peds65 Flashcards
scalding injuries
from hot liquids; most common types of burns
glasgow coma scale assess what?
eye opening (1-4), best motor response (1-6), and best verbal response (1-5)
eye opening
none, response to pain, response to voice, spontaneously
motor
none, decerebrate, decorticate, flexion withdrawl, localizes pain, obeys commands
verbal
none, incomprehensible, innapropriate words, disoriented conversation, oriented
glasgow coma scores
13-15 mild head injury; 9-12 moderate; less than 8 severe
first degree burns
involve only the epidermis; characterized by red, blanching, painful skin that heals without scarring
second degree burns
involve the entire epidermis and part of the dermis; superficial or deep
second degree superficial burn
partial thickness burns involve the entire epidermis and outer portion of the dermis; moist, painful and red; they blister but does not scar
second degree deep partial thickness burns
involve destruction fo the entire epidermis and lower part of the dermis; burns are pale white. They may blister and they heal with scarring
third degree burns
full thickness burns involve the complete destruction of the epidermis, dermis, and part of the subcutaneous tissue; bruns are dry, white, and leathery to the touch and skin grafts are needed
skin grafts for third degree burns
yes right
painful third degree burns?
no, usually victim is insens to pain
management of burns
ABCs (endotracheal intub, assess oxygenation, IV access through nonburned skin)
why is fluid resuscitation critical in management of burn victims
lots of fluid can be lost through the skin and leaky capillaries
first degree burns management
moisturizers and analgesics
second degree burns management
analgesics, debridement of dead skin to prevent infection; bullae (large blisters are not removed because forms barrier; ruptures bullae should be removed
third degree burn management
skin grafting and hydrotherapy; escharotomy may be needed if burn restricts blood flow or chest expansion
escharotomy
surgical removal of a constricting scar
antibiotics are important in the treatment of scars
in second and third degree burns; topical 1 percent silver sulfadiazine
what is a “near drowner”
victim who survives sometimes only temporarily, after asphyxia when submerged in a liquid
how does death by drownign happen?
asphyxia by aspirating liquid (wet drowner) or from larygospasm (dry drowner)
how does inhaling liquid hurt you?
denaturing of surfactant, alveolar instability and collapse and pulm edema
respirations in a near drowner
absent or irreg; and the victim may cough up a pink frothy material;
lungs in a drowner on physical exam
rales, rhonchi, or wheezes
how does a drowner get pneumonia
aspiration of fluid containing mouth flora
how does a drowner get neuro insult
hypoxia
other features of near drowning
CV abnormalities, heamtologic abnormalities, renal failure
management of near drowner
ABCs, cervical spine immobilization, removal of wet clothing, intubation and mechanical ventilation, rewarming of body core
why do you do cervical spine immobilization
possibility of coexistent head trauma
why removal of wet clothing in a near drowner?
to reduce heat loss
how to rewarm a patient who has drowned
warm saline gastric lavage, bladder washings, or peritoneal lavag should be perforemd if needed. Resuscitation should continue until patient temp is 32 deg C
prognosis in a near drowner
children have a better outcome than adults because their primitve dive reflex shunts blood to vital organs
risk of child abuse is greatest in which kids?
less than 4 years old; mental retardation; history of premature birth; chornic illness
bruises inflicted injury vs noninflicted trauma
inflicted in bruises on fleshy or protected areas; exposed areas are typically noninflicted
accidental vs nonaccidental burns
accidental have irreg, splashlike config; nonaccidental have a clear line of demarcation (glovelike pattern suggests submersion)
what fracturs are highly suggestive of abuse?
metaphyseal fractures (bucket or corner fractures); fractures of the posterior or first ribs, sternum, scapula, and vertebral spinous processes
leading cause of death and morbidity due to child abuse
head injury
shaken baby syndrome
kids les than 2 yo; head injury
lab studies for suspected child abuse
within 72 hours of abuse; tests for STDs, incl HIV; pregnancy test and test vaginal fluid for sperm
SIDS
death of an infeant younger than 1 year whose death remains unexplained after a thorough case eval
most common cause of death in kids less than 1 years
SIDS
peak incidence of SIDs
2-4 mos
typical victim of SIDs
found dead in the morning in bed after being put to sleep at night
most common autopsy finding in SIDS
intrathoracic petechiae (unknown cause), pulm congestion or edema, small airway inflamm and evidence of hypoxia
how do most poisonings happen
kids less than 6 yo; 90 percent are accidental; at home when the childs caregiver is distracted; usually ingested; mortality less than 1 percent
most common toxic exposures
cosmetics and personal care products; cleaning agents; cough and cold preparations; vitamins (iron); analgesics; plants, alcohols; carbon monoxide; prescription meds
bitter almond
cyanide
garlic smell on a kid that ingested a poison
arsenic or organophosphates
