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Phase 2 PEDs > Pediatric emergencies > Flashcards

Pediatric emergencies Flashcards

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1
Q

Top causes of pediatric death?

A

<1yo - Genetic/developmental conditions > SIDS

1-24yo - Unintentional injuries/accidents

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2
Q

Top 5 Unintentional injuries in 9-18yo?

A
  1. MVC
  2. Drown
  3. Burn
  4. Fall
  5. Toxin
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3
Q

Primary assessment of Resus?

A 
A- Airway
B- Breathing
C- Circulation
D- Deformity/Disability
E- Environment/Exposure
ADJUNCTS - 
IVF, O2, Vitals, Glucose, Lab/Rad, monitor interventions
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4
Q

Resus fluids?

A 
Isotonic crystalloids (NS/LR)
Blood products
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5
Q

What Isotonic crystalloid is CI w/ pRBC?

A

LR (hemolysis may occur)

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6
Q

What is the primary reason for cardiopulmonary arrest in PEDs? Cardiac or Pulmonary?

A

Respiratory arrest

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7
Q

Respiratory is?

A

Inability to maintain adequate gas exchange to meet metabolic demands (Even if w/ good SO2)

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8
Q

Types of respiratory failure?

A

Hypoxemic - ARDS

Hypercarbic

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9
Q

Hypoxemic Respiratory failure is considered how much partial O2?

A

<60mmHG PaO2

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10
Q

Causes of Hypoxemic Respiratory failure?

A

Ventilation-perfusion mismatch (Lung not vent right)

Shunting - deoxy blood bypasses ventilated aveloi

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11
Q

Early signs of Hypoxemic Respiratory failure?

A

Tachy-P

Tachy-C

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12
Q

Progressive signs of Hypoxemic Respiratory failure?

A

Dyspena, diaphoresis
Nasal flaring, grunting
Accessory muscles used

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13
Q

Late signs of Hypoxemic Respiratory failure?

A

Cyanosis and AMS

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14
Q

Subset of Hypoxemic Respiratory failure?

A

Acute lung injury/ARDS

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15
Q

ARDS is?

A

Diffuse infiltrates or Pulmonary edema present

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16
Q

Hypercarbic Respiratory failure is considered how much CO2?

A

> 50mmHg CO2

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17
Q

Causes of Hypercarbic Respiratory failure?

A

Inadequate alveolar ventilation 2nd to decreased minute ventilation (TV x RR)
or
Increased dead space ventilation (No perfusion)

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18
Q

TXT of Respiratory failure

A

ABC’s, O2, Ventilation, Support, TXT underlying cause

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19
Q

Shock is?

A

The inability to perfuse tissues/organs to meet metabolic demands

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20
Q

Types of shock?

A 
Hypovolemic
Distributive
Cardiogenic
Obstructive
Dissociative
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21
Q

S/S of inadequate tissue perfusion?

A

Increased HR
ABNL BP
Pulse alterations

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22
Q

MC type of shock is?

A

Hypovolemic shock

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23
Q

What is the MC type of shock in PEDs?

A

Hypovolemic shock

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24
Q

Hypovolemic shock is due to?

A

Decreased blood volume

- Loss (Bld, N/V/D, Renal fluid loss, DI or DM, Burns

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25
S/S of Hypovolemic shock?
Tachy-C V-Con Dehydration S/S (dry mucus membranes, urine output)
26
Distributive shock is?
Adequate volume but maldistribution of blood flow
27
Pathophys of Distributive shock is?
V-Dil > Venous pooling > Decreased preload
28
MC cause of Distributive shock is??
Sepsis > SIRS > Anaphylaxis
29
S/S of Distributive shock is?
``` +- bounding pulses, HOTN, V-Con Warm shock (Nl PE) > Cool extremities/mottling > decreased cap refill ```
30
Distributive shock due to sepsis will present w/?
Fever - Lethargy Petechiae/Purpura Infection source
31
Cardiogenic shock is due to?
Decreased myocardial contractility
32
S/S of Cardiogenic shock?
``` Tachy-P Tachy-C Enlarged Liver Gallop +- JVD Poor renal blood flow > Retin Na2+/H20 > oliguria and peripheral edema ```
33
Standout cause of Cardiogenic shock?
Kawasaki Disease
34
Obstructive shock is due to?
Mechanical obstruction to ventricular filling/outflow
35
Causes of Obstructive shock?
Cardiac Tamponade Massive PE Tension PTX Cardiac tumor
36
S/S of Obstructive shock?
Pulses hard to feel Delayed cap refill Enlarged liver JVD
37
Dissociative shock is?
O2 not bound to Hgb or wont release from it
38
Causes of Dissociative shock?
Carbon monoxide poisonin | Methemoglobinemia
39
S/S of Dissociative shock?
Tachy-C Tachy-P AMS CV Collapse
40
TXT of shock?
Recognize early (when in partial state) Guided by S/S - CV vs Respiratory vs Renal Loop diuretics after volume replacement
41
Leading cause of death in pediatric trauma?
MVC
42
MC type of trauma in Pediatrics?
Head trauma > limbs
43
Will a cervical XR catch injuries to the neck w/ PEDs?
No - too immature - require MRI
44
What is SCIWORA?
Spinal cord injury w/out radiologic abnormality
45
If SCIWORA is suspected what rad is req?
MRI
46
2nd leading cause of trauma type resulting in death is?
Thoracic trauma
47
MC thoracic injuries?
Contusion (MC) Rib fractures - (Posterior = abuse) --- force to ribs transmits to lung PTX
48
Abdominal trauma requires what type of w/u?
Abdominal CT and Serial PE (Surgery or not)
49
MC injured organ?
Spleen
50
What is the Kerh sign?
LUQ direct pressure causes L-shoulder pin
51
What sign is indicator for splenic injury?
Kehr sign
52
Common MOI of splenic injury?
MVC or Bicycle handles
53
TOC of splenic injury?
Non-operative mgmt
54
When is surgery indicated for splenic injury?
ONLY if - hemodynamic instability or persistent blood loss
55
What does an aplenic (s/p splenectomy) pt req?
PCN prophylaxis | Vaccines (Pneumococcal and HIB)
56
Severe hemorrhage is MC ass/w what Abdominal injury?
Liver injury (dual blood supply)
57
Renal injury Dx is made via?
Hx, UA (blood/protein high)
58
Pancreatic injury is Dx via?
Abd pain, N/V, Labs (amylase/lipase high - may req days until noticeable)
59
When should an intestinal injury be suspected?
Pneumoperitoneum OR Cant find blood source loss after a trauma
60
MC growth plate Fx locations?
1. Distal Radius 2. Distal Tibia 3. Distal Fibula
61
SALTR Harris classification of growth plate Fx?
``` S - Separated A - Above/Away L - Lower/Longest end T - Through R - Rammed ```
62
Epiphysis is susceptible to what?
Angular/Torsional forces
63
MC non-physeal Fx?
Complete Fx (both sides of cortex Fx)
64
What is a green stick Fx?
``` Bone fails on tension side AND Sustains a bend on compressed side BUT Not enough force to create a complete Fx ```
65
Buckle Fx is AKA?
Torus Fx
66
Buckle Fx is?
- Torus Fx - | Bone compression w/out cortex breakage
67
Buckle Fx MC occurs where on a bone?
Torus Fx - Metaphysis
68
A stable Buckle Fx will heal when?
4wks with immobilization
69
Gymnasts wrist is?
Distal radial physis injury from RPT impacts AND UE becoming wgt bearing so much
70
TXT for Gymnasts wrist is?
Absolute rest (PVT premature closure of growth plate)
71
Lil league elbow is?
``` Medial humeral epicondyle apophysitis TTP at - Medial/Lateral epicondyle - Radial head - Capitellum - Olecrannon process ```
72
Lil league elbow pathophys?
Excess/RPT -tension forces across medial aspect of elbow AND -compression forces across lateral elbow
73
TXT of Lil league elbow?
RICE NSAIDs PT - upper body strengthening/throwing mechanics
74
Nursemaids elbow is?
Radial head subluxation - out of annular ligament surrounding radial head w/ traction at elbow
75
TXT for Nursemaids elbow?
Reduction Supinate hand w/ pressure on radial head THEN Flex elbow 90*
76
Are XR req for Nursemaids elbow?
No - unless unable to reduce OR S/S of Fx
77
Legg-Calve-Perthes Dz is?
Idiopathic avascular necrosis of Capital epiphysis of femoral head
78
Legg-Calve-Perthes Dz is ass/w what coag d/o?
Factor V leiden (hypercoagulability)
79
Gender/Avg age of Legg-Calve-Perthes Dz?
Boys - 7yo (3-12)
80
Classic presentation of Legg-Calve-Perthes Dz?
Atraumatic Hx Painless limp Late/Delayed presentation due to minimal discomfort LROM - internal rotation/abduction Mild pain - hip/groin, anterior thigh, knee
81
Dx of Legg-Calve-Perthes Dz via?
AP and Frog leg hip XR OR MRI or Bone scan to Dx early Disease
82
TXT of Legg-Calve-Perthes Dz consists of?
SL - Ortho refer NSAIDs/Pain control Containment of Femoral head in Acetabulum
83
What orthopedic related disorder is a Emergency?
Slipped Capital Femoral Epiphysis (SCFE)
84
Slipped Capital Femoral Epiphysis Gender/age?
Males - 10-16yo (M=12 and F=11) | - if not in this age range think = endocrine D/O
85
Is Slipped Capital Femoral Epiphysis bilateral or unilateral?
Unilateral - sometimes bilateral or develops into bilateral
86
How is Slipped Capital Femoral Epiphysis classified + classification via XR?
Stable vs Unstable | Displacement Types I, II, III(MC)
87
Slipped Capital Femoral Epiphysis presents as?
Pain - hip/knee Limp or inability to walk Antalgic gait LROM of hip (internal rotation) - Holds in Ext rotation
88
XR eval of Slipped Capital Femoral Epiphysis?
AP/Frog leg XR
89
Earliest XR sign of Slipped Capital Femoral Epiphysis will show?
Physis widening w/out slippage AKA | PRESLIP condition
90
TXT of Slipped Capital Femoral Epiphysis?
PVT further slippage AND close physeal Immediate Non-wgt bearing PEDs ortho refer Internal fixation or Surgical hip dislocation/reduction
91
Complications of Slipped Capital Femoral Epiphysis?
Chondrolysis - (Cartilage destruction) | Avascular necrosis > OA
92
Osgood-Schlatter disease is/pathophys?
Pain at patellar tendon insertion on tibial tubercle - Quadricep contraction stress pulling on tendon > - MicroFx/partial avulsion fx
93
When does Osgood-Schlatter disease typically occur?
After growth spurt
94
Osgood-Schlatter disease gender/age?
Boys (M=13-14yo and F=11)
95
Osgood-Schlatter disease presents as?
TTP/edema over tibial tubercle | Pain after activity
96
Osgood-Schlatter disease Rads and purpose?
XR to r/o Fx, infection, tumor
97
TXT/timeframe of Osgood-Schlatter disease?
Benign course over 1-2yr Rest/activity mod Pain control/Ice PT - mDecrease extremity flexibility/strength exercise
98
What is ALTE (acute life threatening event)?
Unexpected change in condition to - Apnea - Color change (blue/pale) - Suddenly limp - Choke/gagging
99
MC causes of ALTE?
GERD Laryngospasm Then (CNS, CV, Resp infection, serious bacterial infection)
100
Eval of ALTE?
Labs - CMP, CBC, Bood gas, CXR, MRI/CT Head, EEG Test for RSV or Pertussis Braium swallow or pH probe (GERD) Admit 12-24h - CV monitoring
101
Drowning is classified as?
Fatal vs Non-Fatal
102
Drowning pathophys?
``` Submersion > Aspiration of fluid into larynx > Breath holding or Laryngospasm > More fluid or gastric contents aspirated > Surfactant destroyed > No gas exchange > Hypoxemia > Brain injury ```
103
Mgmt of drowning?
Resus - ABCs - Unwitnessed drowning = C-spine - O2 - cerebral perfusion - rewarm hypothermic pts - monitor pH, CV, Pulm, CNS - ICU 6-12h
104
Who will likely survive drownings?
Pts that regain consciousness on arrival to hospital
105
Unfavorable prognosis indicators of drowning?
``` >25m CPR CPR continued into hospital GCS <6 Fixed/dilated pupils Seizures >72h Coma ```
106
Types of Burns?
Superficial (1st D*) Superficial partial thickness (2nd D*) Deep partial thickness (2nd D*) Full thickness burn (3 and 4th D*)
107
Superficial (1st D*) attributes?
Red, painful, dry Epidermis only Sun burn/mild scald injury DO NOT include in BSA calculations
108
How much time for Superficial (1st D*) to heal?
2-5d w/out scarring
109
Superficial partial thickness (2nd D*) attributes?
Fluid blisters > debride = Red, wet, painful w/ blanching | All of Epidermis and portion of dermis
110
How much time for Superficial partial thickness (2nd D*) to heal?
W/in 2wks w/out scarring or grafting
111
Deep partial thickness (2nd D*) attributes?
2nd D* burn (But like a full thickness in attributes) +- Blistering - less blanching, mottled pink/white Less painful than superficial 2nd
112
Deep partial thickness (2nd D*) Mgmt?
Often require Excise and graft
113
Full thickness burn (3 and 4th D*) attributes?
All layers of skin involved Color = Dry, white, dark red, brown/black in colors Does not blanch No feeling/pain
114
Full thickness burn (3 and 4th D*) Mgmt?
Surgical - grafting | +- Reconstruction if 4th D*
115
Difference between 3rd and 4th degree?
4th degree involves Fascia, Muscle, or bone | And requires reconstruction
116
Blanching vs Non-blanching burns?
Blanches - Superficial (1st D*) Blanches - Superficial partial thickness (2nd D*) Less blanching/pain - Deep partial thickness (2nd D*) No blanching/pain - Full thickness burn (3 and 4th D*)
117
Suspect inhalation burn if what is present?
Facial burns Singed nasal hairs Carbonaceous Sputum Hoarseness = Supraglottic injury
118
Infant BSA rule?
HEAD, FRONT, BACK = 18 Arm = 9/per Leg = 14/per
119
Transfer to PEDs to burn center when?
>10% Partial/full thickness (<10yo or >50yo) >20% if 11-49yo Partial/full thick - Face,Hands,Feet,Genitals,Major Joints Electrical, Chemical, Inhalation Burns w/ trauma Burns w/ comorbidities
120
Acute Mgmt of burns?
``` Early intubate - inhalation burn 100% humidified air CO toxicity reversal IVF PVT hypothermia Wound Care Pain control ```
121
IVF mgmt calculation of acute mgmt of burns?
LR - Initial blous = 20mL/kg Parkland formula over next 48h Titrate Urine output >1mL/Kg/hr
122
Parkland formula is?
LR - 4mL/kg/BSA % over 24hrs Half w/in 1st 8hrs Half over next 16hrs
123
After LR in Parklands formula what should be next fluid used?
D5 1/4 NS - Next 24hrs
124
Burns will put metabolism in what type of state?
Hypermetabolic - nutrition support required
125
What topical agents are recommended for Burn wounds?
Silver sulfadiazine | Polymyxin B - (Bacitracin/Neomycin) (Neosporin)
126
TXT of acute poisoning?
Single or Multiple dose activated charcoal | Toxin specific antidotes
127
Activated charcoal purpose?
Decrease drug absorption w/in 1hr of ingestion
128
What will activated charcoal not work against?
Caustic/corrosive agents Hydrocarbons Heavy metals
129
When should multiple dosed activated charcoal be used?
Ingested life threatening quantity of - Carbamazepine - Dapsone - Phenobarbital - Quinine - Theophylline
130
Txt of ASA or methotrexate ingestion?
Alkalization of urine - PVT reabsorption
131
Dialysis may be required for acute poisoning if?
``` Methanol, Ethylene glycol ASA Theophylline Bromide Lithium ```
132
DO NOT perform these procedures in acute poisoning of pts?
Syrup of ipecac | Gastric lavage
133
Complications of poisoning
Dysrythmias GI S/S Seizures
134
Classic triad of Narcotic poisoning?
Miosis Decreased AMS Resp depression
135
TXT of Narcotic poisoning?
Naloxone (Narcan) <1yo - 1 ampule >1yo - 2 ampules RPT doses Q/20-60m (T1/2)
136
Iron poisoning presents as?
``` Hemorrhagic gastroenteritis 30-60m after ingestion AND lasts 4-6 hr Pt may appear okay at 2-12hrs BUT HOTN starts at 12-48h ```
137
Complications of Iron poisoning?
Hepatitis HOTN Bleeding GI w/ scarring or stenosis >3wks
138
TXT of Iron poisoning?
Deferoxamine (IM, SQ, IV) Support - Hemodialysis or Trxf PRN
139
When is Deferoxamine CI?
Renal failure
140
What infection may result in Iron poisoning?
Yersinia Sepsis
141
APAP poisoning lab value?
>140mg/kg
142
APAP poisoning presents as?
2-24h - N/V, Malaise, diaphoresis 24-48h - pt looks better but hepatotoxic effects starts >48h - Hepatic necrosis (Jaundice, HO-Glu, Coag d/o) AND then Hepatic encephalopathy = coma
143
TXT of APAP poisoning?
N-Acetylcysteine (Mucomyst/Mucosil) | - Load dose > q4h 17 doses
144
Pathophys of ASA poisoning?
Early - Respiratory Alkalosis - Tachy-P | Late - Metabolic acidosis - Late severe anion gap
145
ASA poisoning presents as?
1st - Hyperventilation | N/V > Dehydration > Fever
146
Mgmt of ASA poisoning?
``` Serum ASA levels - If NL rpt at 6h post ingestion Charcoal Monitor Urine alkalizatione (IV Bicarb, D5W) Support ```
147
Lead poisoning presents as?
Insidious onset of - Weak, Lethargy, Atacia, growth delay, School issues - Convulsions, Coma - if severe
148
Lead poisoning CBC diff appearance?
Hypochromic microcytic anemia
149
TXT of lead poisoning?
EDTA Dimercaprol - peanut oil (CI?) Succimer (DMSA-Dimercaptosuccinic acid)
150
CO poisoning presents as?
Flu-like S/S (HA, malaise, nausea) Cherry-red complexion Groups of people affected
151
Dx of CO poisoning?
Carboxy-Hgb level | Hx of flu-like illness ass/w groups
152
TXT of CO poisoning?
100% O2 - nonrebreather | Hyperbaric Oxygen PRN
153
Methanol poisoning presents as due to what metabolite?
Formic acid > Retinal edema, Optic papillitis
154
Ethylene glycol poisoning presents as due to what metabolite?
Oxalic acid > Renal/CNS toxicity
155
TXT of Methanol/ethylene glycol poisoning?
10% ethanol AND D5W | Fomepizole - alcohol dehydrohenase inhibitor
156
Supplementation for Methanol vs ethylene glycol poisoning
Methanol = Folic acid | Ethylene glycol = Thiamine and B6
157
Methanol/ethylene glycol poisoning will both present w/ what pH d/o Metabolic/respiratory-Alkalosis/acidosis?
Metabolic acidosis
158
Organophosphate poisoning presentas as? Mnemonic?
``` SLUDGE S- Salivation L- Lacrimation U- Urination D- Defacation/Diarrhea G- Gastroenteritis E- Emesis AND - Pinpoint pupils ```
159
TXT of Organophosphate poisoning?
In order!!! 1L - Atropine 0.05mg/kg - until secretion stops THEN Pralidoxime (2-PAM) for muscle weakness
160
Hydrocarbon poisoning TXT?
O2 and respiratory support
161
Nicotine poisoning presents as?
Moderate dose - Tachy-C, HTN, and SLUDGE Large dose - CNS depression, paralysis, Resp failure - coma/death
162
TXT of Nicotine poisoning
Charcoal Atropine Support
163
Types of FOB ingestion requiring surgical retrieval?
Button batteries Toothpicks/Open safety pins FOB w/ GI S/S - (pain/vomiting) FOB remaining in Esophagus > 18h OR GI tract >5D
164
MC side FOB aspiration go?
Right mainstem bronchus
165
TXT of FOB aspiration?
Endoscopic retrieval
166
Urticaria is?
Hives - IgE mediated response | - Swelling of the dermis that is pruritic
167
Angioedema is?
Urticaria that extends into dermis causing swelling +- erythema but w/out itching.
168
Which is accompanied w/ itching - Urticaria or Angioedema?
Urticaria only
169
Anaphylaxis rxn is?
Systemic IgE rxn - V-dil and increased permeability
170
Anaphylactoid rxn is?
Systemic non-IgE rxn - Histamine release to Anaphylatoxins - Serum sickness
171
Anaphylatoxins include?
C3a and C5a - complement
172
Anaphylaxis TXT?
1L - Epinephrine > IV vasopressors if refract HOTN Avoidance ABC's, IVF, O2, monitor
173
Cautions to consider w/ Anaphylaxis?
Relapse 4-6hr after initial event
174
Anaphylaxis PVT?
EpiPen - Epi Jr. - 15-30kg EpiPen - >30kg

Phase 2 PEDs (23 decks)

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