Exam 2 CR 3

Presentation of Malrotation / Volvulus

Distended abdomen

Fussy infant

Vomiting

Malrotation

Malrotation

How is malrotation / volvus dx

XR → Cutoff wth promixal dilation

Follow with NG tube with barium

Ladd’s procedure

Untwisting of volvulus

Ladd’s bands divided

Tack down small and large bowel

Presentation of Kawasaki Disease

Fever for > 5 days

Bilateral conjunctivitis

Changes to lips and oral cavity (starwberry tongue_

Cervical lymphadenopathy

extremity changes

Polymorphous rash

What is the risk of untreatd Kawsaki disease

coronary aneurysms

Treaetment for Malrotation

Labb’s Procedure

Treatment of Kawasaki Disease

IVIG within 10 days

Steroids

Aspirin

Risk Factors for Intussusception

Males

Viral illness

Presentation of Intussception

Vomiting

Inconsable infant

Bloody Stools

How is intussception dx

XR → Dense intestinal

US → Telescoping of intestine

Treaetment for Intussceoption

Air enema

Surgery if fail

Risk of Air enema

Perforation

Presentation of Orbital Blowout Fracture

Eye pain

Nausea and vomiting

Strabismus

Oribtal Blowout

Pnuemonia

Treatment for Peds Pneumonia

PO Amoxicillin x 7days for

Managment for Septic Shock

O2

Vanco + Ceftriaxone

40cc/kg blous

Epi Drip

ETCO2 Montioring

Treatment for Pleural Effusion

Chest Tube

What abnormality

Cardiomegaly

Pnuemothorax

Esophageal Foreign Body

Disc Battery in Esophagus

Anterior mediastinal mass

What is the ddx for an anterior mediastinal mass

Thymoma

Teratoma

Thyroid

Terrible Lymphoma

What is the general approach to evaluating an ill infant

ABC’s

O2, IV, monitor

D-stick

CXR

EKG

Chemistry, CBC, UA, urine and blood cultures, Utox

Consider LP and head CT

Antibiotics

Slipped Capital Femoral Epiphysis (SCFE)

Most common hip condition in adolescents

Slipped Capital Femoral Epiphysis (SCFE)

Treatment for Slipped Capital Femoral Epiphysis (SCFE)

femoral osteotomy

Psoas Sign

Pain with thigh extension (iliopsoas muscle irritation)

Obturator Sign

Pain with internal rotation of flexed hip (obturator internus muscle irritation)

Rovsing’s Irritation

Pain in RLQ with palpation in LLQ (peritoneal irritation)

Pediatric Appendicitis Score

An approach to working up cases of possible appendicitis

What are signs of peds appendicitis

Anorexia

Migration of pain to RLQ

N/V

RLQ pain with coughing or hopping

Fever > 38 C

RLQ tenderness

WBC > 10

ANC > 7500

How does appendicitis appear on US

Noncompressible, blind-ending tubular structure with diameter > 6 mm

Target-like appearance in transverse view

Intraluminal hyperechoic foci may represent appendicolith

Most common surgical cause of abdominal pain

Appendicitis

Management of Appendicitis

Morphine (does not alter exam findings)

NPO

Antibiotics

Appendectomy

Thymu

Congenital diaphragmatic hernia

Eczema herpeticum

Buccal cellulitis

Erythema migrans-

Herpes zoster

Pyogenic granuloma

varicella

SSSS

Erythema multiforme

Cradle cap, seborrheic dermatitis

Herpetic whitlow

What are the phases of disaster response

Preparation

Response

Recovery

Mitigation / Prevention

Mitigation / Prevention (Diseaster Prep)

Efforts taken to reduce the negative consequences of a disaster or decrease the probability of it happening

What can a hospital do to mitigate/prevent disasters

Community education

Consulting/providing medical knowledge to emergency preparedness teams

Examining potential causes of disasters within the hospital

Preparation (Disaster Preparedness)

Planning, training, and educating for events that cannot be prevented

How can we prepare for disasters

Designating specific teams that are meant to specialize in disaster planning and response and undergo training in this area

Developing protocols and written Incident Action Plans for organized and cohesive responses

Drills and simulations to provide practice in response as well as evaluation of shortcomings that should be addressed

Community education

Response (Disaster Prep)

Efforts taken to reduce morbidity, mortality, and property damage after a distaster has happened

What can happen if response teams are acting independently of each other

Chaos, mistakes, inefficiency, higher levels of morbidity and mortality, possibly harm to responders and others

How do we prevent response teams from acting independently from each other

Incident Command System as well as the other 3 parts of the disaster response cycle

What teams may be part of the disaster responce

EMS, Fire, Police, Medevac

911 Communications,

Emergency Behavioral Health Team,

County and State Emergency Management

Hospital personnel

Coroner/morgue,

Search and rescue teams

Codes,

Utility companies,

American Red Cross

Incident command system (ICS)

Common hierarchy and procedures that allow responders from different agencies to work together effectively, regardless of incident type or size

Incident Commander-

Top of the hierarchy, overseeing all on-site disaster response efforts

Public Information Officer-

Primary liaison between the incident management team and the public, responsible for delivering accurate, timely, and coordinated information

Safety Officer-

Authority on incident safety, responsible for hazard identification, injury prevention, protective equipment readiness, and accident investigations in coordination with OSHA

Liaison Officer-

Single point of contact for assisting and cooperating agencies, speaking on behalf of the Incident Commander, and ensuring inter-agency coordination.

Reaches out to the hospitals to determine capabilities, and patients are distributed based on this information

Operations Section Chief-

Responsible for directing and coordinating all tactical operations, ensuring resources are appropriately deployed, and Incident Action Plans are properly implemented

Planning Section Chief-

Oversees the distribution and tracking of resources (personnel as well as supplies)

Logistics Section Chief-

Oversees the ordering and managing of resources, also ensuring food, medical, and other essential services for incident personnel

Finance Section Chief-

Manages all financial and cost-related aspects of the disaster response

What are the levels of triage

Green - Minor

Yellow - Delayed

Red - Immediate

Black - Dead / Dying

Emergency Behavioral Health (EBH)/ Disaster Crisis Outreach and Referral Teams (DCORT) teams

Operated by most counties and overseen and deployed by the state to address behavioral health impacts of disasters, which can include acute stress, grief, trauma, and mental health crises

Function of EBH / DCORT Teams

Assess and triage behavioral health needs in the field.

Provide crisis intervention and stabilization for individuals in distress.

Support responders with stress management and resilience training.

Coordinate with existing systems to avoid duplication and ensure continuity of care

Psychological First Aid

an evidence based modular approach to mental health in the immediate aftermath of disaster and crisis events.

Reunification center-

designated area set up during disasters for families and significant others to meet up with nonhospitalized survivors or to get information about their loved ones’ status or whereabouts

Moral Injury-

a recognized psychological harm or life circumstance, rather than a standalone disorder, this occurs when an individual perpetrates, witnesses, or fails to prevent acts that deeply violate their moral code

Recovery (Disaster Prepare)

Actions taken to return to normal after a disaster

when was HIV first recognized in the US

1981

when was HIV first detected and isolated in the Us

1984

AZT

First FDA approved treatment for HIV in 1987

When was the first protease inhibitor for HIV approved

1995

when did the CDC recommend screening HIV in 13-64 y/o

2006

when did PreP come out

2010

when did the first injectable ART come out

2021

How did HIV come about

Primate to humar species jumping event

HIV

A ssRNA+ virujs

What genes are in HIV

3 structural genes

6 regulatory genes

what are the structural gnes of HIV

gag

pol

env

What does HIV infect in the body

CD4 T-cells

How does HIV infect a cell

Uses reverse transcriptase (RT) to transcribe its RNA genome into double stranded DNA

Will then integrate its DNA into host DNA within nucleus

what is the common characteristics between HIV-1 and HIV-2

Share same genetic structure and viral replication function

Both cause AIDS

How does HIV-1 and HIV-2 differ

HIV-1 is global and responisble for pandemic whereas HIV-2 is a strand concentrated Western and Central Africa

HIV-1 is more virulent and replicates faster than HIV-2

HIV-1 is more transmissble and more rapid

HIV-2 requires subtype specific tests for antigen/antibody testing

What are the methods of HIV transmission

Sexual Transmission

Mother-to-Child

IV Drug Use

Exposure to Infected Blood

Nosocomial / Occupational

Risk Factors for Sexual Transmission of HIV

Higher viral load

Advanced immunodeficiency

Receptive anal intercourse

sex durng menses

Uncircumcised

STI Coinfection

Risk Factors for Mother to Child HIV Transmission

BReast abscess

Infant Thrush

Where is the highest prevelance for IVDA HIV tranmission

Northeast USA

How can we prevent sexual transmission of HIV

Condoms

Prompt STI treatment

circumcision

PrEP

PEP

Communication

How can we prevent perinatal transmission of HIV

Routine screening & ART (Zidovudine)

Avoidance of breastfeeding

Scheduled Cesarean delivery

How can we prevent IVDA transmission of HIV

PrEP: ~75% risk reduction

Needle exchange programs

Medication-assisted treatment

How can we prevent blood transmission of HIV

HIV serologic testing of all blood donor
Testing of all organ and tissue donations

How can we prevent Occupational transmission of HIV

PPE

Sheathing needles

PEp

What are the stages of HIV

Stage 1: CD4 > 500 or CD4 > 26%

Stage 2: CD4 200-499 or 14-25%

Stage 3: AIDS