EMERGENCY MEDICINE

PEDIA PART 2 GI/NEURO

Gastro Intestinal

Vomiting and Diarrhea

 Most Common: Acute viral gastro

enteritis (AGE) (infants and children)
 Viral: rashes, self - limiting and
supportive therapy
 DIARHHEA and vomiting =
DEHYDRATION
 NO: antibiotic, metronidazole
 YES: (ORS/ORESOL) - oral rehydration
solution – 1st line treatment

DIARREHEA?
 Loose, liquid, increase frequency of
evacuation.
 Regular if 3x a day? Not count.
 Change in consistency and frequency of
bowel movement.
 AGE (Abnormal) = At least 3 or more
episode of diarrhea in 24 hours period.
 ASSESMENT
 Signs/symptoms:
Mild: Color urine: DARK
Sunken eyeballs, sunken fontanels
(infant), dry mouth, no tears, Skin
Turgor (loose skin)
Severe: less active of the baby,
decrease urine output, thirsty
History: when the last change
of diaper? DRY or WET?
CLINICAL DEHYDRATION SCORE
(nasa gilid. hindi ko alam kung same
lang pero ito un.. meron kasi IMCI kaso
pang community yun.)
Replace: (oresol) oral
rehydration solution  why? Because
of WHO world health organization (NO
POCARI SWEAT, GATORADE..etc.)
GOAL: replace 30ml/body
wt./hour -> time of hydration.
Ideal: ORS composition: 75mmol/L
NA(sodium) content.
Other drinks (sports Drink):
increase glucose kesa NA (45-60)- to
retain water
Sports: perspire electrolyte
coming from sweat. Not in vomiting and
diarrhea.
DRUGS:
Zink: prescribe for diarrhea to
promote intestinal mucosa healing
Probiotics: (ersa flora)
imbalance in the gut flora of the GI to
help adapt a good bacteria.
Antibiotics: if NEEDED only
decrease in WBC, (+) fecalysis (pus cell),
urinalysis, fever r/t diarrhea. ETC.
PREVENTION: HANDWASHING
(PAMED/DOH) -> feco-oral route
(children).
Clinical disease
PYLORIC STENOSIS
 Stomach-> pylorus (below
stomach)
 Stenotic - lumiliit
 Pyloric muscle-> hypertrophy –
obstruct blood flow.
 Non bilous – Bile – Coming
from Gall Bladder
 Color: green (dark vomiting),
projectile vomiting
associated with weight loss
and dehydration.
 Hyponatremic (decrease
sodium
 Hypokalemic (decrease
potassium
 Hypochlorimic (decrease
chloride
 Metabolic alkalosis
(increase PH)
INTUSUCCEPTION
 Kinakaen ng small intestine ung
maalaki na intestine
 One segment of the bowel
invaginates to a more distal
segment
 MC site: ilioc cholic (bet ileus
and large intestine)
 “TELESCOPING”
 MC: intestinal obstruction in
infants.
 Triad (classic)
 Abd pain
 Bilous vomiting
 Bloddy stool color: (kurant
jelly)
 Description: tinitiklop ung tiyan
sa sobrang sakit.
 DX: UTZ
 TX: surgery
Thepeutic enema (Air)
Acute Appendicitis (AP)
 MC: surgical emergency in
children
 Localize pain RLQ
 MC Burney’s Point – midway
bet. Umbilicus and asis
(anterior superior iliac spine)
(pelvic bone)
 Increase WBC (-) urine – classic
manifestation
 Assessment: History and
Physical Examination
 Start: Epigastric -> Peri
umbilical -> RLQ
 TX: Surgery
Malrotation & Volvulus
 Normal: Cecum – RLQ
 Incomplete rotation of the gap
in the utero places the cecum
in RUQ
 Pag wala sa pwesto prone
bumuhol
 Malrotation (erroneous) –
andun lang pero hndi pa
bumubuhol
 Complication: Volvulus –
rotating from itself
 Bilous vomiting and abdominal
distention
 Apperance of duodenum in the
UTZ: Bird’s Peak
 TX Surgery
Necrotizing Entero Colitis
 Necrotize – nabulok
 Risk Factor:
 Premature infants less than
1500 grams
 MC finding in X-ray:
Pneumatosis Intestinalis
Constipation
  Infrequent hard stool
 MC: Dietary – low fiber
 3yrs old once a day
GI BLEEDING
 Upper and lower intestinal
bleed
 Boundaries ligament of treitz
(duodenum)
 Hematemesis - Vomit bloody
 Melena – dark/black stool
(acid)
 Hematochezia – bright red
stool
- Massive blood loss in
the Upper GI
bleeding – not enough
time to interact in the
hydrocholoric
Seizure
 Involuntary water activity
associtated with changes in
behavior
 Partial – only part
 Simple – conscious
 Complex –
unconscious
 Generalized - whole part
 Tonic – clonic –
stiffening of the
extremities,
repetitive, absence
(block Stare)
 Atonic – loss of
body tone
Status epilepticus
 Prolong of recurrent lasting
from more than 5 mins.
Without regain consciousness
 Post- ictal stage – drowsy, (-)
bladder tone, regain
consciousness
 DOC (Drug of choice): Diazepam
2 dozes. – Benzodiazepam
 Electrolyte imbalances:
 Hypo natremia
 Hypo glycemia
 Hypo kalcemia
 Hypo magnesimia
Benign Convulsion
 Simple – less than 15 mins. 1
time in 24 hours.
 Complex – more than 15
mins. – occur
 DOC: anti-comvulsive
Head Ache
 Pain in Sculp
 MC: Viral
 MC site: Fronto Temporal
Primary headache
1. Migrain – unilateral;
pulsating
Frontal; temporal
Pain: increase
intense in the 1st 24
hours.
2. Tension – bilateral;
not pulsating.
Tightening; bond
like or pressure
Last for 7 days.
3. Cluster - unilateral
Orbital; frontal;
lacrimation; eyelid
edema; face edema
*NOTE: yung mga kulang na shade un ung
site of headache*
 DOC: Analgesics
 Complication:
 Chronic head ache
  Vomiting Torsion
 Sleep related  Swelling, tenderness
 TX: Surgery
Ways to grade Mental status
 Lethargic – decrease Epidydimis
awareness in the  Phren’s Signs – relief of
environment (lasing) pain (paginangat)
 Stupor – decrease  infection of epidydimis
contact in pain stimuli  pain; manifestation like
(magigising pag sinaktan UTI
mo)
 Comatose – Hydrocele
unresponsive with  Accumulation of water
painful stimuli around testes
 Pain and swelling in
children

Phimosis
 Failure Distal of the
foreskin to loosen,
Boys who do not
Circumcise
 Obstruction of the
blood supply
 Pyrosprism – Prolong
unwanted erection.

Incorporated Hymen
 Cyclic abdominal pain;
no mennarc;
 Bulging hymen; bluish
discoloration;
accumulated blood

Aphasia
 Mild – 13-15  Problem in the
 Moderate – 9-12 language
 Severe – 8 below  Brocca’s – not fluent;
(Intubate) expressive; motor
(hirap magsalita)
Mild Head Injury  Wernick’s – fluent;
 MC: Fall (infant) receptive; auditory
Play & Sports (Non-sense)
(School Age)  Global – mix of brocca’s
Adolescent and wernick’s; Most
(Vehicular Accident) Common
Cranial Nerves MC: Raptured
Aneurysm
Complain: Worst
Headache
 Sub Dural: vein ->
trauma ->
chronic
MC: Atrophy of
vein; alcoholism and
elderly
 Epidural: (MMA)
Middle
meningeal
Artery

Meningitis
 MC: headache
 Menigial
irritiation:
Bruzinki
sign –
Batok
iaangat
Kernig’s – knee
Test Cerebellars – maneuver iaangat
Dysrhythmias – check nose
Rapid alternative Temporal Arterities
monement –  Above 80 yrs old
movement  steroids
 Tender; engorge
Headache category
 Cat IV – not life Vertigo
threatening  Displacement of crystal
 Cat III – benign cases in middle ear
secondary causes  Sensation of imbalance
sinusitis, HPN  Function of imbalance
 Cat II – Critical but not  Nystagmus - Jerking of
emergent eyes
Brain Tumor –
 DSE: Meinierre’s
Not increase in ICP
disease- associated
(intra cranial
with hearing loss
Pressure), trauma
*NOTE: STUDY SA
 Cat I – Critical & BOOK PERIPHERAL
Emergent AND CENTRAL
 Sub Arachnoid VERTIGO*
Hemorrhage: Abdominal Pain
Aneurysm
 Visceral Pain - Rapid, SGOT(AST),
dull; Irritation on SGPT(ALT)
unmyelinated fibers  Urinalysis – UTI,
 Parietal- irritation of  Lactate-
myelinated; localized anaerobic,
 Referred Pain – felt mesenteric
distant from the ischemia
disease organ  Appendicitis
 P- Provoke/ (Pedia) – MC
palliative Burney’s
 Q- Quality point
 R- Region/ - MC:
Radiates Obstruction –
 S- Severity increase
 T- Time secrete
 Forgut – divided into mucous;
different organs: Fecalith
Epigastric DX: CT-SCAN
 Midgut – 1st half of 2/3  Cholecystitis-
transverse ; ¾ Adult ->
duodenum – inflammation
periumbilical of Gall
 Highgut- supra Bladder; URQ
umbilical - Murphy’s –
 Assessment: inspiratory
NORMAL: Inspection, arrest when
Auscultation, doing deep
Palpation, percussion. palpation
Abdomen: inspection, - MC: Stones
Auscultation, -complication ;
Percussion, Palpation cholangitis –
 Lab Test: inspiratory;
 pancreatic – ascending
lipase/  Charcot’s
amylase triad
(more than Fever
3x the Pain
Normal Value) Jaundice
 beta-HCG – (+)  Raynaud’s
pregnant, Pendant –
ectopic, Charcot’s triad
abortion, H- + HPN +
Mole Altered
 liver function – Mental Status
hepatitis,
cholelicystitis,
Pancreatitis
 MC: Gall stone; alcohol;
scorpion bite
 Ranson’s Criteria –
grade sa severity of
pancreatitis
 Lab exam: lipase and
amylase
Hemorrhagic ->
Turner’s Sign – gray
bluish discoloration
of flungs
Cullen’s Sign-
hematoma on
periumbilical

Abdominal Aneurysim
 Arterial wall occur
 Increase 1.5 x Normal =
aneurysm
Risk Factor:
 Older male
 Smoker
 Atherosclerosis
 Prevention: Control BP
 More than 5cm =
Raptured
 TRIAD: flank pain
(abdominal) + HPN +
Containing abdominal
mass
 DX: bedside UTZ

Mesenteric Arterial Occlusion

 Increase lactation
 MC: Atrial fibrillation –
irregular beating of
heart -> thrombosis
 Severe pain; out of
proportion of the
physical finding

EXAM
 Pedia – whole PART
 OB – NEURO – GI ABD
PAIN