Trauma, Fx, Childhood fever

Question 1

What is included in the primary survey

Answer 1

ABCDE

Question 2

can you start the secondary survey before ABC’s are finished?

Answer 2

NO ABC’s must be stabilized first

Question 3

What signs may indicate a basilar injury

Answer 3

Raccoon eyes, Battle sign, hemotympanum, CSF drainage from ears or nose

Question 4

What must you check before inserting a catheter

Answer 4

Rectal tone, meatal blood, vaginal bleeding or injury to the pelvic area

Question 5

Broken hip will appear

Answer 5

Shortened and internally rotated

Question 6

In a trauma what radiographic imaging should you consider

Answer 6

Head and cSpine CT
Standard plain x-rays - CXR, pelvis 
FAST exam
Extremity x-rays
Entire spine image for uptunded/multisystem trauma

Question 7

In a trauma what labs shuold you consider

Answer 7

Type/screen and type/cross
CBC
UA
ETOH
PTT/PT INR
Pregnancy 
> 55= EKG, Cardiac markers

Question 8

What should always be included in the plan of a trauma patient

Answer 8

serial examinations

Question 9

What are the NEXUS criteria for CT

Answer 9

1. Midline cervical tenderness
2. Focal neurological deficits
3. Altered level of consciousness
4. Evidence of intoxication
5. Painful distracting injury
   IF 1 IS POSITIVE = CT

Question 10

When do you place a ET tube

Answer 10

GCS less than 8
No gag reflex
Agitated
Head injury
ETOH/drugs

Question 11

When should you consider a Crichothyrodotomy

Answer 11

when you can’t intubate

Facial trauma

Question 12

What is RSI

Answer 12

Give a paraylitic and premedicate to get an airway

Question 13

If you hear rice crispies in the chest what does that indicate

Answer 13

AIR- subcutaneous emphysema

Question 14

What injuries should you look for to evaluate breathing

Answer 14

Shifted trachea
Paradoxical chest movements
No BS
Open wounds- sucking chest wounds

Question 15

If you hear no breath sounds what do you do

Answer 15

1) Needle decompression- 18 gauge needle in the 2nd intercostal space mid-clavicular line
2) if needle decompression unsuccessful- Chest tube 5th intercostal space anterior to the mid axiallary line

Question 16

Should a needle go in above or below a rib

Answer 16

ABOVE- the NVA are below the rib

Question 17

Will a needle decompression work for a hemothorax

Answer 17

No, need chest tube

Question 18

what is the minimum amount of time to obtain new vital signs

Answer 18

15 mins

Question 19

If you can feel the radial pulse the BP must be at least

Answer 19

80

Question 20

If you can feel the carotid pulse the BP must be at least

Answer 20

60

Question 21

If your patient becomes hypotensive are they getting better or worse

Answer 21

WORSE- bad sign

30% of blood volume can be lost before BP lowers

Question 22

How many IV’s should a trauma patient get

Answer 22

2- large bore -18 or bigger

Question 23

What is the FAST used for

Answer 23

screening tool to identify the cause of shock immediately after the primary survey

Question 24

When is a CT indicated over a FAST

Answer 24

for definitive imaging and location of the bleeding

Question 25

What to do with fractures while stabilizing patient

Answer 25

Control bleeding- consider blood if large area like femur or pelvis Immobilize pelvic fractures Splint extremity

Question 26

If you give 10 or more units of PRBC's what else do you need to give

Answer 26

FFP +Platelets in a 1:1:1 ratio

Question 27

What are the major things in Diasability

Answer 27

GCS pupilary response, blood glucose

Question 28

Is hyperventilation good in a truma patient

Answer 28

Probably not- It may decrease ICP but it lowers blood flow to brain so may worsen ischemia and worsen hemorrhage

Question 29

What does Exposure entail

Answer 29

Undressing them, examining the entire patient, warm blankets or consider inducing hypothermia for TBI

Question 30

When is a NG tube contraindicated

Answer 30

Facial fx

Question 31

should you remove a deeply impailed object

Answer 31

No

Question 32

Indications for emergent thoracotomy

Answer 32

penetrating chest trauma Witnessed signs of life during transport to ED Electrical activity upon arrival

Question 33

Strain

Answer 33

Tendon

Question 34

Sprain

Answer 34

Ligament

Question 35

What are ortho emergencies

Answer 35

Open Fx "Tenting" of a dislocation NV compromise in a closed injury

Question 36

for a long bone Fx you should evaluate...

Answer 36

the joint above and below

Question 37

How so you describe fractures

Answer 37

``` Open vs closed Location Orientation Displacement/separation Shortening Impacted/overriding Angulation Rotational deformity ```

Question 38

If a Fx in intrarticular it ...

Answer 38

extends into joint space

Question 39

When do growth plates close

Answer 39

``` Boys= 18 Girls= 15-16 ```

Question 40

What is the most common type of salter haris Fx

Answer 40

Type 2

Question 41

What is a salter haris fx

Answer 41

a Fx involving the growth plate

Question 42

What is the worst salter haris fx

Answer 42

type 5

Question 43

What is a fever in a neonate and infant under 60 days

Answer 43

100.4 (38)

Question 44

what is a fever in an infant older than 60 days

Answer 44

102.2 (39)

Question 45

in a child less than 60 days what is the most common cause of SBI

Answer 45

UTI

Question 46

If a child less than 60 days has a confirmed UTI and fever greater than 102 what might they have

Answer 46

Pylonephritis

Question 47

Other causes of SBI in a infant less than 60 days

Answer 47

Bactermia +sepsis Pneumonia Sinusitis Meningitis

Question 48

Organisms causing meningitis in a child <3 months

Answer 48

E. coli, Group B strep, Listeria

Question 49

Organisms causing sepsis/bactermia in a child <3 months

Answer 49

E. coli, Group B strep, Listeria

Question 50

Organisms causing meningitis in children >3 months

Answer 50

S.pneumoniae, N. meningitidis, Staph. Aureus

Question 51

Pleocytosis suggests

Answer 51

Viral etiology

Question 52

Meningitis is bacterial if...

Answer 52

``` CSF WBC >30 in neonate and >10 in older CSF anc >1000 cells/microliter CSF protein > 8 Peripheral WBC >10,000 Hx of seizure before or at onset of symptoms ```

Question 53

Treatment of meningitis

Answer 53

Ceftriaxone (Rocephin)- 100mg/kg with a mas of 2g Ampicillin Cefotaxime +/- Gentamycin

Question 54

Most common cause of bronchiolitis

Answer 54

RSV

Question 55

If a child has RSV what else should you check for

Answer 55

UTI

Question 56

What can ceftriaxone cause in children <1 month old

Answer 56

increased bilirubin

Question 57

A 1 year old child comes in with strep throat

Answer 57

NO- strep pharyngitis is uncommon in children less than 2

Question 58

If a fever decreases and the child improves with administration of tylenol or motrin what is the most likeley cause

Answer 58

viral

Question 59

how long do you use the estimated birth date for a preterm baby instead of the actual birth date

Answer 59

90 days

Question 60

A child is screaming when you look in their ear, the typmainc membrane is red. They must have OM

Answer 60

Wrong- all babies ears will be red if the scream loud enough. you must insufulate the ear

Question 61

Dosage of amoxicillin

Answer 61

80-90mg/kg

Question 62

Child 3 months to 36 months causes of fever

Answer 62

Viral OM Pneumonia UTI

Question 63

What are the serious bacterial illnesses of children 3 months to 36 months

Answer 63

S. pneumoniae N. meningtisis MRSA

Question 64

Causes of fever in children over 36 months

Answer 64

Strep pharyngitis Mono Kawasaki

Question 65

Characteristics of Kawasaki disease

Answer 65

``` Children less than 5 High fever Strawberry tongue Conjunctivitis/iritis Peeling or hands and feet Coronary artery aneurysms ```

Question 66

What is the treatment of Kawasaki disease

Answer 66

IV IG | ASA