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ER Treatments/must know facts Flashcards

1
Q

What are some immediate life-threatening conditions to rule out immediately?

A 
airway obstruction (crush injury)
tension PTX
open PTX
Flail chest
Cardiac tamponade
massive internal/external hemorrhage
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2
Q

How do we clear a C-spine?

A

Nexus/Canadian C-spine rules

C-spine X-ray miss 15% of all C-spine fractures

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3
Q

What are the Nexus criteria?

A
  1. midline cervical tenderness
  2. focal neurological deficits
  3. altered level of consciousness
  4. evidence of intoxication
  5. painful distracting injury
    If yes to anything get imaging
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4
Q

is epidural hematoma arterial or venous? what about a subdural?

A 
epidural = arterial
subdural = venous
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5
Q

NG tube/foley can be placed in ED except when?

A

no NG with skullbase/cribiform plate fracture

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6
Q

Before foley you should look for?

A

High riding prostate, blood at urethral meatus(males), perineal ecchymosis (females)

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7
Q

Penetrating chest trauma + witnessed signs of life during transport to the ED + electrical activity upon arrival

A

EMERGENT ED THORACOTOMY

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8
Q

Routine labs for trauma patients?

A 
T/S, T/C
CBC
UA, CHECK BLOOD
ETOH (in CT, its okay without written consent)
FEMALE = PREGNANCY
> 55 y/o = EKG, TNI, CARDIAC MARKERS
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9
Q

What are the most common directions each joint dislocates?

A 
Hip  = posterior dislocation
Glenoid =  anterior
Elbow  = posterior
Knee =  anterior
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10
Q

How will a hip dislocation present?

A

shortened and internally rotated

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11
Q

Sprain vs Strain?

A

Strain—tearing injury to muscle fibers, excessive tension/overuse (tendons)

Sprain—Tearing injury to >= 1 ligaments; joint forced beyond normal ROM

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12
Q

What are the ortho emergencies?

A

open fractures
subluxation/dislocation with tenting/stress to the N/V bundle
N/V injury

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13
Q

How do you describe the direction of the displacement?

A

THE POSITION OF THE DISTAL FRAGMENT RELATIVE TO THE PROXIMAL FRAGMENT

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14
Q

How do you describe a radiograph?

A 
Open vs. closed injury
Location of fx—proximal, midshaft? cm?
Intrarticular?
Use bony landmarks—supracondylar fx etc.
Orientation of the fx line—transverse, oblique, spiral, comminuted 
Displacement/separation—fx fragments offset—use % of bone
Direction of displacement?
Separation?—distance between fragments
Shortening?
Impacted/overriding
Angulation (unbending %)
Rotational deformity?
Dislocation/subluxation?
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15
Q

Tx for colles fracture?

A

emergent reduction and surgery

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16
Q

Tx for posterior dislocation of the elbow?

A

reduction! traction

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17
Q

What are the most common carpal fractures?

A

scaphoid, lunate then triquetrium

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18
Q

Proximal radius fracture tx?

A

long arm case unless comminuted then surgery

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19
Q

Spiral fracture of proximal humorous tx?

A

sling and swathe

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20
Q

Left anterior and superior pubic rami fracture tx?

A

None

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21
Q

Femoral neck tracture tx?

A

percutaneous screws or hemiarthroplasty

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22
Q

femoral shaft fracture tx?

A

intramedullary rods or plates

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23
Q

Intertrochanteric fracture tx?

A

sliding hip screw fixation or a long gamma nail

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24
Q

hip dislocation tx?

A

sedate and locate

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25
How old are neonates?
less than 30 days
26
DDx for fever in neonate?
GBS, meningitis, herpes encephalitis, measles, RSV (no tx), UTI
27
What is the fever threshold for neonates/infants less than 2 months?
100.4 (38 C)
28
What is the fever threshold for infants/children 3-36 months?
102.2
29
What is the fever threshold for children over 36 months?
varies depending on signs and sx
30
Should/how would you tx fever?
yes. acetaminophen 15 mg/kg/dose PO/PR every 4-6 hours | or ibuprofen 10 mg/kg/dose every 6-8 hours (max 40mg/kg)
31
Most common causes of serious bacterial illness?
UTI, bacteremia/sepsis, penumonia, sinusitis, meningitis
32
IF YOU COULD ONLY ORDER A SINGLE TEST ON THESE PATIENTS…WHERE IS THE MONEY????
U/A
33
Fever > 39 C/102.2 F and + positive UA?
PYELO/RENAL PARENCHYMA involved
34
MCC of UTI/bacterial meningitis/sepsis/bacteremia?
E. coli, group B strep, listeria
35
Best way to get urine specimen from a child?
cath or suprapubic tap (which no one does anymore)
36
What is considered a positive urinary culture with cath?
more than 1000 CFU/mL (this is different
37
What is the most common cause of infants less than 3 months?
viral!
38
Most common cause of bacterial meningitis more than 3 months?
S. pneumo, N. meningitidis, S. aureus
39
How to dx bacterial meningitis?
CSF WBC’s > 30 in the neonate & > 10 in children > 1 y/o, + CSF stain, CSF ANC > 1000 cells/microliter, CSF protein > 80 peripheral WBC > 10,000 & hx of seizure before or at onset Initiate abx asap!
40
How do you tx pleocytosis?
may suggest viral etiology; strongly recc. Admit and await cx’s + abx’s; if d/c home, use long acting parental abx = Ceftriaxone (Rocephin) = 100 mg/kg q24hours, max 2g, and await 24 hour cx’s
41
What does bronchiolitis tend to go hand in hand with?
UTI
42
What can ceftriaxone (rocephin) do to neonates (less than one month)?
transient hyperbilirubinemia
43
potential parenteral ABXs in child less than 28 days
ampicillin ceftriaxone, cefotaxime +/- gentamycin
44
Fever, foul smelling urine, crying with urination
UTI
45
< 5 y/o—high fevers, strawberry tongue, conjunctivitis/iritis, red mucous membranes, peeling of hands, feet. How do you treat?
tx for kawasaki disease = IV Ig and ASA (only indication for ASA in kids)
46
What is a bad complication of kawasaki disease?
coronary aneurysms
47
Layers of the scalp?
``` S - skin C - connective tissue/fat A - (Galea) aponeurosis - majority of blood vessels L - loose connective tissue P - periosteum ```
48
Once an pt with epidural hematoma presents with ipsilateral pupillary dilation, is that okay?
nope they've herniated their brainstem. They're done
49
shift of brain stem away from mass/bleed with compression of opposite cerebral peduncle; this can cause IPSILATERAL hemiparesis, instead of the usual thinking (contralateral)
KERNOHAN’S PHENOMENON
50
If brain herniation is imminent, what procedure could you do in the ER/Trauma bay?
burr holes | control ICP/BP/pain
51
Using a CT scan, how can you tell if the subdural hemorrhage is acute (1-3 days) or subacute (4 days - 2/3 weeks?
``` acute = hyperdense subacute = isodense ```
52
What drug reverses heparin?
protamine sulfate
53
What drug reverses coumadin?
Vitamin K
54
How to manage TBI?
``` A-B-C’s Frequent VS/Neuro checks EKG/Continuous cardiac monitoring IV/IVF Immobilize C-/T-/LS spine Strict BP/ICP monitoring; tx as needed Arrange for diagnostic testing Draw labs---CBC, Chem panel, PT/INR, APTT, Type and Cross/Screen, Med levels, as needed ```
55
What labs do you want for a TBI?
Draw labs---CBC, Chem panel, PT/INR, APTT, Type and Cross/Screen, Med levels, as needed
56
Signs of stroke?
``` Sudden onset garbled/inability to speak Unilateral arm or leg numbness Unilateral arm or leg weakness Facial droop Severe H/A, sudden onset LOC Loss of balance/coordination Visual field cut ```
57
In stroke patients, how should you control BP?
Control BP; keep SBP less than 180; don’t rapidly dec, as can worsen area hemm/ischemia; if already HTN keep MAP less than or equal to 130; may keep lower after OR Seizure meds
58
What is one treatment of hemmorhagic stroke?
Recombinant Factor VIIa/Novo 7 | Factor IX
59
What are the inclusion criteria for TPA?
1. at least 18 y/o 2. Within 3 hours of onset—NOW EXPANDED TO 4.5 HOURS FROM 3 IN SOME PTS 3. Stroke sx’s acutely 4. SBP < 185, DBP < 110 5. No assoc seizures 6. Not minor sx’s or rapidly resolving sx’s 7. No Coumadin use****CHANGED, NOW RELATIVE 8. PT < 15, INR < 1.7 9. No Heparin within 48 hours, normal APTT 10. Platelet > 100,000 11. 50 < Glucose < 400 12. No MI 13. No hx AVM, aneurysm, ICH in past 14. No major surgeries in 14 days 15. No CVA or serious head injury in 3 months 16. No GI/GU bleeding in 21 days 17. No lactation or pregnancy in 30 days
60
Dose for TPA
first 10% 0.9mg/kg IV bolus, usually with , remainder 90% as drip
61
Work up for CVA/TIA
MRI FOLLOW-UP AFTER INITIAL CT; CONSIDER MRA CAROTID DUPLEX ULTRASOUND---ESP IF SUSPECT ANTERIOR ORIGIN ECHOCARDIOGRAM—R/O CARDIAC SOURCE; TTE VS. TEE---TEE MORE SENSITIVE TCD’S; TRANSCRANIAL DOPPLERS---R/O POST CIRCULATION SOURCE; *****LIMITED (CONSIDER MRA) CHOICE OF MEDS; ASA, PLAVIX, AGGRENOX, STATIN---CHECK FASTING LIPIDS, ETC….
62
What is the dosage for Acetaminophen?
15 mg/kg/dose PO/PR every 4-6 hours
63
What is the dose for ibuprofen?
10 mg/kg/dose every 6-8 hours (max 40mg/kg) minimum age 6 months
64
MOst common pathogens causing meningitis in a kid 3 months?
< 3- e.coli, group B strep, listeria | > 3- S. pneumo, N. Meningitis, staph aureus

J's ClinMed Deck (12 decks)

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