Term
|
Definition
o Fever and chills (or hypothermia)
o Toxic appearance
o Shock
o Disseminated intravascular coagulation
o Multi organ failure
o Documented source of infection
o Host predisposition |
|
|
Term
|
Definition
| primary and secondary to bacteremia |
|
|
Term
| primary bacteremia in newborns (4) |
|
Definition
| host is compormized, Malignancy, immunodeficiency syndrome, drug therapy |
|
|
Term
| primary bacteriemia in normal children causes (5), most common (3), lease common and why (1) |
|
Definition
• Meningococcemia, pneumococcemia, staphylococcus aureus, B-hemolytic streptococcal septicemia
• Usually a gram negative bacilli, next most common a staph aureus and strep pneumoniae
• Pneumoniacoccus is less likely due to vaccinations |
|
|
Term
| when sepsis is secondary to bacteremia, what is it secondary to |
|
Definition
| remote infection or operation or insturmentation |
|
|
Term
| what causes secondary infection to bacteremia remote infection (7) |
|
Definition
| Meningitis, osteomyelitis, speptic arthritis, pneumonia, orbital cellulitis, wound infection, intestinal obstruction |
|
|
Term
| what causes infection secondary to bacteremia due to operatioon or isturmentation |
|
Definition
| Pyelonephritis, burns, diarrhea |
|
|
Term
| what are the effects of sepsis on: hematologic (3), pulmonary (1), renal (2), cardiac (2), hepatic (2), brain (1) |
|
Definition
hematologic: Granulocytosis, thrombocytopenia, disseminated intravascular coagulation
pulmonary: adult respiratory distress syndrome
Renal: oliguria, acute renal insufficiency
cardiac: hypotension, myocardial depression
hepatic: elevaton og serum glutamic pyrivic transaminase and bilirubin
brain: altered LOC especially with hypotension |
|
|
Term
| early symptoms of septic shock (4) |
|
Definition
fever
increased VO2 and CO
normal arterial VdO2 |
|
|
Term
| later symptoms of septic shock (10) |
|
Definition
Warm shock
Vasodilation
Decreased systemic vascular resistance
Redistribution of blood volume
Increased ventricular preload
Increased CO
Hypotension
Wide pulse pressure
Oliguria
Hypoxemia |
|
|
Term
| what symptoms septic shock can progress into (6) |
|
Definition
Generalized capillary leak
Decreased ventricular volume
Hypotension
Edema
Adult respiratory distress syndrome
Multiple organ system dysfunction |
|
|
Term
| what are the steps in septicemia management (6) |
|
Definition
identify source of infection
physical examination
cultures and radiographs
antibiotics
surgical exploration or drainage if needed
monitor for development of multiple organ system failure |
|
|
Term
| what antibiotics are given for septicemia in neonatal, pediatric, and immunocompormized pt |
|
Definition
Neonatal: ampicillin and cefotaxime, ceftriaxone, or gentamicin
Pediatric: ceftriaxone or cefotaxime and clindamycin
Immunocompormized: tricarcillin and tobramycin and nafcillin |
|
|
Term
| what do you do to monitor for organ failure in septicemia (5) |
|
Definition
Arterial blood monitoring
Record fluid balance hourly
Neurological checks to assess LOC hourly
Arterial blood gas and observation for respiratory distress
WBC and platelet count, hemocrit, liver and renal function daily during acute phases |
|
|
Term
| what are the steps in managing septic shock (5) |
|
Definition
airway
CO
steroids
access and onitoring lines
developing treatments |
|
|
Term
| how is the airway managed in septic shock (3), what is the goal |
|
Definition
Endotracheal intubation
Mechanical ventilation with O2
Positive and expiratory pressure to correct hypoxemia if needed (adult respiratory distress syndrome)
Goal is over 95% oxyHb saturation |
|
|
Term
| how is CO managed in septic shockL= |
|
Definition
Transfusion of packed RBC as needed to ensure tissue O2 delivery
Isotonic crystalloid or colloid (20 ml/kg over 20 min) repleted until circulation stabilized or CVP > 10mmHg or PCWP >12mmHg to optimize preload
Correct acidosis with bicarbonate if pH <7.2
Inotrophic support if preload is optimized by Co is insufficient
Vasoactive agents to maintain normal systemic vascular resistance |
|
|
Term
| how much steroids do you give in septic shock treatment |
|
Definition
|
|
Term
| what access and monitoring lines done in shock treatment (6) |
|
Definition
| iv, intra-arterial, CVP (central venous pressure), PCWP (pulmonary capillary wedge pressure), urinary catheter, neogastric tube (buffers pH) |
|
|
Term
| what are the developing treatments for septic shock (5) |
|
Definition
Monoclonial antibodies
Antitumor necrosis antibody
NO scavenger / nitric osidase synthase inhibitors
Phentoxyphylline
Naloxone and other opiate agonists |
|
|
Term
| mild dehydration: percent lost, symptoms, signs, deficit |
|
Definition
o 3-5% body loss
o Thirsty, alert, restless
o Normal BP and rate
o Good turgor
deficit 30-50 mL |
|
|
Term
| moderate dehydration: percent lost, signs in adults and children, symptoms,deficit |
|
Definition
o 6-9% body loss
o Children: thirsty, lethargic, irritable to touch
o Adult: thirsty, alert, postural hypotension
o Pulse rapid and weak, sunken frontanel, low BP
o Bad turgor, sunken eyes, absent tears
o Dry mucous membranes
o Reduced urine
o Estimated deficit 60-90 |
|
|
Term
| severe dehydration: percent lost, symptoms in adult and child, signs, deficit |
|
Definition
o 10%+ body loss
o Child: drowsy, limp, cold, sweaty, cyanotic, comatose
o Adult: conscious, apprehensive, cold, sweaty, cyanotic, wrinkled skin of fingers and toes, muscle cramps
o Rapid sometimes impalpable pulse
o Deep frontanel
o Low BP
o Bad turgor
o Glossy sunken eyes
o No tears, dry mucous membrane
o Severe oliguria
o 100 or more fluid deficit |
|
|
Term
| what are different rehydration fluids (5), what is their main component |
|
Definition
o WHO: contains bicarbonate and lots of NaCl
o Rehydralyte: contains moderate NaCl and citrate
o Pedialte, lytren, ricelyte: similar NaCl and citrate
o Lytren and Ricelyte: have more K |
|
|
Term
| for gastric, pancreatic, SI, bile, ileostomy, diarrheal, sweat, cystic fibrosis, and burn fluid are are the major components |
|
Definition
o Gastric: mostly Cl
o Pancreatic: mostly Na Cl
o SI: mostly Na Cl
o Bile: mostly Na Cl
o Ileostomy: mostly NaCl
o Diarrheal: mostly Cl, notable K loss
o Sweat: mostly Na Cl
o Cystic fibrosis: mostly NaCl
o Burns mostly NaCl, some protein |
|
|
Term
| hyponatremic dehydration: how to calculate the Na deficit, how to treat it |
|
Definition
o Sodium deficit = (135 – SNa) X TBW (0.6 x kg)
o < 120 meq is treated with 3% NaCl at 1 mL/min to a max 12 mL/kg |
|
|
Term
| what are the two components to treating hypernatremia |
|
Definition
| correct slowly, seizures can happen during treatment so use anticonvoulsant or 3% NaCl to control |
|
|
Term
| why do you need to correct hypernatremia slowly, how do you do it |
|
Definition
Hyperosmolality can cause cerebral damage and hemorrhage, thrombosis, and subdural effusions
No more than 10 meq/L decrease a day |
|
|
Term
|
Definition
| death within 24 hours of submersion |
|
|
Term
|
Definition
| survival greater than 24 hours |
|
|
Term
| risk factors for drowning(6) |
|
Definition
o Age <5 or 10-14 yo
o Make 85%
o Black double risk
o Residential swimming pools for <5 yo
o Bathtubs for <2 yo
o Buckets |
|
|
Term
| what is dry drowning how does it happen |
|
Definition
| Shock of drowning causes anxiety attack > laryngospasm > LOC > cardiovascular collapse > death without aspiration |
|
|
Term
| what is wet drowning what are the 4 steps in how it happens and details of each step |
|
Definition
Anoxic ischemic injury: decreased saturation in blood and all organs are going through hypoxia injuries, cardiac depression, and kidney failure
Pulmonary aspiration: pneumonia, edema, and ventilation perfusion mis-match. Ventilation and monitor blood fas.
Hypothermia: does protect brain and organs in the beginning. Slowly warm the patient up.
Fluid electrolyte changes: fix deficits. Give antibiotics if needed. |
|
|
Term
| what is the difference between fresh and salt water drowning |
|
Definition
Fresh water: leads to capillary alveolar membrane damage and pulmonary edema. Electrolytes still balanced
Salt water: causes pulmonary edema. Presents different bacteria. Changes electrolytes. |
|
|
Term
|
Definition
chart to determine developmentally related percent of burn surface area
depth of burn |
|
|
Term
| first deg burn: affected layers, symptoms, healing time |
|
Definition
epidermis
swelling and pain without blisters
heals in 2-3 days |
|
|
Term
| second deg burn: affected layers, symptoms, healing time |
|
Definition
entire epidermis and dermis
blisters and lots of pain
heals in 7-14 days |
|
|
Term
| third deg burn: affected layers, symptoms, healing time |
|
Definition
entire epidermis and dermis
scar formation
no pain, nerve endings burned |
|
|
Term
| when is a burn an emergency (6) |
|
Definition
o Greater than 15% of body surface area
o Electrical burns can cause arrhythmia
o Inhalation injury
o Inadequate home situation
o Suspected child abuse or neglect
o Burns to hands, feet, or genitalia due to decreased arterial supply |
|
|
Term
| what are the steps in burn care |
|
Definition
estinguish flames
maintain wairway
strip patient and see where there is bleeding or lesions
dressng soaked in saline (biologic or synthetic as available)
fluid reuscitation
evaluate associated injuries
pain control
prevention of infection |
|
|
Term
| what do you need to look for in burn pt airway maintience |
|
Definition
100% O2 if needed
Pt could have oral swelling or lungdamage
Look for soot in nose or coughing black particles |
|
|
Term
| fluids in burn pt: what kind and for what condition |
|
Definition
fluid lost in burns is similar to normal saline
Supply energy requirements
High tension or electrical burns need forced alkaline diuresis of combat myoglobinuria
Parkland formula: 4 mL per kg per percent body burned. Replace 50% in 8 hours than 50% in 16 hours |
|
|
Term
| how is infection prevented in burns |
|
Definition
early excision and grafting
Control of bacteria would flora
Don’t use oral or IV antibiotics unless there is an infection |
|
|
Term
| what is inhalation injury a result of |
|
Definition
| direct heat, acute asphyxia, carbon monoxide poisoning, toxic fumes |
|
|
Term
| what are the complications of an inhalation injury |
|
Definition
Early CO poisoning – begin treatment without lab results back yet if suspected
Airway obstruction
Pulmonary edema
ARDS within 24-48 hours
Late(days-weeks) pneumonia or emboli |
|
|
Term
| how is CO poisoning treated |
|
Definition
immediate treatment without lab results back
remove from source
100# humidified oxygen
hyperbaric oxygen therapy
treat associated injuries |
|
|
Term
| how is CO poisoning classified, what are the symptoms with each stage |
|
Definition
Mild:<20% HbCO, Slight dyspenia, Decreased vision, CNS depression
Moderate: 20-40% HbCO, Irritability, nausea, fatigue, Decreased vision, Impaired judgment
Severe: 60-90% HbCO, Confusion, hallucination, Ataxia, collapse, Coma |
|
|
Term
| what are the clinical features of appendicitis |
|
Definition
o Midabdominal or periumbilical pain, RLQ
o Fever
o Vomiting
o Anorexia |
|
|
Term
| why is appendix pain periumbilical |
|
Definition
| Because the appendix is at T10 the sign shown by the dermatome is periumbulical |
|
|
Term
| what are physical exam findings for appendicitis |
|
Definition
o Many signs not seen in <2 yo
o Retrocecal appendix may not have any signs, need to do rectal exam
o McBurney’s tenderness
o Psoas sign: if you stretch psoas it causes irritation
o Peritoneal signs: guarding and rebound
o Rectal exam |
|
|
Term
| what are lab findings for appendicitis |
|
Definition
o Elevated EBC
o Ketones and sometimes WBC in UA
o Abdominal x-ray |
|
|
Term
| how is an xray for a perforated appendix read |
|
Definition
Pieces that block the appendix opening are often not found on x-ray
Ait comes out of zppendix and goes into diaphragm when standing. Look for bubble over the right because it is masked by the stomach bubble on the left |
|
|
Term
| how can you tell an appendix perforated |
|
Definition
o Signs of toxicity
o Abdominal rigidity and tenderness
o Pallor, dyspnea, grunting, prostration, fever
o Leukocytosis with left shift, leukopenia
o X-ray abdomen free of air
o Ultra sound of pelvis: complex mass, free fluid |
|
|
Term
| how is a perorated appendix managed |
|
Definition
o Stabilization
o Correct hypocholremia, hyponatremia (due to vomiting)
o Acidosis
o Antibotics |
|
|
Term
| primary peritonitis: location, population |
|
Definition
o Focus of infection outside abdominal cavity in blood or node
o Common in kids with ascites secondary to nephrosis |
|
|
Term
| bacteria in primary peritonitis |
|
Definition
Streptococcus pneumonia
Streptococci
Gram negative rods
Mycobacterium tuberculosis
Harmophilus influenza |
|
|
Term
| secondary prtitonitis causes |
|
Definition
| o Rupture of an intra-abdominal viscous or abscess of intra-abdominal organ |
|
|
Term
| bacteria in secondary peritonitis |
|
Definition
Aerobic bacteria: Escherichia coli, Streptococci, Enterococci, Staphylococcus aureus, Enterobacteriaceae, Klehsiella, Proteus, Pseudomonas, Canidia
Anaerobic bacteria: bacteroides fragilis, eubacteria, clostridia, peptococci, propionibacteria, fusobacteria |
|
|
Term
| signs and symptoms of peritonitis |
|
Definition
o Abdominal pain and tenderness
o Edema, aceites (peritoneal thrill)
o Fever
o Anorexia, vomiting, constipation, diarrhea
o Ileus: loops distend and have lots of air
o Lethargy, toxic appearance
o Abdominal wall cellulitis
o All similar to appendix perforation |
|
|
Term
|
Definition
leukocytes
ultrasound of abdomen
paracentesis
positive gram smear of culture fluid |
|
|
Term
| what is found on an ultrasound of peritonitis |
|
Definition
Dilation of intestines
Edema in intestine wall
Peritoneal fluid
Oblideration of psoas
Free air within peritoneal cavity (secondary peritonitis) |
|
|
Term
| what is paracentesis, when is it seen, what will be found in this situation |
|
Definition
Elevated prptein
Pleocytosis (>800 leukocytes/mm3) with more than 25% polymorphonuclear
peritonitis signs |
|
|
Term
| treatment of primary peritonitis |
|
Definition
Ceftriaxone 100mg/kg/d
OR ceftotaxime 200 mg/kg/d |
|
|
Term
| treatment of secondary peritonitis |
|
Definition
Correct hypovolemic and stabilize electrolytes to establish urination
Correct hypoxemia with O2 and mechanical ventilation
Decompress GI tract using nasogastric suction or long intestinal tube
Ampicillin 200 mg/kg/d
Clindamycin 40 mg/kg/d
Gentamicin 7.5 mg/kg/d (not same dose in neonates) |
|
|
Term
| why would peritonitis need an operation, how is it done |
|
Definition
Close, exclude or resect perforated viscous
Complete exposure or peritoneal cavity with radical debridement or peritoneum and massive irrigation OR placement of drains after repair of perforation without exploration or irrigation |
|
|
Term
| post op care for peritonitis |
|
Definition
Systemic antibiotics
Intraperitoneal lavage with antibiotics
Maintain fluids
Observe for autonomic hyperreflexia when draining
Nutritional support to meet metabolic demands
Close observation for intraabdominal abscess formation |
|
|
Term
|
Definition
| • Telescloping of a segment of the bowel into a more distal segment |
|
|
Term
| when does intrussuception usually happen, why |
|
Definition
• Can be done from 3-12 mo
o Usually 4-5 mo due to food introduction causing nodes in gut to lead telescope
o Can be done in older kids due to inflamed node |
|
|
Term
| intrussusception symptoms |
|
Definition
o Abdominal pain, crying, irritability, vomiting, pale, lethargic, shock, currant jelly stool
o Pain ins’t continuous. Episodes of acute pain. |
|
|
Term
|
Definition
o Terminal ileum prolapses through ileocecal valve
o Ileocolic intussusception continues through colon (often palpated) in RUQ
o 1 loop of gut telescopes into distal part often cutting off blood due to mesentery pinching |
|
|
Term
| tests for intrussusception |
|
Definition
| o Barium enema: shows intussusception as filing defect with hepatic flexture surrounded by spiral mucosal folds. Distended small bowel represents distal small bowl obstruction |
|
|
Term
| management of intrussusception |
|
Definition
o NG tube, IV fluids, monitor electrolytes
o Plain x-ray may show obstruction
o Hydrostatic controlled barium enema high pressure (if this dosen’t work you have to go to OR) |
|
|
Term
| acute intestinal obstruction |
|
Definition
o Persistent bilious vomiting
o Abdominal distention
o Constipation, obstipation |
|
|
Term
| when is acute intestinal obstruction an emergency |
|
Definition
| o Small bowel obstruction: minimal air in rectum, step ladder like bowel loops, differential fluid levels indicate obstruction |
|
|
Term
| what is pyloric stenosis, who is it in, what is the treatment |
|
Definition
• Hypertrophy of pyloric musculature
• First born males within 2-5 weeks
surgery |
|
|
Term
| signs of pyloric stenosis |
|
Definition
o Projectile vomiting everything fed
Causes electrolyte imbalanced because people don’t go to doctor right away because baby isn’t toxic and looks hungry after vomiting
o Good appetite
o Loss of weight
o Palpation of olive – hypertrophic muscle |
|
|
Term
| labs pertaining to pyloric stenosis |
|
Definition
o Serum K and Cl low
o Bicarbonate high: Hypokalemic, hypochloremia alkalosis
o Barium swallow and UGI
o Pyloric US |
|
|
Term
| why not use barium swallow in pyloric stenosis |
|
Definition
| Try not to use because if OR is needed they don’t want barium to get out because it is irritating |
|
|
Term
|
Definition
ectopic gastric mucosa causes bleeding ulcer
acid producing cells where they are not supposed to be cause corosion |
|
|
Term
| what are the complications of merkel's diverticulum |
|
Definition
• May lead to peritonitis
• May be the lead site to intussusception
• Ectopic gastric mucosa causes bleeding ulcer
• Nuclear scintigraphy |
|
|
Term
| mesenteric adenitis: what is it, prime symptom, cause |
|
Definition
o Enlargement of notes at terminal ileum caused by virus
o Pain is less localized.
o Often caused by strep |
|
|
Term
| gasteoenteritis: signs, cause, differences from appendicitis |
|
Definition
o Viral origin, no fever, no leukocytes, no blood in stool
o Diarrhea unlike appendicitis, no rebound tenderness, hyperactive bowel sounds, diffuse pain |
|
|
Term
| bacterial gastroenteritis: causes, signs |
|
Definition
o Shigella, Yersinia, campylobacter and salmonella
o Abdominal pain, blood in stool |
|
|
Term
| pneumonia: how it could look like appendicitis, why do you need to look for this especially |
|
Definition
o Pneumonia in right lower lobe may cause abdominal pain
o Auscultate chest or give x-ray to confirm so you don’t send them in for appendix removal |
|
|
Term
| pharyngitis: cause, sympptoms |
|
Definition
o Streptococcal
o Associated with andominal pain and vomiting |
|
|
Term
| acute pyelonephritis: symptoms, what percaution |
|
Definition
o Vomiting, abdominal pain, diarrhea, toxic look, urine has leukocytes, bacteria, nitrires
o Get culture of urine anyways before antibiotics so they don’t ruin the culture |
|
|
Term
|
Definition
| o Vomiting, diarrhea, other family ill |
|
|
Term
| why does pid look like appendicitis, symptoms |
|
Definition
| o pain during period, pain to URQ due to gonorrheal perihepatitis |
|
|
Term
| why does hypoglycemia look like appendicitis |
|
Definition
|
|
Term
| why does DM look like appendicitis, other symptoms |
|
Definition
o abdominal pain thought to be due to diabetic ketoacidosis.
o Polyuria persists during dehydration
o Respiration heavy and deep |
|
|
Term
|
Definition
| o Vomiting, anorexia, non localized pain |
|
|
Term
| iliac adentitis: risk factor |
|
Definition
| o Hx of lower extremity injury |
|
|
Term
| henoch schonlein syndrome: symptoms |
|
Definition
o Hemorrhagic rash within 24h especially on extremities
o Arthritis, nephritis, skin edema |
|
|
Term
|
Definition
| o Acute abdominal pain precedes vesicles over abdominal wall |
|
|
Term
|
Definition
o Sudden onset of acute severe reoccurring episodes of pain accompanied by vomiting
o Unusual hunger
o Dark blood and mucus stool later |
|
|
Term
|
Definition
o Rigid tender abdomen with rebound tenderness
o Diminished bowel sounds
o Acutely ill |
|
|
Term
| obstructive adhesions symptoms |
|
Definition
o Prior history of surgery or peritonitis
o Bowel sounds are high pitched with rushes, vomiting is common |
|
|
Term
| volvulus: symptoms, cause |
|
Definition
o History of intermittent pain prior to mudgut volvulus
o Shock may come quckly
o Rotation around mesentery causes vessels to twist and cut off blood causing angrene |
|
|
Term
| cholecystitis: associations, signs |
|
Definition
o Gallstones may come with hemolysis disorders
o Ahydroptic gall bladder is palpable |
|
|
Term
| acute pancreatitis symproms |
|
Definition
| epigastric pain, vomitting bile |
|
|
Term
|
Definition
| o Sever pain if strangulated of incarcerated |
|
|
Term
| abdominal abscess symptoms |
|
Definition
| o Perinephric, psoas, subdiaphragmatic |
|
|
