Basics Flashcards
(269 cards)
1
Q
Hypotensive trauma patient- imaging
A
FAST, pelvis XR, CXR
2
Q
INtubating trauma patient- what to do first
A
Discuss c spine, obtain quick GCS/neuro exam
3
Q
Pregnant trauma patient- what to do
A
Position on left side
4
Q
Question to ask patient up front
A
Is there anyone else here with you?
5
Q
PINFAT
A
Pain IVF N/v Fever Abx Tetanus
6
Q
Penicillin rash
A
Avoid any related drugs
7
Q
Extra testing to perform on child
A
Fontanelle, tone, capillary refill
8
Q
Trauma ABCDES
A
ABC
Disability- ask for four extremity pulses, address any cold extremities, etc
Exposure- expose the patient
9
Q
Psych- what to always have in room
A
Guard
10
Q
What to say about labs
A
I would like you to draw a rainbow of labs and i will let you know which ones I need after examining the patient
11
Q
Reassessing vitals-
A
After the 1L of fluids is in, could you please let me know what the repeat vitals are?
12
Q
What to do after splint
A
Post-splint neurovascular check
13
Q
Nitroglycerin- what to ask
A
Ask about viagra, ED meds
14
Q
Heparin- also do
A
CXR, rectal exam
15
Q
Minimum child BP
A
70+ (age x2)
16
Q
Neonate HR<100
A
BVM
17
Q
Neonate HR<60
A
Chest compressions
18
Q
When to intubated- ask if managing secretions and if they have what
A
Gag reflex
19
Q
Concern for heart failure- what can you do to make sure no volume overload
A
Check for crackles on exam after giving 500cc
20
Q
ETT size for child
A
(Age/4)+4
21
Q
Newborn hypotension
A
SBP<60
22
Q
Infant hypotension
A
SBP<70
23
Q
When do you use a cuffed tube
A
Down to 1 year of age
24
Q
Normal newborn heart rate range
A
80 to 200
25
3 mo to 2 year heart rate range
75 to 190
26
Heart rate for 2 to 10 years old
60 to 140
27
>10 year heart rate
50 to 100
28
Blade to use at birth
Miller 0 to 1
29
Miller blade for infants/toddlers
1 to 2
30
Ketamine RSI dosing
1.5 to 2mg/kg
31
Etomidate RSI dosing
0.3 to 0.4mg/kg
32
Maintenance IVF rates for children
4ml/kg for first 10kg
2ml/kg for second 10kg
1ml/kg for each kg over 20
33
Parkland formula
Weight in kgx%TBSAx4ml= fluid in 24 hours
34
How to administer fluid in burns
1/2 in first 8 hours, second half in last 8 hours
35
Cancer patient with headache/fever- imaging to get
CT Head
36
Other person in room
Don’t forget to recognize them, ask if any questions
37
Kocher criteria for septic joint
Non-weight bearing
ESR>40
Fever
WBC>12K
38
Overweight young teen with hip pain- diagnosis
SCFE
39
Inflammation of the growth plate in teens with pain at hte tibial tuberosity
Osgood schlatter
40
Persistent crying differential
```
Corneal abrasion
Hair tourniquet
UTI
Meningitis
Abuse
```
41
Nondisplaced oblique distal tibial fracture from minor twist
Toddler’s fracture
42
Location of LP procedure
L3-L4 interspace
43
Normal intracranial pressure
10 to 20cm H20
44
Treatment of <1mo sepsis
Ampicillin 50mg/kg IV, gentamicin 2.5mg/kg IV +/- acyclovir
45
Altered mental status- always get
CT Head
46
Altered mental status labs to always add
UDS, Tylenol, aspirin, ETOH
47
Treatment of thyrotoxicosis
Dexamethasone
Propranolol
PTU
Oral potassium
48
Hyponatremia+focal signs/seizure
3% hypertonic saline 100cc over 10mins then 100cc over next hour
49
Management of hypoglycemia in neonate/infant<1
D10 at 5cc/kg
50
Management of hypoglycemia in child between 1 and 8
D25 at 2cc/kg
51
Management of hypoglycemia in kid>8
D50 at 1cc/kg
52
Maintenance dextrose for infants
10% dextrose at 6–8 mL/kg/hr IV
53
Crotaline
Pit vipers- rattlesnakes, water mocassin
54
Elapidae
Coral snakes
55
How do crotaline venom work
Damage the capillary endothelium and cell membranes resulting in a vascular breakdown and capillary leak
56
What is immediate effect of crotaline bites
Edema- so watch out for compartment syndrome and airway compression if bites to face
57
Treatment of pain in crotaline snake bite
Opioids or Tylenol given risk of bleeding
58
Dressing for crotaline snake bite
Compression dressing or splint
59
Monitoring of snake bite
Measure every 15-30 minutes
| Asymptomatic should be monitored for minimum 8hrs, 12-24 if any tissue damage
60
Labs/work up for crotaline snake bite
complete blood count, coagulation factors including fibrinogen, type and screen, creatinine kinase, urinalysis, and comprehensive metabolic profile. An ECG is
61
When to give crofab
Moderate: progression of swelling beyond bite site, non-life threatening symptoms
Severe: shock, severe local envenomation, coagulopathies
62
How to administer crofab
initial control dose of 3-12 vials followed by scheduled re-dosing of 2 vials at 6, 12, and 18 hours.
63
How elapidae venom works
elapidae venom has no proteolytic activity and thus causes fewer local symptoms but does have a potent neurotoxic component
64
How long to observe elapidae bite victims
24 to 48 hours
65
Worst possible outcome of elapidae bite
Paralysis lasting 3-5 days-> respiratory failure
66
Dispo for elapidae bite victims
All should be admitted, even if asymptomatic for 24-48 hours due to risk of paralysis
67
Additional exam point in pediatric males that you should complete
Testicular exam, diaper exam
68
When is testicular salvage possible
After less than 12 hours of symptoms, but almost impossible after 24 hours
69
Additional testing that should occur for testicular torsion
Epididymitis, check UA/GC
70
Describe manual detorsion
Elevate affected testicle toward inguinal ring, rotate one and half rotations in a medial to lateral motion. relief of pain is indicator that procedure is complete
71
Elderly abdominal pain- also order
Troponin
72
Concern for peritonitis- what to start right away
Antibiotics
73
Backup imaging for free air if CT scan not available
Upright abdominal series and CXR
74
Treatment for pertussis
Azithromycin (also can do erithromycin)
75
What you should try before intubating
Airway maneuvers- chin thrust, oropharyngeal suctioning, pulling tongue forward
76
If animal passes out, what to think of
Carbon monoxide poisoning
77
Additional labs to order if concern for COHB
COHb, arterial blood gas
78
Definite indications for hyperbaric chamber in COHB poisoning
Abnormal neuro exam, altered mental status, coma, syncope, seizure. Relative- 4hours after 100% O2, pregnancy, persistent acidosis, concurrent thermal/chemical burns
79
What to remember during trauma intubations
C spine precuations
80
What to do if teeth are missing
CXR for missing teeth
81
What to ask during ABCs for trauma
4 extremity pulses
82
Absolute contraindications for cricothyrotomy
Tracheal transection, damage to larynx or cricoid cartilage
83
Technique for cric
Hyperextend neck
Identify cricothyroid membrane below thyroid cartilage and above cricoid cartilage (one finger breadth below laryngeal prominence)
Incise skin and cricothyroid membrane with single horizontal stabl-like incision.
Make 90 degree turn, place boogie into hole, pass tube above it
84
What to do before giving any medications
Ask if they have allergies
85
Labs to get during burn
Lactate, carboxyhemoglobin
86
Dose of atropine for bradycardia
0.5mg q5mins up to 3mg
87
What should you ask for immediately with symptomatic bradycardia
Ask to place pacer pads on patient
88
Things to order in bradycardia
CXR, TSH, EKG, =/- head CT, BNP, ?echo, rectal temperature
89
Management of myxedema coma
Passive rewarming, hydrocortisone 100mg IV, levothyroxine (T4) 100-500mcg, treat concurrent conditions, admit to MICU
90
Treatment of beta blocker overdose
3-5mg IV glucagon slow push, high dose insulin therapy 1unit/kg regular insulin IV push with IV dextrose bolus then 1unit/kg/hr with dextrose supplementation as needed, can consider use of CCL, lipid emulsion is last resort
91
treatment of ca blocker overdose
Calcium gluconate/chloride, high dose insulin therapy
92
How to distinguish CCB vs BB toxicity
CCB causes hyperglycemia, BB cause hypoglycemia/hyperkalemia
93
Technique for transcutaneous pacing
Place pads on the patient
Put defibrillator in pace mode
Set rhythm to 70
Start at minimum current and increase the current until capture is noted
94
Dose of epinephrine in severe asthma attack
0.4mg IM (0.01mg/kg in peds)
95
Management of severe asthma attack
```
IV magnesium
Albuterol
ipratroprium
Epinephrine/terbutaline
Steroids
```
96
Lab test to obtain in asthma attack
ABG
97
Additional history to consider obtaining
Sexual history, HIV, etc
98
SJS- additional exam and people to consut
Eye exam, consult ophthalmology.
99
Treatment of GBS
IVIG/plasmapharesis
100
Before intubating, if you have time, what should you do
Update family
101
Lower extremity weakness, additional things to order
LP, head CT
102
Ophthalmoplegia, ataxia, lower extremity weakness- diagnosis
Miller Fischer variant
103
Botulism weakness
Descending weakness iwth CN involvement generally first
104
Additional diagnosis to consider with LE weakness
Tick paralysis
105
symmetric limb weakness, greatly diminished or absent tendon reflexes, and minimal loss of sensation despite paresthesia
G
106
Additional things to do with LE weaknes
Sphincter tone, NIF, ask about bowel/bladder incontinence
107
Management after SBO diagnosis
NGT, consult surgery, NPO
108
Treatment of hypertension from cocaine use
IV phentolamine, cannot use beta blocker as would cause unchecked alpha surge
109
Treatment of cocaine induced chest pain
IV benzoes, admit for cardiac monitoring/continued troponins.
110
When to do LP in children >12mo
Focal seizure
Toxic and not playful in postictal
Follow up is a concern
Patient already receiving abx
111
Seizing infant <6mos should always get
LP
112
Work up for febrile seizure
Can get labs, UA
113
Simple febrile seizure
Generalized tonic clinic <15 mins with return to neuro baseline
114
Discharging someone- what should you do
Counsel regarding medications, call PCP
115
Anaphylaxis treatment
Methylprednisone (1-2mg/kg) IV, Benadryl IV, epinephrine IM, fluids, famotidine, aluterol
116
What to do at discharge for anaphylaxis
Steroids, Benadryl, famotidine for 3 days, epipen, counsel parents, call PCP/allergist
117
Exam to do in woman with abdominal pain
Pelvic exam
118
Does an abscess need antibiotics
Only if systemic symptoms
119
What to remember in ectopic pregnancy
Rhogam for O-
120
+beta hcg + no IUP=
Ectopic pregnancy until proven otherwise
121
Lab work to assess in alcohol use disorder
UDS, Tylenol, alcohol, anion gap, osmolar gap
122
Meds to give in alcohol use disorder
Thiamine, folate, MV
123
Anion gap calculation
(NA+K)- (HCO3+CL)
124
Treatment of AKA
D5NS until rehydrated then D5 1/2NS, give thiamine before dextrose fluids
125
What electrolyte to monitor in AKA
Potassium- treatment can induce insulin production
126
Definition DKA
Glu >250, ph<7.3, ketosis
127
How to replete potassium in DKA
If K > 5.2 mEq/L, no repletement is necessary, and insulin can be started.
If K is 3.3-5.2 mEq/L, provide PO K (20 mEq) and peripheral IV at 10 mEq/hr while starting insulin.
If K < 3.3 mEq/L, hold insulin until > 3.3. Start PO and IV potassium.
128
Fluid resuscitation in DKA
200ml/hr after blouses have been given
129
MI in II, III, aVF
Inferior MI- get right sided leads
130
Questions to ask about with diarrhea
Social history- travel, risk factors for immune compromise, antibiotic use
131
What to send in a stool sample
Ova/parasites, fecal leukocytes, giardia antigen, c. Diff toxin, E. coli O157:H7 toxin assay
132
Persistent diarrhea is most consistent with what type of pathogens
enteric bacterial or protozoal pathogens
133
How long is subacute diarhrea
15-29 days
134
Treatment for invasive bacterial diarrhea
Ciprofloxacin (500 mg orally twice daily) or levofloxacin (500 mg orally once daily) for 3-5 days (avoid in pregnant patient
135
Treatment for diarrhea in children
Avoid antibiotics until stool cultures return
136
What to remember to do when discharging a patient
Make sure to arrange follow up
137
Petechia, altered mental status, microangiopathic hemoltytic anemia, thrombocytopenia, renal impairment, CNS impairment
TTP
138
Concern for TTP- what to order
Peripheral smear
139
Peripheral smear in TTP
Anemia, thrombocytopenia, schistocytes, helmet cells, fragmented RBC
140
Treatment for TTP
Prednisone, PLEX
141
Altered mental status- things to look for
Med list, history from bystanders, contact information in wallet, old chart, medic alert tag
142
What to give with thiamine
Glucose
143
Critical actions for ludwigs
Consult ENT, unasyn 3g (or Clindamycin), awake intubation to protect airway for ICU
144
Steps for awake endotracheal intubation
Dry (Robinho), Topicalize (4% nebulized lidocaine at 5lpm), Sedate (ketamine in 20mg aliquots), Intubate using ETT. Have boogie at bedside
145
Describe nasal intubation
- phenylephrine/oxymetalazine spray
- topical anesthesia with 2-4% viscous lidocaine
- place a lubricated nasal airway to keep it open
- choose nare that is most patent
- lubricate ETT
146
Describe thoracotomy
Patient’s undergoing thoracotomy should be intubated; however, this should not delay starting the procedure and can be performed by another member of the trauma team. On arrival bilateral chest tubes should be placed. Placement of a right sided chest tube enables clinicians to identify potential injuries in the right thorax. In order to expose the heart and lungs, a left anterolateral thoracotomy is performed regardless of site of penetrating trauma. The incision begins at the 4thor 5th intercostal space and extends from the posterior axillary line to the sternum. Retractors are inserted to expose the left thorax for evacuation of blood and clamping of vasculature to achieve hemostasis. The pericardium is then exposed by moving the left lung, and a pericardiotomy is performed through incision of the pericardial sac extending from apex to aortic root. The heart can then be exposed with evacuation of pericardial blood or clots and inspection for myocardial defects or lacerations. These injuries can be repaired with sutures or staples, and larger defects may be tamponaded off with a foley balloon. The aorta is then cross clamped and cardiac massage is initiated. Presence of hemothorax often makes it difficult to distinguish the aorta from the esophagus. To locate the aorta, the anterior aspect of the spinal column should be palpated and the parietal pleura overlying the aorta will then be located and can be digitally opened.1 Placement of a nasogastric tube or bougie into the esophagus can help distinguish the aorta from the esophagus through palpation.1,6If no etiology of hemodynamic collapse is identified, the incision can be extended to the right side of the chest for inspection of the right thorax and better visualization of the right atrium and ventricle. The most common injuries that can be intervened upon involve the right ventricle, due to its anterior location in the chest cavity. If return of spontaneous circulation is achieved, the patient should be transported to the operating room for definitive intervention.
147
What should do if family member is there during private exam
Ask to leave both for exam and sensitive parts of the history
148
Treatment of tubo-ovarian abscess
- Cefotetan 2 g IV every 12 hours plus doxycycline 100 mg PO or IV every 12 hours OR
- Cefoxitin 2 g IV every 6 hours plus doxycycline 100 mg PO or IV every 12 hours OR
- Clindamycin 900 mg IV every 8 hours plus gentamicin loading dose IV/IM 2 mg/kg followed by maintenance dose of 1.5 mg/kg every 8 hours.
149
Dispo for TOA
Admission for IV antibiotics
150
Discharge intstructions for TOA
- Recommendation of abstinence from sexual activity until 1 week after completion of treatment for both partners and/or until symptoms have resolved.
- Strong encouragement of partner evaluation and treatment.
- Education on use of barrier contraceptives and “safe sex” techniques.
- Follow-up in 3 days in ED or with primary care physician/OBGYN.
151
What to do at beginning of every trauma
Make sure C spine is protected
152
Treatment of cerebral venous sinus thrombosis
Steroids (?), abx- vancomycin, Rocephin, flagyl
153
Something to keep people in the room
I’m going to quickly assess for any collateral info- is EMs, family, or records here for me to evaluate?
154
What to order in a paracentesis
Culture, cell count, glucose, gram stain, ?LDH, protein
155
What to do after cardioversion
Repeat ECG to assess for sinus
156
Diagnostic criteria for kawasakis
1. Fever of at least five days duration
2. 4/5 of following:
- conjunctival injection
- lips/oral mucosal findings
- extremity findings (erythema of palms, etc)
- polymorphous rash
- cervical lymphadenopathy
157
Test during cauda equina exam
Perianal sensation, straight leg raise signs, ankle reflexes
158
Medication to give in cauda equina
Talk to neurosurgery about dexamethasone`
159
Who to include during pediatric code
Social worker/clergy for family
160
What to direct people to do in a code
Have someone keep time and monitor quality of compressions, nurse to draw meds, rotating people doing CPR
161
How to monitor quality of CPR
Attach them to end tidal CO2 detector
162
Describe intubating a child
Place a shoulder roll under their shoulders,
163
Defib dose for children in cardiac arrest
2-4K/kg
164
What to specify when giving adenosine
IV close to heart, followed by rapid flush
165
Epi dosing in PALS
0.01 mg/kg (0.1 mL/kg of the 0.1 mg/mL concentration)- follow it with rapid NS push
166
Hs/Ts
```
Hypovolemia
Hypoxia
Hypothermia
Hypo/hyperkalemia
Hypovolemia
Hydrogen ion
Tension pneumo
Tamponade
Thrombosis, pulm
Thrombosis, cardiac
```
167
Lidocaine dosing in PALS
1mg/kg loading dose
168
most common cause of septic arthritis in the sexually active patient population
N. Gonorrhea- also obtain throat, vaginal swabs, etc
169
Abx for septic joint
Vancomycin +/- rocephin (if there are gram negatives or no bacteria seen)
170
Describe knee arthrocentesis
1. Patient lies supine or knees bent at 10-20 degrees
2. Superior- 1cm superior and 1cm either medial or lateral to the patella.
Midpoint- 1cm medial or lateral to the midpoint of the patella.
3. With an 18-20g needle, insert the needle through the region of tissue has been anesthetized. Regardless of the approach being taken, the directionality of the needle should be posterior to the patella while horizontal to the joint space. Proceed into the joint space and maintain negative pressure on the syringe while advancing until fluid is readily returning into the syringe
171
Rash on palms/soles and spreading to trunk
RMSF
172
Lab counts that suggest tickborne illness
high WBC count, hyponatremia, elevated LFTs
173
Treatment of acute chest syndrome
Blood transfusion, exchange transfusion, antibiotics, consult hematology, admit to MICU
174
Treatment of stroke in sickle cell disease
Exchange transfusion
175
Describe kernig’s sign
Contraction of hamstrings in response to knee extension
176
Describe brudzinski’s sign
Flexion of hips/knees in response to neck flexion
177
Gram neg diplococci
Neisserria meningitidis
178
Gram positive diplococci
Strep pneumo
179
Gram neg rods
E. Coli
180
Extra steps to do with meningococcemia
Contact close contacts- start rifampin BID
181
When to admit someone with pericarditis
Pericardial effusion or myocarditis
182
Imaging to do with pericarditis
Echo, CXR
183
How to distinguish acute mountain illness from HACE
Neuro effects
184
Treatment of HACE
Steroids, descent
185
Most lethal form of altitude sickness
HAPE (Pulm edema)
186
Lab level to check in digoxin toxicity
Potassium level (hyperkalemia increases mortality)
187
Critical actions for digoxin toxicity
```
EKG
Atropine/pacer pads
Digital
Treat hyperkalemia
CCu
```
188
Side effect of digifab
Hypokalemia
189
ECG finding of digoxin
Curved upstroke at end of ventricular depolarization, catch, AV block
190
Empiric treatment for acute digoxin toxicity
10-20 vials
191
Empiric treatment for chronic digoxin toxicity
3-6 vials
192
Equations to calculate required number of vials
=(Dose mg x 0.8)/0.5
| =(level ng/ml x weight kg)/100
193
What to consider about heart disease in kids <1mo
Left sided lesion- always ducal dependent
194
How to manage Ductal dependent lesions
Fluids in 5-10ccg/kg aliquots, PGE1, early abx
195
Big four causes of neonatal cyanosis
Congenital Heart Disease
Sepsis
Respiratory disorders (i.e., pneumonia, ARDS)
Hemaglobinopathy (i.e., polycythemia, methemoglobinemia)
196
How to perform hyperoxia test in baby
Apply 100% O2 for 5-10 mins and see if O2 improves. If so- probably a resp etiology
197
Boot shaped heart on CXR
ToF
198
Snowman on CXR
Total anomalous venous return
199
Egg on string on CXR
Transposition of great arteries
200
Cyanosis w/o resp distress- what to order
Methemoglobin
201
What to use for pediatric intubation in CHD
Etomidate
202
Treatment of INH seizure
Benzo, benzo, pyridoxine (1mg for every gram ingested, or 5G dose if unknown ingestion)
203
Size kidney stone to consult urology for
>6mm
204
First line treatment for status epilepticu
- Lorazepam IV: 4mg q4 minutes, may repeat once (*often underdosed in observational studies)
- Midazolam IM: 10 mg IM once (*often underdosed in observational studies)
205
Define status epilepticus
-seizure >5minutes or recurrent seizure without returns to baseline
206
Side effect of phenytoin
Can cause cardiac effects because of Na channel blockade (fosphenytoin less likely to have this effect)
207
Second line treatment for status epilepticus
-Levetiracetam 60 mg/kg IV, max 4500mg
-Fosphenytoin or Phenytoin 20 mg/kg IV, max 1500mg
avoid in toxicologic causes of seizure
-Valproate 40 mg/kg IV, max 3000mg
contraindicated in pregnancy
208
when to intubate in seizure
If aspirating or apneic
| 2. If no response to first adequate dose of benzodiazepine
209
Paralytic of choice for seizure
Succinylcholine if seizure<25 mins
210
Abx treatmnet for fournier
Clindamycin+ vancomycin+ Zosyn
211
Treatment for intussusception
Air contrast enema
212
Labs to add on to PJP pneumonia
LDH, ABG
213
Treatment for PJP pneumonia
Bactrim, prednisone
214
When to give prednisone in PJP pnuemonia
PaO2<70, A-a gradient >35
215
How to give prednisone in PJP pneumonia
PO regimens taper from 40 mg BID for 5 days to 40 mg daily for 5 days to 20 mg daily for 11 days
216
Most common intracranial infection in HIV
Cryptococcus
217
Treatment for cryptocococcal meningitis
IV amphotericin B and flucytosine, followed by prolonged oral therapy with fluconazole. (Get LP pressure)
218
Differential for AMS in HIV/AIDS
toxoplasmosis, EBV-related lymphoma, tuberculosis, and progressive multifocal leukoencephalopathy caused by the JC virus
219
At what levels can neurogenic shock occur
Above T6
220
Lesions above what level can cause diaphragm paralyisis
L5
221
Nexus Cspine criteria
```
No midline tenderness
No pain with neck movement
No distracting injury
No neuro deficit
No alcohol or drugs
No altered mental status
```
222
Fracture of C2
Hangman’s fracture
223
Vertical force transmitted from skull to occipital condyles
Jefferson fracture
224
Patients that should be admitted to the hospital for pyelo
Unstable vital signs, e.g. persistent tachycardia, hypotension, tachypnea, or signs of septic shock
Resistance to oral antibiotics or complicated antibiogram with history of repeat infections
Inability to take oral medications regardless of medical interventions
Refractory pain
Psychosocial issues hindering self-care
Pregnancy
Immunocompromised state
Infected transplanted graft
Repeat presentation to the emergency department with worsening condition
Imaging demonstrating obstructing urolithiasis, abscess, cyst, or abnormal genitourinary tract anatomy
225
Diarrhea in kids plus microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and acute kidney injury (AKI)
HUS
226
Compare TTP vs HUS
TTP has more neuro symptoms, HUS more AKI
227
Disposition for HUS
Talk with ICU/nephro, admit to ICU
228
How much Tylenol is concerning for overdose
140mg/kg or >7.5G per day
229
Treatment for mobitz 1 (wenkebach)
Usually nothing, but if symptomatic, can use atropine
230
Second degree block- what to consider
RCA occlusion because 90% of AV nodes are supplied by RCA
231
Treatment for mobitz 2
Pacing
232
How to distinguish mobitz 1 and 2
Mobitz 1 will respond to atropine, mobitz 2 will not and will typically have a wide QRS due to below AV node
233
Coved ST in V1-V2
Brugada
234
Management of asymptomatic brugada
Aggressively treat fever, close f/u with cardiology/EP
235
Management of symptomatic brugada
Admit for ICD
236
CCB treatment for SVT
Diltiazem 2.5 mg/min, until termination of AVNRT or total dose of 50 mg
237
Ddx for narrow complex regular tachycardi
ST, SVT, atrial flutter
238
Ddx for narrow complex irregular tachycardia
Afib, atrial flutter with variable conduction, MAT
239
Additional blood work to obtain in hypothermia
DIC work up- coags, fibrinogen, LDH
240
When to terminate resuscitation in hypothermia
>32C and K>12
241
Active rewarming measures
ECMO
| Thoracic lovage
242
Active rewarming should continue until a core temperature of what is achieved
32C
243
What else should be worked up in hyperthermia
investigated for rhabdomyolysis, AKI, liver failure and concomitant infection
244
Disposition for hyperthermia
ICU, at risk for rebound
245
Goal for treating hyperthermia
Patients should be rapidly cooled (< 30 min) to a target temperature of 38.3oC (101oF)
246
Antiplatelet before PCI
Ticagrelor 180mg, UFH
247
Sources of fever in nursing home patients
Pneumonia, UTI, cellulitis, decubitus ulcer
248
Cooling in hypothermia should be done until what temp
40c
249
What to set synchronized cardio version at for vtach
100-200J
250
Medical management of VTach
Give amiodarone 150mg IV over 10minutes
Give Lidocaine 1-1.5mg/kg IV over 2-3 minutes
Give Procainamide up to a max dose of 10-20mg/kg IV
251
Goals of treatment in TCA overdose
bicarb drip until QRS duration <100, vitals stable, Na ~150, pH ~7.55. Watch for hypokalemia and hypocalcemia with bicarb drip. Consider hypertonic saline (3%) if refractory or if serum pH>7.55.
252
Ketamine procedural sedation pediatric dose
1-2mg/kg
253
Propofol prcoedural sedation dose
0.5-1mg/kg IV over 3-5 mins, repeat 0.5 mg/kg q3-5 min PRN
254
Ketofol procedural sedation dose
0.5mg/kg of both
255
Ddx for bloody neonate stool
NEC, malrotation with volvulus, hirshcsurping disease, systemic coagulopathy
256
Treatment for SBP
Rocephin daily
| Albumin if Cr >1.1, BUN>30, Tbili>4
257
When gastric lavage may be indicated
Colchicine toxicity
258
When to treat diarrhea with antibiotics
If patient has bloody diarrhea (after first ruling out e coli O157:H7), severe symptoms (fever, >6 episodes per day), dehydration, or foreign travel, empiric antibiotic treatment may be warranted.
259
Dose of pyriidoxone to give in seizure
5G, otherwise 1:1 ratio with isoniazid consumed
260
Negatively bifirigent crystals
Gout
261
Positively bifirgent crystals
Pseudogout
262
Reversal for novel AC
4 factor PCC, kcentra
263
Pediatric morphine dose
0.05-0.1mg/kg
264
Concern for RPA, wHat should you do first?
Prepare airway equipment
265
Dose of dexamethasone in children
0.6mg/kg
266
Management of croup in children
- 0.6mg/kg dexamethasone- should work in 2 hours
| - racemic epi q2h x3- doesn’t work- ICU and ent consult for other cause
267
Assessment of inborn error of metabolism
Ammonia
268
ETT for 1-2 yo
3.5
269
ETT for <1
3.0
