PEDS EM Flashcards
(30 cards)
What is the first line vasoactive drugs used for shock in kids?
Dopamine
Beta 1 and Beta 2 agonist - inc cardiac output and inc SVR
Indications for Intubation in Kids (6)
- Cannot bag mask ventilate
- GCS score < or = 8
- Concern for impending brain herniation
- Resp failure from hypoxemia or hypoventilation
- Loss of laryngeal reflexes
- Decompensated shock resistant to initial fluid resuscitation
GCS Scoring
Eye Opening -
- spontaneous
- response to command
- response to pain
- none
Talking
- oriented
- confused
- inappropriate
- incomprehensible
- none
Movements
- obey commands
- localize pain
- withdraw from pain
- decorticate
- decerebrate (extension)
- flaccid
Burn Surface Area Rules
Head and neck - 9% Anterior trunk - 18% Posterior Trunk - 18% Arms - 9% ea Legs - 18% ea
Who Does Not Need Head CT for Head Trauma?
IF < 2 YO …
- Normal mental status
- No hematoma
- LOC < 5 sec
- Non-severe injury (fall < 3 feet, not struck without helmet, not in MVA involving death, ejection or rolling)
- No palpable skull fracture
- Acting normal per caregiver
IF > 2 YO …
- Normal mental status
- No LOC
- No vomiting
- Non-severe injury (same as above but fall < 5 feet)
- No signs basilar skull fracture
- No severe headaches
Signs of Basilar Skull Fracture
Battle sign - bruises behind ears
Raccoon Eyes - periorbital bruising
Clear rhinorrhea or otorrhea (CSF leak)
Hemotympanum (blood behind TMs)
Volume Replacement in Burns
Give 50% fluid losses over first 8 hours then 50% over next 16 hours
Basics of Acetaminophen Ingestion
Peak serum conc @ 4 hours after ingestion
Use Rumack-Matthew nomogram to predict liver injury and need for NAC
Peak LFT levels @ 72-96 hours
Classic Triad of Salicylate Toxicity
Hyperpnea (stimulates respiratory center of medulla)
Metabolic acidosis
Tachycardia
Ca Channel Blocker v. Beta Blocker Ingestion
Both cause prolonged PR and bradycardia
Ca = HYPERglycemia (give IV Ca)
Beta blocker = HYPOglycemia (give glucagon)
Beta also lipophilic so more CNS changes in mental status
2 Main Oral Hypoglycemic Ingestions
Metformin - lactic acidosis so give bicarb
Sulfonylureas - hypoglycemia so give IV dextrose
3 Agents That Can Cause Methemoglobinemia
1- lidocaine (or benzocaine in some topical teething gels)
2- dapsone
3- nitrites
Lead Poisoning Mgt by Level
MILD (< 44 mcg/dL)
-confirm with venous sample and re-test in 2 mo
MODERATE (45-60)
-chelation w/ IV EDTA or oral succimer
SEVERE (> 60 mcg/dL)
- diazepam infusion for sz
- chelate w/ dimercaprol then EDTA 4 hrs after
Rewarming Technique Choices
> or = 32 degrees AND adequate perfusion then passive (remove wet clothes and use blankets)
< 32 OR >32 but inadequate perfusion then active external rewarming (heated blanket)
< 32 AND inadequate perfusion then active core rewarming with warm fluid lavage +/- warm dialysis
What films do you use if suspect aspiration?
Lateral decubitus in little kids of expiratory in older kids
Look for hyperinflation or failure to deflate distal to FB
Foreign Body Ingestion Rules
- Use scope and remove if sharp, > 5 cm in length, batteries or multiple magnets
- Use scope and remove if child is in sig resp distress or unable to swallow
- Use scope if not past esophagus after 24 hrs
Size of Suture and Length of Stitches by Location
Face - 6.0 nylon or poly; remove in 3-5 days
Scalp - 5.0 poly or staples; remove in 7 days
Oral - 5.0 fast absorbing gut
UE - 4.0 or 5.0 poly; remove in 7 days
LE - 4.0 or 5.0 poly; remove in 8-10days
Joints - 5.0 poly; remove in 10-14 days
Salter Harris Physeal Fracture Classification
I - normal radiographs (immobilize)
II - up from growth plate to metaphyses (immobilize)
** ortho, may need surgery, growth disturbances more likely**
III - down from growth plate thru epiphyses
IV - thru growth plate entirely
V - crushing
Abx for Bites
Amox-clavulanate for 3-5 days
Cover staph, strep, anaerobes
Pasturella if cats or dogs
Eikenella if humans
Greenstick Fracture
Bone is bent w/ fracture line that does not go thru whole width of bone
Immobilize
Buckle Fracture
From compression injury
Usually at distal shaft (esp distal radius)
Looks like raised ring around greek column (torus)
Splinting
Apophyseal Avulsion Fracture
Fragment of bone torn off at a tendon insertion site
Does not affect growth
Ex) Osgood Schlatter (tibial tuberosity), pelvis
Toddler’s Fracture
Spiral fracture thru distal tibia
In 1-4 yr olds after minor fall
May see faint hairline fracture
Supracondylar Elbow Fractures
May involve neuromuscular bundle
Fall onto outstretched hand
Just see effusion –> displaced anterior or posterior fat pads (look like boat sail)
