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Flashcards in Gen ER Deck (19):
1

What are three categories of stridor and at least three causes in each?

1) Supraglottic
(epiglottitis, peri/retro-pharyngeal abscess, adenotonsillar hypertrophy, craniofacial abN)

2) Glottic
(laryngomalacia, laryngospasm, VC paresis/paralysis/dysfunction, VC nodule/mass)

3) Subglottic
(laryngotracheobronchitis, anaphylaxis, bacterial tracheitis, subglottic stenosis, subglottic web, subglottic hemangioma, tracheomalacia)

2

What are the two categories of causes of epistaxis?
List five in each

LOCAL
- trauma
- inflammation (URTI, staph)
- congenital syphilis
- foreign body
- allergic rhinitis
- telangiectasia (Osler-W-R)
- juvenile angiofibroma
- nasopharyngeal lymphoepithelioma
- rhinitis sicca

SYSTEMIC
- hematologic (platelet or hemophilias ie ITP, leuk, aplastic anemia, vWD, DIC, vitK, ASA, VPA, NSAIDs)
- hypertension (arterial, superior vena cava syndrome, CF)
- vicarious menstruation

3

How to manage epistaxis?

- pressure, lean forward
consider:
- dental roll under front gums
- gauze soaked with epi 1:1000
- nasal packing, tampons
- cautery with silver nitrate stick

home therapies:
humidifier
petroleum jelly
consider antibiotic ointment
consider nasal decongestants

4

For nasal cauterization, name the indications, contraindications (2) and complications (3) of the procedure.

indications: failure to control bleed with pressure and topical vasoconstrictor

contraindications: bleeding diathesis (hemophilia, ITP) or previous cauterization within 6 weeks

complications: septal perforation, staining of the upper lip or nares, bacterial superinfection or the cauterized area

*refrain from cauterizing both sides of the nasal septum

5

For nasal packing, name indications and complications of the procedure.

indications: bleeding that cannot be controlled with pressure and topical vasoconstrictor, with a contraindication to or failure of cauterization

complications:
1) bacterial rhinosinusitis
2) toxic shock syndrome
3) nasal alar or columnar necrosis
4) septal ulceration or perforation
5) synechiae formation
6) hypoxemia or resp distress from nasal obstruction

6

Name the components of the GCS score

Eyes Verbal Motor

Eyes
4-open spontaneously
3-closed and open with voice
2-close and open with pain
1-closed

Verbal
5- coherent
4- confused
3- garbled
2- moans
1- nil

Motor
6- command
5- localizes
4- withdraws
3- decorticate
2- decerebrate
1- flaccid

7

Describe AVPU method of assessing level of consciousness

Alert
Voice
Painful
Unresponsive

8

Name the components of the pediatric trauma score and describe its relevance in practice

Size
Airway
Systolic blood pressure
Central nervous system
Skeletal
Cutaneous

The PTS emphasizes the importance of patient size and ability to maintain the airway. Studies have confirmed its use as a predictor of outcome: 9% mortality for PTS >8, 100% mortality for PTS <0 and a directly linear correlation between 0-8.

9

Name physical exam findings that would suggest a difficult airway

- small mouth
- inability to open the mouth
- TMJ abnormalities
- narrow receding mandible
- protuberant maxillae
- large tongue
- distance <6cm between mandible and thyroid prominence
- inability to place in the sniffing position
- short, full or bull necks
- neck mass
- significant penetrating trauma to face or neck

10

Describe ECG changes seen with hypothermia with a core temperature <32C

-marked sinus bradycardia
-1st degree AV block
-Osborn or J waves
-Ass' w/ long QT

11

Describe changes seen in hypothermia with temperatures:
31-32C
28-31C
<28

31-32C: normal vitals, loss of shivering
28-31C: decreased HR and BP, afib, dilated pupils
<28C: absent pulse and BP, Vfic, coma, fixed pupils

12

Name 5 management pearls of hypothermia resuscitation

Warm fluids to 43C
Correct hypoglycemia
Watch for coagulopathy
If VF defib no more than three times until temp >30C
Drugs rarely effective until T>30C

13

What are the stages of frostbite

-initial stinging
-cold, pale, decreased sensation
-blotchy and painful areas

14

Describe features of heat stroke

core temp >41C
dry, hot, ashen skin
ARF
rhabdo
headache, disorientation -> coma, weakness, gait disturbance

15

Describe features of heat exhaustion (or water depletion)

T <40C
lethargy
nausea, vomiting
heaadches
BP, incr HR

16

Name good and poor prognostic features with regards to submersion injury prognosis

Good:
ROSC <10 minutes
Submersion <5 minutes
PERL, NSR at scene

Poor:
Delayed CPR
ROSC >25 minutes
Submersion >10 minutes

17

Describe features of high voltage injuries

tetany *can prevent grip release, arching
muscle damage -> compartment syndrome -> rhabdo
CNS injury
VF / cardiac arrest
Monitor heart, urinanalysis

18

What are the features of a brown recluse spider bite?

local pain -> central blister -> subcutaneous discoloration ->ulcer
systemic reactions develop in small children: fever, n&v, joint pain, hematuria
treat with analgesia and local care, excision and grafting if severe

19

What snakes do you have to worry about in Canada?

Massasauga and Western rattlesnake