ER

Question 1

cardiac arrest

Answer 1

1 cause = hypoxia 2/2 pulmonary prob. CPR. assess brachial artery in infants and carotid in kids. compressions for systole or bradycardia

Question 2

shock classification

Answer 2

compensated- normal BP, adequate perfusion but maldistribution. compensate by tachycardia, vasoconstriction, incr heart contractility, incr venous tone, tachypnea.
decompensated: hypotension, low CO, inadequate perfusion
irreversible shock- cell death, refractory to med

Question 3

hypovolemic shock

Answer 3

most common shock in kids. >25% volume loss –> decompensated shock
MSA, tachypnea, tachycardia, hypotension, cool extremities, oliguria

Question 4

septic shock

Answer 4

hyper dynamic stage- normal or high CO, bounding pulses, warm extremities, wide pulse pressure
decompensated state- impatited mental status, cool extremities, diminished pulses
tx: boluses of fluid until good perfusion. may need interpose like epi or do to incr contractility and vasopressors to incr BP

Question 5

distributive shock

Answer 5

pooling of fluid distally. due to anaphylactic or neurogenic shock (2/2 spinal transection, loss of distal sons CV tone + hypotension), meds, toxins. vasodialtion, incr capillary permeability, third space loss

Question 6

sx of shock

Answer 6

severe N/V, trauma with hemorrhage, febrile illness in IC pt, CHF sx, allergic allergen exposure, SC injury

Question 7

coagulation factors

Answer 7

evaluate for disseminated intravascular coagulation that may accompany shock. give FFP

Question 8

trauma

Answer 8

1 cause of death in

Question 9

pulseless electrical activity on ecg

Answer 9

cardiac tamponade. T PTX, profound hypovolemia

Question 10

head trauma

Answer 10

1. self limiting seizure
2. open fontanelle/suture= susptive to subgaleal/ epidural/subdural hemorrhage = more tolerant of expansion. don’t need fracture or loc. subdural common in infancy & 75% b/l, worse prog than epidural
   3) intracerebral hemorahge - frontal and temporal lobe. contrecoup injury= opp side of impact.
   4) incr ICP: HA= 1st sx then pupillary and AMS is 1st signs.

Question 11

bradycardia

Answer 11

1st sign of herniation in

Question 12

signs of herniation

Answer 12

bradycardia. fixed and dilated pupils. cushion’s triad= late sign= bradycardia, HTN, irreg breathing. CL hemiparesis

Question 13

treat incr ICP

Answer 13

mild hypervent, elevation of head, diuretic, neurosurgery

Question 14

T PTX

Answer 14

distended neck vein, decr breath sounds, hyper resonance to percussion, displaced trachea, pulseless electrical activity shock

Question 15

abdominal trauma

Answer 15

common bc unnerved abd muscle.
duodenal hematoma- 2.2 bicycle handle bar in RUQ
lap belt injury- chance fracture
spleen liver kidney in blent trauma

Question 16

burns

Answer 16

2nd most common injury.

Question 17

secondary burn

Answer 17

superficial partial thickness brun- epi + outer portion of dermis. moist, painful, red, blister +no scar
deep PTB: epi + lower part of dermis. pale whit, blister + scar
tx: opiates, debridement of dead skin, don’t remove bulla unless ruptured

Question 18

first degree burn

Answer 18

red, blanching painful. epi

tx: moisturizer, analgesics

Question 19

3rd degree burn

Answer 19

epi, dermis, part of subQ. dry, white, leathery. need skin graft bc nerve ending burn so insensitive to pain.

Question 20

BSA

Answer 20

adolescent and adult- arm/head+neck=9 each, leg/anterior trunk/posterior trunk= 18 each
child- palm= 1%

Question 21

burn management

Answer 21

1) resuscitation, endotracheal intubation of hot gas, pulse ox, IV through non burned skin
2) fluid resusitation
3) skin care
4) hospitalize if partial burn >10% or full burn >2%, overly J, hands, feet , circumferential, inhalation injury

Question 22

near drowning

Answer 22

older infant/ toddler, + adolescent
drawing cause denaturing of surfactant, alveolar instability and collapse –> pul edema–> decr compliance - incr pul P, restricting gas exchange
penumonia in 24hr from aspirating mouth flora
slow deterioration of pul func in 12-24hr
neuro damage dep on time hypoxia
CV-dysrhythmia, MI
hemolysis and DIC
Renal failure may occur

Question 23

drowning management

Answer 23

1) resuscitate ABC, remove wet cloth to prevent heat loss
2) intubate and mechnical vent PEEP if respiratory failure
3) rewarming with warm saline gastric lavage, bladder washing or peritoneal lavage if needed. conti resuscitation until 89.6- 32
4) attention- fluid and electrolyte imbalance

Question 24

drowning prog

Answer 24

better in children bc dive reflex shunt blood to heart, brain, liver. but poor in 5min, resusitate delay >10min, CV resusitation needed, abn near, ph

Question 25

abuse RF

Question 26

abuse signs

Answer 26

metaphyseal fractures- bucket handle or corner fractures caused by torsional force or violent shaking. feature of posterior or first ribs, sternum, scapular, vertebral spinous process

Question 27

abuse #1 and 2nd cause of death

Answer 27

head injury.

Question 28

sudden infant death syndrome

Question 29

poison

Answer 29

60% occur in

Question 30

odor of poisons

Answer 30

bitter almond- cyanide. garlic- arsenic, organophosphate. acetone- salicylates.

Question 31

skin v poison

Answer 31

cherry red- CO or cyanide. sweaty- organophosphate, sympathomimetics. dry- anti cool. gray cyanosis-methmoglobinema

Question 32

eye v poison

Answer 32

miosis- opiate, phenyclidine, organophos, phenothiazine
mydriasis- tricyclic antidep, atropine
nystagmus- dilantin
retinal hemorrhage- CO, methanol.

Question 33

AMUDPILES

Answer 33

causes of increased anion gap >16. alcohol, methanol, uremia, diabetic ketoacidosis, paraldehyde, iron and isoniazid, lactic acidosis, ethylene glycol, salicylates

Question 34

CHIPE

Answer 34

radioopque substances on imaging of abd. chloral hydrate/calcium ,heavy metals iodine/iron, phenothiazine, enteric coated tablets

Question 35

gastric decontamination

Answer 35

syrup of ipecac- induce emesis- if ingest

Question 36

salicylate poisoning

Answer 36

pepto-bismol, oil of wintergreen. direct stimulation of respiratory center –> hyperventilate–> respiratory alkalosis. and uncouple oxidative phosphorylation producing lactic acidosis enhancing ketosis.
P: fever, diaphoresis, flushed appearance, tinnitus, vomititng, HA, lethargy, restlessness, coma, seizure, yperpnea, dehydration
lab: respiratory alkalosis with anion gap metabolic acidosis
hyperglycmeia to hypoglycemia
hypokalemia
tx: gastric lavage, activated charcoal, serum salicylate lvl q6h, done monogram, alkalization of urine with NaHCO3 to pH 7. dialysis

Question 37

Iron

Answer 37

iron prenatal vitamins.
patho: direct damage to GI= hemorrhage, hepatic injury/necrosis, third spacing and pooling of blood= hypotension, interference with oxidative phosphorylation
P: 4 stages: 1) 500 or 300+ labs abn, can give test dose if urine is red or vin rose color then pos and start IV.

Question 38

Lead

Answer 38

dirt, paint clay
P: abd prob, cns complaints (listlessness, irritbaility, seizure, encephalopathy, decr consiousness), microcytic anemia, basophlic stippling, RBC precursors, radiopacities, dense metapheasl bands on radiograph, lead lines on knees and wrist.
dx- elevated lead or erythrocyte protoporphyrin
management- dimercaprol, british anti-lewisite, or EDTA

Question 39

Caustic acids

Answer 39

acids or alkalis with corrosive potential. damage mouth and esophagus
acids- coat necrosis- superficial damage.
alkalis- liquefaction necrosis- deep and penetrating.
P: burning with hysphagia, salivation, retrosternal pain, vomiting. obstructive airway edema (acid), gastric perforation (acid), esophageal perforation with mediasitnitis (base)

Question 40

caustic agent management

Answer 40

don’t neutralize bc cause exothermic rxn- burn
CI: gastric lavage, ipecac, charcoal
endoscopy assess damage
household bleach - doesn’t need tx

Question 41

CO

Answer 41

low lvl- flu like - nonspecific sx-HA, dizziness
high lvl- visual and auditory changes, vomiting, confusion, syncope, slurred, cyanosis, MI, coma, death
cherry red skin-venous blood has more O2 bc left shift= don’t release O2 to tissue. retinal hemorrhages, tackycardia/pnea. kid= GI>neuro sx. neuro delayed
dx- CO-Hb lvl, anion gap metabolic acidosis, low O2 sat though PaO2 may be normal. MI on ECG or leveled troponin.
hospitalize if COHb> 25% or >10%+ sx

Question 42

dog bites

Answer 42

s. aureas. suture wound, and amoxicillin-clavulanic acid. tetanus prophylaxis

Question 43

cat bite

Answer 43

P. multocida= often infected. cat scratch disease with regional lymphadenitis
punture wound

Question 44

human bite

Answer 44

fist fight-metacarpophalangeal joint. - may penetrate avascular fascial layer- deep infection and tendonitis
high infection with mixed bacteria - strep viridian, s aureus, anaerobic bacteria. hep B, HIV, siphilis
amoxicillin-clavulanic acid

Question 45

black widow

Answer 45

neurotoxin. severe HTN and cramps= pathonomongic

irrigate, tetanos prophylaxis, benzo relive M cramps, latrodectus antivenin

Question 46

brown recluse spider

Answer 46

nrpwm vop;om sj[aed/ cytotoxic. painless bite then 8hr later a painful itchy papule incr in size and discolors over 3-4d. necrotic and ulcerative deep lesion. systemic run 1-2d with fever, chills, weakness, DIC, hemolysis, RF 2.2 myoglobinura.
steroid, skin grafting, dapsone, hyperbaric O2. no antivenin

Question 47

pit viper snake

Answer 47

proteolytic enzyme. swelling and ecchymosis. paresthesias of scalp, weakness, metallic taste in mouth. coagulopathy, thrombocytopenia, hypotension and shock.
crotalidae polyvalent antivenin for all bites within 4-6hr. antivenin can cause serum sickness and anaphylaxis. can use crotalidae polyvalent immune Fab

Question 48

coral snake

Answer 48

red, yellow, black. neurotoxic. severe system sx, diplopia, fascinations, respiratory depression. antivenin.

Question 49

cardiac shock

Answer 49

rare in kids. due to severe CHF, dysrhythmias, cardiomyopathy, tamponade
sx: cool extremities, delay refill, hypotension, tachypnea, incr obtundation, decr urine output

Question 50

gaining access

Answer 50

if peripheral line can’t be placed in 90s, intraosseous line is fastest way to get assess. insert needle in marrow cavity oblong bone

Question 51

fever + petechiae

Answer 51

always think meningococcal sepsis. even if look well. need blood culture and antibiliotics until r/o. when dx, need to get all household contacts tx with ciprofloxacin for adults an rifampin for kids as prophylaxis.
complicaiton: hearing loss, neuro disability, digit or limb amputation, skin scaring.
10-15% fatality. 21%fatality in adolescents

Question 52

toxic shock syndrome

Answer 52

fever, sunburn looking rash -sandpaper texture.

Question 53

rocky mountain spotted fever

Answer 53

also cause fever and petechiae but isolated to pass and soles.

Question 54

meningococcal conjugate vaccine

Answer 54

given to kids 11-18. IM. booster at 16yo.