Peds 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 a tachycardic for kids?
- neonates > 150
- 1-6 years old > 120
- 6-12 years old > 110
- over thirteen > 90
What is the preferred strategy for fluid resuscitation in pediatric trauma?
- start with a 20cc/kg bolus x2
- then move to a 10cc/kg blood transfusion
What is the target UOP for pediatric patients?
- neonates are 2-3 cc/kg/hr
- toddlers and older are 1cc/kg/hr
Which pediatric trauma patients get an uncuffed tube?
neonates
What is the differential for emesis in a neonate?
- medical: infectious, allergy, metabolic disorder
- surgical: GERD, pyloric stenosis, intestinal obstruction, atresia
What is the differential for emesis in toddlers and infants?
- medical: infectious, neurologic/psychologic, gastroparesis
- surgical: intussussception
What is the differential for emesis in an adolescent?
- medical: functional, psychologic, IBD
- surgical: appendicitis
What metabolic disturbance is seen in those with pyloric stenosis?
- hypochloremic hypokalemia
- metabolic alkalosis
- paradoxic aciduria
How is a diagnosis of pyloric stenosis made?
based on an US with thickness > 4mm and length > 14mm
What should guide the fluid resuscitation in a patient with hypertrophic pyloric stenosis?
- use a dextrose containing fluid
- target bicarb < 30 and chloride > 100
What is the difference between a type A and type C TEF?
- A: second most common, just esophageal atresia
- C: most common, esophageal atresia and distal TEF
What other screening should those with a TEF undergo?
look for VACTRL anamolies
- V: vertebral anomalies - sacral US
- A: anorectal - imperforate anus/rectal exam
- C: cardiac - echo
- T: TEF
- R: renal - renal US
- L: limb - physical exam
What tests are used to look for VACTRL anomalies?
- sacral US
- rectal exam
- echo
- AXR
- renal US
- physical exam of limbs
How is a TEF treated?
- resuscitate with areplogle
- place a G-tube and perform a primary repair through a right extra pleural thoracotomy
What is the preferred method to treat an ileocolic intussusception in adults?
surgical since they most likely have a pathologic lead point requiring diagnostic laparoscopy
What is the best first test for bilious emesis?
an upper GI series to evaluate for malrotation
Most patients with malrotation present with volvulus by what age?
one year
Malrotation is associated with what two other abnormalities?
CDH and omphalocele
Where should the bowel lie when you finish a Ladd’s procedure?
the small intestine on the right and the large intestine on the left (turn back time with a counterclockwise rotation)
What procedure should you perform along with a Ladd’s procedure?
an appendectomy
Duodenal atresia has what associations?
- Down’s syndrome
- cardiac, renal, and GI anomalies
How is duodenal atresia diagnosed?
with AXR and an UGI series
