ED Flashcards
Neck xrays
What are the 4 lines to follow
How big should the retropharyngeal space be
Ant and post vertebral, spinolaminal and spinous process tips
< half a vert body at c2
< full at c6
Is c2/3 subluxation normal in children
Yes!
What is a c2 pedicel fracture otherwise called
How is it seen
Hangman fracture
Open mouth views
What happens in a Jefferson fracture
Burst fracture of c1
Do wedge fractures risk the spinal cord?
No!
What is the treatment for a scaphoid fracture
What are the 2 possible bad outcomes
Short arm cast with thumb extension
AVN or non union
How are epicondyle avulsion fractures seen
What is the mnemonic
Abnormal ossification centres
CRITOE
What upper arm fracture can damage the median nerve
Supracoldylar
What is seen on a monteggias fracture
Which line is lost?
Displacement of the radial head and ulnar fracture-
Lose radiocapitellar lines
What does a posterior fat pad indicate
Supracondylar fracture
What age does a sufe occur
If not obesity what rarely can cause it
How is it best seen on X-ray
12 years
Hypothyroidism or growth hormone deficiency
Loss of klein line
How does perches disease look differently to sufe on X-rays
What usually causes it
Klein line is normal, femoral head is irregular
Idiopathic
Where are they tender
Osgood schlater disease
Sinding larding johansen
Tibial tuberosity
Higher- inf patellar pole
Which toxins should not be given activated charcoal
P- pesticides and petroleum H- hydrocarbons and heavy metal A- acids alcohol and alkali I- iron L- lithium S- solvents
What should not be used in seizures with toxic ingestion
Phenytoin
What can hyperthermia predict in toxic ingestion
What should be done for a temp >39 degrees
Multi organ failure
Neuromuscular paralysis and intubation
Name the antidote TCA Organophosphate Lead Iron
Sodium bicarb
Atropine
Dimercalprol
Deferoxamine
Name the antidote Salicylates Methanol Benzodiazepines Beta blockers Ca channel blockers
Na bicarb Ethanol Flumazenil High dose insulin Ca infusion and “
What overdose might you use multi dose charcoal for?
Carbamazepine
What ingestion might you use urinary alkinisation for
Salicylates
What are the features of an anticholinergic toxidrome
What meds can cause it
Agitated confused and picking at objects. Dry. Tachycardic. Big pupils. Reduced or absent bowel sounds. Urinary retention
Antihistamines and TCAs
What are the symptoms of a cholinergic toxidrome
What meds can cause it
What is the specific treatment. How much do you give
Copious secretions, lots of urine. Vomiting and diarrhoea. Eventual resp depression. Pinpoint pupils
Organophosphates, mushrooms, nerve agents
Atropine until the secretions stop!
What are symptoms of a sympathomimetic toxidrome?
What meds cause it?
Tachycardia and sweating. Big pupils. Raised temp
Ecstasy, MDMA. Ritalin
What are symptoms of serotin syndrome
What usually causes it
Give examples of meds
Clonus, agitation, big pupils and sweating
Swapping meds or multiple meds
SSRIs with fentanyl or tramadol
How is neuroleptic malignant syndrome different to serotonin syndrome
Slower onset
No pupil change
More rigid with no clonus normally
What three views are needed in a c spine series
AP and lateral neck views
PEG view
Where are c spine injuries likely to be in
Infants
Older children
C1-3
C3-7
What agents should be used for rapid sequence induction in trauma
Ketamine and rocuronium
Trauma
What additional products are given to replace
Low fibrinogen
Prolonged APTT
Cryoprecipitate
FFP
What is a common injury in the abdomen seen with handlebars
Duodenal perforation
How much haematuria warrants a CT abdomen
> 30
What is a likely organism seen in fight bites
Which is a good antibiotic to use
Eikinella
Augmentin
Burns
How long should they be cooled for
What is different about the rule of 9s In babies
What is the ideal temp of water
20 mins
Babies heads are 18% not 9
18 degrees
When is the biggest risk of bleeding from Eschar formation
2-3 weeks
What is the biggest side effect of ketamine
Does proposal provide analgesia
Laryngospasm
No!
What 4 scenarios make a foreign body unable to be conservatively managed
Batteries
Magnets
>$2 coin (>25mm)
Longer than 5cms
What dose of adrenaline is given in cardiac arrest
What energy is given in J for defibrillation
10microgram/kg of 1:10000
4J/kg
What strengh of adrenaline is given in anaphylaxis in community
In hospial? Dose?
What strength of adrenaline is used in resus? What dose
1: 1000
0. 1ml/kg 1:10000 or 0.01ml/kg of 1:1000 (always 5 zeros!!)
10 micro grams per kg of 1:10000
What is the algorithm for vt with pulse and no shock
“With shock
What can amiodarone cause
If there is torsades what should be given
Amiodarone infusion then synchronised shocks
Shock 1j/kg then 2j/kg and amiodarone infusion
Hypotension
Magnesium sulfate
Catecholaminergic polymorphic VT What causes it What is seen on ecg What happens with adrenaline What is the treatment
AD channelopathy
Frequent ventricular ectopics
Polymorphic VT
IV morphine
What weight is a size 2 LMA useful for
<20kg
How do you calculate estimated weight
(Age+4) x 2
What age group should uncuffed ETTs be used
How are they measured
<8yrs
(Age/4) +4
What physiologically happens In Paracetamol overdose
How does NAC help this
Depletes glutathione stores and builds up NAPQI
Replenishes your stores
