Peds Flashcards
How much weight is normal for a neonate to lose in the first 3-4 days of life and why
10% (Meconium)
how long should it take for a neonate to regain weight lost just after birth
By Day of Life 14
How much weight should children gain per month in first 3 months of Life
2 pounds per month
Why do we measure head circumference?
Reliable indicator of brain growth up to 2 years
What BMI is a significant risk factor for obesity in adulthood
BMI>95%
When should lead testing occur?
Between 9 -12 months
Age 2
Age 3
When should Iron be checked
annually starting at age 1 until age 6
Why do we do developmental screens (3)
Identify delays
Initiates Interventions for best outcomes
Support family
4 parts of development
Gross motor
Fine motor
Language
Social
When does Gross and fine motor skills develop
first 3 years of life
Rapid in 1st year
Kicks ball forward at what age
2 years
rolls back to stomach at what age
4-10 months
sits steadily at what age
6-9 months
pulls to standing at what age
7-12 months
Stands alone at what age
9-16 months
stoops and recovers at what age
15 months
walks pretty well at what age
13 months
Throws ball overhand at what age
3 years
balances on 1 foot 2 seconds, hops at what age
4 years
Catches ball at what age
5 years
Fine motor rake at what age
5-7 months
Fine motor lobster claw grasp at what age
8-10 months
Radial digital grasp between thumb and side of index finger
Perfection of pincher grasp at what age
10-12 months
Fine motor scribbles
15 months
Fine motor imitates vertical or circular strokes - towers 6 cubes
24 months
When do you ask parents if baby startles at loud sounds
0-3 months
When do you ask parents if baby turns eyes and head at the sound of your voice
4-6 months
When do you ask parents if baby makes strings of sounds
7-9 months
When do you refer to professional speech and or language assessment (5)
No talking by age 2 unintelligible speech at age 3 no sentences by age 3 child embarrassed by speech (any age) Known disorder (hearing loss, retardation, autism)
Vision assessments (3)
red reflex in infants (check for retinoblastoma)
Corneal light reflex (for misalignment)
Cover/uncover
What is the vision expectation of a (fullterm) newborn
focuses of face and briefly tracks objects
What is the vision expectation of a 2 month old
tracks across midline,
responsive to smile,
follows movement 6 feet away
social skill at 2 months
social smile
Social skill at 6 months
reaches for objects
social skill at 9 months
feeds self, passes objects from hand to hand
social skill at 12 months
plays appropriately with toys
Social skill at 18 months
drinks from cup
Social skilla t 2 years
Uses spoon
Social skill at 4 years
puts on t shirt
early adolescent concerns
rapid physical changes
concern if different from peers
concrete thinking
middle adolescent concerns
Body comfort (or not) Sense of omnipotence
late adolescence concerns
less self-centered
realistic future plans
Stridor is what diagnosis
Epiglotitis
cough and stridor is what diagnosis
Croup
Wheeze is what diagnosis
Bronchiolitis
who gets epiglottitis?
<6 months (due to not being fully immunized)
What bacteria causes Epiglotitis (3)
strep pyogenes,
Strep Pneumo
Staph
(H. Flu in adults)
Signs and symptoms of Epiglotitis (7)
Mild sore throat and fever to toxic in hours
Muffled voice,
drooling, pain, labored breathing (stridor)
tripoding
Diagnose Epiglotitis?
Clinical suspicion
(used to be xray)
(can directly visualize with intubation and endoscopy)
Treat epiglottitis (5)
Anesthesia STAT - Intubation O2 on blow by KEEP CHILD CALM 2 IV if possible Ceftriaxone or cefotaxime (x 7-10 days)
Who to prophylax with epiglottitis contacts?
What to give?
NOT CONTAGIOUS
immunosuppressed, or Child<6 months without HIB vax - give Rifampin
Croup cause
viral - 75%
age of croup
3 months - 5 years
(fall and spring)
10pm-4am
Croup Clinical course
Day 0-2 URI
Day 0-5 Barking cough - worse DAY 2and 3
Resolves by day 5-7
diagnostics with croup
rapid strep if sore throat
xray if foreign body concern
Croup (mild-moderate) Treatment
Decadron PO 0.6mg/kg max 10mg
Cold air,
humidified air
Croup (severe- with stridor) treatment (3)
ED
Decadron PO 0.6mg/kg max 10mg
Inhaled (racemic) Epi by nebulizer - repeat PRN
Admit if recurrence
Bacterial Tracheitis Signs and symptoms
thick purulent exudate within trachea - may obstruct airway
Urgent or emergent condition
Who gets bronchiolitis
<2 years
more common in boys, non-breastmilk, or smokers
Who is at greatest risk for Bronchiolitis complications
Underlying condition or
Kids <2 months
Cause of Bronchiolitis
> 50% Respiratory syncytial virus
Otherwise (usually still viral)
Presentation of Bronchiolitis
copious clear rhinorrhea,
low grade fever
wheezing with/w/out crackles
Late fall through winter
What is a bad sign in bronchiolitis pts
Decreased breath sound
Diagnostics for Bronchiolitis
if first episode of wheezing or pneumonia consideration - CXR
PCR for RSV if pt <2 months or risk factors, or plans to hospitalize pt
Bronchiolitis treatment
Albuterol/racemic epi Decadron PO Fluids Tylenol If hospitalized - O2 to keep sat >94%
course of Bronchiolitis
Worse Day 2-5 of illness
Lasts 10-12 days
Is Bronchiolitis contagious
yes - bad cold (+wheezing)
who to vaccinate for bronchiolitis
premie, chronic lung disease, cerebral palsy, heart disease, immune compromise,
Signs of asthma
Wheezing over weeks, with instigating factor
Cough -(may be with or without wheezing)
First time wheezing what is the diagnosis
Reactive airway disease
Pertussis vaccine <11 years
dTap
Pertussis vaccine >11 years
tDaP
What causes Pertussis
Bortadella pertussis (gram - coccobaccilus colonizing ciliated epithelium)
Stage 1 of pertussis
Catarral stage (most contagious) lasts 1-2 weeks Cold symptoms
Pertussis incubation period
and contagious timeframe
3-12 days
and
during catarrhal period and first 2 weeks of cough (21 day average)
Stage 2 of pertussis
Paroxysmal stage
Lasts 1-6 weeks (up to 10)
paroxysms of uncontrollable coughing fits
Stage 3 of pertussis
Convalescence stage (lasts for months) paroxysms may recur if subsequent Respiratory infections
Diagnostic for Pertussis
Nasal swab (takes days to weeks to return) clinical diagnosis
Treatment for Pertussis
Zithromax 10mg/kg day 1
5mg/kg day 2-5
Supportive care
Most common cause of morbidity/ mortality under 2 years old
Foreign body aspiration
Where do most foreign bodies end up in kids
proximal main stem bronchus
Concern of Foreign body aspiration if…
1st episode of wheezing get CXR
formerly speaking- won’t speak
coughing without other URI symptoms
Classic triad for Foreign body presentation
Wheezing,
Decreased air entry - usually regionally
Cough
Treatment and diagnosis of Foreign body
Bronchoscopy
Most common population for Cystic fibrosis
Caucasian,
Cause of Cystic Fibrosis
Genetically driven chloride channel disruption
Features of Cystic fibrosis
Viscous secretions in lungs, liver, pancreas, intestine, reproductive tract
What bacteria colonize Cystic fibrosis patients
Staph and H flu in childhood
P. Aeruginosa in adulthood
Sinus symptoms of Cystic fibrosis (2)
Panopacification by age 8 months
Nasal polyposis in 20%
Pancreatic symptoms of Cystic fibrosis (3)
Insufficient digestive enzymes,
malabsorption
failure to thrive, electrolyte abnormalities, anemia
Important early clinical finding in Cystic fibrosis
Meconium ileus is Pathognomonic for CF
May have small bowel obstruction in Older children
Infertility in Cystic fibrosis
95% in Males
20% in females
Cystic fibrosis diagnosis
sweat chloride elevated on 2 occasions
2 disease causing mutations of the CFTR gene
[testes at birth with heel stick (50% are diagnosed at this stage)]
Cystic fibrosis treatment options (7)
Ivacaftor (/tezacaftor) Azithromycin - anti-inflammatory Bronchodilators Dnase Inhaled hypertonic saline Steroids - short term Lung transplant
Respiratory Distress syndrome epidemiology
Premies <30weeks
Cause of RDS
Surfactant deficiency –>
Atelectasis –>
V/Q mismatch –>
Pulmonary response
Diangosis of RDS
Clinical
CXR - air bronchograms, low lung volume, ground glass appearance, pneumothorax
prevention of RDS (3)
antenatal corticosteroids
exogenous surfactant
assisted ventilation
What is most important in diagnostic feature of Child abuse
History that doesn’t make sense
Likely abuse signs and ages(3)
fractures in non-ambulatory children
less than 18 months (>80%)
Multiple fractures or multiple different stages of healing
When does inflammation, pain and swelling occur after a fracture
day 3-7
induction
When does soft callus bone formation occur after a fracture
infants 7-10 days
children 10-14 days
When does union at fracture site - hard callus- occur after a fracture
14-21 days
hard callus
When does woven to lamellar bone occur after a fracture
3 months to 1 year
remodeling
When to do skeletal surveys for child abuse (5)
<2 with obvious abuse
<2with possible abuse
infants with unexplained death
infants with unexpected intracranial injuries
infants and siblings <2 in abused child’s household
abuse fractures (8)
metaphyseal lesions - bucket handle rib fx acromion spinous processes scapular fx sternal and pelvic hand and foot in infants occipital impression fx
When does pyloric stenosis present
3-5 weeks of life
Rare after 12 weeks
Presentation of Pyloric stenosis
Projectile vomiting,
Wt loss,
Hungry after vomiting
Palpable Olive
Diagnostic for Pyloric Stenosis
Ultrasound
(or UGI)
(But also correct electrolytes and hydration - so CBC and CMP)
Treating Pyloric stenosis
Rehydrate and correct ‘lytes
then
Pyloromyotomy
When does intussusception occur most commonly?
3months - 5 years
What usually causes Intussusception?
Ideopathic (75%)
Viral, bacterial, underlying pathology
Presentation of Intussusception
15-20 minutes of Sudden severe crampy pain
Non-bilious vomiting
currant jelly stool
intussusception triad
Pain
Palpable mass
Current jelly stool
(only 15% present with all three)
Diagnosis of Intussusception
Clinical
Xray - crescent sign (+/- reliable)
Ultrasound (100% with good tech)
Treatment of intussusception
barium or pneumatic enema if stable and no perf
Surgical if enema fails or signs of perf
Phenylketonuria (PKU)definition
genetic deficit of phenylalanine hydroxylase - build up of phenylalanine leading to intellectual disability
Untreated PKU symptoms
mental retardation
epilepsy
pigment issues,
blood and urine smell “mousy”
Diagnosis of PKU
Screening done at birth
Treatment for PKU
Initiate by 1st week of life monitor Phenylalanine levels Weekly for first year Twice monthly until 12 years of age Monthly for life Mon
Pediatric appendicitis presentation
1month - 5 years
Limping, Hip pain, may just look ill,
Treatment for Peds appendicitis
FLuids, Pain control, NPO, Antibiotics, (if perforated - triple Abx) High risk goes straight to OR (6-8 hours if non-perf) No radiation (CT) unless surgeon insist Perf goes to OR after 24-48 hours of Abx
Normal stooling frequency for 0-3 month old
3-4 stool/ day
Normal stooling frequency for 3months - 2 years
1-2 stool per day
What is an important dietary counsel point for children less than one (might cause Microbleeding)
Cow’s milk
Treating Constipation
Infants: Glycerine suppository
Older children:
Suppository, MIRALAX, Enema, Laxative
What is encopresis
Involuntary leakage of stool (+/- constipation)
Who gets encopresis
3% of kids
Boys 6x more than girls
around the age of toilet training, and school
What is the most common cause of Encopresis
constipation
DSM-V criteria for Encopresis (4)
- passage of stool into underpants
- 1+ event per month
- older than 4 years
- not result of laxative or illness
Encopresis treatment when caused by constipation
Miralax and water
Hirshsprung disease is what
Genetic mutation of RET proto-oncogene causing a section of the colon to lack ganglion cells - no nerves
Presentation of Hirshsprung disease
due to lack of peristalsis in affected colon, proximal piece fills with feces
Failure of newborn to stool completely
Or in Children - swollen belly, N/V/C/D, failure to thrive and fatigue
Where is Hirshsprung disease usually located
Rectosigmoid (75%) but may comprised the whole colon (8%)
Diagnostic of Hirshsprung disease
Xray
Barium enema,
Manometry of anorectum,
Biopsy of section of colon - gold Standard
Treatment of Hirshsprung disease
Surgical excision of affected segment
What is Meckels disease
Congenital diverticulum
the disease of 2’s
Who gets Meckel’s
2% of Pop males 2:1 2 years old at presentation 2 feet proximal to ileocecal valve 2 inches in length
Presentation of Meckel’s
70% asymptomatic
otherwise may present with GI bleed, Obstruction, Peritonitis, Divericulitis, appendicitis, bezoar
Treatment of Meckel’s
Surgical excision
What is malrotation
rotation of small intestines only (unlike situs inversus) twisting leads to volvulus
Presentation of malrotation
may be asymptomatic
otherwise - infants present with Bilious vomiting, abdominal pain and distension, melena and/or mucoid stool
Diagnose Malrotation
If clinical suspicion do Xray
UGI series if not emergent
Treat malrotation
surgical fix
What are the types of strabismus
Esophoria Exophoria esotrophia exotrophia Intermittent constant monocular alternating
Can strabismus ever be normal
Yes - In the first few months of life
What is hering’s law
when one eye moves, the other eye should move equally (muscle equality from side to side)
What is Sherrington’s law
When the eye is pulled by a muscle the opposing muscle must relax to allow ocular movement
Risk factors for strabismus
Family hx
Low birth weight
visual deprivation (retinopathy of prematurity)
What can occur if Strabismus is not corrected
Amblyopia, Diplopia, Contracture of EOMs, psychosocial and vocational consequences
treating strabismus
prescription glasses,
miotic drops, patching, training exercises
Surgical reposistioning
When to refer strabismus
Any age with esotropis esodeviation after 4 months deviation with cover test asymmetry of appearance on Bruckner test inexplicable torticollis parental/provider concern
impetigo Epidemiology
Kids 2-5
warm climates
spread by contacts,
Impetigo causes
Staph Aureus (not MRSA) (less frequent beta hemolytic strep -A)
Impetigo types
Non-Bullous - most common
Bullous
Ecthyma
Describe non-bullous Impetigo
honey colored crusts
may have regional lymphadenitis
No Systemic symptoms
Describe Bullous impetigo
flaccid bullae with clear yellow fluid
fluid darkens and ruptures
Describe ecthyma impetigo
ulcerative punched out lesions with yellow crusts
relatively rare
treat impetigo
Clinical suspicion Antibiotics - topical - if few lesions Mupirocin Oral - If bullous or many lesions Diclox, Cephalexin Clinda, Bactrim (if MRSA suspect)
What causes pinworms
Eterobiasis
Enterobius Vermicularis
Who gets Pinworms
5-14 year olds
Diagnosis of Pinworms
Hx of anal itching at night and cellophane tape collection
Treat Pinworm
Albendazole
400mg once
repeat in 2 weeks
(pyrantel Pamoate - OTC may work also)
fifth disease AKA
Erythema Infectiousum
Cause of 5th disease
Parvovirus B19
Symptoms of 5th disease
Day 1-2 Fever, HA, N/D
Day 2-5 RASH - slapped cheek
reticulated on trunk
Rash may reappear or linger for weeks to months
Incubation period for 5th disease
1-2 weeks
non-infectious when rash appears
Treating 5th disease
Supportive
Unless there is a pregnant mother - MAY CAUSE FETAL HYDROPS
Mono AKA
Epstein Barr
Incubation for Mono
4-7 weeks
Mono presentation (7)
Fever Pharyngitis Adenopathy Fatigue Atypical Lymphocytes Splenomegally Rash - Maculopapular
Diagnosis of Mono
Clinical
Monospot (high false negative and false positive rate)
EBV panel if Monospot is negative after 1 week
Treat mono
Supportive - Hydrate
Antipyretics, REST (NO SPORTS)
Steroids if Airway is compromised (tonsillar hypertrophy)
Rubeola incubation
7-21 days
Rubeola symptoms
fever, cough, coryza, conjunctivitis Koplik Spots (Head --> toe) - Pathognomonic
When is Rubeola contagious?
4 days before rash appears until 4 days after rash
HIGHLY CONTAGIOUS
Complications of rubeola
OM Pneumonia Croup Diarrhea Acute encephalitis
Measles Prophylaxis
MMR vaccine w/in 72 hours of exposure
IG if administered w/in 6 days of exposure
Measles Treatment
Vitamin A - Immediately and then again the next day
What does Vitamin A prevent when given for measles treatment
Preventable blindness due to xerophthalmia (severe dry eye)
Rubella symptoms
Rash and low grade fever, symptoms last for 2-3 days
May cause birth defects in pregnant women
Roseola epidemiology
affects over 90% of children by age 2
Roseola presentation
Sudden high fever
fever subsides –> rash appears (arms and legs) Asymptomatic rash
Kawasaki disease presentation (7 + age range)
Usually kids <5 years old Fever>5 days Conjunctivitis (non-exudative) Mucositis (cracked red lips and strawberry tongue) Rash (perineal- then desquamates) Extremity changes (swelling of hands and feet) Lymphadenopathy(single- large >1.5 cm) Affects coronary arteries - tachycardia
Diagnose Kawasaki’s
Clinical but get Echo to detect aneurysm -Repeat in 4-6 weeks
Treat Kawasaki’s
Admit all pts - Cardiology consult Monitor for Cardiovascular function IVIG -given w/in 7-10 days of illness onset - fever should abate w/in 36 hours Aspirin 80-100mg/kg q6 hrs may d/c when fever resolves
Coxackie presentation
Apthous stomatitis
Rash on hands an feet
fever
( less common -Aseptic meningitis)
Treating Coxackie
Tylenol or motrin
magic mouthwash
hydrate
prophylaxis for close contacts
Varicella treatment
Motrin or Tylenol for fever
Benadryl and aveeeno for itching
what is eneuresis
urinary incontinence in children
treating nocturnal enuresis
DDAVP (Vasopressin)
What causes UTI in infants (2)
E.coli and anatomical abnormalities
How does a UTI present in Infants
URI symptoms
not UTI symptoms
limping child eval diagnostics (4)
Xray
Labs (CBC, CRP, ESR, Blood Cx, CMP)
Joint aspiration
MRI/CT
Concern with femur fractures in children less than 10 years
Overgrowth - may grow longer than other leg by 1-3 cms
Don’t put back into anatomical alignment
toddler’s fracture
Minimal or undisplaced spiral fracture of the tibia (not fibula)
No Hx of trauma, pt age 1-6
Treating a Bowing fracture
required lots of force (done in OR under general Anesthesia)
Conservative treatment of a Supracondylar fracture
Long arm cast,
analgesics
serial radiographs q 2 weeks
Surgical treatment of supracondylar fracture
Pinning done in OR - avoid injury to Ulnar nerve
Galeazzi fracture
dislocation of distal radioulnar joint and distal fractured radius
muGR
Monteggia fracture
Fracture to ulna
proximal dislocation of radial head
MUgr
Developmental dysplasia of hip
screened on newborn eval
F 4x more than M
early Total hip replacement
Identifying Developmental dysplasia of hip
toe walking
limb length inequality
waddling gate
swayback
Tests for Developmental dysplasia of hip
Galeazzi - knee height difference
Barlow - trying to dislocate hip
Treatment for Developmental dysplasia of hip
Pavlik Harness–>
Closed reduction–>
Open reduction–>
SPICA cast to hold hip in reduced position
Legg-calve Perthes description and epidemiology
osteonecrosis of capital femoral epiphysis
ages 2-14
Boys 5x more than Girls
4 stages of Legg-calve Perthes
Stage 1: necrosis
Stage 2: fragmentation
Stage 3: reossification
Stage 4: remodeling
presentation of Legg-calve Perthes
limited hip Abduction and internal rotation
atrophy of quad,
leg length inequality
tx for Legg-calve Perthes
Reduce activity,
crutches, walker, wheelchair,
refer to specialist
NSAIDS may help with bone regrowth
Transient synovitis of hip diagnosis
diagnosis of exclusion
r/o septic arthritis
tx for transient synovitis
bedrest until symptoms improve
NWB - 1-2 days
NSAIDS
Apophysitis other names and description
Osgood-schlatter’s disease
pain over tibial tuberosity
Sever’s disease
pain in calcaneus at insertion of achilles
treatment for apophysitis
RICE
NSAIDS
Reassurance
Bow legged baby - non-pathologic - name
Physiologic genu varum
concerning genu varum signs and symptoms
asymmetry,
atypical for age
worsening deformity
what age to refer genu verum out
2 years
Blount’s disease description
unilateral genu verum with lateral thrust during gait
normal leg position ages 3-5
Physiologic genu valgus
when to eval toe-walking - causes
older than 3 years,
cerebral palsy
tethered cord
treating club foot
Serial casting
Scoliosis -definition
COBB angle >10degrees
What is the risser classification
used to grade skeletal maturity based on level of ossification and fusion of iliac crest
Stages 0-5
0= earliest
5 = latest
<25 degree scoliosis treatment
observe regardless of risser scale
25-45 degress of scoliosis treatment
Brace from Risser 0-2
Observe if in risser stage 3-5
> 50 degrees of scoliosis treatment
Surgery
meaning of RV heave pediatric
RV hypertrophy
Differential pulses in pediatrics
Coarctation of aorta
bounding pulses in peds
L–> R PDA shunt
pulsus paradoxus in peds
exaggerated SBP drop with inspiration
May indicate tamponade or severe asthma
Pulsus alternans in peds
alternating pulse strength -
LV mechanical dysfunction
Mid systolic click
Mitral Valve Prolapse
Loud S2 heart sound
Pulm HTN
fixed split S2
ASD, Pulmonary stenosis
S3 (gallop)
volume overload or cardiac dysfunction
Holosystolic murmer
VSD,
Mitral regurg
Continuous murmur
PDA
Shunts in fetal circulation
Ductus venosus - bypasses liver
Foramen ovale -
ductus arteriosus
Do umbilical arteries or vein carry oxygenated blood
Umbilical Vein (singular - there are 2 arteries that carry deoxygenated blood)
What causes closing of shunts
Umbilical cord clamp causes changes to vascular resistance and greater L ventricular pressure closing FO
First breath decreases resistance in Pulmonary circulation
How long does it take for ductus arteriosus to close (Functionally)
24-48 hrs (may be longer in premie or persistant hypoxia)
When should the left ventricle be thicker than the right
By 1 month post partum
What do these structures become after birth: Foramen ovale umbilical vein ductus venosus ductus arteriosum
Fossa ovale
ligamentum teres
ligamentum venosus
migamentum arteriosum
murmur that changes with position (concern?)
Innocent murmur(Except HOCM)
vibratory twangy systolic murmur at LSB and apex-
Age 3-5
loudest in supine –> Disapears upright
Still’s murmur (Innocent)
Systolic ejection murmur over pulmonic area grade 1-2 increases insupine, decreases upright
Pulmonary flow murmur (innocent)
Low pitched continuous murmur in infraclavicular area
loudest upright,
decreases supine
Venous hum (innocent)
red flag murmurs (5)
Diastolic (Venous hum ok) Continuous murmurs Loud murmur (with thrill) constant with positional change Symptomatic
L–>R “Acyanotic” Shunts
VSD
PDA
ASD
Holosystolic murmur at LSB with heave +
FFT, Tachypnea, Diaphoresis with feeding
VSD
Systolic ejection murmur in pulmonic area
+/- Diastolic murmur at LSB
ASD
Bounding pulse, Congestive heart failure
FFT and diaphoresis with feeding
PDA
Treatment for PDA
Indomethacin
Tetralogy of fallot
Rt ventricular outflow obstruction
VSD
Overriding aorta
RVH
Tx for Tetralogy of fallot
systemic pulmonary artery shunt in early infancy
later relief of outflow tract, and VSD closure
Skin can tolerate up to what temperature without burning
111 degrees
deepest burn area with dead or dying cells necrosis and absent bloodflow
Zone of coagulation (3)
red zone of burn - may blanch, becomes avascular and necrotic by day 3
zone of stasis (2)
burn area blanches with pressure, healing by day 7
Zone of hyperemia (1)
burns >30% of total body area - concern for what complication
Systemic inflammatory response
-hemolysis, and pulmonary bronchoconstriction
increased vascular permeability - hypovolemia End organ damage,
2nd degree burn -superficial partial thickness- description
fluid filled blisters
soft - very tender to touch
healing over 2-3 weeks no scarring
2nd degree burn -deep partial thickness- description
red and blanched white skin
thick-walled blisters
healing over 3-6 weeks with scarring
3rd degree burn description
full thickness burn - white leathery area
no sensation
Burns >1cm require grafting
4th degree burn treatment
surgical debridement and repair
when counting TBSA burned rule of estimation
Count partial thickness and full thickness separately
1 palm is 1% body area
circumferential burn around torso - treatment
Escharotomy - Longitudinal incisions
axial planes
In to normal skin
down to subcutaneous fat
When does maximal
edema occur after burn
24-48 hours
goal of fluid resuscitation for burn pts
Children urine output of 1-2ml/kg/hour
Adults
urine output of 40ml/hour
Concern if over hydration with burns
ARDS 3-5 days post burn
dressing on burns
2x daily,
partial thickness burns - topical anti-microbial and occlusive dressings
concern with aspirin in peds
Reye’s syndrome
What % TBSA burns go to burn center: Partial thick - adult Partial thick - child full thick other
Partial thick - adult: >25%
Partial thick - child: >20%
full thick: >10%
other - functional or cosmetic impairment (face, hands/feet, perineal)
COncerns with Burns (2)
Infection
Burn shock - coagulation necrosis, fluid loss
what type of electricity causes passes the “let-go current” barrier more easily
AC>DC
Low voltage burns - cause in kids and treatment
hand/mouth from exposed wire contact Small deep burn - requires amputation/ graft prolonged is significant injury Monitor on EKG for 12 hours for arrhythmias
oral burns in toddlers -presentation
Painless demarcation of viable/non-viable skin w/in 5-7 days
Labial artery bleeding risk at 2 weeks from dead tissue coming off
what does contact with high voltage DC current cause
Single muscle contraction throwing victim from source (impact trauma)
How does high voltage current travel in the body
Direct path through body from current source to ground
How does low voltage current travel in the body
travels along path of least resistance along nerves and blood vessels
Internal damage caused by electricity (5)
necrosis periosteal melting fluid leakage rhabdomyolysis - muscle ischemia cardiac - arrhythmias
treating electrical burn pt (6)
IVF + Foley Labs + imaging Tetanus Splinting (after NV Eval) Fetal monitoring and compartment pressure
Symptoms of frostbite (5)
cold –> sting/burn/throb –>
Numbness/complete sensation loss –>
Loss of dexterity sm then large muscles–>
Severe joint pain
Frost bite: 1st 2nd 3rd 4th degree
1st - cold ears in winter +/- peeling in weeks
2nd - clear blistering
3rd - hemorrhagic blister, pain for 5 weeks, ulceration, thick gangrenous eschar,
4th - involves muscle, bone and tendon, avascular, no pain on rewarming, demarcation of viability takes 1 month
Trench foot
Pain, parasthesisas, pallor, pulselesnness, paralysis
reversible if treated early - better than frostbite
Chilblains/ Pernio
chronic repeated exposure to non-freezing, cold/damp
capillary bed damage
resolves in 7-14 days
what blisters should you treat/how to treat
Aspirate clear blister - do not aspirate hemorrhagic blister
what controls body temperature
Hypothalamus
conserve heat via vasoconstriction
produce heat via shivering
EKG findings in Hypothermia
J or Osborne waves
Arrhythmias
Mild Hypothermia temperature
89.6-95 F
32-35 C
altered judgement,
ataxia, apathy
Moderate hypothermia termperature
82.4-89.6 F
28-32 C
CNS Depression, paradoxical undressing
Severe hyptothermia
82.4F
<28 C
V fib COMA
Lab changes in Hypothermia: ABG CBC CMP DIC
ABG - Falsely high O2, CO2 and low pH
CBC - HCT up 2%/1 degree C
CMP- K>10= low recovery
DIC- enzymes may be malfunctioning not accurately reflected in sample
Slow rewarming technique
Warm IV Fluids - 45C,
Heated O2 mask
Warmed blankets
Moderate rewarming technique
Warmed gastric lavage
warmed IV fluid -65 C
peritoneal lavage
Rapid rewarming technique
thoracic lavage
Cardiopulmonary bypass
ECMO, AV Dialysis,
Warm water immersion
What is catastrophic Hyperthermia
> 41.1C
>106 F
Heat stroke temp
> 104.9
with anhydrosis and Altered Mentation
Goal of hyperthermia therapy
Decrease Core temp to <40C within 30 minutes
Malignant hyperthermia treamtment
Dandrolene
