(4.3) Cardiac Pulmonary and Renal Pediatric Pearls 1 [CIS-Newman] Flashcards
Define:
Cardiopulmonary emergency
Absence of effective ventilation, circulation or BOTH
What are the 3 components of cardiopulmonary arrest in children?
- Respiratory (O2)
- Cardiac (Pump, perfusion, BP)
- Circulatory volume (perfusion, BP)
Cardiac arrest in infants and children does not usually result from …
PRIMARY CARDIAC CAUSE
Typically, what is cardiac arrest in children the result of?
Progressive respiratory failure or shock
What is PALS?
Pediatric advanced life support
Pediatric cardiopulmonary arrest could arise from?
- Respiratory failure
- Cardiac failure
- Endocrinopathy
- Trauma
- Infection
- Renal failure
MOST pediatric arrests are?
Respiratory
Describe what you are attentive to with the pediatric assessment triangle (PAT):
Appearance
Breathing
Circulation
When do you use the pediatric assessment triangle (PAT)?
FIrst, from the door, general assessment
What is the overal demeanor of a child in respiratory distress?
- Restlessness
- Anxiety
- Combativeness
- Somnolence
- Lethargy
What is the overal tone of a child in respiratory distress with a REASSURING prognosis?
Vigorous movement and good tone
What is the overal tone of a child in respiratory distress with a BAD prognosis?
Poor tone
Lethargy
Listlessness
What is a reassuring vs NOT reassuring visualization of the interactions of the child?
Reassuring: Somewhat playful, interacting w/ parent/caregiver/care provider
NOT reassuring: Not interacting with others, won’t play with toys
What can consolability reveal about the state of the child’s health?
NOT consolable = VERY sick child
Describe the look/gaze of a child that is very hypoxic
Eyes “rolling around”
Unfocused gaze indicateds decreased level of consciousness
What would the speech/cry be like for a healthy vs very sick child?
Relatively healthy = Loud cry/strong voice
Sick = Hoarse, muffled, weak and NO cry
What is the initial response to respiratory compromise?
Tachypnea
What is an OMINOUS sign in the setting of respiratory compromise?
The development of slower, irregular respiratory pattern
What are some physical findings that indicate respiratory distress?
- Nasal flare
- Intercostal retractions
- Rocking respiration
- Stridor
- Diffuse/localized wheeze
- Grunting
- Accessory muscle involvement
- Decreased breath sounds
- Tripod/leaning forward position
Stridor is most prominent with inspiration or expiration?
Inspiration
Describe
Wheezing
Squeaking noise made by air passing though narrowed tacheobronchial airways
Describe
Rales
Moist sounds heard upon auscultation resulting from air passing through narrowed bronchi
When is grunting most prominent, inspiration or expiration?
Expiration
What are the major signs in the skin exam that reveal respiratory distress?
- Decreased perfusion
- Cooling of the skin
- Pale, mottled, cool or ashen skin
What is a normal cap refill time?
Less than 2 seconds
What will you see both initially and after prolonged period in the heart rate of a respiratory distress pt?
Initially = Tachycardia
After prolonged period = Bradycardia
What are the ABCDE’s of evaluating respiratory distress?
A= airway
B= breathing
C=circulation
D=Disability (depressed consciousness, unresponsiveness)
E=exposure
What are examples of immediately life threatening conditions?
- Severe upper airway obstruction
- Tension pneumothorax
- Cardiac tamponade
- Pulmonary embolism
What is Beck’s triad?
Triad of symptoms that is highly suggestive of cardiac tamponade
- JVD
- Muffled cardiac sounds
- Hypotension
Are pulmonary emboli common in children?
NO
What are some OTHER potential causes of respiratory distress in kids?
- Infections
- Retropharyngeal and peritonsillar abscesses
- Croup
- Epiglottitis
- Bronchiolitis
- Pneumonia
- Asthma
- Anaphylaxis
- Forgein body
- Chest wall abnormalities
What is the most frequent cause of bronchiolitis?
Respiratory syncytial virus (RSV)
What are the characteristics of RSV?
URI symptoms
What is the most common cause of pneumonia in children?
Streptococcus pneumoniae
What is the treatment for anaphylaxis?
Epinephrine
If an allergy is reported, what do you ALWAYS have to ask?
ALWAYS ASK WHAT HAPPENS WHEN EXPOSED TO THE ALLERGEN
What is a SERIOUS choking hazard that could cause erosions in the mucosa?
Button batteries
Children that have developmental delays will decompensate much ______ than normally developed children
Children that have developmental delays will decompensate much QUICKER than normally developed children
What does sickle cell disease with sudden onset RD, chest pain, new infiltrate on CXR and fever lead you to think of?
Acute chest syndrome
