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Emergency Medicine > Quiz #3 > Flashcards

Quiz #3 Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Peds larynx are more ??

A

superior/anterior position (C3 level)

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2
Q

Adults vocal cords are more?

A

perpendicular to trachea

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3
Q

Peds vocal cords are more?

A

slant anteriorly to trachea

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4
Q

How is pediatric tube sizes estimated?

A

ETT= (age + 16) / 4

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5
Q

What is ETT tube size age?

A

older 1 yr

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6
Q

What is more accurate at determining ETT?

A

resuscitation tapes

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7
Q

Formula for Depth of ETT insertion?

A

ETT x 3 = (cm)

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8
Q

What age doesn’t get a cricothyroidotomies?

A

<10-12yr

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9
Q

For children <10 what airway emergency do they get?

A

Needle translaryngeal ventilation

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10
Q

How long does a needle translaryngeal last?

A

~30 mins (30kg)

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11
Q

What is a problem with needle translaryngeal?

A

build up of CO2

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12
Q

What blade is used for <2yr?

A

straight blade (miller)

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13
Q

What tube is used for <6-8yr?

A

uncuffed tubes

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14
Q

What should be avoided when given oxygen to the child?

A

hyperventilation

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15
Q

What does hyperventilation cause?

A

air in the stomach

possible barotrauma

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16
Q

What method is used for fluid boluses?

A

4-2-1 method

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17
Q

For hypovolemia how should a bolus be admin?

A

rapidly as possible (20 min max)

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18
Q

What should be done after each bolus given?

A

reassess patient

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19
Q

In peds cardiac arrest is usually secondary to what?

A

respiratory arrest and shock

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20
Q

What are the 3 priorities in pediatric arrest?

A

airway, oxygenation, ventilation

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21
Q

Who has a poor outcome in ped arrest?

A

child in primary cardiac arrest

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22
Q

What are 6 airway emergencies?

A 
stridor (obstruction)
epiglottitis
croup
foreign body aspiration
peritonsillar/ Retropharyngeal abscess
Bronchiolitis
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23
Q

What are 4 signs of airway/ breathing difficulties?

A

stridor
intercostal and suprasternal retractions
tachypnea
cyanosis

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24
Q

Which child is in imminent danger of airway compromise?

A

Stridorous

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25
Q

What should not be done in a child that is having stridor?

A

DO NOT agitate or lay them down!

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26
Q

What is the txt for stridor?

A

begin intervention to correct cause ASAP

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27
Q

Dysphagia, drooling, distress?

A

Epiglottitis

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28
Q

The three D’s?

A

Epiglottitis

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29
Q

Tripod position

A

Epiglottitis

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30
Q

What is the txt for epiglottitis?

A

IV steroids and abx

oxygen

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31
Q

What is seen on a lateral neck x-ray in epiglottitis?

A

Thumb sign

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32
Q

What pathogen causes croup?

A

parainfluenza

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33
Q

What infection is seen in croup pts?

A

viral laryngotracheobronchitis

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34
Q

What are the classic s/s of croup?

A

nasal congestion
rhinorrhea
cough
low grade fever

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35
Q

Harsh barking cough worse at night

A

croup

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36
Q

What is the severity of symptoms in croup related to?

A

edema and inflammation of the airway

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37
Q

What is the txt and disposition for croup?

A

corticosteroids, +/- nebulized epinephrine

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38
Q

What is seen on a/p neck xray for croup?

A

steeple sign

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39
Q

What pathogen causes bronchiolitis?

A

RSV

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40
Q

What is the most common age for bronchiolitis?

A

<2y

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41
Q

What week are symptoms the worst in bronchiolitis?

A

1st week (out of 3)

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42
Q

What are the 6 symptoms in bronchiolitis?

A

URI symptoms, wheezing, fever, apneic episodes, cyanosis, poor feeding

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43
Q

What is the txt for bronchiolitis?

A

nebulized epinephrine
corticosteroids
nebulized hypertonic saline

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44
Q

What disorders are uncommon in emergency med?

A

unknown pediatric cardiovascular disorders

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45
Q

What are the majority of peds heart diseases seen in the ED?

A

valvular dysfunction
septal defects
vascular anomalies

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46
Q

Txt for peds cardio?

A

immediate cardio consulation

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47
Q

What makes peds heart defects worse?

A

oxygentation

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48
Q

When in doubt about cyanotic infants cardio txt?

A

admit to NICU for observation

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49
Q

Limping child w/ a hx of trauma or overuse, whats next?

A

imaging

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50
Q

Limping child w/ no trauma, whats next?

A

no systemic sx

systemic sx

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51
Q

Limping child w/ no systemic sx, what’s next?

A

imaging

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52
Q

Limping child w/ systemic sx, what’s next?

A

imaging

CBC, ESR, CRP

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53
Q

What things need to be r/o with a limping child?

A 
Fractures
SCPE
AVN
Osteomyelitis
Septic Joint
Cancer
Deep abscess
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54
Q

What are the 3s rule for colic?

A

> 3hrs/day
3days/week
3 weeks

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55
Q

What are 3 non-accidental trauma?

A

bruising in different stages of healing
fractures in different stages of healing
odd story concerning injury

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56
Q

Most common complaint in >75yr pts

A

weak and dizzy

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57
Q

What is often used as a surrogate for fatigue?

A

weakness

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58
Q

Neurological deficit?

A

muscle weakness

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59
Q

What 3 things is lightheadedness often due to?

A

anemia, hypovolemia, or orthostatic hypotension

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60
Q

What is vertigo?

A

loss of balance or spinning room

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61
Q

What is a precursor to altered mental status?

A

malaise

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62
Q

What are 6 emergent concerns for generalized fatigue?

A 
anemia
heart failure
inability to oxygenate
systemic infection
adrenal crisis
myxedema coma
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63
Q

What is the txt for muscle weakness?

A

identify cause and attempt to reverse or limit progression

Get pt to specialist

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64
Q

Dysfunction of the brain or brain stem leading to misinterpretation of peripheral stimuli?

A

Central vertigo

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65
Q

Dysfunction of the inner ear or vestibular nerve creating incorrect stimuli that is sent to brain?

A

Peripheral vertigo

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66
Q

What are 3 symptoms of central vertigo?

A

associated Cranial nerve deficits
Vertical nystagmus
Ataxia

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67
Q

CVA?

A

associated Cranial nerve deficits
Vertical nystagmus
Ataxia

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68
Q

What are 5 symptoms of peripheral vertigo?

A 
unilateral hearing loss
Tinnitus
Fatigable on repeat testing
S/s usually more tense
Positional in nature
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69
Q

What is positive on a Dix- Hallpike maneuver?

A

Latency (peripheral vertigo)

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70
Q

What is the txt for central vertigo?

A

activate stroke if < 4hrs from onset

Call neurology/admit if > 4hrs from onset

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71
Q

What imaging is done in central vertigo?

A

brain CT w/o contrast

brain MRI to evaluate cerebellum

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72
Q

What maneuver is done in peripheral vertigo to txt?

A

Epley Maneuver

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73
Q

What medicines are given for peripheral vertigo if the epley maneuver doesn’t work?

A

Antiemetics (meclizine)
Anticholinergics (scopolamine)
Benzodiazepines (diazepam)

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74
Q

“Passing out”

A

presyncope

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75
Q

Loss of consciousness AFTER a psychologically stressful event

A

vasovagal syncope

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76
Q

What is the patho of vasovagal syncope?

A

Stress increases vagal tone > causes bradycardia >

hypotension > lack of brain perfusion > unconsciousness

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77
Q

Loss of consciousness NOT RELATED to psychological stress event

A

syncope or presyncope

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78
Q

What 2 things should be done in a syncopal pt?

A

check fingerstick glucose and pregnancy

preform detailed PE

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79
Q

CHESS?

A

San Francisco Syncope Rule

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80
Q

What does CHESS stand for?

A 
Congestive Heart Failure
Hematocrit < 30%
E KG abnormality
Shortness of breath
SBP <90mmHg
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81
Q

What is the criteria to r/o a serious outcome for CHESS?

A

if “No” to all

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82
Q

What is the Canadian Syncope Risk Score used for?

A

a +/- to score risk of serious adverse event

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83
Q

What are the 4 first steps in txt a pt w/ syncope?

A

Supplemental O2
IV
Vitals
EKG

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84
Q

Syncope + Headache

A

subarachnoid or ICH

hemorrhage

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85
Q

Syncope + Neuro Deficit

A

CVA/TIA or ICH

86
Q

Syncope + Confusion

A

Seizure

87
Q

Syncope + Chest pain

A

MI, PE, or Aortic Dissection

88
Q

Syncope + Back/Abdominal pain in older patient

A

Abdominal Aortic Aneurysm (AAA)

89
Q

Syncope + Positive HCG

A

Ectopic Pregnancy

90
Q

What is the disposition for syncope?

A

D/C w/ PCM follow if low risk

otherwise ADMIT

91
Q

What are some precautions to give a syncope pt?

A

no exercise until evaluated and cleared

NO driving or swimming, shower w/ a chair or w/ someone nearby

92
Q

What is a level I trauma center?

A

all essential specialties and services available in house 24/7/365

93
Q

What is the No 1 cause of death in 1-37 y/o

A

Trauma

94
Q

Most specialties available in house 24/7/365?

A

Level II

95
Q

What level has transfer capability with level I and Level II

A

Level III

96
Q

What is vital to successful trauma resuscitation?

A

a team

97
Q

What should be performed in the first 1-2 min of arrival?

A 
100% O2
2 large bore IVs
Vitals, pulse oximetry
Removing all clothing and jewelry
Applying EKG leads
Limb splints
Obtaining O neg titer or type specific blood for transfusion
98
Q

What is the first and only drug to actually decrease mortality rates?

A

Tranexamic acid

99
Q

Use for pts with significant bleeding reduces mortality by 1.5% w/o increasing thromboembolic events?

A

Tranexamic acid

100
Q

When imaging done?

A

after ABCDEs

101
Q

What imaging is done in trauma?

A

CXR
Pelvic
X-table lateral C-spine
EARLY CT

102
Q

What is the 5 primary trauma survey?

A 
Airway
Breathing
Circulation/ Control of bleeding (C2)
Disability
Exposure
103
Q

What should ALWAYS be protected in inline immobilization?

A

C- spine

104
Q

For a midfacial trauma what two things can be done to protect the airway?

A

orotracheal or cricothyrotomy

105
Q

For severe head trauma in c-spine injuries what can be used for intubation?

A

pretreatment w/ lidocaine or fentanyl

Consider a dose of depolarizing paralytic (vecuronium)

106
Q

Where is needle decompression in adults done?

A

between the fourth or fifth intercostal space mid axillary line

107
Q

What is the drug of choice for intubation?

A

Ketamine

108
Q

What non-depolarizing paralytic is used?

A

Vecuronium

109
Q

What is FAST?

A

Focused Assessment with sonography in trauma

110
Q

What is RUSH?

A

Rapid ultrasound for Shock and Hypotension

111
Q

What should you be doing when checking the neck and throat?

A

feeling and looking

112
Q

Ensure adequate decompression of the chest and eliminate tension pneumothorax

A

finger thoracostomy

113
Q

What is the txt for losing blood loss?

A

Stop obvious bleeding
2 large bore IVs
16 Ga minimum
FAST/RUSH exam

114
Q

Where should a 16 Ga be performed?

A

long bone

115
Q

What administrated for shock and control of hemorrhage?

A

Pneumatic antishock garments (PASG)

116
Q

What are contraindications to PASG?

A 
Pulmonary edema
Pregnancy
Evisceration
Thoracic injury w/ hemorrhage
Diaphragm injury
Impaled objects
117
Q

What line is used for fluid resuscitation in children?

A

intraosseous line

118
Q

More than ??? of crystalloid fluid has been associated w/ increased mortality

A

1.5 L

119
Q

How fast should tranexamic acid be given?

A

within 3 hours

120
Q

When a 1g dose is given in prehospital setting, where should the other dose be admin?

A

in the ER

121
Q

Beck’s Triad is a indication for?

A

percardiocentesis or thoracotomy

122
Q

For pregnant pts what side should they be positioned to relieve uterine pressure on the IVC?

A

left lateral decubitus

123
Q

What use to be superior to tourniquets?

A

pressure

124
Q

If bleeding diathesis what should NOT be done?

A 
removing gauze
(add more gauze and continue to apply pressure)
125
Q

In a uncontrolled extremity hemorrhage what should be use?

A

tourniquets above the area of injury

126
Q

What 3 body cavities should be checked in internal bleed?

A

thorax
abdomen
retroperitoneum

127
Q

When should neurologic status be performed?

A

BEFORE sedation/intubation

128
Q

What is the rapid neurological assessment (AVPU)

A

Awake
Verbal response
Painful response
Unresponsive

129
Q

What is HNSCASPER?

A 
Head
Neck
Shoulders
Chest
Abdomen
Spine
Pelvis
Extremities
Reassess
130
Q

What is MARCH?

A 
Massive hemorrhage
Airway
Respiration
Circulation
Head injury/ Hypothermia
131
Q

What is most paramount in a mass casualty event?

A

scene and provider safety

132
Q

Once a tourniquet has been applied what shouldn’t be done?

A

DO NOT loosen it

133
Q

What can be used as a temporary measure in massive hemorrhage?

A

direct pressure w/o hemostatic agents

134
Q

If not treated promptly what can a tension pneumothorax progress to?

A

shock and traumatic cardiac arrest

135
Q

Where should a needle NOT be inserted?

A

medial to the nipple line

136
Q

A tourniquet should NOT be taken down after?

A

6 hours

137
Q

When should a tourniquet be converted?

A

2 hrs

138
Q

Less than how many hours is a STROKE ALERT?

A

<4hrs

139
Q

What is Glasgow coma scale usually used for?

A

trauma only… (but used in all emergency medicine)

140
Q

What score is normal on a Glasgow coma scale?

A

15

141
Q

What score is dead on a Glasgow coma scale?

A

3

142
Q

What are the 3 categories of a Glasgow coma scale?

A

eye opening, verbal response, motor response

143
Q

What is the first imaging that is done in a neuro ed workup?

A

Head CT

144
Q

What are 3 focal neurological deficits of acute onset?

A

movement
sensation
cognition (responsiveness)

145
Q

In a stroke like s/s pt what is the first thing that should be determined?

A

attempt to determine time patient “ last known well”

146
Q

What are all focal neuro deficits treated as?

A

STROKE (until either improve or other cause identified)

147
Q

What is the first order of business to help differentiate ischemic vs. hemorrhagic stroke?

A

CT w/o contrast

148
Q

What is seen on CT for a ischemic stroke?

A

focal deficit with NON-HEMORRHAGIC

149
Q

What lab should be done on all neuro pts?

A

fingerstick glucose

150
Q

Dx imaging for cerebellar stroke?

A

emergent brain MRI

151
Q

How many degrees should the bed be elevated in ischemic stroke management?

A

30

152
Q

What should the glucose be kept at for ischemic stroke?

A

140-180

153
Q

When should BP ONLY be lowered ?

A

SBP > 220mmHg
OR
DBP > 120mmHg

154
Q

What percent is Bp lowered in the first 24hr period?

A

15%

155
Q

What 3 meds are used to lower bp?

A

Nicardipine, labetalol, esmolol (IV titratable)

156
Q

What are the good and bad of thrombolytics in ischemic stroke?

A

can reverse deficits and allow for complete recovery

can cause the patient to die

157
Q

When should thrombolytics not be given?

A

SBP > 185 or DBP > 110

Active bleeding

158
Q

Acceleration deceleration injury sheering veins and more common in elderly due to atrophy

A

Subdural

159
Q

Thunderclap HA, worst HA of life, neck stifness?

A

Subarachnoid

160
Q

Hypertensive emergency, bleeding mass, trauma

A

Intracerebral

161
Q

LOC w/ blow to the head, followed by lucid period and mental decompensation?

A

Epidural

162
Q

Dx of hemorrhagic stroke?

A

Brain CT w/o contrast

163
Q

What should the SBP be reduced to in hemorrhagic stroke?

A

140-160mmHg

164
Q

What is the txt of intracranial pressure in hemorrhagic stroke?

A

mannitol and hypertonic saline

165
Q

What should NOT be done in the txt of hemorrhagic stroke?

A

hyperventilate

166
Q

What is the PaCO2 goal in hemorrhagic stroke?

A

30-35

167
Q

Why is the PaCO2 kept between 30-35?

A

to prevent cerebral vasoconstriction

168
Q

What is used as a immediate txt by a neurosurgeon for evacuation in hemorrhagic stroke?

A

burr hole

169
Q

What is the 5th most common symptom presenting to the ED?

A

Headaches

170
Q

You AVOID opiate meds in what two things?

A

Migraines and tension headaches

171
Q

In a approach to a dizzy pt what must be differentiate?

A

central from peripheral vertigo

172
Q

In a approach to a pt “passing out” what must be differentiated?

A

syncope vs. presyncope

173
Q

Trauma Primary Survey

A 
Airway
Breathing
Circulation/ Control of bleeding (C2)
Disability
Exposure
174
Q

What is a big red flag in medication use for headaches?

A

Anticoagulants

175
Q

What is a red flag in findings use for headaches?

A

Papilledema

176
Q

What is the dx for headaches w/ red flags?

A

CT brain w/o contrast

177
Q

A head CT is 100% sensitive within what timeframe?

A

6hrs of SAH onset

178
Q

After 6hrs hours what is necessary to r/o a SAH?

A

Lumbar puncture

179
Q

What two things should be seen on a LP?

A

RBC count clearing and xanthochromia

180
Q

Migraine Cocktail (Phase I)

A 
IV Fluid 1L
Toradol IV
Tylenol PO
Reglan (Metoclopramide) IV
Benadryl IV
181
Q

What must be r/o with Toradol IV admin?

A

ICH

182
Q

What 3 drugs are given in Phase II?

A

Magnesium IV

Solu-Medrol IV

183
Q

What is the time that thrombolytics are ok to give to a ischemic pt?

A

<4.5 hrs

184
Q

What should always be ran before admin thrombolytics?

A

a thrombolytic checklist

185
Q

How are anticoagulants reversed in hemorrhagic stroke?

A

reversal agent or by replace clotting factors

186
Q

What becomes “Veterinarian Medicine”?

A

workup for altered mental status

187
Q

Seizures are most commonly due to?

A

known epileptic patient not taking medications

188
Q

1st seizure w/ no other symptoms or inciting event in a non-epileptic patient

A

r/o toxicity or metabolic issues and d/c home to follow up with PCP

189
Q

2nd seizure w/ no other symptoms or inciting event in a non-epileptic patient?

A

Refer to neurologist

190
Q

A secondary seizure can be a indication of what?

A

trauma, infection or severe metabolic derangement

191
Q

6-60 months, generalized, last less than 15 mins, and do not recur within 24hrs?

A

Febrile seizures

192
Q

Seizures in preggo?

A

Eclampsia (until proven otherwise)

193
Q

Post- Trauma seizure?

A

Intracranial hemorrhage (until proven otherwise)

194
Q

Txt for uncomplicated seizure (non-status)

A 
Oxygen
IV access
Vitals monitor 
Fingerstick glucose
Check seizure medication
Rule out conditions
195
Q

Txt for status epilepticus 5-10min?

A

Lorazepam or diazepam IV + phenytoin or fosphenytoin

Consider intubation

196
Q

Txt for status epilepticus for >10min?

A

Versed IVP w/ drip + propofol or ketamine + phenoarbital

Intubate, Continuous EEG

197
Q

A head injury that does not require neuroimaging or has no diagnostic neuroimaging findings

A

concussion

198
Q

What two algorithms are used in adults to make decisions neck injuries?

A

Pediatric Cervical Spine Clearance Working Group
NEXUS
Canadian C-spine Rule

199
Q

Concussion algorithm used for <18 yo for head trauma?

A

PECARN

200
Q

Concussion algorithm used for >16 yo for head trauma

A

Canadian CT Head Injury

201
Q

Disposition in concussion w/ no intracranial injury?

A

d/c home, FU w/ PCM

202
Q

Txt for a concussion w/ no intracranial injury?

A

Physical and cognitive rest
Acetaminophen prn for 2days
Ondansetron prn for 2 days
Beware of 2nd head injury

203
Q

Has replaced rapid sequence intubation (RSI)?

A

Drug assisted intubation

204
Q

What is the new location for needle decompression?

A

fourth or fifth intercostal space mid axillary line

205
Q

What is the best method for adequate decompression of the chest and eliminates tension pneumothorax?

A

finger thoracostomy

206
Q

More than ??? liters of crystalloid fluid has been associated with increased mortality?

A

1.5

207
Q

What should be used for external bleeding?

A

Tourniquets

208
Q

How should tourniquets be placed?

A

above the area of injury in uncontrolled hemorrhage

209
Q

What should be included in AMPLE hx of a disable person?

A 
Allergies
Medications
PMHX
Last meal
Events (leading up to trauma)
210
Q

What does AVPU stand for? (used as a alternate to GCS)

A

Awake
Verbal response
Painful response
Unresponsive

211
Q

What does MARCH stand for in massive casualty event?

A 
Massive hemorrhage
Airway
Respiration
Circulation
Head injury/ Hypothermia

Emergency Medicine (6 decks)

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