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49 Cards in this Set
- Front
- Back
When is fever an emergency? |
Not all children with a fever need to be seen immediately (one exception being infants youngerthan 6-8 weeks of age).
So determine the level of severity |
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How to assess severity of illness? |
Determine if:
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What emergency conditions cause altered mental status? |
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Conditions that can lead to acidosis and/or shock include what? |
CNS problems can also cause altered mental status |
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CNS causes of altered mental status? |
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Seizures |
generalized |
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Tumour |
increased ICP due to mass effect progressive behavioural changes |
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Subarachnoid hemorrhage |
severe headache altered mental status |
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Meningitis |
increased ICP decreased responsiveness |
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Trauma |
child abuse shaken baby syndrome may lead to intracranial bleeds |
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Physical exam findings in bacterial meningitis? |
neck stiffness fever altered mental status Kernig or Brudzinski's sign |
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What is shock? |
inadequate delivery of substrates and oxygen to meet metabolic needs of tissue |
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What are compensatory mechanisms to shock in children? |
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Types of shock? |
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Distributive shock? |
hypovolemia caused by:VasodilationIncreased capillary permeabilityThird-space fluid losses
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Hypovolemic shock? |
Most common? Mental status changesTachypneaTachycardiaHypotensionCool extremitiesOliguria |
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Cardiogenic |
Associated with: Severe congenital heart diseaseDysrhythmiasCardiomyopathyTamponade Signs/symptoms: Cool extremitiesDelayed capillary refill (> 2 seconds)HypotensionTachypneaIncreasing obtundationDecreased urine output |
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Septic shock? |
Warm extremitiesBounding pulsesTachycardiaTachypneaAdequate urinationMild metabolic acidosis
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Antibiotic treatment of meningoccemia? |
Pen G 250,000 to 300,000 units/kg/day |
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Guidelines for prophylaxis of meningococcus |
in adults, cipro is drug of choice Prophylaxis is also recommended for those health care workers who had intimate exposure (suchas occurs with unprotected mouth-to-mouth resuscitation, intubation, or suctioning beforeantibiotics are administered). |
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MCV4 conjugate vaccine? |
For the general population, the MCV4 is given to children ages 11-18.
Meningococcal conjugate vaccine |
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Morbidity and mortality of meningococcal disease? |
Fatality rate: All ages: 10-15% Adolescents: 21% |
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Complications of meningococcal disease? |
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What is the purpose of CABs? |
To make sure you never miss a patient whose oxygenation or perfusion might be compromised,and2. To be structured in your exam so that you always first check for life-threatening problems thatmust be treated immediately.
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How to assess circulation? |
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How to assess breathing? |
describe effort and rate of breathing listen to how patients lung sound check patient's oxygenation |
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How is breathing assessment done? |
Look at the chest to determine and record the respiratory rate,Listen to breath sounds for wheezes, rales, rhonchi, diminished breath sounds(pneumothorax, effusion, etc.), andUse a pulse oximeter to rapidly assess the oxygenation of the patient
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How to open the airway |
position neck perform jaw thrust |
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What is D? |
neuro assessment check for hypoglycemia |
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DDx of lethargy? |
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Sepsis |
The combination of fever, lethargy, tachypnea, and decreased urination points to sepsis, oreven septic shock
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Meningitis |
Hallmark symptoms of meningitis are fever, headache, stiff neck, altered mental status, andphotophobia, although many patients present with only two or three of these clinicalindicators.
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Encephilitis |
Encephalitis is often caused by viral infections in children, and presents with altered mentalstatus and fever.
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Toxic ingestion |
Overdoses (toxic ingestion) often cause otherwise unexplained lethargy.Depending on the toxin, decreased urine output, rash, and tachypnea may be seen.
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Pneumonia |
Fever and tachypnea are found with pneumoniaAltered mental status would be uncommon unless the patient was severely hypoxic.
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CNS tumour |
Increased intracranial pressure from a CNS tumor may lead to lethargy and tachypnea
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DKA |
lethargy tachypnea |
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Hypoglycemia |
Hypoglycemia is a cause of lethargy or altered mental status.
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Renal failure |
Decreased urine output points strongly toward renal failure.An associated acidosis could lead to tachypnea and lethargy.
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DDx of fever and petechiae |
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Meningococcal sepsis |
Whenever a patient presents with fever and petechiae, this diagnosis must always be at thetop of the list.This is true even if the patient otherwise looks well.A blood culture must always be done and antibiotics must always be given until the diseasecan be definitely ruled out.
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Kawasaki disease |
fever and rash
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Toxic shock syndrome |
Toxic shock syndrome causes fever and a sunburn-looking rash that might feel rough to thetouch (like sandpaper).
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RMSF |
fever and petechiae as well.
The petechiae tend to be on the palms and soles.RMSF is epidemiologically less likely than meningococcus unless in an endemic area. |
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Scarlet fever |
Rash appears on the upper trunk 12-48 hours after the onset of fever.As the exanthem spreads to the extremities, it become confluent and feels like sandpaper.It fades in 4-5 days and is followed by desquamation of the skin.Linear petechiae are evident in body folds and are called Pastia's sign.The pharynx is beefy red and the tongue is initially white and rough (strawberry tongue);within 4-5 days the white coating sloughs off and the tongue becomes bright red.
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Managing fluids in shock? |
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When to use intraosseous access? |
Placement of an intraosseous line is easy and fast, and this type of line may be used to administerany fluid.If a peripheral intravenous line cannot be placed within 90 seconds, an intraosseous line is thefastest way to get access.
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Fluids management in septic shock? |
A patient with septic shock often needs repeated boluses of fluid. Give as much fluid as isneeded to attain perfusion.After a certain point, you may need inotropes to enhance cardiac contractility andvasopressors to raise the blood pressure by vasoconstricting the vessels. Epinephrine anddopamine are acceptable choices.
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Pre-renal failure |
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