Peds E4: Topic List

Tanner stages -boys: development of external genitalia

Stage 1: prepubertal

Stage 2: enlargement of testes/scrotum; scrotal skin reddens & changes in texture

Stage 3: enlargement of penis (length at first); further growth of testes

Stage 4: inc size of penis w/ growth in breadth & development of glans; testes and scrotum larger, scrotal skin darken

Stage 5: adult genitalia

Tanner stages -girls: breast development

Stage 1: prepubertal

Stage 2: breast bud stage w/ elevation of breast & papilla; enlargement of areola

Stage 3: further enlargement of breast & areola; no separation of their contour

Stage 4: areola & papilla form a secondary mound above level of breast

Stage 5: mature stage - projection of papilla only, related to recession of areola

Tanner stages -boys/girls: pubic hair

Stage 1: prepubertal (may have vellus hair)

Stage 2: sparse growth of long, slightly pigmented hair, at base of penis or along labia

Stage 3: darker, coarser, and more curled hair, spreading sparsely over junction of pubes

Stage 4: hair adult in type, but covering smaller area than in adult; no spread to medial surface of thighs

Stage 5: adult in type and quantity, w/ horizontal upper border

AMPLE history

Allergies, Meds, PMHx, Last meal, Events preceding trauma

What is the MCC of bacteremia & SBI in neonates (0-28 days)?

Group B Streptococcus

T/F: You should admit any child who appears ill or toxic or at risk for serious bacterial infection

True

What is considered a fever in peds?

100.4 F

What can be used for outpatient Abxs for fevers in 3-36 months?

Daily injections of Ceftriaxone

How do you manage fevers in children > 3 y/o?

Antipyretics- Acetaminophen & Ibuprofen, Cooling, Fluids, avoid vigorous rubbing of skin

What is Reyes syndrome?

Rapidly progressive encephalopathy with hepatic dysfunction occurring after a viral illness and associated with salicylate use

What is the workup for fevers in young children?

draw CBC/cultures and start empiric Abx

What should you avoid giving children even if they have a fever?

Salicylates (ASA) -d/t risk of Reyes syndrome

What are sx of Reyes syndrome?

Vomiting, confusion, personality changes, lethargy, hyperactive reflexes, inc ICP, hepatomegaly

What is the MC finding of Shaken Baby Syndrome?

Retinal hemorrhages

What are clinical findings of Shaken Baby Syndrome?

Long bone/rib fractures, subdural hematomas

What is a complication of septal hematomas?

septal abscess

What is the tx for stable epistaxis?

Have child sit up & bend forward, apply continuous pressure below bony portion of nose for 5-10 minutes, apply Afrin

What foreign bodies are non-emergent and can be observed w/ a repeat xray in 2 hours?

coins, marbles, round objects w/o sharp edge

What foreign body ingestions require an emergent endoscopy?

Button batteries, sharp objects

What foreign body ingestions require a surgical removal?

> 1 magnets & blunt objects that have remained in the same location for > 1 week

Ingestion of what is a MEDICAL EMERGENCY?

Button battery

What would chest and abd x-rays of button-battery ingestion show?

double-ring or halo sign

What is the tx for button battery ingestion?

STAT surgery consult → immediate endoscopic removal if in the esophagus

What is the MC seizure disorder in childhood?

Febrile seizures

When do febrile seizures develop?

when core temp exceeds 38 C (100.4)

When do febrile seizures typically occur?

6 months - 5 yo

Tonic-clonic seizures are simple febrile seizures that last how long?

< 15 min

What is the tx for Febrile seizures?

Antipyretics

IV Lorazepam or Diazepam if seizure is > 5 min

Mild head injury = GCS _____

> 12

Moderate-Severe head injury = GCS ______

8-12

Review the Glasgow Coma Scale

:)

What does an Epidural hematoma show on imaging?

Lens shaped opacity (biconvex) on CT scan

What is the step by step process of Epidural hematomas leading to the delayed sx?

trauma occurs → pt loses consciousness for a short time → lucid interval (4-6 hrs) → blood accumulates, compresses brain and pt deteriorates rapidly (focal seizures, AMS)

What is a common cause of subdural hematoma in peds?

Shaken Baby Syndrome

What does a Subdural hematoma show on imaging?

Concave mass, crosses suture lines seen on non-contrast head CT

What is a concussion?

Trauma-induced brain dysfunction without demonstrable structural injury on standard neuroimaging findings

When should you avoid closing wounds d/t animal bites?

when there is a high risk of infection

What Abxs are used for animal bites?

Augmentin, Bactrim, Clindamycin

What degree of burns:

Superficial (ie. sunburns)

1st degree

What degree of burns:

Partial thickness

2nd degree

What degree of burns:

Full thickness

3rd degree

What degree of burns:

Epidermis only, painful & erythematous

1st degree

What degree of burns:

Epidermis & Dermis, blisters/blebs, redness, and painful

2nd degree

What degree of burns:

Full thickness burns involving epidermis, dermis, and subcutaneous tissue; dry, leathery, waxy, & painless

3rd degree

When should you refer pts to the burn center?

- Face, eyes, ears, hands, feet, perineum, or major joints

- partial thickness > 10% TBSA

- 3rd degree burn

- chemical burn or inhalation injury

- burns in pts requiring special care

- burns w/ any concomitant trauma

What is a Transverse fracture?

Fracture line is perpendicular to the axis of a long bone

What is a Greenstick fracture?

Fracture is complete except for a portion of the cortex on the compression side of the fracture, which is only plastically deformed

What is an Oblique fracture?

Fracture line is at an angle relative to the axis of a bone

What is a Spiral fracture?

Fracture line takes a curvilinear course around the axis of a bone

What is an Impacted fracture?

Bone ends are crushed together, producing an indistinct fracture line

What is a Comminuted fracture?

Fracturing forces produce more than 2 separate fragments

What is a Bowing fracture?

Bone bends to the point of plastic deformation without fracturing

What is a Torus/buckle fracture?

Bone buckles and bends rather than breaks

Salter-Harris fracture:

Epiphyseal separation through the physis

Type I

Salter-Harris fracture:

Fracture through a portion of the physis but exiting across the metaphysis

Type II

Salter-Harris fracture:

Fracture through the physis but exiting across the epiphysis into the joint

Type III

Salter-Harris fracture:

Fracture line extending across the metaphysis, physis, and epiphysis

Type IV

Salter-Harris fracture:

Crush injury to the physis

Type V

Where do a majority of clavicle fxs occur?

Middle 1/3 portion

Which acute pain agent safely provides anxiolysis, analgesia, and amnesia simultaneously?

Ketamine

What is the minimal toxic acetaminophen dose for a child?

150 mg/kg

What is the minimal toxic acetaminophen dose for an adult?

7.5 grams

When is a referral to ED warranted in an Acetaminophen OD?

200 mg/kg OR 10 g (whichever is less) is ingested

What occurs 0-24 hours after acetaminophen overdose?

GI irritation (N/V, normal LFTs)

What occurs 24-72 hours after acetaminophen overdose?

Latent period- asymptomatic, RUQ pain, LFTs may inc

What occurs 72-96 hours after acetaminophen overdose?

Hepatic failure -peak sx, AST > 20,000, prolong PT, death or coagulopathy

When does recovery or death of acetaminophen overdose occur?

4-14 days

When working up an Acetaminophen OD when should you measure APAP levels?

4 hours from the last dose

When does peak acetaminophen concentration occur?

4 hours post-ingestion

When is Mucomyst (NAC) indicated for APAP OD?

- levels above the probable toxicity line

- suspected ingestion >150 mg/kg or 7.5 g regardless of wt in a pt whom APAP levels won’t be avail until > 8hrs post ingestion

**if time of ingestion is unknown or chronic consult toxicologist

What are the effects of iron toxicity?

corrosive to GI mucosa → N/V/D, abd pain

impairment of capillary permeability

mitochondrial cell dysfunction→ cellular death

direct vasodilation

What toxic stage would you expect 30 min-6 hours after iron ingestion?

GI stage

What toxic stage would you expect 6-12 hours after iron ingestion?

Stability

What toxic stage would you expect 12-72 hours after iron ingestion?

Systemic toxicity

What toxic stage would you expect 12-96 hours after iron ingestion?

Hepatic failure

What toxic stage would you expect 2-6 weeks after iron ingestion?

GI/Pyloric scarring

What is the tx for Iron toxicity?

IV Deferoxamine

What EKG findings are associated with TCA poisoning?

Widened QRS, Prolonged QT

What are sx of TCA poisoning?

lethargy, agitation, seizures, coma, CV effects (tachycardia, HTN or hypotension)

Mnemonic for TCA posioning sx:

TriC Antidepressants

• Coma

• Convulsions

• Cardiac dysrhthymias (wide QRS/prolong QT)

• Acidosis

What is the tx for TCA poisoning?

ABCs, sodium bicarbonate, IVFs, activated charcoal (if w/in 2hrs), benzos for seizures, ECG monitoring

What are AE of cocaine?

seizures, cerebral hemorrhage, hyperactive reflexes, dilated pupils, tachycardia, dysrhythmias, MI

What are AE of MDMA (ecstasy)?

seizures (secondary to hyponatremia), tachycardia, HTN, “water loading” sweating, hyperthermia, SIADH → hyponatremic dehydration

What does Ecstasy intoxication cause?

stimulant, hallucinogenic effects

What are sx of Carbon monoxide?

Cherry red skin, HA, dizziness, nausea, malaise, visual changes, weakness, syncope, vomiting, ataxia, seizures, coma and death

What is the tx for CO poisoning?

O2 by high flow mask immediately

Which agents are Alkali?

Oven and drain cleaners, Hair relaxer, Bleach, Automatic dishwasher detergent

What agents are acidic?

Toilet bowl/grout cleaner, Rust remover, Metal cleaners

Alkali or Acidic:

Tasteless, Liquefaction necrosis --> mucosal perforation

Alkali

Alkali or Acidic:

Bitter, Coagulation necrosis --> superficial injury, Thick eschar formation

Acidic

What are sx of caustic ingestion?

drooling, refusal to drink, dysphagia

T/F: absence of oral lesions does NOT preclude severe esophageal or stomach injury

True

What is the tx for caustic ingestion?

upper endoscopy in 12-48 hrs post consumption w/ oral burns

What should you NOT do in caustic ingestion intoxication?

Induce vomiting, neutralize, gastric lavage or activated charcoal

What is a common component of radiator fluid products in the US?

Ethylene Glycol

T/F: Ethylene Glycol is non-toxic before its metabolized

True

What are the sx of Stage 1 (1-12 hrs) ethylene glycol ingestion?

N/V, drowsiness, slurred speech, lethargy

What are the sx of Stage 2 (12-36 hrs) ethylene glycol ingestion?

tachypnea, cyanosis, pulm edema, ARDS, death

What are the sx of Stage 3 (2-3 days) ethylene glycol ingestion?

cardiac failure, seizure, cerebral edema, renal failure

What is the antidote for Ethylene glycol?

Fomepizol

*if not available → IV ethanol