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Own peds boards > Critical care and Emergency > Flashcards

Critical care and Emergency Flashcards

1
Q

Pattern: 7 mo with diarrhea, vomiting, decreased urine output, tachycardia, poor perfusion

A

Hypovolemic shock

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2
Q

Pattern: 8 day old with poor feeding, tachypnea, mottled, large heart, gallop, murmur, hepatomegaly, jugular venous distension

A

cardiogenic shock

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3
Q

Pattern: 14do with fever, lethargy, extreme tachycardia, grunting, warm extremities, bounding pulses

A

Septic shock

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4
Q

Pattern: 4yo with peanut allergy who went to the circus, tachycardia, warm extremities

A

distributive shock

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5
Q

Fluid administratin for shock

A

20ml/kg (repeat as necessary 60-200ml/kg

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6
Q

Rx for cold shock

A

epinephrine

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7
Q

Rx for warm shock

A

norepinephrine

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8
Q

Rx for cardiogenic shock

A

milrinone

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9
Q

1st line Rx for shock

A

dopamine

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10
Q

Rate of CPR and ratio

A

100/min

15:2

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11
Q

Define bradycardia with pulse

A

HR

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12
Q

Rx for bradycardia with pulse

A

Epi IV/IO 0.01mg/kg

ETT 0.1mg/kg and atropine 0.02mg/kg (minimum dose 0.1mg)

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13
Q

Pattern: tachycardia with poor perfusion, narrow QRS, variable rate

A

Sinus tachycardia

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14
Q

Pattern: tachycardia with poor perfusion, narrow QRS, P waves abnormal, rate not variable

A

Supraventricular tachycardia (vagal, adenosine, syndrchronized cardioversion)

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15
Q

Pattern: Tachycardia with poor perfusion, synchronized cardioversion, wide QRS,

A

ventricular tachycardia, syndchronized cardioversion, increase to 2J/kg if not effective

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16
Q

Which are shockable rhythm?

A

VF

VT

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17
Q

Which are not shockable rhythm?

A

asystole, PEA

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18
Q

Rx for VF/VT

A

2-4J/kg, epi, amiodarone, lidocaine,

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19
Q

Rx of torsades de pointes

A

Magnesium

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20
Q

Rx for aystole/PEA

A

epinephrine

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21
Q

Poor prognosis for near drowning

A

10min, resuscitation >25min or in ER, water >10C

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22
Q

Survival with near drowning

A

75%

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23
Q

What are cardiac patterns seen with hypothermia?

A

bradycardia and a-fib

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24
Q

Prevention of near drowning recs

A

5ft fences that isolate pool from house and yard, self closing gates, appropriate supervision, CPR education

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25
Q

Standard of care for foreign body aspiration

A

Rigid bronchoscopy

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26
Q

Pattern: superficial, pain, redness burn

A

first degree burn

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27
Q

Pattern: partial thickness, superficial pain, blister, deep-white, leathery burn

A

second degree

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28
Q

Pattern: full thickness, well demarcated, black, leathery, painless, no blistering burn

A

3rd degree burn

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29
Q

rx for 2nd degree burn

A

pain and fluid management

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30
Q

rx for 3rd degree burn

A

skin grafting

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31
Q

Pattern: full thickness plus fascia, muscle, bone

A

4th degree burn

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32
Q

rx for 4th degree burn

A

reconstructive surgery

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33
Q

Calculate fluid replacement for burn

A

4ml/Kg x % BSA + maintenance

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34
Q

2nd way to calculate fluid replacement

A

2000mL/m2 burned BSA + 5000mL/m2 TBSA

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35
Q

schedule for fluid replacement of burn patient

A

1/2 over 1st 8 hrs, rest over 16hrs

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36
Q

What replacement fluid type for first 24hrs

A

crystalloid

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37
Q

High voltage AC - power line symptoms

A

devastating thermal injuries, no LOC or cardiac arrest

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38
Q

Low voltage AC burns cause what?

A

skin/oral injury particularly if strong enough to cause tetanic muscle contraction (16-20mAmps) respiratory muscle paralysis (20-50mAmps) ventricular fibrillation (50-120mAmps)

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39
Q

What type of burn cause single muscle contraction that throws victim away from source?

A

DC - railroad

40
Q

Pattern: seizures, respiratory arrest, cardiac standstill that self resolves, superficial burns

A

Moderate lightning injury

41
Q

Pattern: cardiac arrest from lightning injury

42
Q

Rx electrical burns

A

fluid managment goals with focus to clear myoglobin

43
Q

Test for CO posioning

A

Co-oximetry

44
Q

How does half-life of CO change with high flow non rebreather mask and hyperbaric oxygen

A

300 –> 90 –> 30

45
Q

Common bacteria in human bites

A

eikenella corrodens, staph, strep, corynebacterium

46
Q

Rx for high risk bite areas

A

amoxicillin/clavulanate
Ampicillin/sulbactam
bactrim or quinolone and clindamycin

47
Q

Reservoir for rabies

A

skunk, racoons, and foxes

48
Q

What is the Milwaukee protocol for rabies

A

drug-induced coma with ketamine and midazolam, antiviral treatment with amantadine and ribavirin

49
Q

Rx rabies

A

Rabies Ig into the wound or IM and

Rabies vaccine and good wound care

50
Q

Rx of bite if animal is rabid

A

ppx immediately

51
Q

Rx of bite to head/neck

A

ppx immediately

52
Q

Rx of bite if animal is healthy

A

observe animal for 10 days and ppx if animal becomes rabid

53
Q

Rx of animal bite if animal is unavailable and rabies common in region

A

consider ppx

54
Q

Rx for any contact with bat

55
Q

Majority of the venomous bites are from what kind of snakes.

A

Pit vipers

56
Q

Which snake has a neurotoxin

A

Mohave rattlesnake

57
Q

Rx for snake venom

A

crotalid antivenom

58
Q

When should you give antivenom?

A

moderate to severe symptoms or bite to face or neck

59
Q

What are complications of snake bites

A

local necrosis, coagulopathy, rhabdomyolysis, nephrotoxicity, neurotoxicity if antivenom not given

60
Q

Pattern: brown with dark violin shaped mark on back, six eyes, endemic in south, west and midwest, basements

A

brown recluse spider

61
Q

What is the venom from brown recluse spider

A

sphyingomyelinase D –> necrosis

62
Q

Pattern: painless bite, two puncture marks with surroudning erythema –> red –> pain and then resolves

A

brown recluse spider

63
Q

Pattern: bite that become necrotic over several days, 1-2 cm, stops extenidng after 10 days heal over several weeks.

A

brown recluse spider

64
Q

Rx for brown recluse spider

A

wound care, dapsome prevents necrotic lesions, early surgical intervention is harmful so wait until lesion demarcated.

65
Q

Pattern: spider with shiny black with red markings, red hourglass or anvil shape on abdomen

A

widow spiders

66
Q

Which widow spider is harmful?

A

black

brown are benign

67
Q

Pattern: spider bite, latrodectism, painless bite or local pain, blanched patch, PAIN - muscle spasm, generalized or local diaphoresis, HA

A

black widow spiders

68
Q

What does the venom of the black widow spider do?

A

neurotoxin causing massive exocytosis from presynaptic nerve terminals, acetylcholine, norepinephrine, DA, glutamate

69
Q

Rx for black widow

A

local wound care, benzodiazepines for muscle spasm, limited antivenom (bad for asthma and pt with allergies)

70
Q

Pattern: bite, sympathetic release, mydriasis, nystagmus, hypersalivation, dysphagia

71
Q

Rx jellyfish

A

vinegar, coca cola, old wine, box jellyfish antivenom

72
Q

Define heat stroke

A

core body temperature >40C,

73
Q

Pattern: delirium, syncope, seizures, coma, hypotension, tachycarida, hypovolemic shock, rhabdo, renal failure, liver injury, DIC, bacteremia and bacteruria after 24 hours

A

heat stroke

74
Q

what are the 2 triggers for malignant hyperthermia

A

succinylcholine and volatile anesthetics (sevoflurane)

75
Q

Pattern: tachycardia, musclerigidity, mixed acidosis rising ETCO2, hyperkalemia then later hyperthermia

A

malignant hyperthermia

76
Q

How to calculate size of uncuffed endotrachael tube

A

age in years/4 + 4

77
Q

How to calculate size of cuffed endotracheal tube

A

age in years/4 + 3

78
Q

Drugs used for blunting increased ICP during intubation

A

barbiturate or lidocaine

79
Q

Rx for flail chest

80
Q

Coma level requiring intubation

81
Q

Indication for ab CT with IV contrast after trauma

A

1) elevated transaminases
2) gross-microscopic hematuris
3) positive FAST exam
4) declining hematocrit
5) inability to perform serial exams because of other injury

82
Q

Risk of appendicitis eruption in what age

83
Q

What percentage of pt with appendicitis with pyuria

84
Q

First line for appendicitis workup

A

US for non-obese

85
Q

Indication for CT for appendicicitis work up

A

IF US negative but you are still suspicious
Obese
If US cannot visualize appendicitis

86
Q

Intussusception in >5 years should make you suspicious for

A
  1. small bowel lymphoma
  2. Meckel diverticulum
  3. Henoch schonlein purpura
  4. cystic fibrosis
87
Q

Pattern: children with malrotation, emesis quickly leading to shock, imaging show small bowel twisting around superior mesenteric artery

A

midgut volvulus

88
Q

Pattern: gasless abdomen, double-bubble sign signifies duodenal obstruction
What test should you get?

A

midgut volvulus

Upper GI series

89
Q

Pattern: upper GI showed misplaced duodenum, corkscrew sign

A

midgut volvulus

90
Q

Rx for midgut volvulus

A

Ladd procedure

91
Q

Core temp for brain death call

A

Over 35 degress

92
Q

First exam for brain death exam

A

24hrs after CPR or other severe brain injury

93
Q

Interval time between two brain death exam

94
Q

Describe apnea test

A
  1. Provide oxygen
  2. No spontaneous respiratory effort noted
  3. Final PaCo2 >60mmHg
  4. Final PaCO2 >20mmHg increase over baseline
95
Q

When is ancillary test needed

A
  1. if apnea test is contraindication or cannot be completed due to hypoxia or hemodynamic instability
  2. Uncertain about exam
  3. If drugs are on board
  4. Reduce inter-examination
96
Q

Two ancillary testing for brain death

A

EEG or cerebral blood flow study

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