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Pediatrics BRS > Chapter 20 - Emergency Med > Flashcards

Chapter 20 - Emergency Med Flashcards

1
Q

What is the most common cause of cardiac arrest in a child?

A

a lack of oxygen supply to the heart secondary to a pulmonary problem, respiratory arrest, or shock

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2
Q

What is the most common cause of airway obstruction and what are two methods for opening an airway?

A
  • the victim’s tongue

- head-tilt method or jaw-thrust method

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3
Q

What is shock?

A

a clinical state characterized by inadequate delivery of oxygen and metabolic substrates, which may be present with normal or decreased blood pressure

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4
Q

What are the three degrees of shock?

A
  • compensated: blood pressure and cardiac output are adequate but there is maldistribution of blood flow to essential organs
  • decompensated: hypotension and inadequate tissue perfusion
  • irreversible: that characterized by cell death which is refractory to medical treatment
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5
Q

What is the most common cause of shock in pediatrics?

A

hypovolemic, secondary to hemorrhage or dehydration

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6
Q

What volume loss is required for decompensated shock?

A

20-25%

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7
Q

What are the two subtypes of distributive shock?

A

anaphylactic and neurogenic

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8
Q

What is neurogenic shock?

A

a subtype of distributive shock in which there is a loss of distal sympathetic cardiovascular tone with resulting hypotension

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9
Q

What physical exam findings are consistent with shock?

A
  • tachycardia typically occurs before hypotension
  • tachypnea occurs to compensate for severe metabolic acidosis
  • mental status change
  • prolonged capillary refill with cool with mottled extremities
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10
Q

What labs are indicated in someone who is in shock?

A
  • CBC to assess for blood loss and infection
  • electrolytes to assess for abnormalities including acidosis
  • BUN and creatinine to evaluate renal function and perfusion
  • calcium and glucose
  • coagulation factors to evaluate for DIC
  • toxicology screens
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11
Q

How should shock be managed?

A
  • supplemental oxygen and early endotracheal intubation
  • obtaining vascular access and first providing a 20 mL/kg bolus of normal saline
  • restore intravascular volume before use of inotropic or vasopressor agents
  • inotropic and vasopressor medications
  • treatment of metabolic derangements
  • antibiotics if infection is present, blood products for hemorrhage, and fresh-frozen plasma for those in DIC
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12
Q

Shock

A
  • defined as inadequate delivery of oxygen and metabolic substrates with or without hypotension
  • goes through compensated, decompensated, and irreversible stages
  • may be hypovolemic, distributive, or cardiogenic
  • often presents with tachycardia, tachypnea, mental status change, and prolonged capillary refill
  • evaluate patient with a CBC, electrolyte panel, BUN and creatinine, calcium and glucose, coagulation factor assessment, and toxicology screen
  • treat with supplemental oxygen and ET intubation, fluid resuscitation including an initial 20mL/kg bolus, inotropic and vasopressor medications, and correction of metabolic derangements
  • may also require antibiotics, blood products for hemorrhage, or fresh-frozen plasma for DIC
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13
Q

What is the leading cause of death in children less than 1 and older than 1?

A
  • less than 1 yo is SIDS

- more than 1 yo is trauma with MVA’s being the leading cause of trauma-related deaths

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14
Q

Why are children affected by trauma differently than adults?

A
  • children have a shorter neck supporting a relatively greater weight
  • children have a more pliable rib cage meaning more energy is transmitted to internal organs
  • children have growth plates that leave weak epiphyseal-metaphyseal junctions, weaker than ligaments
  • children have underdeveloped abdominal musculature and thus less protection from abdominal trauma
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15
Q

What are the ABCDEs of emergency med?

A
  • airway
  • breathing
  • circulation
  • disability (glasgow coma score)
  • exposure/environmental (undress to facilitate examination and then warm to prevent hypothermia)
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16
Q

What three things could pulseless electrical activity on an ECG indicate?

A
  • cardiac tamponade
  • tension pneumothorax
  • profound hypovolemia
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17
Q

What are the most common complications of pediatric head trauma?

A
  • self-limited post-traumatic seizures
  • infants are at risk for subgaleal and epidural bleeds
  • risk epidural or subdural hematoma
  • intracerebral hematoma, usually affecting the frontal or temporal lobe as a contrecoup injury
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18
Q

Epidural Hematoma

A
  • a collection of blood between the dura and the skull
  • classically caused by a fracture of the temporal bone, which ruptures the middle meningeal artery
  • must be an artery because a vein doesn’t have enough pressure to open a space between the dura and temporal bone
  • often presents with a lucid interval before the onset of neurologic signs and progression indicates an abrupt expansion
  • expansion may cause transtentorial herniation with CN III palsy
  • seen as a “lens-shaped” lesion on CT which doesn’t cross suture lines
  • herniation is the feared, lethal complication which is why epidural hematomas require immediate surgical drainage
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19
Q

Subdural Hematoma

A
  • a collection of blood beneath the dura
  • due to tearing of the bridging veins that lie between the dura and arachnoid, typically with trauma
  • presents with the immediate onset of progressive neurologic signs
  • crescent-shaped lesion on CT that crosses suture lines and which is hyperdense if acute and hypodense if chronic
  • transtentorial herniation is the feared, lethal complication, but drainage is not as emergent as for an epidural hematoma
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20
Q

How does an epidural hematoma differ from a subdural hematoma?

A
  • subdural are more common in pediatric patients
  • epidural appears lens-shaped on CT while subdural appears crescent-shaped
  • epidural is associated with trauma and fracture of the temporal bone, which injures the middle meningeal artery while subdural is associated with age-related cerebral atrophy and rupture of veins
  • epidural hematomas often have a lucid period after the injury followed by the onset of neurologic symptoms while subdurals have no associated lucid period
  • epidurals require immediate drainage whereas subdural are not as emergent
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21
Q

Describe the first and other signs and symptoms of ICP, the complications of rising ICP, and the management.

A
  • headache is usually the first symptom while pupillary changes and altered mental status are the first signs
  • other symptoms include vomiting, stiff neck, double vision, transient vision loss, gait disturbance, dulled intellect, and irritability
  • other signs include papilledema, cranial nerve palsies, stiff neck, head tilt, retinal hemorrhage, obtundation, hyper resonance of the skull to percussion, unconsciousness, and progressive hemiparesis
  • can be complicated by transtenorial or uncalled herniation, producing bradycardia, fixed and dilated ipsalteral pupil which is later bilateral, contralateral hemiparesis, and Cushing’s triad
  • should be managed with mild hyperventilation, elevation of the head to encourage venous drainage, and diuretics like mannitol
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22
Q

What is Cushing’s triad?

A
  • a triad of hypertension, bradycardia, and respiratory depression following a rise in intracranial pressure
  • increased intracranial pressure constricts arterioles and contributes to cerebral ischemia
  • pCO2 rises and pH drops, triggering the central chemoreceptor to initiate reflex sympathetic activity
  • this increases perfusion pressure (hypertension), which stretches the carotid wall and activates the carotid baroreceptor
  • the effect is bradycardia
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23
Q

What is SCIWORA?

A

spinal cord injury without radiographic abnormality, which is more common in children than adults

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24
Q

Tonsillar Herniation

A
  • displacement of the cerebellar tonsils into the foramen magnum
  • results in compression of the brainstem and cardiopulmonary arrest
  • the most common form of brain herniation
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25
Q

Uncal Herniation

A
  • displacement of the temporal lobe uncus under the tentorium cerebelli
  • compresses CN III, leading to a “down and out” positioning of the eye with dilated pupil
  • also compresses the PCA, leading to infarction of the occipital lobe with contralateral homonymous hemianopsia with macular sparing
  • Kernohan notch (indentation of the contralateral cerebral peduncle) results in a “false localization” sign with paralysis on the side ipsilateral the primary lesion/herniation
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26
Q

Transtentorial Herniation

A
  • herniation caused by a supratentorial mass
  • results in caudal displacement of the brain stem
  • potential for rupture of the paramedian artery leading to a brainstem hemorrhage (aka Duret hemorrhage)
  • usually fatal
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27
Q

Tension Pneumothorax

A
  • due to a penetrating chest wall injury
  • air enters but cannot exit the pleural space, pushing the trachea to the side opposite the injury
  • presents with distended neck veins, diminished breath sounds, unilateral chest expansion, pulseless electrical activity, and hyper-resonance to percussion
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28
Q

Duodenal Hematoma

A
  • most commonly due to injury of the right upper quadrant, classically from a bicycle handle bar
  • presents with abdominal pain and vomiting
  • bowel obstruction is found on abdominal x-ray
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29
Q

What are the most common injuries induced by a lap belt?

A
  • chance fracture (flexion disruption of the lumbar spine)
  • liver and spleen laceration
  • bowel perforation
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30
Q

What defines a first-degree, superficial second-degree, deep second-degree, and third-degree burn?

A
  • first involves only the epidermis; presents with red, blanching, painful skin; and heals without a scar
  • superficial second involves the entire dermis and the outer portion of the dermis; presents with moist, painful, red skin which blisters but doesn’t scar
  • deep second involves the entire epidermis and lower dermis; presents with pale white skin which blisters and scars
  • third involve the epidermis, dermis, and subcutaneous tissue; presents with dry, white, and leathery skin that isn’t painful due to destruction of nerve endings
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31
Q

What are two methods for calculating the body surface area of a burn? Which is preferred for pediatrics?

A
  • the rule of 9s: each arm is 9%, each leg is 18%, the anterior trunk is 18%, the posterior trunk is 18%, and the head/neck is 9%
  • the rule of 9s overestimates burns in children because children have relatively larger heads and smaller legs
  • instead, we say that the palm is approximately equivalent to 1% body surface area
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32
Q

How should burns be managed?

A
  • endotracheal intubation for anyone who has inhaled hot gases
  • assessment of oxygenation by pulse ox
  • establishment of IV access with initial fluid resuscitation
  • skin care depending on the degree of burn: first requires moisturizers and analgesics; second require analgesics, debridement, and removal of ruptured bullae; third require grafting, hydrotherapy, and possibly escharotomy
  • second and third degree require antibiotics, typically 1% silver sulfadiazine
  • hospitalization for anyone who has a second-degree burn covering more than 10% of body surface area, third-degree covering more than 2% of surface area, suspected inhalation injury, or suspected non-accidental trauma
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33
Q

Why should anyone who has inhaled hot gases be intubated?

A

because a burn to the upper airway results in progressive edema and airway obstruction

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34
Q

What are the indications for hospitalization in burn patients?

A
  • second-degree covering more than 10% of surface area
  • third-degree covering more than 2% of surface area
  • suspected inhalation injury
  • suspected non-accidental trauma
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35
Q

What is the primary antibiotic used in burn patients?

A

1% silver sulfadiazine

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36
Q

How does skin care differ for the different degrees of burns?

A
  • first: moisturizers and analgesics
  • second: analgesics, debridement, and removal of only ruptured bullae since intact bullae protect against infection
  • third: grafting, hydrotherapy, and possibly escharotomy
  • second and third degree require antibiotics, typically 1% silver sulfadiazine
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37
Q

What is an escharotomy?

A

surgical removal of a constricting scar which may be needed if the burn restricts blood flow or chest expansion

38
Q

What is the difference between a wet drowning and a dry drowning?

A
  • wet involves asphyxia from aspirating liquid

- dry is asphyxia resulting from laryngospasm

39
Q

In what ways does water damage the lungs and contribute to respiratory failure?

A

exposure to fresh or salt what causes diminished pulmonary compliance, increased airway resistance, increased pulmonary artery pressures, and impaired gas exchange through three mechanisms

  • causes desaturating of surfactant
  • triggers alveolar instability and collapse
  • leads to pulmonary edema
40
Q

Near Drowning

A
  • may be a wet drowning in which asphyxia results from aspiration of water or a dry drowning in which asphyxia results from laryngospasm
  • wet drowning is complicated by surfactant denaturation, alveolar instability and collapse, and pulmonary edema due to exposure to the lungs to water
  • presents with absent or irregular respirations and cough productive of pink frothy material; you may also see neurologic insult, cardiovascular abnormalities, or renal failure as a result of hypoxia
  • over the next 24 hours, there may be a slow deterioration of pulmonary function with hypoxemia and hypercarbia or development of pneumonia from aspiration of fluid containing oral flora
  • treat with initial ABCs, cervical spine immobilization, removal of wet clothes, PEEP, and rewarming with warm saline gastric lavage
  • children have a better prognosis than adults because their primitive dive reflex shunts blood to vital organs
  • however, children younger than 3, those submerged more than 5 minutes, those who experienced a more than 10 minute delay in resuscitation, those who required cardiopulmonary resuscitation, those with abnormal neurologic findings/seizures, and those with pH<7 all have a poor prognosis
41
Q

What factors suggest a poor prognosis in pediatric patients who suffer a near drowning?

A
  • younger than 3
  • submerged more than 5 minutes
  • had a more than 10 minute delay in resuscitation
  • required cardiopulmonary resuscitation
  • have abnormal neurologic findings/seizures
  • have a pH<7
42
Q

What are the risk factors for being a victim of child abuse?

A
  • younger than 4 years old
  • mental retardation or challenging temperament
  • history of premature birth, low birth weight, neonatal separation from parents, or multiple births
  • chronic illness
43
Q

What are the risk factors for being an abusive caregiver?

A
  • low self-esteem, social isolation, depression, or history of substance abuse
  • history of child abuse
  • history of mental illness
  • history of violent temperament
  • family dynamics including single parenthood, unemployment, poverty, martial conflicts, and domestic violence
44
Q

What sorts of bruises are consistent with inflicted injury?

A
  • those on fleshy or protected areas
  • those in various stages of healing
  • those with distinct patterns consistent with blunt objects
45
Q

Describe the timeline for color change of a bruise.

A
  • 0 to 3 days: red-blue
  • 3 to 5 days: blue-purple
  • 5 to 8 days: green
  • 8 to 14 days: yellow-brown
46
Q

What is a metaphyseal fracture?

A

one caused by torsional force on a limb or by violent shaking, consistent with inflicted trauma

47
Q

What sorts of fractures are consistent with intentional injury?

A
  • spiral fractures
  • metaphyseal fractures
  • those on the posterior or first ribs, sternum, scapula, or vertebral spinous process
48
Q

Describe the features of shaken baby syndrome?

A
  • most often occurs in children younger than 2 yo

- presents with retinal hemorrhages, subdural hematomas, metaphyseal fractures, and significant brain injury

49
Q

Describe the diagnosis and management of sexual abuse.

A
  • obtain a history with open-ended questions; there will often be non-specific abdominal and GU symptoms
  • young children may exhibit sexual behavior, which is a red flag
  • you may note signs of physical trauma but most physical exams are normal
  • should collect forensic evidence (serology for STEDs, pregnancy test, assessment of vaginal fluid for spermatozoa) if abuse occurred within 72 hours
  • contact child services, provide high-dose oral contraceptives (morning-after), and antibiotics for the empiric treatment of STDs
50
Q

SIDS

A
  • defined as death of an infant younger than 1 yo, which is unexplained by thorough investigation
  • it is the most common cause of death in children younger than 1 with a peak incidence at 2-4 months
  • risk factors include prone sleeping position, soft bedding or overbundling, prematurity, twin of SIDS patient, low birth weight, recent illness, lack of breastfeeding, and maternal smoking, drug abuse, or infection
  • should always attempt resuscitation
  • intrathoracic petechiae are the most common finding on autopsy
51
Q

What screening tests are used in suspected poisoning victims?

A
  • serum glucose
  • electrolytes
  • serum and urine toxicology
52
Q

Give the toxin associated with these odors:

  • bitter almond
  • garlic
  • acetone
  • wintergreen
  • moth balls
A
  • bitter almond: cyanide
  • garlic: arsenic or organophosphates
  • acetone: salicylates or isopropyl alcohol
  • wintergreen: methyl salicylate
  • moth balls: camphor
53
Q

Give the toxin associated with these skin findings:

  • cherry red
  • sweaty
  • dry skin
  • urticaria
  • gray cyanosis
A
  • cherry red: CO and cyanide
  • sweaty: organophosphates and sympathomimetics
  • dry skin: anticholinergics
  • urticaria: allergic reaction
  • gray cyanosis: methemoglobinemia
54
Q

Give the toxins associated with these eye findings:

  • miosis
  • mydriasis
  • nystagmus
  • retinal hemorrhages
A
  • miosis: opiates, phencyclidine, organophosphates, phenothiazines
  • mydriasis: amphetamines, cocaine, TCAs, atropine
  • nystagmus: dilantin, phencyclidine
  • retinal hemorrhages: CO, methanol
55
Q

What is the equation for anion gap?

A

Na - Cl - HCO3, normal is less than 16

56
Q

What are the causes of anion gap metabolic acidosis?

A 
Alcohol
Methanol
Uremia
DKA
Paraldehyde
Iron/Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
57
Q

What toxins are radiopaque?

A 
CHIPE
- chloral hydrate and calcium
- heavy metals
- iodine and iron
phenothiazines
- enteric-coated tablets
58
Q

What is syrup of ipecac? What are the indications and contraindications?

A
  • it is a direct gastric irritant and CNS chemoreceptor stimulator that rapidly induces emesis
  • effective only within the first thirty minutes after ingestion; evidence supporting it’s use under any circumstances, however, is limited
  • contraindicated in those with decreased consciousness, caustic or hydrocarbon ingestion, and in children less than 6mo
59
Q

What is gastric lavage? What are the indications and contraindications?

A
  • it is a method for evacuating the stomach contents using a large bore tube
  • it is indicated for life-threatening ingestions within 1 hour after ingestion or after ingestion of toxins that delay gastric emptying
  • contraindicated in ingestions of caustic substances, hydrocarbons, and those with delayed presentation
60
Q

What is activated charcoal? What are the contraindications?

A
  • it is a substance with very large absorptive surface area which binds toxins and minimizes their absorption
  • considered in most cases of toxic ingestion apart from those of strong acids, alkalis, or heavy metals (e.g. not for iron, lithium, alcohols, ethylene glycol, iodine, potassium, or arsenic)
  • contraindicated in those with caustic ingestion because it interferes with visualization by endoscopy and in those with poor airway protection
61
Q

What is whole bowel irrigation and for which ingestions is it indicated?

A
  • it is a rapid, complete emptying of the intestinal tract with PEG and electrolyte solution
  • can be effective for iron, other heavy metals, and sustained-released medications
62
Q

Acetaminophen Toxicity

A
  • causes hepatic damage as it depletes glutathione, which causes more toxic intermediates to be produced by the CYP450 system
  • there are several stages of presentation: normal LFTs, n/v, malaise, and diaphoresis in the first 24 hours; hepatotoxicity, elevated AST, and prolonged PT in 24-72 hours; maximal hepatotoxicity after 72-96 hours with jaundice, hypoglycemia, lactic acidosis, coagulopathy, and renal failure
  • use the nomogram used on acetaminophen level to determine the need for n-acetyl-cysteine; give activated charcoal; and control n/v
  • NAC is given as a 140 mg/kg loading dose followed by 70 mg/kg q4 x 17; it is hepatoprotective if given within 8 hours and still helpful if given within 72 hours
63
Q

Iron Toxicity

A
  • common in children of pregnant women taking pre-natal vitamins
  • damage is mediated by free radicals and lipid peroxidation, which impairs various cellular processes
  • within hours, patient typically experience abdominal pain, vomiting, diarrhea, Gi bleed, shock, fever, and leukocytosis
  • these will resolve before anion gap metabolic acidosis, circulatory collapse, hepatic/renal failure, DIC, and neuro deterioration ensue
  • pyloric or intestinal scarring with stenosis are long-term complications
  • treat with gastric lavage, IV fluids, IV deferoxamine; activated charcoal will not help
  • can also use a deferoxamine challenge; if patient’s urine turns red/pink, the challenge is considered positive
64
Q

Salicylate Toxicity

A
  • salicylates causes a respiratory alkalosis early as hyperventilation attempts to overcome the metabolic acidosis it also induces
  • in the later stages, metabolic acidosis dominates as oxidative phosphorylation is decoupled and lactic acid accumulates
  • presents with tinnitus, dizziness, fever, flushed appearance, coma, convulsions, and respiratory failure
  • labs show anion gap metabolic acidosis, hyperglycemia followed later by hypoglycemia, and hypokalemia
  • managed with external cooling, mechanical ventilation, IV glucose and electrolytes, sodium bicarb to alkalinize the urine and promote excretion, and activated charcoal
  • dialysis may be required in the most severe cases
65
Q

What is the antidote for acetaminophen?

A

n-acetylcysteine

66
Q

What is the antidote for anticholinergics?

A

physostigmine

67
Q

What is the antidote for benzodiazepines?

A

flumazenil

68
Q

What is the antidote for carbon monoxide?

A

oxygen

69
Q

What is the antidote for cyanide?

A

amyl nitrite, sodium nitrite, and sodium thiosulfate

70
Q

What is the antidote for digitalis?

A

digoxin-specific Fab antibodies

71
Q

What is the antidote for heavy metals?

A
  • penicillamine for lead, mercury, arsenic, and copper
  • dimercaprol for all heavy metals
  • EDTA for lead, nickel, zinc, and manganese
72
Q

What is the antidote for dystonia?

A

diphenhydramine or benzotropine

73
Q

What is the antidote for methemoglobinemia?

A

methylene blue

74
Q

What is the antidote for isoniazid?

A

pyridoxine (vitamin B6)

75
Q

What is the antidote for narcotics?

A

naloxone

76
Q

What is the antidote for methanol and ethylene glycol?

A

ethanol or fomepizole

77
Q

What is the antidote for organophosphates?

A

atropine or pralidoxime

78
Q

What is the antidote for beta-blockers?

A

glucagon

79
Q

Iron Toxicity

A
  • common in children of pregnant women taking pre-natal vitamins
  • damage is mediated by free radicals and lipid peroxidation, which impairs various cellular processes
  • within hours, patient typically experience abdominal pain, vomiting, diarrhea, Gi bleed, shock, fever, and leukocytosis
  • these will resolve before anion gap metabolic acidosis, circulatory collapse, hepatic/renal failure, DIC, and neuro deterioration ensue
  • pyloric or intestinal scarring with stenosis are long-term complications
  • treat with gastric lavage, IV fluids, IV deferoxamine; activated charcoal will not help
  • can also use a deferoxamine challenge; if patient’s urine turns red/pink, the challenge is considered positive
80
Q

Lead Toxicity

A
  • typically from a chronic ingestion, however, children may also present with acute intoxication
  • there may be abdominal complaints as well as CNS complaints
  • peripheral blood smear may show microcytic anemia with basophilic stippling and there may be opacities on abdominal radiographs or “lead lines” (dense metaphyseal bands)
  • should be managed with dimercaprol or EDTA
81
Q

Ingestion of Caustic Agents

A
  • acids cause coagulation necrosis, producing superficial damage, whereas alkalis cause liquefactive necrosis, producing deep and penetrating damage
  • presents with an immediate burning sensation, dysphagia, salivation, retrosternal chest pain, and vomiting
  • obstructive airway edema and gastric perforation with peritonitis is likely to follow acid ingestion whereas alkali ingestion is associated with esophageal perforation with mediastinitis
  • during treatment, never try to neutralize the agent as this is likely to produce an exothermic reaction and worsen the burn; ipecac, gastric lavage, and charcoal are all contraindicated as well
  • perform an endoscopy to assess the degree of damage
82
Q

Carbon Monoxide Poisoning

A
  • CO binds with great affinity for hemoglobin, forming carboxyhemoglobin, which has a low affinity for new oxygen and prevents the release of the remaining oxygen by shifting the dissociation curve to the left
  • presents with cherry red skin as venous blood now carries more oxygen than normal, retinal hemorrhages, tachycardia and tachypnea, visual and auditory changes, confusion and syncope
  • delayed permanent neuropsychiatric syndrome may occur within 4 weeks of exposure with memory loss, personality changes, deafness, and seizures
  • diagnosis is made based on an anion-gap metabolic acidosis, normal PaO2, and diminished oxygen saturation
  • treat with hyperbaric 100% FiO2
  • hospitalization is indicated for those with more than 25% CO-Hb, more than 10% during pregnancy, neurologic symptoms, metabolic acidosis, or ECG changes
83
Q

What secondary infections are most common following a dog and cat bites?

A
  • dog: S. aureus, Steptococcus, Pasteurella

- cat: P. multocida and Bartonella henslae

84
Q

How should a dog bite be managed?

A
  • copious wound irrigation
  • suture wounds on the face, large wounds, and wounds less than 12 hours old
  • treat with antibiotics such as amoxicillin-clavulanic acid
  • administer tetanus prophylaxis
85
Q

Why are bites at the metacarpophalangeal joint significant?

A

because these bites are typical of a fistfight and any infection may penetrate the avascular fascial layers resulting in deep infection and tendonitis

86
Q

Black Widow Spider Bite

A
  • the spider is of the Latrodectus family and characterized by a red or orange hour-glass marking on the ventral surface
  • only the female spider is dangerous and bites only if provoked
  • bites cause few local symptoms apart from a burning or shape pinprick sensation; but the venom is a potent neurotoxin which causes severe hypertension and muscle cramps
  • treat with wound irrigation, tetanus prophylaxis, benzodiazepines or narcotics to relieve cramping, and Latrodectus antivenin
87
Q

Brown Recluse Spider Bite

A
  • the spider is of the Loxosceles species and has a brown, violin-shaped marking on the dorsal surface; these spiders bite only when provoked
  • the venom is cytotoxic, containing tissue-destructive enzymes; there is little initial pain, but a painful itchy papule develops that increases in size and discolors, sometimes becoming necrotic and ulcerated
  • systemic reactions may occur 1-2 days later with fever, chills, weakness, vomiting, DIC, hemolysis, and renal failure from myoglobinuria
  • treat with local wound care and tetanus prophylaxis as there is no antivenin
88
Q

Pit Viper Snake Bite

A
  • rattlesnakes, cottonmouth, and copper head snakes constitute this Crotalidae family and make up 95% of all snake bites
  • the bite location and envenomation determine the severity with head and trunk bites being most severe
  • there is progressive, severe swelling and ecchymosis at the puncture site; systemic effects include paresthesias, weakness, diaphoresis, a metallic taste in the mouth; coagulopathy, thrombocytopenia, hypotension, and shock may also develop
  • should be treated with local wound care, tetanus prophylaxis, immobilization of the extremity, and immediate transport; consider antivenin for all bites and remember that children require more because they receive proportionally more venom
  • polyvalent immune Fab are also available and are safer, more potent, and very effective
89
Q

What are the complications of antivenin?

A

serum sickness and anaphylaxis

90
Q

Coral Snake Bite

A
  • remember for the stripe pattern that “red next to yellow, kill a fellow”, red next to black, venom lack”
  • the neurotoxic venom causes swelling and tenderness, paresthesia, vomiting, weakness, diplopia, fasciculations, and respiration depression
  • treat with antivenin, local wound care, and supportive care

Pediatrics BRS (20 decks)

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