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Emergencies Flashcards

1
Q

What is the leading cause of childhood death in the US?

A

Injuries

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2
Q

Why do head injuries occur more often in kids?

A

Larger head to body ratio
Weak neck muscles (acceleration-deceleration injuries)
Thin skulls
Physically uncoordinated
Lack cognitive ability to predict/understand danger

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3
Q

Critical components of history with head injuries

A

Witnessed fall, height of call, immediate cry, consolable, vomiting, time since injury, arousable, size of mass, other injuries

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4
Q

Concerning signs with head injury

A

Excessively sleep or hard to arouse
Vomiting
Irritability/behavior changes

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5
Q

Primary exam that needs to be done with head injuries

A

ABCs
Neuro status (GCS, pupils, sucking reflex, muscle tone-<8 is immediate resuscitation)
Vital signs

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6
Q

What is Cushing’s triad and what does it indicate?

A

Wide pulse pressure
Bradycardia
Abnormal respirations
Indicates increased intracranial pressure

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7
Q

What are signs of a basilar skull fracture?

A

Battle’s sign
Periorbital ecchymosis (raccoon eyes)
Hemotympanum
Otorrhea/rhinorrhea (CSF)

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8
Q

When is CT not indicated in head injuries?

A

For low risk pts with low risk injuries

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9
Q

How do you decide when to do a CT with a head injury?

A

PECARN (primary one)
CATCH (irritability is involved)
CHALICE (has the speed of the MVA)

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10
Q

Who gets a CT in head injuries?

A 
GCS<15 or acute mental status change
Signs of skull fracture
Vomiting >3 times
Seizure
Less than 2
Nonfrontal scalp hematoma
LOC<5 sec
Severe mechanism
"Not acting right" or lethargic
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11
Q

Where does a subdural hematoma occur?

A

Between the dura and arachnoid membrane (associated with diffuse brain injury)
**crosses the suture lines

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12
Q

How does a subdural hematoma occur?

A

Tearing of bridge veins so a low pressure bleed that dissects the arachnoid away from the dura

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13
Q

How might a pt act with a subdural hematoma

A

LOC/lingering sxs (irritability, lethargy, bulging fontanelle, vomiting)

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14
Q

CT findings in subdural hematoma

A

Crescent shaped, usually parietal area

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15
Q

What has a better prognosis, subdural or epidural hematoma?

A

Epidural

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16
Q

How does an epidural hematoma occur?

A

Rupture of arteries (usually meningeal)–may have an underlying fracture
**does not cross sutures!

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17
Q

History seen in an epidural hematoma

A

Brief LOC

Lucid period followed by deterioration

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18
Q

CT findings for epidural hematoma

A

Elliptical shape

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19
Q

How does a subarachnoid hemorrhage occur?

A

Injury to parenchymal and subarachnoid vessels

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20
Q

CT findings of a subarachnoid hemorrhage

A

Small dense slivers-blood in cisterns, sulci and fissures
Blood in the CSF
May take hime to be visible on a CT tho

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21
Q

Most common bleed with a head injury

A

Subarachnoid hemorrhage

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22
Q

Management for a head injury with no ICH or skull fracture

A

Head injury precautions (monitor for behaviors, vomiting, decreased arousal, seizure irritability)
Sleeping is ok

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23
Q

Management for a head injury with an ICH and +- skull fracture

A

Neuro consult
Admit (evacuation of ICH/surgery to repair fracture)
Repeat imagin

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24
Q

Sxs of a concussion

A 
Amnesia
Confusion and/or blunted affect, distractibility
Delayed response
Emotional lability
Visual changes
Repetitive speech pattern
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25
What must you do when a pt is found to have a substance abuse problem and has a concussion?
Must CT!
26
When does the HA, fogginess and other mild sxs usually resolve with a concussion?
7-10 days (Can go up to a month)
27
What is emergent after a concussion?
Severe, prolonged or worsening HA, vomiting or deterioration
28
What is post-concussive syndrome?
Sxs lasting 3 mos or longer
29
What is second impact syndrome?
2nd concussion within weeks (brain swelling, hernation or death) Kids are at increased risk
30
What is chronic traumatic encephalopathy?
Multiple concussions | Permanent change in mood, behavior, pain
31
Tx for concussion
No same day return to play (regardless if sxs resolve) Physical and cognitive rest Slow advancement of activity after sxs resolve
32
Causes of cervical spine injuries <8
Often MVAs but can be falls | C2-4
33
Causes of cervical spine injuries >8
Often MVAs but can be sports | C5-C7
34
Test of choice for cervical spine injuries
MRI (adolescents can have SCIWORA that is not picked up on CT so use this)
35
What is concerning with a cervical spine abnormality?
Bilateral pain Neuro deficits Torticollis Bony abnormalities
36
Management of a compound open fracture
Splint/dress, start IV abx, ortho consult
37
Management of non-displaced open fracture with overlying laceration
Start PO abx, repair laceration, splint, outpt ortho f/u
38
Management of grossly deformed/displaced fracture
May compromise neurovascular structures so require closed or open reduction and maybe fixation
39
What must you always remember with an intervention for fractures?
Always document neurovascular status before and after!!
40
Cellulitis vs erysipelas
Both skin infections, bacterial entry and all other signs Cellulitis is deeper dermis and subcutaneous fat Erysipelas is upper dermis and superficial lymphatics
41
Tx for cellulitis or erysipelas
Warm wet compress Bactroban topical Keflex or bactrim orally
42
Most often cause for osteomyelitis
Hematogenous spread of infection to bone (sinus infection, dental etc) S. aureus, strep pneumoniae, strep pyogenes
43
Where does osteomyelitis occur?
Long bones
44
Presentation of osteomyelitis
Fever, bone pain, swelling, redness guarding | Focal tenderness during exam
45
What is seen on an x-ray in osteomyelitis?
Early: soft tissue swellig | 10-14 days later: bone destruction with lytic lesions
46
Best study for eval of osteomyelitis
MRI (marrow edema or abscesses)
47
Tx for osteomyelitis
``` Supportive IV abx (empiric at first-vanco, clinda, rocephin) Drainage Debridement Hyperbaric O2 therapy ```
48
Important history with toxic ingestion
``` Substance Route Quantity How long since Progression of sxs Home txs? Underlying med conditions ```
49
Tx for toxic ingestion
``` Stabilize pts (ABCs) contact poison center Disability Drugs Decontamination ```
50
Decontamination for ocular exposure
``` Test pH Copious normal saline lavage until normal pH Flush at least 15 min before re eval Make sure contacts removed Consult opthamo ```
51
Decontamination for skin exposure
Copious NS and water | Follow with soap to concentrate lipid soluble toxins
52
Decontamination for GI exposure
Activated charcoal, cathartics, whole bowel irrigation | Enhance elimination
53
Decontamination for blood stream exposure
Antidote
54
What is ipecac?
For GI decontamination Only helps if given within 30 mins of exposure Not recommended usually
55
When might activated charcoal be used?
Caramazepine, barbiturates, dapsone, quinine, theophylline Digoxin or phenytoin Not with salicylates NOT FOR hydrocarbons, lithium, stong acid/base, metals, EtOH
56
When is simple dilution used?
For mild toxins that only cause irritation or corrosion
57
What is used for enhanced elimination of ingestin?
Activated charcoal urine alkalization Diuresis Dialysis/hemoperfusion
58
Antidote for acetaminophen
Acetylcysteine
59
Antidote for benzos
Flumazenil
60
Antidote for narcotics/opiods
Naloxone (narcan)
61
What happens if a foreign object passes the pylorus?
Continues to rectum and is passed in stool without complications
62
Concerns with foreign object ingestion
Sharp or irregular edges If lodged in esophagus (airway obstruction, strictures, perforation) Aspirated veggies can cause intense pneumonitis
63
Presentation of esophageal FB
``` Refusal to eat Vomiting Choking, coughing, stridor Neck or throat pain, inability to swallow Increased salivation FB sensation in chest ```
64
Procedure of choice to remove FB
Esophagus (endoscopy) | Trachea (bronchoscopy)
65
When should you consult with a FB?
``` Sharp or elongated Multiple Button batteries Perf Longer than 24 hrs Airway compromise Coin at level of cricopharyngeus muscle (below or above) ```
66
What is esophageal button battery?
An emergency!!
67
What happens with a button battery?
Extremely rapid action of alkaline substance on mucosa, pressure necrosis, residual charge (lithium is worst, mercuric oxide can cause heavy metal poisoning)
68
Tx for button battery
Emergent removal if in esophagus If past it then dont remove unless not pass pylorus after 24-48 hrs Surgical consult if Gi sxs
69
2 primary problems in drowning
Hypoxemia and acidosis
70
What can hypoxemia from drowning lead to?
CNS damage and arrhythmias, pulm injury, reperfusion injury, multi organ dysfunction
71
What is dry drowning?
When laryngospasm leads to hypoxia that leads to LOC | No fluid
72
What happens in wet drowning?
Dilute and washout surfactant, lose gas transfer, atelectasisi and VQ mismatch
73
What is near drowning?
Survival past 24 hrs (can see severe brain damage) | alert or mildly obtunded at ED presentation but may see full recovery
74
What has a poor prognosis with near drowning?
Comatose, getting CPR or have fixed and dilated pupils and no spontaneous respirations
75
Poor prognosis in drowning
``` Submersion over 5 mins Longer than 10 mins to get BLS Longer than 25 min resuscitation Ager over 14 GCS<5 Persistent apnea and CPR in ED Arterial blood pH<7.1 ```
76
When should child abuse be considered with near drowning?
Less than 6 mos | Toddlers with atypical presentation
77
What is secondary drowning?
Death up to 72 hrs after near drowning incident Fresh water drowning results in hemodilution from ingested water Can have hemolysis or arrhythmias is large enough water
78
Most critical tx for drowning
Pre hospital care
79
What is a fever without a source?
Rectal temp over 38C (100.4) | Must ID occult bacterial infections (pneumonia, UTI, bacteremia, herpes, meningitis)
80
What does the workup in a fever based on>
Age (<3 mo is neonate and 3 mo-3 yr is infant) Appearance Risk factors (birth history, travel, exposures, vaccinations, immune deficiiences)
81
Workup for kid <3 mos with temp over 38C
Workup regardless of appearance
82
Sxs of infection with neonatal fever
Irritability, decreased activity, poor feeding and no weight gain, lethargy, change in sleep, vomiting, diarrhea, hypothermia
83
Management of neonatal fever
Full septic workup Empiric abx Admission after culture results
84
Managment of ill appearing 3 mo old to 3 yr
``` Labs UA Cultures CXR is tachypnea or leukocytosis Parenteral abx Admit ```
85
Well appearing kid not immunized with a fever with management
CBC with diff BLood culture if WBC>15000 UA if girl <2 yr, uncircumcised <1 yr or circumcised <6 mo CXR is leukocytosis >20000
86
Well appearing immunized kid with fever management
UA and culture if girl <2, uncircumised <1 and circucised <6 mo If older than no routinelabs, no abx therapy but do need UA C&S Fever >39C and abnormal UA should be treated for UTI

X Pediatrics 2 (10 decks)

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