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Peds > Peds Emergencies > Flashcards

Peds Emergencies Flashcards

1
Q

what are the elements of the glasgow coma scale?

A

Eye opening (out of 4)
Best verbal response (out of 5)
Best Motor Response (out of 6)
–> score of three is a brick, 15 is best

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2
Q

ratings for Eye opening component of glasgow coma

A

spontaneous = 4
to speech = 3
to pain = 2
no response = 1

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3
Q

ratings for Best verbal response in GCS?

A 
oriented - infant babbles/coos = 5
confused - infant cries irritable = 4
inappropriate - infant cries to pain = 3
incomprehensible - moans to pain = 2
no response = 1
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4
Q

ratings for best motor response in GCS?

A

obeys (moves purposefully) = 6
localizes (withdraws to touch) = 5
withdraws to pain = 4
abnormal flexion (decorticate posturing) = 3
abnormal extension (decerebrate posturing) = 2
no response = 1

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5
Q

bones involved in the basal skull and why to be concerned if head injury occurs here

A

Bones: sphenoid, temporal, occipital, ethmoid
concern: lots of vessels here, worry about foramen magnum

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6
Q

what should primary PE of head injury consist of

A

1) ABC (airway, breathing, circulation)
2) neuro status - glasgow coma
3) vital signs - cushings triad (wide pulse pressure, bradycardia, abnormal respirations)

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7
Q

Secondary PE of head injury should be..

A

check head/neck:

  • CS alignment
  • eye exam for papilledema indicating hydrocephaly
  • hematomas (stepoffs, crepitus, fontanels)
  • basilar skull fracture (battle sign, ecchymosis, hemotympanum, ear/nose CSF d/c)

check rest of body

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8
Q

How to dx head injury?

A

bedside US emerging, radiography min value, CT is best but high radiation (decide with PECARN, CHALICE, CHART)

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9
Q

young child fell on his head and experienced LOC followed by irritability, lethargy, bulging fontanelle and vomiting. Upon seeing him in the ED you immediately you order a CT exam. Results indicates diffuse blood spread in crescent shape. Dx? and what is the etiology? concern?

A

dx: subdural hematoma
etiology: tearing of VEINS resulting in low pressure bleed that separates arachnoid from dura.
concern: Bad bc crosses suture lines so blood can spread, swell –> death, coma, LT effects if not treated. Poor prognosis

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10
Q

Football player comes in with head injury. He had been tackled, briefly lost consciousness but seemed alright after a bit. What might the CT reveal? dx?

A

CT: elliptical shaped blood due to rupture of ARTERIES, skull fractures

dx: epidural hematoma
* does not cross suture lines but admit for obs bc deterioration with time

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11
Q

Pt has “worst headache ever” following head injury. Small dense slivers are noted on a CT exam. what are these slivers and what is your dx?

A

slivers are blood in sulci, fissures, blood in CSF due to injury to parenchymal and subarachnoid vessels

dx: subarachnoid hemorrhage
* may take time to evolve and be visible on CT

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12
Q

what is a concussion

A

trauma induced alt in mental status w/ or w/o LOC

*the direct force causes shearing of axons

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13
Q

what do you want to make sure to find out from witness of concussion?

A

mech of injury, LOC length, confusion/mental status, seizure or mvmt, concussion hx, substance use (ALWAYS CT if used substance)

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14
Q

PE for concussion:

A

complete neuro exam including GCS, CN II-XII
check every inch, focal neural findings take precedence so put in C collar then if no acute findings to treat, clear ALWAYS clear CS

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15
Q

Concussion sx. Continuing issues?

A

HA, fogginess should improve 7-10 days

  • Post concussive syndrome if sx 3mth or more
  • Second impact syndrome = 2nd concussion w/in weeks can lead to brain swelling, herniation (children at risk)
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16
Q

Tx concussion?

A

no same day return regardless, must be symptom free and eval by neurologist

rest brain and body (no cell phones, video games etc) and slow return to play

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17
Q

why are sprains (torn ligaments) less common in children as opposed to ends of long bones?

A

cartilaginous growth plate - physis!

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18
Q

Salter Harris Type I

A

epiphyseal separation through physis often appears normal

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19
Q

Salter Harris Type II

A

fracture through portion of physis but exiting across metaphysis (goes up) (most common growth plate fx expecially in older children)

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20
Q

salter harris Type III

A

fracture through physis exiting down into joint

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21
Q

salter harris type IV

A

fracture through metaphysis, physis, and epiphysis

IV = ALL!!!

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22
Q

Salter harris type V

A

crush injury to physis

V = COMPRESS/CRUSH

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23
Q

2 yr old pt is irritable and refuses to walk. Her radiograph reveals non-displaced spiral fx of tibia. Dx and what to be on the watch for

A

dx: toddler’s fracture (9mth to 3 yr)

suspicious of child abuse/non accidental injury

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24
Q

tx of open compound fx

A

splint/dress, IV antibio, ortho consul

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25
Q

tx open nondisplaced fx

A

PO antibiotic, repair laceration, splint, ortho FU

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26
Q

deformed/displaced fx tx?

A

make sure to check neurovascular structures, will require closed/open reduction, possible fixation (ortho ED consult)

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27
Q

standard tx for all fx?

A

always document neurovascular status before and after splinting or reduction to any fx (cap refill, nerve sensation)

splint, pain control, ortho f/u

28
Q

common fx to suspect child abuse

A

spiral fracture of long bone, femur fracture, spinous processes, acromion, skull fracture greater than 3 mm, posterior rib fracture, corner fracture or bucket handle from jerking/shaking (metaphyseal fracture)

29
Q

child comes in guarding arm, holding it in slightly flexed prone position and will not use the arm even to grab candy. Normal radiographs. dx and tx?

A

dx: nursemaids elbow
tx: reduction by immobilizing elbow, applying pressure to radial head, supinating forearn and flexing elbow - should feel pop
* do not reduce without xray clearance

30
Q

Acute septic arthritis presentation, cause, labs

A

presentation: fever, constant worsening joint pain, arm swollen joint pain with ROM *hip typically flexion/external rotation
cause: adolescent = N gonorrhea, kids = s aureus or strep
Lab: CBC< CRP, ESR, blood culture, joint aspiration

31
Q

tx for acute septic arthritis

if not treated, this may lead to?

A
  • antibiotics (empiric then targeted)
  • repeated aspiration if peripheral joints or surgical drainage for hips/shoulders (ususal**)

untreated –> osteomyelities

32
Q

Kid comes in with fever, bone pain, swelling, and is guarding limb that began over a week ago. Pain in leg upon palpation. Xray (2 wks after initial onset) reveals bone destruction. MRI (the best study in this scenario) reveals marrow edema, abscesses. Dx, etiology, tx?

A

Osteomyelitis
etiology: hematogenous spread of infection into BONE cause bone destruction in long bone

tx: IV antibiotic (empiric then targeted), surgical drainage, debridement, hyperbaric O2 (to help with tissue healing)

33
Q

this disease commonly affecting 18mth to 2 yrs has unknown etiology, but commonly follows URI, strep or trauma. Sx include abrupt onset pain to hip/thigh or knee, temp but FROM. WBC and ESR is normal and Xray shows some effusion. Dx, tx?

A

dx: transient synovitis
tx: pain relief, obs, f/u

*dx of exclusion, comes on quickly

34
Q

6 year old BOY is limping and holds hip internally rotated with limited abduction but has little to no pain. How to dx and likely dx? etiology, tx?

A

Legg Calve Perthes disease

dx: xray (AP and frog leg lat), bone scan, ortho referral URGENT
etiology: idiopathic avascular necrosis of femoral head (no blood supply, bone dies), slow onset

**think frog LEGG calve

35
Q

this disease has similar presentation as Legg Calve Perthes but affects males 14-16 more freq. Associated with obesity, increased ht, genital underdev, pituitary tumors. Sx are acute or chronic hip/knee pain and xrays reveal ice cream falling off cone.

A

dx: SCFE (slipped capital femoral epiphysis)
- -> femoral head slips and exposes anterior/superior aspects of femoral neck
tx: bed rest with traction but most require surgery

36
Q

toxidromes are helpful in categorizing reactions. Name the main ones

A

Anticholingeric (hot as haire, dry as a bone, red as a beet, blind as a bat; tachycardia) - benadryl is pink and could look like candy

cholinergic (bradycardia), hallucinogenic,
opiate/narcotic, sedative/hypnotic, sympathomimetic

37
Q

poison control phone number

A

1-800-222-1222

38
Q

what is the most important thing to know! deadly in a dose (1-2 tab can kill)

A

the substance!
ASA, Ca chan blockers, oils, clonidine, iron (vit, birth control), chloroquine, methadone, nicotine, TCA, lindane, methyl salicylate

39
Q

tx

A

stabilize ABC, contact poison control, DDD (disability/supportive car, drugs/antidotes, decontaminate)

40
Q

Decontamination - ocular, skin, GI, blood stream

A

ocular (IRRIGATE saline lavage, flush till pH normal via litmus paper, alkali is worse than acidic);
skin (normal saline flush),
blood stream (antidote)
GI (lavage, charcoal, cathartics, whole bowel irrigation, enhance elim - diuretics, dialysis, hemoperfusion, urine, charcoal)

41
Q

GI decontamination methods

A

Ipecac only if within 30 min, gen not rec
Gastric lavage - rarely; use for TCA CCB, iron, EtOH
cathartics - not usually
whole bowel irrigation - sustained release med
charcoal - deox
simple dilution for mild toxin

42
Q

antidote for: acetaminophen

A

acetylcysteine

43
Q

antidote for: anticholinergic

A

physostigmine

44
Q

antidote for: benzodiazepine

A

flumazenil

45
Q

antidote for: beta blocker

A

glucagon

46
Q

antidote for: ca channel blocker

A

calcium

47
Q

antidote for: digoxin

A

digibind

48
Q

antidote for: heavy metals

A

chelation

49
Q

antidote for narcotics/opiates

A

naloxene/narcan

50
Q

if you don’t know what poison was ingested..

A

draw lab for acetaminophen bc worse
C metabolic panel (electrolyte level, kidney function, liver), coags (liver function), ABG, protein

administer antidotes empirically as indicated by exam; you will do less harm by administering antidotes then letting the kid just be

51
Q

places where foreign body often lodges; when is it clear to go

A

circopharyngeal narrowing, tracheal bifurcation, aortic notch, LES
*clear once passes pylorus

52
Q

when to consult for foreign body aspiration

A

sharp/elongated objects, multiple foreign bodies, button batteries, evidence of perforation, coin at cricopharyngeus muscle level, if present more than 24 hr

53
Q

button battery in esophagus.. what is the worry?

A

alkaline battery on mucosa, pressure necrosis, residual charge; burns can occur in as little as 4 hours, perforation in 6, lithium is worst, mercuric oxide worry about fragmenting - measure blood and urine levels or contact national button battery ingestion hotline

54
Q

tx button battery

A

emergent removal if in esophagus, if passed esophagus, no need to remove if asymp UNLESS doesn’t move through pylorus after 24-48 hr

if any GI sx, immediate surgical consult

55
Q

near drowning outcomes

A

survival > 24 post event, but severe brain damage in 10-30% victims

if come to ED comatose, needing CPR, fixed and dilated pupils, no resp = poor prog (30-60% die, 60-100% neuro complication)

56
Q

when to worry about child abuse and drowning

A

if less than 6 mth or in toddlers with atypical presentation

*fences could prevent most drowning events

57
Q

dry drowning

A

laryngospasm –> hypoxia –> LOC

*no fluid in lungs

58
Q

wet drowning

A

more common, aspiration of water into lungs
dilution and washout of surfactant –> diminished gas transfer across alveoli –> atelectasis –> ventilation perfusion mismatch

  • fresh vs salt water
59
Q

secondary drowning - what is it and why is it dangerous

A

may cause death up to 72 hours after near drowning bc…

freshwater ingested during near drowning dilutes blood –> hemolysis and cardiac arrythmias if enough water ingested

60
Q

tx drowning

A

pres hospital care is critical

in ED: ventilation, warmed isotonic IV fluids, address injuries, CXR and repeat at 6 hr, obs by neuro

61
Q

Fever without a source

A

Rectal temp >38 deg c

goal is to identify occult infections: pneumonia, UTI, bacteremia/sepsis, herpes-virus, meningitis

62
Q

how to manage fevers?

A

decide how to manage based on age and risk factors, appearance
<2 mth is neonate, 2 mth-3 yr is infant/young children
risk: birth hx, travel, exposures, vaccination, immune def

63
Q

2 mth to 3 yr: non toxic management

A

UA cath, rapid viral testing (flu, RSV), stool for WBC and guaiac if diarrhea
*if all these things are negative and they appear okay, are fully immunized, etc you can send them home –> f/u 24 hr with PCP

64
Q

2 mth to 3 year: toxic management (judge based on appearance)

A

CBC with diff, CXR, UA cath, CSF analysis via lumbar puncture, stool for WBC and guaiac, rapid virus testing
*admit for obs and begin empiric antibiotics while waiting for culture results

65
Q

toxic management for infants less than 2 mth temp > 38 deg C

A

workup regardless of appearance; get pretinent birth hx (premature, STD exposure, PROM, fetal hypoxia, in NICU at all?)

66
Q

neonatal fever: sx of infection, management

A

irritability * be careful with this documentation

management: full septic workup, early administration of empiric antibiotics (cefotaxime, ampicillin) till culture results

67
Q

febrile seizures age range and types

A

6mth to 5 yr
simple febrile: less than 15 min, isolated
complex febrile: > 15 min multiple in rapid succession
usually benign unless prolonged aspiration, compromised ventilation/perfusion

Peds (8 decks)

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