23-lethargy

Question 1

sick vs not sick

Answer 1

1. If the individual (child or adult) is still perfusing major organ systems:
   Brain (alert vs. lethargic)
   Skin (well-perfused, flushed, or cool and clammy?)
   Kidneys (urine output)
   Lungs (respiratory rate? work of breathing? cyanosis?);
2. How quickly the illness is progressing;
3. If the individual has any underlying conditions (e.g., sickle cell disease, HIV, neutropenia, diabetes mellitus) that raise the risk of serious illness.

Question 2

what is most sensitive test of volume status/circulation

Answer 2

HR- tachycardia=inadequate perfusion

Question 3

shock definition

Answer 3

inadequate delivery of substrates and oxygen to meet the metabolic needs of tissues

Question 4

shock signs

Answer 4

Increased heart rate (tachycardia)

Increased systemic vascular resistance (vasoconstriction)- cool clammy, delayed cap. refill

Increased heart contractility:

Increased venous tone:

Increased respiratory rate (tachypnea): compensate for the metabolic acidosis

hypotension is late sign

Question 5

4 types of shock

Answer 5

Distributive (neurogenic and anaphylactic)
Septic (some experts include septic shock in the Distributive category)
Hypovolemic
Cardiogenic

Question 6

preference for drug delivery

Answer 6

1. IV peripheral access
2. central line
3. intraosseus

Question 7

intraosseus insertion

Answer 7

veins in medullary sinuses that haven’t collapsed

for kids under 6

sites: distal femur, proximal tibia, distal tibia, or the iliac crests

Question 8

intraosseus contraindications

Answer 8

Osteogenesis imperfecta
Fractured bone
Bone recently used for IO
Bone with overlying area of cellulitis, infection, or burn

Question 9

intraosseus complications

Answer 9

Fractures
Infusion of fluid into subcutaneous tissue causing compartment syndrome.
Osteomyelitis
Microscopic fat and bone marrow emboli. (Clinical relevance of these emboli is not clear.)
The only reported deaths resulting from IO infusions were associated with using the sternal approach.

Question 10

meds to treat meningococcal meningitis

Answer 10

ceftriaxone, vancomycin

then pen G once diagnosis confirmed

Question 11

prevention of neisseria men. for contacts

Answer 11

cipro- adults

rifampin- kids

Question 12

treatment for rocky mountain spotted fever

Answer 12

doxycycline and ceftriaxone

Question 13

differential for fever and petechiae

Answer 13

meningococcal sepsis

TSS

RMSF

Bacterial endocarditis