Pediatric Injuries and Poisoning

Question 1

Child Car Seat Safety Restraints: Infants < 1 and weighing < 35 pounds

Answer 1

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.

Question 2

Child Car Seat Safety Restraints: Ages 1-4 and weighing 20-40 pounds

Answer 2

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

Question 3

Child Car Seat Safety Restraints: Ages 4-6

Answer 3

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).

Question 4

Guidelines from the AAP and AFP in regards to Neuroimaging in head trauma

Answer 4

Imaging Recommended: 
LOC > 1 min
Evidence of skull fx
Focal neurologic findings
Consider Imaging: Brief LOC

Question 5

S/S that Increased likelihood of intracranial injury

Answer 5

Immediate seizures
Headache
Vomiting
Lethargy

Question 6

Acetaminophen Overdose Levels

Answer 6

Toxic exposure when greater than 140mg/kg ingested in single dose or when greater than 7.5g is ingested within a 24 hour period
Serum acetaminophen level (draw 4 hours following ingestion in ANYONE suspected of overdose

Question 7

Tylenol OD Steps

Answer 7

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

Question 8

Acetaminophen Overdose Tx.

Answer 8

GI decontamination with early administration of activated charcoal orally or through nasogastric tube
N-acetylcysteine (Mucomyst): then maintenance dose PO
No syrup of Ipecac to induce vomiting

Question 9

Aspirin Overdose

Answer 9

tinnitus & vomiting
Symptom onset within a few hours following ingestion
No specific antidote
Can use Activated charcoal
Alkalinization with IV bicarbonate
Dialysis may be necessary

Question 10

Iron Overdose Tx.

Answer 10

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
Activated charcoal not recommended, doesn’t adsorb significant amounts of iron
Blood levels to determine toxicity: DIE at 60 mg/kg
Deferoxamine IV (chelating agent) until serum iron < 300 mcg

Question 11

Lead Poisoning (Plumbism)

Answer 11

Presentation
Vague symptoms: weakness, irritability, weight loss, vomiting, personality changes, ataxia, constipation, HA, colicky abdominal pain, developmental delay, behavioral disorders, seizures, peripheral neuropathy.
Blood disorders: Anemia
Treatment
Interrupt ingestion
Chelation therapy with Succimer (in symptomatic children)