Additional information Flashcards
1
Q
normal SBP in pediatrics
A
90 + 2(age)
2
Q
hypotension in pediatrics
A
70 +2(age)
3
Q
blood loss before a kid becomes hypotesnsive
A
up to 30% of blood volume b efore low bp
4
Q
estimate circulatory blood volume in pediatrics
A
80ml/kg
5
Q
blood replacement for pediatrics
A
10ml/kg
6
Q
IVF replacement in pediatrics
A
20ml/kg
7
Q
of IVF versus blood for pediatrivs
A
blood = 10ml/kg
pediatrics =20ml/kg
8
Q
calculate maintence fluids for kids
A
1-10kg = 4ml/kg/hr
10-20kg = 2ml/kg/hr
over 20kg = 1ml/kg/hr
**shortcut = if over 20kg, do 40 + wt in kg
9
Q
Dextrose given to pediatrics if hypoglycemic
A
all get 2ml/kg
neonate = D10
infant/toddler = D25
child= D50
10
Q
cric for pediatrics
A
needle cric if under 8yo
11
Q
NG diameter for pediatrics
A
ETT x2
12
Q
depth of ETT for pediatrics
A
ETT x3
13
Q
chest tube for pediatrics
A
ETT x4
14
Q
pediatric adenosine dose
A
0.1mg/kg
15
Q
cardioversion dose for pediatrics
A
0.5 - 2 j/kg
16
Q
defibrillator dose for pediatrics
A
2,3,4,8j/kg
17
Q
CXR of epiglottis
A
thumb sign
18
Q
thumb sign on CXR
A
epiglottis
19
Q
s/s of epiglottis
A
4 D’s = drooling, dysphagia, dysphonia, distres
rapid onset fever, stridor
20
Q
respiratory sounds of epiglottis
A
stridor
21
Q
difference between epiglottis & croup
A
croup = barking epiglottis = stridor
22
Q
interventions for epiglottis
A
life threatening
clam b/c possible rapid airway loss
abx, humidified oxygen
23
Q
lung sounds of bronchio.litis
A
90% are from RSV
wheeze/crackles
24
Q
Waddle’s Triad
A
specifi pattern of injury when ichild is hit by car
- fracture of femoral shaft (initial impact by bumper)
- intra-abd/thoracic when body hits car hood
- contralateral head injuury when thrown and hit groud/other object
25
specific pattern of injuries for pediatrics when they are hit by a car
Waddle's Triad
26
breathing if DKA
Kussmau;s to blow off CO2 in anttempt to orect acidosis
27
fruity breath
DKA
| from ketones
28
how quickly can you lower glucose in DKA
no more than 100 per hr b/c cerebral edema
29
fluids in DKA
average pt is 3-6L deficit
30
when do you swap fluids if HHS
swap to D5 once 250-300mg/dl
31
rx tat can cause diabetes insipitus
phenytoin (Dilantin) overdose b/c suppresses ADH release
32
overdose that can cause diabetes insipitus
phenytoin (Dilantin) overdose
33
treatment of DI
```
first line is IVF b/c often 9L fluid deficit
then DDAVP (synthetic vasopression w/o cardiac response)
```
34
abnormalities r/t ADH
DI
| SIADH = too much
35
using DDAVP
for diabetes insipitus = synthetic vasopression w/o the cardiac resonse
36
rx that can cause SIADH -3
tricyclic antidepressants
narcotics
oral hyopglycemics
37
level of Na when you go into a coma
below 120
38
correction of low Na
hypertonic saline
| no more than 0.5mEq/hr
39
what happens if you correct low Na too quickly
central pontine myelinolysis
| *irreversible brain damage w/cerebal palsy, quadraplegia, death
40
eye bulging
hyperthyroidism
41
consider if heat intolerance
hyperthyroidism
42
treatment of hyperthyroidism
IVF
BB
steroids
43
rx to avoid if hyperthyroidism
asprin b/c it will prevent the binding of thyroglobulin, making the situation worse
44
Grave's Diseae
hypERthyroidism
| *risk thyroid storm/thyrotoxicosis
45
takes synthroid
hyPOthyroidsm
46
rx for hypOthryoidism
synthroid
47
bright red diarrhea
hematochezia
48
Octreotide
for esophagelal varices
* synthetic form of somatostatin
* reduces spleen & liver blood flow which reduces variceal pressures
49
rx given for esophageal varices
Octreotide
50
esophgeal bleeding
varices
51
location that differentiates lower from upper GI bleed
ligament of Treitiz
52
DO NOT DO if esophageal varices
no NG tube b/c can cause a lethal rupture of varices
53
consideration if esophageal varices but you need to intubate
NO NG tube b/c that can cause a lethal rupture of the varices
54
intervention for esophageal varices
Sengstaken Blakemore tube
| *tamponade
55
non-lifethreatening rupture of the esophagus
Mallory-Weiss
56
causes of Mallory-Weiss tears
non=life threatening rupture of the esophagus
| *chronic forceful vomiting like alcoholism/bulemia
57
Boerhaave's Tears
complete transmural rupture of hte lower thoracic esophagus
58
s/s of Boerhaave's Tears -4
complete rupture of lower esophagus
| *shock, CP, Hamman's sign, SC emphysema
59
gold standard for Boerhaave's Tears
EGD
60
BUN to creatinine ratio in GI bleed
gover 30:1
61
problem of increased ammonia
liver breaks down ammonia
| increased ammonia leads to increased ICP
62
treatment for increased ammonia
lactulose
63
IRN in liver disease
INR over 1.5 b/c decreased albumin & coagulation factor
64
normal ALT
under 55
65
normal AST
under 48
66
sign of increased serum ammonia
ICP, LOC changes
67
neuro complication of liver disease
hepatic encephalopathy
68
flapping muscle tremor
asterixis = indicates liver issues
69
what happens in pancreatitis
digestive enzymes destory the pancreas
70
what might happen in untreated pancreatitis
SIRS
71
2 common auss of pancreatitis
alcohol abuse, gallstones
72
2 signs of pancreatitis
Cullen
| Grey-turner
73
what makes pancreatitis pain worse
begins/worsens after eating
| may worsen if flat
74
where is the pain in pancreatitis
epigastric to upper left abd and radiates to back
75
LUQ pain
pancreatitis
76
pain rx in pancreatitis
no morphine b/c spasms lead to obstruction in the sphincter of oddi
NSAIDS?KEtamine/Demoerol for pain
77
contraindication to morphine
pancreatitis b/c morphine leads to spasms that obstruct the spincter of oddi
78
rx that obstructs the spincter of oddi
morphine
79
what does deep tendon reflexes tell you
```
info about he integrity of spinal nerves
0 = absent
1= hypoactive
2= normal
3= hyperactive
4= cp;pmis
```
80
what does Babinski's reflex reflect
pyradimal tract disease
81
2 meningitis signs
Brudzinski's
| kernig
82
severe stiffness of hamstring & inability to straighten leg when the hip is flexed 90 degrees
Kernig
83
how to remember Kernig's sign
"kicking kernig's"
*severe stiffness of hte hamstrings causes an inability to straighten the leg when teh hiop is flexed 90 degrees
meningitis
84
involuntary lifting of the legs when liftin a pt's head
Brudzsinski's sign
| meningitis
85
minimal acceptable cerebral perfusion pressure
normal is 70-90
| cannot go below 70
86
ICP with high mortality rate
over 20
87
location of ICP tranducer
foramen of Monro
88
what is located at teh foramen of MOnro
ICP transfucer
89
goal of ICP monitoring
ensure adquate CPP and oxytenation
90
benefit of ICP monitoring
gives early detection of intracrantial HTN (ICP over 15)
91
ICP waveform parts
```
P1 = perfussion wave. arterial pulsation
P2= tidal wave. intracranial compliance
P3= diacrotic wve-venous>
P2-P3= aortic valve closing
```
92
risk of depressed skull fracture & transport
pneumocephalus if sinus cavities are fractured
93
when is an orbital fracture a surgical emergency
have pt look up. if the injured eye does not move consensually plus pt has double vision, it is a surgical emergency
94
brain bleed w/torn veins
subdural hemtoma
95
venous lakes in brain
subdural hematoma
| torn veins
96
subdural hematoma
tearing of briding veins into the subdural space
97
shape of epidural hematoma
"lenticular" in shape
98
"lenticular" in shape
epidural hematoma
99
arterial versus venous brain bleed
epidural = arterial
| subdual - venous
100
head injury w/a lucid period
epidural = arterial
101
consider if a blow to the side of the head
epidural = arterial
102
sign of tentorial herniation
pupil changes b/c increased pressure against CN3 (0culomotor)
103
"worst headache of my life"
subarachnoid hemorrhage
104
describe subarachnoid hemorrhage
worst headache of life
105
CT if subarachnoid hemorrhage
"worst HA of my life"
| starfish pattern
106
starfish pattern on CT
subarachnoid hemorrhage
107
BP goal if subarachnoid hemorrhage
SBP under 140
108
treatment of subarachnoid hemorrhage
SBP under 140
| nicardipine, nitroprusside
109
respirations in Cushing's triad
Cheyne Stokes
110
pulse pressure if Cushing's triad
wqide pusle pressure
111
minute ventilation goal of increased ICP
CO2 30-34
112
"keep the diaphragm alive"
CC3-4-5"
113
anterior cord compression
incromplete SI from displament of bony fragments into anterior cord
114
what can the anterior cord do
pain
temp
motor
115
what can the posterior cord do
vibration
touch
position in space
116
cause of Brown-Sequard
incomplete penetrating lesion
117
contralateral in Brown-Sequard
loss of pain and temperature sensation
118
loss of pain/temp sensation in Brown-Sequard
contralateral
119
same side loss in BRown-Sequard
motor, sensation to touch, proprioception, vibration
120
what happens in a central cord injury
greater loss of function in upper extremities than in the lower extremiteis with variable loss of sensaiton ot pain/temp
121
SVR in neurogenic shock
SVR udner 800
122
spinal shock
paralysis/absent reflexes for up to 72hrs
123
classic triad of neurogenic shock s/s
low bp
low hr
warm flushed, dry below lesion
SVR under 800
124
good pressor for spinal cord injuries
phenylephrine
fluids
treat bradycardia
125
most common cause of autonomic dysreflexia
bladder distension
126
level of autonomic dysreflexia
over T6
127
BP goals in HTN crisis
lower no more than 25% per hr and now lower than pt normal
128
HOB in stroke
30 degrees
129
thrombolytics for eligible strokes
within 3hr
130
treat seizures
Keppra and benzos
| check glucose
131
most common cause of encephalitis in uS
herpes simplex
132
what does encephalitis look like
flu
133
myasthenia gravis
AcH
| common acute respiratory faioure
134
Guillain-Barre
peripheral nerve syndrome
| hyporeflexia, pain, umb
135
antidote for cocaine
benzodiazepines
136
amyl nitrite
sodium nitrite
sodium thiosulfate
treat cyanide
137
treat cyanide
amyl nitrite
sodium nitrite
sodium thiosulfate
138
hydrocarbon overdose
intubate
139
Deferoxamine
for Fe overdose
140
atropine/2-PAM
for organophosphates
141
organophosphate overdose
atropine
| 2-PAM
142
methanol overdose
aaaaaaaFomepizole (ANtizole)
143
Antizole
alcohol overdose
144
INH overdose
B6/pyridoxine
145
antidote is Ba6 (pyrridoxine)
INH overdose
146
ETT diameter for pediatrics
(16 + age)/4
147
non-emergency maintence fluids for pediatrics
4-2-1m rule
148
normal PT
10-13 seconds
149
normal PTT
25-40 seconds
150
normal INR
0.9 - 1.3
151
normal troponin I
under 0.04
152
normal CK
20-200
153
normal CK-MB
under 3
154
normal troponin T
under 0.01
155
normal troponin I and T
```
I = under 0.04
T= under 0.01
```
156
normal albumnin
3.5-5.5
157
normal ALT8-48
7-55
158
normal AST
8-48
159
normal bi,irubin
.1-1.2
160
normal BUN
8-23
161
normal creatinine
0.7-1.4
162
treatment for SIADH
hypertonic saline
163
treatment of Grave's disease
IVF, BB, dexamethasone, tylenol
164
treatment of Addioson
| 's disease
steroids
165
septic shock treatment
levelpohed
166
treat high K
```
albuterol
bicarbonate
insulin
dextrose
lasix
kayexelate
calcium gluconate
```
167
treatment of asprin overdsoe
dialysis
168
causes of anion gap acidossi
```
MUDPIILES
methanol
uremia
DKA
propylene glyol
INH
Iron
ethylene glycol
salicylates
```
169
what is propylene gluycol
liquid angent used in diasepam/lorazepam
170
treatmnet fo propylene glycol
it is a liquid agent in diazepam/lorazepam
| treat with flumazeinil
171
aka antifreeze
ethylene glycol
172
Oxygen adjustment calculation at altitude
FiO2 x P1/P2
173
FIO2 x P1/P2
oxygen adjustment at alititude
174
1 ATM
2 ATM
1/2 ATM
1 ATM = sea level. 760 torr
2 ATM = 33 ft down
1/2 ATM = 380 torr = 18K
175
altitude where you have 1/2 ATM
18 K = 380 torr
176
normal Vt
4-8mlkg
177
Ve
minute ventilation
F x VT
4-8L/min
178
normal PPLAT
under 30
179
normal PEEP
0-20
