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Medicine > APLS > Flashcards

APLS Flashcards

0
Q

In children coma is caused by:

A
  • diffuse metabolic insult (95%)

- structural lesion (5%)

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1
Q

Drowsiness is defined as:

A

mild reduction in alertness

             and

increase in hours of sleep

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2
Q

Cerebral perfusion pressure is defined:

A

CPP = MAP - ICP (>50 mmHg)

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3
Q

Cerebral blood flow is:

A

> 50 ml/100g/min

  • ischemia when CBF<20
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4
Q

Pinpoint pupils indicates:

A
  • metabolic disorder
  • narcotic ingestions
  • organophosphate ingestion
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5
Q

Fixed midsize pupils indicates:

A

midbrain lesion

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6
Q

Fixed dilated pupils indicates:

A
  • hypotermia
  • severe hypoxia
  • barbiturates ingestion
  • during and postseizure
  • anticholinergic drugs
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7
Q

Unilateral dilated pupils indicates:

A
  • expanding ipsilateral lesion
  • tentorial herniation
  • third nerve lesion
  • epileptic seizure
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8
Q

Examining DISABILITY consist of:

brief neurological examination

A
  • Mental status/conscious level (AVPU)
  • pupilary size and reaction
  • posture
  • neck stifness, seizures
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9
Q

Absolute signs of raised ICP:

A
  • papilloedema
  • bulging fontanelle
  • absence of pulsation in retinal vessels
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10
Q

Signs of raised ICP:

A
  • abnormal oculocephalic reflexes
  • abnormal posture (decorticate, decetebrate)
  • abnormal pupillary responses (dilatation)
  • abnormal breathing patterns
  • Cushing´s triad (slow HR, high BP, abnormal breathing pattern)
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11
Q

Glucose when hypoglycaemia:

A
  • Glc 10% 2 ml/kg IV

- then infusion: 5 ml/kg/hod + 0.45% FR

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12
Q

High ICP - mannitol:

A

250 - 500 mg/kg IV over 15min
-> give 2-hourly (max Osm 325 mOsm/l)

250 = 1.25 ml 20%
500 =  2.5  ml 20%
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13
Q

High ICP - hypertonic FR (instead of manitol):

A

FR 3% 3 ml/kg IV

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14
Q

High ICP - dexametazon:

A

0.5 mg/kg IV 6-hourly

for oedema surrounding space-occupying lesion

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15
Q

Bcterial meningitis - classic signs:

A
  • neck rigidity
  • photophobia
  • headache and vomiting
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16
Q

Meningitis - therapy:

A

1) Cefotaxime 80 mg/kg

2) Dexamethason 0.15 mg/kg 6hourly (max 10mg)
- don’t use in younger than 3 months

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17
Q

Encephalitis - Herpes/Mycoplasma:

A

Macrolid. Erythromycin

  • Aciclovir
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18
Q

Intoxication - opiates:

A

Naloxon 10 ucg/kg IV (up to 2mg) - relapse in 20min

             10 - 20 ucg/kg/min  IV

CAVE: normalize CO2 before administration (arrythmias, seizure)

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19
Q

Cerebral malaria:

A
  1. Quinine 20mg/kg over 4hrs in Glc 5%

2. Cefotaxime 80 mg/kg IV

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20
Q

Generalized status epilepticus is defined:

A

generalised convulsion lasting at least 30 min

                      or

successive convulsions occurs so freq that patient doesn’t recover consciousness

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21
Q

Mortality of status epilepticus is:

A

~ 4%

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22
Q

Common causes of convulsions:

A
  • fever (5% of febrile seizures)
  • meningitis
  • epilepsy (1 - 5% of epileptic children)
  • hypoxia
  • metabolic abnormalities
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23
Q

Antiepiltic drugs - doses:

A
  • Diazepam 0.5 mg/kg RECTAL - effect less than 1hour
  • Midazolam 0.5 mg/kg BUCCAL
  • Lorazepam 0.1 mg/kg IV - effect 12 - 24hours
  • Phenytoin 20 mg/kg IV over 20 min - effect for 24 hours
  • Phenobarbiton 20 mg/kg IV over 5 min (if on phenytoin already)
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24
Q

When can we give phenytoin to child on it?

A

blood level < 5 ucg/ml

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25
Q

How to administer phenytoin?

A
  • in FR
  • max concentration is 10 mg/ml

CAVE: can cause hypotension and arythmias

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26
Q

Severe hypertension treatment - drugs:

A
  • Labetalol 250 - 500 ucg/kg
    infusion: 1 - 3 mg/kg/hour
  • Sodium nitroprusside 0.2 - 1 ucg/kg/min
  • Nifedipine 0.25 mg/kg IV bolus
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27
Q

Severe hypertension - goals:

A
  • to get to the 95th centile for age
  • go over 24 - 36 hours (1/3 in first 8hours)
  • monitoring of visual acuity is crucial (infarction of optic nerve)
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28
Q

Does normal fundi exclude acutely rised ICP ?

A

No

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29
Q

A generalized convulsion increase the cerebral metabolic rate:

A

at least three-fold

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30
Q

Hypertension - priciny:

A
  • dysplastic kidneys
  • reflux nefropathy
  • glomerulonephritis
  • coarctation of aorta
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31
Q

When can be the cervical collar removed ?

A
  • no neck pain
  • radiographs are normal
  • neurological exam is normal
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32
Q

Spinal imaging required if:

A
  • posterior midline spinal tenderness
  • focal neurological deficit or pain
  • reduced mental state
  • sedative drugs
  • painful distracting injury
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33
Q

What have to assesed before removing collar ?

A

rotation left/right for 45 degrees

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34
Q

When must be surgical team involved - in terms of fluids?

A

when 10 + 10 doesn’t stabilized the child

when 40 ml/kg doesn’t stabilized the child -> blood

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35
Q

Morphine - doses:

A

0.1 - 0.2 mg/kg IV
<1 rok 0.08 mg/kg

  • nabiha cca 10 min
  • u hypovolemie ci poruch vedomi 50% dose
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36
Q

Circulation re - assessment at trauma:

A
  • haemodynamics
  • haemoglobin
  • heamostasis
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37
Q

Children - trauma - what to write down:

A

HR BP RR spO2 every 5 mins

GCS pupil size and reactivity every 15min

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38
Q

Sucking chest wound is:

A

diameter in defect in chest wall is greater than 1/3 of diameter of trachey -> aie preferably enters to chest via defect

-> occlusive dressing taled on three sides

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39
Q

Flail chest - therapy:

A

intubation when children is compromised

  • can take 2 weeks before segment stabilises
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40
Q

Uncomplicated pulmonary contusion usually resolves within:

A

36 hours

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41
Q

How to recognize tracheal and bronchial rupture:

A
  • subcutaneous emphysema

- after instertion of chest drain -> vigorous air leak (air passes to drain)

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42
Q

Disruption of great vessels - where:

A

at the insertion of lig.arteriosum

 - close to the left subclavian artery

angiography is ideal

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43
Q

Ruptured diaphragm is more on which side?

A

left

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44
Q

Children’s abdomen - characteristics:

A
  • abdominal wall is thin
  • diaphragm is more horizontally -> liver, spleen more anteriorly
  • ribs are very elastic -> less protection
  • bladder intraabdominal when full
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45
Q

Where does the intestine usually rupture when road accident happens?

A
  • duodenum may develop large hematoma

- rupture at duodenojejunal flexure

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46
Q

How long does warm ischemia for kindey lasts?

A

45 - 60 min

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47
Q

When child should be catethrized?

A
  • when can’t pass urine spontaneously

- when accurate measurement is needed

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48
Q

Trauma v detskem veku - hlava:

A

27% smrtelnych urazu

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49
Q

Secondary brain injury damage:

A
  • ischemia
  • hypoxia
  • fever and infection
  • convulsions
  • hypo and hyperglycaemia
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50
Q

When does the cranium sutures close?

A

12 - 18 months

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51
Q

Indications for intubation of child:

A
  • GCS < 8
  • loss of protective laryngeal reflexes
  • PaO2 < 9kPa ( 6kPa
  • spontaneous hyperventilation causing PaCO2 < 3.5 kPa
  • respiratory irregularity
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52
Q

What is Battle’s sign?

A

bruising behind the ear over the mastiod process

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53
Q

Best grimace response to pain:

A
  • spontaneous normal facial activity. 5
  • only response to touch. 4
  • vigorous grimace to pain. 3
  • mild grimace to pain. 2
  • no response to pain. 1
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54
Q

Indications for head CT scan in ED:

A
  • loss of consciousness > 5min
  • amnesia > 5min
  • 3 and more epizodes of vomiting
  • age>1 year + GCS < 14
  • age< 15
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55
Q

Where do we aim with pCO2 when raising ICP:

A

4 - 4.5 kPa

check arterial (not ETCO2 - may significantly differ in shock)

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56
Q

How to suspect fitting when fully relaxed ?

A
  • sharp increase in BP, HR
               and
  • pupils dilatation
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57
Q

Neurological deterioration prompting urgent reappraisal:

A
  • developement of agitated or abnormal behaviour
  • > 30 min drop of 1 point in GCS
  • any drop of 2 points in GCS
  • severe/ increasing headache/vomiting
  • new neurological signs
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58
Q

Viability of amputated parts of child:

A
  • room temperature 8 hours
  • cooled 18 hours

cleaned, wrapped in a moist sterile towel in plastic bag (water, ice)

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59
Q

Blood loss of femoral fracture:

A

40% of circulating volume

open fracture = loss is twice

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60
Q

What to check on extremity trauma:

A
  • limb temperature
  • capillary refill
  • pulses
  • active range of motion
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61
Q

Signs of compartment syndrom:

A
  • pain especially when passively stretching
  • decreased sensation
  • swelling
  • pallor
  • paralysis
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62
Q

Which vertebrae are involved in children injury ?

A

C 1-3

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63
Q

Retropharyngeal swelling is :

A
  • indirect evidence of spinal trauma

- at C3 level the prevertebral distance should be 1/3 of width of C2 body

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64
Q

CT scan and GCS:

A

GCS < 13 -> head + whole spine

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65
Q

Which is most common injury to cervical spine ?

A

atlantoaxial rotary subluxation

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66
Q

Which is most common injury to thoracic/lumbar spine ?

A

hyperflexion -> wedged shaped vertebra compression

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67
Q

Indications of inhalational injury:

A
  • history of exposure to smoke in a closed space
  • deposits around the mouth and nose
  • carbonaceous sputum
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68
Q

When can’t be applied rule of 9 for children?

A

< 14 years

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69
Q

Burns classification:

A
  • superficial = just epidermis = red skin
  • partial-thickness = some damage to dermis = blister
  • full-thickness = whole dermis = white, no pain
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70
Q

Burns - fluid therapy:

A

additional fluid = percentage burn X weight X 4 (ml) for 24 hours

50% in first 8 hours

urine output should be > 2 ml/kg/hour

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71
Q

When can cold irrigation be used for burns?

A

total burns < 10%

max for 10 mins

burns superficial or partial thickness

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72
Q

Burns poisoning :

A

Carbon monoxide levels:
5 - 20% oxygen
> 20% hyperbaric oxygen chamber

Cyanide levels > 3 mg/ml => discuss with poison centre

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73
Q

Criteria for transfer to a burn unit:

A 
10% partial/full-thickness
5%   full-thickness
face hand feets perineum
any circumferential burn
inhalation burn
chemical, high-voltage and radiation
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74
Q

Where to measure core temperature?

A
  • rectal

- oesophageal

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75
Q

When is interval for resus drugs doubled?

A

core temperature 30 - 35

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76
Q

At what temperature may VF be refractory?

A

< 30 degrees

inotropes and antiarrhytmic should not be given

active core warming needed

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77
Q

Active core warming:

A
  • i.v. fluids 39 degrees
  • gastric, bladder, peritoneal lavage with 42 degrees
    peritoneal - potassium free dialyzate, 20ml/kg 15min cycle
  • warm ventilator 42 degrees

CAVE: 0.25 - 0.5 degree per hour

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78
Q

PEA should make you think of:

A

Tamponade

Tension PNO

Hypovolemia
(often associated with trauma, hypotermia and electrolytes ab)

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79
Q

Asystole should make you think of:

A

Hypoxia

Hypovolemia

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80
Q

VF/pVT should make you think of:

A

Hypotermia

Hyperkalemia

Toxic substances/underlying cardiac disease

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81
Q

Which is commonest arrest rythm in children?

A

Asystole

response of the heart to prolonged hypoxia and acidosis

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82
Q

Weight formulae:

A

6 year: m = (3 x age in years) + 7

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83
Q

Obligate nasal breather is:

A

infant < 6 months

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84
Q

Child’s circulating blood volume:

A

80 ml/kg

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85
Q

Respiratory rate by age at rest:

A

12 15 - 20

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86
Q

Stroke volume at birth:

A

1.5 ml/kg

CI 300 ml/kg/min

adult: 70-80 ml/kg/min

87
Q

Heart rate by age:

A

12 60-100

88
Q

Blood pressure equation:

A

50th centile = 85 + (2 x age in years)

5th centile = 65 + (2 x age in years)

89
Q

Maternal Ab provides protection for:

A

first 6 months

90
Q

Signs of life:

A
  • movement
  • coughing
  • normal breathing
91
Q

Feeling for circulation:

A

Infant - brachial pulse, femoral art.

Child - carotid artery, femoral art.

92
Q

Compression rate when resus:

A

100 - 120/min

93
Q

How long can you be in recovery position?

A

30 min

94
Q

Types of shock:

A
  • Cardiogenic: cardiomyopthy, arrhytmias, heart failure
  • Dissociative: anemia, carbon monixide poisoning
  • Distributive: anaphylaxis, sepsis
  • Hypovolemic
  • Obstructive: tension PNO, cardiac tamponade, flail chest, embolism
95
Q

Kdy je potreba natocit behem ABC ekg?

A
  • > 200/min infant

- >150/min dite

96
Q

Ventricular tachycardia - underlying cause:

A
  • heart disease, surgery
  • TCA intox.
  • procainamid, quinidine, macrolide atb
  • check K, Ca, Mg
97
Q

Terapie bradycardie:

A
  • O2, volume
  • adrenaline bolus
  • adrenaline infusion 0.05 ucg/kg/min
98
Q

Up to what age in needle - cricothyreoidectomy preffered?

A

up to 12 years

99
Q

Needle cricothyreoidectomy - initialnset up:

A

1) Y - connector
2) flow of O2 = children’s age in years
3) occlude with thumb for 1 sec -> if chest’s not elevating

4) increase flow by 1 litre and time by 1 sec

100
Q

Where to drill IO:

A

Tibial - 2-3cm below tibial tuberosity

Femoral - 3cm anterolateral above lateral condyle

101
Q

If infusion ti IO access is painfull:

A

bolus of Lidocaine 2% 0.5 ml/kg slowly

102
Q

Paddle selection for defib:

A

Infants 4.5 cm

Children 8cm

Adult 13cm

103
Q

The standart adult shock is used for children:

A

above 8 years

104
Q

Thoracocentesis - risk of PNO:

A

10 - 20%

check x-rays after procedure

105
Q

Dreny do hrudniku:

A
    1. mezizebri medioklvikularne

- 5. mezizebri medioaxilarne

106
Q

FAST is checking:

A
  • perihepatic space
  • perisplenic space
  • bladder / pelvis
107
Q

Peritonal lavage - setup:

A

Insert NGT, bladder catether

1/3 way from umbilicus to pubis midline

insert dialysis catether

108
Q

ABC of x-ray:

A
  • Adequacy, Alignment
  • Bones
  • Cartilage and soft tissues
  • Disc spaces / Diaphragm
109
Q

What is SCIWORA:

A

Spinal cord injury without radiographic abnormality

110
Q

Lateral cervical spine x-rays - lines:

A
  • anterior vertebral line
  • posterior vertebral line
  • facet line
  • spinolaminar line = posterior wall of spinal canal
111
Q

C 1/2 gap should be:

A

< 3mm

112
Q

When on flexion:

A

C1/2 gap > C2/3 gap

113
Q

Acceptable soft tissue thicknesses on x-rays:

A
  • above larynx: less than 1/3 of the vertebral body width
  • below larynx: not more than one vertebral body width
  • C7 < C5
114
Q

Ideal position of ETT:

A
  • below the clavicles

- 1cm above the carina

115
Q

X - rays cardiac border:

A
  • 1/3 to the right of midline

- 2/3 to the left of midline

116
Q

Thymus can stimulate upper mediastinal mass up to:

A

18 month

117
Q

Furosemid - dose:

A

1 mg/kg

118
Q

Dopamine - dose:

Dobutamin - dose:

A

5 - 20 ug/kg/min

119
Q

Adrenaline - dose:

A

0.05 - 2 ug/kg/min

120
Q

Up to what age in needle - cricothyreoidectomy preffered?

A

up to 12 years

121
Q

Needle cricothyreoidectomy - initialnset up:

A

1) Y - connector
2) flow of O2 = children’s age in years
3) occlude with thumb for 1 sec -> if chest’s not elevating

4) increase flow by 1 litre and time by 1 sec

122
Q

Where to drill IO:

A

Tibial - 2-3cm below tibial tuberosity

Femoral - 3cm anterolateral above lateral condyle

123
Q

If infusion ti IO access is painfull:

A

bolus of Lidocaine 2% 0.5 ml/kg slowly

124
Q

Paddle selection for defib:

A

Infants 4.5 cm

Children 8cm

Adult 13cm

125
Q

The standart adult shock is used for children:

A

above 8 years

126
Q

Thoracocentesis - risk of PNO:

A

10 - 20%

check x-rays after procedure

127
Q

Dreny do hrudniku:

A
    1. mezizebri medioklvikularne

- 5. mezizebri medioaxilarne

128
Q

FAST is checking:

A
  • perihepatic space
  • perisplenic space
  • bladder / pelvis
129
Q

Peritonal lavage - setup:

A

Insert NGT, bladder catether

1/3 way from umbilicus to pubis midline

insert dialysis catether

130
Q

Up to what age in needle - cricothyreoidectomy preffered?

A

up to 12 years

131
Q

Needle cricothyreoidectomy - initialnset up:

A

1) Y - connector
2) flow of O2 = children’s age in years
3) occlude with thumb for 1 sec -> if chest’s not elevating

4) increase flow by 1 litre and time by 1 sec

132
Q

Where to drill IO:

A

Tibial - 2-3cm below tibial tuberosity

Femoral - 3cm anterolateral above lateral condyle

133
Q

If infusion ti IO access is painfull:

A

bolus of Lidocaine 2% 0.5 ml/kg slowly

134
Q

Paddle selection for defib:

A

Infants 4.5 cm

Children 8cm

Adult 13cm

135
Q

The standart adult shock is used for children:

A

above 8 years

136
Q

Thoracocentesis - risk of PNO:

A

10 - 20%

check x-rays after procedure

137
Q

Dreny do hrudniku:

A
    1. mezizebri medioklvikularne

- 5. mezizebri medioaxilarne

138
Q

FAST is checking:

A
  • perihepatic space
  • perisplenic space
  • bladder / pelvis
139
Q

Peritonal lavage - setup:

A

Insert NGT, bladder catether

1/3 way from umbilicus to pubis midline

insert dialysis catether

140
Q

Cuffed tubes’re to be used only at what age:

A

not for neonates

141
Q

Neonates require a tube:

A

3 - 3.5

142
Q

Preterm require a tube:

A

2 - 2.5

143
Q

Tracheal suction catether in gauge:

A

= twice the internal diameter of tube

tube 3 -> suction catether gauge 6

144
Q

Cricothyreoidectomy cannuale:

A

Adult 12G

Child 14G

Baby 18G

145
Q

If hyperkalemia during resus:

A

Calcium gluconate 10% 0.3 ml/kg

146
Q

When do you use Calcium gluconate:

A
  • dose: 0.3 ml/kg i.v.
  • hyperkalemia
  • hypermagnesemia
  • hypocalcemia
  • intox: Ca-blockers
147
Q

Sodium bicarbonate can be used:

A
  • dose: Sodium bicarbonate 8.4% 1ml/kg
  • acidosis, hyperkalemia, intox.TCA

CAVE: precipitation with Calcium, inactivates A Dopamin
no traceal route

148
Q

U VF resuscitace jde Adrenalin a Amiodaron:

A

Adrenalin - po 3 shocku a 4min (tedy a 2 cykly)

Amiodaron - po 3 a 5 shocku

149
Q

Magnesium - resus:

A
  • polymorphic VT (torsades des pointes)
  • hypomagnesemia
  • dose: 25 - 50 mg/kg (max 2g)
150
Q

Amiodarone - resus:

A
  • 5 mg/kg
  • ne u otravy TCA
  • lze podat po 2 davkach kont: 300ucg/kg/hod
    (max 1.5 mg/kg/hod) (max 1.2 g/24 hod)
151
Q

Whitch levels of ETCO2 should prompt attention to chest com ad:

A

2 kPa

152
Q

When to stop resus:

A

no ROSC at any time up to 20 min during ALS

  in the absence of reccuring or refractory VF/VT

exception: poisoning, primary hypotermic insult

153
Q

When can be decreased evidence of brathing effort:

A
  • exhaustion
  • decreased drive (cerebral depression)
  • neuromuscular disease
154
Q

At what spO2 we can see cyanosis?

A

~ 70%

155
Q

The target BP in sepsis:

A

= 90 + (age in years x 2)

156
Q

Comparison AVPU vs GCS:

A

PU ~ GCS<8

157
Q

Adrenalin for INH:

A

400 ucg/kg

0.4 ml/kg INH 1:1 000

158
Q

Diuresis should be:

A

Infant 2ml/kg

Child 1ml/kg

159
Q

Zvyseni teploty o 1 stupen zvysi naroky na metabolismus o:

A

10 - 13%

160
Q

Je vhode deti po dosazeno ROSC chladit ?

A
  • neprokazalo se u deti

- ale vyhnout se teplote

161
Q

Chest drain - transport:

A
  • unclamped

- valve system (no underwater seal)

162
Q

Hendersson - Hasselbach equation:

A

pH = pKa + log (HCO3-)/0.03xpCO2

HCO3- is calculated

163
Q

Normal HCO3- :

A

24 +- 2 mmol/l

18 - 20 mmol/l (young adults)

164
Q

MAC - priciny:

A
  • nadprodukce: laktat, ketoacidoza, acidurie, acidoptie
  • retence: ARF, distal RTA
  • ztraty bikarbonatu: proximal RTA, Fanconi sy
  • nadbytek chloridu
  • intox. salicylaty
165
Q

Jake je riziko pri korekci acidozy:

A
  • rozvoj hypokalemie

- rozvoj hypokalcemie

166
Q

MAL - priciny:

A
  • severe vomiting (loss of gastric acid, hypovolemie -> bicarbonate retention)
  • important to exclude gastric outlet obstruction
  • overload with furosemide
167
Q

Losses of fluid per day:

A
  • insensible losses (sweat, respiration): 10 - 30 ml/kg/day
  • stool: 0 - 10 ml/kg/day
  • urine: 30 ml/kg/day
168
Q

When a shock can occur in terms of fluid:

A
  • loss of 20 ml/kg from intravascular space
  • dehydratation is evident after loss:
    25 ml/kg from total losses
    pozn: if dehydratated and no shock present => loss of 5% TBV
169
Q

Terapie dehydratace:

A

= fluid maintenance + fluid replacement for 24 hours
- check every 4 hours (scales)

170
Q

Is it possible to treat nephrotic sy with furosemide ?

A

No in the begining they have contracted intravascular space

=> first albumin, then diuretics

171
Q

Clinical signs of intravascular fluid overload:

A
  • raised jugular venou pressure
  • enlarged liver
  • cardiac gallop
  • hypertension (particulary in patients with renal problem)
  • pulmonary signs (creapitations in the bases of lungs)
172
Q

How fast can you lower Na?

A

no more than 0.5 mmol/hod

max 8 mmol/day

173
Q

Na - day consumption:

A

first 10kg: 2 - 4 mmol/kg/day
sec 10kg: 1 - 2 mmol/kg/day
subsequent 0.5 - 1

174
Q

K - day consumption:

A

first 10 kg: 1.5 - 2.5 mmol/kg/day

sec. 10kg: 0.7 - 1.5
subsequent: 0.2 - 0.7

175
Q

If hyponatremia and seizures - Na treatment:

A

3% NaCl 4ml/kg for 15min

-> will rise Na by approximatel 3mmol and stop fitting

176
Q

When is likely to have arrythmias concerning K levels?

A

> 7.5 mmol/l

177
Q

Salbutamol a hyperkalemie:

A

age:
< 2.5 2.5 mg
< 7.5 5 mg
> 7.5 10 mg

  • snizi K o cca 1 mmol/l
178
Q

Hyperkalemie - terapie:

A
  1. If arrhytmia present: Ca gluconate 10% IV 0.5ml/kg
  2. If not => Salbutamol INH, then check
  3. If falling => Ca resonium PO/PR 1g/kg
    If not => pH NaHCO3 1-2 ml/kg
    pH > 7.34 => Glc 10% 5ml/kg + Insulin 0.05 U/kg/hod IV
179
Q

DKA - treatment:

A
  • fluids 10ml/kg aliquotes
  • rehydratation for 48hours
  • insulin 1 hour after fluids start 0.05 U/kg/hour
  • risk of cerebral oedema => treat with mannitol
180
Q

Ametop gel

A
  • analgesia after 35 - 40 min

- remains 4 - 6 hours

181
Q

EMLA - gel

A
  • start after 60 min

- tends cause vasoconstriction

182
Q

Lidocaine:

A
  • start within 2mins
  • work 2 hours
  • max 3 mg/kg
  • with adrenalin 7 mg/kg
183
Q

Bupivacain

A
  • start 15 min
  • works 8 hours
  • max 2 mg/kg
184
Q

Fentanyl - intranasal:

A

1.5 ucg/kg

185
Q

Diamorphin intranasal:

A

0.1 mg/kg

186
Q

Codeine

A

dose: 1 - 1.5 mg/kg
effect: 4 - 6hod

187
Q

Paracetamol

A

loading dose: 20 mg/kg (PR 40 mg/kg) á 6hod
max: 90 mg/kg

<3 month: 20/30 (max 60)

188
Q

Diclofenac

A

0.3 - 1 mg/kg PO á 8hod

ne pod 6 mesicu

189
Q

Croup - treatment:

A
  • harsh stridor, barking cough
  • Parainfluenza, RS, Adenovirus
  • Adrenalin INH 0.4 ml/kg
  • Dexamethason 0.15 mg/kg IV / Budesonid 2mg INH
190
Q

Bacterial tracheitis - treatment:

A

= pseudomembranaceous croup
- Stafylokok, Streptokok, Hemophilus => purulent secretions

  • ATB Cefotaxime + Flucloxacilin
191
Q

Epiglottitis - therapy:

A
  • > 1 year, high fever, cough minimal, onset 3-6 hours

- intubation + Cefotaxime

192
Q

Wheeze - basic dif.:

A
  • Asthma > 1 year

- Bronchiolotis < 1 year

193
Q

Acute severe asthma:

A

Too breathless to feed or talk

RR: >50/min (2-5 yrs) >30 (>5yrs)

HR: >120/min (2-5 yrs) >130 (>5yrs)

194
Q

Asthma - emergency:

A
  • O2 (flow 6-8 l/min) -> spO2 94-98%
  • Salbutamol 5mg (2.5 < 5yrs) INH
    Ipratropium 250ucg (125 <2yrs) INH
  • Prednisolon 1mg/kg PO / HCT 4 mg/kg
195
Q

Non- responding astma:

A
  • Salbutamol IV 15ucg/kg (5ucg<2yrs) for 10min
    dale: 1-5ucg/kg/min
  • Magnesium 40mg/kg for 20min
  • Aminophylline 5mg/kg for 20min
    dale: 1mg/kg/hod
196
Q

Bronchiolitis - management:

A
  • O2, fluids
  • Adrenalin INH (uncler)
  • Ribavirin or Palivizumab INH (uncler)

agens: RS
salbutamol, steroids, ATB of no proven value

197
Q

Duct-dependent congenital heart disease - signs:

A
  • baby < 4 weeks
  • cyanosis unresponsive to O2
  • signs of heart failure
  • absent femoral pulses
198
Q

Duct-dependent congenital heart disease - treatment:

A
  • O2 (CAVE: little benefit, may accelerate duct closure)
  • low threshold for intubation
  • Prostin IV 5 nanograms/kg/min (can be up to 20)
    - > can cause vasodilatation a drop in BP
199
Q

Meningokokova sepse - cardinal signs:

A
  • purpuric rash
    - > 15% erythematous rash is first
    - > 7% no rash
200
Q

Threshold for blood:

A

Hb 50 g/l

  • if urine is dark-brown => hemolysis suspected
  • usually sepsis with sickle-cell disease
201
Q

Atropin u bradycardie:

A
  • 20 ug/kg á 5min (min 100 - max 600)

up to the dose: 1mg (child), 2mg (adolescent)

  • trachealne: 40 ug/kg
202
Q

How to distinguish between SVT and sinus tachycardia:

A
  • SVT > 220, sin.tachycardia <
  • sin.tachycadia => vary beat-to-beat and is responsive to stimulation
  • termination of SVT is abrupt
  • P-waves: - SVT -> neg.in II,III, aVF
    - ST -> pos.in I, aVF
203
Q

SVT - treatment:

A
  1. vagal manoeuvre (masaz, diving reflex, valsalva)
  2. consider shock if unstable - synchronous 1J/kg -> 2J/kg
    Adenosin 100mcg/kg - 2 min - 200mcg/kg - 2min - 300mcg/kg
    - up to 500 (<1 month 300), max: 12mg
  3. Amiodarone 5mg/kg for 20min (30 for neonates)
204
Q

Normal drop of pO2 between inspired and alveolar oxygen is:

A

7.5 kPa

205
Q

Volume of cylinders:

A

D 340 l
E 680 l
F 1360 l

206
Q

Anion gap is higher:

A

> 18

  • etanol, metanol
  • etylenglykol
  • salicylaty, zelezo
207
Q

Activated charcoal:

A
  • not for: iron, alcohol

- dose: 25 - 50 g (at least 10 times estimated dose)

208
Q

Poison - Iron:

A
  • if over 20 mg/kg -> toxicity likely (>150 is fatal)
    => shock usually due to gastric hemorrhage, vomiting, diarhea

=> gastric lavage, no charcoal, Desferioxamin 15mg/kg/hod

209
Q

Poisoning - TCA:

A
  • intraventricular conduction delay => QRS widening
  • tachycardia, mydriasis, convulsion

=> pH ~ 7.5 (bicarbonates), hyperventilation
Lidocaine, Phenytoin may help

210
Q

Paracetamol - poisoning:

A
  • unlikely < 150mg/kg
  • charcoal
  • Acetylcystein
211
Q

Poisoning - Salicylates:

A
  • slow stomach emptying - lavage up to 4 hours
  • charcoal
  • measure at 2 hours
  • alkalinization of patient
212
Q

Poisoning - Ethyleneglycol:

A
  • etanol 2.5 ml/kg 40% -> goal 100mg/dl
213
Q

Cocaine - poisoning:

A
  • benzodiazin (Diazepam, Lorazepam)
  • aspirin
  • heparin
  • NaHCO3
  • Betablokry jsou kontraindikovany -> use shocks
214
Q

Poisoning - ectasy:

A
  • charcoal
  • ,diazepam
  • if >39 => dantrolen 2-3 mg/kg for 15 min

Medicine (9 decks)

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