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Flashcards in 23-lethargy Deck (13):
1

sick vs not sick

1. If the individual (child or adult) is still perfusing major organ systems:
Brain (alert vs. lethargic)
Skin (well-perfused, flushed, or cool and clammy?)
Kidneys (urine output)
Lungs (respiratory rate? work of breathing? cyanosis?);

2. How quickly the illness is progressing;

3. If the individual has any underlying conditions (e.g., sickle cell disease, HIV, neutropenia, diabetes mellitus) that raise the risk of serious illness.

2

what is most sensitive test of volume status/circulation

HR- tachycardia=inadequate perfusion

3

shock definition

inadequate delivery of substrates and oxygen to meet the metabolic needs of tissues

4

shock signs

Increased heart rate (tachycardia)

Increased systemic vascular resistance (vasoconstriction)- cool clammy, delayed cap. refill

Increased heart contractility:

Increased venous tone:

Increased respiratory rate (tachypnea): compensate for the metabolic acidosis

hypotension is late sign

5

4 types of shock

Distributive (neurogenic and anaphylactic)
Septic (some experts include septic shock in the Distributive category)
Hypovolemic
Cardiogenic

6

preference for drug delivery

1.IV peripheral access
2.central line
3. intraosseus

7

intraosseus insertion

veins in medullary sinuses that haven't collapsed

for kids under 6

sites: distal femur, proximal tibia, distal tibia, or the iliac crests

8

intraosseus contraindications

Osteogenesis imperfecta
Fractured bone
Bone recently used for IO
Bone with overlying area of cellulitis, infection, or burn

9

intraosseus complications

Fractures
Infusion of fluid into subcutaneous tissue causing compartment syndrome.
Osteomyelitis
Microscopic fat and bone marrow emboli. (Clinical relevance of these emboli is not clear.)
The only reported deaths resulting from IO infusions were associated with using the sternal approach.

10

meds to treat meningococcal meningitis

ceftriaxone, vancomycin

then pen G once diagnosis confirmed

11

prevention of neisseria men. for contacts

cipro- adults
rifampin- kids

12

treatment for rocky mountain spotted fever

doxycycline and ceftriaxone

13

differential for fever and petechiae

meningococcal sepsis

TSS

RMSF

Bacterial endocarditis