Vol.5-Ch.4 "Pediatrics" Part 2 (Specific Emergencies) Flashcards
What are some common pediatric infections you may encounter that can be life threatening for the pt? (3)
- Meningitis
- Pneumonia
- Septicemia
What are the 3 stages of respiratory compromise? What are some assessment findings for each stage?
RESPIRATORY DISTRESS:
Typically noted by increase in respiratory effort and or rate but can also present with the S&Ss: Irritation/anxiety, retractions, nasal flaring, tachycardia, head bobbing, grunting, cyanosis (but is able to improve with O2 supp)
RESPIRATORY FAILURE:
When the resp system is not able to keep up with O2 demands and can’t shed off enough CO2. aka INADEQUATE VENTILATION AND OXYGENATION THAT LEADS TO RESPIRATORY ACIDOSIS. S&Ss seen may include: anxiety that deteriorates to lethargy, tachypnea that deteriorates to bradypnea, retractions that deteriorate to agonal respirations, poor muscle tone, tachycardia that deteriorates to bradycardia, CENTRAL cyanosis
RESPIRATORY ARREST:
This is when the patient has stopped breathing. S&Ss may include: Comatose, apnea, no chest rise/fall, asystole, profound cyanosis
What is Croup and what does it cause?
How can you assess for it/ what are the S&Ss?
How do you manage it?
Croup, AKA Laryngotracheobronchitis, is an UPPER airway obstruction
It causes inflammation of the upper resp tract involving the subglottic region. It leads to edema beneath the glottis and larynx, which narrows the lumen of the airway.
Assessment is a classic case of mild cold or infection and be doing fairly well until the evening when a harsh, barking, brassy cough develops. Most often the first finding will be inspiratory Stridor.
***When assessing for croup NEVER EXAMINE THE OROPHARYNX L, this is because it is often hard to distinguish between Croup and Epiglottitis, and if Epiglottitis is present, an examination of the oropharynx will result in a laryngospasm and possible complete airway obstruction.
Management consists of position of comfort, O2, and if severe the physician may order racemic epi or albuterol. Also studies have shown that nebulized normal epi might be just as good or better than racemic epi. Also steroids are recommended for moderate to severe cases as they improve symptoms, shorten illness, and decrease hospitalizations
What is Epiglottitis and what does it cause?
How can you assess for it/ what are the S&Ss?
How do you manage it?
Epiglottitis is an UPPER airway obstruction involving the acute inflammation of the epiglottis (the cartilage flap that protects the airway during swallowing). Unlike Croup it is caused by a bacterial infection, usually Haemophilus Influenza type B (for which there is a vacc so it is not as common now)
It presents similar to Croup in that the child will often be thought to have a mild infection but once they go to bed but then awakens with a high temp and brassy cough. The child will then start to have pain upon swallowing, sore throat, high fever, shallow breathing, dyspnea, inspiratory stridor, and DROOLING (b/c it hurts to swallow or may not be able to at all b/c of swelling). Pt will often be found in the Tripod position to help airway positioning.
Again, DO NOT VISUALIZE THE AIRWAY as this may cause a serious spasm; if the child is crying, the epiglottis may be visible just above the base of the tongue and will appear cherry red and swollen.
This is a critical disease for a child and they should be managed with rapid transport and supp O2, do not give an IV or take a BP as it may further stress the child and or cause a spams of the larynx. Have intubation equipment ready but DO NOT do unless it evolves into a total airway obstruction
What is Bacterial Tracheitis and what does it cause?
How can you assess for it/ what are the S&Ss?
How do you manage it?
It is an UPPER airway obstruction that is usually secondary to Croup. A pt that recently had croup may get some bacteria that slips passed the epiglottis to the subglottic region and cause a bacterial infection.
Pt will present with high fever, COUGHING OF PUS and/or mucus, a hoarse voice, sore throat, and possible inspiratory/expiratory stridor
Manage this similar to epiglottitis with O2 supp and rapid transport
Compare and Contrast of Croup and Epiglottitis
CROUP:
- Slow onset
- Prefers to sit up
- Barking Cough
- NO DROOL
- Fever of 101-102
EPIGLOTTITS:
- Rapid Onset
- Prefers to sit up
- NO Barking cough
- DROOL
- Fever of 102-104
- Occasional stridor
(THE BIG KEY IS BARK COUGH? DROOL?)
What is the number 1 cause of at-home accidental deaths in children under 6
Foreign Body Airway Obstructions (FBAO)
While other respiratory disease related deaths have been decreasing, what is the main one still on the rise?
ASTHMA, whos been hospitalizing an increase of 200% more children in the past 20 years
What is the pathophysiology of asthma and how can it be treated?
Asthma is chronic inflammation disorder of the lower airways characterized by bronchospasms and excessive mucus production due to a hyper-response to a “trigger”
Within minutes of exposure to a “trigger” a 2 phase response begins:
PHASE 1 = The classic asthma attack where chemical mediators such as histamine are released causing bronchoconstriction and bronchial edema that decrease expiratory airflow. This Phase can usually be quickly treated and corrected with administration of a bronchodilator such as Albuterol
PHASE 2 = Delayed inflammation of the bronchioles as cells of the immune system invade the respiratory tract causing additional edema and further decreasing respiratory airflow. This phase is typically non-responsive to bronchodilators and requires treatment via Corticosteroids (like Solu-Medrol)
THREE MAIN GOALS OF TREATMENT:
- Correct hypoxia
- Reverse Bronchospasms
- Decrease inflammation
What is Bronchiolitis and what does it cause?
How can you assess for it/ what are the S&Ss?
How do you manage it?
Bronchiolitis is an infection of the bronchioles, commonly from the virus Respiratory Syncytial Virus (RSV), that affects the lining of the bronchioles
It is marked by expiratory wheezing and closely resembles asthma. A MAJOR DIFFERENCE between the two however is the AGE. Asthma does NOT typically present in infants less that 1 year of age and commonly has an associated fever.
Treat this similar to asthma, you can withhold a bronchodilator such as albuterol unless there is true difficulty breathing.
What is Pneumonia and what does it cause?
How can you assess for it/ what are the S&Ss?
How do you manage it?
Pneumonia is an infection of the lower airway and lungs, caused by either a virus or a bacteria.
Often the child will have a recent history of a cold or bronchitis and will at the time of assessment have a fever, decreased breath sounds, rhonchi, crackles, and/or pain in the chest.
Treat this like any other compromise to resp system
SKIPPED ARRHYTHMIAS ON PAGES 126-129 BUT CONSIDER GOING BACK AFTER PALS TO COMPARE AND CONTRAST OR SEE IF THERE IS NEW INFO
SKIPPED ARRHYTHMIAS ON PAGES 126-129 BUT CONSIDER GOING BACK AFTER PALS TO COMPARE AND CONTRAST OR SEE IF THERE IS NEW INFO
What is the SECOND major cause of cardiopulmonary arrest in peds after Respiratory impairment?
SHOCK!
Which is an especially bad sign in kids once their BP drop because their blood vessels can contract very efficiently to fight off shock, so a dropped BP is a much later sign for them than with adults and they will deteriorate much much faster than adults once the BP drops.
This is probably because they do not possess as good of an ability to adjust stroke volume, they really regulate perfusion ability through increased heart rate and vasoconstriction/dilation
QUICKLY REVIEW THE SIGNS AND SYMPTOMS ASSOCIATED WITH THE 3 TYPES OF SHOCK ON PGS 123-124
QUICKLY REVIEW THE SIGNS AND SYMPTOMS ASSOCIATED WITH THE 3 TYPES OF SHOCK ON PGS 123-124
What are the main two classifications of shock?
Either CARDIOGENIC, where hypoperfusion results from inadequate cardiac output from things like congenital heart disease, cardiomyopathy, or arrhythmias; and NONCARDIOGENIC which is everything else (hypovolemia, septic, anaphylactic, neurogenic, distributive) and is the more common of the two for peds
What is the primary cause of heart disease in children?
Congenital Heart Disease
What is Cardiomyopathy?
Cardiomyopathy is disease or dysfunction of the cardiac muscle. It is pretty rare but is commonly associated with the Coxsackie virus. Cardiomyopathy causes mechanical pump failure, which is normally biventricular, and often develops slowly and may not even be detected till heart failure.
S&Ss include JVD, crackles, fatigue, engorged liver, and peripheral edema. Basically all the spots that blood will pool are going to be engorged with fluids. Treatment for pre-hospital are supportive, give O2, NO FLUIDS, if breathing becomes at risk of failure b/c of fluids, then you might be ordered by physician to give diuretic.
What are some types of seizures that children can have? (4x) Remember that seizures do not typically ever happen within the first month of life and are still pretty rare for children.
- SIMPLE/PARTIAL SEIZURES (aka Focal motor seizures) where the pt will have jerking or rapid movement of just one part of the body and can include things like, lip smacking, eye blinking, staring, confusion, or lethargy. THEY DO NOT LOOSE CONSCIOUSNESS
- GENERALIZED SEIZURES in which they have the typical tonic clonic movement of hyperflexion and then relaxation of the entire body. THERE IS LOSS OF CONSCIOUSNESS
- STATUS EPILEPTICUS in which a pt has a series of one or more generalized seizures without periods of consciousness between them, this is obviously a major risk of prolonged apnea
- FEBRILE SEIZURES which are the most common for pediatrics is when there is a seizure related to a sudden spike in body temperature
Remember to manage a seizure pt is basically with a benzo, either diazepam or lorazepam via IV or Midazolam via nasal. IF it is a febrile seizure the doc may order acetaminophen to help lower body temp (remember it is part antipyretic)
