Peds Lectures 14, 15, and 17 Flashcards
Fourth-leading cause of child death
Poisoning
peak age of poisoning accidents
2 years
What information do you need to obtain when someone calls in to report a poisoning?
- Name of substance
- time taken
- amount
- patient’s condition
What should you give when an acid or alkaline agent is ingested?
Milk or water
Contraindications to vomiting induction
- Corrosives
- Volatile hydrocarbons
- Absent gag reflex (comatose)
- > 2 hours after ingestion
How do you know when you’ve performed a gastric lavage long enough?
-Clear fluid will return
You only want to give Ipecac if the poison has been ingested within what time frame?
30-60 minutes
What’s a narcotic poison antidote?
Naloxone (Narcan)
How common are fatal poisonings caused by iron?
20-25% of poison deaths
How many phases does a child experienced who’s been poisoned with iron?
5
What are the 5 phases of iron poisoning?
- 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
What color might the urine be of a child with iron poisoning?
Red
Drug tx for iron poisoning
Deferoxamine
How many stages are involved in acetaminophen poisoning?
3
What are the 3 stages of acetaminophen poisoning?
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
Acetaminophen poisoning tx
- Acetyl Cysteine- lessens liver damage
- Ipecac or lavage
- Charcoal
Child presents with N/V, fever, lethargy, sweating, and is hyperventilating. Suspicion?
-Salicylate poisoning
What lab tests will be significant in a child with salicylate poisoning?
- hypokalemia
- hypoglycemia
- metabolic acidosis
Does lead poisoning have a rapid or an insidious onset?
Lead poisoning
How do you treat lead poisoning?
-Succimer, which is a lead chelator
How do you treat CO poisoning?
100% oxygen by mask or hyperbaric oxygen
How do you treat methanol or ethylene glycol (antifreeze)?
-Fomepizole
What do we need to know about petroleum distillate hydrocarbon poisoning tx?
Normal saline or ringers IV for 1 hour
What triggers anaphylactic shock?
Antigens (medications, tree nuts, eggs, etc.)
What immunoglobulin is responsible for mediating anaphylaxis?
IgE
Anaphylaxis tx
- ABC’s
- oxygen
- epinephrine
- saline bolus for hypovolemia
- nebulized beta-agonists
- Diphenhydramine
- corticosteroids
First line drug for symptomatic bradycardia in children
Epinephrine
At what age range does the incidence of SIDS peak?
2-4 months
How should you position a child when laying them down to prevent SIDS?
-On their back
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
How should you treat open bite wounds?
- DTaP booster if > 5 years since last one
- Consider TIG if tetanus status uncertain
- Copious wound irrigation
Where should you refer patients with significant hand bits?
Ortho
Most common pathogen in cat bites
Pasteurella multocida
Most common pathogens in dog bits
- P. multocida
- strep
- staph
- anaerobes
Most common pathogens in human bits
- strep
- staph
- anaerobes
- eikenella corrodens
Treatment for bites
- Augmentin
- Cephalosporins for penicillin allergy patients
Brown recluse bite tx
- cold compress
- tetanus prophylaxis
- total wound excision to the fascia
Black widow spider bit tx
- cold compress
- tatanus prophylaxis
- IV calcium gluconate
Which age group is most affected by burns?
Toddlers
When should you refer a child to a burn center?
- superficial burn > 10% of BSA
- Full thickness burn > 2% BSA
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
When should you consult a surgeon for re: a foreign body?
- Causing GI symptoms
- Remains in GI tract > 5 days
- Remains in esophagus
When is “bag and mask” ventilation indicated?
- apnea
- HR < 100
- central cyanosis on continued O2
- gasping or inadequate respirations
When is endotracheal intubation indicated?
- prolonged or ineffective Bag and mask oxygenation
- to deliver meds
- if transport is anticipated
What is the #1 best drug for neonatal resuscitation?
Oxygen
Common cause of congenital amputations
Amniotic bands
In what kind of delivery presentation is hip dysplasia more common?
Breach presentation
Is developmental dysplasia of the hip more common in girls or boys?
Girls
Signs of DDH in older children
- Asymmetric abduction of the hips
- Galeazzi’s sign
What kind of treatment is usually required for DDH of young infants?
Pavlik harness
What kind of tx is usually required for DDH in older children?
- Traction
- Casting
- Osteotomy
What is another name for avascular necrosis of the proximal femoral head?
Legg-Calve-Perthes disease
What’s the most common symptoms of Legg-Calve-Perthes disease?
- Persistent pain
- limp
- limited ROM
In what patient population is a slipped capital femoral epiphysis more common?
-Obese adolescent males
How does the acute stage of a slipped capital femoral epiphysis present?
Pain and limp with referred pain to the knee
How do you treat a slipped capital femoral epiphysis?
- Pin in place if diagnosed early enough
- If necessary, internally fix, and then pin
What are the primary causes of painless limps in children up to 5 years of age?
- DDH
- leg length discrepancy
- cerebral palsy
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
Torticollis tx
- passive stretching
- massage
Bone infection caused by bacteria or other germs
-Acute osteomyelitis
What part of the bone is usually affected by acute osteomyelitis?
Metaphysis of long bone
In what bones does acute osteomyelitis most often occur?
Long bones of the lower extremities
Most common pathogen responsible for acute osteomyelitis
Staph aureus
Acute osteomyelitis tx
IV antibiotics
Most common pathogen responsible for septic arthritis
Staph aureus
Which joint is most often affected by septic arthritis?
Hip
Which joint is second-most affected by septic arthritis?
Knee
How will an infant present with septic arthritis?
- Irritable
- Hip will be held in flexion and external rotation
What should you look for on x-ray if septic arthritis is suspected?
Widening of the joint space
Septic arthritis tx
- IV antibiotics, then oral antibiotics
- surgical drainage/aspiration
Most common cause of limping and pain in children in the US
Transient (toxic) synovitis
Acute, self-limiting inflammation of a joint
Transient (toxic) synovitis
Transient (toxic) synovitis tx
- Rest
- NSAIDs
Patient presents with low-grade fever, back pain, irritability, and a reluctance to flex their back. Suspicion?
Intervertebral diskitis
Joint inflammation in a child of at least 6 weeks duration
Juvenile RA
Most common rheumatic disease in children
Juvenile RA
Three main types of juvenile RA
- Systemic onset
- Pauciarticular
- Polyarticular
Patient presents with high fever x2 weeks with a macular rash and joint inflammation. Suspicion?
Systemic onset JRA
What percentage of JRA cases are systemic onset?
20%
What percentage of JRA cases are pauciarticular?
40%
What lab result will make you think of pauciarticular JRA?
Presence of ANA
What percentage of JRA cases are polyarticular?
40%
JRA treatment
- NSAIDs
- Hydroxychloroquine
- Methotrexate
Where will a child with Osgood-Schlatter disease feel pain?
At the tibial tuberosity
10yo female presents with arthritic pain, malar rash, and hair loss. Suspicion?
SLE
What types of injuries are battered children usually brought in with?
Orthopedic
What should you suspect if you find a fx in a non-ambulatory infant?
Child-battering syndrome
How do you treat nursemaid’s elbow?
-Supination of hand, full extension, full flexion
How do you define scoliosis?
Lateral curvature of the spine greater than 10 degrees, accompanied by vertebral rotation
What percentage of adolescents diagnosed with scoliosis have curves that progress and require medical attention?
10%
Risk factors for scoliosis curve progression
- Large curve magnitude
- Skeletal immaturity
- Female gender
Test that can illustrate the spinal curvature of scoliosis
Adam’s forward bend test
Patient presents with dull, aching pains in both arms that occur in the evening time. Suspicion?
Growing pains
Growing pain treatment
- Massage
- ASA, NSAIDs
SH Type I fx
Fx through the physis
SH Type II fx
FX through the physis and into the metaphysis
SH Type III fx
Fx through the physis and into the epiphysis
SH Type IV fx
Fx through the physis and into both the metaphysis and the epiphysis
SH Type V fx
Crushing fx of the physis
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
