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*CPS Statements TD > Acute Care > Flashcards

Acute Care Flashcards

1
Q

Status epilepticus

- definition

A

> 30 min of sz or w/o return to b/l btwn

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2
Q

Length of seizure to cause brain cell loss?

A

> 30 min

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3
Q

Status epilepticus tx

A

1st line - Benzo (2 doses)
Pre hospital: buccal or IN midaz
Hospital: IV lorazepam

Get Pheno/Pheny ready while giving Benzo because takes time

2nd line: Pheny/fosphenytoin 20mg/kg
(less likely than phenobarb to cause resp depression and alter LOC)

Then phenobarbital 20mg/kg loading

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4
Q

Side effects

Phenytoin

Phenobarbital

A

Phenytoin S/E - purple glove syndrome (extravasion - severe subcut irritation), cardiac arrhythmias, bradycardia, hypotension

Fosphenytoin - S/e: cardiac arrhythmias, bradycardia, hypotension

Phenobarbitals - S/E - sedation, resp depression, hypotension

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5
Q

Most common cause of status epileptics

A

Febrile sz

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6
Q

Investigations for status epilepticus

A

B/W - lytes, gluc, CBC + diff, Cx, gas
Anticonvulsant levels if on therapy
Serum Ca, BUN, Mg, LFTs, lactate, ammonia
Consider LP (defer until stable, no signs incr ICP)
BCx then Abx if suspicious for sepsis
CT head if hx trauma, evidence increased ICP, focal neuro signs, unexplained LOC, suspicion of cerebral herniation
**Normal CT does not exclude significantly increased ICP
Consider activated charcoal if intoxication
EEG

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7
Q

Admission criteria for Asthma exacerbation

A
  • An ongoing need for supplemental oxygen
  • Persistently increased work of breathing
  • ß2-agonists are needed more often than q4 h after 4 to 8 h of conventional treatment
  • The patient deteriorates while on systemic steroids
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8
Q

Asthma exacerbation - discharge from ER plan

A

3-5 day course of oral steroids
Continue short-acting ß2-agonists until exacerbations resolve and then PRN
Written asthma action plan
Review techniques for MDI
Appropriate F/U (primary care physician or a local asthma clinic)

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9
Q

What are the 4 components of a rapid response system

A 
Four main components:
an event detection and response-triggering arm
a planned response arm
a quality monitoring arm
an administrative support arm
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10
Q

CPR - if advanced airway what compression rate and breathing rate

A

continuous compressions >/=100-120 comp/min w/o pause for rescue breaths

breaths (8-10 vent/min)

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11
Q

Key aspects of compressions

A 
>/= ⅓ AP diameter of chest (4cm infants, 5cm children)
Allow for full recoil
Minimize interruptions
Avoiding excessive ventilation
Rotate compressor q2min
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12
Q

How long can a pulse check be

A

max 10 sec

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13
Q

Meds for shock refractory vent fib or pulseless vent tachycardia

A

Amiodarone or lidocaine

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14
Q

What is considered Wide Complex?

A

> 0.09s

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15
Q

Doses of epi pen

A

EpiPen Jr 0.15mg - 15-25kg; EpiPen 0.3mg - >25kg

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16
Q

Dx of anaphylaxis

A

Skin findings + (Resp OR Cardiac)
Likely allergen + 2 of (Skin/Resp/Cardiac/GI)
Known allergen + low BP

17
Q

Biphasic reaction

  • timing
  • RF
A

most likely 4-6 hours
within 72 hours

delayed administration of epinephrine
more than one dose of epinephrine
initially presented with more severe symptoms

18
Q

anaphylaxis when to observe overnight

A

Biphasic reaction
Use of Bblockers
Repeated Epi
More severe presenting sx (hypotension, severe resp distress)

19
Q

higher risk of severe brochiolitis

A

prematurity < 35wga
<3mo at presentation
hemodynamically significant cardiopulmonary dz
immunodeficiency

20
Q

Proven tx of bronchiolitis

A

O2 to keep sats > 90%

hydration

21
Q

Mgmt of croup

A

Mild: dex

Mod-Sev: dex + epi neb

22
Q

how does high flow work

A
  • Delivers high oxygen concentration (not diluted by r/a)
  • Provides some degree of positive intrathoracic pressure
  • Washes out anatomic dead space
  • Humidity/heating allows higher flow rates to be tolerated
  • Both upper and lower airway resistance are reduced significantly
23
Q

What clinical conditions can respond to HHHFNC therapy

A 
OSA
Bronchiolitis
Asthma
Pneumonia
Heart failure
24
Q

Why are Children are more likely to develop intracranial lesion due to head trauma

A

Larger head to body size ratio

Thinner cranial bone and less myelinated neural tissue

25
Q

What are most frequent causes of Intracranial injury

A
  • falls from a height above 3 feet (91 cm or twice the length/height of the individual),
  • involvement in an MVA or
  • impact from a high velocity projectile
26
Q

When to do a skull xray in head trauma

A

Large boggy hematoma

Suspicious for child abuse

27
Q

When to do CT for head trauma

A

Any moderate or severe head trauma
Absolute indications
- Focal neuro deficit on exam
- Clinically suspected open or depressed skull # or a widened or diastatic skull # observed on xray

28
Q

Increased risk of seizure post head trauma

A 
Younger age
Severe head trauma
Cerebral edema
Subdural hematoma
Open/depressed skull #
29
Q

Poor prognostic indicators for head trauma

A 
Poor prognosis indicators:
Severity at initial presentation
Presence of raised ICP
Other body site injury/severeity
Pre injury ADHD
SES
30
Q

What is the concentration of Na in NS?

A

154 mmol/L

31
Q

Treatment for ITP

A

No active bleeding: observation. Second line = oral corticosteroids or IVIG

Moderate bleeding: IVIG or corticosteroids. Second line = IV anti-D immune globulin

Severe bleeding: in hospital with IV steroids and IVIG. Adjunct = Tranexamic acid

32
Q

Bugs in gastroenteritis

A

Rotavirus & Norovirus

33
Q

Gastroenteritis - kids are at risk for

A

Dehydration, Electrolyte abnormalities, Need for NG/IV rehydration + admission

34
Q

dose ondansetron

A

0.15mg/kg

8-15kg: 2mg
15-30kg: 4mg
>30kg: 6-8mg

35
Q

Rapid response system:

  • Goal?
  • Issues leading to adverse events?
  • 4 main components?
  • Key factors for effective team?
A

Goal: ID critically ill pts and mobilize a clinical response to prevent or reverse pt deterioration

Issues leading to AE:

  • Failure to plan
  • Failure to communicate
  • Failure to recognize a deteriorating patient

4 components:

  • Event detection and response trigger
  • Planned response
  • Quality monitoring
  • Administrative support

Key factors for team:

  • Leadership/Team leader
  • Situational awareness (prevents fixation errors)
  • Resource allocation – assigning tasks
  • Communication – “closed loop”
36
Q

Mechanism of Heated Humidified High Flow NC?

A
  • Delivers high oxygen concentration (not diluted by r/a)
  • Provides some degree of positive intrathoracic pressure
  • Washes out anatomic dead space
  • Humidity/heating allows higher flow rates to be tolerated
  • Both upper and lower airway resistance are reduced significantly
37
Q

What settings to start Heated Humidified High Flow NC?

A

1-2 L/Kg/min at FiO2 50%

38
Q

Conditions potentially responsive to Heated Humidified High Flow NC?

A
  • OSA
  • Bronchiolitis
  • Asthma
  • Pneumonia
  • Heart failure
39
Q

3 modes of intervention for mgmt of pain/distress for procedure

A
  • physical
  • psychological
  • pharmacotherapy

*CPS Statements TD (17 decks)

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