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PICU > General > Flashcards

General Flashcards

0
Q

anticholinergics

A

hold all in

Rx: supportive, bicarb if arrythmis, wide qrs
benzo for sz

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1
Q

general work for toxicology

A

gluc
ECG
lytes

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2
Q

Opiates - morphine, heroine, methadone

A

sedation
miosis
cinfusion

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3
Q

Cholinergic treatment

A

decontaminant
supportive
atropine

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5
Q

what are syndromes associated with pyloric stenosis?

A

Cornelia de Lange
Smith lemli Opitz
Apert syndrome
T 18

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6
Q

serotonin syndrome

A

alt mental status
neuromuscular hyperactivity
autonomic instability

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7
Q

Rx SSRI OD

A

supportive care

cyproheptadine

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8
Q

rabies Rx

A

rabies vaccine(5 dose) and rabies Immunoglobilin - administer into the wound or IM

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9
Q

3 contraindication to ketamine

A

allergic
uncontrolled HTN
neuropsychiatry state

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10
Q

retropharyngeal abscess on xray

A

air fluid level

widened preveretbral space

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11
Q

ibuprofen OD

A

non anion gap metabolic acidosis
apnea
polydipsia
renal dysfunction

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12
Q

pseudoporphyria causes

A

small hypopigmented scars after small trauma
vesicles in sun exposed areas

caused by NSAID

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13
Q

what med taken in pregnancy causes fetal hypothyroidism

A

amiodarone + goiter

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14
Q

What are the clinical features of SLE

A

MD SOAP BRAIN
Malar rash – butterfly rash, sparing of nasolabial folds
Discoid rash –basement mb involved, may cause scarring
Serositis – pleuritis/pericarditis
Oral ulcers
Antinuclear antibody (ANA) – very sensitive test
Photosensitivity – skin rash to sunlight
Blood – haemolytic anaemia, leukopaenia, low PLT
Renal disorder – proteinuria and cell casts
Arthritis – symmetrical, 2+ small or large peripheral joints
Immunological disorder – anti-dsDNA
Neurological – seizures, psychosis

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15
Q

what urological condition should be ruled out in a pelvic fracture?

A

urethral transection injury

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16
Q

Post renal injury, what is a child at risk for?

A

HTN, needs periodic BP

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17
Q

what are the CP of cardiac tamponade

A 
tachycardia
low arterial BP
narrow pulse pressure
pulses paradoxus-excessive fall of systolic blood pressure (>10 mm Hg) with inspiration
muffled HS
distended neck veins - inc JVP
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18
Q

What are clinical features of Carbon monoxide poisoning

A 
HA
confusion/dizzy
Nausea
arrythmia - cardiac arrest
rhabdo
cherry red skin
Sz
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19
Q

How do you treat CO poisoning?

A

worry if carboxyHb > 25%

  1. 100% O2
  2. if CarbHb > 25% - hyperbarric chamber
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20
Q

what are the clinical features of cholinergic overdose (organophosphates/carbamates)

A 
DUMBELLS
Diaphoresis
Urinary and fecal incontinence
Miosis
Bradycardia/bronchorrhea
Emesis
Lacrimation
Lethargy
Salivation
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21
Q

what is the mgnt of organophosphate poisoning

A
  1. decontaminate - remove clothing
  2. Atropine to competitively inhibit Ach at muscarinic receptor
  3. Pralidoxine - breaks bong btw OP and enzymes - helps clear
  4. PICU monitoring for nicotinic effects - Sz, delirium, HTN, inc HR, arryth
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22
Q

what are the clinical features of TCA OD

A
  1. anticholinergic toxidrome:
    - delirium,
    - mydriasis - dilated
    - dry mucous membranes,
    - tachycardia,
    - hyperthermia,
    - urinary retention, and slow GI motility.
  2. CNS toxicity - lethargy, coma, myoclonic jerks, and seizures
  3. Blockade of fast Na channels - wide QRS, arrythmia
23
Q

how do you manage TCA OD

A
  1. activated charcoal if possible
  2. Alkalinalize - HCO3
  3. Treat arrythmia - lidocaine or MgSo4
  4. Sz with benzo
  5. Low BP with Norepinephrine
    MUST avoid Na blocking agents
24
Q

is dialysis effective in TCA OD

A

No

25
Q

after how long can you DC a ? TCA OD if they remain asymptomatic?

A

can DC after 6 hours if well

26
Q

what are poor prognostic factors when dealing with submersion injury

A

Orlowski scale:

  1. submersion> 5 min
  2. Age < 3
  3. time to CPR initiation > 10 min
  4. Coma
  5. Ph < 7.1 in ED
27
Q

what are good prognostic factors for submersion injuries?

A

ROSC in < 10 min
Sub < 5 min
PERL at scene
NSR at Scene

GCS improvement in first 24-72 - best for CNS outcomes

28
Q

if pt post head trauma has one asymmetrical pupil that is not responding to light, what CN is effected

A

CN III due to temporal herniation

29
Q

how do you treat a hypertensive crisis?

A

continuous infusion of labetalol or nicardipine

gaol to decrease BP by 20-25 % over the first 8 hours

30
Q

what is a hypertensive emergency?

A

symptomatic HTN

31
Q

what is the most common cause of pediatric deaths in children ged 12-24 mnths

A

submersion injury

32
Q

how do you manage a submersion injury

A 
C-spine!!!!! if diving, alcohol, ? trauma
give cricoid pressure if doing BMV
try to decompress stomach
rewarm
correct hypoglycemia
monitor for coagulopathy
33
Q

what parts of the skin are involved if superficial burn and what would it look like

A 
Epidermis only
red
pain
NO BLSITERS
heal 3-5 days
34
Q

What does a superficial partial burn look like and what parts of the skin are affected

A 
epidermis + 1/2 of dermis
pain
MOIST
BLISTERS
heals in 2 weeks
35
Q

what layers are involved in a deep partial thickness burn and at does it look like?

A 
epidermis and >1/2 dermis
pale
dry
less pain
speckled
need graft
36
Q

WHat layers are involved in a full thickness burn and what does it look like?

A 
into subcutaneous tissu
pale
charred
leathery
NO PAIN
37
Q

what are important steps when managing burns

A 
cover with steriledressing
early cooling to prevent further injury
Tetanus
analgesia
measure COHb
monitor for low glucose
NO ABX
38
Q

when do we intubate a burn?

A

singed nasal hair
soot in airway
soot in sputum
hoarsness

39
Q

what is the parkland formula?

A

for > 5 yrs
4cc/kg/BSA over 24 hours - 1st hlf in 8 hours, 2nd half in 16 hours
ADD TO MAINTENANCE
use NS

40
Q

what are the admission criteria for burns? 8

A
  1. Suspected non accidental
  2. > 10% BSA fr partial thickness
  3. > 2% BSA full thickness
  4. > 1% BSA of hands/feet/face/perineum
  5. circumferencial
  6. inhalation injury
  7. electrical injury with high tension wire
  8. Associated trauma
41
Q

what are the 3 criteria for an ALTE?

A

apnea
colour change
tone change
frightening for care taker

42
Q

patient has spinal shock - what HR and/or BP support will you give

A

if brady - Dopamine and Epi

if hypotensive - Norepinephrine

43
Q

what lab values will be consistent with a chylothorax?

A

high TGL
lymphocytes
labs similar to serum
high Ig

44
Q

if pre-renal failure, what is your FeNa

A

< 1%
Urine Na < 20
Serum BUN/Creat > 20:1
Urine Osm > 500

45
Q

if your cause is a acute tubular necrosis, what is you Fraction excretion of Na

A

> 2%
Urine Na > 40
serum BUN/crea < 20:1
urine Osm > 300

46
Q

what is the WU for acute renal failure

A 
U/A and R&M
Lytes
BUN, creat
Lytes
Urine lytes and Osm
Cytstatin C, iCa, Mg, PO4
VBG
AUS
ECG for high K
47
Q

what are the indications for dialysis?

A 
AEIOU
Acidosis
Electrolytes - HIGH K, HIGH PO4, low Na
Ingestion - methanol, ethylene, ASA, Li
Overload
Uremia - pericarditis, SZ...
48
Q

how do you declare brain death?

A
  1. Established etiology capable of causing neurological injury in absence of reversible conditions
  2. No confounders including:
  3. Deep unresponsive coma (GCS 3)
    Absent brainstem reflexes:
    Fixed, dilated pupils, Cough, Gag, Corneal, Vestibulo-ocular (eg cold caloric), Motor response
  4. Absent respiratory effort as measured by apnea test
  5. Ancillary tests: if cannot perform an element of clinical NDD (angiography or nuclear med)
49
Q

what is the apnea test?

A

Preoxygenate
Disconnect from vent
Observe for absence of resp effort AND PaCO2 ≥ 60mmHg AND rise ≥ 20mmHg

50
Q

what are the differences in brain death declarations?

A

Children ≥ 1yo = no difference
Children ≥ 30d and < 1yo = 2 separate exams separated by time interval (interval not specified)
Children < 30 days: minimum time from birth 48h, 2 exams separated by at least 24h

51
Q

what are complications post submersion injury

A 
Cerebral edema - ICP is bad 
ARDS - 
myocardial dysfunction
DIC
ischemic bowel
52
Q

what ECG findings are consistent with Hypothermia

A 
bradycardia
flipped T wave
1st degree AV block
Osborn J wave - 
VF
53
Q

reasons to transfer a burn to a burn center?

A 
Partial or full thickness burns: 
>10% in pt < 10 yrs
20% in other age groups
Burns of face, hands, feet, genitalia, perineum or major joints.
Electrical/chemical burns
Inhalation injury
Pre-existing conditions that may complicate mgmt.
Concomitant trauma
Special social, emotional, rehab support

PICU (2 decks)

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