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Laughing Pedi > Critical Care / ED > Flashcards

Critical Care / ED Flashcards

0
Q

tachypnea, muscle rigidity, incr CO2, acidosis, fever after GA?
Tx?

A

malignant hyperthermia

tx w/ hypervent, o2, dantrolene

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1
Q

most common vital sign assoc w/ incr ICP?

A

hyperventilation

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2
Q

Cushing triad?

A

bradycardia, htn, irreg respiration

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3
Q

3 signs of complete heart block?

A

HR incr w/ crying
soft vibratory ejection murmur
intermittent brisk jugular venous pulse wave of neck

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4
Q

salt wasting + fatigue, vomiting, HA, muscle weakness, wt loss

A

adrenal insufficiency

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5
Q

lab findings in adrenal insuff?

A

low glucose
hi K
low Na

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6
Q

candidiasis with adrenal insufficiency- think of what?

A

autoimmune polyendocrinopathy

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7
Q

what should ADH be like in adrenal insufficiency?

A

high, appropriately so.

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8
Q

when can near drowning be observed at home?

A

< 1 min submerged, no LOC, no resuscitation needed

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9
Q

key prognostic predictor in near drowning?

A

length of asphyxia

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10
Q

near drowning w/ any of these three features requires observation for risk of ARDS in 6 hrs

A
  1. hx apnea and CPR in field
  2. resp failure from aspiration
  3. arterial desat / tachypnea –> ARDS
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11
Q

when to intubate (GCS score) after head trauma?

A

GCS </= 8

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12
Q

ARDS CXR findings

A

fine reticular infiltrate

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13
Q

6 causes of ARDS

A
  1. PNA
  2. Lung contusion
  3. smoke inhalation
  4. blood product trf
  5. sepsis
  6. aspiration
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14
Q

SVT tx when adenosine doesn’t work right away or recurs?

A

try again w/ incr dose, if it recurs tx w/ IV Dilt

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15
Q

poor prognosis after near drowning 3 fx

A

submersion > 25 min
apnea / coma at admission
pH < 7

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16
Q

< 10 min CPR has good or bad prognosis

A

good w/o neuro impairment

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17
Q

flail chest w/ resp distress and tachypnea, next step?

A

decompress hemothorax w/ chest tube

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18
Q

normal cardiac ejection fraction?

A

55%

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19
Q

EF in acute heart failure?

A

<25%

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20
Q

infant with grey color, poor cap refill, thready pulses?

A

cardiogenic shock

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21
Q

tx w/ child with aortic stenosis in heart failure

A

PGE1 to maintain or reopen ductus arteriosis

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22
Q

FH of sudden death and epilepsy in patient with syncope in pool?

A

long QT! Familial…

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23
Q

muffled heart sounds and pulsus paradoxus

A

tamponade

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24
define pulsus paradoxus
decr SBP during inspiration
25
absence of vertebral and carotid artery blood flow? How to document.
brain death. | radionucleotide scan or angiography
26
signs of impending liver failure?
high ammonia and change in mental status
27
chronic tremor, anxiety, high LFTs? Dx and next step?
Likely Wilson's, get serum ceruloplasmin
28
TCA (imipramine) ingestion and EKG
QT and QRS prolongation
29
Do the Primary Survey:
1. Airway w/ cervical spine stab 2. Breathing / vent 3. Circ / hemorrhage control 4. Disability: neuro screen 5: environment/exposure
30
optimal end tidal CO2 for trauma pt w/ head injury
30-35mmHg (mild hypervent)
31
imaging of choice to look for abd trauma?
Abd CT, most treated conservatory
32
eye punch, 24-72 hrs later w/ red eye, pain, vision issues, constricted pupil
post traumatic iritis
33
hyphema 2/2 complication in next week
rebleeding
34
teardrop shaped pupil, irregular
ruptured globe
35
indication for burn center referral
1. resp injuries/trauma too 2. chemical/electrical 3. partial thickness burn >20% BSA 4. full thickness burn > 2% 5. full thickness of face, hands, feet, perineum
36
BSA in babies rules
head 18%, trunk 18%, legs 14%, arms 9% each
37
Frx w/ high rate of abuse:
rib, metaphyseal chip, spine/scapula, complex skull
38
spiral humeral frx is what?
NAT
39
Most common growth plate injury
2
40
abuse fractures (3)
metaphyseal chip/corner bucket handle fractures posterior ribs spiral diaphyseal fractures of humerus
41
wounds that should close by secondary intention
animal bites unless on face, human bites on MCP joints (incr risk infx)
42
antidote for propanolol
glucagon
43
toxidrome: incr HR, BP, RR, Temp Agitation and possible seizures/psychosis, sweating, big pupils Types?
sympathomimetic: amphetamine, cocaine, pseudophed, caffeine, albuterol
44
toxidrome: High HR, BP, RR, Temp, altered MS, delirium, hallucinations, big pupils but DRY/FLUSHED skin, DRY mucus membranes, Urinary retention Possible tx?
Anticholinergic (Mad, Dry, Hot, Red)... Antihistamine, TCA, antispasmodic, jimsonweed, atropine Tx: ?physostigmine?
45
toxidrome: | Incr RR, temp, nl HR and BP, Confusion-> coma, small pupils, sweaty/diaphroetic, bronchorrhea, vomiting/diarrhea
Cholinergic / Anticholinesterase (Organophosphate pesticides, nerve agents, nicotine)
46
low HR, BP, RR, temp | euphoria then lethargy, coma, miosis
opiates, clonidine, tetrahydrozyline eyedrops
47
Hi HR, hi Temp, agitaiton, confusion, mania, coma | big pupils, hyperreflexia, myoclonus, akathisia, sz, rigidity
serotonin syndrome / ecstasy
48
low BP, RR, temp, slurred speech, ataxia, decr MS, normal/big pupils, but sluggish
sedative/hypnotic: benzos, barbiturate, buspirone
49
antidote for methanol or ethylene glycol
Fomepizole
50
antidote for cholinesterase inhibitors?
Pralidoxime
51
Antidote for digoxin
digibind
52
antidote for tylenol? how does it work? s.e?
N acetylcysteine - binds directly to NAPQ1 to create a nontoxic metabolite w/ IV form, can have anaphylaxis
53
Stages of Acetaminophen tox correlate with what
``` days out from ingestion: Stage 1: day of, n/v, no pain normal labs Stage 2 (day 2-3): abd pain, hi LFTs Stage 3 (day 3-4) Stage 4 (day 4-5)+ ... ```
54
likely toxic tylenol ingestion? How does it work to destroy liver?
>10gm | Depletes glutathione stores
55
acid base issue with salicylate OD
respiratory alkalosis and metabolic acidosis non gap
56
mydriasis, tachycardia, anxiety, muscle tension leading to hyperthermia, seizure, hypoNa Tx
hallcinogens (ecstasy, LSD, PCP, shrooms) Tx: BZD, Nitroprusside for htn, IVF for rhabdo
57
Endotracheal tube rule? Child Newborn Infant
Uncuffed (age/4) + 4 For cuffed, go one size smaller Term: 3.5mm uncuffed, 3 cuffed Infants 4 / 3.5
58
Depth of ET insertion? | Baby and >2y
ET tube size x 3 | >2y: Depth = (age/2) +12
59
most predictive of outcome in child submerged?
effectiveness of resuscitative efforts at scene
60
Tx of flail chest? | What do you see?
tracheal intubation with PEEP (no more strapping of chest) | (ribs move in and out)/ paradoxical chest wall movement
61
ET size
(age + 16) / 4
62
meds you can give via ETT
LANE: Lidocaine, Atropine, Narcan, Epi
63
formula to calculate tidal volume on the vent
7ml/kg
64
epi dose for anaphylactic
1:1000
65
coverage of cat bites? | Step 1 of bites
deep punctures: cover SA, Pasteurella multocida: Augmentin | Step 1: clean w/ high pressure irrigation
66
red circle around white ring bite
brown recluse (loxosceles reclusa)
67
bite with tiny puncture wound but htn and muscle aches/belly aches?
black widow (latrodectus mactans) spider bite
68
acute management of snake bite
loose fitting constriction band
69
Tx of hypothermia
40 degree IVF gastric lavage w/ warm fluid warm O2 42-46 degrees
70
Riskier bites for rabies (3)
1. close to brain 2. unprovoked 3. bat and woodchuck
71
Tx of rabies suspicion
human rabies Ig | 4 doses of rabies vaccine day 0,3,7,14
72
risk of dilantin if given too fast
bradycardia
73
drug for pump (cardiogenic) shock and drug for warm (vasodilation / septic) shock?
Dobutamine for heart | NE for warm shock
74
Intubate for Glascow < what?
<8
75
normal glascow coma score
15
76
3 components of GCS?
``` eye opening score (1-4) verbal score (no response - conversation 1-5) Motor score (none - posturings - pain - commands: 1-6) ```
77
clear rhinorrhea w/ sugar in it?
CSF: Basilar skull frx
78
What is Caffey disease?
infantile cortical hyperostosis, fever, swelling of face, jaws, and cortical thickening of long/flat bones
79
Type of fracture expected in a boy aged 5-8 falling on outstretched arm
supracondylar fracture
80
injury in 11-15 yr old who fell onto outstretched partially extended arm
dislocation of elbow w/ ? neurovasc compromise
81
direct impact w/ arm laterally rotated causes what injury?
epiphyseal fracture
82
palpable step off of anterior shoulder joint without crepitus?
AC separation
83
Methanol ingestion
visual changes
84
lithium ingestion
DI/polyuria
85
ethylene glycol ingestion
calcium oxalate crystals in urine

Laughing Pedi (24 decks)

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