(4.3) Cardiac Pulmonary and Renal Pediatric Pearls 1 [CIS-Newman]

Question 1

Define:

Cardiopulmonary emergency

Answer 1

Absence of effective ventilation, circulation or BOTH

Question 2

What are the 3 components of cardiopulmonary arrest in children?

Answer 2

1. Respiratory (O2)
2. Cardiac (Pump, perfusion, BP)
3. Circulatory volume (perfusion, BP)

Question 3

Cardiac arrest in infants and children does not usually result from …

Answer 3

PRIMARY CARDIAC CAUSE

Question 4

Typically, what is cardiac arrest in children the result of?

Answer 4

Progressive respiratory failure or shock

Question 5

What is PALS?

Answer 5

Pediatric advanced life support

Question 6

Pediatric cardiopulmonary arrest could arise from?

Answer 6

• Respiratory failure
• Cardiac failure
• Endocrinopathy
• Trauma
• Infection
• Renal failure

Question 7

MOST pediatric arrests are?

Answer 7

Respiratory

Question 8

Describe what you are attentive to with the pediatric assessment triangle (PAT):

Answer 8

Appearance

Breathing

Circulation

Question 9

When do you use the pediatric assessment triangle (PAT)?

Answer 9

FIrst, from the door, general assessment

Question 10

What is the overal demeanor of a child in respiratory distress?

Answer 10

• Restlessness
• Anxiety
• Combativeness
• Somnolence
• Lethargy

Question 11

What is the overal tone of a child in respiratory distress with a REASSURING prognosis?

Answer 11

Vigorous movement and good tone

Question 12

What is the overal tone of a child in respiratory distress with a BAD prognosis?

Answer 12

Poor tone

Lethargy

Listlessness

Question 13

What is a reassuring vs NOT reassuring visualization of the interactions of the child?

Answer 13

Reassuring: Somewhat playful, interacting w/ parent/caregiver/care provider

NOT reassuring: Not interacting with others, won’t play with toys

Question 14

What can consolability reveal about the state of the child’s health?

Answer 14

NOT consolable = VERY sick child

Question 15

Describe the look/gaze of a child that is very hypoxic

Answer 15

Eyes “rolling around”

Unfocused gaze indicateds decreased level of consciousness

Question 16

What would the speech/cry be like for a healthy vs very sick child?

Answer 16

Relatively healthy = Loud cry/strong voice

Sick = Hoarse, muffled, weak and NO cry

Question 17

What is the initial response to respiratory compromise?

Answer 17

Tachypnea

Question 18

What is an OMINOUS sign in the setting of respiratory compromise?

Answer 18

The development of slower, irregular respiratory pattern

Question 19

What are some physical findings that indicate respiratory distress?

Answer 19

• Nasal flare
• Intercostal retractions
• Rocking respiration
• Stridor
• Diffuse/localized wheeze
• Grunting
• Accessory muscle involvement
• Decreased breath sounds
• Tripod/leaning forward position

Question 20

Stridor is most prominent with inspiration or expiration?

Answer 20

Inspiration

Question 21

Describe

Wheezing

Answer 21

Squeaking noise made by air passing though narrowed tacheobronchial airways

Question 22

Describe

Rales

Answer 22

Moist sounds heard upon auscultation resulting from air passing through narrowed bronchi

Question 23

When is grunting most prominent, inspiration or expiration?

Answer 23

Expiration

Question 24

What are the major signs in the skin exam that reveal respiratory distress?

Answer 24

• Decreased perfusion
• Cooling of the skin
• Pale, mottled, cool or ashen skin

Question 25

What is a normal cap refill time?

Answer 25

Less than 2 seconds

Question 26

What will you see both **initially** and **after prolonged period** in the heart rate of a respiratory distress pt?

Answer 26

Initially = Tachycardia After prolonged period = Bradycardia

Question 27

What are the ABCDE's of evaluating respiratory distress?

Answer 27

A= airway B= breathing C=circulation D=Disability (depressed consciousness, unresponsiveness) E=exposure

Question 28

What are examples of **immediately life threatening conditions?**

Answer 28

- Severe upper airway obstruction - Tension pneumothorax - Cardiac tamponade - Pulmonary embolism

Question 29

What is **Beck's triad**?

Answer 29

Triad of symptoms that is highly suggestive of **cardiac tamponade** - JVD - Muffled cardiac sounds - Hypotension

Question 30

Are pulmonary emboli common in children?

Answer 30

NO

Question 31

What are some OTHER potential causes of respiratory distress in kids?

Answer 31

- Infections - Retropharyngeal and peritonsillar abscesses - Croup - Epiglottitis - Bronchiolitis - Pneumonia - Asthma - Anaphylaxis - Forgein body - Chest wall abnormalities

Question 32

What is the most frequent cause of **bronchiolitis?**

Answer 32

Respiratory syncytial virus (RSV)

Question 33

What are the characteristics of RSV?

Answer 33

URI symptoms

Question 34

What is the most common cause of pneumonia in children?

Answer 34

Streptococcus pneumoniae

Question 35

What is the treatment for anaphylaxis?

Answer 35

Epinephrine

Question 36

If an allergy is reported, what do you ALWAYS have to ask?

Answer 36

ALWAYS ASK WHAT HAPPENS WHEN EXPOSED TO THE ALLERGEN

Question 37

What is a SERIOUS choking hazard that could cause erosions in the mucosa?

Answer 37

Button batteries

Question 38

Children that have developmental delays will decompensate much ______ than normally developed children

Answer 38

Children that have developmental delays will decompensate much **QUICKER** than normally developed children

Question 39

What does **sickle cell disease** with **sudden onset RD, chest pain, new infiltrate on CXR and fever** lead you to think of?

Answer 39

Acute chest syndrome