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Paediatrics > Acute Medicine > Flashcards

Acute Medicine Flashcards

1
Q

What is the APLS algorithm including;

  • 4H’s + 4T’s
  • Post resuscitation care
A
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2
Q

How long should you continue resuscitation for with good quality CPR?

A

30 minutes

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3
Q

What are the shockable rhythms?

What shock do you deliver?

A

VF + pulseless VT

4J/kg

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4
Q

What are the 4 types of shock?

A
  • Cardiogenic
  • Hypotensive
  • Septic
  • Anaphylactic
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5
Q

Describe the difference between a vasopressor + inotrope:

A
  • Vasopressor: vasoconstriction and increases MAP
  • Inotrope: cardiac + vascular effects: increases contractility + chronotropy
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6
Q

Effect, receptor + use of;

  • Noradrenaline
  • Adrenaline
  • Dopamine
  • Dobutamine
  • Milrinone
A
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7
Q

Where does the spinal cord lie in this picture?

What is line A + B + C

A
  • Spinal cord lies between B + C
  • A = anterior vertebral line
  • B = posterior vertebral line
  • C = spinolaminar line
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8
Q

What are the normal soft tissue dimensions in the cervical spine?

A

Above the larynx C2 : < 1/3 of the vertebral body width

Below the larynx C3-7: <1 vertebral body wifth

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9
Q

What does the median nerve supply?

A
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10
Q

What does the ulna nerve supply?

A
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11
Q

What sort of fracture is this?

A

Buckle fracture: no breach of cortex

Only requires a splint

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12
Q

What type of # is this + what nerve is commonly injured?

A

Monteggia fracture-dislocation refers to dislocation of the radial head (proximal radioulnar joint) with fracture of the ulna.

  • Anterior dislocation of the radial head is most common
  • Radial nerve is most commonly injured
  • Also look out for plastic deformation of the ulna
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13
Q

What type of # is this?

A

Galeazzi fracture-dislocation

  • Fracture of the distal third of the shaft of the radius with a disruption to the distal radiual ulna joint (DRUJ)
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14
Q

What is the radiocapitellar line?

A
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15
Q

What overdose is MOST likely for a patient with the following ECG:

A

Tricyclic antidepressant overdose

  • Right axis deviation
  • Tall R wave in aVR
  • QTc prolongation (predisposing to VT + VF) due to K blockade
  • QRS prolongation
    • >100ms seizures
    • >160 VT/VF
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16
Q

What is the pathophysiology of tricyclic antidepressant overdose?

A
  • Central + peripheral ACh receptor blockade (anticholinergic)
    • Dilated pupils
    • Tachycardia
    • Vomiting
    • Delirium, confusion, myoclonic jerks, seizures, ataxia, blurred vision
    • Urinary reterntion, ileus
  • Fast Na channel blockade
    • Increases duration of repolarisation + refractory period
  • Noradrenaline + serotonin reuptake blockade
    • CNS depression / coma
    • Seizures
  • Alpha adrenergic receptor blockade
    • Hypotension
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17
Q

Treatment of sodium bicarbonate

A
  • ABCDE’s
  • IV access: 1-2mmol/kg sodium bicarbonate
  • Intubate + hyperventilate (aim pH 7.5-7.55)
  • NGT + charcoal (generally contraindicated but can consider within 2 hrs)
  • IV midazolam for seizures (PHENYTOIN CONTRAINDICATED)
  • Fluid bolus for hypotension +/- noradrenaline
  • If further arrhythmias repeat NaHCO3 then lignocaine
18
Q

Pathophysiology of carbon monoxide poisoning

A
  • Impaired oxygen offloading + impaired peripheral oxygen utilisation
    • Binds to iron moiety of haem with x240 affinity of O2
    • Allosteric change in haem protein = reduced ability of other three O2 binding sites to offload in the peripheral tissues = LEFT shift of O2 curve
19
Q

What are the 3 snake antivenoms we have in Aus?

  • Give if any evidence of neurotoxic paralysis: ptosis, opthalmoplegia, limb weakness, respiratory effects, significant coagulopathy INR >1.3 of prolonged bleeding, history of unconsciousness, collapse, seizure, arrest
A
  • Black snake
    • Rhabdomyolysis
    • Anosmia long term sequelae
    • Local signs at bite site ++
  • Brown snake
    • Most common cause of fatal snake bite
    • Defibrinating coagulopathy
    • Neurotoxicity rare
    • Rhabdomyolysis does NOT occur
    • Collapse 1/3 + arrest 5%
  • Tiger snake
    • Paralysis + rhabdomyolysis over hours
20
Q

Anticholinergic vs sympathomimetic

A

Picking = anticholinergic

21
Q

Serotonin syndrome features

A
22
Q

Serotonin syndrome vs. Neuroleptic malignant syndrome

A
23
Q

What does the handlebar sign indicate?

A
  • Duodenal perforation
  • Liver bleed
  • Spleen bleed

Need to be admitted for serial examination despite normal CT scan as high risk for duodenal perforation

24
Q

Younger children are more likely to have c-spine injuries where?

A

C1-3 whereas older children C3 onwards more likely

25
Q

Location of needle decompression for pneumothorax

Location of chest drain insertion

A

Needle decompression: mid clavicular line 2nd intercostal space

Chest drain: 4-5th intercostal space mid axillary line

26
Q

What is the treatment for raised ICP in trauma?

A
  • Positioning
  • Sedation + analgesia
  • Controlled hyperventilation
  • Hyperosmolar therapy
    • 3% saline 3mL/kg
27
Q

What are toxicology causes of hypoglycaemia?

A
  • Beta blockers
  • Insulin
  • Oral hypogllycaemia agents
  • Quinine
  • Valproic acid
  • Saliculate
28
Q

What drug is contraindicated in toxicology seizures?

A

Phenytoin: acts on sodium channel (many of the toxicology agents act on the Na channel)

29
Q

What are toxicology causes of seizures?

A
  • Venlafazine
  • Bupropion
  • Tramadol
  • Amphetamine
30
Q

In toxicology what is the indication for neuromuscular paralysis?

A

Temp > 39.5

Need neuromuscular paralysis to prevent multi-organ failure

31
Q

Specific antidotes:

  • Tricyclic antidepressant
  • Cholinergic syndrome (Organophosphate poisoning)
  • Anticholinergic syndrome
  • Digoxin
  • Paracetamol
  • Opiates
A
  • Tricyclic antidepressant
    • Sodium bicarbonate
  • Organophosphate poisoning
    • Atropine
  • Anticholinergic syndrome
    • IV fluids
    • Diazepamfor agitation
    • Physostigmine
  • Digoxin
    • Digibind
  • Paracetamol
    • NAC
  • Opiates
    • Naloxone
32
Q

Toxicology: how does fast sodium channel blockade overdose manifest on an ECG?

A
  • Widening of QRS in lead II
  • Right axis deviation
  • Bradycardia
  • VT + VF
33
Q

Toxicology: how does blockade of K+ efflux overdose manifest on an ECG?

A

QT prolongation –> Torsades —> VF

34
Q

Decontamination in paediatrics

A
  • Induced emesis + gastric lavage: NOT used
  • Single dose of activated charcoal: USED in paeds
    • Super heated distilled wood pulp
    • Aspiration is a risk
    • Does NOT work very well for: hydrocarbons/alcohol, metals, corrosives (acids/alkalis)
  • Whole bowel washout: USED in paeds
    • Polyethylene glycol electrolyte solution used + continue until faeces is clear
    • Useful in iron overdose (>60mg/kg), SR K+, diltiazem, verapamil, arsenic, lead ingestion, “body packers”
35
Q

Techniques for enhancing elimination in toxic ingestions

  • Multiple dose activated charcoal
  • Urinary alkalinisation
  • Haemodyalysis + haemofiltration
  • Charcoal haemoperfusion
A
  • Multiple dose activated charcoal
    • Carbamazepine
  • Urinary alkalinisation
    • Salicylates
    • Phenobarbitone
  • Haemodyalysis + haemofiltration
    • Lithium
    • Metformin lactic acidosis
    • Salicylates
    • K+
  • Charcoal haemoperfusion
    • Theophylline
36
Q
A
37
Q

Serotonin syndrome features + management

A
  • Mental state changes
    • Agitation, confusion, anxiety
  • Autonomic stimulation
    • Diarrhoea, flushing, hypertension, fever, sweating, mydriasis, tachycardia
  • Neuromuscular excitation
    • Clonus, hyperreflexia, increased tone, rigidity, tremor

Management

  • Diazepam for seizures
  • Cyproheptadine
38
Q

Drugs of abuse that can cause serotonin syndrome

A
  • Amphetamines
  • MDMA; ecstasy
39
Q

Signs + symptoms of cholinergic syndrome

A

Diarrhoea

Urination

Miosis

Bronchosplasm

Emesis

Lacrimation

Salivation

40
Q

Most common cause of cholinergic syndrome

A

Organophosphate poisoning

41
Q
A
42
Q
A

Paediatrics (23 decks)

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