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Peds Exam 2 > Lecture 9: Emergencies > Flashcards

Lecture 9: Emergencies Flashcards

1
Q

MC trauma by age group:

  1. < 1 y/o
  2. 1-4 y/o
  3. > 4 y/o

MC type of trauma

A
  1. < 1 y/o = suffocation
  2. 1-4 y/o = drowning
  3. > 4 y/o = MVA

MC type of trauma = blunt injuries

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2
Q

How do normal peds vitals change w/increasing age

A

BP incr w/age

HR + RR decr w/age

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3
Q

What is include in the Primary eval for trauma pts? What is main purpose of it?

A

ABCDEs

purpose = identify life-threatening situations

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4
Q

A = airway

what are the 4 things to consider w/pts airway?

A
  1. patency
  2. C spine
  3. suction secretions
  4. consider intubation
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5
Q

B = Breathing

What are you assessing?

How to monitor?

What should be given?

A

assess RR, color, WOB, mental status

Monitor: end tidal CO2, ABG/VBGs

Given 100% high flow O2

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6
Q

C = circulation

What assessing?

What should be started/given?

What is given for excess blood loss?

A

HR, pulse quality, color, skin turgor, mental status

Start IV access w/2 large bores –> fluids

excess blood loss–> blood products

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7
Q

What are the first signs of HoTN/shock?

A

Vital signs

- cool and tachycardia

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8
Q

D = Disability/Neuro Status

what assessing?

what do you do if decr consciousness

what do you do if incr ICP

A

pupillary fx, mental status (AVPU)

optimize oxygenation, ventilation, circulation

elevate HOB, hyperventilate

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9
Q

What is the only difference from GCS scale from adults to peds

A

Verbal response in peds:

5 = coos, babbles,
4 = irritable cry 
3= cries to pain 
2 = moans to pain 
1 = no response
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10
Q

E = exposure

What 2 things do you do for this during primary eval?

A

remove all clothing

prevent heat loss

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11
Q

When to place in C-spine (5)

A
  1. GCS > 13, head on MOA
  2. Neck pain
  3. AMS
  4. Intoxicated
  5. Distracting injury

“Geena needs AID”

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12
Q

What 4 regions for the FAST exam?

A
  1. LUQ
  2. RUQ
  3. subxiphoid region
  4. pelvis region
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13
Q

What is included in the secondary eval? (Nemonic)

A 
Allergies 
Meds 
PMH/preg
Last meal 
Events/Enviro leading to injury
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14
Q

Drowning definition

what does it cause?

A

death w/in 24 hrs of event

respiratory impairment

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15
Q

Tx of drowning pt in pre-hospital setting:

When doing CPR wha should be done first?

What to do if pt has apnea, cyanosis, hypoventilating, have labored respirations

What to do if pt has slow cap refill, cool extrem, AMS

A

ventilations –> compressions

apnea, cyanosis, hypoventilating, have labored respirations –> intubate

slow cap refill, cool extrem, AMS (signs of shock) –> give fluids

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16
Q

Tx of drowning pt in ER setting:

When to intubate (3)

What to do if bedside glucose shows hypoglycemia? hyper?

A

Intubate if:

  1. Cant protect their airway
  2. PO2 < 60 or O2 sat < 90% on O2
  3. PCO2 > 50

hypoglycemia –> D5 1/2 NS
hyper –> fluids (observe)

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17
Q

Tx of drowning pt in ER setting (Hypothermia Tx):

How to perform internal core rewarming (2)

How long continue til (goal core temp)?

What 2 things indicate better outcomes for drowning?

A

internal core warming:

  1. heated IV fluids..or humidified O2 via trach tube
  2. heated irrigation

Continue Tx til core body temp 32-35 C

Better outcomes:

  1. Cold water hypothermia resuscitation
  2. Hypothermia before asphyxia
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18
Q

Tx of drowning pt in ER setting (Hypothermia Tx):

How to perform internal core rewarming (2)

How long continue til (goal core temp)?

What 2 things indicate better outcomes for drowning?

A

internal core warming:

  1. heated IV fluids..or humidified O2 via trach tube
  2. heated irrigation

Continue Tx til core body temp 32-35 C

Better outcomes:

  1. Cold water hypothermia resuscitation
  2. Hypothermia before asphyxia
19
Q

Tx of drowning pt in inpatient setting:

if drowning pts are Asx what should be done?

When do Sxs appear in most pts

When does irrev CNS injury occur

A

observe for 8 hrs

most have sxs w/in 7 hrs

irrev CNS injury w/ 3-5 min of hypoxemia

20
Q

what is MC ingestion? concerning?

A

coins = MC ingestion

- harmless

21
Q
  1. acute multi-organ system dysfx
  2. AMS
  3. Resp/CV compromise
  4. Metabolic Acidosis
  5. New onset seizures
  6. Questionable clinical picture
A

Presentations/reasons to suspect toxic exposure

22
Q

Supportive Tx in toxic exposures

  1. ABCs –>
  2. HoTN –>
  3. HTN –>
  4. VTach –>
  5. Bradycardia–>
  6. Drug assoc agitation –>
  7. Seizures –>
A
  1. ABCs –> O2, fluids
  2. HoTN –> IV fluids
  3. HTN –> BZs, nitroprusside
  4. VTach –> PALS (promcamermide, Amiodarone, Cardioversion)
  5. Bradycardia–> atropine
  6. Drug assoc agitation –> BZs
  7. Seizures –> BZs then barbs
23
Q

OD Tx:

  1. Opioid→
  2. Acetaminophen→
  3. TCA→
  4. Insecticide→
    GI decontamination→
A
  1. Opioid→ naloxone
  2. Acetaminophen→ N-Acetylcysteine
  3. TCA→ sodium bicarbonate
  4. Insecticide→ atropine

GI decontamination- activated charcoal

24
Q

3 emergent ingestions?

Dx?

A
  1. Button batteries
  2. Magnets
  3. sharped pointed objects

Dx = XR (2, 3)

25
Q

When are magnets a concern/why?

what are 2 complications of sharp pointed objects?

A

multiple magnets→ erosion→ perforation

sharp objects

  1. perforation
  2. abscess
26
Q

Cause of most animal bites?

Species responsible for:
animal bites
human bites

A

dog bites = MC

animal bites –> pasturella
human bites –> Eikenella corrodens

27
Q

What is 1st line Tx for human and animal bites? length?

When should you give Tetanus IM?

Note: also clean w/soap or virucidal agent w/NS

A

Augmentin 3-5 days

Give Tetanus IM if > 5

28
Q

When is rabies vaccine given?

When is rabies immune globulin given?

A

Rabies:
- Vaccine = Day 0, 3, 7, 14

  • immune globulin on day of bite (day 0)
29
Q

When should HIV ppx be started?

When should Hep B ppx be started

A

HIV ppx if blood in saliva

Hep B ppx if bitter is HBsAg+

30
Q

Dehydration:

2 kg wt loss = 2L fluid loss

when is it considered severe?

A

> 10% wt loss over 24 hrs = severe

31
Q

Typical 1st sign of dehydration

later vital sign?

Other PE signs

  1. Poor skin turgor, delayed cap refill, deep respirations
  2. sunken anterior fontanelle
  3. dry mucous mem
  4. cool/mottled extrem
  5. frank shock
  6. incr thirst, irritability
  7. decr UOP
  8. Tearing, lethargy
A

1st sign = tachycardia

HoTN = late sign

32
Q

Labs in Dehydration

  1. Serum Bicarb
  2. blood BUN
  3. Na, K
  4. ADH
  5. specfic gravity
A
  1. Serum Bicarb: < 17
  2. incr blood BUN
  3. high Na, low K
  4. incr ADH secretions
  5. higher sp gravity (> 1.015)
33
Q

Tx for dehydration:

  1. PO fluids→
  2. IV fluids→

Fluid rate if emergent?

A
  1. PO fluids→ PO pedialyte 5 ml/2 min
  2. IV fluids→ cystalloid isotonic saline (.9%)

Fluid rate if emergent - rapid bolus infusion at 20 mL/kg

34
Q

Total daily fluid requirements for dehydration Tx… name of the rule

how to calc?

A

100-50-20 rule

  1. 1st 10 kg of wt –> 100 ml/kg/day
  2. 2nd 10kg of wt –> 50 ml/kg/day
  3. rest of wt –> 20 ml/kg/day

add up then take total/24 = rate

35
Q

Definition of SIDS

why is peak 2-4 mo

A

sudden death of an infant < 1 y/o w/unexplained cause

2-4 mo = varying sleep/wake cycles

36
Q

Prevention of SIDS (7)?

A
  1. room sharing
  2. pacifier use
  3. breastfeeding
  4. Fan (keep cool)
  5. immunize
  6. firm mattress
  7. SLEEP SUPINE and TUMMY TIME
37
Q

Prevention of SIDS (7)?

A
  1. room sharing
  2. pacifier use
  3. breastfeeding
  4. Fan (keep cool)
  5. immunize
  6. firm mattress
  7. SLEEP SUPINE and TUMMY TIME
38
Q

2 main drugs used for analgesia in peds patients?

A
  1. Acetaminophen (tylenol)
    - 15 mg/kg/dose
    - Q4H
  2. Ibuprofen (motrin, advil)
    - 10 mg/kg/dose
    - Q6H
39
Q

2 meds used for more severe pain

A
  1. IV Ketorelac (toradol)

2. IV morphine

40
Q

3 meds for LOCAL analgesia

A
  1. LET topical gel (lido- epi- tetracaine)
  2. Lido +/- epi or bicarb
  3. Bupivicaine
41
Q

Where can Epi not be used

what types of procedures are LET and bupivicaine good for?

A

fingers, nose, penis and toes,

LET–> open procedure

Bupivicaine–> abscesses

42
Q

1st line med for minimal sedation

A

IN midazolam (versed)

43
Q

1st line med for moderate sedation

what is mod sedation usu reserved for (4)?

A

IV ketamine

  1. ortho reductions
  2. tongue lacs
  3. extensive lacs
  4. MRI/CT

Peds Exam 2 (9 decks)

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