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Flashcards in Test 1 Deck (82):
1

__________ rolls can help to align the airway in young children

Shoulder

2

__________ rolls can help to align the airway in older children

Neck

3

Excessive mechanical ventilation increases risk of (1), (2), and (3)

(1) Gastric air
(2) Regurgitation
(3) Aspiration

4

Central pulse to assess in infants

Brachial artery

5

Central pulse to assess in older children

Femoral artery

6

Normal BP is maintained until over ____% of the child's circulating volume is lost. Therefore hypotension is a _____ finding in kids

30%
Late

7

Fluid resuscitation for pediatrics in shock

NS or LR 20 ml/kg boluses until signs of improved perfusion and resolution of tachycardia

8

Fluid resuscitation if shock is due to hemorrhage for pediatrics

2 boluses NS or LR 20 ml/kg
Then PRBC 10 ml/kg

9

A pregnancy test is indicated in a case of sexual assault in the child is in Tanner Stage ___ development

3

10

Urine NAATs should be collected in a case of sexual assault for testing _______ and __________

Gonorrhea
Chlamydia

11

Blood should be collected in a case of sexual assault for testing ____, _____, _____

HIV
Hep B
Hep C

12

Prophylactic STI treatment for adolescents in sexual assault case

Ceftriaxone PLUS
Azithromycin PLUS
Metronidazole OR
Tinidazole

13

In a sexual assault case, blood may be collected for up to _____ hours

24

14

In a sexual assault case, urine may be collected for up to ________ hours

72-96

15

In a sexual assault case, evidence collection is appropriate for up to _______ hours for adolescents, and up to ______ hours in kids

120
72

16

5 things needed for pediatric patient that is sick appearing

1. Oxygen and assist ventilation if needed
2. Pulse ox
3. Cardiorespiratory monitor
4. IV access
5. CXR/EKG

17

Common pathways for pediatric arrest

Respiratory failure
Shock

18

Two worrisome conditions concerning breathing for pediatric emergency medicine

Respiratory Failure
Pediatric Arrest

19

Worrisome condition concerning circulation for pediatric emergency medicine

Shock

20

Signs of poor tissue perfusion (possible shock)

Cool or mottled skin
Tachycardia
AMS (very important in kids)

21

Management for pediatric head injuries

Maximize oxygenation, maintain blood pressure!
Worse outcomes with hypoxia and hypotension

22

If signs of increased ICP with herniation in pediatrics

1. Elevate head of bed 30 degrees
2. Hypertonic saline (3%)
3. Mannitol 0.5-1 mg/kg

23

Seatbelt sign

Greatly increases probability of abdominal injury
CT of abdomen warranted

24

Child's blood volume is _____ ml/kg

70

25

Reassuring or warning sign: fever onset before pain

Reassuring (more likely a virus than appendicitis)

26

Reassuring or warning sign: vomiting with frequent watery diarrhea

Reassuring

27

Referred abdominal pain

Lower lobe pneumonia
GAS pharyngitis

28

Reassuring or warning sign: pain before vomiting

Warning (typical of appendicitis)

29

Reassuring or warning sign: vomiting and abdominal distention

Warning

30

Most common cause of abdominal emergency in 1-2 months old

Pyloric stenosis

31

Most common cause of abdominal emergency in 6-10 months old

Intussusception

32

Study of choice for intestinal malrotation

Upper GI series

33

Sign on upper GI series with intestinal malrotation

Corkscrew configuration

34

Management of intestinal malrotation

IV fluid resuscitation
NG tube
Call surgeon
Upper GI series
Laparotomy

35

Imaging for intussusception

Ultrasound

36

Classic image on ultrasound for intussusception

Bullseye
Coiled spring

37

Hypertrophy of Peyer's patches in terminal ileum can serve as lead point

Intussusception

38

Management for intussusception

1. ABCs
2. Resuscitate with IVF (NS)
3. Decompress stomach with NGT if frequent vomiting
4. Consider IV abx if concern for perforation
5. Notify surgeon
6. Abdominal XRays to exclude perforation
6. Air enema reduction

39

Contraindications to air enema for intussusception

1. > 3 days
2. Signs of peritonitis
3. Evidence of free air on plain x-ray

40

Management for appendicitis

1. IVF
2. IV pain medication and antiemetics
3. IV abx (ancef, unless concern for perforation - zosyn)
4. Call surgeon

41

Classic presentation of ovarian torsion

Sudden onset of unilateral lower abdominal pain, right side > left side, N and V

42

Management of ovarian torsion

Pain control
IVF, US with doppler
Emergent operative intervention

43

Intervention for seizures

Needed if > 3 minutes
1. Lorazepam (IV or IM)
2. Diazepam (IV or PR)
3. Midazolam (IV or IM)

44

Febrile Seizure Criteria

Fever > 100.5 (most > 102)
Child less than 6 y/o
No signs of CNS infection
No history of afebrile seizures

45

2 important questions to ask concerning pediatric seizures

1. Vaccination status
2. Recent abx --> can be masking signs/symptoms of meningitis

46

Preferred neuroimaging for epilepsy evaluation

MRI

47

Evaluation for infantile spasms

Urgent EEG, MRI and metabolic evaluation

48

5 Things you can do for a child in diabetic ketoacidosis

1. Oxygen
2. Cardiac and respiratory monitor
3. Pulse ox
4. IV access
5. Consider EKG/CXR

49

2 things that should be ordered immediately when suspected diabetic ketoacidosis

1. Accucheck
2. Urinalysis

50

Definition of DKA

Hyperglycemia > 200 mg/dL
AND
Venous pH < 7.30 and/or
Bicarbonate < 15 mmol/L

51

Characteristic long deep breaths of DKA

Kussmaul Respirations

52

DKA Treatment Step 1

1. IV hydration
NS or LR bolus
20 ml/kg over 1 hour
2. LR at 2x MIVF rate

53

DKA Treatment Step 2

Insulin bolus (unless child!)
Switch to D5NS when glucose is < 300 mg/dL

54

DKA Treatment Step 3

Next 4-6 hours: NS with 40 mEq/L K+
After 4-6 hrs: 0.45% saline with electrolytes

55

Most serious complication of DKA in children

Cerebral Edema

56

Signs/Symptoms of Cerebral Edema

1. Headache
2. Gradual decrease in LOC
3. Slowing of HR inappropriately with increase in BP
4. Change in pupils

57

Treatment of Cerebral edema

1. Reduce rate of IVF infusion
2. Mannitol 0.5-1 g/kg over 20 minutes
3. 3% saline over 30 minutes
4. Consider intubation if needed

58

Management for spinal cord injury

High dose steroids if within 8 hours

59

Preferred imaging modality for traumatic brain injury

CT Scan

60

Cushing's Reflex

Systolic BP increase
Bradycardia
Irregular respirations

61

First tier therapy for intracranial hypertension

Positioning, ventricular drainage, osmotic diuresis, hyperventilation

62

Second tier therapy for intracranial hypertension

Sedation, neuromuscular blockade, hypothermia, barbiturate coma

63

Not recommended for intracranial hypertension

Glucocorticoids

64

Most common pathogens in animal bites

Pasteurella species, staphylococci, streptococci, and anaerobic bacteria

65

Fastidious gram-neg rod that can cause bacteremia and fatal sepsis after animal bites (especially in asplenic pts, chronic alcohol abusers, or those with underlying hepatic dz)

Capnocytophaga canimorsus

66

Bartonella henselae

Organism responsible for cat scratch fever

67

Eikenella corrodens

Organism commonly found in human bites

68

Kanavel's sign

Infectious Tenosynovitis

69

Kanavel's signs (4) - Infectious Tenosynovitis

1. Finger held in slight flexion
2. Fusiform swelling
3. Tenderness along the flexor tendon sheath
4. Pain with passive extension of the digit

70

Common pathogens from human bites

Streptococci, staphylococcus aureus, Eikenella, Fusobacterium, Peptostreptococcus, Prevotella and Porphyromonas species

71

Cervical spine immobilization not recommended after drowning UNLESS

1. Clinical signs of cervical injury
2. Concerning mechanism
3. AMS

72

Indications for intubation in a drowning patient

1. Inability to protect airway, neurological deterioration
2. PaO2 < 60 mmHg or saturation < 90% on high flow O2
3. PaCO2 > 50 mmHg

73

Pseudallescheria boydii

Saprophytic fungus found in contaminated water such as in floods. Most common fungal infection in non-fatal drowning victims

74

Waterborne pathogens that could cause pneumonia post-drowning

Pseudomonas, Proteus, Pseudallescheria boydii

75

Symptoms of heat exhaustion

1. Moist and clammy skin
2. Pupils dilated
3. Normal or subnormal temperature

76

Symptoms of heat stroke

1. Dry hot skin
2. Pupils constricted
3. Very high body temperature (> 104)

77

Fever Work up: criteria for bladder catheterization for UA

1. All males < 6 mo and all uncircumcised males < 12 mo
2. All females < 24 mo and older female children if symptoms of UTI

78

Fever Work Up in the Toxic Child

1. Rapid virus testing
2. CBC with differential (looking for bandemia)
3. Blood culture
4. CXR
5. Obtain stool for WBCs and guaiac if diarrhea present
6. Lumbar puncture

79

RAPID Approach

R: Resuscitation
A: Analgesia and Assessment
S: sx/chief complaint
A: allergies
M: medications
P: past medical history
L: last meal
E: events lead up to presentation
P: patients needs (non-medical)
I: interventions (diagnostic, therapeutic, consults)
D: disposition (admit, transfer, discharge, observation)

80

Treatment for hypotension post-insect bite allergic rxn

1. IV NS bolus
2. Epinephrine
3. Alternatively give norepinephrine
4. Consider vasopressors (dopamine)

81

Treatment for bronchospasm post-insect bite allergic rxn

Mild-mod distress
1. Nebulized beta agonist (albuterol) 2. Parenteral glucocorticoids (methylprednisolone)

Mod-Severe distress
1. Parenteral beta agonists (epinephrine) 2. consider intubation

82

Treatment for urticaria post-insect bite allergic rxn

1. Antihistamines (H1 blockers) diphenhydramine
2. Oral steroids (prednisone, methylprednisolone)
3. Consider epinephrine