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Flashcards in Acute care q-bank Deck (61):

Name the toxidrome: mydriasis, HTN, tachycardia, hyperactive DTRs, hyperthermic, dysphoria or anxiety / panic / hallucinations / depersonalization

hallucinogen intoxication ie: LSD, PCP


Name the toxidrome: mydriasis, HTN, tachycardia, hyperthermia, dry mouth, sweating, paranoid ideation, impulsivity, hyperactivity, convulsions



Name the toxidrome: excitement, restlessness, euphoria, increased motor activity, decreased sense of fatigue, increased tremors, convulsive movements, increased HR/T/BP



How do you declare brain-death in a newborn >36 weeks gestational age and <30 days?

2 clinical exams (CN exam and apnea tests) more than 24h apart with the first exam done at > 48h of life


How do you declare brain-death in a 1 month to 1 year old?

2 separate clinical exam (CN exam and apnea test), no fixed interval between exams


How do you declare brain-death in a child or adolescent > 1 year old?

2 separate exam (CN + apnea test), but apnea test can be done concurrently


What is the caveat to declaring brain death in a hypoxic event at any age?

You must delay the exam 24 hours


What are the three components to a clinical brain death examination?

irreversible coma / unresponsiveness absence of brainstem reflexes apnea


What are the brainstem reflexes that are assessed in brain death?

pupillary light reflex oculocephalic reflex corneal reflex oculovestibular reflex gag and cough reflex


Name 6 indications for hospitalization for burns

>15% of TBSA any 3rd degree face/hands/perineum/genitals/major joints electrical or chemical burns inhalational injury inadequate home or social environment child abuse or neglect complex pre-existing medical condition associated injuries


How do you calculate fluid resuscitation in burns?

Maintenance IVF + Parkland: Ringers lactate (4mL x kg x % BSA) with 1/2 of fluids over first 8 hours and remaining 1/2 over next 16 hours


What toxidrome does TCA overdose present with?

Anticholinergic &amp; lethargy / coma / myoclonic jerks / seizures &amp; CVS refractory hypotension, QRS prolongation


How do you manage TCA overdoses?

Monitor ECG closely for QRS duration Gastric decontamination with activated charcoal in some Supportive treatment: - sodium bicarbonate antidote for QRS >/= 110msec, ventricular dysrhythmia, hypotension - hypertonic saline, lidocaine, lipid emulsion therapy for refractory arrhythmias - vasopressor therapy - benzodiazepines for seizures


What does anticholinergic syndrome look like?

(HOT) Fever, Tachycardia (RED) Flushing ( DRY) Urinary retention, Dry mucous membranes, Absent bowel sounds (BLIND) Dilated pupils (MAD) Altered mental status


What are features of a second degree burn?

Painful Wet blisters and bullae


What are features of a third degree burn?

White waxy and dry eschar No blanching, no bleeding Insensate


Name three negative prognostic factors in a submersion injury

Submersion >10 minutes Failure to respond to CPR after 25 minutes Hyperglycemia in the ED Absence of pupillary light response Apnea Deep coma


What are the features of an organophosphate overdose?

DUMBBELS Diarrhea/defecation Urination Miosis Bronchospasm Bradycardia Emesis Lacrimation Salivation


What is the management of organophosphate overdose?

Decontamination (remove clothing, wash, activated charcoal +/-) Atropine +/- Pralidoxime IVF


What test to order if suspecting alcohol overdose and how to treat?

Alcohols cause increased osmolar gap (measured osmolality minus calculated osmolality) Treat with fomepizole, ethanol or sodium bicarb in severe acidosis.


How do you calculate osmolarity?

2xNa + BUN + glucose


How do you calculate the anion gap?

Na - (Cl+HCO3)


What's the antidote for anticholinergic ingestions?

Physostigmine Physostigmine is a carbamate which inhibits the enzyme acetylcholinesterase and prolongs the central and peripheral effects of acetylcholine


What is the toxic metabolite in methanol poisoning?

Formic acid it block mitochondrial respiration


What is the minimum length of time of observation an asymptomatic near-drowning?

8 hours - in a review, no injuries occurred after 7hrs; resp distress and pulmonary edema develop between 4-8hrs afterwards - perform CXR prior to d/c


What kind of reaction: face and neck involvement manifesting as torticollis, retrocollis, oculogyric crisis, or tongue protrusion with potentially life-threatening presentations with laryngospasm and airway compromise

Acute dystonic reaction


What class do the following fall under? gasoline, propellants, motor oils, lighter fluid, lamp oils



What are the most serious consequences of hydrocarbon ingestion?

chemical pneumonitis (aspiration leads to inactivation of type II pneumocytes)


What is sudden sniffing death?

Some volatile hydrocarbons sensitize the myocardium to the effects of endogenous catecholamines and can result in dysrhythmias examples: toluene, propellants, refrigerants and volatile nitrites, all commonly abused by inhalation


What are the clinical manifestations of hydrocarbon ingestion?

-transient mild CNS depression -coughing with aspiration -CXRs start off normal and by 6 hrs will have developed abnormalities including aspiration pneumonitis, pneumatoceles develop 2-3 weeks after exposure


Treatment for hydrocarbon intoxication?

Supportive standard mechanical ventilation, HFOV, ECMO PRN


What are treatment options for CSE PRE-hospital? (acc to CPS)

Lorazepam PO/PR Midazolam PO/IN Diazepam PR


Give an example of a H1 agonist

Cetirixine Diphenhydramine


Give an example of a H2 agonist



Outline 'first tier' ICP management strategies

Head of bed elevation Sedation and analgesia Osmolar agents: NaCl 3% (4-6ml/kg, Serum Osm <360mOsm/L), Mannitol Intubation and controlled mechanical ventilation Neuromuscular blockade CSF drainage


Outline 'second tier' ICP management strategies

Barbituate infusion Decompressive craniectomy Mild hypothermia Hyperventilation Lumbar CSF drainage


What are the ECG findings of pulmonary embolus?

S1Q3T3 RBBB RV strain Right axis deviation Right atrial enlargement


Describe the tools and techniques for tension pneumothorax drainage

18-20 Fr needle catheter connected through tubing to a three-way stopcock and 60mL syringe top of the child's third rib (second intercostal space) in the midclavicular line or 4th rib anterior axillary line


Management of pulseless v-tach?

Shock-shock-epi-shock- amio 2J/kg then 4 J/kg then 0.01mg/kg 1:10,000


Whats a sulfonylurea? What to consider with ingestion?

Oral DM2 drug. Sulfonylureas work by enhancing endogenous insulin secretion. Duration of hypoglycaemic action can last up to 24h.


How to treat glyburide ingestion?

-Dextrose, oral okay if only mild symptoms. Try to avoid repeated boluses or infusion since can also increase insulin excretion. -Octreotide (somatostatin analog) inhibits insulin release


What are contraindications to ketamine?

<3 months old, schizophrenia, conditions where increased BP are hazardous, ie: glaucoma hypersensitivity or allergy


How to calculate ETT size?

uncuffed: 4 + (age/4) cuffed: 3.5 + (age/4)


What toxidrome does a gravol ingestion cause?

Anticholinergic syndrome


Name three meds for reducing blood pressure in a HTN emergency

labetalol sodium nitroprusside nicardipine


What are the three tenets of informed consent? (CPS)

1) appropriate information 2) decision-making capacity 3) voluntariness


What finding can help identify serotonin syndrome?



What are management options for serotonin syndrome?

Discontinue offending agent Benzodiazepines in mild cases Intubation, sedation, and paralysis in patients with severe manifestations Consider cyproheptadine


What are the features on CT of an epidural bleed



What are the features on CT of a subdural bleed?

crescentic, follows contour of brain


What are characteristic features of Reye syndrome?

vomiting, hepatic dysfunction, confusion, seizures, coma (increased ICP!) - especially with influenza A and varicella - aspirin ingestion


What are features of lightning injury?

cutaneous feathering CVS: cardiac arrest, HTN, PVCs, Vfib CNS: cerebral edema, hemorrhage, seizures, mood changes rhabdomyolysis myoglobinuria


Perinatal acquisition of perineal warts can appear up until what age?



Which bite wounds should get antibiotics?

antibiotics should be administered to all victims of human bites all but the most trivial of dog, cat, and rat bite injuries, regardless of whether there is evidence of infection.


If you have a clean and minor wound with <3 doses of Tdap or uncertain, what do you do?

Give vaccine


If you have a big wound with <3 doses or Tdap or uncertain, what do you do?

Give vaccine and TIG


If you have received at least 3 doses of Tdap and have a big wound, what do you do?

If last tetanus was not within 5 years, give booster.


If you have received at least 3 doses of Tdap and have a clean minor wound, what do you do?

Only give booster if >10 years since last.


What should you think of with the following history? vesicles with sun exposure and hypopigmented flat scars with mild trauma

Porphyria cutanea tarda or pseudo-porphyria secondary to Naproxen


Name side effects of Risperdal

Increased appetite Weight gain Elevated blood sugar secondary to insulin resistance Dyslipidemia (high TG, low HDL) Blood pressure changes Electrocardiogram (EKG) changes, such as prolongation of QTc Fatigue and drowsiness Dizziness Drooling Liver function abnormalities (AST.ALT) Blood dyscrasias Increase in prolactin (of unknown clinical significance) Less common, but serious, side effects include dystonic reactions, tardive dyskinesia, akathisia



signs of pulmonary embolus