pediatric ER Flashcards
in a child with suspected acute abdomen, what are some clues to help you characterize what is going on?
- pain pattern
- localization
- colour of emesis
- appearance of stool
- physical exam
can divide causes into common vs life threatening vs anatomical
what causes for acute abdomen may interest a surgeon?
- acute appendicitis
- intussusception
- bowel obstruction
- volvulus
- malrotation
- hernia, incarcerated
- perforation
- trauma
what causes for acute abdomen would be unlikely to interest a surgeon?
- esopagus
- stomach
- liver
- gall bladder
- ducts
- pancreas
- small bowel
- large bowel
What causes for acute abdomen would definitely not interest the surgeon?
- DKA/sugar abnormalities
- electrolytes
- pneumonia
- UTI/pyelo and other kidney disease
- GU problems
- inflammatory–HSP
how do you manage acute abdomen generally?
- stabilize (ABCs)
- NPO!!
- IV access and fluids
- appropriate investigations
- manage/call for help (surgery)
what is a helpful mnemonic for remembering the important parts of an ER paeds history?
SAMPLE
symptoms allergy meds past medical history last meal events
what is the goal systolic BP in kids? (lower limit of acceptable normal)
higher than:
(2 x age in years) + 70
low BP is a worrisome finding
characterize cold vs. warm shock if BP is low
what are the four classes of causes of shock
hypovolemic
cardiogenic
obstructive
distributive
example of hypovolemic shock
severe gastroenteritis
example of cardiogenic shock
CHD, hypertrophic cardiomyopathy
example of obstructive shock
inflow into heart or outflow from heart obstruction (RV or LV)
example of distributive shock
sepsis or anaphylaxis
how do you manage shock in kids?
fluid management
- IV or IO access x 2
- normal saline 20mL/kg
- reassess and repeat
- consider inotropes, blood
- consider corticosteroids
what are the priorities in the ER for managing meningococcemia?
- early recognition
- stabilize ABCs
- IV fluids
- antibiotics
- avoid delays
- transport to tertiary hospital
what are the priorities for the admitted child for meningococcemia management
- abx
- adequate BP
- adequate ventilation
- transfusions
- find/correct derangements
- treat contacts
what should you ask on hx in the ER for a child presenting with a burn?
- demographics
- SAMPLE hx
- mechanism of injury
- extent/severity of wound
- concerns–> non accidental?
how do you assess severity of burns?
- depth of injury
- total body surface area
- type of injury
- risk factors
how deep are first degree burns? what is the extent of the injury?
superficial
epidermis is injured but the dermis is intact
how deep are second degree burns? what is the extent of the injury?
partial
dermis is partially injured but the skin is still viable
how deep are third degree burns? what is the extent of the injury?
full
dermis is completely injured and the skin is not viable
how do you estimate total body surface area?
Lund and Browder chart
rule of 9s…
front and backs of legs–9% of TBSA each
upper back 9%
lower back 9%
abdomen 9%
one arm is 9% (front is 4.5 and back is 4.5)
head is 9% (face is 4.5, back of head is 4.5)
palms are each 1% and genitalia is 1%
how do you manage burn patients overall initially?
- ABCDE
- stabilize and review ABCs
- burn assessment (depth and TBSA)
- contact the burn centre if moderate to severe
how do you manage the burn itself initially?
- analgesia
- debridement
- burn dressing
- if mild (less than 5%)–treat as outpatient
- if moderate to severe (more than 5%) or other risks, admit to hospital
potential complications from burns?
pain
pruritis
infection
SIRS picture
dehydration/volume loss
scarring
psychological trauma
what is the parkland formula?
fluid resuscitation beyond maintenance for burn victims
volume of ringers lactate equal to 4mL x %BSA x weight (kg)
give half in the first 8 hours
half in the next 16 hours
