Critical care and Emergency Flashcards by Mary Dang

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

Hypovolemic shock

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

cardiogenic shock

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

Septic shock

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

distributive shock

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Fluid administratin for shock

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

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Rx for cold shock

epinephrine

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Rx for warm shock

norepinephrine

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Rx for cardiogenic shock

milrinone

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1st line Rx for shock

dopamine

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Rate of CPR and ratio

100/min

15:2

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Define bradycardia with pulse

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Rx for bradycardia with pulse

Epi IV/IO 0.01mg/kg

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

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

Sinus tachycardia

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

Supraventricular tachycardia (vagal, adenosine, syndrchronized cardioversion)

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

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

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Which are shockable rhythm?

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Which are not shockable rhythm?

asystole, PEA

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Rx for VF/VT

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

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Rx of torsades de pointes

Magnesium

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Rx for aystole/PEA

epinephrine

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Poor prognosis for near drowning

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

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Survival with near drowning

75%

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What are cardiac patterns seen with hypothermia?

bradycardia and a-fib

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Prevention of near drowning recs

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

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Standard of care for foreign body aspiration

Rigid bronchoscopy

Pattern: superficial, pain, redness burn

first degree burn

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

second degree

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

3rd degree burn

rx for 2nd degree burn

pain and fluid management

rx for 3rd degree burn

skin grafting

Pattern: full thickness plus fascia, muscle, bone

4th degree burn

rx for 4th degree burn

reconstructive surgery

Calculate fluid replacement for burn

4ml/Kg x % BSA + maintenance

2nd way to calculate fluid replacement

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

schedule for fluid replacement of burn patient

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

What replacement fluid type for first 24hrs

crystalloid

High voltage AC - power line symptoms

devastating thermal injuries, no LOC or cardiac arrest

Low voltage AC burns cause what?

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

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

DC - railroad

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

Moderate lightning injury

Pattern: cardiac arrest from lightning injury

severe

Rx electrical burns

fluid managment goals with focus to clear myoglobin

Test for CO posioning

Co-oximetry

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

300 --> 90 --> 30

Common bacteria in human bites

eikenella corrodens, staph, strep, corynebacterium

Rx for high risk bite areas

amoxicillin/clavulanate Ampicillin/sulbactam bactrim or quinolone and clindamycin

Reservoir for rabies

skunk, racoons, and foxes

What is the Milwaukee protocol for rabies

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

Rx rabies

Rabies Ig into the wound or IM and | Rabies vaccine and good wound care

Rx of bite if animal is rabid

ppx immediately

Rx of bite to head/neck

ppx immediately

Rx of bite if animal is healthy

observe animal for 10 days and ppx if animal becomes rabid

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

consider ppx

Rx for any contact with bat

ppx

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

Pit vipers

Which snake has a neurotoxin

Mohave rattlesnake

Rx for snake venom

crotalid antivenom

When should you give antivenom?

moderate to severe symptoms or bite to face or neck

What are complications of snake bites

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

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

brown recluse spider

What is the venom from brown recluse spider

sphyingomyelinase D --> necrosis

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

brown recluse spider

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

brown recluse spider

Rx for brown recluse spider

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

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

widow spiders

Which widow spider is harmful?

black | brown are benign

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

black widow spiders

What does the venom of the black widow spider do?

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

Rx for black widow

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

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

scorpion

Rx jellyfish

vinegar, coca cola, old wine, box jellyfish antivenom

Define heat stroke

core body temperature >40C,

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

heat stroke

what are the 2 triggers for malignant hyperthermia

succinylcholine and volatile anesthetics (sevoflurane)

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

malignant hyperthermia

How to calculate size of uncuffed endotrachael tube

age in years/4 + 4

How to calculate size of cuffed endotracheal tube

age in years/4 + 3

Drugs used for blunting increased ICP during intubation

barbiturate or lidocaine

Rx for flail chest

intubate

Coma level requiring intubation

Indication for ab CT with IV contrast after trauma

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

Risk of appendicitis eruption in what age

What percentage of pt with appendicitis with pyuria

4-25%

First line for appendicitis workup

US for non-obese

Indication for CT for appendicicitis work up

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

Intussusception in >5 years should make you suspicious for

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

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

midgut volvulus

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

midgut volvulus | Upper GI series

Pattern: upper GI showed misplaced duodenum, corkscrew sign

midgut volvulus

Rx for midgut volvulus

Ladd procedure

Core temp for brain death call

Over 35 degress

First exam for brain death exam

24hrs after CPR or other severe brain injury

Interval time between two brain death exam

Describe apnea test

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

When is ancillary test needed

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

Two ancillary testing for brain death

EEG or cerebral blood flow study