Critical Care/ER Flashcards
Malignant hyperthermia symptoms and genetics
- Defect in skeletal muscle calcium homeostasis
- Prolonged opening of ryanodine receptor leads to an excess of cytosolic calcium and prolonged muscle contraction
- Increased oxygen consumption –> lactic acidosis, hyperthermia, hypoxia, hypercarbia
- TX: DANTROLENE
Causes of malignant hyperthermia
Succinylcholine, inhaled anesthetics (halothane, isoflurane, desflurane)
Signs of bad prognosis for drowning
- Submersion > 25 minutes
- > 25 minutes of CPR at the scene
- Apnea or coma at admission
- Need for cardiac meds to establish perfusing rhythm
- Initial arterial pH of < 7.1
Flail chest symptoms and treatment
- Paradoxical chest wall movements
- 2 or more rib fractures in 2 or more locations
- Tx: Chest tube if respiratory distress
Pediatric CPR rules
- 1/3 to 1/2 of the anteroposterior depth of the chest
- Rate of 100/minute with complete chest recoil
- One rescuer: 30 compressions to 2 ventilations
- Two rescuer: 15 compressions to 2 ventilations
- If you have an airway: ventilation should be 1 breath every 6 seconds and CPR continuously at 100/minute
Indication for IV antibiotics in burn patients
- Change in appearance of the wound including new discoloration is most suggestive of an infection
- Major infections: wound infections, pneumonia, bloostream infections, UTIs
Causes of right shift of Hgb-dissociation curve
CADET C: Increased CO2 A: Acidosis D: DPG E: Exercise T: Temperature
- Right shift means oxygen is extracted easier at the tissue level (tissues need more oxygen)
Pressor for cold shock
Epinephrine (beta activity)
Pressor for warm shock
Norepinephrine (alpha activity)
Order for treatment of shock
- Fluid boluses (60/kg) + antibiotics
- Norepinephrine
- Epinephrine
- Vasopressin
- Steroids
Vitals in neurogenic shock
Hypotension and bradycardia
Treatment of anaphylactic shock
Epinephrine
Steroids
Anti-histamines
Brain death criteria
- Known and irreveresible cause of coma
- Absence of hypotension, hypothermia, metabolic abnormalities, sedating effect of medication
- Two brain death exams by different physicians done 12-24 hours apart (must have absence of brainstem reflexes including reflex to breathe)
- No ancillary studies are necessary
Requirement for organ donation
EITHER cardiac OR brain death
Brain death exam cranial nerves
- Pupillary (fixed/dilated): CN II and III
- Corneal reflex: CN V and VII
- Vestibulo-occular: CN VI and VIII (Normal cold opposite warm same: COWS)
- Occulocephalic (Doll’s eyes): CN III, IV, VI, VIII
- Tracheal (Cough/gag): CN IX
Complications of specific face laceration
- Vermillion border - line that up first
- Forehead - rule out fracture
- Eyebrow - may have poor hair regrowth
- Eyelid - may have lacrimal duct injuries, globe injury, or muscle injury
- Ear - can get cartilage necrosis
Sequelae of puncture wounds
Cellulitis, osteomyelitis, foreign body, septic joint
ET tube size rules
Child’s age dived by 4 plus 4
Things to think about with acute decompensation in an intubated patient
DOPE
- Displacement of ETT
- Obstruction of ETT
- Pneumothorax
- Equipment failure
Definition of BRUE
- Sudden alteration in breathing, cyanosis/pallor, change in tone, altered level of responsviness, recovered successfully with no medical intervention
Low risk BRUE symptoms
- Age > 60 days
- Gestational age > 32 weeks
- First episode
- Duration < 1 minute
- No CPR by a trained medical provider
Shape of dog/human/cat bites
- Human: half moon
- Dog: tear
- Cat: puncture
Treatment with antibiotics for dog and cat bites
- Augmentin (to cover Staph and pasturella) or cephalosporins or clinda plus bactrim
- Especially if on hands, feet, genitals, or face
Brown recluse spider bite/management
- Target lesion –> appears within hours
- Bite becomes necrotic
- Self limited
Black widow spider bite/management
- Puncture wound
- Muscle aches and hypertension within 8 hours
- Tx: local wound care, tetanus prophylaxis, benzos for severe muscle spasms, antivenom if supportive measure don’t work
Snake bite/management
- Venomous snakes: triangular head/fangs, red/yellow
- Non-venomous: round face
- Local erythema/swelling followed by enlarged lymph nodes
- If venomous: immobilize the limb and let it hang at patient’s side, antivenom if symptoms of coauglopathy/hypotension
Linear skull fractures characteristics
- Most common type in kids
- Often in the parietal region
- 15-30% have underlying intracranial injury
- Can have scalp hematomas (predictive of skull fractures in kids < 1 year if non-frontal)
- Diagnosis is by CT, not xray
Indications for neurosurgical consultation
- Depressed skull fractures, basilar skull fractures, skull fractures with intracranial injury
Temporal bone fracture symptoms
- Visible bleeding from the ear or hemotypmanum
- Hearing loss, facial paraylsis
- CSF otorrhea
Basilar skull fracture symptoms
- Clear rhinorrhea, clear otorrhea (actually CSF)
- Bruising behind ear (battle sign) or under eyes (raccoon eyes)
Signs that a burn was non-accidental
Clear demarcation, stocking glove distribution, full thickness burns
Burns that have to get sent to a referral center
- Moderate or severe burns ( > 10% TBSA)
- Any full thickness burn
- Electrical or chemical burns
- Inhalation injuries
- Burns involving hands, feet, face, genitalia, perineum, or major joints
Burn thickness levels
- Superficial: only epidermis
- Partial thickness (second degree): epidermis and superficial dermis
- Full thickness (third degree): epidermis and dermis ( white/leathery with no pain)
Burns rule of 9s
- Arms: 9% each (4.5% front/back)
- Legs: 18% each (9% front/back)
- Trunk: 36% (18% front/back)
- Head and neck: 9% (4.5% front/back)
- Perineum: 1%
Most sensitive imaging to look for foreign body in a wound
Ultrasound
Things to think about with human bite
HIV/Hepatitis B status
- If deep wound or hand/foot the need antibiotics
Management of abdominal trauma with hematuria
- Rectal exam to assess for neuro status and blood
- Assess pelvis stability
- Assess for blood at the urethra
- FAST
- CT is standard of care when suspecting abdominal injuries
Contraindication to bladder cath
Suspected urethral trauma (often a/w pelvic fx) - blood at urethral meatus or gross hematuria
Clinical findings with subluxation of the radial head
- Hold arm flexed to body, imaging normal, no tenderness/swelling at the elbow (nursemaid’s elbow)
- Age 6 months to 5 years
