Acute Mesenteric Ischemia History of atrial fibrillation “Pain out of proportion to exam” Bowel Obstruction History Abdominal pain Bloating/Distention Vomiting Decrease stool/flatus Exam Abdominal tenderness and distention If guarding/rigidity/rebound tenderness (aka peritonitis) Consider perforated bowel Testing Obtain CT abdomen with IV contrast Treatment Fluids NPO NG Tube Acute Diverticulitis NOTE: DiverticulOSIS is what causes GI […]

Hernia 3 classifications for hernia Reducible Able to be reduced (placed back into the abdomen) at bedside Incarcerated Cannot be reduced but not severely tender or erythematous Can occasionally cause bowel obstructions Strangulated Cannot be reduced but LOSING BLOOD SUPPLY Extremely tender and abnormal exam Needs emergent surgical consult Esophageal Varices Classic presentation Hematemesis/Melena Chronic […]

“Unstable” Arrhythmias Arrhythmias that cause Hypotension Pulmonary Edema Chest Pain Altered Mental Status Supraventricular Tachycardia (SVT) Stable Vagal maneuver Adenosine Beta blocker or calcium channel blocker Unstable SYNCHRONIZED cardioversion Monomorphic Ventricular Tachycardia (VT) Stable Amiodarone Procainamide Lidocaine Unstable SYNCHRONIZED cardioversion Pulseless Defibrillation Polymorphic Ventricular Tachycardia (aka Torsades de Pointes) Known complication of prolonged QTc Side […]

Corneal Abrasion Stain the eye with fluorescein and use woods lamp Look for fixed staining (“uptake”) on the cornea Acute Angle Closure Glaucoma Symptoms Eye Pain Headache Check for intraocular pressure greater than 20 Commonly precipitants OTC cough/cold medicine (anticholinergic effect) Dark environment (such as movie theater) Treatment Timolol Pilocarpine Acetazolamide Apraclonidine Giant Cell Arteritis […]

General Bite Wound Management Irrigate thoroughly Update tetanus LOW RISK bites get sutured High risk bites to cosmetic areas (face) get sutured AND antibiotics High risk bites to non-cosmetic areas are left open AND get antibiotics Rabies Give vaccine if… ANY suspicion for bat bite (bat in room, cave, etc) Bite by wild animal that […]

Febrile Seizures Simple (All features must be present) Age 6 months – 5 years Febrile Lasts less than 15 minutes Only one seizure in 24 hour period No focal neuro deficits on exam Generalized seizure (must have LOC) Treat with acetaminophen and reassurance Complex Does not meet ALL of the criteria for a simple febrile […]

Penetrating Abdominal Trauma Anything below the 4th intercostal space (nipple) is potentially an abdominal injury Gunshot wounds to the abdomen Needs immediate exploratory laparotomy Stab wounds to the abdomen Needs immediate exploratory laparotomy IF… Hemodynamically unstable Peritonitis on exam (rebound, rigidity, guarding) Organs hanging out of abdomen Blunt Abdominal Trauma If the patient is unstable […]

General Approach to a Test Question Read the last sentence of the question Read the answer choices THEN read the vignette Common Scenarios with Quick Answers Hypotensive patients Give a fluid bolus Altered mental status Check a blood glucose Hypoglycemia Orange juice if can swallow safely D50 if patient cannot swallow and mildly altered IM […]