155. Care of Ped Pt Flashcards by Tegan Turner

Why do children tend to lose more heat to the environment?

Larger surface area to mass ratio

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What are key differences in the pediatric airway from adult?

ped larynx is more anterior and cephalad<br></br>2. epiglottis is floppier given more cartilage<br></br>3. larger head in infants and yo children causes more neck flexion when lying down ie obstruction<br></br>4. large tongues<br></br>5. smaller diameter airways mean more obstruction with section

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How to appropriately position a pediatric pt head pre intubation?

Towel roll under the shoulders to align laryngeal, pharyngeal and oral airway axis

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Young infants preferentially breath through their __

noses

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How do kids maintain their cardiovascular system? (in order of compensation)

Increase heart rate<br></br>2. vasoconstrict peripherally to shunt blood centrally <br></br>–> of note, very yo children have limited ability to increase contractility

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CV: ___ is a late finding of shock

hypotension

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Earliest sign of CV compromise in most patients is ___

tachycardia

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a __ pulse, associated with tachycardia may also be considered a sign of shock

thready

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MSK: in peds __ are relatively strong in relation to immature __

ligaments<br></br>bones

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What is the weakest part of a growing child’s bone?

physis/growth plate

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If tenderness is present on exam in MSK, physeal injuries should be considered in pt even with __ radiographs

normal

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What age group is particularly at risk for serious bacterial infections?

febrile infants <1 mo

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Recommendations for safeguards to consider in weight based dosing of children?

pharmacy review<br></br>- computerized order entry<br></br>- templated forms<br></br>- length based resus tapes<br></br>- only report weight in kg

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Why do we not give ceftriaxone to infants <28 days?

risk kernicterus - displacement of bilirubin ffrom albumin leading to BIND (bili induced neuro dysfunction)

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Ibuprofen < 6mo has risk to which 2 organs?

liver<br></br>kidney

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School age/adolescent hx should include HEADSS - stands for?

home<br></br>education<br></br>activities<br></br>drugs<br></br>sex<br></br>suicide<br></br>safety

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Examples of triage systems with pediatric modifications?

<div>
<div>
<div>
<div>
<div>The Emergency
Severity Index</div><div>Paediatric Canadian Triage and Acuity Scale, </div><div>Man-
chester Triage System,</div><div>Australasian Triage Scale. </div>
</div>
</div>
</div></div>

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In neonates, what key hx is important to illicit?

pregnancy<br></br>birth hx<br></br>newborn screen<br></br>urine output - number of wet diapers<br></br>vaccination status<br></br>drug/alc/e cig use

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Three components of the pediatric assessment triangle:<br></br>1.<br></br>2.<br></br>3.

Appearance<br></br>2. WOB<br></br>3. Circulation to the skin

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Pediatric assessment triangel: Appearance - what does TICLS stand for?

tone
interactiveness
consolability
look and gaze
speech
cry

__ is an early sign of inadequate brain perfusion

irritability

High pitched/irritable cry is concerning for ?

CNS disease like meningitis

Pediatric assessment triangle: WOB:
ominous signs

tripoding
sniffing position

Pediatric assessment triangle: WOB:
Hoase voice --> ?disease?

croup

Pediatric assessment triangle: WOB:
muffled/hot potatoe voice

PTA

Pediatric assessment triangle: WOB:
where are retractions? 4

suprasternal
supraclavicular
intercostal
subcostal

Pediatric assessment triangle: WOB:
What does nasal flaring do?

decrease airway resistance

Pediatric assessment triangle: WOB:
Head bobbing and seesaw breathing/paradoxical chest move are signs of ?

impending resp failure

Pediatric assessment triangle: WOB:
normally children function near their maximum __ __ capacity, thus any increase in metabolic rate, such as fever, can increase RR

tidal volume

Ped Assessment Triangle: Circulation:
Early compensated shock - skin signs?

pale, warm to touch, delayed cap refill >2s

Ped Assessment Triangle: Circulation:
Progression beyond early compensated shock - skin changes?

from pale, warm to touch was delayed cap refill to COLD extremities

Ped Assessment Triangle: Circulation:
Mottling vs Cutis mMarmorata

mottling - random patern vasoconstriction adjacent to cap beds in skin
vs
regular lacy patern on skin caused by vascular instability (N in yo infants in cool environment) --> children will otherwise be well appearing

Ped Assessment Triangle: Circulation:
Cyanosis - new - indicates __ __ or ___ __

resp failure
decompensated shock

Physical exam for children - recommended progression

- head to toe
- ausculation of heart, lungs and abdo palpation before frightening/uncomfortable parts
- ear/oropharynx/injury at end of exam
- yo children wide without tongue depressor and pant like dog! or tongue to chin

MC children to ED: (general categories)
1.
2.
3.

1. Resp illness
2. Fever
3. Injury

MC infant hospitalization in neonate period

Resp illness

MC hospitalization school age children vs adolescent

- asthma, appendicitis
- affective disorders

How often do neonates feed?

q2-3 hours

How much do neonates typically feed?

2-3 ounces per feed if bottle fed vs 10-15 mins per breast per feed

How much (%) of birth weight will neonates lose in first 7 days?

0.1

Birth weight should be regained by d10 of life, with ? weight gain (in g/day) for first 3 months of life)

20-30g

Infants with excess w loss, failure to gain weight - concern about what 4 things?

- cardiac
- metabolic
- infectious
-NAT

When am I less worried about regurgitation of breast milk/formula?

- amount is stable
-infant gaining weight
-emesis is not bilious

Benign causes of happy spitter:

- over feeding
- inadequate burp

Serious causes of emesis (4)

- pyloric stenosis
- malrotation with voluvulus
- intussusception
-NAT head or abdo

Bilious emesis always requires __ (type of investigation)

imaging

Normal pattern of breast fed infant stool

- soft mult per day - q5-7d if breast fed

Hx of failure to stool in first 24 hours of life - concerning for ? disease. What is this?

Hirschsprung's - aganglionic segment of colon, fail to relax

Urate crystals forming within first week of life - what are these, why do they form?

reddish brick stained deposits
some degree of dehydration - esp mothers breastfeeding, no good milk supply yet

Neonates born premature commonly get which complication? (esp if <28 weeks)

- chronic lung disease

Certain high risk infants may need RSV IG prophylaxis - what is this med called?

palivizumab - monthly
if missed dose, consider rsv!!

NAT - TEN 4 FACES P meaning

trunk
ears
neck
4 years of younger
frenulum
auricular aea
cheek
eyes
sclera
patterned bruising

Fractures in children <12mo without a significant witnessed trauma mechanism are concern for __

NAT

What does LET in LET gel stand for?

lidocaine
epi
tetracaine

1. Which of the following respiratory signs is characteristic of a child in compensated or decompensated shock?
a. Grunting with abnormal breath sounds
b. Tachypnea with nasal flaring

c. Tachypnea with clear breath sounds on auscultation
d. Tripoding with stridor
e. Wheezing with retractions

2. As the pediatric physician coordinator for your emergency depart- ment, you decide to institute new policies to prevent pediatric medication errors. Which of the following strategies will be most effective in decreasing risk of dosing errors?

a. Pharmacy review of medication orders
b. Use of length-based resuscitation tapes
c. Use of resuscitation calculators
d. Weighing and recording the weight in kilograms

3. You have written an order for a blood draw and placement of an

intravenous line in a nervous 3-year-old boy. Which of the follow- ing is least likely to be helpful in decreasing the patient’s procedure- related distress?
a. Application of a lidocaine-epinephrine-tetracaine mixture

b. Having the patient blow bubbles prior to the needle stick
c. Needle-free jet injection of local anesthetic
d. Use of a vapocoolant

Answer: a. The formulation of lidocaine-epinephrine-tetracaine

only works on broken skin (i.e., lacerations). Unlike eutectic mixture of local anesthetic (EMLA) and 4% liposomal lidocaine preparations which are effective on intact skin, it will not work on intact skin. The use of vapocoolants and a needle-free jet infection of local anesthetic may decrease the patient’s pain. Distraction techniques such as blowing bubbles, singing a song, or watching a video may relieve procedure- related anxiety.

When to use LET vs EMLA gels for pain in peds?

EMLA (eutectic mixture of local anesthetic) or 4% liposomal lido prep on INTACT skin vs LET on broken

155. Care of Ped Pt Flashcards

(67 cards)