Peds Lectures 14, 15, and 17 Flashcards
1
Q
Fourth-leading cause of child death
A
Poisoning
2
Q
peak age of poisoning accidents
A
2 years
3
Q
What information do you need to obtain when someone calls in to report a poisoning?
A
- Name of substance
- time taken
- amount
- patient’s condition
4
Q
What should you give when an acid or alkaline agent is ingested?
A
Milk or water
5
Q
Contraindications to vomiting induction
A
- Corrosives
- Volatile hydrocarbons
- Absent gag reflex (comatose)
- > 2 hours after ingestion
6
Q
How do you know when you’ve performed a gastric lavage long enough?
A
-Clear fluid will return
7
Q
You only want to give Ipecac if the poison has been ingested within what time frame?
A
30-60 minutes
8
Q
What’s a narcotic poison antidote?
A
Naloxone (Narcan)
9
Q
How common are fatal poisonings caused by iron?
A
20-25% of poison deaths
10
Q
How many phases does a child experienced who’s been poisoned with iron?
A
5
11
Q
What are the 5 phases of iron poisoning?
A
- Hemorrhagic gastroenteritis starting 30-60 mins after ingestion, lasting 4-6 hours
- Patient feels better for 2-12 hours
- Hypotension from blood loss, metabolic acidosis, shock
- Liver damage with hepatic failure
- Pyloric stenosis 3-4 weeks post ingestion
12
Q
What color might the urine be of a child with iron poisoning?
A
Red
13
Q
Drug tx for iron poisoning
A
Deferoxamine
14
Q
How many stages are involved in acetaminophen poisoning?
A
3
15
Q
What are the 3 stages of acetaminophen poisoning?
A
2-24 hours: N/V, malaise, diaphoresis
24-48 hrs: looks/feels better, but hepatotoxic effects are starting
48+ hrs: hepatic necrosis, jaundice, coagulopathy, hypoglycemia, coma, encephalopathy
16
Q
Acetaminophen poisoning tx
A
- Acetyl Cysteine- lessens liver damage
- Ipecac or lavage
- Charcoal
17
Q
Child presents with N/V, fever, lethargy, sweating, and is hyperventilating. Suspicion?
A
-Salicylate poisoning
18
Q
What lab tests will be significant in a child with salicylate poisoning?
A
- hypokalemia
- hypoglycemia
- metabolic acidosis
19
Q
Does lead poisoning have a rapid or an insidious onset?
A
Lead poisoning
20
Q
How do you treat lead poisoning?
A
-Succimer, which is a lead chelator
21
Q
How do you treat CO poisoning?
A
100% oxygen by mask or hyperbaric oxygen
22
Q
How do you treat methanol or ethylene glycol (antifreeze)?
A
-Fomepizole
23
Q
What do we need to know about petroleum distillate hydrocarbon poisoning tx?
A
Normal saline or ringers IV for 1 hour
24
Q
What triggers anaphylactic shock?
A
Antigens (medications, tree nuts, eggs, etc.)
25
What immunoglobulin is responsible for mediating anaphylaxis?
IgE
26
Anaphylaxis tx
- ABC's
- oxygen
- epinephrine
- saline bolus for hypovolemia
- nebulized beta-agonists
- Diphenhydramine
- corticosteroids
27
First line drug for symptomatic bradycardia in children
Epinephrine
28
At what age range does the incidence of SIDS peak?
2-4 months
29
How should you position a child when laying them down to prevent SIDS?
-On their back
30
What are the 4 major risks factors that can be modified to reduce the risk of SIDS?
- sleep in supine position
- no cigarette smoking
- keep sleeping environment safe
- breast feeding, rather than bottle-feeding
31
How should you treat open bite wounds?
- DTaP booster if > 5 years since last one
- Consider TIG if tetanus status uncertain
- Copious wound irrigation
32
Where should you refer patients with significant hand bits?
Ortho
33
Most common pathogen in cat bites
Pasteurella multocida
34
Most common pathogens in dog bits
- P. multocida
- strep
- staph
- anaerobes
35
Most common pathogens in human bits
- strep
- staph
- anaerobes
- eikenella corrodens
36
Treatment for bites
- Augmentin
| - Cephalosporins for penicillin allergy patients
37
Brown recluse bite tx
- cold compress
- tetanus prophylaxis
- total wound excision to the fascia
38
Black widow spider bit tx
- cold compress
- tatanus prophylaxis
- IV calcium gluconate
39
Which age group is most affected by burns?
Toddlers
40
When should you refer a child to a burn center?
- superficial burn > 10% of BSA
| - Full thickness burn > 2% BSA
41
How do early CXR findings differ from late findings of aspirated foreign bodies?
- Early: hyperinflation and mediastinal shift away from affected side
- Later findings: atelectasis, pneumonia, abscess
42
When should you consult a surgeon for re: a foreign body?
- Causing GI symptoms
- Remains in GI tract > 5 days
- Remains in esophagus
43
When is "bag and mask" ventilation indicated?
- apnea
- HR < 100
- central cyanosis on continued O2
- gasping or inadequate respirations
44
When is endotracheal intubation indicated?
- prolonged or ineffective Bag and mask oxygenation
- to deliver meds
- if transport is anticipated
45
What is the #1 best drug for neonatal resuscitation?
Oxygen
46
Common cause of congenital amputations
Amniotic bands
47
In what kind of delivery presentation is hip dysplasia more common?
Breach presentation
48
Is developmental dysplasia of the hip more common in girls or boys?
Girls
49
Signs of DDH in older children
- Asymmetric abduction of the hips
| - Galeazzi's sign
50
What kind of treatment is usually required for DDH of young infants?
Pavlik harness
51
What kind of tx is usually required for DDH in older children?
- Traction
- Casting
- Osteotomy
52
What is another name for avascular necrosis of the proximal femoral head?
Legg-Calve-Perthes disease
53
What's the most common symptoms of Legg-Calve-Perthes disease?
- Persistent pain
- limp
- limited ROM
54
In what patient population is a slipped capital femoral epiphysis more common?
-Obese adolescent males
55
How does the acute stage of a slipped capital femoral epiphysis present?
Pain and limp with referred pain to the knee
56
How do you treat a slipped capital femoral epiphysis?
- Pin in place if diagnosed early enough
| - If necessary, internally fix, and then pin
57
What are the primary causes of painless limps in children up to 5 years of age?
- DDH
- leg length discrepancy
- cerebral palsy
58
What are the primary causes of painless limps in children 5-10 years of age?
- DDH
- Cerebral palsy
- leg length discrepancy
- muscular dystrophy
- chronic stage of legg-calve-perthes disease
59
Torticollis tx
- passive stretching
| - massage
60
Bone infection caused by bacteria or other germs
-Acute osteomyelitis
61
What part of the bone is usually affected by acute osteomyelitis?
Metaphysis of long bone
62
In what bones does acute osteomyelitis most often occur?
Long bones of the lower extremities
63
Most common pathogen responsible for acute osteomyelitis
Staph aureus
64
Acute osteomyelitis tx
IV antibiotics
65
Most common pathogen responsible for septic arthritis
Staph aureus
66
Which joint is most often affected by septic arthritis?
Hip
67
Which joint is second-most affected by septic arthritis?
Knee
68
How will an infant present with septic arthritis?
- Irritable
| - Hip will be held in flexion and external rotation
69
What should you look for on x-ray if septic arthritis is suspected?
Widening of the joint space
70
Septic arthritis tx
- IV antibiotics, then oral antibiotics
| - surgical drainage/aspiration
71
Most common cause of limping and pain in children in the US
Transient (toxic) synovitis
72
Acute, self-limiting inflammation of a joint
Transient (toxic) synovitis
73
Transient (toxic) synovitis tx
- Rest
| - NSAIDs
74
Patient presents with low-grade fever, back pain, irritability, and a reluctance to flex their back. Suspicion?
Intervertebral diskitis
75
Joint inflammation in a child of at least 6 weeks duration
Juvenile RA
76
Most common rheumatic disease in children
Juvenile RA
77
Three main types of juvenile RA
- Systemic onset
- Pauciarticular
- Polyarticular
78
Patient presents with high fever x2 weeks with a macular rash and joint inflammation. Suspicion?
Systemic onset JRA
79
What percentage of JRA cases are systemic onset?
20%
80
What percentage of JRA cases are pauciarticular?
40%
81
What lab result will make you think of pauciarticular JRA?
Presence of ANA
82
What percentage of JRA cases are polyarticular?
40%
83
JRA treatment
- NSAIDs
- Hydroxychloroquine
- Methotrexate
84
Where will a child with Osgood-Schlatter disease feel pain?
At the tibial tuberosity
85
10yo female presents with arthritic pain, malar rash, and hair loss. Suspicion?
SLE
86
What types of injuries are battered children usually brought in with?
Orthopedic
87
What should you suspect if you find a fx in a non-ambulatory infant?
Child-battering syndrome
88
How do you treat nursemaid's elbow?
-Supination of hand, full extension, full flexion
89
How do you define scoliosis?
Lateral curvature of the spine greater than 10 degrees, accompanied by vertebral rotation
90
What percentage of adolescents diagnosed with scoliosis have curves that progress and require medical attention?
10%
91
Risk factors for scoliosis curve progression
- Large curve magnitude
- Skeletal immaturity
- Female gender
92
Test that can illustrate the spinal curvature of scoliosis
Adam's forward bend test
93
Patient presents with dull, aching pains in both arms that occur in the evening time. Suspicion?
Growing pains
94
Growing pain treatment
- Massage
| - ASA, NSAIDs
95
SH Type I fx
Fx through the physis
96
SH Type II fx
FX through the physis and into the metaphysis
97
SH Type III fx
Fx through the physis and into the epiphysis
98
SH Type IV fx
Fx through the physis and into both the metaphysis and the epiphysis
99
SH Type V fx
Crushing fx of the physis
100
With what types of orthopedic injuries/diseases should you refer to orthopedics?
- Acute osteomyelitis
- Septic arthritis
- Legg-calve-perthes disease
- Slipped capital femoral epiphysis
- All fractures
