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Pediatrics > Emergencies > Flashcards

Emergencies Flashcards

1
Q

Head injury epidemiology

A

Older than 12 due to recreation and MVAs. less than 1 yo due to falls or abuse.

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2
Q

Basal Skull

A

sphenoid, temporal, occipital, ethmoid bones.

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3
Q

Head injury Concerning signs

A

Excessive sleepiness (is it nap time), decreased arousability, vomiting, irritability.

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4
Q

Cushing’s Triad

A

Wide pulse pressure, bradycardia, abnormal respirations

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5
Q

Basilar skull fracture signs

A

Battle signs, periorbital ecchymosis, hemotympanum, ottorhea/rhinorrhea or CSF.

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6
Q

CT indications

A

GCS less than 14, signs of AMS, palpable skull fracture, or signs of basilar skull fracture.

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7
Q

Observation vs. CT considerations

A

Based on physician experience, multiple v. isolated findings, worsening symptoms, age less that 3 months, parental preference.

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8
Q

Observation Vs. CT Indications

A

Occipital/parietal/temporal hematoma, LOC, Severe MOA, Not acting normal per parents, vomiting, severe headache.

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9
Q

Subdural Hematoma Definition

A

Bleed between the dura and the arachnoid mater. Low pressure bleed along the periphery as the arachnoid disects from the dura and bridging veins are torn.

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10
Q

Subdural Hematoma Presentation

A

LOC with lingering symptoms, irritability, lethargy, bulging fontanelles, vomiting.

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11
Q

Subdural Hematoma CT findings

A

Crescent-shaped bleed that crosses suture lines usually in the parietal area.

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12
Q

Subdural Hematoma Prognosis

A

Very poor.

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13
Q

Epidural Hematoma Definition

A

Rupture of arteries +/- fracture. Usually cause by a blow to the side of the head that ruptures the middle meningeal artery.

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14
Q

Epidural Hematoma Presentation

A

Brief LOC followed by a lucid period then rapid deterioration.

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15
Q

Epidural Hematoma CT findings

A

Elliptical shaped bleed that doesn’t cross suture lines.

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16
Q

Epidural Hematoma Prognosis

A

Better than subdural

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17
Q

Subarchnoid Hemorrhage Definition

A

Injury to the parenchymal and subarachnoid vessels.

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18
Q

Subarchnoid Hemorrhage Presentation

A

Normal to LOC

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19
Q

Subarchnoid Hemorrhage Diagnosis

A

CT: small dense slivers with blood in the cisterns, sulci and fissures (may take time to become visible). LP will reveal blood in the CSF.

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20
Q

No ICH or skull fracture Treatment

A

Head injury precautions, responsible caregiver that is capable of monitoring for any changes. Sleep is ok.

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21
Q

ICH +/- skull fracture Treatment

A

Immediate Neuro consult. Admit to PICU. surgery v. observation.

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22
Q

Mild TBI (concussion) Definition

A

Traumatically induced alteration in mental status with or without LOC. Direct blunt force causes shearing/stretching of the axons.

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23
Q

Mild TBI (concussion) Presentation

A

Amnesia, confusion, distractability, delayed responses, visual changes, repetitive speech. If any substance use must CT scan.

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24
Q

Mild TBI (concussion) Prognosis

A

Most symptoms will resolve in 7-10 days. Any severe/prolonged/worsening symptoms are emergent.

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25
Q

Post concussive syndrome

A

Symptoms that last up to 3 months

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26
Q

Second Impact Syndrome

A

A second concussion within weeks can cause brain swelling and herniation.

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27
Q

Mild TBI (concussion) Treatmetn

A

Physical and cognitive rest. NO same day return to play. Must be completely symptom free and cleared by a neurologist to return.

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28
Q

Compund Fracture Treatment

A

Splin/dress, IV antibiotics, emergent ortho consult.

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29
Q

Non-displaced open fracture

A

PO antibiotics, repair laceration, splint. Ortho referal.

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30
Q

Osteomyelitis Definition

A

Hematogenous spread of infection to the bone often leading to bone destruction. Usually in males less than 5 yo. In the long bones (femur, humerus).

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31
Q

Osteomyelitis Etiology

A

S. aureus (most common), S. pneumoniae, S. pyogenes.

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32
Q

Osteomyelitis Presentation

A

Fever, bone pain, swelling, redness, guarding, focal tenderness.

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33
Q

Osteomyelitis Xray

A

Soft tissue swelling early on and later in the disease evidence of lytic lesions (10-14 days).

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34
Q

Osteomyelitis MRI

A

Best choice. Will show marrow edema, absecesses.

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35
Q

Osteomyelitis Labs

A

Leukocytosis with an elevated ESR and CRP

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36
Q

Osteomyelitis Treatment

A

IV antibiotics (empiric), surgical drainage, debridement, hyperbaric O2 therapy.

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37
Q

Septic Joint etiology

A

Infants/Kids: S. aureus or strep.

Adolescents: N. gonnorrhea

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38
Q

Deadly in a dose

A

Aspirin, Beta-blockers, CCBs, Camphor, chloroquine, clonidine, iron, lindane, methyl salicylate, methadone, nicotine, oils (hydrocarbons), theophylline, TCAs.

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39
Q

Common anticholinergics

A

Antihistamines, scopolamine, jimson weed, angel trumpet, benzotropine, TCAs, atropine.

40
Q

anticholinergics Presentation

A

Tachycardia, hyperthermia, HTN. Delirium, flushed skin, Mydriasis, urinary retention, decreased bowel sounds, memory loss, seizures.

41
Q

Common Cholinergics

A

Organophosphates, Carbamates, mushrooms

42
Q

Cholinergics Presentation

A

SLUDGE. Bradycardia, Hypothermia, tachypnea. Muscle fasciculations, miosis, seizures, diaphoresis.

43
Q

Common Hallucinogenics

A

Amphetamines, cannaboids, PCP, phencyclidine

44
Q

Hallucinogenic Presentation

A

Tachycardia, tachypnea, HTN. Disorientation, panic, moist skin, hyperactive bowel, seizures.

45
Q

Common opiates/narcotics

A

Propoxyphene, dextromethorphan

46
Q

Opiate/Narcotic Presentation

A

Bradycardia Hypothermia, hypotension. AMS, unresponsiveness, miosis, shock. shallow respirations, decreased RR.

47
Q

Common sedatives/hypnotics

A

Barbituates, benzodiazepines, ethanol, anticonvulsants

48
Q

Sedative/hypnotic Presentation

A

Apnea. Coma, stupor, sedation, deterioration of CNS function.

49
Q

Common Sympathomimetics

A

Cocaine, amphetamines, meth, phenylpropanolamine, ephedrine, psuedophedrine, albuterol, ma huang.

50
Q

Sympathomimetics Presentation

A

Tachycardia, bradycardia (alpha agonists), hypertension. Delusions, diaphoresis, paranoia, mydriasis, hyperreflexemia, seizures, anxiety.

51
Q

Toxic Ingestion Treatment

A

ABC- DDD (disability, drugs, decontamination)

52
Q

Ocular decontamination

A

Test pH then flush with normal saline for at least 15 minutes and until pH normalizes. Ophthalmology consult STAT.

53
Q

Ipecac use

A

Not used often. Has to be within 30 mins of ingestion.

54
Q

Gastric Lavage Indications

A

Rarely used. TCAs, CCBs, Iron, Lithium, ETOH.

55
Q

Whole bowel irrigation indications

A

Sustained release meds

56
Q

Charcoal indications

A

Carbamazepine, barbituates, dapsone, quinine and theophylline. Possible use with digoxin and phenytoin.

57
Q

Charcoal Not Indicated for:

A

hydrocarbons, lithium, strong acids/bases, metals, ETOH.

58
Q

Simple dilution indications

A

Mild toxins that only cause irritation/corrosion.

59
Q

Drugs that enhance elimination

A

Charcoal, urine alkalization, diuresis, dialysis, hemoperfusion.

60
Q

Acetaminophen Antidote

A

Acetylcysteine

61
Q

Anticholinergic Antidote

A

Physostigmine

62
Q

Benzodiazepine Antidote

A

Flumazenil

63
Q

Beta blocker Antidote

A

glucagon

64
Q

CCB Antidote

A

Calcium

65
Q

Digoxin Antidote

A

Digibind

66
Q

Heavy Metal Antidote

A

Chelation

67
Q

Narcotic Antidote

A

Naloxone

68
Q

Toxic Ingestion Work up

A

Salicylate, acetaminophen, digitalis, theophylline, methemoglobin levels, urine drug screen, PT/INR, CO levles, CMP, coag factors, ABGs.

69
Q

Foreign Body Ingestion Concerning Signs (consultation)

A

Irregular/sharp edges, lodged in esophagus, vegetable matter (pneumonia), perforation due to mechanical or chemical erosion. Magnets, Batteries, multiple objects, coin at cricopharyngeus muscle. Prescence in same place for more than 24 hours. Once it passes the pylorus the object usually continues through without complications in 48-72 hours.

70
Q

Esophageal Button battery treatment

A

Emergency consult. Lithium is very bad. Mercuric oxide can lead to heavy metal poisoning. Remove immediately if hasn’t passed the pylorus after 24 hours or any symptoms.

71
Q

Near Drowning Epidemiology

A

Usually less than 4 yo and 15-24 yo

72
Q

Dry drowning

A

Laryngospasm causing hypoxemia and LOC. No fluids in the lungs.

73
Q

Wet Drowning

A

More common. Aspiration of water (usually

74
Q

Near Drowning Poor Prognostic Factors

A

Submersion > 5 mins, BLS >10mins, Resucitation >25mins, Age >14, GCS

75
Q

When to suspect abuse with near drownings

A

If less than 6 months old or a toddler with atypical presentation.

76
Q

Secondary Drowning

A

Death up to 72 hours after near drowning due to fresh water (ingested) that causes hemodilution. Large volume aspiration can lead to hemolysis and arrhythmias (electrolyte imbalance).

77
Q

Near Drowning Treatment

A

Assist ventiliation to 95%, Warm isotonic IV fluids with warm blankets, cardiac monitoring. Address associated injuries and electrolytes. CXR then repeated in 6 hours. Admit for observation

78
Q

Work up for Fever in 2 mo- 3 yo Non-Toxic appearance

A

UA (males

79
Q

Work up for Fever in 2 mo-3 yo Toxic appearance

A

UA, Rapid viral, CBC with diff, CXR, LP.

80
Q

Treatment for Fever in 2 mo- 3 yo Non-Toxic appearance

A

Send home with follow up in 24 hours if otherwise healthy, UTD on immunizations, no risk factors, reliable caregiver.

81
Q

Treatment for Fever in 2 mo-3 yo Toxic appearance

A

Admit and begin empiric antibiotics with supportive care

82
Q

Work up for Fever in Neonate (

A

UA, Rapid viral, CBC with diff, CXR, LP, blood cultures.

83
Q

Fever in Neonate (

A

Empiric antibiotic treatment: Cefotaxime (50mg/kg) or Ampicillin (50mg/kg). Cover Group B strep, E. coli, listeria, S. pneumoniae and N. meningitides.

84
Q

Febrile Seizure Epidemiology

A

3mo-5yo. Genetic predisposition.

85
Q

Simple Febrile Seizure

A

Less than 15 mins and isolated with no neuro impairment prioir to seizure.

86
Q

Complex Febrile Seizure

A

Longer than 15 mins or rapid succession

87
Q

Other causes of Seizures

A

CNS infection, Drugs/ETOH withdrawal, toxins, hypoxic injury, vascular accidents, trauma, abuse, metabolic disorders, idopathic epilepsy.

88
Q

Febrile seizure Treatment

A

ABCs, suction, recovery position, if longer than 10-15 mins give benzodiazepine IV.

89
Q

Febrile seizure Work up

A

Full neuro exam, check for meningeal irritation. If less then 12 mo get full septic work up.

90
Q

Febrile Seizure Prevention

A

Common reoccurance. Antipyretics during fevers and phrophylactic rectal diazepam at onset of fever.

91
Q

Animal mouth flora

A

Pasteurella, staph, strep and anaerobic bacteria.

92
Q

Animal Bite Work up

A

Wound culture. Xray if deep wound, near joint or markedly infection. need to rule out foreign body. Can also use ultrasound to see abscesses or foreign bodies that are radiolucent.

93
Q

Cat and human bite treatment

A

Leave open to heal by secondary intention. Except for facial lacerations.

94
Q

Dog bites

A

Perform primary closure (don’t use skin adhesins) if: uninfected, less that 12 hours old (24 for the face), and not located on the hand or foot.

95
Q

Animal bite Treatment

A

Extensive irrigation, tetanus status, Prophylactic antibiotics (augmentin for 3-5 days), follow up within 24-72 hours.

Pediatrics (8 decks)

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