ED/Critical Care Flashcards
- bradycardia
- HTN
- Irregular respirations
Cushing Triad
- tachycardia, muscle rigidity, increased CO2, acidosis, and fever following administration of general anesthesia
- Tx: hyperventilation, oxygen, and dantrolene
Malignant Hyperthermia
- heart rate that increases with crying
- soft vibratory ejection murmur
- intermittent brisk jugular venous pulse wave of the neck
Complete Heart Block
- fatigue, vomiting, HA, muscle weakness, wt loss, and salt wasting
- hypoglycemia, hyperkalemia, hyponatremia, elevated ADH
Adrenal Insufficiency
- afebrile pt presenting with seizure, no trauma, previous seizure history, and developmentally normal
- may have spent a lot of time swimming
- hyponatremia
Water Intoxication
When can a near drowning patient be discharged home?
- submerged for less than 1 minute
- no LOC
- no resuscitation required
What are the risks for future deterioration in a near drowning patient?
- history of apnea or CPR in the field
- seizure or disorientation or respiratory failure
- arterial desaturation and/or tachypnea
- pulmonary edema
- increased permeability of the alveolar capillary membranes
- Xray: fine reticular infiltrate
- worse after 8 hrs
- MOSF
Acute Respiratory Distress Syndrome
-next step in a pt with flail chest or hemothorax
Chest tube
-most helpful vent setting in a pt with ARDS
PEEP
- infant with poor wt gain, tachycardia, and tachypnea
- CXR: cardiomegaly
- EF < 25%
- tricuspid or mitral valve regurg
- Tx: Lasix for acute failure
Acute Heart Failure
- FTT and poor feeding
- Tx: ACE inhibitor
Chronic Heart Failure
- gray color, poor cap refill, thready pulses
- develop gallop, HSM, and JVD after fluid resuscitation
Cardiogenic Shock
- presents with muffled heart sounds and pulsus paradoxus
- decreased blood pressure during inspiration
Cardiac Tamponade
- irreversible absence of cardiorespiratory function
- absence of carotid artery blood flow
- Dx: radionucleotide scan or angiography
Brain Death
- -elevated serum ammonia
- change in mental status
- chronic tremor and anxiety (Wilson’s)
Liver Failure
- Lidocaine
- Atropine
- Narcan
- Epinephrine
Meds that can be given by ETT
- hypocalcemia
- Hyperkalemia
- CCB ingestion
- hypermagnesemia
Indications for Calcium administration
-morning stiffness, evanescent rash, and fever for over a week
JRA
-patient most in need of antipyretics
pt with CHF (reduces cardiac output demand)
-what bugs to cover for in cat bites
anaerobes, S. aureus, and pasturella
-most important first step in management of bite wounds
high pressure irrigation
When are Abx indicated for lacerations?
Dirty cuts Crush injuries Cat bites Bites that penetrate cartilage Cuticles (feet and extremities) Immunocompromised
- self limited local painful lesion caused by spider bite
- target lesion with a red circle surrounding a white ring that appears within hours
- Tx: supportive
Brown Recluse Spider Bite
- spider bite that appears as a puncture wound
- symptoms within 8 hours inclde muscle aches and HTN
- Tx: narcotics and anti-hypertensives
Black widow
-best initial treatment for hypothermia
Internal rewarming
- Risks: bites closer to the brain, unprovoked, unvaccinated animal
- uncommon in small rodents
- MC in carnivores (esp bat), also the woodchuck
- Tx: wash and debride, HRIG, vaccine
- observe if animal is domestic
Rabies
What happens when phenytoin is given too rapidly?
Bradycardia
-bloody discharge from the ear or hemotympanum
Temporal Bone Fracture
-atraumatic tap with lots of RBCs
Epidural hematoma
-poor prognosis for coma
Cerebral Bleeding
Brain Edema
Coma lasting longer than 6 hrs
- clear rhinorrhea
- bruising over the mastoid bone or black and blue eyes, abducens CN palsy
Basilar Skull fracture
-treatment of nasal septal hematoma or cauliflower ear
ENT C/S for drainage
- within 3 months of life
- fever, swelling of the tissues of the face, jaws, and cortical thickening of the long and facial bones
- mimics NAT
Infantile cortical hyperostosis (Caffrey Disease)
-what disease could periorbital ecchymoses indicate?
Neuroblastoma
- bucket handle fractures
- corner fractures (due to pulling an extremity)
- spiral fractures in infants
- rib fractures
- multiple skull fractures
- spinous process fractures
- scapula fractures
- sternum fractures
Fractures due to abuse
- fracture caused by falling on an outstretched arm that is hyperextended at the elbow
- at risk for neurovascular compromise
- pallor, cyanosis of the distal extremity, pain on passive extension of the fingers
- Dx: posterior fat pad on Xray
Supracondylar fx
- fall on outstretched arm or directly on the shoulder
- holding arm with opposite hand
- most heal without intervention
- medial fracture with ant or post displacement at risk for possible displacement of the trachea or mediastinal structures
- Tx: shoulder immobilization
Clavicle fracture
- palpable step off of the right shoulder joint in the absence of creptius
- older skeletally mature teens
- pain over the distal clavicle with point tenderness over the superior aspect
- cannot raise arm above head
AC separation
- fall on an outstretched hand
- cortex and periosteum remain intact
- one side is broken, the other is bent
Greenstick fx
-a head CT is indicated for what symptoms following head trauma
prolonged LOC protracted vomiting progressing HA retrograde amnesia lethargy
-first step in a pt with suspected skull fracture or head bleed
ABCs
- full thickness burns
- distinct margins
- varying depth
- sparing of the interdigital areas*
- stocking glove distriibution
Non-Accidental Burns
-first step in the treatment of burns
debridement and irrigation (Abx are not indicated)
-what is the rule of 9s?
Child older than 9 arms=9% each (9x1) legs= 18% each (9x2) trunk= 36% (9x3) head and neck= 10% (9x1) perineum- 1%
-the only positive culture the is definitive conformation of sexual abuse
Gonorrhea (chlamydia can be vertically transmitted and persists for up to 3 years)
- vaginal bleeding in an AA girl 3-8 years
- hyperemic donut shaped mass
- Tx: warm sitz baths and /u with urology
urethral prolapse
- HA, vomiting, high fever, delirium
- papules->vesicles->pustules->scabs
- lesions in the same stage of evolution
- Dx: pharyngeal swab, or culture the lesions
- spread by direct contact or airborne exposure
- AKA variola
- Tx: cidofovir (experimental)
Smallpox
