Systematic Approach to the Seriously Ill or Injured Child Flashcards Preview

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Flashcards in Systematic Approach to the Seriously Ill or Injured Child Deck (53):
1

Most cardiac arrests in infants and children result from

1) Progressive respiratory failure 2) Shock 3) Both

2

In the out-of-hospital setting, only ___% of children who experience cardiac arrest survive to hospital discharge

4-13%

3

If cardiac arrest occurred at the hospital, ___% survive to hospital discharge

33%

4

Parameters to assess to make an initial impression

1) Consciousness 2) Breathing 3) Color

5

Start CPR even if there is a pulse if the rate is ___

Less than 60/min with poor perfusion despite oxygenation and ventilation

6

Components of primary assessment

ABCDE: Airway, breathing, circulation, disability,

7

Components of secondary assessment

Focused medical history and focused PE

8

Measures to open and maintain a patent upper airway

1) Allow child to assume position of comfort 2) Head tilt-chin lift or jaw thrust 3) Foreign body airway obstruction relief techniques 4) Airway adjuncts

9

Measure of choice in opening and maintaining upper airway in a patient with suspected cervical spine injury

Jaw thrust

10

Technique to relieve foreign body obstruction in children less than 1 y/o

5 back slaps, 5 chest thrusts

11

Technique to relieve foreign body obstruction in children 1 y/o or older

Abdominal thrusts

12

Normal RR: Less than 1 year

30-60

13

Normal RR: Toddler (1-3 years)

24-40

14

Normal RR: Preschooler (4-5 years)

22-34

15

Normal RR: School age (6-12 years)

18-30

16

Normal RR: Adolescent (13-18 years)

12-16

17

Often the first sign of respiratory distress in infants

Tachypnea

18

Define apnea

Cessation of breathing for at least 20 seconds or less than 20 seconds if accompanied by 1) bradycardia 2) cyanosis 3) pallor

19

Classifications of apnea

1) Central 2) Obstructive 3) Mixed

20

Refers to inspiratory effort without airflow

Obstructive apnea

21

Coarse, high-pitched sound typically heard on inspiration

Stridor

22

Short, low-pitched sound typically heard during expiration

Grunting

23

Normal HR: NB to 3 months

85-205

24

Normal HR: 3 months to 2 years

100-190

25

Normal HR: 2-10 years

60-140

26

Normal HR: >10 years

60-100

27

MCC of bradycardia in children

Hypoxia

28

Cyanosis is not apparent until at least ___ of hen are desaturated

5 g/dL

29

When measuring BP, the cuff bladder should cover about ___% of the MUAC

40

30

When measure BP, the cuff should extend at least ___% to ___% of the length of the upper arm

50-75

31

Hypotension in neonates (0-28 days)

Less than 60mmHg

32

Hypotension in infants (1-12 months)

Less than 70mmHg

33

Hypotension in children (1 year to 10 years)

5th percentile BP; Less than 70+(age in years x 2)

34

Hypotension in children >10 years

Less than 90

35

Standard evaluations of disability in pediatric patients

1) AVPU 2) GCS 3) Pupil response to light

36

AVPU

Alert, responsive to voice, responsive to pain, unresponsive

37

3 levels of head injury as defined by the GCS

Mild - GCS 13-15; Moderate - GCS 9-12; Severe GCS 3-8

38

Triad consistent with poor myocardial contractility or extrinsic cardiac compression

Low arterial BP, high CVP, tachycardia

39

O2 consumption in infants

6-8 mL/kg/min

40

O2 consumption in adults

3-4 mL/kg/min

41

When airflow is laminar, what is the relationship of resistance to airway radius

Inversely proportional to 4th power of radius

42

When airflow is laminar, what is the relationship of resistance to airway radius

Inversely proportional to 4th power of radius

43

Mechanisms involved in breathing

1) Brainstem 2) Central and peripheral chemoreceptors 3) Voluntary control

44

Central chemoreceptors for control of breathing respond to

Hydrogen ion concentration

45

Peripheral chemoreceptors for control of breathing respond to

Arterial O2

46

Clinical state characterized by abnormal RR

Respiratory distress

47

Clinical state of inadequate O2, ventilation, or both

Respiratory failure

48

Classifications of respiratory distress or failure

1) Upper airway obstruction 2) Lower airway obstruction 3) Lung tissue disease 4) Disordered control of breathing

49

Intervention for mild croup

Consider Dexamethasone

50

Intervention for moderate to severe croup

1) Humidified O2 2) Nebulized epi (then observe for 2 hours for recurrence of stridor) 3) Dexamethasone 4) Consider heliox

51

Intervention for impending respiratory failure in croup

1) High O2 concentration (nonrebreathing mask) 2) IV/IM Dexa 3) Intubate if indicated using ET half a size smaller than predicted for age 4) Prepare for surgical airway if needed

52

Intervention for anaphylaxis

1) IM epi q10-15min prn 2) If wheezing, salb neb or MDI; continuous neb if w/ severe bronchospasm 3) Prepare for intubation 4) Diphen and H2 blocker (ranitidine) IV 5) Methylpred or equivalent corticosteroid IV

53

Intervention for hypotension in anaphylaxis

1) Trendelenburg position 2) Isotonic crystalloid @ 20cc/kg 3) If unresponsive to fluids, IM epi; if still unresponsive, epi infusion titrated to achieve adequate BP for age