acutely ill child

Question 1

upon arrival at the scene of a compromised child, a caregiver’s first task is a

Answer 1

quick survey of the scene itself

Question 2

any child with a heart rate below 60 beats/min or without a pulse requires

Answer 2

immediate CPR

Question 3

brief, hands on assessment of cardiopulmonary and neurologic function and stability

Answer 3

primary assessment

Question 4

most common precipitating event for cardiac instability in infants and children

Answer 4

respiratory insufficiency

Question 5

first priority in resuscitation of a child

Answer 5

rapid assessment of respiratory failure and immediate restoration of adequate ventilation and oxygenation

Question 6

earliest and most reliable sign of shock

Answer 6

tachycardia

Question 7

components of secondary assessment

Answer 7

SAMPLE

Signs and symptoms
Allergies
Medications
Past Medical History
Last meal
Events leading to situation

Question 8

tertiary assessment

Answer 8

occurs in hospital setting where ancillary laboratory and radiographic assessments contribute to thorough understanding of child’s condition

Question 9

sequential approach in airway obstruction

Answer 9

head tilt/chin lift maneuver
inspection of foreign body
finger sweep clearance or suctioning once visualized

Question 10

most common cause of distributive shock

Answer 10

sepsis and burn injuries

Question 11

most common pre-arrest rhythm

Answer 11

bradyarrhythmias

Question 12

6 Hs that causes bradycardia

Answer 12

hypoxia
hypovolemia
hydrogen ions
hypokalemia or hyperkalemia
hypoglycemia
hypothermia

Question 13

4 T’s

Answer 13

toxins
tamponade
tension pneumothorax
trauma

Question 14

for narrow complex tachycardia, we should distinguish between

Answer 14

sinus tachycardia and SVT

Question 15

history and onset consistent with a known cause if tachycardia; P waves consistently present and of normal morphology

Answer 15

Sinus tachycardia

Question 16

onset abrupt without prodrome; P waves absent or polymorphic; if present rate is often fairly steady at or above 220 beats/min

Answer 16

SVT

Question 17

management for SVT with poor perfusion

Answer 17

convert child’s heart rhythm back to sinus rhythm

Adenosine can be given with rapid “push”
If no IV access or adenosine failed–> synchronized cardioversion using 0.5-1 joule/kg

Question 18

management of wide complex tachycardia

Answer 18

Ventricular tachycardia

cardioversion and increase dose to 2 joules/kg if
1 joule/kg is not effective

Question 19

most important treatment of cardiac arrest

Answer 19

anticipation and prevention

Question 20

most important component of CPR

Answer 20

adequate chest compressions those that circulate blood around the body with a good pulse pressure

Question 21

lone rescuer for unwitnessed pedia cardiac arrest should treat arrest as

Answer 21

asphyxial; immediately inititiate CPR

Question 22

lone rescuer for witnessed pedia cardiac arrest should treat arrest as

Answer 22

primary arrhythmia; immediately activate EMS and obtain AED

Question 23

pulseless VT or VF

Answer 23

emergency defibrillation

Question 24

inotrope, vasodilator

Answer 24

Dobutamine

Question 25

inortrope, chronotrope, renal and splanchnic vasodilator

Answer 25

Dopamine

Question 26

inodilator

Answer 26

Milrinone

Question 27

inotrope; vasopressor

Answer 27

Norepinephrine

Question 28

most common cannulated artery

Answer 28

radial artery

Question 29

intracranial dynamics in the setting of an expanding mass lesion

Answer 29

Munro-Kellie doctrine

Question 30

hallmark of severe TBI

Answer 30

coma

Question 31

3 key components of clinical brain death diagnosis

Answer 31

demonstration of irreversible coma/unresponsiveness absence of brainstem reflexes apnea

Question 32

extension of upper extremities followed by flexion of arms with the hands reaching to midsternal level

Answer 32

Lazarus sign

Question 33

to establish diagnosis of brain death, findings must remain consistent over a period of observation:

Answer 33

7 days to 2 months: 2 examinations separated by at least 48hr 2months to 1yr: 2 examinations separated by 24hr older than 1yr: 12 hour observation

Question 33

to establish diagnosis of brain death, findings must remain consistent over a period of observation:

Answer 33

7 days to 2 months: 2 examinations separated by at least 48hr 2months to 1yr: 2 examinations separated by 24hr older than 1yr: 12 hour observation

Question 34

confirmatory testing of brain death should be performed on

Answer 34

all children less than 1 yr old using EEG and studies to confirm absence of cerebral blood flow such as nuclear medicine cerebral flow scans

Question 35

supports diagnosis of brain death

Answer 35

electrocerebral silence for 30 min recording

Question 36

most common cause of shock in children worldwide

Answer 36

hypovolemic shock

Question 37

seen in patients with CHD, or with congenital or acquired cardiomyopathies including acute myocarditis

Answer 37

Cardiogenic shock

Question 38

stems from any lesion that creates mechanical barrier that impedes adequate cardiac output

Answer 38

obstructive shock

Question 39

inadequate vasomotor tone which leads to capillary leak and maldistribution of fluid into the interstitium

Answer 39

Distributive shock

Question 40

type of distributive shock but the septic process usually involves a more complex interaction of distributive, hypovolemic and cardiogenic shock

Answer 40

septic shock

Question 41

fluid loss and decrease preload

Answer 41

hypovolemic shock

Question 42

state of abnormal vasodilation

Answer 42

distributive shock

Question 43

hallmark of uncompensated shock

Answer 43

imbalance between oxygen delivery and oxygen consumption

Question 44

should be initiated in an attempt to reverse shock

Answer 44

20ml/kg Isotonic saline up to 60-80ml/kg

Question 45

associated with reduction in mortality in septic shock

Answer 45

early administration of broad spectrum antibiotics

Question 46

may improve systolic function and decrease SVR without causing significant increase in HR with added benefit of enhancing diastolic relaxation in cases of cardiogenic shock

Answer 46

Milrinone therapy

Question 47

may be beneficial in pediatric shock with up to 50% of critically ill patients having absolute or relative adrenal insufficiency

Answer 47

Hydrocortisone replacement

Question 48

simplified consensus definition of acute lung injury

Answer 48

acute onset (<7days) severe hypoxemia (PaO2/FiO2 <300 for ALI or <200 for ARDS) diffuse bilateral pulmonary infiltrates on frontal radiograph absence of left atrial hypertension (pulmonary artery wedge pressure <18mmHg)

Question 49

both ventilation and perfusion are lower in nondependent areas of the lung and higher in dependent areas of lung

Question 50

estimation of FiO2 during use of nasal cannula

Answer 50

FiO2- 21% (nasal cannula flow (L/min) x 2)

Question 51

high flow nasal cannula delivers gas flow at

Answer 51

4-16 L/min providing significant CPAP

Question 52

formula for proper internal diameter for tracheal tube

Answer 52

Age (yr) /4 + 4

Question 53

volume of gas left in the alveoli at the end of expiration

Answer 53

Functional residual capacity

Question 54

In intrathoracic airway obstruction, airway narrowing is much more pronounced during

Answer 54

expiration therefore expiratory time is much more prolonged than inspiratory time

Question 55

most common type of shock in trauma

Answer 55

hypovolemic shock due to hemorrhage

Question 56

more common after bicycle handle impact or direct blow to abdomen

Answer 56

pancreatic and duodenal injuries

Question 57

most important step to reducing impact of drowning injury

Answer 57

Prevention followed by early initiation of CPR at the scene

Question 58

highest drowning rates seen in

Answer 58

1-4 yr and 15-19 yo

Question 59

most common cause of mortality and long-term morbidity in drowning

Answer 59

CNS injury

Question 60

pediatric drowning patients should be observed in ED for ___ hours even if aymptomatic

Answer 60

6-8 hours

Question 61

In drowning, death or severe neurologic sequalae are quite likely in patients with the ff:

Answer 61

``` deep coma apnea absence of pupillary responses hyperglycemia in ED submersion duration >10min failure of response to CPR given for 25 min ```

Question 62

most critical and and effective neurologic intensive care measures after drowning are

Answer 62

rapid restoration and maintenance of adequate oxygenation, ventilation and perfusion

Question 63

In drowning, what should be instituted asap after resuscitation and sustained for 12-24hr?

Answer 63

hypothermia (32-34C)

Question 64

burns in young children that should raise the suspicion of child abuse

Answer 64

"glove and stocking" burns of hands and feet single-area deep burns on trunk, buttocks or back small, full-thickness burns (cigarette burns)

Question 65

burns in patients that will warrant admission

Answer 65

BSA >10-15% associated with smoke inhalation burns from high-tension (voltage) electrical injuries burns associated with child abuse or neglect

Question 66

children with burns __% require IV fluid resuscitation

Answer 66

>15% BSA

Question 67

involve only epidermis characterized by erythema, swelling and pain; no blistering

Answer 67

1st degree burn

Question 68

injury to entire epidermis and variable portion of dermal layer; vesicle and blister formation

Answer 68

2nd degree burn

Question 69

destruction of entire epidermis and dermis leaving no residual epidermal cells

Answer 69

Full thickness

Question 70

Rule of nines must only be used in

Answer 70

children older than 14 years old

Question 71

In small burns, <10% what should be used to estimate BSA

Answer 71

rule of palm area from wrist crease to finger crease(palm) in child equals 1% of child's BSA

Question 72

appropriate starting guideline for fluid resuscitation in burns

Answer 72

Parkland formula (4ml LR/kg/%BSA) half of fluid given over 1st 8 hours from onset of injury remaining fluid to be given at an even rate over the next 16 hours

Question 73

chest compression depth

Answer 73

1.5in (4cm) in infants | 2in (5cm) in children

Question 74

chest compression rate

Answer 74

100-120/min

Question 75

A case regarding a 5 year old boy who got reprimanded by his parents. Suddenly, he stops breathing and turns blue in color

Answer 75

*Nelson 21st: These are reflexive events in which the crying child becomes apneic, pale, or cyanotic, may lose consciousness, and occasionally will have a brief seizure. Nelson 21st: Breath-Holding Spell (Chapter 612) ...It is important also to educate parents on how to handle more severe spells with first-aid measures or even basic cardiopulmonary resuscitation when needed.

Question 76

2 types of breathholding spells

Answer 76

A cyanotic spell is caused by a change in the child's usual breathing pattern, usually in response to feeling angry or frustrated. It's the most common type. A pallid spell is caused by a slowing of the child's heart rate, usually in response to pain. Some children may have both types of spells at one time or another. Breath-holding spells can occur in children 6 months through 6 years of age. They are most common from 1 to 3 years of age. Some children have them every day, and some have them only once in a while.