(04-19-17) Oral Sedation for Children Flashcards
what are the reasons you should sedate someone?
- longer appt needed
- difficult to cope with procedure pt
- crying
- struggling
what are the reasons you SHOULD NOT sedate a kid?
- can be managed with less risky method (N2O)
- Underlying medical condition
- too much work (GA would be better option)(if two sedations needed then no sedations needed)
- presedation eval shows VERY uncooperative pt
ultimate management of a child depends on what?
practitioner’s training, skills, and competence
refers to the quality and intensity of a relationship an individual has for the caregiver. the “cling” factor
attachement
*is transfereable but varies in intensity
refers to how and individual reacts to a novel environment or stanger
temperment
what does research say about attachment and temperment?
they are related
what is the key to happiness when communicating with the parents?
- lower expectations
- set realistic goals
- be sure parents understand all potential outcomes
- document parents’ understandings
children are not small adults, they differ in regards to what?
- metabolism
- CV response
- airway anatomy
with children, emergencies most often involve what?
respiratory compromise
AIRWAY, AIRWAY, AIRWAY
what are some differneces in a child’s airway as opposed to an adult’s?
- larynx is more superior and anterior with immature cartilage
- tongue is “relatively larger” and sits higher in the mouth
- tonsils and adenoids are more prominent which restricts the airways even more
- proportionately, the head is larger than the body
in a normal healthy child during oral sedation using common sedative agents, which system of the body is the most important to monitor?
respiratory
what must monitoring of the respiratory system include?
- ventilation
- oxygenation
the movement of air into and out of the lungs via the airway
ventilation
*important factors to monitor are patency of airway, depth, and frequency of ventilation
the transport of O2 to metablically active tissues
oxygenation
*important factors to monitor are HR and O2 saturation
how is a child’s breathing different than an adults?
children breathe faster and have smaller tidal volume than adults
what is the Brodsky Scale for airway assessment?
- if the tonsils are greater than half the airway, the likliness of blockage inc dramatically
- DO NOT sedate with chloral hydrate or meperidine (high doses) if tonsils are “kissing”
- always ask the parent if the pt snores and if so how loudly?
what does the Mallapati scale evaluate?
quality of peritonsilar tissue
what are some airway issues of premature infants?
- delayed developement of airway
- reduced levels of surfactant
- inc incidence of early life intubation
*these children will have inc incidence of post-extubation scarring
what can development of an airway impact?
- muscle tone
- reflex arc
- laryngospasms
what are some things what occur with intubation early in life
- palatal grooves (collapse of max arch)
- odontogenic anomalies (enamel hypoplasia, delayed eruption
- hypersensitive gag
- oral aversions and non-nutrititive sucking
- post-intubaiton tracheal stenosis
- hyperoxygenation (branchopulmonary dysplasia)
what is RSV?
-viral infection that affects up to 125,000 children in US each year and is the most common cause of hospitalization during the first 12 months of life
what are the infection rates of RSV?
greater than 90% but only about 2% of kids become symptomatic
what are the identified risk factors for RSV>
- male
- household crowding
- daycare attendance
- gestational age less than 33 weeks
*inconclusive = breastfeeding less than 2 months
= PSE
what is the the #1 cause for bronchiolitis and pneumonia in kids under 1 year of age in teh US
RSV
