PICU baby Nelson Flashcards
How often is abdominal wall bruising associated with significant intraabdominal injury?
in 10% of patients
presence of peritoneal irritation or abdo wall discolouration, together with signs of IV volume loss, indicates the need for laparotomy
most frequently injured abdo organ in kids
spleen
What is Kehr sign
pressure on LUQ leads to left shoulder pain (from diaphragmatic irritation by ruptured spleen)
Prognostic Factors in Drowning (baby Nelson pg 136)
outcome is determined by the success of immediate resuscitation efforts and severity of HIE to the brain patients who have regained consciousness on arrival to the hospital will likely survive with intact neuro function Unfavorable prognostic markers: 1. need for >25 minutes of CPR 2. continued CPR at hospital 3. GCS of 5 or less 4. fixed and dilated pupils 5. seizures 6. coma for >72 hours
if significant episode of near drowning, even if they are doing okay, need to observe in hospital
6-12 hours of observation
after resuscitation, ARDS is common
after cold water, can get hypothermia with bradycardia/hypotension, and place child at risk of arrythmias
also need to watch mental status
investigations for patient with burns
CBC, type and crossmatch for blood, coagulation studies, chemistry, ABG, CXR
carboxyhemoglobin - for any suspected inhalation exposure
cyanide in children with smoke inhalation and altered mental status
Who should be transferred to a burn centre?
Baby nelson (pg 138)
American Burn Association Criteria:
1) partial and full thickness burns >10% of TBSA in patients 50 year old or >20% in other age groups
2) partial and full-thickness burns on face, hands, feet, genitalia, perineum or major joints
3) electrical burns
4) chemical burns
5) inhalation injury
6) burn injury in patients with preexisting medical conditions that could complicate management, prolong recovery or increase mortality rate
7) any burn with concomitant trauma in which the burn injury poses the greatest risk
8) social situation (including child abuse)
**also see word document with lopa notes on burn management from big nelson
Fluid management in burns
kg/percent burn/4 ml/kg/24 hours
1/2 of fluid in the first 8 hours, the remainder in the rest of the 24 hours
can start with bolus initially
goal directed therapy
controversy with colloid use during resuscitation
main clinical presentations of poisoning in child?
1) coma -
2) direct toxicity - ie hydrocarbon and pulmonary toxicit
also caustic ingestions (alkali and acid)
3) metabolic acidosis - with anion gap/+/- osmolar gap
4) dysrhtyhmias - prolonged QT - phenothiazine or antihistamine
widened QRS - cyclic antidepressants and quinidine
sinus brady - digoxin, cyanide, cholinergic agent or beta blocker
5) GI symptoms
6) seizures - poisoning is an uncommon cause of afebrile seizures (but they are the sixth major mode of presentation for children with toxic ingestions)
formula for osmolar gap
calculated osmoles: 2 x [Na mmol/L] + [glucose mmol/L] + [urea mmol/L] (then subtract from the measured)
ingestions which can cause hypoglycaemia
ethanol isoniazid insulin propanolol oral hypoglycemic
ingestions which cause HYPERglycemia
salicylates isoniazid iron phenothiazines sympathomimetics
ingestions which cause hypocalcemia
oxalate
ethylene glycol
fluoride
see a radiopaque substance on KUB (CHIPPED)
Chloral hydrate, calcium carbonate Heavy metals (lead, zinc, barium, arsenic, lithium, bismuth) iron phenothiazines Play-Doh, potassium chloride enteric coated pills dental amalgam
Patient with suspected ingestion, investigations
bloodwork (gas lutes calculate the osmoses)
ECG
urine screen vs quantitative fox
