Pediatrics Critical Care Flashcards
1
Q
cardiopulmonary arrest
A
- most often associated with respiratory failure and arrest
- decreased oxygen concentrations:
- child becomes hypoxic
- heart slows down, becoming more and more bradycardic
2
Q
shock
A
- inadequate delivery of oxygen and nutrients to tissues to meet metabolic demand
- three types:
- hypovolemic
- distributive
- cardiogenic
3
Q
compensated shock
A
- critical abnormalities of perfusion
- body is able to maintain adequate perfusion to vital organs
- intervention is needed to prevent child from decompensating
4
Q
decompensated shock
A
- state of inadequate perfusion
- child will be profoundly tachycardic and show signs of poor peripheral perfusion
- hypotension is a late and ominous sign
- start resuscitation on scene
5
Q
hypovolemic shock
A
- most common cause of shock in infants and young children
- loss of volume due to illness or trauma
- once IV access is established, begin fluid resuscitation with isotonic fluids (normal saline or lactated ringers) only
- 20 cc/kg Boluses
- in decompensated shock with hypotension, begin initial fluid resuscitation on scene
- evaluates sites for IV access -> if this is unsuccessful, being IO infusion
- signs may include:
- listless or lethargic
- pale, mottled, or cyanotic
- dehydration
6
Q
IO needles
A
-usually consist of a solid-bore needle inside a sharpened hollow needle
7
Q
distributive shock
A
- decreased vascular tone develops
- vasodilation and third spacing of fluids occurs
- caused by sepsis in most pediatric cases -> fever is a key finding
- treatment is volume resuscitation
- with apparent sepsis and persistent hypotension, consider vasopressor support but only after fluid resuscitation
- treat anaphylactic shock with IM epinephrine
8
Q
cardiogenic shock
A
- result of pump failure
- may be present in children with:
- underlying congenital heart disease
- myocarditis
- rhythm disturbances
- Err on the side of fluid resuscitation unless you are sure of diagnosis
- the following confirms cardiogenic shock:
- increased work of breathing
- drop in oxygen saturation
- worsening perfusion after a fluid bolus
9
Q
signs and symptoms of cardiogenic shock
A
- listless or lethargic
- increased work of breathing
- impaired circulation
- skin pale, mottled, or cyanotic
- sweating with feeding
10
Q
initial management of cardiogenic shock
A
- position of comfort
- supplemental oxygen
- consider small fluid bolus (5-10 cc/kg)
- pressor
11
Q
cardiovascular emergencies
A
- relatively rare in children
- often related to volume or infection
- identify through primary assessment
12
Q
dysrhythmias
A
- classified based on pulse rate:
- too slow (bradydysrhythmias)
- too fast (tachydysrhythmias)
- absent (pulseless)
- signs and symptoms are often nonspecific
- pulse rate is lower than normal for age -> often secondary to hypoxia in children
13
Q
initial treatment for dysrhythmias
A
- airway management
- supplemental oxygen
- assisted ventilation as needed
- initially electronic cardiac monitoring
- if child is asymptomatic, no further treatment is indicated in the field
- if pulse rate is lower than 60 and perfusion is poor:
- begin chest compressions
- attempt IV or IO access
14
Q
tachydysrhythmias
A
- pulse rate is higher than normal for age
- interpret in the context of PAT and the primary assessment
- assessment should include pulse rate and an ECG or rhythm strip
15
Q
narrow complex tachycardia: tachydysrhythmias
A
- supraventricular tachycardia is identified by:
- narrow QRS complex
- unvarying pulse rate of more than 220 beats/min (infant) or more than 180 beats/min (child)
16
Q
SVT: tachydysrhythmias
A
- treatment depends on perfusion and stability
- if stable, consider vagal maneuvers while obtaining IV access
- if poor perfusion, synchronized cardioversion is recommended
17
Q
wide complex tachycardia: tachydysrhythmias
A
- wide QRS complex tachycardia and palpable pulse is likely V-tach
- if stable, consider antidysrhythmic medication
- if unstable, use synchronized cardioversion
- if pulseless, begin CPR
