Peds week 8

Question 1

__ are leading

cause of death and disability in the pediatric population of the United States.

Answer 1

Injuries

Question 2

__ is the most common cause of death from injury for victims of all ages

Answer 2

traumatic brain injury

Question 3

Care of a child with TBI is focused on __

Answer 3

optimizing cerebral perfusion

Question 4

Why avoid overzealous fluid resuscitation in the trauma patient?

Answer 4

may worsen bleeding
hemodilution
worsen cerebral edema
worsen pulmonary edema

Question 5

epi dose for hypotension and cardiac arrest

Answer 5

1 mcg/kg for hypotension
10 mcg/kg for arrest

Hypotension is 1/10th of the problem compared to arrest

Question 6

atropine dose for symptomatic bradycardia and max doses for children and adolescents

Answer 6

20 mcg/kg
max 1 mg for child
max 2 mg for adolescent

Question 7

bicarb dose

Answer 7

1-2 meq/kg

Bicarb will raise your pH 1-2 points

Question 8

calcium chloride via central line

Answer 8

10-20 mg/kg

1/3 of the gluconate dose

Question 9

calcium gluconate via peripheral IV

Answer 9

30-60 mg/kg

3x the CaCl dose

Question 10

adenosine dose

Answer 10

100mcg/kg first dose max 6 mg
200 mcg/kg second dose max 12 mg

For SVT going 100 bpm or 200 bpm

Question 11

amiodarone for vfib and vtach

Answer 11

5 mg/kg , max 300 mg

We shocked the vfib 5x before it converted

Question 12

magnesium for torsades

Answer 12

25-50 mg/kg max 2 gm

The amplitude of torsades varies from 25-50 millivolts

Question 13

dopamine and dobutamine rates

Answer 13

1-20 mcg/kg/min

Same as usual

Question 14

epi, isoproterenol, norepi, and phenylephrine rates

Answer 14

0.1-1 mcg/kg/min

They all have one “i” which looks like a “1” - max rate

Question 15

milrinone

Answer 15

50-100 mcg/kg load
0.5-1 mcg/kg/min rate

You’re more bad ass than me if you actually remember this.

Question 16

nipride and ntg rates

Answer 16

1-10 mcg/kg/min

Both nipride and nitro start where epi leaves off

Question 17

prostaglandin e1 rate

Answer 17

0.05 mcg/kg/min

Question 18

vasopressin rate

Answer 18

0. 0001 - 0.0005 units/kg/min

1. 2345 move the 1 to the 5 spot

Question 19

platelets should be

Answer 19

30,000 - 50,000 / mm3

Question 20

refrigerate platelets??

Answer 20

NO NO NO

Question 21

rapid administration of FFP can cause

Answer 21

citrate toxicity

Question 22

what is in cryo?

Answer 22

factors 8 and 13, vWF, and fibrinogen

Question 23

PRBC’s dose

Answer 23

10-15 ml/kg increases hemoglobin 2-3 g/dl

If your hematocrit gets down around 10-15 you should probably give 2-3 units

Question 24

platelets dose

Answer 24

5-10 ml/kg increases platelet count 50k - 100k

Platelet count increases 10,000 per mil per kg

Question 25

FFP dose

Answer 25

10-15 ml/kg Similar to PRBCs

Question 26

cryoprecipitate dose

Answer 26

1-2 units/kg Consider giving some cryo every 1-2 units of blood

Question 27

EBV preterm

Answer 27

100

Question 28

EBV full term

Answer 28

90

Question 29

EBV under 1 year

Answer 29

80

Question 30

EBV 1 year to adult

Answer 30

70

Question 31

EBV obese

Answer 31

65

Question 32

calculate maximal allowable blood loss

Answer 32

hct - minimum allowed hct times EBV divided by hct 40-21= 19 x EBV 1000 ml = 19000 / 40 = 475 ml allowable blood loss

Question 33

calculate PRBC transfusion

Answer 33

desired HCT minus actual HCT times EBV divided by 60 35-23 = 12 x 800 = 9600 / 60 = 160 mls of PRBC

Question 34

children with severe pulmonary dz, cyanotic heart dz, and preterm infants require a __ hct

Answer 34

greater

Question 35

what HCT is acceptable in healthy infants up to 3 mo of age if little potential for postop bleeding?

Answer 35

20-25% 20% for over 3 months

Question 36

if you have nada type O negative blood, could you transfuse type O positive into a male or postmenopausal female?

Answer 36

yes

Question 37

what two processes can occur as a result of disruption of the BBB due to trauma or hypoxia?

Answer 37

cerebral edema and neuronal hypoxia

Question 38

verbal modified GCS

Answer 38

``` 5 - coos, babbles 4 - crying 3 - screaming 2- grunt or moans to pain 1 - no response ```

Question 39

eye opening GCS

Answer 39

4 - spontaneous 3 - to shout 2 - to pain 1 - no response

Question 40

motor response GCS

Answer 40

``` 6 - spontaneous 5 - localizes to pain 4 - withdraws to pain 3 - decerebrate 2 - decorticate 1 - no response ```

Question 41

two stages of pediatric head trauma

Answer 41

primary insult - from mechanical forces at the time of impact secondary insult - parenchymal damage caused by pathologic sequelae

Question 42

PaCO2 for head trauma

Answer 42

35-40, avoid hyperventilation

Question 43

good idea to do a nasal intubation or place an NG on someone with a skull fracture?

Answer 43

not unless you want to intubate their brain through their sphenoid bone

Question 44

what is the usual pathogenesis of a subdural hematoma?

Answer 44

rupture of veins between brain and dura, dura still attached to skull

Question 45

what is the usual pathogenesis of a epidural hematoma?

Answer 45

rupture of artery between skull and dura, the dura is peeled off the skull

Question 46

what are signs of an epidural hematoma, and what is the treatment

Answer 46

signs: LOC, hemiparesis, blown pupil treatment: surgical evacuation

Question 47

what type of bleed results from shaken baby syndrome?

Answer 47

acute subdural that tears the veins

Question 48

bilateral retinal hemorrhage =

Answer 48

90% incidence of shaken baby syndrome

Question 49

children under __ are highest risk for abuse

Answer 49

3