Peds Emergencies

Table Of Contents
1 Anaphylaxis
2 Acute abdomen
3 Airway obstruction
4 Burns
5 Cardiac arrest
6 Cardiac arrhythmias
7 Child Abuse
8 Epiglottis
9 Near drowning
10 Poisoning
11 Respiratory arrest
12 Trauma
13 Fever in the neonate (8 weeks)=ROS
14 Fever + SS disease = ROS
15 SS dz + positive CXR = r/o chest crisis
16 Fever + painful limp = r/o septic arthritis
17 Cyanosis of newborn (dusky)

Anaphylaxis

Acute abdomen

Airway obstruction

Burns

Cardiac arrest

Cardiac arrhythmias

Child Abuse

Epiglottis

Near drowning

Poisoning

Respiratory arrest

Trauma

Fever in the neonate (8 weeks)=ROS

  • Presentation:
    • Fever=temp > 100.4 or 38 C
    • Labs= CBC c diff, BCX, UA, UCX, CSF protein, glucose, cell count, CX
    • If pt rules out then dx is viral syndrome.
    • 6-7% of neonatal swu’s are positive. Of these, 3-4 look sick, 2-3 have an identifiable source of infection and 1-2 would have been missed.
    • The 1-2 that would have been missed is the reason we are so aggressive .
  • Symptoms to look for:
    • changes in mental status, changes in feeding, hypthermia (esp in immediate neonatal period)

Fever + SS disease = ROS

  • Presentation:
    • Sicklers can be functionally asplenic as early as 6 months (when fetal hgb drops) see Howell Jolly bodies (nuclear remnants normally removed by spleen) in blood smear.
    • Asplenics are susceptible to encapsulated organisms (h.flu, meningococcus, pneumococcus)
    • Sicklers with influenza, viral syndromes have 500 times the risk of pneumococcal infection so CX’s and ABX are necessary
  • 3 clinical scenarios:
    1. “sick” at any age gets admitted for iv abx
    2. well appearing and < 4yrs admitted for abx and cx’s
    3. well appearing and >4 yrs may be treated as an outpt with po ampicillin and blood cx’s

SS dz + positive CXR = r/o chest crisis

  • Presentation:
    • A positive CXR in a sickler may be ateletasis, infiltrate or pulmonary infarction
    • In children the cxr appearance will lag weeks behind clinical improvement
    • Chest Crisis: pulmonary infection causes hypoxemia and acidosis which makes RBC’s sickle and leads to vasoocclusion which leads to more hypoxemia and acidosis (viscious cycle)
    • This creates an environment for pulmonary infection to thrive
  • Treatment:
    • fluids and O2 to prevent sickling, PRBC if needed, abx (cefotax or cefurox for encapsulated
      bugs)

Fever + painful limp = r/o septic arthritis

  • Presentation:
    • Fever with a painful hip = r/o septic hip
    • Most likely dx is toxic synovitis (aka transient synovitis, an inflammatory response 7-10 days post URI. Tx’d with antiinflammatories)
    • Septic hips must be ruled out because it can lead to necrosis of the femoral head
    • Hip joint tap done by ortho in the OR
  • DDX:
    • Painful limp: STARTS HOTT
      • Septic arthritis
      • Toxic transient synovitis
      • Acute rheumatic fever
      • Rheumatoid arthritis
      • Trauma
      • Sickle cell dz
      • Henoch Schonlein Purpura
      • Osteomyelitis
      • TB
      • Tumor
    • Other causes: Legg-Calve-Perthes (idiopathic avascular necrosis)
    • Slipped capital femoral epiphysis (head of femur falls posterior and inferior off femur, usually seen in overweight pubertal boys)
    • Fever + Seizure = r/o meningitis
  • Labs:
    • CSF protein, glucose, cell ct, gram stain and cx
      • Be aware of cushings triad from increased ICP: hypertension, bradycardia and variable respirations
      • Fever + Petechiae = ros
      • in adults think mening
      • in children think H. flu type B
  • Treatement:
    • 3rd gen cephalosporin

Cyanosis of newborn (dusky)

  • Presentation:
    • Blue lips
    • polycythemia
    • sepsis/infxs
    • metabolic/hypoglycemic
    • pulm stenosis
    • cardiac lesion
    • neuro – lose stim to breathe
    • *check vitals, O2 sat, ABG on RA and O2, EKG and CXR, consider PG (for tiny babies)then echo last
  • Types:
    • Tet of fallot— if pulm atresia, need PG to keep open ductus arteriosus (blue tet)
    • Tricuspid atresia— need EKG to show all vent large except RV, dec pulm bloodflow, gen VSD
    • Truncus arteriosus— AV cushion defect so always VSD, pulm blood flow sounds cont murmur in blue baby, echo find pulm art off trunk, tx will close VSD and remove pulm art so trunk will be Aorta
    • Transpositoion of great arteries–2 circuits in parallel, no shunting and ductal dependent; CXR ball on string= parallel great vessels cardiomegaly, gen male and big baby, need surgical swap of vessels
    • Total anomalous venous return— may get obstructed vein thru organs (below diaphragm) and lead
      to pulm edema, tachypnea and *small heart with big Right heart