Acute Care Committee

Question 1

Bronchiolitis

1. Statement pertains too
2. What is it?
3. Does it worsen?
4. RSV Timeline
5. Indications for Prognosis
6. Proven Treatment

Answer 1

Statement pertains to those children <2 years of age.
Bronchiolitis is the obstruction of the small airways, due to inflammation, edema and necrosis.
Disease often worsens within the first 72 hours.
November to January is RSV time
Indications for prognosis: subcostal retractions, O2 requirement, resp rate. Worse off if you are <3 months of age or a prem.
Only proven treatment: O2 and hydration. Pulse oximetry is NOT needed unless high risk of APNEA in which it is used to monitor

Question 2

Acute Head Trauma

1. Risk Factors
2. Guidelines
3. <2 and >2 Criteria
4. Post traumatic seizure and skull fracture risks

Answer 2

Kids are more at risk for head trauma due to their large head to surface ratio, thinner skull bones, more prone to myelnation.
2. Risk Factors: Height >3 feet, Motor Vehicle Collision, High Velocity Projectile
You need to get more worried when the signs or symptoms are prolonged or worsening
3. PCARN or CATCH
4. PCARN <2 Years of Age (SCALPS)
Scalp Hematoma, Caregiver concern, Altered LOC, Loss of Consciouness >5; Palpable fracture; Severe Mechanism
5. PCARN >2 years (BASiLAR)
Basilar skull fracture
Altered level of conciousness
Severe headache
Injury mechanism
Loss of loc
Regurgitation repeats.
If there is going to be a post traumatic seizure, it is more likely to occur within the first24 hours but can occur within the first 7 days. If skull fracture >4 mm more at risk for leptomeningeal cyst formation.

Question 3

Acute Asthma Exacerbation

Answer 3

PRAM Score (Pediatric Respiratory Assessment Measure)
Level of Consciousness, Sats, sounds in Chest, and WOB >8 is severe.
Inhaled corticosteroids need to be started at lowest daily dose:
Low <150-200 mcg/day
medium: 200-400 mcg/day
Mild, Moderate and Severe treatment measures
Side Effect of magnesium sulfate is Hypotension.

Question 4

Status Epilepticus

Answer 4

Defined as seizing for >30 minutes, or 2 discrete episodes in which the patient does NOT return to baseline.
The most immediate risk in seizure if inability to maintain the airway.
The most common cause of convulsive status is febrile seizure.
TX: Sugar <2.6 mmol/L; Benzo q 5 minutes x 2-3; phenobarb and dilantin.

Question 5

Anaphylaxis

Answer 5

Distributive type of shock - therefore, have in supine or in trendelenburg to ensure appropriate venous return to the head.
TX: IM Epi 1:1000 q 5-15 minutes.
More likely to have a biphasic reaction (within 4-6 hours up to 72 hours) if requiring more than one dose of epi.
Can also treat with H1, H2, and steroids.

Question 6

Croup

Answer 6

Most commonly occurs in children 6 months - 3 years of age.
Treatment : Epi neb 5 ml 1:100
Dex 0.6 mg/kg to a max of 10 mg.

Question 7

Ondansetron use in the emergency department

Answer 7

Used in Mild to moderate dehydration and vomiting. 
5HT receptor antagonist
NOT for children <6 months of age
Dosing: 0.15 mg/kg
8-15 kg: 2 mg
15-30 kg: 4 mg
>30 kg: 8 mg 
Highest side effect is diarrhea within 48 hours of giving.