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PEDS II, exam 2 > emergency > Flashcards

emergency Flashcards

1
Q

infants and toddlers, due to weak neck muscles, are prone to what type of head injuries

A
  • acceleration-deceleration injuries -> shearing forces -> injury to neurons and vascular structures
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2
Q

what are critical questions to ask when obtaining history about a peds head injury

A
  • height?
  • immediate cry
  • consolability
  • vomiting
  • arousability (is it nap time)
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3
Q

what are concerning signs after head injury when parents are worried about drowsiness

A
  • excessively sleepy or hard to arouse
  • vomiting
  • irritability
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4
Q

Primary survey of head injury in peds includes

A
  1. ABC
  2. Neuro: GCS
  3. vital signs
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5
Q

what is cushings triad

A
  • wide pulse pressure
  • bradycardia
  • abnormal respirations
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6
Q

what are signs of basilar skull fx

A
  • battle’s sign
  • periorbital ecchymosis (raccoon eyes)
  • hemotympanum
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7
Q

When should you order a CT to evaluate head injury in peds < 2 yo

A

PECARN

  • GSC = or < 14, signs of AMS or palpable skull fx -> CT recommended
  • occipital, parietal, or temporal hematoma, or h/o LOC > or = 5 seconds; severe MOI; not acting normally -> CT recommended
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8
Q

subdural hematoma occurs where in brain

A
  • between dura and arachnoid membrane
    • tearing of bridging veins
    • low pressure bleed, dissects arachnoid away from dura
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9
Q

CT findings are consistent with what bleed

  • crescent shaped
  • usually parietal area
  • crosses suture lines
A

subdural hematoma

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10
Q

prognosis of subdural hematoma

A

poor

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11
Q

Explain mechanism of epidural hemotoma

A
  • rupture of artery: high pressure
  • +/- underlying fx
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12
Q

epidural hemotoma has what typical presentation

A
  • brief LOC
  • lucid period
  • followed by deterioration
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13
Q

which brain bleed has this CT

  • elliptical shape
  • does not cross sutures
A

epidural hemotoma

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14
Q

Mechanism of Subarachnoid hemorrhage

A
  • injury to parenchymal and subarachnoid vessels
  • symptoms range from normal to LOC
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15
Q

which brain bleed presents as this on noncontrast CT

  • blood in cisterns, sulci, and fissures
  • blood in CSF
A

Subarachnoid hemorrhage

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16
Q

Management of head traumas that have No Intracranial hemorrhage or skull fx

A
  • head injury precautions
  • responsible caregiver
  • monitor for
    • behavior change, vomiting, decreased arousability, sz
  • sleeping is okay
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17
Q

Management of head traumas that have Intracranial hemorrhage +/- skull fx

A

neuro consult

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18
Q

What is the definition of concussion

A
  • traumatically induced alteration in mental with or without an associated loss of consciousness
    • direct blunt force -> stretching/shearing of axons
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19
Q

clinical presentation post head trauma

  • repetitive speech pattern
  • amnesia
  • confusion and/or blunted affect
  • delayed response
  • visual changes
A

concussion

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20
Q

if you suspect a patient has a concussion and the patient is under the influence of a substance, you must

A

get a CT, regardless of PE findings

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21
Q

headache, mental fogginess, other mild symptoms of concussion should resolve when

A

within 7-10 days

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22
Q

what is post-concussive syndrome

A

symptoms lasting 3 months or longer

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23
Q

what is second impact syndrome (associated with concussion)

A
  • 2nd concussion within weeks -> brain swelling, herniation, death
  • children at increased risk
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24
Q

treatment for concussion

A
  • No same day return to play
  • physical and cognitive rest
    • no cell phones, video games, get adequate sleep, noise reduction
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25
Q

what must you do before and after splinting/reduction/any other fx intervention

A

always document neurovascular status

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26
Q

managment of compound fracture, open fx

A
  • splint/dress
  • start IV abx
  • ortho consult
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27
Q

managment of non-displaced fx with overlying laceration

A
  • start PO abx
  • repair laceration
  • splint
  • outpatient ortho followup
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28
Q

spread of infection to bone is referred to as

A

osteomyelitis

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29
Q

osteomyelitis is most common in what patient population

A
  • under age 5
  • M > F
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30
Q

which bones are most often affected with osteomyelitis

A
  • long bones
    • femur
    • tibia
    • humerus
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31
Q

what are the most common pathogens of osteomyelitis

A
  • S. aureus (most common)
  • S. pneumoniae
  • S. pyogens
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32
Q

what is the best imaging study to evaluate osteomyelitis

A
  • MRI
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33
Q

tx of osteomyelitis

A
  • IV abx (empiric, then directed)
  • surgical drainage and debridement
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34
Q

most common pathogens associated with acute septic arthritis in infants/children

A
  • S. aureus
  • Strep
35
Q

most common pathogens associated with acute septic arthritis in adolescents

A

N. Gonorrhea

36
Q

clinical presentation

  • fever
  • constant, worsening joint pain
  • warm, swollen joint with pain on ROM
  • hip typically held in flexion/external rotation
A

acute septic arthritis

37
Q

transient synovitis is most common in what patient population

A
  • 18 months to 12 years
38
Q

clinical presentation

  • limp
  • abrupt onset of pain to hip, thigh, or knee
  • normal or slightly elevated temp
A

transient synovitis

39
Q

tx of transient synovitis

A
  • anti-inflammatories, observation, close follow up
40
Q

What is the Kocher criteria which helps determine when to get a joint aspiration

A
  • WBC > 12,000
  • ESR >40
  • Fever > 101.3
  • non weight bearing on affected side
  • 2/4 warrants joint aspiration
41
Q

List some meds that are deadly in a dose

A
  • ASA
  • Beta-blockers
  • Calcium channel blockers
  • Chloroquine
  • Iron
  • Methadone
  • Nicotine
  • Tricyclic antidepressants
42
Q

what is a toxidrome

A
  • grouped, physiologically-based abnormalities that are known to occur with specific classes of substances
43
Q

What drug class presents with

  • Delirium, Flushed skin, Dilated pupils, Urinary retention, decreased bowel sounds, memory loss, Sz
  • tachycardia, hyperthermia, HTN
A
  • Anticholinergic
    • hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter
  • antihistamines, atropine, scopolamine, Jimson weed, tricyclic anti-depressants
44
Q

What drug class presents with

  • confusion, weakness, salivation, lacrimation, defecation, emesis, diaphoresis, muscle fasciculations, miosis, sz
  • bradycardia, hypothermia, tachypnea
A
  • Cholinergic
    • organophosphates
    • carbamates
    • mushrooms
45
Q

What drug class presents with

  • disorientation, hallucination, visual illusion, panic reaction, moist skin, hyperactive bowel sounds, sz
  • tachycardia, tachypnea, HTN
A
  • Hallucinogenic
    • amphetamines
    • cannabinoids
    • cocaine
    • PCP
46
Q

What drug class presents with

  • AMS, unresponsiveness, miosis, shock
  • shallow respirations, slow RR, bradycardia, hypothermia, hypotension
A
  • Opiate/Narcotic
    • opiate
    • propoxyphene
    • dextromethophan
47
Q

What drug class presents with

  • coma, stupor, confussion, sedation, progressive deterioration of CNS function
  • apnea
A
  • sedative/hypnotic
    • barbituate
    • benzodiazepines
    • ethanol
    • anticonvulsants
48
Q

What drug class presents with

  • delusions, paranoia, diaphoresis, piloerection, mydriasis, hyperreflexia, sz, anxiety
  • tachycardia, bradycardia ?, HTN
A
  • sympathomimetic
    • cocaine
    • amphetamines
    • ephedrine
49
Q

treatment of poison

A

ABC-DDD

  1. stabilize patient: ABCs
  2. contact poison control
  3. DDD
    1. disability
    2. drugs
    3. decontamination
50
Q

how would you decomtaminate ocular poison exposure

A
  • test PH
    • copious normal saline lavage until pH normal
    • flush at least 15 minutes
    • consult ophth.
51
Q

how would you decomtaminate skin posion exposure

A

copious normal saline

52
Q

specific antidote for acetaminophen

A

acetylcysteine

53
Q

specific antidote for anticholinergic

A

physostigmine

54
Q

specific antidote for benzodiazepines

A

flumazenil

55
Q

specific antidote for beta blockers

A

glucagon

56
Q

specific antidote for calcium channel blockers

A

calcium

57
Q

specific antidote for digoxin

A

digibind

58
Q

specific antidote for heavy metals

A

chelating agents

59
Q

specific antidote for narcotics

A

naloxone

60
Q

what labs should you always order when suspect poisoning

A
  • acetaminophen level
  • CMP
  • coags
  • ABG
61
Q

procedure of choice for removing FB in the esophagus

A

endoscopy

62
Q

procedure of choice for removing FB in the trachea

A

bronchoscopy

63
Q

list indications for consultation

A
  • sharp or elongated object
  • multile FB (magnets)
  • button battery
  • coin at the level of the cricopharyngeus muscle
  • presence of FB more than 24 hours
64
Q

what is the problem with a button battery in the esophagus

A
  • true emergency
  • extremely rapid action of the alkaline substance on the mucosa, pressure necrosis, residual charge
  • burns esophagus and causes perforation
65
Q

what type of button batteries are associated with the most adverse outcome

A

lithium batteries

66
Q

treatment of button battery ingestation

A
  1. emergent removal in lodged in esophagus
  2. if passed esophagus
    1. no need to remove if asymptomatic
    2. UNLESS it has not passes through pylorus after 24-48 hours
  3. usually excreted in 48-72 hours
67
Q

what is dry drowning

A
  • laryngospasm -> hypoxia -> LOC
  • no fluids in lungs
68
Q

what is wet drowning

A
  • more common
  • aspiration of water into lungs
  • dilution and washout of surfactant -> diminished gas transfer
69
Q

what is the most critical factor in determing poor prognosis in near drownings

A

duration of submersion > 5 min

70
Q

secondary drowning may cause death at what time after near drowning incident? cause?

A

up to 72 hours after

  • fresh water drowning results in hemodilution, primarly from ingested water
71
Q

fever without a source? what is the goal

A

identify occult infections: PNA, UTI, bacteremia, Herpes-virus 6 infections, and meningitis

72
Q

non-toxic infants and young children: 2 months-3 years, with fever get what tests

A
  • UA cath and culture
  • rapid viral testing: influenza, RSV
  • stool for WBCs and guaiac, if diarrhea
73
Q

toxic infants and young children: 2 months-3 years, with fever get what tests

A
  • UA cath and culture
  • rapid viral testing
  • stool for WBCs and guaiac
  • CBC with diff
  • CXR
  • CSF analysis (LP)
74
Q

infants < 2 months with a fever > 38 C get what

A
  • full septic workup regardless of appearance
75
Q

febrile sz occurs in what age group

A

3 months to 5 years

76
Q

simple febrile sz

A
  • lasts < 15 min, isolated
  • patient otherwise neurologically intact before sz
77
Q

complex febrile sz

A
  • sz > 15 m or multiple in rapid succession
78
Q

if peds patient has a febrile sz for more than 10-15 minutes, what medication is given

A

benzodiazepine

79
Q

children < 12 months with febrile sz require what

A
  • full septic workup
  • concerned with meningitis
80
Q

complications of cat bites to hand

A
  • osteomyelitis
  • septic arthritis
81
Q

workup of cat or dog bite

A
  • wound culture
  • radiograph if deep bite near joint
82
Q

treatment of cat bite and human bites

A
  • leave open to heal
    • exception: facial laceration
  • augmentin x 3-5 days
83
Q

treatment of dog bite

A
  • may perform primary closure if
    • uninfected
    • less than 12 hours old (24 hrs on face)
    • NOT located on hand or foot
  • augmentin x 3-5 days

PEDS II, exam 2 (3 decks)

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