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Emergencies Flashcards

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1
Q

Head injury epidemiology

A

Older than 12 due to recreation and MVAs. less than 1 yo due to falls or abuse.

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2
Q

Basal Skull

A

sphenoid, temporal, occipital, ethmoid bones.

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3
Q

Head injury Concerning signs

A

Excessive sleepiness (is it nap time), decreased arousability, vomiting, irritability.

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4
Q

Cushing’s Triad

A

Wide pulse pressure, bradycardia, abnormal respirations

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5
Q

Basilar skull fracture signs

A

Battle signs, periorbital ecchymosis, hemotympanum, ottorhea/rhinorrhea or CSF.

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6
Q

CT indications

A

GCS less than 14, signs of AMS, palpable skull fracture, or signs of basilar skull fracture.

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7
Q

Observation vs. CT considerations

A

Based on physician experience, multiple v. isolated findings, worsening symptoms, age less that 3 months, parental preference.

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8
Q

Observation Vs. CT Indications

A

Occipital/parietal/temporal hematoma, LOC, Severe MOA, Not acting normal per parents, vomiting, severe headache.

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9
Q

Subdural Hematoma Definition

A

Bleed between the dura and the arachnoid mater. Low pressure bleed along the periphery as the arachnoid disects from the dura and bridging veins are torn.

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10
Q

Subdural Hematoma Presentation

A

LOC with lingering symptoms, irritability, lethargy, bulging fontanelles, vomiting.

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11
Q

Subdural Hematoma CT findings

A

Crescent-shaped bleed that crosses suture lines usually in the parietal area.

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12
Q

Subdural Hematoma Prognosis

A

Very poor.

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13
Q

Epidural Hematoma Definition

A

Rupture of arteries +/- fracture. Usually cause by a blow to the side of the head that ruptures the middle meningeal artery.

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14
Q

Epidural Hematoma Presentation

A

Brief LOC followed by a lucid period then rapid deterioration.

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15
Q

Epidural Hematoma CT findings

A

Elliptical shaped bleed that doesn’t cross suture lines.

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16
Q

Epidural Hematoma Prognosis

A

Better than subdural

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17
Q

Subarchnoid Hemorrhage Definition

A

Injury to the parenchymal and subarachnoid vessels.

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18
Q

Subarchnoid Hemorrhage Presentation

A

Normal to LOC

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19
Q

Subarchnoid Hemorrhage Diagnosis

A

CT: small dense slivers with blood in the cisterns, sulci and fissures (may take time to become visible). LP will reveal blood in the CSF.

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20
Q

No ICH or skull fracture Treatment

A

Head injury precautions, responsible caregiver that is capable of monitoring for any changes. Sleep is ok.

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21
Q

ICH +/- skull fracture Treatment

A

Immediate Neuro consult. Admit to PICU. surgery v. observation.

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22
Q

Mild TBI (concussion) Definition

A

Traumatically induced alteration in mental status with or without LOC. Direct blunt force causes shearing/stretching of the axons.

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23
Q

Mild TBI (concussion) Presentation

A

Amnesia, confusion, distractability, delayed responses, visual changes, repetitive speech. If any substance use must CT scan.

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24
Q

Mild TBI (concussion) Prognosis

A

Most symptoms will resolve in 7-10 days. Any severe/prolonged/worsening symptoms are emergent.

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25
Post concussive syndrome
Symptoms that last up to 3 months
26
Second Impact Syndrome
A second concussion within weeks can cause brain swelling and herniation.
27
Mild TBI (concussion) Treatmetn
Physical and cognitive rest. NO same day return to play. Must be completely symptom free and cleared by a neurologist to return.
28
Compund Fracture Treatment
Splin/dress, IV antibiotics, emergent ortho consult.
29
Non-displaced open fracture
PO antibiotics, repair laceration, splint. Ortho referal.
30
Osteomyelitis Definition
Hematogenous spread of infection to the bone often leading to bone destruction. Usually in males less than 5 yo. In the long bones (femur, humerus).
31
Osteomyelitis Etiology
S. aureus (most common), S. pneumoniae, S. pyogenes.
32
Osteomyelitis Presentation
Fever, bone pain, swelling, redness, guarding, focal tenderness.
33
Osteomyelitis Xray
Soft tissue swelling early on and later in the disease evidence of lytic lesions (10-14 days).
34
Osteomyelitis MRI
Best choice. Will show marrow edema, absecesses.
35
Osteomyelitis Labs
Leukocytosis with an elevated ESR and CRP
36
Osteomyelitis Treatment
IV antibiotics (empiric), surgical drainage, debridement, hyperbaric O2 therapy.
37
Septic Joint etiology
Infants/Kids: S. aureus or strep. | Adolescents: N. gonnorrhea
38
Deadly in a dose
Aspirin, Beta-blockers, CCBs, Camphor, chloroquine, clonidine, iron, lindane, methyl salicylate, methadone, nicotine, oils (hydrocarbons), theophylline, TCAs.
39
Common anticholinergics
Antihistamines, scopolamine, jimson weed, angel trumpet, benzotropine, TCAs, atropine.
40
anticholinergics Presentation
Tachycardia, hyperthermia, HTN. Delirium, flushed skin, Mydriasis, urinary retention, decreased bowel sounds, memory loss, seizures.
41
Common Cholinergics
Organophosphates, Carbamates, mushrooms
42
Cholinergics Presentation
SLUDGE. Bradycardia, Hypothermia, tachypnea. Muscle fasciculations, miosis, seizures, diaphoresis.
43
Common Hallucinogenics
Amphetamines, cannaboids, PCP, phencyclidine
44
Hallucinogenic Presentation
Tachycardia, tachypnea, HTN. Disorientation, panic, moist skin, hyperactive bowel, seizures.
45
Common opiates/narcotics
Propoxyphene, dextromethorphan
46
Opiate/Narcotic Presentation
Bradycardia Hypothermia, hypotension. AMS, unresponsiveness, miosis, shock. shallow respirations, decreased RR.
47
Common sedatives/hypnotics
Barbituates, benzodiazepines, ethanol, anticonvulsants
48
Sedative/hypnotic Presentation
Apnea. Coma, stupor, sedation, deterioration of CNS function.
49
Common Sympathomimetics
Cocaine, amphetamines, meth, phenylpropanolamine, ephedrine, psuedophedrine, albuterol, ma huang.
50
Sympathomimetics Presentation
Tachycardia, bradycardia (alpha agonists), hypertension. Delusions, diaphoresis, paranoia, mydriasis, hyperreflexemia, seizures, anxiety.
51
Toxic Ingestion Treatment
ABC- DDD (disability, drugs, decontamination)
52
Ocular decontamination
Test pH then flush with normal saline for at least 15 minutes and until pH normalizes. Ophthalmology consult STAT.
53
Ipecac use
Not used often. Has to be within 30 mins of ingestion.
54
Gastric Lavage Indications
Rarely used. TCAs, CCBs, Iron, Lithium, ETOH.
55
Whole bowel irrigation indications
Sustained release meds
56
Charcoal indications
Carbamazepine, barbituates, dapsone, quinine and theophylline. Possible use with digoxin and phenytoin.
57
Charcoal Not Indicated for:
hydrocarbons, lithium, strong acids/bases, metals, ETOH.
58
Simple dilution indications
Mild toxins that only cause irritation/corrosion.
59
Drugs that enhance elimination
Charcoal, urine alkalization, diuresis, dialysis, hemoperfusion.
60
Acetaminophen Antidote
Acetylcysteine
61
Anticholinergic Antidote
Physostigmine
62
Benzodiazepine Antidote
Flumazenil
63
Beta blocker Antidote
glucagon
64
CCB Antidote
Calcium
65
Digoxin Antidote
Digibind
66
Heavy Metal Antidote
Chelation
67
Narcotic Antidote
Naloxone
68
Toxic Ingestion Work up
Salicylate, acetaminophen, digitalis, theophylline, methemoglobin levels, urine drug screen, PT/INR, CO levles, CMP, coag factors, ABGs.
69
Foreign Body Ingestion Concerning Signs (consultation)
Irregular/sharp edges, lodged in esophagus, vegetable matter (pneumonia), perforation due to mechanical or chemical erosion. Magnets, Batteries, multiple objects, coin at cricopharyngeus muscle. Prescence in same place for more than 24 hours. Once it passes the pylorus the object usually continues through without complications in 48-72 hours.
70
Esophageal Button battery treatment
Emergency consult. Lithium is very bad. Mercuric oxide can lead to heavy metal poisoning. Remove immediately if hasn't passed the pylorus after 24 hours or any symptoms.
71
Near Drowning Epidemiology
Usually less than 4 yo and 15-24 yo
72
Dry drowning
Laryngospasm causing hypoxemia and LOC. No fluids in the lungs.
73
Wet Drowning
More common. Aspiration of water (usually
74
Near Drowning Poor Prognostic Factors
Submersion > 5 mins, BLS >10mins, Resucitation >25mins, Age >14, GCS
75
When to suspect abuse with near drownings
If less than 6 months old or a toddler with atypical presentation.
76
Secondary Drowning
Death up to 72 hours after near drowning due to fresh water (ingested) that causes hemodilution. Large volume aspiration can lead to hemolysis and arrhythmias (electrolyte imbalance).
77
Near Drowning Treatment
Assist ventiliation to 95%, Warm isotonic IV fluids with warm blankets, cardiac monitoring. Address associated injuries and electrolytes. CXR then repeated in 6 hours. Admit for observation
78
Work up for Fever in 2 mo- 3 yo Non-Toxic appearance
UA (males
79
Work up for Fever in 2 mo-3 yo Toxic appearance
UA, Rapid viral, CBC with diff, CXR, LP.
80
Treatment for Fever in 2 mo- 3 yo Non-Toxic appearance
Send home with follow up in 24 hours if otherwise healthy, UTD on immunizations, no risk factors, reliable caregiver.
81
Treatment for Fever in 2 mo-3 yo Toxic appearance
Admit and begin empiric antibiotics with supportive care
82
Work up for Fever in Neonate (
UA, Rapid viral, CBC with diff, CXR, LP, blood cultures.
83
Fever in Neonate (
Empiric antibiotic treatment: Cefotaxime (50mg/kg) or Ampicillin (50mg/kg). Cover Group B strep, E. coli, listeria, S. pneumoniae and N. meningitides.
84
Febrile Seizure Epidemiology
3mo-5yo. Genetic predisposition.
85
Simple Febrile Seizure
Less than 15 mins and isolated with no neuro impairment prioir to seizure.
86
Complex Febrile Seizure
Longer than 15 mins or rapid succession
87
Other causes of Seizures
CNS infection, Drugs/ETOH withdrawal, toxins, hypoxic injury, vascular accidents, trauma, abuse, metabolic disorders, idopathic epilepsy.
88
Febrile seizure Treatment
ABCs, suction, recovery position, if longer than 10-15 mins give benzodiazepine IV.
89
Febrile seizure Work up
Full neuro exam, check for meningeal irritation. If less then 12 mo get full septic work up.
90
Febrile Seizure Prevention
Common reoccurance. Antipyretics during fevers and phrophylactic rectal diazepam at onset of fever.
91
Animal mouth flora
Pasteurella, staph, strep and anaerobic bacteria.
92
Animal Bite Work up
Wound culture. Xray if deep wound, near joint or markedly infection. need to rule out foreign body. Can also use ultrasound to see abscesses or foreign bodies that are radiolucent.
93
Cat and human bite treatment
Leave open to heal by secondary intention. Except for facial lacerations.
94
Dog bites
Perform primary closure (don't use skin adhesins) if: uninfected, less that 12 hours old (24 for the face), and not located on the hand or foot.
95
Animal bite Treatment
Extensive irrigation, tetanus status, Prophylactic antibiotics (augmentin for 3-5 days), follow up within 24-72 hours.

Pediatrics (8 decks)

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