A Minnesota tube choice A is a type of esophageal tube with a large balloon at

A minnesota tube choice a is a type of esophageal

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A Minnesota tube (choice A) is a type of esophageal tube with a large balloon at the distal end. The tube, much less commonly used today, can be used to tamponade esophageal variceal bleeds. It has no benefit in management of gastric bleeds. If there is evidence that this patient is continuing to bleed, then urgent upper endoscopy (choice B) is warranted. Otherwise, stabilization with red cells, placement of large bore intravenous access, and stable transport to the endoscopy suite is both safer and more appropriate.
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For refractory cases of upper GI bleeding gastrectomy is often performed. Since this patient has had no therapeutic intervention as of yet, an urgent gastrectomy (choice D) is not indicated at this time. It is unclear how much this patient has bled since there is no hematocrit level. Therefore, to transfuse 2 units packed red cells (choice E) at this time is not appropriate. Rather, ensuring that the patient has large-bore intravenous access and has type-specific blood available are both appropriate interventions. A 3-year-old boy is brought to the emergency department 3 hours after being bitten on the hand by another boy at his daycare center. The child's mother is frantic and wants to "sue the center for allowing such behavior!" The child is up-to-date on his vaccinations. The other child is very healthy and his vaccinations are current. On physical examination, there is puncture wound on the right hand. You gently clean the wound and consult with the hand surgeon who says that there does not appear to be any damage to the nerves, muscles, tendons, or joints of the hand. The most appropriate next step is to A. close the wound with a suture B. obtain a wound culture C. provide ampicillin-sulbactam D. send him home with a follow-up appointment within 48 hours E. vigorously irrigate and debride the wound Explanation: The correct answer C. Human bites have a high rate of infection and should always be treated presumptively with an antibiotic. The most common organisms to infect the wound are streptococci, S.
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aureus, Eikenella corrodens, and anaerobes. The preferred antibiotic is ampicillin- sulbactam or amoxicillin-clavulanate. An alternative for a penicillin-allergic patient is trimethoprim-sulfamethoxazole plus clindamycin. The wound should be inspected within 48 hours for signs of infection. Since puncture-type hand wounds have such a high risk of infection, suturing the wound could enhance the risk of infection. Therefore it is inappropriate to close the wound with a suture (choice A). A wound culture (choice B) should only be taken in wounds less than 8 hours old when there are signs of infection ( erythema, foul odor, and exudate) and in wounds greater than 8 hours old (except if more than 24 hours and without signs of infection).
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