Acute Care Flashcards
Resp and CVS effects of
1. PEEP
2. PIP
- increases oxygenation, decreases venous return
- increases ventilation, affects mean airway pressure
Lung protection ventilation in ARDS
Oxygenation more important than ventilation
Ideally delta P < 15, PIP < 32
When can you start insulin for DKA
After 1 hour of fluids
K > 3
SIADH vs cerebral salt wasting
SIADH: euvolemic hyponatremia, low or normal U/O
CSW: hypovolemic hyponatremia, elevated U/O
Serum osm are low in both, urine Na is high
Bilious emesis in an infant < 1 year
Malrotation with volvulus until proven otherwise
Diagnosis of malrotation
UGI
Are the sats reliable in CO poisoning? Why?
No
Sat probe can’t tell the difference between Hb bound to O2 vs CO
So sats will be falsely elevated
Difference between witnessed vs unwitnessed cardiac arrests
Witnessed = Call EMS and get AED first
Unwitnessed = 2 mins of CPR then call for help/AED
Treatment of choice for DVT or PE
Heparin or LMWH
How long to treat
1. Transient provoked
2. Idiopathic
Clot
- 3 months
- 6-12 months
Dangerous ingredient in energy drinks
Guarana
Treatment for acute dystonic reactions
Anticholinergic agents (diphenhydramine or benztropine)
Benzos second line
Age for ondansetron
> 6 months
Complications of rapid correction of chronic
1. Hyponatremia
2. Hypernatremia
- Osmotic demyelination syndrome
- Cerebral edema
Criteria for burn admission to hospital
Partial thickness burns > 10% BSA
Burns to hands, face, feet, genitals, perineum, or joints
Full thickness burns
Electrical or chemical burns
Evidence of inhalational injury
Most common cause of sudden death in adolescents
Hypertrophic cardiomyopathy
Empiric abx for
1. 0-7 days
2. 8-28 days
3. 29-60 days
4. 61-90 days
- Amp and gent/tobra or cefotax if meningitis
- Amp and gent/tobra or cefotax if meningitis
- CTX and vanco if meningitis
- CTX and vanco if meningitis (if UTI and low risk, could do PO cefixime)
When does death from iron ingestion typically occur
Third stage (12-36 hours)
Treatment for iron overdose
Whole bowel irrigation
Deferoxamine is chelator for moderate to severe intoxication
Whole bowel irrigation is best for
Substances not well adsorbed by charcoal (Li, iron)
Transdermal patches
Foreign bodies
Drug packets
Some sustained release preparations
ETT sizing
Uncuffed: age/4 + 4
Cuffed: age/4 + 3.5
Sympathomimetic signs and antidote
Mydriasis
Sweaty*
Tachycardic
Hypertensive
Hyperthermic
Agitated
Antidote: benzos
Anticholinergic symptoms and antidote
Same as symapthomimetic but DRY
Physostigmine is antidote, but can also manage with benzos
Parkland formula
4 x kg x % BSA
Half given over first 8 hours, half over the next 16 hours
You need to ADD maintenance fluids on top of this
Rule of nines
Only valid for children > 14
Head and neck = 9%
Each arm = 9%
Trunk = 36%
Each leg = 18%
Genitalia = 1%
What percentage BSA burns need tetanus prophylaxis
> 10 %
If < 10% but not fully immunized they should get it
What size pneumothorax can have spontaneous resolution
< 30%
Treatment for
1. Mild
2. Moderate
3. Severe
dehydration
- 50 mL/kg ORS over 4 hours
- 100 mL/kg ORS over 4 hours
- IV fluids
Who should you avoid valproate in
Potential mitochondrial disease
<2 years with unexplained developmental delay
Best test to diagnose esophageal perforation
CT neck and chest
TCA ingestion
Anticholinergic activity and inhibit cardiac fast Na channels
Coma, convulsions, cardiac dysrhythmias, acidosis
Widened QRS, prolonged QTc
If QRS prolongation or arrhythmia = give Na bicarb
Can give activated charcoal if within 1 hr
Organophosphate poisoning (mechanism, management)
Cholinergic and nicotinic
Secretions everywhere! Miosis
Twitching, weakness, paralysis
Atropine, can give pralidoxime in addition
Which acute head trauma patients need a CT
Moderate and severe TBI (GCS 13 or less)
GCS 14-15 with persistent symptoms after 18-24 hours may need a CT
Drowning episode, now well - how long to watch in ED
At least 8 hours
BRUE definition
< 1 year with 1 or more of:
1. Altered LOC
2. Absent, decreased, or irregular breathing
3. Cyanosis or pallor
4. Marked change in tone
No explanation on H+P, brief and now resolved
Low risk BRUE criteria
ALL of
Age > 2 mo
GA 32 weeks +
Only 1 (no prior)
Lasting < 1 min
No CPR by trained provider
Unremarkable H+P
Management of low risk BRUE
Education
Offer CPR training
Follow up within 24 hours
Optional: brief admission <4 hrs with sat monitoring and serial exams, ECG, pertussis swab
Treatment for splenic sequestration
Fluid resuscitation
Careful blood transfusions
What to do if button battery is in
1. Esophagus
2. Stomach
- Emergent scope
- If < 5 and battery 20+ mm, remove, if not then may be able to be managed as outpatient
CT findings of diffuse axonal injury
Small hemorrhages throughout the white matter
Especially at gray-white junction
