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X Pediatrics 2 > Emergencies > Flashcards

Emergencies Flashcards

1
Q

What is the leading cause of childhood death in the US?

A

Injuries

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2
Q

Why do head injuries occur more often in kids?

A

Larger head to body ratio
Weak neck muscles (acceleration-deceleration injuries)
Thin skulls
Physically uncoordinated
Lack cognitive ability to predict/understand danger

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3
Q

Critical components of history with head injuries

A

Witnessed fall, height of call, immediate cry, consolable, vomiting, time since injury, arousable, size of mass, other injuries

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4
Q

Concerning signs with head injury

A

Excessively sleep or hard to arouse
Vomiting
Irritability/behavior changes

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5
Q

Primary exam that needs to be done with head injuries

A

ABCs
Neuro status (GCS, pupils, sucking reflex, muscle tone-<8 is immediate resuscitation)
Vital signs

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6
Q

What is Cushing’s triad and what does it indicate?

A

Wide pulse pressure
Bradycardia
Abnormal respirations
Indicates increased intracranial pressure

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7
Q

What are signs of a basilar skull fracture?

A

Battle’s sign
Periorbital ecchymosis (raccoon eyes)
Hemotympanum
Otorrhea/rhinorrhea (CSF)

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8
Q

When is CT not indicated in head injuries?

A

For low risk pts with low risk injuries

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9
Q

How do you decide when to do a CT with a head injury?

A

PECARN (primary one)
CATCH (irritability is involved)
CHALICE (has the speed of the MVA)

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10
Q

Who gets a CT in head injuries?

A 
GCS<15 or acute mental status change
Signs of skull fracture
Vomiting >3 times
Seizure
Less than 2
Nonfrontal scalp hematoma
LOC<5 sec
Severe mechanism
"Not acting right" or lethargic
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11
Q

Where does a subdural hematoma occur?

A

Between the dura and arachnoid membrane (associated with diffuse brain injury)
**crosses the suture lines

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12
Q

How does a subdural hematoma occur?

A

Tearing of bridge veins so a low pressure bleed that dissects the arachnoid away from the dura

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13
Q

How might a pt act with a subdural hematoma

A

LOC/lingering sxs (irritability, lethargy, bulging fontanelle, vomiting)

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14
Q

CT findings in subdural hematoma

A

Crescent shaped, usually parietal area

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15
Q

What has a better prognosis, subdural or epidural hematoma?

A

Epidural

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16
Q

How does an epidural hematoma occur?

A

Rupture of arteries (usually meningeal)–may have an underlying fracture
**does not cross sutures!

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17
Q

History seen in an epidural hematoma

A

Brief LOC

Lucid period followed by deterioration

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18
Q

CT findings for epidural hematoma

A

Elliptical shape

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19
Q

How does a subarachnoid hemorrhage occur?

A

Injury to parenchymal and subarachnoid vessels

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20
Q

CT findings of a subarachnoid hemorrhage

A

Small dense slivers-blood in cisterns, sulci and fissures
Blood in the CSF
May take hime to be visible on a CT tho

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21
Q

Most common bleed with a head injury

A

Subarachnoid hemorrhage

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22
Q

Management for a head injury with no ICH or skull fracture

A

Head injury precautions (monitor for behaviors, vomiting, decreased arousal, seizure irritability)
Sleeping is ok

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23
Q

Management for a head injury with an ICH and +- skull fracture

A

Neuro consult
Admit (evacuation of ICH/surgery to repair fracture)
Repeat imagin

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24
Q

Sxs of a concussion

A 
Amnesia
Confusion and/or blunted affect, distractibility
Delayed response
Emotional lability
Visual changes
Repetitive speech pattern
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25
Q

What must you do when a pt is found to have a substance abuse problem and has a concussion?

A

Must CT!

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26
Q

When does the HA, fogginess and other mild sxs usually resolve with a concussion?

A

7-10 days (Can go up to a month)

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27
Q

What is emergent after a concussion?

A

Severe, prolonged or worsening HA, vomiting or deterioration

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28
Q

What is post-concussive syndrome?

A

Sxs lasting 3 mos or longer

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29
Q

What is second impact syndrome?

A

2nd concussion within weeks (brain swelling, hernation or death)
Kids are at increased risk

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30
Q

What is chronic traumatic encephalopathy?

A

Multiple concussions

Permanent change in mood, behavior, pain

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31
Q

Tx for concussion

A

No same day return to play (regardless if sxs resolve)
Physical and cognitive rest
Slow advancement of activity after sxs resolve

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32
Q

Causes of cervical spine injuries <8

A

Often MVAs but can be falls

C2-4

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33
Q

Causes of cervical spine injuries >8

A

Often MVAs but can be sports

C5-C7

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34
Q

Test of choice for cervical spine injuries

A

MRI (adolescents can have SCIWORA that is not picked up on CT so use this)

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35
Q

What is concerning with a cervical spine abnormality?

A

Bilateral pain
Neuro deficits
Torticollis
Bony abnormalities

36
Q

Management of a compound open fracture

A

Splint/dress, start IV abx, ortho consult

37
Q

Management of non-displaced open fracture with overlying laceration

A

Start PO abx, repair laceration, splint, outpt ortho f/u

38
Q

Management of grossly deformed/displaced fracture

A

May compromise neurovascular structures so require closed or open reduction and maybe fixation

39
Q

What must you always remember with an intervention for fractures?

A

Always document neurovascular status before and after!!

40
Q

Cellulitis vs erysipelas

A

Both skin infections, bacterial entry and all other signs
Cellulitis is deeper dermis and subcutaneous fat
Erysipelas is upper dermis and superficial lymphatics

41
Q

Tx for cellulitis or erysipelas

A

Warm wet compress
Bactroban topical
Keflex or bactrim orally

42
Q

Most often cause for osteomyelitis

A

Hematogenous spread of infection to bone (sinus infection, dental etc)
S. aureus, strep pneumoniae, strep pyogenes

43
Q

Where does osteomyelitis occur?

A

Long bones

44
Q

Presentation of osteomyelitis

A

Fever, bone pain, swelling, redness guarding

Focal tenderness during exam

45
Q

What is seen on an x-ray in osteomyelitis?

A

Early: soft tissue swellig

10-14 days later: bone destruction with lytic lesions

46
Q

Best study for eval of osteomyelitis

A

MRI (marrow edema or abscesses)

47
Q

Tx for osteomyelitis

A 
Supportive
IV abx (empiric at first-vanco, clinda, rocephin)
Drainage
Debridement
Hyperbaric O2 therapy
48
Q

Important history with toxic ingestion

A 
Substance
Route
Quantity
How long since
Progression of sxs
Home txs?
Underlying med conditions
49
Q

Tx for toxic ingestion

A 
Stabilize pts (ABCs)
contact poison center
Disability
Drugs
Decontamination
50
Q

Decontamination for ocular exposure

A 
Test pH
Copious normal saline lavage until normal pH
Flush at least 15 min before re eval
Make sure contacts removed
Consult opthamo
51
Q

Decontamination for skin exposure

A

Copious NS and water

Follow with soap to concentrate lipid soluble toxins

52
Q

Decontamination for GI exposure

A

Activated charcoal, cathartics, whole bowel irrigation

Enhance elimination

53
Q

Decontamination for blood stream exposure

A

Antidote

54
Q

What is ipecac?

A

For GI decontamination
Only helps if given within 30 mins of exposure
Not recommended usually

55
Q

When might activated charcoal be used?

A

Caramazepine, barbiturates, dapsone, quinine, theophylline
Digoxin or phenytoin
Not with salicylates
NOT FOR hydrocarbons, lithium, stong acid/base, metals, EtOH

56
Q

When is simple dilution used?

A

For mild toxins that only cause irritation or corrosion

57
Q

What is used for enhanced elimination of ingestin?

A

Activated charcoal
urine alkalization
Diuresis
Dialysis/hemoperfusion

58
Q

Antidote for acetaminophen

A

Acetylcysteine

59
Q

Antidote for benzos

A

Flumazenil

60
Q

Antidote for narcotics/opiods

A

Naloxone (narcan)

61
Q

What happens if a foreign object passes the pylorus?

A

Continues to rectum and is passed in stool without complications

62
Q

Concerns with foreign object ingestion

A

Sharp or irregular edges
If lodged in esophagus (airway obstruction, strictures, perforation)
Aspirated veggies can cause intense pneumonitis

63
Q

Presentation of esophageal FB

A 
Refusal to eat
Vomiting
Choking, coughing, stridor
Neck or throat pain, inability to swallow
Increased salivation
FB sensation in chest
64
Q

Procedure of choice to remove FB

A

Esophagus (endoscopy)

Trachea (bronchoscopy)

65
Q

When should you consult with a FB?

A 
Sharp or elongated
Multiple
Button batteries
Perf
Longer than 24 hrs
Airway compromise
Coin at level of cricopharyngeus muscle (below or above)
66
Q

What is esophageal button battery?

A

An emergency!!

67
Q

What happens with a button battery?

A

Extremely rapid action of alkaline substance on mucosa, pressure necrosis, residual charge
(lithium is worst, mercuric oxide can cause heavy metal poisoning)

68
Q

Tx for button battery

A

Emergent removal if in esophagus
If past it then dont remove unless not pass pylorus after 24-48 hrs
Surgical consult if Gi sxs

69
Q

2 primary problems in drowning

A

Hypoxemia and acidosis

70
Q

What can hypoxemia from drowning lead to?

A

CNS damage and arrhythmias, pulm injury, reperfusion injury, multi organ dysfunction

71
Q

What is dry drowning?

A

When laryngospasm leads to hypoxia that leads to LOC

No fluid

72
Q

What happens in wet drowning?

A

Dilute and washout surfactant, lose gas transfer, atelectasisi and VQ mismatch

73
Q

What is near drowning?

A

Survival past 24 hrs (can see severe brain damage)

alert or mildly obtunded at ED presentation but may see full recovery

74
Q

What has a poor prognosis with near drowning?

A

Comatose, getting CPR or have fixed and dilated pupils and no spontaneous respirations

75
Q

Poor prognosis in drowning

A 
Submersion over 5 mins
Longer than 10 mins to get BLS
Longer than 25 min resuscitation
Ager over 14
GCS<5
Persistent apnea and CPR in ED
Arterial blood pH<7.1
76
Q

When should child abuse be considered with near drowning?

A

Less than 6 mos

Toddlers with atypical presentation

77
Q

What is secondary drowning?

A

Death up to 72 hrs after near drowning incident
Fresh water drowning results in hemodilution from ingested water
Can have hemolysis or arrhythmias is large enough water

78
Q

Most critical tx for drowning

A

Pre hospital care

79
Q

What is a fever without a source?

A

Rectal temp over 38C (100.4)

Must ID occult bacterial infections (pneumonia, UTI, bacteremia, herpes, meningitis)

80
Q

What does the workup in a fever based on>

A

Age (<3 mo is neonate and 3 mo-3 yr is infant)
Appearance
Risk factors (birth history, travel, exposures, vaccinations, immune deficiiences)

81
Q

Workup for kid <3 mos with temp over 38C

A

Workup regardless of appearance

82
Q

Sxs of infection with neonatal fever

A

Irritability, decreased activity, poor feeding and no weight gain, lethargy, change in sleep, vomiting, diarrhea, hypothermia

83
Q

Management of neonatal fever

A

Full septic workup
Empiric abx
Admission after culture results

84
Q

Managment of ill appearing 3 mo old to 3 yr

A 
Labs
UA
Cultures
CXR is tachypnea or leukocytosis
Parenteral abx
Admit
85
Q

Well appearing kid not immunized with a fever with management

A

CBC with diff
BLood culture if WBC>15000
UA if girl <2 yr, uncircumcised <1 yr or circumcised <6 mo
CXR is leukocytosis >20000

86
Q

Well appearing immunized kid with fever management

A

UA and culture if girl <2, uncircumised <1 and circucised <6 mo
If older than no routinelabs, no abx therapy but do need UA C&S
Fever >39C and abnormal UA should be treated for UTI

X Pediatrics 2 (10 decks)

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