EM Flashcards
1
Q
What is the first priority for any unresponsive child brought to the ED?
A
ABCs- Establish an airway
2
Q
Have a child who has ingested an unknown substance and is unresponsive…what is the first thing you do?
A
Establish an airway/Stabilize patient
3
Q
What is the equation for ET tube size?
A
Age/4 + 4
4
Q
What size ET tube for a 4 year old?
A
5
4/4 + 4
5
Q
What are 4 things to consider if an intubated patient has sudden deterioration?
A
DOPE D: Displacement of ETT O: Obstruction of ETT P: Pneumothorax E: Equipment failure
6
Q
What is the formula used to calculate tidal volume on a vent?
A
7mL/kg
7
Q
Name 4 medications which can be given via ETT?
A
- Lidocaine
- Atropine
- Narcan
- Epinephrine
8
Q
When is atropine indicated?
A
Bradycarida (not asystole)
9
Q
What can happen if a patient with bradycardia is given too low of a dose of atropine?
A
Bradycardia can worsen
10
Q
What temperature correlates with invasive bacterial infection?
A
> 41C (105.8F)
11
Q
True or False: Consistently using the same method (oral, axillay, tympanic, ect.) to take the temperature is more important than the actual method used
A
True- Easier to monitor for change
12
Q
True or False Tactile temperature noted by parents does correlate with actual temperautr
A
False- This is not considered to be reliable
13
Q
What is done for fever in infants younger than 1 month?
A
- Septic workup (CBCdiff, BC, LP, UC, CXR if resp symptoms)
2. Empiric IV antibiotics pending culture results
14
Q
What should be done for infants between 1-2 months with a fever?
A
They need a workup, but not necessarily inpatient care/empiric antibiotics if initial studies are reassuring
15
Q
What should be done for children 3-36 months with a fever?
A
Clinical judgment
*Watch out for presentation of a kid who wasn’t immunized against pneumococcal disease- may need workup for occult bacteremia.
16
Q
What is important to note in medical history for kids presenting with fever?
A
Things like sickle cell or other immunocompromised status
17
Q
What do you need to consider checking in an infant/toddler girl with a high fever without a source?
A
UTI
18
Q
What type of children who are 5 years old are in the most need of antipyretics when they get a fever?
A
Children with CHF (reduce O2 demand and subsequent CO demand)
*Don’t be fooled by febrile seizures…at 5 they are out of age of risk
19
Q
Which bite is worse and why…cat or dog?
A
Cat- They bite deeply and make puncture wounds
20
Q
What is the most important first step for a dog/cat bite?
A
Wound cleaning via high pressure irrigation
21
Q
When are antibiotics indicated for bites?
A
- Not clean
- Cats/Dogs/Humans
- Crush injuries
- Cartilage involvement
- Cuticles (hands/feet)
- Compromised (immunocompromised)
- Cute faces (on face)
22
Q
What antibiotic can be given for a bite to someone who is penicillin allergic?
A
Clinda + Bactrim
23
Q
What locations of bites are antibiotics especially indicated for?
A
Hands/Feet/Face
24
Q
True or False: Bites and other wounds with high infection risk (human/cat bites) shouldn’t be sutured
A
True
25
What antibiotic do you give for cat/dog bites and why?
Augmentin- Covers against S. Aureus and P. Multocida
26
What do human bites look like?
Half-moon shaped
27
What do dog bites look like?
Tears
28
What do cat bites look like?
Punctures
29
What two types of bites have an especially high risk of infection?
Cat/Human
30
What should you consider for a child with a human bite?
Child abuse/Transmission of infections (HIV/Hep B)
31
What bacteria do you need to cover for with a human bite?
1. Viridans strep
2. S. Aureus
3. Anaerobes
32
What is Loxosceles Reclusa?
Brown recluse spider
33
How does a brown recluse bite present?
Target lesion: Red circle surrounding a white ring (different from target lesion with Lyme)
34
How quickly does the target lesion from a brown recluse bite present?
Within hours (Lyme is within weeks)
35
Which spider bite is more likely to become necrotic...brown recluse or black widow?
Brown recluse
36
True or False: Brown recluse bites can have systemic symptoms
True, but bites are typically a self-limited local painful lesion that requires no additional treatment
37
What is the Latrodectus Mactans?
Black widow
38
How does a black widow bite look?
Puncture wound that is barely noticeable
39
What types of symptoms can be seen with a black widow bite?
Systemic: Muscle aches (abdomen, lower back, chest, extremities), HTN
40
How long does it take for systemic symptoms to appear after a black widow bite?
Can present within 8 hours
41
What is treatment for a black widow bite?
Local wound care and pain control
42
What can be given for severe muscle spams with a black widow bite?
Parenteral benzos
43
What vaccine may need to be given for a black widow bite?
Tatanus
44
When is antivenom given for a black widow bite?
Only as a secondary option:
1. If supportive measures don't work
2. Small children
3. Severe symptoms
45
True or False: Wound excision, steroids, hyperbaric chambers, or dapsone can be used to help with black widow spider bites
False
46
What description of snake would make you think it was venomous?
Triagnular head + Fangs
| or a rattlesnake
47
Would a snake with a round head be likely to be venomous?
No
48
What is one snake with a round head that is venomous?
Red/Yellow... Red on Yellow, Kill a Fellow
49
If you have a child with a bite and they describe fang marks, what should you assume?
Likely a venomous snake bite
50
Name some initial signs of a venomous snake bite
1. Local erythema/swelling
2. Enlarged lymph nodes
3. Bullae
51
If you have a wound from a likely non-venomous snake, what do you do?
1. Wound cleaning
| 2. Verify tetanus status
52
if you have a wound from a venomous snake, what is the first thing you do?
ABCs
53
After you do ABCs with a venomous snake bite, what should you do?
1. Immobilize limb
2. Let limb hand at patient's side
3. Make sure to transport to an appropriate facility
54
True or False: You should not apply a tourniquet, apply ice, or suck venom from a snake bite wound
True
55
What is an early sign of shock?
Delayed capillary refill
56
When does decreased BP occur in shock?
Late
57
When should an IO be placed in the setting of shock?
After 3 attempts at IV access or 90 seconds
58
True or False: Most resuscitation meds/blood products can be administered through an IO line
True
59
What sign/symptoms should make you think of closed-head trauma?
1. Hemotympanum
2. Facial ecchymoses
3. Raccoon eyes
4. Postauricular bruising
5. Clear discharge from nose/ears
60
True or False: The clinical impact of increased ICP can be gradual
True
61
True or False: With ICP papilledema is often absent initially
True
62
How does a subdural hematoma present?
Gradual/non-specific
1. Infants: Irritability
2. Older Children: Headache, vomiting, drowsiness
63
What type of head association is seen in "Shaken Baby Syndrome"?
1. Subdural (not epidural) hematoma
2. Retinal hemorrhages
3. Bulging fontanelle
64
How is subdural hematoma diagnosed?
CT (first and second hours are critical)
65
What can cause electrolyte abnormalities in a child with severe head injury like a subdural hematoma?
SIADH
66
What should you think of in a child with a recent head injury and abnormal electroyltes/urine osmolality values?
SIADH
67
What are the two most common causes of shock in infants/children?
1. Sepsis
| 2. Hypovolemia
68
How does shock in an infant present?
Tachycardia and poor perfusion
69
In children with shock who have a history of persistent vomiting, diarrhea, or obvious blood loss, what should you think?
Hypovolemia
70
In children with shock who are ill appearing with fever, what should you think?
Sepsis
71
How is shock initially treated?
Fluids
72
Which type of shock responds better to fluids?
Hypovolemia
73
If you have persistent shock after fluids, what may you need to give?
Pressors: Dopamine/epinephrine
74
Child with head trauma (hit with baseball/bat), followed by loss of consciousness, then a lucid period, then deteriorates?
Epidural Hematoma
75
What findings on LP are associated with an epidural hematoma?
Bloody atraumatic LP (atraumatic tap with lots of RBCs)
76
What 2 things are associated with a bloody atraumatic LP?
1. Epidural hematoma
| 2. Herpes
77
What is required for an epidural hematoma?
Surgical intervention
78
What should you consider for any child with inexplicable mental status change?
Retinal hemorrhages (even without history or external signs of head trauma)
79
Toddler who is afebrile and irritable, +/- bruises...?
Non-accidental trauma
80
What should you do if you have concern for abuse?
1. Obtain head CT
2. Ophthalmologic exam (retinal hemorrhages)
3. Skeletal survey
81
What is the most highly predictive historical feature for abuse in head trauma?
Having no history of trauma
82
What are things which might make you think about NAT?
1. Changes in history
2. Delay in seeking care
3. Blaming injury on a sibling
83
What is MRI useful for in head trauma?
Determining age, cause, and extend of head bleeds (not helpful in emergency settings where immediate diagnosis is needed)
84
What imaging modality is helpful in the emergency setting to diagnose head trauma (bleed)?
CT (not MRI)
85
True or False: The presence of absence of physical signs is never the sole deciding factor in deciding whether to obtain a head CT scan following trauma?
True
86
What 5 things is a head CT indicated for?
1. Prolonged LOC
2. Protracted vomiting
3. Progressing headaches
4. Retrograde amnesia
5. Lethargy
87
When presented with a child in whom a skull fracture or head bleed is suspected, what is the first step you should take?
ABCs
88
What is the most common type of pediatric skull fracture?
Linear
89
True or False: Linear skull fractures are often accidental
True
90
Where do linear skull fractures occur?
At the site of impact
91
Do linear skull fractures cross suture lines?
No
92
Are linear skull fractures usually single or multiple?
Single
93
What two appearances of skull fracture should make you suspect child abuse?
1. Multiple fractures
| 2. Fracture with a cracked egg appearance
94
Bleeding from ear (hemotympanum), hearing loss, facial paralysis, CSF otorrhea...?
Temporal Bone Fracture
95
Clear rhinorrhea, Battle sign, Raccoon eyes...?
Basilar Skull Fracture
96
If a child has a clear runny nose after a head injury, what should you consider?
CSF rhinorrhea, Basilar skull fracture
97
What is Battle's Sign?
Ecchymosis behind the ear (Basilar Skull Fracture)
98
What are Raccoon eyes?
Periorbital ecchhymosis (Basilar Skull Fracture)
99
What imaging do you get if you suspect a basilar skull fracture?
CT (not XR)
100
What two cranial nerve palsies can be seen in a Basilar Skull Fracture?
6 (abducens) and 7 (facial)
101
Name 3 methods to reduce ICP
1. Mannitol
2. Lasix
3. Hyperventilation
102
What is the range for the Glasgow coma scale?
3-15
103
A Glasgow score under what is considered a severe coma and indication to intubate?
8
104
In a head injury causing coma, what 2 things is prognosis inversely related to?
1. Index (number score)
| 2. Length of time of coma
105
What are 3 poor prognostic signs in terms of a coma from head trauma?
1. Cerebral bleeding
2. Brain edema
3. Coma lasting >6 hours
106
True or False: The Glasgow Coma Scale is useful for assessing metabolic coma?
False- only useful for head trauma
107
List 3 categories for Glasgow Coma Scale
1. Eye opening
2. Verbal
3. Motor
108
What is the scoring for eye opening in Glasgow Coma Scale for adults and children?
1- No response
2- To pain
3- To voice
4- Spontaneous
109
What is the scoring for eye opening in Glasgow Coma Scale for infants?
1- No response
2- To pain
3- To voice
4- Spontaneous
110
What is the scoring for verbal in Glasgow Coma Scale for infants?
```
1- No response
2- Moans to pain
3- Cries to pain
4- Irritable
5- Coos, babbles
```
111
What is the scoring for verbal in Glasgow Coma Scale for adults and children?
```
1- No response
2- Incomprehensible
3- Inappropriate words
4- Disoriented
5- Conversation
```
112
What is the scoring for motor in Glasgow Coma Scale for adults and children?
```
1- No response
2- Decerebrate posturing
3- Decorticate posturing
4- Withdraws to pain
5- Localizes pain
6- Obeys commands
```
113
What is the scoring for motor in Glasgow Coma Scale for infants?
```
1- No response
2- Decerebrate posturing
3- Decorticate posturing
4- Withdraws to pain
5- Withdraws to touch
6- Normal spontaneous
```
114
Swelling of the nasal septum with any degree of obstruction... what do you do?
Immediate ENT consult for drainage
115
What can happen if there is injury to the nasal septum and nothing is done?
Significant cartilage damage with saddle nose deformity
116
True or False: Lesions of child abuse are rarely symmetrical
True
117
Name 5 conditions which can cause fracture and be mistaken for abuse
1. Osteogenesis imperfecta
2. Hypophosphatasia
3. Infantile cortical hyperostosis
4. Pathologic fractures
5. Osteoid osteoma
118
What is the most common form of abuse?
Neglect
119
True or False: Fractures occur in a small number of cases of abuse
True
120
Name 8 fractures which are most likely due to abuse
1. Bucket handle fractures
2. Corner fractures (due to pulling an extremity)
3. Spiral fractures in infants
4. Rib fractures
5. Multiple skull fractures
6. Spinous process fractures
7. Scapular fractures
8. Sternum fractures
121
Name 3 fractures that are often times accidental
1. Non-displaced linear skull fracture in infant
2. Clavicular fractures
3. Supracondylar elbow fractures
4. Buckle fractures
122
Which type of fracture is more often associated with abuse... buckle fractures or bucket handle fractures?
Bucket handle fractures
| Buckle fractures aren't associated with child abuse
123
What are two skin lesions that can mimic abuse?
1. Mongolian spots
| 2. HSP
124
In a skin lesion, what feature of color usually indicates abuse?
Variation in color
| Could be a coagulopathy though so check PT/PTT
125
True or False: Cupping/coining of the back are not technically abuse
True- watch for children from Asian culutes (Vietnam or Cambodia)
126
What children are at a higher risk for physical abuse?
Children with disabilities
127
True or False: Dating bruises by colors is reliable
False
128
What syndrome could be misdiagnosed as a burn?
SJS
129
How can you tell SJS from burn?
Distribution- SJS is around the mouth (erythema multiORALforme)
130
A toddler who was swung by the arms will most likely have what injury?
Subluxation of radial head (Nursemaid's elbow)
| Rather than fracture
131
What are two things to consider with periorbital ecchymosis?
1. Neuroblastoma
| 2. Abuse
132
Most injuries involving exposure to household electrical current involve only what?
Skin
133
What is it called when an electrical current courses through the body?
Arc exposure
134
What can result in deep tissue burns and internal organ involvement sometimes with only minimal visible injury?
Arc exposure
135
What 3 things can an arc exposure lead to?
1. Arrhythmias
2. Rhabdomyolysis
3. Renal failure
136
What are 3 things that are suggestive of non-accidental burn?
1. Full thickness
2. Distinct margins
3. Varying depth
137
Is a splash-like configuration of a burn more suggestive of accidental injury or abuse?
Accidental
138
A stocking and glove distribution of a burn is indicative of what?
Non-accidental cause
139
What is the first step in minor burn treatment?
Debridement and irrigation
140
What should minor burns be cleaned with?
Gently with mild soap and water
141
What do you need to ensure with burns?
Up to date tetanus immunization
142
What is responsible for 80% of burn-related deaths?
Inhalation of smoke and its toxins
143
Name 6 signs of airway injury in a burn
1. Facial burns
2. Carbonaceous (black) sputum
3. Singeing of nasal hair and eyebrows
4. Hoarseness
5. Shortness of breath
6. Stridor
144
What is indicated if you suspect airway injury in burn?
1. Fiberoptic bronchoscopy
| 2. Possible intubation (even prior to overt respiratory distress)
145
Rule of 9s for children older than 9...?
```
Trunk: 18% front, 18% back, 36% total
Arms: 9% each
Legs: 18% each
Head/Neck: 10%
Perineum: 1%
```
146
Rule of 9s for infants...?
Trunk: 18% front, 18% back, 36% total
Arms: 9% each
Legs: 14% each
Head/Neck: 18%
147
What is the palmar method for estimating burn %?
Palm is 1% of surface area
148
How is infection prevention best accomplished with a laceration?
Irrigation and debridement
149
How do you clean a laceration?
Irrigate with normal saline under low pressure
| May need higher pressure in very contaminated wounds
150
Do you need to shave hair in a laceration?
No
151
True or False: Any laceration crossing the vermillion border should be referred to a plastic surgeon
True
