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62 Cards in this Set
- Front
- Back
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When is urological consult required?
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concurrent infection (stenting needs to occur) or stones >6mm, or stones very proximal or RENAL insufficiency
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Diagnosis of testicular torsion?
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made by US
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How to detorse a testicle?
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open a book; call urologist.
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What comorbidity should you look for in pt with balanoposthitis?
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diabetes
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when is phimosis normal?
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physiologic before puberty
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When can pts with paraphimosis or phimosis be discharged home?
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reduceable with ability to urinate
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tx of balanoposthitis
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cleaning and antifungal cream; steroid cream
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What is considered abnormally large amnt of blood during menses?
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>80 mL
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What to do when pregnant women with abdominal pain present with shock?
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ABC, type and screen, OB GYNE consult, ultrasound
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what to do if pregnant female is bleeding?
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Rh- give RhoGAM 50mcgIM
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Proteinuria on dipstick that is significant regarding preeclampsia?
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>1+
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Why are ligamentous injuries in children rare?
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growth plates are weakest portion of bone and most prone to injury
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What labs should be done in children?
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none unless standard like DKA, sickle cell crises, fevers
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MCC of upper airway obstruction and stridor in children 6 mo to 6 yrs?
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Croup.
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Foreign body aspiration common during what ages?
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Childresn 1-4
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MCC bronchiolitis?
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RSV
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Nasopharyngeal obstruction is extremely detrimental to who?
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infants <4 mo bc they are obligate nose breathers
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Inspiratory stridor suggests/
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obstruction above larynx
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expiratory stridor suggests?
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obstruction in bronchi or lower trachea
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What test should be done in children with bronchiolitis?
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nasal washing and send for RSV antigen test.
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How do you know a coin is in the esophagus vs trachea?
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esophagus: round in PA view; trachea: round in lateral view.
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Tx croup?
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O2, steroids, racemic epi
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tx of bronchiolitis?
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nebulize, ribavirin solution and aerosol admin
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Ddx of abdominal pain in children?
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appendicitis, NEC, midgut volvulus, intussusception, UTI, colic. gastroenteritis. HSP!
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most common location of intussuception?
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ileocolic, 80% are age 2 or less
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How to characterize dehydration?
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hypo/hyper/isotonic and by % body weight.
<5/5-10/>10 mild /mod /severe |
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first sign of dehydration? late finding of dehydration?
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first: tachycardia. Late: hypotension.
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What is the most important indicator of resported intravascular volume?
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adequate UOP
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Fluid deficit in peds pt?
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% dehydration x weight in kg ; in mL
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maintanace fluids?
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4/2/1 mL/kg/hr for first second and each additional 10 kg.
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Only reliable sign of acute otitis media?
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decreased TM mobility with insufflation
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CNS depression, miosis, respiratory depression. What toxin?
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opioid; reverse with naloxone
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psychomotor agitation, mydriasis, diaphoresis, tachycardia. What toxin?
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cocain/amphetamines; tx w benzos/ watch for ACS
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ketonuria, low grade fever, respiratory alkalosis, tachycardia, daphoresis, N/V
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aspirin; alkalinize urine with K+ repletion, hemodialyze, MDAC
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diaphoresis, hypertension, AMS?
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hypoglycemia/ sulfonylurea/insulin
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increased muscle tone, hyperreflexia, hyperthermia
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SSRI or TCA overdose
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What drugs cause mydriasis?
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AnithistaminesAntidepressantAtropine cocaine/amPhatamines.
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After ABCs, how to manage toxins?
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Decontaminate, Enhance Elimination, Antidote.
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Antidote for cyanide?
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sodium nitrite, thiosulfate
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CCB overdose antidote?
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glucagon, atropine
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ABCDE of toxicology?
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airway breathing circ; decontamination (lavage or bowel irrigation) Enhanced elimination ie hemodialysis, alkalinize urine or MDAC
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MDAC is?
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multiple doses of activated charcoal
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Why is methanol so toxic?
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conversion to fomic acid
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why is ethylene glycol so toxic?
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converted to glycolic acid and oxalic acid causing renal failure
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What alchol has no anion gap but elevated osmolal gap?
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isopropanol.
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What are some lab markers of alchol ingestion?
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serum acetone level, alcohol level, urine calcium oxalate crystals, serum ethylene glycol and methanol lvls
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When should you treat with EtOH or fomepizole?
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if high suspicion or alchol levels > 20.
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Why is methanol so toxic?
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conversion to fomic acid
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why is ethylene glycol so toxic?
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converted to glycolic acid and oxalic acid causing renal failure
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What alchol has no anion gap but elevated osmolal gap?
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isopropanol.
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What are some lab markers of alchol ingestion?
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serum acetone level, alcohol level, urine calcium oxalate crystals, serum ethylene glycol and methanol lvls
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When should you treat with EtOH or fomepizole?
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if high suspicion or alchol levels > 20.
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when to hemodialyze with alcohol poisoning?
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if ethelynee glyu or methanol >50, or renal failure
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What is toxic about acetaminophen?
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NAPQI is produced but when glutathione stores deplete, NAPQI accumulates
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toxicity amnt with acetaminophen?
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7g/day
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If acetaminophen tox suspected, what to do?
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draw serum APAP levels, consider charcoal and n-acetylcysteine
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peak aspirin levels occur at what point?
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>20 hrs after ingestion.
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Acute toxicity of aspirin occurs at what dose?
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150 mg/kg...
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Aspirin toxicity suspected; what to do?
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immediate charcoal 10:1 and level; if > 30, then alkalinize urine
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management of elevated aspirin level?
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Q2 hr checks and alkalinize urine
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What is important in airway management of aspirin tox pt?
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must allow hyperventilation because increased rate is required
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If pt is extremely acidotic and poison is suspected, what to do?
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immediately warn nephrologist for hemodialysis standby
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