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URGE Flashcards

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1
Q

Fluid resuscitation in for hypotensive shock in a child.

A

Bolus of 20 cc/kg

3:1 rule: give the above bolus x 3, if bp still not responding, give prbc

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2
Q

Head trauma in a patient between the age of 2-20 that seems fine. No PE findings. What’s the recommendation.

A

Observation by reliable family member at home for 24 hours.

If LOC < 1 minute, head CT vs observation (if no LOC, chance of head pathology is 1/5000)

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3
Q

What are the rules to clear a patient from a c-collar?

A

NEXUS (C-Spine) Guidelines

No posterior midline cervical tenderness

No focal neurologic deficits

Normal level of alertness / **No EtOH intoxication / **No distracting injuries

100% sensitive!

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4
Q

Soft neck collar needed for whiplash?

A

No. It actually worsens neck pain and reduces mobility.

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5
Q

Objective dx of compartment syndrome?

A

Tissue pressure > 30mmHg (tissue pressure exceeds perfusion pressure)

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6
Q

Radial nerve injury. What is the motor deficit in the hand?

A

Can’t extend wrist and fingers

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7
Q

Median nerve injury. What is the motor deficit?

A

Can’t flex wrist and fingers. Can’t make the “OK” sign

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8
Q

Ulner nerve injury. What is the motor deficit?

A

Can’t abduct the fingers. (Can’t make the live long and prosper sign)

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9
Q

Spiral fracture of the tibia vs radius. Which is NOT concerning for child abuse?

A

Spiral fx of tibia is a “toddler’s fracture”.

The kids “spin out” and fx the leg. It’s the most common fx of toddler’s presenting with a limp. –> Below the knee walking cast.

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10
Q

Which bite is the most likely to cause infection?

Cat to hand, Human to face, Dog to thigh, Spider to leg

A

Cat to hand

Cat bite is deeper. Hand is less vascular than face.

–> Augmentin

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11
Q

Treatment for cat scratch disease?

A

Que no.

Self-limiting (…in 1-2 months)

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12
Q

Treatment for brown recluse spiider bite?

A

None that really work.

Venom causes skin necrosis.

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13
Q

Treatment for black widow spider bite?

A

Supportive for pain, anxiety

Resolves in 72 hours

No local inflammation

Venom is neuro toxin (muscle cramps/pain, N/V)

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14
Q

Snake bite to arm while camping remotely. What do you do?

A

Elevate arm to reduce edema, drive to hospital.

Antivenom (CroFab) is given to those with severe edema or signs of DIC.

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15
Q

Pt just ate peanuts, now with uticaria, low bp, tachycardia, oral and facial swelling.

Tx?

A

Epinephrine 1:1000 IM or SQ (1:10000 IV is for life-threatening reaction)

+

Benadryl (H1 blocker)

+

Solumedrol

+

ranitadine (H2 blocker)

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16
Q

What is scomboid poisoning? Tx?

A

A pseudo fish allergy that occurs after eating spoiled fish.

Tx with H1, H2 blockers

Histadine in the fish muscle breaks down into histamine –> pt eats a bunch of histamine –> experiences facial flushing, diaphoresis, hives, diarrhea, peppery taste. Usually seen in tuna or mackerel (scombridae family)

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17
Q

Difference between heat exhaustion and heat stroke?

A

Heat stroke has abnormal neuro exam.

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18
Q

Acetaminophen overdose. Tx

A

N-acetylcysteine (Mucomyst)

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19
Q

Meds that cause serotonin syndrome.

Tx?

A

SSRIs, MAOI

Cocaine, Amphetamine, Dextromethorphan, Venlafaxine, Meperidine

Cyproheptadine (NOT dantrolene)

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20
Q

Toxic patient with breath smell of bitter almond. Dx?

A

Cyanide poisoning.

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21
Q

Toxic patient with breath smell of violets. Dx?

A

Turpentine poisoning.

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22
Q

Toxic patient with breath smell of mothballs almond. Dx?

Study These Flashcards
A

Camphor (cough suppressant in Vicks) poisoning, naphthalene (the ingredient in mothballs)

23
Q

Toxic patient with breath smell of garlic. Dx?

Study These Flashcards
A

Arsenic poisoning

24
Q

Toxic patient with breath smell of pear. Dx?

Study These Flashcards
A

Chloral hydrate (used in a “Micky”)

25
Tox substances/meds that may cause hyperthermia?
Anticholinergics, SSRIs, Neuroleptics Amphetamines, PCP, cocaine Thyroid meds Nicotine Aspirin
26
Tox substances/meds that may cause hypothermia?
CO2 EtOH sedative-hypnotics, barbituates
27
Patient being treated for frostbite is found to have black eschar, no pulses on affected fingers and toes. Next step?
**Observe.** *Don't* debride yet. It takes weeks for demarcation line to become apparent.
28
Asymptomatic patient with household bleach ingestion. Next step?
**Observe** (only if *household* bleech and *asymptomatic*) If *industrial* bleach or *drain* *cleaner* --\> to GI for possible endoscopy
29
Patient with heat stroke. Ice pack are ***contraindicated***. Why?
Ice packs supposedly cause cutaneous vasoconstriction which slow cooling. Better to use fans and cool wet cloths for evaporative cooling.
30
Lab test to confirm heat stroke?
**LFTs** are almost uniformly elevated in heat stroke ## Footnote (normal LFTs should make you question your diagnosis)
31
What is the significance of a normal ABG in a tachypneic patient in asthma exacerbation?
**Danger** ## Footnote The patient should have a *low* CO2 from the tachypneia. Normal = retaining in this situation.
32
Asthma exacerbation stepwise treatment.
_1._ **Oxygen** (for O2 \> 90%), **peak flow**, **SABA** nebs (or MDI) +/- **ipratroprium bromide**.... then _2._ **Prednisone**.... then _3._ Better when **FEV1 or PEF \> 70%** _4_. home vs admit
33
What peak flow is considered "good" for discharge to home from the ED.
FEV1 or PEF \> **70%**
34
How many albuterol MDI treatments = a nebulizer treatment?
**8-10** ## Footnote May give albuterol nebs *continuously* if needed (tachycardia usually *improves* as does the oxygenation)
35
Tx for status asthmaticus?
Magnesium sulfate IV
36
Kid is wheezing after eating peanuts. Looks good otherwise. Stepwise tx?
_1._ **Benadryl** (H1 blocker) + **cimetidine** (H2 blocker) _2._ **Solumedrol** _3._ **Epinephrine 1:1000** IM or SQ (1:10000 IV is for life-threatening reaction)
37
Patient just successfully treated for bee sting (or peanut) allergic reaction. Discharge meds?
**Benadryl** q6h x 48 hours + **Cimetidine** q12h x 48 hours + A**naphylaxsis kit**
38
Young man with sudden testicular pain. Dx? Tx?
Diagnose **testicular torsion** with **surgical exploration**. Treatment is **surgery** --orchiopexy within 6 hours!
39
What is the most common cause of epididymitis in a 21 year-old male?
Chlamydia trachomatis (second most common is Neisseria gonorrhoeae)
40
What is the most common cause of epididymitis in a 55 year-old male?
E.Coli (then Klebsiella, Pseudomonas)
41
Do pregnant patients need to be admitted for pyleonephritis?
Not if they are \< 24 weeks with VSS
42
Patient with ab pain in the ED, HCG = 440 IU/L. US is negative for ectopic pregnacy. What's the deal with beta HCG and US in ectopic pregnancy dx?
Beta HCG doubles ~ q72h in normal pregnancies, in etops it *does not*. --\> **check a HCG again in 48 hours.** ## Footnote US is not sensitive until ~ HCG=2000 IU/L so you can't count on it with a level of 440
43
Unresponsive patient is brought in. No info available. Exam is not helpful. Where do you start immediately?
DONT ## Footnote **D**extrose (finger stick) **O**xygen **N**aloxone **T**hiamine
44
What are contraindications to placing a foley catheter in the trauma setting?
**Blood at the urethral meatus** **Perineal hematoma** **High-riding soft boggy prostate** (means urethra has been disrupted and the prostate has shifted).
45
You identify a patient with HTN and an aortic dissection. Next step?
Start **labetalol** and **nitroglycerin/nitroprusside** drip to control the bp (to minimize stress on aortic wall)
46
3 year-old male with belly pain, hematemesis, pill ingestion. What is the presentation of iron toxicity? Tx?
_Phase 1_: **Abdominal** **pain**, **N/V/D,**** +/- ****Hematemesis**, **Hematochezia** (gastric irritation) _Phase 2_: relatively **Asymptomatic**, _Phase 3_: **Hypotension**, **Acidosis**, **Multisystem** **organ** **failure**, **C****oma** _Phase 4_: sometimes **H****epatic necrosis** _Phase 5_: **Bowel obstruction** 2-4 weeks later
47
For what substances does activated charcol *not* work?
Iron Lithium Lead These substance do not absorb to activated charcol.
48
Patient reportedly ingested iron, but is asymptomatic. When is he "out of the woods"?
**6 hours + normal KUB** ## Footnote If no symptoms (abdominal pain, NV/D are the first sx) by then AND no ab xray evidence of iron in the GI tract, pt may be discharged with close follow-up. \*\*\*chewable multivitamins will not show up on xray!!!
49
Newborn that has not been eating well, T=38.2 Exam is normal. Normal urine/stool output far. Next step?
*You don't have a source* in this *\< 28 day-old baby*, so be concerned for: Neisseria meningitides, Listeria monocytogenes, GBS (peak incidence is day 7, but may occur up to 30 days old), HSV (cold sores) Do it all: **CBC**, **BCx**, **catherterized UA/Cx**, **lumbar** **puncture**
50
Treatment for newborn with suspected meningitis?
Ampicillin and gentamycin
51
Febrile child that is \< 28 days old. Next step?
Assume its bacteremia seeding to the CSF. --\> **CBC**, **CRP**, **BCx**, **UA/UCx**, **lumbar** **puncture**, (**stool** if diarrhea), **CXR** (if respiratory sx) **Admit for IV abx** (amp/gent empirically) Age 1-3 months, if WBC \< 15000 with band \< 1500, CTX IM in office and again the next day with observationl otherwise admit for IV abx and BCx.
52
Febrile child that is 6 weeks old. Next step?
Age 1-3 months, if WBC \< 15000 with band \< 1500, CTX IM in office and again the next day with observationl otherwise admit for IV abx and BCx. ## Footnote In neonates (\< 28 days old), full workup and possible admission.
53
6 month-old with difficulty breathing, some runny nose, wheezing, brassy sounding cough. Positive steeple sign on xray (not needed). Dx? Tx?
**Croup** (=laryngotracheobronchitis)... swelling of epiglottis cased by parainfluenza, influenza, and RSV, etc **Dexamethasone 0.6mg/kg IM/PO/IV x 1 ** + **racemic epinephrine nebulizer**
54

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