EM Pedia 12: Pearls

Question 1

remarks on HUS

Answer 1

Hemolytic Uremic syndrome
-associated with Shiga toxin-producing E. coli O157:H7

“ART”
1. Anemia - MAHA
2. Renal failure
3. Thrombocytopenia

typica HUS (>90%) occurs bet 1 and 4 y/o, presenting about 1 week into a case of infectious diarrhea that’s often bloody and without associated fever
-e coli serotype O15:H&

Question 2

remarks on tracheal suctioning in neonatal resuscitation

Answer 2

no longer recommended bec it can cause reflex bradycardia and apnea

Question 3

what are epstein pearls

Answer 3

epstein pearls are remnants of embryonic development that present as white, slightly raised nodules seen most commonly midline at the junction of the soft and hard palates of neonates

most resolve spontaneously

Question 4

2nd most common benign neck mass

Answer 4

thyroglossal duct cysts
-account for ~70% of congenital neck masses
-result from the persistence of any segment of the thyroglossal duct along its course from the foramen cecum of the tongue to the pyramidal lobe of the thyroid
-most are infrahyoid

Question 5

gold standard for assessment of volume status

Answer 5

weight loss

Question 6

goals of treatment in inborn errors of metabolism

Answer 6

1. remove the inciting metabolic substrate (formula or breast milk)
2. provide energy substrate to halt catabolism and toxin production and help eliminate toxic metabolites
3. improve circulatory status by restroring circulatory volume as well as electrolyte balance

Question 7

major life-threateing diagnoses in young infants (0-3 months)

Answer 7

1. necrotizing enterocolitis
2. malrotation with midgut volvolus
3. incarcerated hernias
4. nonaccidental trauma

Question 8

serious causes of abdominal pain in older infants and toddlers (3 months to 3 years)

Answer 8

1. intussusception
2. UTI
3. testicular torsion
4. accidental and inflicted injury

Question 9

appendicitis is the most common surgical emergency in what patient population

Answer 9

3 to 15 years old

Question 10

dose of epinephrine in resus in chldren

Answer 10

IV/IO: epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 conc’n)

endotracheal: 0.1 mg/kg (0.1 mL/kg of 1:1,000 conc’n)

Question 11

doses of other drugs in resus

Answer 11

AMIODARONE
5 mg/kg bolus during cardiac arrest
may repeat up to 2x for refractory VF/pulseless VT

LIDOCAINE
LD 1mg/kg
MD 20-50 mcg/kg per minute infusion
repeat bolus dose if infusion initiated >15 mins after initial bolus therapy

Question 12

shock energies

Answer 12

DEFIB
first shock 2 J/kg
second shock 4 J/kg
subsequent shocks ≥4 J/kg,
max 10 J/kg or adult dose

synchronized cardioversion
begin with 0.5-1 J/kg

Question 13

what is the approx weight of 3 y/o child

Answer 13

16 kg
10 + (2 x age in years)
10 + (2x3)
10+6

weight
<12 months: 4 + (age in months/2)

1-12y: 10 + (2x age in years)

Question 14

APGAR

Answer 14

APPEARANCE
pale
acrocyanosis
completely pink

PULSE
0
<100
>100

GRIMACE / REFLEX
no response
grimace
crying

ACTIVITY
limp
some flexion
fully flexed

RESPIRATORY
absent
weak
crying

Question 15

what is the dose of epinephrine given in neonatal resuscitation

Answer 15

0.01 to 0.03 mg/kg IV/IO

Question 16

begin neonatal resusciation on newborns of what AOG

Answer 16

≥22 weeks of gestation

a fetus <22 weeks of gestation and weighing <400 g is not viable

SURVIVAL
22 weeks: 10-50%
23 weeks: 35-60%
24 weeks: 60-80^

Question 17

most common caue of. neonatal cardiorespiratory distress

Answer 17

neonatal sepsis
-fever or hypothermia signals serious infection in the neonate
-hypothermia: rectal temp of <36.5C

Question 18

remarks on gonococcal conjunctivitis

Answer 18

-usually presents at 2-7 days of life
-with intense bilateral conjunctival erythema, chemosis, and a copious purulent discharge

admit all infants with gonococcal conjunctivitis