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RC Review > Acute Care > Flashcards

Acute Care Flashcards

1
Q

Indications for Intubation

A

GCS < 8
Hemodynamic instability
Airway
Respiratory failure
Muscle weakness
Secretions

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2
Q

EET Size

A

Age/4 + 4

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3
Q

Causes of hypoxemia

A

low FiO2
Hypoventilation
V/Q mismatch
Shunt
Impaired gas exchange

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4
Q

PRAM Score

A

Oxygen saturations 0-2
Suprasternal retractions 0-2
Scalene retractions 0-2
Air entry 0-3
Wheezing 0-3

Mild 0-3
Moderate 4-7
Severe 8-12

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5
Q

Discharge criteria for asthma

A

Sats > 94% on RA
Ventolin > q4hr
Mild exacerbation
Observed in ED for 2 hours without tx

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6
Q

PARDS

A

NIPPV:
CPAP/BiPAP > 5cm H2o
PF < 300
SF < 264
IPV:
mild OI 4-8
mod OI 8-16
sev OI > 16

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7
Q

OI

A

(MAP x FiO2 x 100) / PaO2

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8
Q

High risk bronchiolitis

A

GA < 35 weeks
< 3 months age at presentation
Hemodynamically significant cardioresp disease
Immunodeficiency

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9
Q

Bronchiolitis criteria for admission

A

severe resp distress (WOB, RR > 70)
O2 to keep sats > 90
dehydration/poor intake
cyanosis/apnea
high risk infants
family unable to cope

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10
Q

Oxygen Delivery

A

DO = CaO2 x CO

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11
Q

CaO2 (carrying capacity of oxygen)

A

CaO2 = 1.34 x Hgb x Saturation (+ dissolved O2 - negligible)

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12
Q

H’s & T’s (reversible causes of cardiac arrest)

A

Hypovolemia
Hypoxia
Hypoglycemia
Hydrogen ion (acidosis)
Hypo/hyperkalemia
Hypothermia
Tension PTX
Tamponade
Toxins
Thrombosis (coronary, pulmonary)

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13
Q

Declaration of Brain Death requirements

A

2 exams by qualified positions
deep unresponsive coma with a clear etiology and lack of cofounders (unresuscitated shock, severe metabolic disorders, hypothermia < 34, peripheral neuropathy, drug effects)
Exam: no motor response, gag, cough, corneal reflex, vestibulo-ocular response, pupillary response + apnea test
*may have spinal reflexes

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14
Q

Timing of brain death declaration

A

Newborn: > 24 hours between exams, < 48 hours after birth, minimum temp 36 degrees, need oculocephalic reflex
Infant: full, separate exams, no interval, need oculocephalic reflex
Child: two physicians, can do concurrent exams + apnea test
*Needs for be > 24 hours after a significant event

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15
Q

Apnea test

A

MUST MEET ALL CRITERIA
PaCO2 >/= 60
PaCO2 >/= 20 above baseline
pH </= 7.28
No respiratory effort during entire test

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16
Q

GCS

A
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17
Q

Prognostic Indicators in Drowning

A

Good:
- immediate bystander CPR (most important!)
- ROSC in < 10 mins
- submersion time < 5 minutes
- PERL at scene
- Normal Sinus Rhythm at scene

Bad:
- delayed CPR
- ROSC > 25 minutes
- submersion > 10 min

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18
Q

Burn classification

A
  • Superficial - epidermis only, redness/pain/no blisters
  • Superficial partial thickness - epidermis + 1/2 dermis, red/pain/blisters
  • Deep partial thickness - epidermis + > 1/2 dermis, pale/dry/speckled/less tender/non-blanching
  • Full thickness - subcutaneous tissue, pale/charred/leathery/non-tender/non-blanching
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19
Q

Fluid management in Burns

A

Parkland: 4ml/kg/BSA in 24 hours
- 1st half in 8 hours, 2nd half over 16 hours
- ADD maintenance fluids

20
Q

Admission criteria for burns

A
  • suspected NAT
  • > 10% partial thickness
  • > 2% full thickness
  • hands, feet, face, perineum
  • circumferential burn
  • enclosed space fire or evidence of inhalational injury
  • electrical injury (risk of rhabdo)
  • associated trauma
21
Q

Most common cause of morbidity and mortality in burn patients

A

infection

22
Q

Cholinergic toxidrome

A

DUMBELLS
- diaphoresis
- urination
- miosis
- bronchorrhea/bradycardia
- emesis
- lacrimation
- lethargy
- salivation

23
Q

Treatment of cholinergic ingestion

A

Organophosphates/carbamates
- oxygen
- REMOVE CLOTHING
- atropine
- atrovent
- pralidoxime
- intubate early (NO SUCC)

24
Q

Anticholinergic toxidrome

A

Mad as a hatter, blind as a bat…
- Mydriasis
- Hyperthermia
- Confused, grabbing invisible stuff
- dry mouth
- urinary retention
- tachycardia
- flushed
- absent bowel sounds

25
Q

Treatment of anticholinergic ingestions

A

TCAS, anti-histmines, jimson weed, neuroleptics, atropine
- NaHCO3 (TCAs) for prolonged QRS
- benzos for agitation
- cool
- +/- activated charcoal
- +/- physostigmine if pure (not with TCAs or cardiac involvement)

26
Q

Sympathomimetic toxidrome

A

cocaine, amphetamines, ecstasy
- mydriasis
- diaphoresis
- HTN
- tachycardia
- seizures
- hyperthermia
- psychosis
- severe agitation
- hyperreflexia

27
Q

Management of sympathomimetic ingestions

A
  • benzos
  • fluid restriction or 3% NS (SIADH)
  • activated charcoal if 1 hour
  • cooling
28
Q

Toxidrome of Hallucinogens

A
  • mydriasis (LSD) / miosis (PCP)
  • HTN
  • tachycardia
  • diaphoresis
  • hyperreflexia
  • hallucinations (LSD)
  • nystagmus while awake (PCP)
  • LSD usually not fatal compared to PCP
29
Q

Opiate toxidrome

A
  • miosis
  • bradypnea
  • decreased bowel sounds
  • somnolence
  • hypotension
  • hypothermia
30
Q

Treatment of opioid ingestion

A

Naloxone IN or IV

31
Q

CXR findings of hydrocarbon ingestion

A

pneumatoceles
peri-hilar infiltrates

32
Q

Hypothermia CPR

A

Be-Low 30?
Just push, no Do (pamine, or epi)

33
Q

Rewarming with a pulse

A

34-36
- passive rewarming (dry)

30-34
- passive and active external warming (electric blanket, overhead warmer, hot water bottles, heating pads)

<30
- active external and internal rewarming (warmed IV fluid, warmed O2, peritoneal lavage, ECMO)

34
Q

Upward deflections on ECG with hypothermia?

A

Osborn waves

35
Q

Stages of Iron Overdose

A
  • Stage 1: nausea, vomiting, diarrhea (30min - 6 hours)
  • Stage 2: quiet (6-12 hours)
  • Stage 3: metabolic acidosis –> shock, GI hemorrhage, coagulopathy, respiratory failure (12-24 hours)
  • Stage 4: ARDS, liver failure (2-3 days)
  • Stage 5: GI strictures at gastric outlet (3-4 weeks)
36
Q

Treatment of iron overdose

A
  • fluid resuscitation
  • WBI if seen on X-ray within 6 hours
  • IV deferoxamine
37
Q

Radio-Opaque drugs (COINS)

A
  • chloral hydrate
  • opioid packets (latex)
  • iron and heavy metals
  • neuroleptics
  • sustained release/salicylates

COINS

38
Q

Isopropyl Alcohol

A

ketosis without acidosis

39
Q

methanol ingestion

A
  • profound AG acidosis presents late
  • osmolar gap
  • causes retinal injury (blindness)
  • treat with fomepizole
  • dialysis if already acidotic
40
Q

ethylene glycol

A
  • metabolic acidosis leads to cardiac decompensation
  • hypocalcemia leads to prolonged QTc
  • oxalate crystals appear late
  • fomepizole
41
Q

CATCH CT Head Rule

A

Anyone with minor head injury (GCS 13-15) and one of the following:
HIGH RISK
- GCS < 15 2 hours post
- suspected open or depressed skull fracture
- irritabilty on exam < 2 yo
- worsening headache

LOW RISK
- basal skull fracture
- boggy hematoma (> 2 yo, if < 2 yo, do skull X-ray first)
- dangerous mechanisms (MVC<, fall > 3ft or down 5 stairs, fall from bike without helmet)

42
Q

Absolute and relative indications for CT in head injury

A

ABSOLUTE
- focal neurologic deficit
- clinically suspected open/depressed skull #
- wideded of diastatic skull # on X-ray

RELATIVE
- GCS < 14 after initial assessment or < 15 2 hours post
- clinical deterioration over 4-6 hours
- signs of basal skull #
- boggy hematoma
- mechanism of injury
- seizure at time of event or later
- known coagulopathy

43
Q

Poor prognostic indicators in acute head trauma

A
  • GCS < 5
  • increased ICP
  • pre-injury ADHD
  • low SES
  • injuries to other body sites
44
Q

Diagnosis of Pericarditis

A

2/4
- pericardial chest pain (sharp, pleuritic, improved by sitting up and leaning forward)
- pericardial rub
- widespread ST elevation or PR depression on ECG
- pericardial effusion

Supportive
- elevated inflammatory markers
- imaging with pericardial inflammation

45
Q

ECG changes in myocarditis and pericarditis

A

Pericarditis
- concave ST elevated and PR depression in most limb leads
- reciprocal ST depression and PR elevation in aVR
- sinus tachycardia

Myocarditis
- PACs/PVCs or SVT/VT, intraventricular conduction delay, abnormal q waves, low voltages
- AV node conduction delay
- ST segment and T wave changes
- prolonged QRS
- QT prolongation
- diffuse T wave inversion

46
Q

Treatment of pericarditis

A
  • Ibuprofen
  • Colchicine

No role for steroids or IVIG

47
Q

What is the toxic dose of acetaminophen?

A

150mg/kg (7.5g in adult)

RC Review (26 decks)

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