emergency Flashcards
1
Q
infants and toddlers, due to weak neck muscles, are prone to what type of head injuries
A
- acceleration-deceleration injuries -> shearing forces -> injury to neurons and vascular structures
2
Q
what are critical questions to ask when obtaining history about a peds head injury
A
- height?
- immediate cry
- consolability
- vomiting
- arousability (is it nap time)
3
Q
what are concerning signs after head injury when parents are worried about drowsiness
A
- excessively sleepy or hard to arouse
- vomiting
- irritability
4
Q
Primary survey of head injury in peds includes
A
- ABC
- Neuro: GCS
- vital signs
5
Q
what is cushings triad
A
- wide pulse pressure
- bradycardia
- abnormal respirations
6
Q
what are signs of basilar skull fx
A
- battle’s sign
- periorbital ecchymosis (raccoon eyes)
- hemotympanum
7
Q
When should you order a CT to evaluate head injury in peds < 2 yo
A
PECARN
- GSC = or < 14, signs of AMS or palpable skull fx -> CT recommended
- occipital, parietal, or temporal hematoma, or h/o LOC > or = 5 seconds; severe MOI; not acting normally -> CT recommended
8
Q
subdural hematoma occurs where in brain
A
- between dura and arachnoid membrane
- tearing of bridging veins
- low pressure bleed, dissects arachnoid away from dura
9
Q
CT findings are consistent with what bleed
- crescent shaped
- usually parietal area
- crosses suture lines
A
subdural hematoma
10
Q
prognosis of subdural hematoma
A
poor
11
Q
Explain mechanism of epidural hemotoma
A
- rupture of artery: high pressure
- +/- underlying fx
12
Q
epidural hemotoma has what typical presentation
A
- brief LOC
- lucid period
- followed by deterioration
13
Q
which brain bleed has this CT
- elliptical shape
- does not cross sutures
A
epidural hemotoma
14
Q
Mechanism of Subarachnoid hemorrhage
A
- injury to parenchymal and subarachnoid vessels
- symptoms range from normal to LOC
15
Q
which brain bleed presents as this on noncontrast CT
- blood in cisterns, sulci, and fissures
- blood in CSF
A
Subarachnoid hemorrhage
16
Q
Management of head traumas that have No Intracranial hemorrhage or skull fx
A
- head injury precautions
- responsible caregiver
- monitor for
- behavior change, vomiting, decreased arousability, sz
- sleeping is okay
17
Q
Management of head traumas that have Intracranial hemorrhage +/- skull fx
A
neuro consult
18
Q
What is the definition of concussion
A
- traumatically induced alteration in mental with or without an associated loss of consciousness
- direct blunt force -> stretching/shearing of axons
19
Q
clinical presentation post head trauma
- repetitive speech pattern
- amnesia
- confusion and/or blunted affect
- delayed response
- visual changes
A
concussion
20
Q
if you suspect a patient has a concussion and the patient is under the influence of a substance, you must
A
get a CT, regardless of PE findings
21
Q
headache, mental fogginess, other mild symptoms of concussion should resolve when
A
within 7-10 days
22
Q
what is post-concussive syndrome
A
symptoms lasting 3 months or longer
23
Q
what is second impact syndrome (associated with concussion)
A
- 2nd concussion within weeks -> brain swelling, herniation, death
- children at increased risk
24
Q
treatment for concussion
A
- No same day return to play
- physical and cognitive rest
- no cell phones, video games, get adequate sleep, noise reduction
25
what must you do before and after splinting/reduction/any other fx intervention
always document neurovascular status
26
managment of compound fracture, open fx
* splint/dress
* start IV abx
* ortho consult
27
managment of non-displaced fx with overlying laceration
* start PO abx
* repair laceration
* splint
* outpatient ortho followup
28
spread of infection to bone is referred to as
osteomyelitis
29
osteomyelitis is most common in what patient population
* under age 5
* M \> F
30
which bones are most often affected with osteomyelitis
* long bones
* femur
* tibia
* humerus
31
what are the most common pathogens of osteomyelitis
* S. aureus (most common)
* S. pneumoniae
* S. pyogens
32
what is the best imaging study to evaluate osteomyelitis
* MRI
33
tx of osteomyelitis
* IV abx (empiric, then directed)
* surgical drainage and debridement
34
most common pathogens associated with acute septic arthritis in infants/children
* S. aureus
* Strep
35
most common pathogens associated with acute septic arthritis in adolescents
N. Gonorrhea
36
clinical presentation
* fever
* constant, worsening joint pain
* warm, swollen joint with pain on ROM
* hip typically held in **flexion/external rotation**
acute septic arthritis
37
transient synovitis is most common in what patient population
* 18 months to 12 years
38
clinical presentation
* limp
* abrupt onset of pain to hip, thigh, or knee
* normal or slightly elevated temp
transient synovitis
39
tx of transient synovitis
* anti-inflammatories, observation, close follow up
40
What is the Kocher criteria which helps determine when to get a joint aspiration
* WBC \> 12,000
* ESR \>40
* Fever \> 101.3
* non weight bearing on affected side
* **2/4** warrants joint aspiration
41
List some meds that are deadly in a dose
* ASA
* Beta-blockers
* Calcium channel blockers
* Chloroquine
* Iron
* Methadone
* Nicotine
* Tricyclic antidepressants
42
what is a toxidrome
* grouped, physiologically-based abnormalities that are known to occur with specific classes of substances
43
What drug class presents with
* Delirium, Flushed skin, Dilated pupils, Urinary retention, decreased bowel sounds, memory loss, Sz
* tachycardia, hyperthermia, HTN
* **Anticholinergic**
* hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter
* antihistamines, atropine, scopolamine, Jimson weed, tricyclic anti-depressants
44
What drug class presents with
* confusion, weakness, salivation, lacrimation, defecation, emesis, diaphoresis, muscle fasciculations, miosis, sz
* bradycardia, hypothermia, tachypnea
* **Cholinergic**
* organophosphates
* carbamates
* mushrooms
45
What drug class presents with
* disorientation, hallucination, visual illusion, panic reaction, moist skin, hyperactive bowel sounds, sz
* tachycardia, tachypnea, HTN
* Hallucinogenic
* amphetamines
* cannabinoids
* cocaine
* PCP
46
What drug class presents with
* AMS, unresponsiveness, miosis, shock
* shallow respirations, slow RR, bradycardia, hypothermia, hypotension
* Opiate/Narcotic
* opiate
* propoxyphene
* dextromethophan
47
What drug class presents with
* coma, stupor, confussion, sedation, progressive deterioration of CNS function
* apnea
* sedative/hypnotic
* barbituate
* benzodiazepines
* ethanol
* anticonvulsants
48
What drug class presents with
* delusions, paranoia, diaphoresis, piloerection, mydriasis, hyperreflexia, sz, anxiety
* tachycardia, bradycardia ?, HTN
* sympathomimetic
* cocaine
* amphetamines
* ephedrine
49
treatment of poison
ABC-DDD
1. stabilize patient: ABCs
2. contact poison control
3. DDD
1. disability
2. drugs
3. decontamination
50
how would you decomtaminate ocular poison exposure
* test PH
* copious normal saline lavage until pH normal
* flush at least 15 minutes
* consult ophth.
51
how would you decomtaminate skin posion exposure
copious normal saline
52
specific antidote for acetaminophen
acetylcysteine
53
specific antidote for anticholinergic
physostigmine
54
specific antidote for benzodiazepines
flumazenil
55
specific antidote for beta blockers
glucagon
56
specific antidote for calcium channel blockers
calcium
57
specific antidote for digoxin
digibind
58
specific antidote for heavy metals
chelating agents
59
specific antidote for narcotics
naloxone
60
what labs should you always order when suspect poisoning
* acetaminophen level
* CMP
* coags
* ABG
61
procedure of choice for removing FB in the esophagus
endoscopy
62
procedure of choice for removing FB in the trachea
bronchoscopy
63
list indications for consultation
* sharp or elongated object
* multile FB (magnets)
* button battery
* coin at the level of the cricopharyngeus muscle
* presence of FB more than 24 hours
64
what is the problem with a button battery in the esophagus
* **true emergency**
* extremely rapid action of the alkaline substance on the mucosa, pressure necrosis, residual charge
* burns esophagus and causes perforation
65
what type of button batteries are associated with the most adverse outcome
lithium batteries
66
treatment of button battery ingestation
1. emergent removal in lodged in esophagus
2. if passed esophagus
1. no need to remove if asymptomatic
2. UNLESS it has not passes through pylorus after 24-48 hours
3. usually excreted in 48-72 hours
67
what is dry drowning
* laryngospasm -\> hypoxia -\> LOC
* no fluids in lungs
68
what is wet drowning
* more common
* aspiration of water into lungs
* dilution and washout of surfactant -\> diminished gas transfer
69
what is the most critical factor in determing poor prognosis in near drownings
duration of submersion \> 5 min
70
secondary drowning may cause death at what time after near drowning incident? cause?
up to 72 hours after
* fresh water drowning results in hemodilution, primarly from **ingested** water
71
fever without a source? what is the goal
identify _occult_ infections: PNA, UTI, bacteremia, Herpes-virus 6 infections, and meningitis
72
non-toxic infants and young children: 2 months-3 years, with fever get what tests
* UA cath and culture
* rapid viral testing: influenza, RSV
* stool for WBCs and guaiac, if diarrhea
73
toxic infants and young children: 2 months-3 years, with fever get what tests
* UA cath and culture
* rapid viral testing
* stool for WBCs and guaiac
* CBC with diff
* CXR
* CSF analysis (LP)
74
infants \< 2 months with a fever \> 38 C get what
* full septic workup regardless of appearance
75
febrile sz occurs in what age group
3 months to 5 years
76
simple febrile sz
* lasts \< 15 min, isolated
* patient otherwise neurologically intact before sz
77
complex febrile sz
* sz \> 15 m or multiple in rapid succession
78
if peds patient has a febrile sz for more than 10-15 minutes, what medication is given
benzodiazepine
79
children \< 12 months with febrile sz require what
* full septic workup
* concerned with meningitis
80
complications of cat bites to hand
* osteomyelitis
* septic arthritis
81
workup of cat or dog bite
* wound culture
* radiograph if deep bite near joint
82
treatment of cat bite and human bites
* leave open to heal
* exception: facial laceration
* augmentin x 3-5 days
83
treatment of dog bite
* may perform primary closure if
* uninfected
* less than 12 hours old (24 hrs on face)
* NOT located on hand or foot
* augmentin x 3-5 days
