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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
Sulphoyulureas OD Rx
Octreotide (inhibitis insulin release)
26
Benzo OD Rx
Flumazanil
27
% of children with major abdominal trauma requiring operative intervention
<15%
28
% of children admitted to paediatric trauma centre with abdo injuries
~8%
29
Major causes of traumatic death in childhood
Head and thoracic injuries
30
Abdo injuy occurs in what % of children with fatal injuries
22%
31
Hematuria in trauma
RCC > 30 = further imaging (usually CT abdo) | In the absence of genitalia injury, external urethral injuries are unlikely
32
Complications of septal haematoma
Cartilage necrosis | Septal perforation
33
Nasal injury
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
Neurogenic shock
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
Spinal shock
Not true shock Caused by spinal cord oedema Inhibits sensory/motor/reflexes Resolves over days to weeks
36
Spinal cord levels motor actions
``` 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
Superior orbial wall fracture
Results in pulsating proptosis | Nerve entrapment = cannot look down
38
Organisms suspected in human bites
Eikenella corrodens- gram neg rod, killed by penicillins and 3rd gen cephalosporins (not cephalexin) Also staph, strep
39
Organisms suspected in rat bite
Streprobacillus moniliformis
40
Organisms suspected in cat/dog bites
Pasteurella multicoda
41
Haemorrhage from escar separation following an electrical burn
RIsk greatest 2-3 weeks post
42
Lighetening related injuries
``` Deafness Amnesia Prolonged QT Seizure Peripheral neuropathy (occurs over days) ```
43
First aid for burns
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
Half life IV ketamine
2-3 hours (peak 1 min)
45
Half like propofol
30-60 mins
46
Half life PO midazolam
2-4 hours
47
Half life chloral
8- 10 hours
48
Side effects of keatmine
``` Tachycardia Laryngospasms Hypertension Vomiting Nightmares Emergent reactions Hypersalivation ??Increased ICP ``` Also cases bronchodilation
49
Which sedative is associated with chest wall rigidity
Fentanyl
50
Contraindications to nitrous oxide
Gas filled space eg. PTX, bowel obstruction Severe head injuries (potential for pneumocranium) Intoxication/depressed consciousness state Pregnancy Requiring FiO2 >50%
51
Adverse effects nitrous oxide
Vomiting 5-10% | Dysphoria 1%
52
Gastric foreign bodies
``` 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
Commotio cordis
Ventricular fibrillation occurs when a chest impact is delivered 10-30ms before the T wave peak (4% of the cardiac cycle)
54
ETT size uncuffed
Age/4 + 4
55
ETT size cuffed
Age/4 + 3
56
ETT measurment lip
Age/2 + 12 OR ETT x 3
57
ETT measurment at nose
Age/2 + 15
58
Weight estimate 1-10 years
(Age + 4) x 2
59
99m Technetrium pertechnetate scan for Meckels sens and spec
+ 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
Scaphoid fracture
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
Supracondylar fracture
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
Monteggia
Proximal ulnar fracture + radial head dislocation
63
Anterior humeral line
Runs down the antrior surface of the distal humerus, should intersect with the middle 3rd of the capitellum- detects supracondylar #
64
Radiocapitellar line
Central axis of the radius, intersects with the head of capitellum- detects radial head dislocation
65
Ossification centres of the elbow
CRITOE ``` Capitellum (age 1) Radial head Internal (medial) epicondyle Trochlea Olecranon External epicondyle ```
66
Klein's line
Line along superior aspect of the femoral neck- should intersect part of the proximal femoral epiphysis (if not consider SUFE)
67
Time for XR changes to become apparent in osteomyelitis
7-10 days
68
Indications to give sodium bicarbonate in TCA OD
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
Salicylate OD clinical features
``` Nausea, vomiting, diaphoresis, tinnitus (early) Tachypnoea, tachycardia Altered mental status Hyperthermia Seizures Resp alkalosis and primary anion gap MA ```
70
Perthes
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
Toddler fracture
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

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