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Gen Med: Emergency Med > Pediatric Emergencies > Flashcards

Pediatric Emergencies Flashcards

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1
Q

Cardiac arrest is usually an expression of what kind of injury?

A

Respiratory problem, unless congenital

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2
Q

What are the top 2 places of infection for children?

A
  1. UTI

2. Ears

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3
Q

What the number one cause of death for children over 1?

A 
1. Trauma
A. Falls
B. Abuse
C. Accidents
D. Drowing
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4
Q

When do you remove suture?

A
  1. The closer to the face, the faster it heals
    A. Face: 3-5 days
    B. Add tincture of benzoine (?) and seristrips for extra security
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5
Q

When are staples indicated for trauma?

A

Scalp

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6
Q

How many knots must be placed in order to hold a suture?

A

5!!!

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7
Q

What body parts can you not use epi with lidocaine for anesthesia?

A

Finger and toes, penis and nose

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8
Q

What respiratory problems may you see in a cardiac arrest pt?

A 
1. If airway obstructed, clear it then check breathing & circulation
A. Stridor
B. Gurgling
C. Accessory muscle use
D. ↓ Breath sounds
E. Altered level of consciousness
F. Lethargy
G. Agitation
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9
Q

What can cause shock in peds pts?

A

TBI most common injury in children

  1. Dehydration
  2. DM
  3. Heat illness
  4. Hemorrhage
  5. Burns
  6. immersions
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10
Q

What is the method for treating cardiac arrest and shock in peds?

A

1.ABCs: Evaluate airway for obstruction
2. Assess ventilation status
3. Heart rate/pulses
A. Compare peripheral pulses w/ central (brachial) pulses
B. Thready, weak pulse due to severe hypovolemia
C. Bradycardia is pre-arrest sign
D. Requires aggressive resuscitation

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11
Q

How can shock be ruled out?

A
  1. Cool skin of distal ½ of extremities
  2. Mottled, pallor or ashen
  3. Cap refill > 2 sec (abnormal)
  4. Evaluate mental status (GCS)
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12
Q

What is the most common type of shock in peds?

A

Hypovolemic

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13
Q

True/false: in peds, shock may be present w/o hypotension?

A

True. Shock may be present w/out hypotension

  1. BP maintained until 35-40% blood volume lost (compensated)
  2. Hypotension (decompensated)
  3. Manual reading more accurate than automatic in children
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14
Q

What is used for fluid resuscitation in peds?

A
  1. IV crystalloid via antecubital vein or central line (2)
  2. Use umbilical veins in newborn
  3. Give 60 mL/kg
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15
Q

How is resuscition managed in peds?

A
  1. CPR
  2. Immobilize neck until cleared
  3. 100% high flow oxygen
  4. 2 IV lines
    A. Insert arterial line
  5. Telemetry
  6. Pulse oximetry
  7. Fingerstick glucose
  8. VS
  9. NG tube
    A. CXR for placement & CV line
  10. Foley catheter
    A. Not if pelvis Fx
  11. History
  12. Remove all clothes for exam
  13. Lab draw
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16
Q

What is the mneumonic for the post-resuscitation focused hx for peds?

A 
SAMPLE
S: Signs and sxs
A: Allergies
M:Meds
P: Past medical hx including last tetanus
L: Last meal
E: events leading up to the injury
17
Q

What is included in the trauma peds pt exam?

A
  1. GCS
  2. HEENT
    A. Fundoscopic-look at optic disc
    B. Hemotympanum, clear nasal discharge (CSF), battle sign, raccoon sign
  3. Skin
    A. Lacerations
    B. Hematomas
    C. Burns
    D. Swelling
    E. Abrasions
    F. FB
  4. Neck
    A. R/O C-spine injury
    B. Neuro exam, then cross table lateral X-ray if indicated
  5. Heart
  6. Lungs
    A. CXR if indicated
  7. Abdomen
    A. USN or CT if indicated
  8. Extremities
  9. Genitalia
    A. R/O abuse
18
Q

What dx studies are indicated for a trauma peds pt?

A 
1. CBC
A. Hct  less than 30%
B. AST greater than200
C. ALT > 125 (CT of abdomen)
3. UA
A. > 50 RBC’s/hpf → CT of abd/pelvis
4. X-ray if suspected Fx
19
Q

How is a trauma peds pt treated?

A 
1. 100% high flow oxygen
A. Maintain SaO2 > 90%
2. IV’s to maintain normal BP
3. Update DTaP
4. Neurosurg consult if GCS
20
Q

How is a laceration repaired in a peds pt?

A
  1. Steri-strips
  2. Dermabond
  3. Simple suture repair
    A. Ethilon, Prolene
  4. Layered suture repair
    A. Absorbables (eg, Plain or chromic gut, Dexon, Vicryl, Monocryl)
  5. Staples
  6. Pack dressing if unable to close
    A. Vaseline gauze or wet to dry
21
Q

What is the maximum amount of time after injury that a non-contaminated wound can be successfully closed?

A

12 hours post-injury

22
Q

What local anesthesia can be used for laceration repair?

A
  1. Lidocaine 1% w/ epinephrine is preferred
    A. 2% used if 1% not effective
  2. 1 part NaHCO3 to 4 (up to 10) parts lidocaine w/ epinephrine added to ↓ local burning during infiltration
  3. Topical 5% lidocaine oint to skin 15-20 min before injecting helps w/ needle discomfort
23
Q

What are the types of suture patterns that may be used for laceration repair?

A
  1. Simple interrupted closure
  2. Simple running (continuous) closure
  3. Running subcuticular closure
24
Q

What are the most common pediatric abd pain ddx?

A
  1. Constipation
  2. Gastroenteritis
  3. Viral Syndromes
  4. Gastroesophageal Reflux (spit up, vomiting)
  5. Functional abdominal pain
  6. Mallory-Weiss tears
  7. UTI (usually fever, vomiting)
  8. Pneumonia (often present w/ abd pain, fever & vomiting…look for it!!)
25
Q

What type of CT scan delivers the most radiation?

A
  1. Abdominal CT scans deliver the highest radiation dose of all scans (causing about 1/500 risk for death from cancer)
  2. A single CT abdomen/pelvis scan delivers the equivalent of about 500 chest x-rays
26
Q

Why are children more sensitive to radiation?

A

Children are more radiosensitive because of rapidly dividing cells & long lead times

27
Q

What needs to be performed before ordering CT abd scans on children?

A

Order imaging after taking a history & a few thorough physical exams

28
Q

How is intussussception dxed?

A 
1. Air contrast enema
A. Both diagnostic and therapeutic
2. Target sign on USN
3. Crescent sign on KUB
A. As the intussusceptum pushes into an air filled lumen, it creates the appearance of a crescent
29
Q

How is intussussception managed?

A 
1. Medical stabilization
A. IVF
B. NG tube/NPO
C. Labs (Type & screen, CBC, CMP)
2. Air enema
A. Not in cases of sepsis or peritonitis
3. Surgical correction
A. Done after failed enema attempts
B. Septic infants
30
Q

What sxs may intussussception present with?

A
  1. irritable or lethargic infant or toddler
  2. Often these kids will present w/ some watery stools initially & vomiting, which can fool you into thinking this is just a gastroenteritis
  3. High index of suspicion & select imaging is key
  4. 79% will not present w/ the triad of colicky abdominal pain, currant jelly stool & vomiting
  5. Abdominal exam may be normal
  6. A sausage shaped mass is sometimes palpated in the right upper quadrant
  7. Bowel sounds may be absent or present
  8. Occult blood in the stool may be present or absent
31
Q

What hx may be asst. with intussusception?

A
  1. Most infants present w/ lethargic intussusceptions (almost post-ictal)
  2. Parents usually do NOT describe the child drawing their legs up & crying every 20 min.
  3. Once bowel necrosis & mucosal sloughing have occurred, a “currant jelly stool” is produced
  4. Parents may not describe symptoms typical of intestinal obstruction early on
  5. Vomiting may or may not be present
  6. Fever is absent early & signifies prolonged obstruction
32
Q

What is the general rule for surgical abdomens?

A
  1. As a general rule, if pain starts 1st & is followed by fever, you may have a surgical abdomen
  2. Most commonly, when a fever starts the illness & pain follows, it is not a surgical issue
33
Q

What is the classic hx for pyloric stenosis?

A
  1. Early on, infant may appear well w/ only intermittent vomiting
  2. As the stenosis progresses, infant will have ↑ vomiting & subsequent dehydration, weight loss, & decreased activity
  3. Vomiting becomes projectile
  4. Infant is hungry & vigorously feeds, but then vomits 5-10 min later
  5. Constipation or diarrhea may complicate picture
    A. Constipation occurs when the baby gets dehydrated, but “starvation stools” may occur which are loose & watery
34
Q

What is present on the PE for a pt with pyloric stenosis?

A
  1. Signs of dehydration may or may not be present
  2. The “olive” may or may not be palpable
    A. If palpable, this is diagnostic
35
Q

What is present in the lab tests for a pt with pyloric stenosis?

A
  1. BMP & venous blood gas
  2. Infants presenting with severe disease typically have a hypochloremic, hypokalemic metabolic alkalosis
    A. Vomiting leads to loss of chloride & hydrogen ions leading to hypochloremia & alkalosis
    B. Dehydration leads to sodium retention & potassium excretion
36
Q

How is pyloric stenosis managed?

A
  1. Medical
    A. Rehydration, correction of electrolyte disturbances
  2. Surgical
    A. Pyloromyotomy
    B. Surgical correction is curative
    C. Not an emergent procedure
    D. Pt should be admitted for medical stabilization prior to surgery
37
Q

What needs to be considered in a peds pt with bilious vomiting?

A
  1. malrotation (volvulus)
  2. Bilious emesis in an infant should prompt emergent surgical evaluation
    A. Malrotation until proven otherwise
38
Q

What is the gold standard for diagnosing volvulus?

A

UGI series

39
Q

Why is volvulus emergent?

A

Every minute could mean intestinal necrosis

Gen Med: Emergency Med (13 decks)

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