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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
Q

define pulsus paradoxus

A

decr SBP during inspiration

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25
Q

absence of vertebral and carotid artery blood flow? How to document.

A

brain death.

radionucleotide scan or angiography

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26
Q

signs of impending liver failure?

A

high ammonia and change in mental status

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27
Q

chronic tremor, anxiety, high LFTs? Dx and next step?

A

Likely Wilson’s, get serum ceruloplasmin

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28
Q

TCA (imipramine) ingestion and EKG

A

QT and QRS prolongation

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29
Q

Do the Primary Survey:

A
  1. Airway w/ cervical spine stab
  2. Breathing / vent
  3. Circ / hemorrhage control
  4. Disability: neuro screen
    5: environment/exposure
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30
Q

optimal end tidal CO2 for trauma pt w/ head injury

A

30-35mmHg (mild hypervent)

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31
Q

imaging of choice to look for abd trauma?

A

Abd CT, most treated conservatory

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32
Q

eye punch, 24-72 hrs later w/ red eye, pain, vision issues, constricted pupil

A

post traumatic iritis

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33
Q

hyphema 2/2 complication in next week

A

rebleeding

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34
Q

teardrop shaped pupil, irregular

A

ruptured globe

35
Q

indication for burn center referral

A
  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
Q

BSA in babies rules

A

head 18%, trunk 18%, legs 14%, arms 9% each

37
Q

Frx w/ high rate of abuse:

A

rib, metaphyseal chip, spine/scapula, complex skull

38
Q

spiral humeral frx is what?

39
Q

Most common growth plate injury

40
Q

abuse fractures (3)

A

metaphyseal chip/corner bucket handle fractures
posterior ribs
spiral diaphyseal fractures of humerus

41
Q

wounds that should close by secondary intention

A

animal bites unless on face, human bites on MCP joints (incr risk infx)

42
Q

antidote for propanolol

43
Q

toxidrome: incr HR, BP, RR, Temp
Agitation and possible seizures/psychosis, sweating, big pupils

Types?

A

sympathomimetic: amphetamine, cocaine, pseudophed, caffeine, albuterol

44
Q

toxidrome: High HR, BP, RR, Temp, altered MS, delirium, hallucinations, big pupils but DRY/FLUSHED skin, DRY mucus membranes, Urinary retention

Possible tx?

A

Anticholinergic (Mad, Dry, Hot, Red)…
Antihistamine, TCA, antispasmodic, jimsonweed, atropine

Tx: ?physostigmine?

45
Q

toxidrome:

Incr RR, temp, nl HR and BP, Confusion-> coma, small pupils, sweaty/diaphroetic, bronchorrhea, vomiting/diarrhea

A

Cholinergic / Anticholinesterase (Organophosphate pesticides, nerve agents, nicotine)

46
Q

low HR, BP, RR, temp

euphoria then lethargy, coma, miosis

A

opiates, clonidine, tetrahydrozyline eyedrops

47
Q

Hi HR, hi Temp, agitaiton, confusion, mania, coma

big pupils, hyperreflexia, myoclonus, akathisia, sz, rigidity

A

serotonin syndrome / ecstasy

48
Q

low BP, RR, temp, slurred speech, ataxia, decr MS, normal/big pupils, but sluggish

A

sedative/hypnotic: benzos, barbiturate, buspirone

49
Q

antidote for methanol or ethylene glycol

A

Fomepizole

50
Q

antidote for cholinesterase inhibitors?

A

Pralidoxime

51
Q

Antidote for digoxin

52
Q

antidote for tylenol? how does it work? s.e?

A

N acetylcysteine - binds directly to NAPQ1 to create a nontoxic metabolite
w/ IV form, can have anaphylaxis

53
Q

Stages of Acetaminophen tox correlate with what

A 
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
Q

likely toxic tylenol ingestion? How does it work to destroy liver?

A

> 10gm

Depletes glutathione stores

55
Q

acid base issue with salicylate OD

A

respiratory alkalosis and metabolic acidosis non gap

56
Q

mydriasis, tachycardia, anxiety, muscle tension leading to hyperthermia, seizure, hypoNa

Tx

A

hallcinogens (ecstasy, LSD, PCP, shrooms)

Tx: BZD, Nitroprusside for htn, IVF for rhabdo

57
Q

Endotracheal tube rule?
Child
Newborn
Infant

A

Uncuffed (age/4) + 4
For cuffed, go one size smaller

Term: 3.5mm uncuffed, 3 cuffed
Infants 4 / 3.5

58
Q

Depth of ET insertion?

Baby and >2y

A

ET tube size x 3

>2y: Depth = (age/2) +12

59
Q

most predictive of outcome in child submerged?

A

effectiveness of resuscitative efforts at scene

60
Q

Tx of flail chest?

What do you see?

A

tracheal intubation with PEEP (no more strapping of chest)

(ribs move in and out)/ paradoxical chest wall movement

61
Q

ET size

A

(age + 16) / 4

62
Q

meds you can give via ETT

A

LANE: Lidocaine, Atropine, Narcan, Epi

63
Q

formula to calculate tidal volume on the vent

64
Q

epi dose for anaphylactic

65
Q

coverage of cat bites?

Step 1 of bites

A

deep punctures: cover SA, Pasteurella multocida: Augmentin

Step 1: clean w/ high pressure irrigation

66
Q

red circle around white ring bite

A

brown recluse (loxosceles reclusa)

67
Q

bite with tiny puncture wound but htn and muscle aches/belly aches?

A

black widow (latrodectus mactans) spider bite

68
Q

acute management of snake bite

A

loose fitting constriction band

69
Q

Tx of hypothermia

A

40 degree IVF
gastric lavage w/ warm fluid
warm O2 42-46 degrees

70
Q

Riskier bites for rabies (3)

A
  1. close to brain
  2. unprovoked
  3. bat and woodchuck
71
Q

Tx of rabies suspicion

A

human rabies Ig

4 doses of rabies vaccine day 0,3,7,14

72
Q

risk of dilantin if given too fast

A

bradycardia

73
Q

drug for pump (cardiogenic) shock and drug for warm (vasodilation / septic) shock?

A

Dobutamine for heart

NE for warm shock

74
Q

Intubate for Glascow < what?

75
Q

normal glascow coma score

76
Q

3 components of GCS?

A 
eye opening score (1-4)
verbal score (no response - conversation 1-5)
Motor score (none - posturings - pain - commands: 1-6)
77
Q

clear rhinorrhea w/ sugar in it?

A

CSF: Basilar skull frx

78
Q

What is Caffey disease?

A

infantile cortical hyperostosis, fever, swelling of face, jaws, and cortical thickening of long/flat bones

79
Q

Type of fracture expected in a boy aged 5-8 falling on outstretched arm

A

supracondylar fracture

80
Q

injury in 11-15 yr old who fell onto outstretched partially extended arm

A

dislocation of elbow w/ ? neurovasc compromise

81
Q

direct impact w/ arm laterally rotated causes what injury?

A

epiphyseal fracture

82
Q

palpable step off of anterior shoulder joint without crepitus?

A

AC separation

83
Q

Methanol ingestion

A

visual changes

84
Q

lithium ingestion

A

DI/polyuria

85
Q

ethylene glycol ingestion

A

calcium oxalate crystals in urine

Laughing Pedi (24 decks)

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