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Acute PNP > Acute Care Management > Flashcards

Acute Care Management Flashcards

1
Q

What is PAT?

A

Pediatric Assessment Triangle

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2
Q

What is elements of Primary Survery?

A

ABCDE

Airway

Breathing

Circulation

Disability (neurologic)

Exposure

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3
Q

Sniffing O2?

A

Put them in the sniffing position and provide oxygen

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4
Q

How to calculate ETT size?

A

(Age in years/4) + 4

i.e. 4 year old - (4/4) = 5.0c

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5
Q

How to calculate ETT depth?

A

3x ETT size

4yr old with 5.0c x 3 = 15cm at the teeth

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6
Q

What are signs of mild (15-30%) blood volume loss?

A

Cardiovascular: tachycardia, weak/thready pulses

Neurologic: anxious, irritable, confused

Skin: cool, mottled; prolonged capillary refill

Urine output: minimally decreased

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7
Q

What signs of moderate (30-45%) blood volume loss?

A

Cardivascular: tachycardia, absent peripheral pulses, weak/thready central pulses; mild hypotension with narrow pulse pressure

Neurologic: lethargic, dulled response to pain

Skin: cyanotic unless anemic; markedly prolonged capillary refill

Urine output: minimal

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8
Q

What are signs of severe (>45%) blood volume loss?

Cardiovascular, neurologic, skin, urine output

A

Cardiovascular: tachycardia followed by bradycardia; hypotensino

Neurologic: comatose

Skin: pale, cold

Urine output: none

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9
Q

What does a GCS of <12 signal?

A

Head injury

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10
Q

What does a GCS <8 represent?

A

Less than 8 = intubate

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11
Q

What does a GCS <6 represent?

A
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12
Q

What is the highest GCS score?

A

15

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13
Q

What is the lowest GCS score?

A

3

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14
Q

What has very genetic infromation, but can be helopful in giving basic information about how injuried a child is?

A

Trauma Score

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15
Q

What does a trauma score less than 9 represent?

A

Signficiant risk of morbidity and mortality

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16
Q

What elements are in secondary survey?

A

Obtaining deilated history

Full set of vital signs

Head to toe physical assessment

If any change = repeat primary survey

Guides further interventions

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17
Q

What is MVIT?

A

MVIT from prehospital providers

Mechanism of injury

Injuries sustained

Vital signs

Treatment

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18
Q

What is the intial fluid resutitation goal value?

A

20 mg/kg of Normal saline or lactated ringers

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19
Q

What is the inital fluid resuscitation with a cardiac condition?

A

10 mg/kg of normal saline or lactated ringers

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20
Q

What are the steps on initial management?

A

Fluid resusitation

NPO

Gastric decompresion

Urinary catheter

Analgesia

Consults

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21
Q

What is the first goal in management in ED?

A

Triage

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22
Q

Level 1 Triage

A

Resuscitation–immediate, life-saving intervention required without delay

i.e. cardiac arrest or massive bleeding

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23
Q

Level 2 Triage

A

High risk for deterioriation or signs of time-critical problem

i.e. cardiac-related chest pain, astham attack

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24
Q

Level 3 Triage

A

Urgent–stable, with multiple types of resrouces needed to investigate or treat (lab tests + x-ray)

i.e. abdominal pain, high fever with cough

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25
Q

Level 4 Triage

A

Less Urgent–stable, with only one type of resource anticipated (only x-ray or only sutures)

i.e. simple laceration, pain on urination

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26
Q

Level 5 Triage

A

Nonurgent–stable with no resources anticipated except topical or oral medications or prescriptions

ie. rash or prescription refill

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27
Q

What is CIAMPEDS?

A

Used in regular ED visit

Chief complaint

Immunization/Isolation

Allergies

Past Medical Hx

Events surrounding illness or injruy

Diet/Diapers

Symptoms associated with illness/injury

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28
Q

What constitutes as premature?

A

Any infant born prior to 37 weeks

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29
Q

What is classified as low birth weight?

A

Birth weight < 2,500 gm (5lb 8 oz)

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30
Q

What is classified as very low birth weight (VLBW)?

A

Birth weight <1.500 grams (3lb 5 oz)

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31
Q

What is chornologic or birth age?

A

Time since birth

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32
Q

What is estimated gestational age (EGA)?

A

Approximate time since conception

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33
Q

What is corrected gestational age (CGA)?

A

Age adjusted to reflect current gestational age from date of brith to present

ie. a 12 week old infant who was born at 9 weeks early as a CGA of 3 weeks

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34
Q

What is postconceptual age (PCA)?

A

Weeks gestation + weeks of life

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35
Q

What are the causes of intraventricular hemorrhage (IVH)?

A

Periantal disruption of blood flow, hypoxia, or changes in intravascular pressure

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36
Q

What are signs and symptoms of IVH?

A

Subtle

Full fontanel, decrease in hematocrit

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37
Q

How do you diagnosis IVH?

A

TCD

Serial Cranial US

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38
Q

How do you treat IVH?

A

Maintain normal temperature, avoid rapid fluid boluses, normalize blood pressure, keep baby calm

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39
Q

What causes retinopathy of premaurity?

A

Incomplete development of retinal vessels

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40
Q

What are the risk factors for ROP?

A

Oxygen

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41
Q

What the treament for ROP?

A

Laser therapy or vitrectomy (if retina is detached)

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42
Q

When do all infants experience physiologic nadir?

A

First 3 months of life

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43
Q

Where does the RBC production from to in term infants?

A

Moves from liver to bone marrow and EPO moves from liver to kidney

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44
Q

How do you treat anemia of prematurity?

A

Minimize blood draws, nutritional support, provide pRBCs

45
Q

What is AMPLE?

A

Allergies

Medications

Past Medical Hx

Last Meal

Event

46
Q

What is the pediatric risk of mrotality (PRISM)?

A

Acuity scoring system measure illness severity, morbidty and mortality, cost of care, and length of stay

Provides objective way to assist pediatric critical care professionals with identifying physiologic variables that predict mortality

47
Q

Be honest with patients and caregivers at all times

Admit when an error has happened

Be accountable for your actions

Acknowledge your limits and know when to ask for help

Always place patient’s well-being first

Make a committment to continued education

What are for what committee?

A

AAP committee on bioethics

48
Q

What temperature range is considered cold stress?

A

36.0-37.4 C (96.8-97.5 F)

49
Q

What temperature range is considered moderate hypothermia?

A

32.0-35.9C (89.6-96.6F)

50
Q

What temperature range is severe hypothermia?

A

less than 32C (89.6F)

51
Q

What is considered hyperthermia?

A

Above 37.5C (99.5F)

52
Q

What is considered severe hyperthermia?

A

> 40C (104F)

53
Q

What is nonshivering thermogenesis?

A

Infant tries to minimize heat loss by peripheral vasoconstriction and encourages heat production by increasing metabolism and oxidation of brown fat

54
Q

What are the short tem consequences of pain?

A

Decreased oxgeyn saturation, increased heart rate, increased intracranial pressure, and depression of immune system

55
Q

What are the long-term consequences of pain?

A

Failure to activate or delay in stress response, elevated basal cortisol levels, and altered tactile sensation

56
Q

What is the treatment for apena of prematurity?

A

Methylxantines

57
Q

What are common types of Methylxanthines?

A

Caffeine; Theophylline

58
Q

Where do intraventricular hemorrhage occur in premature infants?

A

Subependymal germinal matrix at head of caudate nucleus near foramen of Monro

59
Q

Grade I IVH

A

Isolated germinal matrix hemorrhage

60
Q

Grade II IVH

A

Intraventricular hemorrhage without ventricular dilation

61
Q

Grade III IVH

A

Intraventricular hemorrhage with ventricular dilation

62
Q

Grade IV IVH

A

Intraventricular hemorrhage with ventricular dilation and hemorrahge into parenchyma of brain

63
Q

Who qualifies for ROP exam?

A

Infants less than 1,500 grams or 32 weeks at birth

64
Q

Liquid nitrogen probe to distroy avascular “scar” tissue

A

Cryotherapy for ROP

65
Q

What is the first-line surgical procedure for ROP?

A

Laser therapy

66
Q

Removal of scar tissue which allows retina to reconnect with back of eye

A

Vitrectomy

67
Q

What are signs of anemia of prematurity?

A

Tachypnea, apnea, increased oxygen requirment, bradycardia, poor weight gain, decreased activity, and pallor

68
Q

How early can erythropoietin be used to treat anemia of prematurity?

A

NOT BEFORE 8 DAYS OLD

Increases risk of ROP

69
Q

What is the recommened iron supplement for preterm infants?

A

2-4 mg/kg elemental iron to breastfed preterm infant

1 mg/kg to formula-fed infant

70
Q

How early can iron supplemental start for preterm infant?

A

As early as 2 weeks of age

71
Q

Intestinal injury leading to abnormal and uncontrolled inflammatory repsonse

A

Necrotizing Enterocolitis

72
Q

What are maternal risk factors for NEC?

A

Placental insufficiency, pregnancy-induced hypertension, suspected/known drug or abuse, antenatal steroids, and chorioamnionitis

73
Q

How does NEC present?

A

Feeding intolerance, abdominal distention, gastric residuals, vomiting, blood in stool, and abdominal tenderess

LATER ON: lethargy, apnea, respiratory distress, bradycarda, temperature instability, shock

74
Q

What will abdominal radiographs show for NEC?

A

Ileus, dilated loops of bowel, pneumatosis intestinalis, ascites, intrahepatic portal venous air, and persistnet sentinel loops of bowel

75
Q

What lab findings will you find for NEC?

A

Early metabolic acidosis

Thrombocytopenia

Neutropenia

Coagulopathies

Electrolyte imbalances

76
Q

What are the most common bacteria for early-onset sepsis?

A

Escherichia coli and Group B streptococcus

77
Q

What are signs and symptoms of early-onset sepsis?

A

Respiratory distress, temperature instability, hypotonia, irritabilty, poor feeding, early-onset jaundice, apnea, poor perfusion, tachycardia, seizures

78
Q

What are the drugs of choice for early-onset sepsis?

A

Ampicillin and Gentamicin

79
Q

What are the common pathogens of late-onset sepsis (after 72 hours of life)?

A

Coagulose-negative staphylococcus (CONS), staphylosis aureus, klebsiella, pseudomonas aeruginosa, candida species, and GBS

80
Q

What is the intial empiric therapy for late-onset sepsis?

A

Ampicillin and Gentamicin

81
Q

What is initial empiric therapy for late-onset sepsis if skin is involved?

A

Vancomycin

82
Q

What are the most common causes of hypoxemia in children?

A

Ventilation/Perfusion (VQ) mismatch and hypoventilation

83
Q

What kind of fluids do you use for initial fluid resuscitation?

A

Isotonic fluids (Normal saline/lactated ringer’s)

84
Q

How do you treat hypoglycemia in intial resuscitation?

A

10% dextrose solution and follow with infusion of dextrose containing fluids in persistently hypoglycemic patient

85
Q

What is SAMPLE?

A

Signs and Symptoms-what were the signs and symptoms that were exhibited by patient prior to presentation?

Allergies-any drug or food allergies?

Medications-what medication does the aptietn take on a daily basis? Was the patient given any medication prior to arrival?

Past medical history-what medical problems does the patient have?

Last meal-what time did the patient last take anything by mouth?

Events leading to presentations-what were the events immediately preceding the decision to present to the ER?

86
Q

What is the mallampati assessment?

A

Visualization of tonsillar pillars, soft palate, and uvula with degree of difficulty of laryngoscopy

87
Q

Class I mallampati assessment

A

All three pharyngeal structures are visible

88
Q

Class II mallampati assessment

A

Uvula and soft palate are visible

89
Q

Class III malampati assessment

A

Only soft palate and base of uvula are visible

90
Q

Class IV mallampati assessment

A

None of pharyngeal structures can be seen

91
Q

What are signs of difficult airways?

A

Trouble of providing bag-mask ventilation/intubating

Hx of stridor, snoring, or sleep apnea

Hx of obesity, limited jaw or neck movement, craniofacial anomalies, facial trauma, or laryngeal abnormalities

92
Q

What kind of patients are not recommended for orpharyngeal airway?

A

Patients with cough or gag reflex–it can stimulate gag and vomiting

93
Q

What age range should have curved laryngoscope blades?

A

More effective for child > 2 years

94
Q

What age range for straight laryngoscope blades?

A

Children < 2 years and those with difficult airways

95
Q

What external layrngeal manipulation helps bring glottis into view?

A

BURP

Backword (posterior)

Upward (cephalad)

Rightward Push

96
Q

What drug prevents bradycardia while intubating in young infants?

A

Atropine

97
Q

What sedative/anesthetic for intubation caused significant vasodilatory properties?

A

Propofol

Thiopental

98
Q

What sedative/anesthetic is best for children with asthma or reactive airway disease?

A

Ketamine

99
Q

What binds to the postsynaptic receptor of the neuromuscular junction, causing transient muscular fasciculation and then paralysis as receptors remain occupied?

A

Depolarizing neuromuscular blocking drugs

100
Q

What is a depolarizing neuromuscular blocking drug?

A

Succinylcholine

101
Q

What are the complications of succinylcholine?

A

Malignant hyperthermia, masseter spasm with subsequent airway obstruction, a modest rise in potassium

102
Q

What binds to postsynaptic receptors of the neuromuscular junction without causing postsynaptic depolarization and neuromuscular transmission?

A

Nondepolarizing neuromuscular blockers

103
Q

What are nondepolarizing neuromuscular blockers?

A

Rocuronium

Vecuronium

104
Q

What are the side effects of rocuronium or vercuronium?

A

It has a longer duration and are not reversible in time to allow spontaneous ventilation if patient cannot be intubated or ventilated

105
Q

What should the tip of the ETT be?

A

Midtrachea (level of 2nd to 4th thoracic vertebrae)

106
Q

What helps prevents an ICP spike during intubation?

A

Lidocaine

107
Q

What should be used with caution in children with shock while incubating?

A

Potent vasodilators (propofol and thiopental)

108
Q

What is contraindicated in facial/laryngotracheal injury intubation?

A

Nasotracheal intubation until basilar skull fracture is ruled out

109
Q

Airway emergency characterized by acute inflammation of supraglottic region

Marked by sudden onset of fever, dysphagia, drooling, “hot potato” voice, and toxemia

A

Acute epiglottis

Acute PNP (8 decks)

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