Paeds - accidents Flashcards
If a pt after head injury and had been in a high speed RTA, how would you manage them?
1) ABC - resus
2) If they have no other issues (vomit X3/impaired consciousness/amnesia/seizure/NAI)
the observe for 4 hours
If you decide to observe a head injury patient for 4 hours due to only 1 minor sign of potentially serious injury: what are you observing for?
- Regularly monitor GCS
- Focal neuro signs
- Seizures
If a patent with head injury, suffered a seizure after the injury, how would you manage them? They have no significant PMH
Post traumatic seizure in the absence of a history of epilepsy –> CT within 1 hour!!
Define concussion
Transient + reversible LOC
How does an infant with haematoma present differently to an older child and why
Sutures haven’t yet fused
Thus ICP doesn’t increase initially w haematoma
May present with shock first
What signs would make you worry about a potentially serious head injury and immediately refer for urgent CT?
- Post-traumatic seizure w/o epilepsy hx
- Basilar skull fracture (panda eye, blood from ear, mastoid bruising)
- ?NAI
- Open fracture
- Deteriorating GCS
What one piece of advice MUST be given to parents on discharge following a head injury
MONITOR FOR 24 HOURS - if deterioration –> come back (extradural haematoma)
Advice to parents on discharge after head injury
Monitor 24 hours!!!
- Can give paracetamol + ice pack
- Return to school once feeling better
- Avoid contact sports for 3 weeks
- Avoid NSAIDs
- Avoid sleeping pills/etoh/drugs
1% Surface area
palms + adducted fingers
Difference btw partial and full thickness skin burn
Partial = painful + pink full = painless, white
When to involve a burn specialist
10% surface area partial thickness
5% surface area full thickness
- Face/mouth/perineum/hands
Mx of paediatric burns - 4 points
1) Rehydrate
2) wound care
3) Analgesia - consider IV opioids
4) ?tetanus boost
Which household product can cause constricted pupils if OD
Organophosphates (eg in insecticides)
2 poisons which can increase RR
aspirin
carbon monoxide
4 drugs which cause hypotension
Beta blockers
Iron
TCA
Opiates
Initial management of suspected poisoning
Stabilise patient + TOXBASE
= check for toxicity severity + recommended duration of monitoring
how is activated charcoal given
Orally or NGT
If oral, can disguise taste in cola
useful Ix for alcohol poisoning
Plasma EtOH level + glucose
useful 4 Ix for paracetamol poisoning
Plasma paracetamol level
Cr
LFTs
PTT
Tx of iron poisoning
Desferrioxamine
2 useful Ix for iron poisoning
Serum iron level
X-Ray = # of tablets
which drug, if OD’d, is plasma level monitoring useless
TCAs (eg imipramine)
useful ix for battery ingestion
Chest and abdo x-ray
what is TOXBASE?
Database w drug toxicities and recommended duration of monitoring
3 causes of lead poisoning
Surma
Exhaust fumes
Chewing paint
2 potential Ddx for pica?
IDA
lead poisoning
in any suspected non-accidental head injury, what ix must be done
CT + MRI head
skeletal survey
coagulation screen
Ophthalmology review
Important documentation in ?NAI
- Interaction between child + carers
- Body map
- Plot growth chart
how may a child’s behaviour manifest in abuse?
Infant: FTT or developmental delay Social withdrawal/apathy ASB bed-wetting faecal incontinence depression, anxiety,
how may a child’s behaviour manifest in abuse?
Infant: FTT or developmental delay Social withdrawal/apathy ASB bed-wetting faecal incontinence Older child: depression, anxiety,
