Emergency Medicine Flashcards
What is Salter
harris fracture
classification?
Type One - Straight through the growth
plate
Type Two - Through and above the
growth plate (into metaphysis)
Type Three - Through and below the
growth plate (into the epiphysis)
Type Four - Above through and below the
growth plate
Type Five - Compression fracture of the
growth plate
Nerve and artery
most likely to be
injured in
supracondylar
fracture?
Brachial
artery and
median nerve
What is a
monteggia
injury?
Ulna fracture at
the elbow with
radial head
dislocation
Clinical Signs
of a scaphoid
fracture?
Pain on dorsiflexion of
wrist
Tenderness in snuff box
Pain on gripping
Normal xray
Treatment
of scaphoid
fracture?
Short arm
cast with
thumb spica
What is the sensory and motor innervation of the radial nerve?
Sensory – Innervates most of the skin of the posterior forearm, the lateral aspect of the dorsum of the hand, and the dorsal surface of the lateral three and a half digits.
Motor – Innervates the triceps brachii and the extensor muscles in the forearm.
Sensory and motor innervation of the axillary nerve?
Sensory functions: Gives rise to the upper lateral cutaneous nerve of arm, which innervates the skin over the lower deltoid (‘regimental badge area’).
Motor functions: Innervates the teres minor and deltoid muscles.
Sensory and motor innervation of the musculocutaneous nerve?
Motor functions – muscles in the anterior compartment of the arm (coracobrachialis, biceps brachii and the brachialis).
Sensory functions – gives rise to the lateral cutaneous nerve of forearm, which innervates the lateral aspect of the forearm.
Sensory and motor innervation of the ulna nerve?
Motor functions:
Two muscles of the anterior forearm – flexor carpi ulnaris and medial half of flexor digitorum profundus
Intrinsic muscles of the hand (apart from the thenar muscles and two lateral lumbricals)
Sensory functions: Medial one and half fingers and the associated palm area.
Sensory and motor innervation of the median nerve?
Motor functions: Innervates the flexor and pronator muscles in the anterior compartment of the forearm (except the flexor carpi ulnaris and part of the flexor digitorum profundus, innervated by the ulnar nerve). Also supplies innervation to the thenar muscles and lateral two lumbricals in the hand.
Sensory functions: Gives rise to the palmar cutaneous branch, which innervates the lateral aspect of the palm, and the digital cutaneous branch, which innervates the lateral three and a half fingers on the anterior (palmar) surface of the hand.
What is the
timeline of
ossification centres
in the elbow?
Capitellum (1)
Radial head (3)
Internal epicondyle (5)
Trochlea (7)
Olecranon (9)
External epicondyle (11)
What the primary
locations of
ewings
sarcomas?
Lateral ribs,
iliac bones,
femur, fibula,
tibia
Where are
chondrosarcomas
typically found?
Costal cartilages
between distal
rib end and
sternum
Appearance of
osteosarcoma
on xray?
Starburst
sclerotic
lesion
What would a
small translucent
hole in a bone on
xray represent?
Osteoid
osteoma
What is the dose
of adrenaline for
anaphylaxis vs
cardiac arrest?
Anaphylaxis = 10mcg/kg
of 1:1000 (1mg/mL =
0.01mL/kg)
Cardiac arrest =
10mcg/kg of 1:10,000
(1mg/10mL = 0.1ml/kg)
If a child came in shocked
and ECG rhythm showed
polymorphic ventricular
ectopics what would you
be thinking? What should
you not give? What is
used to treat?
Catecholaminergic polymorphic
ventricular tachycardia is an inherited
channelopathy where they will have
episoic palpitations, syncope or cardiac
arrest. Precipitated by exercise or acute
emotion.
Don’t give adrenaline as this will worsen
the ectopics.
A child comes in after a MVA, they examine well but have 60 microscopic RCC seen on urinalysis, what should you do?
Abdominal CT scan, children are more vulnerable to significant renal injury. Haematuria of >30RCC warrants further investigation.
Describe the differences in presentation between a child with an extradural haemorrhage vs a subdural haemorrhage?
Extradural - Lucid interval, followed by ongoing severe headache and deterioration. Arterial bleed.
Subdural - Gradual deterioration LOC, venous subdural bridging veins.
What percentage of children experience abdominal injuries after fatal polytrauma?
20%, note it is the most unrecognised cause of fatal injury
How does neurogenic shock present? What treatment would you start?
Bradycardia, hypotension, vasodilation (warm)
Fluids, inotropes, Atropine, Glycopyyronium bromide
2 year old boy accidentally hit in the eye by a cricket bat. He has a pulsating proptosis of his eye and is unable to look down. What is the most likely injury?
Superior wall orbital fracture
If you saw tear drop sign on a CT scan of the facial bones what injury would you suspect?
Inferior wall orbital fracture
Describe the findings in someone with a methamphetamine overdose.
Tachycardia, hypertension, tachypnoea, hyperthermic, mydriasis reactive to light, hyperactive bowel sounds, flushed and sweating, agitation
Describe anticholinergic toxidrome. Examples of medication overdoses that cause this.
Mad as a hatter, blind as a bat (mydriasis - not responsive to light), read as a beat (flushed), hot as a hare (hyperthermic), dry as a bone, bowel and bladder loose their tone (constipation, urinary retention), tachycardia, picking behaviours.
Tricyclic antidepressants, Antihistamines
Describe serotonin syndrome.
Agitation, diaphoresis, tachycardia, hypertension, hyperthermic, sweating, hypertonia, hypereflexia with clonus, mydriasis
Differences between neuroleptic malignant syndrome and serotonin syndrome.
Serotonin syndrome - abrupt onset, hyperreflexia, myoclonus and tremor, mydriasis
Neuroleptic malignant syndrome - Gradual onset, diffuse rigidity, decreased reflexes, normal pupils
Describe cholinergic syndrome and treatment.
Bradycardia, confused, salivation, lacrimation, urination, GI upset - diarrhoea, vomiting, pin point pupils
Atropine
Treatment for neuroleptic malignant syndrome.
Bromocriptine, amantadine, dantrolene
What toxin overdose can cause prolonged QRS interval with hypotension and tachycardia? What is the management?
Tricyclic antidepressant (can also cause anticholinergic syndrome)
Sodium bicarbonate
Antidote for benzodiazepines?
Antidote for iron?
Antidote for calcium channel blockers?
Flumazenil
Desferrioxamine
High dose insulin euglycaemic therapy
What do you give in colchicine ingestion?
Charcoal as there is no antidote
Nausea, vomiting, respiratory alkalosis, anion gap metabolic acidosis, tinnitus, fever, agitation/confusion or coma. What is the likely ingested agent?
Salicylate
Treatment: Sodium bicarbonate to raise urine pH
What is the most common side effect associated with ketamine?
Laryngospasm
Also bronchodilator, tachycardia, hypertension, nightmares, hyper salivation
Which sedation medication causes chest wall rigidity?
Fentanyl
Antagonist for midazolam
Flumazenil
When is nitrous oxide contraindicated?
Gas filled space
Pneumothorax
Bowel obstruction
Severe head injuries (potential for pneumocranium)
Intoxication/depressed conscious level
Pregnancy
Requiring >50% O2
If there is a friction rub in someone with pericarditis what will you not see on ECG?
You will NOT see decrease in precordial voltages as there will not be significant pericardial fluid accumulation
How long is initial burn first aid effective for after the injury?
3 hours
Which zone can be prevented from damage with initial burns first aid?
Zone of stasis
How long should you apply cool running water for burns initial first aid?
20 minutes of room temperature water (18 degrees)
