Test #2 Flashcards
1
Q
Battery
A
- Repeated violence
- This many times is to maintain control
- To keep fear
2
Q
Assault
A
Can be physical or non-physical
3
Q
SANE Nurse
A
Able to do proper exams for woman who have been raped
4
Q
what is rape?
A
physical penetration,
Tx to SANE nurse.
5
Q
Red Flag Law
A
if you believe someone is a danger to themselves or someone else, you can report them (60 day limit on weapons).
Court decides if you are able to be stable.
6
Q
Emotional-Verbal or psychological misuse of another person
A
Includes-Threats, name calling, ignoring, shaming, unfairly, shouting and cursing.
7
Q
Financial / material exploitation
A
withholding money to exercise control.
8
Q
Neglect-Failure of a caregiver to provide for the needs of an individual.
A
- Most common cause of geriatric abuse
- withholding basic human needs.
9
Q
Who do you report child or elderly abuse to?
A
Hospital and Law Enforcement
10
Q
What are the cycles of violence?
A
Phase 1-Arguing and verbal abuse
Phase 2-Physical and sexual abuse
Phase 3-Denial and apologizes
11
Q
what calls do cops get shot on most?
A
Domestic Violence
12
Q
In Phase 1 of Abuse (arguing and Verbal abuse) - what is seen?
A
Can take place over years, buildup of stress, money is a leading contributor- isn’t the thing, it is finding a catalyst
13
Q
In Phase 2 of Abuse (Physical and sexual abuse) - what is seen?
A
Build up and build up until there is physical contact and person leaves
14
Q
In Phase 2 of Abuse (Denial and apologizes) - what is seen?
A
Love is still there or could be retribution. But he comes back apologizes and it won’t happen again (second time is always easier). Cycle continues and evolves and get more intense.
15
Q
What ages do we ask if pregnant?
A
12-70 yo (always follow up, how do you know.)
16
Q
Abuse may exacerbate what?
A
exciting medical conditions
17
Q
What is a common thing that geriatric think when it comes to a house hold?
A
Man controls the woman
18
Q
parents who beat each other tend to also ____ to kids
A
beat
19
Q
True or False: children who grow up in abusive homes tend to beat others?
A
True
20
Q
how many child abuse is happening a year?
A
3 million (about 10,000 die every year)
21
Q
How many woman are abused each year?
A
2-4 million
22
Q
What is IPVA in abuse
A
intimate partner violence and abuse
23
Q
Is it a crime to assault another person physically?
A
Yes
Misdemeanor or a felony depending on:
-Sate Law
-amount of injury inflicted
24
Q
Estimated how many men are battered a year?
A
200,000
25
Estimated how many elderly people are abused a year?
2 million
26
what is child abuse and the ages it can occur?
child abuse can occur infancy to 18 yo
can be inflated by any care giver.
tends to not be a random person
27
What is the biggest thing that tells us a kid is being abused?
Behavior
28
What % of woman said their first violence was during abuse?
Almost 40% of women say that first time violence was when they were pregnant.
29
What are the 3 types of child abuse?
Physical
Emotional
Sexual
(neglect)
30
What is the most important thing to do when we get on a child abuse case?
Really good physical exam
31
Neglect
```
most common form of child abuse
many children suffer more than one type of malnutrition
dehydration and diarrhea
hair loss
untreated medical conditions
inappropriate, dirty, torn clothing
tired and lethargic
```
32
What are some things to look for to see child abuse?
bruising on the back of the legs, and on their back, chest
Upper arm bruising is little less common
33
What are some emotional signs a kid can show that they may be abused?
- they are excessively passive
- they are overly aggressive (they have fought their whole life and they will fight you too)
- Don't look to their parents for reassurance.
- they are very wary of physical contact
34
Where would you expect healthy injuries from being a kid?
- Knees, elbows, bruised shins
We must differentiate those differences.
35
Munchausen's Syndrome by Proxy
People make their kids ill because they enjoy the attention that their kid receives/want attention themselves (attention seeking behavior) The illness/injury may not be done to be fatal but just to injure. (Generally done by women, around 80% of women)
- may injure the kid to gain attention
- cause the child to be sick
-
36
Alopecia
sudden hair loss
37
What causes a scald?
Steam
38
how many should you have with you if you are doing a physical exam on a kid?
Two!!! always think about having a witness.
39
what is key indicator for child abuse?
soft tissue injury
40
what are some the most common burns you will see?
- hot plate
- light bulb
- curling iron
- car cigarette lighter
- steam iron
- knife
41
can kids die from bruising?
yes!!!
42
What is your #1 thing you HAVE to do if you suspect child abuse?
Report it
43
Cultural and medical considerations
Things we have to remember from different cultures and how that culture was raised as well as congenital issues?
- coining
- Cystic Fibrosis
- Tetrology of Fallot
44
Tetralogy of Fallot
Tetralogy of Fallot defects cause oxygen-poor blood to flow out of the heart and into the rest of the body. Risk factors include a viral illness such as rubella during pregnancy, maternal alcoholism, or a family history of the condition.
Symptoms include blue-tinged skin and shortness of breath.
Surgery is typically performed the first year of life, followed by ongoing care.
45
Cystic Fibrosis
is an inherited disorder that causes severe damage to the lungs, digestive system and other organs in the body. Cystic fibrosis affects the cells that produce mucus, sweat and digestive juices. These secreted fluids are normally thin and slippery.
46
Coining
Coining is a technique used in treating many illnesses since ancient times. It is a form of dermabrasion therapy still widely practiced in China and South East Asia. This ancient treatment method is employed to rid the body of “heatiness” or “negative energies”
47
what age is elderly abuse start?
- around 70.
48
most common elder abuse person is?
woman
- over 75 yo
- live with the abuser
- chronic physical or mental impairment
- socially isolated
- problematic behavior from the older person
49
what are the two primary types of elderly abuse?
- inter facility
| - who they live with
50
Profi le of the elder abuser?
- live with victim
- drug or ETOH users
- most over age of 50 (sometimes now they can beat since they were first beat)
- dependent for financial support
- poor impulse
51
who is the number one abuser for elder?
the child (about 30%)
52
What are the type of abuse we see with elderly pt?
- Neglect - Lying in their own urine, malnourished, taking their things so that they can move into homes with kids can be considered neglect.
- Sexual Abuse
- Abandonment
- Physical Abuse
- Emotional-Insults, Threats, Harassment, Humiliation
- Financial (exploitation, withholding of finances) Social security check, Sudden changes in accounts and financial accounts.
53
Are we required to report elder abuse?
YES.
54
What is OBRA 1987?
- Right to self-determination, personal and privacy rights, rights regarding abuse and restraints, rights to information, rights to visit, and rights to transfer and discharge.
- Pt’s have rights, can refuse treatment
55
Red Flags;
- look at their living environment
| - if they are fearful of
56
Ombudsman
one per state
- advocates for nursing home, residents, relatives, and friends,
- investigate quality of care
- reports to licensing authority
- resource for EMS
57
What is PACE?
- government program to provide elderly care.
| Think Innovage
58
Intimate Partner Violence and Abuse phases:
Phase one: arguing and verbal abuse
Phase two: physical and sexual abuse
Phase three: denial and apologies ("honeymoon phase")
59
when does intervention from EMS happen?
during phase two and three
60
what are Mongolian spots?
congenital birthmarks seen most commonly over the lumbosacral area. They are bluish-green to black in color and oval to irregular in shape. They are most commonly found in individuals of African or Asian ethnic background.
(looks like a bruise)
61
why do most men not report abuse?
- humiliation
- guilt
- fear to admit loss of control
- social construct
62
who is the most abused person?
pregnant woman (about 40%)
63
what age do kids form their closes attachments?
age 3
64
what is sexual assault?
Sexual assault-Any unwanted oral, genital, or manual sexual contact
65
How do you handle sexual assault pt.
You have to consider the pt as evidence.
- don't let them bath
- clean up
- change
- try to preserve the "crime" scene
- dont leave the pt alone (chain of evidence)
- document who was with them
- SANE nurse will be involved.
- must be reported.
66
Do we question the sexual assault victim about the offense?
They should not be questioned in detail about the incident.
67
Specific medical questions you should ask sexual assault victim?
```
Where do you hurt?
Are you bleeding?
You breathing ok?
are you able to swallow ok?
Were you punched or kicked?
questions on any life threats.
```
68
Psychosocial with sexual assault victims?
the trauma of sexual assault creates physical and psychological disorganization. Victims behave in a variety of ways. Victims of sexual assault should not be questioned in detail about the incident. Limit history to elements necessary to provide emergency medical care.
69
some type of injuries of a sexual assault?
```
bruises around the wrist,
rope burns
sore
mouth injuries
and soft tissue bruising.
bruising around the neck.
```
70
Stridor
upper airway swelling
71
“Nurse-Maid’s Elbow”
Picking up by arm or swinging around by arms dislocates elbow=radial head subluxation
72
define anger.
Anger is the emotion of control
73
if a sexual assault pt wants to stay and not be transported what should you do?
- call a doc for a refusal
| - try and make sure they have a safe person that come stay with them
74
Children in sexual assault
- common
- usually have frequent contact with assailant
- assault is often at their home
- 1 and 10 kids before 18
- 1 and 7 girls and 1 and 25 boys
- 7-12% of children
75
Documentation
- what you saw
- what you heard
- mechanism
- what you did
- how they responded
- keep your opinions out of it
76
What is our biggest worry about a dehydrated baby?
- they can decompensated very quickly.
77
What makes up the pediatric Triangle?
- Appearance (mental status, muscle tone)
- Breathing (rate and effort)
- Circulation (color, cap refil)
78
What does TICLS stand for?
```
T- tone (activity)
I - interactivity (alertness)
C - consolable (able to be comforted)
L - look (gaze allow movement)
S - speech (strong/weak)
```
79
What is the most important thing to first think with pediatric airways?
- MAKE IT CLEAR (suction bulbs)
| - they are nose breathers (they need to keep it clear)
80
Other than respiratory effects, what is something else you should consider with kids?
The kids sugar.
| They metabolize much faster.
81
strider
- upper airway
82
wheezing
- broncho constriction
83
Rales
- light watery sound at base of lounges (rice crispy)
84
Rhonchi
- thick course sound (usually have a cough, mucous)
85
what does CAPNO measure?
is the measurement of metabolism of O2 in the body, and the release of CO2.
86
What is the fluid dose for Kids?
20ml/kg
87
febrile seizure
(only occur once per instance), fast rising fever- rate of rise
88
Epilepsy (kids)
all other things ruled out or new onset
89
Meningitis (in kids) caused seizure
inflammation of meninges causing seizures (look for stiff neck/nuchal rigidity), seizure can't be broken
90
Diabetic caused seizure
not compliant on meds or new onset (High BGL)
91
Head trauma caused seizure
abuse, falls
92
Purpura
blotchy purple skin (sign of capillaries leaking) its a sign of Sepsis and Meningitis.
93
End Organ perfusion: what is the biggest thing we are looking for?
Urine output
94
What is the right urine output for infants and adults?
1-2 ml/kg per hour
95
Oliguria
the production of abnormally small amounts of urine.
96
< 1 ml/kg/hr of urine output for infants is considered what?
Oliguria
97
< .5 ml/kg/hr in Peds is a clinical halmark of renal failure and considered
Oliguria
98
What is the lowest a GCS scale can be?
3
99
Less than 8 on a GCS scale is a good indication of?
intubate
100
If a kid is less than 60 BPM what do you do?
CPR
101
if the kid is Brady cardia, what is another thing you should do?
O2
102
Asthma
Obstruction of lower airway, bronchoconstriction, inc. mucous prod.
inflammation of mucous membranes (air trapping)
It is an exhalation problem
103
Albuterol
Sympathomimetic Beta 2 agonist
Infant: 0.05-0.14 mg/kg
2-5 y.o. 0.1-0.15 mg/kg
5 and up: 2.5 mg
Put kid in position of comfort
Consider Rebound: when the neb works, but when stopped they can deescalate very quickly.
104
Atrovent (IPRATROPRIUM)
Anticholinergic
0.5 mg / 2.5 ml SVN
Only give one dose
105
METHYLPREDNISONE SODIUM (SOLUMEDROL)
Steroid
Decreases the inflammatory response
Pedi: 2mg/kg SIVP
106
If the kid has a very closed airway from broncho constriction, what can we give?
Epi - IM
Asthma refractory to Albuterol
Allergic reaction with SOB
0.01 mg/kg IM
107
why do people tripod when they are struggling breathing?
To allow us to use all of our accessory muscles. The pecs.
108
what does grunting mean?
We are in respiratory distress, and trying to auto peep (to help keep the airway open)
109
What is Peep?
Positive end-expiratory pressure
110
What is Laryngotracheobronchitis?
Croup
111
Croup is very contagious? (true or false)
True
112
What causes croup?
Narrowing of larynx to cricoid
Parainfluenza Virus
3 months to 3 yrs
113
Do kids have a high or low fever with croup?
lower fever.
114
What are some of the big signs of croup in kids?
- Upper Respiratory Infection
- Low Grade fever< 102.2
- Slow onset usually at night
- Barking cough
- can get better at night.
115
What med can we give to a kid that has Croup?
```
Humidified O2
- Keep Comfortable
- Racemic Epinephrine
- SVN
-0.5 ml of 2.25%
solution in 3ml of saline
```
116
What does the long term care need for the kid with Croup?
Dexamethasone Sodium Phosfate
| - Its a steroid that the kid will get in the hospital
117
Racemic Epinephrine
Class: Catecholamine, sympathomimetic
-SVN (small volume nebulizer)
-0.5 ml of 2.25% solution
mix in 3ml of saline to give it solution to give it volume to nebulize.
118
What is Bronchiolitis?
Respiratory Synctial Virus
Inflammation of lower airways
Usually Self Limiting
December – April
Also known as RSV.
119
What age will Bronchiolitis most likely happen?
Under 1 year
120
Signs of a kid having Bronchiolitis?
- Nose Flaring
- chest wall contractions
- Hypoxemia and cyanosis
- Croupy cough
- Expiratory wheezing, prolonged expiration, rales Tachypnea with apneic and rhonchi episodes
- Tachypnea with apneic and rhonchi episodes
121
Signs and Symptoms of Bronchiolitis?
Wheezing
Tachypnea
Upper respiratory infection
Otitis media (ear infection)
122
what is Otitis Media?
Ear infection
123
Treatment for Bronchiolitis?
Hi flow O2
Transport
Get the boogers out!
If there is some wheezing you can try and give some albuterol.
124
what is EPIGLOTTITIS?
This is a bacterial infection
- High Fever
- This is a big airway problem, you must take them to the hospital.
```
Swelling of the
epiglottis
- H-influenza B
- Critical airway
problem
-Age 3-7 yrs but
not exclusive (adults are being seen with this also.)
```
125
What are signs and symptoms for Epiglottitis?
- Sudden onset
- Sore throat
- High fever
- Drooling
- ‘Sniff Position
126
Treatment for Epiglottitis?
```
Handle gently (especially airway RX)
Keep Sitting
```
Do not attempt to visualize
Hi flow O2
NO IV (IV only if in resp. failure) This is what can upset a kid.
Watch closely
Prepare for airway control
127
What is Tracheitis?
- this will look like croup, if it gets better its croup, if it does not get better then its Tracheitis.
- They will have a higher temp. (fever)
- Bacterial
- Staphylococcus aureus
- More common than epiglottitis
- Commonly seen with pneumonia
- Do not respond to typical croup treatments
- Upper respiratory infection that progresses
128
S/S of Tracheitis:
```
Inspiratory stridor
Barking cough
Hoarsness
Moderate to high fever
No drooling
Will not respond to racemic epi
```
129
Treatment for Tracheitis:
Supportive care
Oxygen
Prepare for advanced airway
Smaller tube necessary
130
What do you do for a child or person that has "swallowed" tongue?
Adjust their airway, tilt head to sniffing position
131
S/S of someone that has foreign body in their airway?
- Acute respiratory distress
- Stridor (partial)
- No air movement (Full Obstruction)
- Drooling
- HX of choking
132
What are some things todo to get things out of a persons airway?
- Magills
- abd thrust
- keep them calm
- position of comfort
If you can not get it out, shelve it farther down (right sided) so we can at least vent one side
133
What are some things that we will see with kids with new onset of type 1 Hyperglycemia?
- They will be more irritable
- Not behaving well
- They will have:
- Polyphesia
- Polydipsia
- Polyuria
134
Treatment for hypoglycemia?
D10
| 0.5 – 1 g/kg (kids)
135
What is SIDS?
Sudden Infant Death Syndrome
136
What causes SIDS?
```
they really dont know.
Stats show:
- race: non whites
- Social: Lower socioeconomic
- Birth: Premature, low APGAR when born
```
137
Seizures in kids can look like?
- Younger than 6 years of age:
- Less complex behaviors, more fragmented
activity
- Tonic-clonic and absence seizure extremely
uncommon in first two years
-Generally we will not see Tonic-Clonic in newborn (no real muscle mass)
138
What is partial (focal) seizure?
limited to one hemisphere
139
Simple partial seizure?
- Awareness is not impacted (able to respond
| normally)
140
Complex partial seizure?
- Awareness is impacted (not able to respond
| normally)
141
What are Generalized seizure?
- Begin in one hemisphere and rapidly spread
bilaterally
- Absence
- Tonic-clonic
142
What is a status seizure?
5 minuets of uninterrupted seizure.
143
will viral or bacterial meningitis kill you?
bacterial
144
when do we assume meningitis with a seizure?
If the seizure does not stop. (even with treatment)
145
Seizure treatment;
- secure airway
- O2 (most common cause of death in seizures is anoxia)
- Valium (0.5 mg/kg)
- Versed IN 0.02mg/kg
- D10, 25 (If still post-ictle)
- Antipyretic (Tylenol)
- Watch for recurrent seizures
146
What are Ventriculoperitoneal (VP shunts) ?
Hydrocephalus
Can drain
- Right atrium
- Pleural space
147
what causes bradycardia in infants?
respiratory
148
types of CONGENITAL HEART DEFECTS:
```
Atrial Septal Defects -9.8%
Patent ductus arteriosus - 9.7%
Ventricular Septal Defects - 30.5%
TGA - 4.2%
Tetrology of Fallot - 5.8%
Other - 16.5%
```
149
What are some of the One Pill Killers?
```
Oral hypoglycemia
Beta Blockers
Calcium Channel Blockers
alpha 2- adrenergic agonist
cyclic antidepressants
opioids
Buprenorphine
```
150
What kills more kids than anything else?
Trauma
151
What is the biggest concern in trauma with kids?
Shock (they have less blood volume to compensate)
152
Shock considerations in kids:
```
Circulating blood volume
Body surface area
Hypothermia
Cardiac reserve
Respiratory fatigue
```
153
Why must we stop hemorrhages in kids!!!!
we worry about blood loss.
154
Falls with kids:
- Off balance
- Lack of nerve development
- Small feet compared to body
- Curiosity
155
What type of trauma is a leading cause of death in kids?
Motor Vehicle Crash
- No or improper car seats
- For gotten pts
- 37 deaths a year
156
what are Epidural Bleeds?
- fast on set
| - arterial (high pressure) bleeds
157
What are subdural Bleeds?
- Slow onset
| - venous (low pressure) bleeds
158
what do we do with close head injuries?
- O2
- get a line if the kid is seizing
- manage airway
- spinal immobilization
- rule out other causes
159
Thoracic Trauma has a very _____ mortality rate?
| Why?
High
- their thoracic cavity if very compact and small.
- Flexible chest wall
- thoracic and abdominal injuries
160
What are the rule of 9s rule for kids?
| good thing to look up
Legs- 13.5%
| Head- 18%
161
what is ALTE?
Apparent Life- Threating Event
- American Academy of Pediatrics recommended removing "life-treating"
- We no longer use this criteria to determine if we transport the pediatric pt.
162
Now we have, BRUE, what does that stand for?
Brief, Resolved, Unexplained Event
- < 1min
- < 1 y.o.
- >= one of the following
- absent, decreased, irregular breathing
- cyanosis or pallor
- altered level of responsiveness
- marked change in muscle tone
We dont need to transport the kid.
163
what is the difference in low risk and high risk BRUE?
Low Risk:
Age >60 days
Gestational age >32 wk
One event only (no repeat or cluster of BRUE)
No CPR required
No concerning history (abuse, family hx of
sudden death) Normal physical exam
High Risk:
Those that don’t meet low risk criteria
- Go to the hospital
164
If you suspect the pediatric is in cardiac shock what amount of fluid should you consider?
5-10 ml/kg
