Year 5 > ED block > Flashcards

ED block Flashcards

(54 cards)

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1
Q

pcm OD management under 1 hour

A

activated charcoal

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2
Q

pcm OD management 1-3 hours

A

wait until 4 hours for bloods, support any other issues

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3
Q

pcm OD management 4-8 hours

A

bloods, plot serum pcm and start NAC depending on this

if serum pcm won’t be back in 8 hrs, start NAC

12 hour SNAP regimen if above treatment line
100mg/kg over 2 hours, 100mg/kg over 10 hours
(in 1L of 5% glucose or 0.9% NaCl)

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4
Q

how does NAC work in pcm od

A

essential for glutathione synthesis which is needed to metabolise the pcm

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5
Q

bloods in pcm od

A

serum pcm & salicylate
clotting
bone profile (mg & ca)
LFTs
U&E
FBC

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6
Q

paeds additional hx

A

vaccinations, birth hx, gestational hx, family hx inc siblings, school

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7
Q

sx of Kawasaki disease

A

fever over 5 days resistant to antipyretics
conjunctival injection (bloodshot)
mucositis (red cracked lips, strawberry tongue)
cervical lymphadenopathy
red palms & soles which peel
polymorphic rash

chest pain
breathlessness
d&v

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8
Q

tx Kawasaki disease

A

aspirin and IVIG

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9
Q

signs of serious illness in under 5s

A

difficult to rouse
reduced skin turgor
raised RR (lowering may be due to tiring)
rigors
pallor
not responding to social cues
decreased activity

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10
Q

if child is ill, what feed & nappies do you aim for?

A

50% feed and 1-2 wet nappies in 12 hours

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11
Q

croup sx, age and causative organism

A

barking cough, stridor, increasing sx with activity

age 6/12-6 years

parainfluenza, rsv, adenovirus

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12
Q

tx for croup

A

dexamethasone single dose

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13
Q

peak age for bronchiolitis

A

6 months

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14
Q

when is bronchiolitis more concerning?

A

CHD, ex-prem, <10 weeks, chronic illness

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15
Q

urine dip leu & nit results- which do you treat

A

+leu +nit = treat
-leu +nit = treat
+leu -nit = culture, don’t treat yet
-leu - nit = nothing to treat

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16
Q

sx of DKA

A

reduced consciousness
n&v
abdominal pain
dehydration
hyperventilation

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17
Q

diagnostic criteria for DKA

A

ketones >3
pH <7.3 OR bicarb >15
glucose >11

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18
Q

tx for dka

A

1 hour of fluids
- 10ml/kg/hour in kids
Fixed-rate insulin
- 0.1unit/kg/hour
fix fluid loss

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19
Q

complications of dka

A

hypokalaemia

cerebral oedema- watch for reducing consciousness
more common in kids- lower threshold for r/v

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20
Q

signs of basilar skull fracture

A

battle’s sign (bruising over both mastoid processes)
racoon eyes (bruising around both eyes)
CSF rhinorrhoea
CSF otorrhoea or haemotympanum ( depending on if tympanic membrane is ruptured)
target sign (CSF with blood in middle)

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21
Q

cardiac effects of cocaine use

A

coronary artery vasospasm, can result in stroke
aortic dissection

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22
Q

what are 1st degree burns

Study These Flashcards
A

epidermis only,
pain, erythema, slight swelling, no blistering or scarring
48-72 hrs for pain to resolve

23
Q

2nd degree superficial burns definition

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A

all epidermis & some dermis
vesicles and blisters, extremely painful (nerve endings)
heals in 7-14 days w/o infection

24
Q

2nd degree deep burns definition

Study These Flashcards
A

some dermal appendages left
some fluid and metabolic effects

25
3rd degree burns
entire epidermis and dermis painless, extensive fluid and metabolic side effects white or black in colour requires intervention for healing (skin grafting or skin flap)
26
airway concerns in burns
inhalation injury- quickest airway compromise local odema general odema watch for airway deterioration
27
breathing concerns in burns
poor chest expansion- pain, burns, cyanide poisoning CO build up
28
circulation concerns in burns
3rd space fluid loss arrhythmias (AC especially) distal blood supply catherisation- fluid balance (aim for 0.5-1 ml/kg/hr, double in rhabdo) CK for muscle IV access through burn is okay, IO
29
disability & exposure concerns in burns
expose whole body keep warm opioids for pain other injuries
30
how do you estimate TBSA
rule of 9s pts palm with fingers together is 1% 9s- head, arms together, each leg, chest, abdomen, back chest, back abdomen, perineum is 1%
31
how do you calculate fluid requirements in burns
2-4ml / kg / % TBSA burn 2 ml in kids 3ml only if adult with CCF / kidney disease 4ml for everyone else aim for 0.5-1 ml/kg/hr UO, double in rhabdo first 50% over 8 hours (starting from time of burn) second 50% in 16 hours after crystalloid,, warmed ideally
32
special considerations for electrical burns
AC causes arrhythmisa so ECG required look for exit point of electricity- sole of foot (or lowest point) more likely to cause rhabdomyolysis
33
when do you consider escharotomy
circumferential burns may not allow area to expand as it should do
34
non-psychiatric causes of psych sx
TINNEDD trauma- head, shock infection- HIV, encehphalitis, syphilis, malaria, meningitis neurological- Parkinson's, CVA, epilepsy, Huntingdon's neoplastic- frontal lobe, temporal lobe, hypercalcaemia endocrine- adrenocortical, thyroid, pheochromocytomas degenerative- dementia drugs- alcohol, illicit, steroids
35
signs and symptoms suggestive of organic cause of psych presentation
no psychiatric hx over 35 at first presentation mainly viscual hallucinations fluctuating behaviour lethargy abnormal vital signs poor cognitive function
36
what do you do as well as A-E in psych primary assessment
AEOI agitation environment objects- razor blades, meds intent now- suicidal, wanting to leave
37
when are physical restraints used
imminent harm to self or others significant disruption of important treatment or damage to environment continuation of effective ongoing behaviour treatment plan
38
what do you look at for risk assessment of psych pt
SLIPA suicidal thoughts lethality intent now protective factors adverse factors psych hx, drugs, alcohol, forensic hx, comorbidities
39
4 words for capacity
understand, retain, weigh, communicate
40
when does Kawasaki disease occur
3 months to 4 years
41
complications of kawasaki
pericardial effusion coronary aneurysm valve regurgitations clot in coronary artery causing MI
42
where are basilar skull fractures most likely to occur
petrous part of the temporal bone cribiform plate
43
high risk groups in burns
children under 4 (20% of all pts) older adults over 65 (10% pts, slower reactions, immobility) alcoholics, epileptics, chronic psychiatric or medical conditions consider NAI
44
DKA triggers
3Is Insulin lack Infection Ischemia (stroke, acs, bowel, limb)
45
causes of AF
cardiac causes- Hypertension IHD HFrEF valvular disease WPW syndrome infection recent surgery non cardiac causes- infections PE hyper or hypothyroidism hypokalaemia hyponatraemia DM
46
Emergency causes of back pain
cauda equina discitis
47
what type of block can be used in NOF
fascia iliaca block- obturator nerve femoral nerve block
48
cauda equina sx
overflow incontinence of urine faecal incontinence saddle parathesia diminished lower limb reflexes lower limb weakness sexual dysfunction lower back pain
49
lidocaine overdose symptoms
1st- numbness in the mouth dizziness blurred vision hypotension VT or VF
50
subarachnoid haemorrhage sx
onset during exercise thunderclap headache that peaks within 1 to 5 mins neck stiffness 3rd nerve palsy - eyelid drooping, diplopia n&v photophobia may have sentinel bleed before full bleed
51
risk factors for sah
female over 50 smoking hypertension alcohol misuse 1st degree relative with SAH acute cocaine use genetic- marinas, eds, ldzs)
52
Eyes on GCS
4- spontaneous 3- voice 2- pain 1- doesn’t open
53
Voice on GCS
5- oriented 4- confused 3- inappropriate words 2- incomprehensible noises 1- none
54
Motor on GCS
6- obeys command 5- localises to pain 4- withdraws from pain 3- flexion to pain 2- extension to pain 1- no response
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