Pediatrics emergency cases

1- You are urgently summoned to the waiting room of the emergency department by a clerk after she witnessed a 3-year-old boy collapse. You are concerned that he may be in cardiac arrest. Which of the following is the correct order of steps for the initial management of a child found in full cardiopulmonary arrest?

A- Open the airway, check for a pulse, administer rescue breaths, start chest compressions.B-Check for a pulse, open the airway, start chest compressions, administer rescue breaths.C-Check for a pulse, start chest compressions, open the airway, administer rescue breaths.D-Open the airway, administer rescue breaths, start chest compressions, check for a pulse.E-Open the airway, administer rescue breaths, check for a pulse, start chest compressions.

Essentials of CPR:A B CAirway: head tilt and jaw thrust, mouth opening – airway clearance – oropharyngeal airway –

ETT.Breathing: look, listen & feel then rescue breathing.Circulation: after 2 rescue breathing, check for the pulse then start chest compression

2. A 2-year-old boy sustains severe head trauma in a three-story fall. Which of the following statements regarding head injury in a patient of this age is correct?

A- Epidural hematoma has a crescentic density on head computed tomography.B- The prognosis is better if he has a subdural hematoma rather than an epidural hematoma.C- Cushing's triad is an early sign of increased intracranial pressure.D- The occipital lobe is the most common site of intracerebral hematoma.E- Bradycardia is an early sign of herniation

Head traumaSeizures are common following head trauma &self limited.Infants are at increased risk for bleeding in subgalae and epidural spaces; -Epidural haematoma: between the inner table of skull &dura matter – CT gives

lenticular pattern- it needs urgent surgical drainage. - Subdural haematoma: inbetween dura layers- CT gives crescentic density- prognosis

is poor. -Intracerebral haemorrage: frontal &temporal lobes are commonly affected- usually

in the opposite site of the impact injury.

Subdural haematoma Epidural haematoma Intracranial haemorrage

Increased ICTHeadache is the first symptomPupillary changes and disturbed consciousness are first signs.Bradycardia is an early sign of herniation in children below 4 years.Cushing triad is late sign (hypertension, bradycardia &irregular respiration)

3.A 1-year-old girl has been involved in a motor vehicle accident, and you suspect she has sustained head injury. On examination, she is unconscious but she opens her eyes to pain and also has abnormal flexion of her extremities to pain. She does not cry but rather grunts with stimulation. What is her Glasgow coma score?

A- 4 B- 5 C- 6 D- 7 E- 8

1 2 3 4 5 6

Eyes Does not open eyes

Opens eyes in response to painful stimuli

Opens eyes in response to voice

Opens eyes spontaneously

N/A N/A

Verbal Makes no sounds

Incomprehensible sounds Utters inappropriate words Confused, disoriented

Oriented, converses normally

N/A

Motor Makes no movements

Extension to painful stimuli (decerebrate response)

Abnormal flexion to painful stimuli (decorticate response)

Flexion / Withdrawal to painful stimuli

Localizes painful stimuli

Obeys commands

GLASGOW COMA SCALE

4. A 19-month-old boy has a burn on his hand that occurred 3 hours ago- On examination, the burn appears to be in a "stock & glove" distribution. The involved area is markedly painful, and red and contains two moden*sized intact blisters. Which of the following statements regarding this burn is correct

A- This patient has suffered a superficial partial-thickness burn.B- This burn will most likely scar.C- Child abuse is unlikely based on burn's characteristics.D- Blisters should be ruptured and debrided.E- Hospitalization is not needed.

BURNS Not all burns are accidental, and child abuse should considered. Degrees of burns:1) First degree: red, blanching, painful, heal without scar.2) Second degree: a: superficial type: moist, painful, red, blisters, no scars. b: deep type: pale white, may blister, scars.3) Third degree: dry, white, leathery, no pain, need grafts.

BSA of burned areaEach arm: 9%Each leg: 18%Anterior trunk: 18%Posterior trunk: 18%Head and neck: 9%Hospitalization is needed if partial thickness burn > 10% or full thickness

burn > 2%.Burns affecting hands, feet, face, perineum, skin over joints must be

hospitalized.

5. A 2-year-old girl is found submerged in a lake. She is suspected to have been under the water for more than 15 minutes. Paramedics find her apneic and pulseless. On arrival at the hospital, her core body temperature is (28°C). Which of the following statements regarding the management, expected clinical findings, and prognosis in this patient is correct?

A- Management is dependent on whether the lake contains fresh or salt water.B- Because the child was found apneic and pulseless, resuscitative efforts should not

be attempted.C- Cervical spine immobilization is unnecessary.D- Pulmonary function would be expected to improve during the next 18 hours.E- The prognosis is poor.

Drowning and near drowningVictims suffer asphyxia from aspirating liquid or due to reflex laryngeospasm.Both salt water and fresh water drowning cause denaturation of surfactant, alveolar

instability, collapse and pulmonary oedema.Deterioration of pulmonary function occur in the first 12 – 24 hours.Pneumonia following aspiration of water containing mouth flora occurs after 24

hours.CNS: hypoxic CNS injury initially may cause agitation, combative behaviour or even

coma.CVS: dysrhythmia, myocardial ischaemia.Haematological: haemolysis and DICRenal failure may occur.

PrognosisPoor if;Child younger than 3 yearsSubmerssion > 5 minutesResuscitation delayed > 10 minutes.CPR required.Abnormal CNS or seizures.PH < 7

6. A 17-year-old girl is brought by her parents to the emergency department after a possible suicide attempt. She mentioned that she swallowed 100 aspirin tablets 4 hours ago. Which of the following acid-base relationships would most likely be found on an arterial blood gas study of this patient?

A- Metabolic alkalosis and respiratory acidosisB- Metabolic alkalosis and respiratory alkaiosisC- Metabolic acidosis and respiratory acidosisD- Metabolic acidosis and respiratory alkalosisE- Respiratory alkalosis only

Salicylates poisoningSalicylate is a weak acid, but rapidly it causes respiratoty centre stimulation , hyperventilation

with the resultant respiratory alkalosis.Salicylate inhibit oxidative phosphorylation and produce lactic acidosis and ketosis.Hyperglycemia followed by hypoglycemiaHypokalemia