Special Topics Flashcards
(36 cards)
What criteria are used to say an event was not a BRUE?
any abnormal vital signs, any symptoms, any obvious explanation
What history should be obtained for all BRUE patients?
Social history-child maltreatment and abuse is common with this presentation
What workup should be done for BRUE in the ED?
Low risk patient-EKG and pulse ox, educate about CPR, if questionable social history or family highly concerned consider observation admission
What age group should you consider inserting a UVC?
Infant <7 days in extremis
What age group could have a thymus on xray?
=4yo-sail sign of the superior mediastinum
What could the abscence of thymus mean in an infant or toddler with chronic infections?
They have an immunodeficiency or digeorge syndrome
What are non-emergent causes of an inconsolable child?
GERD, constipation, milk protein allergy, anal fissure, corneal abrasions, otitis media, oral lesions, teething, hunger
What is the “rule of 3s” for colic?
3 hours/day, 3 days/wk, 3pm, age 3wks-3mos
What are symptoms of VP shunt malfunction?
Headache, vomiting, cushing’s triad (HTN, bradycadia, irregular respirations), abdominal complaints
How do you evaluate for VP shunt malfunction?
- Head CT to detect for dilated ventricles, especially if you are concerned about increased ICP
- Xray shunt series to evaluate for malpositioning/breaks in the shunt
What should you do if a patient with a VP shunt presents with fever?
- Never perform LP as you can miss non-communicating areas of CSF, NSGY needs to tap the shunt
- Shunt tap indicated if <2mos from any shunt manipulation or abdominal pain without other source
- Vanc rocephin bruh
What are potential complications of VP shunts?
peritonitis, distal shunt tip obstruction, shunt infection, distal shunt tip migration–>perforation of surrounding structures (can migrate through anus, scrotum, nipple, bowel, anywhere)
How should you manage a g-tube that has came out <6 weeks after placement?
-Service that placed it needs to replace as there’s a chance to create a false tract to peritoneum if you replace it yourself
What types of G-tubes cannot be replaced by the ED physician?
GJ tubes or any non-balloon type G tubes
What are the steps to replacing a G tube?
- Ensure the balloon port works 1st
- place pt’s knees up, lube tube, insert w/ gentle twisting motion, refill balloon, secure retention ring, check stomach pH (<3)
How do you deal with the following G tube complications?
- Vomiting
- leaking
- clogged
- redness
- shiny pink granulation tissue
- fungal lesion
- irritation
- Vomiting-possible tube migration, pull tube back
- leaking-replace tube
- clogged-use a carbonated drink
- redness-r/o cellulitis
- shiny pink granulation tissue-steroids, or silver nitrate if bleeding
- fungal lesion-topical antifungals
- irritation-topical maalox or calmoseptine
How do you deal with the following causes of trach obstruction?
- mucus plugging
- granuloma
- false tract
- mucus plugging-suction and saline to break up the plug
- granuloma-ENT needs to cauterize
- false tract-Place an ET tube or replace trach into the correct tract if possible
What causes a trach bleed and how should you manage it?
- Erosion into the brachiocephalic trunk, true emergency as a sentinal bleed can quickly progres to frank hemorrhage into the trachea
- Call ENT! they need to scope asap
- Try blowing up balloon of trach cuff or using your finger to tamponade
What are signs of bacterial tracheitis?
- usually a child with a trach
- increased secretions +/- increased need for suctioning, change in secretion color, fever
- How should tracheitis be managed?
- What should you do if a patient has a tracheostomy?
- Cx secretions, obtain CXR, start Abx
- review old cultures as kids with trachs frequently have old culture results and may have grown resistant organisms
How should trach decannulation be managed?
- emergency
- replace the trach obturator before the actual trach, the obturator is analogous to the ET tube stylet
- Use saline based lubricant to replace trach, petroleum bad for the lungs
- If unable to replace the trach: ET intubation if possible, BVM for new trach, cannulate stoma with an ET tube if old trach
What are indications for removing an ingested foreign body? Which FBs can be managed conservatively?
- causing obstruction
- in esophagus >24 hrs
- size>6cm
- sharp object
- any disk or button battery
- known magnet ingestion
- A small (<6cm) smooth FB in stomach or beyond can go home
How can you remove a nasal foreign body?
Insert a small french foley past the FB, inflate the balloon and slowly retract the foley
How should you manage an aural FB?
- kill insects 1st w/mineral oil or viscous lidocaine
- Never irrigate organic material
- Try forceps, sxn, irrigation
- Call ENT s/p 3 unsuccessful attempts
