Pediatrics Flashcards
1 cause of mortality in children? over 1
trauma
what is important to find out about head injury?
IF IT IS:
Minor
IC injury
Neurological defect
Mortality
Scalp injury - what is important to look for?
Foreign bodies
Underlying skull fractures
Bleeding (can lead to Hypotension and shock)
caput succedaneum
Swelling of the scalp in a newborn. It is most often brought on by pressure from the uterus or vaginal wall during a head-first (vertex) delivery. crosses suture lines
Cephalohematoma
Accumulation of blood under the scalp, specifically in the sub-periosteal space. During the birthing shearing forces on the skull and scalp result in the separation of the periosteum from the underlying calvarium resulting in the subsequent rupture of blood vessels. Does not cross suture lines
Linear fracture
There is a break in the bone, but it does not move the bone.
– most common
– typically occur over temporal bone, in area of middle meningeal artery (commonest cause of
epidural hematoma)
Comminuted fracture
a bone that is broken in at least two places.
Depressed fracture
broken bones displace inward with more than 1 thickness of the bone
most common fracture in children?
90% are linear
open fracture
fracture overlayed by laceration
basilar skull fracture
multiple blows to the bones composing the base of the skull
◆ generally a clinical diagnosis (poorly visualized on CT)
Signs of basilar skull factures
battle sign - brusing over mastoid process
Raccoon eyes
CSF otorrhea and rhinorrhea
Concussion
◆ transient alteration in mental status that may involve loss of consciousness
◆ hallmarks: confusion and amnesia, which may occur immediately after trauma or minutes later
◆ loss of consciousness (if present) must be less than 30 min, initial GCS must be between 13-15,
and post-traumatic amnesia must be less than 24h
subdural andepidural hematoma
EDH: times for presentation
Arterial: peak 6-8h
Venous: peak 24h or more
causes of subdural hematoma in peds
Birth trauma:
- presents within 12h
- seizures
- full fontanel
- anisocoria
- respiratory distress
Shaken baby syndrom
- new-onset seizures
- inc hear subconference
- poorly thriving infant
- tense fontanel
subarachnoid hemorrhage
bleeding into subarachnoid space (intracranial vessel between arachnoid and pia)
Shaken baby syndrom
(Diffuse axonal injury)
Absence of external signs of abuse with
respiratory arrest, seizures, or coma.
Ocular exam findings are important
diagnostically for Shaken Baby Syndrome.
These findings include extensive retinal and
vitreous hemorrhages that occur during the
shaking process and are extremely rare in
accidental trauma. A detailed fundoscopic
exam or an ophthalmology referral should
be conducted for all infants in whom abuse
is suspected
Classify severity of head trauma is based on GCS,
14-15 is mild head trauma
8-13 is moderate head trauma
< 8 is severe head trauma.
In non-verbal children: pediatric GCS, rather than an adult GCS
why is E for exposure in primary survey so important in pediatrics?
Because a child may not be able to
tell you about other sites of injury, either because they are too young or because of level of consciousness has deteriorated. Be sure to check the whole body.
Summarize the primary survey
Do the ABCs, and also D and E where D is a quick neuro exam and E is ensuring you have exposed every potential site of injury
Alarming features indicating that they need to be seen by a neurosurgeon ASAP
- Hypotension, suggesting hemodynamic instability;
- Unilaterally fixed and dilated pupils suggesting mass effect from raised ICP
- Bilaterally fixed and dilated pupils, suggesting substantial mass effect and possible herniation
- Any other signs of increased ICP including apneic spells, hypoventilation, and Cushing’s triad
of low heart rate, high blood pressure, and irregular breathing.
type og history in cases where patient is unconscious and unstable
SAMPLE history:
Signs and Symptoms;
Allergies;
Medications;
Past illness;
Last Meal;
Events related to illness or injury.
2 rules used in peds imaging
CATCH: minor head injury but need a head CT
PECARN: low risk of intracranial injury in, CT should be avoided
2 parts of our immune system?
Innate: first defense - fast
Adaptive: second defense - slow (cellular and humoral)
when to suspect immunodeficiency
infections that are severe, persistent, unusual, or
recurrent (mnemonic SPUR).
typical for severe persistent infection infections?
§ two or more months of antibiotics with little effect
§ sepsis in the absence of a known risk
§ bacterial meningitis
§ pneumonia with empyema
typical for recurrent infections?
§ six or more new infections in one-year
§ recurrent tissue or organ abscesses
§ two or more serious sinus infections in one year
§ two or more pneumonias in one year.
when is the onset of clinical features of immunodeficiency?
after 6 months of life because mom provides Ab (or 3 months of severe)
