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Peds Exam 2 > Lecture 8 - Emergencies > Flashcards

Lecture 8 - Emergencies Flashcards

1
Q

What is the leading cause of ED visits?

A

injuries

90% blunt

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2
Q

What are the expected vitals for a 2 month old?

A

0-3 months

100-150 HR
35-55 RR
65-85/45-55

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3
Q

What are the expected vitals for a 4 month old?

A

3-6 mo

90-120 HR
30-45 RR
70-90/50-65

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4
Q

What are the expected vitals for a 9 month old?

A

6-12 mo

80-120 HR
25-40 RR
80-100/55-65

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5
Q

What are the expected vitals for a 2 year old?

A

1-3 yr

70-110 HR
20-30 RR
90-105/55-70

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6
Q

What are the expected vitals for a 4 year old?

A

3-6 yr

65-110 HR
20-25 RR
95-110/60-75

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7
Q

What are the expected vitals for a 7 year old?

A

6-12 yr

60-95 HR
14 - 22 RR
10-120/60-75

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8
Q

What are the expected vitals for a 13 year old?

A

> 12yr

55-85 HR
12-18 RR
110-135/65-85

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9
Q

ABCDE

A 
Airway 
Breathing 
Circulation 
Disability (Neuro scale) 
Exposure
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10
Q

AMPLE

A 
allergies
medications
past medical hx
last meal 
events leading to injury
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11
Q

What is the most common cause of death d/t traumatic injury?

A

MVA

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12
Q

What questions do you need to ask when you have an MVA pt?

A 
event
speed
location
seatbelt
broken glass
airbag deployment 
LOC
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13
Q

Definition of drowning

A

A process resulting in primary respiratory impairment from submersion or immersion in a liquid medium

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14
Q

Who has the highest prevalence for drowning?

A 
Males 
AA
1-5 y/o 
Low SE status 
Southern states
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15
Q

What is the mechanism of drowning?

A

Panic —> breath holding —> reflex inspiratory effort —> hypoxemia —> end organ effects (icshemia)

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16
Q

Why is drowning worse in children?

A

High surface area:mass
Decreased subq fat
Limited thermogenic capacity

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17
Q

Moderate vs severe hypothermia

A

Moderate = 32-35 —> increases O2 consumption

Severe = <32C —> decrease cellular metabolic rate

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18
Q

What is the goal of prehospital drowning treatment?

A

Rapid restoration of oxygenation, ventilation and circulation

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19
Q

Is C-spine recommended for drowning pts?

A

No

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20
Q

Afterdrop

A

Initial drop in temp during initial warming of a drowning pt

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21
Q

What is the ED treatment for drowning?

A

Remove wet clothing, dry skin
External warming:
-warm blankets, plumbed garments, heating pads, radiant heat, forced warm air
Internal warming:
-warmed IV fluids or humidified oxygen via tracheal tub, heated irrigation of peritoneal and pleural cavities
Continue until core temp reaches 33-35

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22
Q

_____ min of hypoxemia = irreversible CNS injury

A

3-5 min

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23
Q

When should you suspect toxic exposure?

A 
Acute onset of multi-organ system dysfunction 
AMS 
Respiratory/CV compromise 
Metabolic acidosis 
Seizure 
Questionable clinical picture

Suspect abuse if <1y/o

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24
Q

What are the most common ingestions in children?

A

Coins

Keep in mind the single load laundry packet

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25
Q

What is the phone number for poison control?

A

800-222-1222

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26
Q

What toxicology screens can we run?

A

Utox, serum acetaminophen levels, salicylate levels

27
Q

If a child is having a seizure secondary to poisoning, what is the treatment?

A

benzos, then barbituates

benzos are also used to HTN and drug associated agitation associated with benzos

28
Q

What is the antidote treatment for opioid poisoning?

A

Naloxone

29
Q

What is the antidote treatment for acetaminophen poisoning?

A

n-acetylcysteine (mucomyst)

30
Q

What is the antidote for insecticide poisoning?

A

atropine

31
Q

What is the antidote for TCA poisoning?

A

sodium bicarb

32
Q

What do you give a pt for GI decontamination?

A

activated charcoal

33
Q

What do you do for a child who ingested button batteries?

A

surgical consult!

emergent

34
Q

What do you do for a child who ingested magnets?

A

emergent

depends on if its single or multiple

Dx: serial x-rays

Tx: keep away from magnetic material until it passes
Endoscopic removal if possible

35
Q

What do you do for a child who ingested sharp pointed objects?

A

straight pens, needles, straightened paperclip, bones, toothpick

Risk: perforation, retropharyngeal abscess

Dx: X-ray

Tx: watchful waiting, OR

36
Q

Epi of bites

A

Dogs (60-90%)
Cats (5-20%)
Humans (2-3%)

20-35 deaths annually in the US

Animals - Pasterurella
Humans - Eikenella corrodens

37
Q

What is the assessment for a bite wound?

A

LA
identify what type of injury it is: skin, muscle, tendon, NV

Xray/US: foreign body or deep bite near bone or joints

Head CT: head injury, <2 years

Infection concern: gram stain aerobic and anaerobic cultures before ABX

38
Q

What is the management of a bite wound?

A 
I and D 
Primary closure if: 
- cosmetically important (ex. facial) 
-clinically uninfected
-<12 hours old, <24 hours on the face

When NOT to close:

  • crush injuries
  • hand or feet
  • cat or human bites (unless on the face)
  • immunocompromised
39
Q

When are you NOT supposed to close a bite wound?

A
  • crush injuries
  • hand or feet
  • cat or human bites (unless on the face)
  • immunocompromised
40
Q

What is the treatment for bites?

A

cleanse with soap and/or virucidal agent with NS

tetanus if >5 years

ABX animal bites
-Augmentin 20mg/kg per dose BID for 3-5 days

ABX human bites
-Augmentin
-Unaysn (ampicillin -sulbactam)
50mg/kg per dose QID for 3-5 days

41
Q

Rabies vaccine

A

Animal bite prophylaxis

4-1ml IM dose of HDCV or PCEC vaccine in deltoid or thigh

Days 0, 3, 7, 14

42
Q

Rabies Immune Globulin (RIG)

A

Animal bite prophylaxis

full dose infusion around bite(s) if possible
remained IM from separate site than vaccine

43
Q

Human bite prophylaxis

A

if blood in saliva:
HIV prophylaxis

if bitter +HbsAg

  • initiate HB vaccine series in all unvaccinated
  • -Hep B immune globulin
  • -Hep B vaccine
44
Q

What are signs and sxs of dehydration?

A

Tachycardia, hypotension

Poor skin turgor, delay in cap refill, deep respirations

cool and mottled extremities, frank shock

decreased OCP

increased thirst, decreased tearing, lethargy irritability

45
Q

What labs do you draw for a pt with dehydration?

A 
serum electrolytes 
serum bicarb <17mEq/L
increased blood BUN
serum sodium and potassium 
ADH secretion 
urine sodium, osmolality and specific gravity
46
Q

What is the treatment for dehydration?

A

5ml/2min
Goal: 10ml/kg of body weight

IV crystalloid isotonic (0.9%) saline

never use hypo/hyper tonic crystalloids
added dextrose shows no benefit

47
Q

What are the fluid rates for someone with severe dehydration?

A

rapid (bolus) infusion of 20ml/kg of isotonic 0.9% saline in 10-30 min

moderate dehydration - rapid rehydration of 60ml/kg vs 20ml/kg over an hour

48
Q

How do you calculate the daily fluid requirement?

A

1st 10kg - 100ml/kg/day
2nd 10kg - 50ml/kg/day
remainder of bodyweight 20ml/kg/day

rate (ml/hour) = total daily requirement divided by 24

49
Q

SIDS

A

sudden infant death syndrome

death of an infant <1yo, unexplained through case investigation, autopsy, and examination

50
Q

What is the leading cause of infant mortality between 1 month and 1 year in US?

A

SIDS

peaks 2-4 months, 90% before 6 months

51
Q

What are risk factors for SIDS?

A

maternal:
- younger, smoker, drug abuse, delayed prenatal care, UTI/STIs

neonatal:
-preterm, low weight for GA

infant:
- prone sleeping position, sleeping on soft surface or with increased accessories, bed-sharing, overheating, sibling of SIDS victim

52
Q

What are preventative factors for SIDS?

A 
room-sharing
pacifier use
breastfeeding
fan use
immunizations
firm mattress
53
Q

What analgesics are used in children?

A

acetaminophen (15mg/kg/dose Q4H)

Ibuprofen (10mg/kg/dose Q6H)

IN Fentanyl (1-2mcg/kg)

Ketoralac (Toradol)
(0.5mg/kg - max dose 30mg)

Morphine (0.2-0.5mg/kg, max 10 mg every 3-4 hours)

54
Q

LET

A

lidocaine-epinephrine-tetracaine

topical anesthetic –30 min prior to procedure

55
Q

What LAs can you use for children?

A

LET topical gel

Lidocaine

Bupivicaine

56
Q

When do you NOT use lidocaine?

A

fingers, nose, penis, toes

57
Q

What drug do we use for minimal sedation?

A

Midazolam (versed)

IN/PO/IV/IM
sedative ONLY

used prior to starting a procedure

onset of action: 1-3 min (IN)

IN dosing: 0.2mg/kg, max dose 10mg

58
Q

What drug do we use for moderate sedation?

A

usually reserved for ortho reduction, tongue lacerations, extensive lacerations, MRI/CT

IV Ketamine
Analgestic + sedative
loading dose + maintenance PRN
SE: N/V, tachy, HTN, agitation, hallucinations, respiratory suppression

59
Q

What is used for irrigation?

A

50-100mL/cm of laceration length

Normal saline > sterile water

60
Q

When is the tetanus vaccine schedule?

A

2mon, 4mon, 6 mon, 15-18mon, and 4-6 years

if <3 doses Dtap or Tdap
if >3 doses vaccine if >5 years

61
Q

When can kids get cough medicine?

A

no until after the age of 12 years

62
Q

What do you do for a child complaining of a HA?

A

all get a neuro exam

record their BP

63
Q

What must you be sure to keep in mind for a boy with abdominal pain?

A

testicular exam

Peds Exam 2 (11 decks)

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