Carpal bones in 30 secs…
Trapezium’s beneath the thumb, Scaphoid then Lunate
Triquetrum joins them up, to make it a U base
Pisi’s under pinky, Hamate and Capitate
Trapezoid points to Scaphoid, that away!
What are the carpal bones?
How do you treat it?
- Elevate HOB to allow blood to settle
- Eye shield (metal or clear plastic)
- Pain Control with Atropine and Prednisolone acetate 1%
- Increased IOP
Topicals - Timolol, Brimonidine
Acetazolamide 500 mg PO q12h (Not in Sickle Cell patients)
Mannitol 1-2 g/kg IV over 45min q24h
- Stop Bleeding - Aminocaproic acid, Tranexamic acid
- Surgery: 8 Ball Hyphema, Sickle Cell Patients, prolonged or elevated IOP
Who should be admitted?
- Sickle cell patients, 8 ball hyphema, violated globe, elevated IOP
What are the discharge instructions?
- Eye Rest
- Rebleed: up to 20% may rebleed in 2-5 days
- Follow-up: 3-5 days, traumatic glaucoma is insidious cause of blindness
Sx: monocular diplopia, iridodonesis
Dx: ultrasound, eye exam
Tx: Urgent (not emergent) ophthalmology follow-up
Sx: floaters described as “spider webs” or “coal dust”, visual field cuts
Fundoscopy: retina appears like "dunes on a beach”
Ultrasound: retinal flap, curtain folded forward
Tx: optho, if macula still attached and acuity intact, surgical repair by a retina specialist is recommended within 24–48 hours (to prevent macula from detaching also).
Globe Rupture / Corneal Laceration
- Pain, decreased vision, loss of fluid from eye.
- History of trauma, fall, or sharp object entering globe
- Seidel Test
- Slit Lamp to look for corneal defects
- CT Brain & Orbits to r/o IOFB
- Gentle B-Scan US to localize posterior rupture sites (usually done by optho)
- Antibiotics: Cefazolin, Vancomycin, FLQs
- Surgical repair
Consider volvulus, shock, early sepsis, myocarditis, and intussusception in well appearing children with extreme tachycardia and tachypnea.
Normal HR in Children
Infancy (0-6 mo) 150
Infancy (6-12 mo) 140
1 year 140
2 years 130
3 years 120
4 years 120
5 years 110
12 years 100
Normal Respiratory Rate in Children:
under 1 month 40-60 RR
1-6 months 30-50 RR
6 mo - 1 year 20-40 RR
2 yr - 4 yr 20-30 RR
5 years 18-24 RR
Here’s ya CHANCE to AVOID IT
Clonidine, Head ICP, Cholines-terase poisoning
Nodal block, Electrolytes, Old Age, and Vagal Tone
Oxygen, Infection, Drugs, Thyroid & naked Cold
Drugs - CCB, BB, Digoxin
I wrote this song to help differentiate and treat common causes of vesicular rashes in children and also score you points on your STEP 1/2/3 Exams and Residency Board Exams.
The mnemonic SICCC GERMS stands for:
S - Smallpox
I - Impetigo
C- Coxsackie virus
C- Contact Dermatitis (Poison Ivy)
G - Gladitorium HSV
E - Eczema
R - Rickettsia Akari
M - Molluscum Contagiosum
S - Scabies
The color-coded highlighting is as follows:
Green - the diagnosis or disease process
Orange - key features and buzzwords
Blue - management and treatment
Maculopapular RAshes of Childhood
Discusses the presentation and management of the classic childhood maculopapular exanthema
1st Disease - Measles
2nd Disease - Scarlet Fever
3rd Disease - Rubella
5th Disease - Erythema Infectiosum
6th Disease - Roseola Infantum
*Extra Disease - Mononucleosis
I wrote this song, while on my 2nd year pediatric rotation at the Children's Hospital of New York. I had an infant that was brought in by his mother because of head bobbing/drops, which I learned are never normal and should be worked up. This song discusses infantile spasms, febrile seizures, and general epilepsy management.
7 Faces in the Crowd
The inspiration for this song, came from a young woman that presented to the ED with Bell's Palsy. It turns out that the facial nerve is responsible for a lot of functions, including motor function to the face, taste, and tears and salivation. The 7 faces in the crowd are drinking seven up, because the 7th cranial nerve, aka Facial nerve, is responsible for taste.
Motor sensation includes muscles of facial expression.
Parasympathetic functions include tears and salivation via petrosal nerve to pterygopalatine ganglion to lacrimal nerve.
Taste via the lingual nerve, chorda tympani, solitary nucleus, thalamic VPM, to the gustatory taste center.
Private Eye In CYANIDE
This song highlights the sources, pathophysiology, clinical presentation, and management of cyanide. Special thanks to Dr. Rana Biary and Toxicologists from the New York Poison Control Center.
Full Court Press
In this song, I use basketball players as a metaphor for vasopressors and inotropes used in critical care medicine. Their jersey numbers reflect their maximum dose. Their position reflects how they should be administered, central vs. peripheral. The song is filled with many homonyms, so that each time you listen you may discover something new. On the right side of the screen, I reveal these meanings as the song progresses.
Video Contest: What Healthcare Simulation Means to You
Rules: Create a one-minute video sharing insight on what healthcare simulation means to you, your organization and/or your team. Video will help raise awareness about the profession, while providing insights to your colleagues and the public as to why healthcare simulation is so important to you.