1. DDx of constipation in a child:
--GI: hirschprungs (no stool in rectal vault, trisomy 21), anal stenosis/anterior anus, IBS, IBD, small L colon (IDM), meconium ileus (on imaging look for bubble sign, underdevelopment of distal colon) or DIOS (same as mec ileus, in older kid)
--Neuro: spinal cord trauma, dysraphism (tethering/MMS), compression. Hypotonia (trisomy 13), neurofibromatosis, CP
--Drugs/toxins: anticholinergics, opiates, iron, lead, laxative abuse, botulism, antidepressants
--Endocrine: hypothyroid, hyperCA/hyperparathyroid, pregnancy
--Heme/Onc: neuroblastoma, pelvic cancer
--GU: over-full bladder, UTI
--Resp: CF
--Diet: anorexia, no fiber in diet, cows milk intolerance
--functional (can be associated with intro of solid foods, toilet training, starting school)
--with-holding (painful defecation leads to withholding--> loss of sphincter tone--> loses sensation of urgency--> worse constipation). Look for kid on toes.
2. NEXUS criteria for clearing C-spine in people of all ages (mnemonic "nsaid"). Little data on children <2 years, but still used by some practicioners.
--No focal Neuro deficits
--No Spinal tenderness (palpate down c-spine)
--No Altered consciousness
--No Intoxication
--No Distracting injuries
Shown to be sensitive in picking up spinal cord injury. Protip: if the kid is flailing his arms and legs all about and crying loudly, his spinal cord is fine.
3. Every peds trauma patient gets O2, regardless of their sat.
4. If you think you may have to intubate a trauma patient, think about drawing up meds (etomidate/succinycholine) beforehand, as you have to calculate doses and volume to draw by weight of kid, and it takes a while. Also, consider gathering fiber optic intubation equipment to the trauma room.
5. In a kid with chest trauma who acutely decompensates, suspect cardiac tamponade. To prepare for chest trauma kid: chest tubes, decompression needles. PS Respiratory symptoms + tachycardia + chest trauma are suggestive of tension pneumothorax, even in the absence of tracheal deviation.
6. A kid with head trauma may have brain bleeds, and thus may seize at inopportune moments: draw up ativan ahead of time in case you need to emergently administer it.
7. Weight loss in newborns: It's normal to lose up to 10% of birthweight in their first week or so of life: you expect a full return to birthweight by the time they're 2 weeks old.
8. Hyperbilirubemia criteria are highly dependent on age (measured in hours). Use http://bilitool.org/ to determine if baby is at risk. Transcutaneous bilirubin measurements are less accurate than serum-- if suspicion is high, do the blood test. Jaundice goes from head to toe, and a rough measure of blood level is possible based how far down the jaundice is seen.
Face 4-8
Upper trunk 5-12
Lower trunk & thighs 8-16
Arms & lower legs 11-18
Palms & soles >15
9. Cri du Chat is associated with many physical and neurological findings, among which are severe developmental delay, largyngeal abnormalities (problems sucking/swallowing, laryngeal stenosis-- may necessitate g-tube feeding) and cardiac anomalies, like ASD, VSD and tetralogy of fallot: if the pulmonic stenosis is repaired, it may be associated with pulmonic insufficiency. The murmur may be a whooshing sound, with a loud systolic and a much quieter diastolic, louder in the pulmonic window.
10. Brain tumors in children come in multiple histological subtypes: meduloblastoma (small round blue cells, may have drop mets), ependymoma (usually in 4th ventricle), pylocytic astrocytoma (grade 1 astrocytoma, solid and cystic components, good prognosis), low grade astrocytoma (grade II), and high-grade astrocytoma (grade III/IV). Prognosis highly dependent on location and diffuse vs focal. Try to avoid radiation, as irradiating children leads to growth stunting and neuro-cognitive delay-- the younger the kid, the worse the consequences.