Term
| Toxicology Emergencies... |
|
Definition
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Term
| What can help in the prompt treatment and diagnosis of a poisoning? |
|
Definition
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Term
| In the history, want to determine how many people are involved and what other 6 things? |
|
Definition
number of people exposed
timing
type
amount
route of exposure
witnesses |
|
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Term
| In the case of an individual poisoning/ overdose, what information in the history is useful? |
|
Definition
pill bottles
empty containers
paraphenalia
unusual odors
suicide note. |
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Term
| Basically will do an entire physical exam including all of these things: |
|
Definition
V.S
General Appearance
Skin
Pupils
Mucous Membranes
Heart
Lung
GI
Neuromuscular |
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Term
| What is the general approach to care? |
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Definition
CAB/Consider Intubation
O2, Cardiac monitoring, IV access
Naloxone 0.4-2 mg IV for adults
Amp of D50 IV
Thiamine 100 mg IV
Foley
Lorazepam 2 mg IV/Consider restraints if patient is agitated
Gastric Lavage, then charcoal |
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Term
| How should gastric lavage be used to help eliminate the toxicology? |
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Definition
gastric lavage with roughly 250 ml of tap water until it turns clear
-then use activated charcoal (1g/kg)
-this should be done within one hour of ingestion |
|
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Term
| When is multiple dose activated charcoal an option? |
|
Definition
-When large amts are ingested
-in the presence of toxins known to slow GI motility
-slow-release toxins |
|
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Term
| When might whole bowel irrigation be useful? |
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Definition
| eliminating sustained release substances, toxins not responsive to charcoal or packages of toxic drugs |
|
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Term
| What is used for whole bowel irrigation? |
|
Definition
polyethylene glycol 2 L/hr in adults
50-250 ml/kg/hr in children until rectal effluent is clear |
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Term
| Might dialysis be indicated in some cases? |
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Definition
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Term
| What are examples of classes of anticholinergics? |
|
Definition
antihistamines
piperazines
phenothiazines
antiparkinson
belladonna alkaloids
cyclic antidepressants |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
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Term
| Name 3 antiparkinson agents. |
|
Definition
|
|
Term
| Name 2 belladonna alkaloids. |
|
Definition
|
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Term
| Name some cyclic antidepressants. |
|
Definition
Elavil
Amitril
Desipramine
Sinequan
Tofranil
Pamelor
Prozac |
|
|
Term
| How might a pt present who is intoxicated with anticholinergics? |
|
Definition
altered mental status
mydriasis
hypo or hypertension
absent bowel sounds
tachycardia
flushed skin and mucous membranes
auditory and visual hallucination
seizures
rhabdomyolosis
death (usually by dysrhysthmias or hyperthermia |
|
|
Term
| How do you treat a pt who is intoxicated with anticholinergics? |
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Definition
cardiac monitor
gastric lavage within 1 hr of ingestion, activated charoal
cooling
Benzodiazepene (Ativan 1-2 mg IV) |
|
|
Term
| What clinical presentations of anticholinergic intoxication specifically warrant management with benzos? |
|
Definition
seizure
agitation
physostigmine when appropriate |
|
|
Term
| What are some examples of opiods? |
|
Definition
heroin
morphine
pecodan
oxycontin
vicodin
lortab |
|
|
Term
| What is the clinical presentation of a person who is intoxicated with opiods? |
|
Definition
CNS depression
miosis
respiratory depression
hypothermia
bradycardia
death by respiratory arrest or pulmonary edema |
|
|
Term
| What is the tx of someone who has overdosed on opiods? |
|
Definition
CAB
IV
Oxygen
Naloxone
Gastric lavage supportive treatment |
|
|
Term
| What is the dosage of Naloxone? |
|
Definition
0.2-0.5 mg IV, 2mg IV d 3 minutes until respiratory depression is reversed
-OR-
up to 10 mg/titrate to level of consciousness |
|
|
Term
| What are examples of sympathomimetics? |
|
Definition
cocaine and amphetamines
things that stimulate |
|
|
Term
| How might someone present with sympathomimetic intoxication? |
|
Definition
psychomotor agitation
mydriasis
diaphoresis
tachycardia
HTN
hyperthermia
seizures
rhabdomyolosis
MI
death usually occurs from MI, hyperthermia or seizures |
|
|
Term
| How would you treat someone who is intoxicated with sympathomimetics? |
|
Definition
cooling
oxygen
cardiac monitor/ EKG
Hydration- IV NS
Sedation- Lorazepam 1-2 mg IV
Nitroprusside IV for severe HTN |
|
|
Term
| How might a pt present who is intoxicated with alcohol? |
|
Definition
slurred speech
uninhibited behavior
CNS depression
altered coordination/ ataxia
acute alcohol intoxication can cause death
morbidity and mortality are generally associated with accidental injury from impaired cognitive fxn |
|
|
Term
| How is alcohol intoxication treated? |
|
Definition
check injury and other trauma
consider other substances of abuses
Thiamine 100 mg IV or IM
Finger-stick glucose
IV D5 and half NS
Observation
Ativan 1-2 mg for agitation, seizure |
|
|
Term
| How might someone present with salicylate intoxication? |
|
Definition
nausea
vomiting
hyperventilation
tinnitus
diaphoresis
fever
neurologic dysfxn
renal failure
pulmonary edema
ARDS
seizures
GI bleed
dysrhythmias |
|
|
Term
| How do you treat a salicylate intoxication? |
|
Definition
CAB, oxygen, monitor, EKG, CMP, CBC, Coags
Activated charcoal 1g/kg
IV NS then D5W in hypoglycemia or neurologic symptoms
Alkalinization of serum and urine
Hemodialysis
Fresh Frozen Plasma and vitamin K (elevated PT or Hemorrhage) |
|
|
Term
| In a salicylate intoxication, how do you alkalinize serum and urine? |
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Definition
Bolus sodium bicarb 1-2 Meq/kg
then 150 meq added to liter of D5W infused at 1.5 to 2 times the maintenance rate) |
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Term
| How might a person present with a acetaminophen intoxication? |
|
Definition
in 4 stages:
1: asymptomatic or nonspecific symptoms of anorexia, nausea, vomiting and malaise
2. Days 2 and 3 evidence of hepatotoxicity- RUQ pain, elevated LFTs and bilirubin
3. days 3&4 liver failure with lactic acidosis, coagulopathy and renal failure
4. if pt survives liver failure, recovery over several weeks with full recovery of hepatic fxn |
|
|
Term
| How do you treat an acetaminophen overdose? |
|
Definition
CAB, Oxygen, IV NS, monitor, EKG, Labs
Activated charcoal 1g/kg
N-acetylcysteine (NAC)
--140 mg/kg PO or NG tube
--effectively prevents toxicity if administered within 8 hrs of ingestion |
|
|
Term
| At what level of serum acetaminophen is it considered to be toxic? |
|
Definition
| at 4 hours if level is >150 micrograms/dL |
|
|
Term
| How do you manage a carbon monoxide intoxication? |
|
Definition
CAB
100% O2
Cardiac/BP monitor, EKG, ABGs
IV NS
Hyperbaric oxygen therapy
--Based on clinical finding and carboxyhemoglobin |
|
|
Term
| What drugs can cause serotonin syndrome? |
|
Definition
meperidine
dextromethorpan
MAOI
SSRI
TCAs
Amphetamines |
|
|
Term
| How does serotonin syndrome present? |
|
Definition
altered mental status
increased muscle tone
hyperreflexia
hyperthermia
intermittent whole body tremor (wet dog shakes)
death may result from hyperthermia |
|
|
Term
| How is serotonin syndrome treated? |
|
Definition
cooling
sedation with benzos
supportive mgmt
possible benefits from cyproheptadine |
|
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Term
| What must you differentiate serotonin syndrome from bc they present similarly with shakes and what not? |
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Definition
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|
Term
| Is serotonin syndrome a present way to die? |
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Definition
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|
Term
| What are some examples of some cholinergics? |
|
Definition
organophosphate
carbamate insecticides |
|
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Term
| How might one present if they are intoxicated with cholinergics? |
|
Definition
salivation
lacrimation
diaphoresis
GI upset
nausea
vomniting/emesis
urination
defecation
muscle fasciculations/ weakness
lethargy/ weakness
bronchocorrhea
bradycardia
misosis/mydriasis
seizures
respiratory failure
paralysis
death usually occurs from respiratory arrest or seizures |
|
|
Term
| How is a cholinergic intoxication treated? |
|
Definition
decontamination, CAB/ consider intubation
oxygen
IV fluids
Ativan 2 mg IV
Vitamin K
Fresh Frozen Plasma
Atropine .05 mg/kg up to 1-2 mg IV initially, titrate to control symptoms
Pralidoxime (2-PAM) 20-40 mg/kg up to 1 g (repeat for 48 hrs) |
|
|
Term
| How do you monitor an NSAID intoxication? |
|
Definition
CAB, Monitor, EKG
Gastric lavage water/activated charcoal
IV NS
Sedation with Benzodiazepines |
|
|
Term
| What are the 6 potential bioterrorism agents? |
|
Definition
Anthrax Botulinum
Plague
Ricin
Ebola
Smallpox |
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|
Term
|
Definition
|
|
Term
| What are the 4 steps to casting? |
|
Definition
immobilization
encases circumference of extremity
several padded layers first
Rigid material applied over padding |
|
|
Term
| When do you apply a cast? why? |
|
Definition
when risk of swelling is minimized:
bc worried about compartment syndrome and neurovascular compromise |
|
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Term
| The application of a splint is similar to casting, what are the steps? |
|
Definition
immobilization
partially encase circumference of the extremity
several padded layers first
apply rigid material over padded material
use an ace or gauze to maintain placement |
|
|
Term
| What is a splint used for? |
|
Definition
| initial injuries where there i s or could be risk for increased swelling or effusion |
|
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Term
| what are the types of splints? |
|
Definition
super tong
guter
posterior mold
thumb spica |
|
|
Term
| What indicates the need for a splint or a cast? |
|
Definition
simple acute fractures (that are not displaced)
immobilized dislocations post reduction
-though prolonged immobilization may lead to atrophy and stiffness
ligament sprains
muscle strains |
|
|
Term
| When should a splint or cat not be used? |
|
Definition
when immediate swelling of extremity is expected
when cast would cover or conceal a soft tissue injury, infection or open wound |
|
|
Term
| What are some potential complications of casts or splints? |
|
Definition
Compartment syndrome
Cast dermatitis
Cast pressure sores
Nerve injury
DVT |
|
|
Term
| What is compartment syndrome? |
|
Definition
| buildup of pressure within the soft tissues impeding circulation and ultimately causing permanent damage to muscles and nerves |
|
|
Term
|
Definition
| air residual is insufficient to clear residual moisture and perspiration whereby patients use foreign objects beneath casting materials such as pencils, coat hangers to relieve itching leading to infection |
|
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Term
| What are cast pressure sores the result of? |
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Definition
| inadequate padding over boney prominences leading to pressure sores secondary to cast |
|
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Term
| What are nerve injuries due to? |
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Definition
| pressure from cast and inadequate padding |
|
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Term
| Why is a CVT a potential complication of a cast? What can DVTs lead to? |
|
Definition
prolonged periods of immobilization
PE |
|
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Term
| How do you prepare a patient for the placement of a splint or a cast? |
|
Definition
discuss procedure
place extremity in position of fxn
splint or cast joint to joint
maintain 90 degrees at elbow or ankle |
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Term
| When applying the cast padding (over the stockinette), where do you begin? |
|
Definition
at the narrow end and working wider
-apply at least 1-2 layers and an additional layer at the boney prominences and proximal and sital portion of the cast |
|
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Term
| With plaster or ortho glass you may need to apply _-_ layers depending on the material. |
|
Definition
|
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Term
| What are some points to consider for follow up care of a splint or a cast? |
|
Definition
Consider crutches for all lower extremity casting or splinting
Avoid getting cast wet
No foreign objects to relieve pruritis
Follow up with recheck as directed
Return if parasthesias, tingling, weakness, increasing pain or infection |
|
|
Term
| What are some points to consider for follow up care of a splint or a cast? |
|
Definition
Consider crutches for all lower extremity casting or splinting
Avoid getting cast wet
No foreign objects to relieve pruritis
Follow up with recheck as directed
Return if parasthesias, tingling, weakness, increasing pain or infection |
|
|
Term
| With cast removal, the saw cuts rigid material only, so avoid sawing over what? |
|
Definition
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|
Term
| Saw at a __ degree angle to the cast. |
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Definition
|
|
Term
| What should you do if the saw becomes too hot? |
|
Definition
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|
Term
| Cut cast on ________ sides for easy removal. |
|
Definition
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|
Term
| Clearing the Cervical Spine in the ED... |
|
Definition
|
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Term
| what are the goals of the spinal clearance prortocol? |
|
Definition
to detect injury to the spine:gross injury or occult injury
prevent extension of injury to para/quadriplegia
prevent complications of immobilization |
|
|
Term
| What do most spinal clearance protocols don't exclude possibility of what? |
|
Definition
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|
Term
| Trauma patients are suspected of having what until proven otherwise? |
|
Definition
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|
Term
| Most spinal trauma results from what four mechanisms? |
|
Definition
hyperflexion
hyperextension
axial loading (vertical compression)
lateral rotation |
|
|
Term
| What should be done with the conscious patient? |
|
Definition
aim to detect serious injury:
immobilize them at the scene
put on cervical collar |
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|
Term
| What four aspects of the neurological assessment must be done? What should be done if one of these is abn? |
|
Definition
sensation
motor function
reflexes
rectal examination/ perianal sensation
if abn present, do not clinically assess, imaging required. |
|
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Term
| In the physical exam you need to inspect and palpate from occiput to coccyx, and you are looking for what 5 things? |
|
Definition
pain with movement
tenderness
gap or step
edema and bruising
spasm of associated muscles |
|
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Term
| What is the clinical assessment NEXUS criteria? (5 questions) |
|
Definition
′ Midline cervical tenderness on palpation?
′ Focal neurologic deficit?
′ Evidence of intoxication?
′ Painful distracting injury?
′ Altered mental status? |
|
|
Term
If no to all NEXUS questions, what is done?
If yes to any, what is required? |
|
Definition
no to all- no imaging
yes to any- imaging!!! |
|
|
Term
| What does the mechanism of injury describe? |
|
Definition
| how, with what force and to which part of the body the pt was injured. |
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Term
| What in general do you want to pay attention to when physically assessing trauma? |
|
Definition
Vital Signs
Obvious evidence of injury: DCAP-BTLS
Head
Eyes
Ears
Nose
Mouth/ Throat
Neck
Chest Abdomen
Pelvis
Extremities
Spine/ Back |
|
|
Term
| What are the vital signs? |
|
Definition
BP
Pulse
Respirations
Temp
Pulse Ox |
|
|
Term
| When inspecting and palpating each body area to identify obvious evidence of injury, what does DCAP-BTLS stand for? |
|
Definition
Deformities
Contusions (deep bruising)
Abrasions (scrapes)
Punctures or penetrations
Burns
Tenderness to palpation
Lacerations
Swelling |
|
|
Term
| What should you be looking for with injury to the head? |
|
Definition
facial bruising
unstable mandible
malocclusion
movable facial bones
altered level of consciousness
Crepitation (rubbing of broken bones together) |
|
|
Term
| What should you be looking for with injury to the eyes? |
|
Definition
trauma
pupil reactivity
symmetry
size |
|
|
Term
| What should you be looking for with injury to the ears? |
|
Definition
external trauma
blood or fluid in the canal
integrity of TM |
|
|
Term
| What should you be looking for with injury to the NOSE? |
|
Definition
Trauma/ deformity
blood or fluid |
|
|
Term
| What should you be looking for with injury to the mouth/ throat? |
|
Definition
trauma
blood
loose teeth
foreign body |
|
|
Term
| What should you be looking for with injury to the neck? |
|
Definition
suspect potential head or neck injury if the patient is unresponsive
obvious evidence of injury
jugular vein distention
stomas/ tracheotomies |
|
|
Term
| What should you be looking for with injury to the chest? |
|
Definition
look, listen and feel.
look: rise and fall of chest
listen: auscultate for breath sounds bilaterally
-at apices, mid-clavicular areas, mid axillary areas and the bases.
feel: anteriorly and posteriorly for blood, tenderness and any other evidence of trauma |
|
|
Term
| What should you be looking for with injury to the abdomen? |
|
Definition
Look, listen and feel.
look: evidence of trauma or blood
listen: bowel sounds
feel: tenderness, soft, firm, distended |
|
|
Term
| What should you be looking for with injury to the pelvis? |
|
Definition
| tenderness or motion (iliac, hip, pubic bones) |
|
|
Term
| What should you be looking for with injury to the extremities? |
|
Definition
pain
blood
ecchymosis
swelling
deformity
pulses
numbness
tingling |
|
|
Term
| What should you be looking for with injury to the spine/ back? |
|
Definition
pain
blood
deformity
timing should be appropriate when the pt it log rolled or if life threatening injury is suspected. |
|
|
Term
| Overview of disaster management.. |
|
Definition
|
|
Term
| Who commissioned the reconstruction finance corporation (RFC) in 1932? |
|
Definition
| President Herbert Hoover during the great depression |
|
|
Term
| What was the purpose of the RFC? |
|
Definition
-to lend money to banks and institutions to stimulate economic activity
-also responsible for dispensing federal dollars in the wake of a disaster |
|
|
Term
| What can the RFC be considered? |
|
Definition
| ***THE FIRST ORGANIZED FEDERAL DISASTER RESPONSE AGENCY |
|
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Term
| What was the bureau of Public Roads in 1934 given authority to finance? |
|
Definition
| the reconstruction of highways and roads after a diaster |
|
|
Term
| What also gave the Army authority over flood control and irrigation projects and thus played a major role in disaster recovery from flooding? |
|
Definition
| The Flood Control Act of 1944 |
|
|
Term
| What was federal disaster relief and recovery brought under the umbrella of? |
|
Definition
| the Department of Housing and Urban Development (HUD) IN 1973 |
|
|
Term
| What was FEMA and what did they oversee? |
|
Definition
Federal Emergency Management Act (1978)
-oversee disasters |
|
|
Term
| When was the Homeland Security Act created? to do what? |
|
Definition
After 9/11 attacks
-to better coordinate among the different federal agencies the deal with law enforcement, disaster preparedness and recovery, border protection and civil defense. |
|
|
Term
| Was FEMA absorbed into DHS (dept of homeland security)? |
|
Definition
|
|
Term
| What is the primary purpose of FEMA? |
|
Definition
To coordinate the response to a disaster that has occurred in the U.S. and that overwhelms the resources of local and state authorities.
-the governor of the state in which the disaster occurs must declare a state of emergency
-does not need the request of the governor if the property falls under federal jurisdiction
-also supplies state and local governments with rebuilding efforts and relief funds by directing individuals to low interest loans (with the Small Business Administration) |
|
|
Term
| FEMA began administering for the Center for Domestic Preparedness in 2007 and has how many regional offices? |
|
Definition
|
|
Term
| What roles does FEMA's mitigation directorate programs hold? |
|
Definition
pre-disaster programs:
-identify risks and reduce injuries and loss of property
-major analysis programs for floods, hurricanes, dams and earthquakes |
|
|
Term
| FEMA consists of smaller specialized teams, name them. |
|
Definition
National Disaster Medical System (NDMS)
-part of Dept of Health and Human Services
-nurses, doctors, pharmacists etc.
Disaster Medical Assistance Teams (DMAT)
-doctors and paramedics
-many subgroups
Urban Search and Rescue (US & R):
-rescue of victims from structual collapses, confined spaces, and other disasters: mine collapses and earthquakes
Mobile Emergency Response Support (MERS)
-communication support to states if these services are not operational |
|
|
Term
| What does DISASTER stand for? |
|
Definition
Detection
Incident command
Safety and Security
Assess hazards
Support
Triage and Treatment- MASS
Evacuation
Recovery |
|
|
Term
| What does MASS stand for under triage and treatment? |
|
Definition
Move
Assess
Sort
Send
-is a disaster triage system that utilizes US military triage categories with a proven means of handling large numbers of casualties in a mass casualty incident. |
|
|
Term
| What state emergency agency responds upon identification of a disaster? |
|
Definition
|
|
Term
|
Definition
| Using a standardized and well practiced decontamination procedure before they are allowed into the main hospital. -->only lifesaving interventions should be rendered during decontamination. |
|
|
Term
| What comes after HazMat has been completed? |
|
Definition
Medical Care:
in the hospital, either inpatient or outpatient |
|
|
Term
| What system began in the 1980's and is an important foundation in the efforts of hospitals to prepare for and respond to various types of disasters? |
|
Definition
| Hospital Emergency Incident Command System (HEICS) |
|
|
Term
| What requires hospitals to have disaster plan and perform exercises and hazard vulnerability analyses? |
|
Definition
|
|
Term
| What organization oversees the best practices for hospital-based first receivers of victims from mass casualty incidents involving the release of hazardous substance? |
|
Definition
|
|
Term
| Which emergency assistance program is led by volunteers? |
|
Definition
American Red Cross
-established in Wash D.C. in 1881
-founded by Clara Barton |
|
|
Term
| Who is the largest supplier of blood and blood products to more than 3,000 hospitals nationally? |
|
Definition
|
|
Term
| Each year the American Red Cross responds to more than 70,000 disasters including what? |
|
Definition
| house or apartment fires (the majority of disaster responses), hurricanes, flood, earthquakes, tornadoes, hazardous materials spills, transportation accidents, explosions, and other natural and man-made disasters. |
|
|
Term
| What does the American Red Cross focus on? |
|
Definition
| disaster relief focuses on meeting people's immediate emergency disaster-caused needs, |
|
|
Term
| What else does red cross provide? |
|
Definition
| translation and interpretation |
|
|
Term
| Does American red cross feed emergency workers of other agencies/ handle inquiries from concerned family members outside of the disaster area? |
|
Definition
|
|
Term
| Does the American Red Cross engage in first responder activities? |
|
Definition
| no, these oles are left to local, state or federal agencies as dictated by the National Response Plan |
|
|
Term
| Who is the American Red Cross co-lead with? |
|
Definition
FEMA, for the mass care portion of the Emergency Support Fxn
-gives FEMA and Red Cross joint responsibility for planning and coordinating mass care services. |
|
|
Term
| What accounts for 15% of critically ill pts? (peds) |
|
Definition
|
|
Term
| What accounts for 90% of critically ill pts? (peds) |
|
Definition
infectious diseases
-bacterial tracheitis
-tonsillar pathology
-mono
-diptheria |
|
|
Term
| Why is airway obstruction more likely in pediatrics than in adults? |
|
Definition
-they have a larger tongue
-narrowest portion of the pediatric airway is at cricoid ring, making obstruction with subglottic pathology more likely than adults
-pediatric larynx |
|
|
Term
| What is stridor caused by? |
|
Definition
rapid turbulent flow through a narrowed airway
sound depends on the degree off constriction and localization of obstruction
observation offers best cue before even using stethoscope |
|
|
Term
| Epiglotisis is a supraglottic lesion, causing what 3 S/S? |
|
Definition
inspiratory stridor
prolonged inspiratory phase
muffled voice or cry |
|
|
Term
| What 2 s/s come out of glottic lesions? |
|
Definition
high pitched inspiratory stridor
weak/ hoarse voice |
|
|
Term
| What 2 S/S come out of subglottic lesions? |
|
Definition
expiratory stridor
normal voice and a brassy cough |
|
|
Term
| What might the sniffing position represent? |
|
Definition
significant upper airway obstruction
-may also see: active expiration with a prolonged expiratory time, use of accessory muscles, wheezing and/or a tripod position is significant for severe airway obstruction. |
|
|
Term
| In respiratory distress, pediatrics will be _____cardic and _____pneic. |
|
Definition
tachycardic
tachypneic: RR>40 (infant)
RR>30 (child) |
|
|
Term
| Which type of retractions represent the most severe form of respiratory distress (obstruction)? |
|
Definition
| suprasternal retractions more severe than intercostal and subcostal retractions. |
|
|
Term
| What are some signs of respiratory failure? |
|
Definition
marked retractions
decreased or absent breath sounds
increasing tachycardia
decreasing respiratory effort or rate
increasing stridor
worried appearance
also: decreased mental status, decreased capillary refill, head bobbing, cyanotic and decreased heart rate may mean the pt is decompensating |
|
|
Term
| Cyanosis is a very ____ sign in upper airway obstruction. |
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Definition
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Term
| What should dictate the intervention of a child? |
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Definition
| clinical state, with the most important parameter being mental status. |
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Term
| What is the leading cause of preventable deaths in children? |
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Definition
| failure to manage the airway. |
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Term
| How do you treat upper airway obstruction? |
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Definition
airway
O2
position of comfort
bag mask ventilation (should always be tried first in a respiratory failure situation)
advanced airway mgmt, IV, cardiac monitor, pulse ox |
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Term
| What would an infant in respiratory distress be displaying? what should be managed first? |
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Definition
| infants dont know how to position themselves, so will hear a lot of gurgling... need to reposition their head before think about ventilation |
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Term
| Why should you always have a smaller ET tube available? |
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Definition
| bc of possible significant airway edema. |
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Term
| What is the formula to figure out the size needed for a cuffed and an uncuffed tube? |
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Definition
uncuffed: age/4 + 4=mm
cuffed: age/3 + 3=mm |
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Term
| Epiglotitis is a true emergency, what might any manipulation precipitate? what management should occur first? |
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Definition
complete obstruction.
definitive airway placement should precede all diagnostic procedures. (KEEP THE CHILD CALM) |
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Term
| What is the most common causative bacteria of epiglottitis? |
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Definition
H. Flu (gram negative rod)
-could also be viral or allergic |
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Term
| How might a child with epiglotitis present? |
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Definition
acute onset
muffled voice or cry
maybe a sore throat, low grade fever and drooling |
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Term
| What will be seen on a lateral CXR in epiglottitis? |
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Definition
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Term
| How should epiglottitis be managed? |
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Definition
give O2 and place pulse ox.
allay anxiety (parent may be more helpful)
have provider accompany child at all times (symptoms can change quickly)
summon pediatrician, anesthesiologist or ENT |
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Term
| When x-raying epiglotitis, what do you need? |
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Definition
| a portable CXR, so pt doesn't have to leave provider. |
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Term
| If the epiglotitis pt is unstable, what should be done? |
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Definition
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Term
| If epiglottitis pt is stable with high suspicion, what should be done? |
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Definition
| escort pt with team to OR for endoscopy and intubation under general anesthesia |
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Term
| If epiglotitis pt is stable with moderate or low suspicion, what should be done? |
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Definition
| obtain lateral neck radiographs. |
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Term
| After airway is secured in epiglotitis patients, what should be done? |
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Definition
cultures of blood and epiglottis
Begin abx to cover: (usu rocephin 8-12 mg/kg)
-h. flu type B (MC)--gram -
-strep pneumoniae--gram +
-group a strep-- gram +
-staph aureus-- gram + |
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Term
| How does a child with croup laryngotracheobronchitis present? |
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Definition
May have elevated temp
Drooling is uncommon
May have mild expiratory wheeze
Inspiratory stridor at rest w/nasal flaring, suprasternal and intercostal retractions
Poor air entry
Lethargy + Agitation = Hypoxia
Dehydration |
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Term
| What is the mean age of croup laryngotracheobronchitis? |
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Definition
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Term
| What are the causative agents of croup laryngotracheobronchitis? |
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Definition
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Term
| What does croup look like on xray? |
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Definition
| steeple sign (narrowing of the trachea) |
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Term
| What is done for mild croup (no stridor at rest)? |
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Definition
Cool mist therapy
Minimal disturbance
Hydration
Antipyretics
Consider steroids |
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Term
| What is done for moderate to severe croup? |
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Definition
Mist or humidified oxygen mask near child’s face
Racemic epinephrine (2.25%), 0.05 mL/kg/dose (maximum dose 0.5 mL) in 3 mL NS solution over 15 min. no more than every 1-2 hrs
OR
Nebulized epinephrine, 0.5 mL/Kg of 1:1000 (1mg/mL) in 3 mL NS solution (maximum dose, 2.5 nL for < 4 yrs old, 5 mL for >4 yrs |
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Term
| What steroid should be given for croup? |
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Definition
| dexamethasone, 0.3 to 0.6 mg/kg IM or PO once |
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Term
| What is equivalent to oral dexamethosone and is effective for mild to moderate croup? |
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Definition
| Nebulized budesonide (2 mg) |
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Term
| What might decrease the work of breathing by decreasing resistance to turbulent gas flow through a narrowed airway? |
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Definition
Helium-oxygen mixture
concentration must be > 70%
not used very often |
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Term
| What should be done if croup treatments are needed a few times? |
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Definition
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Term
| What is the most common lower eespiratory tract pathogen of infants and children? (2-8 mos) |
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Definition
RSV
-cause of URI in older children and adults involving the nose, throat and sinus |
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Term
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Definition
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Term
| What are the RSV seasons? |
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Definition
| late fall/winter and early spring |
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Term
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Definition
Premature
<6 wks of age
Congenital heart dz
Chronic lung condition
Immunodeficiency
Exposure to smoke
Daycare |
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Term
| How does an RSV pt present? |
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Definition
Tachypnea
Cough
Wheeze or rales
Nasal flaring
Retractions |
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Term
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Definition
High flow O2
IV NSS (normal saline)
Particularly if thinking dehydration
Cardiac monitor
Pulse Ox
Consider advance airway mgmt
Bronchodilators (Albuterol, Racemic Epi) |
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Term
| What age mostly has foreign body issues? |
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Definition
<5 years old.
-food and small objects
-history of choking
-event was witnessed |
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Term
| How do you manage a foreign object pt if they are stable (forcefully coughing and well oxygenated)? |
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Definition
| remove by bronchoscopy or laryngoscopy |
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Term
How do you manage the unstable foreign body pt?
unstable: unable to speak, moves air poorly or cyanotic |
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Definition
in the infant:
-5 back blows, 5 chest thrusts one/second
-remove object if visualized
-ventilate if unconscious
-repeat if necessary
in the child:
-5 abdominal thrusts from behind a sitting or standing child lying supine.
-direct thrusts upward in the midline and not to either side of the abdomen
-after thrusts, open mouth, remove FB if visualized
-no blind sweeps (consider forceps)
-consider percutaneous needle cricothyrotomy if attempts to ventilate by BVM or ETT are unsuccessful |
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