Pediatric Flashcards
(162 cards)
1
Q
Most children requiring urgent EMS intervention have?
A
Primary respiratory problem
2
Q
What percentage of pediatric cardiac emergencies originate from respiratory arrest?
A
80 - 90%
3
Q
Assessment of pediatric respiratory status should focus on?
A
General appearance
Work of breathing
4
Q
General appearance in pediatric emergency assessment should be judged by?
A
Alertness Distractability Consolability Eye contact Speech/cry Spontaneous Color
5
Q
Work of breathing for pediatrics is judged by?
A
Use of accessory muscles Respiratory rate Tidal volume Nasal flaring Grunting Cyanosis Pulse oximeter Lung sounds
6
Q
Causes of pediatric airway obstructions?
A
Tongue Foreign bodies Swelling of upper airway due to angio neurotic edema Trauma Infections
7
Q
What is essential to determine proper treatment in upper airway obstructions?
A
Cause
8
Q
How do you try and relief FBAO in unresponsive infants?
A
Chest thrusts and back blows
9
Q
High pitched “crowning” sound caused by restriction of the upper airway(usually herd on inspiration)?
A
Stridor
10
Q
What airway sound can be caused by FBAO and Croup or Epiglottitis?
A
Stridor
11
Q
What is laryngotraceobronchitis?
A
Croup
12
Q
A viral infection of the upper airway, which causes edema/inflammation below the larynx and glottis with resulting narrowing of the lumen of the airway is called?
A
Croup
13
Q
Croup most often occurs in what age children?
A
6 months to 4 years
14
Q
A child with croup will typically have?
A
Stridor
Distinctive barking cough
Cold symptoms(low grade fever)
Gradual onset of respiratory distress
15
Q
An acute infection and inflammation of the epiglottis that is life threatening is called?
A
Epiglottitis
16
Q
Epiglottitis occurs in children ages?
A
4 years and older
17
Q
Signs and symptoms of epigottitis?
A
Stridor Acute respiratory infection Sore throat Pain upon swallowing Distinctive drooling High grade fever(102-104) May be in the tripod position
18
Q
When should you avoid IV’s in the respiratory distressed pediatric?
A
In patients with upper airway emergencies
You must avoid any procedure that will agitate the patient
19
Q
In the patient with epiglottitis you should?
A
Avoid agitating
Keep in position of comfort
Have them held by parent
Never inspect the epiglottis
20
Q
If no humidified oxygen is available for the Croup/Epiglottitis patient you should adminsiter?
A
Nebulized saline
Do not force mask, use blow by if necessary
21
Q
What patient do you administer 3-5 mL of aerosolized Epi 1:1000 to?
A
Croup patient only
22
Q
Aerosolized Epi is contraindicated in ?
A
Epiglottitis patients
23
Q
What sound is associated with narrowing of spasm of the smaller airway which is usually herd on expiration?
A
Wheezing
24
Q
Wheezing in children younger than 1 year of age usually is associated with?
A
Bronchiolitis
25
What is bronchiolitis?
A viral infection of the bronchioles that cause prominent expiratory wheezing
Clinically resembles asthma
26
What different factors can cause asthma?
```
Environmental
Cold air
Exercise
Foods
Irritants
Certain medications
```
27
Asthma is?
Chronic inflammatory disease
28
The first phase of asthma is associated with?
Histamine release which causes Bronchoconstriction and bronchial edema
29
Early treatment with what medication may reverse bronchospasm?
Bronchodilators
30
The second phase of asthma consists of?
Inflammation of the bronchioles and additional edema
This phase does not usually respond to bronchodilators
Anti inflammatory is typically required
31
Why may the asthma patient not have wheezing?
In severe asthma attacks patients may not wheeze at all due to lack of air flow
32
Asthma patients will typically be?
Tachypneic with unproductive cough
33
Albuterol in the pediatric patient less than 1 years old or 10 kg?
1.25mg/1.5 nebulized
| May be repeated twice
34
Albuterol dose for pediatric greater than 1 years of age or 10 kg?
2.5 mg/3 mL
35
Atrovent dose for pediatric less than 8 years of age?
0.25/1.25mL
36
Atrovent dose for pediatric over 8?
0.5mg/2.5 mL
37
If respiratory distress is severe in the pediatric patient you should adminsiter?
Epi 0.1mg/kg 1:1000 IM
38
What is the max dose of Epi 1:1000 in the pediatric respiratory distress patient?
0.3 mg
39
ALS level 2 for pediatric lower airway severe dyspnea is?
Mag sulfate
| Repeat Epi 1:1000
40
Dose of mag sulfate in ALS level 2 for pediatric respiratory distress?
40 mg/kg IV mixed in 50 ml of D5W given over 15-20 minutes
| Max dose 2g
41
Cardiac arrest in the pediatric patient is usually end result of?
Hypoxemia and acidosis from Respirtory insufficiency from shock
42
Initial support for the pediatric patient with cardiac dysrhythmias should be to the?
Respiratory system
43
What three categories can pediatric dysrhythmias be classified into?
Slow
Fast
No rhythm
44
What is the most common pediatric dysrhythmia ?
Bradycardia
45
What is the most common cause of bradycardia in pediatrics?
Hypoxia or acidosis
46
Tachycardia in pediatrics will be?
Compensatory mechanism
| Or reentry mechanism
47
V-fib in pediatric patients is?
rare, but usually result of hypoxia
48
Asystole in pediatric patients is usually caused by?
Prolonged untreated bradycardia
49
AED's may be used on which pediatric patients?
Ages 1-8 who have no signs and symptoms of circulation
50
Asystole/PEA protocol is used for which other cardiac rhythms other than those?
```
Electromechanical dissociation
Pseudo-EMD
Idioventricular rhythms
Bradyasystolic rhythms
Post defibrillation idioventricular rhythms
```
51
How much fluid should be given the the pediatric patient over 1 years old?
20 mL/kg
52
How much fluid should be given to the neonate patient?
10 mL/kg
53
Epi 1:10,000 in pediatric asystole/PEA dose?
0.01 mg/kg IV/IO
| Max dose 1 mg
54
In asystole/PEA pediatric patient is taking calcium channel blockers or with high suspicion for hyperkalemia what medication should be administered?
Calcium chloride
55
Pediatric calcium chloride dose?
20 mg/kg
| IV/IO slowly
56
How do you treat a patient who is less than 1 years old with a BGL of less than 60?
D10
5 mL/kg
IV/IO
57
How do you treat a patient who is between 1 and 8 years of age with a BGL of less than 60?
D25
| 2 mL/kg
58
How do you treat a patient over the age of 8 with BGL of less than 60?
D50
| 1 mL/kg
59
Glucagon dose for pediatrics?
Less than or equal to 20 kg - 0.5 mg IM
| More than 20 kg - 1 mg IM
60
How many cycles of CPR should you perform in pediatrics prior to re checking a heart rhythm?
10 cycles
61
Narcan dose for pediatrics?
0.1 mg/kg
62
How many times may narcan be repeated in Asystole/PEA?
Once
63
How can epi be administered as a last resort in pediatric asystole/PEA?
ETT
64
What is the max dose of Epi 1:1000 for ETT administration in pediatric cardiac arrest?
2 mg
65
Dose of epi for ETT administration for pediatric cardiac arrest?
1: 1000
| 0. 1 mg/kg
66
Causes of symptomatic bradycardia in pediatrics?
```
Hypoxemia
Hypothermia
Head injury
Heart block
Heart transplant
Toxins
```
67
A pediatric with a HR of less than ___ and ____________ is considered symptomatic bradycardia?
Less than 60 with poor systemic perfusion
68
What should you do with a pediatric with a HR of less than 60 and poor systemic perfusion?
Begin chest compression
69
In pediatric patients with symptomatic bradycardia what medication should be given with fluids?
Epi 1:10,000
| 0.01 mg/kg
70
What medication should be given to pediatrics with symptomatic bradycardia after epi 1:10,000?
Atropine
| 0.02 mg/kg
71
What is the minimum single dose of atropine in pediatric symptomatic bradycardia?
0.1 mg
72
How many times may you repeated atropine in pediatric symptomatic bradycardia?
Once
73
What is the preferred benzo when preparing to pace the pediatric symptomatic bradycardia patient?
Versed
74
when would you consider external pacemaker in the symtomatic bradycardia pediatric patient?
Hypotensive and bradycardia after epi and atropine
75
What is the pediatric dose of versed?
0.1 mg/kg
Max dose 4 mg
IV, IO, IM
76
Can versed be given IN for the pediatric patient?
Yes
0.2 mg/kg
Max dose 5 mg
77
If versed is unavailable for external pacemaker in pediatrics you can you?
Diazepam
0.2 mg/kg
IV/IO/IN
Max dose 10 mg
78
If pediatric bradycardia is suspected to be caused by increased vagal tone or primary AV block you should?
Administer atropine before epi
79
What can small doses of atropine cause?
Paradoxical bradycardia
| Less than 0.1 mg
80
What is the max single dose of atropine in pediatrics?
0.5 mg
81
Narrow complex tachycardia is a QRS less than or equal to?
0.08
82
What two types of tachycardia do you see in pediatrics?
- Sinus tachcyardia
| - Supraventricular tachycardia
83
Sinus tachycardia for a child is a rate greater than?
180
84
Sinus tachycardia in infant is rate greater than?
220
85
Supraventricular tachycardia for infants is rate above?
220
86
If a patient is greater than 2 years old, supraventricular Tachcyardia may be?
180-220
| May be lower
87
Because wide complex SVT's are rare in children, they should be considered?
Ventricular unless proven otherwise
| Documented QRS morphology consistent with preexisting BBB or WPW
88
In pediatrics with stable SVT what can you do for ALS level 1 care?
Fluid challenge
89
Level 2 orders for pediatric stable SVT?
Vagal maneuvers and adenosine
90
What vagal maneuver should be attempted first in pediatrics with SVT's?
Ice water
91
What is the dose of adenosine for ALS level 2 stable pediatric SVT?
0. 1 mg/kg, max dose 6 mg, followed by 6 mL flush
| 0. 2 mg/kg, max dose 12 mg, followed by 6 mL flush
92
For unstable pediatrics with SVT when would you give adenosine?
If the patient is responsive
93
If a pediatric patient is unstable with SVT and poorly responsive you should?
Synchronized cardiovert them
94
What is the initial joules setting for unstable pediatric SVT?
0.5 joules/kg
95
If a patient in pediatric SVT remains poorly responsive after 0.5 joules/kg cardioversions you should?
Cardiovert at 1 joule/kg
96
If a patient with SVT remains poorly responsive after 1 joule/kg cardioversion you should?
Cardiovert at 2 joule/kg
97
Prior to converting a pediatric patient you should consider sedation with?
Versed
0.1 mg/kg
Max single dose of 4mg IV, IO, IM
Max total dose
98
Can versed be given IN in pediatrics?
Yes
0.2 mg/kg
Max dose 5 mg
99
If versed in unavailable to give pediatrics in unstable SVT for sedation prior to cardioversion what can be given instead?
Valium
0.2 mg/kg
Max single dose 5 mg
IV, IO, IN
100
Prior to cardioverting a unstable pediatric with SVT you should?
Record patients heart rhythm
101
Should you delay cardioversion of the unstable pediatric for IV access for sedation?
No
102
How do you treat stable V-Tach in the pediatric patient ALS level 1?
There are no ALS level 1 orders for this
103
ALS level 2 orders for stable pediatric V-tach?
Amiodarone
5mg/kg IV over 20-60 minutes
ALS level 2 order
104
How do you treat unstable V-tach in the pediatric patient?
Synchronized cardioversion
| 0.5, 1, 2 joules/kg
105
If a pediatric patient converts from unstable v-tach with synchronized cardioversion and is normotensive you should?
Consult medical control for ALS level 2 orders on amiodarone
| 5 mg/kg over 20 minutes
106
Compressions to ventilations ratio for pediatrics pulseless v-tach/v-fib?
15:2
107
What joules do you initially defibrillate at for the Pulseless pediatric v-tach/v-fib?
2 to 4 joules/kg
108
How many cycles of CPR should you administered after defibrillating v-tach/v-fib patient?
10
109
What joules do you defibrillate at for your second shock of pediatric pulseless v-tach/v-fib?
4 joules
110
What is the dose of epi in the pediatric pulseless v-tach/v-fib patient?
0.01 mg/kg IV/IO 1:10,000
| May be repeated every 3-5 minutes
111
Dose of Amiodarone in pulseless pediatric v-tach/v-fib?
5 mg/kg
| IV/IO
112
If a pediatric has torsades de pointes in pulseless wide complex tachcyardia you should?
Administer Mag sulfate
113
Pediatric mag sulfate dose for tosades de pointes?
25-50 mg/kg IV/IO
Max dose 2 mg
Given over 2 minutes
114
Infant and newborn cardiopulmonary arrest is usually result of?
Prolonged poor oxygenation and or severe circulatory collapse
115
If a newborn has signs of meconium after suctioning with bulb syringe and not virorously crying you should?
Intubate the trachea using the meconium aspirator
116
How quickly should you administer blow by oxygen to newborns that are breathing but have central cyanosis or no improvement in respiratory, circulatory, or neurological status?
Within 90 seconds
117
What situations should you ventilate a newborn?
Apnea
HR less than 100/min
Persistent central cyanosis
118
At what rate should you ventilate a newborn?
40-60 BPM
119
What conditions should you place an advanced airway in the newborn patient?
BVM ineffective after 2 minutes
Tracheal suctioning is required
Prolonged positive pressure ventilation needed
120
What rate should you perform chest compressions on the newborn patient?
120 min
121
When should you perform compressions on newborn patients?
HR less than 100 and not rapidly increasing despite adequate ventilations with 100% oxygen for approximately 30 minutes
122
When would you administer epi 1:10,000 0.01 mg/kg to the newborn patient?
Asystole
| Hr less than 60 BPM despite adequate ventilation with 100% oxygenation and 30 seconds of chest compressions
123
When should a fluid challenge of 10 mL/kg to a newborn?
Pallor that persists after oxygenation
Faint pulses with a good HR
Poor response to resuscitation with adequate ventilations
124
What should you check in all newborn resuscitations who do not respond to initial therapy?
Blood glucose
125
how should you check blood glucose in newborns?
Heel stick
126
When would you administer D10 5 ml/kg IV/IO to newborns?
Blood glucose less than 40
127
Whens should you perform the pediatric assessment triangle in newborn resuscitation?
Frequently
128
When would you administer narcan to newborns during resuscitation?
When newborn is unresponsive with depressed respirations
| This is a ALS level 2 order
129
In which position should a newborn being resuscitated be placed in?
On there back or side with neck in neutral position
130
How can you help maintain body position in newborn resuscitation?
Place a rolled towel under the back and shoulders of the supine newborn to elevate the torso 0.75 to 1 inches off the mattress to extend the neck slightly
131
How should you position the newborn being resusicatated if there are copious amounts of secretions?
On side with neck slightly extended to allow for secretions to collect on side of mouth rather than posterior pharynx
132
How should tracheal suctioning for think meconium be done?
Via ETT using meconium aspirator attached to the 15mm adaptor of ETT
Suction at low pressure
No more than 100
133
How long should meconium suctioning be performed?
Until ETT is clear
Max 5 seconds
It may be necessary to repeat, max 3 times
134
When should you avoid narcan in newborn resuscitation?
If there is a HX of drug use/abuse
135
Why should you avoid the use of narcan in newborn resuscitation if mother has hx of drug abuse?
It may precipitate seizures
136
When does SIDS almost always occur?
When the infant is asleep or thought to be asleep
137
SIDS usually occurs in apparently healthy infants?
Less than 1 years old
138
Some SIDS deaths are mistaken for?
Child abuse
139
In most SIDS instances, resuscitation should be?
Attempted
140
Causes of pediatric AMS?
```
Hypoxia
Head trauma
Ingestion/poison
Infection
Hypoglycemia
```
141
Seizures can be caused in pediatrics by?
```
Underlying disease
Fever
Trauma
Hypoxia
Infection of brain or spinal cord
Hypoglycemia
Ingestion/poisoning
```
142
Signs of altered mental status in pediatric patients include?
```
Combative behavior
Decreased responsiveness
Lethargy
Weak
Cry
Moaning
Hyptonia
Ataxia
Changes in personality
```
143
Initial approach to AMS in pediatrics should be towards?
```
Infection
Hypoxia
Ischemia
Hypoglycemia
Dehydration
```
144
Secondary approach to AMS in pediatrics should be towards?
```
Mediations
Illicit drugs/alcohol
Plants
Trauma
Other factors
```
145
How do you treat hypoglycemia in pediatrics less than 1?
D10
5 mL/kg
IV/IO
146
How do you treat hypoglycemia in pediatrics less than 8 but older than 1?
D25
2 mL/kg
IV/IO
147
How do you treat hypoglycemia in pediatrics over 8?
D50
| 1 mL/kg
148
Glucagon dose for pediatrics less than or equal to 20 kg?
0.5 mg IM
149
Glucagon dose for pediatrics over 20 kg?
1 mg IM
150
How often should narcan be repeated in pediatrics with AMS and depressed respiratory effort?
Every 5 minutes
151
What is the dose of narcan for AMS in pediatrics with respiratory depression?
0.1 mg/kg
Max dose 2 mg
May be repeated every 5 minutes as needed
152
What medication can be given to restrain the pediatric patient?
Valium
Versed
Banadryl
153
Dose of Benadryl for pediatric sedation?
1 mg/kg
| Max dose 50 mg IM or IV
154
What should you do prior to administering Benadryl IV to the pediatric patient?
Dilute in 9mL of NS
155
If intubating a pediatric overdose patient what style tube should you use?
Cuffed tube to prevent aspiration
156
At what rate should fluid be giving to sickle cell anemia pediatrics?
20 mL/kg
| 10 mL/kg for neonates
157
Morphine sulfate may be given to pediatric sickle cell anemia patients how?
0.1 mg/kg
IV
Max dose 4mg
Do not exceed 1 mg/min
158
Can a second dose of morphine be given to sickle cell anemia pediatric patients?
```
Yes it is a level 2 order
May be given 3-5 minutes after 1st
Systolic BP must be adequate
Same dose as first
Max dose 10 mg for all children
Do not exceed rate of 1mg/min
```
159
What is the max total fluid that can be given to pediatric trauma patients?
60 mL/kg
160
What should you do to pediatric patients who present with signs and symptoms of brain stem hernation?
Consider advanced airway
Ventilate child a 20 BPM
Ventilate infant at 30 BPM
161
For massive flail segments with respiratory compromise in pediatrics you should ventilate at?
20 BPM for child
30 BPM for infant
Consider advanced airway
162
For infants with traumatic asphyxia when administering sodium bicarbonate you must?
Dilute from 8.4 to 4.1%
