Emergency Flashcards
what is the leading cause of death in US children
Accidental injuries
What predisposes infants and toddlers to head injuries
Large head compared to body size
Weak neck muscles
Thin skulls
Physically uncoordinated
What should you consider for accidents in ch
Falls
Abuse
Head injury Hx
Witnessed fall What height Immediate cry Consolability vomiting time since happening arousability
Head injury exam
- ABC
* Neurostatus exam: Glasgow
Head injury diagnostics
Bed side US
Radiography
CT
Signs of basilar skull fracture
Battle’s sign
Periorbital ecchymosis (raccoon eyes)
Hemotympanum
otorrhea/rhinorrhea
How to decide whether or not to do the CT
PECARN
CHART
CHALICE
pathophys of subdural hematoma
Acceleration-deceleration injury
Blood pools between dura and arachnoid due to tearing of bridging veins
Sxs of subdural hematoma
irritability
lethargy
buldging fontanelle
vomiting
Subdural hematoma diagnostics
CT-cresecent shape across suture lines (REFER)
Pathophys of epidural hematoma
Blow to the head
Rapture of middle meningeal artery
Sxs of epidural hematoma
blow to the head
brief period of unconsciousness feeling great then dramatic change (btr prognosis)
epidural hematoma
non-contrast CT-elliptical/lentiform shape (REFER)
Subarachnoid hemorrhage pathophys
Blood pooling in cisterns, sulci, fissures, CSF
SAH diagnostics
Non-contrast CT-small dense slivers followed w/ angiography
Tx SAH
No ICH/skull fracture = can go home w/ head injury precautions
ICH +/- skull fracture = REFER
Mild TBI/concussion pathophys
Direct blunt force trauma- force stretches and shears axons
Altered mental status +/- unconsciousness
Sxs of concussion
Amnesia
Confusion
Delayed response
Repetitive speech
Hx qn for concussion
- Did they have seizure at the time
- Has it happened before
- Alcohol or drugs involved (indication for CT)
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
