pediatric emergencies

Question 1

foreign body obstruction sign and symptoms

Answer 1

partial obstruction
choking
cough
stridor

Question 2

epidemiology

Answer 2

90% less than 5 years
65 < infants
Common offenders : Aspiration: food, nuts, grape, popcorn
other: corn, marble, ballon

Question 3

treatment with children less one year

Answer 3

head down and back blow x 4
tunrover chest thrust x 4
heatilt chin lift
visualize and remove
 ventilate

Question 4

treatment child

Answer 4

heimlich maneuver
visualize and extract
ventilate

Question 5

if the above doesn’t work

Answer 5

obstruction above the larynx or in larynx perform cricothyrotomy
obstruction below the larynx: attempt to in tube and push past it past the bifurcation of trachea and attempt to ventilate with high pressure

Question 6

croup

Answer 6

infection of the subglottic region causing inflammation and edema of respiratory mucus which produces edema of cords and subglottic area

Question 7

etiology of croup

Answer 7

parainfluenza
RSV
other viruses

Question 8

sign and symptoms

Answer 8

croupy barking cough
tachypnea
retraction
Hx of upper respiration infection
inspiratory-expiratory stridor
age 8 month to 5 yrs

Question 9

treatment for croup

Answer 9

minimal pathology
supplemental o2 
racemic epinphrine
decadron
more profound pathology:
hospital admission
resp. failure
stridor, hypoxemia, retraction
Hx of tracheal stenosis, recurrent croup, hx of post-intubation croup, previous intubation/ventilation
parents unable to provide care

Question 10

intubation criteria

Answer 10

Pao2 55 mmHG
progressive acidosis
marked anxiety, tachycardia, tachypnea
severe obstruction

Question 11

hospitalization course

Answer 11

5-6 days
extubation 2-5 days
air leaks indication improvement since pediatric tubes don’t have coughs
follow the extubation with racemic eli and close observation

Question 12

eppiglottitis and etiology

Answer 12

an infection of the supraglottic including the epiglottis

Hemophilus age group is 3-5 years

Question 13

sign and symptoms

Answer 13

very gray and ashen appearance
upright hyperextended posture 
sudden temp > 39
excess saliva
signs of partial airway obstruction
enlargment cervical lymph nodes 
may become unconscious or even arrest

Question 14

epidemiology

Answer 14

peak ages 3-6 and range is 17 month to adult

can visualize the swollen structure on a lateral neck film

Question 15

treamtment

Answer 15

position them where they are comfortable
minimize movement
give supplemental o2 as require
intubation if require: one shot, extubation criteria 24 hours antibiotics and swelling reduce also air leak indicates improvements

Question 16

antiobiotics

Answer 16

ampicillin
cefuroxime 200 mg/kg/day
ceftriacone 100 mg/kg/day

Question 17

Picu care

Answer 17

sedation
versed is sometimes helpful
close observation
humidity
supplemental o2
sometimes CPAP
emergency situation  
emergencies situation: mask CPAP, needle cricothyroidtomy, trach

Question 18

tracheitis

Answer 18

bacterial infection of the trachea and major bronchi
Etilogy: Staph Aures(60%) , H. influenza, Strep group A. 2 years peak age range 1 month -9 years
kind rare

Question 19

sign and symptoms

Answer 19

upper resp. infection
stridor and barking cough
resp.arrest may occur if airway become fully obstructed by pus
labs and x-ray:
elevated WBC and left shift
negative blood culture but positive sputum culture from deep suctioning
subglottic edema
infiltrates on chest x-ray 50%

Question 20

treatment

Answer 20

humidity and o2 
promt bronchoscopy under controlled condition
intubation if severe
antibiotics:
cefuroxime
chlrophenical
nefacilin