high yield Flashcards
What are the components of a rapid response system?
- standards for vital signs monitoring
- calling criteria or early warning scores
- planned response army
- quality monitoring process & administrative arm
- education on early detection and management of deteriorating patients for front-line health care providers
What are contraindications to HFNC?
- contraindications:
- nasal obstruction
- epistaxis
- severe upper airway obstruction
Side effects of HFNC?
- excessive gas flow rates can impede exhalation in some patients with increased airway resistance
- higher intrathoracic pressures can reduce preload or increase pulmonary ventricular afterload - leading to hemodynamic instability
- air-leak syndrome
- abdominal distention
- third-spacing in facial trauma or following upper airway or esophageal surgery
What clinical conditions are potentially responsive to HFNC?
Upper airway obstruction
* OSA
Lower airway obstruction
- bronchiolitis
- asthma
Lung parenchymal disease
* pneumonia or pneumonitis
Heart failure
What are the 4 methods of determining treatment goal weight for children with anorexia?
- Based on previous weight percentile prior to ED onset (preferred)
- mean BMI calculation (50th %ile for age and sex): use if growth curve information isn’t available or incomplete
* limitation in this method, especially in cases of AN - Weight at return of menstrual function + 2 kg
* ex menstrual function lost or returns at 55kg, therefore goal is 55 + 2 = 57
* wt at return of menstrual function is a minimal requirement for health - TGW based on weight at same percentile as height percentile
* note that if there is slowed growth velocity, should use premorbid growth pattern instead
What are recommendations for the clinician re: prevention of firearm injuries?
- shouldn’t be present in homes or environments of children/adolescents
* unloaded, locked, separate from ammunition - Ask routinely about firearms in home
- Screen for presence of firearms for children with or at risk of mood disorders, substance abuse issues, self-harming behaviours
- If concern for intimate partner or family violence
- Inform parents nonpowder firearms (air guns, BB guns) are dangerous; children & adolescents should not use unless supervised by adult
* paintball and airsoft guns used only in supervised arenas with safety gear - Nonpowder firearms: pellets can cause significant internal injury
What are recommendations for government re: firearms?
- reduce illegal importation of firearms into Canada
- tighter restrictions on semiautomatic firearms
- gang prevention initiatives
- research on RF for targeted school violence
- evidence based programs to prevent bullying and improve access to mental health services
- Classify air guns & BB guns whose projectile velocity is great enough to cause eye or skin penetration as firearms under Canada’s Firearms Act
Recommended options for contraception?
- Recommend LARCs as the method of first choice
- Promote condom use to enhance safety and effectiveness of other methods and prevent STIs
- Counsel on emergency contraception
Contraindications to contraception?
- BMD
- DMPA has rebound - Thromboembolic events and strokes
- migraine with aura is contraindication - Body weight
- DMPA reported to have wt gain
- transdermal patch effectives for <90 kg
Starting contraception?
- Quick start
- can start outside of 7 days post starting menstrual period
- Pregnancy test at start
- condoms x 7 days (14 if used Ella)
- repeat preg test at 21 days - No pelvic exam
- Year long prescription
What does CPS recommend regarding financial coverage of conception?
- all contraceptives should be covered at no cost until age 25
- Health ministries should provide contraceptives at no cost to community based health care services for youth
- health ministries that adopt public-private models to cover contraceptives must ensure that privately insured youth have equal access to no-cost, confidential contraception.
o create a mechanism for pharmacists to identify insurance provider- contraceptives can be dispensed without parent’s knowledge
o Require private insurers cover entire cost until age 25
o protect confidentiality by not reporting to a primary policy holder - if available over-the-counter, the law should ensure their continued provision at no cost, until age 25
Who can get venom immunotherapy?
positive skin test & history of systemic reaction
EXCEPT if the reaction was skin reaction alone
if history of severe reaction and skin testing negative, serum-specific IgE and repeat skin testing is ordered; if both are negative, the chance of a future systemic reaction to a stinging insect is minimal
What increases the risk of beta-lactam allergy?
- parenteral
- long-term
- high-dose
4 types of immune reaction?
Type 1: IgE-mediated (=<1-2 hours)
- urticaria/angioedema, respiratory distress, GI sx, hypotension, anaphylaxis
Type 2: cytotoxic (10 hr-wks)
- anemia, thrombocytopenia
Type 3: immune-complex (1-3 wk)
- serum sickness-like reaction: fever, urticaria, vasculitis, arthritis/arthralgia
Type 4: T cell-mediated (2-14 days)
- maculopapular rash, SJS, DRESS, acute generalized exanthematous pustulosis (AGEP)
Types of housing need?
- inadequate housing: in need of mjaor repairs
- unsuitable housing (crowded): fails to meet the National Occupancy Standard requirements for number of bedrooms for the size and make-up of the household
- Unaffordable housing: 30% or more of gross household income spent on shelter costs
- Unacceptable housing: doesn’t meet at least 1 of the standards of adequacy, suitability, and affordability
- Core housing need: Unacceptable housing and household would have to spend 30% or more of gross household income to access acceptable housing in their community
