Trauma, Fx, Childhood fever Flashcards
What is included in the primary survey
ABCDE
can you start the secondary survey before ABC’s are finished?
NO ABC’s must be stabilized first
What signs may indicate a basilar injury
Raccoon eyes, Battle sign, hemotympanum, CSF drainage from ears or nose
What must you check before inserting a catheter
Rectal tone, meatal blood, vaginal bleeding or injury to the pelvic area
Broken hip will appear
Shortened and internally rotated
In a trauma what radiographic imaging should you consider
Head and cSpine CT Standard plain x-rays - CXR, pelvis FAST exam Extremity x-rays Entire spine image for uptunded/multisystem trauma
In a trauma what labs shuold you consider
Type/screen and type/cross CBC UA ETOH PTT/PT INR Pregnancy > 55= EKG, Cardiac markers
What should always be included in the plan of a trauma patient
serial examinations
What are the NEXUS criteria for CT
- Midline cervical tenderness
- Focal neurological deficits
- Altered level of consciousness
- Evidence of intoxication
- Painful distracting injury
IF 1 IS POSITIVE = CT
When do you place a ET tube
GCS less than 8 No gag reflex Agitated Head injury ETOH/drugs
When should you consider a Crichothyrodotomy
when you can’t intubate
Facial trauma
What is RSI
Give a paraylitic and premedicate to get an airway
If you hear rice crispies in the chest what does that indicate
AIR- subcutaneous emphysema
What injuries should you look for to evaluate breathing
Shifted trachea
Paradoxical chest movements
No BS
Open wounds- sucking chest wounds
If you hear no breath sounds what do you do
1) Needle decompression- 18 gauge needle in the 2nd intercostal space mid-clavicular line
2) if needle decompression unsuccessful- Chest tube 5th intercostal space anterior to the mid axiallary line
Should a needle go in above or below a rib
ABOVE- the NVA are below the rib
Will a needle decompression work for a hemothorax
No, need chest tube
what is the minimum amount of time to obtain new vital signs
15 mins
If you can feel the radial pulse the BP must be at least
80
If you can feel the carotid pulse the BP must be at least
60
If your patient becomes hypotensive are they getting better or worse
WORSE- bad sign
30% of blood volume can be lost before BP lowers
How many IV’s should a trauma patient get
2- large bore -18 or bigger
What is the FAST used for
screening tool to identify the cause of shock immediately after the primary survey
When is a CT indicated over a FAST
for definitive imaging and location of the bleeding
What to do with fractures while stabilizing patient
Control bleeding- consider blood if large area like femur or pelvis
Immobilize pelvic fractures
Splint extremity
If you give 10 or more units of PRBC’s what else do you need to give
FFP +Platelets in a 1:1:1 ratio
What are the major things in Diasability
GCS pupilary response, blood glucose
Is hyperventilation good in a truma patient
Probably not- It may decrease ICP but it lowers blood flow to brain so may worsen ischemia and worsen hemorrhage
What does Exposure entail
Undressing them, examining the entire patient, warm blankets or consider inducing hypothermia for TBI
When is a NG tube contraindicated
Facial fx
should you remove a deeply impailed object
No
Indications for emergent thoracotomy
penetrating chest trauma
Witnessed signs of life during transport to ED
Electrical activity upon arrival
Strain
Tendon
Sprain
Ligament
What are ortho emergencies
Open Fx
“Tenting” of a dislocation
NV compromise in a closed injury
for a long bone Fx you should evaluate…
the joint above and below
How so you describe fractures
Open vs closed Location Orientation Displacement/separation Shortening Impacted/overriding Angulation Rotational deformity
If a Fx in intrarticular it …
extends into joint space
When do growth plates close
Boys= 18 Girls= 15-16
What is the most common type of salter haris Fx
Type 2
What is a salter haris fx
a Fx involving the growth plate
What is the worst salter haris fx
type 5
What is a fever in a neonate and infant under 60 days
100.4 (38)
what is a fever in an infant older than 60 days
102.2 (39)
in a child less than 60 days what is the most common cause of SBI
UTI
If a child less than 60 days has a confirmed UTI and fever greater than 102 what might they have
Pylonephritis
Other causes of SBI in a infant less than 60 days
Bactermia +sepsis
Pneumonia
Sinusitis
Meningitis
Organisms causing meningitis in a child <3 months
E. coli, Group B strep, Listeria
Organisms causing sepsis/bactermia in a child <3 months
E. coli, Group B strep, Listeria
Organisms causing meningitis in children >3 months
S.pneumoniae, N. meningitidis, Staph. Aureus
Pleocytosis suggests
Viral etiology
Meningitis is bacterial if…
CSF WBC >30 in neonate and >10 in older CSF anc >1000 cells/microliter CSF protein > 8 Peripheral WBC >10,000 Hx of seizure before or at onset of symptoms
Treatment of meningitis
Ceftriaxone (Rocephin)- 100mg/kg with a mas of 2g
Ampicillin
Cefotaxime
+/- Gentamycin
Most common cause of bronchiolitis
RSV
If a child has RSV what else should you check for
UTI
What can ceftriaxone cause in children <1 month old
increased bilirubin
A 1 year old child comes in with strep throat
NO- strep pharyngitis is uncommon in children less than 2
If a fever decreases and the child improves with administration of tylenol or motrin what is the most likeley cause
viral
how long do you use the estimated birth date for a preterm baby instead of the actual birth date
90 days
A child is screaming when you look in their ear, the typmainc membrane is red. They must have OM
Wrong- all babies ears will be red if the scream loud enough. you must insufulate the ear
Dosage of amoxicillin
80-90mg/kg
Child 3 months to 36 months causes of fever
Viral
OM
Pneumonia
UTI
What are the serious bacterial illnesses of children 3 months to 36 months
S. pneumoniae
N. meningtisis
MRSA
Causes of fever in children over 36 months
Strep pharyngitis
Mono
Kawasaki
Characteristics of Kawasaki disease
Children less than 5 High fever Strawberry tongue Conjunctivitis/iritis Peeling or hands and feet Coronary artery aneurysms
What is the treatment of Kawasaki disease
IV IG
ASA
