BCEN
Abrasion vs Laceration vs Avulsion - ANS--Abrasion: rubbing of skin against hard surface
removing epithelium and exposing dermis
-Laceration: blunt trauma causing tissue tearing or crushing
-Avulsion: full thickness skin loss where approximation of wound edges is not possible (includes
degloving of hand/foot/digits/scalp)
Abruptio Placentae (defintion, presentation, assessment, interventions) - ANS-Defintion:
placental separation from uterine wall, rupture of arterial vessels, inhibits supply of O2/nutrients
to fetus, common cause of fetal demise from maternal trauma
Presentation: backache/contractions/abd pain, uterine rigidity, frank/dark red vag bleeding or
concealed bleeding, maternal hemorrhagic shock, abnormal fetal heart tones, elevated D-dimer,
dec platelets
Assessment: OB consult, CBC, type and cross match, continuous fetal heart monitoring
Interventions: transport to tertiary center or ob, high flow O2, fluid resuscitation/transfusion,
emergent delivery
ACE Inhibitors - ANS--pril
RAAS system
Decreases preload and afterload
Monitor for cough/angioedema/rash and renal impairment
Acetaminophen Overdose (definition, presentation, interventions) - ANS--Definition: found in
OTC and prescription meds, toxic to liver in small doses
-Presentation: progressive with time- malaise, nausea, diaphoresis, RUQ pain/elevated LFTs,
dec urinary output, jaundice, enlarged liver, coagulopathies, coma (recovery starts in 7-8 days)
-Interventions: gastric lavage, activated charcoal, poison control, administer N-acetylcysteine
(initiate within 8 hours for best results, effective up to 24 hrs post-ingestion)
Achilles Tendon Rupture (cause, presentation, assessment, interventions) - ANS--Cause:
sudden forced plantar flexion, unexpected dorsiflexion, systemic diseases (renal failure, lupus,
arthritis), trauma, fluoroquinolone use
-Presentation: sharp pain or pop, walking flat-footed, unable to stand on ball of foot, unable to
plantar flex foot
-Assessment: xray to r/o boney injury, US to r/o DVT or Baker cyst, MRI for definitive diagnosis
-Interventions: RICE, splint in plantar flexion, crutches, surgery
Acid Ingestion - ANS-Common sources: batteries, drain cleaners, toilet bowl cleaners, vinegar,
sulfuric acid
Tissue Damage Type: coagulation-type necrosis
GI Damage: greater damage to the stomach
Interventions: NPO, consult toxicology
,Acute Adrenal Insufficiency (definition, causes, presentation, assessment, interventions) -
ANS-Definition: insufficiency caused by low levels of cortisol and aldosterone- medical
emergency, life threatening
Causes: sudden d/c of glucocorticoids, Addison disease, congenital defects, infection, trauma,
surgery, burns, hemorrhage, pregnancy
Assessment: CMP (hyponatremia, hypochloremia, hyperkalemia, hypoglycemia), cortisol and
adrenocorticotropic levels
Interventions: medical emergency, replacement of glucocorticoids and mineralcorticoids,
treatment of shock via IVF, tx electrolyte abnormalities
Acute Angle Closure Glaucoma (definition, presentation, interventions, pt edu) - ANS-Defintion:
aqueous humor cannot escape anterior chamber, intraocular pressure inc, compression of CN
III, blindness within hours if untx'd
Presentation: pain, dec peripheral, halos around lights, N/V, HA, fixed slightly dilated pupil,
cornea w/ cloud appearance, globe may feel firm, redness to eye
Interventions: facilitate drainage, miotic eye drops (pilocarpine), topical B-blockers (timolol
maleate), carbonic anhydrase inhibitors (acetazolamide)
Edu: do not have head lower than waist, avoid coughing/straining, optho f/u
Acute Bronchitis - ANS-viral in nature- OTC cough medication, humidification, bronchodilators,
and corticosteroids can be used supportively
R/O: influenza (if febrile), pneumonia (if hypoxic or rales) and pertussis (if paroxysmal cough)
Acute Coronary Syndrome - ANS-Stable angina--unstable angina-- NSTEMI-- STEMI
Check EKG, Trop and/or CK-MB
MONA
Percutaneous Coronary Intervention or thrombolytics
Acute Gastroenteritis (definition, presentation, interventions) - ANS-Definition: bacterial, viral, or
chemical in origin (including food poisoning)
Presentation: N/V/D, lower abd cramping, fever, dehydration
Splenomegaly suggests bacterial infection
Interventions: fluids, monitor for metabolic acidosis, monitor for K/glucose/Ca abnormalities,
NPO, stool sample, meds for sx management/treatment
Acute Prostatitis (definition, causes, presentation, assessment, interventions) - ANS-Definition:
inflammation of prostate
Causes: bacterial infection ascending ureters or refluxed from bladder- associated with cystitis
Presentation: dysuria, malaise, urinary frequency/urgency, perineal/lower and/penile/suprapubic
pain, fever, chills, hematospermia
Assessment: UA, cultures, elevated PSA (prostate specific antigen), boggy/tender prostate
Interventions: analgesia, indwelling foley, abx (flouroquinolones), encourage fluids
Adenosine - ANS-Indicated for SVT and Wolff-Parkinson-White
Slows SA and AV node conduction
Rapid IVP
May cause transient heartblock or asystole
Airway Obstruction: Bronchi - ANS-Cough, unilateral wheezing, decrease in breath sounds
,80-90% of aspirated objects lodge here
In adults more likely to lodge in R bronchus; peds either side is equally likely
Airway Obstruction: Larynx - ANS-Large obstructions will completely block airway: no airway
sounds/movement, no coughing
Smaller obstructions will cause hoarseness and aphonia
Airway Obstruction: Trachea - ANS-large obstructions will cause complete airway obstruction
with lack of coughing, no airway sounds/movement
Airway/Breathing of Burn Victims - ANS--monitor closely, early intubation may be necessary if:
agitation, dec LOC, hoarseness/stridor/vocal changes, progressive edema, oral/nasal erythema,
inability to manage secretions, extensive facial burns, carbonaceous sputum
- Singed nose hairs alone are not a sign for early intubation
-Consider CO or cyanide poisoning
Alkali Ingestion - ANS-Common sources: drain cleaners, alkaline batteries, fertilizers, lye,
baking soda, ammonia
Tissue Damage Type: liquefaction of tissue
GI Damage: greater damage to esophagus
Interventions: NPO, consult toxicology
Alpha vs Beta Receptors - ANS-A1 stimulation causes periph vasc constriction
B2 stimulation causes bronchial smooth muscle dilation
Amiodarone - ANS-Indicated for unstable VT/VF, SVT
Decreases AV conduction, prolongs action potential and refractory period
Anaphylactic Shock - ANS-Type of Distributive Shock
IGE mediated
IM Epi Q15-20 min
Fluids
Histamine blockers
Albuterol (ensure patent airway)
Corticosteroids
Anterior Cord Syndrome (severity, type of injury, presentation) - ANS--Severity: Incomplete
injury
-Type: hyperflexion
-Presentation: paralysis below level of injury, loss of pain/temp sensation; intact sense of touch
and proprioception
Anticholinergic Toxidrome (definition, agents, presentation, interventions) - ANS--Definition:
blocks acetylcholine and inhibits PNS
-Agents: antihistamines, tricyclic antidepressants, cyclobenzaprine, antispasmodics, ipratropium
brombide, atropine, antiparkinsonism meds, night shade, Jimson weed
-Presentation: htn, tachycardia, tachypnea, hyperthermia, pupil dilation, dec bowel sounds, dry
membranes, flushing, urinary retention, agitation, delirium, hallucinations
-Interventions: sedate with benzos, initiate cooling, haldol, physostigmine administration: inhibits
cholinesterase- must be given slow IVP
, Anticholinergics for Asthma Treatment - ANS-IE: Ipratropium
inhibits contractions of bronchial smooth muscle and limits mucus secretion
side effects: dry mouth, pupil dilation, inc HR, blurred vision
Appendicitis (definition, presentation, assessment, interventions) - ANS-Definition: obstruction of
appendiceal lumen causing decreased blood flow, necrosis, and perforation- can lead to
peritonitis; most common cause of peds abd pain but is rare under 2 years of age
Presentation: early- dull steady periumbilical pain, mild fever, nausea; late (12-48 hrs)- RLQ
pain, flexing of knees may dec pain, rebound tenderness; pregnant pt's may have RUQ pain as
gravid uterus pushes the appendix upwards
Assessment: CBC (leukocytosis), UA/hCG test, CT w/ contrast recommended over US
Intervention: IVF, NPO, prep for surgery
ARBs - ANS--sartan
RAAS system
blocks angiotensin II receptors: vasodilation, decrease aldosterone, inc NA excretion and
sparing K
Only available orally
Monitor for hyperkalemia and hypotension
ARDS (causes, treatments, complications) - ANS-Causes: aspiration, pneumonia, toxic
inhalation, pulmonary contusion, submersion injury (indirect causes include sepsis, trauma,
massive transfusion, burns, DIC, shock, pancreatitis)
Treatments: intubation with PEEP and low tidal volumes, treat underlying cause, caution with
fluids
Complications: renal failure, BGL abnormalities, MODS, ventilator-associated pna
ARDS Definition/Mechanism - ANS-Form of noncardiogenic pulmonary edema
inflammatory syndrome characterized by aveolar injury which increases aveolar capillary
permeability allowing protein-rich fluid to pass into aveoli resulting in hypoxemia
Arterial Gas Embolism (definition, causes, presentation, interventions) - ANS--Definition: high
pressure air forced into circulation-- trapped air in the lung expands leading to rupture of lung
tissue, releasing gas bubbles into the arterial circulation
-Causes: divers who ascend too quickly, panicked ascent, or held breath during ascent; may
also occur in normal ascent in the presence of lung disease (ie: COPD)
-Presentation: chest tightness/dyspnea, pink frothy sputum, pneumothorax sx, vertigo, ams,
seizure, sensory loss
-Interventions: O2, needle decompression, hyperbaric therapy, avoid trendelenburg
Asthma - ANS-Chronic reactive airway disease
respiratory alkalosis (early) and acidosis (late)
Wheezing on inspiration (early) and expiration (late)
Breath sounds decrease in lower lobes first and progress upwards
Abrasion vs Laceration vs Avulsion - ANS--Abrasion: rubbing of skin against hard surface
removing epithelium and exposing dermis
-Laceration: blunt trauma causing tissue tearing or crushing
-Avulsion: full thickness skin loss where approximation of wound edges is not possible (includes
degloving of hand/foot/digits/scalp)
Abruptio Placentae (defintion, presentation, assessment, interventions) - ANS-Defintion:
placental separation from uterine wall, rupture of arterial vessels, inhibits supply of O2/nutrients
to fetus, common cause of fetal demise from maternal trauma
Presentation: backache/contractions/abd pain, uterine rigidity, frank/dark red vag bleeding or
concealed bleeding, maternal hemorrhagic shock, abnormal fetal heart tones, elevated D-dimer,
dec platelets
Assessment: OB consult, CBC, type and cross match, continuous fetal heart monitoring
Interventions: transport to tertiary center or ob, high flow O2, fluid resuscitation/transfusion,
emergent delivery
ACE Inhibitors - ANS--pril
RAAS system
Decreases preload and afterload
Monitor for cough/angioedema/rash and renal impairment
Acetaminophen Overdose (definition, presentation, interventions) - ANS--Definition: found in
OTC and prescription meds, toxic to liver in small doses
-Presentation: progressive with time- malaise, nausea, diaphoresis, RUQ pain/elevated LFTs,
dec urinary output, jaundice, enlarged liver, coagulopathies, coma (recovery starts in 7-8 days)
-Interventions: gastric lavage, activated charcoal, poison control, administer N-acetylcysteine
(initiate within 8 hours for best results, effective up to 24 hrs post-ingestion)
Achilles Tendon Rupture (cause, presentation, assessment, interventions) - ANS--Cause:
sudden forced plantar flexion, unexpected dorsiflexion, systemic diseases (renal failure, lupus,
arthritis), trauma, fluoroquinolone use
-Presentation: sharp pain or pop, walking flat-footed, unable to stand on ball of foot, unable to
plantar flex foot
-Assessment: xray to r/o boney injury, US to r/o DVT or Baker cyst, MRI for definitive diagnosis
-Interventions: RICE, splint in plantar flexion, crutches, surgery
Acid Ingestion - ANS-Common sources: batteries, drain cleaners, toilet bowl cleaners, vinegar,
sulfuric acid
Tissue Damage Type: coagulation-type necrosis
GI Damage: greater damage to the stomach
Interventions: NPO, consult toxicology
,Acute Adrenal Insufficiency (definition, causes, presentation, assessment, interventions) -
ANS-Definition: insufficiency caused by low levels of cortisol and aldosterone- medical
emergency, life threatening
Causes: sudden d/c of glucocorticoids, Addison disease, congenital defects, infection, trauma,
surgery, burns, hemorrhage, pregnancy
Assessment: CMP (hyponatremia, hypochloremia, hyperkalemia, hypoglycemia), cortisol and
adrenocorticotropic levels
Interventions: medical emergency, replacement of glucocorticoids and mineralcorticoids,
treatment of shock via IVF, tx electrolyte abnormalities
Acute Angle Closure Glaucoma (definition, presentation, interventions, pt edu) - ANS-Defintion:
aqueous humor cannot escape anterior chamber, intraocular pressure inc, compression of CN
III, blindness within hours if untx'd
Presentation: pain, dec peripheral, halos around lights, N/V, HA, fixed slightly dilated pupil,
cornea w/ cloud appearance, globe may feel firm, redness to eye
Interventions: facilitate drainage, miotic eye drops (pilocarpine), topical B-blockers (timolol
maleate), carbonic anhydrase inhibitors (acetazolamide)
Edu: do not have head lower than waist, avoid coughing/straining, optho f/u
Acute Bronchitis - ANS-viral in nature- OTC cough medication, humidification, bronchodilators,
and corticosteroids can be used supportively
R/O: influenza (if febrile), pneumonia (if hypoxic or rales) and pertussis (if paroxysmal cough)
Acute Coronary Syndrome - ANS-Stable angina--unstable angina-- NSTEMI-- STEMI
Check EKG, Trop and/or CK-MB
MONA
Percutaneous Coronary Intervention or thrombolytics
Acute Gastroenteritis (definition, presentation, interventions) - ANS-Definition: bacterial, viral, or
chemical in origin (including food poisoning)
Presentation: N/V/D, lower abd cramping, fever, dehydration
Splenomegaly suggests bacterial infection
Interventions: fluids, monitor for metabolic acidosis, monitor for K/glucose/Ca abnormalities,
NPO, stool sample, meds for sx management/treatment
Acute Prostatitis (definition, causes, presentation, assessment, interventions) - ANS-Definition:
inflammation of prostate
Causes: bacterial infection ascending ureters or refluxed from bladder- associated with cystitis
Presentation: dysuria, malaise, urinary frequency/urgency, perineal/lower and/penile/suprapubic
pain, fever, chills, hematospermia
Assessment: UA, cultures, elevated PSA (prostate specific antigen), boggy/tender prostate
Interventions: analgesia, indwelling foley, abx (flouroquinolones), encourage fluids
Adenosine - ANS-Indicated for SVT and Wolff-Parkinson-White
Slows SA and AV node conduction
Rapid IVP
May cause transient heartblock or asystole
Airway Obstruction: Bronchi - ANS-Cough, unilateral wheezing, decrease in breath sounds
,80-90% of aspirated objects lodge here
In adults more likely to lodge in R bronchus; peds either side is equally likely
Airway Obstruction: Larynx - ANS-Large obstructions will completely block airway: no airway
sounds/movement, no coughing
Smaller obstructions will cause hoarseness and aphonia
Airway Obstruction: Trachea - ANS-large obstructions will cause complete airway obstruction
with lack of coughing, no airway sounds/movement
Airway/Breathing of Burn Victims - ANS--monitor closely, early intubation may be necessary if:
agitation, dec LOC, hoarseness/stridor/vocal changes, progressive edema, oral/nasal erythema,
inability to manage secretions, extensive facial burns, carbonaceous sputum
- Singed nose hairs alone are not a sign for early intubation
-Consider CO or cyanide poisoning
Alkali Ingestion - ANS-Common sources: drain cleaners, alkaline batteries, fertilizers, lye,
baking soda, ammonia
Tissue Damage Type: liquefaction of tissue
GI Damage: greater damage to esophagus
Interventions: NPO, consult toxicology
Alpha vs Beta Receptors - ANS-A1 stimulation causes periph vasc constriction
B2 stimulation causes bronchial smooth muscle dilation
Amiodarone - ANS-Indicated for unstable VT/VF, SVT
Decreases AV conduction, prolongs action potential and refractory period
Anaphylactic Shock - ANS-Type of Distributive Shock
IGE mediated
IM Epi Q15-20 min
Fluids
Histamine blockers
Albuterol (ensure patent airway)
Corticosteroids
Anterior Cord Syndrome (severity, type of injury, presentation) - ANS--Severity: Incomplete
injury
-Type: hyperflexion
-Presentation: paralysis below level of injury, loss of pain/temp sensation; intact sense of touch
and proprioception
Anticholinergic Toxidrome (definition, agents, presentation, interventions) - ANS--Definition:
blocks acetylcholine and inhibits PNS
-Agents: antihistamines, tricyclic antidepressants, cyclobenzaprine, antispasmodics, ipratropium
brombide, atropine, antiparkinsonism meds, night shade, Jimson weed
-Presentation: htn, tachycardia, tachypnea, hyperthermia, pupil dilation, dec bowel sounds, dry
membranes, flushing, urinary retention, agitation, delirium, hallucinations
-Interventions: sedate with benzos, initiate cooling, haldol, physostigmine administration: inhibits
cholinesterase- must be given slow IVP
, Anticholinergics for Asthma Treatment - ANS-IE: Ipratropium
inhibits contractions of bronchial smooth muscle and limits mucus secretion
side effects: dry mouth, pupil dilation, inc HR, blurred vision
Appendicitis (definition, presentation, assessment, interventions) - ANS-Definition: obstruction of
appendiceal lumen causing decreased blood flow, necrosis, and perforation- can lead to
peritonitis; most common cause of peds abd pain but is rare under 2 years of age
Presentation: early- dull steady periumbilical pain, mild fever, nausea; late (12-48 hrs)- RLQ
pain, flexing of knees may dec pain, rebound tenderness; pregnant pt's may have RUQ pain as
gravid uterus pushes the appendix upwards
Assessment: CBC (leukocytosis), UA/hCG test, CT w/ contrast recommended over US
Intervention: IVF, NPO, prep for surgery
ARBs - ANS--sartan
RAAS system
blocks angiotensin II receptors: vasodilation, decrease aldosterone, inc NA excretion and
sparing K
Only available orally
Monitor for hyperkalemia and hypotension
ARDS (causes, treatments, complications) - ANS-Causes: aspiration, pneumonia, toxic
inhalation, pulmonary contusion, submersion injury (indirect causes include sepsis, trauma,
massive transfusion, burns, DIC, shock, pancreatitis)
Treatments: intubation with PEEP and low tidal volumes, treat underlying cause, caution with
fluids
Complications: renal failure, BGL abnormalities, MODS, ventilator-associated pna
ARDS Definition/Mechanism - ANS-Form of noncardiogenic pulmonary edema
inflammatory syndrome characterized by aveolar injury which increases aveolar capillary
permeability allowing protein-rich fluid to pass into aveoli resulting in hypoxemia
Arterial Gas Embolism (definition, causes, presentation, interventions) - ANS--Definition: high
pressure air forced into circulation-- trapped air in the lung expands leading to rupture of lung
tissue, releasing gas bubbles into the arterial circulation
-Causes: divers who ascend too quickly, panicked ascent, or held breath during ascent; may
also occur in normal ascent in the presence of lung disease (ie: COPD)
-Presentation: chest tightness/dyspnea, pink frothy sputum, pneumothorax sx, vertigo, ams,
seizure, sensory loss
-Interventions: O2, needle decompression, hyperbaric therapy, avoid trendelenburg
Asthma - ANS-Chronic reactive airway disease
respiratory alkalosis (early) and acidosis (late)
Wheezing on inspiration (early) and expiration (late)
Breath sounds decrease in lower lobes first and progress upwards
