Pediatric Injuries and Poisoning Flashcards
What is the leading cause of death and disability among children and adults (1-44)?
Unintentional injury deaths peak ages ___ years and again at ages ___ years.
What is leading cause of unintentional injury?
trauma by unintentional injury!
Unintentional injury deaths peak during 1-4YO and again ages 15-24.
Leading cause of unintentional injury is FALLS!
what is the leading cause of ACCIDENTAL death in children?
MC cause of motor vehicle injuries?
Motor vehicle injuries
MC cause of MVA:
- Alcohol
- excess speed
- no seat belts
- texting
Infants less than 1YO and weight less than 35lbs should be restrained how in vehicle?
Ages 1-4 and weight 20-40lbs should be restrained how in vehicle?
Ages 4-6 should be restrained how in vehicle?
less than 1YO and less than 35lbs should be in an infant-only or rear facing child safety seat
ages 1-4 and weight 20-40lbs can be in a forward facing only in the back seat of the vehicle.
Ages 4-6 needs a booster seat installed in the back seat of the vehicle (booster seat for children under 60lbs)
Submersion injuries:
- locations of occurrence
- prevention
locations: pools, lakes, streams, oceans, bathtubs, 5 gal buckets.
prevention: SUPERVISE YOUR KIDS!
Bicycle injuries:
-MC in who?
boys ages 5-14YO.
Which cartilaginous structure is weaker than bone and predisposed to injury in pediatric sports injuries?
MC fractured bone in children?
- the physis (growth plate)
- peds bone has higher water content and lower mineral content.
- less brittle than adult bone..
most fx bone in children is clavicle
(kids are more prone to upper extremity fxs)
peds head trauma:
- risk factors
- always consider ___ on DDX.
- when do you image?
Risk factors:
- large head
- thin skulls
- poor muscle control
always consider Concusiion on DDX,
Image when LOC greater than 1 min, evidence of skull fx, focal neurological findings, GCS of 13-14
Coma score of ___ correlates with mild brain injury.
Score of ___ - ___ is moderate injury.
Score less than ___ is a severe brain injury.
13 or higher = mild TBI
9-12 is moderate brain injury
8 or less = severe brain injury.
Head Trauma:
-signs of elevated ICP
Signs of elevated ICP
-AVPU (alert, voice, pain, unresponsive)
- pupils
- vomiting
- cushing response (htn, bradycardia, apnea)
Concussion:
- presentation
- tx
- HA
- confusion/disorientation
- difficulties with memory
- inattentiveness
- dizziness
Tx:
- physical and cognitive rest are primary interventions
- meds for HA and nausea
- gradual return to activity after sx resolve.
- gradual return to play protocol:
- -no activity
- -light aerobic exercise
- -sport specific exercise
- -non contact training drills
- -full contact practice
- -return to play
Common causes of poisoning
- cosmetics and personal care products
- cleaning substances
- analgesics
- plants
- cough and cold remedies
- tylenol, aspirin, iron, lead.
- SSRIS, sedatives, antipsychotics, stimulants, illicit drug, cardiac drugs
Acetaminophen Overdose
- assessment?
- presentation stages
- tx
assessment: serum acetaminophen level (draw 4 hrs following ingestion); use toxicity nomogram to determine need for tx.
Presentation:
-stage 1: 1st 24hrs- minimal signs and sx, anorexia, n/v, pallor, and malaise
-stage 2: 2-3 days; signs of hepatotoxicity including RUQ pain and tenderness, elevated LFTs and bili.
Stage 3: 3-4days; some progress to fulminant hepatic failure, metabolic acidosis, coagulopathy, renal failure, encephalopathy, recurrent GI sx
Stage 4: pts who survive stage 3
Tx: N-acetylcysteine; works to counteract hepatic toxicity by replenishing glutathione.
-activated charcoal
Aspirin Overdose
- presentation
- dx
- Tx
Presentation:
- tinnitus & vomiting
- hyperpnea, fever, lethargy, confusion, coma, resp/cardiac failure
Dx: plasma salicylate concentrations
Tx:
- no specific antidote
- activated charcoal
- alkalinization of IV bicarbonate
- Dialysis may be necessary
Iron overdose
- presentation
- tx
- dose causing toxicity and death
Presentation:
- vomiting, abd pain, GI bleed, diarrhea
- has a stable period of 6-24hrs where sx may resolve)
dx:
- abd xray (for iron pills only)
- serum iron concentrations
Tx:
- whole bowel irrigation
- Deferoxamine IV (chelating agent) for severe cases.
Death from iron toxicity has been reported from 60-300mg/kg elemental iron.
Lead Poisoning
- aka
- causes
- presentation
- tx
aka: plumbism
Cause: -paint/chip ingestion -contaminated household dusts in old homes -living near lead smelter -lead-contaminated soils ...in flint its in the water!!!!
Presentation:
-weakness, irritability, weight loss, vomiting, colicky abd pain, developmental delay, sz, peripheral neuropathy, anemia
Tx:
- interrupt ingestion
- chelating therapy with succimer
