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Special Populations Flashcards

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1
Q

Define Neonate, Infant, Toddler, Preschool age, school age, and adolescent?

A

Neonate: first month of life
Infant: 1 month to 12 months
Toddler: 1-2 years
Preschool: 3-5 years
School age: 6-12 years
Adolescent: 13-18 years

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2
Q

What are some nonspecific behaviours that may indicate a serious underlying illness or injury?

A

Feeding changes
Sleep pattern changes
Ordinary behaviour changes

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3
Q

What is significant about an infant’s head?

A

An infant’s head is already 2/3 of the size it will be in adulthood
Traumatic brain injury is the leading cause of death and significant disability in pediatrics

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4
Q

What is the paediatric assessment triangle? (PAT)

A

An assessment tool used for forming a general impression from the doorway.
The triangle includes Appearance, Circulation, Work of breathing.

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5
Q

What is the TICLS mnemonic? What does it mean?

A

The TICLS mnemonic highlights the most important features of a child’s appearance.
Tone (does the child have good muscle tone)
Interactiveness (how alert is the child)
Consolability (can crying or agitation be relieved)
Look or gaze (does the child fix their gaze on you or is there a vacant stare)
Speech or cry (is the child’s cry spontaneous and strong)

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6
Q

What is the significance of grunting?

A

Grunting involves exhaling against a partially closed glottis. Lower airway obstructions are suggested by grunting. Grunting may present as a symptom of pneumonia, bronchiolitis, and pulmonary edema.

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7
Q

Define Pallor, Mottling, and Cyanosis?

A

Pallor: white or pale skin or mucous membranes from inadequate blood flow
Mottling: lacy pattern of skin discolouration
Cyanosis: blue or purple discolouration of skin and mucous membranes

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8
Q

What is a length based resuscitation tape?

A

A tool used to estimate a child’s weight and identify correct size for pediatric equipment and medication doses

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9
Q

Why might only counting 10-15 seconds give you a falsely low respiratory rate in an infant?

A

Healthy infants may show periodic breathing or variable respiratory rates with short periods of apnea for less than 20 seconds.

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10
Q

What is the formula for determining the lower limit of acceptable blood pressure for children ages 1-10?

A

Minimum systolic blood pressure = 70 + (2 x age)

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11
Q

Explain the difference between resp. Distress, resp. Failure, and resp. Arrest?

A

Resp. Distress: increased work of breathing to maintain oxygenation or ventilation
Resp. Failure: a patient can no longer compensate for the problem causing increased work of breathing
Resp. Arrest: the patient has stopped breathing spontaneously

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12
Q

How do you clear an obstruction in the airway of a responsive infant?

A

5 back slaps followed by 5 chest thrusts
If the patient becomes unresponsive, start CPR

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13
Q

What is croup? Who and what does it affect?

A

Croup is a viral infection of the upper airway and the most common cause of upper emergencies in young children. Most commonly affects children ages 6 months to 6 years and most cases occur in the fall and winter. Has an affinity for the subglottic space (narrowest part of the airway).

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14
Q

What is epiglottitis?

A

Severe inflammation of the supraglottic structures due to bacterial infection.
Rare in children since the introduction of the childhood vaccine against mophilus influenzae type B

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15
Q

How does the pathophysiology of an upper airway emergency differ from a lower airway emergency?

A

Upper: restriction of airflow into the lungs (inhalation)
Lower: restriction of airflow out of the lungs (exhalation)

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16
Q

How many children are affected by Asthma? What are the 3 components that lead to obstruction and poor gas exchange?

A

5-10% of children are affected by asthma
The three components leading to obstruction are:
Bronchospasm
Mucous production
Airway inflammation

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17
Q

What is Bronchiolitis?

A

Inflammation of the bronchioles due to viral infection. Most commonly caused by the respiratory syncytial virus (RSV).
Signs and symptoms are similar to asthma however Bronchiolitis is common in children younger than 2 years and asthma is rare in children less than 1 year old.

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18
Q

What special precautions is taken to align the airway of a child younger than 2 years?

A

Place a hon layer of padding under the shoulders or upper torso to align the airway

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19
Q

What are the 2 most common ways of delivering oxygen to a a pediatric patient?

A

Blow by technique or non-rebreathe mask

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20
Q

At what rate should you deliver BVM breaths for infants and children?

A

12-20 bpm
Avoid excessive tidal volumes to reduce risk of distension, vomiting, and aspiration

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21
Q

Explain the DOPE mnemonic used for troubleshooting a tracheal tube?

A

Displacement: re-auscultate, if breath sounds are louder in the right pull the tube out slightly, if breath sounds are absent and gurgling is heard remove the tube and BVM with 100% oxygen
Obstruction: if thick secretions interfere with your ability to ventilate perform tracheobronchial suctioning
Pneumothorax: ventilation compliance may be decreased, call ALS for needle decompression, suspect if breath sounds are louder on the left and decreased on the right
Equipment failure: check the reservoir bag, ensure delivery of 100% oxygen

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22
Q

Why is hypovolemic shock the most common type of shock in infants and young children?

A

Due to their relatively small blood volume (70 ml/kg), excessive fluid loss and poor intake can result in shock relatively quickly.
May be lethargic and appear mottled or cyanotic with compensatory tachypnea.

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23
Q

What are the best sites for IV starts in infants and children?

A

Hands
Antecubital fossa
Saphenous veins
Ankle and feet

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24
Q

How might a child in disruptive shock appear?

A

Early: warm flushed skin and bounding pulses
Late: appear similar to hypovolemic shock (lethargic, cyanotic)

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25
How might a child in obstructive shock present?
Usually has history of symptoms or trauma to the chest Asymmetric chest rise Absent breath sides Muffled heart sounds Jugular venous distension
26
What may cause cardiogenic shock in children?
An underlying heart disease, myocarditis, or rhythm disturbances
27
What is the difference between a narrow complex tachycardia or a wide complex tachycardia?
Narrow: QRS less than 0.09s Wide QRS greater than 0.09s
28
What is the most common cause of tachycardia in an infant or young child?
Sinus tachycardia caused by fever, dehydration, or pain
29
What assessment questions should you ask a child with a fever?
Asking about… Vomiting Diarrhea Poor feeding Headache Neck pain or stiffness Rash …may provide clues to the underlying problem
30
What is meningitis?
Inflammation or infection of the meninges that cover the brain and spinal cord. Viral meningitis may make a child very I’ll but is rarely fatal, bacterial meningitis is potentially fatal. Symptoms include: fever, lethargy, irritability, poor feeding, bulging fontanelle, neck stiffness, headaches, photophobia (light sensitivity), altered LOC. In general, the younger the child, the vaguer the symptoms.
31
What may present with meningococcal meningitis?
Petechial rash: small, purple, non blanching spots on the skin Purpuric rash: larger, purple or black spots on the skin
32
Define hypoglycemia in a newborn and a child?
Neonatal hypoglycemia: <2.2 mmol/L Infant/Child hypoglycemia: <3.3 mmol/L
33
What are some causes of seizures in children?
Brain abnormalities Trauma Metabolic disturbances Ingestion Infection
34
What are the types of seizures?
Generalized: involve the entire brain Tonic-Clonic: jerking of arms or legs Absence: loss of attention without abnormal body movements Focal (focal aware or focal impaired awareness): involve only one part of the brain, may be body jerking without loss of consciousness or with loss of consciousness
35
What is a febrile seizure?
A seizure in a child age 3 months to 6 years presenting along with a fever Simple: lasts less than 15 minutes Atypical: lasts longer than 15 minutes
36
What is the most common method for gastrointestinal decontamination?
Administration of activated charcoal that absorbs ingested toxins. Sometimes cathartics such as sorbitol are combined with activated charcoal to speed up elimination.
37
When should you suspect salicylate poisoning?
When a child is experiencing hyperpnea
38
What is Sudden Infant Death Syndrome (SIDS)?
Sudden death of an infant less than 1 year old that cannot be explained. Leading cause of death in infants age 1 month to 1 year with peak incidence between 2-4 months.
39
What is a Brief Resolved Unexplained Event (BRUE)?
A BRUE is an episode during which an infant becomes pale or cyanotic, chokes or gags, or has an ape if spell, or loses muscle tone.
40
Define the CHILD ABUSE mnemonic that lists child abuse indications.
Consistency of the injury with child’s age History inconsistent with injury Inappropriate parental concerns Lack of supervision Delay in seeking care Affect (of the parent and the child in relation to the parent) Bruises of varying ages Unusual injury patterns Suspicious circumstances Environmental cues
41
What is shaken baby syndrome?
Abnormal appearance with no signs of external injury may be caused by a brain injury as a result of being violently shaken by a caregiver when the baby cries inconsolably.
42
What should you suspect when you see a seat belt bruise on a young child?
Seat belt cruising should cause high suspicion for a spinal fracture. Air bags pose a threat for head and neck injuries.
43
How much IV fluid should you give a pediatric patient?
If the MOI is concerning and the child is tachycardic, assume the presence of compensated shock and initiate volume resuscitation with 20 ml/kg of fluid.
44
What types of pain treatment techniques are best used on kids?
Calm, reassuring voice Distraction techniques When appropriate, analgesic medications
45
How is the rule of 9s modified for infants?
Head and trunk count for 18% of body Arms each count as 9% Legs each count as 13.5% Palm represents about 1%
46
How should burns be treated?
All burns get treated with oxygen Cover with dry clean dressings Use salbutamol or epinephrine for respiratory distress Start an IV and give 20 ml/kg for burns greater than 5% of body surface area Consider analgesia
47
What is Hydrocephalus? What are Cerebrospinal fluid shunts?
A condition resulting from impaired circulation and absorption of CSF, leading to increased size of the ventricles of the brain and increased ICP. Cerebrospinal fluid shunts are inserted to drain excessive fluid from the brain, normalizing ICP.
48
What does the term geriatrics refer to?
The assessment and treatment of disease or injury in someone 65 years or older.
49
What is the old age dependency ratio?
The ratio used to determine the number of older people in a society in relation to the number of potential workers who are theoretically capable of providing resources to sustain the whole population.
50
How does the cardiovascular system change over time?
Heart hypertrophies (enlarges) Blood vessels stiffen Stroke volume decreases Arteriosclerosis contributes to hypertension Electrical conduction cells deteriorate with age
51
How does the respiratory system change over time?
Elasticity of the lungs decreases Respiratory muscles lose size and strength Calcification of costochondral cartilage makes the chest wall stiffer Ciliary mechanisms that remove secretions slow down Kyphosis (outward curvature of T spine) may effect pulmonary function
52
How does the nervous system change over time?
Most common changes are, cognitive speed, memory, and postural stability Brain weight may shrink by 10-20% Visual changes in 50% of patients over 65
53
What are the 2 most common causes of vision disturbances in older adults?
Cataracts: blurred vision, double vision, spots, or ghost images (may be corrected with surgery) Glaucoma: increased intraocular pressure damages the optic nerve resulting in permanent vision loss
54
What are the most common causes of hearing loss in older people?
Presbycusis: progressive hearing loss particularly in the high frequencies along with lessened ability to determine between a particular sound and background noise. Ménière disease: Vertigo, hearing loss, tinnitus, and pressure in the ear that presents in cycles that last several months at a time.
55
How does the digestive system change over time?
Taste buds decrease reducing taste and smell Volume of saliva is reduced Gastric motility slows Risk of diverticulitis increases
56
How does the renal system change over time?
Response to sodium deficiency decreases (higher risk of dehydration and overhydration) Capacity of the bladder decreases
57
What are the 2 major types of incontinence?
Stress: occurs during activities such as coughing, laughing, sneezing, lifting, and exercise Urge: triggered by hot or cold fluids, running water, sometimes the thought of going to the bathroom
58
How does the integumentary system change over time?
Wrinkling occurs become skin becomes thinner, drier, less elastic, and more fragile Elastin and collagen decrease Ability to sweat decreases Blood vessels are affected by atherosclerosis and provide less oxygen at the cellular level
59
How does the musculoskeletal system change over time?
Bones become more brittle Tendons and Ligaments lose elasticity Synovial fluid increases and cartilage decreases in the joints Muscle mass decreases
60
How does aging affect the risk of aneurysms?
The risk of aneurysms (balloon defect of arterial wall) increases with age, life threatening aneurysms develop in the brain, chest or abdomen, may present as a chronic headache pattern but most commonly first manifestation is a sudden stroke.
61
What is aortic disruption?
Tearing of the inside of the arterial wall allowing blood to collect between the layers. Weakens the arterial wall making it susceptible to rupture
62
How does aging affect the risk of stroke?
The risk of stroke double every decade after 55 years of age, mirroring the increase in risk factors such as hypertension and atrial fibrillation.
63
What is a TIA?
Transient Ischemic Attack (mini stroke) entails temporary disturbance of blood supply to the brain that results in sudden temporary decrease in brain function. Symptoms are the same as a stroke but last 1-24 hours. Warning sign of a future stroke!
64
Who is considered at risk for pneumonia?
People with underlying problems such as, COPD Diabetes Vascular disease Depressed immune system (AIDS, cancer therapy, organ transplant)
65
What does the term COPD refer to?
Chronic obstructive pulmonary disease is a term given to a group of 3 diseases, Chronic Asthma Bronchitis Emphysema
66
What are the 2 features of age related cognitive changes?
Relatively isolated Onset and prgression “in time” with the persons aging process
67
How do delirium and dementia differ?
Delirium: symptom not a disease, acute brain syndrome of state of confusion Dementia: disorder causing irreversible brain failure
68
How does Parkinson’s disease present?
2 or more of the following symptoms, Resting tremor of extremity Slowness of movement (bradykinesia) Rigidity or stiffness of extremities or trunk Poor balance
69
What are the risk factors for developing diabetes in geriatrics?
Multiple chronic diseases such as hypertension, heart disease, and stroke Family history Diet Obesity Sedentary lifestyle
70
What are the symptoms of hypothyroidism?
Cold intolerance Constipation Dry skin Weakness Weight gain
71
Define Osteoporosis and Osteoarthritis?
Osteoporosis: decrease in bone mass leading to reduction in bone strength and greater chance of fracture. Osteoarthritis: progressive disease of the joints that destroys cartilage, promotes formation of bone spurs, and leads to joint stiffness.
72
What is Rheumatoid arthritis?
A long term autoimmune disorder characterized by inflammation of the joints and surrounding tissues. Symptoms are usually bilateral pain and stiffness.
73
How many geriatric patients develop an abuse problem in response to a life changing event?
Approximately 1/3
74
What is the incidence of depression in the geriatric population?
5-10%
75
What are the 2 types of falls among older people?
Extrinsic: tripping on a rug or slipping on ice Intrinsic: dizzy spell or syncopal attack
76
What is the GEMS Diamond?
Acronym for remembering themes when caring for geriatrics Geriatric: present atypically, deserve respect Environmental: is the environment contributing to the problem? Medical assessment: may have a variety of problems and prescriptions Social assessment: smaller social network due to death of spouse, family, or friends
77
What does the DELIRIUMS mnemonic stand for?
Causes of delirium: Drugs or toxins Emotional Low PaO2 Infection Retention of stool or urine Ictal state (seizures) Undernutrition (vitamin deficiencies) Metabolism (thyroid, endocrine, electrolytes) Subdural hematoma
78
Why is it a good idea for a paramedic crew to have a code word?
It’s a good idea for a paramedic crew to have a code word that indicates that your partner should discreetly call for police. This way you will not aggravate a patient by letting them know of your request for police.
79
What are some risk factors for child maltreatment?
Parental history of maltreatment Substance abuse Insufficient knowledge of child development Disorganized family structure Marital or partner discord Financial stressors (poverty, unemployment) Disability of the child Dificult temperament of child Isolation of caregivers (lack of social support) Violent/ crime filled community
80
What are some “red flag” caregiver behaviours?
Apathy Strange conduct Little or no concern about the child Overreaction to child misbehaviour Not forthcoming with events surrounding injury Intoxication Overreaction to child’s condition
81
When is the CHILD ABUSE mnemonic helpful?
When assessing for possible child maltreatment Consistency of injury with child’s age History inconsistent with injury Inappropriate parental concerns Lack of supervision Delay in seeking care Affect Bruises of varying ages Unusual injury patterns Suspicious circumstances Environmental clues
82
What is the difference between active neglect and passive neglect?
Active neglect refers to deliberate withholding of companionship, medicine, food, exercise, or assistance with mobility. Passive neglect occurs when an older person is ignored, left alone, isolated, or forgotten.
83
What are the 4 types of domestic maltreatment?
Physical: hitting, kicking, pushing, shoving, choking, beating Emotional: negative comments, calling names, mind games Economic: keeping a person for getting a job of gaining financial independence Sexual: making a person perform sexual activities against his or her will
84
What is the difference between sexual assault and rape?
Sexual assault refers to unwanted sexual contact Rape means penile penetration of the genitalia without the victim’s consent
85
Explain the 2 types of deafness?
Conductive deafness: usually curable, temporary condition caused by an injury to the eardrum, an infection, or simply buildup of earwax Sensorineural deafness: permanent, may be caused by a lesion or damage to the inner ear, or damage to the 8th cranial nerve
86
What are 5 tips for working with patients with hearing impairments
Speak slowly and distinctly Change speakers Provide paper and pencil Only one person should ask questions
87
What are the 4 types of hearing aids?
In the canal: tiny case that fits in the ear canal In the ear: all parts are contained in a shell that fits in the outer part of the ear Behind the ear: all parts are contained in a plastic case that rests behind the ear Conventional body type: older style for profound hearing loss
88
What does Dysarthria mean?
The inability to make speech sounds correctly, resulting from a lack of muscle control and coordination of the larynx, tongue, mouth, and lips.
89
Define Hemiplegia, Paraplegia, and Quadriplegia?
Hemi: paralysis of one side of the body Para: paralysis of the lower part of the body Quadri: paralysis of all 4 extremities and the trunk
90
What does the term bariatric mean?
Bariatrics is the branch of medicine that studies and treats obese patients, obesity is defined as being 20-30% or more over a patients ideal body weight.
91
What are some contributing factors to obesity?
Poor dietary choices Excessive food intake Lack of exercise Hormonal changes Inadequate sleep Low basal metabolic rate Environmental toxins Genetic predisposition Cessation/reduction of cigarette smoking
92
What is Pickwickian syndrome and what are it’s signs and symptoms?
Obesity hypoventilation syndrome or pickwickian syndrome is a condition causing hypoxemia, hypercapnia, and polycythemia. Symptoms include, extreme obesity, headache, apnea, sleepiness, red face, muscle twitching, signs of right sided heart failure
93
What is Down syndrome? What are it’s symptoms?
A developmental disability caused by a genetic chromosomal defect during fetal development. Symptoms include, round head with flat occipital bone, enlarged tongue, slanted and wide set eyes, flat skin on either side of the nose covering the inner corner of the eyes, short and broad hands, heart defects, thyroid problems, hearing and vision problems.
94
What are some of the symptoms of autism?
Characterized by difficulty in social interaction, repetitive behaviour, and verbal or non verbal communication.
95
What is cerebral palsy?
A non progressive, bilateral, neuromuscular disorder in which muscles are poorly controlled. It results from developmental brain insults in utero.
96
What is Cystic Fibrosis?
Chronic dysfunction of the endocrine system that targets multiple body systems but primarily the respiratory and digestive systems. Cystic fibrosis causes unusually high sodium loss resulting in abnormally thick mucous secretions.
97
What is Multiple sclerosis?
A chronic disease of the central nervous system characterized by destruction of the myelin and nerve axons within the brain and spinal cord. Usually affects women in their 20s-40s and 2-3x more often than men
98
What is muscular distrophy?
An inherited muscular disease that causes progressive degeneration of the muscle fibres causing gradual muscle weakness
99
What is Spina Bifida?
The most common permanently disabling birth defect. In the first month of development the fetus’s spinal column does not close properly and vertebrae do not develop. May lead to partial or full paralysis, bladder or bowel control difficulties, learning disabilities, and latex allergy.
100
What is Myasthenia Gravis?
A rare autoimmune disorder characterized by chronic fatigability and weakness of muscles, especially in the face and throat.
101
What is the objective of rehabilitation care?
Restore a person with disabilities to their maximum potential in several areas, physical, social, spiritual, psychological, and vocational.
102
What is the paramedic’s role in identifying and preventing injury in the patient’s home?
You may be able to help the patient or their family identify hazards that need to be removed.
103
What is a Stoma?
An oriface that connects any hollow entity of the body to the outside air.
104
What does a peak flow meter do?
A peak flow meter measures the rate of air being expired in litres per minute and gives an indication of the condition of the larger airways.
105
What is considered an adequate ejection fraction?
A left ventricle ejection fraction of 55% or greater is adequate Less than 55% may limit the patient’s activity level and be a sign of cardiomyopathy (heart muscle not working at the optimal level)
106
What is a central venous catheter (CVC)?
A venous access device with the tip of the catheter in the superior vena cava. Used in many home care patient’s needing long term IV medications.
107
What is an Adhesion?
Scar tissue that may form after an abdominal surgery that connects one loop of bowel to another or encircle a segment of bowel resulting in an obstruction.
108
How much volume causes the urge to urinate?
The urge to urinate occurs when the bladder fills to approximately 150ml An extreme urge occurs when the volume reaches approximately 400ml
109
Explain the difference between Serous exudate and Purulent exudate?
Serous: clear, watery drainage from a wound Purulent: pus, consisting of white blood cells, liquified dead tissue, and bacteria
110
What is dehiscence?
A complication of wound healing causing the separation of the edges of the wound
111
What are some complication of pregnancy that increase the risk of sepsis in a newborn?
Maternal bleeding Maternal fever Infection in the uterus Premature rupture of membranes
112
When is home monitoring of apnea in an infant indicated?
Unresolved prematurity apnea at the time of discharge from the hospital Severe gastroesophageal reflux History of an apparent life threatening event Sibling of an infant that died of SIDS
113
What are the 2 major types of nociceptors?
Alpha (fast) fibres: transmit sharp localized pain usually associated with an injury C (slow) fibres: transmit slow pain often described as burning, throbbing, or aching, associated with long term conditions
114
What are the potential side effects of chemotherapy?
Alopecia (hair loss) Anorexia Fatigue Leukopenia (decreased leukocytes) Thrombocytopenia (decreased platelets) Anemia
115
What are the stages of adjustment to chronic illness?
Denial- refusal to follow plan Anger- verbal or physical abuse Bargaining- refusal to follow plan as part of bargain Withdrawal and depression- profound sadness and reduction in interaction Acceptance- adaptive behaviours
116
What is the pediatric dose for Acetaminophen?
10-15 mg/kg (650 mg max) Repeat every 4 hours (75 mg/kg daily max)
117
What is the pediatric dose for Epinephrine?
Anaphylaxis 0.01 mg/kg IM Repeat every 10 minutes as required Asthma 0.01 mg/kg IM (0.5 mg max dose) Repeat once after 20 minutes
118
What is the pediatric dose for Naloxone?
2 mg IN 0.1 mg/kg IM (2 mg max dose) 0.1-2 mg IV (5 years and older) Repeat after 2-3 minutes
119
What is the pediatric dose for Oral Glucose?
12.5 grams (Infants/Children) 12.5-25 grams (adolescents) Repeat every 10 minutes up to 3 times
120
What is the pediatric dose for Dextrose?
5 ml/kg 10% Dextrose IV (max dose 250 ml, slow push over 1 min.)(infants and children) Repeat every 5 minutes as required
121
What is the pediatric dose for Dimenhydrinate?
0.5 mg/kg IV or IM (25 mg max dose, slow push over 2 min.)(Infants and children) Repeat every 4 hours as required
122
What is the pediatric dose for Midazolam?
Seizures 0.2 mg/kg IN or IM (5 mg max dose) Repeat once in 10 min. IN Repeat once in 15 min. IM
123
What is the pediatric dose for Salbutamol?
First hour: 4-10 inhalations every 20 min., up to 3 times Repeat: 4-10 inhalations every hour as required

Criti Care EMS (10 decks)

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