Pediatric emergency medicine trisk 0155 0155
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Secondary
survey
Exam finding
(examples)
Potential disease
implications
(examples)
Head
Hematomas,
lacerations
Occult traumatic brain
injury
Step-offs
Skull fracture
Ventriculoperitoneal
shunt
Shunt
malfunction/increased
intracranial pressure
(ICP)
Bulging fontanel
Sunken fontanel
Increased ICP
Dehydration
Battle sign
Skull fracture
Pupil examination:
size, reactivity,
symmetry
Toxidromes, increased
ICP, ruptured globe,
laceration of globe
Eyes
Extraocular movement Increased ICP, Lyme
palsies
disease, orbital
cellulitis
Ears
Nose
Proptosis or
exophthalmos
Orbital cellulitis;
thyroid dysfunction,
intraorbital or
retrobulbar bleed
Scleral icterus
Papilledema
Biliary dysfunction,
hemolysis
Increased ICP
Racoon eyes
Skull fracture; neoplasm
Mastoid tenderness or Mastoiditis
ear proptosis
Tympanic membrane
abnormalities:
bulging,
perforation,
hemotympanum
Acute otitis media;
tympanic membrane
perforation; basilar
skull fractures
Nasal flaring
Respiratory distress
Recommended
immediate
imaging or
interventions
