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Peds Exam 2 > Lecture 8 - Emergencies > Flashcards

Lecture 8 - Emergencies Flashcards

1
Q

What is the leading cause of ED visits?

A

injuries

90% blunt

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2
Q

What are the expected vitals for a 2 month old?

A

0-3 months

100-150 HR
35-55 RR
65-85/45-55

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3
Q

What are the expected vitals for a 4 month old?

A

3-6 mo

90-120 HR
30-45 RR
70-90/50-65

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4
Q

What are the expected vitals for a 9 month old?

A

6-12 mo

80-120 HR
25-40 RR
80-100/55-65

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5
Q

What are the expected vitals for a 2 year old?

A

1-3 yr

70-110 HR
20-30 RR
90-105/55-70

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6
Q

What are the expected vitals for a 4 year old?

A

3-6 yr

65-110 HR
20-25 RR
95-110/60-75

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7
Q

What are the expected vitals for a 7 year old?

A

6-12 yr

60-95 HR
14 - 22 RR
10-120/60-75

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8
Q

What are the expected vitals for a 13 year old?

A

> 12yr

55-85 HR
12-18 RR
110-135/65-85

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9
Q

ABCDE

A 
Airway 
Breathing 
Circulation 
Disability (Neuro scale) 
Exposure
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10
Q

AMPLE

A 
allergies
medications
past medical hx
last meal 
events leading to injury
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11
Q

What is the most common cause of death d/t traumatic injury?

A

MVA

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12
Q

What questions do you need to ask when you have an MVA pt?

A 
event
speed
location
seatbelt
broken glass
airbag deployment 
LOC
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13
Q

Definition of drowning

A

A process resulting in primary respiratory impairment from submersion or immersion in a liquid medium

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14
Q

Who has the highest prevalence for drowning?

A 
Males 
AA
1-5 y/o 
Low SE status 
Southern states
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15
Q

What is the mechanism of drowning?

A

Panic —> breath holding —> reflex inspiratory effort —> hypoxemia —> end organ effects (icshemia)

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16
Q

Why is drowning worse in children?

A

High surface area:mass
Decreased subq fat
Limited thermogenic capacity

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17
Q

Moderate vs severe hypothermia

A

Moderate = 32-35 —> increases O2 consumption

Severe = <32C —> decrease cellular metabolic rate

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18
Q

What is the goal of prehospital drowning treatment?

A

Rapid restoration of oxygenation, ventilation and circulation

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19
Q

Is C-spine recommended for drowning pts?

A

No

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20
Q

Afterdrop

A

Initial drop in temp during initial warming of a drowning pt

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21
Q

What is the ED treatment for drowning?

A

Remove wet clothing, dry skin
External warming:
-warm blankets, plumbed garments, heating pads, radiant heat, forced warm air
Internal warming:
-warmed IV fluids or humidified oxygen via tracheal tub, heated irrigation of peritoneal and pleural cavities
Continue until core temp reaches 33-35

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22
Q

_____ min of hypoxemia = irreversible CNS injury

A

3-5 min

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23
Q

When should you suspect toxic exposure?

A 
Acute onset of multi-organ system dysfunction 
AMS 
Respiratory/CV compromise 
Metabolic acidosis 
Seizure 
Questionable clinical picture

Suspect abuse if <1y/o

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24
Q

What are the most common ingestions in children?

A

Coins

Keep in mind the single load laundry packet

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25
What is the phone number for poison control?
800-222-1222
26
What toxicology screens can we run?
Utox, serum acetaminophen levels, salicylate levels
27
If a child is having a seizure secondary to poisoning, what is the treatment?
benzos, then barbituates benzos are also used to HTN and drug associated agitation associated with benzos
28
What is the antidote treatment for opioid poisoning?
Naloxone
29
What is the antidote treatment for acetaminophen poisoning?
n-acetylcysteine (mucomyst)
30
What is the antidote for insecticide poisoning?
atropine
31
What is the antidote for TCA poisoning?
sodium bicarb
32
What do you give a pt for GI decontamination?
activated charcoal
33
What do you do for a child who ingested button batteries?
surgical consult! emergent
34
What do you do for a child who ingested magnets?
emergent depends on if its single or multiple Dx: serial x-rays Tx: keep away from magnetic material until it passes Endoscopic removal if possible
35
What do you do for a child who ingested sharp pointed objects?
straight pens, needles, straightened paperclip, bones, toothpick Risk: perforation, retropharyngeal abscess Dx: X-ray Tx: watchful waiting, OR
36
Epi of bites
Dogs (60-90%) Cats (5-20%) Humans (2-3%) 20-35 deaths annually in the US Animals - Pasterurella Humans - Eikenella corrodens
37
What is the assessment for a bite wound?
LA identify what type of injury it is: skin, muscle, tendon, NV Xray/US: foreign body or deep bite near bone or joints Head CT: head injury, <2 years Infection concern: gram stain aerobic and anaerobic cultures before ABX
38
What is the management of a bite wound?
``` I and D Primary closure if: - cosmetically important (ex. facial) -clinically uninfected -<12 hours old, <24 hours on the face ``` When NOT to close: - crush injuries - hand or feet - cat or human bites (unless on the face) - immunocompromised
39
When are you NOT supposed to close a bite wound?
- crush injuries - hand or feet - cat or human bites (unless on the face) - immunocompromised
40
What is the treatment for bites?
cleanse with soap and/or virucidal agent with NS tetanus if >5 years ABX animal bites -Augmentin 20mg/kg per dose BID for 3-5 days ABX human bites -Augmentin -Unaysn (ampicillin -sulbactam) 50mg/kg per dose QID for 3-5 days
41
Rabies vaccine
Animal bite prophylaxis 4-1ml IM dose of HDCV or PCEC vaccine in deltoid or thigh Days 0, 3, 7, 14
42
Rabies Immune Globulin (RIG)
Animal bite prophylaxis full dose infusion around bite(s) if possible remained IM from separate site than vaccine
43
Human bite prophylaxis
if blood in saliva: HIV prophylaxis if bitter +HbsAg - initiate HB vaccine series in all unvaccinated - -Hep B immune globulin - -Hep B vaccine
44
What are signs and sxs of dehydration?
Tachycardia, hypotension Poor skin turgor, delay in cap refill, deep respirations cool and mottled extremities, frank shock decreased OCP increased thirst, decreased tearing, lethargy irritability
45
What labs do you draw for a pt with dehydration?
``` serum electrolytes serum bicarb <17mEq/L increased blood BUN serum sodium and potassium ADH secretion urine sodium, osmolality and specific gravity ```
46
What is the treatment for dehydration?
5ml/2min Goal: 10ml/kg of body weight IV crystalloid isotonic (0.9%) saline never use hypo/hyper tonic crystalloids added dextrose shows no benefit
47
What are the fluid rates for someone with severe dehydration?
rapid (bolus) infusion of 20ml/kg of isotonic 0.9% saline in 10-30 min moderate dehydration - rapid rehydration of 60ml/kg vs 20ml/kg over an hour
48
How do you calculate the daily fluid requirement?
1st 10kg - 100ml/kg/day 2nd 10kg - 50ml/kg/day remainder of bodyweight 20ml/kg/day rate (ml/hour) = total daily requirement divided by 24
49
SIDS
sudden infant death syndrome death of an infant <1yo, unexplained through case investigation, autopsy, and examination
50
What is the leading cause of infant mortality between 1 month and 1 year in US?
SIDS peaks 2-4 months, 90% before 6 months
51
What are risk factors for SIDS?
maternal: - younger, smoker, drug abuse, delayed prenatal care, UTI/STIs neonatal: -preterm, low weight for GA infant: - prone sleeping position, sleeping on soft surface or with increased accessories, bed-sharing, overheating, sibling of SIDS victim
52
What are preventative factors for SIDS?
``` room-sharing pacifier use breastfeeding fan use immunizations firm mattress ```
53
What analgesics are used in children?
acetaminophen (15mg/kg/dose Q4H) Ibuprofen (10mg/kg/dose Q6H) IN Fentanyl (1-2mcg/kg) Ketoralac (Toradol) (0.5mg/kg - max dose 30mg) Morphine (0.2-0.5mg/kg, max 10 mg every 3-4 hours)
54
LET
lidocaine-epinephrine-tetracaine topical anesthetic --30 min prior to procedure
55
What LAs can you use for children?
LET topical gel Lidocaine Bupivicaine
56
When do you NOT use lidocaine?
fingers, nose, penis, toes
57
What drug do we use for minimal sedation?
Midazolam (versed) IN/PO/IV/IM sedative ONLY used prior to starting a procedure onset of action: 1-3 min (IN) IN dosing: 0.2mg/kg, max dose 10mg
58
What drug do we use for moderate sedation?
usually reserved for ortho reduction, tongue lacerations, extensive lacerations, MRI/CT IV Ketamine Analgestic + sedative loading dose + maintenance PRN SE: N/V, tachy, HTN, agitation, hallucinations, respiratory suppression
59
What is used for irrigation?
50-100mL/cm of laceration length | Normal saline > sterile water
60
When is the tetanus vaccine schedule?
2mon, 4mon, 6 mon, 15-18mon, and 4-6 years if <3 doses Dtap or Tdap if >3 doses vaccine if >5 years
61
When can kids get cough medicine?
no until after the age of 12 years
62
What do you do for a child complaining of a HA?
all get a neuro exam | record their BP
63
What must you be sure to keep in mind for a boy with abdominal pain?
testicular exam

Peds Exam 2 (11 decks)

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