- Did they have seizure at the time - Has it happened before - Alcohol or drugs involved (indication for CT)

Emergency Flashcards by christine lenia

what is the leading cause of death in US children

Accidental injuries

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What predisposes infants and toddlers to head injuries

Large head compared to body size
Weak neck muscles
Thin skulls
Physically uncoordinated

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What should you consider for accidents in ch

Falls

Abuse

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Head injury Hx

Witnessed fall
What height 
Immediate cry
Consolability
vomiting 
time since happening
arousability

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Head injury exam

* Neurostatus exam: Glasgow

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Head injury diagnostics

Bed side US
Radiography
CT

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Signs of basilar skull fracture

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

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How to decide whether or not to do the CT

PECARN
CHART
CHALICE

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pathophys of subdural hematoma

Acceleration-deceleration injury

Blood pools between dura and arachnoid due to tearing of bridging veins

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Sxs of subdural hematoma

irritability
lethargy
buldging fontanelle
vomiting

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Subdural hematoma diagnostics

CT-cresecent shape across suture lines (REFER)

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Pathophys of epidural hematoma

Blow to the head

Rapture of middle meningeal artery

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Sxs of epidural hematoma

blow to the head

brief period of unconsciousness feeling great then dramatic change (btr prognosis)

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epidural hematoma

non-contrast CT-elliptical/lentiform shape (REFER)

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Subarachnoid hemorrhage pathophys

Blood pooling in cisterns, sulci, fissures, CSF

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SAH diagnostics

Non-contrast CT-small dense slivers followed w/ angiography

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Tx SAH

No ICH/skull fracture = can go home w/ head injury precautions
ICH +/- skull fracture = REFER

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Mild TBI/concussion pathophys

Direct blunt force trauma- force stretches and shears axons

Altered mental status +/- unconsciousness

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Sxs of concussion

Amnesia
Confusion
Delayed response
Repetitive speech

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Hx qn for concussion

Did they have seizure at the time
Has it happened before
Alcohol or drugs involved (indication for CT)

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post concussion syndrome

symptoms lasting 3mos or longer

2nd impact syndrome

second concussion within weeks leading to brain swelling and herniation

What do people with a concussion need to be able to return to sports

Neurologist clearance

What do you need to always do with a fracture

Document neuromuscular status before and after splinting/reducton

Fracture mgt

Open: Cpd-splint/dress, IV abs, ortho non-displaced w/ laceration-PO abs, repair laceration, splint, ortho FU Grossly displaced/deformed: Ortho - may compromise neurovascular structures Other: splint, pain control, ORTHO

Osteomyelitis pathophys

Hematogenous spread of infection to bone

Dx osteomyelitis

MRI (best) Xray: lytic lesions (10-14days) Labs: CBC, CRP, ESR

Most common location for osteomyelitis

Long bones (femur, tibia, humerus)

Causative agents of osteomyelitis

S. aureus (MRSA) S. pneumonia S. pyogenes

pathophys acute septic arthritis

hematogenic spread of bacteria to joint

Etiology of septic arthritis

S. aureus (chn.) | Neisseria (adolescents/young adults)

Deadly in a dose

Aspirin, beta blockers, Ca channel blockers, camphor, chloroquine, clonidine, iron, lindane, methyl salicylate, methadone, nicotine, oils, theophylline

Hx for poisons

``` Substance Qty Route How long since they took sthng Progression of sxs. Home treatments ```

Toxidromes

Group of responses seen in classes of meds

Anticholinergic

Hot as a hare, dry as a bone, red as a beet, blind as a bat Vitals: Tachycardia, Hyperthermia, HTN Meds: Atropine, Jimsonweed

Cholinergic

Sweating, salivation, urination, lacrimation, miosis, seizures Vitals: Bradychardia, hypothermia, tachypnea

Concerns for foreign body

Sharp | long

Vegetable matter foreign body

Causes pneumonitis

Danger of ingesting magnets

Attraction to other things can cause entrapment of tissues

risk with button battery ingestion

Burns wishing 4hrs

Dry drowingin

Laryngospasm leading to hypoxia. No fluid in the lungs

Wet drowning

Aspiration of water into lungs leading to dilution of surfactant and impaired gas transfer = atelectasis = VQ mismatch

Age range to consider child abuse in drowning situation

Secondary drowing

Death that occurs 72hrs after near drowning incident. depends on aunt of water ingested

neonate

infant/young child

>2mos to 3yrs

Fever w/ out a source

Rectal temp >38˚C(100.4)

Who gets cathetarized for urine sample for fever w/out a source

All males

Work up for non-toxic appearing fever w/out a source

UA (cath) & culture Rapid viral test Stool for WBC w/ Guiac

Work up for toxic appearing fever w/out a source

``` UA (cath) & culture Rapid viral test Stool for WBC w/ Guiac CBC w/ diff CXR CSF analysis ```

Mgt non-toxic fever w/out source

``` go home must come back in 24hr for follow up no sig risk factors fully immunized healthy prior to fever cargiver ```

Mgt toxic fever w/out a source

Admit | Empiric abx