CPS acute care

Question 1

GCS eyes

Answer 1

Eyes:

1. no response
2. to pain
3. to verbal stimuli
4. spontanous

Question 2

GCS verbal

Answer 2

1. no response
2. nonspecific sounds
3. inappropriate
4. confused
5. oriented

Question 3

GCS motor

Answer 3

1. no response
2. decerebrate extension
3. decorticate flexion
4. withdraws to pain
5. localizes pain
6. follows commands

Question 4

Indication skull x-rays in head injury (3)

Answer 4

• children < 2 yrs: with large, boggy hematoma
• obvious penetrating lesion or dpsressed skull fracture
• suspicion child abuse

Question 5

Indication for CT scan in head injury

- Relative Indications (8)

Answer 5

Relative:

• GCS <14 at any point or GCS <15 at 2hr after injury
• clinical deterioration e.g. worsening HA or vomiting
• signs of basal skull
• large boggy hematoma >2yrs
• high risk mechanism
• persistent irritability in child<2 yrs
• seizures at time of event or later
• known coag disorder

Question 6

Indication for CT scan in head injury

- absolute indications

Answer 6

Absolute indications:

• focal neuro deficit
• suspected open or depressed skull fracture or a widened or diastatic skill fracture on X-ray

Question 7

RFs for post-traumatic seizures (5)

Answer 7

• younger age
• severe head trauma
• cerebral edema
• subdural hematoma
• open or depressed skull #

Question 8

Risk factors for ICU admission in asthma (4)

Answer 8

• previous life-threatening events
• admissions to ICU
• intubation
• deterioration while on systemic steroids

Question 9

Oxygen goal sats in Asthma

Answer 9

• target 94% as per CPS

Question 10

Acute management of anaphylaxis

Answer 10

1. ABCs - oxygen if needed
2. immediate admin of IM epi
3. IV access with large-bore
   - if hypotensive then 20mL/kg of NS
   - if sever resp distress prep for definitive airway management

Question 11

Epinephrine dose in anaphylaxis

Answer 11

• 0.01mg/kg to max of 0.5mg

= epineprhine 1:1000 IM to anterolateral thigh

Question 12

Epinephrine dosing IV infusion

Answer 12

epi 0.1-1 ug/kg/min (max 10ug/min)

Question 13

Diagnosis of asthma in preschoolers requires

Answer 13

1. objective documentation of signs of airflow obstruction
2. reversiility of airflow obstruction
3. absence of alternative diagnosis
   - diagnosis apply to children with 2+ exacerbations

Question 14

When to refer a preschooler to a specialist for asthma (6)

Answer 14

Severity:
- life-threatening exacerbation,
- 2+ exacerbation requiring steroids/hospitalizations
- or frequent sx (>8 days per month) despite moderate daily doses of ICS
Associated sx:
- diagnostic uncertainty,
- need for allergy testing
Other: parental anxiety or need for more education

Question 15

guidelines for admission in bronchiolitis (6)

Answer 15

• resp distress e.g. RR>70/min
• supplemental O2 required to keep sats >90%
• dehydration or hx of poor fluid intake
• cyanosis or hx of apnea
• infant at high risk for severe disease
• family unable to cope

Question 16

groups at high risk for severe disease bronchiolitis

Answer 16

• infants born <35 weeks
• <3 months at presentation
• hemodynamically significant cardiopulmonary disease
• immunodeficiency

Question 17

Recommended tx for bronchiolitis
Equivocal tx
Not recommended tx

Answer 17

• Recommended: oxygen, hydration
• Evidence equivocal: epi neb, nasal suctioning, combined epi+dex
  Not recommended: salbutamol, steroids, abx, antivirals, cool mist therapy/saline aerosol, hypertonic saline nebs, chest PT

Question 18

Covid-19 acute clinical severity

• mild
• moderate
• severe
• critical

Answer 18

Mild: asymptomatic or URTI < 7 days, no oxygen, normal X-rays, no evidence of sepsis
Moderate: more sx than a URTI, increased WOB,PNA on CXR no hypoxemia, no sepsis,
Severe: features of resp distress or organ dysfunction, tachypnea, hypoxemia, CNS effects, GI effects, coag dysfunction
Critical: rapid disease PLUS resp failure, septic shock, organ failure

Question 19

Blood work for unwell pts with covid who require hospitalization

Answer 19

Blood: CBC, blood culture, electorlytes (+ extended lytes), glucose, renal function, liver enzymes, bili, LDH, troponin, coag screen, blood gas, lactate, inflamm markers e.g. cRP, procalcitonin, ferritin
Other: 12-lead ECG, CXR

Question 20

Treatment for covid

Answer 20

• supportive care: oxygen, Iv hydration, anti-pyritics
  severe disease: aditional pressure and ventilatory support
• abx only if suspect bacterial co-infection
  Not supported by evidence: antivirals, corticosteroid IVIG, ACEi and ARBs, IL-6 receptor antagonists

Question 21

Pediatric populations high risk for covid

Answer 21

• infants
• children with heart or lung disease
• neuro or neuromuscular condition
• other chronic conditions: diabetes, sickle cell, malignancies, immunosuppressive conditions, home ventilation

Question 22

Croup epidemiology

Answer 22

• 6 mo to 3 years of age

- sx last 3-7 days, peaks in fall and winter

Question 23

Croup DDX

Answer 23

• bacterial tracheitis
• retropharyngeal, parapharyngeal, peritonsillar abscess
• epiglottis
• foreign body aspiration
• anaphylaxis

Question 24

Ondansetron in gastro

Answer 24

consider for:

• infants 6+ months
• vomiting due to suspected acute gastro
• mild/mod dehydration
• OR who have failed ORT

Question 25

Most common side effect of ondansetron in gastro

Answer 25

- diarrhea (self-limited and lasts <48hrs) | - risk of arrhythmia

Question 26

ITP red flags on history (4)

Answer 26

- constitutional sx - bone pain - recurrent thrombocytopenia - poor treatment response

Question 27

ITP red flags on physical exam

Answer 27

- lymphadenopathy - hepatomegaly - splenomegaly - signs of chronic disease

Question 28

ITP red flags on investigations

Answer 28

- low hemoglobin (unless mildly low due to bleeding - high MCV - abN WBC and/or neutrophil count - abN cell morphology on smear

Question 29

ITP relapse rate

Answer 29

- 1/3

Question 30

Advanced airway in place | - compression-ventilation ratio

Answer 30

- compressions: 100-120 pm | - resps 8-10/min

Question 31

3 Ps to minimize pain

Answer 31

1. physical 2. psychological 3. pharmacological

Question 32

which is more painful heel lances or venicpuncture

Answer 32

heel lances

Question 33

Sepsis vs. septic shock

Answer 33

Sepsis = life-threatening organ dysfunction caused by a dysregulated host response to infection Septic shock = severe infection leading to CV dysfunction (e.g. hypotension, need for treatment with a vasoactive medication or impaired perfusion)

Question 34

Sepsis shock and lab findings of adrenal insufficiency and management

Answer 34

- relative hyponatremia, hyperkalemia and hypoglycemia | - give hydrocortisone 50-100mg/m2 early in course, before septic shock develops

Question 35

in status treat blood sugar is <=

Answer 35

2. 6 | - tx with 2-4mL/kg of 25% dextrose of 5mL/kg of 10% dextrose water

Question 36

side effects of - phenytoin/fosphenytoin - phenobarb

Answer 36

Pheny: cardiac arrhythmias, bradycardia, hypotension Phenobarb: sedation, resp depression, hypotension

Question 37

Indications for pyridioxine in seizures

Answer 37

- children < 18 months with seizures caused by undiagnosed metabolic disorder

Question 38

indications for CT in status epilepticus (5)

Answer 38

- hx of trauma - increased ICP - focal neuro signs - unexplained LOC - suspicion of herniation

Question 39

How does HHHFNC work?

Answer 39

- supplemental gas flow rates wash out anatomic dead space - humidification and heating allows gas at flow rates that are better tolerated - provides some degree of positive pressure

Question 40

Starting HHHFNC

Answer 40

- start flow at 1-2L/kg/min - escalate for WOB max = 2L/kg/min with UL being 50-60 for adult-size pts O2 concentration start at 50% and go up and down to achieve target - if flow too high may breath stack or auto-PEEP

Question 41

Contraindications to HHFNC

Answer 41

- nasal obstruction - epistaxis - severe upper airway obstruction rare, serious SE: air-leak syndrome, abdominal distention