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Royal Super 4th Year Brain > Critical Care > Flashcards

Critical Care Flashcards

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The Brain flashcards Royal College: Emergency Medicine flashcards
1
Q

Epistaxis - complications of cautery

A
  • Septal perforation
  • Staining of silver nitrate
  • Secondary bacterial infection
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2
Q

Epistaxis - complications of packing (try for x8)

A
  • Pressure necrosis
  • Pain, discomfort
  • Airway compromise
  • Neurogenic syncope
  • Septal hematoma, ulceration, perforation
  • Synechiae/adhesion formation
  • Rhino-sinusitis infection
  • TSS
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3
Q

Indications to transfuse platelets?

A
  • <100 for CNS bleed or CNS surgery
  • <50 if actively bleeding or undergoing major surgery or unstable NAIT
  • <10 for prophylactic treatment
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4
Q

Indications for pRBC transfusion?

A
  • Acute blood loss of >15% of total blood volume
  • Hb <70 with symptoms of anemia
  • Significant pre-operative anemia without other corrective options available
  • Hb <130 on ECLS
  • Chronic transfusion program for disorders of RBC production
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5
Q

Decision to CT for head injury - rules to use and absolute/relative indications.

A

Rules: PECARN, CATCH
Absolute: focal neuro deficit, suspected or diagnosed open/depressed fracture
Relative: GCS <14 initially (or GCS <15 at 2h post), clinical worsening 4-6h, boggy/large hematoma, basal skull fracture signs, mechanism, seizures, persistent irritability, known coagulopathy

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6
Q

Pharmacological management of status epilepticus (include doses)

A

First line: midaz IN/IM (0.2 mg/kg), lorazepam IV (0.1 mg/kg)
Second line: keppra 60 mg/kg, fospheny/pheny 20 mg/kg, phenobarb 20 mg/kg (for <6 months)

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7
Q

Cardiac manifestations of TCA toxicity, including mechanism

A

Due to ability to block fast Na channels

  • sinus tachycardia
  • widening of QRS complex
  • PVCs
  • ventricular dysrhythmias
  • hypotension
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8
Q

Rx for widened QRS secondary to TCA toxicity?

A

Na bicarb

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9
Q

Med to give in refractory VF (including dose)

A

Amiodarone 5 mg/kg

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10
Q

How to check tetany in hypocalcemia?

A

Chvostek - tapping face

Trousseau - BP cuff

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11
Q

VT with pulse - what to do with hemodynamic compromise?

A

Synchronized cardio version

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12
Q

Epi dosing for anaphylaxis and cardiac arrest

A

Anaphylaxis: 0.01 ml/kg of 1 mg/ml
Cardiac: 0.1 ml/kg of 0.1 mg/ml

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13
Q

Parkland formula

What fluid to give?

A

4ml x kg x %BSA = first 24 hours
Divide by 1/2 for the first 8 hours
Add maintenance if patient <30kg
Ringer’s lactate

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14
Q

What bacterial pneumonia is associated with RSV?

A

Pneumococcal pneumonia

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15
Q

Jimson weed - purple flower

A

Anti-cholinergic

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16
Q

Antidote for benzo overdose

A

Flumazenil

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17
Q

Iron toxic ingestion - medication, next step

Give activated charcoal?

A

Deferoxamine

Whole bowel irrigation

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18
Q

ETT x2 equations

A

Uncuffed: age/4 +4
Cuffed: age/4 + 3.5

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19
Q

Min SpO2 for bronchiolitis

A

90

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20
Q

How do you differentiate serontonin syndrome vs neuroleptic malignant syndrome?

A

Rigidity in NMS

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21
Q

Sympathemetic vs anti-cholinergic

A

AC - pupils slow to react, dry, bowel sounds decreased

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22
Q

Anticholinergic - toxins

A

Anti-histamines, atypical antipsychotics, Jimson weed, TCAs

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23
Q

What size of needle to use for pneumothorax?

A

18 gauge angiocath

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24
Q

What RSI medication is contraindicated for burn patients?

A

Succinylcholine

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25
Q

Signs of inhalation injury

A

Burns involving face/neck, singeing of eyebrows/nasal hairs, hoarseness/stridor, sings of parenchymal involvement

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26
Q

First management for CO poisoning

A

Initiate 100% FiO2 through NRM

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27
Q

Signs on examination of when to consider intubation for upper airway obstruction?

A
  • Muffled/hot potato voice
  • Inability to control secretions
  • Stridor
  • Dyspnea
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28
Q

Dx for patient with upper airway obstruction + trismus

A

Peritonsilar abscess

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29
Q

Steeple sign

A

Croup

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30
Q

Thumb printing

A

Epiglottitis

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31
Q

Brassy cough

A

Bacterial tracheitis

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32
Q

Minimal oxygen supplementation for age (L/min)

A

<1 yr = 2 L/min
1-5 yr = 4 L/min
5-10 yr = 6 L/min
>10 yr = 8 L/min

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33
Q

Most respiratory cause of ARDS and most common non-respiratory cause of ARDS

A 
Resp = PNA
Non-resp = sepsis
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34
Q

Why is intubation avoided in asthma patients - x2 pathophysiology reasons?

A

Hemodynamic instability

FB in airway can cause further bronchospasm

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35
Q

What is the normal range for SVO2?

A

70-75%

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36
Q

x3 signs of uncompensated shock

A
  • Hypotension
  • Altered LOC
  • Oliguria
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37
Q

Better to push bolus through central or peripheral line

A

Peripheral

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38
Q

SIRS criteria

A

Require 2 of the following - with one being temperature or WBC:

  • Temperature instability
  • Tachycardia/bradycardia
  • Tachypnea
  • Leukopenia/leukocytosis
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39
Q

Sepsis = definition

A

SIRS + suspected/confirmed infection

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40
Q

What dosing range will you have more beta effect vs alpha effect for epi?

A

Beta - low dose

Alpha - high dose

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41
Q

What is the one VS derangement do we want to avoid the most with TBI patients?

A

Hypotension

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42
Q

What should our ICP be below in setting of TBI?

A

<20 cm H20

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43
Q

CPP targets for age to maintain ICP thresholds

A 
Infants/toddlers = >40
Children = >50
Adolescents = >60
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44
Q

Steps (x3) to address increased ICP

A
  • Hyperosmolar therapy
  • Analgesia + sedation
  • Neuromuscular blockade
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45
Q

What could you give in rhabdo with anuria?

A

Mannitol infusion

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46
Q

Difference between costochondritis vs Tietze Syndrome

A

Costo = multiple costochondral + costosternal junctions, no swelling typically. Tietze = more localized form with discrete area of swelling

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47
Q

Airway differences between children and adults

A
  • Large occiput
  • Large tongue
  • Floppy epiglottis
  • Anterior/cephalad larynx
  • Narrow subglottic airway
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48
Q

Fasting guidelines

A
  • Clear fluids 1 hour
  • Human milk 4 hours
  • Formula, light meal, non-human milk 6 hours
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49
Q

ASA - basic ideas for anesthesia

A
  • ASA I = healthy
  • ASA II = mild systemic disease
  • ASA III = severe systemic disease
  • ASA IV = constant threat to life
  • ASA V = not expected to survive 24 hours
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50
Q

Emergency equipment to have at bedside for procedural sedation

A

SOAPME:

  • Suction
  • Oxygen
  • Airway equipment
  • Positive pressure system (BVM)
  • Monitors
  • Emergency cart
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51
Q

PECARN absolute rules for CT

A

<2 years = GCS<15, AMS, palpable skull fracture

>2 years = GCS<15, AMS, signs of basilar skull facture

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52
Q

PECARN intermediate factors for CT

A

<2 years = emesis, LOC >5s, irritable, severe mechanism of injury
>2 years = emesis, LOC >5s, worsening HA, severe mechanism

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53
Q

Causes of elevated AG metabolic acidosis

A

MUDPILES:

  • Methanol
  • Uremia
  • DKA
  • Paraldehyde
  • IEM, iron
  • Lactic acidosis
  • Ethanol, ethylene glycol
  • Salicylate
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54
Q

2 main categories + causes for primary metabolic alkalosis

A
  • Saline responsive: pyloric stenosis, GI loss (emesis), laxative/diuretic use, CF, Cl deficient infant formula
  • Saline resistant: hyper-reninemic HTN, CC’s, K deficiency, genetic block of steroid synthesis (17-OH def), renal dysfunction (Bartter, Gitelman, Liddle syndrome(
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55
Q

x4 side effects of ventolin

A
  • Tachycardia
  • Hyperglycemia
  • Hypokalemia
  • Lactic acidosis
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56
Q

x2 side effects of MgSO4 in asthma exacerbation

A
  • Hypotension

- Bradycardia

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57
Q

Equation to calculate size of ETT for cuffed + uncuffed

A
  • Uncuffed: age/4 + 4

- Cuffed: minus 0.5

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58
Q

MOA of ketamine

A
  • NMDA receptor antagonist
  • Dissociative analgesia, sedation + amnesia
  • Bronchodilator
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59
Q

SE and contraindication for ketamine

A
  • SE: hypotension, increased secretions, hallucinations

- Contraindication: hx of anaphylaxis, cardiac sensitivity to catecholamine surge (myocarditis)

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60
Q

Is PUD a common cause of abdominal pain for CF?

A

No

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61
Q

Clinical presentation of cholinergic toxidrome

A

=DDUMBELLS!

  • Diaphoresis
  • Diarrhea
  • Urination
  • Miosis
  • Bronchorrhea
  • Emesis
  • Lacrimination
  • Lethargy
  • Salivation
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62
Q

x3 categories/examples of cholinergic toxins

A
  • Organophosphates: insecticides
  • Carbamates: neostigmine, pyridostigmine, pesticides
  • Alzheimer’s medications
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63
Q

Difference in MOA between (a) organophosphates and (b) carbamates?

A

Both bind/inhibit acetylcholine esterase

(a) irreversibly
(b) transiently

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64
Q

Management of cholinergic intoxication

A

Supportive:

  • Supplemental O2
  • ETT if needed (avoid succhinycholine)
  • IVF
  • Benzos (for agitation/seizures)

Decontamination:

  • Remove all clothes
  • Irrigate skin
  • Wear PPE

Treatment:

  • Atropine 0.05 mg/kg IV/IM/IO bolus q5min until secretions improved
  • Pralidoxime (pries pesticide off anticholinergic receptors)
  • Inhaled atrovent
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65
Q

Clinical presentation for anti-cholinergic toxidrome

A

=Opposite DDUMBELLS

  • Hyperthermia, flushed
  • Decreased bowel sounds
  • Dry skin + mouth
  • Decreased urination
  • Mydriasis
  • Confused
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66
Q

If you are seeing an anti-cholinergic toxidrome, what is the most important Ix to consider?

A

ECG - to see if widening QRS as a clue for TCA overdose

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67
Q

Examples of toxins that would present with anti-cholinergic toxidrome

A
  • Atropine, cyclopentolate
  • Scopolamine, glycopurrolate
  • Antihistamines
  • Jimson weed
  • Neuroleptics (olanzapine)
  • TCA
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68
Q

Management of anti-cholinergic toxidrome

A

Supportive:

  • IVF
  • Cool down with H20/fans
  • Benzos for agitation

Decontamination:
-Activated charcoal

Treatment:

  • Physostigmine = reversible acetylcholinesterase inhibitor (do NOT give if TCA)
  • Sodium bicarb = if TCA
69
Q

x2 differences between anti-cholinergic and sympathomimetic toxidromes?

A
  • Antiperspirant keeps you dry = so do anticholinergic!

- Pupils are both dilated but sympath are reactive

70
Q

Clinical presentation for sympathomimetic toxidrome (minus complications)

A
  • Mydriasis
  • Diaphoresis
  • Psychosis
  • Severe agitation
  • Tachycardia/HTN
  • Hyperthermia
  • Rigidity + hyperreflexia
71
Q

Complications of sympathomimetic toxidrome

A
  • Seizures (from hypoNa)
  • Rhabdo/DIC (from hyperthermia)
  • MI
  • Hypertensive emergency (SAH, ICH)
  • Hepatotoxicity
72
Q

Examples of sympathomimetic toxidrome

A
  • Cocaine
  • Amphetamines/metamphetamines
  • MDMD (ectasy)
  • Methylxanthines
73
Q

Management of sympathomimetic toxidrome

A

Supportive:

  • Fluid restriction if hypoNa
  • Keep cool
  • Benzo if agitation

Decontamination:
-Activated charcoal

Treatment:
-No antidote

74
Q

Serotonin syndrome - triad of symptoms

plus SSRI other symptoms

A

= altered mental status, autonomic instability, neuromuscular hyperactivity
-sedation, tachycardia (QTc prolongation), seizures

75
Q

What is the antidote for serotonin syndrome?

A

-Cyproheptadine

76
Q

What causes neuroleptic malignant syndrome?

A

-Anti-psychotic medications

77
Q

Tx for neuroleptic malignant syndrome

A
  • Supportive

- Withdrawal of agent

78
Q

For (a) serotonin syndrome, (b) neuroleptic malignant syndrome, and (c) anticholinergic toxicity - what is (1) time course, (2) pupil size, (3) mucosa/skin, (4) neuro, and (5) mental status?

A

(a) 1. <12 hours, 2. big, 3. wet, 4. hyperreflexia/hypertonia, 5. agitation
(b) 1. 3-4 days, 2. normal, 3. wet, 4. rigid, 5. stupor
(c) 1. <12 hours, 2. big, 3. dry, 5. normal, 5. agitation

79
Q

Presentation for an opioid toxidrome

A
  • Respiratory depression
  • Bradycardia
  • Hypotension
  • Miosis
  • Coma
80
Q

Antidote for opioids

A

Naloxone

81
Q

When to NOT use activated charcoal?

A

PHAILS:

  • Potassium
  • Hydrocarbons
  • Alcohols
  • Iron
  • Lithium
  • Solvents (caustic ingestions)
82
Q

Examples of hydrocarbons

A
  • Kerosene
  • Lamp oil
  • Gasoline
  • Camphor
  • Nail polish remover
83
Q

What could you give as decontamination for local anesthetics, bupropion, and amitriptyline?

A

Intravenous lipids

84
Q

Antidote for methanol

A

Fomepizol

85
Q

Antidote for carbon monoxide

A

Oxygen

86
Q

Antidote for diazepam

A

Flumazenil

87
Q

Antidote for iron

A

Deferoxamine

88
Q

Antidote for beta blocker or CCB

A

Glucagon

89
Q

Antidote for glyburide

A

Glucose

90
Q

What is the complication for hydrocarbon toxicity?

A

Aspiration + surfactant inactivation

91
Q

What is your first step in investigation and management for hydrocarbons?

A
  • STAT CXR + repeat in 4-6 hours

- O2 + bronchodilators

92
Q

What toxin do you think of if you see perihilar infiltrates + pneumatoceles on CXR?

A

Hydrocarbons

93
Q

How does an overdose of metformin look like?

A
  • No hypoglycemia

- Produces lactic acidosis

94
Q

What stage for tylenol ingestion is there peak hepatic injury (liver failure)?

A

Stage 3 at 72-96 hours

95
Q

What acid base disturbance occurs in tylenol toxicity?

A

Anion gap metabolic acidosis

96
Q

What time frame should NAC be started within?

A

within 8 hours

97
Q

Why is it important to have patients on CRM as NAC starts?

A

For anaphylaxis reactions

98
Q

What dose of tylenol is (a) hepatoxic and (b) toxic?

A

(a) >90 mg/kg/day for more than 1 day

(b) >200 mg/kg/day

99
Q

Presentation for salicylate overdose

A
  • N/V, GI bleeding
  • Diaphoresis, hyperthermia
  • Seizures
  • Tinnitus
  • Tachypnea = resp alkalosis
  • Metabolic acidosis
  • Hypoglycemia
100
Q

Hallmark features of salicylate overdose

A
  • Resp alkalosis + metabolic acidosis
  • Dehydration
  • Intracellular hypoglycemia
101
Q

Management of salicylate overdose

A
  • Decontamination = AC within 6 hours
  • No antidote
  • Treatment = glucose bolus (even if serum is normal), alkalinize to urine pH, fluid resus, treat hypoK, hemodialysis
102
Q

Iron overdose presentation - within the first 6 hours + in the 3rd/4th stages

A
  • First 6 hours: emesis, bloody diarrhea, abdo pain
  • Within 6-72 hours: met acidosis, GI hemorrhage, coagulopathy, shock, multi-organ failure (ARDS, hepatoxicity, liver failure)
103
Q

Management for iron toxicity

A

Supportive:
-IV fluid resus = follow along UA until clear

Decontamination:
-WBI if lots of pills on XR

Treatment:
-IV deferoxamine

104
Q

What is the hallmark feature of isopropyl alcohol toxicity?

A

Ketosis

105
Q

What is the complication of methanol toxicity?

A

Retinal injury

106
Q

What are the x2 lab findings (+associated consequences) related to ethylene glycol toxicity?

A
  • HypoCa –> prolong QT

- Metabolic acidosis –> cardiac decompensation

107
Q

The pathophysiology for TCA toxicity (including receptors/neurotransmitters involved).

A
  • Inhibits NER + serotonin reuptake
  • Block fast Na cardiac channels = wide QRS + prolonged QT
  • Block alpha receptors = hypotension
  • Block GABA receptors = seizure
  • Block histamine receptors = sedation
  • Block muscarinic receptors = weakly anticholinergic
108
Q

management of TCA toxicity

A
  • Activated charcoal

- Na bicarb if QRS >100

109
Q

When to consider a XR for a toxic ingestion?

A

Think COINS

  • Choral hydrate
  • Opioids
  • Iron
  • Neuroleptics
  • Salicylate, sustained release
110
Q

What ingestion do you think about if high osmolar gap?

A

Toxic alcohols

111
Q

What are the two phases of nicotine toxicity?

A
  1. Stimulant

2. Parasympathetic

112
Q

What is the best test to do in a patient who presents reporting an ASA ingestion?

A

Do tylenol level (often confused)

113
Q

What is the most common cause of death in (a) 1-4 year olds and (b) 5-14 year olds?

A

(a) trauma

(b) MVC

114
Q

Complications of a submersion event?

A
  • ARDS
  • Pulmonary edema
  • PNA
  • Cerebral edema (then increased ICP)
  • Trauma
  • Hypothermia
115
Q

Best prognostic factor for submersion injury plus 4 other ones

A
  • BEST = immediate bystander CPR
  • ROSC <10 minutes
  • Submersion <5 minutes
  • PERL at scene
  • Normal sinus at scene
116
Q

Definition of hypothermia

A

Core temp <35

117
Q

At what temperature does shivering stop?

A

32 deg

118
Q

At what temperature do ECG changes occur in hypothermia?

A

Below 32 deg

119
Q

What are the classic ECG changes (x4) in hypothermia?

A
  • Osborn or J waves
  • Marked sinus brady
  • First deg AV block
  • Prolonged QT
120
Q

What x6 biochemical changes are associated with hypothermia?

A
  • Lytes = hypoK, hypoCa, hypoglycemia
  • Metabolic acidosis
  • Coagulopathy
  • Pancreatitis
121
Q

Stages of re-warming for a hypothermia injury

A
  • Mild (32-35) = passive external rewarming
  • Moderate (28-32) = ADD active external + core rewarming
  • Severe (<28) = ADD additional active core rewarming + ECMO
122
Q

If there is a shockable rhythm, how may defibrillations can you give in a hypothermic patient?

A

x3 until T >30

123
Q

When can you use vasoactive drugs in a hypothermic patient?

A

Once core temp is >30

124
Q

What renal complication is seen in 30% of patients with heat stroke?

A

Acute tubular necrosis

125
Q

Definition of heat stroke

A

-Core temp >40 deg with CNS dysfunction

126
Q

Three stages of heat injuries

A
  • Heat cramps
  • Heat exhaustion (T 37.7-39.4)
  • Heat stroke (T >40)
127
Q

x5 complications of heat injuries

A
  • HypoNa
  • Seizure
  • Rhabdo
  • DIC
  • Multi-organ dysfunction
128
Q

x4 causes of lactic acidosis in a fire

A
  • Hypoperfusion/hypovolemia
  • Cyanide poisoning
  • Mathamoglobinemia
  • Carbon dioxide
129
Q

x4 types of burns

A
  • Superficial
  • Superficial partial thickness
  • Deep partial thickness
  • Full thickness
130
Q

How to differentiate between (a) superficial partial thickness burn and (b) deep partial thickness burn?

A

(a) blisters, pain, moist

(b) dry, less pain, speckled

131
Q

What rules can you use for BSA calculation for children for burn injuries

A

> 9 years old = rule of 9’s

<9 years old = child’s palm = 1%

132
Q

x4 indications for intubation following a fire

A
  • Carbonaceous sputum
  • Singed nasal hair
  • Soot in airway
  • Hoarseness
133
Q

x2 bugs each for early infection + late infection associated with burns

A
  • Early = staph, GAS

- Late = pseudomonas, bacteroides

134
Q

x8 indications for admission for a burn injury

A
  • > 1% BSA to hands/feet/face/perineum
  • > 2% BSA full thickness burn
  • > 10% BSA partial thickness burn
  • Suspected NAT
  • Circumferential burn
  • Inhalation injury
  • Electrical injury
  • Associated trauma
135
Q

What Abx prophylaxis or empiric Abx should be started in a burn patient?

A

No role

136
Q

Complications to monitor for from a high tension wire electrical injury?

A
  • Muscle injury –> compartment syndrome, rhabdo, ARF
  • VF/arrest
  • CNS injury
137
Q

What is the source of the electrical injury if there is (a) a feathering pattern on the skin vs (b) entrance + exit wound?

A

(a) Lightning

(b) High tension wire

138
Q

Definition of status epilepticus?

A
  • Continuous seizure activity for >30 minutes

- OR x2 discrete seizures with no return to baseline in-between

139
Q

When do you consider status epilepticus refractory during hospital management?

A

Once received x2 different second-line medications and the patient continues to seize >5 minutes later.

140
Q

VF with a pulse + hemodynamic compromise - next step

A

Synchronized cardioversion - 1J/kg then 2J/kg

141
Q

VF with a pulse + stable hemodynamics - next step

A
  • Check to make sure the rhythm is regular + QRS is monomorphic
  • Then try adenosine - then synchronized cardioversion
142
Q

Threshold for intervention for a pneumothorax (percentage wise in terms of size)?

A

> 30%

143
Q

How much to give of ORT?

A

50-100 mL/kg over 4 hours

144
Q

Do GCS scoring

A

Yes you got it!!

145
Q

x2 equations for ETT size

A

Uncuffed: age/4 +4
Cuffed: age/4 + 3.5

146
Q

What IV Abx is recommended to start empirically for uncomplicated PNA?

A

Ampicillin

147
Q

Algorithm/approach for child post-swallowing a button battery?

A
  • Urgent XR
  • Determine if esophageal vs gastric
  • If esophageal = urgent endoscopy
  • If gastric = (a) if <5 y/o + >20mm = endoscope in 24-48 hours, (b) if >5 y/o +/or <20mm = could consider observation
148
Q

x4 criteria for the apnea test

A

-Final PaCO2 >60
-Final PaCO2 >20 from pre-test
No spontaneous respiratory effort
-pH <7.28

149
Q

pVT - CPR started, 100% sats, what next step?

A

Defibrillate 2J/kg

150
Q

What would count as a serious iron ingestion that would cause you to consider desfuroxime?

A
  • High iron level at 4-6 hours
  • Ingestion of >60mg/kg (or lots of pills on AXR to suggest this)
  • Significant AG metabolic acidosis
  • Severe symptoms
151
Q

Antidote for barbituates?

A

None

152
Q

How can we manipulate - (a) oxygenation, (b) ventilation, and (c) respiratory effort?

A

(a) FiO2, PEEP
(b) RR, Vt, dead space
(c) increase caliber of airway, increase inspiratory pressure

153
Q

Typical low to high range for flow in HFNC

A

1-3 L/kg/min

154
Q

What is the PRAM score out of? And what are the main components?

A

=out of 12

  • Oxygen saturation
  • Suprasternal retraction
  • Scalene muscle contraction
  • Air entry
  • Wheezing
155
Q

How many breaths to compressions do you give once an advanced airway has been placed?

A

Breath every 2-3 seconds (approximately 30 breaths/minute)

156
Q

4mo adm with bronchiolitis, acute crash, appears cyanotic/limp, sats 50% + HR 40 bpm, pulse+ = what is next step?

A

Bag-mask ventilate with FiO2 100%

-Given chest compressions if HR <60 after adequate oxygenation/ventilation

157
Q

How must a NDD assessment be done for a (a) neonate (<30 days and >36 wk GA), (b) infant, and (c) child >1 year?

A

(a) Full + separate exams must be done by x2 physicians at lest 24 hours apart and >48h after birth
(b) Full + separate exams but no fixed interval
(c) Full exams but can be done concurrently

158
Q

If there has been significant resuscitation, when is the earliest time that you can do a NDD assessment?

A

> 24 hours

159
Q

x3 diagnostic criteria for DKA

A
  • Acidosis = pH <7.3, HCO3 <15
  • Ketones present
  • Glucose >11
160
Q

Dx if diffusely tall QRS complexes on ECG

A

Pompe

161
Q

Antidote for methanol ingestion - what is x1 long term consequence?

A

Fomepizole

-Blindness

162
Q

Migraine ED protocol

A

IV fluids
IV metoclopramide
IV ketoralac (ensure spaced out from other NSAIDs)
IV ondans

163
Q

10 day old, lethargy, poor feeding. RR 56, HR 183, BP 60. No femoral pulses, hepatomegaly. (a) what kind of shock, (b) cause, (c) why now, and (d) treatment

A

(a) obstructive
(b) coarct
(c) PDA closing
(d) PGE infusion, intubation, cardiology

164
Q

Name for nursemaid’s elbow

A

Radial head subluxation

165
Q

What do Cullen and Grey’s sign indicate?

A

Intra-abdo hemorrhage

166
Q

What to think of if serpiginous rash?

A

Serum sickness

167
Q

Dx if atypical lymphocytes, epitrochlear adenopathy, and exudative tonsillitis

A

EBV

168
Q

What to give for pertussis?

A

Azithro

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