Emergencies Flashcards
What are the two primary components of the PE post-head injury?
- ABC (airway, breathing, circulation)
- GCS (Glasgow Coma Scale)
What is Cushing’s Triad, and what type of injury might it be seen with?
Head injury
- Wide pulse pressure
- Bradycardia
- Abnormal respirations
What are two possible PE findings seen with a basilar skull fracture?
- Battle’s sign
- Raccoon eyes
What diagnostic criteria is used when determining the need for CT post-head injury?
PECARN/CATCH/CHALICE
Realistically, what NINE (ugh) criteria would warrant the need for CT post-head injury?
- GCS <15
- Acute AMS/”not acting right”
- Signs of skull fracture
- Vomiting 3+ times
- Seizure
- <2 years old
- Non-frontal scalp hematoma
- LOC for 5+ seconds
- Severe mechanism
Of the three types of head bleeds, which has the poorest prognosis?
Subdural hematoma
Of the three types of head bleeds, which is most common?
Subarachnoid hemorrhage (SAH)
What type of head bleed has CT shows crescent-shaped hematoma that crosses suture lines (usually parietal area)?
Subdural hematoma
What type of head bleed often presents with brief LOC → lucid period (normal) → deterioration?
Epidural hematoma
What type of head bleed has CT shows elliptical shape that does NOT cross suture lines?
Epidural hematoma
How can you differentiate Subdural hematoma from Epidural hematoma on CT?
- Subdural: crosses suture lines
- Epidural: does NOT cross suture lines
What type of head bleed has CT shows small, dense “slivers”?
Subarachnoid hemorrhage (SAH)
Under what two conditions could you send a child home with head injury precautions as disposition for head injury?
- No ICH
- No skull fracture
Under what condition would you admit a patient + neuro consult as disposition for head injury?
- ICH +/- skull fracture
What condition involves appears normal but amnesia/repetitive speech, confusion, delayed response?
Concussion
For concussion, when might a patient expect HA, mental fogginess to resolve?
Within 7-10 days
What tool is used to evaluate concussions?
ACE (Acute Concussion Evaluation)
What two conditions MUST be relayed to the patient with diagnosis of concussion?
- NO same-day return to play regardless of sxs (must be completely sxs-free to return)
- SLOW advancement of activity with sxs resolution
What is post-concussive syndrome?
3+ months of sxs
What is second impact syndrome?
2nd impact within weeks of 1st
- Increases risk of brain swelling, death
What is Chronic Traumatic Encephalopathy?
Permanent changes (long-term sequela) after multiple impacts
What type of injury is rare in peds and often due to if <8 years = falls, if 8+ years = MVA? What should you still consider?
Cervical Spine Injuries
- Consider SCIWORA (Spinal Cord Injuries w/o Radiographic Abnormality)
What is the gold standard test to evaluate for Cervical Spine Injuries?
MRI
What exam (three components) should ALWAYS be checked and documented before/after splinting?
Neuro exam
- ROM
- Pulses
- Capillary refill
What three treatments are recommended for an open compound fracture?
- Splint
- Start abx
- Ortho consult
What two treatments are recommended for a grossly deformed/displaced fracture?
- Closed/open reduction +/- fixation
- Ortho consult
What four treatments are recommended for a non-displaced compound fracture?
- Start abx
- Repair laceration
- Splint
- Ortho follow up
For what two types of fractures is ortho consult recommended?
- Open compound
- Grossly deformed/displaced
What condition is most common if <5 years and male; more common in long bones?
Osteomyelitis
What is the most common etiology of Osteomyelitis?
Staph aureus
What two diagnostic tests are recommended for Osteomyelitis?
- MRI
- Cultures
What is the recommended treatment for Osteomyelitis?
Vancomycin (IV)
What is unique about the following drugs and their toxicity: ASA, beta-blockers, CCBs, Camphor, Chloroquine, Clonidine, Iron, Lindane, Methyl Salicylate, Methadone, Nicotine, oils, Theophylline, Tricyclic Antidepressants
LETHAL IN ONE DOSE
What is the recommended treatment for toxic ingestion?
ABC-DDD
- ABC: airway, breathing, circulation
- DDD: disability, drugs, decontamination
What is the antidote for Acetaminophen toxicity?
Acetylcysteine
What is the antidote for Benzos toxicity?
Flumazenil
What is the antidote for Opioids/Narcotics toxicity?
Narcan (Naloxone)
If a FB has past the pylorus, what does this mean?
SHOULD pass in stool on its own (no intervention)
What can aspirated vegetables cause?
Pneumonitis
What test should be used to remove FB from the esophagus?
Endoscopy
What test should be used to remove FB from the trachea?
Bronchoscopy
Symptoms of feeding refusal, vomiting, choking/coughing, neck/throat pain, dysphagia, increased salivation are indicative of what?
Esophageal FB
Where should a patient be referred if the FB is above the cricopharyngeus?
ENT
Where should a patient be referred if the FB is below the cricopharyngeus?
GI
What type of FB is an emergency?
Button battery in Esophagus
When is removal of a button battery in Esophagus considered emergent?
When is it NOT necessary, unless…?
Lodged in esophagus = emergent removal
- Past esophagus, no need to remove UNLESS not past pylorus after 24-48 hours
In what two age groups is drowning most common?
- Children <4 years
- Young adults 15-24 years
What does impaired ventilation in drowning lead to (2)?
- Hypoxemia
- Acidosis
What is the most common type of drowning?
Wet drowning
What condition involves aspiration of water into lungs?
Wet drowning
What condition involves occurs when laryngospasm → hypoxia → LOC?
Dry drowning
What two findings can indicate very poor prognosis for near-drowning?
- CPR
- Fixed/dilated pupils
What is the most critical factor in determining prognosis for drowning? What are three other factors?
Duration of submersion
- Time to effective BLS (worse if 10+ minutes)
- Resuscitation duration (worse if 25+ minutes)
- Young respond better
What is the goal for identifying Fever Without Source?
Identify occult systemic bacterial infection
- PNA
- UTI
- Bacteremia
- HSV-6
- Meningitis
For what condition should you work up infants regardless of appearance?
Fever Without Source
For Fever Without Source, if Group B Strep is present, what condition should always be checked for?
Meningitis
For infantile fever and ill-appearing, what two diagnostic tests are recommended?
- UA (cath)
- Urine C&S
For infantile fever and well-appearing/NOT fully vaccinated, what diagnostic test is recommended, and for what three specific groups?
UA (cath)
- Female <2 years
- Uncircumcised boy <1 year
- Circumcised boy <6 months
For infantile fever and well-appearing/fully vaccinated, what two diagnostic tests are recommended, and for what three specific groups?
UA (cath)
UA C&S
- Female <2 years
- Uncircumcised boy <1 year
- Circumcised boy <6 months
