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Flashcards in BRS Emergency Medicine Deck (121):
0

MCC of cardiac arrest in a child is _______

lack of oxygen supply to the heart
heart disease is an uncommon cause in children

1

2 ways to open up the airway

head tilt method
jaw thrust method if suspect cspine injury

2

assess breathing with this method

look listen feel

3

where to assess pulse in infants vs. children

infants- brachial
children- carotid

4

compensated
decompensated
irreversible
*describe these forms of shock

compensated- normal BP and CO with adequate tissue perfusion, maldistributed blood flow to essential organs
decompensated- hypotension, low CO, inadequate tissue perfusion
irreversible- cell death, refractory to medical treatment

5

_____ is the MCC of shock in kids
it is commonly due to _____ or _____

hypovolemic
hemorrhage, dehydration

6

in hypovolemic shock, volume losses > _____ lead to decompensated shock

25%

7

2 phases of septic shock

1. hyperdynamic stage- bounding pulses, high CO, warm extremities, wide pulse pressure
2. decompensated stage- impaired mental status, cool extremities, diminished pulses

8

2 types of distributive shock

anaphylactic- acute angioedema of upper airway, bronchospasm, pulmonary edema, urticaria, hypotension

neurogenic- total loss of distal sympathetic cardiovascular tone with hypotension 2/2pooling of blood within the vascular bed

9

changes in ____ often occur before changes in BP in shock

HR- tachycardia occurs before hypotension

10

initial fluid management in shock

20 mL/kg bolus of NS or LR

11

give ______ for DIC

FFP

12

_____ are the leading cause of trauma in kids

MVA

13

special considerations in trauma in kids

-they have larger heads so head injuries are more common
-rib cage is more pliable so more energy is transmitted to lungs, liver, spleen
-growth plates are weak and are at the highest risk of injury (ligaments are stronger than the growth plate)

14

causes of PEA

cardiac tamponade
tension ptx
profound hypovolemia

15

in addition to primary and secondary survey, do these tests

EKG
urinary cathether
NG tube
CXR

16

seizures are common after head trauma... what do you do?

nothing... they are self limited

17

infants are at risk for bleeding in the ______ and ______ because of open fontanelles and cranial sutures

subgaleal and epidural

18

epidural hematoma is tearing of the ______
on CT, you see _______
tx by _______

middle meningeal artery
lenticular density
surgical drainage

19

subdural hematoma is due to tearing of ______
on CT, you see _______
how to tx

bridging veins
crescentic density
neurosurg consult and usually surgical drainage

20

intracerebral hematoma usually occurs on _____ (side/opposite side) of trauma

opposite side
contrecoup injury

21

______ is an early sign of herniation in children < 4 years of age

bradycardia

22

cushing's triad (late sign of herniation)

bradycardia
HTN
irregular breathing

23

how to manage increased ICP

mild hyperventilation
elevation of head
diuretics like mannitol
neurosurg consult

24

kids are prone to spinal cord injuries w/o radiographic abnormality

yep
SCIWORA

25

distended neck veins, decreased breath sounds, hyperresonance to percussion, displaced trachea, PEA, shock

tension pneumothorax
tx with needle decompression

26

occurs after injury to RUQ (esp bicycle handle bar)
-abdominal pain and vomiting
-bowel obstruction is found on radiographic evaluation

duodenal hematoma

27

lap belt injuries

chance fracture- flexion disruption of the lumbar spine
liver and spleen lacs
bowel perfs

28

_____ are the second MCC of accidental death in children
esp due to _____

burns
scalding injuries from hot liquids

29

classifying degree of burn

first degree- only the epidermis
-red, blanching, painful skin (ex. sunburn)

second degree (partial thickness)- epidermis and part of the dermis
-superficial partial thickness- entire epidermis and outer portion of dermis; moist, painful, red; blister but no scar
-deep partial thickness- entire epidermis and lower portion of the dermis; pale white; may blister and heal with scarring

third degree (full thickness)- epidermis, dermis, part of subcu tissue
-dry, white, leathery
-insensitive to pain b/c nerve endings are destroyed
-skin grafts are needed

30

if you suspect someone inhaled hot gases, do this

intubate!!

31

for burns, fluid resuscitation is critical

yep

32

skin care for burns

1st degree
-moisturizers, analgesics
2nd degree
-opiates, debridement of dead skin to prevent infection
3rd degree
-skin grafting, hydrotherapy, escharotomy

abx in the form of topical 1% silver sulfadiazine for 2nd and 3rd degree

33

victims of near drowning may suffer from aspirating liquid (_____) or from laryngospasm (______)

wet drowner
dry drowner

34

near drowners might cough up ______
in the next few days, monitor for these things

pink frothy material
aspiration pneumonia
deterioration of pulmonary function

35

bruises on fleshy or protected areas (face, cheek, back, chest, abdomen, buttocks, genitalia) suggest______

child abuse

36

what do nonaccidental burns look like

clear line of demarcation

37

aging of bruises by color

red blue: 0-3 days
blue purple: 3-5 days
green: 5-8 days
yellow brown: 8-14 days

38

top 2 causes of death in child abuse cases

head injuries
visceral injuries

39

fxs of first or posterior rib, sternum, scapula, vertebral spinous processes
bucket handle or corner fxs

child abuse!

40

what to do if you suspect child abuse

call CPS
skeletal survey
dilated ophtho exam to look for retinal hemorrhages

41

what postmortem finding is common in SIDS pts

intrathoracic petechiae

42

most cases of poisoning in children are 2/2 child abuse

F
90% are accidental

43

poisoning: bitter almond odor

cyanide

44

poisoning: garlic odor

arsenic
organophosphates

45

poisoning: acetone odor

salicylates
isopropyl alcohol

46

poisoning: wintergreen odor

methylsalicylate

47

poisoning: moth ball odor

camphor

48

poisoning skin finding: cherry red color

carbon monoxide
cyanide

49

poisoning skin finding: sweaty

organophosphates
sympathomimetics

50

poisoning skin finding: dry skin

anticholinergics

51

poisoning skin finding: urticaria

allergic reaction

52

poisoning skin finding: gray cyanosis

methemoglobinemia

53

poisoning miosis

opiates
phencyclidine
organophosphates
phenothiazines

54

poisoning mydriasis

amphetamines
cocaine
TCAs
atropine

55

poisoning nystagmus

dilantin
phencyclidine

56

poisoning retinal hemorrhages

CO
methanol

57

in a poisoning situation, radio-opaque stuff in the stomach on imaging may indicate:

CHIPE
chloral hydrate and calcium
heavy metals
iodine and iron
phenothiazines
enteric-coated tablets

58

in AMS, always give these

dextrose and naloxone

59

ipecac
-what does it do
-is it effective

rapidly induces emesis
does not really improve clinical outcome

60

gastric lavage can be performed if it's within _____ of ingestion of a toxin

1 hour

61

activated charcoal improves clinical outcome but is ineffective for the following:

iron
lithium
alcohols
ethylene glycol
iodine
K
arsenic

62

whole bowel irrigation is a rapid and complete emptying of the intestinal tract with ______ and ______

polyethylene glycol and an electrolyte solution

63

pathophys of acetaminophen poisoning

depletion of glutathione (a cofactor used during metabolism of acetamionphen by the cytochrome P-450 system) --> accumulation of toxic intermediates --> hepatocellular necrosis

64

4 phases of acetaminophen poisoning

stage 1
-30 min-24 hours
-asymptomatic, or N/V/D
stage 2
-24-72 hours
-GI sxs resolve; hepatic transaminases begin to increase
stage 3
-72-96 hours
-hepatic necrosis, jaundice, hypoglycemia, hepatic encephalopathy, renal failure, etc
stage 4
-4 days-2 weeks
-resolution of sxs, progressive liver damage, or death

65

how to tx acetaminophen poisoning

-gastric lavage
-activated charcoal
-get serum acetaminophen levels 2-4 hours after ingestion --> Matthew-Rumack nomogram --> if hepatitis, give NAC (give it within 8 hours of ingestion)

66

respiratory alkalosis with anion gap metabolic acidosis indicates ______ poisoning

salicylate (aspirin)

67

pathophys of salicylate poisoning

-directly stimulates respiratory center --> respiratory alkalosis
-uncouples ox phos --> lactic acidosis

68

fever, diaphoresis, flushed appearnace, tinnitus, etc
poisoning by _____

salicyclate

69

how to tx salicylate poisoning

gastric lavage
activated charcoal
get serum salicylate level 6 hours after ingestion --> Done nomogram
alkalinize the urine with sodium bicarb, IV fluids

70

antidote for acetaminophen

NAC

71

antidote for anticholinergic agents

physostigmine

72

antidote for benzos

flumazenil

73

antidote for black widow spinder

antivenin lactrodectus mactans

74

antidote for CO

oxygen

75

antidote for coral snake

antivenin micrurus fulvius

76

antidote for cyanide

CN antidote kit
hydroxocobalamin (vitamin B12)

77

antidote for digitalis

digoxin specific Fab antibodies

78

antidote for heavy metals

D-penicillamine
dimercaprol
DMSA
EDTA, Ca

79

antidote for inducers of dystonia

diphenhydramine
benztropine

80

antidote for inducers of mehemoglobinemia

methylene blue

81

antidote for iron

deferoxamine

82

antidote for isoniazid

pyridoxine (vitamin B6)

83

antidote for methanol and ethylene glycol

ethanol
fomepizole

84

antidote for narcotics

naloxone

85

antidote for organophosphates; carbamate pesticides

atropine
pralidoxime

86

antidote for beta blockers; CCBs

glucagon

87

antidote for sulfonylurea oral hypoglycemic agents

octreotide
glucagon

88

pathophys of iron poisoning in children

direct damage to GI tract --> hemorrhage
hepatic injury and necrosis
third spacing and pooling of blood in the vasculature
interference with ox phos

89

stages of iron toxicity

stage 1: 1-6 hours
-abd pain, N/V/D, GI bleeding, shock, fever, leukocytosis
stage 2: 6-12 hours
-resolution of stage 1 sxs
stage 3: 12-36 hours
-metabolic acidosis, circulatory collapse, hepatic and renal failure, DIC, neuro deterioration
stage 4: 2-6 weeks
-pyloric or intestinal scarring with stenosis

90

how to tx iron poisoning

-gastric lavage **note: activated charcoal doesn't work
-obtain serum iron level 2-6 hours after ingestion
-give IV deferoxamine if serum iron levels > 500, severe GI sxs, more than 100 mg/kg of iron was ingested
-can also do deferoxamine test dose... if urine turns pink/red, give it

91

lead poisoning is typically _____ in timeline

chronic

92

sxs of lead poisoning

abdominal- colicky pain, constipation, anorexia, vomiting
neuro- irritabliilty, seizures, listlessness
peripheral blood smear- microcytic anemia with basophilic stippling
dense metaphyseal bands on xrays of the knees and wrists (lead lines)

93

how to dx and tx lead poisoning

dx with elevated lead level or elevated erythrocyte protoporphyrin
tx for significant toxicity with dimercaprol, BAL, EDTA

94

____ cause coagulation necrosis that produces superficial damage to the mouth, esophagus, and stomach

acids (toilet bowl cleaner)

95

_______ cause liquefaction necrosis that produces deep and penetrating damage

alkalis (oven and drain cleaners, bleach, laundry detergent)

96

gastric perforation and peritonitis may follow ______ ingestion

acid

97

esophageal perforation with mediastinitis may follow _____ ingestion

alkali

98

how to manage caustic ingestions

no ipecac, gastric lavage, or activated charcoal
do an endoscopy

99

pathophys of CO poisoning

-CO displaces oxygen from hemoglobin, creating carboxyhemoglobin (CO-Hb)
-oxygen hemoglobin dissociation curve is shifted to the left (they are bound tighter... impaired release of oxygen to tissues)
-CO interferes with cellular oxidative metabolism

100

low levels: HA, flulike illness, dizziness
high levels: visual and auditory changes, vomiting, confusion, slurred speech, cyanosis, MI, coma, death

CO poisoning

101

cherry red skin and retinal hemorrhages suggest ______

CO poisoning

102

CO poisoning can cause delayed permanent neuropsych syndrome (memory loss, personality change, deafness, seizures, etc)

yep

103

how to dx CO poisoning

dx CO poisoning by measuring CO-Hb levels

104

how to tx CO poisoning

100% oxygen
hyperbaric oxygen if available
hospitalization for CO-Hb > 25% or > 10% if there are other problems

105

management of bite wounds

copious irrigation
wounds on face, large wounds, wounds < 12 hours old- suture it!
abx like augmentin
tetanus ppx if needed

106

cat bites are at high risk of infection with ____

P multocida
you might also get cat scratch disease

107

human bites are especially serious if at the MCP joint
likelihood and organisms of infection

high risk of infection
strep viridans, staph aureus, bacteroides, peptostreptococcus, eikenella corrodens

108

spider with red or orange hour glass marking on the ventral surface
what kind of toxin is the venom

black widow spider
neurotoxin

109

black widow spider bite sxs

few local sxs
severe HTN and muscle cramps
nonspecific sxs

110

how to tx black widow bite

local wound care
benzos for muscle camps
latrodectus antivenin

111

spider with a brown violin-shaped marking on the dorsum of the thorax

brown recluse/fiddleback spider

112

brown recluse spider bite clinical features

-initial bite not bad... after 1-8 hours, painful itchy papules that increases in size and discolors
-some pts develop necrotic and ulcerated deep lesion
-systemic rxns within 24-48 hours: fever, chills, weakness, vomiting, joint pain, DIC, renal failure

113

how to tx brown recluse spider bite

local wound care, tetanus ppx
steroids, skin grafting, dpasone, hyperbaric oxygen
no antivenin available

114

most snake bites are via the _____

pit viper snakes (rattlesnake, cottonmouth, copperhead)

115

venom of the pit viper snakes
clinical features

proteolytic enzymes
-paresthesias of the scalp, periorbital fasciculations, weakness, metallic taste in mouth
-coagulopathy, thrombocytopenia, hypotension, shock

116

how to tx pit viper snake bite

crotalidae polyvalent antivenin within 4-6 hours
children require more of the antivenin
can also give crotalidae polyvalent immune Fab

117

coral snakes- how to know if they're dangerous
tx for their bites

red next to yellow, kill a fellow
red next to black, venom lack
neurotoxic venom causes severe systemic sxs... there is antivenin for the Eastern US and Texas coral snakes

118

GCS < ____ signifies severe head injury

8

119

infection with pasteurella is more common in cat/dog bites than human bites (T/F)

T

120

ingestion of prenatal vitamins puts kids at risk for ____ poisoning

iron