EMED Exam 2 Review
Pediatrics
Signs of a problem in kids → Lethargy, weak cry, irritable, poor feeding, poor urine output, less diapers, elevated
temp/hypothermia, persistent vomiting, headache & fever (ONLY reliable in those > 18 months), seizures, resp distress,
AMS, drooling, stridor, hypotension (extreme), blunt head/thorax injury, petechiae, rash, purpura with fever
TRUE life-threatening emergencies → respiratory compromise leading to increased metabolic demands and cardiac
compromise as a secondary event
CAVEATS FOR KIDS
• Use CT’s conservatively
• NO tetracycline or fluoroquinolones
• Augmentin causes diarrhea
• They dehydrate easily & dump K+ easily
• Compensate well then drop precipitously → ACT QUICK
• PRETESTING
o ALL girls 10 and older get UCG (unless pre-menarche)
o U/A for females (rare in males unless infant/early toddlers)
Common Injuries in kids
• Teeth (don’t worry about baby teeth, adult teeth get treated as adults → milk or Hank’s sol) – always get dental
consult
• Dislocation & fx → Splint EVERYTHING
o X-rays may be inconclusive (get comparison view)
o ALWAYS refer to ortho
Salter Harris Fracture
• Usually kids 10-15 from falls or sports (tenderness around fx site,
swelling, redness)
• Type 1 – fracture through the physis (only growth plate)
o Fix with a cast
• Type 2 – fracture through physis and metaphysis (M/C ONE)
• Type 3 – fracture through the physis and epiphysis
• Type 4 – fracture through the epiphysis, physis and metaphysis (all 3)
• Type 5 – Crush injury to the physis (WORST ONE, it can affect growth)
• TYPES 2-5 need proper positioning under anesthesia
Nursemaid’s Elbow
• Usually toddlers (1-4 y/o because after that ligaments strengthen)→ M/C elbow injury in children
, • Cause → hanging from parent
• X-ray nonrevealing (get comparative view) kid won’t use that arm
• Reduce it! → either Hyperpronation or Supination-Flexion
Respiratory Emergencies
• ASTHMA → #1 (may wheeze, coughing, inspiration issue is a worse sign)
• ASTHMA
o Repeat albuterol
o Steroids (per weight → prelone 2mg/kg)
o Mg sulfate
o Epi in sick patients
o CXR and tube prn (ketamine → choice of drug for sedation)
• CROUP
o Viral (parainfluenza virus) → 6mo – 3 y/o
o S&S → Low fever, seal bark cough, stridor, hoarseness, inflamed & thick secretions at cricoid
o Tx → hot shower (steam), cold night exposure, antipyretics, fluids, Decadron or prelone PO, racemic epi
▪ Bag valve mask (BVM) → DO NOT TUBE THEM
• EPIGLOTTITIS
o Rare now that we have vaccines (cause → H. flu (bacterial)
o X-ray → soft tissue neck (THUMB SIGN)
o S&S → fever (high), sore throat, drooling, odynophagia, HOT POTATO voice, irritable, anxious, tripod
“sniffing” position
o Tx → BVM (DO NOT TUBE THEM), steroids & abx ASAP, racemic epi
• Pneumonia
o Monitor breathing (high O2), get temp rectally, BVM/tube prn (BiPAP not tolerated well)
o Nasal swab → bacterial or viral
o Admit
▪ All UNDER 6 months
, ▪ Pulse ox < 92%
▪ Temp > 103
▪ Suspicious
o Dx → CXR or sputum Cx if inconclusive radiology
o Tx → Augmentin (PO), 2nd or 3rd gen cephalosporin, maybe Vanco/Zosyn
Child Abuse
• One of the leading causes of death ages 1-12 months (By 18: 1 in 6 boys and 1 in 4 girls are sexually abused)
• Types → physical, sexual, physical neglect (shelter, medical care, food), emotional neglect, By-proxy neglect
(Munchhausen syndrome)
• Suspect if their injuries are unexplained, delay in seeking care, fx is different locations and diff stages of healing
• Look for
o Bruises → in areas that cannot be reached, unusual in a fall, or take the shape of an object)
o Fractures → from wrenching or pulling that damage bone metaphysis or a spiral fx
o Damaged hair → tinea capitis vs pulling (look for lack of skin involvement)
o Burns → circular punched out (cigarette), V shaped (iron), linear pattern on outer body (immersion)
o Head Trauma → M/C/C of death (subdural hematoma, skull/rib fx, shaken baby syndrome)
▪ Shaken baby syndrome → retinal hemorrhaging, brain swelling, subdural hematoma
o Intra-abdominal injuries → 2nd M/C/C of death (shock if liver or spleen rupture)
• SIDS
o Can appear as trauma/abuse (don’t presume) → *BACK TO SLEEP
• Evaluating Abuse
o Rape testing protocols, photographed area of concern,
o Labs (CBC, PT/PTT, INR), Culture (vagina, rectum, urethra, pharyngeal, urine, stool)
o X-ray all bones, CT of head & ABD
• Report Abuse
o To proper authorities (do not release kid until safety is assured, perpetrator in custody)
o If you suspect it, YOU MUST REPORT by phone AND in writing (within 48 hours)
• Domestic Violence
o Physical, sexual, emotional, verbal and economic
o Get patient to talk, call law enforcement
Burns
SKIN → largest organ of the body that protects against heat, infection, radiation, chemicals and supports nerves/BV’s
Pediatrics
Signs of a problem in kids → Lethargy, weak cry, irritable, poor feeding, poor urine output, less diapers, elevated
temp/hypothermia, persistent vomiting, headache & fever (ONLY reliable in those > 18 months), seizures, resp distress,
AMS, drooling, stridor, hypotension (extreme), blunt head/thorax injury, petechiae, rash, purpura with fever
TRUE life-threatening emergencies → respiratory compromise leading to increased metabolic demands and cardiac
compromise as a secondary event
CAVEATS FOR KIDS
• Use CT’s conservatively
• NO tetracycline or fluoroquinolones
• Augmentin causes diarrhea
• They dehydrate easily & dump K+ easily
• Compensate well then drop precipitously → ACT QUICK
• PRETESTING
o ALL girls 10 and older get UCG (unless pre-menarche)
o U/A for females (rare in males unless infant/early toddlers)
Common Injuries in kids
• Teeth (don’t worry about baby teeth, adult teeth get treated as adults → milk or Hank’s sol) – always get dental
consult
• Dislocation & fx → Splint EVERYTHING
o X-rays may be inconclusive (get comparison view)
o ALWAYS refer to ortho
Salter Harris Fracture
• Usually kids 10-15 from falls or sports (tenderness around fx site,
swelling, redness)
• Type 1 – fracture through the physis (only growth plate)
o Fix with a cast
• Type 2 – fracture through physis and metaphysis (M/C ONE)
• Type 3 – fracture through the physis and epiphysis
• Type 4 – fracture through the epiphysis, physis and metaphysis (all 3)
• Type 5 – Crush injury to the physis (WORST ONE, it can affect growth)
• TYPES 2-5 need proper positioning under anesthesia
Nursemaid’s Elbow
• Usually toddlers (1-4 y/o because after that ligaments strengthen)→ M/C elbow injury in children
, • Cause → hanging from parent
• X-ray nonrevealing (get comparative view) kid won’t use that arm
• Reduce it! → either Hyperpronation or Supination-Flexion
Respiratory Emergencies
• ASTHMA → #1 (may wheeze, coughing, inspiration issue is a worse sign)
• ASTHMA
o Repeat albuterol
o Steroids (per weight → prelone 2mg/kg)
o Mg sulfate
o Epi in sick patients
o CXR and tube prn (ketamine → choice of drug for sedation)
• CROUP
o Viral (parainfluenza virus) → 6mo – 3 y/o
o S&S → Low fever, seal bark cough, stridor, hoarseness, inflamed & thick secretions at cricoid
o Tx → hot shower (steam), cold night exposure, antipyretics, fluids, Decadron or prelone PO, racemic epi
▪ Bag valve mask (BVM) → DO NOT TUBE THEM
• EPIGLOTTITIS
o Rare now that we have vaccines (cause → H. flu (bacterial)
o X-ray → soft tissue neck (THUMB SIGN)
o S&S → fever (high), sore throat, drooling, odynophagia, HOT POTATO voice, irritable, anxious, tripod
“sniffing” position
o Tx → BVM (DO NOT TUBE THEM), steroids & abx ASAP, racemic epi
• Pneumonia
o Monitor breathing (high O2), get temp rectally, BVM/tube prn (BiPAP not tolerated well)
o Nasal swab → bacterial or viral
o Admit
▪ All UNDER 6 months
, ▪ Pulse ox < 92%
▪ Temp > 103
▪ Suspicious
o Dx → CXR or sputum Cx if inconclusive radiology
o Tx → Augmentin (PO), 2nd or 3rd gen cephalosporin, maybe Vanco/Zosyn
Child Abuse
• One of the leading causes of death ages 1-12 months (By 18: 1 in 6 boys and 1 in 4 girls are sexually abused)
• Types → physical, sexual, physical neglect (shelter, medical care, food), emotional neglect, By-proxy neglect
(Munchhausen syndrome)
• Suspect if their injuries are unexplained, delay in seeking care, fx is different locations and diff stages of healing
• Look for
o Bruises → in areas that cannot be reached, unusual in a fall, or take the shape of an object)
o Fractures → from wrenching or pulling that damage bone metaphysis or a spiral fx
o Damaged hair → tinea capitis vs pulling (look for lack of skin involvement)
o Burns → circular punched out (cigarette), V shaped (iron), linear pattern on outer body (immersion)
o Head Trauma → M/C/C of death (subdural hematoma, skull/rib fx, shaken baby syndrome)
▪ Shaken baby syndrome → retinal hemorrhaging, brain swelling, subdural hematoma
o Intra-abdominal injuries → 2nd M/C/C of death (shock if liver or spleen rupture)
• SIDS
o Can appear as trauma/abuse (don’t presume) → *BACK TO SLEEP
• Evaluating Abuse
o Rape testing protocols, photographed area of concern,
o Labs (CBC, PT/PTT, INR), Culture (vagina, rectum, urethra, pharyngeal, urine, stool)
o X-ray all bones, CT of head & ABD
• Report Abuse
o To proper authorities (do not release kid until safety is assured, perpetrator in custody)
o If you suspect it, YOU MUST REPORT by phone AND in writing (within 48 hours)
• Domestic Violence
o Physical, sexual, emotional, verbal and economic
o Get patient to talk, call law enforcement
Burns
SKIN → largest organ of the body that protects against heat, infection, radiation, chemicals and supports nerves/BV’s
