Pediatrics 8.9 Flashcards
Sick patient big five
oxygen, pulse ox, Cardiac monitor, IV access, CXR/EKG
ABCD
Airway, breathing, circulation, disability, environment
Fluid resuscitation
Isotonic solutions (normal saline or LR), 20ml/kg bolus until improved perfusion, and resolution of tachycardia. Hemorrhagic–>2 boluses and then PRBC 10ml/kg
AMPLE history
Allergies, Medications, PMHX, last meal, events surrounding visit
Most common cause of death and disability in children
injury
Leading cause of death in ped trauma
head injury
“Jump Test”
jump three times= no appendicitis
Abdominal Emergency warning signs
Bilious vomiting, vomiting and abdominal distention, pain before vomiting, blood in stool of ill appearing infant, focal abdominal pain, involuntary guarding
1-2 months abd emergency
pyloric stenosis
6-10 months abd emergency
intusseception
pre-school/school age
appendicitis, intussesception, test/ovarian torsion, incarcerated hernia, NAT with blunt abdominal pain trauma
adolescent females abd emergency
ectopic pregnancy, ovarian cyst, appendicitis, STD/PID, tuboovarian abscess
Intestinal malrotation
hallmark= bilious emesis in a 1-2 week old. Surgical emergency because it can lead to bowel necrosis.
Study of choice is upper GI series. contrast passes in corkscrew formation and shows abnormal position of duodenum.
IV fluid resuscitation, NG tube, call surgeon, upper GI series, laparotomy
Intussusception
most common early childhood abd emergency. 5-9 months
severe cramping belly pain in episodes. drawing knees up, blood stool.
Classic image is ultrasound bulls eye or coiled spring.
Manage with IVF, NGT, IV abx, surgery, abd xrays/ultrasound, air enema
Classic intussusception triad
pain, palpable sausage shaped mass, currant jelly colored stool
air enema contraindications
prolonged symptoms (>3 days), signs of peritonitis, evidence of free air on plain x-ray.
Appendicitis
RLQ pain, rovsings, jump test, obturator, surgery! imaging not necessary in classic presentation
Ovarian Torsion
sudden onset of unilateral lower abd pain right side > left, nausea and vomiting in 70-80% most common during reproductive years 1 in 5 are pregnant when it's diagnosed imaging- ultrasound emergent operation
causes of seizures in children
Fever (50%), congenital malformation, metabolic abnormalities, infections, trauma, vascular event, tumor, drugs, idopathic (35%)
Types of seizures
Generalized- tonic clonic, tonic, clonic, absence, atonic, myoclonic
Partial- simple, complex partial, partial with secondary generalization
seizure protocol
ABCs, place patient on side, O2, O2 sat, monitor, IV access, bedside glucose, Lorazepam, diazepam, midazolam.
febrile seizure criteria
temp of >100.4,
febrile seizure
12-18 months, viral or bacterial infection, vaccinations, familial
complex febrile seizure
> 15 mins, focal features or postical paresis (todd’s paralysis), recurrence within 24 hrs
factors that increase risk of recurrent febrile seizure
young age, family history, baseline developmental delay, complex febrile seizure
indications for admission in febrile seizure
prolonged postictal phase, complex febrile seizure, age
Absence epilepsy
absent staring w/ or w/o eyelide flutter
Juvenile myoclonic epilepsy
AM, early adolescence, precipitated by stress, may have tonic-clonic or absence as well
Benign epilepsy of Childhood with centrotermporal spikes
Somatosensory changes, speech arrest, facial twitching, drooling, may have tonic-clonic seizures at night. may not require therapy and is often out grown
infantile spasms
sudden flexion, extension or mixed movements, of trunk and proximal muscles, more urgent
lennox-gastaut
3-5 yrs, mixed seizure types, developmental delay
DKA definition
hyperglycemia >200mg/dl AND
Acidosis- venous pH 7.3 and/or bicarb
symptoms of acidosis
abd pain, vomiting, SOB, HA, confusion, altered mental status, kussmaul respirations
symptoms of hyperglycemia
polyuria, polydipsia, urinary incontinence, weight loss, muscle cramps
DKA physical exam findigs
kussmaul respirations, dehydration, tachycardia, delayed capillary refill, abdominal tenderness
DKA precipitant “I’s”
insulin lack, indiscretion, infection, impregnation or other stressor
treatment DKA
correct dehydration, correct acidosis, resotre normoglycemia, correct electrolyte imbalance, identify and treat precipitation event.
Symptoms of cerebral edema
cushings triad- bradycardia, hypertension, irregular respirations
change in pupil size, decrease in LOC, HA
