Rosh 3 Flashcards
Tx for pt with V-tach, unstable, WITH a pulse?
- Synchronized cardioversion
* If no pulse, Defib
Tx for pt with V-tach, unstable, without pulse?
-Defib
Tx for a patient with V-tach, stable, with a pulse?
- Amio
- Procainamide
- Lidocaine
- Sotalol
Tx for polymorphic V-tach with pulse?
- Defib
* only time you defibrillator with a pulse?
What is a jones fracture and pseudo-jones fracture?
- Jones - 5th metatarsal mataphysis (not involving styloid or articular surface)
- Pseudo-jones - 5th metatarsal styloid avulsion fracture
What is a Lisfranc fracture?
injury of the foot in which one or more of the metatarsal bones are displaced from the tarsus
Signs and symptoms of heat stroke?
*What differentiates it from heat exhaustion?
temperature greater than 106°F, mental status changes ranging from irritability to coma, and organ damage such as renal failure, cardiac myocyte injury, rhabdomyolysis from skeletal muscle breakdown, or coagulopathy
*Presence of CNS dysfunction differentiates heat exhaustion from heat stroke
What vessel is responsible for the majority of inferior myocardial infarctions?
Right coronary artery (80%) with the remainder due to occlusion of a dominant left circumflex artery.
Management of jellyfish sting?
4 steps…
- Remove nematocysts (scrape off)
- Hot water immersion
- Acetic acid
- Antivenom
What is the normal width of the retropharyngeal space on lateral neck X-ray?
7 mm (at C2) in both children and adults.
What components are contained in cryoprecipitate?
Factor VIII, XIII, von Willebrand factor (vWF), fibrinogen and fibronectin.
EKG findings in pericarditis?
- diffuse STE
- PR depression
- PR elevation in aVR
When does tumor lysis syndrome typically occur in relation to chemo?
1 - 5 days after
Clinical triad of infantile spasms? AKA West syndrome
*Management?
- seizures/myoclonus (especially on awakening)
- Hypsarrhythmia on EEG
- developmental delay
*ACTH, Steroids, Benzos
When anticoagulating a patient with a deep venous thrombosis with enoxaparin and warfarin, when is it safe to have the patient stop administering the enoxaparin?
When the INR is greater than 2.0 for two consecutive days.
What meds do you give for hyperthyroid and in what order?
- Propanalol
- PTU
- methimazole (slower onset and teratogenic)
- Iodine (do not give before methimazole) at least 1 hr later
- Steroids
Outside of sinus tachycardia, what is the most common dysrhythmia seen in blunt cardiac injury?
Atrial fibrillation.
What is diagnosis in a neonate 2 - 5 days old with purulent eye discharge?
treatment?
- Gonorrheal conjunctivitis
- IV Cefotaxime and admission
In PECARN imaging rules for kids….what 2 factors automatically merit a head CT?
- GCS < or equal to 14
- evidence of skull fracture
Management of nasal septal hematoma?
-I&D,antibiotics (Augmentin), ENT followup
Clinical presentation of measles?
- Cough, coryza, conjunctivitis
- fever
- maculopapular rash 2-4 days later (begins on face, spreads down)
- Koplik spots
Most common malignant brain tumor in children?
other 2 most common?
- Medulloblastoma: HA, nausea, eventually ataxia + cerebellar stuff
- Astrocytoma and ependymoma also common
What is the treatment for a hemodynamically unstable child with supraventricular tachycardia?
Cardioversion at 0.5 to 1 J/kg. If unsuccessful, increase energy dose to 2 J/kg on subsequent attempts
Slow atrial fibrillation is pathognomonic of_______ toxicity?
Digoxin
Someone exposed to a pt with bacterial meningitis should receive ______
- Rifampin 600mg PO BID x 2 days
* other options, though less effective: Ceftriaxone 250 mg IM. or Cipro 500 mg PO x7 days
Methylene blue can cause hemolytic anemia in what subset of patients?
Methylene blue causes oxidative stress which should be avoided in patients with glucose-6-phosphate dehydrogenase deficiency.
What are signs of severe/complicated malarial infection?
- Seizures
- Kidney failure
- > 5% parasitemia
- hypoglycemia
Treatment of severe/complicated malaria?
- IV quinidine gluconate + doxycycline
What diameter of the colon is diagnostic for toxic megacolon on abdominal X-ray?
> 6 cm
Diagnostic criteria for toxic megacolon:
> 6 cmdiameter + at east 3 of the following:
- Fever
- HR >120
- WBC > 10.5
- Anemia
PLUS at least 1 of the following:
- Deydration
- AMS
- Electrolyte imbalance
- hypotension
What is the maximum dose of lidocaine without epinephrine?
5 mg/kg.
What important structures pass through the cavernous sinus?
-clinical findings?
- internal carotid artery, CN 3, 4, 6 (also portion of 5)
- HA
- fevers
- periorbital edema
- lateral gaze palsy (CN 6) most common CN abnormality on exam
Most common organism in CST?
-Staph aureus
Treatment of hypercalcemia?
- IVF
- Calcitonin
- bisphosphonates
- Maybe loop diuretics
- avoid thiazides
- HD in severe cases
What is your BP goal after giving tPA for stroke?
< 180/105
What diagnostic test can help identify right coronary artery involvement vs left circumflex involvement in an acute inferior wall myocardial infarction?
Right-sided electrocardiogram with a focus on V4R; an upright T wave in lead V4R indicates involvement of the distal right coronary artery (RCA), and ST segment elevation indicates proximal RCA lesion.
What are the contraindications for succinylcholine?
-malignant hyperthermia
-motor neuron disease
-muscular dystrophies
myotonic distrophies
-GBS
-severe burns (>5 days after)
-spinal cord damage (1 week - 3 months)
In which patients do you need to give a lower dose of Such to?
- organophosphate poisoning
- Eaton-lambert syndrome
- hypothyroidism
What med do you give to a pt with Von Willebrand disease and mild bleeding? (epistaxis, mucosal bleeding, etc)
-DDAVP (desmopressin)
What med do you give to a pt with Von Willebrand disease and severe or life-threatening bleeding?
Factor 8
Describe a Galeazzi fracture
- fracture of distal 3rd of radius and disruption of distal radioLunar joint
- Concurrent ulnar styloid fracture is common
Describe a Monteggia fracture
- proximal to mid ulna fracture
- radial head dislocation
Describe the clinical course of scarlet fever:
Age group:
-kids 2 - 10 years
Rash
- Starts 1-2 days after fever, begins in groin and axilla, spares palms and soles
- blanching
- sandpaper
Circumoral pallor
strawberry tongue
*caused by strp pyogenes
Smudge cells are seen in which malignancy?
CLL
Which lab values drawn from an IO line are coparable to venous?
Which are inaccurate?
comparable:
- Hgb
- VBG
- Cl
- BUN
- Creatinine
- Glucose
- serum drug levels
Inaccurate:
- WBC
- K
- Calcium
- AST/ALT
- O2 sat
Which antihypertensive agent is recommended in a patient who presents to the emergency department with a hypertensive emergency related to cocaine overdose and intoxication?
Phentolamine
In eye exposure to acid or alkali, what is the target pH when you irrigate?
7 - 7.2
Which patients with carbon monoxide toxicity should be treated with hyperbaric oxygen?
Patients with neurologic abnormalities, cardiovascular instability and a COHb level > 25 % (or 15% in pregnant women) should have hyperbaric oxygen therapy.
What is the discriminatory zone in pregnancy?
The discriminatory zone is the ßhCG level at which a normally developing pregnancy should be seen. In general transvaginal ultrasound level is 1,000 - 2,000mIU/ml and transabdominal ultrasound level is 6,500mIU/ml.
In a patient who presents to the Emergency Department after an acute digoxin overdose, at what level of potassium should digoxin immune fab be administered without first obtaining a digoxin level?
Potassium > 5 mEq/L
What EKG finding is seen in hypothermia?
Osborn waves
-J-wave, positive deflection at the J-point
Treatment of polycythemia vera?
- Hydroxyurea for elevated uric acid
- Phlebotomy
- Aspirin
What antibiotic(s) should empirically be used to treat bacterial meningitis in an infant less than 28 days old?
-Cefotaxime + Ampicillin
OR
-Gentamicin + Ampicillin
What antibiotic(s) should empirically be used to treat meningitis in an infant (1 - 3 months)?
-Ceftriaxone + Ampicillin + Vancomycin
What antibiotic(s) should empirically be used to treat meningitis in a child ( 3 months - 18 years) ?
- Ceftriaxone + vancomycin
* Same as adults
What dose of phenytoin or phospheny do you give if Benzos didn’t work for status epileptics?
-20 mg/Kg IV
Most splenic lacs are now managed non-operatively with observation and/or IR embolization. What are the contraindications of non-operative management?
- persistent hemodynamic instability,
- generalized peritonitis,
- inability to follow clinically
- high-grade splenic injury (grade IV or higher)
- need for operative management of other intra-abdominal injuries.
- Age > 55 is a relative contraindication
What immunizations are indicated in patients after splenectomy?
Pneumococcal, meningococcal, and H. influenzae type b (Hib) vaccines
What common bile duct diameter is considered dilated in a patient who still has a gallbladder?
8 mm
Tx of typhoid?
- IVF
- Fluoroquinolone
In a potential overdose pt who has bradycardia, hypotension, and hyperglycemia….think ______
Calcium channel blockers
Treatment of CCB OD?
- Calcium chloride IV 6 grams followed by drip
- Glucagon
- High dose insulin + D50
- Fluids
- vasoppressor support as necessary
