Emergency, PICU

Question 1

Gastroenteritis and ORT

Answer 1

Optimal Glucose:Na Ratio (1:1)

Question 2

Signs of Dehydration - Mild

Answer 2

Mild (<5%) Slightly decreased urine output Slightly increased thirst Slightly dry mucous membrane Slightly elevated heart rate

Question 3

Signs of Dehydration - Moderate

Answer 3

Moderate (5-10%) Decreased urine output Moderately increased thirst Dry mucous membrane Elevated heart rate Decreased skin turgor Sunken eyes Sunken anterior fontanelle

Question 4

Signs of Dehydration - Severe

Answer 4

Severe (>10%) Markedly decreased or absent urine output Greatly increased thirst Very dry mucous membrane Greatly elevated heart rate Decreased skin turgor Very sunken eyes Very sunken anterior fontanelles Lethargy, Coma Cold extremities, Hypotension

Question 5

Mild Dehydration - Management

Answer 5

Mild Dehydration (<5%) 1) Rehydrate with ORS (50mL/kg) over 4 hours 2) Replace ongoing losses with ORS 3) Age-appropriate diet after rehydration

Question 6

Moderate Dehydration - Management

Answer 6

Moderate Dehydration (5-10%) 1) Rehydrate with ORS (100mL/kg) over 4 hours 2) Replace ongoing losses with ORS 3) Age-appropriate diet after rehydration

Question 7

Severe Dehydration - Management

Answer 7

Severe Dehydration (>10%) 1) IVF with NS/RL (20-40mL/kg) over 1 hour 2) Reassess and repeat if needed 3) ORT when patient is stable

Question 8

ORT Contraindications

Answer 8

-Prolonged vomiting despite small amounts -Severe dehydration -Impaired LOC -Paralytic ileus -Monosaccharide malabsorption

Question 9

Indications for Odansetron

Answer 9

CPS Single dose ondansetron SHOULD be considered for children aged 6 months to 12 years who present to the ED with acute gastroenteritis and who have mild to moderate dehydration OR who have failed oral rehydration therapy

Question 10

Definition of Shock

Answer 10

acute inability to deliver adequate O2 to meet metabolic demands of vital organs/tissues.

Question 11

Types of Shock

Answer 11

-Septic -Hypovolemic -Obstructive -Cardiogenic -Distributive

Question 12

SIRS - Systemic Inflammatory Response Syndrome

Answer 12

≥2/4 of (≥1* required): o *Temp >38.5, or <36 o *WBCs ↑ or ↓ or left shift >10% o Tachycardia or bradycardia o Tachypnea

Question 13

Status Epilepticus Management

Answer 13

ABCs 1st line: Buccal midazolam> Rectal diazepam, intranasal midazolam = IV lorazepam 2nd line: Fosphenytoin/phenytoin > phenobarbital

Question 14

Asthma Exacerbation Management

Answer 14

Question 15

Injuries Caused by Smoke Inhalation

Answer 15

1) Acute asphyxia
2) Thermal injury to upper airways
3) Chemical injury to tracheobronchial tree
4) Systemic poisoning - CO +/- cyanide

Question 16

How is Oxyhemoglobin measurement affected by CO poisoining?

Answer 16

Percentage of oxyhemoglobin is OVERESTIMATED in CO poisoning and methemoglobinemia

Question 17

Smoke inhalation - Intubation Indications

Answer 17

Intubation if:

• Stridor
• Increased WOB
• Resp distress
• Hypoventilation
• Deep burns to face/neck
• Oropharynx blistering/edema (develops in 1st 24h)

Question 18

Head Trauma Severity and GCS

Answer 18

Mild: GCS 14-15

Moderate: GCS 9-13

Severe: GCS <9

Question 19

Head Trauma CT Indications

Answer 19

• GCS <15 at 2h after injury
• Suspected open/depressed skull #
• Worsening headache
• Irritability on examination
• Basal Skull # signs - hemotympanum, racoon eyes, CSF oto/rhinorrhea, Battle’s sign
• Large, boggy hematomy of scalp
• Dangerous MOI ( MVC, fall from >3ft, bicycle without helmet)
• Not in rule, but also CT if focal neuro abN on exam or suspected depressed skull #