Peds Facts from MDA lecture Flashcards
(32 cards)
For children 37 weeks to 30 days old what are the guidelines for timing of determining brain death?
2 exams of brain death, 24 hours apart with first one 24 hours after the birth/CPR/CNS injury
(normal temp, pressure, no purposeful movements, no reflexes, no meds + apnea test)
For children 30 days to 18 years old what are the guidelines for timing of determining brain death?
2 exams of brain death, 12 hours apart with first one 12 hrs after CPR/CNS injury
what is criteria on apnea test for brain death?
CO2 >60mmHg or 20mmHg above baseline.
who should perform brain death exams in children?
ICU, Neuro, critical care providers… 2 providers from different departments for each exam
What does the Team supply for families in communicating during family meetings?
Options
what does the family bring to the family meeting
family values
If a family does not want to disclose illness to a child, what is the stepwise approach? (6 items)
- prevention, OPEN dialogue
- Determine what child knows
- what are they afraid will happen?
- Disclosure is not a tell all - it’s STEPWISE
- Reassure Info will be age appropriate
- Child is the guide stepwise! (wks to months)
Why do children not talk about illness in front of parents?
They child is protecting their parents
- when I die who will take care of my:
1. parents
2. my siblings
3. my pets?
What do toddlers (0-2 years) old understand about death?
no conceptualization.
What do children aged 3-5 years understand about death?
Cannot perceive universality of death
Do not understand irreversible nature of death
What do children aged 10-13 years understand about death?
Understand that death is universal
Pre-occupied with death
Psychosomatization of feelings around death
What do children aged 13-18 years understand about death?
Risk of impaired grief if death occurs in adolescence
“Death is not fair”
What do children aged 5-10 years understand about death?
Death is irreversible and final.
Can escape death if they do not think about it
Magical Thinking
What are the typical grief responses for a child aged 3-4 years?
Intense but brief
Asks questions repeatedly
What interventions are helpful for children aged 3-4 with grief responses?
play therapy
What interventions are helpful for children aged 5-9 with grief responses?
Answer questions honestly
Help with memorials/goodbyes
What interventions are helpful for children aged 0-2 with grief responses?
cuddling
simple music
When do we use the FLACC Scale?
Children younger than 3yo and non verbal
what is the FLACC scale?
Face Legs Arms Cry Consolability
(0-2 for each…sums up to 10)
When do we use faces (aka wong baker)?
from 3yo to 7 yo
when can you use standard 0-10 or visual analog scale?
8yo and older
Children with neurologic injury have a hard time addressing pain, who do you rely on?
The parents!
how do children with neuro disorders end up with bone fractures?
increased CNS tone –> contractures/spasticity –> fractures
DMD starts at 2-6, when do they die and what from?
Late teens from progressive cardiomyopathy
