Coral snake - Pearl: remember mnemonic,. âred on yellow, kill a fellow; red on black, venom lack.â Coral snakes are âred on yellowâ and are poisonous.
Images IMAGE
EXPLANATION
Positive FAST exam note dark stripe above kidney. Pearl: If hemodynamically stable and the question asks next step in management, answer will be CT. If unstable, answer will be transfer directly to operating room.
Slapped cheek disease Pearl: caused by parvoB19
Henoch-Schonlein Purpura (HSP) Pearls: HSP is a vasculitis that can affect kidneys so check urine in these patients. If child has abdominal pain, consider intussusception.
A. Steeple sign Pearl: classically seen in cases of croup. B. Thumbprint sign Pearl: classically seen in epiglottitis
Images
11
IMAGE
EXPLANATION
Positive fat pad Pearl: anterior fat pad can be normal, posterior is always pathologic. In kids with elbow trauma and fat pads classically one should think of a supracondylar fracture, in adults occult radial head fracture.
Monteggia Fracture Ulnar fracture with radial head dislocation.
Galeazzi Fracture Radius fracture with dislocation of the radioulnar joint.
Pityriasis Rosea Pearl: classically herald patch followed by erythematous rash to trunk.
Erythema chronicum migrans Pearl: pathognomonic for lyme disease.
Stevens Johnson syndrome Pearl: rash with mucous membrane involvement and a positive Nikolsky should raise red flags. Patients should be treated in a Burn ICU.
Pericarditis - classically diffuse ST elevations with PR depression. Pearl: treat with NSAIDS.
Delta wave - seen in WolffParkinson White syndrome. Pearl: Consider this in all cases of syncope. Arrhythmias are due to accessory pathway. If wide, fast, and irregular rhythm is seen, consider atrial fibrillation with WPW and do NOT give adenosine as this can cause death.
Images
13
IMAGE
EXPLANATION Brugada Incomplete right bundle branch block pattern with ST elevation in V1-V3. Pearl: this is a sodium channel defect that can lead to sudden cardiac death. Evaluate all syncope ECGs for this process.
Ultrasound - pericardial effusion. Pearl: clinical signs of pericardial tamponade are Beck’s triad (hypotension, jugular venous distension, muffled heart sounds).
Xray - scaphoid fx. Pearl: requires high index of suspicion. If pain on exam noted at anatomic snuffbox or with axial load of thumb, splint in thumb spica and refer. Missed fractures can lead to necrosis of the bone and significant morbidity.
Epidural hematoma - Pearl: These do not cross suture lines. Classically caused by skull fracture leading to middle meningeal artery injury.
Subdural hematoma Pearl: subdurals cross suture lines. Classically caused by damage to bridging veins.
Images
14
IMAGE
EXPLANATION
Pneumothorax Pearl: on radiograph, look for lack of vessel markings extending to periphery.
Wide mediastinum Pearl: consider aortic dissection in patients with chest pain and wide mediastinum. CT angiography is the best imaging modality.
Coral snake - Pearl: remember mnemonic, “red on yellow, kill a fellow; red on black, venom lack.” Coral snakes are “red on yellow” and are poisonous.
Rattlesnakes - Pearl: rattlesnakes are pit vipers and can be identified by the pits on their face as well as the vertical slits for their eyes, and certainly by their rattles. Treatment for severe envenomations is CroFab.
