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J's ClinMed Deck > ER Treatments/must know facts > Flashcards

ER Treatments/must know facts Flashcards

1
Q

What are some immediate life-threatening conditions to rule out immediately?

A 
airway obstruction (crush injury)
tension PTX
open PTX
Flail chest
Cardiac tamponade
massive internal/external hemorrhage
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2
Q

How do we clear a C-spine?

A

Nexus/Canadian C-spine rules

C-spine X-ray miss 15% of all C-spine fractures

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3
Q

What are the Nexus criteria?

A
  1. midline cervical tenderness
  2. focal neurological deficits
  3. altered level of consciousness
  4. evidence of intoxication
  5. painful distracting injury
    If yes to anything get imaging
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4
Q

is epidural hematoma arterial or venous? what about a subdural?

A 
epidural = arterial
subdural = venous
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5
Q

NG tube/foley can be placed in ED except when?

A

no NG with skullbase/cribiform plate fracture

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6
Q

Before foley you should look for?

A

High riding prostate, blood at urethral meatus(males), perineal ecchymosis (females)

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7
Q

Penetrating chest trauma + witnessed signs of life during transport to the ED + electrical activity upon arrival

A

EMERGENT ED THORACOTOMY

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8
Q

Routine labs for trauma patients?

A 
T/S, T/C
CBC
UA, CHECK BLOOD
ETOH (in CT, its okay without written consent)
FEMALE = PREGNANCY
> 55 y/o = EKG, TNI, CARDIAC MARKERS
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9
Q

What are the most common directions each joint dislocates?

A 
Hip  = posterior dislocation
Glenoid =  anterior
Elbow  = posterior
Knee =  anterior
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10
Q

How will a hip dislocation present?

A

shortened and internally rotated

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11
Q

Sprain vs Strain?

A

Strain—tearing injury to muscle fibers, excessive tension/overuse (tendons)

Sprain—Tearing injury to >= 1 ligaments; joint forced beyond normal ROM

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12
Q

What are the ortho emergencies?

A

open fractures
subluxation/dislocation with tenting/stress to the N/V bundle
N/V injury

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13
Q

How do you describe the direction of the displacement?

A

THE POSITION OF THE DISTAL FRAGMENT RELATIVE TO THE PROXIMAL FRAGMENT

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14
Q

How do you describe a radiograph?

A 
Open vs. closed injury
Location of fx—proximal, midshaft? cm?
Intrarticular?
Use bony landmarks—supracondylar fx etc.
Orientation of the fx line—transverse, oblique, spiral, comminuted 
Displacement/separation—fx fragments offset—use % of bone
Direction of displacement?
Separation?—distance between fragments
Shortening?
Impacted/overriding
Angulation (unbending %)
Rotational deformity?
Dislocation/subluxation?
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15
Q

Tx for colles fracture?

A

emergent reduction and surgery

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16
Q

Tx for posterior dislocation of the elbow?

A

reduction! traction

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17
Q

What are the most common carpal fractures?

A

scaphoid, lunate then triquetrium

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18
Q

Proximal radius fracture tx?

A

long arm case unless comminuted then surgery

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19
Q

Spiral fracture of proximal humorous tx?

A

sling and swathe

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20
Q

Left anterior and superior pubic rami fracture tx?

A

None

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21
Q

Femoral neck tracture tx?

A

percutaneous screws or hemiarthroplasty

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22
Q

femoral shaft fracture tx?

A

intramedullary rods or plates

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23
Q

Intertrochanteric fracture tx?

A

sliding hip screw fixation or a long gamma nail

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24
Q

hip dislocation tx?

A

sedate and locate

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25
Q

How old are neonates?

A

less than 30 days

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26
Q

DDx for fever in neonate?

A

GBS, meningitis, herpes encephalitis, measles, RSV (no tx), UTI

27
Q

What is the fever threshold for neonates/infants less than 2 months?

A

100.4 (38 C)

28
Q

What is the fever threshold for infants/children 3-36 months?

A

102.2

29
Q

What is the fever threshold for children over 36 months?

A

varies depending on signs and sx

30
Q

Should/how would you tx fever?

A

yes. acetaminophen 15 mg/kg/dose PO/PR every 4-6 hours

or ibuprofen 10 mg/kg/dose every 6-8 hours (max 40mg/kg)

31
Q

Most common causes of serious bacterial illness?

A

UTI, bacteremia/sepsis, penumonia, sinusitis, meningitis

32
Q

IF YOU COULD ONLY ORDER A SINGLE TEST ON THESE PATIENTS…WHERE IS THE MONEY????

A

U/A

33
Q

Fever > 39 C/102.2 F and + positive UA?

A

PYELO/RENAL PARENCHYMA involved

34
Q

MCC of UTI/bacterial meningitis/sepsis/bacteremia?

A

E. coli, group B strep, listeria

35
Q

Best way to get urine specimen from a child?

A

cath or suprapubic tap (which no one does anymore)

36
Q

What is considered a positive urinary culture with cath?

A

more than 1000 CFU/mL (this is different

37
Q

What is the most common cause of infants less than 3 months?

A

viral!

38
Q

Most common cause of bacterial meningitis more than 3 months?

A

S. pneumo, N. meningitidis, S. aureus

39
Q

How to dx bacterial meningitis?

A

CSF WBC’s > 30 in the neonate & > 10 in children > 1 y/o, + CSF stain, CSF ANC > 1000 cells/microliter, CSF protein > 80
peripheral WBC > 10,000 & hx of seizure before or at onset
Initiate abx asap!

40
Q

How do you tx pleocytosis?

A

may suggest viral etiology; strongly recc.
Admit and await cx’s + abx’s; if d/c home, use long acting parental abx = Ceftriaxone (Rocephin) = 100 mg/kg q24hours, max 2g, and await 24 hour cx’s

41
Q

What does bronchiolitis tend to go hand in hand with?

A

UTI

42
Q

What can ceftriaxone (rocephin) do to neonates (less than one month)?

A

transient hyperbilirubinemia

43
Q

potential parenteral ABXs in child less than 28 days

A

ampicillin
ceftriaxone,
cefotaxime
+/- gentamycin

44
Q

Fever, foul smelling urine, crying with urination

A

UTI

45
Q

< 5 y/o—high fevers, strawberry tongue, conjunctivitis/iritis, red mucous membranes, peeling of hands, feet. How do you treat?

A

tx for kawasaki disease = IV Ig and ASA (only indication for ASA in kids)

46
Q

What is a bad complication of kawasaki disease?

A

coronary aneurysms

47
Q

Layers of the scalp?

A 
S - skin
C - connective tissue/fat
A - (Galea) aponeurosis - majority of blood vessels
L - loose connective tissue
P - periosteum
48
Q

Once an pt with epidural hematoma presents with ipsilateral pupillary dilation, is that okay?

A

nope they’ve herniated their brainstem. They’re done

49
Q

shift of brain stem away from mass/bleed with compression of opposite cerebral peduncle; this can cause IPSILATERAL hemiparesis, instead of the usual thinking (contralateral)

A

KERNOHAN’S PHENOMENON

50
Q

If brain herniation is imminent, what procedure could you do in the ER/Trauma bay?

A

burr holes

control ICP/BP/pain

51
Q

Using a CT scan, how can you tell if the subdural hemorrhage is acute (1-3 days) or subacute (4 days - 2/3 weeks?

A 
acute = hyperdense
subacute = isodense
52
Q

What drug reverses heparin?

A

protamine sulfate

53
Q

What drug reverses coumadin?

A

Vitamin K

54
Q

How to manage TBI?

A 
A-B-C’s
Frequent VS/Neuro checks
EKG/Continuous cardiac monitoring
IV/IVF
Immobilize C-/T-/LS spine
Strict BP/ICP monitoring; tx as needed
Arrange for diagnostic testing
Draw labs---CBC, Chem panel, PT/INR, APTT, Type and Cross/Screen, Med levels, as needed
55
Q

What labs do you want for a TBI?

A

Draw labs—CBC, Chem panel, PT/INR, APTT, Type and Cross/Screen, Med levels, as needed

56
Q

Signs of stroke?

A 
Sudden onset garbled/inability to speak
Unilateral arm or leg numbness
Unilateral arm or leg weakness
Facial droop
Severe H/A, sudden onset
LOC
Loss of balance/coordination
Visual field cut
57
Q

In stroke patients, how should you control BP?

A

Control BP; keep SBP less than 180; don’t rapidly dec, as can worsen area hemm/ischemia; if already HTN keep MAP less than or equal to 130; may keep lower after OR
Seizure meds

58
Q

What is one treatment of hemmorhagic stroke?

A

Recombinant Factor VIIa/Novo 7

Factor IX

59
Q

What are the inclusion criteria for TPA?

A
  1. at least 18 y/o
  2. Within 3 hours of onset—NOW EXPANDED TO 4.5 HOURS FROM 3 IN SOME PTS
  3. Stroke sx’s acutely
  4. SBP < 185, DBP < 110
  5. No assoc seizures
  6. Not minor sx’s or rapidly resolving sx’s
  7. No Coumadin use**CHANGED, NOW RELATIVE
  8. PT < 15, INR < 1.7
  9. No Heparin within 48 hours, normal APTT
  10. Platelet > 100,000
  11. 50 < Glucose < 400
  12. No MI
  13. No hx AVM, aneurysm, ICH in past
  14. No major surgeries in 14 days
  15. No CVA or serious head injury in 3 months
  16. No GI/GU bleeding in 21 days
  17. No lactation or pregnancy in 30 days
60
Q

Dose for TPA

A

first 10% 0.9mg/kg IV bolus, usually with , remainder 90% as drip

61
Q

Work up for CVA/TIA

A

MRI FOLLOW-UP AFTER INITIAL CT; CONSIDER MRA
CAROTID DUPLEX ULTRASOUND—ESP IF SUSPECT ANTERIOR ORIGIN
ECHOCARDIOGRAM—R/O CARDIAC SOURCE; TTE VS. TEE—TEE MORE SENSITIVE
TCD’S; TRANSCRANIAL DOPPLERS—R/O POST CIRCULATION SOURCE; *****LIMITED (CONSIDER MRA)
CHOICE OF MEDS; ASA, PLAVIX, AGGRENOX, STATIN—CHECK FASTING LIPIDS, ETC….

62
Q

What is the dosage for Acetaminophen?

A

15 mg/kg/dose PO/PR every 4-6 hours

63
Q

What is the dose for ibuprofen?

A

10 mg/kg/dose every 6-8 hours (max 40mg/kg) minimum age 6 months

64
Q

MOst common pathogens causing meningitis in a kid 3 months?

A

< 3- e.coli, group B strep, listeria

> 3- S. pneumo, N. Meningitis, staph aureus

J's ClinMed Deck (12 decks)

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