11/16 Flashcards
NAT basics- imaging/ labs
Perform a head computed tomography (CT) in a child <1 y old if non-accidental trauma head trauma is suspected
Skeletal survey may be considered
Labs: CBC, coagulation panel, CMP, amylase, lipase, and urinalysis.
Early ophthalmology consultation to look for______________ is an important component of the inpatient non-accidental trauma evaluation.
retinal hemorrhage
Exam should be within 72 h
Orthopedic abuse injuries - High-specificity findings
Corner fractures
Bucket handle fractures
Posterior rib fractures
Scapula fractures
Sternal fractures
Spinous process fractures
Five diagnoses related to thrombocytopenia of which the emergency physician should be aware
1- immune thrombocytopenia (ITP)
2- thrombotic thrombocytopenic purpura (TTP)
3- disseminated intravascular coagulation (DIC)
4- hemolytic uremic syndrome (HUS)
5- heparin-induced thrombocytopenia (HIT)
Patients with TTP, DIC and HUS will generally require admission.
With the exception of patients with ______________, thrombocytopenic patients with life-threatening bleeding should be transfused to a platelet count of 50
Thrombotic thrombocytopenic purpura (TTP)
ITP is defined as a platelet count below 100 × 109/L caused by _______________
immune-mediated destruction of platelets.
In children, a _____________ is classically reported prior to the onset of ITP
viral illness
DIC is a clinical syndrome with a wide array of presentations/etiologies caused by:
Intravascular coagulation cascade activation, with a subsequent loss of inhibitory control mechanisms
Causes of Disseminated Intravascular Coagulation (DIC)
Sepsis
ARDS
Acute leukemia
Trauma
Liver failure
Pancreatitis
Obstetrical complications
Envenomation
Transfusion reactions
The goal of care in DIC to:
support the body’s ability to coagulate until the underlying insult is stabilized
- Plts should be transfused to maintain > 50 × 109/L.
- Fibrinogen via cryoprecipitate
- Transfuse FFP to maintain PT and PTT
Diagnosis of DIC involves a combination of laboratory tests and clinical evaluation. Laboratory findings suggestive of DIC include
low platelets
elevated D-dimer
decreased fibrinogen
prolongation of clotting times ie PT
_____________ has long been the first-line drug for anticoagulation in patients with HIT
Argatroban
There are essentially two major ways one can develop TTP. They are?
Both are destruction to ADAMTS13.
Either an individual can have a genetic defect that leads to decreased production of ADAMTS13, or they can develop autoantibodies against ADAMTS13.
HUS is a member of a larger group of diseases known as ______________
thrombotic microangiopathy.
HUS shares some clinical features with TTP. Both manifest as microangiopathic hemolytic anemia and thrombocytopenia; however, HUS emphasizes ____________ while TTP shows minimal renal injury, instead causing neurologic dysfunction in up to 50% of affected patients.
renal injury
