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Exam > ED + Ortho > Flashcards

ED + Ortho Flashcards

1
Q

Serotonin syndrome- medications

A 
TCA
MAOIs
SSRI
St Johns Wart
Amphetamines
Tramadol
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2
Q

Serotonin syndrome clinical featuress

A

Hyperreflexia, tremor, clonus (greater in lower extremities)
Autonomic instability- hypertensive, tachycardia
Agitations
Diaphoresis
Mydriasis
Increased bowel sounds and diarrhoea
Abrupt onset, rapidly resolving

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3
Q

Neuroleptic malignant syndrome

A

Idiosyncratic reaction to neuroleptic or antipsychotic drugs
Onset 4-14 days post commencement of Rx
Rx is stopping meds immediately
SYmptoms resolve within 1-2 weeks

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4
Q

Neuroleptic malignant syndrome clinical features

A 
Hyperthermia, sweating
Autonomic dysfunction- unstable BP
Stupor
Gradual onset, prolonged course
DIffuse rigifity, decreased reflexes
Normal pupils
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5
Q

Beta blocker overdose

A

Altered mental status
Bradycardia- ECG can show sinus brady, abnormal AV node conduction or accelerated junctional rhythm
Hypotension

Rx: glucagon

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6
Q

Digoxin overdose

A

Altered mental status, bradycardia, hypotension
Hyperkalaemia (distiguishes from beta blocker)
Also AV dissociation (1st-3rd degree heart block)

Rx: digoxin-specific antibody

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7
Q

Calcium channel blocker overdose

A

Altered mental status
Bradycardia- ECG can show sinus brady, abnormal AV node conduction or accelerated junctional rhythm
Hypotension

Rx: high dose insulin therapy (increases ionotropy)

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8
Q

TCA overdose

A 
Rapid onset (1-2 hours) of:
Sedation and coma
Seizures
Tachycardia, hypotension
Broad complex dysrythmias eg. long QT
Anticholinergic syndrome

QRS >100ms is predictive of seizures
QRS >160ms is predictive of ventricular arrhytmias

Rx: sodium bicarbonate

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9
Q

Colchicine overdose

A

Rapidly absorbed- peak serum concentration after 30 mins- 3 hours
50% protein bound
Gastro Sx within 24 hours

Mortality:
>0.5mg/kg = 10%
>0.8mg/kg = 100%

No antidote- give charcoal

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10
Q

Activated charcoal not useful or contraindicated

A

PHALIS

Pesticides, pertoleum distilates
Hydrocarbon (eg. inhalant abuse), heavy metals, >1 hour since ingestion
Acids, alkali, alcohols
Iron
Lithium
Solvents
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11
Q

One pill kill drugs
+
One mouthful can kill

A

Sodium channel blockers- hydroxychloroquine, propanolol, TCA, atropine
Calcium channel blockers- verapamil, diltiazem
Theophyline SR
Sulfonylureas
Amphetamines and ecstasy
Opiates- methadone, morphine, oxycodone
Colchicine

Organophosphates/carbamates
Paraquat
Napthalene (1 mothball)
Camphor
Hydrocarbons- kerosene, eucalyptus oil, solvents
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12
Q

Toxicology- things that are bad for fetuses

A

Carbon monoxide
Methhaemaglobin inducing agents- napthalene, dapsone
Lead
Salicylates

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13
Q

Anticholinergic examples

A

Atropine, scopolamine, glycopyrulate, benztropine, antihistamines

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14
Q

Anticholingeric clinical features

A 
Tachycardia, hypertension
Hyperthermic
Mydriasis
Absent bowel sounds
Dry flushed skin 
Urinary retention
Altered CNS, agitated
(Mad as a hatter, dry as a bone, blind as a bat, hot as a desert, red as a beet)
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15
Q

Cholinergic examples

A

Organic phosphate compounds, pilocarpine, mushrooms

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16
Q

Cholinergic clinical features

A 
Miosis, increased bowel sounds at diarrhoea, sweaty
Vomiting
Urination
Lacrimation
Bradycardia
SLUDGE BBB
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17
Q

Opiod OD clinical features

A 
Hypotensive, bradycardic
Slow RR
Cold
Miosis
Absent bowel sounds
Dry skin
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18
Q

Sympathomimetic examples

A

Caffeine, cocaine, amphetamines, ritalin, LSD, theophyline, MDMA

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19
Q

Sympathomimetic clincial features

A

Tachycardic, hypertensive, tachypnoeic, hyperthermic
Mydriasis
Increased bowel sounds
Sweaty

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20
Q

Sedaive-hypnotic OD clinical features

A

Hypotensive, bradycardic, low RR, hypothermic
Absent bowel sounds
No change in pupils- distiguisges from opiates

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21
Q

Isoniazid OD

A

Pyridoxime

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22
Q

Methemoglobinaemia Rx

A

Methylene blue

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23
Q

Ethylene glycol OD Rx

A

Ethanol

Fomipazole

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24
Q

Iron OD Rx

A

Desferroxamine

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25
Q

Sulphoyulureas OD Rx

A

Octreotide (inhibitis insulin release)

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26
Q

Benzo OD Rx

A

Flumazanil

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27
Q

% of children with major abdominal trauma requiring operative intervention

A

<15%

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28
Q

% of children admitted to paediatric trauma centre with abdo injuries

A

~8%

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29
Q

Major causes of traumatic death in childhood

A

Head and thoracic injuries

30
Q

Abdo injuy occurs in what % of children with fatal injuries

A

22%

31
Q

Hematuria in trauma

A

RCC > 30 = further imaging (usually CT abdo)

In the absence of genitalia injury, external urethral injuries are unlikely

32
Q

Complications of septal haematoma

A

Cartilage necrosis

Septal perforation

33
Q

Nasal injury

A

XR nasal bones not useful
Can only detect # once swelling settled- d/c and review in 5/7
ENT ref as OPD if fracture found

34
Q

Neurogenic shock

A

Any factor which stimulates PNS or inhibits SNS activity of vascular smooth muscles = vasodilation, bradycardia

Causes: spinal cord injury above T5, spinal anaesthseia, vasomoptor centre depression eg. severe pain, drugs, hypoglycaemia

Resolves over weeks

35
Q

Spinal shock

A

Not true shock
Caused by spinal cord oedema
Inhibits sensory/motor/reflexes
Resolves over days to weeks

36
Q

Spinal cord levels motor actions

A 
C4- shrug shoulders
C5- flex elbow
C6- extend wrist
C7- extend elbow
C8- open and close fingers
T1- abduct fingers
L1/L2- flex hip
L3- extend knee
L4- dorsiflex ankle
L5/S1- plantarflex ankle
37
Q

Superior orbial wall fracture

A

Results in pulsating proptosis

Nerve entrapment = cannot look down

38
Q

Organisms suspected in human bites

A

Eikenella corrodens- gram neg rod, killed by penicillins and 3rd gen cephalosporins (not cephalexin)

Also staph, strep

39
Q

Organisms suspected in rat bite

A

Streprobacillus moniliformis

40
Q

Organisms suspected in cat/dog bites

A

Pasteurella multicoda

41
Q

Haemorrhage from escar separation following an electrical burn

A

RIsk greatest 2-3 weeks post

42
Q

Lighetening related injuries

A 
Deafness
Amnesia
Prolonged QT
Seizure
Peripheral neuropathy (occurs over days)
43
Q

First aid for burns

A

Cooling should occur for 20 mins, effective up to 3 hours following injury
Optimal temp is 18 degrees
Can stop progression in the zone of stasis

44
Q

Half life IV ketamine

A

2-3 hours (peak 1 min)

45
Q

Half like propofol

A

30-60 mins

46
Q

Half life PO midazolam

A

2-4 hours

47
Q

Half life chloral

A

8- 10 hours

48
Q

Side effects of keatmine

A 
Tachycardia
Laryngospasms
Hypertension
Vomiting
Nightmares
Emergent reactions
Hypersalivation
??Increased ICP

Also cases bronchodilation

49
Q

Which sedative is associated with chest wall rigidity

A

Fentanyl

50
Q

Contraindications to nitrous oxide

A

Gas filled space eg. PTX, bowel obstruction
Severe head injuries (potential for pneumocranium)
Intoxication/depressed consciousness state
Pregnancy
Requiring FiO2 >50%

51
Q

Adverse effects nitrous oxide

A

Vomiting 5-10%

Dysphoria 1%

52
Q

Gastric foreign bodies

A 
Most will pas in 4-6 days
Conservtive Mx not appripriate if:
- Button battery (in the somtach can be allowed to pass, but must be followed radiographically to observe for disruption of the battery- if does not pass the stomach in 1-2 days needs endoscopic removal)
- >1 Magnet
- Longer than 5cm
- Diameter >25mm

Weekly radiograph

53
Q

Commotio cordis

A

Ventricular fibrillation occurs when a chest impact is delivered 10-30ms before the T wave peak (4% of the cardiac cycle)

54
Q

ETT size uncuffed

A

Age/4 + 4

55
Q

ETT size cuffed

A

Age/4 + 3

56
Q

ETT measurment lip

A

Age/2 + 12
OR
ETT x 3

57
Q

ETT measurment at nose

A

Age/2 + 15

58
Q

Weight estimate 1-10 years

A

(Age + 4) x 2

59
Q

99m Technetrium pertechnetate scan for Meckels sens and spec

A

+ and - PV 0.93
However, if lower GI bleeding and Hb <110 only has sens of 0.6 (still 26% chance of Meckels even with negative scan)
Sens improved by ranitidine

60
Q

Scaphoid fracture

A

Pain on dorsiflexion of the wrist, tenderness in snuff box, pain on gripping
Can have normal XR for the first few days
Needs complete below elbow ccase with thumb spica- remove if normal XR after 2 weeks
Complications- AVN of proximal fragment, non-union

61
Q

Supracondylar fracture

A

Posterior fat pad
7% have radial nerve injury

Gartland classification:
1= non displaced
2 = displaced with intact posterior cortex
3= displaced with no cortical contact

62
Q

Monteggia

A

Proximal ulnar fracture + radial head dislocation

63
Q

Anterior humeral line

A

Runs down the antrior surface of the distal humerus, should intersect with the middle 3rd of the capitellum- detects supracondylar #

64
Q

Radiocapitellar line

A

Central axis of the radius, intersects with the head of capitellum- detects radial head dislocation

65
Q

Ossification centres of the elbow

A

CRITOE

Capitellum (age 1)
Radial head
Internal (medial) epicondyle
Trochlea
Olecranon
External epicondyle
66
Q

Klein’s line

A

Line along superior aspect of the femoral neck- should intersect part of the proximal femoral epiphysis (if not consider SUFE)

67
Q

Time for XR changes to become apparent in osteomyelitis

A

7-10 days

68
Q

Indications to give sodium bicarbonate in TCA OD

A

QRS >100ms
Ventricular dysrhythmias
Hypotension

Goal of therapy is pH 7.45-7.55, haemodynamic stability and narrowing of the QRS complex

MOA: Na load overcomes the Na channel blockade, and alkalosis decreases the drug binding to Na channels

69
Q

Salicylate OD clinical features

A 
Nausea, vomiting, diaphoresis, tinnitus (early)
Tachypnoea, tachycardia
Altered mental status
Hyperthermia
Seizures
Resp alkalosis and primary anion gap MA
70
Q

Perthes

A

Temporary interruption of the blood supply to the proximal femoral epiphysis -> osteonecrosis and femoral head deformity
Assoc with thrombophilia, FVL, protein C/S deficiencyx, lupus anticoagulant etc
MC boys than girls
4-8 years
Bilateral 10%

71
Q

Toddler fracture

A

1-4 yrs
Occur after a seemingly harmless twist or fall
Non-displaced spiral # of the distal tibial metaphysis
Above knee cast for 3 weeks

Exam (16 decks)

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