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Flashcards in peds66 Deck (100):
1

clinical features of growing pains

kids awaken at night crying in pain; however, the physical exam is normal

2

management of growing pains

analgesics and reassurance

3

compression fracture

torus or buckle fracture; occurs if the soft bony cortex buckles under compressive force; occurs in metaphysis and requires only splinting 3-4 weeks

4

incomplete fracture

greenstick fracture; occurs if only one side of the cortex is fractured; reduction may include fracturing the other side

5

complete fracturs

transverse, oblique, spiral, communuted

6

spiral fracture

oblique fracture encircling the bone; occur with twisting injury; associated with child abuse

7

comminuted fracture

fracture that is composed of multiple fracture fragments

8

physeal fracture

involves the growth plate

9

Salter-harris classification

describes fracture involving the physis; GradeI-V; Same, Above, Low, through and through, crush

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grade I salter-harris

fracture within the physis

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grade II- salter harris

fracture in the metaphysis and the physis

12

grade III salter harris

fracture in the epiphysis and the physis

13

grade IV salter harris

fracure in the physis, metaphysis, and epipysis

14

grade V salter harris

crushing of the physis

15

metaphyseal fracture

involves the ends of the central shaft (between the epiphyses and diaphyses)

16

diaphyseal fractures

involve the central shaft of the bone

17

clavicular fractures

common in childhood

18

causes of clavicular fracture?

falling onto the shoulder

19

major cause of clavicular fracture in neonates

birth injury

20

clinical features of clavicular fracture

asymp or asymm moro reflex or pseudoparalyiss (refusal to move extremity); crepitus may be felt over the fracture

21

supracondylar fractures happen how?

when kid falls onto an outstretched arm or elbow

22

why is a supracondylar fracture a med emergency?

if the fracture is displaced and angulated, there is a risk of neurovascular injury and compartment syndrome

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clinical features of supracondylar fracture

point tenderness, swelling, and deformity of the elbow;

24

supracondylar injury and pain with passive extension of the fingers suggests what?

compartment syndrome

25

"posterior fat pad sign"

triangular fat pad shadow posterior to the humerus may be observed if afracture is present

26

why should you never passively move the elbow if supracondylar fracture is suspected?

may increase the risk of further neurovascular injury

27

complications of supracondylar fracture

compartment syndrome; injury to the radial, median, or ulnar nerve; cubitus varus

28

compartment syndrome

pressure in the anterior fascial compartment is elevated, leading to ischemic injury and flexion deformity of the fingers and wrist

29

5P's of compartment syndrome

palor, pulselessness, paralysis, pain, and paresthesia; this is a late sign

30

best sign of compartment syndrome

pain with passive extension of the fingers

31

cubitus varus

decreased or absent carrying angle of the arm as a result of poor positioning of the distal fragment

32

three common types of forearm fractures

colles fracture; monteggia fracture; galeazzi fracture

33

colles fracture

fracture of the distal radius

34

monteggia fracture

fracture of the proximal ulna with dislocation of the radial head

35

galeazzi fracture

fracture of the radius with distal radioulnar joint dislocation

36

management of forearm fractures

splint first until swelling goes down, then cast

37

toddler's fracture

spiral fracture of the tibia; fibula remains intact

38

how do toddler's fractures happen?

between 9 mos and 3 years; when toddler trips and falls while playing

39

what should make the clinician suspect child abuse?

metaphyseal fractures (corner or bucket handle fractures); posteror or first rib fractures; complex skull fractures; scapular, sternal, and vertebral spinous process fractures

40

most common cause of cardiac arrest in a child

lack of oxygen supply to the heart 2/2 pulmonary problem (choking, suffocation, lung dz), resp arrest, or shock

41

how to open the airway in a kid that is not responding

head-tilt method, which lifts the tongue from the back of the throat; or by the jaw-thrust method if the child has suspected neck or cervical spine injury

42

how to assess for breathign

look, listen, and feel for exhaled airflow

43

what is "circulation" all about in ABCs?

you need to assess the need for chest compressions; this need should be determined after two rescue breaths

44

how to assess pulse (part of circulation)

in the brachial artery for infants; in the carotid artery for children

45

when are chest compressions administored

for asystole or bradycardia

46

shock

inadequate delivery of oxygen and metabolic substrates to met the metabolic demands of the tissues

47

shock bp?

normal or decreased

48

compensated shock

normal bp and CO with adequate tissue perfusion but maldistributed blood flow to essential organs

49

decompensated shock

hypotension, low CO, and inadequate tissue perfusion

50

irreversible shock

cell death and is refractory to medical treatment

51

hypovolemic shock- how does your body respond?

endogenous catecholamine release to try to increase blood pressure

52

two stages of septic shock

hyperdynamic stage (normal or high CO with bounding pulses, warm extremites and a wide pulse pressure) and decompensated stage

53

distributive shock typically caused by what?

anaphylactic or neurogenic shock, or as a result of medications or toxins

54

anaphylactic shock

acute angioedema of the upper airway, bronchospasm, pulm edema, urticaria, and hypotension because of extravasation of intravascular fluid from permeable capillaries

55

neurogenic shock

typically secondary to spinal cord transection; characterized by total loss of distal sympathetic CV otone with hypotension resulting from pooling of blood wihin the vascular bed

56

cardiogenic shock

when CO is limited because of primary cardiac dysfunction

57

why is recognition of shock difficult?

compensatory mechanisms that prevent hypotension until 25% of intravasc volue is lost

58

tachycardia almost always accompanies shock

and occurs before bp changes in children

59

peripheral pulses bounding

in early septic shock

60

capillary refill in shock

may be prolonged with cool and mottled extremites

61

management of shock

supplemental oxygen, early endotracheal intubation to secure the airway and decr patient's energy expenditure; vascular access with fluid resuscitation

62

initial fluids in shock

20 mL/kg bolus of normal saline or lacted ringers solution

63

when are inotropes indicated in shock?

if the blood pressure increase in response to fluids is insuff

64

expamples of inoropes/vasopressors used in shock

dobutamine, dopamine, epinephrine

65

treatment for DIC

fresh frozen plasma

66

leading cause of death in kids greater than 1 year

trauma

67

leading cause of trauma

MVA

68

why are head injuries more common in kids than adults in trauma?

child's head comprises a larger percentage of total body mass

69

why are spleen and liver injuries more common in kids than adults during trauma?

rib cage is more pliable in kids

70

prmary survey when a kid comes into the ER with trauma

ABCD (disability assessment with glasgow coma scale); and Exposure/environmental control in which patient is undressed to facilitate exam and then warmed

71

adjuncts to primary survey when kid comes into ER from trauma

ECG monitoring, urinary catheter and NG tube, diagnostic studes (radiographs of bones and CT scans of brain and abdomen)

72

pulseless electrical activity on ecg may indicate wat?

cardiac tamponade, tension pneumothorax, or profound hypovolemia

73

why urinary catheter and NG tube in ER for trauma?

monitor ins and outs; and reduce abdominal distension

74

secondary survey in trauma

the head to toe evaluation

75

seizures after head trauma

common in kids and self-limited

76

why are infants at risk for bleeding in the head after trauma?

at risk for bleeding in the subgaleal and epidural spaces because of open fontanelles and cranial sutures

77

epidural hematoma

bleeding between the inner table of the skull and the dura; associated with tearng of the middle meningeal artery

78

clinical features of epidural hematoma

increased ICP; dx by head CT which shows lenticular density representing blood in the epidural space

79

management of epidural hematoma

immediate surgical drainage

80

subdural hematoma

associated with tearing of the bridging meningeal veins by direct trauma or shaking

81

which is more common- subdural or epidural hematoma

subdural

82

clinical features of subdural hematoma

seizures and signs of incr ICP; bilateral in most cases; symptoms develop more gradually than epidural

83

diagnosis of subdural hematoma

head CT which shows crescentic density representing blood in the subdural space

84

management of subdural hematoma

neurosurgical consultation and usually surgical drainage; prognosis poor if underlying brain is also injured

85

intracerebral hemorrhage

bleeding in the brain parenchyma; frontal and temporal lobes most often affected, usually on opp side of impact

86

management of intracerebral hemorrhage

surgical drainage if the hematoma is accessible

87

clinical features of ICP

headache, pupillary changes and altered mental status are the first signs and symptoms

88

complications of incr ICP

cerebral herniation, most commonly trasntentorial or uncal herniation in which the temporal lobe or uncus is displaced into the infratentorial compartment

89

clinical features of herniation

bradycardia (early sign of herniation in kids less than 4 yo); fixed and dilated ipsilateral pupil; contralateral hemiparesis; pupils will eventually become bilaterally fixed and dilated; cushing's triad

90

cushing's triad

sign of herniation; bradycardia, hypertension, and irreg breathing

91

signs of incr ICP

papilledema, CN palsy, stiff neck, head tilit, retinal hemorrhage, macewen's sign, obtundation, unciousness, progressive hemiparesis

92

macewen's sign

hyperresonance of the skull on percussion; sign of elevated ICP

93

managemnt of increased ICP

mild hyperventilation with 100% oxygen to lower PaCO2, which mildly vasoconstricts cerebral vessels; elevation of head to encourage venous drain; diuretics; neurosurg consult

94

spinal cord injury without radiographic abnormality

SCIWORA; occurs more commonly in kids than adults

95

tension pneumothorax

life threatening

96

clinical signs of tension pneumothorax

distended neck veins, decreased breath sounds, hyperresonance to percussion, displaced trachea, pulseless electrical activity, and shock

97

management of tension pneumothorax

emergent chest decompress by needle thoracotomy; don't wait for radiographic confirmation- it may be too late!

98

duodenal hematoma

often secondary to injury to the RUQ, commonly from a bicycle handle bar; abdom pain and vomitting; bowel obstruction is found on radiograph

99

lap belt injury

chance fracture (flexion disruption of lumbar spine), liver, and spleen lacerations, and bowel perforations

100

burns

second most common cause of accidental death in kids