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pedi emergencies
| Question | Answer |
|---|---|
| New born to 1 year | -dont seperate from parent,dont like o2 masks, examine with parent holding.Observe resp,level of activity, and color from a distance-heart and lungs first then head |
| 1-5 months-personality | should double birth weight by 5-6months,follow movmnt,muscle control starts at head and moves distally |
| 1-5 months common illnesses | SIDS,dehydration,meningitis,fever,resp distress,child abuse,household accidents,sepsis |
| 6-12 months-personality | stand/ealk with help,active/explore world w/mouth,stranger anxiety,dont like lying on back,cling to parents |
| 6-12 common illnesses | febrile seizures,dehydration,bronchiolitis,MVA's,sepsis,resp distress,croup,abuse,poisonings,falls,foreign bodies,meningitis |
| 1-3 yr personality | dont like touch/seperate,illness=punishment,frighten easily,understands alot,dont remove from parent,examine trunk to head.blow by o2 |
| 3-5 yrs personality | very verbal,magical thinking,understands anatomy,close to one parent,question child first-examince cheast first head last |
| 3-5 yrs common illness | croup,asthma,poisonings,MVA,burns,sepsis,abuse,F bodies,drowning,epiglottitis,febrile seizures,meningitis |
| 6-12 yrs-personality | cooperates,fears bld,pain,modest.let child give hx,explain your actions-active, carefree |
| 6-12 common illnesses | drowning,MVA,bicycle accidents,fractures,falls,sports injuries,abuse,burns |
| 12-18 yrs-personality | wants to be treated like adult,suppport like a child,explain actions,respect modesty,asses away from parents |
| 12-18 common illnesses | mono,suicide,asthma,MVA,sports inj,drug/alcohol probs,abuse,pregnancy |
| Posterior fontanelle | closes by 2-4 months |
| anterior fontanelle | diminishes after 6 months, closes by 9-24 months-normal is level w/surface of skull,slightly sunken,may pulsate- bulging w/icp,sunken w/dehydration |
| Airway differences | neck muscles are immature,trachea narrow,chest wall softer,larnx higher in neck,vocal cords short/concave,<8 cricoid cartilage is narrowest potion. |
| Cardio system | rates determine CO,volume in children 7-8% of TBW-85mg/kg,small volume loss is bad,100ml loss=15-20% volume loss=shock/ shock may be present w/normal BP |
| Hypotension | ominous sign |
| TICLS Mneumonic | tone,consolability,look/gaze,speech/cry |
| Vital functions | resp rate-tachyapnea=1st sign of resp distress, bradyapnea=ominous sight, Cyanosis (late sign)-cap refill check in sternum/forehead (due to hypothermia) reliable in kids <6 |
| BP cuff | should be 2/3 width of upper arm |
| focused exam | toe to head,pupils,cap refill <6, hyrdation/tugor,pulse ox |
| Suctioning | for infants <100 mm/hg-suction <10 sec-o2 before and after |
| Cricothyrotomy indications | resp/cardiac arrest with obstruction,facial trauma,laryngeal fracture-14 gauge, midline at 45 degree angle |
| Laryngoscope | Miller=preferred for infants and toddlers Mac blade=older children |
| RSI | succs (common)-1-2 mg/kg IVP, acts in 60 - 90 sec, has no effect on consciousness or pain, used with sedating drug |
| scalp veins | veins on forehead/temporal,on infants <1 yo,rubber band as tourniquet |
| IO indications | <6yo,3 peripheral attempts unsuccesful,90 secs gone w/out acess,in shock or cardiac arrest,unresponsive pts-medial tibial tuberosity,1-3cm,2 fingers below knee |
| IO indication of placement | lack of resistance,needle stands upright,can aspirate bone marrow,free flow of fluid w/out extravation |
| Fluids | Hypovolumic shock-20ml/kg may require 40-60 ml/kg over 10-20 min.- Septic shock 60-80ml/kg |
| Electrical activity | initial dose for defib-2joules/kg--second dose-4 joules/kg (cardioversion 0.5-1j/kg) |
| Resp distress | nasal flaring,muscle retractions,head bobbing,see saw pattern,grunting,tachyapnea-stridor,prolonged expiration |
| REsp failure | when supply cant meet demand,inadequate ventilation/oxygen,CO2 rises=acidotic-s/s=irritable,tachyapnea,retractions,poor muscle tone, tachy,central cyanosis |
| Resp arrest | unresponsive,bradyapnea,absent chest movnt,bradycardia,profound cyanosis |
| Upper airway emergencys | croup,epiglottitis,aspirated foreign body |
| Lower airway emergencies | asthma,status asthmaticus,pneumonia,lower airway FBAO |
| Croup -slow onset- | Laryngotracheobronchitis, viral infection of upper airway-(6mon-4yrs),fall/winter,edema below glottis,lumen is constricted-s/s=low fever,seal bark,develops at night-TX:racemic epi,steroids-fever <100-101 F |
| Epiglottitis -rapid onset- | acute bacterial,epiglotis swollen/cherry red,edema develops covering vocal cords-4 yrs +,inspiratory stridor,shallow breath,sob,-fever >102-104F |
| FBAO | 90% of deaths in <5yrs,65% are infants- 5back blows/5chest thrusts |
| LAFBO | traps air in distal lung,intractable coughing,diminished breath sounds,needs fiber optic scope |
| Aspiration | common 1-4yrs- #1 cause of in home accidental deaths in <6 yrs |
| Bacterial Tracheitus | Staph infection of upper airway/subglottic trachea-seen after viral illness. infants/toddlers:1-5 yo |
| Asthma-rarely before 1yo | bronchiole smooth muscle contract and inflammation-overproduction of thick mucus-expiratory is uneffective air traps=increased thoracic pressure |
| tx | atrovent,xopenex(levabuterol),epi,terbutaline,mag sul,steroids |
| Broncholitis <18mon,cause virus | viral infection (like croup)wheezing in child under 24mon,infection of bronchioles not large bronchs,fever, sob |
| Pneumonia | bacterial or viral,affects lower airways,common in infants, toddlers and 1-5yrs-s/s=low fever,decreased breath sounds,crackles,ronchi |
| Pertussis | can last 1-2 mon |
| Bronchopulm displasia | rare,premis-lung damage from o2 toxcity/barotrauma-o2 radicals, |
| Neurogenic shock | cord cut below C5=phrenic nerve intact-diaphragmatic breathing-TX: dopamine |
| Cardiomyopathy | dysfunction of heart muscle,from congenital dx,infections,pump failure-develops slowly-S/S=early fatigue,crackles,jvd,engorged liver,perepheral edema,shock (late)-TX=lasix,vasopressor |
| SVT | rate exceeding 220 |
| POST resus care | preserve brain fx,o2 sat at least 94%,tx=pain, morphine,sedate, lorazepam, midazolam |
| Bacterial meningitis | 5-10%mortality rate,S/S are sudden,chills,muscle joint pain,HA,petechiae,sore throat,tachy,temp |
| Viral meningitis-aseptic meningitis | associated with excisting viral disease,less severe than bacterial |
| Febrile seizures | 6mon-6 yrs-usualloy associated with a virus-URI,gastroenteritis,otitis media- due to sudden rise in temp.tonic clonic or subtle,5mins or less->20mins not beingn-fever >103F |
| Diazepam 1mo-5yrs | 0.2-0.5 mg SIVP every 2-5 min max 25 mg |
| Diazepam 5 yrs and older | 1mg SIVP every 2-5 min max 5 mg or 0.1-0.2 mg/kg |
| Rectal valium | 0.5 mg/kg in 1 cc |
| Hypoglycemia | treat if sugar is <70mg/dl-AAOx3=oral glucose or sugar fluids. <LOC=D25W 2-4 ml/kg or glucogon 50-150mf/kg over 1 min |
| Hyperglycemia | very serious,may lead to dehydration,acidosis,coma-common in new onset diabetes-BG >200 mg/dl-TX=fluids 20mg/kg |
| N/V | symptoms of a dx process,can cause dehydration n electrolyte imbalance-most common causes=fever,ear infections and resp infections |
| Diarrhea | 10 or more loose stools per day,most due to viral infections |
| Poisoning | leading cause od death in kids <5,mostly iron, kitchen and bath most danger, |
| Trauma | leading cause of pedi deaths-MVA's most common,mostly from blunt trauma |
| Near drowning | 3rd leading cause of death |
| head and neck injury | 60-70% of fractures occur in C1/C2-head injuries most common cause of traumatic death |
| Infants 12-18 mont | tolerate ICP and have delayed signs due to open fontanelles-subdural hematoma can produce shock, consider shaken baby syndrom |
| GCS | 13-15=mild injury, 9-12=moderate injury,8 or less =severe injury= intubate |
| Signs of ICP | increased BP,decreased pulse,irregular respirations,bulging fontanells |
| signs of herniation | asymmetrical pupils, abnormal posturing |
| chest injuries | 2nd most common cause of trauma,usually from blunt trauma |
| Tension pneumo | decompress-4th or 5th mid axillary, nipple line- older children 2nd mid clavicular |
| burns | 2nd leading cause of death,scald burns more common-head and neck 18%, legs 14%, palm is 1% |
| pain mgmt for all trauma | fentanyl,ketamine,ketoralac,morphine,nitrous ox |
| SIDS | death during 1st years of life, unknown reason,leading cause of death between 2weeks and 1 yr of age-peak incidents @2-4mon-die during sleep,fall/winter,young mom,low birth wt, |
| bruises colors | yellow:7-10days,brown:10-14days,resolution 2-4weks |
| subdural hematomas | from shaken baby syndrom-s/s: retinal hemorrhage,irratability,altered LOC,vomiting,full fontanelle |
| 1 | head injury |
| 2 | abd injury |
| 3 | bone injury |
Created by:
rebeccabelleth
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