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Pediatrics > Pediatric accidents & injuries > Flashcards

Pediatric accidents & injuries Flashcards

1
Q

classifications of injuries according to age

A
  1. infants
  2. toddlers
  3. preschool
  4. school-age
  5. early teens and adolescents
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2
Q

common infant injuries (6)

A
  1. Bedding - < 1yo
  2. Sleep Positioning
  3. Feeding Safety
  4. Car seat Safety
  5. Crib Safety
  6. Co-sleeping
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3
Q

common toddler injuries (7)

A
  1. Crib Safety
  2. Choking Foods & Toys
  3. Cords and Cribs
  4. Electrical Sockets
  5. Stairs / Windows
  6. Burns
  7. Poisoning
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4
Q

common preschooler injuries

A
  1. Drowning - 1-4 yrs
  2. Toy Safety
  3. Traffic Safety / Pedestrian Injury
  4. Bicycle / Tricycle Safety
  5. Gun Safety
  6. Stranger Safety
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5
Q

common school age injuries (5)

A
  1. Bike and ATV safety
  2. Pool safety
  3. Sports
  4. Gun safety
  5. Stranger Safety
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6
Q

common early teen/adolescent injuries (6)

A
  1. Vehicle Safety / Seat Belt - 5 - 19 years
  2. Helmets and Protective Gear
  3. Sports
  4. Drug & Alcohol Abuse
  5. Bike & ATV Safety
  6. Gun Safety
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7
Q
  • #1 cause of death d/t accidents in 5-9 y/o?
  • MC injury out of this incident?
A
  • MVA
  • head injury d/t improper use of seat belts
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8
Q

MVA - important hx questions to ask

A
  1. blunt trauma
  2. description of crash
  3. seat bleat/car seat use
  4. airbag deployment
  5. direction of impact
  6. where was the pt
  7. damage to car
  8. MPH (>20 high risk)
  9. distance of ejection from car
  10. body part hit/injured
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9
Q

guideline for rear-facing car seat?

A

until 2 years old or highest wt or ht allowed by car seat manufacturer (AAP recommended)

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10
Q

Forward facing with 5-point harness for as long as possible and at least what of age and weights how much?

A
  • 4 years
  • 40 lbs
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11
Q

Belt positioning booster seats until reaching ? in height and at least ? old

A
  • 4 feet 9 inches
  • 8 years
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12
Q

school-aged kids should be in the backseat only until how old

A

13 years of age

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13
Q

T/F: Any car seat involved in an MVC must be discarded

A

T

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14
Q

what condition makes fitting in a seat properly in a vehicle an obstacle?

A

obesity

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15
Q

Need to support the young child’s __, __, ___, and ___ and to distribute crash forces over the entire body

A

posterior torso, neck, head and pelvis

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16
Q

what is seat belt syndrome?

A

serious cervical and lumbar spinal cord injuries as well as intra-abdominal injuries in children in MVC resulting from poorly fitting seat belts

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17
Q

proper way to wear a seat belt

A
  1. Shoulder belt across mid chest not neck
  2. Lap belt low across hips and pelvis, not the abdomen
  3. Tall enough to sit in backseat with knees bent without slouching
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18
Q

Second most common childhood injury due to a consumer product, next to MVC

A

Bicycle Injuries - MC d/t head injury

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19
Q

the single most effective measure for prevention of significant head injury

A

helmet

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20
Q

RF for bike injuries

A
  1. Non-daylight hours
  2. Exposure time
  3. Riding on sidewalk
  4. Using for play
  5. Male gender
  6. Age
  7. < 3 years oldno cognitive ability to both pedal and steer
  8. > 80% d/t bicyclist’s behavior: not following rules, riding against traffic flow, riding into street without stopping
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21
Q

< 3 y/o should have what type of bike?

A
  • bike w/ training wheels w/ foot brakes.
  • No bike hand brakes until 6 years old
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22
Q

discard bike helment if:

A
  1. head hits hard surface
  2. fall results in marks on shell
  3. greater than 5 years old
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23
Q
  • 2nd leading cause of accidental trauma in children next to MVC, esp under age 5
  • Leading cause of death ages 1-4 - even > birth defects
A

drowning

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24
Q

Non-fatal or near-drowning often results in ?

A

brain damage or long-term disability

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25
Q

MC places of drowning in < 4y & >4y?

A
  • < 4y - bathtubs or pool (42% home pool)
  • > 4y - pools or bodies of water

Males 6x more likely

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26
Q

mgmt for drowning

A

at site: CPR + 100% O2; protect C-spine

  1. Cold water (< 20 C): resuscitation + restore temp to 30-34C; NG tube, cath-core rewarming, warm O2, lavage at 40C
  2. warm water: poorer prognosis, arrives comatose
  3. 100% O2 15 L non-rebreathing mask
    - Intubation and mech vent if < 80 on 15 L
  4. IVF (20 ml/kg)
  5. NG tube for water removal
  6. Temp management
  7. Outcome
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27
Q

how to prevent drownings

A
  1. learn to swim after 4/yo
  2. lifejackets
  3. fencing for pools
  4. Anticipatory Guidance - “Touch Supervision” - within reach
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28
Q

if child drowns in cold water, why only restore their temp below 34C?

A

if above can cause ischemic brain injury

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29
Q

how are most children found after drowning?

A

silently floating with NO screaming or splashing being noted

30
Q

degree of burns

A
  • 1st degree - superficial; Only epidermis
  • 2nd degree – partial thickness; Epidermis and dermis – blisters
  • 3rd degree – full thickness; Destroys epidermis and dermis
31
Q

Leading cause of injury-related death in home

A

burns

32
Q
  • MCC burns in younger children?
  • older children & teens?
A
  • Younger child: Scald burns - hot liquids
  • Older child and teens: Open flame
33
Q

what is the burn chart?

A
  • Letters are differentiated by age
  • Numbers are constant
  • Minor burns are < 10% of body surface area for 1st/2nd degree burns; < 2% for 3rd degree burns
34
Q

tx for 1st degree burn

A

Cool compresses, analgesics

35
Q

tx for 2nd degree

A

Silvadene and analgesics with sterile non-adhesive dressings

36
Q

tx for Third degree burns

A

Referrals
Immediate: IVF, monitor airway, Foley and transfer

37
Q

tx for electrocutions

A
  • Watch for entrance and exit wounds
  • ECG for arrhythmias, CK for muscle injury, UA for myoglobinuria, BMP to monitor kidney function and check for rhabdomyolysis
38
Q

anticipatory guidance to prevent burns?

A
  1. water temp: < 120 degrees
  2. sun - wear protective clothing, SPF >15 for >6 months old
  3. outlet covers
  4. smoke detectors
39
Q

dog and cat bites are MC in who?

A

Dog bites - Boys
Cat bites - Girls

40
Q

mgmt for bite injuries

A
  1. All require high pressure, high volume irrigation with saline, scrubbing and debridement
  2. Tetanus prophylaxis/Rabies vaccine - Quarantine x 10 d or brain tested at DHHR
  3. Closure of wound (face, large wounds)
  4. Augmentin - Pasteurella multocida common canine microbe
41
Q

Leading cause of non-fatal injury in children 0 - 19 years of age

A

falls

42
Q

MC ways to fall based of age groups?

A
  • Infants - furniture or stairs
  • Toddlers - windows, crib, shopping carts
  • Older children - playground, trees, ladders
43
Q

Trauma centers generally use “fall ____ feet” as most serious (or ___ times pt ht)

A
  • > 10-15
  • 2-3

< 10 ft not life-threatening.

44
Q

MC types/locations from falls

A
  1. baby walkers
  2. tubs
  3. playground
  4. shopping carts
  5. furniture
45
Q

prevention for falls

A
  1. Baby gates & guards
  2. Never leave baby or infant unattended on bed/furniture
  3. restraints on highchairs and shopping carts
  4. Guard rails on cribs and lower mattress with age - Beds moved away from cords and drapery
  5. Infant seats on floor instead of furniture
  6. Kids in shopping carts should wear seat belt and should not ride in basket, stand in cart or climb on side
46
Q

choking/FB is MC in what age group?

A

6 months - 4 years - highest risk; limit certain snacks under age 4

47
Q

s/s of choking/FB?
mgmt?

A
  • Acute onset of coughing, choking, wheezing, cyanosis, drooling or stridor
  • < 1 y - Hard back blows; >1 - Abd thrusts / Heimlich; Anticipatory Guidance
48
Q

10 MCC of choking (food & toys)

A
  1. hot dogs
  2. candy -hard foods
  3. peanutes, grapes - whole
  4. popcorn
  5. chewy sticky foods (peanut butter, raisins, etc)
  6. batteries
  7. coins, marbles, stones
  8. balloons
  9. magnets
  10. art supplies, small toys
49
Q

T/F: Toy-related injuries MC do require hospitalization

A

F - 97% do not need

50
Q

MC leading risk of death from toy-related injuries

A

non-powered scooters

51
Q

Almost how many injuries occur to head and face when child falls from toy or struck by vehicle?

A

1/2 injuries

52
Q

Most deaths from toy-related injuries are from ?

A

asphyxiation

53
Q

age restriction for skateboards?

A

< 5 y

54
Q

who is more susceptible to spinal injury in ATV accidents?

A
  • females
  • Injury rate for boys’ double that of girls however
  • 11 - 15 years of age most at risk
55
Q

Compared to MVC injuries, ATV-related injuries are how likely to be hospitalized

A

twice as likely

56
Q

MC fractures in ATV accidents?

A
  • Younger children: lumbar fractures
  • Older children: thoracic fractures
57
Q

Anticipatory Guidance for ATV rides

A
  1. Off road use only on non-paved surfaces
  2. Always wear a helmet - Reduces head and neck injuries by 50%
  3. Not having a passenger
  4. Prohibiting < 16 y as recommended by AAP
  5. ATVs are NOT toys
58
Q

MC injury from sports incident?

A

sprains and strains - Inversion ankle injuries

59
Q

MC sports to cause concussions and neck injuries?
MC neck injury?

A
  • Football and rugby, hockey; then soccer
  • Cervical spine
60
Q

mgmt for concussions - return to play

A
  • Kids through HS age take longer to recover; conservative tx
  • H/o concussion or younger age - associated with longer recovery after a concussion
  • h/o one concussion more likely to experience another, esp during next 10 days
  • Field concussion assessment - “Concussion Quick Check”
  • Return to play guidelines
  • SCAT5 Guidelines
  • Remove from play immediately and do not return to game
61
Q

90% poisonings occur where?

A
  • home
  • Majority under the age of 5 and unintentional
62
Q

MCC of poisoning

A
  1. cosmetics / personal care products
  2. analgesics
  3. household cleaning products
63
Q

mgmt for poisonings

A
  1. lavage ONLY IF within 1-2 of ingestion
  2. activated charcoal - Repeated q 2-6h until pooped out
64
Q

CI to activated charcoal

A
  • Depressed mental status
  • Late presentation
  • Incr risk and severity of aspiration with AC use - Hydrocarbon ingestion
  • Need for endoscopy - AC impairs visibility
  • Toxins poorly absorbed by AC - Metals - iron, lithium, alkali, mineral acids and alcohols
  • Presence of intestinal obstruction (Absolute CI)
65
Q

Poisoning – Common Threats

A
  1. Acetaminophen (Tylenol)
  2. iron
  3. lead
  4. disk-shaped batteries
66
Q

mgmt for acetaminophen toxicity

A
  • N-Acetylcysteine (Acetadote)
  • Plot on chart
  • 150 mg/kg loading dose over 15-60 min
  • 2nd infusion 50 mg/kg x 4 h
  • 3rd infusion 100 mg/kg x 16 h
  • Daily AST, ALT, serum bilirubin, PT
  • Liver abnormalities may not peak until 72 - 96 h
67
Q

iron Dose ? mg/kg will cause sx

poisoning

A

> 20

68
Q

s/s of iron toxicity?
mgmt?

A
  • Hemorrhagic gastroenteritis 30-60 min after ingestion - Shock, acidosis, coagulation defects and coma lasting 4 - 6 hours
  • Phase of improvement 2 - 12 hours
  • Delayed shock 12 - 48 hours, liver damage and hepatic failure
  • Met. acidosis, F, leukocytosis, liver damage with hepatic failure, or coma
  • Gastric lavage and whole bowel irrigation; tx of shock
69
Q

s/s of lead poisoning
mgmt?

A
  • weakness, irritability, wt loss, V, ataxia, HA, colicky abd pain, developmental delays
  • Lead paint, esp homes built before 1960
  • CBC and Lead in every child 12-month WCC
  • Positive: ≥ 5-9 mcg/dl; confirmed in 1-3 months and repeated after 3 mo, then 6-9 mo after environmental changes
  • Chelation therapy (Succimer) - blood lead lvl ≥45 mcg/dL
70
Q

mgmt for disk-shaped battery poisoning

A
  • X-rays - MC pass through GI tract in 48 - 72 hoursl Repeat if doesn’t pass within 7 days
  • Removal if in esophagus; If in esophagus >24 hrs, greater risk for erosion
71
Q

firearm injury and safety?

A
  • Nearly all occur in or around the home
  • Screening and Anticipatory Guidance at WCC
  • Removal from home, unloaded in safe with ammunition in separate location, gun locks

Pediatrics (23 decks)

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