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CPS acute care Flashcards

1
Q

GCS eyes

A

Eyes:

  1. no response
  2. to pain
  3. to verbal stimuli
  4. spontanous
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2
Q

GCS verbal

A
  1. no response
  2. nonspecific sounds
  3. inappropriate
  4. confused
  5. oriented
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3
Q

GCS motor

A
  1. no response
  2. decerebrate extension
  3. decorticate flexion
  4. withdraws to pain
  5. localizes pain
  6. follows commands
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4
Q

Indication skull x-rays in head injury (3)

A
  • children < 2 yrs: with large, boggy hematoma
  • obvious penetrating lesion or dpsressed skull fracture
  • suspicion child abuse
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5
Q

Indication for CT scan in head injury

- Relative Indications (8)

A

Relative:

  • GCS <14 at any point or GCS <15 at 2hr after injury
  • clinical deterioration e.g. worsening HA or vomiting
  • signs of basal skull
  • large boggy hematoma >2yrs
  • high risk mechanism
  • persistent irritability in child<2 yrs
  • seizures at time of event or later
  • known coag disorder
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6
Q

Indication for CT scan in head injury

- absolute indications

A

Absolute indications:

  • focal neuro deficit
  • suspected open or depressed skull fracture or a widened or diastatic skill fracture on X-ray
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7
Q

RFs for post-traumatic seizures (5)

A
  • younger age
  • severe head trauma
  • cerebral edema
  • subdural hematoma
  • open or depressed skull #
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8
Q

Risk factors for ICU admission in asthma (4)

A
  • previous life-threatening events
  • admissions to ICU
  • intubation
  • deterioration while on systemic steroids
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9
Q

Oxygen goal sats in Asthma

A
  • target 94% as per CPS
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10
Q

Acute management of anaphylaxis

A
  1. ABCs - oxygen if needed
  2. immediate admin of IM epi
  3. IV access with large-bore
    - if hypotensive then 20mL/kg of NS
    - if sever resp distress prep for definitive airway management
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11
Q

Epinephrine dose in anaphylaxis

A
  • 0.01mg/kg to max of 0.5mg

= epineprhine 1:1000 IM to anterolateral thigh

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12
Q

Epinephrine dosing IV infusion

A

epi 0.1-1 ug/kg/min (max 10ug/min)

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13
Q

Diagnosis of asthma in preschoolers requires

A
  1. objective documentation of signs of airflow obstruction
  2. reversiility of airflow obstruction
  3. absence of alternative diagnosis
    - diagnosis apply to children with 2+ exacerbations
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14
Q

When to refer a preschooler to a specialist for asthma (6)

A

Severity:
- life-threatening exacerbation,
- 2+ exacerbation requiring steroids/hospitalizations
- or frequent sx (>8 days per month) despite moderate daily doses of ICS
Associated sx:
- diagnostic uncertainty,
- need for allergy testing
Other: parental anxiety or need for more education

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15
Q

guidelines for admission in bronchiolitis (6)

A
  • resp distress e.g. RR>70/min
  • supplemental O2 required to keep sats >90%
  • dehydration or hx of poor fluid intake
  • cyanosis or hx of apnea
  • infant at high risk for severe disease
  • family unable to cope
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16
Q

groups at high risk for severe disease bronchiolitis

A
  • infants born <35 weeks
  • <3 months at presentation
  • hemodynamically significant cardiopulmonary disease
  • immunodeficiency
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17
Q

Recommended tx for bronchiolitis
Equivocal tx
Not recommended tx

A
  • Recommended: oxygen, hydration
  • Evidence equivocal: epi neb, nasal suctioning, combined epi+dex
    Not recommended: salbutamol, steroids, abx, antivirals, cool mist therapy/saline aerosol, hypertonic saline nebs, chest PT
18
Q

Covid-19 acute clinical severity

  • mild
  • moderate
  • severe
  • critical
A

Mild: asymptomatic or URTI < 7 days, no oxygen, normal X-rays, no evidence of sepsis
Moderate: more sx than a URTI, increased WOB,PNA on CXR no hypoxemia, no sepsis,
Severe: features of resp distress or organ dysfunction, tachypnea, hypoxemia, CNS effects, GI effects, coag dysfunction
Critical: rapid disease PLUS resp failure, septic shock, organ failure

19
Q

Blood work for unwell pts with covid who require hospitalization

A

Blood: CBC, blood culture, electorlytes (+ extended lytes), glucose, renal function, liver enzymes, bili, LDH, troponin, coag screen, blood gas, lactate, inflamm markers e.g. cRP, procalcitonin, ferritin
Other: 12-lead ECG, CXR

20
Q

Treatment for covid

A
  • supportive care: oxygen, Iv hydration, anti-pyritics
    severe disease: aditional pressure and ventilatory support
  • abx only if suspect bacterial co-infection
    Not supported by evidence: antivirals, corticosteroid IVIG, ACEi and ARBs, IL-6 receptor antagonists
21
Q

Pediatric populations high risk for covid

A
  • infants
  • children with heart or lung disease
  • neuro or neuromuscular condition
  • other chronic conditions: diabetes, sickle cell, malignancies, immunosuppressive conditions, home ventilation
22
Q

Croup epidemiology

A
  • 6 mo to 3 years of age

- sx last 3-7 days, peaks in fall and winter

23
Q

Croup DDX

A
  • bacterial tracheitis
  • retropharyngeal, parapharyngeal, peritonsillar abscess
  • epiglottis
  • foreign body aspiration
  • anaphylaxis
24
Q

Ondansetron in gastro

A

consider for:

  • infants 6+ months
  • vomiting due to suspected acute gastro
  • mild/mod dehydration
  • OR who have failed ORT
25
Q

Most common side effect of ondansetron in gastro

A
  • diarrhea (self-limited and lasts <48hrs)

- risk of arrhythmia

26
Q

ITP red flags on history (4)

A
  • constitutional sx
  • bone pain
  • recurrent thrombocytopenia
  • poor treatment response
27
Q

ITP red flags on physical exam

A
  • lymphadenopathy
  • hepatomegaly
  • splenomegaly
  • signs of chronic disease
28
Q

ITP red flags on investigations

A
  • low hemoglobin (unless mildly low due to bleeding
  • high MCV
  • abN WBC and/or neutrophil count
  • abN cell morphology on smear
29
Q

ITP relapse rate

A
  • 1/3
30
Q

Advanced airway in place

- compression-ventilation ratio

A
  • compressions: 100-120 pm

- resps 8-10/min

31
Q

3 Ps to minimize pain

A
  1. physical
  2. psychological
  3. pharmacological
32
Q

which is more painful heel lances or venicpuncture

A

heel lances

33
Q

Sepsis vs. septic shock

A

Sepsis = life-threatening organ dysfunction caused by a dysregulated host response to infection
Septic shock = severe infection leading to CV dysfunction (e.g. hypotension, need for treatment with a vasoactive medication or impaired perfusion)

34
Q

Sepsis shock and lab findings of adrenal insufficiency and management

A
  • relative hyponatremia, hyperkalemia and hypoglycemia

- give hydrocortisone 50-100mg/m2 early in course, before septic shock develops

35
Q

in status treat blood sugar is <=

A
  1. 6

- tx with 2-4mL/kg of 25% dextrose of 5mL/kg of 10% dextrose water

36
Q

side effects of

  • phenytoin/fosphenytoin
  • phenobarb
A

Pheny: cardiac arrhythmias, bradycardia, hypotension

Phenobarb: sedation, resp depression, hypotension

37
Q

Indications for pyridioxine in seizures

A
  • children < 18 months with seizures caused by undiagnosed metabolic disorder
38
Q

indications for CT in status epilepticus (5)

A
  • hx of trauma
  • increased ICP
  • focal neuro signs
  • unexplained LOC
  • suspicion of herniation
39
Q

How does HHHFNC work?

A
  • supplemental gas flow rates wash out anatomic dead space
  • humidification and heating allows gas at flow rates that are better tolerated
  • provides some degree of positive pressure
40
Q

Starting HHHFNC

A
  • start flow at 1-2L/kg/min
  • escalate for WOB
    max = 2L/kg/min with UL being 50-60 for adult-size pts
    O2 concentration start at 50% and go up and down to achieve target
  • if flow too high may breath stack or auto-PEEP
41
Q

Contraindications to HHFNC

A
  • nasal obstruction
  • epistaxis
  • severe upper airway obstruction
    rare, serious SE: air-leak syndrome, abdominal distention

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