Peds ED

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What are the signs of salicylate poisoning in children?
- 20,000 reported cases to United States poison control centers annually.
- Low-dose aspirin as primary prevention for cardiovascular disease in adults means that aspirin is readily available and potentially accessible to children in many households.
- Mild symptoms (<300 mg/kg)
- Moderate symptoms (>300 mg/kg) lead to moderate toxicity
- Severe symptoms/death (>500 mg/kg)
- Early/mild signs and symptoms include: fever/hyperpyrexia, nausea, vomiting, diarrhea, and tinnitus.
- Tachypnea/hyperpnea, tachycardia, hypoglycemia, metabolic acidosis with an elevated anion gap, altered mental status (lethargy to coma), and seizures are commonly seen in more severe poisonings
What are the indications for a tetanus vaccine booster in patients who present to the office after stepping on a nail?
- 1. ? status or <3 doses=Vaccine+IG
- 2. ≥3 doses AND last was ≥5 years ago
What are the indications for TIG in a patient who presents with a tetanus-prone wound?
- 1. ? status or <3 doses
- 2. ≥3 doses but last >10 years ago
- 3. Any child with HIV or <1 year s/p BMT
What are the recommended times for suture removal?
- ●Eyelids – Three days
- ●Neck – Three to four days
- ●Face – Five days
- ●Scalp – 7 to 14 days
- ●Trunk and upper extremities – Seven days
- ●Lower extremities – 8 to 10 days