em 10.2 - pediatric trauma

What age range is affected by febrile seizures?

6 months to 5 years; peak around age 2.

What are the most common seizures of childhood?

Febrile seizures.

When are febrile seizures most common seasonally?

Winter/early spring.

What are important risk factors for febrile seizures?

Fever, daycare attendance, developmental delay, neonatal hospitalization, viral infections, family history, vitamin deficiency, and vaccinations.

What important diagnoses are in the differential for febrile seizure?

Meningitis, epilepsy, and Dravet syndrome.

What should the exam include after a febrile seizure?

Complete neurologic exam and identification of the fever source.

🔴 What are 4 red flags in a child with presumed febrile seizure?

Meningeal signs, complex seizure, persistent altered consciousness, or age less than 6 months.

🔴 What 5 criteria must ALL be present for a febrile seizure?

1) A convulsion with a temperature >38°C (100.4°F) 2) 6 months - 5 years old 3) Absence of central nervous system (CNS) infection or inflammation 4) Absence of acute systemic metabolic abnormality that may produce convulsions 5) No history of previous afebrile seizures [e.g., epilepsy]

Which is the more common febrile seizure type in pediatrics?

🔴 Simple.

What 3 features make a febrile seizure 🔴simple🔴?

Generalized, last less than 15 minutes*, and do not recur in a 24-hour period

Describe more in depth what the seizure in a simple febrile seizure is like.

• Most are generalized tonic-clonic, but may also be atonic or tonic • Median duration 3-4 minutes • Short postictal period - usually return to baseline quickly (e.g., within 5-10 minutes after seizure)

What 3 features make a febrile seizure 🔴complex🔴?

Focal onset, >15 minutes, or >1 seizure in 24 hours.

What is an example of a focal onset for a complex febrile seizure?

Shaking limited to one limb or one side of the body.

Are labs routinely needed in a well-appearing child with febrile seizure?

No.

What limited tests may be considered after a febrile seizure?

Finger-stick glucose and urinalysis.

What is general treatment of febrile seizure?

Acetaminophen/ibuprofen and treatment of the underlying infection.

What temperature is required in the definition of febrile seizure?

>38°C (100.4°F).

What defines a simple febrile seizure?

Generalized, less than 15 minutes, and no recurrence within 24 hours.

What type of seizure is a simple febrile seizure usually?

Generalized tonic-clonic; may also be atonic or tonic.

What is the median duration of a febrile seizure?

3-4 minutes.

How quickly do children with simple febrile seizures usually return to baseline?

Within about 5-10 minutes.

Persistently open and deviated eyes after convulsive activity stops may indicate what?

An ongoing focal seizure.

Are febrile seizures considered epilepsy?

No; epilepsy involves recurrent nonfebrile seizures.

What age group most commonly develops strep pharyngitis?

3-14 years.

Strep pharyngitis is uncommon in what age group?

Less than 3 years.

What is the incubation period of strep pharyngitis?

24-72 hours.

When can a child with strep return to school?

After 24 hours of antibiotics and when afebrile.

What scoring system helps determine need for strep testing?

Modified Centor Criteria.

What findings are included in the Modified Centor (McIsaac) score?

Fever, tonsillar exudate, absent cough, anterior cervical lymphadenopathy, and age adjustment (age 3-14 adds 1 point).

What test is used initially for suspected Group A strep?

Rapid antigen detection test (RADT).

What should be done if RADT is negative in a child/adolescent?

Follow with a throat culture.

🔴 Modified Centor score ≤1: management?

No testing or antibiotics; symptomatic treatment.

Modified Centor score ≥2: management?

Test; treat if positive.

What are antibiotic options for strep pharyngitis?

🔵 Penicillin VK/amoxicillin first-line;

non-type I PCN allergy: 1st gen ceph like cephalexin (Keflex)

type I PCN allergy: clindamycin, clarithromycin, or azithromycin

What causes erythema infectiosum/fifth disease?

Parvovirus B19.

How is erythema infectiosum transmitted?

Respiratory droplets; vertical transmission is possible.

Is erythema infectiosum contagious after the rash appears?

No.

What is the classic facial finding of erythema infectiosum?

Slapped-cheek appearance.

What rash follows the slapped-cheek appearance?

Pruritic lacy-reticular maculopapular rash.

How is erythema infectiosum usually managed?

Symptomatic treatment.

What hematologic complications should be watched for with parvovirus B19?

Anemia and bone marrow suppression.

What virus causes measles?

Morbillivirus.

How is measles transmitted?

Respiratory droplets.

What are the classic 3 C's of measles?

Cough, coryza, conjunctivitis.

What oral lesion is classically associated with measles?

Koplik spots.

What type of rash occurs with measles?

Erythematous maculopapular rash.

How does the measles rash spread?

Forehead → trunk → extremities.

What should be done when measles is suspected?

Contact local public health department and use 🔵airborne precautions.🔵

How is measles generally treated?

Supportive care.

What treatment is specifically listed for children with measles?

🔵 Vitamin A.

🔵 What antiviral may be considered in immunocompromised patients with measles?

Ribavirin.

What is roseola also called and what causes it?

Sixth disease; HHV-6.

What age group has peak incidence of roseola?

6-18 months.

What happens around day 3 of roseola?

High fever, often ≥103°F.

What classic sequence distinguishes roseola?

High fever followed by rash as the fever resolves.

What does the roseola rash look like?

Fine erythematous or pink macules and papules.

How is roseola treated?

Symptomatic care with acetaminophen or ibuprofen.

Roseola is a common cause of what neurologic event?

Febrile seizures.

What age has peak onset of varicella?

5-9 years.

How is varicella transmitted?

Direct contact or respiratory droplets; vertical transmission is possible.

What is the classic rash characteristic of varicella?

Pruritic lesions in various stages of healing.

What is the lesion progression of varicella?

Macules → papules → vesicles → pustules.

When is a patient with varicella no longer contagious?

When all lesions have crusted.

What symptomatic treatments are listed for varicella?

Calamine lotion and oatmeal baths.

Which varicella patients should be considered for hospitalization?

Age less than 1 year, immunocompromised patients, pregnancy, and adults with primary varicella.

What antiviral is listed for varicella?

Acyclovir 20 mg/kg/dose 5 times/day.

What age group commonly gets impetigo?

2-5 years.

What is the most common bacterial skin infection in children?

Impetigo.

What organisms commonly cause impetigo?

Strep pyogenes and Staph aureus.

What is the classic lesion of impetigo?

Honey-crusted lesions.

First-line topical treatment for localized impetigo?

Mupirocin 2% ointment 2-3 times/day for 5 days.

What oral antibiotic is listed for severe impetigo?

Cephalexin for 7 days.

What are the most common pediatric tinea infections listed?

Tinea capitis and tinea corporis.

How is tinea easily spread?

Fomites/hair (e.g., hats, brushes, barber instruments), person-to-person contact, and animal/soil exposure.

What is black-dot ringworm?

Tinea capitis in which hairs break off, leaving black dots in areas of hair loss.

What is inflammatory tinea capitis called?

Kerion.

🔵 How are tinea corporis, cruris, and pedis usually treated?

Topical antifungals.

How long is tinea corporis or cruris usually treated?

1-3 weeks, until resolution.

How long is tinea pedis usually treated?

4 weeks.

🔵 How is tinea capitis treated?

Oral antifungal plus topical antifungal shampoo.

What oral antifungals are listed for tinea capitis?

Terbinafine, griseofulvin, itraconazole, or fluconazole.

What is the 🔵 gold standard treatment for onychomycosis?

Oral antifungals.

What is first-line for most dermatophyte onychomycosis?

Oral terbinafine.

What important adverse effect should be remembered with terbinafine?

Hepatotoxicity.

How does irritant diaper dermatitis typically distribute?

Convex surfaces; spares skin folds.

How does Candida diaper dermatitis typically appear?

Beefy-red plaques with satellite papules/pustules.

Does Candida diaper dermatitis involve the skin folds?

Yes; it is accentuated in the folds.

How is irritant diaper dermatitis managed?

Keep area dry, diaper-free aeration, and barrier cream such as zinc oxide.

What can be added for severe irritant dermatitis if Candida is absent?

Low-potency topical corticosteroid such as 1% hydrocortisone.

How is Candida diaper dermatitis treated?

Topical antifungal such as miconazole/clotrimazole plus barrier cream.

What is the most common cause of serious bacterial illness in young children?

UTI.

What is the most common cause of pediatric UTI?

E. coli.

What age group is particularly emphasized for pediatric UTI?

2-24 months.

What clues increase concern for UTI in young children?

Prior UTI, temp >39°C, fever without source, fever >24 hours, ill appearance, or suprapubic pain.

Frequent pediatric UTIs should raise concern for what?

Reflux.

How should urine generally be obtained in young children being evaluated for UTI?

🔴 Catheterized urinalysis 🔴 and urine culture.

Why may nitrites have reduced sensitivity in young children?

Frequent urination leaves insufficient time for nitrate-to-nitrite conversion.

What UA findings support treatment for pediatric UTI?

Positive leukocyte esterase, nitrite, or microscopy showing WBCs/bacteria.

🔴 What antibiotic regimen is listed for pediatric UTI?

Cephalexin (Keflex) 75 mg/kg/day PO divided TID; 5 days if afebrile, 10 days if febrile.

What characterizes non-inflammatory diarrhea?

No blood or mucus; small-intestine involvement.