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Emergency Care Flashcards

0
Q

Is there a sex bias with sexual abuse?

A

Yes girls account for 75% of reported cases. 1 in 4 girls and 1 in 10 boys.

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1
Q

Is there a sex bias to physical abuse?

A

Yes, boys more than girls

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2
Q

What is the age of a bruise that is red?

A

< 1 day

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3
Q

What is the age of a bruise that is blue in color?

A

Day 1-4

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4
Q

How old is a bruise when it is green in color?

A

Day 5-7

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5
Q

What is the age of a bruise when it is yellow in color?

A

Day 7-10

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6
Q

Burns account for what percentage of abuse?

A

5%

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7
Q

What feature make a burn less likely to be abuse?

A

Asymmetric location

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8
Q

A head injury in a child <1 year usually represents?

A

Abuse

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9
Q

Are there bone fractures more specific for abuse?

A

Bucket handle (epiphyseal-metaphysical) and rib fractures

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10
Q

When should you consider abuse in fractures of what bones?

A

Skull, femur, ribs

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11
Q

What type of scans are useful for detecting rib fractures?

A

Bone scans- a soft callus forms at 7-10 and before this time there is a sharp fracture

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12
Q

Do sexually abuse children have abnormal genital or anal findings?

A

Very few

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13
Q

What is miosis?

A

Pinpoint pupils

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14
Q

What is mydriasis?

A

Dilated pupils

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15
Q

What are the common drugs that induce miosis?

A

COPS: Cholinergics, clonidine; Opiates, organophosphates; Phencyclidine, phenothiazines, pilocarpine; Sedatives (barbiturates)

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16
Q

What are the common causes of mydriasis?

A

AAAS: Anticholinergics (atropine); antihistamines; Antidepressants (cyclic); Sympathomimetics (amphetamine, cocaine, LSD

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17
Q

What are the common causes of diaphoretic skin?

A

SOAP: Sympathomimetics (amphetamine, cocaine, LSD), organophates, aspirin (salicylates), PCP (phencyclidine)

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18
Q

What are the causes of red skin?

A

Carbon monoxide, boric acid

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19
Q

What are the common causes of blue skin?

A

Cyanosis, methemoglobin

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20
Q

What might increase anion gap?

A

MUDPILES: methanol, uremia, DKA, phenol, iron, INH, lactate, ethanol, ethylene glycol, salicylates

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21
Q

What substances might be seen on an X-Ray?

A

CHIPES: choral hydrate, calcium, heavy metals, iron, phenothiazines, enteric coated substances, sustained release tablets

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22
Q

How much activate charcoal should be given?

A

1 gm/kg

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23
Q

When is charcoal ineffective or contraindicated?

A

CHEMICAL CamP

Caustics, Hydrocarbons, Electrolytes, Metals, Iron, Cyanide, Alcohols, Lithium, Camphor, phosphorus

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24
Is Ipecac recommended for home use?
No
25
What are the symptoms of Anticholinergic ingestion?
Dry as a bone, red as a beet, blind as a bat, mad as a hatter, hot as a hare
26
What is the treatment for Anticholinergic ingestion?
Charcoal
27
How many stages of iron toxicity are there?
5
28
What is the first stage of iron toxicity?
GI stage: duration 30 min to 6 hours - nausea- vomiting, - hematemesis & bloody diarrhea - symptoms related to direct damage to GI
29
What is the second stage of iron toxicity?
Stability: duration of 6-12 hours
30
What is the third stage of iron toxicity?
Systematic toxicity- within 48 hours - hypovolemic shock, cardiovascular shock - severe metabolic acidosis - anions gap
31
What is the fourth stage of iron toxicity?
Hepatotoxic its - 2-3 days post ingestion Hepatic failure Coagulation failure worsens GI bleeding
32
What is the 5th stage of iron toxicity?
GI/ pyloric scarring- 2-6 weeks post-ingestion
33
A serum iron level 4 hours post ingestion of a toxic ingestion should be?
> 500 mcg/dL
34
What is the treatment for iron toxicity?
IV deferoxamine
35
What is the classic triad of opiate ingestion?
Coma, respiratory depression, and pinpoint pupils (miosis).
36
What is seen with phenothiazine ingestion?
Dose dependent dystonia of the neck, tongue, and oculogyric crisis.
37
What is the treatment for phenothiazine ingestion?
IV or IM Benadryl
38
What are the acute findings of salicylate ingestion? Remember oil of wintergreen
GI-nausea/vomiting | Respiratory- hypernea leading to respiratory alkalosis, and TINNITUS
39
Name the common electrolyte abnormalities in theophylline toxicity?
Increase glucose and calcium and decreased potassium and phosphate and metabolic acidosis
40
What are the findings in tricyclic antidepressant ingestion?
Tachycardia, hyper or hypotension, widen QRS, and prolonged QT.
41
What are the common findings of TCA ingestion?
CCCA- coma, convulsions, cardiac dysrhythmiaa, acidosis
42
What is the treatment for TCA overdose?
Charcoal, sodium bicarbonate, and lidocaine for the dysrhythmiaa
43
Carbon monoxide toxicity has what symptoms
Headache, malaise, nausea, cherry red skin even coma and seizures
44
What is the treatment for carbon monoxide toxicity?
High flow oxygen- decreases half life of CO
45
How should you diagnose CO toxicity?
Blood gas
46
Acid ingestion can cause severe gastritis, perforation, or late strictures without mouth/esophagus burns?
Yes
47
What are the similarities between ethanol, methanol, and ethylene glycol ingestion?
High osmolal gap, metabolic acidosis, GI symptoms (N/V), drowsiness, ataxia
48
What are the differences between ethanol, methanol, and ethylene glycol ingestion?
Ethanol- hypothermia, hypoglycemia Methanol- blurry vision with photophobia, optic nerve damage Ethylene glycol- respiratory problems, renal failure, cardiac failure
49
Organophosphate ingestion leads to the inhibition of cholesterase and what symptoms?
DUMBELS: | Diarrhea, Urination, miosis, Bronchorrhea/bronchi spasm, Emesis, Lacrimation, salivation
50
What is the treatment for organophosphate ingestion?
Charcoal, atropine, and pralidoxime (2-PAM)
51
What plants have a Digitalis effect?
Foxglove, lily of the valley and oleander | - confusion, irregular pulse, loss of appetite, palpitations
52
What plants give atropine like effects?
Jimpson weed, deadly nightshade- | Bradycardia, irregular heart rhythms, dilated pupils, dry mouth, ataxia
53
What plants have cyanide effects?
Pear and apple seeds, peach pit, bitter almond | -inhibits complex IV-weakness, HA, giddiness, vertigo,
54
What are two common organism found in a cat bite infection?
Pasteurella and staph aureus.
55
What organisms are found in dog bites?
Pasteurella, staph aureus and DF2
56
What is the best treatment for snake bites?
Keep area BELOW the heart and provide wound pressure(do not excise and suction)
57
How are burns classified?
By burn depth.
58
What is the leading cause of unintentional pediatric death?
Burns
59
What are first degree burns?
Superficial, red, dry, minor swelling and pain. Heal in 5-7 days
60
What are second degree burns?
Partial thickness, red, wet, very painful, heal in 2-5 weeks. The tissue underneath is still well perfused
61
What is a third degree burn?
Full thickness, dry, leathery, waxy, and there is no pain. They require grafts for healing
62
What are the rule of "9" in calculating burn surface area?
``` Head & neck=9% Each upper limb=9% thorax and abdomen-front=18% Thorax & back=18% Perineum=1% Each lower limb=18% ```
63
What is the rule Palm
Each child's Palm not including fingers=1%
64
How do manage a near drowning victim.
Hospitalize all near drowning patients for at least 12 hours. Respiratory symptoms will develop within 8 hours.
65
What are the findings of basilar skull fracture?
Raccoon eyes, battle sign, and hemotympnorium
66
Describe the findings of a temporal bone fracture?
Bleeding from external auditory canal, CSF otorrhea, hearing loss, facial paralysis.
67
When is CT with bone windows preferred?
Depressed mental status, focal neuro signs, seizures, irritability, bulging fontelle, LOC> 1 min
68
How are growth plate fractures classified?
Salter-Harris classification
69
What is a Salter-Harris type 1 fracture?
Fracture through the epiphysis and metaphysics. Growth plat is left intact. Cannot occur if growth plate is fused.
70
What is a Salter-Harris type 2 fracture?
A fracture where the metaphyseal bone separates from the epiphysis. The growth plate remains intact. Remember this by "above" growth plate up through the metaphysics. Most common.
71
What is a Salter-Harris-Harris 3 fracture?
A fracture through the epiphysis extending to the epiphyseal plate. Surgery is usually required. This is a fracture down through the epiphysis.
72
What is a type 4 Salter-Harris fracture?
A fracture that extends from the articular surface , through the epiphysis, and through the metaphysics. Surgery is required and there is growth plate compromise. The proliferate and reserve zones are interrupted.
73
What is a type 5 Salter-Harris fracture?
A crush fracture to the epiphysis.
74
What is the most common fracture in children < 10 years?
Clavicle fx. Treatment is immobilization
75
Where is the most common place for a buckle fracture?
Distal radial metaphysics
76
In a young child with a spiral fracture of a lower extremity, femur- is called what?
A toddler's fracture.
77
A spiral fracture in a non-walking child should make you suspicious of what?
Abuse.
78
What is the concern for a distal humerus fracture?
Neuro vascular status due to brachial artery, median and radial nerves near.
79
What is compartment syndrome?
Common with tibial and supra condylar fractures- swelling that compromises vascular system and ischemia.
80
What is nursemaids elbow?
Subluxation of the radial head.
81
When are the usual ages for nursemaid's elbow to occur?
6 months to 5 years.
82
How does subluxation happen?
Axial traction on an out stretched arm, the annular ligament slides over the radial head.
83
How is the subluxation reduced?
Supinate the forearm and flex the elbow
84
What is the definition of a sprain?
Injury to a ligament around a joint.
85
What are the common findings is a sprain?
Tenderness, swelling and bruising
86
How do you treat an ankle sprain?
RICE: rest, ice, compression, elevation
87
What are the symptoms of corneal abrasion?
Pain, tearing, photophobia, decreased vision
88
What is hyphenated?
Blood in the anterior chamber of the eye.
89
Does chest compressions change location in infants versus children?
Blows to the back < 1 and Heimlich > 1 year

Pediatric Board Review (10 decks)

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