Peds Emergency: Heent

Front 1

What is the time frame for the best prognosis of reimplanted avulsed teeth?

Back 1

30 mins

Front 2

what are the antibiotics given after reimplantation of avulsed teeth?

Back 2

PCN or Amox for 7-10 days

Front 3

what is the most common complication of bites?

Back 3

infection

Front 4

what type of bite are the biggest worry to parents?

Back 4

rabies

Front 5

when is infection most likely to occur following a bite?

Back 5

1. delay in treatment > 24 hours 2. puncture wounds 3. hand wounds

Front 6

what are the general management for bites?

Back 6

1. cleaning 2. moderate pressure irrigation 3. debride devitalized tissue 4. suturing: controversial 5. antibiotics 6. rabies 7. tetanus 8. careful follow up

Front 7

what are the agents to cause infection for human bites?

Back 7

Eikenella corrodens, staph aureas, strep species

Front 8

what are the pathogens to cause infection after cat/dog bite/

Back 8

s. aureaus, pastuerlla, strep, rabies

Front 9

what are the 2 drugs given for rabies protocol?

Back 9

1. Human Immune Globulin (HRIG) @ 20 IU/kg: .5 dose into the wound and .5 dose IM 2. Human diploid cell vaccine (HDCV): 1cc days 0,3,7,14 and 28

Front 10

what are the agents to cause conjunctivitis in neonates < 24 hours?

Back 10

chemical

Front 11

what is the common agent to cause conjunctivities in neonates < 1 week old? 1-2 weeks?

Back 11

N. gonorrhea; chlamydia

Front 12

what are the agents to cause conjuct in infants/toddlers w/o otitis

Back 12

h. flu, strep pneumo, b. catarrhals

Front 13

what are the agents to cause conjunct in school age?

Back 13

HSV, varicella, viral

Front 14

which age often get conjucntivitis from allergic causes?

Back 14

school age and adolescents

Front 15

what are the characteristics of bacterial conjunctivitis?

Back 15

neonates and toddlers; purulent discharge; 1+ to 3+ amount of dc;; 3+ injection; occasional lymphadenop; otitis media often seen; tx with abx

Front 16

what are the characteristics of viral conjunct?

Back 16

school age to adults; watery dc; 1+ to 2+ dc; 2+ injection; common lymphadenop; pharyngitis and URI associated; tx with artificial tears and acyclovir

Front 17

describe allergic conjunctivitis.

Back 17

seen in late childhood early adult; 1+ mucoid discharge; 1+ injection; no lymphadenop; associated with rhinitis, asthma, eczema; tx with antihistamines; decongest; mast cells; and NSAIDs

Front 18

what is the most common virus to cause conjunct?

Back 18

adenovirus

Front 19

which pathogen causes pre-auricular lymphaden?

Back 19

h. flu

Front 20

what are the characteristics of h. flu conjucnt?

Back 20

1. conjunctivitis and otitis 2. pre-auricular nodes 3. fever 4. URI

Front 21

what are the characteristics of bact conjunct?

Back 21

1. younger children 2. fever +/- 3. papillary response 4. bilateral 5. purulent dc

Front 22

what are the common adenoviruses to cause conjunct?>

Back 22

3,4, and 7

Front 23

what are the differentials for conjunctivitis?

Back 23

dacriostenosis, corneal abrasion, gluacoma, herpes blepharitis, iritis

Front 24

what are the anticipatory guidance for conjunct?

Back 24

contagion, spread, medication admin, SxS of periorbital cellulitis, ointment cause temp blurry vision

Front 25

what are the PE findings for allergic response in the eyes?

Back 25

intense itching; conjunctival chemosis and hyperemia, tearing, rhinnorhea, unliateral/bilateral signs

Front 26

what are the findings for a chemical reaction in the eye?

Back 26

hyperemia of conjunctivae; tearing; hx of exposure to the agent

Front 27

what are the management options for allergic conjunct?

Back 27

cool compress; ID and avoid allergen; topical anti-inflammatory agent (Acular); mast cell stabilizer (Alomide); systemic antihistoamines; zxyrtec, claritin, benadryl

Front 28

what is the tx for chlamydia conjunct in the neonate?

Back 28

PO erythro qid for 14 days, no eye ointment, same tx for chlamydial pneumonia

Front 29

what is the tx for GC conjunct in the neonate?

Back 29

admit; flushing out of the eyes, ceftriaxone IV

Front 30

which usually occurs within the first week of life, chlamydia or GC conjunct?

Back 30

GC

Front 31

what symptoms of conjunctivitis should have a ophthalmology referral?

Back 31

1. suspicion of herpes 2. no response to tx in 3-5 days 3. pain, severe photophobia, decrease in vision 4. pupillary abnormalities 5. unable to examine well

Front 32

___ account for almost 70% of all ocular injuries

Back 32

boys

Front 33

boys between ages 11 to 15 are the most vulnerable to occular injury with a __ to __ ratio compared to girls

Back 33

4 to 1

Front 34

what are the hx components to an eye injury?

Back 34

mechanism of injury; coexisting systemic disease?; allergy? Tetanus status

Front 35

what is the first goal of the eye exam with eye trauma?

Back 35

rule out open globe

Front 36

what are the signs of an open globe?

Back 36

chemosis, peaked pupil; vitreous hemorrhage

Front 37

the vision exam following an eye injury should occur ___ eye at a time

Back 37

one

Front 38

what does the lack of a red light reflex mean after an eye injury?

Back 38

possible retinal detachment

Front 39

what must occur if a chemical injury occurs to the eye?

Back 39

MUST provide copious irrigation before history and physical

Front 40

visual acquity is considered the __ __ of the eye

Back 40

vital signs

Front 41

describe the fluorescein exam

Back 41

use topical anesthetics, tetracaine (onset of action <1min) or proparacaine (<20secs); apply sterile fluourescein eye strips with saline or anesthetic used with woods light or cobalt blue light

Front 42

when is the slit lamp exam done?

Back 42

used for anterior chamber looking at the cornea, intraocular pressure and evaluating for foreign bodies

Front 43

what is the benefit of the dilated eye exam?

Back 43

allows the slit lamp exam to be used to view the posterior globe as well (the retina, optic nerve, blood vessels and the macula)

Front 44

what is the radiologic study of choice for an eye injury?

Back 44

ct scan

Front 45

what are the presenting symptoms of a corneal abrasion?

Back 45

pain, tearing, photophobia, FB sensation

Front 46

what is the tx for corneal abrasion?

Back 46

topcial abx drops; pain meds and NO PATCHING

Front 47

what is important to do if you suspect a conjuctival/corneal FB?

Back 47

evert the eyelid using a qtip

Front 48

what are the common corneal/conjunctival FBs?

Back 48

dust, dirt, or metallic silvers

Front 49

metallic FBs can leave a __ __ in the cornea

Back 49

rust ring

Front 50

what type of abrasion is characteristic of a FB under the eyelid?

Back 50

linear abrasion

Front 51

corneal/scleral lacerations are usually caused by?

Back 51

penetrating or blunt trauma

Front 52

what is the most important PE component with a corneal/scleral laceration?

Back 52

visual acuity

Front 53

what should be done in the ED for a scleral/corneal laceration?

Back 53

1. visual acuity 2. shield the eye and call optho 3. cycloplegics used to relieve ciliary muscle spasms (can cause tissue prolapse) 4. tetanus shot 5. IV antibiotics 6. CT if you think the FB pierced through the cornea

Front 54

what are the ED management for a lid laceration?

Back 54

1. eye exam 2. tetanus prophylax 3. wound closure if superficial lac

Front 55

what are the determinants for an ophtho referral from a lid lac?

Back 55

1. involves the medial 1/3 of the lid (canaliculi injury) 2. lid margins (tarsal plate) 3. levator palpebra muscle (ptosis may develop)

Front 56

what are the symptoms of a globe rupture?

Back 56

pain, decreased vision, diplopia

Front 57

what are the signs of a globe rupture?

Back 57

teardrop pupil, prolapsed iris, hyphema

Front 58

what are the PE steps for a possible globe rupture?

Back 58

Focused: visual acuity (how many fingers or light perception); EOMs examined for entrapment

Front 59

what is the goal of ED management of globe rupture?

Back 59

to prevent increased in IOP

Front 60

what is the management for globe rupture in the ED?

Back 60

1. shield the eye 2. pain relief 3. antiemetics 4. NPO 5. Tetanus 6. broad spec abx (ancef/ceftraz/vanco) 7. stool soft 8. ophtho consult

Front 61

what are the symptoms of orbital floor fractures?

Back 61

eyelid swelling and bruising; enophthlamos "sinking I" of the affected eye; ptosis; diplopia; anesthesia of the cheek; inability to move the eye upward

Front 62

what are the images done for orbital fracture?

Back 62

orbital CP and plain films may be helpful

Front 63

what are the 3 views used on plain film for an orbital fracture?

Back 63

Water's; caldwell and lateral views

Front 64

when is surgery most often done following an orbital fracture?

Back 64

after 7-14 days

Front 65

what are the indications for surgery following an orbital fracture?

Back 65

entrapment; facial hypoesthesia; symptomatic diplopia w/ minimal improvement over time; large floor fracture leading to enophthalmos

Front 66

what should you tell a pt do avoid after an orbital fracture?

Back 66

blowing their nose

Front 67

what is a hyphema?

Back 67

blood in the anterior chamber

Front 68

how do hyphemas usually occur?

Back 68

blunt, projectile or penetrating trauma

Front 69

the majority of hyphemas have less than 50% of the __ __ filled with blood

Back 69

anterior chamber

Front 70

what are the SxS of hyphema?

Back 70

pain, decreased vision, injection, irregular appearing pupil

Front 71

what is a grade 1 hyphema?

Back 71

layered blood occupying less than 1/3 of the anterior chamber

Front 72

what is the grade of a hyphema that have blood filling 1/3 - 1/2 of the anterior chamber?

Back 72

2

Front 73

what is a grade 3 hyphema?

Back 73

layered blood filling .5 to less than the total anterior chamber

Front 74

what is grade 4 hyphema? What are the other names?

Back 74

total clotted blood, often referred to as blackball or 8-ball hyphema

Front 75

what is the major complication of hyphema?

Back 75

secondary hemorrhage (rebleeding)

Front 76

what is the cause of rebleeeding in hyphema?

Back 76

lysis and retraction of the clot and fibrin aggregates

Front 77

when is the highest risk of rebleeding for hyphema?

Back 77

in the first 5 days

Front 78

what is the average rate of rebleeding for hyphema? Who is at greatest risk?

Back 78

25% and those under age 6

Front 79

ToF: 100% visual acuiity is regained following a hyphema?

Back 79

false: nearly 80% regain acuity to only 20/40

Front 80

what is the management for hyphemas>?

Back 80

1. elevate head of bed 2. eye shield 3. pain control 4. topical cycloplegics 5. topical miotics 6. topical vs systemic AMICAR 7. topical vs systemic steroids 8. sickle cell prep

Front 81

what are the SxS of retrobulbar hemorrhage?

Back 81

acute proptosis, subconjunctival hemo, decreased vision, pain limitation of ocular movement

Front 82

what is the management for retrobulbar hemorrhage?

Back 82

immediate ophtho consult, IV mannitol, IV steroids, lateral canthotomy (by experienced person)

Front 83

what is the key in the management of ocular chemical burns?

Back 83

No H&P…COPIOUS IRRIGATION until pH is neutral near 7. use 1 -2 liters of NS.

Front 84

why are chemical burns to the eye so bad? Describe acid and alkaline

Back 84

Acid burns cause coag necrosis and denature surface proteins but usuallys don't penetrate the eye. Alkaline are more serious becaues they rapidly penetrate the cornea and anterior chamber causing liquefication necrosis.

Front 85

what are examples of alkaline agents that can burn the eye?

Back 85

Lye, cement cleaner, drain cleaner, fertilieer, sparklers, and firecrackers.

Front 86

what is the name of the tool used to treat ocular chemical burns?

Back 86

the morgan lens

Front 87

where do chalazia often occur?

Back 87

in the lid

Front 88

which of the sinuses are presnet at birth?

Back 88

maxillary and ethmoid

Front 89

what is the most common site for sinusitis?

Back 89

ethmoid sinus

Front 90

the __ sinus moves to position at 5-6 years of age and not developed until late adolecsence.

Back 90

frontal

Front 91

the __ sinus are not a frequent site of infection but are common for CNS spread

Back 91

frontal

Front 92

what are the common organisms to cause sinusitis?

Back 92

strep pneumo, H. flu, M. Catarrhalis, strep aureas (chronic sinusitis)

Front 93

what are the 2 common presentations of acute sinusitis?

Back 93

persistent and severe

Front 94

what is the classification of persistent sinusitis?

Back 94

resp symptoms for > 10 days and < 30 days, 10 days of resp symptoms without improvement, any form of nasal discharge, cough worse at night, malodorous breath, rare facial pain and headache,+/- fever

Front 95

what are the characteristics of severe sinusitis?

Back 95

cold that is more severe than usual, combo of high fever and purulent nasal idscharge, and combo lasting 3-4 days= bacterial infection in paranasal sinuses

Front 96

what is the chronic sinusitis?

Back 96

nasal symptoms for > 30 days without getting better, cough: worse at night, sorethroat, nasal dc of any type, headache not common and fever is rare

Front 97

what are the criteria for CT scan for sinustis?

Back 97

toxic appearance, proptosis, impaired vision, limited eoms, severe facial pain, swelling of forehead or eyes, adolesecents with risk of frontal sinusitis

Front 98

what is the tx for sinusitis?

Back 98

amoxil 60-90 mg/kd, augment 45/10/mg/kd, Pediazole, Bactrim, Cefuroxime, 10 dyas vs 14 days- 10 days then until no more symtpomss for 7 more days

Front 99

do antihistamines work for sinusitis?

Back 99

they don't hurt but are controversial

Front 100

what is the #1 and 2 cause of preseptal and orbital cellulitis?

Back 100

1: sinusitis 2: eyelid lesion

Front 101

what age group is more common to have bacteremia from orbital cellulitis?

Back 101

< 2 yrs

Front 102

what is the #1 sinus to be involved with orbital cellulitis in children?

Back 102

ethmoid sinusitis

Front 103

what are the risk factors for orbital cellulitis?

Back 103

hx of sinusitis, periorbital inflammation, trauma, dacrycystisis, dental abscess

Front 104

__% of children with preseptal or obital cellulits will have fevers

Back 104

75

Front 105

ToF: chemosis is useful in differentiating preseptal from orbital cellulitis

Back 105

false, it occurs in both

Front 106

what are the infectious causes of preseptal cellulitis?

Back 106

1. conjunctivitis, 2. herdeolum 3. chalazion, 4. dacryocystisi, 5. bacerial cellulitis

Front 107

ToF: preseptal cellulits never has proptosis

Back 107

TRUE

Front 108

are the eoms in tact in preseptal cellulitis?

Back 108

yes

Front 109

does ptosis occur in preseptal cellulitis?

Back 109

yes

Front 110

what is the management of preseptal?

Back 110

must ro orbital, cbc, blood cx, < 3 yrs hospitalize, abx (cetriazone, ceuroxime, aug) *** dialy followup

Front 111

what is the age group of orbital?

Back 111

usually > 5 ys

Front 112

tof: orbital cell rarely spreads from adjacent sinuses

Back 112

false, nearly always

Front 113

what are the rare causes of orbital?

Back 113

trauma, eye surgery, dental infections

Front 114

what are the characteristics of orbital?

Back 114

mod to severe eyelid edema, ptosis, proptosis, conjunctiva hyperemia, chemosis, diplopia

Front 115

what are the Sxs of orbital?

Back 115

pain on movement, decrease eoms, altered visual acuity, dilated pupil, fever, toxic appearance

Front 116

what are the clinical findings that differentiate orbital from preseptal?

Back 116

decreased and painful eoms with proptosis

Front 117

what type of FB must be removed before returning home?

Back 117

nasal fb

Front 118

what are the causes of nasal bleeds?

Back 118

infection, dry heat, nose picking

Front 119

what is the management of nose bleeds?

Back 119

lean forward, mild pressure, do not use clothes pin or tongue blades

Front 120

what are the types of congenital masses of the neck?

Back 120

1. 1st, 2nd and 3rd branchial cleft cysts 2. thyroglossal, 3. cystic hygroma 4. hemangioma 5. dermoid cysts 5 venous malformation

Front 121

what are the common causes of cervical adenitis?

Back 121

usually bacterial: staph a. most common, then group a strep

Front 122

what is the tx for cervical adenitis?

Back 122

2 abx: systemic penicillin, and first gen ceph follow up 24-36 hours and admit if they get worse

Front 123

what is the definition of AOM?

Back 123

is an infectious process of the middle ear cleft and to a variable extent of the mastoid air cell system

Front 124

what are the most common causes of AOM?

Back 124

strep pneumo, H flu, morax catarrh, p hemolytic strep, psuedo aeruginosa

Front 125

what are the symps of AOM?

Back 125

fever, otalgia, fullness, hearing loss

Front 126

what is the management of AOM?

Back 126

abx therapy, traditional duration 10-14 days, now 5-7 days,

Front 127

what is the management for perfed TM?

Back 127

Floxicin otic drops OR PO abx, may take weeks

Front 128

what is the definition of acute mastoiditis?

Back 128

an infection of the mastoid characterized by diffuse osteitis followed by rarefaction and breakdown of the bony septae

Front 129

when is the mastoid bone mature?

Back 129

age 4

Front 130

what are the symptoms of acute mastoiditis?

Back 130

may follow AOM, otalgia, aural discharge, conductive hearing loss, fever

Front 131

what are the physical findings of mastoiditis?

Back 131

fever, otorrhea, pulsatile, tympanic perf, welling of superior TM, postauricular aura: erythema and tenderness, pitting edema, obliteration of the postauricular crease

Front 132

what is the management of acute mastoiditis?

Back 132

abx: IV therpary should be maintained for at least 24-48 hours after resolution of symptoms, then oral abx for 2 weeks, treated like an osteo, emergency surgery (simple mastoidectomy, + ventilation tube)