Pediatric Fever/Evaluation Study Guide

Question 1

What are MSK anatomical differences between adults and pediatrics?

Answer 1

1. Less muscle more skin (surface area) = cold fast
2. Flexible bones, less muscle = trauma to solid organs
3. Large head = dart heads

Question 2

What are anatomical differences in the respiratory system?

Answer 2

1. large tongue
2. narrow glottic opening
3. shorter trachea

Sniffing position

Question 3

What are the cardiovascular differences with pediatric patients?

Answer 3

1. Increase HR (not SV) to improve cardiac output
2. Respiratory failure typically occurs before cardiac failure

Question 4

Describe what typically happens prior to cardiac failure in pediatric patients.

Answer 4

1. Respiratory failure –> hypoxia
2. Hypercarbia —> acidosis
3. Bradycardia and hypotension (due to cardiac ischemia and tissue acidosis)

Question 5

What are the three components of the Pediatric assessment triangle?

Answer 5

1. Appearance
2. Work of breathing
3. Circulation to skin

Question 6

What components of appearance are assessed?

Answer 6

TICLS

Tone - floppy?
Interaction - irritable, feeding, listless?
Consolable - inconsolable?
Look/gaze - blank stare red flag
Speech/Cry - pitch, is caregiver concerned?

Question 7

______ and _____ are late findings of pending respiratory failure.

Answer 7

Head bobbing, seesaw

Question 8

What type of retractions indicate mild distress?

Answer 8

subcostal and substernal

Question 9

What type of retractions indicate severe distress?

Answer 9

supraclavicular and suprasternal

Question 10

A systolic BP or heart rate under __ is abnormal in any age group.

Answer 10

60

Question 11

One of the earliest signs of pediatric distress is their appearance, as well as resistance to ______ and infants that are _______

Answer 11

Socialize, inconsolable

Question 12

Narrowed pulse pressure is a ________(early/late) sign of distress.

Answer 12

Early
Pulse pressure = sys - dia

Question 13

What is the difference between BLS in pediatrics and adults?

Answer 13

Adults –> CAB (arrest usually cardiac related)
Pediatrics —-> ABC (arrest usually due to respiratory failure)

Question 14

What is commotio cordis and how is it treated?

Answer 14

Blunt trauma to the chest during ventricular repolarization (beginning of T wave) causes ventricular depolarization before the ventricles fully repolarize

Sends heart into V fib or arrest, TX is to shock 150j for biphasic, or 300j

Question 15

Leading cause of death under 1

Answer 15

congenital causes (cyanotic cardiac conditions, inborn errors of metabolism, ect), SIDs

Question 16

What are 3 risks for SIDs?

Answer 16

Prone position in bed, low birth weight, second hand smoking

Question 17

Leading cause of death age over age 1

Answer 17

unintentional injury

Question 18

Other leading causes of death in pediatrics

Answer 18

drowning, suicide, malignancy

Question 19

Leading cause of death over age 4

Answer 19

MVA

Question 20

Dose of epi for 10-20kg

Answer 20

0.15 cc of 1:1000
-OR-
0.15 ml auto injector

Question 21

Dose of epi for >20kg

Answer 21

0.3 cc of 1:1000
-OR-
0.3 ml autoinjector

Question 22

Dose of epi for those under 1 year or 10 kg

Answer 22

0.1 mL of 1:1000

Question 23

What is a BRUE?

Answer 23

Brief resolved unexplained event

Change in color, tone, responsiveness, or apnea for 1-2 minutes that resolves on its own with no other symptoms such as feeding problems or fever in PT under 1 years old.

Question 24

What makes a patient with a BRUE low risk and may require no further work up other than observation with O2 sat?

Answer 24

• > 60 days
• > 32 weeks gestational age or >45 weeks post conception age
• 1 event of short duration
• no concerning history

Question 25

What BRUE patients are considered high risk?

Answer 25

- less than 2 months old - pre-term <32 weeks who are <45 weeks post conception - significant medical history - multiple events

Question 26

What is the work up for BRUE in high risk infants?

Answer 26

-monitor and admit -CBC, Blood cultures, electrolytes -CXR & EKG -LP w/ CSF culture, abc, gram stain -UA with organic acids (inborn errors of metabolism) -Check pertussis and RSV

Question 27

Pts with BRUE under ___ days gestational age or with high risk hx will need ____ analysis and admission.

Answer 27

60, CSF

Question 28

_______ is problematic as kids increase HR to improve cardiac output instead of increasing stroke volume.

Answer 28

Hypovolemia

Question 29

Pediatric patients can lose up to ___% of blood volume before they show signs of hypotension.

Answer 29

30%

Question 30

In pediatric resuscitation you should place in the sniffing position, give high flow O2 via NC, and initiate a fluid bolus of ____cc/kg of NS.

Answer 30

20 cc/kg

Question 31

What should be considered in neonate resusciation?

Answer 31

congenital heart abnormalities --> prostaglandin

Question 32

The pressor of choice in pediatric resuscitation is ______ but make sure they are _______ loaded first.

Answer 32

epinephrine, volume

Question 33

What is the ratio for pediatric CPR?

Answer 33

Lone CPR - 30:2 2 Person - 15:2 (adults are always 30:2) *Start with rescue breath*

Question 34

What is the rule of 50?

Answer 34

Glucose dose in pediatric patients: a x b = 50 a = type of fluid b = cc/kg (solve for this) example: D25 25 x b = 50, dose is 2 cc/kg

Question 35

What is the neonate infant dose of D10?

Answer 35

1 cc/kg (rule of 50 doesn't work here)

Question 36

Toddler/preschool dose for D25?

Answer 36

2cc/kg

Question 37

School age and adolescence dose for D50?

Answer 37

1cc/kg

Question 38

Pediatric fevers, anyone under ____ days gets a full workup.

Answer 38

28 days

Question 39

Common pathogens for SBI ages 8-28 days are:

Answer 39

S. pneumonia, H. influ type b, N Meningitidis, Listeria

Question 40

What do you start with for pediatric fevers age 29-60 days?

Answer 40

- UA, blood cultures, & IM IM high --> LP ---> +LP ----> admit IV Ab IM low, but UA+ ---> home w/ Ab All negative can send home.

Question 41

Common bugs age 29 - 60 days:

Answer 41

S. pneumonia, H influenza, E. Coli

Question 42

What is the workup for SBI if PT is RSV/flu (bronchiolitis) positive?

Answer 42

Can do UA and make sure to follow up