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Blunt Neck Trauma

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981. Dopamine

Dopamine Dopamine Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Dopamine Dopamine Aka: Dopamine From Related Chapters II. Mechanism (...) Low dose (2-5 ug/kg/min) Increases splanchnic flow Increases coronary perfusion Increases cerebral flow Increases renal perfusion Previously recommended for oliguric No longer recommended due to lack of GFR effect Mid-dose (5-10 ug/kg/min) Direct effects Increases cardiac contractility No effect on No effect on Stimulates release Effect blunted if stores depleted High Dose (10-20 ug/kg/min) Increase in may be significant problem striction of renal and splanchnic beds Half life of Dopamine is short

2015 FP Notebook

982. Carvedilol

Carvedilol Carvedilol Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Carvedilol Carvedilol Aka: Carvedilol , Coreg From Related (...) Chapters II. Indication Stable (Compensated) III. Mechanism: Third generation Beta Blocker (vasodilatory properties) Antagonist Non-selective Vasodilator (alpha antagonist) Blunts sympathetic drive Preserves some heart function Does not affect IV. Dosing: Stable Congestive Heart Failure Start: 3.125 mg PO bid with food Titrate up by doubling dose every 2 weeks Maximum dose Weight <85 kg: 25 mg bid Weight >85 kg: 50 mg bid Conversion from prior No overlap from 50 mg or 50 mg Start Carvedilol 6.25 mg bid

2015 FP Notebook

983. Hypertension in Diabetes Mellitus

Hypertension in Diabetes Mellitus Hypertension in Diabetes Mellitus Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Hypertension (...) Mixed data on s s beneficial s beneficial s beneficial IV. Management: Medications First-Line Agents Increases (GFR) Decreases Angiotension II Receptor Blockers Alternative to s Second-Line Agents s (especially in ) Third-Line Agents s Now thought to be a viable option for control in Historically has been used only when other options have been exhausted Blunts hypoglycemic response (not seen in studies) Associated with increased weight gain and lipids less affected with s s s Other Medications Alpha

2015 FP Notebook

984. Plantar Wart

Plantar Wart Plantar Wart Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Plantar Wart Plantar Wart Aka: Plantar Wart , Verrucae (...) scarring For Plantar Warts, was no more effective than home therapy with pumice stone and salicylic acid XI. Management: Blunt surgical dissection Precautions Careful! Risk of painful scarring if too deep Do not enter on dissection More effective than electrosurgical techniques (ED&C) Efficacy: 90% cure rate Technique See After lesion removed consider agent Cover normal skin with Vaseline (petroleum jelly) Apply 88% Trichloroacetic acid References XII. Course Two thirds of Plantar Warts resolve by 2

2015 FP Notebook

985. Dermatographism

Dermatographism Dermatographism Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Dermatographism Dermatographism Aka: Dermatographism (...) , Dermatographia II. Causes s Third trimester of pregnancy Following treatment III. Pathophysiology Abnormal autonomic reflex response to allergen IV. Technique Stroke skin of back with blunt object ( blade) V. Interpretation Normal response: White line Faint pale line along stimulation path Abnormal response: Red line Mild: Bright red line with red mottling extension Exaggerated: with raised, edematous, pale skin Images: Related links to external sites (from Bing) These images are a random sampling from

2015 FP Notebook

986. Hemorrhagic Shock

Hemorrhagic Shock Hemorrhagic Shock Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Hemorrhagic Shock Hemorrhagic Shock Aka (...) mmHg or less with 120 bpm or higher Penetrating Injury Elevated serum Low VI. Causes (most common) Blunt Atraumatic Hemorrhage rupture (e.g. , , ) (e.g. , ) (e.g. , angiodysplasia, aortoenteric fistula) (e.g. , , ) VII. Causes: Hemorrhage Compartments (Mnemonic: "Blood on the floor, and 4 more") External sites and scalp Occult tic Hemorrhage sites (and ) and long bones VIII. History: Bleeding Source ( , ) Non- tic Sources Melana, maroon stool or IX. Symptoms ralized weakness or Confusion Lethargy X

2015 FP Notebook

987. Observed Affect

Observed Affect Observed Affect Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Observed Affect Observed Affect Aka: Observed Affect (...) , Affect Examination , Affect Exam , Stated Mood , Emotional Mood II. Definition Observed Affect Clinician's objective observation of a patient's emotional state Stated Mood Constant emotional state (depression, euphoria, anxiousness, anger, irritability) the patient can describe III. Exam: Affect Characteristics Emotional Range: Broad or Restricted Intensity: Expansive, Blunted/Flat or Normal Stability IV. Exam: Consistency Appropriate for situation? Congruence with Stated Mood Is Observed Affect

2015 FP Notebook

988. Narcotic Overdose

Narcotic Overdose Narcotic Overdose Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Narcotic Overdose Narcotic Overdose Aka: Narcotic (...) Typically follows reversal (unclear etiology) May require XII. Prevention: Prescribed Chronic Opioids Best prevention is to keep naive patients naive See Identify alternatives to s in Prescribe Home in case of for those on high dose s Keep equianalgesic doses in mind when administering parenteral s ( ) 1 mg is equivalent to up to 10 mg of caution when combining agents that blunt respiratory drive (e.g. s with s) s Muscle relaxants tolerance occurs before tolerance to respiratory depression tolerant

2015 FP Notebook

989. Lung Anatomy

Lung Anatomy Lung Anatomy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Lung Anatomy Lung Anatomy Aka: Lung Anatomy , Lung II (...) tree. Examples: There are only two instances, right lung and left lung. Definition (NCI_CDISC) One of a pair of viscera occupying the pulmonary cavities of the thorax, the organs of respiration in which aeration of the blood takes place. As a rule, the right lung is slightly larger than the left and is divided into three lobes (an upper, a middle, and a lower or basal), while the left has two lobes (an upper and a lower or basal). Each lung is irregularly conical in shape, presenting a blunt upper

2015 FP Notebook

990. Emergency Thoracotomy

Emergency Thoracotomy Emergency Thoracotomy Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Emergency Thoracotomy Emergency (...) Thoracotomy Aka: Emergency Thoracotomy II. Indications Unresponsive (BP < 70mmHg) despite and other stabilization Refractory to Unresponsive (BP < 70mmHg) May be considered in blunt , but worse outcomes III. Contraindications No signs of life in the field Lacking pupil response, respirations, extremity movement, cardiac eletrical activity Loss of s >5-10 minutes (>15 minutes in ) without cardiac activity or IV. Preparations (See ) with internal paddles Surgical instruments Scalpel and scissors retractor

2015 FP Notebook

991. Traumatic Cardiopulmonary Arrest

Traumatic Cardiopulmonary Arrest Traumatic Cardiopulmonary Arrest Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Traumatic (...) Cardiopulmonary Arrest Traumatic Cardiopulmonary Arrest Aka: Traumatic Cardiopulmonary Arrest , Traumatic Arrest , Cardiac Arrest Due to Trauma From Related Chapters II. Evaluation: Recognize pre-arrest changes Agonal respirations or apnea Weak pulses Decreasing mental status III. Precautions CPR should not interfere with acute life-threatening measures Unless medial was concurrent with or massive blood loss, CPR is unlikely to offer benefit CPR interferes with diagnostic , , Key initial diagnostics

2015 FP Notebook

992. Blast Injury

Blast Injury Blast Injury Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Blast Injury Blast Injury Aka: Blast Injury , Explosion (...) Deeper, serious injuries may exist despite relatively mild external wounds Treat all wounds as contaminated (avoid primary closure) Associated injuries Blunt s tic amputation VII. Adverse Effects: Tertiary Blast Injury Mechanism Blast victim is propelled by the blast force against another object May result in blunt or Associated Injuries s Joint dislocations tic amputations VIII. Adverse Effects: Quaternary Blast Injury Mechanism Environmental injuries and exposures related to the blast Associated

2015 FP Notebook

993. Muscle Weakness in Children

Muscle Weakness in Children Muscle Weakness in Children Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Muscle Weakness in Children (...) (Gowers Maneuver) VII. Symptoms Muscle cramps VIII. Signs: General Gross Motor Delay Delayed crawling or walking Decreased Decreased neck strength and ability to hold head upright (head lag) Decreased muscle tone (floppiness) Frequent falls Other findings variably present Fine motor delay Cognitive delay (see ) IX. Signs: Distinguishing central from peripheral cause Central Nervous System cause (e.g. ) Typically fixed deficits, with signs in neonatal period Increased es and Spastic gait Variable

2015 FP Notebook

994. Family Practice Notebook Updates

Family Practice Notebook Updates Family Practice Notebook Updates Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Family Practice (...) be used up to age 4 years old (rear facing until age 2 years) s should be used from age 4-8 years old (until height >=57 inches) Premature use of the adult - risks neck extension and flexion injuries, head injuries, s, (neuro, cv) Observe for mild changes (esp. facial droop which may be subtle) Patients may have severe symptoms (e.g. in posterior CVA), yet have a low NIH stroke score (neuro, , cv) Consider in any patient with or (even when transient) (surgery, pharm) allows for much safer regional

2015 FP Notebook

995. Mass Casualty Incident

Mass Casualty Incident Mass Casualty Incident Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Mass Casualty Incident Mass Casualty (...) Incident Aka: Mass Casualty Incident , Disaster Medical Management , Disaster Medical Preparedness , Field Trauma Assessment and Treatment , MARCH Field Trauma Protocol From Related Chapters II. Preparation Mobilize resources ral surgeons (as well as other surgeons such as OB/Gyn, Urology) Medical providers Set up a volunteer staging area and designate someone to facilitate the area Assign someone to obtain adequate supplies (e.g. bandages, splints) Clear potentially available beds ESI 4-5 patients may

2015 FP Notebook

996. Sternal Fracture

Sternal Fracture Sternal Fracture Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Sternal Fracture Sternal Fracture Aka: Sternal (...) Fracture , Fractured Sternum , Sternum Fracture II. Epidemiology Uncommon injury associated with Typical patient is an older male III. Causes (typically ) IV. Precautions Sternal Fracture is a marker of significant blunt force to the chest V. Imaging Poor for Sternal Fracture CT chest Sternal Fractures may be difficult to identify even on CT and requires careful inspection to detect VI. Labs First line study in all Sternal Fractures VII. Diagnostics (EKG) First line study in all Sternal Fractures

2015 FP Notebook

997. Spinal Cord Hemisection

Spinal Cord Hemisection Spinal Cord Hemisection Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Spinal Cord Hemisection Spinal Cord (...) Hemisection Aka: Spinal Cord Hemisection , Brown-Sequard Syndrome , Hemicord Syndrome , Hemiparaplegic Syndrome From Related Chapters II. Epidemiology Rare III. Pathophysiology Unilateral (hemi-cord) cord injury affecting the dorsal columns, and crosses to the contralateral side (giving the crossed effects) IV. Causes (most common) Blunt spinal cord injury Disc tion complication V. Signs Ipsilateral motor weakness Ipsilateral proprioception and vibratory sensation loss below the lesion Contralateral pain

2015 FP Notebook

998. Contusion

Contusion Contusion Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Contusion Contusion Aka: Contusion , Bruise , Soft Tissue Hematoma (...) , Subcutaneous Hematoma , Subepidermal Hemorrhage , Bruising II. Pathophysiology Blunt injury disrupts soft tissue (skin, muscle) capillaries and venules, resulting in into local interstitial tissue III. Risk Factors (e.g. Ehlers-Danlos Syndrome) s IV. Exam Do not blanch on pressure Contrast with a ( , ) which does blanch Compare with or which like a Contusion does not blanch Color (unreliable as an indicator of injury timing) Days 0-2: Swelling and tenderness Days 2-5: Red, blue or purple coloration Days 5

2015 FP Notebook

999. Musculoskeletal Injury

Musculoskeletal Injury Musculoskeletal Injury Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Musculoskeletal Injury Musculoskeletal (...) Injury Aka: Musculoskeletal Injury , Soft Tissue Injury II. Types: Soft Tissue Injury Injury to ligament or capsule ( ) Injury translated at musculotendinous junctions Blunt injury disrupts soft tissue (skin, muscle) capillaries and venules, resulting in into local interstitial tissue (children) Secondary ossification sites for tendon insertions, which may be injured with overuse prior to closure Examples (knee) (heel) III. Types: Fractures See See See (children) IV. Types: Nerve Injuries ral

2015 FP Notebook

1000. Fascia Iliaca Block

Fascia Iliaca Block Fascia Iliaca Block Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Fascia Iliaca Block Fascia Iliaca Block Aka (...) not insert deeply - just make a hole) Insert an 18 gauge blunt needle through this hole and insert straight down (or in-plane with probe) Slowly insert needle until a pop is heard or felt as the needle breaches the fascia lata plane Slowly insert needle until a second pop is heard or felt when the needle breaches the fascia iliaca can be used for localization, but it is not mandatory Aspirate to confirm not in vessel confirmation of position Inject an initial 1 to 2 ml anesthetic Anesthetic will track

2015 FP Notebook

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