ER Flashcards

1
Q

cardiac arrest

A

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

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2
Q

shock classification

A

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

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3
Q

hypovolemic shock

A

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

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4
Q

septic shock

A

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

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5
Q

distributive shock

A

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

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6
Q

sx of shock

A

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

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7
Q

coagulation factors

A

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

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8
Q

trauma

A

1 cause of death in

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9
Q

pulseless electrical activity on ecg

A

cardiac tamponade. T PTX, profound hypovolemia

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10
Q

head trauma

A
  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.
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11
Q

bradycardia

A

1st sign of herniation in

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12
Q

signs of herniation

A

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

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13
Q

treat incr ICP

A

mild hypervent, elevation of head, diuretic, neurosurgery

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14
Q

T PTX

A

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

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15
Q

abdominal trauma

A

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

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16
Q

burns

A

2nd most common injury.

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17
Q

secondary burn

A

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

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18
Q

first degree burn

A

red, blanching painful. epi

tx: moisturizer, analgesics

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19
Q

3rd degree burn

A

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

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20
Q

BSA

A

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

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21
Q

burn management

A

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

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22
Q

near drowning

A

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

23
Q

drowning management

A

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

24
Q

drowning prog

A

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

25
abuse RF
26
abuse signs
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
27
abuse #1 and 2nd cause of death
head injury.
28
sudden infant death syndrome
29
poison
60% occur in
30
odor of poisons
bitter almond- cyanide. garlic- arsenic, organophosphate. acetone- salicylates.
31
skin v poison
cherry red- CO or cyanide. sweaty- organophosphate, sympathomimetics. dry- anti cool. gray cyanosis-methmoglobinema
32
eye v poison
miosis- opiate, phenyclidine, organophos, phenothiazine mydriasis- tricyclic antidep, atropine nystagmus- dilantin retinal hemorrhage- CO, methanol.
33
AMUDPILES
causes of increased anion gap >16. alcohol, methanol, uremia, diabetic ketoacidosis, paraldehyde, iron and isoniazid, lactic acidosis, ethylene glycol, salicylates
34
CHIPE
radioopque substances on imaging of abd. chloral hydrate/calcium ,heavy metals iodine/iron, phenothiazine, enteric coated tablets
35
gastric decontamination
syrup of ipecac- induce emesis- if ingest
36
salicylate poisoning
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
37
Iron
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.
38
Lead
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
39
Caustic acids
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)
40
caustic agent management
don't neutralize bc cause exothermic rxn- burn CI: gastric lavage, ipecac, charcoal endoscopy assess damage household bleach - doesn't need tx
41
CO
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
42
dog bites
s. aureas. suture wound, and amoxicillin-clavulanic acid. tetanus prophylaxis
43
cat bite
P. multocida= often infected. cat scratch disease with regional lymphadenitis punture wound
44
human bite
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
45
black widow
neurotoxin. severe HTN and cramps= pathonomongic | irrigate, tetanos prophylaxis, benzo relive M cramps, latrodectus antivenin
46
brown recluse spider
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
47
pit viper snake
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
48
coral snake
red, yellow, black. neurotoxic. severe system sx, diplopia, fascinations, respiratory depression. antivenin.
49
cardiac shock
rare in kids. due to severe CHF, dysrhythmias, cardiomyopathy, tamponade sx: cool extremities, delay refill, hypotension, tachypnea, incr obtundation, decr urine output
50
gaining access
if peripheral line can't be placed in 90s, intraosseous line is fastest way to get assess. insert needle in marrow cavity oblong bone
51
fever + petechiae
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
52
toxic shock syndrome
fever, sunburn looking rash -sandpaper texture.
53
rocky mountain spotted fever
also cause fever and petechiae but isolated to pass and soles.
54
meningococcal conjugate vaccine
given to kids 11-18. IM. booster at 16yo.