Peds And Wound Healing Flashcards by Amy Fraser

Definition of BRUE

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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High risk BRUE criteria

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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Nursemaid’s elbow

Radial head subluxation

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Clinical presentation of nursemaid’s elbow

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

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Treatment for nursemaid’s elbow

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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Fever criteria 0-90 days

100.4

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Fever criteria 3-6 months - 3 years

> 101.2

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Fever criteria 3+ years

> 101.2-101.5

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

Tx cause

Full workup

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Full workup for a fever

CBC w/ diff
blood cx
u/a
u/cx
LP
CXR

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

Tx cause

Full workup minus LP

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

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

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Workup for 3+ year old with fever and known source

tx cause

- No further workup

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Workup for a neonate with a fever without known source

Full workup

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

Full workup +/- LP

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

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

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Normal growth development

Between 5 and 95 percentile

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Abnormal growth development

Below 5 or above 95 percentile

Causes of microcephaly

craniosynostosis
chromosomal abnormalities
congenital infections
metabolic disorders
neurologic insults

Craniosynostosis

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

Phases of wound healing

Hemostasis
Inflammation
Proliferation
Remodeling

Hemostasis

occurs immediately
platelet plug forms and vasoconstriction occurs
thrombus develops to seal wound

Inflammation

occurs in the first 2-3 days

- WBC remove necrotic tissue and control infection

Proliferation

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

Remodeling

- 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)

1% lidocaine

Blocks pain stimuli but leaves pressure and touch intact

2% lidocaine

Blocks all stimuli including pressure and touch

Max dose of lidocaine

4 mg/kg

Examples of absorbable sutures

- plain cat gut - chromic gut - monocryl - vicryl - panacryl - coated and rapide - polydioxanone

Absorbable sutures

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

Non-absorbable sutures

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

Examples of non-absorbable sutures

- ethilon - prolene - nurolon - permahand silk - stainless steel

Length of scalp sutures

6-8 days

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

4-5 days cheek (3-5) neck (5)

Length of trunk and extremity sutures

8-10 days

Length of foot/sole sutures

12-14 days

Tetanus prone wound

- soiled with feces, saliva - gunshot wounds - puncture wounds - burns - frostbite - wound > 6 hrs - > 1 cm deep - stellate lacerations

When to update tetanus shot

- if > 10 years since last vaccine | - if tetanus prone wound and last vaccine was >5 years ago

Primary wound healing

6-12 hours | *do not close wound after 6-12 hours

Secondary wound healing

48-72 hrs

Use of epinephrine

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

More common allergy for anesthetics

Esters

Red flags for childhood development

If the plots cross 2 or more standard deviations

Neonate with a fever that is ill appearing

Septic until proven otherwise