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Unit 2 Peds II > L6: Basic pediatric emergencies > Flashcards

L6: Basic pediatric emergencies Flashcards

1
Q

Cushing’s triad (increased ICP)

A

wide pulse pressure
bradycardia
abnormal respirations

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2
Q

Battle sign

A

basilar skull fracture:

bruise behind ear

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3
Q

Periorbital ecchymosis

A

basilar skull fracture:

raccoon eyes

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4
Q

Hemotympanum, otorrhea/rhinorrhea (CSF)

A

other signs of basilar skull fracture

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5
Q

Basal skull/skull base is

A

sphenoid + temporal + occipital + ethmoid bones

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6
Q

Concerning head injury signs

A

excessively sleepy or hard to arouse
vomiting
irritability

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7
Q

What can a head xray tell you

A

no brain visualization

air-fluid levels in sinus

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8
Q

PECARN algorithm (for when to CT) group A

A
  1. CT recommended for:
    GCS=14 or lower, other signs of AMS, palpable skull fracture,
  2. Observation vs CT for: occipital, parietal, or temporal scalp hematoma, LOC > 5 secs, severe MOI, not acting normally
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9
Q

PECARN algorithm (for when to CT) group B

A
  1. CT recommended for:
    GCS=14 or lower, other signs of AMS, signs of basilar skull fracture
  2. Observation vs. CT for:
    History of LOC, vomiting, severe MOI, severe HA
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10
Q

GCS less than __ always gets a CT

A

14

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11
Q

“the reality” guideline for CT

A 
GSC <15 or AMS
Skull fracture
Vomiting > 3 times, seizure
< 2 years old
Non-frontal scalp hematoma
LOC > 5 secs
Severe MOI
Not acting right/lethargic
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12
Q

Most common bleed

A

subarachnoid hemorrhage

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13
Q

CT of subdural hematoma

A

Crescent-shaped, usually parietal area

Crosses suture lines

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14
Q

CT of epidural hematoma

A

Elliptical shape

Does not cross suture line

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15
Q

CT of subarachnoid hemorrhage

A

Small, dense “slivers”
Blood in cisterns, sulci, and fissures
Blood in CSF
May take time to evolve and be visible on CT

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16
Q

bleed with the worst prognsosis

A

subdural hematoma

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17
Q

Can kids sleep if they’ve got a head injury?

A

Yes, if they’re not bleeding and don’t have a fracture.

Monitor: behavior change, vomiting, decreased arousability, seizures, irritability

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18
Q

Management for a head injury associated with bleeding or skull fracture

A

Neuro consult
Admit to PIC
evaluation for surgery vs. observation with repeat imaging

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19
Q

Concussion definition

A

Traumatically induced alteration in mental status, with or without LOC
Direct blunt force→ stretching/shearing of axons

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20
Q

Concussion symptoms

A 
amnesia
confusion
blunted affect
distractibility
delayed response
emotional lability
visual changes
repetitive speech pattern
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21
Q

How long does it take for a concussion to resolve?

A

7-10 days

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22
Q

Post-concussive syndrome

A

sx >3 months

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23
Q

Chronic traumatic encephalopathy

A

Multiple concussions → permanent change in mood, behavior, pain

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24
Q

Second impact syndrome

A

2nd concussion within weeks → brain swelling, herniation, death
Children at increased risk

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25
Q

Concussion management

A

No same day return to play: must be completely symptom free to return, no sports 1-2 weeks

Physical and cognitive rest

Slow advancement, structured return-to-play protocols

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26
Q

Who to CT with a concussion?

A

Severe/prolonged/worsening HA

Vomiting

deterioration in mental status → Emergent CT

ETOH/substance

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27
Q

Are C spine injuries common in peds?

A

NO

most commonly from car crashes

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28
Q

<8 years old c-spine injuries

A

falls

C2-C4

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29
Q

SCIWORA: Spinal Cord Injuries Without Radiographic Abnormalities

A

More commonly seen in adolescents

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30
Q

> 8 years old c-spine injuries

A

sports

C5-C7

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31
Q

Concerning symptoms for C-spine injuries

A

Bilateral pain
Neuro deficits
Torticollis (neck muscles contract on one side)
Bony abnormalities

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32
Q

Cervical spine injuries imaging of choice

A

MRI

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33
Q

When managing fractures make sure to

A

always document neurovascular status (pulse, sensation) before and after interventions

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34
Q

Management of a compound, open fracture

A

splint/dress
IV abx
ortho consult

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35
Q

Management of a non-displaced open fracture

A

repair laceration
splint
PO abx
outpatient ortho follow up

36
Q

Management of a grossly deformed fracture

A

may compromise neurovascular structures → ortho consult in ED → closed/open reduction, possible fixation w/plates/screws

37
Q

Cellulitis/erysipelas management

A

Warm wet compress
Topical: Bactroban
Oral: Keflex or bactrim
Failed outpatient treatment: admit, labs, IV abx

38
Q

Cellulitis

A

deeper dermis and subcutaneous fat

39
Q

Erysipelas

A

upper dermis and superficial lymphatics

40
Q

Both cellulitis and erysipelas have similar pathophysiology:

A

Breaches in skin→ bacterial entry→ skin infection → erythema, warmth, tenderness, induration, +/- fever, N/V/D

41
Q

Osteomyelitis

A

Hematogenous spread of infection to bone→ bone destruction

42
Q

Osteomyelitis is most common in

A

males <5

long bones: femur, tibia, humerus

43
Q

most common causes of osteomyelitis

A

**Staph aureus (most common, MRSA)

Strep pneumoniae
Strep pyogenes

44
Q

Osteomyelitis presentation

A 
Fever
bone pain
swelling
redness
guarding
focal tenderness during exam
45
Q

Osteomyelitis xray

A

Early: soft tissue swelling

10-14 days later: bone destruction with lytic lesions

46
Q

Best imaging for osteomyelitis

A

MRI

shows marrow edema, abscesses

47
Q

Empiric abx for osteomyelitis

A

vancomycin
clindamycin
rocephin

change meds once culture and sensitivity comes back

48
Q

other management of osteomyelitis

A

Surgical drainage, debridement

Hyperbaric oxygen therapy (100% O2 chamber)

49
Q

eye toxic exposure requires

A

pH testing, flushing, retest until normal

50
Q

lipd-soluble toxins and skin exposure

A

follow flushing with soap

51
Q

compounds for enhanced elimination of toxins

A

Activated Charcoal
Urine Alkalization
Diuresis
Dialysis/hemoperfusion

52
Q

if a patient ingested sustained release medication

A

whole bowel irrigation

53
Q

Ipecac

A

has to be used within 30 mins for GI toxins

not recomended

54
Q

if a patient has ingested mild toxins that only cause irritation/corrosion

A

simple dilution

55
Q

activated charcoal is effective for the following poisonings

A 
carbamazepine
barbiturates
dapsone
quinine
theophylline
\+/- digoxin and phenytoin
56
Q

Sites of foreign body obstruction (narrowings)

A

cricopharyngeal narrowing to upper esophageal sphincter
tracheal bifurcation
aortic notch
lower esophageal sphincter

57
Q

If a foreign body passes the pylorus

A

it usually continues to rectum without complications

58
Q

an aspirated vegetable could lead to

A

intense pneumonitis

59
Q

With esophageal foreign bodies, make sure of

A

patency of the airway

60
Q

Consult if an esophageal foreign body is…..

A 
Sharp/elongated
Button batteries
Perforation
>24 hours
Airway compromise
61
Q

Ingested magnets can cause

A

volvulus and bowel perforations

appear as multiple foreign bodies

62
Q

Does a negative chest, neck, abdomen xray rule out esophageal foreign body?

A

no

63
Q

Coin above cricopharynxgeus muscle

A

consult ENT

64
Q

Coin below cricopharynxgeus muscle

A

consult GI

65
Q

Coin below esophageal sphincter

A

leave it

66
Q

what kind of batteries have the worst outcome

A

lithium batteries

67
Q

Mercuric oxide batteries have a risk of

A

fragment → heavy metal poisoning

68
Q

Why is a button battery dangerous

A

Extremely rapid action of alkaline substance on mucosa, pressure necrosis, residual charge → esophageal burns and perforation in hours

69
Q

Button battery management

A

EMERGENT removal if in esophagus

Passed esophagus→ observe→ remove if hasn’t passed pylorus after 24-48 hours
Usually excreted within 48-72 hour

Observed to split in GI tract→ blood and urine mercury levels

70
Q

Which age groups are most at risk of drowning?

A

<4 years

15-24 years

71
Q

How much liquid is aspirated in a drowning?

A

<4 mL

72
Q

Drowning MOA

A

impaired ventilation: 1. Hypoxemia 2. Metabolic and/or respiratory acidosis
Hypoxemia → CNS damage → arrhythmias, ongoing pulmonary injury, reperfusion injury, multi-organ dysfunction

73
Q

Dry drowning

A

no fluid in lungs.

Laryngospasm→ hypoxemia → LOC

74
Q

Wet drowning

A

more common, fresh or saltwater.
Aspiration of water into lungs → dilution/washout of surfactant→ diminished gas transfer across the alveoli → atelectasis → V/Q mismatch

75
Q

Near drowning

A

survival 24 hours post event

Severe brain damage occurs in 10-30% of peds

76
Q

Consider child abuse in a near drowning if….

A

<6 months or toddlers with atypical presentation

77
Q

Poor prognosis after a near drowning

A 
***
Submersion > 5 mins
Time for life support > 10 mins
Resuscitation duration > 25 mins
>14 years
 Glasgow coma scale <5
Apnea + cardiopulmonary resuscitation
Arterial blood pH <7.1 
***
78
Q

Non-primary drowning

A

follows primary event such as: seizures, head/spine trauma, cardiac arrhythmias, hypothermia, alcohol and drug ingestion, syncope, apnea, hyperventilation, suicide, hypoglycemia

79
Q

Secondary drowning

A

may cause death up to 72 hours after near drowning incident

Fresh water drowning→ ingestion→ hemodilution

Large volume of water aspirated:
Significant hemolysis
Electrolyte disturbance→ cardiac arrhythmias

80
Q

Near drowning treatment

A 
Pre-hospital care is critical
Assist ventilation→ O2 95%
Warmed isotonic IV fluids, warming blankets
CXR and repeat at 6 hours
Admit for observation
Address injuries
81
Q

Fever without a source is defined as

A

Rectal temperature >38 C/100.4

82
Q

Who to work up with a fever without a source regardless of appearance

A

Infants < 3 months

83
Q

Who gets a urinalysis if they have a fever without a source?

A

girls <24 months

circumcised boy <6 months

uncircumcised <12 months

Ill-appearing children 3months-3 years

All children < 3 months

84
Q

Treat for a UTI if

A

> 3 months, completely immunized, Fever >39, and abnormal ultrasound

85
Q

when to do a CXR on a ill appearing child 3 months-3 years

A

tachypnea or leukocytosis (>20,000)

86
Q

when to do a CXR on a well-appearing child >3 months

A

leukocytosis (>20,000)

Unit 2 Peds II (5 decks)

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