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Flashcards in Pediatric Emergencies Deck (108)
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1
Q

Pediatric Assessment Triangle

A

Appearance
Work of breathing
Circulation to the skin

2
Q

Begin your assessment with the ___ and move toward the ___ in children under 6.

A

feet, head

3
Q

Respiratory rate, HR, BP, and temperature of neonate

A

30 to 60
90 to 160
67/35 to 84/53
98 to 100

4
Q

Respiratory rate, HR, BP, and temperature of infant

A

30 to 53
90 to 150
72/37 to 104/56
96.8 to 99.6

5
Q

Respiratory rate, HR, BP, and temperature of toddler

A

22 to 37
80 to 120
86/42 to 106/63
96.8 to 99.6

6
Q

Respiratory rate, HR, and BP of preschool age

A

20 to 28
65 to 100
89/46 to 112/72

7
Q

Respiratory rate, HR, and BP of school age

A

18 to 25
58 to 90
97/57 to 120/80

8
Q

Respiratory rate, HR, and BP of adolescent

A

12 to 20
50 to 90
110/64 to 131/83

9
Q

Even though the tidal volume in children is similar to adults, children have smaller oxygen reserves due to “

A

Metabolic oxygen demand is doubled

Functional residual capacity is smaller

10
Q

Keep the nares clear in infants younger than ____.

A

6 months

11
Q

Signs of vasoconstriction

A

Weak peripheral pulses in extremities
Delayed capillary refill
Pale, cold extremities

12
Q

Pediatric differences in skin -thinner more elasticity, increased surface area, and decrease subcutaneous tissue - contributes to an increase in :

A

Hypothermia
Severity of burns
Injury following temperature extremes

13
Q

TICLS

A
Tone
Interactiveness
Consolability
Look or gaze
Speech or cry
14
Q

What does the appearance aspect of PAT reflects?

A
Adequacy of ventilation
Oxygenation
Brain perfusion
Body homeostasis
CNS function
15
Q

Signs of work of breathing

A
Tachypnea
Abnormal airway noises
Retractions of intercostal muscles or sternum
Abnormal posturing
Head bobbing
Nasal flaring
16
Q

Three characteristics when assessing circulation :

A

Pallor
Mottling
Cyanosis

17
Q

What is mottling caused by?

A

Constriction of peripheral blood vessels

18
Q

What are the components of assessing breathing?

A

RR
Auscultate breath sounds
Pule ox

19
Q

What are the components of assessing circulation?

A
Control active bleeding
HR and quality
Skin 
Capillary refill
BP
20
Q

In infants, palpate the _____ pulse or _____ pulse.

A

Brachial

Femoral

21
Q

In children older than 1 year, palpate the _____ pulse.

A

Carotid

22
Q

Weak or absent peripheral pulses are indications of?

A

Decreased perfusion

23
Q

Weak central pulses indicate?

A

Significant hypotension

Decompensated shock

24
Q

Absence of central pulse indicates?

A

Immediate need for CPR

25
Q

Indications of rapid transport

A
Significant MOI
Hx compatible w/ serious illness
Physical abnormality
Potentially serious anatomic abnormality
Significant pain
AMS
s/s shock
26
Q

When should a pediatric patient be placed in a cart seat during transport?

A

Weighing less than 40 lbs and do not require spinal immobilization

27
Q

Capillary refill should be noted in children younger than ___ years.

A

6

28
Q

To obtain an accurate reading of a pediatric patient’s BP, use a cuff that covers _____ of the upper arm.

A

two-thirds

29
Q

Formula for calculating BP in children aged 1 to 10.

A

(Age [in years] x 2) / 70

30
Q

Albuterol dosage

A

<20 kg : 1.25 mg
>20 kg : 2.5 mg
Over 20 minutes. May repeat once within 20 minutes.

31
Q

D25

A

> 1 y/o : 0/5-1 g/kg via slow IV/IO push.
Repeat as necessary.

Neonates and infants : 200 - 500 mg/kg slow IV push. Repeated as necessary. Mx concentration of 12.5%

32
Q

Dextrose 10%

A

2.5 - 5.9 mL/kg

Administrated w/ infusion.

33
Q

Epinephrine

A

Anaphylaxis and asthma : 0.01 mg/kg of 1 mg/mL solution SQ/IM.
Max dose of 0.3 mg.
Can repeat every 5 minutes.

34
Q

Glucagon

A

<20 kg or 5 y/o : 0.5 mg IM/IN

>20 kg : 1 mg IM/IN

35
Q

Narcan

A

< 20 kg or 5 y/o : 0.1 mg/kg IV/IO/IM
>20 kg or 5 y/o : 2.0 mg
Repeat every 2 minutes PRN.
Max dose of 2 mg.

36
Q

Activated charcoal

A

0.5-1 g/kg PO

37
Q

Signs of respiratory distress

A
Pallor or mottled color
Irritability, anxiety, restlessness
Increased respiratory rate
Retractions
Abdominal breathing
Nasal flaring
Inspiratory stridor
Grunting
Mild tachycardia
38
Q

Signs of impending respiratory failure

A
AMS
Central cyanosis, pallor
Tachypnea to bradypnea to apnea
Severe retractions
Accessory muscle use
Nasal flaring
Grunting
Paradoxical Abdominal motion
Tripod position
Tachycardia to bradycardia
39
Q

3 causes of airqay obstruction in children

A

Foreign object
Infections
Disease

40
Q

When should you consider an infection as a possible cause of airway obstruction?

A

Patient has congestion, fever, drooling, and cold sxs.

41
Q

Signs of severe airway obstruction

A
Ineffective cough
Inability to speak or cry
Increasing respiratory difficulty w/ stridor
Cyanosis
LOC
42
Q

If an infant is conscious with a complete airway obstruction, perform:

A

5 back blows followed by 5 chest thrusts

43
Q

If a child older than 1 year is conscious with a complete airway obstruction, perform :

A

Abdominal thrusts

44
Q

Management of anaphylaxis

A

Epinephrine
Supplemental oxygen
Fluid resuscitation for shock
Bronchodilators for wheezing

45
Q

s/s of croup

A
Cold symptoms
Low-grade fever
Barky cough
Stridor
Difficulty breathing
46
Q

Management for croup

A

Position of comfort

Nebulize epinephrine if stridor at rest, mod to severe resp distress, poor air exchange, hypoxia or AMS

47
Q

s/s of epiglottitis

A
Looks sick
Anxious
Sniffing position
Drooling
Increased work of breathing
Pallor or cyanosis
High fever
Sore throat
48
Q

Management of epiglottitis

A

Position of comfort
Supplemental oxygen if tolerated
BVM and suction ready

49
Q

Where is the best place to auscultate breath sounds in a pediatric patient?

A

Level of armpit

50
Q

Asthma triggers

A
URI
Allergies
Changes in environmental temperature
Smoke
Physical exertion
Emotional stress
51
Q

What is the pathophysiology of an acute asthma attack?

A

The body starts with the immune system responding to the trigger releasing histamines. As the attack progresses, mucous membranes in the bronchiolar walls swell and mucous plugging in the bronchiolar lumen restrict expiratory airflow. Pulmonary gas exchanged in impaired and the child becomes hypoxemic.

52
Q

s/s of acute asthma attack

A
Preferential position
Prolonged expiratory phase
Wheezing
Tachycardia
Tachypnea
Agitation
53
Q

What age group is pneumonia commonly seen in pediatric patients?

A

Infants, toddlers, and preschoolers

54
Q

s/s of pneumonia

A
Rapid breathing
Grunting
Wheezing
Nasal flaring
Tachypnea
Crackling
Hypothermia
Fever
55
Q

What is bronchiolitis?

A

Bronchioles become inflamed, swell, and fill with mucus.

56
Q

s/s pertussis

A

Coughing
Sneezing
Rhinorrhea

57
Q

Whooping

A

Type of cough described as whooping during inspiratory phase

58
Q

Contraindications for NPA

A

Nasal obstruction
Head trauma
Facial trauma

59
Q

The _____ naris is commonly larger than the ___ naris.

A

right, left

60
Q

When should you use a BVM?

A

Respirations less than 12 breaths or more than 60 breaths, AMS, inadequate tidal volume.

61
Q

Signs of shock in children

A

Tachycardia
Poor capillary refill
AMS

62
Q

Common causes of shock in pediatric patients

A

Hypovolemia
Sepsis
Allergic reactions
Poisonings

63
Q

Greater than ____ blood volume loss significantly increases the risk of shock in children.

A

25%

64
Q

Low blood pressure is a sign of _____ shock.

A

Decompensated

65
Q

Management of shock in pediatric patients

A
Ensure patent airway
Prepare for ventilation
Control bleeding
Give supplemental oxygen
Position of comfort
Keep warm
IV access
Administer nl saline or 20 mL/kg boluses of lactacted ringer solution to maintain perfusion
Immediate transport
Call ALS PRN
66
Q

Signs in anaphylactic shock

A
Hypoperfusion
Stridor and/or wheezing
Increased work of breathing
Restlessness, agitation, impending doom
Hives
67
Q

Management for anaphylactic shock

A

Maintain airway
Administer oxygen
Epinephrine
IV or IO access
Administer 20 mL/kg of isotonic crystalloid solution to maintain perfusion
Call ALS early if advanced airway is needed

68
Q

Explain why butterfly catheters are associated with a higher rate of infiltration?

A

A stainless steel needs lies within the vein rather than a Teflon catheter or over-the-needle catheter.

69
Q

When should you attempt IO access?

A

3 unsuccessful attempts with IV or 90 seconds in a critically ill or injure patient

70
Q

What can occur if too much fluid is administered in pediatric patients?

A

Acute left-sided heart failure and pulmonary edema

71
Q

Formula for kg if weight of pediatric patient is unknown.

A

(age [in years] x 2) + 8 = weight in kg

72
Q

Most common causes of AMS in children :

A

hypoglycemia
hypoxia
seizure
drug or ETOH ingestion

73
Q

How do nonverbal infants demonstrate responsiveness?

A

Follow a person’s face or object (tracking)
Babbling and cooing
Crying

74
Q

Common causes of seizures in children :

A
Child abuse
Electrolyte imbalance
Fever
Hypoglycemia
Infection
Ingestion
Hypoxia
Poisoning
Seizure disorder
Recreational drug use
Head trauma
Idiopathic
75
Q

Signs of seizures in infants can be :

A

Abnormal gaze
Sucking motions
Bicycling motions

76
Q

Management of seizures

A

Open airway
Suction
Consider left recumbent position if actively vomiting and suction is inadequate
Provide 100% oxygen via NRB or blow-by

77
Q

Febrile seizures

A

Occurs first day of febrile illness
Generalized tonic-clonic seizure
Lasts less than 15 minutes

78
Q

Management for febrile seizures

A
Maintain airway
Begin cooling with tepid water
IV or IO access
Blood sugar reading
Prompt transport
79
Q

s/s of meningitis

A

Fever
Headache
Altered LOC
Nuchal rigidity

80
Q

s/s of meningitis in infants

A

Increasing irritability especially when handles

Bulging fontanelle w/o crying

81
Q

Management of meningitis

A

Supplemental oxygen

IV access and administer IV fluids if vital signs are unstable.

82
Q

Questions you should ask to determine fluid loss.

A

How many wet diapers has your child had today?
Is your child tolerating liquids and are they able to keep them down?
How many times has your child had diarrhea and for how long?
Are tears present when your child cries?

83
Q

Common sources of poisonings in children :

A
ETOH
ASA and APAP
Household cleaning products
Houseplants
Iron
Rx medications
Illicit drugs
Vitamins
84
Q

Vital signs and sxs of severe dehydration

A
HR : >160
Activity : variable, weak
Urine output : none
Skin : cool, clammy, poor turgor, delayed cap refill
Mouth : dry mucous membranes
Eye : sunken eyes
Anterior fontanelle : extremely sunken
Consciousness : altered
BP : normal to low
85
Q

What is the most common cause of dehydration in children?

A

Vomiting and diarrhea

86
Q

Common causes of fever in peds.

A
Infection
Status epilepticus
Cancer
ASA ingestion
Arthritis and systemic lupus erythematosus
High environmental temperatures
87
Q

Signs of hypoglycemia

A
Hunger
Malaise
Tachycardia
Tachypnea
Diaphoresis
Tremors
88
Q

Management for hypoglycemia

A

Administer 100% oxygen
IV/IO access
Oral glucose or IV glucose
Unable to obtain IV/IO access contact medical control to administer 1 mg of glucagon IM.

89
Q

How to dilute D50 to D25 for pediatric use?

A

D50 25 g of dectrose in 50 mL of water. Push out 25 mL of D50 and draw 25 mL of normal saline. (1:1 ration) 12.5 g in 50 mL

90
Q

How to dilute D50 to D10?

A

Draw 4 mL of D50 into 20 mL syringe. Draw 16 mL of NS with same syringe. (1:4 ratio) 2g in 20 mL

91
Q

How to dilute D25 to D10?

A

Use prepared D25 in 50 mL. Push out 40 mL of D25 and draw 40 mL of NS resulting in 5g of 50 mL.

92
Q

Management of hyperglycemia

A

Administer 100% oxygen
Assist w/ ventilations PRN
Monitor vital signs
IV access
Administer 20 mL/kg bolus if isotonic crystalloid solution to maintain adequate perfusion
Call ALS if respiratory status deteriorates

93
Q

Management of drowning

A

Assess and manage ABCs
Administer 100% oxygen NRB or BVM
Prepare suction
Apply c-collar and place on backboard if trauma is suspected
Perform CPR if unresponsive and in cardiopulmonary arrest

94
Q

Suspect a serious ____ in any child who experiences nausea and vomiting after a traumatic event.

A

head injury

95
Q

At what age is it no longer required for you to pad underneath a child’s torso to create a neutral position?

A

Age 8 to 10

96
Q

When can the patient be left in their car seat?

A

Vital signs are stable
Minimal Injury
Car seat is visibly undamaged

97
Q

Why are burns to children considered more serious than adults?

A

Children have more surface area relative to their total body mass which means greater fluid and heat loss.

98
Q

Describe a minor severe of burn

A

Partial-thickness involving less than 10% of body surface

99
Q

Describe a moderately severe burn.

A

Partial-thickness involving 10% to 20% of body surface

100
Q

Describe a critically severe burn.

A

Any full-thickness.
Any partial-thickness involving more than 20% of body surface.
Any burn involving hands, feet, face, airway, or genitalia.

101
Q

CHILD ABUSE mnemonic

A
C : consistency of the injury
H : history inconsistent w/ injury
I : inappropriate parental concerns
L : lack of supervision
D : delay in care
A : parent or caregiver affect
B : bruising of varying degrees
U : Unusual injury patterns
S : suspicious circumstances
E : environmental clues
102
Q

Locations of bruises that are suspicious

A

Back, buttocks, ears, or face

103
Q

What type and location of fractures should you be suspicious of?

A

Humerus or femur fx

Complete

104
Q

Necessities of life that should be provided by caregiver or parent.

A

Food, water, clothing, shelter, personal hygiene, medicine, comfort, and personal safety

105
Q

Three tasks first responders are responsible for at the scene of a suspected SIDS.

A

Assessment of the scene
Assessment and management of the patient
Communication and support of the family

106
Q

When inspecting the environment of a suspected SIDS scene, what should you concentrate on?

A
Signs of illness, including medications, humidifies, thermometers
General condition of the house
Signs of poor hygiene
Family interaction
Site where the child was discovered
107
Q

Signs of SIDS

A

Pale or blue
Apneic
Pulseless
Unresponsive

108
Q

BRUE

A

Brief Resolved Unexplained Event

Cyanosis
Apnea
Distinct change in muscle tone
Choking or gagging