Emergency medicine

Question 1

what is the ‘3-P’ approach to managing pain

Answer 1

physical, psychological, and pharmacological

Question 2

is sitting or laying better for child during painful procedure?

Answer 2

sitting upright

Question 3

What age should sucrose be used up to and how should it be given

Answer 3

evidence for use up to 12 months, part of it must be given 2 minutes before procedure and rest during procedure

Question 4

are heel lances or venipuncture more painful?

Answer 4

heel lancing

Question 5

what age group should you not use EMLA (lidocaine-prilocaine) in and why?

Answer 5

<1 yr, methemoglobinemia

Question 6

contraindications for using LET (lidocaine/emla/tetracaine)

Answer 6

patients <3 months old, mucosal surfaces, in large, deep or contaminated wounds

Question 7

what components of a child’s anatomy mask them more likely to develop a intracranial lesion due to head trauma (3)

Answer 7

larger head to body size ratio, thinner cranial bone, less myelinated neural tissue

Question 8

4 signs that have been particularly associated with intracranial injury (4)

Answer 8

1. prolonged loss of consciousness or impaired level of consciousness
2. disorientation or confusion; amnesia
3. worsening headache
4. repeated or persistent vomiting

Question 9

classify minor, moderate and severe head trauma according to GCS

Answer 9

GCS 14-15: minor
GCS 9-13: moderate
GCS<=8: severe

Question 10

How is pediatric GCS different than regular GCS?

Answer 10

Verbal: coos/babbles (5), irritable/cries (4), cries to pain (3), moans to pain (2)
Best motor response: spontaneous movement (6), withdraws to touch (5),

Question 11

4 high risk findings (need for neurological intervention) in the CATCH CT head rule

Answer 11

1. GCS <15 at 2 h after injury
2. Suspected open or depressed skull fractures
3. Hx of worsening headache
4. Irritability on exam

Question 12

3 Medium risk findings (brain injury on CT scan) as part of the CATCH CT head rule

Answer 12

1) any sign of basal skull fracture
2) large boggy hematoma of the scalp
3) dangerous mechanism of injury (MVC, fall from height >=3 ft or down five stairs, falling from bicycle without a helmet)

Question 13

what are 2 absolute indications for CT head after minor head injury

Answer 13

focal neuro deficit on PE
clinically suspected open or depressed skull fracture, or a widened or diastatic skull fracture observed on xray

Question 14

at what age should you consider doing an x-ray before a CT head when there is a large boggy scalp hematoma

Answer 14

<2 yrs

Question 15

Relative indications for CT head (8)

Answer 15

1) known coagulation disorder
2) seizures at the time of the event or later
3) persistent irritability in a child <2 yrs
4) mechanism of trauma raising suspicion of serious injury
5) large boggy scalp hematoma in a child >=2 yrs
6) signs of basal skull fracture
7) clinic deterioration over 4-6h of observing symptomatic patient in ED (ex. worsening headache, repeated vomiting)
8) Abnormal mental status: GCS <14 at any point of time from initial assessment onward, or GCS<15 at 2h after injury

Question 16

what is a complication of a widened skull fracture (>4mm) ?

Answer 16

leptomeningeal cyst

Question 17

what GCS should undergo CT?

Answer 17

moderate head trauma (GCS 9 -13) and obvi severe head trauma

Question 18

3 other factors that affect prognosis following TBI

Answer 18

presence and severity of other injuries, pre-injury ADHD, socio-economic status