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RCPEM > EMS/ADMIN/Psych > Flashcards

EMS/ADMIN/Psych Flashcards

1
Q

4 components to the pediatric trauma score

A
  1. Weight
  2. Airway
  3. Systolic BP
  4. CNS / Mental status
  5. Open wound
  6. Skeletal
    *scores assigned a 2, 1 or (-)1
    *score < 8 = referral to trauma center
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2
Q

Injurity Severity Scale (trauma) - how to calculate

A

Combine AIS for 3 most seriously injured regions

(AIS = 1 to 5 (survival uncertain) for injuries within 6 body regions: head/neck, face, chest, A/P, extremities, skin)

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3
Q

What does ISS predict?

A

Valid predictor of mortality, length of stay and cost of trauma care

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4
Q

5 reasons to activate trauma team? (9)

A
  1. Trauma mechanism with unstable VS
  2. Penetrating injury to head, neck, torso
  3. Head injury with GCS < 14
  4. Pediatric trauma score < 8
  5. Gunshot wound victim
  6. Two or more proximal long bone fractures
  7. Severe maxillofacial injuries w/ airway compromise
  8. Evidence of spinal cord injury w/ paralysis
  9. At discretion of trauma / ED physician
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5
Q

6 things to include in brochure for playground safety?

A
  1. Use age appropriate equipment
  2. Hold onto protective barriers/guardrails
  3. Use vertical rather than horizontal bars (to discourage climbing)
  4. Active supervision is important
  5. Discourage climbing on guardrails
  6. Ensure appropriately protective surfacing under and around play equipment
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6
Q

2 things required of quality assurance program?

A
  1. Process for monitoring a specific procedure or process to ensure it is meeting the standard
  2. Need known standard / measureable outcome
  3. Need continuous review of processes
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7
Q

4 steps of a quality improvement program?

A
  1. Plan - create team, define objectives and questions, plan data collection
  2. Do - carry out plan, collect data
  3. Study - analyze data, compare to predictions
  4. Act - plan next cycle, decide whether to implement change
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8
Q

2 factors that reflect quality in asthma management

A
  1. Number of admissions/hospitalizations
  2. Number of return ED visits
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9
Q

4 requirements for a continuous quality improvement program

A
  1. Structure - people / technology
  2. Process
  3. Output
  4. Outcome
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10
Q

CTAS Primary Modifiers (4)

A
  1. Level of consciousness
  2. Respiratory - RR, SpO2, effort
  3. Hemodynamic - HR, BP, perfusion
  4. Pain
  5. Temperature (> 38.5 for pts 3 mo - 3 yrs, > 38 for pts > 3 yr)
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11
Q

JUMP START Triage System

A

Minor (Green) = walking wounded

Black (expectant) = No spontaneous breathing with positioning of airway or 5 rescue breaths if has a pulse

Red (immediate) = Spontaneous breathing with airway positioning, RR <15 or > 45, no pulse or PU on AVPU

Yellow (delayed) = unable to walk but breathing, RR 15-45, (+) pulses, AV on AVPU

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12
Q

10 things that measure quality assurance in peds ED

A
  1. Length of stay
  2. Pain intervention at triage
  3. Patient satisfaction
  4. Hand hygeine
  5. ED admissions within 8 hours
  6. Left without being seen rate
  7. 48-72 hour returns
  8. Specimen ID errors
  9. Cultural sensitivity
  10. Time to abx in sepsis
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13
Q

CTAS levels - name and time guidelines

A

Level 1: Resuscitation - immediate

Level 2: Emergent - 15 minutes

Level 3: Urgent - 30 minutes

Level 4: Semi-urgent - 60 minutes

Level 5: Non-urgent - 120 minutes

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14
Q

Three offline (indirect) roles of EMS Medical Director

A
  1. Training of EMS: certification, CME
  2. Protocol development: standing orders
  3. Quality assurance: field assessments, medical simulation, audits/review of care
  4. Authorization of clinical practice
  5. Serving as a liason within medical community
  6. Promotion of research
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15
Q

Examples of Direct Medical Oversight

A
  1. Physician-directed care
  2. Direct patient care on scene
  3. Patient care delivery suggestions: radio, phone, videp
  4. Provider advocacy: physical/scene safety, PPE
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16
Q

List 2 advantages of a cohort study

A
  1. Less expensive and time consuming than RCT
  2. Can estimate relative risk (incidence)
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17
Q

List 2 disadvantages of cohort study

A
  1. Challenging for rare disease/outcomes
  2. Controls may be difficult to obtain
  3. Does not account for all potential confounders
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18
Q

What factor is important in determining pre-test probability?

A

Prevalance of disease

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19
Q

What factors (3) influence post-test odds?

A
  1. Prevalance of the disease in catchment population
  2. Patient-specific patient risk factors
  3. Diagnostic test itself (likelihood ratio)

Post-test odds = pre-test odds x likelihood ratio

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20
Q

Post-test probability

A

Post-test probability = post test odds / 1 + post-test odds

Post-test probability is the proportion of patients that test positive that truly have the disease (same as positive predictive value)

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21
Q

Levels of Evidence / “Quality categories” (5)

A

Level 1: atleast one proper RCT

Level 2: Well designed controlled trial w/o randomization

Level 2b: Well design cohort, > 1

Level 3: Descriptive or observational studies, case control

Level 4: Expert opinion, case reports

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22
Q

8 elements of informed consent for participation in pediatric clinical research trial

A
  1. Description of clinical investigation - purpose, duration, procedures
  2. Risks or discomforts
  3. Benefits
  4. Appropriate alternative treatments/procedures
  5. Confidentiality
  6. Compensation and medical treatment in event of injury
  7. Contact information
  8. Voluntary
  9. Should consider assent in pediatric cases
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23
Q

Prevalence

A

Prevalence = # of people with disease / population at same time x 100

Total number of cases of disease existing in a population at a given time

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24
Q

Incidence

A

Incidence = # of new causes of disease in specific time / size of population at start of study period x 100

probability of being diagnosed with a disease during a given period of time

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25
Q

Regression analysis

A

set of statistical processes for estimating the relationship between a dependent variable (outcome) and one or more independent variable

26
Q

2 types of Regression Analysis

A
  1. Simple linear regression - continuous or ordinal data, only one independent variable
  2. Multiple linear regression - more than one independent variable used; analyze whether the variable significantly contributes to the model
27
Q

Relative Risk

A

Risk/probability og event (disease) in the exposed group vs control group

RR = (A/A+B) / (C/C+D)

28
Q

4 Ethical Principles of Human Research

A
  1. Beneficience - apply evidence based care to children
  2. Nonmalificience - avoid harmful therapies extracted from adult data
  3. Respect for informed consent
  4. Distributive justice - allow research benefits to be available to all populations
  5. Respects confidentiality and privacy
29
Q

3 criteria for authorship on scientific paper

A

Substantial contributions to all of the following:

  • Concept, design, analysis and/or interpretation of data
  • Writing/ revieweing drafts
  • Approving final version of manuscript for publication
  • Agree to be accountable for all aspects of work
  • Identify which coworkers did what
30
Q

What amount of risk is acceptable in healthy children participating in a study?

A

Minimal risk –>risk that is equivalent to that ordinarily encountered in daily life or during the performance of routine physical or psychological tests

  • any harms during procedure will be transient and reversible in consideration of the nature of the harm
31
Q

3 indications to break confidentiality with patient

A
  1. suicidal / homicidal ideations
  2. child abuse/neglect
  3. public health concerns
32
Q

4 quality indicators in RCT (6)

A
  1. Randomization
  2. Allocation concealment
  3. Blinding
  4. Eligibility defined
  5. Sample size calculation
  6. Intention to treat analysis
33
Q

5 things to do when applying physical restraints

A
  1. Attempt de-escalation techniques first and consider chemical restraints prior to physical restraints
  2. Regular reassessments: < 9 yo - 1 hr, 9-17 yo - 2 hr, adults - 4 hrs
  3. Ensure constant supervision
  4. Require 5 staff to apply restraints (one / limb plus head)
  5. Regularly record VS / behavior changes
34
Q

5 common historical features in Munchausen by Proxy

A
  1. Diagnosis does not match objective findings
  2. Inconsistent histories from different observers
  3. Caregiver insists on invasive or painful procedures and hospitalizations
  4. Sibling has had an unusual illness or death
  5. Failure of the child’s illness to respond to normal treatments
  6. Use of multiple medical facilities
  7. Sensitivity to multiple environmental substances
35
Q

6 common risk factors for suicide in teenagers

A
  1. History of mental illness
  2. Prior history of self harm or SI
  3. Substance abuse
  4. Parental mental illness or family hx of suicide
  5. Family conflict or poor child-parent communication
  6. Lack of psychosocial support or follow-up
  7. Hx of impulsivity (aggression, risk taking behavior)
36
Q

Methods of verbal de-escalation (4)

A
  • Introduce yourself
  • Simplified language, soft voice, slow movements
  • Reduce environmental stimulation
  • Offer food/drink
  • Reassure child that your job is to keep them safe
  • Listen and empathize
  • Offer distracting toys / sensory modalities
  • Find things for the child to control (choice of drink)
37
Q

4 common signs/symptoms of adolescent depression

A

S - sleep changes

I - loss of interest

G - feelings of guilt or worthlessness

E - lack of energy / fatigue

C- impaired concentration

A- change in appetite

P - psychomotor agitation/retardation

S - suicide/death preoccupation

38
Q

Diagnostic Triad for School Refusal

A
  1. Vague physical symptoms
  2. Normal physical exam and lab findings
  3. Poor school attendance
39
Q

5 Behavioral Manifestations that go along with school refusal

A
  1. Anxiety
  2. Mood disorder - depression
  3. Anger / aggressive behaviors
  4. Arguing / defiance
  5. Learning disorders, tics, nightmares
  6. Somatization
40
Q

4 physical signs of Bulimia Nervosa

A
  1. Dental enamel erosions
  2. Enlarged parotid glands
  3. Callused knuckles/fingers
  4. Xerosis / dry skin
41
Q

2 serious complications of bulimia nervosa

A
  1. Electrolyte derangements/ dehydration- hypokalemia, metabolic acidosis/alkalosis
  2. Arrhythmia –> prolonged QTc
  3. Mallory Weiss tear
42
Q

3 comorbidities associated with school phobia

A

separation anxiety

major depressive disorder

adjustment disorder

social phobia / simple phobia

conduct disorder

43
Q

Precipitating factors for suicide

A

vital role in interaction with predisposing RF for suicide

  • access to means (firearms)
  • alcohol/drug use
  • exposure to suicide (fhx)
  • social stress / isolation
  • emotional / cognitive factors
44
Q

4 reasons to put a patient in physical restraints

A
  • threat to themselves
  • threat to others
  • failure of verbal deescalation and chemical restraint
  • unable to give chemical restraint (allergy or C/I)
45
Q

Emancipated minor (4)

A
  • Pregnant or already a parent
  • Married
  • Enlisted in armed forces/military
  • Legally / economically self supporting
46
Q

Exceptions to consent in minors

A
  • Emergency or life-threatening situation
  • STI
  • Pregnancy
  • Alcohol / substance use
  • Mental health treatment
  • Sexual / physical abuse
  • Emancipated minor
47
Q

Sensitivity formula

A

A / A+C

Rule OUT

48
Q

Type 1 error

A

conclude that there is a difference between groups when one does not exist (incorrectly reject the null hypothesis)

49
Q

Type 2 error

A

conclude that there is no difference in outcomes but a difference does exist

(minimize by recruiting adequate sample size)

50
Q

CRAFT screening for alcohol use

A
  • C = have you been in car alone with someone using
  • R = do you use it to relax
  • A = do you use it alone
  • F = have friends/family told you to cut down
  • F = do you forget things
  • T = has it gotten you in trouble?

If > 2 yes = needs assessment for substance use/dependence

51
Q

2 features of a good SCREENING test

A
  1. Sensitive
  2. Inexpensive or cost effective
52
Q

2 requirements for a minor to give consent

A
  1. Capacity: be considered a mature minor and/or must comprehend information
  2. Informed and voluntary: be able to understand risks/benefits without coercion from provider
53
Q

Advantages of case-control study

A

Can study rarer diseases/conditions or those have a long lag from exposure

54
Q

Disadvantages of case control study

A
  1. Recall/recording bias
  2. Does not account for possible confounding variables
  3. Usually have smaller sample size
55
Q

4 principles of informed consent

A

Must have decision-making capacity

Medical provider must disclose information on treatment, test or procedure including risk, benefits and likelihood that the benefits/risks will occur

Pt/parent must comprehend information

Must be voluntary

56
Q

Reasons to use physical restraints

A

Threat to themselves (not responding to meds / deescalation)

Threat to others

Patient refusing chemical restraint or continued aggression despite chemical restraint

Unable to give chemical restraint

57
Q

Complications of physical restraints

A

Feelings of shame

PTSD

Asphyxiation

MSK injury if improperly restrained

Rhabdomyolysis

58
Q

4 quality indicators in RCT

A

Random allocation to groups

Allocation concealment

Blinding

Sample size calculation

Intention to treat analysis

59
Q

2 things to consider when evaluating allocation

A

Were groups comparable at start

Were groups randomized appropriately

Were allocation groups concealed beforehand

60
Q

Reasons to stop resuscitation in field

A

Decapitation or other non-survivable injury, ex 100% TBSA burns

Valid DNR / SDM confirming such at scene

Prolonged downtime, no bystander CPR and no ROSC 20 minutes of ALS care

RCPEM (5 decks)

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