Shock
What should be the first thing you give in hypovolemic shock?
Fluids!
While getting a blood transfusion, patient starts to complain of new symptoms. What is the first step you should take?
Stop the transfusion
How long do you do CPR before a pulse check?
What is example of a vagal maneuver?
Ice to face
Blowing through syringe (+ position change)
Until what age is any bruise suspicious of child abuse?
4 months
"those who don't cruise, don't bruise"
When giving fluids in cardiogenic shock, what do you need to carefully assess for and what signs do you look for?
Fluid Overload
Crackles in the lungs, hepatomegaly, peripheral edema, respiratory distres
What is the first line treatment for anaphylaxis?
What is the maneuver that can help a patient who is in a TET spell?
knee-to-chest
squatting
Describe 2 symptoms that infants with SVT might have
Irritability
Difficulty feeding
Vomiting
Pallor or cyanosis
What pattern of burn is suspicious for child abuse?
submersion - "glove", "sock", buttox. or any burn that doesn't match the description of the story
Name the 3 types of distributive shock
Septic
Anaphylaxis
Neurogenic
What medication can be helpful for TACO (transfusion associated circulatory overload)?
Diuretics (furosemide)
A patient's heart rhythm on the monitor is ventricular fibrillation. What is the treatment per APLS & dose?
administer shock 4j/kg
A patient is 15kg and in SVT. You are going to perform synchronize cardioversion. How many joules will you use?
15 Joules
Name one type of fracture (or place of fracture) that is suspicious for abuse?
Fractures involving posterior ribs, scapula, sternum, spinous processes, metaphaphyses
Multiple healing fractures
A 12-year-old previously healthy boy is brought to the emergency department after a motor vehicle accident. He was unrestrained and sitting in the front passenger seat.
Vital signs: HR: 150 beats/min BP: 80/40mmHg. RR: 20
Physical exam:
He is initially taking frequent, shallow breaths. He has tracheal deviation to the left. His breath sounds are asymmetric, heart sounds seem distant. His abdomen is soft. His pulses are thready and his extremities are cold.
During your exam, his condition abruptly worsens and his blood pressure becomes undetectable.
What type of shock is he in?
Obstructive (tension pneumothorax)
During a 1 unit blood transfusion, a patient develops respiratory distress and fever. Patient has crackles bilaterally on exam. Xray and lab work show no evidence of cariogenic causes. What is the most likely diagnosis?
TRALI (transfusion associated lung injury)
Name 2 medications you give to help a TET spell
Morphine
Midazolam
Fentanyl
Beta-blocker
Phenylephrine
Vagal maneuvers don't work, what is the medication you give next and what is the dose?
Adenosine 0.1mg/kg
A patient has an intracranial bleed from "shaken baby syndrome". What are 2 interventions you should perform to help with increased ICP?
Elevate head of bed 15-30%
Maintain midline head position
Decrease stress on the body - maintain normal temperature, normal glucose, treat pain
BP should be carefully monitored to prevent hypotension
IV mannitol (0.25-1g/kg) or IV 3% saline (5ml/kg)
Hyperventilation to PaCO2 30-35 mmHg
a 16 year old, previously healthy girl, complains of feeling dizzy and collapses while playing volleyball. She is brought into the emergency department.
Vital signs: HR: 160beats/min BP: 60/50mmHg RR: 36 T: 37.2c
She has cool, clammy extremities. She is alert but confused. She has clear lungs with no crackles.
What is the most likely type of shock she is experiencing?
Cardiogenic
During a transfusion, patient develops fever, back pain, and dark urine. Name 3 tests you will order to help confirm diagnosis
CBC
DAT
Blood cultures
Urine dipstick
Coags
Name 4 reversible reasons a patient can go into cardiac arrest
Hypovolemia
Hypoxia
Hypo/hyperkalemia
Hydrogen ions (acidosis)
Hypoglycemia
Hypothermia
Toxins
Tension Pneumothorax
Thrombosis (cardiac or pulmonary)
What are 2 classic ECG changes you will find in SVT?
Narrow QRS
No P-waves
Tachycardia
You are concerned for a brain hemorrhage due to non-accidental trauma (child abuse). What are the 3symptoms of "Cushing's triad" or brain herniation?
Bradycardia
Hypertension (or widened pulse pressure)
Irregular (or aganol) breathing