Quiz #3 Flashcards
(211 cards)
1
Q
Peds larynx are more ??
A
superior/anterior position (C3 level)
2
Q
Adults vocal cords are more?
A
perpendicular to trachea
3
Q
Peds vocal cords are more?
A
slant anteriorly to trachea
4
Q
How is pediatric tube sizes estimated?
A
ETT= (age + 16) / 4
5
Q
What is ETT tube size age?
A
older 1 yr
6
Q
What is more accurate at determining ETT?
A
resuscitation tapes
7
Q
Formula for Depth of ETT insertion?
A
ETT x 3 = (cm)
8
Q
What age doesn’t get a cricothyroidotomies?
A
<10-12yr
9
Q
For children <10 what airway emergency do they get?
A
Needle translaryngeal ventilation
10
Q
How long does a needle translaryngeal last?
A
~30 mins (30kg)
11
Q
What is a problem with needle translaryngeal?
A
build up of CO2
12
Q
What blade is used for <2yr?
A
straight blade (miller)
13
Q
What tube is used for <6-8yr?
A
uncuffed tubes
14
Q
What should be avoided when given oxygen to the child?
A
hyperventilation
15
Q
What does hyperventilation cause?
A
air in the stomach
possible barotrauma
16
Q
What method is used for fluid boluses?
A
4-2-1 method
17
Q
For hypovolemia how should a bolus be admin?
A
rapidly as possible (20 min max)
18
Q
What should be done after each bolus given?
A
reassess patient
19
Q
In peds cardiac arrest is usually secondary to what?
A
respiratory arrest and shock
20
Q
What are the 3 priorities in pediatric arrest?
A
airway, oxygenation, ventilation
21
Q
Who has a poor outcome in ped arrest?
A
child in primary cardiac arrest
22
Q
What are 6 airway emergencies?
A
stridor (obstruction) epiglottitis croup foreign body aspiration peritonsillar/ Retropharyngeal abscess Bronchiolitis
23
Q
What are 4 signs of airway/ breathing difficulties?
A
stridor
intercostal and suprasternal retractions
tachypnea
cyanosis
24
Q
Which child is in imminent danger of airway compromise?
A
Stridorous
25
What should not be done in a child that is having stridor?
DO NOT agitate or lay them down!
26
What is the txt for stridor?
begin intervention to correct cause ASAP
27
Dysphagia, drooling, distress?
Epiglottitis
28
The three D's?
Epiglottitis
29
Tripod position
Epiglottitis
30
What is the txt for epiglottitis?
IV steroids and abx
| oxygen
31
What is seen on a lateral neck x-ray in epiglottitis?
Thumb sign
32
What pathogen causes croup?
parainfluenza
33
What infection is seen in croup pts?
viral laryngotracheobronchitis
34
What are the classic s/s of croup?
nasal congestion
rhinorrhea
cough
low grade fever
35
Harsh barking cough worse at night
croup
36
What is the severity of symptoms in croup related to?
edema and inflammation of the airway
37
What is the txt and disposition for croup?
corticosteroids, +/- nebulized epinephrine
38
What is seen on a/p neck xray for croup?
steeple sign
39
What pathogen causes bronchiolitis?
RSV
40
What is the most common age for bronchiolitis?
<2y
41
What week are symptoms the worst in bronchiolitis?
1st week (out of 3)
42
What are the 6 symptoms in bronchiolitis?
URI symptoms, wheezing, fever, apneic episodes, cyanosis, poor feeding
43
What is the txt for bronchiolitis?
nebulized epinephrine
corticosteroids
nebulized hypertonic saline
44
What disorders are uncommon in emergency med?
unknown pediatric cardiovascular disorders
45
What are the majority of peds heart diseases seen in the ED?
valvular dysfunction
septal defects
vascular anomalies
46
Txt for peds cardio?
immediate cardio consulation
47
What makes peds heart defects worse?
oxygentation
48
When in doubt about cyanotic infants cardio txt?
admit to NICU for observation
49
Limping child w/ a hx of trauma or overuse, whats next?
imaging
50
Limping child w/ no trauma, whats next?
no systemic sx
| systemic sx
51
Limping child w/ no systemic sx, what's next?
imaging
52
Limping child w/ systemic sx, what's next?
imaging
| CBC, ESR, CRP
53
What things need to be r/o with a limping child?
```
Fractures
SCPE
AVN
Osteomyelitis
Septic Joint
Cancer
Deep abscess
```
54
What are the 3s rule for colic?
> 3hrs/day
>3days/week
>3 weeks
55
What are 3 non-accidental trauma?
bruising in different stages of healing
fractures in different stages of healing
odd story concerning injury
56
Most common complaint in >75yr pts
weak and dizzy
57
What is often used as a surrogate for fatigue?
weakness
58
Neurological deficit?
muscle weakness
59
What 3 things is lightheadedness often due to?
anemia, hypovolemia, or orthostatic hypotension
60
What is vertigo?
loss of balance or spinning room
61
What is a precursor to altered mental status?
malaise
62
What are 6 emergent concerns for generalized fatigue?
```
anemia
heart failure
inability to oxygenate
systemic infection
adrenal crisis
myxedema coma
```
63
What is the txt for muscle weakness?
identify cause and attempt to reverse or limit progression
Get pt to specialist
64
Dysfunction of the brain or brain stem leading to misinterpretation of peripheral stimuli?
Central vertigo
65
Dysfunction of the inner ear or vestibular nerve creating incorrect stimuli that is sent to brain?
Peripheral vertigo
66
What are 3 symptoms of central vertigo?
associated Cranial nerve deficits
Vertical nystagmus
Ataxia
67
CVA?
associated Cranial nerve deficits
Vertical nystagmus
Ataxia
68
What are 5 symptoms of peripheral vertigo?
```
unilateral hearing loss
Tinnitus
Fatigable on repeat testing
S/s usually more tense
Positional in nature
```
69
What is positive on a Dix- Hallpike maneuver?
Latency (peripheral vertigo)
70
What is the txt for central vertigo?
activate stroke if < 4hrs from onset
Call neurology/admit if > 4hrs from onset
71
What imaging is done in central vertigo?
brain CT w/o contrast
| brain MRI to evaluate cerebellum
72
What maneuver is done in peripheral vertigo to txt?
Epley Maneuver
73
What medicines are given for peripheral vertigo if the epley maneuver doesn't work?
Antiemetics (meclizine)
Anticholinergics (scopolamine)
Benzodiazepines (diazepam)
74
"Passing out"
presyncope
75
Loss of consciousness AFTER a psychologically stressful event
vasovagal syncope
76
What is the patho of vasovagal syncope?
Stress increases vagal tone > causes bradycardia >
| hypotension > lack of brain perfusion > unconsciousness
77
Loss of consciousness NOT RELATED to psychological stress event
syncope or presyncope
78
What 2 things should be done in a syncopal pt?
check fingerstick glucose and pregnancy
| preform detailed PE
79
CHESS?
San Francisco Syncope Rule
80
What does CHESS stand for?
```
Congestive Heart Failure
Hematocrit < 30%
E KG abnormality
Shortness of breath
SBP <90mmHg
```
81
What is the criteria to r/o a serious outcome for CHESS?
if "No" to all
82
What is the Canadian Syncope Risk Score used for?
a +/- to score risk of serious adverse event
83
What are the 4 first steps in txt a pt w/ syncope?
Supplemental O2
IV
Vitals
EKG
84
Syncope + Headache
subarachnoid or ICH
| hemorrhage
85
Syncope + Neuro Deficit
CVA/TIA or ICH
86
Syncope + Confusion
Seizure
87
Syncope + Chest pain
MI, PE, or Aortic Dissection
88
Syncope + Back/Abdominal pain in older patient
Abdominal Aortic Aneurysm (AAA)
89
Syncope + Positive HCG
Ectopic Pregnancy
90
What is the disposition for syncope?
D/C w/ PCM follow if low risk
| otherwise ADMIT
91
What are some precautions to give a syncope pt?
no exercise until evaluated and cleared
| NO driving or swimming, shower w/ a chair or w/ someone nearby
92
What is a level I trauma center?
all essential specialties and services available in house 24/7/365
93
What is the No 1 cause of death in 1-37 y/o
Trauma
94
Most specialties available in house 24/7/365?
Level II
95
What level has transfer capability with level I and Level II
Level III
96
What is vital to successful trauma resuscitation?
a team
97
What should be performed in the first 1-2 min of arrival?
```
100% O2
2 large bore IVs
Vitals, pulse oximetry
Removing all clothing and jewelry
Applying EKG leads
Limb splints
Obtaining O neg titer or type specific blood for transfusion
```
98
What is the first and only drug to actually decrease mortality rates?
Tranexamic acid
99
Use for pts with significant bleeding reduces mortality by 1.5% w/o increasing thromboembolic events?
Tranexamic acid
100
When imaging done?
after ABCDEs
101
What imaging is done in trauma?
CXR
Pelvic
X-table lateral C-spine
EARLY CT
102
What is the 5 primary trauma survey?
```
Airway
Breathing
Circulation/ Control of bleeding (C2)
Disability
Exposure
```
103
What should ALWAYS be protected in inline immobilization?
C- spine
104
For a midfacial trauma what two things can be done to protect the airway?
orotracheal or cricothyrotomy
105
For severe head trauma in c-spine injuries what can be used for intubation?
pretreatment w/ lidocaine or fentanyl
| Consider a dose of depolarizing paralytic (vecuronium)
106
Where is needle decompression in adults done?
between the fourth or fifth intercostal space mid axillary line
107
What is the drug of choice for intubation?
Ketamine
108
What non-depolarizing paralytic is used?
Vecuronium
109
What is FAST?
Focused Assessment with sonography in trauma
110
What is RUSH?
Rapid ultrasound for Shock and Hypotension
111
What should you be doing when checking the neck and throat?
feeling and looking
112
Ensure adequate decompression of the chest and eliminate tension pneumothorax
finger thoracostomy
113
What is the txt for losing blood loss?
Stop obvious bleeding
2 large bore IVs
16 Ga minimum
FAST/RUSH exam
114
Where should a 16 Ga be performed?
long bone
115
What administrated for shock and control of hemorrhage?
Pneumatic antishock garments (PASG)
116
What are contraindications to PASG?
```
Pulmonary edema
Pregnancy
Evisceration
Thoracic injury w/ hemorrhage
Diaphragm injury
Impaled objects
```
117
What line is used for fluid resuscitation in children?
intraosseous line
118
More than ??? of crystalloid fluid has been associated w/ increased mortality
1.5 L
119
How fast should tranexamic acid be given?
within 3 hours
120
When a 1g dose is given in prehospital setting, where should the other dose be admin?
in the ER
121
Beck's Triad is a indication for?
percardiocentesis or thoracotomy
122
For pregnant pts what side should they be positioned to relieve uterine pressure on the IVC?
left lateral decubitus
123
What use to be superior to tourniquets?
pressure
124
If bleeding diathesis what should NOT be done?
```
removing gauze
(add more gauze and continue to apply pressure)
```
125
In a uncontrolled extremity hemorrhage what should be use?
tourniquets above the area of injury
126
What 3 body cavities should be checked in internal bleed?
thorax
abdomen
retroperitoneum
127
When should neurologic status be performed?
BEFORE sedation/intubation
128
What is the rapid neurological assessment (AVPU)
Awake
Verbal response
Painful response
Unresponsive
129
What is HNSCASPER?
```
Head
Neck
Shoulders
Chest
Abdomen
Spine
Pelvis
Extremities
Reassess
```
130
What is MARCH?
```
Massive hemorrhage
Airway
Respiration
Circulation
Head injury/ Hypothermia
```
131
What is most paramount in a mass casualty event?
scene and provider safety
132
Once a tourniquet has been applied what shouldn't be done?
DO NOT loosen it
133
What can be used as a temporary measure in massive hemorrhage?
direct pressure w/o hemostatic agents
134
If not treated promptly what can a tension pneumothorax progress to?
shock and traumatic cardiac arrest
135
Where should a needle NOT be inserted?
medial to the nipple line
136
A tourniquet should NOT be taken down after?
6 hours
137
When should a tourniquet be converted?
2 hrs
138
Less than how many hours is a STROKE ALERT?
<4hrs
139
What is Glasgow coma scale usually used for?
trauma only... (but used in all emergency medicine)
140
What score is normal on a Glasgow coma scale?
15
141
What score is dead on a Glasgow coma scale?
3
142
What are the 3 categories of a Glasgow coma scale?
eye opening, verbal response, motor response
143
What is the first imaging that is done in a neuro ed workup?
Head CT
144
What are 3 focal neurological deficits of acute onset?
movement
sensation
cognition (responsiveness)
145
In a stroke like s/s pt what is the first thing that should be determined?
attempt to determine time patient " last known well"
146
What are all focal neuro deficits treated as?
STROKE (until either improve or other cause identified)
147
What is the first order of business to help differentiate ischemic vs. hemorrhagic stroke?
CT w/o contrast
148
What is seen on CT for a ischemic stroke?
focal deficit with NON-HEMORRHAGIC
149
What lab should be done on all neuro pts?
fingerstick glucose
150
Dx imaging for cerebellar stroke?
emergent brain MRI
151
How many degrees should the bed be elevated in ischemic stroke management?
30
152
What should the glucose be kept at for ischemic stroke?
140-180
153
When should BP ONLY be lowered ?
SBP > 220mmHg
OR
DBP > 120mmHg
154
What percent is Bp lowered in the first 24hr period?
15%
155
What 3 meds are used to lower bp?
Nicardipine, labetalol, esmolol (IV titratable)
156
What are the good and bad of thrombolytics in ischemic stroke?
can reverse deficits and allow for complete recovery
| can cause the patient to die
157
When should thrombolytics not be given?
SBP > 185 or DBP > 110
| Active bleeding
158
Acceleration deceleration injury sheering veins and more common in elderly due to atrophy
Subdural
159
Thunderclap HA, worst HA of life, neck stifness?
Subarachnoid
160
Hypertensive emergency, bleeding mass, trauma
Intracerebral
161
LOC w/ blow to the head, followed by lucid period and mental decompensation?
Epidural
162
Dx of hemorrhagic stroke?
Brain CT w/o contrast
163
What should the SBP be reduced to in hemorrhagic stroke?
140-160mmHg
164
What is the txt of intracranial pressure in hemorrhagic stroke?
mannitol and hypertonic saline
165
What should NOT be done in the txt of hemorrhagic stroke?
hyperventilate
166
What is the PaCO2 goal in hemorrhagic stroke?
30-35
167
Why is the PaCO2 kept between 30-35?
to prevent cerebral vasoconstriction
168
What is used as a immediate txt by a neurosurgeon for evacuation in hemorrhagic stroke?
burr hole
169
What is the 5th most common symptom presenting to the ED?
Headaches
170
You AVOID opiate meds in what two things?
Migraines and tension headaches
171
In a approach to a dizzy pt what must be differentiate?
central from peripheral vertigo
172
In a approach to a pt "passing out" what must be differentiated?
syncope vs. presyncope
173
Trauma Primary Survey
```
Airway
Breathing
Circulation/ Control of bleeding (C2)
Disability
Exposure
```
174
What is a big red flag in medication use for headaches?
Anticoagulants
175
What is a red flag in findings use for headaches?
Papilledema
176
What is the dx for headaches w/ red flags?
CT brain w/o contrast
177
A head CT is 100% sensitive within what timeframe?
6hrs of SAH onset
178
After 6hrs hours what is necessary to r/o a SAH?
Lumbar puncture
179
What two things should be seen on a LP?
RBC count clearing and xanthochromia
180
Migraine Cocktail (Phase I)
```
IV Fluid 1L
Toradol IV
Tylenol PO
Reglan (Metoclopramide) IV
Benadryl IV
```
181
What must be r/o with Toradol IV admin?
ICH
182
What 3 drugs are given in Phase II?
Magnesium IV
| Solu-Medrol IV
183
What is the time that thrombolytics are ok to give to a ischemic pt?
<4.5 hrs
184
What should always be ran before admin thrombolytics?
a thrombolytic checklist
185
How are anticoagulants reversed in hemorrhagic stroke?
reversal agent or by replace clotting factors
186
What becomes "Veterinarian Medicine"?
workup for altered mental status
187
Seizures are most commonly due to?
known epileptic patient not taking medications
188
1st seizure w/ no other symptoms or inciting event in a non-epileptic patient
r/o toxicity or metabolic issues and d/c home to follow up with PCP
189
2nd seizure w/ no other symptoms or inciting event in a non-epileptic patient?
Refer to neurologist
190
A secondary seizure can be a indication of what?
trauma, infection or severe metabolic derangement
191
6-60 months, generalized, last less than 15 mins, and do not recur within 24hrs?
Febrile seizures
192
Seizures in preggo?
Eclampsia (until proven otherwise)
193
Post- Trauma seizure?
Intracranial hemorrhage (until proven otherwise)
194
Txt for uncomplicated seizure (non-status)
```
Oxygen
IV access
Vitals monitor
Fingerstick glucose
Check seizure medication
Rule out conditions
```
195
Txt for status epilepticus 5-10min?
Lorazepam or diazepam IV + phenytoin or fosphenytoin
| Consider intubation
196
Txt for status epilepticus for >10min?
Versed IVP w/ drip + propofol or ketamine + phenoarbital
| Intubate, Continuous EEG
197
A head injury that does not require neuroimaging or has no diagnostic neuroimaging findings
concussion
198
What two algorithms are used in adults to make decisions neck injuries?
Pediatric Cervical Spine Clearance Working Group
NEXUS
Canadian C-spine Rule
199
Concussion algorithm used for <18 yo for head trauma?
PECARN
200
Concussion algorithm used for >16 yo for head trauma
Canadian CT Head Injury
201
Disposition in concussion w/ no intracranial injury?
d/c home, FU w/ PCM
202
Txt for a concussion w/ no intracranial injury?
Physical and cognitive rest
Acetaminophen prn for 2days
Ondansetron prn for 2 days
Beware of 2nd head injury
203
Has replaced rapid sequence intubation (RSI)?
Drug assisted intubation
204
What is the new location for needle decompression?
fourth or fifth intercostal space mid axillary line
205
What is the best method for adequate decompression of the chest and eliminates tension pneumothorax?
finger thoracostomy
206
More than ??? liters of crystalloid fluid has been associated with increased mortality?
1.5
207
What should be used for external bleeding?
Tourniquets
208
How should tourniquets be placed?
above the area of injury in uncontrolled hemorrhage
209
What should be included in AMPLE hx of a disable person?
```
Allergies
Medications
PMHX
Last meal
Events (leading up to trauma)
```
210
What does AVPU stand for? (used as a alternate to GCS)
Awake
Verbal response
Painful response
Unresponsive
211
What does MARCH stand for in massive casualty event?
```
Massive hemorrhage
Airway
Respiration
Circulation
Head injury/ Hypothermia
```
