APLS Flashcards
0
Q
In children coma is caused by:
A
- diffuse metabolic insult (95%)
- structural lesion (5%)
1
Q
Drowsiness is defined as:
A
mild reduction in alertness
and
increase in hours of sleep
2
Q
Cerebral perfusion pressure is defined:
A
CPP = MAP - ICP (>50 mmHg)
3
Q
Cerebral blood flow is:
A
> 50 ml/100g/min
- ischemia when CBF<20
4
Q
Pinpoint pupils indicates:
A
- metabolic disorder
- narcotic ingestions
- organophosphate ingestion
5
Q
Fixed midsize pupils indicates:
A
midbrain lesion
6
Q
Fixed dilated pupils indicates:
A
- hypotermia
- severe hypoxia
- barbiturates ingestion
- during and postseizure
- anticholinergic drugs
7
Q
Unilateral dilated pupils indicates:
A
- expanding ipsilateral lesion
- tentorial herniation
- third nerve lesion
- epileptic seizure
8
Q
Examining DISABILITY consist of:
brief neurological examination
A
- Mental status/conscious level (AVPU)
- pupilary size and reaction
- posture
- neck stifness, seizures
9
Q
Absolute signs of raised ICP:
A
- papilloedema
- bulging fontanelle
- absence of pulsation in retinal vessels
10
Q
Signs of raised ICP:
A
- abnormal oculocephalic reflexes
- abnormal posture (decorticate, decetebrate)
- abnormal pupillary responses (dilatation)
- abnormal breathing patterns
- Cushing´s triad (slow HR, high BP, abnormal breathing pattern)
11
Q
Glucose when hypoglycaemia:
A
- Glc 10% 2 ml/kg IV
- then infusion: 5 ml/kg/hod + 0.45% FR
12
Q
High ICP - mannitol:
A
250 - 500 mg/kg IV over 15min
-> give 2-hourly (max Osm 325 mOsm/l)
250 = 1.25 ml 20% 500 = 2.5 ml 20%
13
Q
High ICP - hypertonic FR (instead of manitol):
A
FR 3% 3 ml/kg IV
14
Q
High ICP - dexametazon:
A
0.5 mg/kg IV 6-hourly
for oedema surrounding space-occupying lesion
15
Q
Bcterial meningitis - classic signs:
A
- neck rigidity
- photophobia
- headache and vomiting
16
Q
Meningitis - therapy:
A
1) Cefotaxime 80 mg/kg
2) Dexamethason 0.15 mg/kg 6hourly (max 10mg)
- don’t use in younger than 3 months
17
Q
Encephalitis - Herpes/Mycoplasma:
A
Macrolid. Erythromycin
- Aciclovir
18
Q
Intoxication - opiates:
A
Naloxon 10 ucg/kg IV (up to 2mg) - relapse in 20min
10 - 20 ucg/kg/min IV
CAVE: normalize CO2 before administration (arrythmias, seizure)
19
Q
Cerebral malaria:
A
- Quinine 20mg/kg over 4hrs in Glc 5%
2. Cefotaxime 80 mg/kg IV
20
Q
Generalized status epilepticus is defined:
A
generalised convulsion lasting at least 30 min
or
successive convulsions occurs so freq that patient doesn’t recover consciousness
21
Q
Mortality of status epilepticus is:
A
~ 4%
22
Q
Common causes of convulsions:
A
- fever (5% of febrile seizures)
- meningitis
- epilepsy (1 - 5% of epileptic children)
- hypoxia
- metabolic abnormalities
23
Q
Antiepiltic drugs - doses:
A
- Diazepam 0.5 mg/kg RECTAL - effect less than 1hour
- Midazolam 0.5 mg/kg BUCCAL
- Lorazepam 0.1 mg/kg IV - effect 12 - 24hours
- Phenytoin 20 mg/kg IV over 20 min - effect for 24 hours
- Phenobarbiton 20 mg/kg IV over 5 min (if on phenytoin already)
24
When can we give phenytoin to child on it?
blood level < 5 ucg/ml
25
How to administer phenytoin?
- in FR
- max concentration is 10 mg/ml
CAVE: can cause hypotension and arythmias
26
Severe hypertension treatment - drugs:
- Labetalol 250 - 500 ucg/kg
infusion: 1 - 3 mg/kg/hour
- Sodium nitroprusside 0.2 - 1 ucg/kg/min
- Nifedipine 0.25 mg/kg IV bolus
27
Severe hypertension - goals:
- to get to the 95th centile for age
- go over 24 - 36 hours (1/3 in first 8hours)
- monitoring of visual acuity is crucial (infarction of optic nerve)
28
Does normal fundi exclude acutely rised ICP ?
No
29
A generalized convulsion increase the cerebral metabolic rate:
at least three-fold
30
Hypertension - priciny:
- dysplastic kidneys
- reflux nefropathy
- glomerulonephritis
- coarctation of aorta
31
When can be the cervical collar removed ?
- no neck pain
- radiographs are normal
- neurological exam is normal
32
Spinal imaging required if:
- posterior midline spinal tenderness
- focal neurological deficit or pain
- reduced mental state
- sedative drugs
- painful distracting injury
33
What have to assesed before removing collar ?
rotation left/right for 45 degrees
34
When must be surgical team involved - in terms of fluids?
when 10 + 10 doesn't stabilized the child
when 40 ml/kg doesn't stabilized the child -> blood
35
Morphine - doses:
0.1 - 0.2 mg/kg IV
<1 rok 0.08 mg/kg
- nabiha cca 10 min
- u hypovolemie ci poruch vedomi 50% dose
36
Circulation re - assessment at trauma:
- haemodynamics
- haemoglobin
- heamostasis
37
Children - trauma - what to write down:
HR BP RR spO2 every 5 mins
GCS pupil size and reactivity every 15min
38
Sucking chest wound is:
diameter in defect in chest wall is greater than 1/3 of diameter of trachey -> aie preferably enters to chest via defect
-> occlusive dressing taled on three sides
39
Flail chest - therapy:
intubation when children is compromised
- can take 2 weeks before segment stabilises
40
Uncomplicated pulmonary contusion usually resolves within:
36 hours
41
How to recognize tracheal and bronchial rupture:
- subcutaneous emphysema
| - after instertion of chest drain -> vigorous air leak (air passes to drain)
42
Disruption of great vessels - where:
at the insertion of lig.arteriosum
- close to the left subclavian artery
angiography is ideal
43
Ruptured diaphragm is more on which side?
left
44
Children's abdomen - characteristics:
- abdominal wall is thin
- diaphragm is more horizontally -> liver, spleen more anteriorly
- ribs are very elastic -> less protection
- bladder intraabdominal when full
45
Where does the intestine usually rupture when road accident happens?
- duodenum may develop large hematoma
| - rupture at duodenojejunal flexure
46
How long does warm ischemia for kindey lasts?
45 - 60 min
47
When child should be catethrized?
- when can't pass urine spontaneously
| - when accurate measurement is needed
48
Trauma v detskem veku - hlava:
27% smrtelnych urazu
49
Secondary brain injury damage:
- ischemia
- hypoxia
- fever and infection
- convulsions
- hypo and hyperglycaemia
50
When does the cranium sutures close?
12 - 18 months
51
Indications for intubation of child:
- GCS < 8
- loss of protective laryngeal reflexes
- PaO2 < 9kPa ( 6kPa
- spontaneous hyperventilation causing PaCO2 < 3.5 kPa
- respiratory irregularity
52
What is Battle's sign?
bruising behind the ear over the mastiod process
53
Best grimace response to pain:
- spontaneous normal facial activity. 5
- only response to touch. 4
- vigorous grimace to pain. 3
- mild grimace to pain. 2
- no response to pain. 1
54
Indications for head CT scan in ED:
- loss of consciousness > 5min
- amnesia > 5min
- 3 and more epizodes of vomiting
- age>1 year + GCS < 14
- age< 15
55
Where do we aim with pCO2 when raising ICP:
4 - 4.5 kPa
check arterial (not ETCO2 - may significantly differ in shock)
56
How to suspect fitting when fully relaxed ?
- sharp increase in BP, HR
and
- pupils dilatation
57
Neurological deterioration prompting urgent reappraisal:
- developement of agitated or abnormal behaviour
- >30 min drop of 1 point in GCS
- any drop of 2 points in GCS
- severe/ increasing headache/vomiting
- new neurological signs
58
Viability of amputated parts of child:
- room temperature 8 hours
- cooled 18 hours
cleaned, wrapped in a moist sterile towel in plastic bag (water, ice)
59
Blood loss of femoral fracture:
40% of circulating volume
open fracture = loss is twice
60
What to check on extremity trauma:
- limb temperature
- capillary refill
- pulses
- active range of motion
61
Signs of compartment syndrom:
- pain especially when passively stretching
- decreased sensation
- swelling
- pallor
- paralysis
62
Which vertebrae are involved in children injury ?
C 1-3
63
Retropharyngeal swelling is :
- indirect evidence of spinal trauma
| - at C3 level the prevertebral distance should be 1/3 of width of C2 body
64
CT scan and GCS:
GCS < 13 -> head + whole spine
65
Which is most common injury to cervical spine ?
atlantoaxial rotary subluxation
66
Which is most common injury to thoracic/lumbar spine ?
hyperflexion -> wedged shaped vertebra compression
67
Indications of inhalational injury:
- history of exposure to smoke in a closed space
- deposits around the mouth and nose
- carbonaceous sputum
68
When can't be applied rule of 9 for children?
< 14 years
69
Burns classification:
- superficial = just epidermis = red skin
- partial-thickness = some damage to dermis = blister
- full-thickness = whole dermis = white, no pain
70
Burns - fluid therapy:
additional fluid = percentage burn X weight X 4 (ml) for 24 hours
50% in first 8 hours
urine output should be > 2 ml/kg/hour
71
When can cold irrigation be used for burns?
total burns < 10%
max for 10 mins
burns superficial or partial thickness
72
Burns poisoning :
Carbon monoxide levels:
5 - 20% oxygen
> 20% hyperbaric oxygen chamber
Cyanide levels > 3 mg/ml => discuss with poison centre
73
Criteria for transfer to a burn unit:
```
10% partial/full-thickness
5% full-thickness
face hand feets perineum
any circumferential burn
inhalation burn
chemical, high-voltage and radiation
```
74
Where to measure core temperature?
- rectal
| - oesophageal
75
When is interval for resus drugs doubled?
core temperature 30 - 35
76
At what temperature may VF be refractory?
< 30 degrees
inotropes and antiarrhytmic should not be given
active core warming needed
77
Active core warming:
- i.v. fluids 39 degrees
- gastric, bladder, peritoneal lavage with 42 degrees
peritoneal - potassium free dialyzate, 20ml/kg 15min cycle
- warm ventilator 42 degrees
CAVE: 0.25 - 0.5 degree per hour
78
PEA should make you think of:
Tamponade
Tension PNO
Hypovolemia
(often associated with trauma, hypotermia and electrolytes ab)
79
Asystole should make you think of:
Hypoxia
Hypovolemia
80
VF/pVT should make you think of:
Hypotermia
Hyperkalemia
Toxic substances/underlying cardiac disease
81
Which is commonest arrest rythm in children?
Asystole
| response of the heart to prolonged hypoxia and acidosis
82
Weight formulae:
6 year: m = (3 x age in years) + 7
83
Obligate nasal breather is:
infant < 6 months
84
Child's circulating blood volume:
80 ml/kg
85
Respiratory rate by age at rest:
12 15 - 20
86
Stroke volume at birth:
1.5 ml/kg
CI 300 ml/kg/min
adult: 70-80 ml/kg/min
87
Heart rate by age:
12 60-100
88
Blood pressure equation:
50th centile = 85 + (2 x age in years)
5th centile = 65 + (2 x age in years)
89
Maternal Ab provides protection for:
first 6 months
90
Signs of life:
- movement
- coughing
- normal breathing
91
Feeling for circulation:
Infant - brachial pulse, femoral art.
Child - carotid artery, femoral art.
92
Compression rate when resus:
100 - 120/min
93
How long can you be in recovery position?
30 min
94
Types of shock:
- Cardiogenic: cardiomyopthy, arrhytmias, heart failure
- Dissociative: anemia, carbon monixide poisoning
- Distributive: anaphylaxis, sepsis
- Hypovolemic
- Obstructive: tension PNO, cardiac tamponade, flail chest, embolism
95
Kdy je potreba natocit behem ABC ekg?
- >200/min infant
| - >150/min dite
96
Ventricular tachycardia - underlying cause:
- heart disease, surgery
- TCA intox.
- procainamid, quinidine, macrolide atb
- check K, Ca, Mg
97
Terapie bradycardie:
- O2, volume
- adrenaline bolus
- adrenaline infusion 0.05 ucg/kg/min
98
Up to what age in needle - cricothyreoidectomy preffered?
up to 12 years
99
Needle cricothyreoidectomy - initialnset up:
1) Y - connector
2) flow of O2 = children's age in years
3) occlude with thumb for 1 sec -> if chest's not elevating
4) increase flow by 1 litre and time by 1 sec
100
Where to drill IO:
Tibial - 2-3cm below tibial tuberosity
Femoral - 3cm anterolateral above lateral condyle
101
If infusion ti IO access is painfull:
bolus of Lidocaine 2% 0.5 ml/kg slowly
102
Paddle selection for defib:
Infants 4.5 cm
Children 8cm
Adult 13cm
103
The standart adult shock is used for children:
above 8 years
104
Thoracocentesis - risk of PNO:
10 - 20%
check x-rays after procedure
105
Dreny do hrudniku:
- 2. mezizebri medioklvikularne
| - 5. mezizebri medioaxilarne
106
FAST is checking:
- perihepatic space
- perisplenic space
- bladder / pelvis
107
Peritonal lavage - setup:
Insert NGT, bladder catether
1/3 way from umbilicus to pubis midline
insert dialysis catether
108
ABC of x-ray:
- Adequacy, Alignment
- Bones
- Cartilage and soft tissues
- Disc spaces / Diaphragm
109
What is SCIWORA:
Spinal cord injury without radiographic abnormality
110
Lateral cervical spine x-rays - lines:
- anterior vertebral line
- posterior vertebral line
- facet line
- spinolaminar line = posterior wall of spinal canal
111
C 1/2 gap should be:
< 3mm
112
When on flexion:
C1/2 gap > C2/3 gap
113
Acceptable soft tissue thicknesses on x-rays:
- above larynx: less than 1/3 of the vertebral body width
- below larynx: not more than one vertebral body width
- C7 < C5
114
Ideal position of ETT:
- below the clavicles
| - 1cm above the carina
115
X - rays cardiac border:
- 1/3 to the right of midline
| - 2/3 to the left of midline
116
Thymus can stimulate upper mediastinal mass up to:
18 month
117
Furosemid - dose:
1 mg/kg
118
Dopamine - dose:
Dobutamin - dose:
5 - 20 ug/kg/min
119
Adrenaline - dose:
0.05 - 2 ug/kg/min
120
Up to what age in needle - cricothyreoidectomy preffered?
up to 12 years
121
Needle cricothyreoidectomy - initialnset up:
1) Y - connector
2) flow of O2 = children's age in years
3) occlude with thumb for 1 sec -> if chest's not elevating
4) increase flow by 1 litre and time by 1 sec
122
Where to drill IO:
Tibial - 2-3cm below tibial tuberosity
Femoral - 3cm anterolateral above lateral condyle
123
If infusion ti IO access is painfull:
bolus of Lidocaine 2% 0.5 ml/kg slowly
124
Paddle selection for defib:
Infants 4.5 cm
Children 8cm
Adult 13cm
125
The standart adult shock is used for children:
above 8 years
126
Thoracocentesis - risk of PNO:
10 - 20%
check x-rays after procedure
127
Dreny do hrudniku:
- 2. mezizebri medioklvikularne
| - 5. mezizebri medioaxilarne
128
FAST is checking:
- perihepatic space
- perisplenic space
- bladder / pelvis
129
Peritonal lavage - setup:
Insert NGT, bladder catether
1/3 way from umbilicus to pubis midline
insert dialysis catether
130
Up to what age in needle - cricothyreoidectomy preffered?
up to 12 years
131
Needle cricothyreoidectomy - initialnset up:
1) Y - connector
2) flow of O2 = children's age in years
3) occlude with thumb for 1 sec -> if chest's not elevating
4) increase flow by 1 litre and time by 1 sec
132
Where to drill IO:
Tibial - 2-3cm below tibial tuberosity
Femoral - 3cm anterolateral above lateral condyle
133
If infusion ti IO access is painfull:
bolus of Lidocaine 2% 0.5 ml/kg slowly
134
Paddle selection for defib:
Infants 4.5 cm
Children 8cm
Adult 13cm
135
The standart adult shock is used for children:
above 8 years
136
Thoracocentesis - risk of PNO:
10 - 20%
check x-rays after procedure
137
Dreny do hrudniku:
- 2. mezizebri medioklvikularne
| - 5. mezizebri medioaxilarne
138
FAST is checking:
- perihepatic space
- perisplenic space
- bladder / pelvis
139
Peritonal lavage - setup:
Insert NGT, bladder catether
1/3 way from umbilicus to pubis midline
insert dialysis catether
140
Cuffed tubes're to be used only at what age:
not for neonates
141
Neonates require a tube:
3 - 3.5
142
Preterm require a tube:
2 - 2.5
143
Tracheal suction catether in gauge:
= twice the internal diameter of tube
tube 3 -> suction catether gauge 6
144
Cricothyreoidectomy cannuale:
Adult 12G
Child 14G
Baby 18G
145
If hyperkalemia during resus:
Calcium gluconate 10% 0.3 ml/kg
146
When do you use Calcium gluconate:
- dose: 0.3 ml/kg i.v.
- hyperkalemia
- hypermagnesemia
- hypocalcemia
- intox: Ca-blockers
147
Sodium bicarbonate can be used:
- dose: Sodium bicarbonate 8.4% 1ml/kg
- acidosis, hyperkalemia, intox.TCA
CAVE: precipitation with Calcium, inactivates A Dopamin
no traceal route
148
U VF resuscitace jde Adrenalin a Amiodaron:
Adrenalin - po 3 shocku a 4min (tedy a 2 cykly)
Amiodaron - po 3 a 5 shocku
149
Magnesium - resus:
- polymorphic VT (torsades des pointes)
- hypomagnesemia
- dose: 25 - 50 mg/kg (max 2g)
150
Amiodarone - resus:
- 5 mg/kg
- ne u otravy TCA
- lze podat po 2 davkach kont: 300ucg/kg/hod
(max 1.5 mg/kg/hod) (max 1.2 g/24 hod)
151
Whitch levels of ETCO2 should prompt attention to chest com ad:
2 kPa
152
When to stop resus:
no ROSC at any time up to 20 min during ALS
in the absence of reccuring or refractory VF/VT
exception: poisoning, primary hypotermic insult
153
When can be decreased evidence of brathing effort:
- exhaustion
- decreased drive (cerebral depression)
- neuromuscular disease
154
At what spO2 we can see cyanosis?
~ 70%
155
The target BP in sepsis:
= 90 + (age in years x 2)
156
Comparison AVPU vs GCS:
PU ~ GCS<8
157
Adrenalin for INH:
400 ucg/kg
0.4 ml/kg INH 1:1 000
158
Diuresis should be:
Infant 2ml/kg
Child 1ml/kg
159
Zvyseni teploty o 1 stupen zvysi naroky na metabolismus o:
10 - 13%
160
Je vhode deti po dosazeno ROSC chladit ?
- neprokazalo se u deti
| - ale vyhnout se teplote
161
Chest drain - transport:
- unclamped
| - valve system (no underwater seal)
162
Hendersson - Hasselbach equation:
pH = pKa + log (HCO3-)/0.03xpCO2
HCO3- is calculated
163
Normal HCO3- :
24 +- 2 mmol/l
18 - 20 mmol/l (young adults)
164
MAC - priciny:
- nadprodukce: laktat, ketoacidoza, acidurie, acidoptie
- retence: ARF, distal RTA
- ztraty bikarbonatu: proximal RTA, Fanconi sy
- nadbytek chloridu
- intox. salicylaty
165
Jake je riziko pri korekci acidozy:
- rozvoj hypokalemie
| - rozvoj hypokalcemie
166
MAL - priciny:
- severe vomiting (loss of gastric acid, hypovolemie -> bicarbonate retention)
- important to exclude gastric outlet obstruction
- overload with furosemide
167
Losses of fluid per day:
- insensible losses (sweat, respiration): 10 - 30 ml/kg/day
- stool: 0 - 10 ml/kg/day
- urine: 30 ml/kg/day
168
When a shock can occur in terms of fluid:
- loss of 20 ml/kg from intravascular space
- dehydratation is evident after loss:
25 ml/kg from total losses
pozn: if dehydratated and no shock present => loss of 5% TBV
169
Terapie dehydratace:
= fluid maintenance + fluid replacement for 24 hours
- check every 4 hours (scales)
170
Is it possible to treat nephrotic sy with furosemide ?
No in the begining they have contracted intravascular space
=> first albumin, then diuretics
171
Clinical signs of intravascular fluid overload:
- raised jugular venou pressure
- enlarged liver
- cardiac gallop
- hypertension (particulary in patients with renal problem)
- pulmonary signs (creapitations in the bases of lungs)
172
How fast can you lower Na?
no more than 0.5 mmol/hod
| max 8 mmol/day
173
Na - day consumption:
first 10kg: 2 - 4 mmol/kg/day
sec 10kg: 1 - 2 mmol/kg/day
subsequent 0.5 - 1
174
K - day consumption:
first 10 kg: 1.5 - 2.5 mmol/kg/day
sec. 10kg: 0.7 - 1.5
subsequent: 0.2 - 0.7
175
If hyponatremia and seizures - Na treatment:
3% NaCl 4ml/kg for 15min
-> will rise Na by approximatel 3mmol and stop fitting
176
When is likely to have arrythmias concerning K levels?
> 7.5 mmol/l
177
Salbutamol a hyperkalemie:
age:
< 2.5 2.5 mg
< 7.5 5 mg
> 7.5 10 mg
- snizi K o cca 1 mmol/l
178
Hyperkalemie - terapie:
1. If arrhytmia present: Ca gluconate 10% IV 0.5ml/kg
2. If not => Salbutamol INH, then check
3. If falling => Ca resonium PO/PR 1g/kg
If not => pH NaHCO3 1-2 ml/kg
pH > 7.34 => Glc 10% 5ml/kg + Insulin 0.05 U/kg/hod IV
179
DKA - treatment:
- fluids 10ml/kg aliquotes
- rehydratation for 48hours
- insulin 1 hour after fluids start 0.05 U/kg/hour
- risk of cerebral oedema => treat with mannitol
180
Ametop gel
- analgesia after 35 - 40 min
| - remains 4 - 6 hours
181
EMLA - gel
- start after 60 min
| - tends cause vasoconstriction
182
Lidocaine:
- start within 2mins
- work 2 hours
- max 3 mg/kg
- with adrenalin 7 mg/kg
183
Bupivacain
- start 15 min
- works 8 hours
- max 2 mg/kg
184
Fentanyl - intranasal:
1.5 ucg/kg
185
Diamorphin intranasal:
0.1 mg/kg
186
Codeine
dose: 1 - 1.5 mg/kg
effect: 4 - 6hod
187
Paracetamol
loading dose: 20 mg/kg (PR 40 mg/kg) á 6hod
max: 90 mg/kg
<3 month: 20/30 (max 60)
188
Diclofenac
0.3 - 1 mg/kg PO á 8hod
ne pod 6 mesicu
189
Croup - treatment:
- harsh stridor, barking cough
- Parainfluenza, RS, Adenovirus
- Adrenalin INH 0.4 ml/kg
- Dexamethason 0.15 mg/kg IV / Budesonid 2mg INH
190
Bacterial tracheitis - treatment:
= pseudomembranaceous croup
- Stafylokok, Streptokok, Hemophilus => purulent secretions
- ATB Cefotaxime + Flucloxacilin
191
Epiglottitis - therapy:
- > 1 year, high fever, cough minimal, onset 3-6 hours
| - intubation + Cefotaxime
192
Wheeze - basic dif.:
- Asthma > 1 year
| - Bronchiolotis < 1 year
193
Acute severe asthma:
Too breathless to feed or talk
RR: >50/min (2-5 yrs) >30 (>5yrs)
HR: >120/min (2-5 yrs) >130 (>5yrs)
194
Asthma - emergency:
- O2 (flow 6-8 l/min) -> spO2 94-98%
- Salbutamol 5mg (2.5 < 5yrs) INH
Ipratropium 250ucg (125 <2yrs) INH
- Prednisolon 1mg/kg PO / HCT 4 mg/kg
195
Non- responding astma:
- Salbutamol IV 15ucg/kg (5ucg<2yrs) for 10min
dale: 1-5ucg/kg/min
- Magnesium 40mg/kg for 20min
- Aminophylline 5mg/kg for 20min
dale: 1mg/kg/hod
196
Bronchiolitis - management:
- O2, fluids
- Adrenalin INH (uncler)
- Ribavirin or Palivizumab INH (uncler)
agens: RS
salbutamol, steroids, ATB of no proven value
197
Duct-dependent congenital heart disease - signs:
- baby < 4 weeks
- cyanosis unresponsive to O2
- signs of heart failure
- absent femoral pulses
198
Duct-dependent congenital heart disease - treatment:
- O2 (CAVE: little benefit, may accelerate duct closure)
- low threshold for intubation
- Prostin IV 5 nanograms/kg/min (can be up to 20)
- > can cause vasodilatation a drop in BP
199
Meningokokova sepse - cardinal signs:
- purpuric rash
- > 15% erythematous rash is first
- > 7% no rash
200
Threshold for blood:
Hb 50 g/l
- if urine is dark-brown => hemolysis suspected
- usually sepsis with sickle-cell disease
201
Atropin u bradycardie:
- 20 ug/kg á 5min (min 100 - max 600)
up to the dose: 1mg (child), 2mg (adolescent)
- trachealne: 40 ug/kg
202
How to distinguish between SVT and sinus tachycardia:
- SVT > 220, sin.tachycardia <
- sin.tachycadia => vary beat-to-beat and is responsive to stimulation
- termination of SVT is abrupt
- P-waves: - SVT -> neg.in II,III, aVF
- ST -> pos.in I, aVF
203
SVT - treatment:
1. vagal manoeuvre (masaz, diving reflex, valsalva)
2. consider shock if unstable - synchronous 1J/kg -> 2J/kg
Adenosin 100mcg/kg - 2 min - 200mcg/kg - 2min - 300mcg/kg
- up to 500 (<1 month 300), max: 12mg
3. Amiodarone 5mg/kg for 20min (30 for neonates)
204
Normal drop of pO2 between inspired and alveolar oxygen is:
7.5 kPa
205
Volume of cylinders:
D 340 l
E 680 l
F 1360 l
206
Anion gap is higher:
> 18
- etanol, metanol
- etylenglykol
- salicylaty, zelezo
207
Activated charcoal:
- not for: iron, alcohol
| - dose: 25 - 50 g (at least 10 times estimated dose)
208
Poison - Iron:
- if over 20 mg/kg -> toxicity likely (>150 is fatal)
=> shock usually due to gastric hemorrhage, vomiting, diarhea
=> gastric lavage, no charcoal, Desferioxamin 15mg/kg/hod
209
Poisoning - TCA:
- intraventricular conduction delay => QRS widening
- tachycardia, mydriasis, convulsion
=> pH ~ 7.5 (bicarbonates), hyperventilation
Lidocaine, Phenytoin may help
210
Paracetamol - poisoning:
- unlikely < 150mg/kg
- charcoal
- Acetylcystein
211
Poisoning - Salicylates:
- slow stomach emptying - lavage up to 4 hours
- charcoal
- measure at 2 hours
- alkalinization of patient
212
Poisoning - Ethyleneglycol:
- etanol 2.5 ml/kg 40% -> goal 100mg/dl
213
Cocaine - poisoning:
- benzodiazin (Diazepam, Lorazepam)
- aspirin
- heparin
- NaHCO3
- Betablokry jsou kontraindikovany -> use shocks
214
Poisoning - ectasy:
- charcoal
- ,diazepam
- if >39 => dantrolen 2-3 mg/kg for 15 min
