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Pediatrics > Emergency Care > Flashcards

Emergency Care Flashcards

1
Q

Which type of snake bites do you have to worry about?

A

Pit vipers - triangle shaped head, elliptical eyes, pit between each eye and nostril

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2
Q

How do you treat snake bites?

A

Initially, immobilize body part and keep it above the level of the heart. Then can give antivenom if its a viper

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3
Q

Brown recluse bite

A

bite is painless, but pain at site 2-8 hours later, hemorrhagic blister with large ulceration. No antivenon

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4
Q

Black widow spider bite

A

Neurotoxic, muscle cramps, abdominal pain, chest tightness, hypertension, Supportive care with pain meds and benzos, antivenim for severe cases

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5
Q

first degree burns

A

superficial, red, blanches with pressure, dry minor swelling and pain, resolve in 5-7 days

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6
Q

Second-degree burns

A

partial thickness - red, wet, very painful often with blisters or blebs. The tissue underneath is stillw ell perfused, may take 2-5 weeks to heal

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7
Q

third-degree burns

A

dry leathery, waxy, no pain, require grafting

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8
Q

How to measure burn surface for >14yo

A

Rule of 9s, palm rule for

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9
Q

When do you need IVFs for burns?

A

When >15% BSA

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10
Q

Which toxic substances cross the placenta easily?

A

lead, mercury (enhanced by placenta), insecticides

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11
Q

For which substances is activated charcoal a poor choice?

A

alcohol, lithium, cyanide, heavy metals

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12
Q

When should coins be removed?

A

When they have not passed through the stomach within 24 hours, even if the child is asymptomatic. All coins in the proximal esophagus should be removed. If in the mid - lower esophagus can observe for 12-24 hours

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13
Q

Which coins do you worry about if swallowed

A

pennies made before 1982 because they have zinc in them which is corrosive to the esophagus - patient needs endoscopy quickly

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14
Q

What is the most important predictor of outcome regarding acetaminophen toxicity?

A

the 4 hour post ingestion level - if >150 = moderate hepatotox, if >300 = severe toxicity

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15
Q

What is management of tylenol ingestion?

A

1) activated charcoal 2) 4 hour level and plot on nomogram, 3.) If within 8 hours of ingestion give NAC

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16
Q

For what amount of acetaminophen should NAC be given empirically without waiting for a level?

A

> 150mg/kg

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17
Q

When do transaminases rise in tylenol toxicity?

A

3-4 days out

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18
Q

Management of salicylate toxicity

A

activated charcoal, salicylate level, sodium bicarb to alkalinize the urine

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19
Q

depressed mentation, constricted pupils, profuse sweating, tearing, abdominal pain, wheezing and respiratory distress

A

organophosphate toxicity

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20
Q

anasarca, asymmetric pupils, agitated and violent

A

PCP ingestion

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21
Q

What is the MOA of organophosphates?

A

Inhibits acetylcholinesterase therefore the effect is due to AcH overload - both muscurinic (pulmonary - bronchospasm and increased secretions - can give atropine) and nicotinic effects ( salivation, sweating, urination, diarrhea, emesis, miotic pupils,and cns depression - can give pralidoxime.)

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22
Q

When is the hyperbaric chamber indicated for CO toxicity?

A

pregnancy, acidosis, signs of cardic involvement, signs of neurologic involvement

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23
Q

How do cyanide poisoned patients present?

A

Similar to CO toxicity, but do not improve with 100% oxygen. Any smoke exposure can cause CN toxicity

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24
Q

treatment of cyanide toxicity

A

hydroxocobalamin, sodium thiosulfate or nitrate used previously

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25
Q

What dose of iron is toxic?

A

> 40mg/kg of elemental iron. IF level of Iron is >500, need chelation

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26
Q

What can iron toxicity cause?

A

phase 1 : vague GI symptoms, pain, vomiting, phase 2: deceptive improvement 6-24 hours phase 3: metabolic acidosis, coagulopathy, CV collapse phase 4: GI strictures

27
Q

Management of iron toxicity

A

Levels at 4 hours. If serum iron > 350, WBC > 15 or glc > 150 this is significant and need chelation. Should do KUB,

28
Q

which substances decrease lead absorption.

A

Calcium, iron, and vitamin C reduce lead absorption, therefore diets rich in these nutrients should be encouraged for patients at risk for lead toxicity

29
Q

Management of causic ingestions?

A

symptomatic - EGD immediately, asymptomatic, ok to observe for 6 hours

30
Q

What kind of household substances are caustic?

A

toilet bowl cleaners, laundry detergents, stain and mildew removers, floor cleaners, oven cleaners, rust removers, phenol-based disinfectants, swimming pool products, and batteries

31
Q

Most commonly reported form of abuse

A

neglect

32
Q

the most commonly reported manifestation of physical abuse

A

soft tissue injury

33
Q

The most commonly reported cause of death due to physical abuse

A

head injury

34
Q

Which type of fractures are concerning for abuse?

A

posterior rib fractures, metaphyseal chip fractures, spiral fractures of the long bones (especially if too young to ambulate)

35
Q

When does a soft callus of bone form?

A

7-14 days

36
Q

oil of wintergreen

A

is ASA

37
Q

Which systems dose salicylate toxicity affect?

A

CNS - tinnitus, vertigo, agitation, confusion, coma, Resp - tachypnea, respiratory alkalosis, ARDS, GI - abdominal pain, nausea, vomiting

38
Q

What is Reye syndrome?

A

hepatitis and encephalitis associated with ingestion of large doses of ASA in the setting of a recent viral illness

39
Q

What are the cardiac effects are TCAs

A

hypo or hypertension, tachycardia including VT, widened QRS, prolonged QT, rightward axis. *A tall R wave in avR is specific

40
Q

When do you treat with sodium bicarb in TCA overdose?

A

When have ECG abnormalities. Titrate dose to QRS widening

41
Q

symptoms of an anticholinergic syndrome

A

dry skin, low UOP, flushing, mydriasis, agitation, sz, hyperthermia

42
Q

What is akathisia?

A

a subjective feeling of restlessness and impulse to move. Associated with antipsychotics

43
Q

What is acute dystonic reaction and how do you treat?

A

wry (twisted) neck, protruding tongue or deviated gaze. Side effect of antipsychotics. Treat with benztropine or diphenhydramine.

44
Q

Ibuprofen toxicity

A

If >400mg/kg can cause seizures and coma

45
Q

What does cherry red skin suggest?

A

CO toxicity

46
Q

How do patients with cyanide toxicity present?

A

Interferes with oxygen utilization by the mitochondria. Pts have histotry of smoke inhalation, shock and profound lactic acidosis. Or exposed to nitroprusside. A venous blood gas has high PaO2 suggests oxygen is not being extracted by tissues

47
Q

Management of hydrocarbon exposure

A

Get CXR, may be normal and still need to be observed in ED. Need to externally decontaminate

48
Q

treatment of methanol ingestion

A

sodium bicarb, fomepizole, folate enhances metabolism of formic acid, hemodialysis if severe

49
Q

Management of organophosphate toxicity

A

decontaminate (can’t only use latex gloves and mask (need full protective clothing)), give activated charcoal. Atropine, pralidoxime. Symptoms persist for weeks without treatment.

50
Q

What are the effects of foxglove, lily of the valley, oleander?

A

digitalis effect

51
Q

What are the effects of jimson weed, deadly nightshade?

A

atropine effects (anticholinergic)

52
Q

What are the effects of pear and apple seeds, peach pit, bitter almond?

A

cyanide like

53
Q

What are the effects of pilodendron and dieffenbachia?

A

oral pain

54
Q

What are the effects of poinsettia, mistletoe, holly

A

mild GI upset

55
Q

Which substances are particularly important to decontaminate topically?

A

corrosives and organophosphates

56
Q

Amanita mushroom has what effect?

A

anticholinergic

57
Q

Which alcohol causes gastritis?

A

isopropyl

58
Q

Which alcohol causes pancreatitis?

A

methanol

59
Q

vertical nystagmus, hallucinations, psychosis

A

PCP

60
Q

Altered perception, seeing smells and hearing colors, tachycardia, dilated pupils

A

LSD

61
Q

Antidote for CCB ingestion

A

calcium chloride

62
Q

What age is skeletal survey the most helpful for?

A

<3yo

63
Q

For which ingestion is it important to avoid epinephrine?

A

Hydrocarbon ingestion as can induce ventricular fibrillation

Pediatrics (25 decks)

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