Pediatric Emergency Flashcards

1
Q

What are the leading causes of death in children less than 1-year?

A
  • Congenital anomalies
  • Gestational issues
  • SIDS
  • Maternal complication of pregnancy
  • Unintentional injuries
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2
Q

What are the leading causes of death in children ages 1-4?

A
  • Unintentional injury
  • Congenital
  • Homicide
  • Malignancy
  • Heart Disease
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3
Q

What are the leading causes of death in children ages 5-9?

A
  • Unintentional injuries
  • Malignancy
  • Congenital
  • Homicide
  • Heart Disease
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4
Q

What are the leading causes of death in children ages 10-14?

A
  • Unitentional injuries
  • Malignancy
  • Suicide
  • Homicide
  • Congenital defects
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5
Q

What are the leading causes of death in children ages 15-24?

A
  • Unitentional injuries
  • Suicide
  • Homicide
  • Malignancy
  • Heart Disease
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6
Q

How do you assess work of breathing in a kiddo?

A
  • Fast or slow
  • Inadequate breaths
  • Tripoding
  • Nasal flaring
  • Low O2
  • Cyanosis or flushed
  • Fast/slow cap refill
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7
Q

What is AVPU?

A
  • Alert
  • Responsive to verbal stimuli
  • Painful Stimuli
  • Uncresponsive
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8
Q

What is TICLS?

A
  • Tone
  • Interactability
  • Consolability
  • Look/gaze
  • Speech/cry
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9
Q

What system is most likely to fail in kiddos leading to a code?

A

Respiratory Failure

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10
Q

What temperature defines a fever?

How should the temperature be obtain?

A

38 degres C (100.4 F)

Rectal

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11
Q

Is a fever a normal response to infection in kids?

What should determine when you treat a fever with acetamenophen?

A

Yes

Affect of child

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12
Q

What are do not miss diagnosis of febrile infant

A
  • Sepsis
  • Meningitis
  • Pneumonia
  • Bacteremia
  • Bacterial enteritis
  • UTI
  • Cellulitis
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13
Q

What are the most common bacteria from birth canal?

A
  • E. Coli
  • GBS
  • HSV
  • Listeria
  • MRSA
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14
Q

What is the work-up for an infant with a fever?

Are they being admitted?

A
  • WBC
  • CRP
  • Procalcitonin
  • All the cultures (blood, urine, CSF)
  • +/- CXR, stool cultures

Yes! Need abx until cultures return

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15
Q

Do you need to obtain an LP in an infant 29-60 DOL with a fever?

A

No, depends on risk factors and presentation

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16
Q

What broad spectrum abx are used in kids less than 60 days with a fever until cultures return?

A

Cefotaxime (or cefrixaxone) PLUS vancomycin

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17
Q

What broad spectrum abx are used in infants less than 28 days with a fever until cultures return?

A

Cefotaxime (or gentamicin) PLUS Ampicillin

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18
Q

What lab value should be checked in every kid who is SICK?

What will be the physiologic change?

A

Glucose

Glucose will be wanky either high or low

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19
Q

What is the first line treatment in a child who is hypotensive?

What is second line

A

Fluid Bolus

May require pressors (Epi or norepi)

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20
Q

What are the administration routes of Tylenol for kids?

What is the dosing

A

PO, PR, IV

15 mg/kg Q4-6hrs, max 80 mg/kg/day

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21
Q

How is meningitis transmitted?

A

Droplet Spread

22
Q

What is the classic triad of meningits?

A
  • Fever
  • Stiff Neck
  • Altered mental status (lethargic)
23
Q

What is the cause of death in kids with sepsis?

What about cause of death in menengitis?

A

Death from cardiovascular failure

Death from raised ICP

24
Q

What is the diagnostic work-up for bacterial meningitis in pediatric patients?

What is the diagnositic study of choice?

A
  • CBC: Leukocytosis and thrombocytopenia
  • Coagulation studies: go along with DIC(PT, PTT, and D-dimer)
  • CMP: elevated anion gap
  • Lactate
  • 2 sets of blood cultures
  • +/- head CT

LP

25
Q

What etiology of meningitis will have a low CSF glucose?

What will be the level?

A

Bacterial

< 40

26
Q

What broad spectrum antibiotics are used in bacterial meningitis?

A

Vancomycin (15 mg/kg) + Ceftriaxone (50 mg/kg)

27
Q

What is the classic presentation of appendicitis in kids?

What is your concern for complications?

A
  • Fever
  • Periumbilical pain that migrates to RLQ
  • Poor PO Intake

Rupture

28
Q

What is the work-up for appendicitis in kids?

A
  • If suspected, may be evaluated by US but may not be inconclusive
  • CBC
  • CMP
  • CRP
  • UA
  • +/- CT
29
Q

What is the management of appendicitis?

What antibiotics are used for appendicitis?

A
  • Keep NPO
  • Treat their pain (morphine or fentanyl)
  • Hydrate
  • Consult surger
  • Once confirmed, IV antibiotics

Piperacillin-tazobactam or Ceftriaxone and metronidazole

30
Q

What are the first steps in assessing a trauma?

What does ABC stand for?

A

ABC/IV/O2/Monitor

Airway, breathing, circulation, disability, exposure

31
Q

How is hypotension defined in a kid?

What physical exam finding can be associated with hypotension?

A

SBP < 70 + (age in years x 2)

Moddling

32
Q

What is the most common cause of death in pediatric trauma?

What is the common mechanism of injury?

A

Head Injury

Falls

33
Q

Do kids less than 8 typically get C-spine injuries?

What can change this and increase the risk?

A

No, they are bowling bowls on a popsicle stick

Cologen disorders, autism

34
Q

What is the work-up of truama in kids?

A

All depends on level of concern
* Labs: CBC, CMP, lactate, PT/PTT, type and cross, VBG, UA
* EFAST (do they need a CT)

35
Q

What are the two types of drowning?

A

“Wet” drowning: aspiration –> hypoxia
“dry” drowning: aspiration –> hypoxia

36
Q

What medical conditions can lead to drowning?

A
  • Channelopathy (30%)
  • Seizures
  • Trauma
  • Fatigue, respiratory arrest
  • ETOH, intoxications
  • Syncope
37
Q

In a near drowning what pulmonary effects are you worried about?

A
  • Pulmonary edema
  • ARDS
  • SOB
  • Crackles
38
Q

Hypoxia from a near-drowning may cause what cardiac effects?

A
  • Arrhythmias
  • Cardiac Arrest
39
Q

Do you need to kill the bug prior to pulling it out?

With what?

A

Yes

Ethanol, use lidocaine or an immersion oil

40
Q

Where will a foreign body aspiration most commonly occur?

A

Right mainstem

41
Q

What is the triad in presentation of a foreign body aspiration?

A

Cough, Wheeze, diminished breath sounds

42
Q

For ingested button batteries, if you can’t remove urgently due to resources what should you give the child?

A

Have them swallow honey to neutralize the pH

43
Q

What are the 4 E’s of Poisoing?

A
  • Estimated amount
  • Elapsed time
  • Early symptoms
  • Early interventions
44
Q

What is the presentation of acetaminophen toxicity?

What is the toxic dose?

A

m/c asymptomatic: late can be abdominal pain, N/V, acidosis, transaminitis

> 150 mg/kg or 10g

45
Q

What is the treatment for acetaminophen toxicity?

A

If < 1 hr from ingestion, consider activated charcoal

If > 150 at hour 4 then start NAC N-acetylcysteine

46
Q

A 4-year-old child presents with a sudden onset of wheezing, coughing, and difficulty breathing. The child has a history of atopic dermatitis and allergies. On examination, you note decreased air entry on the left side and hyperresonance on percussion. What is the most likely diagnosis?

Why is asthma relevant?

A

Foreign Body Aspiration

Asthma makes him more susceptible for bronchospasm

47
Q

A 14-year-old boy presents with a 2-day history of high fever, headache, and photophobia. On physical examination, you note nuchal rigidity and positive Brudzinski’s and Kernig’s signs. What is the most likely diagnosis?

A

Meningitis

48
Q

A 7-year-old previously healthy boy presents with a sudden onset of severe right lower abdominal pain associated with nausea and vomiting. On physical examination, there is tenderness in the right lower quadrant with guarding and rebound tenderness. What is the most likely diagnosis?

A

Appendicitis

49
Q

What advantageous breath sound is associated with a upper respiratory track foreign body aspiration?

A

Stridor

50
Q

A 6-month-old infant is brought to the clinic with a history of vomiting, diarrhea, and poor feeding. On examination, the infant appears lethargic with sunken fontanelles. What is the most likely diagnosis?

A

Dehydration

51
Q

A 5-year-old child is brought to the emergency department with difficulty breathing, drooling, and a muffled voice. What is the most likely diagnosis, and what is the appropriate initial management?

A

Croup, administer corticosteriods

Consider admission