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Peds II > Exam 2 - Basic Emergencies > Flashcards

Exam 2 - Basic Emergencies Flashcards

1
Q

What are some concerning signs after a child has had a head injury?

A
  • Excessively sleepy or hard to arouse
  • Vomiting
  • Irritability
  • Decreased mental cognition
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2
Q

What is Cushing’s triad?

A
  • Wide pulse pressure
  • Bradycardia
  • Abnormal respirations
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3
Q

What are possibly signs of a basilar skull fracture?

A
  • Battle’s sign
  • Periorbital ecchymosis (raccoon eyes)
  • Hemotympanum
  • Otorrhea/rhinorrhea
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4
Q

What tests/criteria can help in the decision to get a CT after a head injury?

A
  • PECARN
  • CATCH
  • CHALICE
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5
Q

When should a CT be ordered in a pediatric patient with a head injury?

A
  • GCS < 15 or acute mental status change
  • Signs of skull fracture
  • Vomiting > 3 times
  • Seizure
  • Less than 2 years of age
  • Non-frontal scalp hematoma
  • LOC > 5 seconds
  • Severe mechanism
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6
Q

What does a cresent-shaped area that crosses the suture line on CT indicate?

A

Subdural hematoma

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7
Q

What symptoms are associated with a subdural hematoma?

A
  • LOC
  • Irritability
  • Bulging fontanelle
  • Vomiting
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8
Q

What is the typical history associated with an epidural hematoma?

A

Brief LOC, lucid period, followed by deterioration

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9
Q

If you observe an elliptical shape that does not cross the suture line on head CT, what should you suspect?

A

Epidural hematoma

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10
Q

If you observe an small, dense “slivers” on head CT, what should you suspect?

A

Subarachnoid hemorrhage

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11
Q

What is the most common head bleed from acute head trauma?

A

Subarachnoid hemorrhage

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12
Q

What is a traumatically induced alteration in mental status, WITH or WITHOUT an associated loss of consciousness?

A

Concussion

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13
Q

What are some symptoms associated with a concussion?

A
  • Amnesia
  • Confusion
  • Delayed response
  • Emotional lability
  • Visual changes
  • Repetitive speech pattern
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14
Q

What is the treatment for a concussion?

A
  • No same-day return to play
  • Must be completely symptom-free to return to sports
  • Physical and cognitive rest
  • Structured return-to-play protocols (slow advancement of activity)
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15
Q

What is post-concussive syndrome?

A

Concussive symptoms lasting 3 months or longer

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16
Q

What symptoms are considered emergent and require immediately evaluation following a concussion?

A
  • Severe, prolonged or worsening headache
  • Vomiting
  • Deterioration in mental status
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17
Q

What is second impact syndrome?

A

2nd concussion within weeks –> brain swelling, herniation, death

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18
Q

What is chronic traumatic encephalopathy?

A
  • Multiple concussions

- Permanent change in mood, behavior, pain

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19
Q

What is the test of choice for a cervical spine injury?

A

MRI

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20
Q

What is SCIWORA and in what age group is this more common in?

A

Spinal Cord Injuries Without Radiographic Abnormalities

More common in adolescents

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21
Q

Which type of intracranial bleed has a very poor prognosis?

A

Subdural hematoma

22
Q

What is important in regards to documenting splinting/reduction/or any other fracture intervention?

A

Always document neurovascular status and pulses before and after the intervention

23
Q

What is the management for a compound open fracture?

A
  • Splint/dress
  • Start IV abx
  • Ortho consult
24
Q

What is the management for a non-displaced open fracture?

A
  • Start PO abx
  • Repair laceration
  • Splint
  • Outpatient ortho follow up
25
Q

What is the management of a grossly deformed/displaced fracture?

A

Will require closed/open reduction or possible fixation as it could compromise neurovascular structures

26
Q

Osteomyelitis most commonly affected what age group?

Which bones are most often affected?

What is the most common pathogen?

A

Under age 5

Long bones

Staph. aureus

27
Q

What are some symptoms associated with osteomyelitis?

A
  • Fever
  • Bone pain
  • Swelling
  • Redness
  • Guarding
  • Focal tenderness during exam
28
Q

What is the study of choice for osteomyelitis?

A

MRI

29
Q

What will be seen on x-ray in an individual with osteomyelitis?

A

Early: soft tissue swelling

10-14 days later: Bone destruction with lytic lesions

30
Q

What is the treatment for osteomyelitis?

A
  • Supportive care
  • IV abx (Vancomycin, Clindamycin, Rocephin)
  • Surgical drainage and debridement
  • Hyperbaric oxygen therapy
31
Q

What are some symptoms associated with an esophageal foreign body?

A
  • Refusal to eat
  • Vomiting
  • Choking, coughing, stridor
  • Neck or through pain, inability to swallow
  • Increased salivation
  • Foreign body sensation in chest
32
Q

What is the procedure of choice for removing a foreign body from the esophagus?

Trachea?

A

Esophagus - Endoscopy

Trachea - Bronchoscopy

33
Q

What is the treatment for a swallowed button battery?

A
  • Emergent removal if lodged in the esophagus
  • If passed esophagus, no need to remove if asymptomatic unless it has not passed through pylorus after 24-48 hours
  • Immediate surgical consultation if any GI signs or symptoms
34
Q

If patient presents with possible toxidrome, what should your treatment approach be?

A
  1. Stabilize patient (ABCs)
  2. Contact poison center
  3. DDD (disability, drugs, decontamination)
35
Q

What are two primary problems related to impaired ventilation in drowning?

A
  • Hypoxemia

- Acidosis

36
Q

What occurs in a “wet drowning”?

A

Aspiration of water into the lungs

Dilution/washout of surfactant –> Diminished gas transfer across alveoli –> Atelectasis –> Ventilation-perfusion mismatch

***More common

37
Q

What occurs in a “dry drowning”?

A
  • Occurs when laryngospasm leads to hypoxia and LOC

- There is NO fluid in the lungs

38
Q

If a patient experiences a near-drowning and is alert or mildly obtunded at ED presentation, what is the likely prognosis?

A

May experience full recovery

39
Q

If a patient experiences a near-drowning but is comatose, receiving CPR in route to the ED, or has fixed and dilated pupils and no spontaneous respirations, what is the likely prognosis?

A

Very poor prognosis

Up to 60% die and those that do survive will likely experience long-term neurological damage

40
Q

What defines a near-drowning?

A

Survival > 24 hours post drowning event

41
Q

What defines a secondary drowning?

A

Cause of drowning was due to other condition such as seizure, head trauma, hypothermia, cardiac arrhythmia, alcohol/drugs, syncope, etc.

42
Q

If a patient survives a near-drowning but aspirated a large volume of water, what could they be at risk for?

A
  • Significant hemolysis

- Cardiac arrhythmia

43
Q

What circumstances are associated with a poor prognosis in regards to drowning?

A
  • Duration of submersion > 5 minutes (most critical factor)
  • Time to effective basic life support > 10 minutes
  • Resuscitation duration > 25 minutes
  • Age > 14 years
  • GCS < 5
  • Persistent apnea and requirement of cardiopulmonary resuscitation in the ED
  • Arterial blood pH < 7.1 upon presentation
44
Q

What is the goal if neonate/infant presents with a fever without any source?

A

Identify occult systemic bacterial infections such as PNA, UTI, bacteremia, herpes-virus 6, meningitis

45
Q

What classifies a fever in neonates and infants?

A

Rectal temp > 38.3C (101F)

46
Q

What is the management of an ill-appearing child that is 3 to 36 months of age who presents with a fever but no known source?

A
  • Labs
  • UA - cath with C&S
  • Cultures: blood, urine, stool, and CSF if meningitis suspected
  • CXR if tachypnea or leukocytosis
  • Parenteral abx
  • Admit
47
Q

What is the management of a neonatal fever (< 3 months old)?

A
  • Full septic workup
  • Consider early administration of empiric abx
  • Consider trial of NSAIDs
  • Admission pending culture results
48
Q

What is the management for a well appearing, but not completely immunized infant/young child who presents with a fever with no known source?

A
  • CBC with diff
  • Blood cultures if WBC > 15,000
  • UA (cath in girls < 24 months, uncircumcised boys < 12 months, circumcised boys < 6 months)
  • CXR if leukocytosis > 20,000
49
Q

What is the management for a well appearing and completely immunized infant/young child who presents with a fever with no known source?

A
  • UA and culture (cath in girls < 24 months, uncircumcised boys < 12 months, circumcised boys < 6 months)
50
Q

When would you treat for a UTI in an infant or young child presents with a fever with no source.

A

Fever > or = 39C and abnormal UA

Peds II (11 decks)

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