Misc PEM Q Book Flashcards
lab abnormality in hereditary angioedema
low C4
reasons to use VariZig
only for post-exposure ppx, but NOT once there is varicella infection
lab abnormalities in strep glomerulonephritis
low C3, nml C4.
if levels are normal, consider something else
non-ketotic hypoglycemia with metabolic acidosis should make you think of…
fatty acid oxidation disorder
classic lab findings in fatty acid oxidation disorder
non-ketotic hypoglycemia
anion gap formula
AG = Na - Cl - HCO3
calculated osmolarity
= 2 x Na + glucose/18 + BUN/2.8
Multi-casualty vs mass casualty event
multi-casualty = 5+ victims
mass casualty = strains the existing EMS system
what’s unique about the sterile pyuria of Kawasaki disease?
it is lymphocyte predominant
What can different levels of responders do: first responders? EMT-B? EMT-I? EMT-P?
1st responders: airway clearance, control blood loss, AED, CPR
EMT-B: assessment, spinal immobilization, BVM, defibrillation
EMT-I: pacing, cardioversion, IO, EKG, needle thoracostomy, advanced airway management
EMT-P: arrhythmias, advanced airway management, intubation, cricothyrotomy, meds, fluids
Best pressors for shock that is:
- cold
- warm
- normal BP
- epi
- norepi
- dopa
CXR findings (measurements) for RPA
prevertebral soft tissue swelling >7mm at C2 or 14mm at C6
Lab findings concerning for a pulmonary EXUDATE
WBC >10K glucose < 50% of serum protein > 50% of serum amylase > 200 LDH > 60% of serum pH < 7.0 (v. suggestive of empyema)
EKG findings in pericarditis
widespread ST elevation
PR depression
ST elevation in limb and precordial leads with concave elevations
Location for ____ nerve block at wrist:
1) ulnar
2) median
3) radial
1) ulnar - proximal ventral crease at ulnar styloid
2) median - medial tendon of flexor carpi radialis
3) radial - dorsal crease @ radial styloid
pressure readings associated with compartment syndrome
> 30 mmHg
Components of the pediatric trauma score
- size
- airway
- consciousness
- SBP
- fractures
- cutaneous
How do you determine size for:
- ET tube
- ET tube depth of insertion
- NG tube size
- chest tube size
- ET tube = age/4 + 4
- ET tube depth of insertion = ETT x 3
- NG tube size = ETT x2
- chest tube size = ETT x 4
low plasma alanine levels are associated with what IEM?
ketotic hypoglycemia
what are treatments for hyperammonemia?
IV arginine
sodium benzoate
phenylacetate
hemodialysis
what disease is associated with +reducing substances in the urine, cloudy cornea, and HSM?
galactosemia
What is the BP treatment for pheochromocytoma?
phenotalamine
2nd line is CCBs
NO beta-blockers!!!
Patient with a PAINFUL Horner’s syndrome should make you think of…
carotid artery dissection
treatment for HOCM emergency?
B-blockers and CCBs
what is the treatment for lichen sclerosis?
topical steroids
treatment of prolapsed urethra
topical estrogen
treatment for tet spells
morphine (decreases pulmonary venous return, relaxes the infundibulum)
phenylephrine (increases SVR)
sodium bicarb (reduces acidosis)
beta-blockers (relaxes infundibular spasm, decreases inotropic effect)
treatment of HOCM?
what should you avoid?
beta-blockers
CCBs
avoid - diuretics and digoxin
Criteria for Acute Rheumatic Fever
Major: carditis, polyarthritis, chorea, erythema marginatum, subcutaneous nodules
Minor: fever, prolonged PR, elevated ESR/CRP/WBC, previous rheumatic fever, arthralgias
*Polyarthritis is the most frequently found major criteria
*Dx if 2 major or 1 major + 2 minor
med to rapidly inhibit release of thyroid hormone in pediatrics
potassium iodide (PTU is contraindicated in kids; methimazole doesn't work acutely)
SIRS criteria
T 38 tachypnea tachycardia WBC 12K 10% bands
Symptoms of autonomic dysfxn syndrome
tachycardia, tachypnea, diffuse diaphoresis, hyperthermia, hypertension, mydriasis, and dystonia
Treatment of autonomic dysfxn/sympathetic storm
bromocriptine, dantrolene, benzodiazepines, clonidine, and narcotics
A painful Horner’s syndrome should make you concerned about…
a carotid artery dissection
What are the components of Cushing’s triad?
What is the earliest and most sensitive indicator?
bradycardia, hypertension, irregular respirations
most sensitive/earliest: bradycardia
What are the impt landmarks for IJ venous access?
The medial approach uses the apex of the triangle formed by the sternal and clavicular heads of the SCM.
Best localized with mild hyperextension of the neck.
Location for a distal ulnar nerve block?
just proximal to the ulnar styloid process
Nerve block achieved at: just proximal to the ulnar styloid process
ulnar nerve block
Location for a distal median nerve block?
between the palmaris longus and flexor carpi radialis tendons
Nerve block achieved at: between the palmaris longus and flexor carpi radialis tendons
median nerve block
Reasons to refer a patient to a burn center (4)
1) partial thickness depth >10% if 20% BSA > 11 years)
2) full thickness depth > 2% BSA
3) high risk for disability or poor cosmetic outcome (e.g., hands, feet, face, circumferential burns and those overlying joints)
4) associated inhalation injury or trauma
Parkland Formula
4 x BSA x wt (kg) Give half in first 8 hours Give second half in subsequent 16 hours Does NOT account for maintenance fluids Should only include partial and full thickness burns in BSA calculation Only apply if 15% BSA is involved
Max dose of bupivicaine
2mg/kg without epi
3mg/kg with epi
1% lidocaine is how many mg/ml
0.25% bupivicaine is…
10mg/ml
2.5mg/ml
Things that can cause false positive guaiac stools
Horseradish
Turnips
Cherries
Tomatoes
Things that can cause red stool that isn’t bloody
cefdinir/omnicef red food dye licorice blueberries spinach beets bismuth iron preparations
Most common reason for child to have hypoglycemia?
What’s low/wrong?
ketotic hypoglycemia
low alanine stores in muscles
Distinction between organic acidemias and urea cycles defects?
OA: elevated ammonia and acidotic
UC: VERY high ammonia (1000s) and usually NOT acidotic; low BUN, nml lactate, encephalopathy
IEM associated with reducing substances in urine?
galactosemia
Lab that is usually diagnostic for CAH
17-hydroxyprogesterone (17-OHP)
IEM mimic of child abuse with macrocephaly, chronic subdural effusions?
How to diagnose?
glutaric acidemia type I
dx with urine organic acids
dx usually made during crises (intercurrent illnesses) with metabolic acidosis, hyperammonemia and encephalopathy.
Management of Kawasaki when acute?
When convalescent?
Acute: IVIG, high dose ASA
Conv: low dose ASA (3-5mg/kg/day)
Management of dry gangrene in scleroderma
tx with systemic or topical nitro; or CCBs
How do you calculate sodium deficit?
Figure out the volume deficit
Na/1000 x 0.6 x volume deficit
Labs in RTA type IV
hyperkalemic, hyperchloremic, metabolic acidosis with normal AG
Winter’s Formula
PCO2 = 1.5 x HCO3 + 8 +/- 2
Symptoms of scorpion sting
local pain, restlessness, hyperactivity, roving eye movements, and respiratory distress. More severe signs include seizures, drooling, wheezing, hyperthermia, cyanosis, GI hemorrhage, respiratory distress and death from shock or respiratory paralysis
Envenomation associated with metallic taste
rattlesnake
systemic symptoms of brown recluse spider bite
fever, chills, malaise, weakness, nausea, vomiting, joint pain, petechial morbilliform rash, intravascular hemolysis, hematuria, and renal failure
fish that cause scombroid
tuna, mackerel, and bonito
fish that cause ciguatera
barracuda, grouper, and snapper
what do you need to avoid when treating a patient with ciguatera poisoning?
opioids - may interact with toxin and cause hypotension
order of tissues with resistance to electricity
Bone > fat > tendon > skin > muscle > nerve.
when should you consider active rewarming measures
cardiovascular instability, T < 32ºC, or inadequate response to passive re-warming methods
how do you grade frostbite injuries?
1st degree- numbness and erythema with no tissue loss
2nd - superficial blistering, with clear to milky fluid, surrounded by edema and erythema
3rd - deeper blisters with blood containing fluid (leave blisters alone)
4th - affects muscle and bone.
pressor of choice in heat stroke
dobutamine - maintains peripheral vasodilation
in hypothermia, resuscitate to at least what temperature
The patient should be resuscitated until a body temperature of 32 – 34ºC
Symptoms of lithium toxicity
coarse tremor, ataxia, dysarthria, vomiting, diarrhea, cardiovascular changes and renal dysfunction.
Later signs: impaired consciousness, muscle fasciculations, myoclonus, seizures, coma and death.
Best med for an agitated (possibly delirious) child?
haldol NOT BDZs (could loosen inhibitions or worsen delirium)
What are the different levels of sedation?
Minimal - respond normally to verbal commands and not asleep.
Moderate - does not need repeated painful stimulation to be aroused and should not require intervention to maintain a patent airway.
Deep sedation - patient cannot be easily aroused but respond purposefully after repeated verbal or painful stimulation; ability to independently maintain ventilatory function may be impaired.
General anesthesia is not arousable, even by painful stimulation.
What are the ASA classifications?
I - normal, healthy patient
II - mild systemic illness without functional limitation
III - severe systemic disease with definite functional limitation.
IV - severe systemic disease that is a constant threat to life.
V - moribund patient who is not expected to survive without the procedure
Epi dose for bradycardia in neonatal resuscitation
0.01 mg/kg of 1:10,000
How do you determine ETT sizes in neonatal resuscitation?
2.5 = < 1000g, 3000g, >38wks
How do you differentiate between main types of neonatal conjunctivitis?
Gonococcal - 3-5 days after birth.
Chlamydial - 5- 14 days after birth. Negative gram stain (obligate intracellular parasite)
Non-gonococcal, non-chlamydial bacterial - after the first 2 weeks of life.
Chemical(due to silver nitrate prophylaxis) - first day of life and resolves in 2-4 days.
Symptoms of morning glory intoxication?
mydriasis, hyper or hypothermia, perspiration, bronchorrhea and increased salivation
What’s the difference between:
boutonniere deformity
swan neck deformity
hammer/mallet finger
boutonniere - flexed PIP, extended DIP
swan neck - extended PIP, flexed DIP
hammer - flexed DIP due to rupture of extensor digitorum tendon
Fruity odor, ingestion with no acidosis, but +osmolar gap?
isopropyl alcohol (odor is from acetone metabolic byproduct)
How often do physically restrained patients need their restraints renewed according to JACHO?
< 9 years - every hour
9-17 years - every 2 hours
adults - every 4 hours.
Patients must be evaluated, face-to-face, by the physician ordering the restraints within 1 hour of placing the order.
Findings in cardiac tamponade
Beck’s triad: hypotension, muffled heart sounds, and distended neck veins
Low QRS voltages in all leads
Electrical alternans in precordial leads
What is the dose for naloxone?
0.1mg/kg
x-ray findings in RPA
> 7mm at C2
>14mm at C6
EKG findings in pericarditis
An ECG will demonstrate changes of epicardial inflammation with widespread ST elevation, PR depression, ST elevation in limb and precordial leads. The elevations are concave.
treatment of malignant hyperthermia
dantrolene
Treatment of labial adhesions?
Treatment of urethral prolapse?
Treatment of lichen sclerosis?
1st line: topical estrogen cream; 2nd line: topical steroids
topical estrogen
topical steroids
medical treatment of phimosis
topical steroids
epi dosing for anaphylaxis
1: 1000 epi
0. 01 mg/kg
0. 01 ml/kg
epi dosing for codes
1: 10,000
0. 01 mg/kg
0. 1 mg/kg
management of frenulum lacerations
expectant - do not suture as they heal spontaneously
With regards to hemothorax, what amount of bloody output should trigger operative management?
Immediate return of 1500mL or 10-15ml/kg
>200ml/hr or 2-4ml/kg/hr of bloody drainage
Immediate treatment of commotio cordis?
defibrillation
What qualifies for a positive DPL?
free aspiration of gross blood, gastrointestinal contents, vegetable fibers or bile through the lavage catheter upon entering the abdominal cavity or the presence of ≥100,000 RBC/mm3, ≥500 WBC/mm3 or bacteria on Gram stain of the lavage fluid.
