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Flashcards in Pediatric Emergencies Deck (71):
1

Birth to 2 months

Controls gaze
Turns head

2

2-6 months

Eye contact
Uses both hands
Rolls over
Sleep through night

3

6-12 months

Sits without support
Crawls
Puts things in mouth
Teething begins

4

Toddler

1 to 3 years
Use parent to do things to child

5

Toddler Development

-Crawls/walks
Sensory developments
-Runs climbs
Balance
-Fine motor Skills
Toiler training
Draw a circle

6

Preschool Age

3 to 5 years
Can understand directions
4 years old develops 20/20 vision and has normal running or walking

7

School Age

6-12 years
Can communicate well

8

Adolescence

13-17 years
Issues of independence and sexuality

9

Neck and Airway

Short necks
Airway smaller
Epiglottis is LONG and floppy
Keep nares clear <6 months old
Neck very soft and collapsible, don't hyperextended neck

10

Narrowest portion of child's airways is____

Occurs at cricoid cartilage rather than vocal cords in adults

11

Respiratory System

Metabolic oxygen demand of child is doubled to adult
Children inhale toxins faster than adults and become symptomatic sooner

12

Ventilating

Only enough air to see rise of the chest

13

Pediatric Resp Rates

Neonate-1month: 30-60
Infant: 25-50
Toddler: 20-30
Preschool: 20-25
School: 15-20
Adolescent: 12-20
Adult: 12-20

14

Pediatric Pulse Rates

Neonate-1month: 100-180
Infant: 100-160
Toddler: 90-150
Preschool: 80-140
School: 70-120
Adolescent: 60-100
Adult: 60-100

15

Cardiovascular System

Pulse can be 200 or more for compensation
Peds rely on heart rate for cardiac output rather than vasoconstriction

16

Blood Volume in Ped

Appx. 70ml/kg

17

Hypovolemia in Ped

May lose a lot of blood before hypotension show

18

Delayed Capillary Refill

Shunting of the vessels causing peripheral vasoconstriction

19

Nervous System

Brain and spinal cord not very well protected
Less subarachnoid space causing less cushion for the brain
Easier to damage head and spine

20

Suspect Shock in Ped

Tachycardia
Brady for hypoxia

21

Spinal column

Fulcrum of spine is closer to C1-C2 because head is heavier

22

Abdomen and Pelvis

Head 1st cause of injury, abdominal injuries second
Not as much protection with ribs and abdominal organs

23

Musculoskeletal

Fractures are easier due to lack of ossification centers

24

Chest and Lungs

Very thin chest wall
Ribs are more pliable and flexible
Easier to hear heart and lung sounds

25

Skin

Thinner more elastic skin
More BSA ratio
Temperature isn't regulated as well
Increased risk of hypothermia and severe burns

26

Metabolic

Not much glycogen stores in liver of pediatrics
Cover head to manage heat loss

27

Pediatric Assessment Triangle

Work of breathing
Circulation of skin
Appearance

28

TICLS

Most important feature of child's appearance
Tone: muscle tone, ridged or limp?
Interact: alert? How easily distracted? Grasp or reach?
Consolability: can be calmed by caregiver?
Look: fixed gaze or glass stare
Speech: strong cry? Age appropriate speech

29

Work of Breathing

Abnormal Airway Sounds: snoring, hoarse speech, strider, wheezing or grunting
Abnormal Positioning: sniffing positions, tripod, refusing to lie down
Retractions: superclavicular, intercostal, substernal retractions, head bobbing
Flaring: flaring of nares on inspiration

30

Grunting

Indicative of partially closed epiglottis and moderate to severe hypoxia
Seen with pnuemonia

31

Mottling

Reflects vasomotor instability in capillary beds seen by patchy areas of vasoconstriction and vasodilation

32

Acrocyanosis

Blue hands or feet in younger than two months

33

Pallor

Whit or pale skin of mucous membranes

34

Length Tape

Measures up to 75lbs or 34kg

35

Blood Pressure

80+age(2)
Minimal:
Infant- >70
Toddler- >80
Preschool and School- >80

36

Respiratory Emergencies

90% cause of cardiac arrest in Peds

37

Foreign Body Airways in Infant

Responsive: deliver 5 back blows and five chest thrusts
Unresponsive: look in mouth, start CPR start with 30 or 15:2 if another person available

38

Foreign Body in Children

Responsive: abdominal thrusts
Unresponsive: start CPR 30:2 unless another person available then do 15:2.
THEN open airway and look in the mouth. Continue CPR and then laryngoscope

39

Anaphylaxis

Respiratory Distress and End Organ failure qualifies as Anaphylaxis
Epinephrine !
.01mg/kg IM 1:1

40

Croup

Seal bark cough
Viral infection of upper airway
Treat with racemic Epi
.5ml in 3ml
Racemic- localized
Epi- systemic

41

Epiglottitis

Do not work patient up.
Stay calm and keep calm
Don't look in mouth

42

Asthma

Bronchospasm
Mucus production
Inflammation
Albuterol 2.5mg in 3ml
Atrovent <22lbs= 250mcg >22lbs= 500mcg
Corticosteroids
Fluid!

43

Bronchitis

Racemic Epi or Albuterol

44

Cystic Fibrosis

Fluid lungs and GI tract

45

Bronchopulmonary Dysplasia

Spectrum of lung conditions found in premature neonates who required long periods of high oxygen and ventilators support.
May have home ventilators and oxygen
May consider Atrovent

46

Airway Management

Use shoulder Roll for head tilt chin lift

47

Long Term ventilation

Intubate!

48

OPA

Same as adult

49

Bag Mask

Capnography saturation
12-20 breaths/min

50

Oxygenation

Blow by technique for minimal oxygen needed

51

Intubation

Size: age+16 / 4 = size of tube
1month-adolescent = straight blade
Adolescent to adult = straight or curved
2-3cm beyond vocal cords

52

Oro or Nasogastric Insertion

Need 30-60ml syringe
Twice the size of ET tube 5mm et is 10FR
Continuous stomach suction at 20-40mmHg

53

Congenital Heart Disease

Common heart defects

54

Cyanosis Disease

More serious
HLHS hypoplastic Left heart syndrome ( does not distribute oxygen in heart ) - almost no left ventricle at all which mixes oxygenated and deoxygenated blood
DO NOT FLOOD WITH OXYGEN
76-82% oxygen
Tetralogy of Fallot

55

Noncyanotic Disease

Atrial Septal Defects
Ventricular Septal Defects

56

Congestive Heart Failure

Heart can no longer meet metabolic demands of the body

57

Myocarditis

Inflammation of heart muscle
Can lead to heart failure
Symptoms- dyspnea, exercise intolerance, syncope, or murmur

58

Cardiomyopathy

DCM- Dialate Cardiomyopathy: heart becomes weakened and enlarged making it less efficient in pumping
HCM- Hypertrophic Cardiomyopathy: thickened heart so heart has to pump harder

59

Seizures

Same as adult but most common is a febrile seizure

60

Febrile seizure

Occur in 25% of peds
Simple Febrile Seizures: brief generalized seizures, lasting less than 15 minutes

61

Complex Febrile Seizure

Longer, lasting more than 15 minutes
FIX the FEVER !!!!!! Tylenol
Acetaminophen is 15mg/kg
Tylenol is 10mg/kg
Fluids!
BGL!

62

Meningitis

Gown up! Very deadly and contagious
Unchallenged Ridgidity
Purpuric and Patecial coloration of the skins. Patecial is small dots
Symptoms- fever,

63

Biliary Atresia

Build up of bilirubin

64

Inussusception

6months-6years
Telescoping of intestine, small, into itself

65

Meckel Diverticulum

Malformation of small intestine

66

Pyloric Stenosis

Pylorics become hypertrophied and present with projectile vomiting

67

Hyperglycemia

Fluids and insulin

68

CAH Congenital Adrenal Hyperplasia

Not enough cortisol

69

Panhypopituitarism

Inadequate production of pituitary hormones

70

Toxicological Emergencies

Call Posion control
1800-222-1222

71

Antidotes

Carbon Monoxide: oxygen
Organophosphate: atropine
Tricyclics AntiDepressants: Bicarbonate
Opiates: Naloxone
Beta Blockers: Glucagon
Ca channel blockers: calcium
Benzodiazepines: Romazicon