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EM Peds
Emergency Medicine Pediatrics
76
Medical
Post-Graduate
01/21/2009

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Term
Bacterial tracheitis
Definition
Membranous laryngotracheobronchitis
3mo - 10 y/o
Copious secretions
Super infection w/ viral URI
Prodrome URI - 4 days, then rapid deteriorations with high fvr
Barking cough
Resp. distress
Normal voice
Toxic appearance
Term
Lymphocytosis in the face of pediatric pneumonia suggests which pathogen?
Definition
Viral, chlamydial, pertussis (usually marked lymphocytosis)
Term
Orbital cellulitis
Definition
Staph, Strep, H.Flu, 2ry sinusitis
-Decr. pupillary response, proptosis, decr.& painful EOM movement, increase IOP
Term
Kawasaki phases
Definition
Acute: 1-11 days - fvr, myocarditis MCC of death in this phase
Subacute: 11-20 days -gradual resolution of Sx, greatest risk for coronary artery thrombosis, MCC of death here is MI, aneurysm rupture
Convalescent: 21-60 days - sings resolve, death may occur 2ry to MI/thrombosis
Term
Common bacterial meningitis pathogens 4-12 weeks/age? Tx?
Definition
Pathogens: H.Flu->GBS->S.Pnemo->N.Meningitidis->E.Coli, L.Monocytogenic, G(-) bacili
Tx: Ampi + cefotaxime or ceftriaxone
Term
Congenital hip dislocation
Definition
1st born male
(+) ortholani (hip click)
Term
DOC in ped shock
Definition
Inotropic - Dopamine 2-20 micrograms/kg/min
(+) beta1 & 2 receptors
Term
2nd cup technique in U/A
Definition
1st cup 10-15 ml of urine -> 2nd cup
If WBC predominates in 1st cup=urethritis
If WBC predominates in 2nd cup=kidney, prostate infection
Term
Meningitis 1-3 mo/age
Definition
GBS->E.coli->Listeria Mono-> Strep-> H.Flu-> Neisseria
Term
Yes or No: In small child one can give large vol of fluid & blood through a small cannula
Definition
Yes
Term
Hypovolemic classifications I-IV
Definition
I:15%
II: 15-30%-mild tachycardia, tachypnea, decr. capillary refill
III: 30-40%-obvious shock, altered mental status, tachycardia, tachypnea, decr. systemic pressures
IV: >40%-life threatening, mentally depressed, cold, pale, tachycardia/pnea, no urine output
Term
Croup
Definition
[image]
Term
Child w/ transient synovitis of the hip
Definition
18 mo- 12 y/o (MC 5-6 y/o)
male
limp
non-toxic, neg tap
Term
Ped septic arthritis
Definition
Age: 4 y/o
Limp, fvr, irritable, toxic, flexed & abducted & externally leg
Org: MC staph
Term
MC single injury assoc. w/death in injured child
Definition
Head trauma
Term
Characteristic of febrile seizure
Definition
Age: 9- 18 mo.age
Generalized
<20 mins
Short post-ictal phase
Assoc. w/rapid increase in temp
30-40% recurrance rate
Term
Newborn male w/micropenis <2cm stretche & low glucose. Dx?
Definition
Hypopituitarism
Term
SCA clinical presentation in children
Definition
Unexplained bone pain, LUQ pain (splenic infarct), severe hemolytic anemia, jaundice, painful swelling hands/feet (dactylitis), infections (sepsis, pneumonia, meningitis) - encapsulated H.Flu, S. Penumo, salmonella osteomyelitis
Term
Name the only 2 proven effective T's for RSV bronchiolitis
Definition
Hydration & O2
Term
When treating children in shock, aim for u/output of at least
Definition
1 ml-1.5 ml/kg/hr
Term
MCC of distributive shock in children
Definition
Sepsis
Term
Meningitis kids < 3mo
Definition
S. Pneumo, H.Fli, Neisseria
Term
Si/Sx Peds volvulus
Definition
Bloody streaks in stools, bilous vomiting, abd distention, palpable mass
Term
Causes Peds volvulus
Definition
Congenital malrotation less 1 y/o, usually 1st mo
Term
Tx Peds volvulus
Definition
Ng, IV, Surgery
Term
Post-natal risks for SIDS
Definition
•Hx BPD •Acute infection •ALTE •Sibbling w/SIDS •Sleeping in prone position
Term
Risk for RSV apnea
Definition
< 6 mo/age, premies
Term
MCC shock in children
Definition
Hypovolemia 2ry to acute gastroenteritis w/Rotavirus
Term
Henoch-Schonlein Purpura
Definition
•Ages: 4-11 y/o •Migratory arthritis •Palpable purpuric rash on lower ext & buttocks •Colicky abd pain •Absent thrombocytopenia
Term
ETT premies / newborn
Definition
Premies: 2.5-3.0 / Newborn: 3.0-3.5
Term
MCC hypovolemic/hyponatremia in children
Definition
Viral grastroenteritis
Term
Lidocaine kids dose
Definition
1 mg/kg, then drip 20-50 mg/kg/min
Term
Peds: Atropine dosage
Definition
0.02 mg/kg / 0.1-0.5 kids / 0.5-1 teen
Term
Si/Sx Rubella - Vertical transmission
Definition
Vertical transmission of rubella: cataracts, deafness, PDA
Term
Rubella: Times of maternal infxn
Definition
1°mo: 50% chance / 2°mo: 25% / 3°mo: 10%
Term
Peds: Relate time of presentation to cause of CHF
Definition
[image]
Term
Reye's Syndrome
Definition
•↑NH3 (early finding), SGOT, SGPT, PT, Bili, BUN, CPK •↓Glu
Term
Bullous myringitis
Definition
•Usually viral, mycoplasm •Pain occurs suddenly and persists for 24 to 48 h •Hearing loss and fever suggest a bacterial origin ❑Tx: local heat, analgesia, erythro
Term
Causes of Pneumonia kids 4mo-4y/o
Definition
#1 Viral; Strep, H.Flu, Staph
Term
Painless rectal bleeding in peds
Definition
Fissure MC in infants; colon polyps; meckels; Inf. gastro; swallowed maternal blood if <2mo.
Term
MC peds arrest
Definition
Bradyarrythmia
Term
Kawasaki Criteria
Definition
[image]
Term
Ped airway obstruction w/strident
Definition
Insp stridor: above larynx / Biphasic stridor: trachea / Expiratory stridor: below carina
Term
DDx newobrn cyanosis
Definition
5 T's - R->L shunts: Tetra fallot, Transposition, Truncus arteriosum, Total anomalous pukm venous return, Tricuspid atresia
Term
Neglet; FTT pt's will
Definition
↑ Weight in hospi
Term
Cause of bacteremia 3-36 mo/age
Definition
Strep. Pneumo
Term
MC peds pneumonia
Definition
Viral *URI w/myalgias in flu season, pathcy interstitial patterin on CXR
Term
MC pathogen Croup
Definition
Parainfluenza virus •Ages: 6mo-3 y/o
Term
Causes of Bacterial meningitis in neonates 0-4 wks/old
Definition
•E. Coli •GBStrep •Lysteria •G(-) bacilli
Term
Tx Bacterial meningitis in neonates 0-4 wks/old
Definition
❑ Ampi + ceftaxomine (claforan) or Ampi + Gara
Term
Why is bradycardia so poorly tolerated in the infant?
Definition
Recall: CO = SVxHR. Very low myocardial contractility, hence ↑CO is dependent upon ↑HR (cant ↑SV & ↓MC). Infants tolerate ↑↑↑HR better. Ventr filling time is less critical in maintaining SV & CO.
Term
MC emergent peds abd surgery
Definition
Appendectomy
Term
Characteristics of Meckel's diverticulum
Definition
•Painless rectal bleeding (may be massive) •Meckle's isotope scan is false neg in 50% •May form a volvulus of small bowel or internal hernia - signs of obstruction •Inflamm. of the diverticulum may mimic an appy
Term
MCC peds nephrogenic DI
Definition
X-linked recessive, males early in infancy
Term
Rx: 1st line neonatal Sz
Definition
Phenobarbital 20 mg/kg, then pheny 20 mg/kg, then ativan 0.05-0.1 mg/kg or Valium 0.2-0.3 mg/kg
Term
Classic triad of intussusception
Definition
(1) Intermittent colicky abd pain (1st sign) (2) Vomiting (6-12 hrs later) (3) Current jelly stool (late & ominous sign, however, almost always guaiac (+))
Term
Pathogens: Sepsis in infants
Definition
H.Flu, Strep, N.Mening
Term
Locked-in syndrome is caused by
Definition
Basilar artery occlusion •Quadraplegia •Loss of al motor, except upward gaze •Coma
Term
CC of SIADH in child
Definition
[image]
Term
Major physio diff b/w aduts & peds in response to stress
Definition
Greater surface area relative to body size, results in greater susceptibility to body heat loss & insensible fluid loss
Term
MCC otitis externa
Definition
Pseudomonas
Term
MCC minor lower GI bleeding in infants
Definition
Rectal fissures
Term
Potential complications of pertussis
Definition
Pneumonia, PTx, hypoxia, apnea, Sz, encephalitis, hypoxic encephalopahty. Infants <1 mo old have worse course.
Term
Si/Sx of NEC
Definition
1st 2 wks of life. Abd distention w/gastric retention Most frequent finding. Other: apnea, lethargy, bloody stolls, abd tenderness, abd wall erythema.
Term
X-Ray of NEC
Definition
Pneumatosis intestinalis: Air/fluid levels separation of bowel loops
Term
Measles (Rubeola) rash
Definition
•Paramyxovirus •Rash: starts in forehed -> spreads includes palms/soles •Fever↑ •Kopliks spots @ buccal mucosa •Complic: OM, pneumonia, encephalitis
Term
Prenatal risk factors for SIDS
Definition
Prematurity, IUGR
Term
Peds arrest proven drug
Definition
Epi 0.01 mg/kg 1:10,000 / 0.1 mg/kg 1:1,000
Term
Meningitis 3mo-18 y/o
Definition
H.flu, Strep, Neiss ❑ Tx:Ceftriaxones or cefotaxime
Term
MC ped UTI org
Definition
E.Coli 80-90%. Also, Kleb, Strep. faecalis enterococcus, Proteus, Pseudo, Strap. epid
Term
Significant hypoglycemia in child will show ____ in U/A. If not urine should be sent for ___?
Definition
-Ketone -Should be sent for organic acids to r/o enzyme def
Term
MC preventable cause of death in injured child
Definition
Failure to secure airway
Term
PE in shaken baby syndrome
Definition
Retinal hemomrrhage 50-80%
Term
Bacterial tracheitis is a potentially serious complication of ___?
Definition
Croup
Term
A "herald patch" rash followed by a "Christmas tree" distribution rash 1-2 wks later in a well-appearing child is___?
Definition
Pytiriasis rosea (probably due to a virus)
Term
DOC shock in child'n
Definition
Inotropic: dopamine 2-20 mg/kg/min (B1 & B2 fxn)
May add epi in sepsis + nipride
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