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Flashcards in Emergency, PICU Deck (20)
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1

Gastroenteritis and ORT

Optimal Glucose:Na Ratio (1:1)

2

Signs of Dehydration - Mild

Mild (<5%) Slightly decreased urine output Slightly increased thirst Slightly dry mucous membrane Slightly elevated heart rate

3

Signs of Dehydration - Moderate

Moderate (5-10%) Decreased urine output Moderately increased thirst Dry mucous membrane Elevated heart rate Decreased skin turgor Sunken eyes Sunken anterior fontanelle

4

Signs of Dehydration - Severe

Severe (>10%) Markedly decreased or absent urine output Greatly increased thirst Very dry mucous membrane Greatly elevated heart rate Decreased skin turgor Very sunken eyes Very sunken anterior fontanelles Lethargy, Coma Cold extremities, Hypotension

5

Mild Dehydration - Management

Mild Dehydration (<5%) 1) Rehydrate with ORS (50mL/kg) over 4 hours 2) Replace ongoing losses with ORS 3) Age-appropriate diet after rehydration

6

Moderate Dehydration - Management

Moderate Dehydration (5-10%) 1) Rehydrate with ORS (100mL/kg) over 4 hours 2) Replace ongoing losses with ORS 3) Age-appropriate diet after rehydration

7

Severe Dehydration - Management

Severe Dehydration (>10%) 1) IVF with NS/RL (20-40mL/kg) over 1 hour 2) Reassess and repeat if needed 3) ORT when patient is stable

8

ORT Contraindications

-Prolonged vomiting despite small amounts -Severe dehydration -Impaired LOC -Paralytic ileus -Monosaccharide malabsorption

9

Indications for Odansetron

CPS Single dose ondansetron SHOULD be considered for children aged 6 months to 12 years who present to the ED with acute gastroenteritis and who have mild to moderate dehydration OR who have failed oral rehydration therapy

10

Definition of Shock

acute inability to deliver adequate O2 to meet metabolic demands of vital organs/tissues.

11

Types of Shock

-Septic -Hypovolemic -Obstructive -Cardiogenic -Distributive

12

SIRS - Systemic Inflammatory Response Syndrome

≥2/4 of (≥1* required): o *Temp >38.5, or <36 o *WBCs ↑ or ↓ or left shift >10% o Tachycardia or bradycardia o Tachypnea

13

Status Epilepticus Management

ABCs 1st line: Buccal midazolam> Rectal diazepam, intranasal midazolam = IV lorazepam 2nd line: Fosphenytoin/phenytoin > phenobarbital

14

Asthma Exacerbation Management

15

Injuries Caused by Smoke Inhalation

1) Acute asphyxia

2) Thermal injury to upper airways

3) Chemical injury to tracheobronchial tree

4) Systemic poisoning - CO +/- cyanide

16

How is Oxyhemoglobin measurement affected by CO poisoining?

Percentage of oxyhemoglobin is OVERESTIMATED in CO poisoning and methemoglobinemia

17

Smoke inhalation - Intubation Indications

Intubation if:

-Stridor

-Increased WOB

-Resp distress

-Hypoventilation

-Deep burns to face/neck

-Oropharynx blistering/edema (develops in 1st 24h)

18

Head Trauma Severity and GCS

Mild: GCS 14-15

Moderate: GCS 9-13

Severe: GCS <9

19

Head Trauma CT Indications

  • GCS <15 at 2h after injury
  • Suspected open/depressed skull #
  • Worsening headache
  • Irritability on examination
  • Basal Skull # signs - hemotympanum, racoon eyes, CSF oto/rhinorrhea, Battle's sign
  • Large, boggy hematomy of scalp
  • Dangerous MOI ( MVC, fall from >3ft, bicycle without helmet)
  • Not in rule, but also CT if focal neuro abN on exam or suspected depressed skull #

20