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CPS Statement > Acute Care > Flashcards

Acute Care Flashcards

1
Q

If a pediatric AED system is not available, what should be done for a pulseless infant in V-Fib?

A

Use the adult system

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2
Q

What has been the major update to the 2010 PALS guidelines with respect to general approach to resuscitation?

A

C-A-B (instead of A-B-C)

Focus on circulation and early CPR instead of trying to obtain adequate airway and ventilation before starting CPR.

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3
Q

Describe qualities of good CPR

A
  • Compression depth at least 1/3 of the AP diameter of the chest
  • Allow for full recoil
  • Minimize interruptions in CPR
  • Rotate the compressor every 2 minutes
  • Switch compressors within 5 seconds
  • Limit pulse checks to maximum 10 seconds
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4
Q

What is the calculation for the size of cuffed endotracheal tube in a patient older than 2 years of age?

A

Cuffed endotracheal tube = 3.5 + age/4

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5
Q

After successfully resuscitating a patient, what management steps should be considered?

A
  1. Titrating oxygen to obtain sats 94-99% (avoid hyperoxia)

2. Consider therapeutic hypothermia (target temps 32-34degC)

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6
Q

What are some of the side effects of antiemetic medications such as dimenhydrinate, metoclopramide, promethazine, domperidone?

A
  • drowsiness
  • EPS reactions
  • hallucinations
  • convulsions
  • NMS
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7
Q

What are the favourable features of ondansetron as an antiemetic medication?

A
  • can be administered orally
  • rapid absorption
  • fast peak plasma concentrations
  • absence of drowsiness as a side effect
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8
Q

What is the major side effect of ondansetron in patients with gastroenteritis?

A

Diarrhea

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9
Q

To which patients with gastroenteritis should oral ondansetron be given?

A
  • 6 months - 12 years
  • those with primary symptom of vomiting
  • those with mild to moderate dehydration
  • have failed oral rehydration
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10
Q

Which patients with gastroenteritis should not be given ondansetron?

A

Patients with predominant symptom of moderate to severe diarrhea

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11
Q

Define hyponatremia

A

Serum Na

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12
Q

List symptoms of acute cerebral edema, secondary to acute hyponatremia

A
  • headache
  • nausea/vomiting
  • irritability
  • lethargy/decreased LOC
  • seizures
  • respiratory and/or cardiac arrest secondary to brain stem herniation
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13
Q

Which groups of inpatients are at highest risk of non physiological ADH secretion?

A
  • patients with nausea, stress, pain
  • patients with pulmonary or CNS system disorders
  • patients undergoing surgical procedures
  • patients taking morphine
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14
Q

Which patients are at increased risk of hypernatremia?

A

Those patients with:

  • impaired ability to excrete Na
  • renal concentrating defects
  • significant water loss
  • prolonged fluid restriction
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15
Q

Describe the ideal monitoring parameters for a patient on IV maintenance fluids with pneumonia.

A
  • Baseline lytes, BUN, Cr and at least daily monitoring of same
  • Adequate ins/outs
  • Close monitoring of symptoms of hyponatremia
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16
Q

In whom should D5W 0.9% NaCl not be used as maintenance fluids?

A
  • Patients with serum sodium > 145 –> should receive D5W 0.45%NaCl
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17
Q

List the types of viruses that can cause bronchiolitis

A
  1. RSV
  2. HMPV
  3. Influenza A/B
  4. Rhinovirus
  5. Adenovirus
  6. Parainfluenza
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18
Q

List 5 differential diagnoses for wheezing in young children/infants

A
  1. viral bronchiolitis
  2. asthma
  3. pneumonia
  4. larnygotracheomalacia
  5. foreign body aspiration
  6. GERD
  7. congestive heart failure
  8. vascular ring
  9. allergic reaction
  10. cystic fibrosis
  11. mediastinal mass
  12. tracheoesophageal fistula
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19
Q

What clinical features would support admission for a child with bronchiolitis?

A
  • signs of severe respiratory distress (in drawing, grunting, RR > 70/min)
  • supplemental O2 required to keep sats > 90%
  • dehydration or history of poor fluid intake
  • cyanosis or history of apnea
  • infant at high risk for severe disease
  • family unable to cope
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20
Q

Which groups of infants are at higher risk of severe disease with bronchiolitis?

A
  • infants born prematurely (
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21
Q

For infants with bronchiolitis requiring admission, which interventions are recommended?

A
  • supportive care with:
  • oxygen to keep sats > 90%
  • hydration (NG or IV)
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22
Q

For infants with bronchiolitis requiring admission, which interventions have equivocal evidence?

A
  • nasal suctioning
  • epinephrine nebs
  • 3% hypertonic saline nebs
  • combined epinephrine and dexamethasone
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23
Q

For infants with bronchiolitis requiring admission, which interventions are NOT recommended?

A
  • salbutamol
  • corticosteroids
  • antibiotics
  • antivirals
  • cool mist therapies or therapy with saline aerosol
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24
Q

What criteria should be met before discharging an infant admitted with bronchiolitis?

A
  • improved work of breathing and tachypnea
  • no supplemental oxygen required to maintain sats ?90%
  • adequate oral intake
  • education provided and follow-up arranged
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25
Q

Which patients with bronchiolitis benefit from continuous electronic cardiac and respiratory monitoring?

A
  • high risk patients (
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26
Q

Which patients with bronchiolitis benefit from continuous saturation monitoring?

A
  • high risk patients early in the course of disease
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27
Q

Which patients with bronchiolitis benefit from intermittent saturation monitoring?

A
  • low risk patients

- all patients once they are feeding well, weaning from supplemental O2 and showing improvement in work of breathing

28
Q

What are the most common triggers for asthma exacerbations in children?

A
  • viral respiratory tract infections
  • exposure to allergens
  • suboptimal asthma control at baseline
29
Q

What are the risk factors for ICU admission and death in a patient presenting with asthma exacerbation?

A
  • previous ICU admissions
  • previous life-threatening events
  • previous intubation
  • deterioration while already on systemic steroids
30
Q

What are signs of cerebral hypoxemia in a patient with severe asthma exacerbation?

A
  • mental agitation
  • drowsiness
  • confusion
31
Q

Name two assessment tools that reliably assess the severity of an asthma exacerbation?

A
  • PRAM (Pediatric Respiratory Assessment Measure)

- Clinical Assessment Score

32
Q

For patients with an acute asthma exacerbation, what saturations should be targeted?

A
  • SpO2 greater than or equal to 94%
33
Q

Which delivery method is preferable for bronchodilator therapy in patients with asthma exacerbations - MDI or nebulizer?

A
  • MDI (except in patients with severe episodes with impending respiratory failure)
34
Q

List side effects of salbutamol

A
  • tachycardia
  • hypokalemia
  • hyperglycemia
35
Q

List side effects of MgSO4

A
  • hypotension

- bradycardia

36
Q

List the risks associated with mechanical ventilation use during an asthma exacerbation.

A
  • increased risk of death
  • pneumothorax
  • impaired venous return
  • cardiovascular collapse because of increased intrathoracic pressure
37
Q

What clinical features would suggest admission for a patient with acute asthma exacerbation?

A
  • ongoing need for supplemental O2
  • persistent increased work of breathing
  • use of ventolin more frequently than q4 hours after 4-8 hours of conventional therapy
  • deterioration while on systemic steroids
38
Q

What discharge criteria should be met for a patient with acute asthma exacerbation?

A
  • needing ventolin q4h or less frequently
  • SpO4 > 94% on room air
  • minimal to no signs of respiratory distress
  • improved air entry
39
Q

Define convulsive status epilepticus

A

GTC seizure activity with LOC for longer than 30 minutes
OR
>2 discrete seizures without a return to baseline mental status

40
Q

Discuss issues with airway and ventilation in a patient with status epilepticus

A
  • Clenched jaw
  • Poorly coordinated respirations
  • Secretion production
  • Vomitus
  • Should position child on side, suction frequently
  • Chin lift/jaw thrust
  • O2 provided by face mask
41
Q

List algorithm for management status epilepticus

A
  • Benzo, Benzo
  • Fosphenytoin (preferred as 2nd line because of less reap depression and altered LOC than PB)
  • Phenobarb (1st line in neonatal seizures)
  • **Check glucose
  • **manage airway
42
Q

List the side effects of phenytoin/fosphenytoin

A
  • cardiac arrhythmias
  • bradycardia
  • hypotension
43
Q

When should pyridoxine be used in management of seizures?

A
  • for children
44
Q

What investigations should be done in the case of status epilepticus when the aetiology is unclear

A
  • lytes
  • glucose
  • CBC and diff
  • cultures
  • cap/art gas
  • anticonvulsant levels (as appropriate)
  • urine and serum fox screen
  • Ca, Mg
  • BUN, Cr
  • liver enzymes
  • lactate, ammonia
  • LP once stable
45
Q

What are the indications for doing CT head in a patient with status epilepticus?

A
  • history of head trauma
  • evidence of increased ICP
  • focal neurological signs
  • unexplained LOC
  • suspicion of cerebral herniation
  • ***Only done once ABCs stabilized
46
Q

List pharmacological options for management of refractory status epilepticus

A
  • Failure to respond to 2 different anti epileptic meds
  • Midazolam infusion (hypotension)
  • Barbiturates
  • Propofol
  • Topiramate
  • Keppra
47
Q

What are the most common triggers for anaphylactic reaction?

A

1) foods (peanuts, tree nuts, fish, milk, eggs, shellfish)
2) hemoptera stings
3) medications

48
Q

List the clinical criteria for diagnosing anaphylaxis

A

1) Acute onset of illness with skin and/or mucous membrane involvement PLUS: a) respiratory compromise or hypotension/end-organ dysfunction
2) Following rapidly an exposure to likely allergen, 2 or more of: a) skin/mucous membranes b) respiratory compromise c) reduced BP/end organ dysfunction d) persistent GI symptoms
3) Hypotension after exposure to known allergen for that patient

49
Q

What is the dose of epinephrine by weight?

A
  • 0.01mg/kg 1:1000 concentration
  • Epi Pen Jr (10-25kg) = 0.15mg
  • Epi Pen (>25kg) = 0.3mg
  • If
50
Q

List steps in management of anaphylaxis

A
  • EPI IM
  • ABCs
  • Prepare to intubate as needed
  • EPI IM again
  • 2 large bore IVs
  • Trendelenburg
  • Bolus PRN
51
Q

What are the effects of epinephrine?

A
  • increase PVR to reverse peripheral vasodilation
  • positive chronotropic and inotropic effects on heart
  • bronchodilation and reduced inflammatory mediator release from mast cells and basophils
52
Q

What are the adjunctive pharmacologic options for anaphylaxis management?

A
  • H1 antagonists (cetirizine or diphenhydramine) for SKIN symptoms (second gen are less sedating)
  • H2 antagonists combined with H1 for superior results in treatment SKIN symptoms
  • Steroids (1mg/kg) slow onset
  • Salbutomol if wheezing or reap distress
53
Q

How long should a patient be monitored in the ED following anaphylaxis before discharge?

A
  • 4-6 hours (most biphasic reactions occur by this time, but can occur up to 72 hours after)
54
Q

List risk factors for biphasic anaphylactic reaction

A
  • repeated epi doses

- those presenting with severe symptoms

55
Q

Which patients with anaphylaxis should be considered high risk and be monitored overnight?

A
  • those with biphasic reactions
  • concurrent peanut allergy, asthma
  • those on beta-blockers
56
Q

List the components of discharge planning for a patient with anaphylaxis

A

List the components of discharge planning for a patient with anaphylaxis

57
Q

What unique anatomical features of children make them more likely to develop an intracranial lesion due to head trauma?

A
  • larger head-to-body size ratio
  • thinner cranial bone
  • less myelinated rural tissue
  • more commonly develop a pattern of diffuse axonal injury
  • secondary cerebral edema
58
Q

What are the most common causes of head trauma in children and youth presenting to ED?

A
  • falls (esp >3ft)
  • sports-related injuries
    hit on head (by an object or colliding with an obstacle)
  • injuries involving use of bicycle
  • Injuries involving MVCs
59
Q

List clinical manifestations of head trauma in children

A
  • HA
  • Amnesia
  • Impaired LOC, disorientation, confusion
  • vomiting
  • LOC
  • blurred vision
  • Seizures
60
Q

How is the severity of head trauma scored?

A
  • GCS 14-15 - mild
  • GCS 9-13: moderate
    GCS 8 and less: severe
61
Q

List components of a history into head injury

A
  • mechanism of head trauma
  • witnessed?
  • state in which patient was found (LOC, seizures?)
  • presenting symtoms
  • medical history of head injury, neurological disorders, medication use and bleeding diathesis
62
Q

In which patients with head injury should skull fractures be conducted?

A
  • Not routinely done in all patients

- Definitely done in

63
Q

In which patients with head injury should a CT head be done?

A
  • all patients with moderate or severe head trauma
  • patients with minor head trauma and ANY of the following:
    a) GCS 3ft/five stairs, fall from bike without a helmet)
64
Q

Which factors increase the risk of post-traumatic seizures (usually within 24hrs)

A
  • younger age
  • severe head trauma (GCS 8 or less), cerebral edema
  • subdural hematoma
  • open or depressed skull fractures
65
Q

What are indicators of poor prognosis in head injury?

A
  • clinical severity at initial presentation (esp GCS

CPS Statement (19 decks)

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