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40 Cards in this Set
- Front
- Back
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Two types of spiders in USA |
Black widow (lactrodectus), brown recluse (loxosceles) |
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Black widow spider bite toxin and pathophys |
alpha-latrotoxin --> binds presynaptic receptors and causes massive release of NE and ACh at the NMJ --> excessive muscle depolarization and autonomic hyperactivity |
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Local and systemic effects of black widow spider bite |
local effects = pinprick sensation at bite, pale 2-3 mm area with red border, contiguous spread of pain systemic effects = latrodectism --> hypertoxic myopathic syndrome (muscle cramps, severe pain), cholinergic and sympathomimetic actions (HTN, tachycardic, diaphoresis, bronchorrhea, agitation, N&V) |
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Most common symptoms of latrodectus envenomation |
generalized abdominal, back, or extremity pain |
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Management of black widow spider bite |
pain control (opioids, BZDs), antivenom (watch for anaphylaxis or serum sickness), tetanus prophylaxis Do NOT give prophylactic antibiotics, calcium gluconate, or dantrolene |
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how to distinguish black widow spider from brown recluse |
black widow = hourglass-shaped marking brown recluse = brown violin-shaped marking on thorax |
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common diagnoses mistaken for a brown recluse spider bite |
erythema chronicum migrans, SJS/TEN, erythema nodosum, erythema multiforme, HSV, GC arthritis dermatitis, purpura fulminans, diabetic ulcers, bed sore, poison oak or poison ivy |
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toxic components of brown recluse spider bite |
cytotoxic --> 2 main components --> hyaluronidase (facilitates tissue entry) and sphingomyelinase-D (necrosis and hemolysis) |
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clinical manifestations of brown recluse spider bite |
mild envenomation that starts as a painless small red papule with local urticaria --> papule either heals w/o necrosis OR cytotoxic rxn (violaceous necrosis and ulceration)
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symptoms of systemic loxoscelism |
not predicted by 24-72 hrs post envenomation flu-like symptoms, petechial eruption, hemolysis (leads to hemoglobinuria and renal failure), DIC, seizure, death |
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signs of respiratory distress |
RR, mental status, work of breathing, hypoxia |
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how to differentiate between an upper vs. lower airway problem |
upper airway (barky cough, stridor, prominence of suprasternal retractions, "tripod" position, scared child/parent) lower airway (wheezing, distress or hypoxia out of proportion to exam, prominent "belly breathing" and/or intercostal retractions) |
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causes of upper airway problems |
croup, foreign body, epiglottitis, tracheitis, retropharyngeal abscess, congenital abnormalities, secretions |
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major pathogen that causes croup |
parainfluenza |
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major pathogen that causes epliglottitis |
RSV |
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another name for croup |
laryngotracheobronchitis |
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clinical presentation of group |
starts out as a viral URI (few days of mild cough and congestion) affects kids 6 mo to 6 yrs old usually occurs in fall and winter commonly occurs in the middle of the night |
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when are x-rays helpful in croup? |
when children aren't responding to therapy rules out other diagnosis such as retropharyngeal abscess or tracheitis |
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classic x-ray sign in croup |
steeple sign |
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what is the westley score? what dz used for? |
criteria for assessing treatment response in croup; not useful clinically looks at stridor, retractions, air entry, cyanosis, and LOC mild = cough only, no stridor moderate = little bit of stridor when agitated severe = tachypneic, stridor, barky sounding cough |
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treatment for croup (important!) |
1. create calm atmosphere (cool mist not beneficial) 2. steroids (0.15 or 0.6 mg/kg PO or IM dexamethasone, or 1 mg/kg prednisolone) 3. racemic epi (alpha agonism leads to dec edema in airway, for mod or severe croup where audible stridor at rest, onset in 30 min and lasts 2 hrs, observe for 2-4 hr in ED) 4. rarely intubation |
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when do you consider admission for croup |
minimal response to treatment req more than 1 racemic epi dose age <6 mo recurrent ED visits within 24-36 hrs |
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causes of lower airway problems |
asthma, bronchiolitis, PNA, bronchopulmonary dysplasia, CHF/pulm edema (d/t viral myocarditis), aspiration, tumor/node compressing bronchus |
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signs of a foreign body in airway on X-ray |
vertically aligned coin (coin slot going through vocal cords and immature post trachea in kids) wheezing over right middle lobe |
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most common chronic dz of childhood |
asthma (20% of population) |
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pathophysiology of pediatric asthma |
IgE-mediated bronchospasm, inflammation, mucous plugging leads to inc airway resistance, airway obstruction, atelectasis, V-Q mismatch |
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triggers for pediatric asthma |
viral infection, allergy, weather change, inhaled irritants (cigarette smoke), drug sensitivity (ASA) |
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are CXR indicated for pediatric asthma? |
usually not exceptions: minimal/no response to Rx, hypoxia out of proportion to exam, older first time wheezer (might be a mediastinal mass) |
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why are kids more susceptible to asthma than adults? |
already higher resistance smaller reserve dec elastic recoil: airway collapse prone to hypersecretion |
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management of pediatric asthma |
1. supportive (hydration, keep O2 sat >90%, fever control) 2. albuterol (MDI or spacer, dose depends on severity of exacerbation, usually 4-6 puffs x1 for mild and continuous for severe) 3. atrovent aka ipratropium bromide (mod/severe exacerbations, only give in ED, 4 puffs Q15 x3) 4. steroids (takes 2-3 hrs to see effect, IV for severe cases) |
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how to categorize pediatric asthma into mild, mod, or severe |
mild = a few alb treatment would have stopped mod = not responsive to a few treatments, wheezing, not tachypneic severe = tachypneic, retractions, hypoxic, diffusely wheezing |
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steroid options in pediatric asthma |
1. prednisone (tablet, 2 mg/kg max dose 60 mg, give to older kids who can swallow pills) 2. prednisolone (liquid, 2 mg/kg max dose 60 mg, give to younger kids) 3. decadron (1 time dose of 0.6 mg/kg PO, alternative) |
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what to do in severe asthma exacerbation/impending failure |
more albuterol IM epi terbutaline (IV form of albuterol) mg sulfate 25-75 mg/kg max 2 g intubation with ketamine infusion |
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when to admit for asthma |
1. persistent distress 2. persistent O2 sat <92% (note that albuterol can give you a transient hypoxia) 3. vomiting 4. repeat visits on appropriate Rx at home 5. concomitant cardiac/pulm dz 6. socioeconomic factors |
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what to do when discharging asthma kid |
PO prednisone/methylprednisolone 2 mg/kg for 5 days OR single dose dexamethasone in ED albuterol MDI with spacer Q3-4 hrs consider inhaled steroids f/u in 1-2 days |
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how to diagnose bronchiolitis |
clinical diagnosis --> no imaging/labs req'd viral URI prodrome followed by inc resp effort and wheezing in children under 2 yrs old lower resp symptoms (wheezing, rales, retractions) 2/3 have fever (15% have concomitant OM 15% have concomintant PNA) |
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most common cause of pediatric infectious dz death worldwide |
bronchiolitis |
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most common cause of bronchiolitis |
RSV |
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management of bronchiolitis |
supportive care (oxygen, fluids, suctioning, and time) albuterol (clinical improvement in 25% of time) racemic epi + high dose decadron (1 study) |
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when do you admit for bronchiolitis |
very young patients (<1 mo old) b/c RSV+ inc risk of apnea O2 sats <90% concomitant pulm/cardiac dz evidence of bacterial PNA or dehydration hx of prematurity poor f/u |
