Emergency Flashcards
What are the states that require immediate medical attention?
- unstable vital signs
- change in level of consciousness
- compromise in ABC
- major trauma
What is ataxia and what are some common causes
- disturbance in smooth accurate coordination of movements, usually associated with unsteady gait Acute: - CNS: neoplasm, infection, trauma, cerebellar ataxia, toxicity - PNS: Guillan-Barre syndrome, acute demyelinating encephalomyelitis Intermittent: - seizure - BPPV - migraine Chronic - congentinal anomaly - degenerative - multiple sclerosis
When do you have to intubate
GCS <8
When does toxin exposure need to be considered?
Children 1-4 with any of the following:
- acute onset multiple system failure
- altered mental status
- respiratory or cardiac compromise
- unexplained metabolic acidosis
- seizure
What are the most common ingestants
Medication - iron supplements - anti-depressants - cardiotoxic agents - salicyclate Non-drug toxins - hydrocarbons - alcohol - cosmetics - cleaning products and pesticides
Discuss the universal treatment for toxin ingestion
ABCDEFG
- Airway
- Breathing
- Circulation: require ECG monitor, fluids if hypotensive
- DONT is universal antidotes: Dextrose 2.5mL/kg IV, Oxygen, Naloxone, Thiamine for chronic alcoholics
- Decontamination: skin by water irrigation and GI by activated charcoal or whole bowel irrigation
Elimination: dialysis
- Focused therapy
- Get Toxin help
Discuss the differential for anion gap metabolic acidosis
MUDPILESCT
- Methanol/Metformin
- uremia
- DKA
- Paraldehyde
- Iron
- Lactate
- Ethylene glycol
- Salicyclates
- CO
- Toluene
Discuss the toxidrome for Sympathomimetics
Drugs: Amphetamines and cocaine
Presentation: Increase vital signs, agitated, mydriasis, diaphoretic
Management: supportive
Discuss the toxidrome for narcotics
Presentation: decreased vital signs, with respiratory depression, decreased LOC, miosis
Management: naloxone
Discuss the toxidrome for anticholinergics
Drugs: TCA, antihistamines
Presentation: hot as a hare (hyperthermia), mad as a hatter (confusion), dry as a bone (dry skin), red as a beet (flushing), blind as a bat (myodriasis), urinary retention and constipation
Investigations: ECG can show AV block -> wide QRS (>100ms) -> prolonged QT interval
Management: ECG changes guide treatment, antidote for TCA, supportive, fluids and NaHCO3
Discuss the toxidrome for cholinergics
Drugs: organic phosphates, pesticides
Presentation: lacrimation, salivation, urination, diarrhea, significant bradycardia
Management: atropine for organophosphate poisining
Discuss the phases of iron toxicity
1st Phase: occur 30min to 6 hours post ingestion where have GI symptoms of nausea, vomiting, hematemesis and melena
2nd Phase: stabile for 6-24hrs post ingestion
3rd Phase: shock and metabolic acidosis 6-72 hours after ingestion
- cardiac toxicity leading to pallor and shock
- hepatic toxicity leading to coagulopathy
- metabolic acidosis due to iron and lactic acidosis
4th Phase: hepatic toxicity and necrosis over 12-96 hrs
5th Phase: bowel obstruction 2-8 weeks following
What are the investigations and management for iron toxicity
Investigations:
- serum iron concentration with <63mmol/L suggesting minimal toxicity and >90mmol/L suggesting severe
- LFTs
Management:
- iron chelating agent Deferoxamine IV 15mg/kg/hr
Discuss the presentation and management of aspirin ingestion
Dose: >300mg/kg
Presentation:
- hyperthermia
- neurologic: tinnitus, confusion, seizure
- GI: nausea and vomiting
- Resp: metabolic acidosis leading to hyperventilation
Investigations:
- serum ASA level Q2H until declining
- art gas Q2H until acid-base improving
Management:
- Dextrose 50% if have neurologic symptoms
- GI decontamination with activated charcoal
- NaHCO3 to alkanilize urine
- hemodialysis if deteriorating
Discuss the presentation and management of acetominophen ingestion
Dose:
- children <6 200mg/kg or 10g
- children >6 150mg/kg
Presentation:
Day 1: have non-specific nausea and vomiting
Day 1-3: hepatitis (RUQ tenderness, elevated AST/ALT), pancreatitis, acute renal failure
Day 4-5: liver failure (jaundice, coagulopathy, hypoglycemia, enecephalopathy), renal failure, sepsis
Day 5-10: if survive previous stage will have complete liver recovery
Investigations: serum acetaminophen at presentation and then 4 hours post ingestion
Management:
- Rumack-Matthew nomogram to plot if require treatment with n-acetyl cysteine
- GI decontamination if within 1 hour
Discuss the presentation and management of caustic ingestion
Drugs: acidic or alkaline substances (cleaning agents)
Pathophysiology: burn upper airway with delayed injury of necrosis and granulation. Risk of esophageal perforation, fibrosis, or tracheoesophageal fistula
Presentation:
- oral burns, stridor, hoarseness, respiratory distress
- drooling, hematemesis, dysphagia
Investigations:
- CXR, upper GI series
Treatment: prevent vomiting, choking or aspiration
- endoscopy findings of perforation provide ceftriaxone
Discuss the presentation and management of hydrocarbon ingestion
Drugs: petroleum and turpentine
Pathophysiology:
- can lead to pulmonary damage and inflammation
- systemic toxicity leading to CNS damage and cardiac arrhythmias
Presentation:
- lung injury leading to hypoxemia and respiratory distress
- altered mental status
- dysrhymthias
- leukocytosis, hemolysis, hemoglobinuria, coagulopathy
Investigations:
- CXR 6 hours post ingestion showing multiple small patchy infiltrates densities with ill defined margins - pneumonitis (discharge if no findings and asymptomatic)
Treatment:
- intubation if have respiratory distress
- supportive
Discuss the pathophysiology of flail chest
Have >=2 fractures in >=2 spots -> ribs do not move with rest of ribcage during breathing.
Inspiration flail segment moves inward due to negative pressure and during expiration flail segment moves outward
Result in asymmetrical chest wall movements.
List the CT head rules
Children <16 GCS<13 or GCS<15 2hrs following injury Obvious skull fracture one exam Sign of skull fracture Vomiting >= 2 episodes Amnesia before impact >= 30 minutes Mechanism
