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Pediatrics > Pediartic Injuries and Poisenings > Flashcards

Pediartic Injuries and Poisenings Flashcards

1
Q

Motor vehicle incidence is most common at what ages?

What factors contribute to this? 3

A

age 15-24
Adolescent drivers more likely to be involved in fatal MVA than adults

  1. Alcohol –
  2. Excess Speed –
  3. No seat belts
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2
Q

Prevention for motor vehicle accidents?

5

A
  1. Safe driving habits
  2. Driver’s education
  3. Safer cars
  4. Safer roads
  5. RESTRAINTS
    - Age-appropriate
    - Properly installed/used
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3
Q

Infants less than 1 and weighing less than 35 pounds should be in what kind of car restraint?

A

an infant-only, rear-facing child safety seat (or a convertible child safety seat turned to face the rear of the vehicle), installed in the back seat.

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4
Q

Ages 1-4 and weighing 20-40 pounds can be in a what kind of car restraint?

Ages 4-6 need what?

A

forward-facing only, or convertible child safety seat, installed in the back seat of the vehicle.

a booster seat installed in the back seat of the vehicle. (Booster seat for children under the age of 6 or less then 60 pounds in MT but varies from state to state).

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5
Q

Prevention of submersion injuries?

3

A

Prevention
SUPERVISION NEAR WATER!
“Two seconds left alone is too long”
1. Fence unguarded pools with self-closing gates
2. Swimming lessons for school-age children
3. Diving safety

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6
Q

What kind of things could cause burn injuries? 4

What things could prevent this? 3

A
  1. House fires
  2. Scalding burns (hot water)
  3. Electrical burns (electrical cords/plugs)
  4. Contact burns (hot appliances, wood-burning stoves)
  5. Keep those pan handles turned towards the rear of the stove top!
  6. Keep water heater set at less than 125 F
  7. Never leave a clothes iron or curling iron unsupervised while it is on
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7
Q 
Hot water causes third degree burns…
1 second?
2 second?
5 seconds?
15 seconds?
A

…in 1 second at 156º
…in 2 seconds at 149º
…in 5 seconds at 140º
…in 15 seconds at 133º.

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8
Q

What is the most common cause of non-fatal injury in children/toddlers?

A

Falls

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9
Q

Child Fall prevention?

7

A

Home safety:

  1. Barriers,
  2. pointed corners,
  3. sharp edges,
  4. closed doors,
  5. inaccessible windows,
  6. bars on apartment windows
  7. NO INFANT WALKERS!
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10
Q

At what age are children highest risk for pedestrian injuries?

A

10-15 years old

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11
Q

Boys at what ages are at highest risk of death from Bicycle injuries?

  • what kind of injuries?
  • Most deaths involve what?
A

Boys ages 5-14 highest risk of death

  • Head trauma most serious injuries
  • Most deaths involve crash with motor vehicle
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12
Q

Foreign Bodies/Choking: Greatest risk period?

Prevention Strategies?
5

A
  1. Greatest risk period: 1st year of life
  2. Prevention
    - Age-appropriate toys
    - Food preparation (size of pieces, cut anything that’s round into odd shape)
    - Liquid medications
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13
Q

Toy-Related Injuries

5

A
  1. Aspiration and ingestion dangers
  2. Burns & electric shock
  3. Lacerations
  4. Projectile injuries
  5. Skateboards, rollerblades, other high speed devices
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14
Q

Most common sports injuries?

4

A
  1. Sprains,
    2, strains and
  2. contusions
  3. Re-injury is a major problem
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15
Q

Types of life-threatening injuries sports injuries?

4

A
  1. Severe head/neck injury
  2. Cardiac or respiratory arrest
  3. Severe hemorrhage or shock
  4. Heat stroke
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16
Q

How is pediatric bone different that adult bone?4

What is the physis?

A
  1. Pediatric bone has a higher water content and lower mineral content
  2. Less brittle than adult bone
  3. Thick periosteum in children
  4. Rich blood supply in pediatric bone
The physis (growth plate)
cartilaginous structure that is weaker than bone predisposed to injury
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17
Q

Whats the most common fractured bone in children?

A

Clavicle

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18
Q

Younger children most commonly fracture what part of the body?

Older children?

What type of fractures are the most common?

A
  1. Younger children fracture upper extremities
  2. As children get older, more risk for lower extremity fractures
  3. Closed reductions of fractures more common in children
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19
Q

Why is head trauma so prevalent in pediatric trauma?
3

What more common than intracranial hematomas?

A
  1. Large heads
  2. Thin skulls
  3. Poor muscle control

Diffuse edema

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20
Q

Consider the possibility of serious head injury if? 3

A
  1. the injured child has altered mental status or appears to have inappropriate behavior
  2. there is significant mechanism regardless of whether there are obvious injuries
  3. the injured child has evidence of poor systemic perfusion
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21
Q

Guidelines from the AAP and AFP in regards to Neuroimaging in head trauma.
When should you:
1. Imaging recommended?
2. Consider imaging or observation?

A

1.

  • LOC > 1 min
  • Evidence of skull fx
  • Focal neurologic findings
  1. Brief LOC
22
Q

What signs would be Increased likelihood of intracranial injury?
4

A
  1. Immediate seizures
  2. Headache
  3. Vomiting
  4. Lethargy

These nonspecific signs have limited predictive value

23
Q

What does PTA stand for?

A

post traumatic amnesia

24
Q

A Coma Score of ___ or higher correlates with a mild brain injury, ______ is a moderate injury and ___or less a severe brain injury.

A
  1. 13
  2. 9 to 12
  3. 8
25
Q

When would you get a CT on infants and children?

3

A
  1. Symptomatic and/or
  2. neurologically abnormal
    or
  3. skull radiograph is abnormal
26
Q

Head Trauma: Monitor for Signs of elevated ICP? 4

Treatment? 2

A
  1. AVPU (alert, voice, pain, unresponsive)
  2. Pupils
  3. Vomiting
  4. Cushing Response - (hypertension, bradycardia and apnea)
  5. Controlled hyperventilation if ↑ ICP
  6. Resuscitate hypovolemic shock aggressively
27
Q

Concussion definition

A

Concussion in children is generally defined as a symptomatic head injury with no intracranial injury identified with computed tomography (CT). A “mild TBI.”

28
Q

Concussion Presentation 5

A
  1. HA
  2. Confusion and disorientation
  3. Difficulties with memory
  4. Inattentiveness
  5. Dizziness
29
Q

Concussion management

5

A
  1. Physical and cognitive rest are primary interventions for concussion
  2. Assessment for concomitant injuries
  3. May use meds for headache and nausea short term
  4. Gradual return to activity after symptoms have resolved
  5. Return to play only after the patient is asymptomatic and has progressed through increasing levels of exertion without symptoms
30
Q

Common causes of poisoning?

5

A
  1. Cosmetics and personal care products
  2. Cleaning substances
  3. Analgesics
  4. Plants
  5. Cough and cold remedies
31
Q

Risks of ingestion

3

A
  1. Improper or dangerous storage practices (Cupboard locks work very well)
  2. Changes in normal home routines
  3. Visiting friends/relatives
32
Q

Some dangerous Rx’s: involved in childrens poisoning?

4

A
  1. Antidepressants (Especially tricylics, SSRI’s are less worrisome)
  2. Sedatives and antipsychotics
  3. Stimulants and illicit drugs
  4. Cardiac drugs
33
Q

Acetaminophen Overdose
assessment?
3

A
  1. # tablets/amount of syrup ingested?
  2. Strength?
  3. Serum acetaminophen level
34
Q

Toxic exposure is suggested when greater than____mg/kg ingested in single dose or when greater than ____g is ingested within a 24 hour period)

A
  1. 140

2. 7.5

35
Q

In what way should we draw the serum acetomenophen levels?

A

(draw 4 hours following ingestion in ANYONE suspected of overdose) → toxicity nomogram to determine need for Tx

36
Q

APAP overdose presentation is variable and depending on the length of time following ingestion
4

A

Stage 1: first 24 hours – often minimal signs and symptoms of toxicity, perhaps anorexia, nausea, vomiting, pallor, and malaise

Stage 2: 2-3 days – signs of hepatotoxicity including RUQ pain and tenderness, elevated LFTS and bilirubin

Stage 3: 3-4 days – some patients will progress to fulminant hepatic failure; findings include metabolic acidosis, coagulopathy, renal failure, encephalopathy, and recurrent GI symptoms

Stage 4: Patients who survive stage 3

37
Q

Acetaminophen Overdose: PP?

4 steps

A
  1. Initially liver breaks down acetaminophen to a non-toxic form
  2. Shortly thereafter however, because of the high acetaminophen load, glutathione levels are depleted.
  3. When glutathione stores decrease to less than 30% of normal, hepatic necrosis ensues (if there is sufficient acetaminophen remaining).
  4. N-acetylcysteine (Mucomyst) works to counteract hepatic toxicity by replenishing glutathione.
38
Q

Acetaminophen Overdose: Intervention?
3

What should we not use?

A
  1. GI decontamination with early administration of activated charcoal orally or through nasogastric tube
  2. N-acetylcysteine (Mucomyst): (140 mg/kg) then maintenance dose (70 mg/kg) q4h x 17 doses
  3. Supportive care

No syrup of Ipecac to induce vomiting as this will delay the administration of N-acetylcysteine

39
Q

Why has The number of exposure to aspirin has decreased?

3

A
  1. Fear of Reye syndrome
  2. Lower doses for chewable forms (81mg)
  3. Restriction on the number of tablets per bottle
40
Q

Aspirin overdose presentation? 8 (two most common?)

How long do symptoms present after ingestion?

Diagnosis?

A 
Presentation:  
Typically:  
1. tinnitus &
2.  vomiting 
Other possible signs and symptoms: 
3. hyperpnea, 
4. fever, 
5. lethargy, 
6. confusion, 
7. convulsions, 
8. coma, respiratory/cardiac failure

Symptom onset within a few hours following ingestion

Diagnosis
Plasma salicylate concentrations

41
Q

Aspirin treatment?

4

A
  1. No specific antidote
  2. Activated charcoal
  3. Alkalinization with IV bicarbonate
  4. Dialysis may be necessary
42
Q

Iron is toxic to what systems of the body? 3

What will it cause?

A

Toxic to the

  1. GI system,
  2. cardiovascular system, and
  3. CNS
  4. Will cause a metabolic acidosis
43
Q

Iron overdose presentation:
Initial GI Symptoms 4

After this what happens?

A
  1. vomiting,
  2. abdominal pain,
  3. GI bleed,
  4. diarrhea

Stable period (after 6 hours and up to 24 hours symptoms may resolve, which may falsely reassure a physician assistant)

44
Q

The resolution of GI symptoms is presumed to occur why?

What can it progress to?

A

as circulating free iron is redistributed into the reticuloendothelial systems.

  • Can progress to circulatory shock
45
Q

Iron overdose Dx?

2

A

Abdominal x-ray

Serum iron concentrations

46
Q

Iron overdose treatment? 3

What dont we use? 2

A
  1. Whole-bowel irrigation
  2. Blood levels to determine toxicity
  3. Deferoxamine IV (chelating agent) for severe cases
  4. Syrup of Ipecac not used as it may obscure the initial signs of clinical toxicity and it is not thought to be more effective at gastric emptying than is iron-induced vomiting
  5. Activated charcoal not recommended, doesn’t adsorb significant amounts of iron
47
Q

Patients who ingest less than 1.___mg/kg of elemental iron are usually asymptomatic.

Ingestions of 2.______ mg/kg may or may not produce symptoms of serious toxicity.

A small number of patients who have taken 3._____ mg/kg of iron are symptomatic.

Ingestions of more than 4.____ mg/kg can be associated with serious toxicity.

Death from iron toxicity has been reported from a wide range of doses (from 5.__________ mg/kg).

A
  1. 20
  2. 20 to 60
  3. 40 to 60
  4. 60
  5. 60 to 300
48
Q 
Lead Poisoning (Plumbism)
-What kind of exposure is the most dangerous?
A

Insidious disorder but may have acute episodes (repetitive ingestions of small amounts far more serious and common than single massive exposure!)

49
Q

What things would cause lead poisoning?

4

A
  1. Paint/paint chip ingestion
  2. Contaminated household dusts in old homes
  3. Living near lead smelter
  4. Lead-contaminated soils
50
Q

Lead Poisoning (Plumbism)
presentation?
2

A
  1. Vague symptoms: weakness, irritability, weight loss, vomiting, personality changes, ataxia, constipation, HA, colicky abdominal pain, developmental delay, behavioral disorders, seizures, peripheral neuropathy.
  2. Blood disorders: Anemia
51
Q

Treatment of lead poisoning?

2

A
  1. Interrupt ingestion

2. Chelation therapy with Succimer (in symptomatic children)

52
Q
  1. What is the KEY intervention for APAP overdose, it replenishes glutathione which reduces APAP to a nontoxic form?
  2. Don’t be fooled by that “stable period” with ____ overdose
  3. The best approach to lead ingestion is what? This is not one of those poisonings that you can tie to a sudden event in the history!
A
  1. N-acetylcystein
  2. iron
  3. screening appropriately.

Pediatrics (18 decks)

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