Pediatrics Flashcards
What is the number one cause of death in children?
trauma
What is the best indicator of shock in pediatric patients?
tachycardia
What is considered tachycardia for the following age groups:
- neonates
- 1-6 years old
- 6-12 years old
- 13 years or older
- neonates: > 150 bpm
- 1-6 years old: > 120 bpm
- 6-12 years old: > 110 bpm
- 13 years or older: > 90
What is the appropriate volume for boluses in children of crystalloid and blood?
- crystalloid: 20cc/kg
- blood: 10cc/kg
When should blood be transfused in pediatric trauma patients?
if still hypotensive after two crystalloid boluses
What is considered adequate urine output in neonates, infants, and toddlers?
- neonates: 2-3 mL/kg/hr
- infants: 2-3 mL/kg/hr
- toddlers: 1 mL/kg/hr
What is the appropriate size and type of ETT in children less than 10 years old?
- they always get an uncuffed tube
- use a tube with same diameter as patient’s pinkie or use Breslow tape to decide
Describe the presentation, diagnosis, and treatment of pyloric stenosis.
- presents with projective, non-bilious emesis and an olive-like mass palpable in the epigastrium
- labs reveal hypochloremic, hypokalemic, metabolic alkalosis
- US shows a pylorus > 3mm thick and > 14mm long
- treat with resuscitation (NS) then dextrose-containing mIVF and take to the OR for pyloromyotomy
What is the most common type of tracheoesophageal fistula?
a blind ending of the esophagus with distal TE fistula
What are the VACTERL syndrome components?
- Vertebral anomalies
- Anorectal (imperforate anus)
- Cardiac
- TE fistula
- Renal
- Limb anomalies
In addition to the workup and treatment of a TE fistula, what other diagnostic studies are required to work up the VACTERL syndrome?
- vertebral anomalies: sacral US
- anorectal: digital exam for imperforate anus
- cardiac: TTE
- TE fistula: AXR
- renal: ultasound
- limb anomalies: exam
How is TE fistula treated?
primary repair through a right extra pleural thoracotomy plus a G-tube
What are the five types of TE fistula?
- A: isolated esophageal atresia
- B: esophageal atresia with proximal fistula
- C: esophageal atresia with distal fistula
- D: esophageal atresia with double fistula
- E: isolated fistula
What are the most common etiologies for intussusception in children?
1) inflamed peers patches after viral illness
2) lymphoma
3) Meckel’s diverticulum
How is ileocolonic intussusception managed in children? Adults?
- begin with air-contrast enema
- repeat enema if it recurs
- operate if unable to reduce with enema, they are peritonitis, or they are obstructed
- always operate for adults since malignant lead point is much more common
What is the etiology for malrotation with midgut volvulus?
- malrotation secondary to failure of normal 270-degree rotation during intestinal development
- volvulus secondary to Ladd’s bands (adhesions to right retroperitoneum)
Describe the presentation, etiology, diagnosis, associations, and treatment of malrotation with mid-gut volvulus.
- presents with bilious emesis, typically before one year of age
- malrotation (asymptomatic) is due to failure of 270-degree rotation while volvulus (symptomatic) is due to Ladd’s bands (adhesions to right RP)
- diagnosed with an upper GI series, which will show that the duodenum does not cross the midline
- associated with congenital diaphragmatic hernia and omphalocele
- treat with resection of Ladd’s bands, counterclockwise detorsion to place the small intestine on the right and large intestine on the left, and appendectomy
What is the treatment for malrotation with volvulus?
- resection of Ladd’s bands
- counterclockwise detorsion, placing the small bowel on the right and large bowel on the left (think “turn back time” for counterclockwise)
- appendectomy to prevent later diagnostic confusion
Malrotation with midgut volvulus is associated with what two other anomalies?
- congenital diaphragmatic hernia
- omphalocele
How is duodenal atresia diagnosed?
- AXR showing double bubble sign is usually first
- follow with an upper GI series
What causes small bowel atresia?
- duodenal atresia is failure of re-canalization
- other intestinal atresias are due to intrauterine vascular accidents (usually jejunum)
Give the etiology, diagnostic workup, and treatment for duodenal atresia.
- due to failure of re-canalization
- diagnosed with AXR and UGI series
- treated with primary reconnection
Describe the presentation, associations, diagnosis, and treatment of meconium ileum.
- presents with failure to pass meconium in the first 24hrs of life
- diagnosed with AXR showing dilated small bowel without air fluid level and a positive sweat chloride test given the high association with cystic fibrosis
- treated with gastrhogafin enema or N-acetylcysteine enema
- operate for perforation or ostomy creation for anterograde NAC enemas
What is the most common cause of colonic obstruction in neonates?
Hirschsprung’s disease
How is Hirschsprung’s disease diagnosed?
with suction rectal biopsy showing an absence of ganglion cells in the myenteric plexus
What is the treatment for Hirschsprung’s disease?
resection of affected rectum and colon with delayed anastomosis
What is the treatment for Hirschsprung’s colitis?
rectal irrigations, may require emergent colectomy
