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Patient Care Theory > pediatric a/w +trauma > Flashcards

pediatric a/w +trauma Flashcards

1
Q

physiological differences of peds anatomy….

A
  • larger head, larger tongue, higher larynx, flat/flexible epiglottis thats funnel shaped, vocal cords are lower and more forward, less residual long capacity
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2
Q

resistance to air flow formula?

A

=inversly proportionate to the 4th power of the radius of the airway

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2
Q

size of infant airway?

A

4mm across while adults are 8mm a

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3
Q

how should you lay your pediatric pt down?

A

rolled towel/blanket under the patient shoulders to align a/w! do not over extend neck, sniff position, chin life to move tongue out tf the way

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4
Q

what are common ages to have mechanical airway obstructions?

A

12-24 months

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5
Q

how to treat airway obtructions?

A

basic maneuvers, Back-blows/chest thrust?abdo thrusts, suction at (80mmhg-100mmhg)

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6
Q

child vsa

A

1 analysis than transport (unless vf-3 analysis then transport), 2 breaths- 15 compressions ( solo), check a/w after 1 round *noadjuncts for FBAO

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7
Q

what is CROUP?

A

Laryngotacheobronchiolitis
- subglottic airway infection usually affecting pt ages 3months-3 years old,Hx of URTI/fever/runny nose etc. causes major airway swelling, baring cough at night time, slow onset (24-72 hours), impending respiratory failure

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8
Q

management for croup?

A

blow by O2 w/ simple face mask, NRB if tolerated, neb EPI, dexamethasone, PPV prn, cold air

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9
Q

indications for nebulize epi?

A

current history of URTI

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10
Q

conditions for neb epi?

A

> 6 months-8 yrs old, hr=<200bpm, stridor at rest

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11
Q

Contraindications for epi?

A

allergy/sensitivity

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12
Q

croup standard tx?

A

weight=<10kg, route: NEB, concentration: 1:1000, dose=25mg, ma single=25mg, max #=1
Weight>10kg, dose=5mg, max single=5mg, max#=1

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13
Q

what is epiglotitis?

A

supraglottic viral infection with a rapid onset of high fever, drooling, SOB/stridor w/ retractions

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14
Q

epiglotitis management?

A

keep kid calm ( w parent), DO NOT INSPECT A/W, sniff possition, O2, ppv w/ BVM prn, support under the pt shoulders for alignment!

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15
Q

pediatric respiratory triangle

A

1)appearance: muscle tone, speech, retractions etc
2) circulation: pallor, cyanosis, mottling
3) WOB: abnormal?head bobbing?nasal flare?

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16
Q

what is the pediatric Tidal volume?

A

5-6mls/kg, vent till you see chest rise & fall

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17
Q

why is a scared child crying concerning?

A

+secretions, +aw irritability, +risk of laryngospasms, +a/w edema+wheeze

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18
Q

normal breathing rates for peds:

A

3months-6months: 25-45bpm
0-3months:30-60bpm
*higher metabolic demand

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19
Q

presentation of aspiration in peds?

A

dyspnea/tachypnea, fever, crackles, pleural rib, decreased breath sounds

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20
Q

Asthma:

A

chronic a/w inflammation and bronchial hyperactiviry causing bronchospasms and air trapping when exacerbated (ex exercise). will have dyspnea/tachypnea, tachycardia, chest tightness, pulsus paradoxus

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21
Q

triad for asthma:

A

dyspnea, wheeze, cough

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22
Q

what is pulsus paradoxus?

A

when you SBP changes by 10 sd during inspiration

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23
Q

Status asthmaticus:

A

caused by an acute exacerbation. pt is unresponsive to initial bronchodilators and will be hypercapnic–> resp fialure & retarctions&wheeze& pneumo, lethargy
- give pt epi first, then bag so air can get in

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24
Q

CF?

A

cyctic fibrosis genetic disorder characterized by abnormal Cl- ion transport on the surface of the epithelial cells in the exocrine glands causing sticky thick secretions of mucous that obstructs small bronchioles.
- airtrapping, electrolyte imbalances, digestive issues, salty skin on babies, dyspnea, chronic cough, sputum, fracturs

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25
Q

Bronchiolitis (febrile disorder)

A

inflammation of the small airways in the lower resp tract—> necrosis caused by RSV. common in ages 1-12 months, <2 yrs)
presentation: recent fever/cold, dyspnea, wheeze, crackles, chest retarctions

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26
Q

pneumonia

A

can be bacterial, virus, or fungal, commonly strep. Inflammation of the lung parenchyma–> aveolar exudate.
presentation: fever, dyspnea, sputum or not, pleuritic cp, unilateral crackles

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27
Q

management for pneumonia?

A

posiiton of comfort, O2 therapy, PPV prn, salbutamol, bronchidlators, NEB.aero chamber…

28
Q

Bronchconstriction ALS PCS indications….

A

EPI- NBM vent required, Hx of asthma
dex- Hx of asthma CR, COPD, or 20 pack-year hx
salbutamol- none

29
Q

contraindications for bronchoconstriction management?

A

salbu: allergy
Dex: allergy/currently on PO/parental steroids (systemic)
EPI: allergy

30
Q

Salbutamol Tx:

A

weight:<25kg, route: MDI, Dose up to 600 mcg (6puffs), max single=600mg, dose int:5-15mins prn, 3x
- route:NEB, dose 25mg, max single=25, 3x, int-5-15mins
weight>25kg
- routeMDI, dose:up to 800 mcg ( 8puffs), max single=800mcg, dose int:5-15min, 3x
route: NEB, dose=5mg, max single=5mg, 5-15mins, 3x

31
Q

consider epi tx for broncho constriction?

A

route:IM, dose: 0.01mg/kg, 0.5mg, 1 dose

32
Q

what drug should be deliver first if pt is apneic? which is second?

A

1) epi 2)salbutamol subsequently

33
Q

how often to peds traumas occur?

A

25% of traumatic injuries occur in peds, common: fire, homicide, TBI, MVC, suicide

34
Q

Hypovolemia?

A

extreme blood loss from the body—> shock due to poor perfusion and loss of blood vol
management: stop bleeds, keep warm, CPR:low hr <60bpm/pulseless/signs of hypoperfusion, decreased LOA, IV access 20cc/KG fluid bolus (patch)

35
Q

tx for different types of shock?

A

Hypovolemic: most common in kids due to hemorrhage, diarrhea, vomit, DKA, poisoning, 20ml/kg over 5 mins lost
cariogenic: 5-0ml/Kg over 60-120mins
septic: 20 ml/kg start(may need up to 60 ml/kg
DKA: patch required for 10-20ml/kg over 1-2 hrs

36
Q

common causes of TBI

A

infancy: (non-accidental traumas), falls,
childhood: MVA, pedestrian struck, bicycle
adolescence: MVA, pedestrians, bike, boards, violence
*men=5x more likely to get tbi

37
Q

S/s for tbi?

A

LOC changes, pupil size/reactivity changes, postur(decebrate/laccid), decreased motor, vomit, changes in speech, vs changes(cushings triad:+sbp, -pulse, alt breathing), seizure activity, headache
infants: bulging fronttanels, cranial suture separation, +heard circumference, high pitched cry

38
Q

TBI management?

A

head at 30 degree angle, bvm rates

39
Q

chest traumas?

A

2nd most common( MVA,bike,falls), increased mediastinal mobility(+tension pneumo).

40
Q

abdo trauma?

A

3rd leading cause of traumatic death
seatbelt–> small bowel injury/fractures
Handle bar: duodenal hematoma/pancreatic injury
sport related: spleen/kidneybowel

41
Q

Burns:

A

70%–>hot liquids, 20%–> abuse/neglagence
- lots of fluid loss ( to interstitial fluid shift),
management: ppe, analgesics, fluid resus(IV/20cc/lg)

42
Q

submersions

A

drowning: respiratory impairment
near drownings: survial=within 24 hours of submersion
- >50% of drown victims=<5 y/o (peak 1-2 yrs/o)(deaths= higher in men)
most common cause of cardiac arrest in children:<1yr-bathtubs55%, 1-4yrs=pools 56%, >4yrs freshwater(63%)

43
Q

submersion patho?

A

loss of normal breath pattern and possible laryngospasm causing aspiration, apnea, & hypoxia ( hypercarbia–> organ damage)

44
Q

submersion management?

A

take off wet clothes, tx hypothermia,

45
Q

bradycardic rhythms in peds?

A

hr<100 in NB & <80 in a small child= very slow
*tier acp, O2, transport

46
Q

Tachycardic rhythms in peds/

A

hr<180bpm
- causes: hyperthermina, toxicity, hypoxemia, metabolic stress

47
Q

peds SVT?

A

often occurs in PSVT 60% ar >200-300bpm.* hr >180 in peds=SVT until proven otherwise
presentation: depends on age, lightheadedness, dizzy, chest tightness, delayed cap refill
*can lead to chf

48
Q

Ventricular tachycardia

A

*uncommon usually caused from underlying structural heart disease like myocarditis
causes: acute hypoxemia, acidosis, electrolyte imbalance, toxins

49
Q

CPR in children until showing signs of puberty?

A

Hr<60, signs of hypo-perfusion

50
Q

how to estimate peds weight?

A

age x2+10=weight in kg

51
Q

causes of dehydration in peds?

A

vomit, diarrhea, DKA
–>electrolyte imbalance, potential arrhythmias
management: supportive, minimal scenentime, warm pt

52
Q

meningitis:

A

inflammation/infection of the meninges can be bacterial or viral
s/s: fever, alt loa, bulging frontanelle, rash non-blanching, shock

53
Q

seizures s/s:

A

lateralized tongue bitting, flickering eyelids, dilated pupils, lip smacking, +hr/BP+, post ictal phase

54
Q

generalized seizures

A

loss of awarness & both hemispheres of the brain,ex:grand mal, tonic clonic

55
Q

focal seizures:

A

involve loss of awareness & only 1 side of brain, jerking motion but still conscious,

56
Q

simple febrile seizures:

A

age: 6months-5yrs
frequency: single seizure in 24hrs
Nature: generalized
duration: lasting<15mins
recovery: post ictal w return to base line & normal neuro exam (early onset of illness)

57
Q

complex febrile seizure

A

multiple in 24hrs
focal or generalized, prolonged duration, recovery; Post ictal may not fully return to normal if multiple seizures

58
Q

if a pt is post ictal for >10 mins you can assume…

A

status epilepticus

59
Q

SIDS

A
  • unknown etiology, suspected suffocation in bed , 10-200
60
Q

how often do we see toxicology in peds?

A

50% in kids <6yrs, consider <5=accidental or intentional

61
Q

poisonings

A

ca channel blockers/beta blockers ingested—>hypotension/weak heart contractility
ex: 2 glyburides (5mg each)—>fatal in toddler

62
Q

physical child abuse?

A

pt harmed by his/her caregiver/when caregiver fails to protect child.

63
Q

emotional abuse

A

neglecting/damage to peds self esteem from caregiver
ex: headaches w no med cause

64
Q

sexual abuse

A

sexula explotation of a child by a caregiver

65
Q

consider human trafficking when…

A

many EMS calls, Substance abuse, incongruent behavior

66
Q

neglect

A

pattern when a care giver fails to provide basic needs.

67
Q

failure to report to the CAS…

A

$1000 fine, duty overrides PHIPA

68
Q

pediatric GCS?

A

spontaneous eyes=4
opents to verbal commona=3
opens to pain=2
npne=1
speech
oriented/infant babbles:5
infant irritable &cries/confused=4
infant cries to pain/inappropriate response=3
infant moans to pain/incomprehensible speech=2
none=1
motor;
INFANT MOVES SPONTANEOUSLY=6
WITHDRAWS from touch=5
withdraws to pain=4
abnorm flexion to pain=3extends to pain=2
none=1

Patient Care Theory (8 decks)

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