Peds T- Tummy and Non-Accidental Trauma
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 18 February 2018
⏱️ 9 minutes
🧾️ Download transcript
Summary
Non-Accidental Trauma
* Estimated 10% of pediatric patients are victims of abuse* Sexual abuse* Physical abuse* Neglect* Common red flags* Changing story* Story that doesn’t make since* Delays in seeking care* Unusual bruising locations* Torso* Ears* Neck* Common tests if non-accidental trauma suspected* Skeletal survey x-rays* Head CT* Especially if altered mental status* Abdominal CT* Especially if abdominal trauma* Report to child protective services (CPS)
Tummy Ache
* Necrotizing enterocolitis* Classic presentation* Premature baby* 1st month of life* Ill appearing* Classic finding on x-ray* “Pneumatosis intestinalis”* Volvulus* Classic presentation* 1st month of life but previously healthy* Distended abdomen* Bilious vomiting* Testing* Abdominal Xray* Upper GI Series (ideal test)* Toxic megacolon* Complication of Hirchsprung Disease* Seen on x-ray* Intussusception* Telescoping bowel resulting in ischemia* Classic presentation* 2 months – 2 years old* Intermittent abdominal pain followed by lethargy* Diagnose with abdominal ultrasound* Pyloric stenosis* Classic presentation* Projectile vomiting* Normal appetite/hungry* Palpable “olive” in epigastrium * Testing* Electrolyte panel* Hypokalemia* Hypochloremia* Alkalosis* Abdominal ultraound
Additional Reading
* Pediatric Abdominal Pain (EM Clerkship)
Transcript
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| 0:00.0 | Hello, med students. |
| 0:02.7 | My name is Zach Olson, and thank you for downloading this week's episode of the EM Clerkship |
| 0:07.6 | Podcast. |
| 0:09.0 | Let's repeat our case one more time. |
| 0:19.0 | Okay, everybody, this is Dakota. He's a three-and-a-half a half year old male is awoken with diffuse |
| 0:23.8 | abdominal pain according to mom he vominated about five times some of that was productive |
| 0:28.1 | has a rash on the interior chest he was lethargic when we got there since we've been |
| 0:33.4 | there with him and through the transport now crying as you can see long sounds |
| 0:38.2 | were clear as far as we can tell we then noticed O2 sats dropping and had |
| 0:43.1 | sinusis around the lips so he put him on O2 he's one of he had no previous fever |
| 0:49.0 | now 102.3 rectal mom and extended family are out here so just FYI GCS at 10 BP 100 over 60 |
| 0:56.7 | Pulse 20 97% on the O2 and no allergies no meds had not been sick for the past |
| 1:03.0 | couple days any questions anybody I know it's a lot he's kind of crunking on us okay |
| 1:07.7 | thank you on us. Okay? Thank you. Over the last several weeks, we've been going through our |
| 1:18.1 | fallback panic mnemonic for the undifferentiated sick child, sick baby. It's been a long road, |
| 1:25.3 | but you've been sticking with me because I promise this |
| 1:28.0 | would be really high yield, and it is. You've got to know this. We've covered oxygen and respiratory |
| 1:34.1 | disorders. We checked that finger stick blood sugar, and we considered sepsis and heart problems |
| 1:40.4 | and inborners of metabolism and endocrinology. And our final week, this week, T, tummy, with a brief comment about non-accidental trauma. |
| 1:50.3 | All very high yield for your test and the USMLE. |
| 1:53.3 | These are big hitting topics. |
| 1:56.1 | Let's start with the most important topic today and get trauma, specifically non-accidental trauma, out of the way. |
... |
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