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Specialty Care > PEDS EM > Flashcards

PEDS EM Flashcards

1
Q

What is the first line vasoactive drugs used for shock in kids?

A

Dopamine

Beta 1 and Beta 2 agonist - inc cardiac output and inc SVR

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2
Q

Indications for Intubation in Kids (6)

A
  • 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
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3
Q

GCS Scoring

A

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
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4
Q

Burn Surface Area Rules

A 
Head and neck - 9% 
Anterior trunk - 18% 
Posterior Trunk - 18% 
Arms - 9% ea 
Legs - 18% ea
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5
Q

Who Does Not Need Head CT for Head Trauma?

A

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
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6
Q

Signs of Basilar Skull Fracture

A

Battle sign - bruises behind ears

Raccoon Eyes - periorbital bruising

Clear rhinorrhea or otorrhea (CSF leak)

Hemotympanum (blood behind TMs)

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7
Q

Volume Replacement in Burns

A

Give 50% fluid losses over first 8 hours then 50% over next 16 hours

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8
Q

Basics of Acetaminophen Ingestion

A

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

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9
Q

Classic Triad of Salicylate Toxicity

A

Hyperpnea (stimulates respiratory center of medulla)

Metabolic acidosis

Tachycardia

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10
Q

Ca Channel Blocker v. Beta Blocker Ingestion

A

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

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11
Q

2 Main Oral Hypoglycemic Ingestions

A

Metformin - lactic acidosis so give bicarb

Sulfonylureas - hypoglycemia so give IV dextrose

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12
Q

3 Agents That Can Cause Methemoglobinemia

A

1- lidocaine (or benzocaine in some topical teething gels)

2- dapsone

3- nitrites

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13
Q

Lead Poisoning Mgt by Level

A

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
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14
Q

Rewarming Technique Choices

A

> 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

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15
Q

What films do you use if suspect aspiration?

A

Lateral decubitus in little kids of expiratory in older kids

Look for hyperinflation or failure to deflate distal to FB

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16
Q

Foreign Body Ingestion Rules

A
  • 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
17
Q

Size of Suture and Length of Stitches by Location

A

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

18
Q

Salter Harris Physeal Fracture Classification

A

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

19
Q

Abx for Bites

A

Amox-clavulanate for 3-5 days

Cover staph, strep, anaerobes

Pasturella if cats or dogs

Eikenella if humans

20
Q

Greenstick Fracture

A

Bone is bent w/ fracture line that does not go thru whole width of bone

Immobilize

21
Q

Buckle Fracture

A

From compression injury

Usually at distal shaft (esp distal radius)

Looks like raised ring around greek column (torus)

Splinting

22
Q

Apophyseal Avulsion Fracture

A

Fragment of bone torn off at a tendon insertion site

Does not affect growth

Ex) Osgood Schlatter (tibial tuberosity), pelvis

23
Q

Toddler’s Fracture

A

Spiral fracture thru distal tibia

In 1-4 yr olds after minor fall

May see faint hairline fracture

24
Q

Supracondylar Elbow Fractures

A

May involve neuromuscular bundle

Fall onto outstretched hand

Just see effusion –> displaced anterior or posterior fat pads (look like boat sail)

25
Q

Bacterial Meningitis Score

A

Pos CSF gram stain

CSF ANC > 1,000

CSF protein > 80 mg/dL

Peripheral blood ANC > 10,000

Seizure

  • *Considered low risk if 0 (may d/c with single dose Ceftriaxone)
    • Considered high risk if 1+(admit for IV abx)
26
Q

Assessment Triangle

A
  • A - appearance
    • Tone, interactiveness, consolability, look/gaze, speech, cry
  • B - breathing
    • Abnormal airway sounds, tripod, retractions, nasal flaring, head bobbing
  • C - circulation
    • Pallor, mottling (means inappropriate thermoregulation), cyanosis (location?)
27
Q

Respiratory Distress v Respiratory Failure

A
  • Respiratory Distress = abnormal breathing but normal appearance and circulation
  • Respiratory Failure = all 3 abnormal
28
Q

Basic Peds Neuro Assessment Categories

A
  • Alert
  • Verbal
  • Painful Stimuli
  • Unresponsive

AVPU

29
Q

How long can a viral fever last?

A

Up to 5 days

30
Q

Low Risk Criteria for Infant < 60 Days w/ Fever (6)

A
  • WBC 5,000- 15,000
  • Bands < 1500
  • US WBC < or = 9
  • CSF WBC < 5
  • Stool WBC < 5
  • Normal CXR

Means …can observe off antibiotics in those less than 1 month or d/c home if greater than 1 month

Specialty Care (5 decks)

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