Pediatric Emergencies

Question 1

Interactions and developmental milestones.

birth - 2 months

Answer 1

• controls gaze
• turns head

Question 2

Interactions and developmental milestones.

2-6 months

Answer 2

• eye contact
• uses both hands
• rolls over
• sleep through night

Question 3

Interactions and developmental milestones.

6-12 months

Answer 3

• sits without support
• crawls
• puts things in mouth
• teething begins

Question 4

Interactions and developmental milestones.

toddler

Answer 4

• crawls/walks
• sensory developments
• runs, climbs
• balance
• fine motor Skills
• toilet training

Question 5

Interactions and developmental milestones.

preschool

Answer 5

• can understand directions
• normal running/walking
• 20/20 Visions

Question 6

Interactions and developmental milestones.

school

Answer 6

Can communicate efficiently.

6 - 12 years old.

Question 7

Interactions and developmental milestones.

adolescence

Answer 7

Issues of independence and sexuality.

13 - 17 years old.

Question 8

What are some airway considerations for pediatrics?

Answer 8

• Short necks
• Smaller airway
• The epiglottis is long and floppy.
• Keep nares clear <6 months old.
• The neck is very soft and collapsible; don’t hyper-extend the neck.

Question 9

Fill in the blank.

The narrowest portion of child’s airways is ____.

Answer 9

cricoid cartilage

Question 10

What is the approximate blood volume in a pediatric?

Answer 10

70 ml/kg

Question 11

What causes delayed capillary refill in shock?

Answer 11

Shunting of the vessels causes peripheral vasoconstriction.

Question 12

What considerations are present for the nervous system of a pediatric with trauma?

Answer 12

• The brain and spine are not as protected.
• Less subarachnoid space = less cushion for the brain.
• It is easier to damage the head and spine.

Question 13

What considerations are present for the musculoskeletal system in pediatrics?

Answer 13

Fractures are easier due to the lack of ossification centers.

Question 14

What considerations are present for the chest and lungs of a pediatric?

Answer 14

• Very thin chest wall.
• Ribs are more pliable.
• It is easier to hear heart and lung sounds.

Question 15

What considerations are present for the skin in a pediatric patient?

Answer 15

• Skin is thin and more elastic.
• More BSA ratio.
• Temperature isn’t regulated as well.
• Increased risk of hypothermia and severe burns.

Question 16

What considerations are present for the metabolic demands of a pediatric?

Answer 16

• Less glycogen stores in the liver.
• Cover the head to manage heat loss.

Question 17

What is the Pediatric Assessment Triangle?

PAT

Answer 17

• Work of breathing
• Circulation of skin
• Appearance

Question 18

What is the mnemonic TICLS used for when assessing the appearance of a pediatric patient?

Answer 18

• Tone: Muscle tone – are they rigid or limp?
• Interactiveness: Are they alert and how easily are they distracted? Do they grasp or reach?
• Consolability: Can they be calmed by a caregiver?
• Look/gaze: Do they have a fixed gaze or a glassy stare?
• Speech/cry: Is their cry strong, and is their speech age-appropriate?

Question 19

What do you assess with work of breathing in the PAT?

Answer 19

• Abnormal airway sounds: snoring, hoarse speech, strider, wheezing or grunting
• Abnormal positioning: sniffing positions, tripod, refusing to lie down
• Retractions: supraclavicular, intercostal, substernal retractions, head bobbing
• Flaring: flaring of nares on inspiration

Question 20

What is grunting indicative of?

Answer 20

Partially closed epiglottis.

Typically common in patients with pneumonia.

Question 21

What is mottling indicative of?

Answer 21

vasoconstriction and vasodilation

Question 22

Define:

Acrocyanosis

Answer 22

It is characterized by blue hands or feet.

Question 23

Define:

Pallor

Answer 23

It is characterized by white or pale skin.

Question 24

What is the minimal blood pressure formula in an infant and child?

Answer 24

• 70 + age (2) = infant
• 80 + age (2) = child

Question 25

What is the most **common** cause of **s****eizure** in pediatrics?

Answer 25

fever

Question 26

# Treatment: febrile seizure

Answer 26

* Tylenol 10-15mg/kg * Midazolam .1mg/kg * Ativan .1mg/kg * Fluids 20ml/kg * Check BGL

Question 27

What are the **signs/symptoms** of **meningitis**?

Answer 27

* Unchallenged rigidity * Purpuric and patechial coloration of the skins. * AMS

Question 28

# Define: biliary atresia

Answer 28

Excess bilirubin ## Footnote *Yellow skin*

Question 29

# Define: intussusception

Answer 29

Telescoping of small intestine into itself. ## Footnote Typically common to children from 6 months - 6 years.

Question 30

# Define: meckel diverticulum

Answer 30

**Malformation of small intestine** causing pockets.

Question 31

# Define: pyloric stenosis

Answer 31

The **pyloric sphincter becomes hypertrophied** and presents with projectile vomiting.

Question 32

# Treatment: **Hyperglycemia** in pediatrics

Answer 32

* fluids * insulin

Question 33

# Define: Congenital Adrenal Hyperplasia | CAH

Answer 33

Decrease in **cortisol** production.

Question 34

What is the **poison control's** phone number?

Answer 34

1-800-222-1222

Question 35

_List the medications for:_ 1. Carbon Monoxide 2. Organophosphate 3. TCA 4. Opiates 5. Beta Blockers 6. Ca Channel Blockers 7. Benzoiazepines

Answer 35

1. Oxygen 2. Atropine 3. Bicarbonate 4. Naloxone 5. Glucagon 6. Calcium 7. Romazicon

Question 36

What do you look for when assessing circulation of **skin** in PAT?

Answer 36

* pallor * mottling * cyanosis

Question 37

List the steps to remove a **foreign body airway obstruction**.

Answer 37

1. Hold the infant face down on your forearm. 2. Support the head and face with your hand. 3. Deliver five back blows. 4. Turn the infant upright. 5. Perform five chest thrusts using two fingers. 6. Check the airway.

Question 38

# Treatment: Unresponsive upper airway obstruction

Answer 38

Immediately begin **CPR**. ## Footnote Try to visualize with DL after compressions for removal with Magill forceps.

Question 39

# Define: croup

Answer 39

**Viral infection** of the **upper airway**.

Question 40

List **assessment findings** for **croup**.

Answer 40

* Age: Typically <5 years old. * Auscultation: Stridor * Symptoms: Barking cough, difficulty breathing.

Question 41

# Treatment: croup

Answer 41

* **Allow child to be comfortable** and do not irritate. * Administer **racemic epinephrine** (2.25%) 0.5ml mixed in 3ml *normal saline*.

Question 42

List **assessment findings** for **anaphylaxis**.

Answer 42

* Mild: urticaria, wheezing * Severe: wheezing, hypotension, diffuse edema, shortness of breath, tachycardia

Question 43

# Treatment: anaphylaxis

Answer 43

* **Epinephrine**: 0.01 mg/kg IM (1:1,000), max 0.3 mg, Q 5 minutes * **Diphenhydramine**: 1-2 mg/kg IV, max 50 mg * **Albuterol**: 1.25 mg via nebulizer with 6 lpm O₂

Question 44

# Define: epiglottitis

Answer 44

**Bacterial infection** of supraglottic structures.

Question 45

List **assessment findings** for **epiglottitis**.

Answer 45

* sitting upright in sniffing position * drooling * stridor * muffled voice

Question 46

# Treatment: epiglottitis

Answer 46

* rapid transport _Do not_: * agitate the pt * start an IV * visualize the oropharynx ## Footnote Consider: Nebulized normal saline.

Question 47

# Treatment: asthma

Answer 47

* **Albuterol/Atrovent:** 1.25mg / 250 mcg * **Epinephrine:** .01 mg/kg IM, Max .3mg (1:1,000) Q 5min

Question 48

If a pediatric will not tolerate a **NRB**, how can you deliver oxygen if needed?

Answer 48

Blow-by technique

Question 49

How often do you **ventilate** a pediatric patient?

Answer 49

1 breath every 3-5 seconds

Question 50

What is the formula for **minimum systolic BP** in children \> 1 yr?

Answer 50

(Age x 2) + 80

Question 51

What is the **minimum systolic** for an **infant?**

Answer 51

\>70mmHg