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Emergency Medicine > Test 1 > Flashcards

Test 1 Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

__________ rolls can help to align the airway in young children

A

Shoulder

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2
Q

__________ rolls can help to align the airway in older children

A

Neck

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3
Q

Excessive mechanical ventilation increases risk of (1), (2), and (3)

A

(1) Gastric air
(2) Regurgitation
(3) Aspiration

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4
Q

Central pulse to assess in infants

A

Brachial artery

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5
Q

Central pulse to assess in older children

A

Femoral artery

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6
Q

Normal BP is maintained until over ____% of the child’s circulating volume is lost. Therefore hypotension is a _____ finding in kids

A

30%

Late

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7
Q

Fluid resuscitation for pediatrics in shock

A

NS or LR 20 ml/kg boluses until signs of improved perfusion and resolution of tachycardia

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8
Q

Fluid resuscitation if shock is due to hemorrhage for pediatrics

A

2 boluses NS or LR 20 ml/kg

Then PRBC 10 ml/kg

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9
Q

A pregnancy test is indicated in a case of sexual assault in the child is in Tanner Stage ___ development

A

3

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10
Q

Urine NAATs should be collected in a case of sexual assault for testing _______ and __________

A

Gonorrhea

Chlamydia

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11
Q

Blood should be collected in a case of sexual assault for testing ____, _____, _____

A

HIV
Hep B
Hep C

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12
Q

Prophylactic STI treatment for adolescents in sexual assault case

A

Ceftriaxone PLUS
Azithromycin PLUS
Metronidazole OR
Tinidazole

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13
Q

In a sexual assault case, blood may be collected for up to _____ hours

A

24

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14
Q

In a sexual assault case, urine may be collected for up to ________ hours

A

72-96

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15
Q

In a sexual assault case, evidence collection is appropriate for up to _______ hours for adolescents, and up to ______ hours in kids

A

120

72

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16
Q

5 things needed for pediatric patient that is sick appearing

A
  1. Oxygen and assist ventilation if needed
  2. Pulse ox
  3. Cardiorespiratory monitor
  4. IV access
  5. CXR/EKG
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17
Q

Common pathways for pediatric arrest

A

Respiratory failure

Shock

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18
Q

Two worrisome conditions concerning breathing for pediatric emergency medicine

A

Respiratory Failure

Pediatric Arrest

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19
Q

Worrisome condition concerning circulation for pediatric emergency medicine

A

Shock

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20
Q

Signs of poor tissue perfusion (possible shock)

A

Cool or mottled skin
Tachycardia
AMS (very important in kids)

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21
Q

Management for pediatric head injuries

A

Maximize oxygenation, maintain blood pressure!

Worse outcomes with hypoxia and hypotension

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22
Q

If signs of increased ICP with herniation in pediatrics

A
  1. Elevate head of bed 30 degrees
  2. Hypertonic saline (3%)
  3. Mannitol 0.5-1 mg/kg
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23
Q

Seatbelt sign

A

Greatly increases probability of abdominal injury

CT of abdomen warranted

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24
Q

Child’s blood volume is _____ ml/kg

A

70

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25
Q

Reassuring or warning sign: fever onset before pain

A

Reassuring (more likely a virus than appendicitis)

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26
Q

Reassuring or warning sign: vomiting with frequent watery diarrhea

A

Reassuring

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27
Q

Referred abdominal pain

A

Lower lobe pneumonia

GAS pharyngitis

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28
Q

Reassuring or warning sign: pain before vomiting

A

Warning (typical of appendicitis)

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29
Q

Reassuring or warning sign: vomiting and abdominal distention

A

Warning

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30
Q

Most common cause of abdominal emergency in 1-2 months old

A

Pyloric stenosis

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31
Q

Most common cause of abdominal emergency in 6-10 months old

A

Intussusception

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32
Q

Study of choice for intestinal malrotation

A

Upper GI series

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33
Q

Sign on upper GI series with intestinal malrotation

A

Corkscrew configuration

34
Q

Management of intestinal malrotation

A 
IV fluid resuscitation
NG tube
Call surgeon
Upper GI series
Laparotomy
35
Q

Imaging for intussusception

A

Ultrasound

36
Q

Classic image on ultrasound for intussusception

A

Bullseye

Coiled spring

37
Q

Hypertrophy of Peyer’s patches in terminal ileum can serve as lead point

A

Intussusception

38
Q

Management for intussusception

A
  1. ABCs
  2. Resuscitate with IVF (NS)
  3. Decompress stomach with NGT if frequent vomiting
  4. Consider IV abx if concern for perforation
  5. Notify surgeon
  6. Abdominal XRays to exclude perforation
  7. Air enema reduction
39
Q

Contraindications to air enema for intussusception

A
  1. > 3 days
  2. Signs of peritonitis
  3. Evidence of free air on plain x-ray
40
Q

Management for appendicitis

A
  1. IVF
  2. IV pain medication and antiemetics
  3. IV abx (ancef, unless concern for perforation - zosyn)
  4. Call surgeon
41
Q

Classic presentation of ovarian torsion

A

Sudden onset of unilateral lower abdominal pain, right side > left side, N and V

42
Q

Management of ovarian torsion

A

Pain control
IVF, US with doppler
Emergent operative intervention

43
Q

Intervention for seizures

A

Needed if > 3 minutes

  1. Lorazepam (IV or IM)
  2. Diazepam (IV or PR)
  3. Midazolam (IV or IM)
44
Q

Febrile Seizure Criteria

A

Fever > 100.5 (most > 102)
Child less than 6 y/o
No signs of CNS infection
No history of afebrile seizures

45
Q

2 important questions to ask concerning pediatric seizures

A
  1. Vaccination status

2. Recent abx –> can be masking signs/symptoms of meningitis

46
Q

Preferred neuroimaging for epilepsy evaluation

A

MRI

47
Q

Evaluation for infantile spasms

A

Urgent EEG, MRI and metabolic evaluation

48
Q

5 Things you can do for a child in diabetic ketoacidosis

A
  1. Oxygen
  2. Cardiac and respiratory monitor
  3. Pulse ox
  4. IV access
  5. Consider EKG/CXR
49
Q

2 things that should be ordered immediately when suspected diabetic ketoacidosis

A
  1. Accucheck

2. Urinalysis

50
Q

Definition of DKA

A

Hyperglycemia > 200 mg/dL
AND
Venous pH < 7.30 and/or
Bicarbonate < 15 mmol/L

51
Q

Characteristic long deep breaths of DKA

A

Kussmaul Respirations

52
Q

DKA Treatment Step 1

A
  1. IV hydration
    NS or LR bolus
    20 ml/kg over 1 hour
  2. LR at 2x MIVF rate
53
Q

DKA Treatment Step 2

A 
Insulin bolus (unless child!)
Switch to D5NS when glucose is < 300 mg/dL
54
Q

DKA Treatment Step 3

A

Next 4-6 hours: NS with 40 mEq/L K+

After 4-6 hrs: 0.45% saline with electrolytes

55
Q

Most serious complication of DKA in children

A

Cerebral Edema

56
Q

Signs/Symptoms of Cerebral Edema

A
  1. Headache
  2. Gradual decrease in LOC
  3. Slowing of HR inappropriately with increase in BP
  4. Change in pupils
57
Q

Treatment of Cerebral edema

A
  1. Reduce rate of IVF infusion
  2. Mannitol 0.5-1 g/kg over 20 minutes
  3. 3% saline over 30 minutes
  4. Consider intubation if needed
58
Q

Management for spinal cord injury

A

High dose steroids if within 8 hours

59
Q

Preferred imaging modality for traumatic brain injury

A

CT Scan

60
Q

Cushing’s Reflex

A

Systolic BP increase
Bradycardia
Irregular respirations

61
Q

First tier therapy for intracranial hypertension

A

Positioning, ventricular drainage, osmotic diuresis, hyperventilation

62
Q

Second tier therapy for intracranial hypertension

A

Sedation, neuromuscular blockade, hypothermia, barbiturate coma

63
Q

Not recommended for intracranial hypertension

A

Glucocorticoids

64
Q

Most common pathogens in animal bites

A

Pasteurella species, staphylococci, streptococci, and anaerobic bacteria

65
Q

Fastidious gram-neg rod that can cause bacteremia and fatal sepsis after animal bites (especially in asplenic pts, chronic alcohol abusers, or those with underlying hepatic dz)

A

Capnocytophaga canimorsus

66
Q

Bartonella henselae

A

Organism responsible for cat scratch fever

67
Q

Eikenella corrodens

A

Organism commonly found in human bites

68
Q

Kanavel’s sign

A

Infectious Tenosynovitis

69
Q

Kanavel’s signs (4) - Infectious Tenosynovitis

A
  1. Finger held in slight flexion
  2. Fusiform swelling
  3. Tenderness along the flexor tendon sheath
  4. Pain with passive extension of the digit
70
Q

Common pathogens from human bites

A

Streptococci, staphylococcus aureus, Eikenella, Fusobacterium, Peptostreptococcus, Prevotella and Porphyromonas species

71
Q

Cervical spine immobilization not recommended after drowning UNLESS

A
  1. Clinical signs of cervical injury
  2. Concerning mechanism
  3. AMS
72
Q

Indications for intubation in a drowning patient

A
  1. Inability to protect airway, neurological deterioration
  2. PaO2 < 60 mmHg or saturation < 90% on high flow O2
  3. PaCO2 > 50 mmHg
73
Q

Pseudallescheria boydii

A

Saprophytic fungus found in contaminated water such as in floods. Most common fungal infection in non-fatal drowning victims

74
Q

Waterborne pathogens that could cause pneumonia post-drowning

A

Pseudomonas, Proteus, Pseudallescheria boydii

75
Q

Symptoms of heat exhaustion

A
  1. Moist and clammy skin
  2. Pupils dilated
  3. Normal or subnormal temperature
76
Q

Symptoms of heat stroke

A
  1. Dry hot skin
  2. Pupils constricted
  3. Very high body temperature (> 104)
77
Q

Fever Work up: criteria for bladder catheterization for UA

A
  1. All males < 6 mo and all uncircumcised males < 12 mo

2. All females < 24 mo and older female children if symptoms of UTI

78
Q

Fever Work Up in the Toxic Child

A
  1. Rapid virus testing
  2. CBC with differential (looking for bandemia)
  3. Blood culture
  4. CXR
  5. Obtain stool for WBCs and guaiac if diarrhea present
  6. Lumbar puncture
79
Q

RAPID Approach

A 
R: Resuscitation
A: Analgesia and Assessment
S: sx/chief complaint
A: allergies
M: medications
P: past medical history
L: last meal
E: events lead up to presentation
P: patients needs (non-medical)
I: interventions (diagnostic, therapeutic, consults)
D: disposition (admit, transfer, discharge, observation)
80
Q

Treatment for hypotension post-insect bite allergic rxn

A
  1. IV NS bolus
  2. Epinephrine
  3. Alternatively give norepinephrine
  4. Consider vasopressors (dopamine)
81
Q

Treatment for bronchospasm post-insect bite allergic rxn

A

Mild-mod distress
1. Nebulized beta agonist (albuterol) 2. Parenteral glucocorticoids (methylprednisolone)

Mod-Severe distress
1. Parenteral beta agonists (epinephrine) 2. consider intubation

82
Q

Treatment for urticaria post-insect bite allergic rxn

A
  1. Antihistamines (H1 blockers) diphenhydramine
  2. Oral steroids (prednisone, methylprednisolone)
  3. Consider epinephrine

Emergency Medicine (2 decks)

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