ED

Question 0

True or false. You cannot draw labs from an IO line

Answer 0

False.

Most labs (BMP) can be drawn off an IO. 
CBC cannot.

Question 1

A child presents to ED with suspected DKA. What are first steps in management?

Answer 1

1. Get your labs (bmp, vbg, ua)
2. Start isotonic IVF ( NO K+) at 10 ml/kg run over 1 hour
3. After those fluids doe, IVF (NS + 20 KCL + 20 KPhos) to rehydrate maintenance + estimated fluid deficit evenly over next 48 hours
4. In second hour start continuous I sulking infusion 0.1 units/kg/hr

Question 2

What is the differential diagnosis for a 4 day old who presents to the ED with altered mental status and looks like she is in shock?

What is the acronym?

Answer 2

=the misfits
T= trauma (NAT or accidental)
H= heart disease and hypovolemia
E= endocrine (CAH)
M= metabolic (electrolytes)
I= inborn errors of metabolism
S=sepsis
F= formula mishaps 
I= intestinal catastrophes  (volvulus, nec, intususception)
T= toxins and poisons
S= seizures

Question 3

What is the differential diagnosis for the child who presents with confusion and lethargy(AMS). What is the acronym?

Answer 3

=AEIOU TIPS
A= alcohol, abuse of substances
E= epilepsy, encephalopathy, electrolyte issues, endocrine
I= insulin, intususception 
O= overdose, oxygen deficiency
U= uremia
T= trauma. (NAT), temp abnormal, tumor
I= infection
P= poisoning, psych conditions
S= shock, stroke, space occupying lesion (brain)

Question 4

What are 3 things that can give you a heart rate over 200?

Answer 4

1. SVT
2. Sepsis
3. Ingestions

SVT. Look for limited variability in the heart rate

Question 5

What’s the differential diagnosis of a febrile seizure?

Answer 5

1. Infection (meningitis, shigella, roseola)
2. Trauma
3. Toxic ingestion

Question 6

What’s the definition of a simple febrile seizure? What makes it complex?

Answer 6

Simple febrile sz

1. Generalized motor seizure
2. Short (< 10-15 min)
3. Does not recur in 24 hrs

Complex

1. Focal
2. Prolonged
3. Recurs within 24 hrs

Question 7

What is the typical age group for febrile seizures?

Answer 7

6 months to 6 years

Question 8

Risk factors for recurrence of febrile seizures?

Answer 8

1. Onset less than 1 year
2. Family hx of febrile seizures
3. Associated with low grade fever
4. Do not occur on the first day of illness

Question 9

When should a CT head always be performed Ina suspected concussed pt?

Answer 9

1. Altered mental status/ GCS< 15

2. Signs of basilar skull fracture

Question 10

Who with a concussion should undergo observation in ED? Wha else should you consider?

Answer 10

Also consider getting a head CT

LOC
Vomiting
Severe mechanism of injury
Severe or worsening headache

Question 11

True or false: you can get the same cold more than once.

Answer 11

True. Depending on the virus. Some viruses have waning immunity so you can get the same one again. Others have lasting immunity but many serotypes.

Question 12

How long does it take after inoculation with a cold virus to develop symptoms?

Answer 12

1-2 days

Question 13

Name 2 evidenced based txs for the common cold.

Answer 13

1. Nasal rinses

2. Honey

Question 14

True or false: RSV causes LRT infections in adults and colds in infants and adults.

Answer 14

False. LRTIs in infants/toddlers, colds in adults