peds66 Flashcards
clinical features of growing pains
kids awaken at night crying in pain; however, the physical exam is normal
management of growing pains
analgesics and reassurance
compression fracture
torus or buckle fracture; occurs if the soft bony cortex buckles under compressive force; occurs in metaphysis and requires only splinting 3-4 weeks
incomplete fracture
greenstick fracture; occurs if only one side of the cortex is fractured; reduction may include fracturing the other side
complete fracturs
transverse, oblique, spiral, communuted
spiral fracture
oblique fracture encircling the bone; occur with twisting injury; associated with child abuse
comminuted fracture
fracture that is composed of multiple fracture fragments
physeal fracture
involves the growth plate
Salter-harris classification
describes fracture involving the physis; GradeI-V; Same, Above, Low, through and through, crush
grade I salter-harris
fracture within the physis
grade II- salter harris
fracture in the metaphysis and the physis
grade III salter harris
fracture in the epiphysis and the physis
grade IV salter harris
fracure in the physis, metaphysis, and epipysis
grade V salter harris
crushing of the physis
metaphyseal fracture
involves the ends of the central shaft (between the epiphyses and diaphyses)
diaphyseal fractures
involve the central shaft of the bone
clavicular fractures
common in childhood
causes of clavicular fracture?
falling onto the shoulder
major cause of clavicular fracture in neonates
birth injury
clinical features of clavicular fracture
asymp or asymm moro reflex or pseudoparalyiss (refusal to move extremity); crepitus may be felt over the fracture
supracondylar fractures happen how?
when kid falls onto an outstretched arm or elbow
why is a supracondylar fracture a med emergency?
if the fracture is displaced and angulated, there is a risk of neurovascular injury and compartment syndrome
clinical features of supracondylar fracture
point tenderness, swelling, and deformity of the elbow;
supracondylar injury and pain with passive extension of the fingers suggests what?
compartment syndrome
“posterior fat pad sign”
triangular fat pad shadow posterior to the humerus may be observed if afracture is present
why should you never passively move the elbow if supracondylar fracture is suspected?
may increase the risk of further neurovascular injury
complications of supracondylar fracture
compartment syndrome; injury to the radial, median, or ulnar nerve; cubitus varus
compartment syndrome
pressure in the anterior fascial compartment is elevated, leading to ischemic injury and flexion deformity of the fingers and wrist
5P’s of compartment syndrome
palor, pulselessness, paralysis, pain, and paresthesia; this is a late sign
best sign of compartment syndrome
pain with passive extension of the fingers
cubitus varus
decreased or absent carrying angle of the arm as a result of poor positioning of the distal fragment
three common types of forearm fractures
colles fracture; monteggia fracture; galeazzi fracture
colles fracture
fracture of the distal radius
monteggia fracture
fracture of the proximal ulna with dislocation of the radial head
galeazzi fracture
fracture of the radius with distal radioulnar joint dislocation
management of forearm fractures
splint first until swelling goes down, then cast
toddler’s fracture
spiral fracture of the tibia; fibula remains intact
how do toddler’s fractures happen?
between 9 mos and 3 years; when toddler trips and falls while playing
what should make the clinician suspect child abuse?
metaphyseal fractures (corner or bucket handle fractures); posteror or first rib fractures; complex skull fractures; scapular, sternal, and vertebral spinous process fractures
most common cause of cardiac arrest in a child
lack of oxygen supply to the heart 2/2 pulmonary problem (choking, suffocation, lung dz), resp arrest, or shock
how to open the airway in a kid that is not responding
head-tilt method, which lifts the tongue from the back of the throat; or by the jaw-thrust method if the child has suspected neck or cervical spine injury
how to assess for breathign
look, listen, and feel for exhaled airflow
what is “circulation” all about in ABCs?
you need to assess the need for chest compressions; this need should be determined after two rescue breaths
how to assess pulse (part of circulation)
in the brachial artery for infants; in the carotid artery for children
when are chest compressions administored
for asystole or bradycardia
shock
inadequate delivery of oxygen and metabolic substrates to met the metabolic demands of the tissues
shock bp?
normal or decreased
compensated shock
normal bp and CO with adequate tissue perfusion but maldistributed blood flow to essential organs
decompensated shock
hypotension, low CO, and inadequate tissue perfusion
irreversible shock
cell death and is refractory to medical treatment
hypovolemic shock- how does your body respond?
endogenous catecholamine release to try to increase blood pressure
two stages of septic shock
hyperdynamic stage (normal or high CO with bounding pulses, warm extremites and a wide pulse pressure) and decompensated stage
distributive shock typically caused by what?
anaphylactic or neurogenic shock, or as a result of medications or toxins
anaphylactic shock
acute angioedema of the upper airway, bronchospasm, pulm edema, urticaria, and hypotension because of extravasation of intravascular fluid from permeable capillaries
neurogenic shock
typically secondary to spinal cord transection; characterized by total loss of distal sympathetic CV otone with hypotension resulting from pooling of blood wihin the vascular bed
cardiogenic shock
when CO is limited because of primary cardiac dysfunction
why is recognition of shock difficult?
compensatory mechanisms that prevent hypotension until 25% of intravasc volue is lost
tachycardia almost always accompanies shock
and occurs before bp changes in children
peripheral pulses bounding
in early septic shock
capillary refill in shock
may be prolonged with cool and mottled extremites
management of shock
supplemental oxygen, early endotracheal intubation to secure the airway and decr patient’s energy expenditure; vascular access with fluid resuscitation
initial fluids in shock
20 mL/kg bolus of normal saline or lacted ringers solution
when are inotropes indicated in shock?
if the blood pressure increase in response to fluids is insuff
expamples of inoropes/vasopressors used in shock
dobutamine, dopamine, epinephrine
treatment for DIC
fresh frozen plasma
leading cause of death in kids greater than 1 year
trauma
leading cause of trauma
MVA
why are head injuries more common in kids than adults in trauma?
child’s head comprises a larger percentage of total body mass
why are spleen and liver injuries more common in kids than adults during trauma?
rib cage is more pliable in kids
prmary survey when a kid comes into the ER with trauma
ABCD (disability assessment with glasgow coma scale); and Exposure/environmental control in which patient is undressed to facilitate exam and then warmed
adjuncts to primary survey when kid comes into ER from trauma
ECG monitoring, urinary catheter and NG tube, diagnostic studes (radiographs of bones and CT scans of brain and abdomen)
pulseless electrical activity on ecg may indicate wat?
cardiac tamponade, tension pneumothorax, or profound hypovolemia
why urinary catheter and NG tube in ER for trauma?
monitor ins and outs; and reduce abdominal distension
secondary survey in trauma
the head to toe evaluation
seizures after head trauma
common in kids and self-limited
why are infants at risk for bleeding in the head after trauma?
at risk for bleeding in the subgaleal and epidural spaces because of open fontanelles and cranial sutures
epidural hematoma
bleeding between the inner table of the skull and the dura; associated with tearng of the middle meningeal artery
clinical features of epidural hematoma
increased ICP; dx by head CT which shows lenticular density representing blood in the epidural space
management of epidural hematoma
immediate surgical drainage
subdural hematoma
associated with tearing of the bridging meningeal veins by direct trauma or shaking
which is more common- subdural or epidural hematoma
subdural
clinical features of subdural hematoma
seizures and signs of incr ICP; bilateral in most cases; symptoms develop more gradually than epidural
diagnosis of subdural hematoma
head CT which shows crescentic density representing blood in the subdural space
management of subdural hematoma
neurosurgical consultation and usually surgical drainage; prognosis poor if underlying brain is also injured
intracerebral hemorrhage
bleeding in the brain parenchyma; frontal and temporal lobes most often affected, usually on opp side of impact
management of intracerebral hemorrhage
surgical drainage if the hematoma is accessible
clinical features of ICP
headache, pupillary changes and altered mental status are the first signs and symptoms
complications of incr ICP
cerebral herniation, most commonly trasntentorial or uncal herniation in which the temporal lobe or uncus is displaced into the infratentorial compartment
clinical features of herniation
bradycardia (early sign of herniation in kids less than 4 yo); fixed and dilated ipsilateral pupil; contralateral hemiparesis; pupils will eventually become bilaterally fixed and dilated; cushing’s triad
cushing’s triad
sign of herniation; bradycardia, hypertension, and irreg breathing
signs of incr ICP
papilledema, CN palsy, stiff neck, head tilit, retinal hemorrhage, macewen’s sign, obtundation, unciousness, progressive hemiparesis
macewen’s sign
hyperresonance of the skull on percussion; sign of elevated ICP
managemnt of increased ICP
mild hyperventilation with 100% oxygen to lower PaCO2, which mildly vasoconstricts cerebral vessels; elevation of head to encourage venous drain; diuretics; neurosurg consult
spinal cord injury without radiographic abnormality
SCIWORA; occurs more commonly in kids than adults
tension pneumothorax
life threatening
clinical signs of tension pneumothorax
distended neck veins, decreased breath sounds, hyperresonance to percussion, displaced trachea, pulseless electrical activity, and shock
management of tension pneumothorax
emergent chest decompress by needle thoracotomy; don’t wait for radiographic confirmation- it may be too late!
duodenal hematoma
often secondary to injury to the RUQ, commonly from a bicycle handle bar; abdom pain and vomitting; bowel obstruction is found on radiograph
lap belt injury
chance fracture (flexion disruption of lumbar spine), liver, and spleen lacerations, and bowel perforations
burns
second most common cause of accidental death in kids
