why is it important to drain an auricular hematoma?
may scar up and result in cauliflower ear if untreated
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which nerve supplies sensation to the upper portion of the ear? lower portion?
upper: auriculotemporal nerve lower: great auricular nerve
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what procedures should you do after evacuating/draining the auricular hematoma?
place bolsters with through-and-through sutures then abx ointment
- bolster dressing needs to be on for 4-8 days - 1 week of suture if they aren't participating in the tournament
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what factors can make removal of an ear foreign body more difficult?
- location in medial half of canal - ungraspable or large object - uncooperative patient - no space to insert instruments - blood or edema in the ear
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what do you need to approximate when repairing an ear laceration?
skin only - trim away cartilage if needed and sew the skin loosely for swelling and draining
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bleeding from where always bleeds anteriorly and can be resolved with pressure or spontaneously
kiesselbach's plexus
- anterior septum is most common site of epistaxis
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in epistaxis, which affected artery can result in patient bleeding anteriorly and/or posteriorly and is not resolved with just pressure?
anterior ethmoid artery - treated w/ packing and time
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bleeding from sphenopalatine artery always bleeds __ first, and it bleeds profusely and always requires tx
posteriorly
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what would be your next treatment option of anterior nasal bleeding after pressure, humidity, and nasal saline?
cauterization with silver nitrate stick
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can you use nasal clamp during epistaxis?
NO! it can cause pressure necrosis on the external nose
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why is it necessary to place patients on prophylactic abx when using nasal packing?
to prevent TSS and sinusitis
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Unilateral nasal drainage and a foul smell indicates what
FB
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what is the MC complication of septal hematoma if it becomes infected?
perforation
- nose cartilage has no blood supply, which can lead to a perforation
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patient presents with severe unilateral sore throat, on exam LNs are inflamed and uvula is pointed away from the side of the swollen tonsil. what do you suspect?
peritonsillar abscess
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how do you tx peritonsillar abscess?
I&D and place on 5-10 days of PO ATBs (GAS coverage)
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(T/F) when draining PTA, you can only numb the surface by applying topical xylocaine, you can't numb the whole pocket of fluid
true
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laceration repair for hard palate and gums
dont do anything, leave alone
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laceration repair for soft palate
needs general anesthetic
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is high riding prostate on DRE a contraindication for urinary cath?
yes
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what diagnostic test should you do prior to Cath placement?
retrograde urethrogram (RUG) to see potential urethral injury
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complications of urinary cath
- urethral strictures/dilatation - structural trauma - bladder stones formation on the cath balloon - hematuria - knotted catheter - UTI
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what type of catheter is for difficult cath placement and can avoid false passage?
caude catheter
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what type of catheter is for bladder irrigation?
three way catheter
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what's the average foley size for adults?
16 Fr.
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examples of male anatomy that won't allow you to pass catheter
CSF collection: first tube - second tube - third tube - fourth tube -
1: cell count 2: glucose and protein 3: gram stain and culture and sensitivity (C&S) 4: cell count & diff
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Max dose and max daily dose of acetaminophen in adults
Max dose - 1000mg every 4 hours Max daily - 4000mg
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Max dose and max daily dose of acetaminophen in peds
Max dose - 15mg/kg every 4 hours (max 1000mg) Max daily - 75mg/kg/d
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how many mg/tsp in peds for APAP
160mg/tsp
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Max dose and max daily dose of ibuprofen in adults
Max dose - 800mg every 6 hours (sometimes 600mg) Max daily - 3200mg
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Max dose and max daily dose of ibuprofen in peds
Max dose - 10mg/kg every 6 hours (max 600mg) Max daily - 40mg/kg/d
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how many mg/tsp in peds for ibuprofen
100mg/tsp
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How many mL in a teaspoon?
5 mL
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1st line tx of MRSA after I&D of abscess
Bactrim and doxy
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1st line tx of MRSA for parental inpatient after I&D of abscess
vancomycin
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abx for known MSSA after I&D of abscess
keflex - problem is QID dosing :(
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contraindications of subungal trephination
- Crushed or fractured nails - Fracture of the tuft (distal phalanx) - Suspected melanoma - Artificial acrylic nails
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what gauge needle is used for a subungal trephination
18g
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if there's no significant relief of pain when the drainage of subungal trephination begins, what should you suspect?
underlying injury/fx
- if fx while draining, apply aluminum splint and f/u
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what type and size of suture is used for repair of nail bed injuries?
6-0 absorbable suture (vicryl)
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Onychocryptosis- Onychogryphosis-
ingrown nail curved nail
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what type of chemical can be used to ablate an ingrown nail? who is it contraindicated in?
- phenol solution (reduce risk of recurrent problems) - contraindicated in pregnancy
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during the ablation of ingrown nail, what is used to reduce bleeding?
silver nitrate
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risk factors of Paronychia
- poor manicure technique - Nail biting - Thumbsucking - DM - Occupational- hands soaking in water - Antiretroviral therapy in HIV Tx
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Paronychia Treatment for oral exposure (Eikenella)
DOC: Augmentin
or
doxy/bactrim PLUS metronidazole (flagyl)/clindamycin
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Paronychia Treatment for non-oral exposure
bactrim for MRSA keflex (cephalexin) for MSSA
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which fingers are MC affected in felon?
thumb and index
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Flexor Tenosynovitis is a true hand emergency, how is it typically caused? MC organism?
- penetrating injury - staph
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four cardinal signs of flexor tenosynovitis on PE (Kanaval signs)
1. Fusiform swelling of the entire digit (sausage digit) 2. Partially flexed posture of the finger 3. Tenderness limited to the course of the flexor tendon/sheath 4. Disproportionate pain with passive extension of the finger
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flexor tenosynovitis tx
- Immediate hand consult - Emperic IV ABX with Vanc PLUS 3rd gen cephalosporin OR debridement and sheath irrigation
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where can flexor tenosynovitis extend the infections?
palmar hand - thenar space - midpalmar space - hypothenar space