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pediatric a/w +trauma Flashcards

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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
CF?
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
25
Bronchiolitis (febrile disorder)
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
26
pneumonia
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
27
management for pneumonia?
posiiton of comfort, O2 therapy, PPV prn, salbutamol, bronchidlators, NEB.aero chamber...
28
Bronchconstriction ALS PCS indications....
EPI- NBM vent required, Hx of asthma dex- Hx of asthma CR, COPD, or 20 pack-year hx salbutamol- none
29
contraindications for bronchoconstriction management?
salbu: allergy Dex: allergy/currently on PO/parental steroids (systemic) EPI: allergy
30
Salbutamol Tx:
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
consider epi tx for broncho constriction?
route:IM, dose: 0.01mg/kg, 0.5mg, 1 dose
32
what drug should be deliver first if pt is apneic? which is second?
1) epi 2)salbutamol subsequently
33
how often to peds traumas occur?
25% of traumatic injuries occur in peds, common: fire, homicide, TBI, MVC, suicide
34
Hypovolemia?
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
tx for different types of shock?
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
common causes of TBI
infancy: (non-accidental traumas), falls, childhood: MVA, pedestrian struck, bicycle adolescence: MVA, pedestrians, bike, boards, violence *men=5x more likely to get tbi
37
S/s for tbi?
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
TBI management?
head at 30 degree angle, bvm rates
39
chest traumas?
2nd most common( MVA,bike,falls), increased mediastinal mobility(+tension pneumo).
40
abdo trauma?
3rd leading cause of traumatic death seatbelt--> small bowel injury/fractures Handle bar: duodenal hematoma/pancreatic injury sport related: spleen/kidneybowel
41
Burns:
70%-->hot liquids, 20%--> abuse/neglagence - lots of fluid loss ( to interstitial fluid shift), management: ppe, analgesics, fluid resus(IV/20cc/lg)
42
submersions
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
submersion patho?
loss of normal breath pattern and possible laryngospasm causing aspiration, apnea, & hypoxia ( hypercarbia--> organ damage)
44
submersion management?
take off wet clothes, tx hypothermia,
45
bradycardic rhythms in peds?
hr<100 in NB & <80 in a small child= very slow *tier acp, O2, transport
46
Tachycardic rhythms in peds/
hr<180bpm - causes: hyperthermina, toxicity, hypoxemia, metabolic stress
47
peds SVT?
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
Ventricular tachycardia
*uncommon usually caused from underlying structural heart disease like myocarditis causes: acute hypoxemia, acidosis, electrolyte imbalance, toxins
49
CPR in children until showing signs of puberty?
Hr<60, signs of hypo-perfusion
50
how to estimate peds weight?
age x2+10=weight in kg
51
causes of dehydration in peds?
vomit, diarrhea, DKA -->electrolyte imbalance, potential arrhythmias management: supportive, minimal scenentime, warm pt
52
meningitis:
inflammation/infection of the meninges can be bacterial or viral s/s: fever, alt loa, bulging frontanelle, rash non-blanching, shock
53
seizures s/s:
lateralized tongue bitting, flickering eyelids, dilated pupils, lip smacking, +hr/BP+, post ictal phase
54
generalized seizures
loss of awarness & both hemispheres of the brain,ex:grand mal, tonic clonic
55
focal seizures:
involve loss of awareness & only 1 side of brain, jerking motion but still conscious,
56
simple febrile seizures:
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
complex febrile seizure
multiple in 24hrs focal or generalized, prolonged duration, recovery; Post ictal may not fully return to normal if multiple seizures
58
if a pt is post ictal for >10 mins you can assume...
status epilepticus
59
SIDS
- unknown etiology, suspected suffocation in bed , 10-200
60
how often do we see toxicology in peds?
50% in kids <6yrs, consider <5=accidental or intentional
61
poisonings
ca channel blockers/beta blockers ingested--->hypotension/weak heart contractility ex: 2 glyburides (5mg each)--->fatal in toddler
62
physical child abuse?
pt harmed by his/her caregiver/when caregiver fails to protect child.
63
emotional abuse
neglecting/damage to peds self esteem from caregiver ex: headaches w no med cause
64
sexual abuse
sexula explotation of a child by a caregiver
65
consider human trafficking when...
many EMS calls, Substance abuse, incongruent behavior
66
neglect
pattern when a care giver fails to provide basic needs.
67
failure to report to the CAS...
$1000 fine, duty overrides PHIPA
68
pediatric GCS?
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 (9 decks)

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