BRS Emergency Medicine Flashcards
(121 cards)
0
Q
2 ways to open up the airway
A
head tilt method
jaw thrust method if suspect cspine injury
1
Q
MCC of cardiac arrest in a child is _______
A
lack of oxygen supply to the heart
heart disease is an uncommon cause in children
2
Q
assess breathing with this method
A
look listen feel
3
Q
where to assess pulse in infants vs. children
A
infants- brachial
children- carotid
4
Q
compensated
decompensated
irreversible
*describe these forms of shock
A
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
Q
_____ is the MCC of shock in kids
it is commonly due to _____ or _____
A
hypovolemic
hemorrhage, dehydration
6
Q
in hypovolemic shock, volume losses > _____ lead to decompensated shock
A
25%
7
Q
2 phases of septic shock
A
- hyperdynamic stage- bounding pulses, high CO, warm extremities, wide pulse pressure
- decompensated stage- impaired mental status, cool extremities, diminished pulses
8
Q
2 types of distributive shock
A
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
Q
changes in ____ often occur before changes in BP in shock
A
HR- tachycardia occurs before hypotension
10
Q
initial fluid management in shock
A
20 mL/kg bolus of NS or LR
11
Q
give ______ for DIC
A
FFP
12
Q
_____ are the leading cause of trauma in kids
A
MVA
13
Q
special considerations in trauma in kids
A
- 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
Q
causes of PEA
A
cardiac tamponade
tension ptx
profound hypovolemia
15
Q
in addition to primary and secondary survey, do these tests
A
EKG
urinary cathether
NG tube
CXR
16
Q
seizures are common after head trauma… what do you do?
A
nothing… they are self limited
17
Q
infants are at risk for bleeding in the ______ and ______ because of open fontanelles and cranial sutures
A
subgaleal and epidural
18
Q
epidural hematoma is tearing of the ______
on CT, you see _______
tx by _______
A
middle meningeal artery
lenticular density
surgical drainage
19
Q
subdural hematoma is due to tearing of ______
on CT, you see _______
how to tx
A
bridging veins
crescentic density
neurosurg consult and usually surgical drainage
20
Q
intracerebral hematoma usually occurs on _____ (side/opposite side) of trauma
A
opposite side
contrecoup injury
21
Q
______ is an early sign of herniation in children < 4 years of age
A
bradycardia
22
Q
cushing’s triad (late sign of herniation)
A
bradycardia
HTN
irregular breathing
23
Q
how to manage increased ICP
A
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
