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pedi emergencies

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