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Pediatric Emergency Medicine > Special Topics > Flashcards

Special Topics Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What criteria are used to say an event was not a BRUE?

A

any abnormal vital signs, any symptoms, any obvious explanation

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2
Q

What history should be obtained for all BRUE patients?

A

Social history-child maltreatment and abuse is common with this presentation

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3
Q

What workup should be done for BRUE in the ED?

A

Low risk patient-EKG and pulse ox, educate about CPR, if questionable social history or family highly concerned consider observation admission

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4
Q

What age group should you consider inserting a UVC?

A

Infant <7 days in extremis

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5
Q

What age group could have a thymus on xray?

A

=4yo-sail sign of the superior mediastinum

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6
Q

What could the abscence of thymus mean in an infant or toddler with chronic infections?

A

They have an immunodeficiency or digeorge syndrome

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7
Q

What are non-emergent causes of an inconsolable child?

A

GERD, constipation, milk protein allergy, anal fissure, corneal abrasions, otitis media, oral lesions, teething, hunger

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8
Q

What is the “rule of 3s” for colic?

A

3 hours/day, 3 days/wk, 3pm, age 3wks-3mos

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9
Q

What are symptoms of VP shunt malfunction?

A

Headache, vomiting, cushing’s triad (HTN, bradycadia, irregular respirations), abdominal complaints

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10
Q

How do you evaluate for VP shunt malfunction?

A
  • Head CT to detect for dilated ventricles, especially if you are concerned about increased ICP
  • Xray shunt series to evaluate for malpositioning/breaks in the shunt
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11
Q

What should you do if a patient with a VP shunt presents with fever?

A
  • Never perform LP as you can miss non-communicating areas of CSF, NSGY needs to tap the shunt
  • Shunt tap indicated if <2mos from any shunt manipulation or abdominal pain without other source
  • Vanc rocephin bruh
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12
Q

What are potential complications of VP shunts?

A

peritonitis, distal shunt tip obstruction, shunt infection, distal shunt tip migration–>perforation of surrounding structures (can migrate through anus, scrotum, nipple, bowel, anywhere)

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13
Q

How should you manage a g-tube that has came out <6 weeks after placement?

A

-Service that placed it needs to replace as there’s a chance to create a false tract to peritoneum if you replace it yourself

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14
Q

What types of G-tubes cannot be replaced by the ED physician?

A

GJ tubes or any non-balloon type G tubes

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15
Q

What are the steps to replacing a G tube?

A
  • Ensure the balloon port works 1st
  • place pt’s knees up, lube tube, insert w/ gentle twisting motion, refill balloon, secure retention ring, check stomach pH (<3)
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16
Q

How do you deal with the following G tube complications?

  • Vomiting
  • leaking
  • clogged
  • redness
  • shiny pink granulation tissue
  • fungal lesion
  • irritation
A
  • Vomiting-possible tube migration, pull tube back
  • leaking-replace tube
  • clogged-use a carbonated drink
  • redness-r/o cellulitis
  • shiny pink granulation tissue-steroids, or silver nitrate if bleeding
  • fungal lesion-topical antifungals
  • irritation-topical maalox or calmoseptine
17
Q

How do you deal with the following causes of trach obstruction?

  • mucus plugging
  • granuloma
  • false tract
A
  • mucus plugging-suction and saline to break up the plug
  • granuloma-ENT needs to cauterize
  • false tract-Place an ET tube or replace trach into the correct tract if possible
18
Q

What causes a trach bleed and how should you manage it?

A
  • Erosion into the brachiocephalic trunk, true emergency as a sentinal bleed can quickly progres to frank hemorrhage into the trachea
  • Call ENT! they need to scope asap
  • Try blowing up balloon of trach cuff or using your finger to tamponade
19
Q

What are signs of bacterial tracheitis?

A
  • usually a child with a trach

- increased secretions +/- increased need for suctioning, change in secretion color, fever

20
Q
  • How should tracheitis be managed?

- What should you do if a patient has a tracheostomy?

A
  • Cx secretions, obtain CXR, start Abx

- review old cultures as kids with trachs frequently have old culture results and may have grown resistant organisms

21
Q

How should trach decannulation be managed?

A
  • emergency
  • replace the trach obturator before the actual trach, the obturator is analogous to the ET tube stylet
  • Use saline based lubricant to replace trach, petroleum bad for the lungs
  • If unable to replace the trach: ET intubation if possible, BVM for new trach, cannulate stoma with an ET tube if old trach
22
Q

What are indications for removing an ingested foreign body? Which FBs can be managed conservatively?

A
  • causing obstruction
  • in esophagus >24 hrs
  • size>6cm
  • sharp object
  • any disk or button battery
  • known magnet ingestion
  • A small (<6cm) smooth FB in stomach or beyond can go home
23
Q

How can you remove a nasal foreign body?

A

Insert a small french foley past the FB, inflate the balloon and slowly retract the foley

24
Q

How should you manage an aural FB?

A
  • kill insects 1st w/mineral oil or viscous lidocaine
  • Never irrigate organic material
  • Try forceps, sxn, irrigation
  • Call ENT s/p 3 unsuccessful attempts
25
Q

What are potential xray findings for aspirated foreign bodies?

A

radiopaque object, atelectasis, emphysema, mediastinal shift, pneumonia
-lateral films are not useful

26
Q

What are indications to get bronchoscopy for aspirated foreign bodies?

A

cough, drooling, desating, fever, vomiting, abnormal xray, abnormal physical exam

27
Q

How should you manage an acute aspiration?

A

back blows, Heimlich maneuver, cricothyrotomy vs tracheostomy vs mainstem bronchi intubation

28
Q

What workup should be obtained with suspected NAT?

A

CBC, coags, LFTs, serum and urine tox screens

  • consider platelet function testing, abdominal CT, skeletal survey, ophtho eval
  • Rape kit for sexual abuse w/in 96 hours of event
29
Q

What is a good way to figure out if a bite was an adult sized bite?

A

-molar-molar distance>3cm=adult bite

30
Q

-At what age should a child have 3 or more tetanus immunizations if they are normally vaccinated?
-If a child has <3 tetanus vaccinations and a clean minor open wound, how should you provide tetanus prophylaxis?
If a child has <3 tetanus vaccinations and a dirty or major open wound, how should you provide tetanus prophylaxis?

A
  • By 6mos children should have received 3x DTaPs
  • <3 immunizations and clean/minor wound=tetanus vaccine only
  • <3 immunizations and dirty wound=tetanus vaccine and tetanus immune globulin
31
Q
  • If a child has <3 tetanus vaccinations and requires tetanus vaccination for wound prophylaxis purposes what vaccine do you give them for the following age groups:
  • <7yo
  • 7-10 yo
  • > /=11yo
  • Which vaccination is given to all pregnant women?
A

-<7 years: DTaP.
-Underimmunized children ≥7 and <11 years who have not received Tdap previously: Tdap.
≥11 years: A single dose of Tdap is preferred to Td for all individuals in this age group who have not previously received Tdap; otherwise, Td or Tdap can be administered without preference.
-Pregnant women should receive Tdap during each pregnancy.

32
Q

-When do children finish their childhood DTaP?
-When do children get their first Tdap?
-If a child has >/=3 tetanus vaccinations and a clean minor open wound, how should you provide tetanus prophylaxis?
If a child has >/=3 tetanus vaccinations and a dirty or major open wound, how should you provide tetanus prophylaxis?

A
  • Finish DTaP at 4yo
  • First Tdap at 11yo
  • > /=3 and clean-no immune globulin and only provide tetanus vaccine if last immunization was >/=10 years ago
  • > /=3 and dirty-no immune globulin and only provide tetanus vaccine if last immunization was >/=5 years ago
33
Q
  • What timeframe does a fever from the MMR vaccine develop?

- What additional side effect is noted particularly in teenage females from the MMR vaccine?

A
  • Up to 15% of recipients can be expected to become febrile 5-12 days post vaccination due to either the measles or rubella component of the vaccine.
  • Approximately 15% of adolescent and adult women can experience arthritis or arthralgias after the vaccination, which is generally given as a booster at age 11-12 years.
34
Q
  • What is a simple was to detect suspected metal foreign body ingestions that are not visualized on x ray prior to getting a more invasive CT scan?
  • What type of metal is classically poorly radiopaque?
A
  • Strip away the kid’s clothes and wand them with a metal detector!
  • Aluminum!
35
Q

What is a potentially deadly complication of a foreign body lodged in the esophagus?

A

Creation of an aorto-esophageal fistula! Foreign bodies have the ability to migrate, if it is lodged in the esophagus over time it may migrate toward the heart/major vessels

36
Q

What are potential alternatives to endoscopy for meat impactions in the lower esophagus?

A

When adults get meat impacted in the lower esophagus, glucagon, nifedipine, and benzodiazepines are often successful alternatives to endoscopic removal. They rarely work, however, in children and especially do not work for proximal esophageal foreign bodies.

Pediatric Emergency Medicine (18 decks)

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