Preventive Flashcards
Parents refuse to immunize children….what to do?
- Inquire about concerns, address non-confrontationally, give written materials
- Ask them to think about it and discuss at next visit
- Tell them to always notify medical people of kids underimmunized status during ill visits, especially to ED
- Have sign refusal form that lists risks of not vaccinating child (must sign at every well-child visit…this can be persuasive)
When is DTaP given?
2, 4, 6, 15-18 months, and kindergarten visit
4th dose can be given as early as 12 months old, as long as 6 months elapsed since 3rd dose given
Most effective way to prevent drowning?
Fence around the pool
What type of DTaP vaccine was given in the olden days that was effective in preventing disease, but had higher rates of local and systemic reactions?
Whole cell pertussis vaccines (DTP)
What is the current pertussis vaccine used in U.S.?
Acellular (DTaP)
What’s the difference between Tdap and DTaP?
Less pertussis antigen (little p) and less diphtheria antigen (little d)
What age do you no longer use DTaP?
7 and older (too much p)
Between what age should patients get a single dose of Tdap?
Adolescents 11-18 (preferably between 11-12)
*This replaces the Td booster that was previously given (commercial names for licensed vaccines are Boostrix and Adacel- 2 brands can be used interchangeably)
Which 3 vaccines can be given to adolescents at the same visit?
Tdap, meningococcal, and HPV
Do you adjust the immunization schedule for prematurity?
No, immunizations are based on postnatal age, even for preemies
What is the difference between Td and DT?
Td vaccine is booster similar to Tdap
DT vaccine is a variant of DTaP given to small children who can’t handle aP component
Little d is less amount of diphtheria toxoid
In kids 7-18 what is substituted for a single dose of Td in the catch up series?
Tdap
If you substitute Tdap for a single dose of Td in the catch up series for kids 7-18, does it count as the Tdap booster?
Yes, another one isn’t needed at 11
What should be the booster for kids 10-18 with regard to tetanus, diphtheria, pertussis?
Tdap (you use Td for other doses)
If you give DTaP to a kid 7 or older (which you shouldn’t), does it count as the adolescent Tdap booster?
Yes
Who to give DTaP v. Tdap?
DTaP is “D” for diapers (no DTaP in kids 7+)
Tdap is “T” for teens
What are contraindications to tetanus, pertussis, diphtheria vaccines?
- Serious allergic reaction: Refer to allergist to confirm allergy and asses need for desensitization
- Encephalopathy within 7 days of receiving pertussis-containing vaccine (this isn’t a contraindication for Td though)
- No other identifiable causes for the reaction
What are some things that are misconstrued as contraindications or precautions for administering Tdap, but it is actually safe to administer the vaccine when indicated?
- History of extensive limb swelling (that wasn’t part of an arthus reaction) after getting vaccine
- Stable neurological conditions, including well controlled seizures and cerebral palsy
- Brachial neuritis
- Contact allergy to latex gloves
- Pregnancy/breast feeding
- Immunosuppression
- Minor illnesses including antibiotic use
Is pregnancy a contraindication for Tdap or Td?
No…don’t be fooled by pregnant teenager
What should close family contacts of newborns be immunized for if the immune status is lacking or unknown?
Pertussis
If an adolescent has a history of pertussis should they receive Tdap immunization?
Yes
Is tetanus immune globulin indicated for any clean wounds?
No
When does a child have to get a tetanus vaccine?
If the immunization status is unknown or if the child has received less than 3 tetanus vaccines
When is a booster indicated for tetanus?
If it’s been more than 10 years
What do you do for a kid with a dirty wound that has received less than 3 tetanus vaccines or history unknown?
Tetanus vaccine and TIG
For a dirty wound, when is a booster indicated?
If it has been more than 5 years since last tetanus given
If you have to give tetanus to a kid between 11-18, what should they get?
Single dose of Tdap (versus Td) if they haven’t gotten a previous Tdap
*If the adolescent got Tdap in the past or if Tdap isn’t available, give Td
If you need tetanus immune globulin, but it isn’t available, what do you give?
IV immune globulin
What constitutes a dirty wound?
Risk of contamination from feces, dirt, or saliva. Severe injuries like burns, frostbite, or crush injuries.
What has decreased the incidence of meningitis and epiglottitis?
Hib vaccine
When do you give Hib vaccine?
Depending on vaccine, either 2, 4, 6 months, or 2 and 4 months
What vaccine preventable disease can cause liver disease and hepatocellular carcinoma?
Hepatitis B
In how many cases of Hep B are no identifiable risk factors identified?
1/3
When is Hep B given?
First dose at birth (prior to d/c from nursery), second at 1-2 months, third at 6-18 months
If you are given a kid who hasn’t been completely immunized against Hep B, what do you do?
Begin or complete the 3 part series
What is the only absolute contraindication to Hep B vaccination?
Severe allergic reaction to a prior dose
Is pregnancy or autoimmune disease (like SLE) a contraindication to Hep B vaccine?
No
When do you give a newborn Hep B immunoglobulin in the first 12 hours of life in addition to the routine immunization?
If mom has hepatitis B (HBsAg positive) or mom has an unknown hepatitis status
When should an infant born to a HBsAg positive mom have their post vaccination status verified and how?
9-12 months of age, serological testing (HBsAb)
What high risk groups should have serologic testing done to confirm immunity after the Hep B vaccine series?
Immunocompromised patients, hemodialysis patients, high risk jobs (health care, prostitute)
What 3 “turning points” are children at risk for Hepatitis B?
- Intrapartum
- Early childhood (household contacts or group care facilities)
- Adolescence (sexually transmitted and IV drug use)
What are the age restrictions for the combo DTaP/HepB/IPV vaccine?
- Can’t be used in kids 7 or older (only approved for primary series, not used for booster dose at kindergarten or later)
- Can’t be used before 6 weeks of age (can’t be used for the birth dose of Hep B)
When do preemies get their Hep B vaccine?
Within 30 days of life or before discharge (whichever is first)
*Even if they are less than 2kg
Does the birth vaccine of Hep B in infants under 2kg count towards the completion of the series?
No
What is given for post exposure prophylaxis for Hep B in infants and other unvaccinated patients?
HBIG and start Hep B series
What is given for post-exposure prophylaxis for hepatitis B in patients who have received the full vaccination series and are antibody positive?
Nothing
What is given for post-exposure prophylaxis for Hep B in patients who received the full vaccination series and are antibody negative?
HBIG and full revaccination…they are considered pretty much unvaccinated
What is given for post-exposure prophylaxis for Hep B in patients who have unknown immunization status?
Test for antibody, if negative, give HBIG and start series
When do kids in U.S. get Hepatitis A vaccine?
At 1
What are the trade names for hepatitis A vaccine?
Havrix and Vaqta
How is Hepatitis A given?
2 doses, at least 6 months apart, same brand (start at 1)
Is an immunocompromising condition a contraindication to receiving Hep A vaccine?
No
What are contraindications to Hep A vaccine?
Hypersensitivity or allergic reaction to vaccine components (aluminum hydroxide, phenoxyethanol)
If a kid under 1 is traveling to an area that is endemic for hepatitis A, what do you do?
Give passive immunization with immune globulin
For a kid older than 12 months traveling to an area endemic for Hepatitis A, what do you do?
Give hepatitis A vaccine 4 weeks prior to departure (2 at the very least)
What is the meningococcal vaccine given and what strains does it cover?
MCV4 vaccine (old vaccine was MPSV4, a polysaccharide model)
A, C, Y, W-135…provides improved, longer lasting immunity than old model and reduces carrier state
What subtype causes more than half of meningococcal disease in infants?
B (vaccine provides no protection for this)
“B is the Bad strain of meningococcus, most common in Babies”
When is routine immunization against meningococcemia with MCV4 vaccine indicated?
- Pre-adolescents at 11-12 visit
- At high school entry or 15 (whichever comes first), if not previously immunized
- Kids entering freshman college dorms (previously unvaccinated)
Is syncope after vaccination a contraindication to future vaccination?
No, syncope after vaccination is common, especially in adolescents and young adults
When can kids with HIV infection receive the MCV4 vaccine?
If they are over 2
What kids would be considered at increased risk for meningococcemia?
Terminal complement deficiency, asplenia (including functional), travel to prevalent area
When would you give MCV4 to a kid who already got MPSV4?
Still at risk and it has been 3 years since receipt of MPSV4
Gardasil and Menveo are trade names for what vaccine?
HPV
What is the recommended age for the HPV vaccine in girls?
11-12
How young can girls get HPV vaccine?
9
Is HPV vaccine recommended for males?
Yes, since HPV is an STD it provides protection against anal cancer along with vaginal warts
When is catch up HPV vaccination recommended for females?
Between 13-26 if not previously vaccinated
How is cervical cancer screening done in females who received the HPV vaccine?
According to recommended schedules (vaccine isn’t considered to be a substitute for routine cervical cancer screening)
Since intro of MMR vaccine, incidence of measles, mumps, and rubella has decreased by what %?
99%
When is MMR given?
Between 12-15 months of age, with booster at school entry
When is second dose of MMR given?
4-6 years
*Booster dose of MMR can be given at any visit as long as 4 weeks elapsed since first dose
Do MMR vaccines given before 12 months (for travel or during an outbreak) count towards completion of series?
No, two doses must be given at 12 months of age or later
7 month old infant exposed to measles…what to do?
Under 72 hours (3 days) from exposure: Measles vaccine (rule applies to infants who are at least 6 months)
Over 72 hours, but under 6 days from exposure: Measles immunoglobulin
How man doses of MMR would an infant between 7-11 months traveling to a part of the world where measles is endemic receive?
3…they would need to be immunized for travel (considered short term immunization) and then resume the regular immunization schedule for MMR at the appropriate age
When can you give MMR with other live vaccines?liv
MMR may not be given within 4 weeks of other live vaccines (varicella and live influenza)
*Live vaccines can be given together or in a combined vaccine
What do up to 15% of kids who receive MMR develop?
High fever (>103) that occurs within 12 days after vaccine administration and lasts 1-2 days
*5% will also develop a rash during this time frame
What to do for a kid who got MMR and then got a high fever and/or rash within 12 days that lasts 1-2 days?
Reassurance
What are the absolute contraindications to MMR?
- Severe allergic reaction to a vaccine component, neomycin, or gelatin
- Pregnancy in patient
- Severely immunocompromised (chemo, AIDS)
What 9 things are not contraindications for MMR?
- Positive TB skin test
- Concurrent TB skin testing
- Pregnancy in mother or other close contact
- Breast feeding
- Immunodeficiency in member of household
- Egg allergy
- Mild or a symptomatic HIV infection
- Non life threatening reaction to neomycin
- History of seizure (slightly increased risk, but not a contraindication)
Do you withhold the MMR vaccine for a mild reaction?
No
Can you place a PPD and give an MMR together?
A PPD can be placed with MMR with no mitigation of its effect
PPD shouldn’t be placed within 4-6 weeks after MMR has been given
Can MMR and varicella be given together?
Yes, they often are at the 12 or 15 month visit and at the kindergarten visit
Who is MMR contraindicated in?
Pregnant (do documented cases of birth defects from vaccines, but still contraindicated)
Is a therapeutic abortion indicated if MMR is accidentally given to a pregnant woman?
Not medically
What is the MMRV vaccine associated with?
Higher rates of febrile seizures in kids 12-23 months (not preferred over single vaccine components MMR and Varicella)
What kids is MMRV contraindicated in?
HIV
When is varicella vaccine given?
Between 12-15 months with booster upon entry to kindergarten (between 4-6)
Should you vaccinate an older kid who has not had chickenpox?
Yes
What are contraindications to varicella vaccine?
- Pregnancy
- Prior allergic reaction to vaccine
- Substantial suppression of cellular immunity (severe AIDS, bone marrow transplant, or solid organ transplant)
What 3 things are not contraindications to varicella vaccine?
- Pregnancy in the recipient’s mother or other household contacts
- Mild or asymptomatic HIV infection
- Immunodeficiency in household contact
What 5 situations do you consider varizig and acyclovir after exposure to varicella?
- Immunocompromised children with no previous varicella infections or immunizations
- Pregnant women without immunity
- Hospitalized preemies of 28 or more weeks gestation whose mom lacks immunity
- Hospitalized preemies of less than 28 weeks gestation regardless of maternal status
- Newborn infants if mother contracted varicella 5 days before to 2 days after birth
What HIV patients can get the measles vaccine?
Symptomatic but not severely immunocompromised or asymptomatic
When do you give a kid with HIV varicella vaccine?
Get vaccine if their CD4 counts are high enough (these kids are at increased risk from complications from varicella)
What flu vaccine do you give to kids with HIV?
Inactivated influenza vaccine (not live attenuated influenza…LAIV or FluMist)
How long do you withhold live vaccines in a kid who is immunodeficient from chemo?
At least 3 months after chemo ended
What is the one exception to no live vaccines in a kid who is immunodeficient from chemo?
Varicella… This is given to kids in remission of ALL (risk of natural varicella disease outweighs risk associated with live-attenuated vaccine virus)
When can varicella vaccine be given to prevent or modify disease and who should this be considered in?
72-120 hours after exposure…susceptible children 12 months and older if there are no contraindications to vaccine use
*Second dose should be given at age-appropriate interval after first dose
What type of pneumonia vaccine do kids under 5 get?
Pneumococcal conjugate vaccine
When is Prevnar (PCV-13) given to kids?
2, 4, 6, and 12-15 months (with catch up for kids under 5)
*Old version of vaccine was P7
Who gets an additional single dose of PCV-13?
Kids older than 6 who are at high risk for invasive pneumococcal disease (children with chronic conditions like asthma on prolonged high dose oral steroids, significant heart disease, and diabetes who aren’t necessarily immunocompromised)
They should get this additional dose regardless of previous immunization history
How many more serotypes are covered in PPSV23 than PCV-13?
11
Who gets PSV23 vaccine after age 6?
Immunocompromised children (functional asplenia, sickle cell disease, HIV, malignancy, transplant recipient, congenital), CSF leaks, cochlear implants
Who gets PSV23 after age 2
Chronic heart or lung disease or diabetes mellitus
The immunocompromised kids get another PSV23 how long after the initial vaccine?
5
How many weeks apart do you give PPSV23 and PCV-13?
8
Who gets PCV13 series and when?
Everyone, 2, 4, 6, 12-15 months
Who gets an additional single dose of PCV13 and PPSV23 and when?
Immunocompromised, CSF leaks, cochlear implants
After age 6 (2 vaccines must be given 8 weeks apart)
Who gets PPSV23 after age 2?
Chronic heart or lung disease or diabetes mellitus
Who gets a PPSV23 booster and when?
Immunocompromised, give 5 years after initial dosage
Who doesn’t get a PPSV23 booster?
CSF leaks, cochlear implants, chronic heart or lung disease, and diabetes mellitus
What is the only contraindication for receiving the pneumococcal vaccine?
A serious allergic reaction to a component of the vaccine
What is the only available poliovirus vaccine in the U.S.?
Inactivated polio vaccine
*Last reported case of wild-type polio occurred in 1979
What is vaccine associated paralytic poliomyelitis?
Occurs in polio vaccine recipients or their contacts and is attributable to oral poliovirus vaccine (since 1986 all other cases of polio acquired in U.S. have been this)
*Implementation of an all-IPV vaccine schedule in 2000 essentially ended occurrence of VAPP cases in U.S.
What is the % seroconversion of recipients of IPV after 3 doses?
99-100% (immunity is probably life long)
How many IPV doses are recommended for routine immunization of all infants and kids in U.S.?
4 doses
When do you give IPV vaccine?
First 2 given at 2 month intervals beginning at 2 months, third recommended between 6-18 months, final dose given at 4 or older
What is the minimum age to give IPV vaccine?
6 weeks
If you need accelerated protection to polio how short of intervals can you give the doses?
4-week intervals
When is the last dose of IPV given and how much time between the third and fourth dose?
4 years of age or older (regardless of number of previous doses)
6 months must have elapsed after last dose
What issue did the old rotavirus vaccination cause?
Intussusception (no link between new vaccine and intussusception)
If giving R5 for rotavirus, how is it given?
Orally at 2, 4, 6 months
If giving R1 for rotavirus, how is it dosed?
Orally at 2 and 4 months
What are the age constraints with rotavirus vaccine?
First dose shouldn’t be given after 15 weeks of age, once series started it needs to be completed by 8 months of age
What do you do if you accidentally give the first dose of rotavirus after 15 weeks?
Give the remainder of the series on schedule
If a kid gets rotavirus gastroenteritis, do you still vaccinate?
If infant gets mild rotavirus gastroenteritis, still complete 3-dose schedule (initial infection only confers partial immunity)
If infant gets moderate to severe gastroenteritis, no vaccine until clinically improved
Can kids with mild illness or low grade fever get the rotavirus vaccine?
Yes
When can kids with underlying GI disease get the rotavirus vaccine?
If they aren’t receiving immunosuppressive treatment
When can you give a preemie the rotavirus vaccine?
As long as they are 6 weeks old, “clinically stable”, and will be discharged from the nursery
Are immunocompromised household contacts or pregnant household contacts a contraindication to rotavirus vaccine?
No
What do you do if an infant spits up or vomits their rotavirus vaccine?
Just continue with series (no re-administration is needed)
What do you do for a baby who has to be hospitalized after they get the rotavirus vaccine?
No extra precautions beyond universal precautions
What are contraindications to the rotavirus vaccine?
- Infants who had severe hypersensitivity reaction or allergic reaction to previously administered doses
- SCID (both rotavirus vaccines)
- History of intussusception (both rotavirus vaccines)
Can immunocompromised infants get rotavirus vaccine?
Benefits and risks should be weighed
Who is annual influenza immunization indicated for?
- Kids between 6 months and 18 years
- Caregivers in or out of the house for kids with high risk conditions or kids under 5
Who is inactivated influenza vaccine approved for?
Kids 6 months and older (given IM)
Who is the live attenuated influenza vaccine approved for?
Healthy children 2 years of age and older (nasal spray)
At what age do kids only need one dose of vaccine each season?
9 and older
What ages do kids get 2 doses of influenza vaccine?
Between 6 months and 8 years…they get 2 doses of the vaccine the first year they get the flu vaccine
When is the second dose of the influenza vaccine given?
At least 4 weeks after the first dose
Who should get annual influenza vaccine to limit spread of disease?
Medical personnel
What does cocooning mean with relation to influenza?
Since infants under 6 months can’t get influenza vaccine, only way to protect them is to make sure caretakers and household contacts get influenza vaccine
What is the CAPE pneumonic for influenza vaccine?
Provides a “cape” of protection for following high risk groups…
C: Chronic metabolic disorder or renal problems and Cardiac disease
A: Asthma and Acquired immunosuppression
P: Pulmonary disorder
E: Empty bladder (renal problems)
Where do you get info on immunizations for patients and families traveling to foreign countries?
CDC website and many areas have specialized travel clinics that you can refer to for immunization
Can you give MMR to someone with an egg allergy?
Yes, current MMR preparation doesn’t have enough egg cross-reacting proteins to be an issue
Can you give yellow fever vaccine to someone with an egg allergy?
No, it does have enough egg protein to worry about allergic reaction…including anaphylaxis
Can you give inactivated influenza vaccine to a kid with egg allergy?
Yes and No…Doesn’t have enough egg to trigger an allergic reaction in most kids with egg allergy
Kids that only get hives from eggs should get IIV and be monitored for 30 minutes in the office
Kids with systemic allergic reaction to eggs shouldn’t get it…refer to allergist for skin testing or immunization under allergist observation
What constitutes a systemic allergic reaction?
Hypotension, GI symptoms, airway distress
Can you give influenza vaccine to someone who has severe anaphylactic reaction (requiring epinephrine injection) to eggs?
No…it is contraindicated period…these patients can get chemoprophylaxis, but not the vaccine
Weight requirement for Epi Pen Junior?
30kg or less
When can EpiPens lose their potency?
Within 6 months of expiration date
Where should EpiPen be injected?
In outer thigh, not through clothes
How do you store EpiPens
Kept at room temperature (don’t leave in car)
How many EpiPens do you prescribe?
3
One for the child, one in an obvious place in the home, and one for school/baby sitter
When do you start screening for HTN?
3
What is HTN in kids?
A BP greater than the 95th percentile for age and gender, taken on at least 3 separate occasions, best done one month apart
What to do for kid who is noted to have high BP and no other issues?
Repeat the BP 2 more times on 2 separate occasions
*Do not get tricked with urinalysis and culture…one elevated reading isn’t enough for any work up beyond confirming diagnosis is real
What is one thing to look out for in a case of high blood pressure?
Clues that you may have the wrong sized cuff
When would you check cholesterol on a kid 5-9?
Get a fasting lipid profile if there is a family history of hyperlipidemia, a parent with dyslipidemia, any other risk factors, or a high-risk condition
When do you do universal (regardless of family history or risk factors) cholesterol screening on kids?
9-11
Name 6 risk factors for hypercholesterolemia
- Poor diet, including too many or too few calories (anorexia nervosa…even though this is counterintuitive)
- Steroid medications
- Anticonvulsants
- Beta blockers
- Alcohol abuse
- Chronic diseases: Liver, renal, hypothyroidism
Name risk factors associated with cardiovascular disease.
Family history, age, gender, poor nutrition/diet, physical inactivity, tobacco use, HTN, HLD, overweight/obesity, DM, metabolic syndrome, inflammatory markers, perinatal factors
When should you discuss childproofing?
6 month visit, before child is mobile
What are 6 topics to present anticipatory guidance on at well visits?
- Stairway safety
- Use of recreational equipment
- Preventing animal bites
- Appropriate use of topical insect repellants
- Internet safety
- Limiting TV time
When is UV A sunlight the worst?
Constant throughout day (A is All day)
What is the main issue with UV A sunlight?
Drug induced photo sensitivity reactions
*Also skin aging, sunburn, and skin cancer
When is UV B sunlight the biggest problem?
Varies, but strongest from 10AM to 5PM (B is strongest during business hours)
What problems does UV B sunlight cause?
Skin aging, sunburn, skin cancer
What % of a persons sun exposure occurs before age 20?
80%
Using sun screen in the pediatric population can reduce the risk of sun exposure problems by what %
80%
What is the minimum SPF that should be used for kids?
15
Which types of UV does physical sunscreen block?
UVA and UVB
How many minutes before sun exposure should sunscreen be applied?
20 minutes
What happens if you don’t apply enough sunscreen?
It reduces the SPF rating
What car seat for infants under 20lbs and under 2?
Infant car seat or rear facing car seat that is rear facing in back seat
What car seat for kids more than 20lbs (toddler/preschool)?
Convertible car seat with harness that is forward facing in back seat
Car seat for school age kids (up to 4’9” tall or until adult seat belt fits right)?
Booster seat that is forward facing in back seat
Car seat for older kids (until at least 13)?
Standard seat belts in the back seat
Which seat in the car is safest?
Middle in back
When can a kid sit in the front seat of a car?
Until age 13, regardless of weight
What is the angle for a rear facing infant car seat?
45 degrees
Most bicycle deaths and injuries occur in kids younger than what age?
15
What % of kids riding bicycles wear helmets?
Less than 10%
By what % do bicycle helmets reduce serious injuries?
85%
What % of deaths from bicycle accidents are due to head injuries?
75%
Where should reflectors be on a bicycle?
Pedals, tire sidewall/rims, front/rear of bicycle
If you have a list of answer choices with % and numbers, which answer should you pay attention to?
The one without numbers…
What % of US households have guns in them?
Over 30%
What can reduce unintentional injury due to guns?
Safety mechanisms like trigger locks
This isn’t proven
What % of suicide attempts with guns are fatal?
More than 90%
What is the key answer for gun safety in the home?
Locked and unloaded with ammunition stored and locked in a separate location
- Also recommended for gun to have high trigger pressure to fire (reduce risk of child firing)
- Trigger locks MAY reduce risk, so don’t pick definitive statements like “handguns can be kept safely in home as long as there is a trigger lock in place”
What type of burn is most common in the home?
Hot liquid burns
What type of burn increases the suspicion for child abuse (non-accidental trauma)?
Sharp demarcation burns
What temperature should water heaters be set at?
120F
When is drowning most common?
Warm weather months
What are the peak ages for drowning?
Preschool age and late teens
Where are infants most likely to drown?
Bathtub
Where are kids younger than 5 most likely to drown?
Residential pool
Where are adolescents most likely to drown?
Fresh water
What type of pools are less likely to cause drowning?
Above ground
What ethnicity and race is drowning higher in?
African American males
What is the most common cause of death in patients with epilepsy?
Drowning
What gender accounts for 75% of all drownings?
Males
What is the most effective preventative measure for preventing drowning in children?
4-sided fence around the pool, with a locked gate
Fence around the yard with one side being the house is not good enough
Do infant and toddler swimming lessons prevent drowning?
No, they are ineffective when it comes to preventing drowning (but fun social events)
What % of boat-related drowning incidents occur in people not wearing life jackets?
90%
All children aboard a boat should be wearing what?
Life jacket
What are 3 additional causes of death and injury while boating, and what do many of these accidents involve?
- Carbon monoxide poisoning
- Fractures and laceration
- Head injures
Alcohol
What is the most important safety measure to prevent pediatric drownings regardless of setting/location?
Adequate supervision
In adolescents how much nicotine can cause addiction?
Addiction can occur after exposure to a small amount of nicotine
Can teens get respiratory issues from smoking?
Yes, certain respiratory sequelae may be seen in teen years
What % of low birthweight infant births are due to smoking during pregnancy?
Up to 25%
Name 6 things second hand smoke increases the risk for
SIDS, otitis media, asthma, bronchiolitis, bronchitis, and pneumonia
School based edu action programs aimed at smoking prevention are effective if they focus on what 2 things?
- Role playing refusal skills
2. Provide information of the health impact
Is nicotine replacement therapy approved by the FDA for use in adolescence?
No…so before using this treatment, have to document that quitting is unlikely to be achieved without assistance and you must feel confident that the adolescent will use it appropriately (First do no harm!)
If nicotine replacement fails to stop smoking in an adolescent, what can you use?
Bupropion when combined with counseling (approved option)
What exposures can cause breathing or respiratory problems in poorly-ventilated environments?
Common exposures like wood fires, stoves, cigarette smoke, hairspray, cooking spray, or other potentially harmful chemicals
What is the treatment of choice for a kid with anaphylaxis?
Epinephrine
Are there any contraindications for epinephrine?
No
If you have to give a kid with anaphylaxis epinephrine, what do you do next?
ER visit
How do you correctly remove a tick?
Grab the tick at the skin line with fine tweezers and remove with steady upward traction
