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RC Review > Acute Care > Flashcards

Acute Care Flashcards

(47 cards)

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1
Q

Indications for Intubation

A

GCS < 8
Hemodynamic instability
Airway
Respiratory failure
Muscle weakness
Secretions

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2
Q

EET Size

A

Age/4 + 4

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3
Q

Causes of hypoxemia

A

low FiO2
Hypoventilation
V/Q mismatch
Shunt
Impaired gas exchange

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4
Q

PRAM Score

A

Oxygen saturations 0-2
Suprasternal retractions 0-2
Scalene retractions 0-2
Air entry 0-3
Wheezing 0-3

Mild 0-3
Moderate 4-7
Severe 8-12

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5
Q

Discharge criteria for asthma

A

Sats > 94% on RA
Ventolin > q4hr
Mild exacerbation
Observed in ED for 2 hours without tx

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6
Q

PARDS

A

NIPPV:
CPAP/BiPAP > 5cm H2o
PF < 300
SF < 264
IPV:
mild OI 4-8
mod OI 8-16
sev OI > 16

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7
Q

OI

A

(MAP x FiO2 x 100) / PaO2

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8
Q

High risk bronchiolitis

A

GA < 35 weeks
< 3 months age at presentation
Hemodynamically significant cardioresp disease
Immunodeficiency

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9
Q

Bronchiolitis criteria for admission

A

severe resp distress (WOB, RR > 70)
O2 to keep sats > 90
dehydration/poor intake
cyanosis/apnea
high risk infants
family unable to cope

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10
Q

Oxygen Delivery

A

DO = CaO2 x CO

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11
Q

CaO2 (carrying capacity of oxygen)

A

CaO2 = 1.34 x Hgb x Saturation (+ dissolved O2 - negligible)

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12
Q

H’s & T’s (reversible causes of cardiac arrest)

A

Hypovolemia
Hypoxia
Hypoglycemia
Hydrogen ion (acidosis)
Hypo/hyperkalemia
Hypothermia
Tension PTX
Tamponade
Toxins
Thrombosis (coronary, pulmonary)

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13
Q

Declaration of Brain Death requirements

A

2 exams by qualified positions
deep unresponsive coma with a clear etiology and lack of cofounders (unresuscitated shock, severe metabolic disorders, hypothermia < 34, peripheral neuropathy, drug effects)
Exam: no motor response, gag, cough, corneal reflex, vestibulo-ocular response, pupillary response + apnea test
*may have spinal reflexes

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14
Q

Timing of brain death declaration

A

Newborn: > 24 hours between exams, < 48 hours after birth, minimum temp 36 degrees, need oculocephalic reflex
Infant: full, separate exams, no interval, need oculocephalic reflex
Child: two physicians, can do concurrent exams + apnea test
*Needs for be > 24 hours after a significant event

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15
Q

Apnea test

A

MUST MEET ALL CRITERIA
PaCO2 >/= 60
PaCO2 >/= 20 above baseline
pH </= 7.28
No respiratory effort during entire test

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16
Q

GCS

A
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17
Q

Prognostic Indicators in Drowning

A

Good:
- immediate bystander CPR (most important!)
- ROSC in < 10 mins
- submersion time < 5 minutes
- PERL at scene
- Normal Sinus Rhythm at scene

Bad:
- delayed CPR
- ROSC > 25 minutes
- submersion > 10 min

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18
Q

Burn classification

A
  • Superficial - epidermis only, redness/pain/no blisters
  • Superficial partial thickness - epidermis + 1/2 dermis, red/pain/blisters
  • Deep partial thickness - epidermis + > 1/2 dermis, pale/dry/speckled/less tender/non-blanching
  • Full thickness - subcutaneous tissue, pale/charred/leathery/non-tender/non-blanching
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19
Q

Fluid management in Burns

Study These Flashcards
A

Parkland: 4ml/kg/BSA in 24 hours
- 1st half in 8 hours, 2nd half over 16 hours
- ADD maintenance fluids

20
Q

Admission criteria for burns

Study These Flashcards
A
  • suspected NAT
  • > 10% partial thickness
  • > 2% full thickness
  • hands, feet, face, perineum
  • circumferential burn
  • enclosed space fire or evidence of inhalational injury
  • electrical injury (risk of rhabdo)
  • associated trauma
21
Q

Most common cause of morbidity and mortality in burn patients

22
Q

Cholinergic toxidrome

Study These Flashcards
A

DUMBELLS
- diaphoresis
- urination
- miosis
- bronchorrhea/bradycardia
- emesis
- lacrimation
- lethargy
- salivation

23
Q

Treatment of cholinergic ingestion

Study These Flashcards
A

Organophosphates/carbamates
- oxygen
- REMOVE CLOTHING
- atropine
- atrovent
- pralidoxime
- intubate early (NO SUCC)

24
Q

Anticholinergic toxidrome

Study These Flashcards
A

Mad as a hatter, blind as a bat…
- Mydriasis
- Hyperthermia
- Confused, grabbing invisible stuff
- dry mouth
- urinary retention
- tachycardia
- flushed
- absent bowel sounds

25
Treatment of anticholinergic ingestions
TCAS, anti-histmines, jimson weed, neuroleptics, atropine - NaHCO3 (TCAs) for prolonged QRS - benzos for agitation - cool - +/- activated charcoal - +/- physostigmine if pure (not with TCAs or cardiac involvement)
26
Sympathomimetic toxidrome
cocaine, amphetamines, ecstasy - mydriasis - diaphoresis - HTN - tachycardia - seizures - hyperthermia - psychosis - severe agitation - hyperreflexia
27
Management of sympathomimetic ingestions
- benzos - fluid restriction or 3% NS (SIADH) - activated charcoal if 1 hour - cooling
28
Toxidrome of Hallucinogens
- mydriasis (LSD) / miosis (PCP) - HTN - tachycardia - diaphoresis - hyperreflexia - hallucinations (LSD) - nystagmus while awake (PCP) - LSD usually not fatal compared to PCP
29
Opiate toxidrome
- miosis - bradypnea - decreased bowel sounds - somnolence - hypotension - hypothermia
30
Treatment of opioid ingestion
Naloxone IN or IV
31
CXR findings of hydrocarbon ingestion
pneumatoceles peri-hilar infiltrates
32
Hypothermia CPR
Be-Low 30? Just push, no Do (pamine, or epi)
33
Rewarming with a pulse
34-36 - passive rewarming (dry) 30-34 - passive and active external warming (electric blanket, overhead warmer, hot water bottles, heating pads) <30 - active external and internal rewarming (warmed IV fluid, warmed O2, peritoneal lavage, ECMO)
34
Upward deflections on ECG with hypothermia?
Osborn waves
35
Stages of Iron Overdose
- Stage 1: nausea, vomiting, diarrhea (30min - 6 hours) - Stage 2: quiet (6-12 hours) - Stage 3: metabolic acidosis --> shock, GI hemorrhage, coagulopathy, respiratory failure (12-24 hours) - Stage 4: ARDS, liver failure (2-3 days) - Stage 5: GI strictures at gastric outlet (3-4 weeks)
36
Treatment of iron overdose
- fluid resuscitation - WBI if seen on X-ray within 6 hours - IV deferoxamine
37
Radio-Opaque drugs (COINS)
- chloral hydrate - opioid packets (latex) - iron and heavy metals - neuroleptics - sustained release/salicylates COINS
38
Isopropyl Alcohol
ketosis without acidosis
39
methanol ingestion
- profound AG acidosis presents late - osmolar gap - causes retinal injury (blindness) - treat with fomepizole - dialysis if already acidotic
40
ethylene glycol
- metabolic acidosis leads to cardiac decompensation - hypocalcemia leads to prolonged QTc - oxalate crystals appear late - fomepizole
41
CATCH CT Head Rule
Anyone with minor head injury (GCS 13-15) and one of the following: HIGH RISK - GCS < 15 2 hours post - suspected open or depressed skull fracture - irritabilty on exam < 2 yo - worsening headache LOW RISK - basal skull fracture - boggy hematoma (> 2 yo, if < 2 yo, do skull X-ray first) - dangerous mechanisms (MVC<, fall > 3ft or down 5 stairs, fall from bike without helmet)
42
Absolute and relative indications for CT in head injury
ABSOLUTE - focal neurologic deficit - clinically suspected open/depressed skull # - wideded of diastatic skull # on X-ray RELATIVE - GCS < 14 after initial assessment or < 15 2 hours post - clinical deterioration over 4-6 hours - signs of basal skull # - boggy hematoma - mechanism of injury - seizure at time of event or later - known coagulopathy
43
Poor prognostic indicators in acute head trauma
- GCS < 5 - increased ICP - pre-injury ADHD - low SES - injuries to other body sites
44
Diagnosis of Pericarditis
2/4 - pericardial chest pain (sharp, pleuritic, improved by sitting up and leaning forward) - pericardial rub - widespread ST elevation or PR depression on ECG - pericardial effusion Supportive - elevated inflammatory markers - imaging with pericardial inflammation
45
ECG changes in myocarditis and pericarditis
Pericarditis - concave ST elevated and PR depression in most limb leads - reciprocal ST depression and PR elevation in aVR - sinus tachycardia Myocarditis - PACs/PVCs or SVT/VT, intraventricular conduction delay, abnormal q waves, low voltages - AV node conduction delay - ST segment and T wave changes - prolonged QRS - QT prolongation - diffuse T wave inversion
46
Treatment of pericarditis
- Ibuprofen - Colchicine No role for steroids or IVIG
47
What is the toxic dose of acetaminophen?
150mg/kg (7.5g in adult)

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