Test 1 Flashcards
__________ rolls can help to align the airway in young children
Shoulder
__________ rolls can help to align the airway in older children
Neck
Excessive mechanical ventilation increases risk of (1), (2), and (3)
(1) Gastric air
(2) Regurgitation
(3) Aspiration
Central pulse to assess in infants
Brachial artery
Central pulse to assess in older children
Femoral artery
Normal BP is maintained until over ____% of the child’s circulating volume is lost. Therefore hypotension is a _____ finding in kids
30%
Late
Fluid resuscitation for pediatrics in shock
NS or LR 20 ml/kg boluses until signs of improved perfusion and resolution of tachycardia
Fluid resuscitation if shock is due to hemorrhage for pediatrics
2 boluses NS or LR 20 ml/kg
Then PRBC 10 ml/kg
A pregnancy test is indicated in a case of sexual assault in the child is in Tanner Stage ___ development
3
Urine NAATs should be collected in a case of sexual assault for testing _______ and __________
Gonorrhea
Chlamydia
Blood should be collected in a case of sexual assault for testing ____, _____, _____
HIV
Hep B
Hep C
Prophylactic STI treatment for adolescents in sexual assault case
Ceftriaxone PLUS
Azithromycin PLUS
Metronidazole OR
Tinidazole
In a sexual assault case, blood may be collected for up to _____ hours
24
In a sexual assault case, urine may be collected for up to ________ hours
72-96
In a sexual assault case, evidence collection is appropriate for up to _______ hours for adolescents, and up to ______ hours in kids
120
72
5 things needed for pediatric patient that is sick appearing
- Oxygen and assist ventilation if needed
- Pulse ox
- Cardiorespiratory monitor
- IV access
- CXR/EKG
Common pathways for pediatric arrest
Respiratory failure
Shock
Two worrisome conditions concerning breathing for pediatric emergency medicine
Respiratory Failure
Pediatric Arrest
Worrisome condition concerning circulation for pediatric emergency medicine
Shock
Signs of poor tissue perfusion (possible shock)
Cool or mottled skin
Tachycardia
AMS (very important in kids)
Management for pediatric head injuries
Maximize oxygenation, maintain blood pressure!
Worse outcomes with hypoxia and hypotension
If signs of increased ICP with herniation in pediatrics
- Elevate head of bed 30 degrees
- Hypertonic saline (3%)
- Mannitol 0.5-1 mg/kg
Seatbelt sign
Greatly increases probability of abdominal injury
CT of abdomen warranted
Child’s blood volume is _____ ml/kg
70
Reassuring or warning sign: fever onset before pain
Reassuring (more likely a virus than appendicitis)
Reassuring or warning sign: vomiting with frequent watery diarrhea
Reassuring
Referred abdominal pain
Lower lobe pneumonia
GAS pharyngitis
Reassuring or warning sign: pain before vomiting
Warning (typical of appendicitis)
Reassuring or warning sign: vomiting and abdominal distention
Warning
Most common cause of abdominal emergency in 1-2 months old
Pyloric stenosis
Most common cause of abdominal emergency in 6-10 months old
Intussusception
Study of choice for intestinal malrotation
Upper GI series
Sign on upper GI series with intestinal malrotation
Corkscrew configuration
Management of intestinal malrotation
IV fluid resuscitation NG tube Call surgeon Upper GI series Laparotomy
Imaging for intussusception
Ultrasound
Classic image on ultrasound for intussusception
Bullseye
Coiled spring
Hypertrophy of Peyer’s patches in terminal ileum can serve as lead point
Intussusception
Management for intussusception
- ABCs
- Resuscitate with IVF (NS)
- Decompress stomach with NGT if frequent vomiting
- Consider IV abx if concern for perforation
- Notify surgeon
- Abdominal XRays to exclude perforation
- Air enema reduction
Contraindications to air enema for intussusception
- > 3 days
- Signs of peritonitis
- Evidence of free air on plain x-ray
Management for appendicitis
- IVF
- IV pain medication and antiemetics
- IV abx (ancef, unless concern for perforation - zosyn)
- Call surgeon
Classic presentation of ovarian torsion
Sudden onset of unilateral lower abdominal pain, right side > left side, N and V
Management of ovarian torsion
Pain control
IVF, US with doppler
Emergent operative intervention
Intervention for seizures
Needed if > 3 minutes
- Lorazepam (IV or IM)
- Diazepam (IV or PR)
- Midazolam (IV or IM)
Febrile Seizure Criteria
Fever > 100.5 (most > 102)
Child less than 6 y/o
No signs of CNS infection
No history of afebrile seizures
2 important questions to ask concerning pediatric seizures
- Vaccination status
2. Recent abx –> can be masking signs/symptoms of meningitis
Preferred neuroimaging for epilepsy evaluation
MRI
Evaluation for infantile spasms
Urgent EEG, MRI and metabolic evaluation
5 Things you can do for a child in diabetic ketoacidosis
- Oxygen
- Cardiac and respiratory monitor
- Pulse ox
- IV access
- Consider EKG/CXR
2 things that should be ordered immediately when suspected diabetic ketoacidosis
- Accucheck
2. Urinalysis
Definition of DKA
Hyperglycemia > 200 mg/dL
AND
Venous pH < 7.30 and/or
Bicarbonate < 15 mmol/L
Characteristic long deep breaths of DKA
Kussmaul Respirations
DKA Treatment Step 1
- IV hydration
NS or LR bolus
20 ml/kg over 1 hour - LR at 2x MIVF rate
DKA Treatment Step 2
Insulin bolus (unless child!) Switch to D5NS when glucose is < 300 mg/dL
DKA Treatment Step 3
Next 4-6 hours: NS with 40 mEq/L K+
After 4-6 hrs: 0.45% saline with electrolytes
Most serious complication of DKA in children
Cerebral Edema
Signs/Symptoms of Cerebral Edema
- Headache
- Gradual decrease in LOC
- Slowing of HR inappropriately with increase in BP
- Change in pupils
Treatment of Cerebral edema
- Reduce rate of IVF infusion
- Mannitol 0.5-1 g/kg over 20 minutes
- 3% saline over 30 minutes
- Consider intubation if needed
Management for spinal cord injury
High dose steroids if within 8 hours
Preferred imaging modality for traumatic brain injury
CT Scan
Cushing’s Reflex
Systolic BP increase
Bradycardia
Irregular respirations
First tier therapy for intracranial hypertension
Positioning, ventricular drainage, osmotic diuresis, hyperventilation
Second tier therapy for intracranial hypertension
Sedation, neuromuscular blockade, hypothermia, barbiturate coma
Not recommended for intracranial hypertension
Glucocorticoids
Most common pathogens in animal bites
Pasteurella species, staphylococci, streptococci, and anaerobic bacteria
Fastidious gram-neg rod that can cause bacteremia and fatal sepsis after animal bites (especially in asplenic pts, chronic alcohol abusers, or those with underlying hepatic dz)
Capnocytophaga canimorsus
Bartonella henselae
Organism responsible for cat scratch fever
Eikenella corrodens
Organism commonly found in human bites
Kanavel’s sign
Infectious Tenosynovitis
Kanavel’s signs (4) - Infectious Tenosynovitis
- Finger held in slight flexion
- Fusiform swelling
- Tenderness along the flexor tendon sheath
- Pain with passive extension of the digit
Common pathogens from human bites
Streptococci, staphylococcus aureus, Eikenella, Fusobacterium, Peptostreptococcus, Prevotella and Porphyromonas species
Cervical spine immobilization not recommended after drowning UNLESS
- Clinical signs of cervical injury
- Concerning mechanism
- AMS
Indications for intubation in a drowning patient
- Inability to protect airway, neurological deterioration
- PaO2 < 60 mmHg or saturation < 90% on high flow O2
- PaCO2 > 50 mmHg
Pseudallescheria boydii
Saprophytic fungus found in contaminated water such as in floods. Most common fungal infection in non-fatal drowning victims
Waterborne pathogens that could cause pneumonia post-drowning
Pseudomonas, Proteus, Pseudallescheria boydii
Symptoms of heat exhaustion
- Moist and clammy skin
- Pupils dilated
- Normal or subnormal temperature
Symptoms of heat stroke
- Dry hot skin
- Pupils constricted
- Very high body temperature (> 104)
Fever Work up: criteria for bladder catheterization for UA
- All males < 6 mo and all uncircumcised males < 12 mo
2. All females < 24 mo and older female children if symptoms of UTI
Fever Work Up in the Toxic Child
- Rapid virus testing
- CBC with differential (looking for bandemia)
- Blood culture
- CXR
- Obtain stool for WBCs and guaiac if diarrhea present
- Lumbar puncture
RAPID Approach
R: Resuscitation A: Analgesia and Assessment S: sx/chief complaint A: allergies M: medications P: past medical history L: last meal E: events lead up to presentation P: patients needs (non-medical) I: interventions (diagnostic, therapeutic, consults) D: disposition (admit, transfer, discharge, observation)
Treatment for hypotension post-insect bite allergic rxn
- IV NS bolus
- Epinephrine
- Alternatively give norepinephrine
- Consider vasopressors (dopamine)
Treatment for bronchospasm post-insect bite allergic rxn
Mild-mod distress
1. Nebulized beta agonist (albuterol) 2. Parenteral glucocorticoids (methylprednisolone)
Mod-Severe distress
1. Parenteral beta agonists (epinephrine) 2. consider intubation
Treatment for urticaria post-insect bite allergic rxn
- Antihistamines (H1 blockers) diphenhydramine
- Oral steroids (prednisone, methylprednisolone)
- Consider epinephrine