EM Pediatric Emergency Med

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Question

Answer

Colic time frame

periodic 2-12 weeks

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Infection

Otitis Media, thrush, UTI, Meningitis, Pneumonia, GE reflux

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Bulging fontanel

ominous sign, ICP, meningitis, encephalitis

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Other causes of irritable infant: teething, constipation, corneal abrasion, hernia, torsion, sickle crisis, medications and

volvulus, intussusception, encircling hair, fb, hydrocephalus, subdural, fracture, quiet infant may be ominous

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red streak on external frenulum (between nose and mouth) indicates

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Femur fx

think of abuse

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Toddler's fx

spiral tibial fx in child <5yo

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Dissociative anesthetic

provides sedation and anesthesia (ketamine)

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reversal agents

Naloxone for narcotics, flumazenil for benzodiazepines

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Cardiac dz

arrhythmias, IHSS, Mitral prolapse, Pericarditis, myocarditis

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Musculoskeletal

strains, trauma, costochondritis

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respiratory

asthmna, pneumonia (may cause belly pain if lungs push down on belly area), pneumothorax, PE

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GE reflux, FB aspiration

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Normal HR

<3mo (85-205), 3mo-2yr (100-190), 2-10yr (60-140), >10yr (60-100)

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Stridor, hoaseness, distress are associated with

upper airway obstruction

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Epiglottitis organisms

H. flu (used to be number one until vaccination), S.pyogenes, S. aureus , S. pneumonia

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Sx of epiglottitis

ABRUPT ONSET of: high fever, sore throat, stridor, dysphagea and drooling. Caution on PE can cause laryngospasm.

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Dx of Epiglottitis

lateral neck film in extension during inspiration

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Steeple sign on AP of neck is evidence of

Croup - laryngotracheobronchitis, subglottic inflammation. Etiology: parainfluenza viruses I,II, III

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Bronchiolitis

Etiology: RSV. Happy wheezers. Sx: URI sx wtih wheezing and +/- fever. Dx: CXR, Elisa RSV nasal wash, WBC, O2 sat

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Admit for Bronchiolitis if

Age<3mo, prematurity, underlying dz, O2 sat<95%, toxic distress, dehydrated, unreliable parents

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CXR of Bronchiolitis

Diffuse interstitial consolidation

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unilateral wheezing suspect

fb in right mainstem bronchus. Bronchoscopy to remove it

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hot potato voice

retropharyngeal abscess

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Retropharyngeal abscess

most common in kids <5yo (GABS, S. aureus). Sx: fever, sore throat, odynophagia, dysphagia, stridor, hot potato voice. >3mm soft tissue swelling

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PE of Retropharyngeal abscess

tender cervical adenopathy, pharyngeal erythema, and unilateral pharyngeal edema

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Quincy

old term for peritonsillar abscess, etiology: GABS. Sx: sore throat, fever, dysphagia, drolling.

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Asthma PE

Expiratory wheeze, retractions, nasal flaring. CXR shows: hyperinflation with flattened diaphragms.

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Fever (rectal temp)

>38 (100.4)

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Toxic infant

lethargy, poor perfusion, resp. distress

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SBI:

serious bacterial infection. Meningitis, sepsis, UTI, pneumonia, Osteo, GI. 10% of well appearing young infants with temp. >38 have SBI

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Rochester Criteria is used for

identifying febrile infants at low risk for serious bacterial infections

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</= 1 month old with 100.4 fever

admit to hospital, full work up for sepsis

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2 ways to get U/A from infants

suprapubic tap (rare used), straight cath

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Tx for FUO (fever of unknnown origin)

Infants<3mo Ampicillin and Gent., Infants>3mo Ceftriaxone, Cefotaxime

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Febrile Seizures

3mo-5yr. recurrence common, <5% develop epilepsy, adverse rxn to reset of temp. LP, MRI, EEG only if indicated (if suspect epilepsy)

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Tx for Febrile seizure

evaluate for source of fever, temperature control, prophylactic phenobarbital not recommended, Lorazepam or Diazepam for status epilepticus

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Dangerous Rashes

Meningococcemia, Rocky mountain spider fever, idiopathic thrombocytopenia. Think Purpura

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Benign rashes

Viral exanthems (measles, scarlet fever, german measles, fifth disease, roseola), infestations, dermatitis

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Vomiting and Diarrhea

Gastroenteritis

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Double bubble sign

duodenal atresia

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Bilious vomiting

a sign of intestinal obstruction

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Malrotation w/ volvulus

ischemia

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Meconium Ileus

retained meconium

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Necrotizing ileus

blood in stool

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Hirschsprung's

aganglionosis - no peristalsis, can't have appropriate bowel movement.

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Bilious vomiting differential

Duodenal atresia, malrotation with volvulus, Meconium Ileus, necrotizing ileus, Hirschsprung's

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non-bilious Vomiting

pyloric stenosis, Intussusception, TE fistula, Appendicitis, Ileus, Incarcerated inguinal hernia

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Pyloric Stenosis

Hypertrophic pyloric sphincter causes gastric outlet obstruction. 3 – 6 weeks old. Can't keep anything down including water. More common in males, 4:1. Palapable pyloric "olive"

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string of pearls, beak sign

duodenal obstruction

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Most common cause of intestinal obstruction in infants<1yo

Intussusception

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Bloody, "current jelly" stools with intermittent "colicky" abdominal pain

Intussusception. "sausage" feeling in RUQ.

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ADCVANDISL (how to write admitting orders)

admitting, diagnosis, condition, vital signs, ambulation, Nutrition, Drugs, IV fluids, Special studies, Labs

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Maintenance fluids

4-2-1method. 4ml/kg/hr for the first 10kg. 40ml/hr +2ml/kg/hr for each kg between 10-20kg body weight. 60ml/hr +1mL/kg/hr for each kg>20kg

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Fluid deficit

Calculate current TBW vol: 60% x Wt. Calculate desired volume: (plasma Na/140)x TBW. Fluid deficit= desired vol-current vol

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Incarcerated hernia

Contents cannot be returned (reduced) to the abdominal cavity

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Strangulated hernia

Blood supply to the bowel loop is compromised. Pain & nausea

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Testicular Torsion

extreme pain, vascular compromise, more common in adolescents, true surgical emergency, diagnosis by doppler or ultrasound

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Paraphimosis

inability of the retracted foreskin to reduce

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Dactylitis, organ infarcts and acute chest syndrome are suggestive of

sickle cell crisis. Sickle cells obstruct vessels causing hypoxia and pain. Tx: hydration, pain management, abx, transfusion for Hgb<5g/dL

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Sudden Cardiac Death

Belly sleepers are re-breathing their CO2 and become hypoxic. unsuspected cardiac disease most common

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Most common cause of death in infants aged 1 mo to 1 year

SIDS

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ALTE

acute life-threatening event: Sepsis, RSV, GER, 30% have identifiable cause

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Prevention of SIDS

breast feed, avoid exposure to milk, avoid soft surfaces, back to sleep, parent BLS training

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Red flags for child abuse includes: multiple lesions in diff. stages, lesions with shape of object, plus

trauma inconsistent with hx, hx that shifts with retelling, injury involves an unwitnessed event

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retinal hemorrhages can be seen in

shaken baby syndrome

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Fruity odor

isopropanol (anti freeze), acetone, nail polish remover

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Garlic odor

Arsenic

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Bitter almond odor

cyanide

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Acetaminophen poisoning

most frequently seen. Rumack nomogram tells you if you'll have hepatic toxicity or not

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# 1 cause of death <1yr

Accidents

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Poison Tx:

24-32 F orogastric tube (serial influsion/withdrawal 200ml), Activated charcoal: 1g/kg PO. Lavage and activated charcoal

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Hypothesized cause of SIDs

Prolonged QT syndrome leading to arrhythmia. Hypoxia & apnea, either obstructive, central

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Created by: ltm12