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physical exam II > Peds And Wound Healing > Flashcards

Peds And Wound Healing Flashcards

1
Q

Definition of BRUE

A 
Brief resolved unexplained event
<12 months and episode of 1 or more:
-cyanosis or pallor
-absent, irregular, or decreased rate of breathing
-hyper/hypotonia
-altered level of consciousness
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2
Q

High risk BRUE criteria

A

Any of the following:

  • <60 days old
  • born <32 weeks
  • CPR needed by medical professional
  • event lasted >1 min
  • not first event
  • worried about safety/child abuse
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3
Q

Nursemaid’s elbow

A

Radial head subluxation

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4
Q

Clinical presentation of nursemaid’s elbow

A
  • age 15 months- 3 yrs
  • arm by side w/ slight elbow flexion
  • no area of true tenderness**
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5
Q

Treatment for nursemaid’s elbow

A
  • no dx imaging necessary
  • simple reduction
  • flexion of arm w/ hand external rotation
  • no lifting or twisting 2-3 days
  • NSAIDs for pain
  • education on preventing in the future
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6
Q

Fever criteria 0-90 days

A

100.4

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7
Q

Fever criteria 3-6 months - 3 years

A

> 101.2

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8
Q

Fever criteria 3+ years

A

> 101.2-101.5

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9
Q

Workup for a neonate <28 days w/ fever and known source

A

Tx cause

Full workup

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10
Q

Full workup for a fever

A
  • CBC w/ diff
  • blood cx
  • u/a
  • u/cx
  • LP
  • CXR
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11
Q

Workup for 1mo-3mos with a fever and known source

A

Tx cause

Full workup minus LP

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12
Q

Workup for >3mos-3 yrs with a fever and known source

A

Tx cause
Full workup minus LP
+/- CXR if cough

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13
Q

Workup for 3+ year old with fever and known source

A
  • tx cause

- No further workup

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14
Q

Workup for a neonate with a fever without known source

A

Full workup

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15
Q

Workup for 1mo-3months with a fever and no known source

A

Full workup +/- LP

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16
Q

Workup for 3 months and older with a fever and no known source

A

Full workup minus LP
+/- blood cx
+/- CXR

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17
Q

Normal growth development

A

Between 5 and 95 percentile

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18
Q

Abnormal growth development

A

Below 5 or above 95 percentile

19
Q

Causes of microcephaly

A
  • craniosynostosis
  • chromosomal abnormalities
  • congenital infections
  • metabolic disorders
  • neurologic insults
20
Q

Craniosynostosis

A

Premature fusing of the skull
Brain is still growing but head is not
At risk for brain herniation

21
Q

Phases of wound healing

A
  1. Hemostasis
  2. Inflammation
  3. Proliferation
  4. Remodeling
22
Q

Hemostasis

A
  • occurs immediately
  • platelet plug forms and vasoconstriction occurs
  • thrombus develops to seal wound
23
Q

Inflammation

A
  • occurs in the first 2-3 days

- WBC remove necrotic tissue and control infection

24
Q

Proliferation

A
  • begins on day 2/3 and lasts 2-4 weeks
  • fibroblasts proliferate to produce structural proteins
  • new capillaries form and epithelial cells migrate across top of the wound
  • granulation tissue forms
25
Q

Remodeling

A
  • new capillaries atrophy and collagen changes from type III to I
  • collagen is rearranged to give the best tensile strength
  • myofibroblasts cause scar contracture
  • wound strength increases to ~80% of original strength
  • forces on wound shape the remodeling process (best results when force is uniaxial)
26
Q

1% lidocaine

A

Blocks pain stimuli but leaves pressure and touch intact

27
Q

2% lidocaine

A

Blocks all stimuli including pressure and touch

28
Q

Max dose of lidocaine

A

4 mg/kg

29
Q

Examples of absorbable sutures

A
  • plain cat gut
  • chromic gut
  • monocryl
  • vicryl
  • panacryl
  • coated and rapide
  • polydioxanone
30
Q

Absorbable sutures

A

Dissolved by the body’s tissues by enzymes or hydrolysis
Don’t need to be removed
Tend to leave a more pronounced scar
Often used under the skin

31
Q

Non-absorbable sutures

A

Remain in place until removed
Less tissue reactive so not as much scarring as long as they are removed in a timely fashion
Best used on the skin

32
Q

Examples of non-absorbable sutures

A
  • ethilon
  • prolene
  • nurolon
  • permahand silk
  • stainless steel
33
Q

Length of scalp sutures

A

6-8 days

34
Q

Length of head and neck sutures (ears, eyelids, eyebrows, nose, lips, face/forehead, cheek, neck)

A

4-5 days

cheek (3-5)
neck (5)

35
Q

Length of trunk and extremity sutures

A

8-10 days

36
Q

Length of foot/sole sutures

A

12-14 days

37
Q

Tetanus prone wound

A
  • soiled with feces, saliva
  • gunshot wounds
  • puncture wounds
  • burns
  • frostbite
  • wound > 6 hrs
  • > 1 cm deep
  • stellate lacerations
38
Q

When to update tetanus shot

A
  • if > 10 years since last vaccine

- if tetanus prone wound and last vaccine was >5 years ago

39
Q

Primary wound healing

A

6-12 hours

*do not close wound after 6-12 hours

40
Q

Secondary wound healing

A

48-72 hrs

41
Q

Use of epinephrine

A

Vasoconstrictive properties

Mixed with lidocaine to increase duration of action and to decrease systemic sx

42
Q

More common allergy for anesthetics

A

Esters

43
Q

Red flags for childhood development

A

If the plots cross 2 or more standard deviations

44
Q

Neonate with a fever that is ill appearing

A

Septic until proven otherwise

physical exam II (5 decks)

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