Critical Care/ER Flashcards
1
Q
Malignant hyperthermia symptoms and genetics
A
- 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
2
Q
Causes of malignant hyperthermia
A
Succinylcholine, inhaled anesthetics (halothane, isoflurane, desflurane)
3
Q
Signs of bad prognosis for drowning
A
- 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
4
Q
Flail chest symptoms and treatment
A
- Paradoxical chest wall movements
- 2 or more rib fractures in 2 or more locations
- Tx: Chest tube if respiratory distress
5
Q
Pediatric CPR rules
A
- 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
6
Q
Indication for IV antibiotics in burn patients
A
- Change in appearance of the wound including new discoloration is most suggestive of an infection
- Major infections: wound infections, pneumonia, bloostream infections, UTIs
7
Q
Causes of right shift of Hgb-dissociation curve
A
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)
8
Q
Pressor for cold shock
A
Epinephrine (beta activity)
9
Q
Pressor for warm shock
A
Norepinephrine (alpha activity)
10
Q
Order for treatment of shock
A
- Fluid boluses (60/kg) + antibiotics
- Norepinephrine
- Epinephrine
- Vasopressin
- Steroids
11
Q
Vitals in neurogenic shock
A
Hypotension and bradycardia
12
Q
Treatment of anaphylactic shock
A
Epinephrine
Steroids
Anti-histamines
13
Q
Brain death criteria
A
- 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
14
Q
Requirement for organ donation
A
EITHER cardiac OR brain death
15
Q
Brain death exam cranial nerves
A
- 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
16
Q
Complications of specific face laceration
A
- 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
17
Q
Sequelae of puncture wounds
A
Cellulitis, osteomyelitis, foreign body, septic joint
18
Q
ET tube size rules
A
Child’s age dived by 4 plus 4
19
Q
Things to think about with acute decompensation in an intubated patient
A
DOPE
- Displacement of ETT
- Obstruction of ETT
- Pneumothorax
- Equipment failure
20
Q
Definition of BRUE
A
- Sudden alteration in breathing, cyanosis/pallor, change in tone, altered level of responsviness, recovered successfully with no medical intervention
21
Q
Low risk BRUE symptoms
A
- Age > 60 days
- Gestational age > 32 weeks
- First episode
- Duration < 1 minute
- No CPR by a trained medical provider
22
Q
Shape of dog/human/cat bites
A
- Human: half moon
- Dog: tear
- Cat: puncture
23
Q
Treatment with antibiotics for dog and cat bites
A
- Augmentin (to cover Staph and pasturella) or cephalosporins or clinda plus bactrim
- Especially if on hands, feet, genitals, or face
24
Q
Brown recluse spider bite/management
A
- Target lesion –> appears within hours
- Bite becomes necrotic
- Self limited
25
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
26
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
27
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
28
Indications for neurosurgical consultation
- Depressed skull fractures, basilar skull fractures, skull fractures with intracranial injury
29
Temporal bone fracture symptoms
- Visible bleeding from the ear or hemotypmanum
- Hearing loss, facial paraylsis
- CSF otorrhea
30
Basilar skull fracture symptoms
- Clear rhinorrhea, clear otorrhea (actually CSF)
| - Bruising behind ear (battle sign) or under eyes (raccoon eyes)
31
Signs that a burn was non-accidental
Clear demarcation, stocking glove distribution, full thickness burns
32
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
33
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)
34
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%
35
Most sensitive imaging to look for foreign body in a wound
Ultrasound
36
Things to think about with human bite
HIV/Hepatitis B status
| - If deep wound or hand/foot the need antibiotics
37
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
38
Contraindication to bladder cath
Suspected urethral trauma (often a/w pelvic fx) - blood at urethral meatus or gross hematuria
39
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
