Trauma/Critical Care

Question 1

sick neonate: ddx

Answer 1

THE MISFITS

Trauma

Heart failure (ductal dependent disease)

electrolyte: DKA, glucose, Na

Metabolic–CAH

IEM

Seizures (remember b6 pyridoxine)

Formula (low Na)

Intestinal catastrophes (volvulus)

Tox

Sepsis

Question 2

cyanotic heart disease

• hyperoxia test
• what O2 sat to target

Answer 2

may present with sats in 80s

hyperoxia: give 100% O2 for short period of time, if 10% or greater response, think pulm etiology

target 80-85% sats. resist urge to target 100% as ductus arteriosus requires hypoxia to stay open

Question 3

neonatal resus:

when to hold resus

how long to do CPR

Answer 3

1. <23 weeks
2. < 400kg
3. severe congenital abnormalities

stop at 10 min

Question 4

Burn center transfer criteria

Answer 4

Partial thickness >10% in <10y, >20% in other age groups

face/hands/feet/genitals/perineum/major joints

3rd degree burns

electrical, lightning

chemical

inhalation injury

others…

Question 5

Peds resus:

good weights to memorize for age

BP to memorize (5%)

Answer 5

1y: 10 kg
3y: 15
5y: 20
7: 25 kg
neonate: 60mm
infant: 70mm

1-10: 70 + age x2

Question 6

PECARN criteria:

Answer 6

SCALPS, BASILaR (>2y)

scalp hematoma (not frontal), caregiver concern, ams, LOC>5sec, palpable fx, severe mech

Basilar signs, AMS, severe HA, injury mech severe, LOC, Regurg (vomit)

severe: >3ft, >5ft, high velocity

Question 7

posterior palatal trauma

-worry about what

Answer 7

carotid aneurysm/dissection

low threshold to get CTA

give abx

Question 8

peds resus:

estimating HR and RR

Answer 8

0-1: 140, 40

1-4y: 120, 30

4-12: 100, 20

12+: 80, 15

Question 9

1. how often do neonates breastfeed
2. how much bottlefeeding in neonate, amount
3. when do neonates regain birth weight

Answer 9

1. q1-3h
2. 2-4oz q2-4h (6-9 feeds in 24h)
3. 10 days should be back at birthweight