EM Pediatrics



Consent for Treating Minors

  • Life/limb-threatening emergency
  • State-protected right to treatment:
    • Child abuse
    • Pregnancy
    • STD
    • Substance abuse
    • Outpatient mental health
  • Emancipated Minor:
    • Married
    • Member of armed forces
    • Self-supporting and living on own

Rapid Assessment

  • Rapid assessment of a pediatric patient:
    • Remember the PAT ABCs!
    • 1. Appearance (TICLS)
      • – Tone: Is the infant/child limp, listless, or flaccid?
      • – Interactiveness: Is the infant/child uninterested in playing or interacting with the caregiver or HCP?
      • – Consolability: Is the infant/child’s crying or agitation unrelieved by gentle reassurance?
      • – Look (Gaze): Is there a “nobody home,” glassy-eyed stare?
      • – Speech (Cry): is the cry weak or high-pitched?
      • Is the content confused or garbled?
    • 2. Breathing
      • – Abnormal Lung Sounds
      • – Abnormal Positioning
      • – Retractions
      • – Nose Flaring
    • 3. Circulation
      • – Cyanosis
      • – Mottling
      • – Pallor
      • – Cap Refill

HEENT

Fever
Conjunctivitis
Acute otitis media
Acute sinusitis

Crying

PresentationDiagnosis
Intestinal ColicMC cause of excessive crying
– 3 or > hrs/day for 3 or > day/wk
over a 3 week period
– self limited
– 13% neonates

Sudden onset of paroxysmal crying
flushed face
circumoral palor
tense abdomen
drawing up of legs
clenched fists

Child abuse
Normal physical and lab

Dx of exclusion

increase soothing
background noise
stroller or car rides
assure burping
stop cow’s milk
Trauma– Soft tissue or bony trauma
(falls or battered child)
– strangulation of digit/penis
– Corneal abrasion
Head to Toe check
look under the diaper
look at 5 fingers and 5 toes
InfectionsMeningitis
Otitis media
UTI
Gastroenteritis
Diaper Dermatitis
Cellulitis
Joint Infection
Pneumonia
Stomatitis
Head to Toe check
look under the diaper
Surgical ConditionsIncarcerated hernia
Testicular Torsion
Anal Fissure
Volvulus
Intussusception
Head to Toe check
look under the diaper

Congenital heart defects

Left-sided Congenital heart defects

Coarctation of the Aorta
AS (Aortic Stenosis)
TAPVR (Total Anomalous Pulmonary Venous Return)
Hypoplastic Left Heart Syndrome

R-sided Congenital heart defects

Transposition of the Great Vessels
Tetralogy of Fallot

Rashes

Chickenpox
Hand Foot and Mouth Dz
Kawasaki

Exanthems

Measles (RubEOLA)
Scarlet Fever
German Measles (rubELLA)
Erythema Infectiosum (5th Dz)
Roseola Infantum
PresentationPathogensManagement
Viral InfectionsWinter
3-15 months
1. Rotavirus
2. Adenoviruses
Vaccine:
Rotavax (2,4,6 mos.)
Bacterial InfectionsSummer
bloody diarrhea
Salmonella (chicken)

Shigella
– high fevers, febrile seizures (due to neurotoxin) then bloody diarrhea
Overfeeding and Allergyweight 3x in a year
Anatomic abnormalitiesintussusception
-bloody diarrhea
– current jelly stools (late finding)
– partial obstruction
Inflammatory disordersIBD
Crohn’s
Malabsorption syndromes
Immunodeficiencies
Antibiotic Inducedamoxicillin-clavulanate
Secondary lactase deficiencyresult from gastroenteritis-induced injury to small bowel

inability to break down lactose which then is fermented in the colon causing gas and an osmotic diarrhea

Metabolic Abnormalities

Electrolyte deficit
  • Calculate electrolyte deficit:
    • (Ideal electrolyte level – Actual electrolyte level) X (Fractional distribution of electrolyte) X (Weight in Kg)
Fluid deficit
HYPERtonic fluid
HYPOtonic solution

Gastrointestinal

Acute Abdomen

GI malrotation

Hyperbilirubinemia
Invasive bacterial disease
Necrotizing Enteritis
  • Path:
    • Ischemia/death of the intestinal lining with desquamation
  • Presentation:
    • 3-10 days of life
    • MC GI emergency in neonates (2000-4000 cases/yr)
    • Feeding intolerance
    • Bile Stained
    • Vomitus
    • Abdominal distention
    • Bloody Stools
    • Explosive diarrhea
    • Respiratory distress
    • Respiratory acidosis
    • Septic shock
  • Risk:
    • Prematurity (50-80%)
    • Congenital heart disease
    • Perinatal asphyxia
  • Diagnosis:
    • Late X-ray
      • – intramural gas
      • – general bowel dilation
      • – loss of normal gas pattern
      • – pneumatosis intestinalis
      • – portal air
      • – free air
      • – loss of colon haustrations
  • Management:
    • Consult surgeon
    • Give broad spectrum Abx

Respiratory

Rapid Breathing in Neonate

Differential Dx
RespiratoryPneumonia
Bronchiolitis
Aspiration
CardiovascularCHF
Aortic stenosis
Coarctation
PDA
Congenital Diaphgragmatic Hernia
TE fistula
Stenosis
Web
NeuromuscularBotulism
Organ SystemsSepticemia
CNS infection
Metabolic Acidosis

Strep pharyngitis

Septic

Shock in Pediatrics


Vomiting in Infants

PresentationPathManagement
Abusive Head Trauma
(shaken baby)
Increased ICP
Inborn Metabolism Errorslow glucose
metabolic acidosis
Incarcerated Hernia(2-12 mo)
InfectionsUTI
Sepsis
Gastroenteritis
Intussusception(2-12 mo)
Hepatobiliary diseaseyelloJaundice
Malrotation of the GutBilious vomiting (yellow, green)Obstruction distal to the ampulla of Vater

1/500 births first month of life
Surgical Emergency
Pyloric StenosisProjectile vomiting at the end of feeding

MC surgical correctable cause of vomiting in newborns (2-6 mos)