Acute Care Management Flashcards
(109 cards)
1
Q
What is PAT?
A
Pediatric Assessment Triangle
2
Q
What is elements of Primary Survery?
A
ABCDE
Airway
Breathing
Circulation
Disability (neurologic)
Exposure
3
Q
Sniffing O2?
A
Put them in the sniffing position and provide oxygen
4
Q
How to calculate ETT size?
A
(Age in years/4) + 4
i.e. 4 year old - (4/4) = 5.0c
5
Q
How to calculate ETT depth?
A
3x ETT size
4yr old with 5.0c x 3 = 15cm at the teeth
6
Q
What are signs of mild (15-30%) blood volume loss?
A
Cardiovascular: tachycardia, weak/thready pulses
Neurologic: anxious, irritable, confused
Skin: cool, mottled; prolonged capillary refill
Urine output: minimally decreased
7
Q
What signs of moderate (30-45%) blood volume loss?
A
Cardivascular: tachycardia, absent peripheral pulses, weak/thready central pulses; mild hypotension with narrow pulse pressure
Neurologic: lethargic, dulled response to pain
Skin: cyanotic unless anemic; markedly prolonged capillary refill
Urine output: minimal
8
Q
What are signs of severe (>45%) blood volume loss?
Cardiovascular, neurologic, skin, urine output
A
Cardiovascular: tachycardia followed by bradycardia; hypotensino
Neurologic: comatose
Skin: pale, cold
Urine output: none
9
Q
What does a GCS of <12 signal?
A
Head injury
10
Q
What does a GCS <8 represent?
A
Less than 8 = intubate
11
Q
What does a GCS <6 represent?
A
12
Q
What is the highest GCS score?
A
15
13
Q
What is the lowest GCS score?
A
3
14
Q
What has very genetic infromation, but can be helopful in giving basic information about how injuried a child is?
A
Trauma Score
15
Q
What does a trauma score less than 9 represent?
A
Signficiant risk of morbidity and mortality
16
Q
What elements are in secondary survey?
A
Obtaining deilated history
Full set of vital signs
Head to toe physical assessment
If any change = repeat primary survey
Guides further interventions
17
Q
What is MVIT?
A
MVIT from prehospital providers
Mechanism of injury
Injuries sustained
Vital signs
Treatment
18
Q
What is the intial fluid resutitation goal value?
A
20 mg/kg of Normal saline or lactated ringers
19
Q
What is the inital fluid resuscitation with a cardiac condition?
A
10 mg/kg of normal saline or lactated ringers
20
Q
What are the steps on initial management?
A
Fluid resusitation
NPO
Gastric decompresion
Urinary catheter
Analgesia
Consults
21
Q
What is the first goal in management in ED?
A
Triage
22
Q
Level 1 Triage
A
Resuscitation–immediate, life-saving intervention required without delay
i.e. cardiac arrest or massive bleeding
23
Q
Level 2 Triage
A
High risk for deterioriation or signs of time-critical problem
i.e. cardiac-related chest pain, astham attack
24
Q
Level 3 Triage
A
Urgent–stable, with multiple types of resrouces needed to investigate or treat (lab tests + x-ray)
i.e. abdominal pain, high fever with cough
25
Level 4 Triage
Less Urgent--stable, with only one type of resource anticipated (only x-ray or only sutures)
i.e. simple laceration, pain on urination
26
Level 5 Triage
Nonurgent--stable with no resources anticipated except topical or oral medications or prescriptions
ie. rash or prescription refill
27
What is CIAMPEDS?
Used in regular ED visit
**C**hief complaint
**I**mmunization/Isolation
**A**llergies
**P**ast Medical Hx
**E**vents surrounding illness or injruy
**D**iet/**D**iapers
**S**ymptoms associated with illness/injury
28
What constitutes as premature?
Any infant born prior to 37 weeks
29
What is classified as low birth weight?
Birth weight \< 2,500 gm (5lb 8 oz)
30
What is classified as very low birth weight (VLBW)?
Birth weight \<1.500 grams (3lb 5 oz)
31
What is chornologic or birth age?
Time since birth
32
What is estimated gestational age (EGA)?
Approximate time since conception
33
What is corrected gestational age (CGA)?
Age adjusted to reflect current gestational age from date of brith to present
ie. a 12 week old infant who was born at 9 weeks early as a CGA of 3 weeks
34
What is postconceptual age (PCA)?
Weeks gestation + weeks of life
35
What are the causes of intraventricular hemorrhage (IVH)?
Periantal disruption of blood flow, hypoxia, or changes in intravascular pressure
36
What are signs and symptoms of IVH?
Subtle
Full fontanel, decrease in hematocrit
37
How do you diagnosis IVH?
TCD
Serial Cranial US
38
How do you treat IVH?
Maintain normal temperature, avoid rapid fluid boluses, normalize blood pressure, keep baby calm
39
What causes retinopathy of premaurity?
Incomplete development of retinal vessels
40
What are the risk factors for ROP?
Oxygen
41
What the treament for ROP?
Laser therapy or vitrectomy (if retina is detached)
42
When do all infants experience physiologic nadir?
First 3 months of life
43
Where does the RBC production from to in term infants?
Moves from liver to bone marrow and EPO moves from liver to kidney
44
How do you treat anemia of prematurity?
Minimize blood draws, nutritional support, provide pRBCs
45
What is AMPLE?
**A**llergies
**M**edications
**P**ast Medical Hx
**L**ast Meal
**E**vent
46
What is the pediatric risk of mrotality (PRISM)?
Acuity scoring system measure illness severity, morbidty and mortality, cost of care, and length of stay
Provides objective way to assist pediatric critical care professionals with identifying physiologic variables that predict mortality
47
Be honest with patients and caregivers at all times
Admit when an error has happened
Be accountable for your actions
Acknowledge your limits and know when to ask for help
Always place patient's well-being first
Make a committment to continued education
What are for what committee?
AAP committee on bioethics
48
What temperature range is considered cold stress?
36.0-37.4 C (96.8-97.5 F)
49
What temperature range is considered moderate hypothermia?
32.0-35.9C (89.6-96.6F)
50
What temperature range is severe hypothermia?
less than 32C (89.6F)
51
What is considered hyperthermia?
Above 37.5C (99.5F)
52
What is considered severe hyperthermia?
\> 40C (104F)
53
What is nonshivering thermogenesis?
Infant tries to minimize heat loss by peripheral vasoconstriction and encourages heat production by increasing metabolism and oxidation of brown fat
54
What are the short tem consequences of pain?
Decreased oxgeyn saturation, increased heart rate, increased intracranial pressure, and depression of immune system
55
What are the long-term consequences of pain?
Failure to activate or delay in stress response, elevated basal cortisol levels, and altered tactile sensation
56
What is the treatment for apena of prematurity?
Methylxantines
57
What are common types of Methylxanthines?
Caffeine; Theophylline
58
Where do intraventricular hemorrhage occur in premature infants?
Subependymal germinal matrix at head of caudate nucleus near foramen of Monro
59
Grade I IVH
Isolated germinal matrix hemorrhage
60
Grade II IVH
Intraventricular hemorrhage without ventricular dilation
61
Grade III IVH
Intraventricular hemorrhage with ventricular dilation
62
Grade IV IVH
Intraventricular hemorrhage with ventricular dilation and hemorrahge into parenchyma of brain
63
Who qualifies for ROP exam?
Infants less than 1,500 grams or 32 weeks at birth
64
Liquid nitrogen probe to distroy avascular "scar" tissue
Cryotherapy for ROP
65
What is the first-line surgical procedure for ROP?
Laser therapy
66
Removal of scar tissue which allows retina to reconnect with back of eye
Vitrectomy
67
What are signs of anemia of prematurity?
Tachypnea, apnea, increased oxygen requirment, bradycardia, poor weight gain, decreased activity, and pallor
68
How early can erythropoietin be used to treat anemia of prematurity?
NOT BEFORE 8 DAYS OLD
Increases risk of ROP
69
What is the recommened iron supplement for preterm infants?
2-4 mg/kg elemental iron to breastfed preterm infant
1 mg/kg to formula-fed infant
70
How early can iron supplemental start for preterm infant?
As early as 2 weeks of age
71
Intestinal injury leading to abnormal and uncontrolled inflammatory repsonse
Necrotizing Enterocolitis
72
What are maternal risk factors for NEC?
Placental insufficiency, pregnancy-induced hypertension, suspected/known drug or abuse, antenatal steroids, and chorioamnionitis
73
How does NEC present?
Feeding intolerance, abdominal distention, gastric residuals, vomiting, blood in stool, and abdominal tenderess
LATER ON: lethargy, apnea, respiratory distress, bradycarda, temperature instability, shock
74
What will abdominal radiographs show for NEC?
Ileus, dilated loops of bowel, pneumatosis intestinalis, ascites, intrahepatic portal venous air, and persistnet sentinel loops of bowel
75
What lab findings will you find for NEC?
Early metabolic acidosis
Thrombocytopenia
Neutropenia
Coagulopathies
Electrolyte imbalances
76
What are the most common bacteria for early-onset sepsis?
*Escherichia coli* and Group B *streptococcus*
77
What are signs and symptoms of early-onset sepsis?
Respiratory distress, temperature instability, hypotonia, irritabilty, poor feeding, early-onset jaundice, apnea, poor perfusion, tachycardia, seizures
78
What are the drugs of choice for early-onset sepsis?
Ampicillin and Gentamicin
79
What are the common pathogens of late-onset sepsis (after 72 hours of life)?
Coagulose-negative *staphylococcus* (CONS), *staphylosis aureus*, *klebsiella*, *pseudomonas aeruginosa, candida* species, and GBS
80
What is the intial empiric therapy for late-onset sepsis?
Ampicillin and Gentamicin
81
What is initial empiric therapy for late-onset sepsis if skin is involved?
Vancomycin
82
What are the most common causes of hypoxemia in children?
Ventilation/Perfusion (VQ) mismatch and hypoventilation
83
What kind of fluids do you use for initial fluid resuscitation?
Isotonic fluids (Normal saline/lactated ringer's)
84
How do you treat hypoglycemia in intial resuscitation?
10% dextrose solution and follow with infusion of dextrose containing fluids in persistently hypoglycemic patient
85
What is SAMPLE?
**S**igns and Symptoms-what were the signs and symptoms that were exhibited by patient prior to presentation?
**A**llergies-any drug or food allergies?
**M**edications-what medication does the aptietn take on a daily basis? Was the patient given any medication prior to arrival?
**P**ast medical history-what medical problems does the patient have?
**L**ast meal-what time did the patient last take anything by mouth?
**E**vents leading to presentations-what were the events immediately preceding the decision to present to the ER?
86
What is the *mallampati assessment*?
Visualization of tonsillar pillars, soft palate, and uvula with degree of difficulty of laryngoscopy
87
Class I *mallampati assessment*
All three pharyngeal structures are visible
88
Class II *mallampati assessment*
Uvula and soft palate are visible
89
Class III *malampati assessment*
Only soft palate and base of uvula are visible
90
Class IV *mallampati assessment*
None of pharyngeal structures can be seen
91
What are signs of difficult airways?
Trouble of providing bag-mask ventilation/intubating
Hx of stridor, snoring, or sleep apnea
Hx of obesity, limited jaw or neck movement, craniofacial anomalies, facial trauma, or laryngeal abnormalities
92
What kind of patients are **not** recommended for orpharyngeal airway?
Patients with cough or gag reflex--it can stimulate gag and vomiting
93
What age range should have curved laryngoscope blades?
More effective for child \> 2 years
94
What age range for straight laryngoscope blades?
Children \< 2 years and those with difficult airways
95
What external layrngeal manipulation helps bring glottis into view?
BURP
**B**ackword (posterior)
**U**pward (cephalad)
**R**ightward **P**ush
96
What drug prevents bradycardia while intubating in young infants?
Atropine
97
What sedative/anesthetic for intubation caused significant vasodilatory properties?
Propofol
Thiopental
98
What sedative/anesthetic is best for children with asthma or reactive airway disease?
Ketamine
99
What binds to the postsynaptic receptor of the neuromuscular junction, causing transient muscular fasciculation and then paralysis as receptors remain occupied?
Depolarizing neuromuscular blocking drugs
100
What is a depolarizing neuromuscular blocking drug?
Succinylcholine
101
What are the complications of succinylcholine?
Malignant hyperthermia, masseter spasm with subsequent airway obstruction, a modest rise in potassium
102
What binds to postsynaptic receptors of the neuromuscular junction without causing postsynaptic depolarization and neuromuscular transmission?
Nondepolarizing neuromuscular blockers
103
What are nondepolarizing neuromuscular blockers?
Rocuronium
Vecuronium
104
What are the side effects of rocuronium or vercuronium?
It has a longer duration and are not reversible in time to allow spontaneous ventilation if patient cannot be intubated or ventilated
105
What should the tip of the ETT be?
Midtrachea (level of 2nd to 4th thoracic vertebrae)
106
What helps prevents an ICP spike during intubation?
Lidocaine
107
What should be used with caution in children with shock while incubating?
Potent vasodilators (propofol and thiopental)
108
What is contraindicated in facial/laryngotracheal injury intubation?
Nasotracheal intubation until basilar skull fracture is ruled out
109
Airway emergency characterized by acute inflammation of supraglottic region
Marked by sudden onset of fever, dysphagia, drooling, "hot potato" voice, and toxemia
Acute epiglottis
