L6: Basic pediatric emergencies Flashcards
(86 cards)
1
Q
Cushing’s triad (increased ICP)
A
wide pulse pressure
bradycardia
abnormal respirations
2
Q
Battle sign
A
basilar skull fracture:
bruise behind ear
3
Q
Periorbital ecchymosis
A
basilar skull fracture:
raccoon eyes
4
Q
Hemotympanum, otorrhea/rhinorrhea (CSF)
A
other signs of basilar skull fracture
5
Q
Basal skull/skull base is
A
sphenoid + temporal + occipital + ethmoid bones
6
Q
Concerning head injury signs
A
excessively sleepy or hard to arouse
vomiting
irritability
7
Q
What can a head xray tell you
A
no brain visualization
air-fluid levels in sinus
8
Q
PECARN algorithm (for when to CT) group A
A
- CT recommended for:
GCS=14 or lower, other signs of AMS, palpable skull fracture, - Observation vs CT for: occipital, parietal, or temporal scalp hematoma, LOC > 5 secs, severe MOI, not acting normally
9
Q
PECARN algorithm (for when to CT) group B
A
- CT recommended for:
GCS=14 or lower, other signs of AMS, signs of basilar skull fracture - Observation vs. CT for:
History of LOC, vomiting, severe MOI, severe HA
10
Q
GCS less than __ always gets a CT
A
14
11
Q
“the reality” guideline for CT
A
GSC <15 or AMS Skull fracture Vomiting > 3 times, seizure < 2 years old Non-frontal scalp hematoma LOC > 5 secs Severe MOI Not acting right/lethargic
12
Q
Most common bleed
A
subarachnoid hemorrhage
13
Q
CT of subdural hematoma
A
Crescent-shaped, usually parietal area
Crosses suture lines
14
Q
CT of epidural hematoma
A
Elliptical shape
Does not cross suture line
15
Q
CT of subarachnoid hemorrhage
A
Small, dense “slivers”
Blood in cisterns, sulci, and fissures
Blood in CSF
May take time to evolve and be visible on CT
16
Q
bleed with the worst prognsosis
A
subdural hematoma
17
Q
Can kids sleep if they’ve got a head injury?
A
Yes, if they’re not bleeding and don’t have a fracture.
Monitor: behavior change, vomiting, decreased arousability, seizures, irritability
18
Q
Management for a head injury associated with bleeding or skull fracture
A
Neuro consult
Admit to PIC
evaluation for surgery vs. observation with repeat imaging
19
Q
Concussion definition
A
Traumatically induced alteration in mental status, with or without LOC
Direct blunt force→ stretching/shearing of axons
20
Q
Concussion symptoms
A
amnesia confusion blunted affect distractibility delayed response emotional lability visual changes repetitive speech pattern
21
Q
How long does it take for a concussion to resolve?
A
7-10 days
22
Q
Post-concussive syndrome
A
sx >3 months
23
Q
Chronic traumatic encephalopathy
A
Multiple concussions → permanent change in mood, behavior, pain
24
Q
Second impact syndrome
A
2nd concussion within weeks → brain swelling, herniation, death
Children at increased risk
25
Concussion management
No same day return to play: must be completely symptom free to return, no sports 1-2 weeks
Physical and cognitive rest
Slow advancement, structured return-to-play protocols
26
Who to CT with a concussion?
Severe/prolonged/worsening HA
Vomiting
deterioration in mental status → Emergent CT
ETOH/substance
27
Are C spine injuries common in peds?
NO
| most commonly from car crashes
28
<8 years old c-spine injuries
falls
| C2-C4
29
SCIWORA: Spinal Cord Injuries Without Radiographic Abnormalities
More commonly seen in adolescents
30
>8 years old c-spine injuries
sports
| C5-C7
31
Concerning symptoms for C-spine injuries
Bilateral pain
Neuro deficits
Torticollis (neck muscles contract on one side)
Bony abnormalities
32
Cervical spine injuries imaging of choice
MRI
33
When managing fractures make sure to
always document neurovascular status (pulse, sensation) before and after interventions
34
Management of a compound, open fracture
splint/dress
IV abx
ortho consult
35
Management of a non-displaced open fracture
repair laceration
splint
PO abx
outpatient ortho follow up
36
Management of a grossly deformed fracture
may compromise neurovascular structures → ortho consult in ED → closed/open reduction, possible fixation w/plates/screws
37
Cellulitis/erysipelas management
Warm wet compress
Topical: Bactroban
Oral: Keflex or bactrim
Failed outpatient treatment: admit, labs, IV abx
38
Cellulitis
deeper dermis and subcutaneous fat
39
Erysipelas
upper dermis and superficial lymphatics
40
Both cellulitis and erysipelas have similar pathophysiology:
Breaches in skin→ bacterial entry→ skin infection → erythema, warmth, tenderness, induration, +/- fever, N/V/D
41
Osteomyelitis
Hematogenous spread of infection to bone→ bone destruction
42
Osteomyelitis is most common in
males <5
| long bones: femur, tibia, humerus
43
most common causes of osteomyelitis
**Staph aureus (most common, MRSA)
Strep pneumoniae
Strep pyogenes
44
Osteomyelitis presentation
```
Fever
bone pain
swelling
redness
guarding
focal tenderness during exam
```
45
Osteomyelitis xray
Early: soft tissue swelling
| 10-14 days later: bone destruction with lytic lesions
46
Best imaging for osteomyelitis
MRI
| shows marrow edema, abscesses
47
Empiric abx for osteomyelitis
vancomycin
clindamycin
rocephin
*change meds once culture and sensitivity comes back*
48
other management of osteomyelitis
Surgical drainage, debridement
| Hyperbaric oxygen therapy (100% O2 chamber)
49
eye toxic exposure requires
pH testing, flushing, retest until normal
50
lipd-soluble toxins and skin exposure
follow flushing with soap
51
compounds for enhanced elimination of toxins
Activated Charcoal
Urine Alkalization
Diuresis
Dialysis/hemoperfusion
52
if a patient ingested sustained release medication
whole bowel irrigation
53
Ipecac
has to be used within 30 mins for GI toxins
| not recomended
54
if a patient has ingested mild toxins that only cause irritation/corrosion
simple dilution
55
activated charcoal is effective for the following poisonings
```
carbamazepine
barbiturates
dapsone
quinine
theophylline
+/- digoxin and phenytoin
```
56
Sites of foreign body obstruction (narrowings)
cricopharyngeal narrowing to upper esophageal sphincter
tracheal bifurcation
aortic notch
lower esophageal sphincter
57
If a foreign body passes the pylorus
it usually continues to rectum without complications
58
an aspirated vegetable could lead to
intense pneumonitis
59
With esophageal foreign bodies, make sure of
patency of the airway
60
Consult if an esophageal foreign body is.....
```
Sharp/elongated
Button batteries
Perforation
>24 hours
Airway compromise
```
61
Ingested magnets can cause
volvulus and bowel perforations
| *appear as multiple foreign bodies*
62
Does a negative chest, neck, abdomen xray rule out esophageal foreign body?
no
63
Coin above cricopharynxgeus muscle
consult ENT
64
Coin below cricopharynxgeus muscle
consult GI
65
Coin below esophageal sphincter
leave it
66
what kind of batteries have the worst outcome
lithium batteries
67
Mercuric oxide batteries have a risk of
fragment → heavy metal poisoning
68
Why is a button battery dangerous
Extremely rapid action of alkaline substance on mucosa, pressure necrosis, residual charge → esophageal burns and perforation in hours
69
Button battery management
EMERGENT removal if in esophagus
Passed esophagus→ observe→ remove if hasn’t passed pylorus after 24-48 hours
Usually excreted within 48-72 hour
Observed to split in GI tract→ blood and urine mercury levels
70
Which age groups are most at risk of drowning?
<4 years
| 15-24 years
71
How much liquid is aspirated in a drowning?
<4 mL
72
Drowning MOA
impaired ventilation: 1. Hypoxemia 2. Metabolic and/or respiratory acidosis
Hypoxemia → CNS damage → arrhythmias, ongoing pulmonary injury, reperfusion injury, multi-organ dysfunction
73
Dry drowning
no fluid in lungs.
| Laryngospasm→ hypoxemia → LOC
74
Wet drowning
more common, fresh or saltwater.
Aspiration of water into lungs → dilution/washout of surfactant→ diminished gas transfer across the alveoli → atelectasis → V/Q mismatch
75
Near drowning
survival 24 hours post event
| Severe brain damage occurs in 10-30% of peds
76
Consider child abuse in a near drowning if....
<6 months or toddlers with atypical presentation
77
Poor prognosis after a near drowning
```
***
Submersion > 5 mins
Time for life support > 10 mins
Resuscitation duration > 25 mins
>14 years
Glasgow coma scale <5
Apnea + cardiopulmonary resuscitation
Arterial blood pH <7.1
***
```
78
Non-primary drowning
follows primary event such as: seizures, head/spine trauma, cardiac arrhythmias, hypothermia, alcohol and drug ingestion, syncope, apnea, hyperventilation, suicide, hypoglycemia
79
Secondary drowning
may cause death up to 72 hours after near drowning incident
Fresh water drowning→ ingestion→ hemodilution
Large volume of water aspirated:
Significant hemolysis
Electrolyte disturbance→ cardiac arrhythmias
80
Near drowning treatment
```
Pre-hospital care is critical
Assist ventilation→ O2 95%
Warmed isotonic IV fluids, warming blankets
CXR and repeat at 6 hours
Admit for observation
Address injuries
```
81
Fever without a source is defined as
Rectal temperature >38 C/100.4
82
Who to work up with a fever without a source regardless of appearance
Infants < 3 months
83
Who gets a urinalysis if they have a fever without a source?
girls <24 months
circumcised boy <6 months
uncircumcised <12 months
Ill-appearing children 3months-3 years
All children < 3 months
84
Treat for a UTI if
>3 months, completely immunized, Fever >39, and abnormal ultrasound
85
when to do a CXR on a ill appearing child 3 months-3 years
tachypnea or leukocytosis (>20,000)
86
when to do a CXR on a well-appearing child >3 months
leukocytosis (>20,000)
