Pediatric Emergency Flashcards
What are the leading causes of death in children less than 1-year?
- Congenital anomalies
- Gestational issues
- SIDS
- Maternal complication of pregnancy
- Unintentional injuries
What are the leading causes of death in children ages 1-4?
- Unintentional injury
- Congenital
- Homicide
- Malignancy
- Heart Disease
What are the leading causes of death in children ages 5-9?
- Unintentional injuries
- Malignancy
- Congenital
- Homicide
- Heart Disease
What are the leading causes of death in children ages 10-14?
- Unitentional injuries
- Malignancy
- Suicide
- Homicide
- Congenital defects
What are the leading causes of death in children ages 15-24?
- Unitentional injuries
- Suicide
- Homicide
- Malignancy
- Heart Disease
How do you assess work of breathing in a kiddo?
- Fast or slow
- Inadequate breaths
- Tripoding
- Nasal flaring
- Low O2
- Cyanosis or flushed
- Fast/slow cap refill
What is AVPU?
- Alert
- Responsive to verbal stimuli
- Painful Stimuli
- Uncresponsive
What is TICLS?
- Tone
- Interactability
- Consolability
- Look/gaze
- Speech/cry
What system is most likely to fail in kiddos leading to a code?
Respiratory Failure
What temperature defines a fever?
How should the temperature be obtain?
38 degres C (100.4 F)
Rectal
Is a fever a normal response to infection in kids?
What should determine when you treat a fever with acetamenophen?
Yes
Affect of child
What are do not miss diagnosis of febrile infant
- Sepsis
- Meningitis
- Pneumonia
- Bacteremia
- Bacterial enteritis
- UTI
- Cellulitis
What are the most common bacteria from birth canal?
- E. Coli
- GBS
- HSV
- Listeria
- MRSA
What is the work-up for an infant with a fever?
Are they being admitted?
- WBC
- CRP
- Procalcitonin
- All the cultures (blood, urine, CSF)
- +/- CXR, stool cultures
Yes! Need abx until cultures return
Do you need to obtain an LP in an infant 29-60 DOL with a fever?
No, depends on risk factors and presentation
What broad spectrum abx are used in kids less than 60 days with a fever until cultures return?
Cefotaxime (or cefrixaxone) PLUS vancomycin
What broad spectrum abx are used in infants less than 28 days with a fever until cultures return?
Cefotaxime (or gentamicin) PLUS Ampicillin
What lab value should be checked in every kid who is SICK?
What will be the physiologic change?
Glucose
Glucose will be wanky either high or low
What is the first line treatment in a child who is hypotensive?
What is second line
Fluid Bolus
May require pressors (Epi or norepi)
What are the administration routes of Tylenol for kids?
What is the dosing
PO, PR, IV
15 mg/kg Q4-6hrs, max 80 mg/kg/day
How is meningitis transmitted?
Droplet Spread
What is the classic triad of meningits?
- Fever
- Stiff Neck
- Altered mental status (lethargic)
What is the cause of death in kids with sepsis?
What about cause of death in menengitis?
Death from cardiovascular failure
Death from raised ICP
What is the diagnostic work-up for bacterial meningitis in pediatric patients?
What is the diagnositic study of choice?
- CBC: Leukocytosis and thrombocytopenia
- Coagulation studies: go along with DIC(PT, PTT, and D-dimer)
- CMP: elevated anion gap
- Lactate
- 2 sets of blood cultures
- +/- head CT
LP
What etiology of meningitis will have a low CSF glucose?
What will be the level?
Bacterial
< 40
What broad spectrum antibiotics are used in bacterial meningitis?
Vancomycin (15 mg/kg) + Ceftriaxone (50 mg/kg)
What is the classic presentation of appendicitis in kids?
What is your concern for complications?
- Fever
- Periumbilical pain that migrates to RLQ
- Poor PO Intake
Rupture
What is the work-up for appendicitis in kids?
- If suspected, may be evaluated by US but may not be inconclusive
- CBC
- CMP
- CRP
- UA
- +/- CT
What is the management of appendicitis?
What antibiotics are used for appendicitis?
- Keep NPO
- Treat their pain (morphine or fentanyl)
- Hydrate
- Consult surger
- Once confirmed, IV antibiotics
Piperacillin-tazobactam or Ceftriaxone and metronidazole
What are the first steps in assessing a trauma?
What does ABC stand for?
ABC/IV/O2/Monitor
Airway, breathing, circulation, disability, exposure
How is hypotension defined in a kid?
What physical exam finding can be associated with hypotension?
SBP < 70 + (age in years x 2)
Moddling
What is the most common cause of death in pediatric trauma?
What is the common mechanism of injury?
Head Injury
Falls
Do kids less than 8 typically get C-spine injuries?
What can change this and increase the risk?
No, they are bowling bowls on a popsicle stick
Cologen disorders, autism
What is the work-up of truama in kids?
All depends on level of concern
* Labs: CBC, CMP, lactate, PT/PTT, type and cross, VBG, UA
* EFAST (do they need a CT)
What are the two types of drowning?
“Wet” drowning: aspiration –> hypoxia
“dry” drowning: aspiration –> hypoxia
What medical conditions can lead to drowning?
- Channelopathy (30%)
- Seizures
- Trauma
- Fatigue, respiratory arrest
- ETOH, intoxications
- Syncope
In a near drowning what pulmonary effects are you worried about?
- Pulmonary edema
- ARDS
- SOB
- Crackles
Hypoxia from a near-drowning may cause what cardiac effects?
- Arrhythmias
- Cardiac Arrest
Do you need to kill the bug prior to pulling it out?
With what?
Yes
Ethanol, use lidocaine or an immersion oil
Where will a foreign body aspiration most commonly occur?
Right mainstem
What is the triad in presentation of a foreign body aspiration?
Cough, Wheeze, diminished breath sounds
For ingested button batteries, if you can’t remove urgently due to resources what should you give the child?
Have them swallow honey to neutralize the pH
What are the 4 E’s of Poisoing?
- Estimated amount
- Elapsed time
- Early symptoms
- Early interventions
What is the presentation of acetaminophen toxicity?
What is the toxic dose?
m/c asymptomatic: late can be abdominal pain, N/V, acidosis, transaminitis
> 150 mg/kg or 10g
What is the treatment for acetaminophen toxicity?
If < 1 hr from ingestion, consider activated charcoal
If > 150 at hour 4 then start NAC N-acetylcysteine
A 4-year-old child presents with a sudden onset of wheezing, coughing, and difficulty breathing. The child has a history of atopic dermatitis and allergies. On examination, you note decreased air entry on the left side and hyperresonance on percussion. What is the most likely diagnosis?
Why is asthma relevant?
Foreign Body Aspiration
Asthma makes him more susceptible for bronchospasm
A 14-year-old boy presents with a 2-day history of high fever, headache, and photophobia. On physical examination, you note nuchal rigidity and positive Brudzinski’s and Kernig’s signs. What is the most likely diagnosis?
Meningitis
A 7-year-old previously healthy boy presents with a sudden onset of severe right lower abdominal pain associated with nausea and vomiting. On physical examination, there is tenderness in the right lower quadrant with guarding and rebound tenderness. What is the most likely diagnosis?
Appendicitis
What advantageous breath sound is associated with a upper respiratory track foreign body aspiration?
Stridor
A 6-month-old infant is brought to the clinic with a history of vomiting, diarrhea, and poor feeding. On examination, the infant appears lethargic with sunken fontanelles. What is the most likely diagnosis?
Dehydration
A 5-year-old child is brought to the emergency department with difficulty breathing, drooling, and a muffled voice. What is the most likely diagnosis, and what is the appropriate initial management?
Croup, administer corticosteriods
Consider admission
