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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
What is the management of a grossly deformed/displaced fracture?
Will require closed/open reduction or possible fixation as it could compromise neurovascular structures
26
Osteomyelitis most commonly affected what age group? Which bones are most often affected? What is the most common pathogen?
Under age 5 Long bones Staph. aureus
27
What are some symptoms associated with osteomyelitis?
- Fever - Bone pain - Swelling - Redness - Guarding - Focal tenderness during exam
28
What is the study of choice for osteomyelitis?
MRI
29
What will be seen on x-ray in an individual with osteomyelitis?
Early: soft tissue swelling 10-14 days later: Bone destruction with lytic lesions
30
What is the treatment for osteomyelitis?
- Supportive care - IV abx (Vancomycin, Clindamycin, Rocephin) - Surgical drainage and debridement - Hyperbaric oxygen therapy
31
What are some symptoms associated with an esophageal foreign body?
- Refusal to eat - Vomiting - Choking, coughing, stridor - Neck or through pain, inability to swallow - Increased salivation - Foreign body sensation in chest
32
What is the procedure of choice for removing a foreign body from the esophagus? Trachea?
Esophagus - Endoscopy Trachea - Bronchoscopy
33
What is the treatment for a swallowed button battery?
- 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
If patient presents with possible toxidrome, what should your treatment approach be?
1. Stabilize patient (ABCs) 2. Contact poison center 3. DDD (disability, drugs, decontamination)
35
What are two primary problems related to impaired ventilation in drowning?
- Hypoxemia | - Acidosis
36
What occurs in a "wet drowning"?
Aspiration of water into the lungs Dilution/washout of surfactant --> Diminished gas transfer across alveoli --> Atelectasis --> Ventilation-perfusion mismatch ***More common
37
What occurs in a "dry drowning"?
- Occurs when laryngospasm leads to hypoxia and LOC | - There is NO fluid in the lungs
38
If a patient experiences a near-drowning and is alert or mildly obtunded at ED presentation, what is the likely prognosis?
May experience full recovery
39
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?
Very poor prognosis Up to 60% die and those that do survive will likely experience long-term neurological damage
40
What defines a near-drowning?
Survival > 24 hours post drowning event
41
What defines a secondary drowning?
Cause of drowning was due to other condition such as seizure, head trauma, hypothermia, cardiac arrhythmia, alcohol/drugs, syncope, etc.
42
If a patient survives a near-drowning but aspirated a large volume of water, what could they be at risk for?
- Significant hemolysis | - Cardiac arrhythmia
43
What circumstances are associated with a poor prognosis in regards to drowning?
- 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
What is the goal if neonate/infant presents with a fever without any source?
Identify occult systemic bacterial infections such as PNA, UTI, bacteremia, herpes-virus 6, meningitis
45
What classifies a fever in neonates and infants?
Rectal temp > 38.3C (101F)
46
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?
- Labs - UA - cath with C&S - Cultures: blood, urine, stool, and CSF if meningitis suspected - CXR if tachypnea or leukocytosis - Parenteral abx - Admit
47
What is the management of a neonatal fever (< 3 months old)?
- Full septic workup - Consider early administration of empiric abx - Consider trial of NSAIDs - Admission pending culture results
48
What is the management for a well appearing, but not completely immunized infant/young child who presents with a fever with no known source?
- 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
What is the management for a well appearing and completely immunized infant/young child who presents with a fever with no known source?
- UA and culture (cath in girls < 24 months, uncircumcised boys < 12 months, circumcised boys < 6 months)
50
When would you treat for a UTI in an infant or young child presents with a fever with no source.
Fever > or = 39C and abnormal UA

Peds II (11 decks)

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