Alert Medical Series: Emergency Medicine Alert III

Ala Sarraj

Description

This series is a compilation of powerful high yield random notes and comparisons that will guarantee laser-sharp comprehensive and effective knowledge acquisition and high score passing rates in the fields of USMLE (US Medical Licensing Exam), Internal Medicine and Emergency Medicine boards.

Sujets

• Médecine
• Spécialités médicales
• Médecine d'urgence
• Emergency Medicine
• Medical

Informations

• Publié par: Outskirts Press
• Date de parution: 03 novembre 2016
• Nombre de lectures: 0
• EAN13: 9781478784005
• Langue: English

Extrait

The opinions expressed in this manuscript are solely the opinions of the author and do not represent the opinions or thoughts of the publisher. The author has represented and warranted full ownership and/or legal right to publish all the materials in this book.

Alert Medical Series: Emergency Medicine Alert III
All Rights Reserved.
Copyright © 2016 Ala Sarraj, MD
v6.0 r1.0

Cover Photo © 2016 thinkstockphotos.com. All rights reserved - used with permission.

This book may not be reproduced, transmitted, or stored in whole or in part by any means, including graphic, electronic, or mechanical without the express written consent of the publisher except in the case of brief quotations embodied in critical articles and reviews.

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ISBN: 978-1-4787-8400-5

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PRINTED IN THE UNITED STATES OF AMERICA

Preface
Alert M edical Series is a compilation of powerful random high yield notes and comparisons that will guarantee comprehensive and effective knowledge base and high score passing rates in the fields of USMLE (US Medical Licensing Exam), INTERNAL MEDICINE and EMERGENCY MEDICINE boards alike.
It reflects years of revision and update that will save medical students, residents and physicians measurable time of test prep and knowledge acquisition.
Alert Medical Series will serve you like multitude of pixels creating very high resolution and sharp picture.
The USMLE series notes (basic and clinical) were put in a random manner mixing basic and clinical notes to simulate real life knowledge building and to reflect the future trend in USMLE testing to combine clinical science and the clinically based basic science.
• Assessment triangle in children:
1. Appearance : color, muscle tone, mental status, adequacy of oxygenation.
2. Work of breathing : wheezing, retractions, stridor, grunting, flaring.
3. Circulation : color, pulses.
• Neonate: nasal breather, nasal congestion can lead to retractions.
• Cricoid ring: the most narrow portion of the upper airway ages 7-9 yo, site of foreign body occlusion.
• The diaphragm is the primary muscle of breathing in infants.
• Grunting: closure of the glottis at the end of expiration, causes additional positive end exp. Pressure.
• Normal respiratory rate/ minute:
Newborn: 30-60.
1-4 yo: up to 30.
6-12 yo: 20.
• Pulsus paradoxus : decrease in pulse > 20 at the end of inspiration.
• Bradypnea and hypoxia ---> bradycardia (ominous sign).
• Compare:
Nasal cannula
2-4 L O2
24-28% (O2%)
Simple face mask
6-10
25-60
Venturi face mask
4-10
25-60
Partial rebreathing mask
10-12
50-60
Non rebreathing mask
10-12
90-95
Face tent
10-15
35-40
Oxyhood
10-15
80-90
• Bacterial tracheitis: Staph.aureus, H.flu.
• Retropharyngeal abscess: polymicrobial.
• Bronchiolitis: RSV, Parainfluenza, Adenovirus.
Infants < 3 months.
Can present with apnea.
• Atropine is used:
In children < 1 yo.
With Succinylcholine.
For bradycardia at time of intubation.
• Thiopental is alkaline, incompatible with Succinylcholine,Atropine or Vecuronium.
• Ketamine:
Is analgesic as well.
Do not use in < 3 months of age, head or eye globe injuries or glaucoma.
• Fentanyl:
Can cause chest wall rigidity with rapid injection or with a dose > 15 ug/ kg.
• Diprivan (Pro pofol): can be used in > 3 yo.
• Etomidate: not recommended in children < 10 yo.
• Defasciculating dose: > 5yo, weight > 20 kg.
• Hypoglycemia, blood glucose < 40 mg/dL:
If < 2 yo: 2-4 cc/kg D25W.
If > 2 yo: 2 cc/ kg D50 W.
• Normal saline bolusing can be up to 60-80 cc/ kg.
• Blood volume in children 80 cc / kg.
• Sinus tachycardia usually does not exceed 220/ min even in infants.
• Bradycardia secondary to hypoxia is a sign of impending cardio respiratory arrest.
• Sweating during feeding = dyspnea on exertion.
• Kawasaki disease Tx : gamma globulin 2g/kg over 12 hrs along with Aspirin 100 mg/ kg/ day.
• Syncope causes:
Aortic stenosis.
Hypertrophic cardiomyopathy.
Pulmonary hypertension.
Tetralogy of Fallot---> decreased pulmonary blood flow and hypoxia.
Prolonged QT interval.
Sick sinus syndrome.
V. Tach.
• Pulmonary hypertension exacerbation:
Use 100% O2.
Sodium bicarbonate, keep PH> 7.5-7.55
• Cranial sutures are open till age 18-24 months of age.
• Children are diaphragmatic or “belly” breathers.
• Trauma approach:
Primary survey is physiological.
Secondary survey is anatomical.
• Hypotension develops with > 25% loss of total blood volume.
• Add accucheck (blood glucose) to the primary survey or to the vital signs.
• Intracranial volume:
CSF: 10%.
Blood: 8 %.
Brain: 80%.