secrets ER2 Flashcards
(57 cards)
A child presents with sudden inability to see after getting punched in the eye, the eye looks shrunken and the pupil looks tear shaped. What is the diagnosis and what do you do?
ruptured globe inability to see after eye trauma eye sunken - decreased IOP anterior chamber may be flattened or shallow may see tear shaped pupil
management of globe rupture
emergency, cal optho
Sterile dressing and shiled
Antiemetics (to protect against increased pressure)
NPO to prepare for surgery
Tetanus shot
Analgesics (parenteral or oral NOT topical)
Sedation (if not other contraindications) should be given
What are contraindications to pupil dilatation drops
- need neuro exams
- increasing ICP with herniation is possible
- acute angle glaucoma- moderate eye pain, decreased vision, cloudy cornea, asymmetric pupil size, poor pupillary reaction)
to avoid systemic absorption, should put pressure on the medial can thus
A two year old loses a tooth after falling on the playground. What should you do?
a) re-implant it
b) leave it and refer to dentist
b)
don’t replant baby teeth because it can damage the nerve root or cause dental ankylosis (solid fixation of the tooth to the bone)
A 10 year old year old loses a permanent tooth after falling on the playground. What should you do?
a) re-implant it
b) leave it and refer to dentist
a)
for secondary teeth, should repair as soon as possible
early insertion after gentle rinsing
disturb the root as minimally as possible
if you can’t (because patient rowdy, etc) then transport in cold milk or saliva or under parent’s tongue, reimplant temporarily until definitive dental care can be obtained
Persistant nasal bleeding, 3 management options
- pressure
- topical vasoconstrictors
- cauterization
- anterior or posterior nasal packing
A child has there nasal septum bulging into the nasal cavity. What are two risks if this goes untreated?
septal hematoma,
if we don’t treat (i.e. drain) risk of abscess formation or pressure necrosis
Clear fluid leaking from nose of a child after a head injury. What should you think of?
could be a CSF leak from cribriform plate, suborbital ethmoid, phenoid sinur or frontal sinus fracture
CT scan etc to figure it out
how to tell if clear fluid from the nose is CSF or just fluid?
check glucose
CSF: higher glucose than nasal mucous (should be 0)
to remember, snot is not sweet
When should you reduce a broken nose in a child?
within 4-5 days if causing asymmetry
frontal scalp hematoma in otherwise well 1 year old after minor trauma, do you need a CT?
nope, other scalp hematomas are an indication
also need to look at the mechanism of injury and the patient’s status (check the Canadian CPS statement for the best answer for our exam)
What is the risk of lethal malignancies from cranial CT in childhood?
1/1000-1500 based on one study
very important not to order too many CTs
true or false - papilledema is apparent as soon as increased ICP occurs
false - takes 24-48 hours to get papilledema
3 different types of herniation
- tentorial herniation - ipsilaterl third nerve findings - dilated pupil, ptosis, loss of medial gaze; contralateral hemiparesis and decerebrate posturing (temporal lob herniating through ridig tentorium)
- cerebellar tonsils through foramen magnum - abnormalities of tone, bradycardia, hypertension, progressive respiratory distress
- subfalcine herniation - herniation of cerebral hemisphere beneath the flax - get leg weakness and bladder abnormalities
what type of cervical spinal fracture more likely in younger kids?
higher in younger kids, lower in older kids, based on head size/neck muscles
What is SCIWORA?
spinal cord injuries without radiographic abnormality
most are younger than 8 years old
have symptoms of spinal cord injury but normal x ray and CT
MRI can help
with these symptoms need to keep evaluating the spine and get further evaluation
How many view to clear a c spine
at least 3 views: 1. AP (include C7-T1 and C1-C7) 2. lateral 3. open mouth (odontoid) if symptomatic but these are negative then consider CT and MRI oblique are controversial
A child sustains a punch to the stomach at school and complains of pain in the left shoulder , what injury should you consider?
Kehr sign - referred pain from blood under the diaphragm
suggests injury to abdominal organ
most commonly spleen
can elucidate with LUQ palpation or trendelenburg (since it shifts the blood closer to the diaphragm)
a 5 year old has ethimosis of the lear abdomen after a car accident, what injury should you suspect
lap belt injury
kids who are to young or too small
lap elt rests high
1. lumbar spine injuries - especially flexion disruption (chance)
2. bowel/bladder perforations/distruptions
proven pelvic fracture what test should you do?
worry about urethral injury
do a retrograde urethrogram
contraindications to foley ?
boggy high riding prostate
blood at the urethral meatus
when to do abx in shock
within 1 hour start antibiotics
comes before inotropes
principles of opioid
rigmorphine, hydrator is regarded as first choice
use PCA/NCA to avoid need for PRNs , ght dose is the right dose that prevents pain
assess side effects
if >1 week taper to avoid withdrawal
PCA/NCA avoid infusion to avoid the need for pen decision
switch from IV to po morphine give 3x dose oral
All of the following are therapeutic measures in TCA overdoses EXCEPT
hemodialysis does not work for TCA because TCA has a really wide distribution into the tissues, dialysis won’t help because it is already in your tissues and cells
bound to your receptors
nelson says does not work
phenytoin - don’t use in TCA/general overdoses because most bad medicines cause sodium channel blockage and can worsen arrythmias
alkalinize urine
sodium bicarb
norepi will make your heart rate worse - more selective on alpha receptors, may worsen potential arrythmias ->use if hypotensive
how long to monitor for TCA overdose: 6 hours
Can give more than one dose than activated charcoal if you think the med slowed down their gastric emptying
