Pediatric emergency management

Pediatric emergency management US Medical PG Question 1: A 24-year-old man is rushed to the emergency room after he was involved in a motor vehicle accident. He says that he is having difficulty breathing and has right-sided chest pain, which he describes as 8/10, sharp in character, and worse with deep inspiration. His vitals are: blood pressure 90/65 mm Hg, respiratory rate 30/min, pulse 120/min, temperature 37.2°C (99.0°F). On physical examination, patient is alert and oriented but in severe distress. There are multiple bruises over the anterior chest wall. There is also significant jugular venous distention and the presence of subcutaneous emphysema at the base of the neck. There is an absence of breath sounds on the right and hyperresonance to percussion. A bedside chest radiograph shows evidence of a collapsed right lung with a depressed right hemidiaphragm and tracheal deviation to the left. Which of the following findings is the strongest indicator of cardiogenic shock in this patient?

• A. Jugular venous distention (Correct Answer)
• B. Hyperresonance to percussion
• C. Subcutaneous emphysema
• D. No right chest raise
• E. Tracheal shift to the left

Pediatric emergency management Explanation: ***Jugular venous distention*** - In this trauma patient with tension pneumothorax, **jugular venous distention (JVD)** is the strongest indicator that the patient is developing **obstructive shock** with cardiovascular compromise. - JVD indicates **impaired venous return** to the heart due to increased intrathoracic pressure compressing the vena cava and right atrium. - While this is technically **obstructive shock** (not pure cardiogenic shock), JVD represents the cardiovascular manifestation indicating that the mechanical obstruction is now critically affecting cardiac filling and output. - Among the options listed, **JVD is the only finding that directly reflects cardiovascular compromise** and impending circulatory collapse. *Hyperresonance to percussion* - This finding indicates **air in the pleural space**, characteristic of pneumothorax. - While it confirms the diagnosis of pneumothorax, it is a **respiratory finding** rather than a direct indicator of cardiovascular compromise or shock state. *Subcutaneous emphysema* - This indicates **air in subcutaneous tissues** from chest wall injury or air leak. - It confirms significant chest trauma but does not directly indicate the severity of cardiovascular compromise or shock. *Tracheal shift to the left* - **Tracheal deviation** away from the affected side is a classic sign of **tension pneumothorax** indicating mediastinal shift. - While this confirms tension physiology, it is primarily an **anatomical/structural finding** rather than a direct hemodynamic indicator like JVD, which specifically reflects impaired venous return and cardiovascular compromise.

Pediatric emergency management US Medical PG Question 2: A 40-year-old Caucasian male presents to the emergency room after being shot in the arm in a hunting accident. His shirt is soaked through with blood. He has a blood pressure of 65/40, a heart rate of 122, and his skin is pale, cool to the touch, and moist. This patient is most likely experiencing all of the following EXCEPT:

• A. Decreased sarcomere length in the myocardium
• B. Increased stroke volume (Correct Answer)
• C. Confusion and irritability
• D. Decreased preload
• E. Increased thromboxane A2

Pediatric emergency management Explanation: ***Increased stroke volume*** - The patient is experiencing **hypovolemic shock** due to significant blood loss, meaning their **cardiac output** is severely compromised. - In shock, the heart attempts to compensate by increasing **heart rate**, but **stroke volume** is typically decreased due to reduced **preload**. *Decreased sarcomere length in the myocardium* - In situations of significant blood loss and **decreased preload**, there is less venous return to the heart, leading to reduced end-diastolic volume. - According to the **Frank-Starling law**, reduced end-diastolic volume results in shorter initial sarcomere length, which reduces the force of contraction and thus, **stroke volume**. *Confusion and irritability* - **Hypovolemic shock** leads to widespread **tissue hypoperfusion**, especially to vital organs like the brain. - Reduced cerebral blood flow results in impaired brain function, manifesting as **confusion, irritability**, and altered mental status. *Decreased preload* - Significant blood loss leads to a reduction in the **total circulating blood volume**. - This reduction directly decreases the venous return to the heart, thus lowering the **end-diastolic volume** and subsequently, the **preload**. *Increased thromboxane A2* - In response to **vascular injury and bleeding**, the body initiates hemostasis, a critical component of which is platelet aggregation. - **Thromboxane A2** is a potent vasoconstrictor and platelet aggregator released by activated platelets to form a **platelet plug** and help stop bleeding.

Pediatric emergency management US Medical PG Question 3: A 15-year-old boy is brought to the emergency department one hour after sustaining an injury during football practice. He collided head-on into another player while wearing a mouthguard and helmet. Immediately after the collision he was confused but able to use appropriate words. He opened his eyes spontaneously and followed commands. There was no loss of consciousness. He also had a headache with dizziness and nausea. He is no longer confused upon arrival. He feels well. Vital signs are within normal limits. He is fully alert and oriented. His speech is organized and he is able to perform tasks demonstrating full attention, memory, and balance. Neurological examination shows no abnormalities. There is mild tenderness to palpation over the crown of his head but no signs of skin break or fracture. Which of the following is the most appropriate next step?

• A. Discharge without activity restrictions
• B. Discharge and refrain from all physical activity for one week
• C. Observe for 6 hours in the ED and refrain from contact sports for one week (Correct Answer)
• D. Administer prophylactic levetiracetam and observe for 24 hours
• E. Administer prophylactic phenytoin and observe for 24 hours

Pediatric emergency management Explanation: ***Observe for 6 hours in the ED and refrain from contact sports for one week*** - This patient experienced a brief period of **confusion, headache, dizziness**, and **nausea** immediately after a head injury, which are symptoms consistent with a **mild traumatic brain injury (mTBI)** or **concussion**. - Although his symptoms have resolved at presentation, observation in the ED for a few hours is prudent to ensure no delayed onset of more severe symptoms, and he should **refrain from contact sports** for at least one week as part of concussion management. *Discharge without activity restrictions* - Discharging without activity restrictions is unsafe given the initial symptoms of **confusion** and the potential for delayed symptom presentation or complications from a concussion. - Concussion management requires a period of **physical and cognitive rest** to allow the brain to heal and prevent **second impact syndrome**. *Discharge and refrain from all physical activity for one week* - While refraining from all physical activity for one week is part of concussion management, discharging immediately without any observation period after initial neurological symptoms could be risky. - An observation period allows for monitoring of any **worsening neurological signs** or symptoms that might indicate a more serious injury. *Administer prophylactic levetiracetam and observe for 24 hours* - **Prophylactic anticonvulsants** like levetiracetam are typically not recommended for routine management of **mild traumatic brain injury** or concussion. - Their use is generally reserved for patients with more severe injuries, evolving conditions, or those who have had **seizures post-trauma**. *Administer prophylactic phenytoin and observe for 24 hours* - Similar to levetiracetam, **phenytoin** is an anticonvulsant and its prophylactic use is not indicated for **mild head injuries** or concussions. - Anticonvulsant prophylaxis is associated with potential side effects and is reserved for specific high-risk scenarios, such as **severe TBI** or **penetrating head trauma**.

Pediatric emergency management US Medical PG Question 4: A 7-month-old boy is brought to the ED by his mother because of abdominal pain. Two weeks ago, she noticed he had a fever and looser stools, but both resolved after a few days. One week ago, he began to experience periodic episodes during which he would curl up into a ball, scream, and cry. The episodes lasted a few minutes, and were occasionally followed by vomiting. Between events, he was completely normal. She says the episodes have become more frequent over time, and this morning, she noticed blood in his diaper. In the ED, his vitals are within normal ranges, and his physical exam is normal. After confirming the diagnosis with an abdominal ultrasound, what is the next step in management?

• A. Supportive care
• B. Broad-spectrum antibiotics
• C. Air contrast enema (Correct Answer)
• D. Abdominal laparotomy
• E. Abdominal CT scan

Pediatric emergency management Explanation: ***Air contrast enema*** - An **air contrast enema** is both diagnostic and therapeutic for **intussusception**, which is strongly suggested by the patient's symptoms (colicky abdominal pain, drawing legs to chest, currant jelly stools). - It uses air pressure to **reduce the intussusception**, avoiding surgery if successful and the bowel is not compromised. *Supportive care* - While supportive care (IV fluids, pain control) is important, it does not address the underlying mechanical issue of **intussusception** and would not resolve the condition. - Delaying definitive treatment for intussusception can lead to **bowel ischemia, necrosis, and perforation**, which are life-threatening. *Broad-spectrum antibiotics* - Antibiotics are not the primary treatment for **intussusception**, as it is a mechanical obstruction, not typically a primary infection. - They might be considered if there are signs of **perforation or peritonitis**, but the immediate goal is reduction. *Abdominal laparotomy* - An **abdominal laparotomy** is a surgical intervention reserved for cases where **non-operative reduction** (like an air enema) fails or if there are signs of **bowel perforation or gangrene**. - It is not the *first-line* next step after diagnosis, especially if non-invasive options remain viable. *Abdominal CT scan* - An **abdominal CT scan** can diagnose intussusception but is typically not the preferred initial imaging because it involves **radiation exposure** and **does not offer therapeutic benefit**, unlike an air contrast enema. - Abdominal ultrasound is usually sufficient for diagnosis and safer for pediatric patients.

Pediatric emergency management US Medical PG Question 5: A 7-year-old boy presents to the pediatric emergency department for knee pain. The child fell while riding his skateboard yesterday. He claims that ever since then he has had swelling and knee pain that is severe. His parents state that he has trouble walking due to the pain. The child has a past medical history of seasonal allergies and asthma. His current medications include loratadine, albuterol, and fluticasone. His temperature is 99.5°F (37.5°C), blood pressure is 95/48 mmHg, pulse is 110/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, you note a young boy laying on the stretcher in pain. Cardiopulmonary exam is within normal limits. Inspection of the patient's left knee reveals an erythematous knee that is tender and warm to the touch. Passive movement of the knee elicits pain. The patient refuses to walk so you are unable to assess his gait. Which of the following is the best initial step in management?

• A. ESR, CRP, and CBC
• B. Arthrocentesis (Correct Answer)
• C. CT scan
• D. Antibiotics
• E. Supportive therapy and further physical exam

Pediatric emergency management Explanation: ***Arthrocentesis*** - The patient presents with classic signs of **septic arthritis**, including acute onset of severe knee pain, warmth, erythema, tenderness, and refusal to bear weight, especially following a minor trauma which can sometimes be a precipitating factor or merely draw attention to existing infection. - **Arthrocentesis** is the most crucial diagnostic and therapeutic step in suspected septic arthritis, as it allows for fluid analysis (cell count, Gram stain, culture) to identify the causative organism and guide targeted antibiotic therapy. *ESR, CRP, and CBC* - While these labs (erythrocyte sedimentation rate, C-reactive protein, and complete blood count) are important for assessing the degree of **inflammation** and **infection**, they are not the definitive initial step for diagnosing septic arthritis. - These tests support the suspicion of infection but do not provide the specific bacterial diagnosis or immediate relief of joint pressure that arthrocentesis offers. *CT scan* - A CT scan is generally not the initial diagnostic modality for **acute septic arthritis** unless there is a concern for osteomyelitis or other bony involvement not clearly visible on plain radiographs or if aspiration is difficult. - **Plain radiographs** are usually the first imaging study to rule out fracture or other bony pathology, but they cannot diagnose joint infection. *Antibiotics* - While antibiotics are essential for treating septic arthritis, initiating them **before arthrocentesis** can **sterilize the joint fluid**, making culture results negative and hindering the identification of the specific pathogen. - Empirical antibiotics should only begin *after* joint fluid has been aspirated for diagnostic purposes. *Supportive therapy and further physical exam* - Supportive therapy (e.g., pain control, immobilization) is important but **insufficient** as the sole initial management for suspected septic arthritis, which is a **medical emergency**. - Delaying definitive diagnosis and treatment (arthrocentesis) can lead to **rapid joint destruction** and long-term morbidity, outweighing the benefit of further physical exam beyond initial assessment.

Pediatric emergency management US Medical PG Question 6: A 3-week-old boy is brought to the emergency department by his parents because of a 3-day history of progressive lethargy and difficulty feeding. He was born at term and did not have difficulty feeding previously. His temperature is 39.4°C (103°F), pulse is 220/min, respirations are 45/min, and blood pressure is 50/30 mm Hg. Pulse oximetry on 100% oxygen shows an oxygen saturation of 97%. Examination shows dry mucous membranes, delayed capillary refill time, and cool skin with poor turgor. Despite multiple attempts by the nursing staff, they are unable to establish peripheral intravenous access. Which of the following is the most appropriate next step in management?

• A. Intraosseous cannulation (Correct Answer)
• B. Ultrasound-guided antecubital vein cannulation
• C. Internal jugular vein cannulation
• D. Intramuscular epinephrine
• E. Rapid sequence intubation

Pediatric emergency management Explanation: ***Intraosseous cannulation*** - This infant is in **pediatric septic shock** with signs of **poor perfusion** (delayed capillary refill, cool skin, poor turgor, hypotension) and **difficulty obtaining peripheral intravenous access**. - **Intraosseous (IO) access** is recommended in pediatric emergencies when IV access cannot be established rapidly, providing a route for fluids, medications, and blood products. *Ultrasound-guided antecubital vein cannulation* - While ultrasound can improve success rates for peripheral IVs, the **critical condition** of this infant necessitates immediate vascular access, making IO a faster and more reliable option when peripheral attempts fail. - Delaying definitive fluid resuscitation and medication administration to attempt a more technically challenging peripheral IV could worsen the patient's outcome. *Internal jugular vein cannulation* - **Central venous access (e.g., internal jugular)** is a more invasive and time-consuming procedure with higher risks (e.g., pneumothorax) and is not the first-line access in an emergent, unstable pediatric patient due to the time constraint. - **IO access** is a quicker and safer route for immediate life-saving interventions in pediatric emergencies. *Intramuscular epinephrine* - **Intramuscular epinephrine** is primarily used for the treatment of **anaphylaxis** or in certain cardiac arrest algorithms, neither of which is the primary concern here. - This patient is in septic shock requiring fluid resuscitation and likely antibiotics, which cannot be adequately delivered via intramuscular injection. *Rapid sequence intubation* - While intubation might be considered if the patient's respiratory status deteriorates further or for airway protection, the **immediate priority** is to address the **shock** and **poor perfusion** through vascular access and fluid resuscitation. - **Intubation** alone will not correct the underlying circulatory collapse and shock state.

Pediatric emergency management US Medical PG Question 7: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

• A. "Does the diarrhea typically precede the constipation, or vice-versa?"
• B. "Is the diarrhea foul-smelling?"
• C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
• D. "Are the symptoms worse in the morning or at night?"
• E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)

Pediatric emergency management Explanation: ***Can you tell me more about the symptoms you have been experiencing?*** - This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis. - In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions. *Does the diarrhea typically precede the constipation, or vice-versa?* - While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience. - It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture. *Is the diarrhea foul-smelling?* - Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions. - However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed. *Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life* - Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time. - However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially. *Are the symptoms worse in the morning or at night?* - Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related. - This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.

Pediatric emergency management US Medical PG Question 8: A mother brings her 6-month-old boy to the emergency department. She reports that her son has been breathing faster than usual for the past 2 days, and she has noted occasional wheezing. She states that prior to the difficulty breathing, she noticed some clear nasal discharge for several days. The infant was born full-term, with no complications, and no significant medical history. His temperature is 100°F (37.8°C), blood pressure is 60/30 mmHg, pulse is 120/min, respirations are 40/min, and oxygen saturation is 95% on room air. Physical exam reveals expiratory wheezing, crackles diffusely, and intercostal retractions. The child is currently playing with toys. Which of the following is the most appropriate next step in management?

• A. Monitoring (Correct Answer)
• B. Intubation
• C. Albuterol
• D. Chest radiograph
• E. Azithromycin and ceftriaxone

Pediatric emergency management Explanation: ***Monitoring (Supportive Care)*** - This infant presents with classic **viral bronchiolitis** (tachypnea, wheezing, crackles, retractions following upper respiratory symptoms) - The child is **clinically stable**: O2 saturation 95% on room air, alert and playing with toys - **Current AAP guidelines** recommend **supportive care only** for bronchiolitis, which includes monitoring vital signs, assessing work of breathing, ensuring adequate hydration, and oxygen supplementation if saturation drops below 90% - This patient requires close observation but no immediate intervention given stable vital signs and reassuring clinical appearance *Albuterol* - **Bronchodilators are NOT recommended** for routine use in bronchiolitis per current AAP clinical practice guidelines - Multiple randomized controlled trials have shown **no significant benefit** from albuterol in bronchiolitis - While a trial may be considered in select cases with strong family history of asthma, routine use is discouraged - Bronchiolitis is caused by **small airway inflammation and mucus plugging**, not bronchospasm *Intubation* - **Intubation** is reserved for severe respiratory failure with impending respiratory arrest, persistent hypoxemia despite high-flow oxygen, apnea, or altered mental status - This child has adequate oxygenation (95%), is alert, and playing—**no indication for intubation** - Signs that would warrant intubation include lethargy, severe retractions with fatigue, O2 sat <90% despite supplementation *Chest radiograph* - **Not routinely indicated** in typical bronchiolitis - Consider only if there's diagnostic uncertainty, concern for complications (pneumothorax, lobar consolidation suggesting bacterial pneumonia), or failure to improve with supportive care - The clinical presentation is clearly consistent with bronchiolitis, and imaging would not change initial management *Azithromycin and ceftriaxone* - Bronchiolitis is a **viral infection** (most commonly RSV), and **antibiotics provide no benefit** - Antibiotics should only be used if there is clear evidence of **bacterial superinfection** (high fever, focal consolidation, elevated inflammatory markers) - Routine antibiotic use contributes to antimicrobial resistance and adverse effects

Pediatric emergency management US Medical PG Question 9: A 7-month-old boy presents to the emergency room with three episodes of vomiting and severe abdominal pain that comes and goes for the past two hours. The patient's most recent vomit in the hospital appears bilious, and the patient had one stool that appears bloody and full of mucous. The mother explains that one stool at home appears to be "jelly-like." On physical exam, a palpable mass is felt in the right lower quadrant of the abdomen. What is the next best diagnostic test for this patient?

• A. Peripheral blood culture
• B. Exploratory laparotomy
• C. Kidney, ureter, bladder radiograph
• D. Complete blood count with differential
• E. Abdominal ultrasound (Correct Answer)

Pediatric emergency management Explanation: ***Abdominal ultrasound*** - An abdominal ultrasound is the **next best diagnostic test** for this patient, as the clinical presentation (sudden onset of severe, intermittent abdominal pain, bilious vomiting, **currant jelly stool**, and a palpable **sausage-shaped mass in the right lower quadrant**) is highly suggestive of **intussusception**. - Ultrasound is **non-invasive**, provides real-time imaging, and can confirm the diagnosis by visualizing the characteristic **"target sign" or "donut sign"**, indicating one segment of the bowel telescoping into another. *Peripheral blood culture* - A peripheral blood culture would be considered if there were strong signs of **sepsis or bacteremia**, such as fever, lethargy, or other systemic inflammatory responses, which are not the primary concern here. - While infection could cause abdominal pain, the classic signs of intussusception (currant jelly stool, palpable mass) point away from an initial bacterial infection requiring blood cultures. *Exploratory laparotomy* - Exploratory laparotomy is a surgical procedure and would be considered an **intervention or treatment**, not the initial diagnostic test, especially when less invasive options are available. - It is typically reserved for cases where non-invasive diagnostics are inconclusive or when there are signs of **perforation or peritonitis** requiring immediate surgical intervention. *Kidney, ureter, bladder radiograph* - A KUB radiograph might show signs of obstruction like dilated bowel loops or absence of gas in the colon, but it is **not definitive for intussusception** and has low sensitivity for diagnosing it. - It would not provide the detailed soft tissue visualization necessary to confirm the telescoping of the bowel that an ultrasound would. *Complete blood count with differential* - A CBC with differential would provide information about the patient's **hemoglobin, white blood cell count**, and platelet count, which can indicate infection or anemia. - While it may show elevated white blood cells in response to inflammation or ischemia, it is a **non-specific test** and would not definitively diagnose intussusception.

Pediatric emergency management US Medical PG Question 10: A 4-year-old boy presents to the emergency department after his parents found him drinking blue liquid out of an unlabeled bottle in the garage. They have no idea what was in the bottle and are concerned for his health. They have brought the bottle with them to the emergency department. The child's past medical history is not remarkable, and he is currently not taking any medications. The patient's vitals are within normal limits for his age. Physical exam reveals a crying child who is drooling. A radiograph is performed, and the child's vitals are closely monitored. It is determined that the blue liquid is a strong alkali. Which of the following is the best next step in management?

• A. Administration of a diluent
• B. Gastrografin swallow and endoscopy (Correct Answer)
• C. Administration of a weak acid
• D. Charcoal
• E. Ipecac

Pediatric emergency management Explanation: ***Gastrografin swallow and endoscopy*** - **Endoscopy within 12-24 hours** is the gold standard for evaluating caustic ingestions, allowing direct visualization of mucosal injury and grading of severity to guide management. - A **Gastrografin swallow** (water-soluble contrast study) may be considered if esophageal perforation is suspected, though it is not routinely performed in all cases; CT imaging is often preferred for perforation assessment. - The key intervention is **endoscopy**, which should not be delayed beyond 24 hours to avoid missing the optimal window for assessment before granulation tissue forms. *Administration of a diluent* - Administering a diluent is **contraindicated** when there are signs of esophageal injury such as drooling, as it can worsen inflammation, induce vomiting, or lead to perforation. - Dilution may also cause vomiting which re-exposes the esophagus to the caustic substance, causing additional injury. *Administration of a weak acid* - Neutralizing a strong alkali with a weak acid is **not recommended** due to the exothermic reaction this causes, generating heat and worsening tissue damage. - The precise amount of acid needed for safe neutralization cannot be reliably determined, making this approach dangerous. *Charcoal* - **Activated charcoal** does not bind to strong alkalis or acids and is therefore not indicated for caustic ingestions. - It may also impede endoscopic visualization, delaying definitive diagnosis and management. *Ipecac* - **Syrup of ipecac** induces vomiting and is **contraindicated** in caustic ingestions because it causes re-exposure of the esophagus to the corrosive substance, increasing mucosal damage. - Vomiting also carries significant risk of aspiration into the lungs, which can cause severe respiratory complications.

Pediatric emergency management Flashcard 1 of 7

Question: DTaP vaccine and anaphylaxis is managed with _____ DTaP vaccine and encephalopathy/neuro disorder is managed with _____

Answer: do not give any more DTaP

Extra Information:  https://onlinemeded.org/spa/pediatrics/vaccinations/acquire?ref=anki 

Pediatric emergency management Flashcard 2 of 7

Question: What is the mnemonic for the criteria for Kawasaki disease? _____

Answer: Conjunctival injection Rash Adenopathy (cervical) Strawberry tongue Hand-foot changes fever

Extra Information:  https://onlinemeded.org/spa/rheumatology/vasculitis/acquire?ref=anki 

Pediatric emergency management Flashcard 3 of 7

Question: Evidence of physical abuse in a child includes _____ (e.g. ribs, long bone spiral, multiple in different stages of healing)

Answer: fractures

Pediatric emergency management Flashcard 4 of 7

Question: What is the major risk factor for sudden infant death syndrome (SIDS)? _____

Answer: Second-hand smoke (nicotine, CO)

Pediatric emergency management Flashcard 5 of 7

Question: What is the likely diagnosis in a child that presents with fever and signs of heart failure ~1 week after an URI? _____

Answer: Viral myocarditis

Extra Information:  * preceded by ~1 week of flu-like symptoms Watch Myocarditis [https://dashboard.sketchy.com/study/medical/courses/medical-pathophysiology/units/medical-pathophysiology-cardiac/videos/medical-pathophysiology-cardiac-myocardial-and-pericardial-disorders-myocarditis?utm_source=anki&utm_medium=partnership&utm_campaign=february_update&utm_content=medical] https://onlinemeded.org/spa/cardiac?ref=anki 

Pediatric emergency management Flashcard 6 of 7

Question: What is the range of APGAR scores? What are the cutoffs for acceptable, worrisome, and dangerous score?

Answer: 0-10 point scale > 6 acceptable 4-6 needs assistance/stimulation < 4 needs resuscitation

Pediatric emergency management Flashcard 7 of 7

Question: Give five situations when parental consent is not required to treat a minor. (state-specific)

Answer: 1 - emergency 2 - contraception 3 - pre-natal care 4 - STI 5 - addiction