PEDIATRIC EMERGENCIES & TRAUMA

Question 1

The most common precipitating event for cardiac instability in infants and children is _

Answer 1

Respiratory insufficiency

Question 2

_ is the earliest and most reliable sign of shock.

A. Tachypenea
B. Tachycardia
C. Hypotension
D. Poor peripheral pulses

Answer 2

B. Tachycardia

Question 3

Factors known to cause bradycardia
6Hs, 5Ts

Answer 3

Hypoxia
Hypovolemia
H ions (acidosis)
Hypo or hyperkalemia
Hypoglycemia
Hypothermia

Toxins
Tamponade
Tension pneumothrorax
Thrombosis (pulmonary or cardiac circulations)
Trauma

Question 4

Laceration vs Cut vs abrasions

Answer 4

A laceration is a tear in the skin caused by BLUNT or shearing forces.

A cut is caused by a SHARP object.

An abrasion is a scrape to the epidermis or dermis, caused by friction of the skin against a rough surface.

Question 5

Hallmark of sevvere TBI is _.

Answer 5

Coma.
> GCS 3-8

2nd clinical key manifestation is the development of INTRACRANIAL HYPERTENSION.

Question 6

Signs of increased ICP (6)

Answer 6

1. New onset or worsening headache
2. depressed level of consciousness
3. VS abnormalities (hypertension. bradycardia, irregular respirations)
4. CN 3 (anisocoria, dilated pupils) or 6 (LR) palsies, 5. ptosis, down and out position of globe
5. CN compression

Question 7

IVF of choice in TBI

Answer 7

Normal saline.

AVOID HYPOTONIC IVF.

Question 8

Components to determine brain death. (3)

Answer 8

1. Demonstration of coexisting irreversible coma with a known cause
2. Absence of brainstem reflexes (5)
3. Apnea

Brain death is the irreversible cessation of brain functions.
> also known as death by neurologic criteria
> Determine cause of coma.

Question 9

Pathophysiology of drowning (3)

Answer 9

1. Anoxic-Ischemic injury
2. Pulmonary injury
3. Cold water injury

Question 10

Risk factors for neonatal sepsis include all of the following EXCEPT:

A. Maternal GBS colonization
B. Prematurity
C. Peripartum maternal fever
D. Prolonged rupture of membranes
E. Mother received treatment for UTI during pregnancy

Answer 10

E. Mother received treatment for UTI during pregnancy

Question 11

The factor most clearly predicting mortality in shock is:
A. Cardiac failure
B. Renal failure
C. Hepatic failure
D. Metabolic acidosis
E. Multiple organ system failure

Answer 11

E. Multiple organ system failure

Multiple organ dysfunction syndrome (MODS) is defined as any alteration of organ function that requires medical support for maintenance, and the presence of MODS in patients with shock substantially increases the probability of death.

Question 12

A 5 yr old boy presents with petechiae, fresh bruises, low-grade fever, dizziness, and lethargy. You admit him to the hospital and start an IV. The most appropriate next step in management would be:

A. Administration of high-dose Solu-Medrol or Decadron
B. CT scan of the head to rule out meningococcal meningitis
C. Collection of blood for a culture, CBC, and platelet count
D. Administration of 20 mL/kg of normal saline
E. Administration of 1-2 mg/kg of furosemide (Lasix)

Answer 12

D. Administration of 20 mL/kg of normal saline

In suspected septic shock, immediately following establishment of intravenous (IV) or intraosseous (IO) access, aggressive, early goal-directed therapy (EGDT) should be initiated unless there are significant concerns for cardiogenic shock as an underlying pathophysiology. Rapid IV administration of 20 mL/kg isotonic saline should be initiated in an attempt to reverse the shock state. This bolus should be repeated quickly up to 60-80 mL/kg; it is not unusual for severely affected patients to require this volume within the first hour. Fluid resuscitation in the first hour is unquestionably essential to survival in septic shock, regardless of the fluid type administered.

Question 13

Which site of respiratory disease is NOT matched with the common clinical presentation?

A. Subglottic stenosis—rapid shallow respirations, grunting, chest wall retractions
B. Status asthmaticus—wheezing, prolonged expiration
C. Pneumonia—rapid shallow respirations, chest wall retractions, grunting
D. Viral croup—inspiratory stridor, suprasternal retractions, prolonged inspiration
E. Bronchiolitis—wheezing, prolonged expiration, chest wall retractions

Answer 13

A. Subglottic stenosis—rapid shallow respirations, grunting, chest wall retractions

Clinical examination is important in localizing the site of pathology. Extrathoracic airway obstruction occurs anywhere above the thoracic inlet. Inspiratory stridor, suprasternal, chest wall, and subcostal retractions, and prolongation of inspiration are hallmarks of extrathoracic airway obstruction.

By comparison, features of intrathoracic airway obstruction are prolongation of expiration and expiratory wheezing. Typical manifestations of alveolar interstitial pathology are rapid, shallow respirations, chest wall retractions, and grunting. The site of pathology can be localized and the differential diagnosis established on the basis of the clinical signs and symptoms.

Question 14

Elevated blood ____ levels reflect poor tissue oxygen delivery noted in all forms of shock.

A. CO2
B. O2
C. Lactate

Answer 14

C. Lactate