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28 Cards in this Set

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CPR

circulation


airway


breathing

CAB efforts

Tap the infant's foot to see if he responds.

Check for breathing.


If he is unresponsive and not breathing (or only gasping) begin CPR.

ALTE

Apparent life threatening event


Replaced "near-miss SIDS"


description of event

ALTE event

The observer finds the episode frightening and may think the infant has died.The caregiver's description usually includes apnea or change in breathing pattern, colorchange (cyanosis, pallor, erythema, plethora), change in muscle tone (usually limpness), andpossibly choking or gagging.Recovery occurs only after stimulation or resuscitation

Differential Diagnosis?


  • CNS
  • Cardiac
  • Pulmonary
  • Gastrointestinal
  • Systemic

CNS ALTE

seizures (bleed, infection, structural abnormalities, metabolic disorder, lyte abnormalities, genetic syndromes or epilepsy)


breath holding spells

Breath holding spells


  • occursduring expiration and is reflexive in nature.
  • cries andthen suddenly falls silent in the expiratory phase of respiration.
  • followed by a color change. S
  • pallid(acyanotic) or cyanotic.
  • Pallid spells are typically associated with aninjury such as a fall
  • cyanotic spells with anger.
  • mayresolve spontaneously, or the child may lose consciousness.

Cardiac

QT syndrome


SVT


congenital heart disease

Pulmonary

apnea is respiratory syncytial virus infection


pertussis


lower RI

Gastrointestinal

Reflux


swallowing abnormalities


tracheoesophageal fistula



Systemic


  • sepsis: apnea, pallor, tachycardia, tachypnea, fever or hypothermia, decreased feeds or change in tone
  • ingestion of meds/toxins
  • botulinum
  • environment exposures, carbon monoxide, mental status changes
  • hypoxia

Normal neurological findings in 2 month old

  • Can fix and follow easily with their eyes;
  • Exhibit a meaningful smile in response to voices;
  • Have a strong suck;
  • andAre beginning to coo

Subdural hematoma

head trauma, accidental or non accidental

Accidental trauma

MVA



abusive head trauma

10-12% of all deaths among children who are victims of child abuse

Role of physician in suspected child abuse cases

determine likelihood injury was accidental or non-accidental


health care workers report suspected child abuse



Team members in suspected child abuse


  • attending
  • neurologist
  • child advocacy doctor
  • opthalmologist
  • social worker

neurologist

If there is head trauma, a neurologist can help assess the extent of injury,recommend treatment, and provide follow-up monitoring.

child advocacy doctor

recommend specific studies,such as a skeletal survey to look for old or new fractures, or additional consultations needed toevaluate the possibility of abuse

ophthalmologist

Retinal hemorrhages, found in 65-90% of victims, is highly suggestive of abusivehead trauma, and is rarely seen for any reason other than severe accidental injury (e.g., highspeedmotor vehicle collision) or non-accidental trauma

social worker

team coordinators

skeletal surveys are for...?


  • fractures
  • multiple fractures at various stages of healing
  • posterior rib fractures
  • skull fracture

Prognosis of victims of abusive head trauma?

Many babies with subdural hematomas and retinal hemorrhages have long-term developmentaldelays, seizures, and/or difficulty with vision.

Temperature of 2 month old?

A normal rectal temperature is greater than 96.5° F and less than 100.4° F.

Hear rate?

Tachycardia may suggests a deterioration in cardiovascular status related to sepsis, shock,or increased ICP (intracranial pressure).

Respiration rate?

A decreased repiratory rate is suggestive of a CNS (central nervous system) depression ofthe respiratory center.Sepsis or a respiratory infection generally present with increased respiratory rate

Blood pressure?

An elevated blood pressure indicates a response from the cardiovascular system either topain, compensated shock, or increased ICP.

How to discuss non accidental trauma with parents?

gather more history


share info directly


ask parents for their ideas