ACH Review (General Peds/Neo) Flashcards
What safety equipment should be checked for a first assessment?
- Working JR bag
- Trach bag (if applicable)
- Chest tube (SxN pres, water lvl, balloon etc.)
What should the general work flow be in a patient assessment?
ETT->WOB->Auscultate->palpate-?cap refill->chart
- Grab RR before waking the pt if possible
What topics should you keep in mind for rounds and during you assessment?
- Vent settings and any changes
- Recent blood gasses
- Sxn trends
- Breath sounds
- Meds
- concerns/suggestions
- Samish report as handover
Initial Pediatric Vt goal?
5-8 ml/kg
Normal/Initial RR goals for Pediatrics:
- Infant
- Toddler
- Pre-school
- Child
- Teen
- Infant 30-50 bpm
- Toddler 24-40bpm
- Preschooler 20-35 bpm
- Child 18-30 bpm
- Teen 12-20
Normal/Initial Ti goals for pediatrics?
- Infant
- Toddler
- Pre-school
- Child
- Teen
- Infant 0.3-0.55 s
- Toddler 0.5-0.75 s
- Preschooler 0.6-0.8 s
- Child 0.7-0.8s
- Teen 0.8-1s
Normal/initial peep goals?
5-8 cmH2O
When do you use the 100ml/kg estimated for MV for peds?
When they’re greater than 25kg, below that stick to 5-8ml/kg and normal RR for their age group
Peds estimated OETT suction depth?
Refer to broslow or ETT ID x3
How do you determine ETT size?
(Age/4) + 4
- you add 3.5 instead if a microcuff is used
How do you add 20% of a number?
for example, for your Vt alarm setting?
- Calculate 20% of the number: Multiply the number by 0.20.
- Add the result to the original number.
What do you SBT kids on for extubation?
Tube smaller (ETT< 3.5) = PS 8/+5
Tube bigger (ETT>3.5)= PS 6/+5
- Once passed, return to rest settings
- Intubated < 48hrs = 30mins
- Intubated > 48hrs = 60-120mins
What equipment is needed in a pediatric extubation?
Extubate off the bagger with sxn and reintubation equipment ready.
How many ml/kg do you start a kid on HFNC?
2ml/kg
What is back to back therapy? (B2B)
Puffs every 20 mins x3
- Takes about an hour
- Drugs depend on PRAM on PRAM severity
- reassess and stretch as tolerable
Asthma protocol for mild, moderate, and severe
Based on PRAM
- Mild (0-4) = Ventolin
- Mod (5-8) = Ventolin+Atrovent+dex
- Sev (9-12) = nebs for O2 and resp failure
TBI goals for kids?
- Low normal CO2 goals (35-40)
- PaO2 > 80mmHg
- CPP >60, ICP ideally <20
- Reverse Trendelenburg bed
- Sedation bolus before any procedure (sxn, position change)
- Watch for Cushing triad
- Mannitol and 3% saline bolus to control ICP
Normal Saline bolus amount for hypovolemic shock/hypovolemia?
20 ml/kg normal saline bolus up to 100 ml/kg to improve BP
- Once fluids don’t work, Inotropes should be used
What is Cushings Triad?
Coning or increased ICP
- Apnea
- Brady
- Hypertension
What can you do if Cushings triad occurs?
Bag them down to low CO2 bc it helps with ICP
Salbutamol MDI Dosing for Peds?
Children < 20kg get 5 puffs MDI
Children > 20kg get 10 puffs MDI
Ipratropium MDI Dosing for Peds?
4 puffs MDI regardless of weight
dexamethasone dosing?
Starting 0.3 mg/kg, Max dose: 10mg
- Dex is preferred over Prednisone
Prednisone dosing?
Starting 2mg/kg, max 60mg
Severe PRAM large volume neb doses for children < 20kg?
7.5mg salbutamol + 750mcg ipratropium into a large volume nebulizer.
- Dilute with normal saline for a total volume of 20mL
- Administered with 8LPM O2.
Severe PRAM large volume neb doses for children > 20kg?
get 15mg salbutamol+750mcg ipratropium into a large volume nebulizer.
- Dilute with normal saline for a total of 20ml
- Admin with 8 LPM of O2
- Basically, double the amount of the < 20kg kids
ECMO rest settings?
10-10-10
- PC/PS 10
- RR 10
- PEEP 10
