,
- vertigo,
- TM perforation,
- nystagmus
-
Temporal bone fx: dx
- CT Temporal Bone, non-contrasted;
- ENT Consult
-
croup bugs
- parainfluenza 1&2,
- adenovirus,
- RSV
-
croup s/s
- afebrile, normal sats;
- retractions, tachypnea, audible stridor;
- steeple sx on neck xray
-
croup tx
- normal: neb mist, O2, poss neb epinephrine, steroids if stridor at rest;
- if upper airway obstruction, intubate (watch for post pulmo edema)
-
bronchiolitis
- paraflu, 100k hosps/yr;
- 2-6 mos old, winter-spring
-
bronchiolitis s/s
- tachypnea, fever, tachy, hypoxia, nasal flaring, retractions;
- rales, wheezes, long exp phase;
- xray hyperinflation, hypoxia on ABG
-
Fever (>38C), <28 days old
- Admit,
- blood cx,
- ucc,
- LP;
- poss cxr;
- IV amp/gent;
- NO ROCEPHIN d/t kernicterus risk
-
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
-
Fever (>39C), 3 mos - 3 yo
- ucc (M <6 mo, F <2 yo);
- poss cxr if sxs;
- poss stool cx;
- close f/u
-
SIDS epidemiology
- usu 2-4 mos old;
- 90% are <60 mos;
- 40% reduction since Back to Sleep;
- 2-10% may be undx'd abuse
-
most common site of intussusception
ileocecal valve (pt of ileum into ascending colon)
-
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
-
intussusception dx/tx
- cardiac monitor,
- IVF,
- CMP,
- coag,
- cbc,
- T&C;
- u/s or xray;
- barium or air enema both dx/tx
-
pneumothorax s/s
- dyspnea, ipsilateral pleuritic CP;
- tension PTX = hypotension, tracheal deviation, elevated JVP
-
PTX tx
needle or tube thoracostomy
-
tension PTX tx
needle decompression: 14-ga IV cath into 2nd intercostal space, midclav line
-
PE EKG
- S1 Q3 T3;
- sinus tach, nonspecific TW changes;
- RAD, new RBBB, TWI in v1-v4
-
-
PE PE
- tachy/tachy,
- dyspnea,
- pleuritic CP,
- rales,
- wheezes,
- hemoptysis,
- syncope,
- anxiety,
- loud P2,
- S3/S4 gallop,
- cyanosis
-
Asthma tx
- O2;
- B2 agonists (neb or MDI);
- poss neb anticholinergics,
- steroids
-
Typical pneumonia bugs
SP, SA, H flu, PA
-
Atypical pneumonia bugs
mycoplasma, Chlamydia pneumo, Legionella
-
pneumonia PE
- tachy/tachy, febrile;
- fremitus, dull to percussion, egophony, rales;
- poss decreased breath sounds
-
PORT scores predicts M&M for:
Pneumonia
-
CHF / pulmo edema tx
- pt upright;
- O2 / CPAP;
- nitro;
- lasix;
- morphine;
- pressors (dopamine, dobutamine)
-
Hypertensive emergency etiology
fibrinoid necrosis of small arteries causes end organ damage (heart, brain, kidneys, eyes)
-
Hypertensive emergency definitions
- crisis >180/110;
- urgency DBP >130;
- emergency is EOD;
- malignant is papilledema
-
Hypertensive emergency tx
- nitroprusside (CI in PG) or labetolol;
- to 110 over several hrs
-
pericarditis PE
- beck triad, fever, friction rub sitting/leaning forward (pain less);
- pulsus paradoxus
-
Roth spots
small white spots on retina surrounded by hemorrhage
-
Osler nodes
tender lesions on finger/toes fat pads (= immune complex deposition)
-
Janeway lesions
painless red macular lesions on hands/feet
-
infective endocarditis
- Janeway/Osler/Roth;
- Duke criteria to dx; Staph, strep, entero, HACEK;
- EKG, blood cx;
- tx w/nafcillin & gent
-
DKA vs HHNS
- HHNS: no ketosis/acidosis;
- both: dehydration, hypotension
-
DKA labs
- glucose >250,
- HCO3 <15,
- pH<7.3
-
HHNS labs
- glu >600,
- serum osmo >320;
- prerenal azotemia
-
DKA/HHNS tx
- ABCs,
- cards monitor,
- pulse ox,
- O2,
- IV insulin
-
thyroid storm
- monitor,
- cooling,
- tx dehydration,
- PTU,
- dexamethasone
-
myxedema coma testing
- high TSH, low T4, low glucose/sodium /chloride;
- CXR: pulmo edema, lg card silhouette;
- EKG: brady, long PR, TWI
-
adrenal crisis labs:
- low Na,
- high K+,
- hypoglycemia
-
sutures stay in for:
- Face and Neck: 3–5 days;
- Trunk: 7–10 days;
- Upper extremities: 10–12 days;
- Lower extremities: 12–16 days
-
hypokalemia
- areflexia, paralysis, ortho hypotension, ileus;
- EKG: U waves, ST flattening, TWI, ST depression
-
hyperkalemia
- short QT, wide QRS, peaked TW;
- bicarb; Ca CO3 / Ca gluconate;
- IV insulin/glucose
-
Rumack-Matthew nomogram assesses:
APAP toxicity level
-
ASA tox dx/tx
- tachy, hyperpnea/resp alkalosis, metab acidosis, hyperthermia;
- charcoal, IV urine alkalization, HD?
-
cocaine tox tx
- NO beta blockers;
- tx w/benzos
-
methanol / ethylene glycol toxicity tx
- gastric lavage in 1st 2 hrs;
- ethanol or 4-MP; HD if severe
-
For general OD: coma cocktail =
glucose, thiamine, naloxone, and O2
-
ketosis without acidosis may be due to:
isopropyl toxicity
-
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
-
AMPLE
- Allergy/Airway;
- Medications;
- PMH;
- Last meal;
- Event: what happened?
-
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
-
What is the treatment for a corneal abrasion in a non-contact lens wearer
- Erythromycin or Polytrim drops,
- cycloplegic agent,
- consider patch
-
What is the treatment for a corneal abrasion in a contact lens wearer
- Must cover pseudomonas (tobramycin ointment, fluoroquinolone drop),
- cycloplegic agent,
- consider patch
-
What is the treatment for infectious keratitis
Broad spectrum antibiotic drops
-
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
-
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
-
What is the treatment of endophthalmitis
Injection of intravitreal antibiotics or surgery ASAP
-
What is the treatment for viral conjunctivitis
- Supportive,
- throw out contact lens/case/solution,
- wash sheets/towels,
- wash hands religiously
-
Gonococcal conjunctivitis requires __ treatment
Systemic
-
Treatment for hordeolum/chalazion
- Start conservatively,
- warm compresses, e
- rythromycin ointment,
- consider I&D,
- steroids sometimes injected to prevent recurrence
-
Treatment of blepharitis
- Warm compresses,
- lid scrubs,
- consider erythromycin ointment or doxycycline
-
What is the treatment for periorbital cellulitis
PO or IV antibiotics
-
Treatment for stye (external hordeolum)
- Warm wet compresses 4x day,
- erythromycin ointment 2x/day for 7-10 days
-
Treatment of viral conjunctivitis
- Cool compresses 4x/day,
- naphazoline/pheniramine drops for conjunctival congestion or itching.
- Follow up in 7-14 days
-
What is the initial empiric treatment for endophthalmos
Vancomycin and ceftazidime
-
What should be done in the case of orbital cellulitis
- Emergent CT of the orbits and sinuses,
- ophthalmologic consultation and admission for cefuroxime IV
-
How should superficial conjunctival abrasions be treated
- Erythromycin ointment 2x/day for 2-3 days,
- ocular foreign body should be excluded
-
What is the preferred topical ocular anesthetic used when assessing a corneal abrasion
Proparacaine
-
What is the treatment for a simple corneal abrasion
- A cycloplegic (cyclopentolate, homatropine) for the pain,
- and a topical antibiotic (tobramycin, erythromycin, bacitracin/polymyxin)
-
What is the antibiotic treatment for a corneal abrasion for a person with contact lenses
Should include coverage for pseudomonas (ofloxacin or ciprofloxacin)
-
A hyphema should be dilated with __ to prevent pupillary movement from tearing damaged blood vessels
Atropine 1%
-
Treatment for ruptured globe
- Call ophthalmologist immediately.
- Metallic eye shield,
- first gen cephalosporin,
- antiemetic (prevent Valsalva),
- tetanus update,
- CT to look for foreign body.
-
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
-
What are some treatments used to reduce IOP
- Timolol,
- apraclonidine,
- prednisolone
- acetate drops
-
What can you use to decrease pressure if the IOP is greater than 50 mmHg
Acetazolamide IV
-
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
-
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
-
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
-
What may be done if there is a low suspicion for giant cell arteritis
Pt may be discharged with prednisone with close follow up
-
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
|
|